The emerging role of stereotactic radiotherapy in oligometastatic cancer

BJMO - volume 10, issue 2, april 2016

D. Van Brummelen MD, R. Van den Begin MD, B. Engels MD, PhD, C. Collen MD, T. Gevaert MD, PhD, D. Verellen PhD, G. Storme MD, PhD, M. De Ridder MD, PhD


Most metastatic cancer patients pass through an oligometastatic disease phase. Management of oligometastatic cancer is changing due to the increasing application of local treatments, leading to longer disease control and, in some cases, even cure. This paper discusses stereotactic radiotherapy as a progressively more effective treatment of oligometastatic cancer due to technological developments enabling the specific delivery of higher radiation doses to the tumour itself, more insight in disease-related factors influencing its effectiveness, and its potential of synergy with immunotherapy.

(BELG J MED ONCOL 2016;10(2):58–62)

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Clinical implementation of frameless radiosurgery

BJMO - volume 7, issue 3, july 2013

T. Gevaert MD, PhD, D. Verellen PhD, B. Engels MD, PhD, J. D’Haens MD, PhD, M. De Ridder MD, PhD


Stereotactic radiosurgery is a treatment technique that uses a single high ablative dose of radiation to benign and malignant laesions while sparing healthy brain tissue. Several systems have been developed to perform this technique, and these differed in the way the irradiation was performed. An accurate positioning, immobilisation of the patient and a precise localisation of the laesion are essential. Traditionally, this was performed with a headring screwed onto the patient’s skull (frame-based technique). The positioning is achieved using a localiserbox, mounted on the invasive headring and stereotactic coordinates, obtained through the planning system. With recent developments in radiotherapy, this high precision positioning can nowadays also be performed without the invasive headring. This non-invasive approach, called frameless, improves patient comfort and uses a mask system to immobilise the patient and image-guidance to accurately position the patient on the basis of anatomy. The Novalis system (Brainlab AG) at the UZ Brussel can use both a frame-based and frameless approach. Frameless radiosurgery is carried out with a mask device and two stereoscopic x-ray images. This innovative frameless positioning technique showed equivalent positioning accuracy and immobilisation characteristics to the invasive frame-based technique.

(BELG J MED ONCOL 2013;7(3):93–97)

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Clinical implementation of intensity-modulated and image-guided radiotherapy in colorectal cancer

BJMO - volume 6, issue 2, april 2012

B. Engels MD, PhD, M. De Ridder MD, PhD

The concept of intensity-modulated and image-guided radiotherapy (IMRT-IGRT) with a simultaneous integrated boost (SIB) by the TomoTherapy Hi-Art II System in preoperative RT of rectal cancer was implemented in our department. Two pilot studies demonstrated its ability to minimize the setup margin, which led to a significant decrease in the irradiated volume of small bowel and bladder. Besides, this technique allows the delivery of a SIB in patients at high-risk for local failure, this as an alternative strategy to the concomitant administration of chemotherapy. The synergism of improved dose distributions by IMRT and correction of daily treatment uncertainties by IGRT resulted in a limited acute toxicity profile and promising local control in a phase II study with a total accrual of 108 locally advanced rectal cancer patients. Finally, the implementation of this novel modality appeared to be attractive in inoperable oligometastatic colorectal cancer, by displaying a promising response rate and limited toxicity in a phase II trial. (BELG J MED ONCOL 2012;6:70–72)

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