Articles

Locally advanced rectal cancer: What is the best perioperative strategy?

BJMO - volume 14, issue 6, october 2020

I. Joye MD, S. Vanderkam MD, N. Meireson , R. Weytjens MD

SUMMARY

The treatment for locally advanced rectal cancer involves a multidisciplinary approach in which total mesorectal excision usually is preceeded by (chemo)radiotherapy. Depending on risk factors, adjuvant chemotherapy is frequently applied. Preoperative short course radiotherapy and chemoradiotherapy result in high local control rates. However, the high risk on systemic relapse and the appealing concept of organ preservation urge researchers to explore alternative perioperative strategies. This review provides an overview of the established role of preoperative short course radiotherapy and chemoradiotherapy, as well as the evidence so far for short course radiotherapy with delayed surgery, induction chemotherapy and for neoadjuvant chemotherapy without radiotherapy.

(BELG J MED ONCOL 2020;14(6):254-62)

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Partial breast irradiation of early-stage breast cancer

BJMO - volume 14, issue 4, june 2020

M. Machiels MD, PhD, D. Nevens MD, PhD, K. Erven MD, PhD, G. Buelens MD, C. Billiet MD, PhD, Y. Geussens MD, P. Janssens MD, S. Vanderkam MD, R. Weytjens MD

SUMMARY

Whole-breast irradiation, as part of breast-conservation therapy (BCT), has been well-established the last decades. Nonetheless, most local recurrences found after BCT are within or close to the tumour bed. This led to the concept of partial breast irradiation (PBI), delivering the radiation dose to a decreased target volume, thereby lowering exposure to the organs at risk and hence potentially minimizing late adverse effects. This became increasingly important with growing survivorship of patients with early-stage breast cancer over the past decades and the consideration of late adverse effects is gaining more importance. In this review, we will present an overview of the current literature, techniques to deliver PBI and we try to establish whether there is a place for PBI in early-stage breast cancer treatment.

(BELG J MED ONCOL 2020;14(4):140–45)

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Highlights in gastrointestinal oncology

BJMO - volume 10, issue 8, december 2016

Rasschaert M , Papadimitriou K , J. Van den Brande MD, R. Weytjens MD, Peeters M

Summary

From October 7th till October 11th, Copenhagen formed the background for the 2016 annual meeting of the European Society for Medical Oncology (ESMO). This report will focus on some of the key studies presented during the meeting, referring to gastrointestinal cancer.

(BELG J MED ONCOL 2016;10(8):290–94)

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Radiation pneumonitis: occurrence, prediction, prevention and treatment

BJMO - volume 7, issue 4, september 2013

R. Weytjens MD, K. Erven MD, PhD, D. De Ruysscher MD, PhD

Summary

Radiation pneumonitis is the most important dose-limiting toxicity in the treatment of thoracic malignancies amendable for high-dose radiotherapy such as lung or oesophageal cancer.
Several patient-specific factors (e.g. age, smoking history, pre-existing inflammatory lung disease, tumour location and performance score) as well as treatment-related factors (e.g. radiation dose and volume, chemotherapy, hormonal therapy) have been studied as potential predictors of the risk of radiation pneumonitis. The most robust parameters that correlate with radiation pneumonitis are Dose Volume Histogram-related, such as the mean lung dose, the percentage of a volume receiving a certain dose such as the V20 and more complex models. All of these show a low overall accuracy with an area under the receiver-operator curve of about 0.65, although they might be still clinically useful by virtue of their high negative predictive value.
Besides research in the underlying genetics of radiation pneumonitis, the interaction between radiotherapy and most targeted agents has not been elucidated.
At present, validated Dose Volume Histogram parameters can be used in clinical practice. Drugs administered concurrently with irradiation of the lungs should only be carried out in combinations with proven safety in prospective trials.

(BELG J MED ONCOL 2013;7(4):105–10)

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