Papers by Dirk Van Gestel
Radiotherapy and Oncology
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Cancer/Radiothérapie
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Physics and Imaging in Radiation Oncology
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Frontiers in Medicine
Due to the general aging population and the fashion trend of sun exposure, non-melanoma skin canc... more Due to the general aging population and the fashion trend of sun exposure, non-melanoma skin cancer (NMSC) is rising. The management of NMSC is difficult and necessitates a multidisciplinary team (i.e., pathologists, dermatologists, medical oncologists, surgeons, and radiation oncologists). When surgery is not an option or will cause unacceptably functional morbidity, radiation therapy (RT) may be a preferable tissue-preserving option. Whether used alone or in conjunction with other treatments, RT has been shown to be quite effective in terms of cosmetic results and local control. Contact hypofractionated RT, brachytherapy, and electronic brachytherapy are all promising new treatments. However, rigorous, randomized trials are missing, explaining the disparity in dose, fractionation, and technique recommendations. Therefore, it is essential that interdisciplinary teams better understand RT modalities, benefits, and drawbacks. Our review will provide the role and indications for RT in...
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Technical Innovations & Patient Support in Radiation Oncology
Highlights • Radiation Therapists specialised in image-guided radiation therapy (RTT spIGRT) expe... more Highlights • Radiation Therapists specialised in image-guided radiation therapy (RTT spIGRT) experience their role positiveltly.• The RTT spIGRT role is perceived to have a positive influence on radiotherapy treatment delivery.• A legal framework to provide formal RTT training and continuous education in order to increase radiotherapy treatment quality is of utmost importance.
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Radiotherapy and Oncology, 2020
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Frontiers in Oncology, 2021
Quality assessment is indispensable in all areas of cancer care, and that is certainly true for h... more Quality assessment is indispensable in all areas of cancer care, and that is certainly true for head and neck cancer. The increased complexity of diagnosis and the multimodal and multiprofessional treatment and expanding (financial) burden to the health care system leads to concern whether new knowledge is effectively transferred to all patients. Moreover, there are major geographical differences in accessibility of radiotherapy equipment and anti-cancer drugs around the globe. Impaired quality of care results in compromised quality of life or sometimes even in impaired survival. Quality assurance must cover the entire patient care process from the diagnosis to the therapeutic decision and for that the multidisciplinary team (MDT) meetings are playing a crucial role.
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Radiotherapy and Oncology, 2020
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Radiotherapy and Oncology, 2021
BACKGROUNDAND PURPOSE: to evaluate dosimetric differences in unintended dose to the lower axilla ... more BACKGROUNDAND PURPOSE: to evaluate dosimetric differences in unintended dose to the lower axilla between 3D-standard (3DCRT), tangential beam forward intensity modulated radiotherapy (F-IMRT) and volumetric modulated arc therapy (VMAT). The objective is to evaluate whether results of clinical trials, such as the ACOSOG-Z011 trial, that evaluated omission of axillary clearance can be extrapolated towards more conformal techniques like VMAT. MATERIALS AND METHODS twenty-five consecutive patients treated with whole breast radiotherapy alone (WBRT) using a F-IMRT technique were identified. Three additional plans were created for every patient: one plan using a single 270° arc (VMAT 1x270°), another using two small ≤90° opposing arcs (VMAT 2x <90°) and thirdly a 3DCRT plan without F-IMRT. Axillary levels I-II were contoured after the treatment plans were made. RESULTS the volume of the axilla level I that was covered by the 50% isodose (V50%) was significantly higher for VMAT 2x <90° (71.3cm3, 84% of structure volume, p<0.001) and VMAT 1x270° (68.8 cm3, 81%, p<0.01) compared to 3DCRT (60.3cm3, 71%) and F-IMRT (60.8cm3, 72%). The V50% to the axilla level II, however, was low for all techniques: 12.3cm3 (12%); 8.9cm3 (9%); 4.3cm3 (4%); 4.4cm3 (4%) for VMAT 2x <90°, VMAT 1x270°, 3DCRT, F-IMRT, respectively. For the higher doses (V90% and above), no clinically relevant differences were seen between the different modalities. CONCLUSION WBRT treatments with VMAT do not lead to a significant reduction of the unintended axillary dose in comparison with a tangential beam setup. Hence, concerning tumor control, VMAT can be applied to clinical situations similar to the Z0011 trial. The intermediate axillary dose is higher with VMAT, but the clinical consequence of this difference on toxicity is unknown.
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BMC Cancer, 2021
Background Residual breast cancer after neo-adjuvant chemotherapy (NACT) predicts disease outcome... more Background Residual breast cancer after neo-adjuvant chemotherapy (NACT) predicts disease outcome and is a surrogate for survival in aggressive breast cancer (BC) subtypes. Pathological complete response (pCR) rate, however, is lower for luminal B BC in comparison to the triple negative (TNBC) and HER2+ subtypes. The addition of immune checkpoint blockade (ICB) to NACT has the potential to increase pCR rate but is hampered by the lower immunogenicity of luminal B BC. Novel strategies are needed to stimulate the immune response and increase the response rate to ICB in luminal B BC. Methods The Neo-CheckRay trial is a randomized phase II trial investigating the impact of stereotactic body radiation therapy (SBRT) to the primary breast tumor in combination with an anti-CD73 (oleclumab) to increase response to anti PD-L1 (durvalumab) and NACT. The trial is designed as a three-arm study: NACT + SBRT +/− durvalumab +/− oleclumab. The result at surgery will be evaluated using the residual ...
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Radiotherapy and Oncology, 2021
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Radiotherapy and Oncology, 2021
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Physica Medica, 2020
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Cancers, 2019
Radiotherapy (RT) in patients with melanoma historically showed suboptimal results, because the d... more Radiotherapy (RT) in patients with melanoma historically showed suboptimal results, because the disease is often radioresistant due to various mechanisms such as scavenging free radicals by thiols, pigmentary machinery, or enhanced DNA repair. However, radiotherapy has been utilized as adjuvant therapy after the complete excision of primary melanoma and lymph nodes to reduce the rate of nodal recurrences in high-risk patients. The resistance of melanoma cells to radiotherapy may also be in relation with the constitutive activation of the MAPK pathway and/or with the inactivation of p53 observed in about 90% of melanomas. In this study, we aimed to assess the potential benefit of adding RT to BRAF-mutated melanoma cells under a combined p53 reactivation and MAPK inhibition in vitro and in a preclinical animal model. We found that the combination of BRAF inhibition (vemurafenib, which completely shuts down the MAPK pathway), together with p53 reactivation (PRIMA-1Met) significantly en...
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Radiotherapy and Oncology, 2019
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World Journal of Urology, 2019
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Physica Medica, 2019
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European Journal of Cancer, 2015
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Frontiers in Oncology, 2021
Immunotherapy with checkpoint inhibitors opened new horizons in cancer treatment. Clinical trials... more Immunotherapy with checkpoint inhibitors opened new horizons in cancer treatment. Clinical trials for novel immunotherapies or unexplored combination regimens either need years of development or are simply impossible to perform like is the case in cancer patients with limited life expectancy. Thus, the need for preclinical models that rapidly and safely allow for a better understanding of underlying mechanisms, drug kinetics and toxicity leading to the selection of the best regimen to be translated into the clinic, is of high importance. Humanized mice that can bear both human immune system and human tumors, are increasingly used in recent preclinical immunotherapy studies and represent a remarkably unprecedented tool in this field. In this review, we describe, summarize, and discuss the recent advances of humanized mouse models used for cancer immunotherapy research and the challenges faced during their establishment. We also highlight the lack of preclinical studies using this mod...
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Papers by Dirk Van Gestel