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Helical tomotherapy and systemic targeted therapies in solitary plasmacytoma: Pilot study

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World Journal of Radiology 2013年第6期5卷 248-252页

作者： Nadia Wiazzane Cyrus Chargari Corine Plancher Jerome Tamburini Bernard Asselain Alain Fourquet Didier Bouscary youlia m kirova Department of Radiation Oncology Institut Curie75005 Paris France Department of Biostatistics Institut Curie75005 Paris France Department of Haematology Cochin Hospital75014 Paris France

AIm: To assess the feasibility of the combination of helical tomotherapy(HT) and a concurrent systemic targeted therapy in patients with solitary plasmacytoma (SP) with the aim to decrease toxicity while improving therapeutic efficacy. mETHODS: Six patients with biologically, histologically, and radiologically confirmed SP were treated using HT and a systemic targeted treatment concomitantly. Total dose was 40 Gy/20 fractions. Four patients received 4 cycles of concurrent lenalidomide-dexamethasone combination and two patients were treated with concomitant bortezomib-dexamethasone. All toxicities were described using the Common Terminology Criteria for Adverse Effects ***: Five patients had a bone tumor and one patient had an isolated pancreatic mass. Five patients presented with pain, one had neurologic symptoms related to medullary compression, which was treated by an emergency surgery. median age was 59.5 years (range, 50-74 years). All patients had initial positron emission tomography-computed tomographys, three patients had total body bone magnetic resonance imaging examination, and three patients had computed tomodensitometry scans. The toxicity profile was excellent with no higher than grade 1 toxicity. Four of the six patients experienced a partial radiological response, four had complete response on positions emission tomography and 5/6 patients experienced a complete relief of their symptoms 4 mo after treatment. At a median follow-up of 18 mo, 5/6 patients were controlled clinically, radiologically, and biologically. CONCLUSION: Using HT, we could deliver a highly conformal irradiation concurrently with a molecularly targeted therapy. This association yielded in a high response rate and a low toxicity. A prospective study with longer follow-up will help determining the true benefit of such strategy.

关键词： Plasmacytoma Radiation therapy Targeted treatment Tolerance Lenalidomide Bortezomib

Recent advances in breast cancer radiotherapy:Evolution or revolution,or how to decrease cardiac toxicity?

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World Journal of Radiology 2010年第3期2卷 103-108页

作者： youlia m kirova Radiation Oncology Institut Curie 26Rue d' Ulm

Radiation therapy has a major role in the management of breast ***,there is no consensus on how to irradiate and on volume definitions,and there are strong differences in strategies according to different centers and *** treatment protocols and techniques have been used with the principal purpose of decreasing lung and heart toxicity and adapting radiation treatment to patients' *** is evidence that indicates internal mammary chain radiotherapy should be used carefully and that high quality techniques should be used for decreasing the dose delivered to the *** review of the literature presents the state of the art on breast cancer radiotherapy,with special focus on the indications,techniques,and potential toxicity.

关键词： Cardiac toxicity Ejection fraction Breast cancer Radiotherapy Chemotherapy Herceptin

Applications of new irradiation modalities in patients with lymphoma:Promises and uncertainties

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World Journal of Radiology 2011年第3期3卷 66-69页

作者： youlia m kirova Cyrus Chargari Department of Radiation Oncology Institut Curie 26rue d'Ulm75248 ParisCedex 05France

New highly conformal irradiation modalities have emerged for treatment of Hodgkin *** Tomotherapy offers both intensity-modulated irradiation and accurate patient positioning and was shown to significantly decrease radiation doses to the critical *** we review some of the most promising applications of helical tomotherapy in Hodgkin *** decreasing doses to the heart or the breast,helical tomotherapy might decrease the risk of long-term cardiac toxicity or secondary breast cancers,which are major concerns in patients receiving chest *** strategies,such as debulking radiotherapy prior to stem cell transplantation or total lymphoid irradiation may be clinically ***,helical tomotherapy may also increase the volume of tissues that receive lower doses,which has been implicated in the carcinogenesis *** assessments of these new irradiation modalities of helical tomotherapy are required to confirm the potential benefits of highly conformal therapies applied to hematological malignancies.

关键词： Hodgkin lymphoma Helical tomotherapy Cardiac toxicity Secondary cancers

Could helical tomotherapy do whole brain radiotherapy and radiosurgery?

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World Journal of Radiology 2010年第4期2卷 148-150页

作者： youlia m kirova Cyrus Chargari Sofia Zefkili Franois Campana Department of Radiation Oncology Institut Curie

Whole brain radiotherapy (WBRT) remains the standard management of breast cancer patients with brain metastases, allowing for symptomatic improvement and good local control in most patients. However, its results remain suboptimal in terms of both efficacy and toxicity. In highly selected breast cancer patients, stereotaxic radiotherapy demonstrates a very good local control with a low toxicity. With the purpose of improving the efficacy/toxicity ratio, we report the association of integrated boost with WBRT in a breast cancer patient with brain metastases. Two and a half years after completion of helical tomotherapy (HT), the patient experienced clinical and radiological complete remission of her brain disease. No delayed toxicity occurred and the patient kept her hair without need of radiosurgical procedure. The HT provided a high dosimetric homogeneity, delivering integrated radiation boosts, and avoiding critical structures involved in long-term neurological toxicity. Further assessment is required and recruitment of breast cancer patients into clinical trials is encouraged.

关键词： Brain metastases Radiotherapy Breast cancer Tomotherapy

Helical tomotherapy and volumetric modulated arc therapy:New therapeutic arms in the breast cancer radiotherapy

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World Journal of Radiology 2016年第8期8卷 735-742页

作者： Olivier Lauche youlia m kirova Pascal Fenoglietto Emilie Costa Claire Lemanski Celine Bourgier Olivier Riou David Tiberi Francois Campana Alain Fourquet David Azria Department of Radiation Oncology Institut Curie Departement of Radiation Oncology Institut du Cancer de Montpellier Department of Radiation Oncology Centre Hospitalier de l’Universite de Montreal Hopital Notre Dame

AIm To analyse clinical and dosimetric results of helical tomotherapy(HT) and volumetric modulated arc therapy(VmAT) in complex adjuvant breast and nodes *** Seventy-three patients were included(31 HT and 42 VmAT). Dose were 63.8 Gy(HT) and 63.2 Gy(VmAT) in the tumour bed, 52.2 Gy in the breast, 50.4 Gy in supraclavicular nodes(SCN) and internal mammary chain(ImC) with HT and 52.2 Gy and 49.3 Gy in ImC and SCN with VmAT in 29 fractions. margins to particle tracking velocimetry were greater in the VmAT cohort(7 mm vs 5 mm).RESULTS For the HT cohort, the coverage of clinical target volumes was as follows: Tumour bed: 99.4% ± 2.4%; breast: 98.4% ± 4.3%; SCN: 99.5% ± 1.2%; ImC:96.5% ± 13.9%. For the VmAT cohort, the coverage was as follows: Tumour bed: 99.7% ± 0.5%, breast: 99.3% ± 0.7%; SCN: 99.6% ± 1.4%; ImC: 99.3% ± 3%. For ipsilateral lung, Dmean and V20 were 13.6 ± 1.2 Gy, 21.1% ± 5%(HT) and 13.6 ± 1.4 Gy, 20.1% ± 3.2%(VmAT). Dmean and V30 of the heart were 7.4 ± 1.4 Gy, 1% ± 1%(HT) and 10.3 ± 4.2 Gy, 2.5% ± 3.9%(VmAT). For controlateral breast Dmean was 3.6 ± 0.2 Gy(HT) and 4.6 ± 0.9 Gy(VmAT). Acute skin toxicity grade 3 was 5% in the two *** HT and VmAT in complex adjuvant breast irradiation allow a good coverage of target volumes with an acceptable acute tolerance. A longer follow-up is needed to assess the impact of low doses to healthy tissues.

关键词： Three-dimensional conformal radiotherapy Intensity modulated radiation therapy Toxicity Helical tomotherapy Volumetric modulated arc therapy Breast cancer radiotherapy

Concurrent use of aromatase inhibitors and hypofractionated radiation therapy

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World Journal of Radiology 2012年第7期4卷 318-323页

作者： Cyrus Chargari Pablo Castro-Pena Ivan Toledano marc A Bollet Alexia Savignoni Paul Cottu Fatima Laki Franois Campana Patricia De Cremoux Alain Fourquet youlia m kirova Department of Radiation Oncology Institut Curie 75005 Paris France Department of Biostatistics Institut Curie 75005 Paris France Department of medical Oncology Institut Curie 75005 Paris France Department of Surgery Institut Curie 75005 Paris France

AIm: To retrospectively assess the acute and long-term toxicity using aromatase inhibitors (AI) therapy concurrently with hypofractionated radiotherapy (HFRT) in breast cancer patients. mETHODS: From November 1999 to October 2007, 66 patients were treated with breast HFRT and concurrent AI. In 63 patients (95.5%), HFRT delivered a total dose of 32.5 Gy to the whole breast within 5 wk (five fractions, one fraction per week). Other fractionations were chosen in three patients for the patients' personal convenience. A subsequent boost to the tumor bed was delivered in 35 patients (53.0%). Acute toxicities were scored according to the Common Toxicity Criteria for Adverse Events v3. Late toxicity was defined as any toxicity occurring more than 6 mo after completion of HFRT and was scored according to the Late Effects Normal Tissue Task Force-Subjective, Objective, management and Analytic scale. RESULTS: At the end of the HFRT course, 19 patients (28.8%) had no irradiation-related toxicity. Acute grade 1-2 epithelitis was observed in 46 patients (69.7%). One grade 3 toxicity (1.5%) was observed. With a median follow-up of 34 mo (range: 12-94 mo), 31 patients (47%) had no toxicity, and 35 patients (53%) presented with grade 1-2 fibrosis. No grade 3 or greater delayed toxicity was observed. CONCLUSION: We found that AI was well tolerated when given concurrently with HFRT. All toxicities were mild to moderate, and no treatment disruption was necessary. Further prospective assessment is warranted.

关键词： Breast cancer Hypofractionated radiotherapy Skin toxicity Aromatase inhibitors

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妊娠期乳腺癌9例的诊断和综合治疗

中国癌症杂志 2001年第5期11卷 453-455页

作者：陈佳艺林原 youlia kirova Franck FEUILLADE Jean-Paul Le BOURGEOIS Henri mondor医院放疗科

目的 :研究妊娠期乳腺癌在诊断和手术、化疗、放疗综合治疗方面的特殊性。方法 :1992年 12月—1999年 6月 ,法国巴黎第十二大学附属Henrimondor医院放疗科收治 9例妊娠期乳腺癌患者 ,其中 3例诊断于妊娠期 ,6例诊断于分娩后 1年内。 5... 详细信息

目的 :研究妊娠期乳腺癌在诊断和手术、化疗、放疗综合治疗方面的特殊性。方法 :1992年 12月—1999年 6月 ,法国巴黎第十二大学附属Henrimondor医院放疗科收治 9例妊娠期乳腺癌患者 ,其中 3例诊断于妊娠期 ,6例诊断于分娩后 1年内。 5例行乳房保留治疗 ,4例改良根治术。所有病例行术后放疗。 7例接受化疗。结果 :9例钼靶摄片中 7例和所有的 5例超声检查提示肿瘤征象 ,诊断时总体病期晚 ,Ⅰ、Ⅱ、、Ⅲ期比例分别为11%、44 %和 44 %。中位随访 6 0月 (9— 89月 )时 ,6例无病生存 ,3例在治疗结束后 14月— 48月出现局部复发或远处转移。结论 :妊娠期乳腺癌诊断延误较为常见 ,对分娩后确诊的患者 ,应重视妊娠、哺乳期乳房体检和超声检查在鉴别诊断乳房肿块中的作用。治疗原则必须兼顾疾病的迫切性和胎儿的安全性。在可以及时开展化疗和放疗的综合治疗的前提下。

关键词：妊娠期乳腺癌诊断综合治疗

放射疗法在经典型皮肤卡勃基氏肉瘤治疗中的应用

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齐鲁肿瘤杂志 1999年第1期6卷 23-24页

作者：郭灵林焕新潘琼广东省人民医院放疗科中山医科大学肿瘤医院放疗科上海第二医科大学瑞金医院放疗科

目的探讨放射疗法在经典型皮肤卡勃基氏肉瘤（Ｋａｐｏｓｉｓｓａｒｃｏｍａ，ＫＳ）这种罕见肿瘤治疗中的有效性。方法１９８６年６月～１９９６年１２月，法国巴黎第十二大学亨利·孟德尔医院肿瘤科共收治经典型皮肤ＫＳ５例。所有病... 详细信息

目的探讨放射疗法在经典型皮肤卡勃基氏肉瘤（Ｋａｐｏｓｉｓｓａｒｃｏｍａ，ＫＳ）这种罕见肿瘤治疗中的有效性。方法１９８６年６月～１９９６年１２月，法国巴黎第十二大学亨利·孟德尔医院肿瘤科共收治经典型皮肤ＫＳ５例。所有病人均接受４５～７０ＫＶＸ线局部放射治疗，共设４８个照射野，剂量均＜３０Ｇｙ。放疗方式为：第１周１０Ｇｙ，２．５Ｇｙ／次×４，休息１０～１５天后再行第２阶段放疗，追加剂量１５～２０Ｇｙ。结果完全缓解率１００％。皮肤对放射的耐受良好，不影响美观。２例出现射野外新病灶，其中１例行放疗而另１例行长春花碱治疗，均完全缓解。结论放射疗法对ＫＳ可以提供有效的局部控制率并保持皮肤的完整美观，剂量２０～３０Ｇｙ足以使经典型皮肤ＫＳ完全缓解。

关键词：经典型卡勃基氏肉瘤放射疗法皮肤肿瘤

microsurgical Treatment of Optic Nerve metastasis: Case Report and Review of the Literature

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Case Reports in Clinical medicine 2015年第11期4卷 352-355页

作者： Sl. Kondoff m. milev Chr. Tzekov T. Spiriev L. Laleva G. kirova Chr. Kostadionova Department of Neurosurgery Tokuda Hospital Sofia Sofia Bulgaria Department of medical Imaging Diagnostics Tokuda Hospital Sofia Sofia Bulgaria Department of Anesthesiology Tokuda Hospital Sofia Sofia Bulgaria

metastatic lesions to the eye and optic nerve have incidence of 12% and are observed predominantly in patients, diagnosed with breast and lung cancer. However, isolated involvement of the optic nerve by breast cancer metastasis is much rarely reported with only 13 cases reported in the literature by 2013, according to Cherkaev et al., that were often preoperatively misdiagnosed. Herewith we present a rare case of optic nerve metastasis in a previously diagnosed breast cancer patient. Review of the literature was done with analysis of the diagnostic difficulties that these cases present and the role of the neurosurgeon in the management of the patients.

关键词： Optic Nerve metastasis Surgical Treatment Breast Cancer