BJMO - volume 10, issue 6, september 2016
P. Szturz MD, PhD, J.B. Vermorken MD, PhD
The majority of patients diagnosed with recurrent and/or metastatic squamous cell carcinoma of the head and neck are deemed ineligible for surgery or irradiation. Their management prioritise symptom control and quality-of-life improvement. According to patient’s performance status, medical comorbidities and symptoms, recommended treatment options include supportive care only, mono- or multi-drug chemotherapy or cetuximab (epidermal growth factor receptor inhibitor) either alone or as an adjunct to cytotoxic drugs. Despite achieving response rates superior to single-agents, doublet and triplet regimens incorporating cisplatin and/or taxanes did not increase overall survival and were often difficult to tolerate. The platinum (cisplatin or carboplatin)/5-fluorouracil/cetuximab regimen is the only regimen showing significant survival improvement over PF alone in a large randomised trial, and therefore is the only approved new standard systemic treatment today. However, the very poor overall survival of six to ten months expected in this patient population, remains a continuous challenge and novel anticancer therapies are urgently needed. The potential to induce durable responses with manageable toxicity has propelled immunotherapy to the forefront of cancer research, yet its validation in phase III clinical trials is pending. Another crucial task is the identification of reliable, prospectively confirmed prognostic and predictive biomarkers. Mounting evidence from retrospective analyses suggests that human papillomavirus status with p16 immunohistochemical positivity as its surrogate represent promising candidates for this role.
(BELG J MED ONCOL 2016;10(6):207–214)
Read moreBJMO - volume 10, issue 4, july 2016
P. Pauwels MD, PhD, M. Remmelink MD, PhD, D. Hoton MD, J. van Dorpe MD, PhD, K. Dhaene MD, PhD, F. Dome MD, A. Jouret-Mourin MD, PhD, B. Weynand MD, PhD, N. D’Haene MD, PhD
In recent years, the management of patients with non-small cell lung cancer has been modified thanks to the development of targeted therapies. The pathologist is now asked to give the most accurate possible diagnosis in association with theranostic information in order to provide the best therapeutic option.
Different international societies have already underlined the importance of guidelines for managing samples of non-small cell lung cancer. These Belgian guidelines have the goal of adapting these international recommendations to the Belgian landscape.
(BELG J MED ONCOL 2016;10(4):123–131)
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BJMO - volume 10, issue 3, may 2016
F.P. Duhoux MD, PhD, P. Neven MD, PhD, A. Awada MD, PhD, M. Berlière MD, PhD, H. Wildiers MD, PhD, H. Denys MD, PhD
Oestrogen receptor positive early invasive breast cancer is a common disease in pre- and perimenopausal women. Adjuvant endocrine therapy is an essential part of its treatment. Until recently, premenopausal patients were uniformly treated with tamoxifen during five years. Given the recent publication of large clinical trials showing a benefit for other treatment regimens, the BSMO Breast Cancer Task Force met on the 6th of March, 2015, to propose common guidelines for adjuvant endocrine therapy for premenopausal patients. The members agreed that low-risk patients should be treated with five to ten years of tamoxifen, while the highest-risk patients should be treated with exemestane or tamoxifen plus ovarian function suppression. Special attention should be given to patients less than 35 years at diagnosis: in this subgroup, exemestane plus ovarian function suppression is preferred to tamoxifen plus ovarian function suppression.
(BELG J MED ONCOL 2016;10(3):92–96)
Read moreBJMO - 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 10, issue 1, february 2016
C. Dooms MD, PhD, B. Weynand MD, PhD, S. Vander Borght PhD, L. Vliegen MSc, E. Verbeken MD, PhD, J. Vansteenkiste MD, PhD, P. Vandenberghe MD, PhD
Endobronchial ultrasonography is a minimally invasive endoscopic technique that enables a real time transbronchial needle aspiration. Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) specimens have a high diagnostic accuracy in the detection of intrathoracic lymph node metastasis for a variety of malignancies. Predictive biomarker testing is gaining wide importance to tailor the treatment with the largest benefit to the patient. Endobronchial ultrasound guided transbronchial needle aspiration also results in an accurate analysis of molecular alterations (by ImmunoHistoChemistry, Fluorescence In Situ Hybridisation, or gene sequencing) provided that the endoscopist takes sufficient tumour samples and a dedicated cytopathologist is involved in the mastery of the specimens.
Endobronchial ultrasound guided transbronchial needle aspiration samples can be handled in different ways. Liquid-based cytology and smears are mostly used. The choice of the testing method should be based primarily on the nature of the sample to be tested, testing laboratory’s expertise, and available equipment. ImmunoHistoChemistry, Fluorescence In Situ Hybridisation and targeted polymerase chain reaction-based sequencing can be performed on >80% of the endobronchial ultrasound guided transbronchial needle aspiration specimens, as the latter is more sensitive in terms of limit of detection than Sanger sequencing. The next step are the next generation sequencing assays, with only 10–20 ng of DNA sample input per gene mutation, which will minimise rejected samples due to insufficient sample quantity.
(BELG J MED ONCOL 2016;10(1):15–20)
Read moreBJMO - volume 9, issue 7, december 2015
J. Yserbyt MD, C. Dooms MD, PhD
Management of malignant pleurisy should be patient- and symptom-centred. The presence of trapped lung is the most important factor compromising the success rate of pleurodesis. Although scientific evidence is debatable, early referral for pleurodesis is advisable and thoracoscopy with talc poudrage is the treatment option of choice. The use of indwelling catheters is a novel alternative technique for specific indications.
(BELG J MED ONCOL 2015;9(7):279–85)
Read moreBJMO - volume 9, issue 5, september 2015
D. Mortier MD, H. Van Poppel MD, PhD
To present a comparison between the recommendations for early detection of prostate cancer in men without evidence of prostate cancer related symptoms, as proposed by the European Association of Urology and the American Urological Association. Prostate-specific antigen screening for prostate cancer has been and still is one of the most controversial issues in medicine. Recent guideline statements and recommendations have led to further confusion and controversy regarding the use of prostate-specific antigen testing for the early detection of prostate cancer. In this text we try to summarise the different points of view of both societies and the evidence they are based upon.
(BELG J MED ONCOL 2015;9(5):179–82)
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