The Henri Mondor Procedure of Morbidity and Mortality Review Meetings: Prospective Registration of Clinical, Dosimetric, and Individual Radiosensitivity Data of Patients With Severe Radiation Toxicity

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• 作者：Yazid Belkacemi ; MD ; PhD^&lowast ; ; ^&dagger ; ; ^# ; ^{yazid.belkacemi@aphp.fr" class="auth_mail" title="E-mail the corresponding author} ; Laurianne Colson-Durand ; MD^&lowast ; ; ^&dagger ; ; Adeline Granzotto ; PhD^&Dagger ; ; Shan Husheng ; MD^&lowast ; ; Nhu Hanh To ; MD^&lowast ; ; Soufya Majdoul ; MD^&lowast ; ; Saada Guet ; MD^&lowast ; ; Marie-Laure Hervé ; PhD^&lowast ; ; Gloria Fonteneau^&lowast ; ; Christian Diana ; MD^&lowast ; ; Cindy Le Bret ; PhD^&lowast ; ; Claude Dominique ; PhD^&lowast ; ; Maryse Fayolle ; MD^&lowast ; ; ^&dagger ; ; Nicolas Foray ; PhD^&Dagger ;
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2016
• 出版时间：1 November 2016
• 年：2016
• 卷：96
• 期：3
• 页码：629-636
• 全文大小：740 K

文摘

After radiation therapy (RT), various radiation-induced toxicities can develop in about one-fourth of patients. An international interest in using morbidity and mortality rates to monitor the quality of care and integrate morbidity and mortality review (MMR) meetings into organizations' governance processes has arisen. We report the first results of patients included in our MMR procedure that included biological assays for individual intrinsic radiosensitivity (IIRS).

Methods and Materials

Twenty-three patients were prospectively included in the MMR database. Twenty-two were evaluable for IIRS. Prostate (n=10) and breast (n=8) cancers were the most frequent disease types. The total dose delivered, determined according to the type of disease, ranged from 30 to 74 Gy. Our MMR procedure requires strict criteria: patients with unresolved toxicity of grade 3 or higher with availability of clinical (photographic) data, IIRS results obtained from skin biopsy assays, treatment modalities, and follow-up data. The RT technique and dosimetry were reviewed.

Results

Our prospective registration of toxicities showed mainly rectitis, occurring in 7 cases, and skin toxicities, occurring in 9. Of the 7 patients with rectitis, 5 received 66 Gy of post-prostatectomy RT with V50 (rectum volume receiving 50 Gy) ranging from 45% to 75% and a mean maximal dose of 66.5 Gy. For dermatitis and cystitis, the mean maximal doses were in the range of classical constraints without any overdosage or dose heterogeneity. No errors were found in the review of treatment planning and positioning. Conversely, all the patients were considered biologically as radiosensitive with genomic instability and ATM (ataxia telangiectasia mutated)-dependent DNA double-strand break repair impairments.

Conclusions

The MMR review of files allowed clear answers for patients on the relationship between clinical events and their IIRS. Our procedure has allowed education of all our staff to monitor, identify, and document clinical, physical, and biological aspects of radiation-induced toxicities. Thus we recommend the introduction of the MMR procedure in RT departments.