BJMO - volume 14, issue 6, october 2020
C. Focan MD, PhD, M-P. Graas MD, M. Bourhaba , N. Blétard MD
In this article the authors reviewed literature regarding mucinous ovarian carcinoma (MOC), which represents a special challenge as a rare ovarian tumour (about 3%) with unique clinical characteristics as compared to serous ovarian carcinoma (SOC). MOC is mostly diagnosed at an early stage and is generally associated with an excellent prognosis. However, later stages usually remain resistant to medical treatment, with early deaths occurring. Overall, advanced MOC patients seem 2.3 times more likely to die of their tumour as compared to SOC patients. Anatomo-pathological diagnosis and distinguishing between primary and metastasised MOC remains difficult and sometimes inconclusive, despite the contribution of immunohistochemistry (IHC) and/or molecular biology. The preservation of fertility is currently conceivable in younger patients with an early stage disease.
(BELG J MED ONCOL 2020;14(6):246-53)Read more
BJMO - volume 14, issue 6, october 2020
I. Joye MD, N. Meireson , R. Weytjens MD, S. Vanderkam MD
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)Read more
BJMO - volume 14, issue 6, october 2020
C. Colpaert MD, PhD, FP. Duhoux , J. Vandeven , L. Van Eycken , L. van Walle , N. van Damme , P. Neven MD, PhD
The aim of this study is to provide a reference for the Belgian breast cancer population, offering detailed information on various patient and tumour characteristics for the breast cancer population as a whole, as well as for the different molecular subtypes. Incidence data for primary invasive breast cancer in females diagnosed in 2014 were selected in the Belgian cancer registration database and underwent individual manual reviewing of the pathology protocols. Subsequently, in 95% of the study population a surrogate molecular subtype was successfully derived, using the combined expression of oestrogen receptor, progesterone receptor, human epidermal growth factor receptor-2, and tumour differentiation grade as surrogate for the proliferation marker Ki67, in conformity with the 2011 St Gallen surrogate classification. Ultimately, differences between the molecular subtypes regarding initial presentation and histopathological features were evaluated by means of a Pearson Chi-squared test for independence. Furthermore, relative survival was calculated for the different molecular subtypes. Histologically, the large majority of the Belgian breast cancer population presents with invasive breast carcinoma of no special type (NST), formerly called invasive ductal carcinoma (75.2%), 14.5% with invasive lobular carcinoma and 5.8% with mixed ductal/lobular invasive carcinoma. Less than five percent of the population harbours less frequently occurring histological subtypes. The Belgian breast cancers are predominantly of the luminal A-like subtype (54.4%), followed by the luminal B-like HER2 negative (14.7%) and the luminal B-like HER2 positive subtype (12.2%). The mean age at diagnosis is 62 years, with almost a third of the patients being 70 years or older. One out of five patients is younger than 50 years, and in the triple negative population this group counts for 31.9%, compared to 16.6% in the luminal A-like breast carcinomas. Most patients (69.4%) are diagnosed with early stage breast cancer (clinical stage 0-II); six percent of the breast cancers are clinically metastasised at the time of diagnosis. For 19% of the patients, information on clinical stage was lacking or staging was not applicable. The unadjusted five-year relative survival proportion for the Belgian cohort is 91.4%. Luminal A-like breast cancer opposed to triple negative breast cancer have the best and worst relative survival, with respectively 96.8% and 77.4% five-year relative survival proportions.
(BELG J MED ONCOL 2020;14(6):263-73)Read more
BJMO - volume 14, issue 4, june 2020
C. Billiet MD, PhD, D. Nevens MD, PhD, G. Buelens MD, K. Erven MD, PhD, M. Machiels MD, P. Janssens MD, R. Weytjens MD, S. Vanderkam MD, Y. Geussens MD
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)Read more
BJMO - volume 14, issue 3, may 2020
A. Coolbrandt PhD, A. Courtens , E. Decoene , G.A. Goossens PhD, I. Decadt , L. Vandezande , M. Daem , M. Reymen
Cancer nursing is a profession in full development. In oncology, as well as in other domains, nursing roles have evolved substantially to better meet patients’ needs and expectations, the complexity of evidence-based (nursing) practice and to better fit needs related to quickly evolving oncology treatments and services. The recognition of advanced practice nurses (APN) in the Belgian legislation in 2019 may further stimulate the implementation of advanced practice nursing in interdisciplinary care, and in oncology in particular. APN have completed a master’s degree as well as additional education and training in a specific clinical domain, such as oncology. The core competencies of APN are clinical practice; expert coaching and guidance; consultation; collaboration; improvement of quality care and innovation; leadership; research and ethical decision-making. APN share a care-oriented focus and person-centred approach. Besides their role in direct clinical practice, APN create an added value in quality improvement, innovation and implementation of evidence-based nursing practice. Therefore, APN closely collaborate with nursing staff, medical staff, other healthcare professionals, management and stakeholders.
(BELG J MED ONCOL 2020;14(3):93–9)Read more
BJMO - volume 14, issue 2, march 2020
J.H. Loge MD, PhD, K. Beernaert MSc, PhD, L. Deliens MA, PhD, MSc, L. Lapeire MD, PhD, N. Dhollander PhD, MSc, S. Kaasa MD, PhD, T. Lundeby PhD
An international collaboration between 30 experts in oncology, palliative care, public health and psycho-oncology provided opportunities and guidelines on how to achieve full integration based on current findings of palliative care research in a Lancet Oncology Commission paper. This review provides a summary of this commission paper in which an overview is given of the different levels of palliative care and which elements of patient-centred care are crucial in the provision of optimal integrated palliative care. Due to the increase in incidence and prevalence of patients living with advanced cancer and associated care needs, palliative care should be seen as an essential component of comprehensive care throughout the life course and disease trajectory. If cure is not achievable, a combined tumour-directed approach and patient-centred approach is needed. We need to rethink and reorganise the delivery of oncology and palliative care to improve treatment and promote collaboration at the appropriate levels of care. Palliative care needs to be implemented in cancer care plans and in clinical care pathways. To guide patients and their family through the healthcare system and improve their health care outcomes, a multidisciplinary team approach is needed in which primary, secondary and tertiary palliative care providers can collaborate and communicate and in which patients can be referred to tertiary palliative care if needed.
(BELG J MED ONCOL 2020;14(2):47–55)Read more
BJMO - volume 14, issue 1, january 2020
J. Brauns MD, P. Pauwels MD, PhD
Immunotherapeutics, like immune checkpoint blockade (ICB), have demonstrated therapeutic efficacy in a variety of human cancers. Even among the tumour types described as responsive, immunotherapy is only efficient in a minority of the patients. To maximise therapeutic benefits, a biomarker to identify ICB-responders is needed. Tumour mutational burden would correlate with the efficacy of immune checkpoint inhibitors. Clinical evidence for TMB as biomarker already exists in metastatic melanoma, non-small cell lung cancer (NSCLC) and renal cell carcinoma (RCC). In this review an update about tumour mutational burden (TMB) is given.
(BELG J MED ONCOL 2020;14(1):4–7)Read more