Professor Sylvie Négrier discusses the clinical activities and innovations in the field of radiotherapy at the Centre Léon Bérard in Lyon, France
Sylvie Négrier MD PhD
Medical Oncology Department,
Centre Léon Bérard, Lyon, France
The Centre Léon Bérard (CLB) is the Lyon and Rhône-Alpes Regional Cancer Centre. Specialised in oncology, the CLB offers diagnostic tests and cancer treatments on the same site. Currently there are 1500 people working at the CLB and more than 26,000 different patient visits at the centre each year.
As a non-profit private healthcare facility, it is affiliated with the French Federation of Regional Cancer Centers, which comprises 18 centres: the FFCLCC UNICANCER Group.
Its status as a regional cancer centre confers the CLB a regional vocation that covers the eight departments of the Rhône-Alpes administrative region. Its influence goes far beyond because it also treats patients from other French departments, and even from overseas.
The regional health organisation plan (schéma régional d’organisation sanitaire) recognises the CLB as a regional oncology referral centre and the CLB was certified by the French National Authority for Health in April 2011.
Multidimensional and multidisciplinary innovation
CLB offers its patients cost-effective care, the earliest treatment in the course of their care, and access to multidimensional innovation at all stages of care, while taking into account the patients’ health status, social aspects, and their needs in terms of prevention.
Multidisciplinarity is the major characteristic of the Regional Cancer Centers. It is a collegial medical approach for the benefit of the patient. Experts from different disciplines (pathologists, medical imaging, radiotherapy, oncology) work together to establish the diagnosis and treatment course for a patient. However, one clinician is responsible for the treatment of any one given patient.
In Rhône-Alpes, cancer remains the leading cause of death in men and in women before the age of 65. Cancer accounts for 28,000 new cases per year (including 200 children) and, unfortunately, 12,500 deaths each year.
At the CLB, there are 32,000 annual visits (including 4500 paediatric) on average, including 47,000 radiotherapy sessions, in excess of 35,000 surgical stays and 25,285 stays for chemotherapy.
A strategic project
Approved by the Regional Rhône-Alpes Hospitalization Agency, the institutional project 2009–2014, which contains the CLB strategy for the next five years, corresponds to the broad outlines of the Cancer Plan II, announced on 2 November, 2009 by the President of the Republic. Integral to the institutional project are:
- the consultation and monitoring of the patient throughout the disease, in relationship with different hospital departments and healthcare personnel
- the innovation offered at all stages of the disease
- the coordination of care between the health professionals at the hospital
- different types of cancer and the special considerations for certain patient groups (for example, children and the elderly)
- the development of care through direct contact between researchers and clinicians.
One of the main achievements of this institutional project is the opening of a centre dedicated to outpatient care, which represents the treatment of the future
The mission of the CLB
Constantly promoting quality, innovation and research is in the CLB’s DNA. The centre is dedicated to cancer patients and oncology, patient care, research and teaching. The performance target is important: excellence both in quality of care and excellence in research, with the desire to have beneficial outcomes for patients. We want to ensure comprehensive care of the patient.
Activities of the CLB
The activities of the Centre are diverse: from diagnosis to prevention, including genetic risks, and all types of surgical, medical, or interventional radiology treatment, and, of course, radiotherapy. The radiotherapy department treats 2700 patients each year with external therapy.
The CLB is a regional centre that provides integrated treatment, relying also on specific services such as the supportive care department and the coordination of the home care department. Also, a radiotherapy branch has been opened at the Hôpital de Villefranche-sur-Saône to meet the needs of the population of this area, who had no access to radiotherapy.
Strategic developmental axes
Firstly, the primary mission is to meet growing needs, due to a permanent increase in the incidence of cancers. In the context of innovative projects, the centre has invested in dedicated systems, such as CyberKnife® and TomoTherapy®. At the CLB, there is a global vision of treatment and a strong culture of quality in terms of treatment.
From 2009 to the present day
Since I became Director, the Centre has grown significantly, with the opening of a new clinic building dedicated to outpatient care in January 2013. This offers patients optimal treatment, while improving their quality of life. Investment in the new technologies fits into this thinking.
Besides radiotherapy, CLB innovates at all stages in the disease, from diagnosis to treatment. We have an operating suite of 11 fully integrated rooms, inaugurated in 2013, offering a range of minimally invasive and ambulatory surgery services. We also possess a suite entirely dedicated to interventional radiology. Thanks to our French national cancer institute-approved early phase trials centre, we can propose innovative molecules to patients as rapidly as possible. Moreover, our establishment’s clinical research has been ISO 9001 certified since September 2013. Finally, we also provide innovative care because since 2010, patients arrive standing at the operating suite, that is, they travel there on foot, rather than being pre-medicated and taken in a bed. At CLB, innovation is a key component of our strategic project, a value shared by all our teams. Since I have been the director of the Léon Bérard Center, the number of patients enrolled in clinical trials has thus risen from 830 in 2008 to nearly 2000 in 2013, thanks to the Profiler trial.
Benefits from the investment in new technologies
The CLB has seven accelerators, including CyberKnife® and TomoTherapy® systems. The acquisition of these two systems allows us to not only treat some patients much faster, but to also use some types of radiation that are not feasible with conventional equipment.
Impact on treatment cost
Today, in spite of the maintenance costs of the equipment, the fees are attractive, and the centre will have a return on the initial investment in a few years. With the CyberKnife®, for example, transport costs will decrease because of the fewer number of sessions required compared with conventional methods.
This equipment has also allowed us to expand our recruitment area to the Rhône-Alpes region and beyond and to expand
The radiotherapy department
Directed by Dr Christian Carrie, Member of the Scientific Council of the International Society of Radiotherapy and Pediatric Radiotherapy, and President of the Pediatric Radiation Oncology Society, the department is one of the largest for radiotherapy, paediatric radiotherapy and brachytherapy in France.
It publishes two to three articles in international peer-reviewed journals per year. Having an area of over 1200m², each year the department conducts:
- 2350 external radiotherapy treatments
- 250 sessions under general anaesthesia for children under three years of age
- 2000 sessions for children ages 3–15 years
- 100 stereotactic procedures
- 400 brachytherapies.
The department houses seven accelerators, including the CyberKnife®, VSI System, a next-generation accelerator in the radiotherapy centre at Beaujolais and on the site of the Hôpital Nord-Ouest de Villefranche-sur-Saône, TomoTherapy®, INTRABEAM, two surgical units for brachytherapy, one dedicated scanner and a 20-bed hospital with ten sealed rooms.
It accommodates approximately 250 patients each day, Monday to Friday, from 7.30am to 8pm, and sometimes opens on Saturday from 7.30am to 1pm. Staff include:
- Ten doctors
- Four interns
- Ten physicists and five assistant physicists
- 37 technicians, including six dosimetrists
- Nine medical assistants
- One quality expert, full time
- One research team, comprising 25 researchers.
Outpatient treatment is progressing in France, but progress is still too slow in public hospitals.
The impact of radiotherapy in outpatient treatment
Hypofractionation will limit daily patient commutes compared with the longer durations, and thus improve the quality of life of these patients. CyberKnife® and TomoTherapy® represent an alternative choice in the treatment of outpatient cancers, namely by improving quality of life through a reduced number of sessions, maintaining the ability to work for most patients, and a quicker return to normal life..The challenge for radiotherapy is to enable patients to benefit from more targeted treatments with more efficient doses delivered to the diseased area, and also safer treatment, because it is also more sparing of the non-diseased areas.
Benefits of hypofractionation
Radiotherapy will shortly be a real alternative to the physical methods used today in interventional radiology. It is estimated that 50% of lung cancers, >45% of breast cancers and 35% of prostate cancers should benefit from hypofractionation by 2020.
The future for radiotherapy
Radiotherapy is really changing (techniques, protocols). By 2020, it will increasingly progress towards hypofractionation and fewer sessions. In this context, high-precision techniques are establishing themselves as an alternative to consider in the treatment of cancers.
Mission of the CLB
- Re-integration of patients
- Screening and prevention
- Teaching and training in oncology
A brief history of the CLB
In November 1923, Professor Léon Bérard, one of the pioneers of thoracic surgery and cancer treatment in France, inaugurated, under the great dome of the Hotel-Dieu de Lyon, the second French cancer centre, which had 60 beds.
With this Lyon association for cancer treatment, the centre benefited from one of the first large allocations of radium, a powerful weapon for treating cervical cancer and cancers of the oral mucosa. Many patients came, and the centre at the Hôtel-Dieu quickly became too small.
In 1935, a new centre was housed in one of the wings of the Edouard Herriot Hospital in Lyon. It had high-capacity radiotherapy devices and a modern surgical department. When Professor Bérard retired in 1940, the new centre was already saturated. A new project for a centre able to accommodate 300 patients was then initiated by Professor Paul Santy. The construction of the new centre began in 1950, and was inaugurated on its current site in 1958, where it remains.