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See detailVirtual reality: A tool in the treatment of anxiety in stereotaxic radiotherapy?
Gamin, Nicolas ULiege; JANSEN, Nicolas ULiege; COUCKE, Philippe ULiege et al

Poster (2019, May 14)

Stereotaxic radiotherapy (SR) is an effective treatment for many types ofcancer but seems to cause anxiety. The purpose of this study is to determine whether experiencing the medical procedure by using ... [more ▼]

Stereotaxic radiotherapy (SR) is an effective treatment for many types ofcancer but seems to cause anxiety. The purpose of this study is to determine whether experiencing the medical procedure by using immersive virtual video can reduce preoperative anxiety. The experimental group (n=10) received information about the intervention and was exposed three times to the procedure before the SR. Two immersions took place in the days precedingthe intervention and the third took place just before the SR. The control group (n=10) only received information about the intervention. The STAI Y-A scale was used to measure state anxiety before and after each virtual immersion in the experimental group and just before and after the SR in both groups. We observed a similar decrease in anxiety across groups, which did not differ between them. Despite this result, it is important to point out that the experimental group reported a significant decrease in anxiety after the two immersions of day 1. The third immersion was not accompanied by a decrease of it. In conclusion, virtual reality seems useful in the treatment of preoperative anxiety, but its use is not enough to neutralize patient’s anxiety when approaching treatment [less ▲]

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See detailTumor modifications recorded with IVIM and DCE-MRI after Neoadjuvant radiotherapy.
LALLEMAND, François ULiege; LEROI, Natacha ULiege; Bahri, Mohamed Ali ULiege et al

in Radiotherapy and Oncology (2019, April), 133(Supplement 1), 284-285

Purpose or Objective Neoadjuvant radiotherapy (NeoRT) improves tumor local control and facilitates tumor resection in many cancers. We hypothesized anti-cancer treatments (i.e. radiotherapy) modify tumor ... [more ▼]

Purpose or Objective Neoadjuvant radiotherapy (NeoRT) improves tumor local control and facilitates tumor resection in many cancers. We hypothesized anti-cancer treatments (i.e. radiotherapy) modify tumor microenvironment and could potentially impact distant metastases occurrence. Previously, we developed a pre-clinical model demonstrating an impact of NeoRT schedule and the timing of surgery on metastatic spreading (Leroi et al. Oncotarget 2015). Here, we aim to identify by fMRI noninvasive markers reflecting NeoRT related tumor microenvironment modifications that could predict the best timing for performing surgery and avoiding tumor spreading. Material and Methods To briefly delineate the NeoRT model, MDA-MB 231 tumor cells implanted in the flank of SCID mice were locally irradiated with 2x5Gy when tumor reached 100mm3 and then surgically removed at different time points. We performed fMRI, Diffusion Weighted (DW) and Dynamic Contract enhancement (DCE) – MRI, before RT and every 2 days between RT and surgery. We acquired 8 slices of 1 mm thickness and 0.5 mm gap with an “in plane voxel resolution” of 0.5 mm. For DW-MRI, we performed FSEMS (Fast Spin Echo MultiSlice) sequences, with 9 different Bvalue (from 40 to 1000) and B0. We performed IVIM (IntraVoxel Incoherent Motion) analysis to obtain information on intravascular diffusion, related to perfusion (F: perfusion factor) and subsequently tumor vessels perfusion. For DCE-MRI, we performed a T1 mapping with multiple TR and DCE acquisition with 200 repetitions of 3 sec each and gadolinium IV injection after 10 repetitions. We performed semi-quantitative analysis. We validated tumor perfusion by immunochemistry with injection of FITC-dextran IV 3 min before surgery and CD31 labelling. Human Ki67 was used for lung metastases labelling and quantification. Results After the tumor irradiation, we observed a significant and transient increase at day 6 (60% of the basal value (n=6, p<0,05)) of F and D* parameters related to perfusion. The other parameters of the DW-MRI, ADC and D presented no modifications. The sham irradiated tumors used as control showed no modifications of all fMRI parameters. At the same timing, 6 days post-radiotherapy, DCE-MRI significantly demonstrated a WhashinSlope (n=13, p<0,05) increase. Immunochemistry confirmed the increase of tumor perfusion when surgery is performed at day 6. The sham irradiated tumors never demonstrated such changes. Finally, when surgery is performed on tumor increased perfusion measured by fMRI, it demonstrated a burst of lung metastasis compared to the other timings. Conclusion We showed a significant difference in perfusion-related parameters with fMRI and immunochemistry at a specific time point after NeoRT. These modifications are correlated with an increase of metastasis spreading related to surgery procedure. These results open new perspectives in the personalized medicine and MRI guided surgery timing after NeoRT. [less ▲]

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See detailExercise and Education Program After Breast Cancer: Benefits on Quality of Life and Symptoms at 3, 6, 12, and 24 Months' Follow-up
LECLERC, Anne-France ULiege; Slomian, Justine ULiege; JERUSALEM, Guy ULiege et al

in Clinical Breast Cancer (2018), 18(5), 1189-1204

BACKGROUND: Various clinical trials show benefits of physical training offered during and / or after breast cancer treatments. However, given the variety of side effects that may be encountered, physical ... [more ▼]

BACKGROUND: Various clinical trials show benefits of physical training offered during and / or after breast cancer treatments. However, given the variety of side effects that may be encountered, physical training could be combined with psychological, relational and social guidance. This kind of multidisciplinary program, just like their long-term effects, have been little studied so far. Therefore, the objective of our study is to determine the benefits at 3, 6, 12 and 24 months of a three-month exercise and education program among women after breast cancer treatment. MATERIALS AND METHODS: Two hundred and nine outpatients who have been treated for a primary breast carcinoma were divided into a control group (n=106) and an experimental group (n=103) which has benefited from a three-month rehabilitation program including physical training and psycho-educational sessions. The assessments, performed before the program and at 3, 6, 12 and 24 months after inclusion, included validated questionnaires on quality of life and symptoms. RESULTS: The analyses show an improvement in quality of life and symptoms following the exercise and education program within the experimental group and a maintenance of these improvements during the two years of follow-up. These improvements are significantly superior to those presented in the control group, demonstrating the programs benefits. CONCLUSIONS: This trial identifies the benefits of a well detailed three-month exercise and education program over a follow-up of 24 months among women after breast cancer treatment. [less ▲]

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See detailTumor microenvironment modifications recorded with IVIM perfusion analysis after radiotherapy.
LALLEMAND, François ULiege; LEROI, Natacha ULiege; Bahri, Mohamed Ali ULiege et al

in Radiotherapy and Oncology (2018, April), 127(Supplement 1), 1285-1286

Purpose or Objective Neoadjuvant radiotherapy (NeoRT) improves tumor local control and facilitates tumor resection in many cancers. The timing between the end of the NeoRT and surgery is driven by the ... [more ▼]

Purpose or Objective Neoadjuvant radiotherapy (NeoRT) improves tumor local control and facilitates tumor resection in many cancers. The timing between the end of the NeoRT and surgery is driven by the occurrence of side effects or the tumor downsizing. Some clinical studies demonstrated that the timing of surgery and the RT schedule influence tumor dissemination and subsequently patient overall survival (Acta Oncol 2006). Previously, we developed a pre-clinical model demonstrating an impact of NeoRT schedule and the timing of surgery on metastatic spreading (Oncotarget 2015). Here, we used functional MRI (fMRI) to record tumor microenvironment modifications after NeoRT. We aim to get non-invasive markers to establish the best timing to perform surgery and avoiding tumor spreading. Material and Methods Based on our NeoRT model, MDA-MB 231 and 4T1 cells were implanted in the flank of SCID and BalbC mice, respectively. We locally irradiated (PXI, X-Rad SmART) tumors with 2x5Gy and then surgically removed at different time points after RT. We acquired fMRI (9,4T Agilent) before and after RT. Diffusion Weighted (DW) - MRI was performed every 2 days between RT and surgery. For each tumor, we acquired 8 slices of 1 mm thickness and 0.5 mm gap with an "in plane voxel resolution” of 0.5 mm. For DW-MRI, we performed FSEMS (Fast Spin Echo MultiSlice) sequences, with 9 different B-value (from 40 to 1000) and B0, in the 3 main directions. We performed IVIM (IntraVoxel Incoherent Motion) analysis to obtain information on intravascular diffusion, related to perfusion (F: perfusion factor) and subsequently tumor vessels perfusion. Results With the MDA-MB 231, we observed a significant and transient increase (60% of the basal value (n=6, p<0,05)) of F and D* parameters related to perfusion. The other parameters of the DW-MRI, ADC and D presented no modification. We observed similar results with 4T1 cells, where F increased at day 3 (55% of the basal value, n=10, p<0,05) then returned to initial level. The difference in timing for the peak of F (day 6 vs day 3) could be related to the difference in tumor growth according to the cell line (four weeks for MDA-MB 231 cells vs one week for 4T1 cells). We also observed a decrease of hypoxia (pimonidazole staining) when surgery was performed on the peak but vascular architecture was not affected. Moreover, performing surgery during F and D* peak, in the MDA-MB 231model, is associated with an increase of lung metastases: 115% and 187% compared to a surgery performed before or after the peak. Conclusion We demonstrated the feasibility of repetitive fMRI imaging in preclinical models after NeoRT. We showed a significant difference in perfusion-related parameters (D* and F) at a specific time point depending of tumor cells correlated with tumor metastases. We demonstrated the feasibility of Image Guided Surgery for decreasing tumor metastases after NeoRT. [less ▲]

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See detailBrain modifications after stereotactic radiotherapy recorded by Functional MRI.
LALLEMAND, François ULiege; LEROI, Natacha ULiege; Bahri, Mohamed Ali ULiege et al

in Radiotherapy and Oncology (2018, April), 127(Supplement 1), 582

Purpose or Objective Brain irradiation is commonly used in malignant diseases (i.e. metastases or Glioblastoma) and in benign diseases (i.e. meningioma, epilepsy, vestibular schwannoma or Parkinson ... [more ▼]

Purpose or Objective Brain irradiation is commonly used in malignant diseases (i.e. metastases or Glioblastoma) and in benign diseases (i.e. meningioma, epilepsy, vestibular schwannoma or Parkinson disease). The use of stereotactic radiosurgery (SRS) allows the administration of very high doses in a single fraction (e.g. 120Gy), in a small brain volume. After irradiation, morphological and functional cerebral changes occur depending on the total dose, dose per fraction and the irradiated brain volume. The aim of this work is to use f-MRI to record adult normal brain tissue modification after irradiation with different radiotherapy doses and schedules and to identify new parameters of brain radio-damages. Material and Methods With a dedicated small animal radiotherapy device allowing IGRT (PXI, X-Rad SmART), we specifically irradiated with a 2mm-collimator, mimicking SRS, a small part of adult brain mice (n=72), known to have no impact on vital function, with dose schedules: 1X20Gy, 3X10Gy, 4X5Gy and no RT as control. We imaged brain mice longitudinally with a dedicated 9.4-T MRI (Agilent). Imaging was realized once before as reference level and after irradiation every month for the first 6 months and every 3 months during one year. For each mouse we acquired 14 slices of 1 mm thickness and 0.5 mm gap with an “in plane voxel resolution” of 0.5 mm. We performed T1-weighted, T2-weighted, T1-mapping, T2-mapping and DW-MRI. For DW-MRI, we performed Fast Spin Echo MultiSlice sequences, with 9 different B-value and B0 (from 20 to 1000). We performed IntraVoxel Incoherent Motion (IVIM) analysis to obtain information on intravascular diffusion, related to perfusion (F: perfusion factor). Results Only mice irradiated with 120Gy showed brain modifications in T1 and T2 anatomic images and in T1 mapping, ADC, D and F but no changes were recorded in D* or T2 mapping. All these changes started 5 weeks after SRS and then stabilized after 7 weeks. The mean values for the control group were stable during the 5 months (ADC 0,73μm²/ms; D 0,66μm²/ms; F 4,67%, T1 1,25 sec). For the 120Gy group, values were significantly higher after 5 weeks (Δ = compared to the control group) with ADC 1,66μm²/ms (Δ=151%); D 1,37μm²/ms (Δ=107%); F 18,84% (Δ=303%); T1 1,99 sec (Δ=59%). No specific behaviour changes were observed during all the experiment. Conclusion In this work, we studied normal brain modifications after SRS therapy with anatomical and functional MRI. SRS doses and schedules in this work reflected those used in clinic for tumor treatment or functional SRS. We showed an increase of ADC value 5 weeks after one single dose of 120Gy, compared to normal brain tissue. These results are consistent with radio-necrosis. In addition, we highlighted an increase of IVIM parameters D and F and an increase of T1 mapping in radio-necrosis area. These results increase the numbers of MRI parameters that could be used for following brain damage after radiation. [less ▲]

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See detailA simple clinical method for predicting the benefit of prone vs. supine positioning in reducing heart exposure during left breast radiotherapy
Kahan; Rarosi, Ferenc; Gaal, Szilvia et al

in Radiotherapy and Oncology (2018)

Background and purpose: The benefit of reduced radiation heart exposure in the prone vs. supine position individually differs. In this prospective cohort study, the goal was to develop a simple method for ... [more ▼]

Background and purpose: The benefit of reduced radiation heart exposure in the prone vs. supine position individually differs. In this prospective cohort study, the goal was to develop a simple method for the operation of a validated model for the prediction of preferable treatment position during left breast radiotherapy. Material and methods: In 100 cases, a single CT slice was utilized for the collection of the needed patientspecific data (in addition to body mass index, the distance of the LAD from the chest wall and the area of the heart included in the radiation fields at the middle of the heart in the supine position). Outcome was analyzed in relation to the full CT series acquired in both positions and dosimetric data. Results: Great consistency was found between the tested and original method regarding sensitivity and specificity. The prioritization of LAD dose, and the use of heart dose and position-specific dose constraints as safety measures ensure sensitivity and specificity values of 82.8% and 87.3%, respectively. In an additional ‘‘routine clinical practice” series of 60 patients the new method seemed feasible in routine clinical practice. External testing on a 28-case series indicated similar accuracy. Conclusion: We consider this simple clinical tool appropriate for assisting individual positioning aiming at maximum heart protection during left breast irradiation [less ▲]

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See detailI have a dream… Et si nous rêvions de nouvelles approches en oncologie?
COUCKE, Philippe ULiege

in Onco: Revue Multidisciplinaire d'Oncologie (2018), 12(3), 3

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See detailNecessite d'un nouvel ecosysteme en sante... Tous les elements sont deja disponibles.
Coucke, Philippe ULiege; Coucke-Gilson, L.

in Revue medicale de Liege (2018), 73(9), 454-461

The key performance indicators in healthcare illustrate that the system we run nowadays is no longer sustainable. There is an urgent need for fundamental changes within the current ecosystem, if we want ... [more ▼]

The key performance indicators in healthcare illustrate that the system we run nowadays is no longer sustainable. There is an urgent need for fundamental changes within the current ecosystem, if we want to maintain or improve the levels of quality, security and equity in healthcare. Disruptive technologies profoundly modify all domains of our society. Those changes, driven by technical convergence, are particularly rapid and extensive in the fields such as big data and analysis, artificial intelligence, cloud and blockchain. These continuously evolving technologies could potentially offer opportunities to efficient problem solving in the health care sector. The culture of our organizations needs major changes and especially adaptability and fast speed integration to a process which is inevitable. [less ▲]

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See detailNHL-ChirEx: An interprofessional cross-border education initiative in the Greater Region with a focus on radiation morbidity and patient safety
Vogin, Guillaume; Fleckenstein, Jochen; Servotte, Jean-Christophe ULiege et al

in Radiotherapy and Oncology (2018)

NHL-ChirEx is an interprofessional cross-border education initiative that addresses the potential excess of radiation induced morbidity.

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See detailPeut-on considérer que la radiothérapie agit en dehors du site irradié ? L'effet abscopal.
Pleyers, C.; Piret, P.; RORIVE, Andrée ULiege et al

in Revue Médicale de Liège (2018), 73(1), 17-21

Radiotherapy is known for its action on local tumoral control. However, it is also able to induce immunomodulatory effects at a systemic level. The abscopal effect (from latin ab scopus which means <<away ... [more ▼]

Radiotherapy is known for its action on local tumoral control. However, it is also able to induce immunomodulatory effects at a systemic level. The abscopal effect (from latin ab scopus which means <<away from the target>>) is an illustration of this phenomenon. It is defined as a tumor regression observed outside and at a distance of the irradiation fields. The potential application of this effect of treatment in disseminated cancers is a fast-growing field of research. The optimal therapeutic strategy to achieve this effect remains unknown. [less ▲]

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See detailMultidisciplinary rehabilitation program after breast cancer: benefits on physical function, anthropometry and quality of life.
Leclerc, Anne-France ULiege; Foidart-Dessalle, Marguerite ULiege; Tomasella, Marco ULiege et al

in European Journal of Physical and Rehabilitation Medicine (2017), 53(5), 633-642

BACKGROUND: Different clinical trials show beneficial effects of physical training offered during and / or after breast cancer treatment. However, given the variety of side effects that may be encountered ... [more ▼]

BACKGROUND: Different clinical trials show beneficial effects of physical training offered during and / or after breast cancer treatment. However, given the variety of side effects that may be encountered, physical training could be combined with psychological, relational and social guidance. This kind of multidisciplinary program has been little studied so far. AIM: To determine the benefits of a three-month multidisciplinary rehabilitation program among women after breast cancer treatment. DESIGN: Controlled no-randomized trial. SETTING: University for outcomes, University Hospital Center for interventions. POPULATION: Two hundred and nine outpatients who have been treated for a primary breast carcinoma. METHODS: Patients were divided into a control group (n=106) and an experimental group (n=103) which has benefited from a rehabilitation program of three months including physical training and psycho-educational sessions. The assessments, performed before and after the program, included functional assessments ("Sit and Reach Test", maximal incremental exercise test and "Six-Minute Walk Test"), body composition measurements (body mass index (BMI) and body fat percentage) and a questionnaire (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30). RESULTS: After three months, flexibility, walking distance and all parameters measured during the maximal incremental exercise, except maximal heart rate, were significantly improved in the experimental group. The body fat percentage was significantly decreased and a significant improvement was observed for perceived health status (quality of life), functional role, emotional state, physical, cognitive and social functions and for most symptoms. In the control group, most of these improvements didn't appear and a significant increase in BMI and body fat percentage was observed. CONCLUSIONS: This trial identifies the benefits of a well detailed multidisciplinary rehabilitation program, including physical re-conditioning and psycho-educational sessions, with important improvements in functional capacity, body composition and the majority of functions and symptoms among women after breast cancer treatment. CLINICAL REHABILITATION IMPACT: Through its results, this study could contribute to the development of hospital quality standards for oncologic rehabilitation. Physiotherapists can efficiently propose this kind of multidisciplinary rehabilitation program. [less ▲]

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See detailMethodological approach for the implementation of a simulator in augmented reality in a radiation therapy department
Servotte, Jean-Christophe ULiege; Guillaume, Michèle ULiege; BOGA, Deniz ULiege et al

in International Journal of Healthcare Management (2017), 10(3), 154-159

Radiation therapy (RT) is one of the cornerstones for the treatment of cancer. In most countries RT machines are handled by professionals benefitting from an ad hoc training in theoretical knowledge as ... [more ▼]

Radiation therapy (RT) is one of the cornerstones for the treatment of cancer. In most countries RT machines are handled by professionals benefitting from an ad hoc training in theoretical knowledge as well as technical and non-technical skills. In Belgium, RT departments are hiring in nurses for this activity. In countries where there is a specified core curriculum for basic training of radiation technologist, this basic training falls short once in practice and there is an obvious requirement for a continuous updating of skills in order to keep up with the accelerating evolution of technology. Therefore, the decision has been taken to implement a simulator in augmented reality in the RT department in Liège, to face the double challenge i.e. basic professional training as well as continuous education in technical and nontechnical skills and Crew Resource Management. We describe a methodological approach to implement this simulator in augmented reality. [less ▲]

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See detailFollowing tumour microenvironment after Neoadjuvant radiotherapy with IVIM perfusion analysis.
LALLEMAND, François ULiege; LEROI, Natacha ULiege; Bahri, Mohamed Ali ULiege et al

in Radiotherapy and Oncology (2017, May), 123(Supplement 1), 545

Purpose or Objective Neoadjuvant radiotherapy (NeoRT) improves tumor local control and facilitates tumor resection in many cancers. The timing between the end of the NeoRT and surgery is driven by the ... [more ▼]

Purpose or Objective Neoadjuvant radiotherapy (NeoRT) improves tumor local control and facilitates tumor resection in many cancers. The timing between the end of the NeoRT and surgery is driven by the occurrence of side effects or the tumor downsizing. Some clinical studies demonstrated that the timing of surgery and the RT schedule influence tumor dissemination and subsequently patient overall survival. Previously, we developed a pre-clinical model demonstrating an impact of NeoRT schedule and the timing of surgery on metastatic spreading (Leroi et al. Oncotarget 2015). Here, we evaluate the impact of NeoRT on the tumor microenvironment by functional MRI (fMRI). We aim to identify non-invasive markers allowing to determine the best timing to perform surgery and avoiding tumor spreading. Material and Methods Based on our NeoRT model, MDA-MB 231 and 4T1 cells were implanted in the flank of SCID and BalbC mice, respectively. We locally irradiated tumors with 2x5Gy and then surgically removed at different time points after RT. Diffusion Weighted (DW) -MRI was performed every 2 days between RT and surgery. For each tumors we acquired 8 slices of 1 mm thickness and 0.5 mm gap with an 'in plane voxel resolution” of 0.5 mm. For DW-MRI, we performed FSEMS (Fast Spin Echo MultiSlice) sequences, with 9 different B-value (from 40 to 1000) and B0, in the 3 main directions. We performed IVIM (IntraVoxel Incoherent Motion) analysis to obtain information on intravascular diffusion, related to perfusion (F: perfusion factor) and subsequently tumor vessels perfusion. Results With the MDA-MB 231, we observed a significant peak of F at day 6 after irradiation, this increasing is about 60% of the basal value (n=6, p<0,05). Moreover, D* parameters (also related to perfusion) increase at the same time. The other parameters of the DW-MRI, ADC and D presented no modification. We observed similar results with 4T1 cells, where F increased at day 3 (about 55%, n=10, p<0,05) then returned to initial level. The difference in timing for the peak of F (day 6 vs day 3) could be related to the difference in tumor growth according to the cell line (four weeks for MDA-MB 231 cells vs one week for 4T1cells). We performed surgery at the time of the F parameter peak in the MDA-MB 231 and we observed a decrease of the metastasic burden compared to surgery performed at day 4 or day 11(absolute number of metastasis 23 VS 1 VS 8 with n=4). Conclusion For the first time, we demonstrate the feasibility of repetitive fMRI imaging in preclinical models after NeoRT. With these models, we show a significant difference in perfusion-related parameters (D* and F) at a specific time point depending of the tumor cells. These modifications are correlated to a decrease of metastasis spreading related to the surgery procedure. These results open new perspectives in the personalized medicine and MRI guided surgery timing after NeoRT. [less ▲]

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See detailStereotactic Robotic Body Radiotherapy for Patients With Unresectable Hepatic Oligorecurrence
Berkovic, P.; GULYBAN, Akos ULiege; Nguyen, P. V. et al

in Clinical Colorectal Cancer (2017), 16(4), 349-3571

Micro-Abstract We present our retrospective study of 42 patients treated for hepatic oligorecurrence with stereotactic body radiotherapy using the CyberKnife system (Accuray Inc). Besides reporting on ... [more ▼]

Micro-Abstract We present our retrospective study of 42 patients treated for hepatic oligorecurrence with stereotactic body radiotherapy using the CyberKnife system (Accuray Inc). Besides reporting on acute and late toxicities, the influence of patient and lesion characteristics on local control, liver and distant progression-free survival, and overall survival were also investigated. Background The purpose of this study was to analyze local control (LC), liver progression-free survival (PFS), and distant PFS (DFS), overall survival (OS), and toxicity in a cohort of patients treated with stereotactic body radiotherapy (SBRT) with fiducial tracking for oligorecurrent liver lesions; and to evaluate the potential influence of lesion size, systemic treatment, physical and biologically effective dose (BED), treatment calculation algorithms and other parameters on the obtained results. Patients and Methods Unoperable patients with sufficient liver function had [18F]-fluorodeoxyglucose-positron emission tomography-computed tomography and liver magnetic resonance imaging to confirm the oligorecurrent nature of the disease and to further delineate the gross tumor volume (GTV). An intended dose of 45 Gy in 3 fractions was prescribed on the 80% isodose and adapted if risk-related. Treatment was executed with the CyberKnife system (Accuray Inc) platform using fiducials tracking. Initial plans were recalculated using the Monte Carlo algorithm. Patient and treatment data were processed using the Kaplan–Meier method and log rank test for survival analysis. Results Between 2010 and 2015, 42 patients (55 lesions) were irradiated. The mean GTV and planning target volume (PTV) were 30.5 cc and 96.8 cc, respectively. Treatments were delivered 3 times per week in a median of 3 fractions to a PTV median dose of 54.6 Gy. The mean GTV and PTV D98% were 51.6 Gy and 51.2 Gy, respectively. Heterogeneity corrections did not influence dose parameters. After a median follow-up of 18.9 months, the 1- and 2-year LC/liver PFS/DFS/OS were 81.3%/55%/62.4%/86.9%, and 76.3%/42.3%/52%/78.3%, respectively. Performance status and histology had a significant effect on LC, whereas age (older than 65 years) marginally influenced liver PFS. Clinical target volume physical dose V45 Gy > 95%, generalized equivalent uniform dose (a = −30) > 45 Gy and a BED (α/β = 10) V105 Gy > 96% showed statistically significant effect on the LC. Acute Grade 3 gastrointestinal (GI) and late Grade 2 GI and fatigue toxicity were found in 5% and 11% patients, respectively. Conclusion Favorable survival and toxicity results support the potential paradigm shift in which the use of SBRT in oligorecurrent liver disease could benefit patients with unresectable or resectable liver metastases. © 2017 Elsevier Inc. [less ▲]

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See detailLa «Health Literacy»,un moyen pour réduire les inégalités sociales de santé
Bragard, Isabelle ULiege; COUCKE, Philippe ULiege; Pétré, Benoît ULiege et al

in Revue Médicale de Liège (2017), 72(1),

Health literacy (HL) is defined as ‘the knowledge, motivation, and competences to access, understand, appraise and apply health information in order to make judgments and take decisions in everyday life ... [more ▼]

Health literacy (HL) is defined as ‘the knowledge, motivation, and competences to access, understand, appraise and apply health information in order to make judgments and take decisions in everyday life concerning health care, disease prevention and health promotion to maintain or improve quality of life’. This concept begins to be recognized as a priority area for action at political level in Belgium. Indeed, a limited HL may affect health by leading, by example, with poorer management of chronic diseases, more hospital admissions and premature deaths. This paper addresses the question of HL evaluation, improvement interventions as well as the many challenges that remain in this area. HL seems fundamental to the development of better health management. It would allow patients to play a more active role in health care, to involve all health stakeholders, and to contribute to a more sustainable health system. Improving HL could allow better equal access to health care. [less ▲]

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