GLP-1 receptor agonists (GLP-1RAs) are the most extensively studied drug class for obesity treatment. These molecules induce significant weight loss and an improvement regarding comorbidities associated with excess weight. Weight loss results almost exclusively from caloric intake reduction. GLP-1RAs are well tolerated and have a satisfactory safety profile. Molecules currently under development aim to enhance weight loss, notably by targeting other receptors, and to improve patient compliance. Their use raises many questions (cost and possible reimbursement, duration of use, very long-term safety, place in relation to dietary management and bariatric surgery, etc.). Even though all these questions must be addressed, a paradigm shift is taking shape in the management of obesity, after decades of failure.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common condition in patients with metabolic syndrome and, a fortiori, type 2 diabetes. Simple tools are available to define disease severity, which should be assessed in routine practice.

In 2023 there were numerous groundbreaking developments in diabetology, metabolic diseases and endocrinology. In the field of diabetes, recommendations for managing cardiovascular diseases (CVDs) in patients with Type 2 diabetes were revised, and a new algorithm for estimating cardiovascular risks in primary prevention was introduced. In addition, patients with diabetes mellitus eligible for a category B convention may claim full reimbursement for a continuous interstitial glucose measurement system using a subcutaneous sensor. The widespread use of glucagon-like peptide-1 (GLP-1) receptor agonists for the therapeutic management of obesity was a notable feature of 2023. In the field of endocrine pathologies, new international guidelines on prolactinoma treatment have been published. Moreover, the 2016 recommendations on the management of adrenal incidentalomas, issued by the European Society of Endocrinology (ESE) in collaboration with the European Network for the Study of Adrenal Tumors (ENSAT), have been updated

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.