Bio


I am a radiation oncologist with a PhD in biomedical informatics. My clinical research focuses on new radiation therapy techniques that can be used to limit side effects and improve the patient's outcome, such as Intensity Modulated Radiation Therapy (IMRT) and Stereotactic Body Radiation Therapy (SBRT). My translational research is exploring the use of machine learning for cancer prediction and classification.

Between 2013 and 2015, he was the President of the French Society of Young Radiation Oncologists and became chair of the Young Committee of the European Society for Radiotherapy and Oncology between 2015 and 2018.

I’ve developed several mobile health apps for iPhone and Android and co-founded a mHealth startup that was acquired in 2014. I'm currently a postdoctoral research fellow in Artificial Intelligence at Stanford and the Chief Medical Officer of wefight, a startup whose mission is to help patients with chronic diseases.

Honors & Awards


  • Paul Mathieu Award, French Academy of Medecine (2019)
  • Jean Paul Le Bourgeois Award, Biennale d'Oncologie de Monaco (2016)
  • Best Young Oncologist MD Thesis, French Society of Cancer (2015)
  • Best Young Poster Award, French Radiation Oncology Society (2014)
  • French National Cancer Institute Translational Research Grant, French National Cancer Institute (2011)
  • Best Oral Communication, European Society for Therapeutic Radiology and Oncology Conference (2010)

Boards, Advisory Committees, Professional Organizations


  • Education Council Member, European Society for Therapeutic Radiology and Oncology Conference (2016 - Present)
  • Young Committee Chair, European Society for Therapeutic Radiology and Oncology Conference (2015 - 2018)
  • President, French Society of Young Radiation Oncologists (2012 - 2015)

Professional Education


  • Doctor of Philosophy, Universite de Paris V (Rene Descartes) (2018)
  • Diplome de Medecin, Universite Du Droit Et De La Sante (2014)
  • MSc, Université de Paris XI, Radiobiology (2011)
  • Bachelor, Lycée Henri IV, Paris (2001)

Stanford Advisors


Research Interests


  • Data Sciences

All Publications


  • [Stereotactic body radiotherapy: Prospective study to evaluate asthenia and quality of life]. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique Abbassi, L. M., Laurans, M., Gasnier, A., Smulevici, A., Tournat, H., Bibault, J. E., Huertas, A., Jouglar, E., Suissa, A., Kreps, S., Giraud, P., Durdux, C. 2019; 23 (4): 316–21

    Abstract

    To evaluate prospectively asthenia and the quality of life in patients treated by stereotactic body irradiation and to determine their predictive factors.Quality of life was assessed by the EORTC QLQ-C30 and asthenia was evaluated with the Brief Fatigue Inventory (BFI), on the first day (T1), last day (T2) and 1-3 weeks after the end of treatment (T3).Sixty-three patients were treated with stereotactic body irradiation from February 2017 to May 2017 and 41 were included in the analysis (22 patients excluded for lack of understanding, organization, psychologic disorders or refusal). The mean number of fractions was 5 (±2). The compliance to quality of life assessment was 98%, 95% was 81% at T1, T2 and T3, respectively. An increase of asthenia and a worsened quality of life were found in 12 (29%) and 14 (34%) patients between T1 and T2. Univariate analysis demonstrated a correlation between asthenia and quality of life were correlated with performans status (P=0.03 and 0.05 respectively), hemoglobin level (p=0.01 and 0.004), albumin level (P=0.01 and 0.06), distance between home and radiotherapy department (P=0.05 and 0.02). Multivariate analysis demonstrated a correlation between female gender (P=0.012), albumin level (P<0.001), distance over 25km (P<0.001) with asthenia, and albumin level (P=0.003), hemoglobin level (P=0.004) and previous chemotherapy (P=0.003) with quality of life. No influence of stereotactic body ratiotherapy parameters was seen.Despite hypofractionation, stereotactic body radiotherapy induced asthenia and deterioration of quality of life.

    View details for DOI 10.1016/j.canrad.2019.02.003

    View details for PubMedID 31153770

  • [Stereotactic pulmonary radiotherapy: Which machine?] Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique Giraud, P., Kreps, S., Tournat, H., Bibault, J. E., Fabiano, E., Feutren, T., Dautruche, A., Durdux, C. 2019; 23 (6-7): 658–61

    Abstract

    Stereotactic radiotherapy represents a fundamental change in the practice of radiotherapy of lung cancers. Despite the great heterogeneity of sites, techniques, and doses, most studies found a high local control rate, around 70 to 90% at 2 years, and reduced toxicity, around 5% of grade 3 at 2 years. Stereotactic radiotherapy can be realized either by a dedicated accelerator (CyberKnife®) or by a conventional accelerator associated with specific systems. The two modalities deliver a very precise irradiation whose very good results published to date are similar. Some technical characteristics specific to each type of linear accelerator could guide the choice according to the target volume treated.

    View details for DOI 10.1016/j.canrad.2019.07.126

    View details for PubMedID 31471252

  • Radiomics and Machine Learning for Radiotherapy in Head and Neck Cancers. Frontiers in oncology Giraud, P., Giraud, P., Gasnier, A., El Ayachy, R., Kreps, S., Foy, J. P., Durdux, C., Huguet, F., Burgun, A., Bibault, J. E. 2019; 9: 174

    Abstract

    Introduction: An increasing number of parameters can be considered when making decisions in oncology. Tumor characteristics can also be extracted from imaging through the use of radiomics and add to this wealth of clinical data. Machine learning can encompass these parameters and thus enhance clinical decision as well as radiotherapy workflow. Methods: We performed a description of machine learning applications at each step of treatment by radiotherapy in head and neck cancers. We then performed a systematic review on radiomics and machine learning outcome prediction models in head and neck cancers. Results: Machine Learning has several promising applications in treatment planning with automatic organ at risk delineation improvements and adaptative radiotherapy workflow automation. It may also provide new approaches for Normal Tissue Complication Probability models. Radiomics may provide additional data on tumors for improved machine learning powered predictive models, not only on survival, but also on risk of distant metastasis, in field recurrence, HPV status and extra nodal spread. However, most studies provide preliminary data requiring further validation. Conclusion: Promising perspectives arise from machine learning applications and radiomics based models, yet further data are necessary for their implementation in daily care.

    View details for DOI 10.3389/fonc.2019.00174

    View details for PubMedID 30972291

    View details for PubMedCentralID PMC6445892

  • Healthcare ex Machina: Are conversational agents ready for prime time in oncology? Clinical and translational radiation oncology Bibault, J. E., Chaix, B., Nectoux, P., Pienkowsky, A., Guillemasse, A., Brouard, B. 2019; 16: 55–59

    Abstract

    Chatbots, also known as conversational agents or digital assistants, are artificial intelligence-driven software programs designed to interact with people in a conversational manner. They are often used for user-friendly customer-service triaging. In healthcare, chatbots can create bidirectional information exchange with patients, which could be leveraged for follow-up, screening, treatment adherence or data-collection. They can be deployed over various modalities, such as text-based services (text messaging, mobile applications, chat rooms) on any website or mobile applications, or audio services, such as Siri, Alexa, Cortana or Google Assistant. Potential applications are very promising, particularly in the field of oncology. In this review, we discuss the available publications and applications and the ongoing trials in that setting.

    View details for DOI 10.1016/j.ctro.2019.04.002

    View details for PubMedID 31008379

    View details for PubMedCentralID PMC6454131

  • Recommended ESTRO Core Curriculum for Radiation Oncology/Radiotherapy 4th edition. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology Benstead, K., Lara, P. C., Andreopoulos, D., Bibault, J. E., Dix, A., Eller, Y. G., Franco, P., Guiliani, M., Jaal, J., Juretic, A., Kozma, E., Lumsden, G., Maddalo, M., Magrini, S., Mjaaland, I., Pfeffer, R., de Sousa de Sa Pinto, O. M., Spalek, M., Vozenin, M. C., Verfaillie, C., Van Egten, V., Eriksen, J. G. 2019

    Abstract

    In 2017 it was decided to revise the European Core Curriculum for Radiation Oncology/Radiotherapy to produce a 4th edition. The aims of the ESTRO curriculum are to develop comparable standards for training across Europe and to facilitate free movement of specialists across borders. It is also hoped that it will improve the level of training across Europe and will make the non-medical expert roles more explicit.A wide range of stakeholders including National Society representatives, trainees, recently appointed specialists, members of the European Union Medical Specialists Radiotherapy section, an RTT, a radiobiologist, a physicist and lay members from ESTRO staff developed and commented on iterations of the curriculum.The 4th edition is based on the CanMEDS 2015 framework and identifies 14 Entrustable Professional Activities (EPAs) and the competencies required to perform these. The manager role is replaced by competencies related to leadership. The levels of proficiency required for tumour sites is defined as levels of EPAs.It is hoped that the inclusive method of developing the 4th edition has resulted in a document that will have utility in the wide range of environments in which radiation oncology is practised in Europe.

    View details for DOI 10.1016/j.radonc.2019.08.013

    View details for PubMedID 31495514

  • Deep Learning: A Review for the Radiation Oncologist. Frontiers in oncology Boldrini, L., Bibault, J. E., Masciocchi, C., Shen, Y., Bittner, M. I. 2019; 9: 977

    Abstract

    Introduction: Deep Learning (DL) is a machine learning technique that uses deep neural networks to create a model. The application areas of deep learning in radiation oncology include image segmentation and detection, image phenotyping, and radiomic signature discovery, clinical outcome prediction, image dose quantification, dose-response modeling, radiation adaptation, and image generation. In this review, we explain the methods used in DL and perform a literature review using the Medline database to identify studies using deep learning in radiation oncology. The search was conducted in April 2018, and identified studies published between 1997 and 2018, strongly skewed toward 2015 and later. Methods: A literature review was performed using PubMed/Medline in order to identify important recent publications to be synthesized into a review of the current status of Deep Learning in radiation oncology, directed at a clinically-oriented reader. The search strategy included the search terms "radiotherapy" and "deep learning." In addition, reference lists of selected articles were hand searched for further potential hits of relevance to this review. The search was conducted in April 2018, and identified studies published between 1997 and 2018, strongly skewed toward 2015 and later. Results: Studies using DL for image segmentation were identified in Brain (n = 2), Head and Neck (n = 3), Lung (n = 6), Abdominal (n = 2), and Pelvic (n = 6) cancers. Use of Deep Learning has also been reported for outcome prediction, such as toxicity modeling (n = 3), treatment response and survival (n = 2), or treatment planning (n = 5). Conclusion: Over the past few years, there has been a significant number of studies assessing the performance of DL techniques in radiation oncology. They demonstrate how DL-based systems can aid clinicians in their daily work, be it by reducing the time required for or the variability in segmentation, or by helping to predict treatment outcomes and toxicities. It still remains to be seen when these techniques will be employed in routine clinical practice.

    View details for DOI 10.3389/fonc.2019.00977

    View details for PubMedID 31632910

    View details for PubMedCentralID PMC6779810

  • Organ preservation in early esophageal cancer. Gastroenterology Barret, M., Bibault, J. E., Coriat, R. 2019

    View details for DOI 10.1053/j.gastro.2019.05.079

    View details for PubMedID 31628900

  • [Stereotactic body radiotherapy of oligometastases: Main pending trials and to come in France]. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique Giraud, P., Tournat, H., Kreps, S., Bibault, J. E., Dautruche, A., Fabiano, E., Feutren, T., Durdux, C. 2019; 23 (6-7): 496–99

    Abstract

    Stereotactic radiotherapy of oligometastases, mono- or hypofractionated, represents a fundamental change in the practice of the specialty as it was developed for a century. Despite the great heterogeneity of sites, techniques, and doses, most studies found a high local control rate, around 70 to 90% at 2 years, and reduced toxicity, around 5% of grade 3 at 2 years. Four main phase II and III trials are underway in France. Future research concerns the association of stereotactic radiotherapy with immunotherapy or different conventional chemotherapy protocols, the identification of the best clinical presentations, and optimization of fractionation and biological dose for poor prognosis localizations.

    View details for DOI 10.1016/j.canrad.2019.07.124

    View details for PubMedID 31471251

  • Effective delivery of palliative radiotherapy: A prospective study. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique Clément-Zhao, A., Luu, M., Bibault, J. E., Daveau, C., Kreps, S., Jaulmes, H., Dessard-Diana, B., Housset, M., Giraud, P., Durdux, C. 2019

    Abstract

    The main goal of palliative radiotherapy is to reduce patient's discomfort. But sometimes patients do not receive any benefits from this treatment because of rapid worsening of their general condition. This prospective monocentric study assessed the effective delivery of palliative radiotherapy.From 1st December 2015 to 29th February 2016, all consecutive patients receiving palliative radiotherapy in our hospital were included. The primary endpoint was the effective delivery of palliative radiotherapy according to the initial prescription (total dose, overall treatment time and fractionation). The secondary endpoints were the number of treatment breaks, the clinical benefit, the number of deaths and the delays for admission in the palliative care unit.Fifty-nine patients were included and 64 treatments were analysed. The treatment sites were: bone (70.3%) and brain (21.9%). The treatment goals were: pain control only (43.8%), decompression only (21.9%), pain control and decompression (32.8%), haemostatic aim (1.6%). Palliative treatment was achieved in 57 cases (89%). Temporary interruption of the radiotherapy treatment was necessary in six cases (9.4%; three for medical reason, three for logistic reason). The main reason of permanent interruption was worsening of performance status (seven cases). Palliation of symptoms (complete or partial responses) was obtained in 44 cases (68.8%). Seven patients (11.9%) died during the month after the end of the treatment. No delay or cancellation for admission in the palliative care unit were observed.Palliative radiotherapy was completed as originally planned in 51 cases (79.9%) with a clinical benefit for 44 cases (68.8%). Radiation therapy must not be neglected as a palliative treatment at the end-of-life.

    View details for DOI 10.1016/j.canrad.2018.09.006

    View details for PubMedID 31300329

  • When Chatbots Meet Patients: One-Year Prospective Study of Conversations Between Patients With Breast Cancer and a Chatbot. JMIR cancer Chaix, B., Bibault, J. E., Pienkowski, A., Delamon, G., Guillemassé, A., Nectoux, P., Brouard, B. 2019; 5 (1): e12856

    Abstract

    A chatbot is a software that interacts with users by simulating a human conversation through text or voice via smartphones or computers. It could be a solution to follow up with patients during their disease while saving time for health care providers.The aim of this study was to evaluate one year of conversations between patients with breast cancer and a chatbot.Wefight Inc designed a chatbot (Vik) to empower patients with breast cancer and their relatives. Vik responds to the fears and concerns of patients with breast cancer using personalized insights through text messages. We conducted a prospective study by analyzing the users' and patients' data, their usage duration, their interest in the various educational contents proposed, and their level of interactivity. Patients were women with breast cancer or under remission.A total of 4737 patients were included. Results showed that an average of 132,970 messages exchanged per month was observed between patients and the chatbot, Vik. Thus, we calculated the average medication adherence rate over 4 weeks by using a prescription reminder function, and we showed that the more the patients used the chatbot, the more adherent they were. Patients regularly left positive comments and recommended Vik to their friends. The overall satisfaction was 93.95% (900/958). When asked what Vik meant to them and what Vik brought them, 88.00% (943/958) said that Vik provided them with support and helped them track their treatment effectively.We demonstrated that it is possible to obtain support through a chatbot since Vik improved the medication adherence rate of patients with breast cancer.

    View details for DOI 10.2196/12856

    View details for PubMedID 31045505

  • Integrating Multimodal Radiation Therapy Data into i2b2. Applied clinical informatics Zapletal, E., Bibault, J. E., Giraud, P., Burgun, A. 2018; 9 (2): 377–90

    Abstract

    Clinical data warehouses are now widely used to foster clinical and translational research and the Informatics for Integrating Biology and the Bedside (i2b2) platform has become a de facto standard for storing clinical data in many projects. However, to design predictive models and assist in personalized treatment planning in cancer or radiation oncology, all available patient data need to be integrated into i2b2, including radiation therapy data that are currently not addressed in many existing i2b2 sites.To use radiation therapy data in projects related to rectal cancer patients, we assessed the feasibility of integrating radiation oncology data into the i2b2 platform.The Georges Pompidou European Hospital, a hospital from the Assistance Publique - Hôpitaux de Paris group, has developed an i2b2-based clinical data warehouse of various structured and unstructured clinical data for research since 2008. To store and reuse various radiation therapy data-dose details, activities scheduling, and dose-volume histogram (DVH) curves-in this repository, we first extracted raw data by using some reverse engineering techniques and a vendor's application programming interface. Then, we implemented a hybrid storage approach by combining the standard i2b2 "Entity-Attribute-Value" storage mechanism with a "JavaScript Object Notation (JSON) document-based" storage mechanism without modifying the i2b2 core tables. Validation was performed using (1) the Business Objects framework for replicating vendor's application screens showing dose details and activities scheduling data and (2) the R software for displaying the DVH curves.We developed a pipeline to integrate the radiation therapy data into the Georges Pompidou European Hospital i2b2 instance and evaluated it on a cohort of 262 patients. We were able to use the radiation therapy data on a preliminary use case by fetching the DVH curve data from the clinical data warehouse and displaying them in a R chart.By adding radiation therapy data into the clinical data warehouse, we were able to analyze radiation therapy response in cancer patients and we have leveraged the i2b2 platform to store radiation therapy data, including detailed information such as the DVH to create new ontology-based modules that provides research investigators with a wider spectrum of clinical data.

    View details for DOI 10.1055/s-0038-1651497

    View details for PubMedID 29847842

    View details for PubMedCentralID PMC5976493

  • Evaluation of the Theoretical Teaching of Postgraduate Radiation Oncology Medical Residents in France: a Cross-Sectional Study. Journal of cancer education : the official journal of the American Association for Cancer Education Faivre, J. C., Bibault, J. E., Leroy, T., Agopiantz, M., Salleron, J., Wack, M., Janoray, G., Roché, H., Culine, S., Rivera, S. 2018; 33 (2): 383–90

    Abstract

    This study's purpose was to have residents evaluate Radiation Oncology (RO) theoretical teaching practices in France. An anonymous electronically cross-functional survey on theoretical teaching practices in the RO residents was conducted by (i) collecting data from residents in the medical faculties in France, (ii) comparing the data across practices when possible and (iii) suggesting means of improvement. A total of 103 out of 140 RO residents responded to the survey (73.5% response rate). National, inter-university, university and internships courses do not exist in 0% (0), 16.5% (17), 53.4% (55) and 40.8% (42) of residents, respectively. Residents need additional training due to the shortage of specialised postgraduate degree training (49.5% (51)), CV enhancement to obtain a post-internship position (49.5% (51)) or as part of a career plan (47.6% (49)). The topics covered in teaching to be improved were the following: basic concept 61.2% (63), advanced concept 61.2 (63) and discussion of frequent clinical cases 50.5% (52). The topics not covered in teaching to be improved were the following: the development of career (66.0% (68)), medical English (56.3% (58)), the organisation of RO speciality (49.5% (51)) and the hospital management of RO department (38.8% (40)). This is the first national assessment of theoretical teaching of RO residents in France.

    View details for DOI 10.1007/s13187-017-1170-2

    View details for PubMedID 28138918

  • Choosing a career in oncology: results of a nationwide cross-sectional study. BMC medical education Faivre, J. C., Bibault, J. E., Bellesoeur, A., Salleron, J., Wack, M., Biau, J., Cervellera, M., Janoray, G., Leroy, T., Lescut, N., Martin, V., Molina, S., Pichon, B., Teyssier, C., Thureau, S., Mazeron, J. J., Roché, H., Culine, S. 2018; 18 (1): 15

    Abstract

    Little information is currently available concerning young medical students desire to pursue a career in oncology, or their career expectations.This project is a cross-sectional epidemiological study. A voluntary and anonymous questionnaire was distributed to all young oncologists studying in France between the 2nd of October 2013 and the 23rd of February 2014.The overall response rate was 75.6%. A total of 505 young oncologists completed the questionnaire. The main determining factors in the decision to practice oncology were the cross-sectional nature of the field (70.8%), the depth and variety of human relations (56.3%) and the multi-disciplinary field of work (50.2%). Most residents would like to complete a rotation outside of their assigned region (59.2%) or abroad (70.2%) in order to acquire additional expertise (67.7%). In addition, most interns would like to undertake a fellowship involving care, teaching and research in order to hone their skills (85.7%) and forge a career in public hospitals (46.4%). Career prospects mainly involve salaried positions in public hospitals. Many young oncologists are concerned about their professional future, due to the shortage of openings (40.8%), the workload (52.8%) and the lack of work-life balance (33.4%).This investigation provides a comprehensive profile of the reasons young oncologists chose to pursue a career in oncology, and their career prospects.

    View details for DOI 10.1186/s12909-018-1117-2

    View details for PubMedID 29334939

    View details for PubMedCentralID PMC5769332

  • Automatic Intracranial Segmentation: Is the Clinician Still Needed? Technology in cancer research & treatment Meillan, N., Bibault, J. E., Vautier, J., Daveau-Bergerault, C., Kreps, S., Tournat, H., Durdux, C., Giraud, P. 2018; 17: 1533034617748839

    Abstract

    Stereotactic hypofractionated radiotherapy is an effective treatment for brain metastases in oligometastatic patients. Its planning is however time-consuming because of the number of organs at risk to be manually segmented. This study evaluates 2 automated segmentation commercial software.Patients were scanned in the treatment position. The computed tomography scan was registered on a magnetic resonance imaging and volumes were manually segmented by a clinician. Then 2 automated segmentations were performed (with iPlan and Smart Segmentation). RT STRUCT files were compared with Aquilab's Artistruct segment comparison module. We selected common segmented volume ratio as the main judging criterion. Secondary criteria were Dice-Sørensen coefficients, overlap ratio, and additional segmented volume.Twenty consecutive patients were included. Agreement between manual and automated contouring was poor. Common segmented volumes ranged from 7.71% to 82.54%, Dice-Sørensen coefficient ranged from 0.0745 to 0.8398, overlap ratio ranged from 0.0414 to 0.7275, and additional segmented volume ranged from 9.80% to 92.25%. Each software outperformed the other on some organs while performing worse on others.No software seemed clearly better than the other. Common segmented volumes were much too low for routine use in stereotactic hypofractionated brain radiotherapy. Manual editing is still needed.

    View details for DOI 10.1177/1533034617748839

    View details for PubMedID 29343204

    View details for PubMedCentralID PMC5784565

  • Labeling for Big Data in radiation oncology: The Radiation Oncology Structures ontology. PloS one Bibault, J. E., Zapletal, E., Rance, B., Giraud, P., Burgun, A. 2018; 13 (1): e0191263

    Abstract

    Leveraging Electronic Health Records (EHR) and Oncology Information Systems (OIS) has great potential to generate hypotheses for cancer treatment, since they directly provide medical data on a large scale. In order to gather a significant amount of patients with a high level of clinical details, multicenter studies are necessary. A challenge in creating high quality Big Data studies involving several treatment centers is the lack of semantic interoperability between data sources. We present the ontology we developed to address this issue.Radiation Oncology anatomical and target volumes were categorized in anatomical and treatment planning classes. International delineation guidelines specific to radiation oncology were used for lymph nodes areas and target volumes. Hierarchical classes were created to generate The Radiation Oncology Structures (ROS) Ontology. The ROS was then applied to the data from our institution.Four hundred and seventeen classes were created with a maximum of 14 children classes (average = 5). The ontology was then converted into a Web Ontology Language (.owl) format and made available online on Bioportal and GitHub under an Apache 2.0 License. We extracted all structures delineated in our department since the opening in 2001. 20,758 structures were exported from our "record-and-verify" system, demonstrating a significant heterogeneity within a single center. All structures were matched to the ROS ontology before integration into our clinical data warehouse (CDW).In this study we describe a new ontology, specific to radiation oncology, that reports all anatomical and treatment planning structures that can be delineated. This ontology will be used to integrate dosimetric data in the Assistance Publique-Hôpitaux de Paris CDW that stores data from 6.5 million patients (as of February 2017).

    View details for DOI 10.1371/journal.pone.0191263

    View details for PubMedID 29351341

    View details for PubMedCentralID PMC5774757

  • In Reply to Tallet et al. International journal of radiation oncology, biology, physics Bibault, J. E., Giraud, P., Morelle, M., Perrier, L., Huguet, M. 2018; 100 (2): 529–30

    View details for DOI 10.1016/j.ijrobp.2017.10.039

    View details for PubMedID 29353662

  • In Reply to Daisne et al. International journal of radiation oncology, biology, physics Bibault, J. E., Giraud, P., Morelle, M., Perrier, L., Huguet, M. 2018; 100 (3): 808–9

    View details for DOI 10.1016/j.ijrobp.2017.11.042

    View details for PubMedID 29413297

  • RE: The Rise of Radiomics and Implications for Oncologic Management. Journal of the National Cancer Institute Foy, J. P., Durdux, C., Giraud, P., Bibault, J. E. 2018; 110 (11): 1275–76

    View details for DOI 10.1093/jnci/djy037

    View details for PubMedID 29546427

  • Learning radiation oncology in Europe: Results of the ESTRO multidisciplinary survey. Clinical and translational radiation oncology Bibault, J. E., Franco, P., Borst, G. R., Van Elmpt, W., Thorwhart, D., Schmid, M. P., Rouschop, K. M., Spalek, M., Mullaney, L., Redalen, K. R., Dubois, L., Verfaillie, C., Eriksen, J. G. 2018; 9: 61–67

    Abstract

    Radiotherapy education can be very different across Europe, despite the publication of the ESTRO core curricula in 2011. The purpose of the current study is to map the different RO European education systems, to report their perceived quality and to understand what could be improved to better teach RO.An online survey consisting of 30 questions was sent to RO professionals under 40 years of age via email and social media. Clinicians, radiobiologists, physicists and radiation therapists (RTTs) were invited to answer questions regarding (1) demographics data, (2) duration, (3) organization, (4) content, (5) quality and potential improvements of national education programs.Four hundred and sixty three questionnaires were received from 34 European countries. All disciplines were represented: 45% clinicians (n = 210), 29% physicists (n = 135), 24% RTTs (n = 108) and 2% radiobiologists (n = 10). Male and female participants were well-balanced in each speciality, except for radiobiologists (80% males). Median age was 31.5 years old (range 21-40). A large range of the duration of the National RO education programs was observed: median = 9 years (range: 3-15). In half of the surveyed countries the European Credit Transfer System (ECTS), that facilitates mobility for trainees, has been implemented. Participants declared only a minority of countries have implemented the ESTRO Core Curriculum (n = 5). A quarter of participants indicated that their national education program is insufficient.This is the first study to examine the different RO education systems in Europe. Large differences in organization and duration of national education programs have been found, along with perceived quality across Europe within each speciality. These results show the necessity of a discussion on how to move forward in this diversity of education programs and the potential contribution that the ESTRO may fulfil.

    View details for DOI 10.1016/j.ctro.2018.02.001

    View details for PubMedID 29594252

    View details for PubMedCentralID PMC5862689

  • Treating Metastatic Prostate Cancer With Local Therapies: Is It Still Wishful Thinking? Journal of clinical oncology : official journal of the American Society of Clinical Oncology Bibault, J. E., Blanchard, P. 2018; 36 (22): 2348–49

    View details for DOI 10.1200/JCO.2017.77.5429

    View details for PubMedID 29856690

  • Deep Learning and Radiomics predict complete response after neo-adjuvant chemoradiation for locally advanced rectal cancer. Scientific reports Bibault, J. E., Giraud, P., Housset, M., Durdux, C., Taieb, J., Berger, A., Coriat, R., Chaussade, S., Dousset, B., Nordlinger, B., Burgun, A. 2018; 8 (1): 12611

    Abstract

    Treatment of locally advanced rectal cancer involves chemoradiation, followed by total mesorectum excision. Complete response after chemoradiation is an accurate surrogate for long-term local control. Predicting complete response from pre-treatment features could represent a major step towards conservative treatment. Patients with a T2-4 N0-1 rectal adenocarcinoma treated between June 2010 and October 2016 with neo-adjuvant chemoradiation from three academic institutions were included. All clinical and treatment data was integrated in our clinical data warehouse, from which we extracted the features. Radiomics features were extracted from the tumor volume from the treatment planning CT Scan. A Deep Neural Network (DNN) was created to predict complete response, as a methodological proof-of-principle. The results were compared to a baseline Linear Regression model using only the TNM stage as a predictor and a second model created with Support Vector Machine on the same features used in the DNN. Ninety-five patients were included in the final analysis. There were 49 males (52%) and 46 females (48%). Median tumour size was 48 mm (15-130). Twenty-two patients (23%) had pathologic complete response after chemoradiation. One thousand six hundred eighty-three radiomics features were extracted. The DNN predicted complete response with an 80% accuracy, which was better than the Linear Regression model (69.5%) and the SVM model (71.58%). Our model correctly predicted complete response after neo-adjuvant rectal chemoradiotherapy in 80% of the patients of this multicenter cohort. Our results may help to identify patients who would benefit from a conservative treatment, rather than a radical resection.

    View details for DOI 10.1038/s41598-018-30657-6

    View details for PubMedID 30135549

    View details for PubMedCentralID PMC6105676

  • [Management of patients with pacemakers or implantable cardioverter defibrillator undergoing radiotherapy]. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique Huertas, A., Thuillot, M., Bibault, J. E., Sharifzadehgan, A., Laurans, M., Giraud, P., Lavergne, T., Marijon, É., Durdux, C. 2018; 22 (6-7): 515–21

    Abstract

    An increasing number of patients with cardiac implantable electronic devices benefit from radiotherapy, warranting specific collaborative management between both radiation oncologists and cardiologists. Interactions between electromagnetic fields, secondary particles and cardiac implantable electronic devices may result in transient and reversible malfunctions with significant consequences depending on the underlying cardiac pathology and the level of patient's cardiac implantable electronic devices dependency. Numerous international guidelines on patients' management have been proposed and all agree on a total cumulated dose limit at the battery of 5Gy and on the need for an initial as well as repeated evaluation over time, up to 6months after the last radiation. The analysis of the published data revealed relatively rare incidence of significant adverse events. The most recent international guidelines underline the feasibility and safety of radiotherapy for cardiac implantable electronic devices holders, with the need for systematic local protocol in all radiotherapy centers.

    View details for DOI 10.1016/j.canrad.2018.06.017

    View details for PubMedID 30153976

  • Impact of a dedicated multidisciplinary meeting on the management of superficial cancers of the digestive tract. Endoscopy international open Dermine, S., Barret, M., Prieux, C., Ribière, S., Leblanc, S., Dhooge, M., Brezault, C., Abitbol, V., Terris, B., Beuvon, F., Rouquette, A., Dousset, B., Gaujoux, S., Soyer, P., Dohan, A., Bibault, J. E., Coriat, R., Prat, F., Chaussade, S. 2018; 6 (12): E1470–E1476

    Abstract

    Background  The recent development of endoscopic resection for superficial gastrointestinal cancers could justify the need for a dedicated oncological multidisciplinary meeting (MDM). The aim of our study was to evaluate the impact of the dedicated MDM on the management of superficial cancers of the digestive tract. Methods  A dedicated MDM was developed at our tertiary referral center. A retrospective review of the MDM conclusions for all patients referred from March 2015 to March 2017 was performed. Outcomes measurements were the outcomes of endoscopic resection, and the concordance rate between the MDM recommendations, European Society of Gastrointestinal Endoscopy (ESGE) guidelines, and final patient management. Results  In total, 153 patients with a median age of 69 years were included. Half of the patients had major comorbidities. The mean lesion size was 25 mm, and R0 and curative resection rate were 73.9 % and 56.9 %, respectively. Forty-three patients had an indication for surgery after endoscopic resection. The concordance rate between ESGE guidelines and MDM recommendation was 92.2 %, and 12 patients did not receive the treatment recommended due to comorbidities. Conclusion  A MDM dedicated to superficial tumors helped tailor the ESGE guidelines to each patient in order to avoid unnecessary surgery.

    View details for DOI 10.1055/a-0658-1350

    View details for PubMedID 30574537

    View details for PubMedCentralID PMC6291401

  • [Siriade 2.0: An e-learning platform for radiation oncology contouring]. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique Bibault, J. E., Denis, F., Roué, A., Gibon, D., Fumagalli, I., Hennequin, C., Barillot, I., Quéro, L., Paumier, A., Mahé, M. A., Servagi Vernat, S., Créhange, G., Lapeyre, M., Blanchard, P., Pointreau, Y., Lafond, C., Huguet, F., Mornex, F., Latorzeff, I., de Crevoisier, R., Martin, V., Kreps, S., Durdux, C., Antoni, D., Noël, G., Giraud, P. 2018; 22 (8): 773–77

    Abstract

    In 2008, the French national society of radiation oncology (SFRO) and the association for radiation oncology continued education (AFCOR) created Siriade, an e-learning website dedicated to contouring.Between 2015 and 2017, this platform was updated using the latest digital online tools available. Two main sections were needed: a theoretical part and another section of online workshops.Teaching courses are available as online commented videos, available on demand. The practical section of the website is an online contouring workshop that automatically generates a report quantifying the quality of the user's delineation compared with the experts'.Siriade 2.0 is an innovating digital tool for radiation oncology initial and continuous education.

    View details for DOI 10.1016/j.canrad.2018.02.003

    View details for PubMedID 30360973

  • [Stereotactic body radiation therapy for oligometastatic prostate cancer]. Bulletin du cancer Bibault, J. E. 2018; 105 (1): 120–25

    Abstract

    The first line treatment of metastatic prostate cancer is medical or surgical androgen-deprivation. This treatment however has significant side effects that can affect the patients' quality of life. For oligometastatic patients, a new therapeutic approach, focusing on local treatment of metastases, is emerging.A systematic review of studies published on Stereotactic Body Radiation Therapy (SBRT) for oligometastatic prostate cancer was performed using results from search request on MEDLINE.Treatment regimens vary from a single fraction of 20Gy (bone lesions) to ten fractions for a total dose of 64Gy (visceral metastases). Local control is 95.5 to 100% at 2 years with grade 1 and 2 toxicities around 10%, without any grade 3 side effects. These retrospective studies show the feasibility and very low toxicity of SBRT for this population of patients. The effect of SBRT on disease-free or global survival and quality of life has not been assessed. Several prospective trials (STOMP & ORIOLE) are underway.Treating patients with up to five prostate cancer metastases is efficient and has a low toxicity. Prospective trials should identify which patients, if any, really benefit from this approach.

    View details for DOI 10.1016/j.bulcan.2017.09.017

    View details for PubMedID 29191358

  • Clinical Outcomes of Several IMRT Techniques for Patients With Head and Neck Cancer: A Propensity Score-Weighted Analysis. International journal of radiation oncology, biology, physics Bibault, J. E., Dussart, S., Pommier, P., Morelle, M., Huguet, M., Boisselier, P., Coche-Dequeant, B., Alfonsi, M., Bardet, E., Rives, M., Calugaru, V., Chajon, E., Noel, G., Mecellem, H., Servagi Vernat, S., Perrier, L., Giraud, P. 2017; 99 (4): 929–37

    Abstract

    The Advanced Radiotherapy Oto-Rhino-Laryngologie (ART-ORL) study (NCT02024035) was performed to prospectively evaluate the clinical and economic aspects of helical TomoTherapy and volumetric modulated arc therapy (RapidArc, Varian Medical Systems, Palo Alto, CA) for patients with head and neck cancer.Fourteen centers participated in this prospective comparative study. Randomization was not possible based on the availability of equipment. Patients with epidermoid or undifferentiated nasopharyngeal carcinoma or epidermoid carcinoma of the oropharynx and oral cavity (T1-T4, M0, N0-N3) were included between February 2010 and February 2012. Only the results of the clinical study are presented in this report, as the results of the economic assessment have been published previously. Inverse probability of treatment weighting using the propensity score analysis was undertaken in an effort to adjust for potential bias due to nonrandomization. Locoregional control, cancer-specific survival, and overall survival assessed 18 months after treatment, as well as long-term toxicity and salivary function, were evaluated.The analysis included 166 patients. The following results are given after inverse probability of treatment weighting adjustment. The locoregional control rate at 18 months was significantly better in the TomoTherapy group: 83.3% (95% confidence interval [CI], 72.5%-90.2%) versus 72.7% (95% CI, 62.1%-80.8%) in the RapidArc group (P=.025). The cancer-specific survival rate was better in the TomoTherapy group: 97.2% (95% CI, 89.3%-99.3%) versus 85.5% (95% CI, 75.8%-91.5%) in the RapidArc group (P=.014). No significant difference was shown in progression-free or overall survival. TomoTherapy induced fewer acute salivary disorders (P=.012). Posttreatment salivary function degradation was worse in the RapidArc group (P=.012).TomoTherapy provided better locoregional control and cancer-specific survival than RapidArc treatment, with fewer salivary disorders. No significant difference was shown in progression-free and overall survival. These results should be explored in a randomized trial.

    View details for DOI 10.1016/j.ijrobp.2017.06.2456

    View details for PubMedID 28864403

  • [Artificial intelligence applied to radiation oncology]. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique Bibault, J. E., Burgun, A., Giraud, P. 2017; 21 (3): 239–43

    Abstract

    Performing randomised comparative clinical trials in radiation oncology remains a challenge when new treatment modalities become available. One of the most recent examples is the lack of phase III trials demonstrating the superiority of intensity-modulated radiation therapy in most of its current indications. A new paradigm is developing that consists in the mining of large databases to answer clinical or translational issues. Beyond national databases (such as SEER or NCDB), that often lack the necessary level of details on the population studied or the treatments performed, electronic health records can be used to create detailed phenotypic profiles of any patients. In parallel, the Record-and-Verify Systems used in radiation oncology precisely document the planned and performed treatments. Artificial Intelligence and machine learning algorithms can be used to incrementally analyse these data in order to generate hypothesis to better personalize treatments. This review discusses how these methods have already been used in previous studies.

    View details for DOI 10.1016/j.canrad.2016.09.021

    View details for PubMedID 28433591

  • Social media for radiation oncologists: A practical primer. Advances in radiation oncology Bibault, J. E., Katz, M. S., Motwani, S. 2017; 2 (3): 277–80

    View details for DOI 10.1016/j.adro.2017.04.009

    View details for PubMedID 29114592

    View details for PubMedCentralID PMC5605316

  • Big Data and machine learning in radiation oncology: State of the art and future prospects. Cancer letters Bibault, J. E., Giraud, P., Burgun, A. 2016; 382 (1): 110–17

    Abstract

    Precision medicine relies on an increasing amount of heterogeneous data. Advances in radiation oncology, through the use of CT Scan, dosimetry and imaging performed before each fraction, have generated a considerable flow of data that needs to be integrated. In the same time, Electronic Health Records now provide phenotypic profiles of large cohorts of patients that could be correlated to this information. In this review, we describe methods that could be used to create integrative predictive models in radiation oncology. Potential uses of machine learning methods such as support vector machine, artificial neural networks, and deep learning are also discussed.

    View details for DOI 10.1016/j.canlet.2016.05.033

    View details for PubMedID 27241666

  • Toxicity and efficacy of cetuximab associated with several modalities of IMRT for locally advanced head and neck cancer. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique Bibault, J. E., Morelle, M., Perrier, L., Pommier, P., Boisselier, P., Coche-Dequéant, B., Gallocher, O., Alfonsi, M., Bardet, É., Rives, M., Calugaru, V., Chajon, E., Noël, G., Mecellem, H., Pérol, D., Dussart, S., Giraud, P. 2016; 20 (5): 357–61

    Abstract

    Intensity-modulated radiation therapy (IMRT) has shown its interest for head and neck cancer treatment. In parallel, cetuximab has demonstrated its superiority against exclusive radiotherapy. The objective of this study was to assess the acute toxicity, local control and overall survival of cetuximab associated with different IMRT modalities compared to platinum-based chemotherapy and IMRT in the ARTORL study (NCT02024035).This prospective, multicenter study included patients with epidermoid or undifferentiated nasopharyngeal carcinoma, epidermoid carcinoma of oropharynx and oral cavity (T1-T4, M0, N0-N3). Acute toxicity, local control and overall survival were compared between groups (patients receiving cetuximab or not). Propensity score analysis at the ratio 1:1 was undertaken in an effort to adjust for potential bias between groups due to non-randomization.From the 180 patients included in the ARTORL study, 29 patients receiving cetuximab and 29 patients treated without cetuximab were matched for the analysis. Ten patients (34.5%) reported acute dermal toxicity of grade 3 in the cetuximab group versus three (10.3%) in the non-cetuximab group obtained after matching (P=0.0275). Cetuximab was not significantly associated with more grade 3 mucositis (P=0.2563). There were no significant differences in cutaneous or oral toxicity for patients treated with cetuximab between the different IMRT modalities (P=1.000 and P=0.5731, respectively). There was no significant difference in local relapse-free survival (P=0.0920) or overall survival (P=0.4575) between patients treated with or without cetuximab.Patients treated with cetuximab had more cutaneous toxicities, but oral toxicity was similar between groups. The different IMRT modalities did not induce different toxicity profiles.

    View details for DOI 10.1016/j.canrad.2016.05.009

    View details for PubMedID 27345843

  • Empowering patients for radiation therapy safety: Results of the EMPATHY study. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique Bibault, J. E., Pernet, A., Mollo, V., Gourdon, L., Martin, O., Giraud, P. 2016; 20 (8): 790–93

    Abstract

    With the increase of treatment complexity, enhancing safety is a key concern in radiation oncology. Beyond the involvement of the healthcare professional, patient involvement and empowerment could play a major role in that setting. We explored how patients perceived and fulfilled that role during their radiation treatment.A voluntary and anonymous questionnaire was administered to all patients treated in our department between November 2013 and May 2014. The following data were collected: sociodemographic profile; information received and initiatives to search for additional information; behavior when an unusual treatment event was perceived; active involvement in the safety of the treatment; nature and perception of their own involvement. A statistical analysis was performed to assess behavioral predictors.A total of 155 patients answered the survey. Most of them were treated for prostate (n=58, 37.4%), lung (n=27, 17.4%), head and neck (n=26, 16.8%) and breast (n=25, 16.1%). Only eight patients (5%) had previously received radiation therapy. Ninety-five percent of the patients estimated they had received enough information about their treatment, but 48% would have wanted more. When patients noticed an unusual event during their treatment session, most of them (61%) reported it to the radiation therapist.Patient participation to radiation therapy safety should be encouraged to ensure a cooperative risk management. Healthcare professionals need to inform the patients on the basic technical processes involved in their treatment. Patient empowerment should be added to the verifications made by the radiation therapists and physicians but should not replace them.

    View details for DOI 10.1016/j.canrad.2016.06.006

    View details for PubMedID 27769636

  • Evaluation of patients' engagement in radiation therapy safety. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique Pernet, A., Mollo, V., Bibault, J. E., Giraud, P. 2016; 20 (8): 765–67

    Abstract

    Treatment safety has become a priority in health policies after several incidents occurred around the world in radiation oncology departments. The aim of this study was to analyse the patients' contribution in that field and to understand which actions empower the patient in that regard.Several methods were used in a general hospital and in a comprehensive cancer centre to analyse the activities of the radiation therapists and the patients and the interactions between them: treatment session observations, semidirective interviews with radiation therapists and patients, self and alloconfrontation with radiation therapists and explanatory interviews with patients.Cooperation of the patients in treatment safety acts as an additional step that contributes to safer treatments. Radiation therapy sessions are a creative opportunity for the patient to observe, learn and analyse what is happening. Changes between treatment sessions are a source of anxiety for the patients. This study highlights the factors that favour the patients' participation. A trusting relationship and support from the health professionals can be leveraged in that manner.There is a common will shared between the patients and the health professionals towards better treatment safety. The cooperation is still not well-known and underused. This empowerment of the patient cannot be mandatory but should be promoted and developed.

    View details for DOI 10.1016/j.canrad.2016.02.010

    View details for PubMedID 28270322

  • Adapted Prescription Dose for Monte Carlo Algorithm in Lung SBRT: Clinical Outcome on 205 Patients. PloS one Bibault, J. E., Mirabel, X., Lacornerie, T., Tresch, E., Reynaert, N., Lartigau, E. 2015; 10 (7): e0133617

    Abstract

    SBRT is the standard of care for inoperable patients with early-stage lung cancer without lymph node involvement. Excellent local control rates have been reported in a large number of series. However, prescription doses and calculation algorithms vary to a great extent between studies, even if most teams prescribe to the D95 of the PTV. Type A algorithms are known to produce dosimetric discrepancies in heterogeneous tissues such as lungs. This study was performed to present a Monte Carlo (MC) prescription dose for NSCLC adapted to lesion size and location and compare the clinical outcomes of two cohorts of patients treated with a standard prescription dose calculated by a type A algorithm or the proposed MC protocol.Patients were treated from January 2011 to April 2013 with a type B algorithm (MC) prescription with 54 Gy in three fractions for peripheral lesions with a diameter under 30 mm, 60 Gy in 3 fractions for lesions with a diameter over 30 mm, and 55 Gy in five fractions for central lesions. Clinical outcome was compared to a series of 121 patients treated with a type A algorithm (TA) with three fractions of 20 Gy for peripheral lesions and 60 Gy in five fractions for central lesions prescribed to the PTV D95 until January 2011. All treatment plans were recalculated with both algorithms for this study. Spearman's rank correlation coefficient was calculated for GTV and PTV. Local control, overall survival and toxicity were compared between the two groups.205 patients with 214 lesions were included in the study. Among these, 93 lesions were treated with MC and 121 were treated with TA. Overall survival rates were 86% and 94% at one and two years, respectively. Local control rates were 79% and 93% at one and two years respectively. There was no significant difference between the two groups for overall survival (p = 0.785) or local control (p = 0.934). Fifty-six patients (27%) developed grade I lung fibrosis without clinical consequences. GTV size was a prognostic factor for overall survival (HR = 1.026, IC95% [1.01-1.041], p<0.001) and total dose was a prognostic factor for local control (HR = 0.924, IC95% [0.870-0.982], p = 0.011). D50 of the GTV calculated with MC correlated poorly with the D95 of the PTV calculated with TA (r = 0.116) for lesions with a diameter of 20 mm or less. For lesions larger than 20 mm, spearman correlation was higher (r = 0.618), but still insufficient.No difference in local control or overall survival was found between patients treated with a type A or a type B algorithm in our cohort. A size and location adapted GTV-based prescription method could be used with a type B algorithm. External validation of these results is warranted.

    View details for DOI 10.1371/journal.pone.0133617

    View details for PubMedID 26207808

    View details for PubMedCentralID PMC4514775

  • Cytotoxic effect of lapatinib is restricted to human papillomavirus-positive head and neck squamous cell carcinoma cell lines. OncoTargets and therapy Fumagalli, I., Dugue, D., Bibault, J. E., Clémenson, C., Vozenin, M. C., Mondini, M., Deutsch, E. 2015; 8: 335–45

    Abstract

    Lapatinib is a dual epidermal growth factor receptor (EGFR) and HER2 inhibitor. Overexpression of these receptors is frequently observed in head and neck squamous cell carcinoma (HNSCC). As growing proportion of HNSCC is characterized by human papillomavirus (HPV) infection, we aimed at evaluating the efficacy of lapatinib as function of HPV status in HNSCC cell lines.Two HPV-positive and two HPV-negative HNSCC cell lines were used. Proliferation, cell cycle, and Annexin V assays were performed to test their sensitivity to lapatinib. Combination of lapatinib and ionizing radiation was evaluated with clonogenic survival assays. Akt, EGFR and HER2, and E6/E7 expression and activation were analyzed by immunoblotting and quantitative reverse transcription polymerase chain reaction.Lapatinib reduced E6 and E7 expression and Akt phosphorylation, inhibited cell proliferation and induced cell death in HPV-positive cell lines. An additive effect of lapatinib with radiation was observed in these cells. Lapatinib had no effect on HPV-negative cells.Lapatinib efficacy restricted to the HPV-positive cells suggests that HPV status could be a potential marker for enhanced response to lapatinib in HNSCC.

    View details for DOI 10.2147/OTT.S68235

    View details for PubMedID 25678800

    View details for PubMedCentralID PMC4322874

  • Next-generation sequencing of FLT3 internal tandem duplications for minimal residual disease monitoring in acute myeloid leukemia. Oncotarget Bibault, J. E., Figeac, M., Hélevaut, N., Rodriguez, C., Quief, S., Sebda, S., Renneville, A., Nibourel, O., Rousselot, P., Gruson, B., Dombret, H., Castaigne, S., Preudhomme, C. 2015; 6 (26): 22812–21

    Abstract

    Minimal Residual Disease (MRD) detection can be used for early intervention in relapse, risk stratification, and treatment guidance. FLT3 ITD is the most common mutation found in AML patients with normal karyotype. We evaluated the feasibility of NGS with high coverage (up to 2.4.10(6) PE fragments) for MRD monitoring on FLT3 ITD. We sequenced 37 adult patients at diagnosis and various times of their disease (64 samples) and compared the results with FLT3 ITD ratios measured by fragment analysis. We found that NGS could detect variable insertion sites and lengths in a single test for several patients. We also showed mutational shifts between diagnosis and relapse, with the outgrowth of a clone at relapse different from that dominant at diagnosis. Since NGS is scalable, we were able to adapt sensitivity by increasing the number of reads obtained for follow-up samples, compared to diagnosis samples. This technique could be applied to detect biological relapse before its clinical consequences and to better tailor treatments through the use of FLT3 inhibitors. Larger cohorts should be assessed in order to validate this approach.

    View details for DOI 10.18632/oncotarget.4333

    View details for PubMedID 26078355

    View details for PubMedCentralID PMC4673201

  • [Adaptive radiation therapy for non-small cell lung cancer]. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique Bibault, J. E., Arsène-Henry, A., Durdux, C., Mornex, F., Hamza, S., Trouette, R., Thureau, S., Faivre, J. C., Boisselier, P., Lerouge, D., Paragios, N., Giraud, P. 2015; 19 (6-7): 458–62

    Abstract

    Anatomical changes and tumor regression during thoracic radiotherapy may alter the treatment volumes. These modifications are not taken into account into set-up or motion margins used for treatment planning. Their dosimetric impact could be significant and a better understanding of the changes occurring during the 6 to 7 weeks of treatment could be useful in order to define quantitative thresholds before a new treatment planning is needed. Margins could also be reduced in order to better spare organs at risk and perform targeted dose escalation. This review assesses the potential of morphologic and metabolic imaging during treatment for adaptive radiotherapy in non-small cell lung cancer.

    View details for DOI 10.1016/j.canrad.2015.05.021

    View details for PubMedID 26337476

  • [Positron emission tomography and stereotactic body radiation therapy for lung cancer: From treatment planning to response evaluation]. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique Bibault, J. E., Oudoux, A., Durand-Labrunie, J., Mirabel, X., Lartigau, É., Kolesnikov-Gauthier, H. 2015; 19 (8): 790–94; quiz 795–99

    Abstract

    Stereotactic body radiation therapy is the standard treatment for inoperable patients with early-stage lung cancer. Local control rates range from 80 to 90 % 2 years after treatment. The role of positron emission tomography in patient selection is well known, but its use for target definition or therapeutic response evaluation is less clear. We reviewed the literature in order to assess the current state of knowledge in this area.

    View details for DOI 10.1016/j.canrad.2015.05.027

    View details for PubMedID 26476702

  • Feasibility study of pelvic helical IMRT for elderly patients with endometrial cancer. PloS one Bibault, J. E., Nickers, P., Tresch, E., Cordoba, A., Leblanc, E., Comte, P., Lacornerie, T., Lartigau, E. 2014; 9 (11): e113279

    Abstract

    Standard treatment for early-stage endometrial cancer involves surgery (when possible) followed by brachytherapy or external-beam radiotherapy (EBRT) for high-risk tumors. EBRT is not without toxicity, meaning that it could be difficult to complete for elderly patients, who typically have decreased reserve and resistance to stressors.Patients aged 70 and over treated between April 2009 and May 2013 for endometrial cancer and received IMRT (Intensity-Modulated Radiation Therapy) were included in this observational study. IMRT could be performed as adjuvant treatment or as an exclusive treatment for patients not amenable to surgery. The primary endpoints of this study were to assess the feasibility and toxicity of pelvic IMRT in this population. Secondary endpoints were to assess disease-specific survival, overall survival, and local control. Predictors of toxicity were also explored.Forty seven consecutive patients were included in the analysis. Median age at diagnosis was 75 years (range, 70-89 years). Eleven patients were aged 80 years and older. Toxicities were found in thirty four patients (72%) during treatment. Among these, toxicity did not exceed grade 2 for 32 patients (68%). Two patients had a grade 3 toxicity (4%). Overall survival rates were 87% and 83% at 1 and 2 years, respectively. Six patients (12.8%) had a local relapse and nine others (19.1%) had distant relapse.Pelvic helical IMRT for patients aged 70 and older is feasible with full standard radiation doses, showing that age greater than 70 should not be considered as a reason not to perform optimal treatment.

    View details for DOI 10.1371/journal.pone.0113279

    View details for PubMedID 25423024

    View details for PubMedCentralID PMC4244154

  • [Brachytherapy training: a survey of French radiation oncology residents]. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique Fumagalli, I., Faivre, J. C., Thureau, S., Bibault, J. E., Diaz, O., Leroy, T., Pichon, B., Riou, O., Fournier, C., Hannoun-Lévi, J. M., Peiffert, D. 2014; 18 (1): 28–34

    Abstract

    The goal of this study was to evaluate the interest of the members of the French society of young radiation oncologists (SFjRO) for brachytherapy as well as their theoretical and practical level in this radiation technique.An anonymous survey was conducted regarding practical and theoretical teaching of brachytherapy before the French national courses on brachytherapy.Among the 106 residents attending this teaching course, 99 (93%) answered the survey. Most of them were interested in brachytherapy but 82% considered they had not received sufficient teaching. Relevant indications of brachytherapy were known by 76% of the residents for gynaecological malignancies and 70% for prostate. Seventy-one percent of the residents have seen at least one gynecological brachytherapy but only 12% knew how to deal with this technique. Fifty-six percent have seen vaginal high dose rate brachytherapy and 21% had acquired the technique. For prostate brachytherapy, 65% had seen and done an implant and only 4% had acquired the technique. Fifty percent have performed at least one brachytherapy treatment during their residency. Residents expressed a strong wish for more courses about dosimetry (82%), technique (75%) and treatment planning (90%).Our study shows the interest of French residents for brachytherapy but suggests that practical teaching courses and an evaluation of the existing theoretical courses are warranted.

    View details for DOI 10.1016/j.canrad.2013.07.150

    View details for PubMedID 24332865

  • Mobile technology and social media in the clinical practice of young radiation oncologists: results of a comprehensive nationwide cross-sectional study. International journal of radiation oncology, biology, physics Bibault, J. E., Leroy, T., Blanchard, P., Biau, J., Cervellera, M., Diaz, O., Faivre, J. C., Fumagalli, I., Lescut, N., Martin, V., Pichon, B., Riou, O., Thureau, S., Giraud, P. 2014; 90 (1): 231–37

    Abstract

    Social media and mobile technology are transforming the way in which young physicians are learning and practicing medicine. The true impact of such technologies has yet to be evaluated.We performed a nationwide cross-sectional survey to better assess how young radiation oncologists used these technologies. An online survey was sent out between April 24, 2013, and June 1, 2013. All residents attending the 2013 radiation oncology French summer course were invited to complete the survey. Logistic regressions were performed to assess predictors of use of these tools in the hospital on various clinical endpoints.In all, 131 of 140 (93.6%) French young radiation oncologists answered the survey. Of these individuals, 93% owned a smartphone and 32.8% owned a tablet. The majority (78.6%) of the residents owning a smartphone used it to work in their department. A total of 33.5% had more than 5 medical applications installed. Only 60.3% of the residents verified the validity of the apps that they used. In all, 82.9% of the residents had a social network account.Most of the residents in radiation oncology use their smartphone to work in their department for a wide variety of tasks. However, the residents do not consistently check the validity of the apps that they use. Residents also use social networks, with only a limited impact on their relationship with their patients. Overall, this study highlights the irruption and the risks of new technologies in the clinical practice and raises the question of a possible regulation of their use in the hospital.

    View details for DOI 10.1016/j.ijrobp.2014.05.012

    View details for PubMedID 24986747

  • [Nationwide implementation of stereotactic radiotherapy: the challenges of initial training and continuing professional education]. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique Bibault, J. E., Denis, F., Marchesi, V., Lisbona, A., Noël, G., Mahé, M. A. 2014; 18 (5-6): 387–90

    Abstract

    Stereotactic body radiation therapy is a rapidly growing advanced treatment technique that delivers high radiation dose with great precision. The implementation of stereotactic body radiation therapy should be associated with a specific initial training and continuing professional education for radiation oncologists and medical physicists. The creation of a French stereotactic body radiation therapy group gathering radiation oncologists (SFRO and AFCOR) and medical physicists (SFPM) is mandatory in order to create dedicated national guidelines, prospective databases and to promote clinical trials in this field.

    View details for DOI 10.1016/j.canrad.2014.06.006

    View details for PubMedID 25179253

  • Personalized radiation therapy and biomarker-driven treatment strategies: a systematic review. Cancer metastasis reviews Bibault, J. E., Fumagalli, I., Ferté, C., Chargari, C., Soria, J. C., Deutsch, E. 2013; 32 (3-4): 479–92

    Abstract

    Radiosensitivity varies to a great extent across tumor types and also between patients bearing the same type of tumor. Radiation oncology pioneered the field of biomarkers with attempts to correlate tumor response to clonogenic survival, tumor potential doubling time (Tpot), and PaO₂. Biomarkers predicting the clinical outcome after radiotherapy are already available, but their levels of evidence are heterogeneous. In light of these molecular factors, the issue of personalized radiation therapy in combination or as a standalone modality is addressed. Known molecular prognostic and predictive biomarkers and their present or potential respective therapeutic implications are described for six tumor types where radiotherapy is considered to be part of the mainstay: chemoradiation (e.g., gliomas, head and neck, cervical cancer), radiotherapy with or without androgen deprivation (e.g., prostate), neo-adjuvant chemoradiation (e.g., rectum), or adjuvant radiotherapy (e.g., breast).

    View details for DOI 10.1007/s10555-013-9419-7

    View details for PubMedID 23595306

  • CT appearance of pulmonary carcinomas after stereotactic radiation therapy. Diagnostic and interventional imaging Bibault, J. E., Ceugnart, L., Prevost, B., Mirabel, X., Lartigau, E. 2013; 94 (3): 255–62

    Abstract

    Stereotactic radiation therapy (SRT) is becoming more and more important in the treatment of inoperable patients with early stages of pulmonary carcinomas (T1-T2 N0M0). In certain cases, evaluation of the response is still problematical and it can be difficult to differentiate response from progression. The aim of this paper is to set out these various changes and to produce a protocol for optimal monitoring. By comparing our clinical experience with data from the literature, the main visual aspects on a CT scan are set out and illustrated for each clinical situation: radiation pneumonitis, radiation fibrosis, therapeutic response and progression. The literature was reviewed by querying the main databases and selecting papers concerning pulmonary SRT and post-therapeutic radiological appearance. CT appearance induced by SRT differs significantly from images after classic conformal radiation therapy, both morphologically and chronologically. In particular, the modifications induced by stereotactic radiation therapy are only seen in a limited volume surrounding the volume treated. Knowledge of the radiological criteria necessary to differentiate between a therapeutic response and recurrence is of major importance in the present context of increase in use of this technique.

    View details for DOI 10.1016/j.diii.2012.06.006

    View details for PubMedID 23276463

  • IGF-1R targeting increases the antitumor effects of DNA-damaging agents in SCLC model: an opportunity to increase the efficacy of standard therapy. Molecular cancer therapeutics Ferté, C., Loriot, Y., Clémenson, C., Commo, F., Gombos, A., Bibault, J. E., Fumagalli, I., Hamama, S., Auger, N., Lahon, B., Chargari, C., Calderaro, J., Soria, J. C., Deutsch, E. 2013; 12 (7): 1213–22

    Abstract

    Insulin-like growth factor receptor-1 (IGF-1R) inhibition could be a relevant therapeutic approach in small cell lung cancer (SCLC) given the importance of an IGF-1R autocrine loop and its role in DNA damage repair processes. We assessed IGF-1R and pAkt protein expression in 83 SCLC human specimens. The efficacy of R1507 (a monoclonal antibody directed against IGF-1R) alone or combined with cisplatin or ionizing radiation (IR) was evaluated in H69, H146, and H526 cells in vitro and in vivo. Innovative genomic and functional approaches were conducted to analyze the molecular behavior under the different treatment conditions. A total of 53% and 37% of human specimens expressed IGF-1R and pAkt, respectively. R1507 showed single-agent activity in H146 and H526 cells but not in H69 cells. R1507 exhibited synergistic effects with both cisplatin and IR in vitro. The triple combination R1507-cisplatin-IR led to a dramatic delay in tumor growth compared with cisplatin-IR in H526 cells. Analyzing the apparent absence of antitumoral effect of R1507 alone in vivo, we observed a transient reduction of IGF-1R staining intensity in vivo, concomitant to the activation of multiple cell surface receptors and intracellular proteins involved in proliferation, angiogenesis, and survival. Finally, we identified that the nucleotide excision repair pathway was mediated after exposure to R1507-CDDP and R1507-IR in vitro and in vivo. In conclusion, adding R1507 to the current standard cisplatin-IR doublet reveals remarkable chemo- and radiosensitizing effects in selected SCLC models and warrants to be investigated in the clinical setting.

    View details for DOI 10.1158/1535-7163.MCT-12-1067

    View details for PubMedID 23640142

    View details for PubMedCentralID PMC3707930

  • Delegation of medical tasks in French radiation oncology departments: current situation and impact on residents' training. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique Thureau, S., Challand, T., Bibault, J. E., Biau, J., Cervellera, M., Diaz, O., Faivre, J. C., Fumagalli, I., Leroy, T., Lescut, N., Martin, V., Pichon, B., Riou, O., Dubray, B., Giraud, P., Hennequin, C. 2013; 17 (5-6): 370–77

    Abstract

    A national survey was conducted among the radiation oncology residents about their clinical activities and responsibilities. The aim was to evaluate the clinical workload and to assess how medical tasks are delegated and supervised.A first questionnaire was administered to radiation oncology residents during a national course. A second questionnaire was mailed to 59 heads of departments.The response rate was 62% for radiation oncology residents (99 questionnaires) and 51% for heads of department (30). Eighteen heads of department (64%) declared having written specifications describing the residents' clinical tasks and roles, while only 31 radiation oncology residents (34%) knew about such a document (P=0.009). A majority of residents were satisfied with the amount of medical tasks that were delegated to them. Older residents complained about insufficient exposure to new patient's consultation, treatment planning and portal images validation. The variations observed between departments may induce heterogeneous trainings and should be addressed specifically.National specifications are necessary to reduce heterogeneities in training, and to insure that the residents' training covers all the professional skills required to practice radiation oncology. A frame endorsed by academic and professional societies would also clarify the responsibilities of both residents and seniors.

    View details for DOI 10.1016/j.canrad.2013.07.144

    View details for PubMedID 24011599

  • [White paper on radiation oncology in France. Twelve proposals to improve a major cancer treatment. Société française de radiothérapie oncologique]. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique Chauvet, B., Mahé, M. A., Maingon, P., Mazeron, J. J., Mornex, F., Chauvet, B., Mahé, M. A., Maingon, P., Mazeron, J. J., Mornex, F., Azria, D., Barillot, I., Chauvet, B., Denis, F., Lartigau, É., Lipinski, F., Maingon, P., Mornex, F., Ardiet, J. M., Bibault, J. E., Caudrelier, V., Diaz, O., de Crevoisier, R., Dubray, B., Estivalet, S., Faivre, J. C., Fenoglietto, P., Fumagalli, I., Ferlay, J., Giraud, P., Hennequin, C., Henoch, H., Khodri, M., Llacer, C., Lagrange, J. L., Lorchel, F., Mahé, M. A., Meyrieux, C., de Martel, C., Noël, G., Oozeer, R., Peiffert, D., Pointreau, Y., Pourel, N., Pradier, O., Rocher, F., Thureau, S., Eschwège, F., Martin, P., Parmentier, G. 2013; 17 Suppl 1: S2–72

    View details for DOI 10.1016/j.canrad.2013.04.002

    View details for PubMedID 23916854

  • A single-institution study of stereotactic body radiotherapy for patients with unresectable visceral pulmonary or hepatic oligometastases. Radiation oncology (London, England) Fumagalli, I., Bibault, J. E., Dewas, S., Kramar, A., Mirabel, X., Prevost, B., Lacornerie, T., Jerraya, H., Lartigau, E. 2012; 7: 164

    Abstract

    The purpose of this study is to evaluate the feasibility, efficacy and toxicity of SBRT for treatment of unresectable hepatic or lung metastases regardless of their primary tumor site for patients who received prior systemic chemotherapy.Between July 2007 and June 2010, 90 patients were treated with the CyberKnife® SBRT system for hepatic or pulmonary metastatic lesions. Medical records were retrospectively reviewed. The endpoints of this study were local control, overall survival (OS), disease-free survival (DFS), local relapse free-survival (LRFS), and treatment toxicity.A total of 113 liver and 26 lung metastatic lesions in 52 men (58%) and 38 women (42%) were treated. Median follow-up was 17 months. Median age at treatment was 65 years (range, 23-84 years). Primary cancers were 63 GI, three lung, eight breast, four melanoma, three neuro-endocrine tumors, and three sarcomas. Median diameter of the lesions was 28 mm (range, 7-110 mm) for liver and 12.5 mm (range, 5-63.5 mm) for lung. Local control rates at 1 and 2 years were 84.5% and 66.1%, respectively. Two-year overall survival rate was 70% (95% CI: 55-81%). The 1 and 2-year disease-free survival rates were 27% (95% CI: 18-37%) and 10% (95% CI: 4-20%), respectively. Median duration of disease-free survival was 6.7 months (95% CI: 5.1-9.5 months). Observed toxicities included grade 1-3 acute toxicities. One grade 3 and no grade 4 toxicity were reported.High-dose SBRT for metastatic lesions is both feasible and effective with high local control rates. Overall survival is comparable with other available techniques. Treatment is well tolerated with low toxicity rates. It could represent an interesting treatment option for oligometastatic patients not amenable to surgery, even when patients had been pre-treated with chemotherapy.Stereotactic body radiotherapy (SBRT) has previously been successfully used in the treatment of metastatic lesions. It could be considered as a curative option for oligometastatic patients. This retrospective study involved 90 patients, designed to test potential effectiveness of SBRT in the treatment of oligometastases irrespective of primary. Results suggest SBRT could be an effective treatment extending patients' life span. This treatment appears to be more effective when used prior to multiple systemic treatment regimens.

    View details for DOI 10.1186/1748-717X-7-164

    View details for PubMedID 23014094

    View details for PubMedCentralID PMC3494573

  • Image-guided robotic stereotactic radiation therapy with fiducial-free tumor tracking for lung cancer. Radiation oncology (London, England) Bibault, J. E., Prevost, B., Dansin, E., Mirabel, X., Lacornerie, T., Lartigau, E. 2012; 7: 102

    Abstract

    Stereotactic body radiation therapy (SBRT) for early-stage lung cancer can be achieved with several methods: respiratory gating, body frame, or real-time target and motion tracking. Two target tracking methods are currently available with the CyberKnife® System: the first one, fiducial tracking, requires the use of radio-opaque markers implanted near or inside the tumor, while the other, Xsight® Lung Tracking System, (XLTS) is fiducial-free. With XLTS, targeting is synchronized directly with target motion, which occurs due to respiration. While the former method (fiducial tracking) is well documented, the clinical relevance of the latter (tracking without fiducials) has never been well described to this date.A study was performed at our department for each patient treated for lung cancer with CyberKnife using XLTS. Selection criteria were: primary or recurring T1 or T2 stage non-small-cell lung cancer (NSCLC) with 15-60 mm tumor size. Initial staging included CT-Scan and FDG-PET.Fifty-one patients not amenable to surgery were treated with XLTS. Median follow-up was 15 months (range, 5-30 months). Median tumor size was 24 mm (range, 15-60 mm). Median total dose was 60 Gy (36-60 Gy) in three fractions. Actuarial overall survival was 85.5% (95% CI = 74.5-96%) at 1 year and 79.4% (95% CI = 64-94.8%) at 2 years. Actuarial local control rate was 92% (95% CI = 84-99%) at one 1 year and 86% (95% CI = 75-97%) at 2 years.Local control and overall survival rates were similar to previous reports that used fiducials for tumor tracking. Toxicity was lower than most studies since tumor tracking did not require fiducial implantion. This fiducial-free method for respiratory motion tracking is a valid option for the most fragile patients.

    View details for DOI 10.1186/1748-717X-7-102

    View details for PubMedID 22726884

    View details for PubMedCentralID PMC3432006

  • The French Society of Young Radiation Oncologists: History, goals and perspective. Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology Bibault, J. E., Fumagalli, I., Diaz, O., Faivre, J. C., Leroy, T., Pichon, B., Riou, O., Thureau, S., Rivera, S. 2012; 17 (5): 255–58

    Abstract

    The SFjRO was created ten years ago to promote radiation oncology teaching in France. Our society has now more than 120 members from all around the country. Each year, two national courses are organized where all members are invited.

    View details for DOI 10.1016/j.rpor.2012.07.006

    View details for PubMedID 24669304

    View details for PubMedCentralID PMC3885888

  • Prognostic factors affecting local control of hepatic tumors treated by Stereotactic Body Radiation Therapy. Radiation oncology (London, England) Dewas, S., Bibault, J. E., Mirabel, X., Fumagalli, I., Kramar, A., Jarraya, H., Lacornerie, T., Dewas-Vautravers, C., Lartigau, E. 2012; 7: 166

    Abstract

    Robotic Stereotactic Body Radiation Therapy with real-time tumor tracking has shown encouraging results for hepatic tumors with good efficacy and low toxicity. We studied the factors associated with local control of primary or secondary hepatic lesions post-SBRT.Since 2007, 153 stereotactic liver treatments were administered to 120 patients using the CyberKnife® System. Ninety-nine liver metastases (72 patients), 48 hepatocellular carcinomas (42 patients), and six cholangiocarcinomas were treated. On average, three to four sessions were delivered over 12 days. Twenty-seven to 45 Gy was prescribed to the 80% isodose line. Margins consisted of 5 to 10 mm for clinical target volume (CTV) and 3 mm for planning target volume (PTV).Median size was 33 mm (range, 5-112 mm). Median gross tumor volume (GTV) was 32.38 cm3 (range, 0.2-499.5 cm3). Median total dose was 45 Gy in three fractions. Median minimum dose was 27 Gy in three fractions. With a median follow-up of 15.0 months, local control rates at one and two years were 84% and 74.6%, respectively. The factors associated with better local control were lesion size < 50 mm (p = 0.019), GTV volume (p < 0.05), PTV volume (p < 0.01) and two treatment factors: a total dose of 45 Gy and a dose-per-fraction of 15 Gy (p = 0.019).Dose, tumor diameter and volume are prognostic factors for local control when a stereotactic radiation therapy for hepatic lesions is considered. These results should be considered in order to obtain a maximum therapeutic efficacy.

    View details for DOI 10.1186/1748-717X-7-166

    View details for PubMedID 23050794

    View details for PubMedCentralID PMC3494572

  • Acute myocarditis induced by hypomethylating agents. Journal of clinical oncology : official journal of the American Society of Clinical Oncology Bibault, J. E., Cambier, N., Lemahieu, J. M., Quesnel, B., Auffret, M., Rose, C. 2011; 29 (14): e411–2

    View details for DOI 10.1200/JCO.2010.33.4656

    View details for PubMedID 21357777

  • Adjuvant radiation therapy in metastatic lymph nodes from melanoma. Radiation oncology (London, England) Bibault, J. E., Dewas, S., Mirabel, X., Mortier, L., Penel, N., Vanseymortier, L., Lartigau, E. 2011; 6: 12

    Abstract

    To analyze the outcome after adjuvant radiation therapy with standard fractionation regimen in metastatic lymph nodes (LN) from cutaneous melanoma.86 successive patients (57 men) were treated for locally advanced melanoma in our institution. 60 patients (69%) underwent LN dissection followed by radiation therapy (RT), while 26 patients (31%) had no radiotherapy.The median number of resected LN was 12 (1 to 36) with 2 metastases (1 to 28). Median survival after the first relapse was 31.8 months. Extracapsular extension was a significant prognostic factor for regional control (p = 0.019). Median total dose was 50 Gy (30 to 70 Gy). A standard fractionation regimen was used (2 Gy/fraction). Median number of fractions was 25 (10 to 44 fractions). Patients were treated with five fractions/week. Patients with extracapsular extension treated with surgery followed by RT (total dose ≥50 Gy) had a better regional control than patients treated by surgery followed by RT with a total dose <50 Gy (80% vs. 35% at 5-year follow-up; p = 0.004).Adjuvant radiotherapy was able to increase regional control in targeted sub-population (LN with extracapsular extension).

    View details for DOI 10.1186/1748-717X-6-12

    View details for PubMedID 21294913

    View details for PubMedCentralID PMC3041681

  • Robotic image-guided reirradiation of lateral pelvic recurrences: preliminary results. Radiation oncology (London, England) Dewas, S., Bibault, J. E., Mirabel, X., Nickers, P., Castelain, B., Lacornerie, T., Jarraya, H., Lartigau, E. 2011; 6: 77

    Abstract

    The first-line treatment of a pelvic recurrence in a previously irradiated area is surgery. Unfortunately, few patients are deemed operable, often due to the location of the recurrence, usually too close to the iliac vessels, or the associated surgical morbidity. The objective of this study is to test the viability of robotic image-guided radiotherapy as an alternative treatment in inoperable cases.Sixteen patients previously treated with radiotherapy were reirradiated with CyberKnife® for lateral pelvic lesions. Recurrences of primary rectal cancer (4 patients), anal canal (6), uterine cervix cancer (4), endometrial cancer (1), and bladder carcinoma (1) were treated. The median dose of the previous treatment was 45 Gy (EqD2 range: 20 to 96 Gy). A total dose of 36 Gy in six fractions was delivered with the CyberKnife over three weeks. The responses were evaluated according to RECIST criteria.Median follow-up was 10.6 months (1.9 to 20.5 months). The actuarial local control rate was 51.4% at one year. Median disease-free survival was 8.3 months after CyberKnife treatment. The actuarial one-year survival rate was 46%. Acute tolerance was limited to digestive grade 1 and 2 toxicities.Robotic stereotactic radiotherapy can offer a short and well-tolerated treatment for lateral pelvic recurrences in previously irradiated areas in patients otherwise not treatable. Efficacy and toxicity need to be evaluated over the long term, but initial results are encouraging.

    View details for DOI 10.1186/1748-717X-6-77

    View details for PubMedID 21699690

    View details for PubMedCentralID PMC3141526

  • eLQ : A biologically-equivalent dose calculator available on iPhone, Android, and the web. Practical radiation oncology Bibault, J. E., Blanchard, P., Dubray, B., Lartigau, E. 2011; 1 (3): 212–13

    View details for DOI 10.1016/j.prro.2011.04.001

    View details for PubMedID 24673953

  • Delineation in thoracic oncology: a prospective study of the effect of training on contour variability and dosimetric consequences. Radiation oncology (London, England) Dewas, S., Bibault, J. E., Blanchard, P., Vautravers-Dewas, C., Pointreau, Y., Denis, F., Brauner, M., Giraud, P. 2011; 6: 118

    Abstract

    As part of French residents' radiotherapy training, delineation workstations were available at a national teaching course. We report a prospective comparative study of a non small cell lung cancer (NSCLC) case delineated by 120 residents before and after a radioanatomy/radiotherapy lecture.The case of a patient with right upper lobe non small cell lung cancer (NSCLC) was provided for delineation to 32 groups of residents before and after a radiation therapy lecture about thoracic delineation. GTV, CTV and PTV was asked to each group. In a second step, the GTV, CTV and PTV were compared with those of 9 groups of senior physicians. Finally the consequences for treatment planning between each group before and after the course were explored.The expert's average GTV, CTV and PTV were 89.1 cm3, 242.3 cm3 and 293.9 cm3 respectively. For residents, those volumes were 103.4 cm3, 242.3 cm3 and 457.9 cm3 before teaching, compared to 99.5 cm3, 224.2 cm3 and 412.5 cm3 after teaching. The overlap (OV) and kappa (KI) indices before and after education were respectively 0.58 and 0.73. Compared to senior physicians, OV and KI indices were lower in the residents group (p = 0.039 and p = 0.043). An increased dose to the lung is noted for the residents' dosimetry compared to the experts' (V20: 23.2% versus 36.5%) due to the larger PTV delineated. No significant difference was observed for other organs at risk.There were no significant differences for the delineation of the GTV and CTV before and after the course, although the differences tended to decrease after the course. The good initial quality of the contours could explain the lack of difference. V20 for lung was higher in the residents group compared to the experts group (23.2% vs 36.5%). No other treatment planning consequences were observed for other critical organs.

    View details for DOI 10.1186/1748-717X-6-118

    View details for PubMedID 21929770

    View details for PubMedCentralID PMC3195101

  • [Stereotactic radiotherapy for lung cancer: Non-invasive real-time tumor tracking]. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique Bibault, J. E., Prevost, B., Dansin, E., Mirabel, X., Lacornerie, T., Dubus, F., Lartigau, E. 2010; 14 (8): 690–97

    Abstract

    Stereotactic radiation therapy using the CyberKnife(®) has been introduced in France in 2006. Two treatment modalities are currently available: the first one (Synchrony(®)) is a real-time fiducial-based target tracking system, while the other (Xsight Lung Tracking [XLT] System(®)) is completely fiducial-free.Sixty-eight patients were treated for a pulmonary tumor between June 2007 and November 2009. Since august 2008, the XLT System(®) was used for 26 patients. We report the necessary conditions for the XLT System (position, laterality and size of the tumor), the toxicity and outcome of this treatment.Twenty-two patients were analyzed. Median follow-up was 6 months (min=3; max=16). Local control rate was 100%. The main toxicity was grade grade 1 pulmonary alveolitis (27%). No grade 3 or 4 toxicities were reported.The high local control rate and low toxicity obtained with the CyberKnife(®) XLT System(®) suggest that such treatment is an alternative for inoperable patients.

    View details for DOI 10.1016/j.canrad.2010.03.010

    View details for PubMedID 20674448

  • [Radiotherapy of gliomas]. Soins; la revue de reference infirmiere Bibault, J. E., Comet, B. 2009: 37

    View details for PubMedID 19366000