G. De Meerleer MD, PhD

Novel strategies in the management of high-risk and oligometastatic prostate cancer

SUMMARY

The aim of this thesis was to assess the impact of intensive hormonal therapy prior to radical prostatectomy in high-risk prostate cancer (PCa) in order to optimise the outcome of this patient population. Next, the recurrence patterns of PCa patients with prostate-specific antigen (PSA) relapse following localised therapy were assessed using novel imaging techniques such as prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT). Moreover, the safety and oncological outcomes of PCa men with oligometastatic recurrence (1–5 lesions) following localised therapy treated with metastasis-directed therapy were investigated. Lastly, the safety and efficacy of radium-223 in men with PSA relapse following localised therapy without visible lesions on PSMA PET/CT were assessed.

(Belg J Med Oncol 2023;17(7):267–70)

Traveling the prostate cancer timeline in chase of treatment paradigms: Can we cure the incurable?

SUMMARY

When prostate cancer (PCa) patients are diagnosed as ‘incurable’, most patients still have many years to live and often undergo a continuum of burdensome and expensive systemic treatments that can impair quality of life. Due to the active promotion of new systemic therapies in the treatment of metastatic and/or castrationrefractory PCa patients, other treatment modalities such as modern radiotherapy (RT) have been considered as therapies that relieve symptoms, without offering any possibility of cure or additional quality of life-adjusted life years. This PhD thesis investigated whether the implementation of modern RT in previously non-RT indications could prove otherwise. To achieve this, the PCa timeline was followed in search of treatment paradigms, and re-introduced RT in different disease settings. Firstly, the addition of elective para-aortic lymph node radiotherapy was investigated in patients diagnosed with locally advanced pN1 prostate cancer, with local treatment of the prostate (bed) and pelvic lymph nodes, along with 24 months of ADT, in the prospective multicentric PART study. Secondly, a large retrospective study was performed, focused on patients with oligorecurrent prostate cancer who were treated with metastasis-directed therapy (MDT). Finally, the use of MDT was investigated in patients diagnosed with oligoprogressive metastatic castration-resistant prostate cancer (mCRPC), while continuing otherwise successful ongoing systemic treatment. Will this approach lead to a substantial postponement of next-line systemic treatment (NEST)?

(BELG J MED ONCOL 2022;16(7):363–6)

Repeated stereotactic body radiotherapy (SBRT) in a patient presenting with oligometastatic prostate cancer while treated with anti-androgens: a case report

SUMMARY

This case report of an 80-year-old patient, who presented with up to six manifestations of oligorecurrent prostate cancer (PCa) over a time period of nine years, shows that repeated treatment with metastasis directed therapy (MDT) in this setting is feasible and nearly atoxic.

(BELG J MED ONCOL 2021;15(6):325-30)

Immune Checkpoint Inhibition for metastatic penile cancer: a case report and review of the literature

Metastatic penile cancer patients have a poor prognosis of six to twelve months with conventional therapies including surgery, cytotoxic chemotherapy and radiotherapy. We present the promising result of the use of an immune checkpoint inhibitor in a metastatic penile cancer patient. A review of the potential for immuno-therapy in penile cancer is presented.

Case report of a patient treated locally for bone metastatic renal cell carcinoma

SUMMARY

Based on a case report of a 47-year old male with primary bone metastatic renal cell carcinoma, the current treatment options are reviewed in this article.

(BELG J MED ONCOL 2019;13(7):305–8)

Highlights of Scientific Summits Meeting

Summary

Since last year a board of respectively three urologists and one radiation oncologist created the ‘Scientific Summits’. This is a scientifically independent Belgian congress for urologists, radiation oncologists, medical oncologists and radiologists with special interest in urology and more specifically in urologic oncology. The aim of Scientific Summits is providing up-to-date scientific information based on the highlights of the most recent international congresses. The 4^th edition took place in the charming city of Durbuy, Belgium.

The first day of the meeting focussed on the treatment and prevention of side effects of various anticancer treatments in urologic oncology. Experts in the field shared practical tips and tricks, based on interactive case discussions. They illustrated difficult situations and how to deal with them. On the second day of the meeting, interactive state-of-the-art lectures provided us with up-to-date information on how to evaluate and manage advanced and recurrent prostate cancer.

(BELG J MED ONCOL 2018;12(2):82–85)

Oligometastatic ovarian cancer successfully treated with stereotactic radiotherapy

A 53-year old woman presented with an ovarian cancer, FIGO stage IIIc, for which she received a (suboptimal) debulking. Chemotherapy was started, consisting of three-weekly carboplatin-paclitaxel. After four cycles, an interval-debulking was done, which revealed one positive lymph node (out of 21) located interaortocaval. Chemotherapy was resumed, until seven cycles. She had a complete remission, but after four years, she developed positive mediastinal and interaortocaval lymph nodes. She was treated with stereotactic radiotherapy, which resulted in resolution of the lesions and normalisation of the tumour marker. She has no signs of relapse after nearly two years.

This case illustrates that radiotherapy can be an important treatment option in selected patients with oligometastases.

(BELG J MED ONCOL 2014;8(3):87–90)