PRACTICE GUIDELINES

New medical treatments in thyroid cancer

Thyroid cancers are rare diseases and include types that range from indolent localised differentiated carcinomas to fulminant and lethal anaplastic disease. Until recently, treatment options for advanced or metastatic radio-iodine refractory thyroid cancer were limited. Recently kinase inhibitors targeting angiogenesis and other pathways have shown promising activity.

(BELG J MED ONCOL 2014;8(3):81–6)

How to sequence systemic therapies and radiotherapy in early breast cancer?

Breast cancer is the most common malignancy in women in the Western world. Over the last decades, the use of postoperative systemic therapies (chemotherapy, hormonal therapy, trastuzumab) and radiotherapy led to significant survival benefits for patients with early breast cancer. Although these modalities have been extensively studied and used, a major question is how these systemic therapies are optimally sequenced with radiotherapy in the adjuvant setting. This article reviews available data on how to combine systemic therapies with radiotherapy in women with early stage breast cancer, and provides recommendations that unfortunately do not reach level I evidence due to insufficient quality of available clinical data.

BELG J MED ONCOL 2014;8(3):72–80

The ideal cervical cancer screening recommendation for Belgium, an industrialised country in Europe

Cervical cancer should be a historical disease, why are we not succeeding! The prophylactic vaccination will reduce cervical cancer by almost 80% in Belgium. Cervical cancer screening should therefore continue in order to prevent the remaining 20%. The currently used Pap cytology test misses 50% of all clinically significant precancers and cancers at the time of testing. The test should remain but the analysis should be altered. The screening should be modified based on our knowledge of human papillomavirus as a causal factor. Instead of looking for cell abnormality one should look for the presence of human papillomavirus. Then, depending on the test, only two to ten percent of all relevant lesions are missed. The introduction of the vaccination should lead to the reintroduction of the screening based on human papillomavirus. This will lead to a considerable reduction in morbidity and mortality, allow longer screening intervals and be more cost-effective. More for less should be the driving force in cervical cancer screening if we want to be successful.

(BELG J MED ONCOL 2014;8(2):44–51)

Belgian Society of Medical Oncology (BSMO) task force on breast cancer survivorship

Summary

Advances in screening, diagnostic procedures, surgical techniques, knowledge about molecular pathways and targets, and new treatment options have substantially improved the outcome of breast cancer patients. Care for breast cancer survivors has thus become an essential part of care for breast cancer patients. Therefore, the Belgian Society of Medical Oncology set-up a task force charged with developing guidance on issues important for breast cancer patients who have completed their primary treatment.

(BELG J MED ONCOL 2013;7(5):142–55)

Soft tissue sarcoma: the clinically relevant basics and an update on systemic therapy options for patients with advanced disease

Summary

Sarcomas are a group of rare solid tumours arising from mesenchymal or connective tissue. This review focuses on soft tissue sarcoma and covers general topics such as the epidemiology, age distribution, site of disease, histogenesis, histological subtypes, prognosis and outcome of treatment. In more detail the article reviews current systemic treatment standards and selected adverse events of agents such as doxorubicin, ifosfamide, trabectedin and pazopanib, and briefly highlights some drugs that are used off-label in rare subtypes of sarcoma.

(BELG J MED ONCOL 2013;7(3):80–88)

Practice guidelines in the management of uveal melanoma

Summary

Uveal melanoma is a rare oncological disease. This incidence has remained stable for the past 50 years. There is no survival difference depending on the type of ocular treatment (enucleation versus radiotherapy versus tumour resection). Brachytherapy (Ru-106, I-125) presently remains the most common method for treating uveal melanoma. Despite adequate and early local treatment, half of the patients will develop metastatic recurrence with an average of 2.5 years after initial diagnosis. Clinical and histological prognostic factors have been identified, but some studies suggest that inactivation of BAP1 by chromosomal deletion or mutation is a key event driving metastasis development. Presently, no adjuvant treatment prevents those metastatic relapses. Nearly 90% of patients who relapse have only liver metastases. The median survival of those patients is about four months. Numerous trials evaluating the interest of exclusive liver treatment have failed to demonstrate an increase in survival, except surgery for solitary liver metastasis. Chemotherapy with dacarbazine remains the standard treatment of metastatic patients. New treatments targeting the signal transduction pathways or aiming at the stimulation of the immune system are under development.

(BELG J MED ONCOL 2013;7:20–26)

The role of laparoscopy in the evaluation and treatment of epithelial ovarian cancer

Laparotomy has been the standard approach for diagnosis and treatment of ovarian cancer. The goal of this article was to collect and summarise the evidence concerning the use of laparoscopy in ovarian cancer. We performed a Medline search of studies and reviews about the laparoscopic approach for evaluation of surgery of ovarian cancer.

Laparoscopy appears to be a safe, accurate and patient-friendly alternative for laparotomy in primary surgery for early-stage ovarian cancer and in accurate staging and evaluation of operability in advanced ovarian cancer. Very little evidence is available on the role of laparoscopy in advanced ovarian cancer. (BELG J MED ONCOL 2012;6:157–163)