The Henri Mondor Procedure of Morbidity and Mortality Reviews (MMR) Meetings: Prospective Registration of Clinical, Dosimetric and Individual Radiosensitivity Data of Patients with Severe Radiation Toxicity

Publication date: Available online 22 July 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Yazid Belkacemi, Laurianne Colson-Durand, Adeline Granzotto, Shan Husheng, Nhu Hanh To, Soufya Majdoul, Saada Guet, Marie-Laure Hervé, Gloria Fonteneau, Christian Diana, Cindy Le Bret, Claude Dominique, Maryse Fayolle, Nicolas Foray
PurposeAfter radiotherapy (RT), about one-fourth of the patients can develop various radiation-induced toxicities. An international interest has arisen in using morbidity and mortality rates to monitor the quality of care and integrate the morbidity and mortality review (MMR) meetings into their governance processes. We report the first results of patients included in our MMR procedure that included biologic assay for individual intrinsic radiosensitivity (IIRS).Materials and methodsTwenty-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 more frequent concerned disease. The total dose delivered was according to the disease ranged from 30 Gy to 74 Gy. MMR procedure requires strict criteria: patients with unresolved grade > 3 toxicity with availability of clinical (photography) data, IIRS results obtained from skin biopsies assays, treatment modalities and follow-up data. The RT technique and dosimetry were reviewed.ResultsOur prospective registration of toxicities showed mainly 7 rectitis, 9 skin toxicities. Five out of 7 rectitis received 66 Gy post-prostatectomy RT with a V50 (rectum volume receiving 50Gy) ranged from 45 to 75% and mean maximal dose (Dmax) of 66.5Gy. For dermatitis and cystitis, the mean Dmax were in the range of classical constraints without any overdosage or dose heterogeneity. No errors have been found in the review of treatment planning and positioning. Conversely, all the patients were considered biologically as radiosensitive with genomic instability and ATM-dependent DNA double-strand break (DSB) repair impairments.ConclusionThe MMR review of files, allowed clear answers to patients on the relationship between clinical events and their IIRS. Our procedure has allowed educating all our staff to monitor, identify and document clinical, physical and biological aspects of radiation-induced toxicities. Thus, we recommend introduction of the MMR procedure in RT departments.

Teaser

Radiation-induced toxicity can induce morbidity and impact negatively the patients' quality of life. The morbidity and mortality review (MMR) meetings in radiotherapy departments aim to ensure that there is no controversy about the quality of radiotherapy delivered and to investigate other potential causes, such as the particular radiosensitivity of a patient for a given standard treatment. Our MMR procedure coupled to in skin biopsies tests showed a correlation between patients' radiosensitivity and their toxicity.


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