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)
Read moreBJMO - 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)
Read moreBJMO - volume 6, issue 3, june 2012
G. Miedema , M. De Ridder MD, PhD
Bone metastases are common in many cancers. They can cause a wide range of symptoms impairing quality of life and shortening survival. Direct complications of bone involvement include severe pain, pathologic fractures, hypercalcaemia and spinal cord compression. Evaluation is critical to assess location and extent of bone metastases. This includes clinical and neurological examination. Possible imaging studies are: radiographs, skeletal scintigraphy, CT, MRI and 18-FDG-PET. The management of bone metastases is multidisciplinary. Bisphosphonates are commonly the most frequently used osteoclast inhibitors and should always form part of treatment. Radiotherapy is most efficient for pain relief. (BELG J MED ONCOL 2012;6:80–86)
Read moreBJMO - volume 6, issue 3, june 2012
A. Smeets MD, PhD, B. Carly MD, V. Cocquyt , M. Vanhoeij , C. Bourgain MD, PhD, E. Lifrange , G Villeirs MD, PhD, M. De Ridder MD, PhD, M. Drijkoningen , J. Lamote , R. Van Den Broecke , M. Voordeckers , J. De Grève MD, PhD, P. Neven MD, PhD, M.R. Christiaens
The aim of this article is to highlight the recent changes in the surgical approach of the axilla in breast cancer patients. Axillary staging is dominated by the sentinel lymph node (SLN) biopsy, which is now widely practiced in clinically node negative patients. Most authors believe a SLN biopsy may even be performed in patients with a large or multifocal tumour, before neo-adjuvant systemic therapy, during pregnancy, after prior excisional biopsy and after prior mantle field radiotherapy of the breast. Intra-operative assessment of the SLN is recommended as it can identify half of all positive lymph nodes. It is generally accepted that it is safe to omit an axillary lymph node dissection (ALND) in patients with a negative SLN or with only isolated tumour cells (<0.2 mm) in the SLN. Moreover, in a subset of patients with a micro-/macrometastasis in the SLN it might not be necessary to perform a completion of ALND. We suggest to accept the option of omitting completion of ALND in frail patients with a positive sentinel lymph node on final pathology OR in these patients with, on final pathology, one or two positive SLNs AND a grade I or II tumour smaller than 4 cm AND adjuvant radiotherapy on the whole breast or chest wall. In conclusion, an increasingly tailored surgical approach is guiding the management of the axilla for women with early breast cancer. (BELG J MED ONCOL 2012;6:87–95)
Read moreBJMO - 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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