Jean-François Baurain, Jean-Pascal Machiels, François DuhouxPublished in the journal : February 2017Category : Oncologie
Major advances in medical oncology were observed in 2016. This article highlights some of these advances. Firstly, a new therapeutic class, the CDK4/6 inhibitors (palbociclib, ribociclib), was discovered, arousing major interest. When combined with hormonotherapy, these inhibitors were shown to increase overall survival of ER-positive metastatic breast cancer patients by several months. Secondly, PARP inhibitors (niraparib) that block one of the two DNA repair mechanisms were shown active in all relapsing ovarian cancer patients with a response to platinum-based chemotherapy. Finally, immunotherapy is now generally regarded as an essential therapeutic modality in the treatment of cancer, with shapes of some survival curves suggesting that some patients could be definitely cured. Ipilimumab, an anti-CTL-4 antibody, was shown able to increase the global survival of resected Stage III melanoma patients at high risk of relapse. The combination of anti-PD1 and CTLA-4 antibodies proved superior to the respective monotherapies in the treatment of metastatic melanoma. Anti-PD1 antibodies currently represent the standard of care in the treatment of metastatic head and neck cancers, kidney cancers, and lung cancers. The administration of these antibodies was associated with a very specific, autoimmune toxicity, which was at times severe or even fatal if not recognized and treated early. All these treatments are presently accessible at the King Albert II Cancer Institute.
Edward Fomekong 1 MD ; Denis Dufrane 2 MD, PhD; Bruno Vande Berg 3 MD, PhD; Christian Raftopoulos 1 MD, PhDPublished in the journal : February 2017Category : Neurochirurgie
In 2016, the neurosurgery department of the Cliniques universitaires Saint-Luc, Brussels, published an application of a scaffold-free osteogenic three-dimensional (3D) graft made of adipose-derived mesenchymal stem cells (AMSCs) in patients undergoing minimally-invasive transforaminal lumbar interbody fusion (MI-TLIF). Three patients with degenerative spondylolisthesis were included in the study, one with Level 1 and two with Level 2 disease. In order to obtain AMSCs, fatty tissue was collected from the abdomen by means of liposuction and differentiated afterwards in our cell/tissue bank. Clinical outcomes, including the Oswestry Disability Index (ODI) and visual analog scale (VAS), as well as fusion status, were assessed preoperatively and for up to 12 months’ post-surgery. At 12 months, all four operated AMSC levels could be assessed (n= 4). Our results showed that Grade 3 fusion could be confirmed at two levels out of four. Mean VAS score improved from 8.3 to 2, and ODI also improved from 47% to 31%. No donor site complication was observed. This study demonstrated that a scaffold-free 3D graft made of AMSCs can be manufactured and used as a promising alternative for spinal fusion procedures. Nevertheless, further studies involving larger patient series are required in order to confirm the technique's effectiveness.
Although it was hoped for that joint replacement surgery would provide longer-lasting results through the development of uncemented implants and low-friction bearings, and despite its indications being extended to younger patients, total hip arthroplasty does not allow for an implant with sufficient longevity to prevent us from considering a later revision. Moreover, replacement does not systematically offer the comfort of a native joint. The development of techniques designed to preserve the native joint and slow down or avoid osteoarthritis is therefore of particular interest. The realization of a periacetabular osteotomy (PAO) in hip dysplasia falls within this framework, increasing the acetabular coverage by a reorientation of the acetabulum. The use of preoperative three-dimensional reconstruction and planning help the surgeons to predict corrections. The use of cutting guides and an intraoperative scanner ensure accuracy and control throughout the whole intervention. PAO should therefore be recognized as the treatment of choice for acetabular dysplasia in young adults, prior to the occurrence of osteoarthritis.
Minimally-invasive surgery has been demonstrated to be an optimal approach in visceral surgery. Laparoscopy is associated with less postoperative pain, faster recovery, and shorter hospital stay. Esophagectomy is a complex operation with significant morbidity. Minimally-invasive approaches can nonetheless reduce this morbidity. Over the last years, hybrid techniques have been introduced, in which one part of the surgical procedure is laparoscopic or thoracoscopic while the other one is performed via the open approach.
Michel Jadoul, Selda Aydin, Sylvie Goletti, Johann Morelle, Eric Goffin, Michel Mourad, Nathalie Demoulin, Anh Ho, Nathalie Godefroid, Caroline Clerckx, Laurence Annet, Yves Pirson, Olivier DevuystPublished in the journal : February 2017Category : Nephrology
Here we present three important innovations in the nephrology field. The first one concerns the management of autosomal dominant polycystic kidney disease, and in particular the treatment by tolvaptan, a drug that slows down disease progression and is reimbursed in Belgium since 2016. The other two innovations presented are, on one hand, the progress made in the diagnosis and follow-up of idiopathic membranous nephropathy, which is often of autoimmune nature, and on the other hand, the hope raised by living kidney donor exchange programs for patients awaiting transplantation.
Stéphanie Dehem, Gaëtan Stoquart, Vincenza Montedoro, Martin Edwards, Sophie Heins, Bruno Dehez, Thierry LejeunePublished in the journal : February 2017Category : Physical and Rehabilitation Medicine
Following cerebral injury, motor and cognitive disorders are common, and rehabilitation can prove challenging, for both patients and therapists. In recent years, robotics and serious games have been widely developed in this area in order to increase the functional recovery of patients. Robotics enable an intensification of therapy, assist patients in moving, and provide prompt feedback. As for the serious games, they make reeducation more funny and motivating; furthermore, the game’s difficulty level continuously adapts to the patient’s performances. These two complementary technologies do appear promising for the rehabilitation of brain-injured patients
The development of proteasome inhibitor (PI) and immunomodulatory drugs (IMiDs) have considerably changed the treatment paradigm of multiple myeloma (MM), while significantly improving survival. Nevertheless, many patients exhibit disease relapse and develop drug resistance. The better understanding of disease biology will likely influence our approach to myeloma treatment, resulting in the advent of newer drug classes, such as monoclonal antibodies and adoptive cellular therapies. There is much hope that MM will soon become a chronic illness with sustained complete response in a significant number of patients.
Anne-France Dekairelle*, Delphine Hoton**, Julie Lelotte**, Christine Galant**, Pascal Van Eeckhout**, Pamela Baldin**, Yves Guiot**, Louis Libbrecht**, Anne Jouret Mourin**Published in the journal : February 2017Category : Anatomie pathologique
The characterization of tumor molecular markers, along with the development of targeted therapies. Over half of these therapies can only be prescribed after determination of the status of a biomarker, rendering it necessary to carry out molecular tests. Recent technological advances enable us to simultaneously analyze numerous genes or portions of genes of interest by means of next-generation sequencing (NGS). Since January 2016, NGS has been applied in the Cliniques universitaires Saint-Luc (CUSL) as part of clinical routine analyzes related to diagnosis, prognosis, or therapeutic response prediction. At present, the panel used at CUSL allows mutations in different exons of eight genes (BRAF, c-Kit, EGFR, IDH1, IDH2, KRas, NRas, and PDGFRA) to be identified, such as those involved in metastatic colorectal cancers, non-small-cell lung cancers, melanomas, gliomas, and gastro-intestinal stromal tumors. This method has become an excellent diagnostic and prognostic tool, which also enables oncologists to individually determine the best treatment modality for each patient, with better chances of therapeutic success while diminishing unnecessary treatments.
Martin Buysschaert, Chantal Daumerie, Michel Hermans, Vanessa Preumont, Jean-Paul Thissen, Bernard Vandeleene, Dominique Maiter, Stéphanie Rouhard, Laura Orioli, Raluca Maria Furnica, Audrey Loumaye, Maria-Cristina Burlacu, Orsalia Alexopoulou, Sonia BrichardPublished in the journal : February 2017Category : Endocrinologie, diabétologie et nutrition
The year 2016 was again full of novelties, with numerous diagnostic and therapeutic innovations in the fields of endocrine diseases, diabetes, and metabolic disorders. In this article, we deliberately chose to only discuss those which have already improved the current management of such diseases, be it for specialists or general practitioners. The article should therefore be interesting for every reader. In the field of diabetes, we have here reported on the main features of the new agreement between social security system, physicians, and diabetic patients (“Convention INAMI”). We have also reported on a newly reimbursed system for continuous measurement of interstitial glucose through a sensor, on the impressive technological advances in modern insulin pumps, as well as on the significant cardiovascular and renal benefits of SGLT2 transporter inhibitors in Type 2 diabetes patients. As for metabolic pathologies, the PCSK9 inhibitors are now reimbursed in heterozygous familial hypercholesterolemia, and specific GLP-1 analogues are available for an effective treatment of obesity. In the field of thyroid diseases, isolated maternal hypothyroxinemia during pregnancy is now better characterized, and new recommendations have been issued regarding the diagnosis and treatment of Grave’s ophthalmopathy. Finally, as regards general endocrinology, new recommendations clarify and simplify the management of adrenal incidentaloma, whose detection frequency continually increases in the era of common and more efficient abdominal imaging.