N. Sundahl MD, PhD

Update on the management of renal cell carcinoma: The BSMO expert panel recommendations

SUMMARY

The management of renal cell carcinoma is evolving rapidly. Here, the BSMO expert panel discusses recent advances focusing on systemic therapies, and provides guidelines adapted to the Belgian context.

(BELG J MED ONCOL 2023;17(4):118–27)

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Bladder preservation in patients with muscle-invasive bladder cancer

During the 2021 Belgian Multidisciplinary meeting on Urological Cancers (BMUC) three presentations were given on the subject of bladder preservation in muscle invasive bladder cancer (MIBC). The first presentation by Dr. Nora Sundahl, from the department of radiation oncology, University of Gent, Belgium, addressed the question whether it is best to use radio-chemotherapy, radio-immunotherapy or a combination of all three in patients with muscle invasive bladder cancer (MIBC). Dr. Nieves Martinez-Chanza, from the Medical Oncology department at Jules Bordet Institute, Brussels, Belgium, aimed to answer the question whether neo-adjuvant immunotherapy is already good enough as a treatment option. Lastly Prof. James Catto, professor in Urological Surgery at the University of Sheffield and Urological Surgeon at Sheffield Teaching Hospital discussed four common clinical assumptions around radical cystectomy (RC) and the role of RC in current practice. Although there is some overlap in the discussed topics we will honour the presenters interpretations of the subject by discussing them separately.

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Boosting anticancer immunity with radiotherapy

SUMMARY

Preclinical and early clinical data indicate that stereotactic body radiotherapy (SBRT) could work synergistically with checkpoint inhibitors and increase response rates. Given the potential synergistic effect between both treatments, the associated toxicity might also be increased. We conducted two phase I trials combining SBRT with ipilimumab (n=13) or pembrolizumab (n=18) in metastatic/inoperable melanoma and metastatic urothelial carcinoma respectively. To evaluate the effect of SBRT timing, patients were randomised to either sequential or concurrent SBRT in the latter trial. To assess early efficacy, a phase II trial of SBRT and nivolumab was conducted in metastatic/inoperable melanoma (n=20). Our data shows that SBRT combined with ipilimumab, nivolumab or pembrolizumab is safe and might increase efficacy in a subset of patients.

(BELG J MED ONCOL 2020;14(1):28–30)

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MRI in prostate cancer diagnosis, surgical or radiation treatment, focal therapy, active surveillance and follow-up

Serum prostate-specific antigen, digital rectal examination and transrectal ultrasound, supplemented with biopsy, are conventionally used for the screening, diagnosis, staging and surveillance of prostate cancer (PCa). However, their sensitivity and specificity are limited with diagnosis of clinically insignificant cancer and a potential risk of overtreatment as a result. Multiparametric MRI combines anatomical and functional pulse sequences, including diffusion-weighted imaging and dynamic contrast-enhanced MRI, and has evolved out of its limited role in PCa staging. The ability to visualise the prostate accurately and to detect or exclude clinically significant PCa makes multiparametric MRI a great tool to improve the diagnosis, staging, treatment planning and follow-up of patients with PCa. Multiparametric MRI can rule out clinically significant PCa and therefore has the potential to reduce the need for biopsies or to determine whether active surveillance or immediate treatment is appropriate.

(BELG J MED ONCOL 2018;12(7):313–318)

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