Radiotherapy innovations in 2023

Sofie Heylen*, Geneviève Van Ooteghem, Xavier Geets, Eléonore Longton**, Dario Di Perri**, Ad Vandermeulen Published in the journal : February 2024 Category : Radiothérapie

The recent introduction of the artificial intelligence-powered linear accelerator Ethos® in our department now allows us to offer patients continuous and real-time adaptation of their radiation therapy treatment based on the patients’ daily anatomy.

In 2023, this adaptive radiotherapy was performed for the first time in the world in “breath-hold” to treat gastric lymphomas. This approach allows for a reduction of the irradiation margins while preserving adjacent organs.

Another area of innovation is stereotactic radiotherapy (SBRT) for liver tumors with mechanical ventilation assistance, which is an alternative to surgery for selected cases. Since 2018, non-invasive ventilation assistance, called MANIV, has been adopted, reducing irradiation margins and improving treatment quality. In October 2023, the Cliniques universitaires Saint-Luc became the first center to integrate MANIV into their routine clinical practice for treating liver tumors.

Stereotactic radiotherapy can also be offered for localized prostate cancer. It represents a faster and more precise alternative compared to traditional radiotherapy. Studies show comparable success rates with fewer side effects, highlighting the potential of SBRT for the treatment of prostate cancer.

Finally, an increasing number of patients are being treated with radiotherapy for bladder cancer. This conservative treatment is a new therapeutic alternative that can be offered under certain conditions. The application of adaptive radiotherapy in this indication is of maximum benefit due to the rapid and frequent variation in bladder volume during treatment. This makes it possible to avoid cystectomy and offer patients a better quality of life.

All these developments in radiotherapy align with our department's commitment to progress and improve patient care regarding oncological outcomes and quality of life.

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Innovations 2023 in Pulmonology

Antoine Froidure, Charles Pilette Published in the journal : February 2024 Category : Pneumology

The treatment of asthma and inflammatory lung diseases is increasingly moving towards personalised medicine: 2023 has seen the availability in Belgium of two new biotherapies for patients suffering from severe asthma, and the possible use of mepolizumab in certain chronic inflammatory diseases. Finally, the reimbursement of allergen immunotherapy against house dust mites enables a more extended use of this therapeutic option in mild to moderate asthma. All these factors underline the importance of a careful phenotyping of patients prior to treatment.

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Adult Psychiatry Innovations in 2023

Nausica Germeau, Peter Stärkel, Catherine Bataille de Longprey, Carmen Mallard, Samia Karaki, Jacqueline Petit, Philippe de Timary, Avigaëlle Amory, Achille Bapolisi, Laurence Ayache, Denis Chaidron, Francesca Vellozi, Jamal Ziane, Francesca Melas et al Published in the journal : February 2024 Category : Psychiatrie adulte

In this section on psychiatric innovations, we will be presenting two important aspects of what is currently happening in adult psychiatry: firstly, the creation of the Integrated Psychiatry Institute, a real plus for UCLouvain psychiatry, which combines the skills developed by Sanatia, the psychiatric hub of the ASBL Valisana, and the Adult Psychiatry Department of the Cliniques Saint-Luc, which we will outline in a first article.

In a second article, we will describe the virtues of the split-hospitalization model. Psychiatric care does not rely solely on pharmacological or psychotherapeutic approaches. Our proposal here aims to ensure that the suggested hospital setting, and more specifically the idea of inviting patients to return home during stays designed to be shorter, helps to counteract the risks of chronicity and allow patients to be back in charge of their own lives and care. Such a model has existed for 20 years in the field of alcohol use disorders. We are implementing a similar model for mood disorders as part of the Integrated Psychiatry Institute, being set up on the Woluwé site.

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Innovations in 2023 In Otorhinolaryngology

Anaïs Grégoire, Philippe Rombaux, Monique Decat, Caroline Huart, Daniele De Siati, Caroline De Toeuf, Sandra Schmitz, Sara Castelein, Valérie Hox Published in the journal : February 2024 Category : Otorhinolaryngology

The year 2023 saw new reimbursements from RIZIV-INAMI for implantable ear-nose-throat (ENT) devices, thereby improving our patients’ access to specific care. For children with unilateral deafness, a cochlear implant is now being reimbursed, on account of conducted studies demonstrating an improvement in several aspects of hearing and learning, following cochlear implantation. For patients with sleep apnea syndrome not responding to CPAP, the hypoglossal nerve stimulator is now being reimbursed under certain conditions, after many years of procedural usage within clinical studies. In addition, an automated process has been introduced for skin allergy testing, improving both the reliability and reproducibility of our examinations. All these elements are certainly instrumental in improving patient care from diagnosis to treatment.

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Innovations in 2023 in Medical Oncology

Emmanuel Seront1, Cédric Van Marcke1, Paulina Bartoszek4, Stéphanie van Raemdonck2, Louise Favaretto2, Laura Krolikowska3, Frank Cornélis1, Jean-François Baurain1 Published in the journal : February 2024 Category : Oncologie médicale

The year 2023 witnessed a significant revolution in oncology, marked by the emergence of new anti-cancer molecules and innovative strategies.

Antibody conjugates have considerably improved patient survival in numerous cancer types. These treatments are likely to play a key role in advanced-stage disease of urothelial cancers and in several breast cancer types as well, including triple-negative, HER2-positive, and a new entity known as “HER2 weak”.

Considering renal cancer, targeting the HIF transcription factor by means of a targeted therapy that inhibits not only angiogenesis, but also various survival pathways, looks rather promising. This novel therapeutic strategy can be administered either as a single agent or in combination.

Uveal melanoma is the most common primary malignant intraocular tumor. Despite the efficacy of local treatments, half of all affected patients experience extra-ocular recurrence, with liver involvement observed in 90% of them. Median survival for patients with metastatic disease has been proven to range between 6 and 12 months. Targeted treatments, such as thermo-ablation or surgery, likely improve the prognosis of patients with single-site recurrences. Chemotherapy is not very effective. Treatment with immune checkpoint inhibitors, such as anti-PD-1 antibodies, only modestly increases overall survival in metastatic disease patients. Tebentafusp, a new form of immunotherapy, is the first molecule to demonstrate a real improvement in overall survival of metastatic patients. Tebentafusp is a T-cell receptor coupled with an anti-CD3 antibody, being able to transform all lymphocytes into anti-melanocyte lymphocytes. Nevertheless, only patients with an HLA-A*02:01 allele, meaning 50% of Caucasians, are likely to benefit from this therapeutic innovation.

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Innovations in 2023 in Nephrology

Elliott Van Regemorter1, Nada Kanaan1, Michel Jadoul1, Arnaud Devresse1, Laura Labriola1, Thibaut Gervais2, Antoine Buémi3, Tom Darius3, Yannick France3, Michel Mourad3, Véronique Deneys2, Corentin Streel1, Eric Goffin1 Published in the journal : February 2024 Category : Nephrology

The year 2023 witnessed a number of significant advances in understanding and managing kidney disease. Among these figure the discoveries concerning the genetic variants in the gene encoding apolipoproteine L1 (APO-L1), shown to be closely associated with an increased risk of developing chronic kidney disease, particularly among populations of African or African-American descent. The precise mechanisms by which these APO-L1 variants contribute to the development of kidney disease have not been fully elucidated. Nevertheless, several studies have suggested that these variants may lead to an impaired podocyte function at the glomerular level. The discovery of the links between APO-L1 abnormalities and kidney disease has actually opened new perspectives for research pertaining to the development of targeted therapies. Understanding how these genetic variants influence the progression of kidney disease could similarly allow for the development of more effective prevention and treatment strategies, in addition to the identification of high-risk patient subgroups.

A new therapeutic approach to anemia in chronic kidney disease was made available last year. Roxadustat (EvrenzoR) belongs to a class of drugs known as hypoxia-inducible factor (HIF) prolyl hydroxylase inhibitors. These drugs act on the HIF-dependent erythropoiesis. Unlike the traditional treatment of kidney-disease-associated anemia consisting of subcutaneous or intravenous injections of recombinant erythropoietin (EPO), Evrenzo is administered orally. Consequently, this more convenient administration route could improve patient compliance and simplify the therapeutic process. In addition, in most patients, roxadustat was demonstrated to exhibit a safety and tolerability profile similar to that of recombinant EPO.

Another 2023 breakthrough was the approval of imlifidase in kidney transplantation. Imlifidase is a proteolytic enzyme that acts by selectively cleaving IgG antibodies. This agent can be employed to desensitize patients with high levels of pre-existing antibodies against human leukocyte antigen (HLA) antigens, meaning that transplantation could be considered even in the presence of immunological incompatibility with the donor. This approach may help improve access to transplantation for hyper-immunized patients.

These novelties developed in 2023 will gradually be implemented in clinical practice in 2024.

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Innovations in 2023 for Internal Medicine and Infectious Diseases

Laurence Bamps, Leila Belkhir, Julien De Greef, Anne Vincent, Jean Cyr Yombi (1) Published in the journal : February 2024 Category : Médecine interne et maladies infectieuses

The Department of Internal Medicine and Infectious Diseases at Cliniques universitaires Saint-Luc deals with pathologies that affect the whole body system, one of its priorities being to raise awareness and promote disease prevention. In this issue, we have tackled two very different themes, both of which having been the focus of ongoing innovation and discovery in recent years. These topics include on one hand the diagnosis of inborn errors of immunity in adults, which is a scarcely-known clinical entity within the medical world, though less rare than we would think. On the other hand figures the prevention of sexually transmitted infections, which is both a medical and societal concern

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Highlights and innovations in 2023

Olivier Devuyst1, Joëlle Thonnard1,2, Aline van Maanen3, Audrey Timmermans2, Yannick Barussaud4, Cédric Van Marcke5, Demet Yuksel2, Marianne Philippe2 Published in the journal : February 2024 Category : Rare Diseases

Rare diseases, most often of genetic origin, represent fertile ground for diagnostic and therapeutic innovations. The following two abstracts show how the development of genetic models, artificial intelligence, and computerized patient records are opening up new perspectives for these diseases and public health issues.

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Myelofibrosis, Multiple Myeloma, Anti-PF4 Antibodies, Acquired Hemophilia, Intravenous Iron, and Refractory Autoimmune Thrombocytopenia

Violaine Havelange1,2, Stefan N. Constantinescu1-5, Cédric Hermans1, Catherine Lambert1, Marie-Christiane Vekemans1 Published in the journal : February 2024 Category : Hematology/Oncology

Myelofibrosis is a myeloproliferative neoplasm with a poor survival rate, primarily characterized by anemia, splenomegaly, constitutional symptoms, bone pain, and cachexia. The only curative treatment is allogeneic peripheral stem cell transplantation, although it is associated with a non-negligible mortality and morbidity risk. JAK2 inhibitors help reduce spleen size and alleviate symptoms in these patients. The two most recent JAK2 inhibitors (pacritinib and momelotinib) may also confer erythropoietic benefits.

Despite therapeutic advances in multiple myeloma management, the disease remains incurable, largely due to the emergence of resistant tumor clones. Immunotherapy has made significant progress in recent years. In front-line therapy, the inclusion of monoclonal antibodies alters the outcomes for transplant-eligible patients, providing potential long-term disease control. In relapse, bispecific antibodies and CAR-T cells demonstrated notable efficacy in terms of survival and residual disease control, offering real hope for patients resistant to conventional treatments. These two aspects will be addressed in this article.

In patients presenting with venous or arterial thrombosis associated with thrombocytopenia, the presence of anti-PF4 antibodies and their properties (heparin dependence and platelet activation capacity) should be investigated. Widely adopted in congenital hemophilia, emicizumab, a bispecific antibody mimicking the action of factor VIII, is poised to become a first-line hemostatic treatment for patients with acquired hemophilia. These patients will benefit from better protection against bleeding, delaying the onset of severe and often deleterious immunosuppression in fragile patients. Certain intravenous iron formulations may lead to hypophosphatemia, a neglected but avoidable complication. For refractory forms of autoimmune thrombocytopenia, complement, Bruton's tyrosine kinase, CD38, and the neonatal Fc receptor represent promising therapeutic targets.

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Vascular malformations in 2023: Sirolimus confirms its efficacy and allows treatment in utero

Emmanuel Seront MD PhD1, An Van Damme MD PhD2, Julien Coulie MD3, Valérie Dekeuleneer MD3, Miikka Vikkula MD PhD4, Laurence M Boon, MD PhD3,4 Published in the journal : February 2024 Category : Chirurgie vasculaire

The mTOR pathway plays an essential role in the development of vascular malformations. A recently published VASE study confirms the efficacy of sirolimus, an mTOR inhibitor, in vascular malformations, with an efficacy rate of 85% and good overall safety.

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