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.
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).



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.



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.



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.
AP-HP, Department of Radiation Oncology, University of Paris-Est, Créteil, France; AP-HP, Henri Mondor Breast Center, University of Paris-Est, Créteil, France; INSERM U955 Eq 07, University of Paris-Est, Créteil, France. Electronic address: yazid.belkacemi@aphp.fr.
Yazid
Y
Belkacemi
AP-HP, Department of Radiation Oncology, University of Paris-Est, Créteil, France; AP-HP, Henri Mondor Breast Center, University of Paris-Est, Créteil, France.
Laurianne
L
Colson-Durand
INSERM, UMR1052, Radiobiology Group, Cancer Research Centre of Lyon, Lyon, France.
Adeline
A
Granzotto
AP-HP, Department of Radiation Oncology, University of Paris-Est, Créteil, France.
Shan
S
Husheng
AP-HP, Department of Radiation Oncology, University of Paris-Est, Créteil, France.
Nhu Hanh
NH
To
AP-HP, Department of Radiation Oncology, University of Paris-Est, Créteil, France.
Soufya
S
Majdoul
AP-HP, Department of Radiation Oncology, University of Paris-Est, Créteil, France.
Saada
S
Guet
AP-HP, Department of Radiation Oncology, University of Paris-Est, Créteil, France.
Marie-Laure
ML
Hervé
AP-HP, Department of Radiation Oncology, University of Paris-Est, Créteil, France.
Gloria
G
Fonteneau
AP-HP, Department of Radiation Oncology, University of Paris-Est, Créteil, France.
Christian
C
Diana
AP-HP, Department of Radiation Oncology, University of Paris-Est, Créteil, France.
Cindy
C
Le Bret
AP-HP, Department of Radiation Oncology, University of Paris-Est, Créteil, France.
Claude
C
Dominique
AP-HP, Department of Radiation Oncology, University of Paris-Est, Créteil, France; AP-HP, Henri Mondor Breast Center, University of Paris-Est, Créteil, France.
Maryse
M
Fayolle
INSERM, UMR1052, Radiobiology Group, Cancer Research Centre of Lyon, Lyon, France.
Nicolas
N
Foray
D054508:Acute Radiation Syndrome / Q000401:mortality*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011834:Radiation Monitoring / Q000706:statistics & numerical data*; D011836:Radiation Tolerance; D011878:Radiotherapy / Q000401:mortality* / Q000706:statistics & numerical data; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis