Oncology: from research to clinic
2021 - volume 76 (5-6)
|Editorial. Oncology, at a turning point in its history (2021)|
|The Arsène Burny Cancer Institute (ICAB) and its new building for the Integrated Oncology Center (CIO) at the CHU de Liège (2021)|
Rev Med Liege 2021, 76(5-6),300-306
Summary : The Arsène Burny Cancer Institute (ICAB) of the CHU de Liège is the reference university medical center, open to its environment, dedicated to cancer care. Transversality, academic expertise, quality of care and direct links with research are at the heart of this ambitious achievement, which is much more than a building. The Integrated Center of Oncology (CIO) is the new ICAB building, dedicated to outpatient cancer care and high performance technical platforms such as radiotherapy with its Cyberknife, oncology imaging with its radiopharmacy, the Laboratory of Cell and Gene Therapy, the Liège University Hospital Biobank, or the laboratories grouped together within Unilab, while hospitalizations remain in the existing towers of the CHU.
|From fundamental research to translational research in oncology (2021)|
|The contribution of «Télévie» and the «Léon Fredericq Foundation» to the fundamental cancer research in Liège (2021)|
Rev Med Liege 2021, 76(5-6),311-320
Summary : Télévie and the Léon Fredericq Foundation support many research projects in the CHU of Liège and the ULiège. This paper summarizes some projects aiming at a better knowledge of the basic mechanisms leading to cancer development, of the immune defenses against tumours, of specific characteristics of some cancer types and, finally, of strategies for improving quality of life of patients whose fertility has been threatened by anti-cancer treatments.
|Contribution of « GIGA-Cancer » at ULiege to the research on tumour microenvironment (2021)|
Noël A , Gilles C , Sounni NE , Cataldo D , Colige A
Rev Med Liege 2021, 76(5-6),321-326
Summary : The evolution of cancers is dictated by the intrinsic characteristics of malignant cells, but also by the multiple dynamic and reciprocal interactions that they establish with their tissue and cellular environment. This tumour microenvironment is therefore the subject of an ever-increasing part of cancer researches. These notably shed light on the plasticity of function of these non-malignant cells and on the diversity of their impact on the progression of the disease, both in primary tumours and during the formation of metastases. The improvement of the current therapy and the development of innovative treatments therefore require the identification of these cell subpopulations, either «allies» or «enemies» of aggressive cancer cells, as well as a more extensive understanding of the mechanisms modulating their phenotypes. This article summarizes some research projects carried out in two GIGA-Cancer laboratories supported by «Télévie» and the «Fondation Léon Frédéricq».
|Heredity and cancer (2021)|
Docampo E , Martin M , Gangolf M , Harvengt J , Bulk S , Segers K , Leroi N , Lete C , Palmariciotti V , Freire Chadrina V , Lambert F , Bours V
Rev Med Liege 2021, 76(5-6),327-336
Summary : A personal or family history of cancer has now become the primary cause of genetic consultations. In recent years, various genes have been identified that are associated with a more or less marked genetic predisposition to the development of cancers. The syndrome associated with the hereditary risk of breast and ovarian cancer and the Lynch syndrome are the most frequent ones, but there are many other, much less common, situations associated with familial cancer risk. In most cases, there are clear recommendations regarding the indications for genetic testing and the follow-up of patients identified as having a predisposition to cancer. At the CHU of Liège, we currently perform more than 1.400 oncogenetic consultations per year and we maintain a positivity rate of genetic tests performed in this indication higher than 10%. In this way, we allow a multidisciplinary care of patients with a high oncological risk and participate in a prevention and surveillance activity. We also pay increasing attention to the hereditary risk associated with pediatric cancers and to patients with multiple cancers, especially when these develop at an early age. Finally, the oncogenetic consultation must consider the psychological, ethical and legal aspects of a diagnosis that involves the patient and his or her future, but also the whole family.
|Environment and cancer : not easy to dissect the exposome ! (2021)|
Rev Med Liege 2021, 76(5-6),337-343
Summary : Environment contains numerous potentially toxic substances among which certain have demonstrated to be carcinogenic. They can reach the human organism mainly through the repiratory or digestive routes. Even if it is not always easy to demonstrate a causal relationship in observational studies whose interpretation is limited by numerous confounding factors, some compounds from the environment are clearly associated with a higher risk of cancers. The present article describes the effects of both outdoor and indoor air pollution, pesticides, some endocrine disruptors and radiations. The identification of environmental factors associated with a higher risk of cancer allows implement eradication strategies and thereby efficacious prevention.
|Concepts of medical imaging in the work up and follow-up of cancer : oncological imaging at a glance (2021)|
Cousin F , Valkenborgh C , Hustinx R
Rev Med Liege 2021, 76(5-6),344-351
Summary : Oncological imaging is a subspecialty of medical imaging and focuses on the workup and the follow-up of cancer. Oncological imaging takes into account all the specificities of cancer diseases, which is a constantly evolving field, especially in the era of precision medicine, and plays a key role in the care of cancer patients. It permits reliable diagnosis and gives precious information concerning disease extension at diagnosis, which is essential for the treatment planning. Oncological imaging allows also followup of patients under treatment, using response evaluation scores. Interventional imaging, which provides minimally invasive procedures, is useful in order to obtain a histological diagnosis, to treat some tumour or to improve quality of life of cancer patients. Finally, numerous perspectives, among them the advent of artificial intelligence (radiomics), will further strengthen the role of oncologic imaging in the near future.
|Clinical chemistry laboratory assay of circulating oncology biomarkers : limitations and perspectives (2021)|
Sqalli G , Cavalier E , Ladang A
Rev Med Liege 2021, 76(5-6),352-357
Summary : In current practice, the use of circulating oncological biomarkers by clinicians is almost inseparable from cancer patients management. However, the interpretation of the results is not always easy because it is more specific to laboratory medicine and involves notions of peri-analytical orders as well as analytical sensitivity and specificity. In the past, the development of new analytical techniques improved the analytical sensitivity or allowed the implementation of new biomarkers; this observation would still be true today. Mass spectrometry, microRNA assay, or Single Molecule Array (SiMoA) are recent analytical developments with very good analytical performances that could contribute to the improvement of cancer patient management.
|Aid of artificial intelligence for the anatomo-pathological diagnosis of tumours (2021)|
Reginster M , de Froidmont S , Somja J , Delvenne P
Rev Med Liege 2021, 76(5-6),358-361
Summary : The anatomo-pathological diagnosis of tumors is based on many criteria related mainly to image analysis. Currently, in most pathology laboratories, tissues or cells are placed on glass slides and directly analyzed with an optical microscope. Because of technological evolutions, it is currently possible to digitize slides (digital pathology). The digitization of whole slides has allowed the development of computer programs of artificial intelligence (AI) for image analysis. Applied to tumour pathology, this technology allows the detection, diagnosis or evaluation of the prognosis of neoplastic lesions. There are many challenges associated with the use of AI in routine pathology. These are mainly related to the amount of data to be analyzed and to the development of reliable algorithms. Nevertheless, this technology is promising and could become a valuable aid in the field of precision medicine for which the amount of data related to a patient is constantly increasing.
|How to improve radiotherapy ? Technological developments and radiotherapy of tomorrow (2021)|
Colin G , Coucke PA
Rev Med Liege 2021, 76(5-6),362-368
Summary : Radiotherapy established itself in the 20th century as an essential modality in the fight against cancer. The major technological advances of the last decades have allowed a considerable improvement in the therapeutic window. They have also paved the way for stereotactic radiotherapy and new indications. The aim of this article is to enable readers to understand external radiotherapy in 2021 and to understand the challenges of tomorrow. Three areas of improvement in the discipline will be described, the optimization of the prescribed therapeutic dose, the improvement of the distribution of this dose and, finally, the better understanding of radiobiology. For each of these axes, the current implications will be described as well as those which could/should have a major impact on the radiotherapy. FLASH radiotherapy will also be discussed.
|Radiomics and automation in radiotherapy (2021)|
Rev Med Liege 2021, 76(5-6),369-374
Summary : Cancer incidence is steadily progressing worldwide, in parallel with the aging of the population. Workload is increasing constantly, especially in the fields of oncology and radiotherapy. This is particularly worrysome, as there is a general shortage of skilled professionals in the field (for example in medical physics). Moreover, every single patient does represent an enormous amount of data issued from a wide range of sources. This is especially true as far a medical imaging is concerned. Extraction of morphological data (anatomical location and extent of the tumour) and functional data (tumour biology and metabolism in general) becomes laborious. Moreover, images contain information which cannot be discerned by the human eye. Therefore, to handle shortage of human resources and transform this enormous amount of data automatically, artificial intelligence becomes a «must have». We intend to highlight the growing importance of radiomics as a cornerstone in automation of processes in radiotherapy, especially for treatment planification and a more personalized individualized treatment approach.
|Palliation by radiation is also our business ! (2021)|
Lamande M , Lallemand F , Ben Mustapha S , Coucke PA
Rev Med Liege 2021, 76(5-6),375-379
Summary : Radiotherapy (RT), both with a curative and a palliative intent, is one of the cornerstones of oncological treatments. A variety of symptoms linked to cancer can be relieved with RT (such as pain, bleeding, compression exerted by a tumour lesion…). Very often, palliative RT is proposed when other medical treatments (painkillers, morphine…) are no longer efficient, or the patient does not tolerate them anymore. Palliative RT is an integral part of the global supportive oncological care. Indeed, patients’ wishes and prognosis are taken into account in each and every step of the treatment pathway. Every treatment deserves an individualized approach and benefits from the best available techniques.
|Precision medicine in oncology : where do we stand ? (2021)|
Rev Med Liege 2021, 76(5-6),380-386
Summary : The «one size fits all» approach is seriously challenged by rapid progression of medical knowledge, especially in the field of individual genome expression. It is currently known that the anti-tumour effect of a given treatment and possible side effects at the level of healthy tissues, can at least partly be predicted and explained by individual variations of gene expression. However, most of us realize that these differences in response are also linked to a variety of other individual characteristics, such as for example the environment and socio-economic factors. Without any possible doubt, there are multiple problems (technical, administrative, financial, cultural and ethical) to be solved, before we witness the real irruption of precision medicine and its holistic individualized approach in our daily oncological practice. It has to start with an international effort, disregarding borders of individual countries, in order to obtain very large amounts of data (with a high degree of variability to avoid bias). This holistic approach, at both societal and individual levels, is the entrance door for a personalized approach in care, whether this is curative, predictive or preventive.
|The rise of targeted therapies in pediatric oncology (2021)|
Dresse MF , David BA , Demarche M , Florkin B , Forget P , Gatineau S , Longton J , Piette C , Seghaye MC
Rev Med Liege 2021, 76(5-6),387-391
Summary : Cancers are rare pathologies in children. Improvement in survival rates has been obtained thanks to new therapeutic strategies based on the identification of risk factors. Targeted therapies in paediatric oncology are new treatments providing hope that cure is achievable without long-term sequelae.
|PD-L1 : a natural immunosuppressor related to carcinogenesis. A pathologist’s point of view (2021)|
Lacremans P , Detrembleur N , Dome F , Collins P , Delvenne P
Rev Med Liege 2021, 76(5-6),392-397
Summary : The goal of this article is to emphasize the role of anatomopathology for the intratumoral detection of the immune checkpoint PD-L1. This molecule is one of the main targets in the anti-cancer immunotherapy. The binding of PD-L1 to its receptor PD-1 results in the inactivation of the cytotoxic T-cells, thus providing a mechanism of keeping immune reactions under control. This process can be circumvented by tumour cells to evade immune system. By blocking PD-1/PD-L1 binding, it is possible to reactivate T-cells targeting tumour neo-antigens. This article focuses on how PD-L1 works, on its implication in neoplastic processes, on the general principles of its therapeutic blockade, on the biomarkers underlying the treatment efficacy and on the practical implications of these biomarkers, especially in the anatomopathological practice.
|Immunotherapy for head and neck squamous cell carcinoma (2021)|
Lecocq M , Poncin A , Sautois B
Rev Med Liege 2021, 76(5-6),398-402
Summary : Current recommendations for systemic treatments of head and neck squamous cell carcinoma have been significantly modified with the advent of immunotherapy for a majority of these cancers. Indeed, immune checkpoint inhibitors are now recommended in metastatic disease and in locoregional recurrence not amenable to a local treatment. PD-L1 positive tumours are eligible for immunotherapy in first line and immunotherapy is also available in second line, after failure of platinum based chemotherapy, regardless of PD-L1 expression. Ongoing clinical trials are exploring the role of immune checkpoint inhibitors in the adjuvant setting as well as with radiotherapy as definitive treatment. Immunotherapy has changed the treatment landscape and has improved the prognosis of patients with head and neck squamous cell carcinoma.
|Immune-related adverse events (2021)|
Frères P , Poncin A , Lecocq M
Rev Med Liege 2021, 76(5-6),403-407
Summary : Immunotherapy has revolutionized cancer management in recent years and is affecting more and more patients. Immunotherapy side effects are specific, immune-related, and their early recognition and management are essential. Here we describe the main adverse effects of immunotherapy and their general principles of management.
|Cardio-oncology, why is it a new specialty ? (2021)|
Moonen M , Nguyen Trung ML , Deneye M , Lancellotti P
Rev Med Liege 2021, 76(5-6),408-412
Summary : Cardio-oncology is a new interdisciplinary specialty that has emerged over the past ten years. With the development of increasingly potent cancer therapies which improve cancer survival, but at the cost of cardiovascular toxicity, the demand for specialized cardio-oncology services has emerged. Also, cardiovascular diseases are more common and more serious in cancer patients than in the general population. Cardio-oncology focuses on the prevention, detection, monitoring, and treatment of cardiovascular diseases in cancer patients, mostly those occurring as a side effect of chemo- and radiotherapy.
|Paraneoplastic neurological syndromes (2021)|
Lambert N , Lutteri L , Sadzot B , Maquet P , Moonen G
Rev Med Liege 2021, 76(5-6),413-418
Summary : Neurological paraneoplastic syndromes are non-metastatic complications of systemic cancers, often resulting from an immune response triggered by the crossed expression of neuronal antigens by tumour cells. Several neurological syndromes such as cerebellar degeneration, sensory neuronopathy, limbic encephalitis, encephalomyelitis or the Lambert-Eaton myasthenic syndrome are most often paraneoplastic and require prompt cancer screening, particularly if the patient shows risk factors for cancer. Although there are many exceptions to this rule, a given syndrome is often associated with a particular antibody and the corresponding tumour. A prompt diagnosis of neurological paraneoplastic syndrome is of major importance as it often reveals the underlying tumour. The treatment relies on both the elimination of the neoplasia and the control of the immune response.
Martin DH , Bianchi E , Ben Mustapha S , Frères P
Rev Med Liege 2021, 76(5-6),419-424
Summary : Glioblastoma is the most common primary malignant brain tumor. Despite treatments combining excisional surgery, chemotherapy, and radiotherapy, overall survival remains low and the incidence of tumor recurrence remains high. Advances in the understanding of the disease, particularly its molecular biology and the mechanisms of action of systemic and radiotherapeutic treatments, as well as the development of image-guided surgical techniques, offer hope for the control of this hitherto incurable disease.
|Neuroendocrine neoplasms : a new era to the top of multidisciplinarity ! (2021)|
Lousberg L , Collignon J , Troisfontaine F , Paulus A , Vaillant F , Jadoul A, Delannoy P , Petignot S , Petrossians P , Rohmer V , Beckers A
Rev Med Liege 2021, 76(5-6),425-431
Summary : Neuroendocrine neoplasms are histologically defined by a common neuroendocrine cellular phenotype. These are still considered as rare tumours even though their incidence is increasing. Heterogeneity is everywhere whether in the localization of the primitive cancer, the clinical presentation, the histological classification, the prognosis, as well as in therapeutic options, which clearly justifies specialized multidisciplinary care. Heterogeneity and scarcity explain the still fragmented nature of knowledge in this domain. Thanks to an increase in incidence, a desire for standardization of classification as well as the arrival of major therapeutic advances, such as vectorized internal radiotherapy, the future of neuroendocrine neoplasia seems more than promising and exciting. In our daily clinical practice at CHU Liège, we hope to bring our stone to the building by listing as many cases as possible in national and/or international databases, by centralizing therapeutic discussions within specific multidisciplinary concertations and by participating in multicenter study protocols.
|Managing of dyspnea in oncology (2021)|
Duysinx B , Paulus A , Vaillant F , Duquenne JB , Corhay JL , Louis R , Sibille A
Rev Med Liege 2021, 76(5-6),432-439
Summary : The perception of ventilatory effort is common in oncology, especially but not exclusively in the advanced stages of neoplastic disease. Dyspnea is a symptom whose discomfort and anguish it generates in the patient and his/ her entourage require constant management throughout the illness. The first step is to identify and optimize the treatment of comorbidities associated with tumour disease. Relief of respiratory oppression as a symptom requires a multidisciplinary approach. Opiates and benzodiazepines are at the forefront of pharmacological management. The mechanical obstruction that limits ventilatory flow and/or chest ampliation may justify more invasive management, including endoscopic techniques. Oxygen therapy will be considered on a case-by-case basis. Finally, global management includes respiratory revalidation, psychological support and improvement of environmental quality.
|Pre-cancerous lung lesions and lung cancer screening (2021)|
Duquenne JB , Paulus A , Sibille A , Corhay JL , Louis R , Duysinx B
Rev Med Liege 2021, 76(5-6),440-445
Summary : Lung cancer remains the deadliest cancer. It is the result of genetic aberrations in the cells of the respiratory tract exposed to carcinogenic agents, responsible for their anarchic multiplication. It is necessary to study these abnormalities in order to better understand the early stages and the mechanisms of evolution, thereby to establish new screening, monitoring and treatment strategies. The NELSON study confirms that systematic screening for lung cancer in target populations leads to a reduction in mortality from this disease. Despite this, there is currently no consensus in Belgium between medical experts and politicians for systematic lung cancer screening.
|Non small cell lung carcinoma in never-smokers at the Liege University Hospital : a retrospective cohort study, 2017-2018 (2021)|
Debruche M , Mettlen C , Paulus A , Vaillant F , Sibille A , Frères P , Duysinx B , Louis R
Rev Med Liege 2021, 76(5-6),446-451
Summary : Lung cancer is the third most common cancer in Belgium in 2017 and remains the leading cause of cancer death worldwide. There is no longer any doubt that the main cause of lung cancer is smoking. However, the prevalence of lung cancer in never-smokers has been increasing overtime. Moreover, it is now recognized that the lung cancer of non-smoker patients has very distinct characteristics. In this retrospective cohort study (N = 520), we describe the characteristics of non-smoker patients and their non-small cell lung carcinoma and compare them to those of smokers. The patients included in this study were whose with a new diagnostic of lung cancer made at the Liège University Hospital of Liège over 2 years round. Non small cell lung cancer occurring in never-smokers patients is more often seen in young and very old patients, more frequent in female, essentially adenocarcinoma and often associated with mutations. This work confirms that lung cancer in never-smokers shows different features than lung cancer seen in patients with a smoking history.
|Small cell lung cancer : update of therapy (2021)|
Paulus A , Lousberg L , Duysinx B , Sibille A , Duquenne JB , JL Corhay , Louis R , Vaillant F
Rev Med Liege 2021, 76(5-6),452-457
Summary : Small cell lung cancer is a malignant tumour with a poor prognosis. Standard treatment of metastatic stages has been a platinum doublet since 1980, but the addition of immunotherapy has improved prognosis. For locally advanced stages, the combination of radio-chemotherapy remains the treatment of choice, with no evidence at present of the value of immunotherapy in consolidation, and for localized stages, surgery is the first-line therapy. Unfortunately, in the second line, we have no other molecule than the topotecan despite several studies. Prophylactic brain irradiation remains debated even if it has been validated in localized forms. Finally, there is hope with targeted therapy following the development of subtypes of small cell lung cancer but studies remain difficult to conduct.
|Targeted therapies for non-small cell lung cancer : state of the art in 2021 (2021)|
Sibille A , Corhay JL , Vaillant F , Paulus A , Louis R , Duysinx B
Rev Med Liege 2021, 76(5-6),458-463
Summary : The majority of non-small cell lung cancers are diagnosed as advanced disease. Subsets of adenocarcinomas and of squamous cell carcinomas in nonsmokers present a molecular aberration leading to tumour survival. Epidermal Growth Factor Receptor (EGFR), Anaplastic Lymphoma Kinase (ALK) and Repressor Of Silencing1 (ROS1) have been identified and targeted with good efficacy for fifteen years. Newer inhibitors brought even greater efficacy with a generally better tolerability. Other molecular aberrations (Kirsten Rat Sarcoma, Rearranged during Transfection, MET, NeuroTrophic Receptor yrosine kinase) are targets for newly developed, more selective drugs. As more and more patients will benefit from targeted therapies, the identification of molecular aberration is more than ever crucial for optimal lung cancer patient care.
|Allogeneic hematopoietic stem cell transplantation : general principles and recent progress (2021)|
Narinx J , Servais S , Baron F , Beguin Y , Willems E
Rev Med Liege 2021, 76(5-6),464-469
Summary : Hematopoietic stem cell transplantation is a potentially curative therapeutic option for many oncologic and non-oncologic hematological diseases. There is a constant evolution regarding donor choice, conditioning regimen intensity and immunosuppressive treatments, which leads to a reduction in morbidity and mortality during and after transplantation. In this article, we describe the general principles of hematopoietic stem cell transplantation and discuss the progress of global patient management after transplantation.
|Overview of the general management of acute leukemia for adults (2021)|
De Voeght A , Jaspers A , Beguin Y , Baron F , De Prijck B
Rev Med Liege 2021, 76(5-6),470-475
Summary : Acute leukemias are a heterogeneous group of malignant hemopathies which are subdivided according to the cytological orientation of the pathological blast cell into lymphoblastic (ALL) and myeloblastic (AML) acute leukemias. Recent advances in the biological and genetic understanding of these diseases have led to improved treatments. Specific chemotherapy treatment or so-called «targeted» treatments, advances in bone marrow transplantation and better supportive care have gradually improved the prognosis. This review, focused on the adult patient, aims to describe recent progress in terms of diagnosis, prognostic markers and therapy.
|Diffuse large B-cell lymphoma: a revolutionary treatment based on genetically-modified immune cells called CAR T cells (2021)|
Maquet C , Beguin Y , De Prijck B , Willems E , Servais S , Bonnet C
Rev Med Liege 2021, 76(5-6),476-481
Summary : Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. Firstline immunochemotherapy cures approximatively 60 % of patients. The prognosis of patients with refractory disease or with relapsed disease within the first two years after the end of treatment is highly unfavourable. Since June 2019, a new third-line treatment with CAR T cells (chimeric antigen receptor T cells) seems to completely modify the prognosis of these patients. A significant proportion of long-lasting complete responses is obtained with this revolutionary treatment. Quick specialized intervention is required for the unique side effects of this therapy.
|Multiple myeloma : an overview of advances in biology and treatment (2021)|
Vrancken L , Lejeune M , Pirotte M , Duray E , Köse M , Beguin Y , Caers J
Rev Med Liege 2021, 76(5-6),482-487
Summary : Multiple myeloma is the second most common hematological malignancy, characterized by an uncontrollable proliferation of clonal plasma cells. Although progresses in understanding its pathobiology and its treatment are made every day, it remains incurable. Since myeloma is more and more common, especially in the elderly, we would like to propose an overview of its pathobiology, diagnostic criteria and treatment «guidelines».
|Melanoma : the patient’s care pathway. From diagnosis to therapy (2021)|
Absil G , Damsin T , Lebas E , Libon F , Somja J , Collins P , Reginster MA , Quatresooz P , Rorive A , Marchal N , Jacquemin D , Bous A , Piret P , Nikkels AF
Rev Med Liege 2021, 76(5-6),489-495
Summary : The management of melanoma is a typical example of a pluridisciplinary approach, in order to provide the patient with a rapid and adequate treatment plan after the initial diagnosis. Both in the domains of dermatology, pathology and oncology, enormous progress has been made. Recent advances permit a rapid access to diagnostic techniques using teledermoscopy, an improved diagnostic accuracy using dermoscopy, pre-interventional high-frequency ultrasound and optical coherence tomography, a determination of risk factors using immunohistochemistry and genetic analyses on the pathology samples. Furthermore, the development of immunotherapies, in particular the anti-PD1 antibodies, and the directed therapies, therapies permitting an increased number of patients to experience an increased survival with an acceptable tolerance profile in the event of metastatic lesions. This article describes the patient’s care pathway, from the initial diagnosis, staging, to an eventual treatment and follow-up.
|Management of metastatic hormone-naive prostate cancer at diagnosis (2021)|
Colassin A , Denis C , Hermesse J , Waltregny D , Sautois B
Rev Med Liege 2021, 76(5-6),496-501
Summary : In Belgium, 12 % of patients present with upfront metastatic hormone-naive prostate cancer. Surgical or medical castration has been the only approved treatment for decades. Since 2014, several randomized trials have demonstrated that survival could be significantly improved in patients who are deemed fit enough to cope with the potential added side-effects. Docetaxel chemotherapy and androgen receptor axis-targeted next generation hormonal agents such as abiraterone, enzalutamide and apalutamide have been shown to improve overall survival when given within 12 weeks after castration initiation. Similarly, prostate radiotherapy, in the absence of urological contraindications, might also improve overall survival in patients presenting with less than 5 bone metastases. How these strategies can be combined remains a matter of debate and is currently under investigation.
|Breast cancer : individualized risk assessment for tailor-made screening (2021)|
Bleret V , Cusumano P , Danthine D , Desreux J , Houet E , Remacle N , Lifrange E
Rev Med Liege 2021, 76(5-6),502-506
Summary : Breast cancer is the leading cause of neoplastic death in women around the world. In the era of personalized medicine, legitimately awaited by our patients, the future of breast cancer screening will depend on an individual-based risk assessment, making it possible to better adapt the age of onset, frequency and the type of examinations useful for this screening. This article reviews the three broad categories of highest risk factors available to establish a risk score appropriate for each patient.
|Locally-advanced cervix cancer : multidisciplinary management (2021)|
Lapaille L , De Cuypere M , Goffin F , Kakkos A , Gonne E , Hermesse J , Lovinfosse P , Delbecque K , Thille A , Kridelka F , Gennigens C
Rev Med Liege 2021, 76(5-6),507-514
Summary : Cervical cancer is the fourth most common cancer in women and is linked in over 95 % of cases to papillomavirus infection, the incidence of which has fallen in recent years due to screening and vaccination. Almost half of these cancers are diagnosed at a locally advanced stage with an overall 5-year survival of around 65 %. In recent decades, the management strategy of these locally advanced cancers has changed considerably and has allowed the improvement of survival but above all of local control as well as the reduction of toxicity, due to the implementation of imaging. Standard treatment consists of external beam radiation therapy combined with concomitant chemotherapy followed by intrauterine brachytherapy. The role of neo-adjuvant and adjuvant chemotherapy is still being evaluated. New therapeutic approaches (particularly immunotherapy) in addition to standard treatment are also being studied.
|«Watch and Wait» strategy in the management of rectal adenocarcinoma (2021)|
Labille V , Louis E , Loly C
Rev Med Liege 2021, 76(5-6),515-518
Summary : Currently, the standard management of locally advanced adenocarcinoma of the middle and lower rectum consists in first intention of pre-operative radio-chemotherapy. This treatment is then usually followed by rectal surgery with removal of the mesorectum. The local recurrence rate is quite low, but at the cost of a non negligible morbidity (urinary, anal and sexual functional sequelae). This raises the question of a possible sparing of surgery and therefore organ preservation in well selected patients with a complete response after radio-chemotherapy. The Brazilians are pioneers in this field. Already in 2004, their publications suggested that the «Watch and Wait» strategy was safe and effective in patients with a complete clinical response. Other publications have followed and tend to confirm that there is no oncological risk in proposing a «watch and wait» strategy for these well selected patients in complete clinical, endoscopic and iconographic remission on the basis of magnetic resonance imaging (MRI). In these conditions, an attentive surveillance strategy allows to avoid operative morbi-mortality without oncological compromise. Monitoring is therefore multi-modal, clinical and endoscopic, but also based on MRI
|Multidisciplinary management of the primary liver cancers (2021)|
Detry O , Troisfontaine F , Meurisse N , Delwaide J , Lamproye A , Warling O (3), Jadoul A (4), Loly C (3), Collignon J (2), pour le Centre Universitaire Liégeois des Tumeurs Hépatiques (CULTHE)
Rev Med Liege 2021, 76(5-6),519-524
Summary : In Belgium and around the world, the incidence of primary malignant liver tumours is increasing, both for hepatocarcinoma and cholangiocarcinoma. Their curative treatment is based on multidisciplinary and specialized care, of which surgery (including liver transplantation) remains the cornerstone, often associated with other logoregional treatments, as radioembolisation, radiofrequency ablation, and chemoembolisation. For advanced cases, the prognosis remains poor, in particular due to a certain chemoresistance of these tumours. New treatments include targeted therapies (including various tyrosine kinase inhibitors) and immunotherapy. A specialized multidisciplinary discussion is therefore necessary to define the best therapeutic management, individualized to each patient. In this article, the authors review the most recent data relating to the treatment of hepatocarcinoma and cholangiocarcinoma.
|Pre-malignant and malignant diseases of the pancreas, a centralized and multidisciplinary approach (2021)|
Meurisse N , Postal A, Dresse D , Geurde B , Honoré P , De Roover A
Rev Med Liege 2021, 76(5-6),525-529
Summary : The incidence of pancreatic cancer has doubled during the past three decades. Pancreatic cancer is projected to become the second leading cause of cancer-related death by 2030. Overall 5-year survival is less than 10 %. It is thus of paramount importance to identify patients at risk to develop pancreatic cancer. The “pancreatic emergency route” and the weekly-organized complex surgery consultations are essential for fast and coordinated investigations for patients diagnosed of a pancreatic lesion. Pancreatic surgery, often preceded by neoadjuvant therapy, remains the only curative treatment if applicable. Implemented to decrease surgical morbidity and mortality, current centralization limits pancreatic resection surgery to a restricted numbers of expert centres in Belgium. Thanks to a close collaboration with the CHR of Liège, the CHR of Huy, the CHR of Bois de l’Abbaye, the Clinique André Renard and Vivalia, the reference centre of the CHU of Liège offers surgical, intensive, anaesthetic, oncological, gastroenterological, radiological and paramedical cares as part of a multidisciplinary approach characterized by expertise in the treatment of adenocarcinoma of the pancreas, 24 hours a day and 7 days a week.
|Pre-malignant and malignant diseases of the esophagus, a centralized and multidisciplinary approach (2021)|
Kohnen L , Honoré P , Kotzampassakis N , Dresse D , Legrand M , Loly JP , De Roover A
Rev Med Liege 2021, 76(5-6),530-534
Summary : Esophageal cancer is the 19th most common cancer in the European Union. Its prognosis remains poor with a 5-year survival rate estimated between 15 % and 25 %. Accurate diagnosis and pre-therapeutic assessment are essential and should allow a rapid start of therapy. Current treatment is based on multimodal management of which surgery remains the cornerstone. Since 2019, Belgium has started an agreement to centralize esophageal surgery in order to improve surgical outcomes. One year after implementation of centralization, our centre shows a low rate of severe complications (Clavien-Dindo classification IIIb-V) of 20 % and a 0 % mortality rate at 30 and 90 postoperative days. Our patients have benefited from a full minimally invasive or hybrid surgical procedure, contributing to those positive results. In the future, all our efforts must be done to improve collaboration between hospitals in order to provide best medical and surgical treatments.
|What follow-up after pediatric cancer ? The SALTO consultation experience (2021)|
Fohn A , Quenon C , Jacquemin C , David B , Florkin B , Forget P , Gatineau S , Longton J , Sondag C , Malpas C , Dresse MF , Piette C
Rev Med Liege 2021, 76(5-6),535-540
Summary : During the past 50 years, the mortality due to childhood cancers decreased dramatically thanks to improvements in supportive care and the use of multimodal approaches. In this context, the long-term follow up after childhood cancer has become a main concern for pediatric oncologists. The SALTO programme was developed in 2012 at the CHR Citadelle in Liège in order to organize a multidisciplinary long-term follow-up for the patients previously treated in our department for a childhood cancer. The aim of the present study was to review, for the most frequent childhood cancers, the long-term sequellae and the second cancers developed by the patients participating to the SALTO programme in order to define the follow-up needed. Our data confirm the importance of a multidisciplinary long-term follow-up, based on the treatments received and following international guidelines.
|Long-term follow-up of survivors of cancer : general practitioner’s role and resources (2021)|
Duchesnes C , Quenon C , Roblain F , Giet D
Rev Med Liege 2021, 76(5-6),541-544
Summary : More and more patients surviving cancer consult again their general practitioner for various reasons. The aim of this article is to consider ways to reinforce the role of the general practitioners in the follow-up protocol. Two candidates for general practice synthetized, based on literature review, cancer follow-up information of childhood cancer, breast and colorectal cancers. Their concise presentations are examples of useful documents for their colleagues. The general practitioner must receive all information concerning the cancer disease, the treatment and the agenda of the follow-up examinations to guarantee continuity of care. Collaboration between general practitioners and cancer specialists is necessary to provide best care to the patients, to share clear and relevant information and to train future general practitioners.
|Contribution of physical rehabilitation to cancer follow-up (2021)|
Lambrigts C , Kaux JF , Maquet D
Rev Med Liege 2021, 76(5-6),545-549
Summary : The number of people with cancer is constantly increasing. Thanks to new screening techniques and treatment protocols, the number of survivors is also increasing. However, treatments cause some undesirable side effects that usually persist over time. The level of physical activity of these patients tends to decrease with the diagnosis of cancer and does not usually increase before the end of the treatments or even beyond. However, physical activity is beneficial not only in terms of preventing the progression or recurrence of the disease but also in the fight against side effects related to the disease and its treatments. There are various physical activity recommendations for cancer survivors that will be developed in this article. The project «Sport après cancer. Citoyen sportif, j’agis pour ma santé», developed by the University and the University Hospital of Liège, aims to promote adapted physical activity after cancer, creating a link between outpatient rehabilitation in a hospital setting and the practice of physical activity in a sporting and associative context.
|Bring back a smile after oral cancer, it’s possible ! (2021)|
Urrea Juan V , Salhi L , Lamy M
Rev Med Liege 2021, 76(5-6),550-553
Summary : Treatments for oral cancer can seriously impair the function and the aesthetic, and thus contribute to a significant reduction in the quality of life of affected patients. The role of prosthetic dentists in the multidisciplinary management of these patients is essential both in oral rehabilitation and in prosthetic planning and subsequent rehabilitation. Therefore, these dentists should be involved in the care pathway in order to shape and design the further oral rehabilitation prior to reconstructive surgery and ultimately make the patient smile again.
|Dental management of head and neck irradiated patients (2021)|
Piret P , Coucke PA
Rev Med Liege 2021, 76(5-6),554-558
Summary : The oncological management of head and neck tumours is well known and standardized. Radiotherapy is one of the effective tools. However, it induces major changes in healthy tissues: teeth, gums, mucous membranes, salivary glands and bones. Some, like mucositis, are immediate and often reversible; others, like hyposialia or fibrosis, are late effects and often irremediable. These changes greatly affect oral health and make its management more complex. Dental management also becomes a capital element of the care path but, unfortunately, often remains neglected by the patient but also by some practitioners. It concerns all the stages of the clinical course: initial assessment, cancer treatment itself and long-term follow-up. If neglected, the patient’s quality of life will be affected and complications, sometimes serious, such as osteoradionecrosis, may occur. Specific care recommendations for maintaining oral health are mentioned, especially for those patients requiring oral cavity irradiation.
|Well-being center in CHU of Liege : interest for oncological patients and their families (2021)|
Paye A , Faymonville ME , Devos M
Rev Med Liege 2021, 76(5-6),559-564
Summary : Although conventional medicine has made considerable progress in the treatment of cancer, this disease remains a distressing experience for patients who may feel they are losing control of their live. In response to this need for autonomy over their therapeutic choices and their health, some patients turn to complementary and alternative medicine. Some oncology care centres therefore complete their offer of care by providing patients with a well-being centre where activities focusing on the well-being and comfort of the person are offered. In order to ensure that the needs of people are met, a survey was carried out among 82 patients attending the oncology day hospital and the radiotherapy department. The results enabled us to establish an action plan in line with the patients’ wishes with a view to creating a well-being centre named OASIS, which will be located in the heart of the Arsène Burny Cancer Institute at the CHU of Liège. The different activities organised around psycho/corporal and bodily/psychological axes are presented in this article.
|Appropriate care at the end of life : insuring quality of life (2021)|
Serre CH , Brichant G , Devos M , EMSCP , Barthelemy N
Rev Med Liege 2021, 76(5-6),565-568
Summary : Progress of medical knowledge pushed the limits of medicine. This raises major ethical issues. The Belgian lawmaker, concerned to ensure the observance of Human Rights, attempted to regulate some of these issues. It remains essential to listen to the patient and to respect his/her will. Likewise, defining therapeutic goals based on patient’s values and priorities is crucial until the end of patient’s life.