REVIEW ONCOLOGY

The androgen receptor in prostate cancer

The androgen receptor plays a role as a nuclear transcription factor after activation by its ligands. It is an essential component in the development and progression of prostate cancer. The different factors that play a role in relation to the androgen receptor and prostate cancer are discussed. The different treatment strategies in relation to prostate cancer are addressed.

(BELG J MED ONCOL 2015;9(2):61–4)

Isolated lung perfusion as additional treatment for lung metastases

The golden standard for the treatment of lung metastases remains complete surgical resection. Prognostic factors for patients with lung metastases are histology, number of metastases and disease-free interval. However, the chance of recurrent disease in the treated lung remains high after complete resection, even in combination with systemic chemotherapy. Systemic toxicity limits the dose of the latter, resulting in only limited local pulmonary control. Therefore, new techniques are developed to deliver a high-dose of chemotherapy selectively into the lung, reducing the risk of systemic toxicity. One of these techniques is isolated lung perfusion, which is comparable with isolated limb perfusion. This experimental surgical technique allows delivery of a very high-dose of chemotherapy with or without biological response modifiers to the lung, without the risk of systemic exposure. Experimental studies with this technique have shown its superiority in achieving higher tissue concentrations of chemotherapy in the target organ as well as improved survival in comparison with systemic chemotherapy. As shown in several phase I studies, this technique is technically feasible with minimal morbidity and minimal impact on pulmonary function. In a recent phase II study, an improved local pulmonary control was found in comparison with the literature. This review discusses the current status of isolated lung perfusion as well as newer, less invasive techniques to deliver high-dose chemotherapy selectively to the lung.

(BELG J MED ONCOL 2015;9(1):5–10)

Health-related quality of life research in EORTC cancer clinical trials: an emphasis on quality

A short review on health-related quality of life, including patient reported outcomes measurements in oncology to help increase awareness in the Belgian oncological community. This review is also meant for educational purposes and to highlight the benchmarks that the work of EORTC has contributed to the field.

(BELG J MED ONCOL 2015;9(1):11–15)

Current management of malignant pleural mesothelioma

Malignant pleural mesothelioma remains a lethal disease and its incidence is expected to increase until the 2020’s. Disease extent and performance status at diagnosis are the clinical prognostic factors, besides epithelioid subtype which confers a better outcome than the less common sarcomatoid one. Currently, only administration of palliative chemotherapy has a proven impact on outcome. Treatment of early stage malignant pleural mesothelioma should be offered in a multimodality setting, including at least a systemic and a locoregional treatment. The role of radical surgery remains controversial. Optimal treatment schedules are not defined yet. The standard first line palliative treatment consists of platinum in combination with an antifolate, either pemetrexed or raltitrexed. As the outcome in first line remains modest, it is ethical to include these patients in clinical trials comprising a chemotherapy backbone. For maintenance therapy there’s still no standard in malignant pleural mesothelioma. In second line treatment, referral of patients for inclusion in trials is highly recommended.

(BELG J MED ONCOL 2014;8(5):197–205)

Geriatric oncology in Belgium

As in other developed countries, the management of older cancer patients has become a major public health concern in Belgium owing to an increasing incidence and to other challenging specificities of this population. Since 2009, the Cancer Plan has played a leading role in the development of geriatric oncology in our country by supporting numerous pilot projects. By the year 2015, a scientific analysis of each of these projects will provide important information to the public authorities and care givers in order to organise the management of older cancer patients in an optimal way in Belgium. In this article, we describe the present landscape of geriatric oncology in Belgium focusing on epidemiological data and pilot projects supported by the Cancer Plan 2009–2011 and 2012–2015.

(BELG J MED ONCOL 2014;8(5):206–12)

Biomarkers and genomics in prostate cancer

Biomarkers and genomics are making their entrance in daily clinical practice in many tumour types. In prostate cancer, their use is relatively limited. This article reviews biomarkers and genomics used in different clinical settings such as screening, diagnosis, prognosis, prediction and surrogate endpoints for overall survival and shows an unmet need in prostate cancer.

(BELG J MED ONCOL 2014;8(4):104–8)

The development of a safety culture: a fanciful hope in the health care sector?

Patient safety is a dimension of health care quality and a part of organisational safety culture. A deficit in safety culture represents an increased risk for ‘system’ errors. Errors in the health care sector are frequent and seriously harm a significant amount of patients. These errors must be seen as the end-product of accumulation of latent and active failures within the system and not systematically as the result of an individual mistake. The management of system failure to increase patient safety requires a cultural change. A long-lasting ‘blame and shame policy’ is seriously hampering this cultural change as under-registering of near misses and adverse events are the norm!

Organisational safety culture is multi-faceted and multidimensional. The main characteristics of the safety culture will be highlighted, as well as the methods to assess and detect a weakening safety culture. The health care sector faces an enormous challenge and the journey to better and safer care is a never ending road full of stumbling blocks hindering progression, especially in an environment where reduced financial potential will soon become the norm.

(BELG J MED ONCOL 2014;8(3):66–71)