Institut Bordet - Institut Jules Bordet Instituut

Missions
technologies
Organisation
Focus On
Research
Institut
Jules Bordet
2011
Institut
Jules Bordet
2011
1
INTRODUCTION
2
3
4
Proud of its past, focused on the future
A Comprehensive Cancer Centre
Facts & Figures 8
10
12
CANCER
PREVENTION
Screening & Early Diagnosis
Support Centre
for Smokers
Environmental Health
16
18
19
Patient care
Diagnostic Laboratories 22
Pathology
Cytogenetics
Clinical Biology
22
24
25
Imaging
26
Nuclear Medicine 28
Radiation Oncology
30
Surgery
32
32
33
34
35
36
Cervicofacial & Thoracic Digestive
Bone & Connective Tissue
Oncoplasty
Breast & Gynaecolgy
4
MULTI­
DISCIPLINARY
CANCER MANAGEMENT
Bone and Connective Tissue Cancers
Brain Cancers
Breast Cancers Gastrointestinal Cancers
Gastrointestinal Cancers
(Endocrine Tumours)
54
55
56
58
60
Head and Neck Cancers 61
Gynaecological Cancers 62
Urology 37
Medicine Haematological Cancers 64
38
38
40
42
43
44
Prostate Cancers
66
Skin Cancers
68
Thoracic Cancers
69
Medical Oncology
Haematology
Internal Medicine
Infectious Diseases
Day Hospital
Intensive Care 45
Anaesthesiology 46
& Postoperative Care
Nursing
Supportive Care
48
Psycho-Oncology
Pain Management
Palliative & Supportive Care
48
50
51
47
5
PATIENT SUPPORT
Social Services, Intercultural Mediation,
Religion
Mediation
Families
6
RESEARCH
Laboratory of Clinical
78
Cell Therapy
Experimental 80
Haematology Laboratory
Oncology 81
& Experimental Surgery
Laboratory
Breast Cancer 82
Translational Research
Laboratory Jean-Claude
Heuson
Clinical Research Unit of 84
the Medical Oncology Clinic
Thoracic Oncology
86
Laboratory
Statistics & 87
Epidemiology Unit
Breast European Adjuvant 88
Studies Team
Breast International 89
Group
7
8
EDUCATION
Teaching
92
Seminars
93
Fellowships
93
ASSOCIATIONS
Amis de Les
l‘Institut Bordet
Fonds Jean-Claude Heuson
Fonds Ariane
Notre Boutique Les Tournesols
96
97
97
98
98
72
74
75
5
1
roud of its past, P
focused on the future
6
8
A Comprehensive 10
Facts & Figures 12
Cancer Centre
INTRODUCTION
7
Proud of its past, focused on the future
F
introduction
or over 70 years, the
Institut Jules Bordet
has been providing
its patients – and the general
public – with a wide range of
state-of-the-art strategies for
dealing with cancer. The Institute, which is an academic one,
combines three essential missions: treatment, research and
teaching. Its international reputation draws many talented
people to the Institute, who
discover an environment conducive to fulfilling their human
and professional qualities.
8
The Institut Jules Bordet, which initially consisted of a surgical and
a radiotherapy department, was established in 1939. The Institute
started to expand considerably after the Second World War.
Spirit of innovation
Following the impetus of Professors Albert Claude and Henri Tagnon
after their respective returns from the United States in the early
1950s, the Institute rapidly developed innovative activities: a department of medicine with specific sectors for chemotherapy and
immunotherapy; pathology and nuclear medicine laboratories; and
new medical imaging techniques. Already at this time, the ideas of
approaching cancer treatment and care in a multidisciplinary manner and integrating research and teaching into treatment had taken
shape. Since then, the Institute has continued to participate actively
in the development of new diagnostic, therapeutic and preventive
techniques, which are quickly made available to the public.
Some examples of this innovation include the following:
1953, creation of a research laboratory in the Department of Medicine
1964, opening of a screening clinic
1972, inauguration of the first oncological “day hospital” for chemo­
therapy in Belgium
1975, the first autologous transplantation of haematopoietic stem
cells and the development of a new method for measuring oestrogen receptors in breast cancers
1978, convening the first hospital ethics committee in Belgium
1985, establishment of the first Psycho-Oncology Unit and Breast
Clinic in the country
1989, creation of a training course in oncology for nurses and
establishment of a rehabilitation unit
1990, first developments in translational research and the commencement of a programme for giving up smoking
1994, set-up of the first Belgian cord blood bank
1997, introduction of the sentinel lymph node surgical technique
1999, first haploidentical haematopoietic stem cell transplantation in the world and first laparoscopic radical prostatectomy in
Belgium
2004, first treatment of hepatic metastases with radioactive
microspheres in Belgium
2006, development of the Genomic Grade Index, a genomic signature making it possible to predict the aggressiveness of breast
cancers to help determine the best treatment options
2009, establishment of intraoperative radiotherapy with Mobetron
International collaborative research
Aware as it is of the challenges and choices of research and the
importance of working in collaboration with others, the Institute has
participated in the creation of several international networks: the
European Organisation for Research and Treatment of Cancer, the
Multinational Association of Supportive Care In Cancer, the Breast
International Group, the European Lung Cancer Working Party, and
the Organisation of European Cancer Institutes.
New structures for 2016
As the first integrated cancer centre in Belgium, the Institute is
part of the public hospitals network in Brussels and the Université
Libre de Bruxelles. With its 154 beds entirely devoted to cancer
treatment, annually it looks after 6,000 hospitalised patients, carries
out 75,000 consultations, and provides over 12,000 outpatient
treatments. But the Institute is cramped for space. To respond
adequately to the demographic, epidemiological and scientific
developments of the future, it plans to move to new facilities in 2016,
thereby increasing its hospital-bed capacity to 250. Joining forces
with the Hôpital Universitaire Erasme and the research laboratories of
the Faculty of Medicine of the Université Libre de Bruxelles on a single
campus, it will continue to be able to fulfill its pioneering role within
the European network of centres active in the fight against cancer.
9
A Comprehensive Cancer Center
C
introduction
ancer remains one of
the principal public
health challenges. Its
incidence is increasing everywhere, mainly due to the aging
of the population. At the same
time, treatment and survival
are improving and cancer mortality rates decreasing (about
1.0% to 1.5% per year for the
last 20 years) because of medical progress – and the reduction of smoking in men! These
changes have been made possible by the dynamism of the
scientific community.
The dazzling progress of molecular biology in particular has opened
the way to new treatments that are much better suited to the individual characteristics of each patient and each tumour. This progress
has also enabled the rapid development of new laboratory diagnostics and new medical imaging technologies.
Multidisciplinarity and integration
For this progress to be possible and to benefit patients quickly,
physicians in the various diagnostic and therapeutic disciplines,
nurses, and other healthcare professionals must work closely
together in a structure organised around the well-being of the
patient. This is multidisciplinarity. Moreover, research activities
must coexist with teaching, with both being closely associated with
care. This is called integration. A multidisciplinary cancer centre
associating the treatment of patients with research and teaching
is a comprehensive cancer centre. This has always been the policy
and practice of the Jules Bordet Institute.
Focus on the patient
In the Institute, doctors and the nursing teams conduct their
activities in a system in which interdisciplinary clinical consultation is well-organised and constant. At the centre is the patient,
whose unique, computerised medical file compiles all the information available about his or her case in a structured and protected
manner. The medical teams also take part in research that offers
patients access to a variety of experimental treatments. The effectiveness of these treatments is monitored continually, as are ways
of improving the quality of care. Patient-oriented research includes
the 120 clinical studies vetted by the Institute’s Ethics Committee, on which patients are represented, as well as the activities of
5 translational and basic research laboratories.
Services for which safety poses a particular concern, such as
radiotherapy, nuclear medicine or clinical research, require specific
quality assurance and safety programmes. The Institute is involved
in the European certification programme for comprehensive
cancer centres and has commenced the process of obtaining the
Organisation of European Cancer Institutes accreditation label. All
these activities are coordinated by the Quality Unit, which is part
of the Medical Department.
other considerations. The Institute is
above all a point of contact between
care­givers and patients. They share
a project: to see that life wins out,
by jointly taking on the multiple incertitudes of the medical art in which
they have put their hopes.
At the service of life
This brochure is designed to give you a better understanding of
our Institute, its functioning and the multiple facets of its fight
against cancer. The information was drawn up by people directly
involved in its activities. These people and their teams are entirely
engrossed in their missions and put respect for human life beyond
Extensive training opportunities
Several of the Institute’s physicians teach at the Université Libre
de Bruxelles, of which the Institute is one of its medical training
centres. On average, 40 doctors receive specialist training at any
one time at the Institute, which also accommodates 200 medical
students and 250 student nurses each year. The Institute also provides opportunities for scholarship holders and doctors from overseas who wish to train in Europe. Numerous continuous-training
activities are organised in the form of symposia, seminars, workshops and scientific trips.
Dr Dominique de Valeriola
Olivier Van Tiggelen
Dr Jean-Benoît Burrion
General Medical Director
General Director
Deputy Medical Director
Accreditation for greater quality
Desirous to ensure the quality of its services and the safety of
its patients, the Institute implements a quality management policy
at different levels. Certain sensitive or complex activities, such
as transplantation in haematology or work in the clinical biology,
pathology and molecular biology laboratories, are specially certified.
10
11
Facts & figures
M ain Facilities
Hospitalisation
154
Admittances
Intensive Care Beds
7
Days of Hospitalisation
Laminar Flow Rooms
7
Average length of stay (days)
Outpatient Beds
13
Surgery
Operating Theatres
5
Haematology
Outpatient Admittances: Chemotherapy
6,000
42,300
7.1
10,000
Outpatient Admittances: Others
5,000
Multidisciplinary Meetings
3,500
Surgery
Bone Marrow Bank
4,000 Units
Cord Blood Bank
1,700 Units
Surgical Procedures
4,600
Radiotherapy
Treatments
Cytapheresis Unit
Total
720
Medical Specialists
136
Nurses
260
Psychologists
9
Physiotherapists
7
Dieteticians
4
Speech Therapists
2
Occupational Therapists
2
Social Workers
4
1,800
Outpatient Clinic
Radiotherapy
Linear Accelerators
Introduction
( F ull-T ime E qui vale n t )
Hospitalisation
Inpatient Beds
3
Intra-Operative Radiotherapy
Stereotaxic Cerebral Radiotherapy
T eams
A cti v ities ( 2 0 10)
1 Mobetron
1 Gamma Knife
Consultations (screening excluded)
62,900
Screening
12,000
Imaging
Conventional Radiology
Imaging
51,500
CT Scanners
2
CT Scans
MRI Scanners
2
MRI Scans
Mammographs
2
Echographs
2
Nuclear Medicine in vivo
4000
3 D Echograph
1
PET-Scans
4,400
X-ray Machines
3
Nuclear Medicine
9,100
6,400
Nuclear Medicine
Pathology, Clinical Biology
Histology
25,800
21,200
PET-CT Scanners
1
Cytology
SPECT-CT Scanners
1
Molecular Biology
1,100
Gamma Cameras
2
Cytogenetics
2,700
Mammoscintigraphy Device
1
Clinical Biology Analyses
F i n a n ces (2 01 0, €)
Health Care Expenditure
102,250,000
Research Expenditure
12,300,000
130,000
Pathology
Conventional Pathology
Immunohistochemistry
Molecular Pathology
Cytogenetics
Tumour Bank
Basic & Translational Research Laboratories
E ducatio n ( 2 01 0)
Clinical Trials
120
Faculty Associate Professors
Micro Array Technology
Patients Included
400
Medical Students
200
Flowcytometry
Scientific Publications
155
Nurses Students
250
Genomics
Cumulative Impact Factor
778
Specialists in Training
40
Proteomics
Impact Factor > 10
Research Fellows
10
HPLC
Next Generation Sequencing Technology
12
R esearch (2 01 0)
19
22
2
creening S
& Early Diagnosis
16
upport Centre
S
for Smokers
18
Environmental 19
Health
14
CANCER
PREVENTION
15
Screening & Early Diagnosis Clinic
Dr Evelyne Staquet
General Practitioner
Dr Anne-Marie Schrauwen
General Practitioner
Dr André-Robert Grivegnée
Radiologist, Head of Clinic
Missions
Putting into practice the prevention and screening principles
recommended by national and European authorities,
particularly for breast, cervical, prostate and colorectal cancer
and for melanoma
Providing screening customised according to risk profiles
Guaranteeing the quality of the service and techniques
provided
Providing clear and complete information to the general public
about cancer screening, its advantages and limitations
Promoting a global vision of preventive medicine, including
Cancer Prevention
smoking cessation, weight control, balanced diet, and physical
activity
ield,
F
technologies
and methods
Medical imaging (e.g., mammography,
ultrasonography, virtual colonoscopy and
endoscopy)
Laboratory testing, both biochemical and
Key figures
12,000
patients screened in 2010
3 cancers detected in 2010
6
Our aim is to move from non-customised to customised
screening by identifying an individual’s cancer risk as it relates to biochemical, genetic and behavioural factors.
Dr André-Robert Grivegnée, Head of Screening & Early Diagnosis Clinic
genetic
epartmental
D
organisation
The Screening and Early Diagnosis Clinic
comprises 1 senior resident, 2 assistant
senior residents, 7 general practitioners,
2 receptionists, and 2 administrative secretaries.
Their work includes patient consultations
at the Institute, services provided to private
and public enterprises and participation in
mass screening campaigns. The Clinic favours
a holistic approach to patients: care − from
screening and diagnosis to treatment and
follow-up − is ensured in a multidisciplinary
environment. The Clinic takes the time to
identify each person’s risk factors and then to
select the screening methods that will be the
most effective to detect potential anomalies.
16
Applied Research
Participation in various international studies, mainly in the areas of breast, prostate
and colon cancer, and melanoma
Development and validation of virtual colonoscopy in screening for colon cancer, as
an alternative when colonoscopy is inappropriate
Use of three-dimensional ultrasound imaging in screening for breast cancer
F
ocus On
Genetic counselling
To date, there are no reliable tests to predict an individual’s risk of developing cancer.
However, it is acknowledged that hereditary predisposition plays a role in 5% to 10% of all
cancers. This arises because of gene deterioration, which can be identified by DNA testing
(predictive genetic testing). Consultation with an oncogenetic specialist may be helpful for
individuals who, because of their personal and family history of cancer, could be carrying
a genetic characteristic predisposing them to develop cancer. This genetic counselling is
available for both individuals in whom an inherited risk factor is suspected or confirmed
and for their family members.
17
CAF - Support Centre for Smokers
Martial Bodo
Psychologist
Missions
Catherine Primo
CAF Coordinator
Providing public and private institutions with validated
information about the links between the environment
and different cancers
Giving medical support for the management of local
environmental problems (e.g., uncontrolled effluent,
former industrial sites)
Presenting clear, complete and scientifically validated
information to members of the public
Cancer Prevention
Hilde Vandecasteele
Psychologist
Prof Darius Razavi
Psychiatrist, Head of the
Psycho-Oncology Clinic
M
issions
Offering various types of
support to help people stop
smoking (individual visits,
support groups, medical
treatment)
Organising programmes
for companies and public
institutions to help their
employees stop smoking
epartmental
D
organisation
The Centres d’Aide aux Fumeurs (CAF) (Support Centres for Smokers) were set up in 1984
by the Fonds des Affections Respiratoires
(Respiratory Diseases Foundation) to help
people stop smoking. The idea for setting up
CAFs came from European recommendations
that have been adapted for different countries and regions.
F
ocus On
Smoke-Free Hospital
The Institute is a member of the European
Network of Smoke-Free Hospitals. It therefore
complies with a 10-point charter established by
the network, which has about 50 members in
Belgium. The members’ common mission is to
turn their institutions into smoke-free zones,
both for staff and patients.
www.hopitalsanstabac.be
r André Grivegnée
D
Head of the Screening & Early
Diagnosis Clinic
arianne Paesmans
M
Head of the Statistics &
Epidemiology Unit
r Jean-Benoît Burrion
D
Coordinating Physician
Key figures
Cancer is often associated with environmental factors. Our first task is to put such
risk in the correct context by providing clear
and scientifically sound information.
tobacco-addiction experts providing
5
consultations
476 individual consultations/year
150 consultations/year for hospitalised
patients
450 group sessions (5 to 10 persons)
ield, technologies
F
and methods
Dr Jean-Benoît Burrion, Coordinating Physician
ield, technologies
F
and methods
D
epartmental
organisation
C ognitive-behavioural therapy, either for individuals or for groups
Epidemiology of cancers: evaluation of clusters; calculation of Standardised
U
se of nicotine substitutes to help people deal with the withdrawal symptoms
associated with abrupt cessation of smoking
Incidence Rates
Industrial toxicology: evaluation of external and internal exposure risks in an open
P
rescription of medications to help fight tobacco addiction
setting for neighbouring populations
Epidemiological investigations (e.g., cancer
Preventive medicine: promotion of preventive medicine; training of general
Biomonitoring in potentially exposed po­pu­
U
se of complementary therapies (e.g., self-hypnosis, relaxation), which are
beneficial over the long-term
The Institute’s CAF comprises 1 doctor, 3 psychologists and 1 secretary.
18
Environmental Health
Applied Research
T raining of health professionals in the motivational counseling of smokers: this
training targets hospital nurses, to help them counsel hospitalised patients on the
subject of smoking. Similar training is given to students of the Université Libre de
Bruxelles (ULB)
esearch and action projects that support different groups: smoking cessation in
R
occupational environments, for the unemployed and for young adults (18-25 years)
practitioners in environmental health
Communication: providing information to groups at environmental risk
F
ocus On
Cancer clusters
In the case of cancer clusters, certain factors on the one hand, such as media hype, may
aggravate a local environmental crisis. On the other hand, other factors can have a moderating
influence: the provision of free medical screening, for example, can play an important role
in preventing panic. This strategy, based on sound methodology, scientific supervision,
and close cooperation with general practitioners, can transmit objective information to all
concerned and thereby help restore serenity and confidence in the future.
The Clinic has developed three principal types
of support in situations of particular environmental risk.
clusters)
lations
O rganising
the medical follow-up of
persons exposed to a proven risk
These interventions are the result of coope­
ration between the doctors in the Screening
and Early Diagnosis Clinic and the Statistics &
Epidemiology Unit team. This multidisciplinary
approach invol­ves epidemiologists, industrial
toxicologists, occu­pational health physicians,
and general practitioners. The Institute
collaborates with Société Publique d’Aide à
la Qualité de l’Environnement and the schools
of public health of the Université Libre de
Bruxelles, the Université Catholique de
Louvain and the Université de Liège.
19
3
Patient care
Diagnostic Laboratories 22
Pathology
Cytogenetics
Clinical Biology
22
24
25
Imaging
26
Nuclear Medicine 28
Radiation Oncology
30
Surgery
32
Cervicofacial & Thoracic Digestive
Bone & Connective Tissue
Oncoplasty
Breast & Gynaecolgy
Urology 37
Medicine 38
38
40
42
43
44
Medical Oncology
Haematology
Internal Medicine
Infectious Diseases
Day Hospital
Intensive Care 45
Anaesthesiology 46
Nursing
47
Supportive Care
48
Psycho-Oncology
Pain Management
Palliative & Supportive Care
48
50
51
& Postoperative Care
20
32
33
34
35
36
21
Diagnostic laboratories
Dr Aurore Dubois
Biomedical Scientist, Molecular Biology
Pierre Sidon
Biologist, Cytogenetics
pathology
Missions
Diagnosing cancerous and non-cancerous diseases
Staging cancers and evaluating response to therapy
Main areas
roviding accurate molecular tests needed to determine
P
a patient’s eligibility for targeted therapies
In addition to conventional
pathology, the Department
provides expertise in tumour
pathology and several related
domains such as:
immunohistochemistry
molecular pathology
tumour banking
quality assurance
Participating in multidisciplinary collaborations
E ngaging in research and development of new molecular
tests for clinical practice
Patient Care
Prof Denis Larsimont
Pathologist, Head of Department
Françoise Bury
Technologist, Immunohistochemistry
Key figures
2 6,000 biopsies and surgical
specimens analysed/year
21,000 cytology analyses/year
45 staff members
Advances in our understanding of cellular functioning
and in technological progress have enabled us to better
characterise tumours. What we dreamed might become
possible in the past has now become reality.
PrOF DENIS LARSIMONT, Head of the Pathology Department
ield, technologies
F
and methods
T umour pathology, mainly for breast, gynaecological, gastro-intestinal
and genito-urinary cancers
Immunohistochemistry robotic platform to detect specific and/
or more widely expressed antigens needed to identify tumours that
cause metastases or to determine suitability for targeted therapy
olecular technologies such as PCR, RT-PCR, ISH to detect amplification,
M
deletion and mutation of genes
icro-array technology to characterise genomic profiles of tumours
M
with prognostic or predictive values
D
epartmental organisation
The Department of Pathology directly serves
both the Institute and the neighbouring university hospital, CHU Saint-Pierre. It also provides pathology services for two other area
hospitals, making it the primary laboratory for
the public hospitals network of Brussels.
The Department’s work is carried out in a conventional histology laboratory, as well as in two
other specialised units:
t he immunohistochemistry unit uses
several robotic platforms to perform about
22,000 tests a year with approximately
120 different antibodies
t he molecular pathology unit uses techniques such as PCR, RT-PCR or ISH. These
tests detect anomalies in the nucleus of a
cell, such as gene amplification, deletion or
mutation, and consequent dysfunctions.
22
The Department also manages the Institute’s
tumour bank, which collects both frozen and
formalin-fixed paraffin-embedded tissues
on a continual basis. The bank, which has
about 9,000 frozen samples available (from
6,000 patients) at any given time, stores tissues that are essential for future research.
The Department also has a research and
develop­ment unit using micro-array technology to analyse several thousand genes expressed in any given tumour. This approach,
now available at the Institute as part of daily
practice, provides a wealth of information
about individual tumours, which in turn can
help determine the best treatment options for
an individual patient.
The Department and all its units are fully
accredited according to ISO 15189 standards,
and it is applying for College of American
Pathologists accreditation.
23
Diagnostic laboratories
Cytogenetics
Clinical biology
Pierre Sidon
Biologist, Cytogenetics
Missions
Prof Pierre Heimann
Pathologist, Head of Laboratory
roviding fast and accurate biological measurements
P
elivering results for well established diagnostic tests
D
Meeting evolving clinical needs by implementing new,
Diagnostic Laboratories
rof Olivier Vandenberg
P
Clinical Biologist, Head of Department
high complexity tests
Patient Care
M
issions
Providing cytogenetic and
molecular marker analyses
needed for accurate diagnosis,
prognostic assessment and
treatment decision-making in
haematopoietic and mesenchymal cancers
Evaluating the extent of disease and response to therapy
Ensuring long-term follow-up
of patients
Implementing new molecular
cytogenetic tests
Conducting translational and
basic research, especially in
the field of paediatric cancers
epartmental
D
organisation
The Cytogenetics Laboratory comprises
1 medical doctor, 1 biologist and 12 technicians. Its activities are carried out in two specialised sections, one conducting karyotype
analyses and another dealing with molecular
cytogenetics (FISH testing).
Key figures
2 ,600 karyotype analyses/year
1,000 molecular cytogenetic (FISH)
analyses/year
14 staff members
ield, technologies
F
and methods
The Cytogenetics Laboratory performs karyotype and molecular analyses (FISH) on
blood, bone marrow, lymph nodes or any other tissues affected by haematopoietic or
mesenchymal cancers.
Karyotype analysis makes it possible to visualise the entire tumour genome in the
form of chromosomes. It requires fresh tumour tissue cultivated according to cancer
type. Tumour chromosomes are then extracted and analysed in order to detect specific
abnormalities that can aid in making a diagnosis, determining patient prognosis and
selecting appropriate therapies.
FISH methodology complements karyotype analysis because it can be used on nondivided cells and is able to detect abnormalities too small to be seen on the karyotype.
FISH technology uses a fluorescent molecular probe that recognises and makes visible
the region of interest within tumour DNA. FICTION methodology is a variant of FISH
and is used with cancers like multiple myeloma that have a poor proliferation index.
Applied Research
Key figures
Our goal is to combine routine clinical
lab tests with innovative approaches to meet
the challenges of medicine today… and in the
future.
Prof Olivier Vandenberg, Head of the Clinical Biology Department
D
epartmental organisation
The Department of Clinical Biology is shared between CHU Saint-Pierre and the Institute,
and its work is carried out in specia­lized subunits:
T he Clinical Chemistry Laboratory performs approximately 3,000,000 tests annually.
This laboratory provides a variety of standard tests on blood, urine and other bodily
fluids, including spinal fluid. The laboratory also offers speciality testing such as the
identification of haemoglobin variants by electrophoresis
T he Haematology Laboratory plays a key role in the Institute. It offers diagnostic
testing for haematological abnormalities and analyses over 700 bone marrow
aspirates annually. It also performs more than 1,130,000 routine haematological tests
per year on blood and bodily fluids
T he Blood Bank Laboratory performs blood typing, antibody screening and crossmatching. Accordingly, it provides required blood components for patients with
various conditions
T he Microbiology Laboratory plays an essential role in oncology. Immuno-depressed
patients are more prone to infection. Pathogens and their sensitivity to treatments
can be identified immediately and accurately
,230,000 analyses/
5
year
110 staff members
ISO 15189 certification since 2010
Main areas
In addition to comprehensive
chemistry and haematology
testing, the Department of
Clinical Biology provides
expertise and services in:
Transfusion medicine
Flow cytometry
Bacteriology
Virology
Mycology
Parasitology
Molecular biology
T he Molecular Diagnostics Laboratory offers expertise and services for both diagnosis
and research collaboration, especially in the field of infectious diseases (e.g., viral
DNA/RNA detection).
Genetics of childhood mesenchymal cancers
enotypic and gene expression studies on congenital melanocytic naevi (moles) as
G
well as atypical childhood melanocytic lesions
24
25
Imaging
Dr Yolène Lefebvre
Radiologist
Prof Marc Lemort
Radiologist, Head of Department
Lionel Gantois
Radiology Nurse
Missions
Cancer diagnosis from a screening or treatment perspective
Evaluating the extent and severity of disease
Evaluating response to therapy
Long term follow-up of patients
Participating in multidisciplinary collaborations
Main areas
Research and development in the field of innovative imaging
methods
-Ray and echography
X
Computed tomography
Magnetic resonance imaging
Senology
Patient Care
Teaching and training of young radiologists
epartmental
D
organisation
Key figures
,400 MRIs/year
6
9,100 CTs/year
52 staff members
The
team comprises 12 radiologists and
40 members of staff, including nurses, imaging technologists, data entry and administrative staff, an engineer and a physicist.
The Department is divided into 4 sections:
PROF Marc Lemort, Head of the Medical Imaging Department
X-ray and ultrasonography (US); breast
imaging; computed tomography (CT); and
magnetic resonance imaging (MRI). Each is
headed by a senior physician.
There
is active collaboration in the field
of interventional angiography with the
Department of Nuclear Medicine and the
Radiology Department at the neighbouring
hospital, CHU Saint-Pierre.
Images
are stored on a safely networked
central Picture Archival and Communication
System. Medical staff accessing the computerised medical charts of patients can easily
visualise commented images on their own
computer screens. Patient privacy is strictly
regulated.
Requests
for imaging examinations are
managed through a computerised scheduling system.
Within the field of imaging, we are experiencing a
change of paradigm paralleling the one in cancer therapy:
from organ to disease or even to cells, from morphology to
function, from diagnosis to follow-up.
ield, technologies
F
AND methods
Conventional X-ray section
Computed Tomography (CT)
The Department’s conventional X-ray section is equipped with Computed Radiography (CR), digital fluoroscopy technologies and dual-energy bone densitometry (DEXA)
technologies.
In our CT section, a new, ultrafast, multi-detector scanner offers the best possible
technology for quickly collecting images over large body areas, thereby greatly improving
patient comfort. A second CT scanner is available exclusively for radiotherapy planning
purposes. The Department has developed the virtual CT colonoscopy technique, an
alternative method for detecting polyps or tumours of the large intestine that can
help avoid total colonoscopy in sensitive patients. CT is also used in clinical studies
for detecting responses to therapy with the help of powerful lesion-tracking software
integrated into the PACS computer system. A CT based 3-D guiding system may assist
diagnostic and therapeutic procedures such as the removal of tumour tissue through
percutaneous radio frequency.
Ultrasonography (US)
Two examination rooms are equipped with multiprobe machines able to carry out
advanced techniques such as contrast-enhanced US, harmonic imaging and advanced
Doppler. These systems are used both for diagnostic and interventional US.
Breast imaging
The senology suite dedicated to breast examinations is designed to be welcoming and to
help patients feel at ease, while providing a full array of the latest imaging technologies.
Both breast cancer screening and diagnostic mammography services are provided. The
screening section is equipped with a contemporary low-dose mammograph, along with a
new device using automated 3-D ultrasound. The diagnostic section provides a full digital
mammography unit connected to two US rooms. If required during a breast examination,
senologists are directly able to carry out a diagnostic puncture. A prone-position, numeric
stereotactic X-ray system is available for macro biopsies. Breast MRI is available in the MRI
unit, including MRI-guided biopsy.
26
Magnetic Resonance Imaging (MRI)
The Institute has a high-field 3 Tesla MRI machine complementing a state-of-the-art 1.5
Tesla machine. With this technology, the Department evaluates innovative techniques
and software for whole-body oncologic imaging, diffusion-weighted imaging, dynamic
contrast-enhanced MRI and quantitative in-vivo spectroscopy. These main areas of
research aim to identify new functional or molecular imaging surrogate markers that
can help predict how patients will respond particular therapies and how they will do
over time.
27
Nuclear Medicine
Dirk Staelens
Nuclear Medicine Technologist
Prof Patrick Flamen
Nuclear Medicine Physician,
Head of Department
Dr Kristoff Muylle
Nuclear Medicine Physician
Dr Camillo Garcia
Nuclear Medicine Physician
Bruno Vanderlinden
Radiation Medicine Physicist
Missions
Providing high quality diagnostic and therapeutic services
using radioactive elements
Carrying out translational and early clinical research,
with a particular focus on molecular imaging and new
targeted radionuclide treatments
Main areas
Delivering high quality pre- and postgraduate teaching in
nuclear oncology
C onventional nuclear medicine
(SPECT-CT; sentinel node
scintigraphy; lymphography)
PET-CT
Radionuclide therapy
Integrating imaging into the multidisciplinary oriented
approach to patient care
Patient Care
epartmental
D
organisation
The medical team comprises 5 nuclear medicine
physicians, 1 radiopharmacist, 2 radiophysicists,
1 bio-imaging engineer, 7 imaging technologists
and/or nurses, 2 clinical research assistants
and 2 administrative assistants. The Institute’s
PET-CT centre is also the referral unit for the
Brussels public hospital network.
Key figures
1 SPECT-CT, 1 SPECT, 1 PET-CT camera,
1 dedicated breast gamma camera
8,000 diagnostic examinations/year
(4,400 PET)
> 120 patients treated/year
Applied Research
PROF Patrick Flamen, Head of the Nuclear Medicine Department
Field, technologies and methods
Sentinel node scintigraphy
Diagnostic applications
In sentinel node scintigraphy, a radioactive dye is injected that is then transported to the lymph nodes closest to the tumour. The accumulated
radioactivity makes it possible to identify the sentinel lymph node during surgery using a hand-held detection probe. Analysis of this lymph
node shows whether cancer cells have been released out of the tumour or not. Surgical and medical treatments can be adapted accordingly.
This technique is mainly applied in breast cancer, but also in head and neck, prostate and gynaecological cancers.
The basic principle of nuclear medicine is that a target or a biomarker (a molecule found
in the body that is a sign of normal or abnormal processes, or that can show response
to a treatment) is visualised using molecules or drugs that are marked or “labelled”
with radioactive elements called (radio)isotopes or radionuclides. After administering
such a radioactively labelled molecule, highly sensitive, three-dimensional imaging is
performed using special detectors.
Early metabolic assessment of the efficacy of treatment
Cancer cells often use more glucose than normal cells. PET imaging can show a reduction of the glucose used by the tumour at the beginning
of treatment, which tends to be interpreted as a sign of treatment efficacy. Similarly, PET is used in drug development to provide an early
indication of a new drug’s effectiveness.
Radiolabelled antibodies for PET-CT-based molecular imaging and
dosimetry for radio-immunotherapy
Monoclonal antibodies can be labelled with long-living positron emitting isotopes (e.g., Zr 89 labelled trastuzumab). When whole body
PET-CT imaging is performed at multiple time points, the biodistribution and the biokinetics of the administered antibody can be measured.
These quantitative data can be then used to predict the treatment efficacy of the cold antibody (e.g., trasuzumab in metastatic breast cancer), or determine the optimal dosages of treatment for individual patients (e.g., Y90-labelled rituximab therapy for lymphoma patients).
Yttrium-90 labelled microspheres for the treatment of liver cancer
This technique uses millions of tiny resin beads (microspheres) containing Yttrium-90 that are injected selectively in the artery leading to
the liver tumour. The beads become fixed in the blood vessels and irradiate the tumour cells from within, using doses that are impossible
using conventional radiotherapy.
28
The shift of imaging from a structural to a molecular focus and the ongoing integration of molecular and functional
imaging in cancer management are crucial milestones on the way
to patient-tailored medicine.
thyroid cancer patients with high doses of
iodine-131. This treatment is given to remove
any remaining thyroid tissue following
surgery, or to treat recurrent metastatic
disease.
The Institute is increasingly integrating two types of imaging, namely molecular or
metabolic techniques (scans to look at physiological or biological processes in the
body) and structural-morphological ones (scans that look at the structural aspects of
disease, tissues and organs). Such “multimodality” technology – using PET and SPECT
from nuclear medicine and conventional X-ray CT from radiology – has led indirectly to
growing collaboration between the Departments of Nuclear Medicine and Radiology.
Together they recently created a Multidisciplinary Platform of Functional Imaging in
Oncology, which will ultimately benefit patients by offering the latest diagnostic and
therapeutic applications of imaging technology available today.
Therapeutic applications
The reason that molecules or drugs containing radioactive substances are used to treat
cancer is that they can deliver high-dose radiation to a tumour, killing cancer cells while
limiting “collateral damage” to the neighbouring non-tumour tissues. This is known as
the “magic bullet” approach. For example, the Institute is a referral centre for treating
29
Radiation Oncology
Roger Demorsy
Radiation Technologist
Dr Daniel Devriendt
Radiation Oncologist
Prof Paul Van Houtte
Radiation Oncologist, Head of Department
Patient Care
Sara Quental Poeta
Radiation Technologist
D
epartmental
organisation
The Radiation Oncology Department comprise
45 staff members, of which 8 are specialised
physicians based in the Institute who participate in multidisciplinary rounds in several hospital sites.
Missions
Provinding patients with high quality, tailored radiation
onco­logy care in a multidisciplinary setting
Main areas
T raining graduate and undergraduate students
aintaining an active research agenda
M
Key figures
1 ,800 new treatments per year
4 radiation units and 2 afterloaders
45 staff members
Intensity-modulated
radiotherapy
Image-guided radiotherapy,
Radiosurgery
Brachytherapy
Intraoperative radiotherapy
Combined modalities exist with
chemotherapy, targeted biological therapies and surgery.
The future of radiation therapy lies in better understanding tumour metabolism and in integrating different imaging modalities into our current approaches to radiation treatment.
PROF Paul Van Houtte, Head of the Radiation Oncology Department
Field, technologies and methods
Imaging facilities
Intraoperative radiotherapy
Image-guided radiotherapy
Individualised treatment
The Department is connected to the Institute’s
imaging facilities: PET-CT, CT and magnetic resonance. Medical imaging is essential to perform a
wide range of modern radiotherapy techniques:
Intraoperative radiotherapy, mainly used in breast cancer, makes it possible to apply a
single dose of radiation, so that patients need not return post-surgery for additional
therapy. The radiation is delivered in the operating theatre immediately after the surgical removal of the tumour and is strictly limited to the surgical site. State-of-the-art
technology, namely the Mobetron machine, has been acquired for this purpose.
Radiotherapy treatment often takes 6 to 7 weeks. An important aspect is the integration of PET-CT into treatment planning. PET-CT is a highly sensitive technique. While
the CT component is commonly used to perform planning, the PET component has the
advantage of being able to more accurately delineate the limits of a tumour. Planning
logically precedes treatment; however, some unpredictable changes may occur due to
the way a tumour responds. Thus, there are great benefits to be gained from repeated
adaptation of planning, and adjustments to treatment are continually made in accordance
with tumour response.
The ultimate aim of radiation oncologists is
to individualise treatment not only according
to the physical and anatomical aspects of
a patient’s tumour, but also in relation to its
radiobiological characteristics (degree of oxygenation, proliferation rate, intrinsic radiosensitivity). PET-CT using new tracers may make it
possible to clearly define such biological maps.
These can then be monitored throughout the
course of treatment in order to provide permanent, accurate tailoring of the radiation required for each individual patient.
3 -D conformal radiotherapy (treatment plans
based upon a 3-D image of the tumour)
intensity modulated radiotherapy
Brachytherapies
image guided radiotherapy
More than 120 brachytherapies (local implants
of a radiation source) are
performed each year, including
gynaecological applications,
prostatic implants with
iodine 125, endoluminal
brachytherapy (for
oesophageal and lung cancers),
head and neck implants, and
implants for uveal melanoma.
Specially equipped rooms and
adequate “afterloader” machines
make such local therapies available
in the Institute.
s tereotactic radiotherapy or radiosurgery (treatment of tiny brain tumours by highly precise
delivery of a single, high dose of radiation)
t otal body irradiation before a bone marrow
transplant.
The principle is firstly to acquire an accurate
image of the site to be treated. CT and PET-CT
are used for this purpose.
Secondly, the treatment is planned on the basis of
this imaging that aims to achieve a defined dose
distribution in 3-D.
The third step is the radiation treatment itself.
30
Applied Research
The main goal of modern radiation techniques is to focus the radiation exposure on the
tumour while preserving the surrounding healthy tissue as much as possible. For example,
IMRT used in the management of head and neck cancers makes it possible to preserve
the salivary glands, which in turn spares patients the side effect of dry mouth syndrome. It
is also possible to reduce the risk of irradiating healthy tissue by taking into account the
patient’s breathing motion through what is known as a “gating” technique.
Partial breast irradiation
Partial breast irradiation is an area under development, using different approaches. As
well as external radiation, the department has a long history of preoperative implants
for breast cancer. The latest technique to be implemented is intraoperative electron
beam irradiation (the Veronesi approach), enabling full radiation treatment to be delivered
at the time of surgery.
31
Surgery
Cervicofacial & Thoracic Clinic
Digestive Oncology CLINIC
Dr Antoine Digonnet
Head and Neck and Thoracic Surgeon
Surgery
rof Issam El Nakadi
P
Digestive Oncology Surgeon,
Head of Clinic
Prof Guy Andry
Head of Clinic,
Head of Surgery Department
Missions
Dr Esther Willemse
Head and Neck and Thoracic Surgeon
Developing an integrated treatment programme in digestive
oncology in association with the Institute’s Gastrointestinal Cancer
Clinic and with the Department of Medicosurgical Gastroenterology
of the Hopital Universitaire Erasme.
r Fikri Bouazza
D
Digestive Oncology Surgeon
r Gabriel Liberale
D
Digestive Oncology Surgeon
D
epartmental organisation
The Clinic comprises 1 senior resident (Prof Issam El Nakadi), 4 surgeons
(Dr Fikri Bouazza, Dr Gabriel Liberale, Dr Vincent Donckier, Dr Jean Van de Stadt)
and 2 postgraduates.
Patient Care
Dr Marie Quiriny
Head and Neck Surgeon
Dr Luc Vandevelde
Ear, Nose and Throat Specialist
Dr Cécile Dekeyser
Ear, Nose and Throat Specialist
M
issions
Applied Research
Analysis of gene expression profiles of thyroid tumours using microarray technology,
in collaboration with the Breast Cancer Translational Laboratory Jean-Claude Heuson
and the Institute of Interdisciplinary Research in Human and Molecular Biology
Applied Research
The Clinic regularly conducts medicosurgical studies,
such those focused on the following topics:
Multimodal treatment of hepatocarcinoma
T ogether with the Medical Oncology Clinic, participation in clinical studies for
head and neck tumours, in collaboration with the European Organisation for the
Research and Treatment of Cancer
Predictive factors for hepatic metastases of primary breast cancer
ork on biological markers in lung cancers, in collaboration with the Thoracic
W
Oncology Laboratory
Role of PET scans in peritoneal carcinosis
Role
of an early PET scan in the assessment of response to preoperative
chemotherapy (e.g., metastases of colon, stomach, liver)
Key figures
1 0 studies ongoing
on average
1,000 interventions/
year
Profiling of peritoneal carcinosis nodules originating from colorectal cancer
Providing high quality service
to patients
Informing patients about their
illness and the optimal treatment for cure
Fulfilling our missions in a
multidisciplinary way
ield, technologies
F
and methods
Areas
epartmental
D
organisation
The Cervicofacial and Thoracic Surgery Clinic
comprises 4 surgeons and 2 Ear, Nose and Throat
specialists working in close collaboration with
various other departments, including Pathology,
Medical Imaging, Medical Oncology, Radiation
Therapy, and Psycho-Oncology. Paramedical
disciplines, such as speech- and physiotherapy,
also play an important role.
The Clinic has expertise in treating a broad range of malignant and benign disease:
epidermoid (squamous cell) carcinoma of the oral cavity and adjacent areas; tumours
of the major salivary glands; lymph-node metastases of the neck and the superior
mediastinum; sarcomas; schwannomas; chemodectomas; glomus jugular tumours;
lipomas; lymphangiomas of the cervicofacial region; tumors of the sinuses; goiters;
Graves’ disease; thyroid tumours; primary hyperparathyroidism; and pleural effusions.
Technologies
All types of state-of-the-art surgery, with prior radiological examination (scanning,
MRI, PET-CT and image blending); sentinel lymph node biopsy; laryngeal endoscopy
and microsurgery; parotid gland surgery with image-guided dissection of the facial
nerve; binocular surgery; complex reconstructions; radiofrequency ablation; fine-needle aspiration cytology under ultrasound guidance; fibrolaryngoscopies (and biopsies);
photodynamic therapy; fiber-optic endoscopies; and thoracoscopies.
The key to success in caring for patients
with digestive cancer? A multidisciplinary
approach, multimodal therapy, appropriate
surgical techniques and efficient
postoperative care.
Prof Issam El Nakadi, Head of the Digestive Oncology Surgery Clinic
ield, technologies
F
and methods
Using a multidisciplinary approach, multimodal treatments and minimally invasive
surgery whenever possible, the Clinic is specialised in
Surgery of the upper digestive tract (oesophagous, stomach) and pancreas
epatobiliary surgery using radiofrequency ablation and multi-stage resections of
H
hepatic tumours
C olorectal surgery applying laparoscopic techniques, total mesorectal excision and
conservative surgery of the anus
T reatment of peritoneal carcinosis using intraperitoneal hyperthermic chemoperfusion, standardised according to well-defined protocols
Central venous access surgery
32
33
Surgery
bone & connective tissue CLINIC
Prof Michaël Gebhart
Orthopaedic Surgeon, Head of Clinic
Oncoplasty CLINIC
Missions
r Maxime De Wulf
D
Plastic Surgeon
Carrying out breast, cervicofacial, pelvic and perineal reconstruc-
r Frédéric-Claude Urbain
D
Plastic Surgeon, Head of Clinic
tive surgery
Conducting limb reconstructions and other surgeries such as
those related to malignancies of the bone, soft-tissue or skin
Training future plastic surgeons by offering specialist courses in
reparative- and micro-surgery
Perfecting new techniques in oncoplastic surgery
Dr Félix Shumelinsky
Orthopaedic Surgeon
Surgery
D
epartmental organisation
The team is composed of 2 plastic surgeons specialised in micro- and oncoplastic
surgery, as well as 2 assistants.
Patient Care
M
issions
Providing surgical treatment
for bone and soft-tissue
tumours, metastases and
pathologies related to cancer
treatment (e.g., bone necrosis,
tissue contractures)
Ensuring a multidisciplinary
treatment approach by
associating surgery with
radiotherapy, chemotherapy,
nuclear medicine,
physiotherapy, psychological
support and other forms of
cancer care
epartmental
D
organisation
The principal members of the medical team
are Prof Michaël Gebhart, Head of Clinic and
Dr Félix Shumelinsky, surgeon
Key figures
30 osteosarcomas/year in Belgium
60% to 70% survival rate at 10 years
for bone sarcoma (versus 10% in 1970)
ield,technologies
F
AND METHODS
The Clinic treats childhood osteosarcomas and Ewing’s sarcoma in close consultation
with the Hôpital Universitaire des Enfants Reine Fabiola in Brussels; adult osteosarcomas; chondrosarcomas; bone metastases of the peripheral and axial skeleton; malignant tumours of the bone (myeloplaxis, osteoblastomas, chondroblastomas) or of
the soft tissues (desmoid tumours); and other extremely rare bone tumours, including
chordomas, adamantinomas and fibrosarcomas.
The Clinic uses state-of-the-art techniques such as the following:
egaprostheses to reconstruct extensive bone defects
M
Pasteurized autografts for reconstruction of the pelvis
High-speed burrs and argon-based cryoablation for locally aggressive bone
tumours
Prostheses made-to-measure for children, with a prosthetic growth function
activated by an external magnet
Applied Research
rowth megaprostheses with physiological lengthening using an external magnet
G
(photo left)
E xtensive clinical research activity with the European Organisation for the
Research and Treatment of Cancer Sarcoma Group
Treatment of aggressive, benign bone tumours and intramedullary chondrosarcomas
using argon-based cryoablation
34
Today’s reconstructive surgery aims to
maximally restore the integrity of patients’
bodies so that they can resume an active role
in society.
Main areas
reast surgery
B
Cervicofacial surgery
Dr Frédéric-Claude Urbain, Head of the Oncoplastic Surgery
Clinic
ield,technologies
F
AND METHODS
reast reconstructions: placement of adjustable volume implants, tissue expansion,
B
tissue transposition using micro-vascularised composite flaps and the new
perforator flaps
C ervicofacial reconstructions: removing and implanting simple or combined tissues
to optimise both functionality and aesthetic
elvic and perineal reconstructions: use of myocutaneous or thin fasciocutaneous
P
flaps in particular
L imb reconstructions: according to the case, use of cutaneous, fasciocutaneous or
myocutaneous flaps, microvascularized bone transfer
Applied Research
Optimising fat transfers to restore volume and repair tissue
Modifying damaged tissues structure with stem cells
S paring patients unnecessary surgery by constructing some structures outside of
the body so that they may be implanted later
C alculating and facilitating the development of irrigation systems and circulatory
structures needed for the successful transfer of tissue from one part of the body
to another
35
Surgery
Breast & Gynaecological CLINIC
Dr Filip De Neubourg
Gynaecological Surgeon
Missions
Dr Jean-Marie Nogaret
Gynaecological Surgeon,
Head of Clinic
Treating all genito-urinary diseases, whether in children, young
adults or older adults of both sexes, with specific concentration
on cancer
Training students in medicine and urology
Participating in clinical studies designed to improve the treatment of genito-urinary diseases
Dr Isabelle Veys
Gynaecological Surgeon
Dr Dina Hertens
Gynaecologist
Dr Danièle Noterman
Gynaecologist
Key figures
Patient Care
Urology
7 00 patients with breast cancer
operated/year
240 patients with gynecological
cancer operated/year
epartmental
D
organisation
Conducting breast cancer sur-
gery, including reconstructions
Conducting gynaecological
surgery
Offering psychological support
to patients
Developing advanced surgical
techniques and participating in
clinical studies
Training medical and paramedical staff
rof Roland van Velthoven
P
Urologist, Head of Department
r Alexandre Peltier
D
Urologist
r Éric Hawaux
D
Urologist
A great deal of the improvement in the quality of
care given to cancer patients is because of our ability to
translate most of the state-of-the art surgical protocols
into minimally invasive, valid procedures.
Prof Roland van Velthoven, Head of the Urology Department
The Clinic includes 9 surgeons, 1 head nurse,
3 psychologists, 2 data managers and 3 secretaries.
M
issions
r Ksenija Limani
D
Urologist
ield, technologies
F
and methods
Diagnoses
For breast pathologies, the department carries out biopsies (micro- or
macrobiopsies) using a Mammotome ®, a device that uses imaging guidance
for precision and patient comfort. Gynaecological tumours are detected by
ultrasound, colposcopy, biopsy or hysteroscopy.
ield, technologies
F
and methods
The Department treats all diseases of the genital system and of the urinary tract,
whether cancerous or not. The team has expertise in all techniques used for treating
genito-urinary tumours, specialising in the following areas:
inimally invasive approach to radical prostatectomy
M
(robot-assisted procedure, prospective assessment)
Reconstructive surgery, including complex reconstructions of the bladder
Treatments
High-intensity focused ultrasound to treat prostate cancer
Apart from standard breast and gynaecological surgery, our team uses stateof-the-art technology and techniques, such as intraoperative radiation therapy, robotic surgery, or debulking surgery.
Cryotherapy treatment of kidney tumours
D
epartmental
organisation
The medical team comprises 4 senior urologists, 2 assistants, 1 coordinating nurse and
1 physiotherapist. The Department is a member of the Genito-urinary Group of the European Organisation for Research and Treatment of Cancer and participates in European
Institute of Tele-Surgery training
Sentinel lymph-node technique to enhance lymph node staging of prostate cancer
Photodynamic diagnosis of bladder tumours
Functional urology and urodynamic investigations
Applied Research
The Clinic is a Belgian pioneer in introducing new techniques such as intraoperative
radiation therapy, the sentinel lymph-node procedure, macrobiopsy and
psychological support for patients. It regularly participates in national and
international research studies.
36
37
Medicine
Medical Oncology Clinic
Prof Martine Piccart
Medical Oncologist,
Head of Medicine Department
Prof Ahmad Awada
Medical Oncologist, Head of Clinic
Missions
Offering to each cancer patient at risk of relapse or presenting
with advanced disease the best possible therapy with anticancer
drugs to prevent the development or slow the progression of
metastases
Managing promptly and optimally all the side effects induced by
these therapies, in case preventive measures fail
Patient Care
Key figures
58 new patients hospitalised/year
6
13,000 patients seen
in consultations/year
120 ongoing clinical trials
ield,
F
technologies
and methods
Quality of care in the field of medical oncology
requires constant interaction with other
disciplines, in particular nursing, pathology
(for in-depth characterisation of the molecular
profile of each tumour, which guides doctors
in the selection of the best anticancer drug),
tumour imaging (for the rigorous evaluation of
disease status and response or lack of response
to the selected anticancer therapy), infectiology
(to rapidly treat infectious complications of
certain therapies), and supportive care (to
minimise the side effects of anticancer drugs).
In addition, continual dialogue with other
cancer disciplines such as radiotherapy and
surgical oncology makes it possibly to rapidly
identify combined treatment approaches,
which are often more effective than single
treatment types.
38
epartmental
D
organisation
The Clinic is divided into specialised teams with particular expertise in the management of site-specific cancers, such as breast, gynaecological, thoracic, head and
neck, genito-urinary, and rare tumours.
There are 3 medical oncologists on staff. In addition, each year the department
hosts an average of 6 interns and residents, junior doctors who are being trained in
medical oncology.
The cases of all patients needing treatment with anticancer drugs are presented
and discussed during weekly multidisciplinary rounds.
Every possible effort is made to offer all patients the opportunity to participate in
clinical trials, since these provide both optimal medical care as well as access to
new therapies that are potentially more effective, or are associated with fewer side
effects.
This dynamic approach to treatment requires the medical oncology staff to participate actively in cancer research organisations, such as the European Organisation
for Research and Treatment of Cancer.
Main areas
Treatment of solid tumours
with chemotherapy, endocrine
and biological therapies
Clinical (phase I, II and III
trials) and translational
research (mainly genomics)
Data management of large,
international phase III trials
of adjuvant therapy for breast
cancer
Applied Research
The Medical Oncology Clinic has over 30 years of experience in the conduct of phase I, II and III clinical trials. These not only provide
optimal treatment and access to new therapies, but represent the process by which effective anticancer drugs receive regulatory
approval for use in cancer patients. Clinical trials are particularly important for many types of cancers that respond poorly to currently available anticancer drugs.
A team of 13 research nurses and 2 full-time research physicians play an active role in the daily management of an average of
120 clinical trials of new medical therapies.
By using a multidisciplinary approach to manage the
treatment of all patients with solid tumours, by participating
actively in new drug development and clinical research,
by conducting cutting-edge translational research, and by
engaging significantly in teaching activities, the Medical
Oncology Clinic fulfils the mission of the Institute: care,
research and education.
PROF Ahmad Awada, Head of the Medical Oncology Clinic
Another key responsibility of the medical oncologists on staff lies in training interns
and residents. This is done on an ongoing basis by supervising their clinical activities
and by regularly holding educational seminars and workshops.
39
medicine
medicine
Haemato-Oncology
& Transplantation
Prof Nathalie Meuleman
Haematologist
Dr Philippe Lewalle
Haematologist
Prof Dominique Bron
Haematologist, Head of Department
Missions
Screening and treating malignant haemopathies
Managing long-term aplasia
Main areas
Providing haematopoietic stem cell transplantations
alignant haemopathies
M
Management of febrile
neutropaenia
Haematopoietic stem cell
transplantations
Cellular therapies and
regenerative medicine
Participating in collaborative clinical research
Educating medical students, haematology specialistsin-training, and visiting foreign fellows
Patient Care
epartmental
D
organisation
The Haemato-Oncology & Transplantation
Department is divided into three separate units:
ospitalisation unit with a capacity of
H
20 beds, including a 6-bed sterile unit for
patients receiving transplants (JACIE accredited)
C ytapheresis unit, making it possible to
remove and conserve cell-based components
of blood for subsequent transplantation
anking unit for stem cells and cord blood
B
(internationally accredited).
Key figures
0 stem cell transplantations/year
5
2,500 consultations with
160 new patients/year
500 hospitalisations/year
Our dreams of yesterday have become today’s reality: as research advances, the disease retreats.
PROF Dominique Bron, Head of the Haemato-Oncology & Transplantation Department
Applied Research
The Department consists of 6 senior haematologists, 2 consultant haematologists,
4 haematologists-in-training, 22 nurses, and
1 haemovigilance/quality control manager.
T ranslational research, in particular an important study designed to better define
prognostic factors of chronic lymphocytic leukaemia and, ultimately, to provide better
therapies for patients.
Each patient is discussed in weekly, multidisciplinary rounds involving other departments.
Affiliated hospitals are also invited to discuss
their patients at these weekly meetings.
C ellular (and regenerative) therapy using mesenchymal stromal cells, isolated
from bone marrow, cord blood and adipose tissue. These cells have the potential
to accelerate haematological engraftment, to limit post-transplantation immune
reactions, and to regenerate bone, adipose or muscular tissues.
Work is conducted in close collaboration with
the laboratory of the CHU Saint-Pierre with
the human lymphocyte antigen typing laboratory at Hôpital Érasme and the Experimental
Haematology Laboratory in the Institute. Colleagues from these departments also join staff
meetings when required for a specific patient.
S tem cell transplantation, including the development of new transplantation techniques (e.g., double cord blood, haplo-identical).
The Department also collaborates with the
Groupe d’Étude des Lymphomes de l’Adulte,
the Intergroupe Francophone du Myélome, the
European Organisation for Research and Treatment of Cancer and the European Group for
Blood and Marrow Transplantation.
T reatment and follow-up of patients with malignant haemopathies, febrile neutropaenia
and tranfusions-at-risk
ield, technologies
F
and methods
one marrow and haematopoietic stem cell transplantations in collaboration with the
B
Hôpital Universitaire des Enfants Reine Fabiola: classical autologous and allogeneic, non
myeloablative (for patients up to the age of 70); haploidentical; and cord blood
Isolation of patients with neutropaenia or aplasia
evelopment of new haematopoietic approaches (e.g., experimental transplantations,
D
regenerative cellular therapies, extracorporeal photopheresis)
40
41
Medicine
Internal Medicine Clinic
Infectious diseases
M
issions
Prof Anne-Pascale Meert
Internist
medicine
r Angela Loizidou
D
Internist
Caroline Gustin
Training Coordinator
Preventing and treating infectious complications
r Michael Aoun
D
Internist, Head of Unit
Prof Jean-Paul Sculier
Internist-Intensivist, Head of Department
Carrying out clinical research
atheline Devleeshouwer
C
Infection Control Nurse
D
epartmental organisation
The Infectious Diseases Unit comprises 1 head physician, 2 assistant physicians,
1 research nurse, 2 nurses specialising in infection control and a secretary. The
team is available 7 days a week/24 hours a day to provide assistance with any
infectious problem or alert that arises in the hospital and, on a daily basis, visits
patients affected by infectious complications. The team is responsible for the
monitoring and reporting of infections acquired by patients while in hospital
(nosocomial infections). The Unit is a key member of the Institute’s Hygiene
Committee and works closely with the Microbiology Laboratory. It takes part in
the multidisciplinary meetings as required.
Patient Care
M
issions
Overseeing and training
undergraduates in medicine
and post-graduates in internal
medicine
Supervising the theses of doctors
specialising in internal medicine
Managing and organising shift
duty
epartmental
D
organisation
The medical team consists of 2 internists
and 8 assistant specialists working in the
different departments of the Institute. The
Clinic accommodates 10 trainee medical
students and 8 doctors specialising in internal
medicine.
Main areas
T eaching undergraduate
and postgraduate medical
students
Practising and teaching
evidence-based medicine
42
Key figures
trainee doctors specialising
8
in internal medicine
40 trainees in a third and fourth
years’ master’s course in medicine
ield, technologies
F
and methods
The Internal Medicine Clinic is integrated into the various departments of the Institute.
While its main function is didactic, the Clinic also plays an important role at the patient
bedside, whether during the day or at night.
All teaching is based on the review of actual patient cases and discussion in small
groups. Logistical support for teaching is provided by the www.pneumocancero.com
and www.oncorea.com websites. The Internal Medicine Clinic is also a pioneer in teaching evidence-based medicine, which refers to using the latest scientific knowledge to
guide treatment decision-making.
F
ocus On
Evidence-based medicine
The teaching of evidence-based medicine at the Institute was initiated by Prof Jean-Paul
Sculier. Every year a two-day training course is organised in collaboration with the various
experts of the Université Libre de Bruxelle’s medical faculty. Speakers from abroad are
also invited. While this event is aimed primarily at doctors who are specialising, it is open
to the entire medical profession.
Key figures
,000 ward consultations/year
6
Expertise in 20 environmental and food control procedures
in collaboration with specialised laboratories
6 staff members
ield, technologies
F
and methods
Infection control is mandatory in hospitals in order to prevent, control and decrease
the incidence of nosocomial infections.
Standard environmental controls include sampling air to detect Aspergillus conidia
in critical areas such as the sterile and intensive care units, and sampling water to
detect Legionella. In the event of nosocomial infection, patients are isolated to prevent
further contamination. A daily tour of all wards, and visits to all patients receiving
antibiotics who have infections or are febrile, contribute to improving the management
of infectious complications.
In collaboration with other specialized units, protective measures, vaccination
programmes and antimicrobial prophylaxis with antibacterial and antifungal agents
are implemented when and where needed, in accordance with various risk factors.
Advances in the use of
cancer therapeutic agents in
parallel with antimicrobial
prevention and treatment of
infectious complications can
give years, if not decades,
of productive life to many
cancer patients.
Dr Michael Aoun, Head of the Infectious
Diseases Unit
Management of febrile neutropaenia is a main concern. With a view towards preserving
the best possible quality of life, low risk patients are provided with oral antibiotics and
followed up as out-patients until the febrile neutropaenic episode has been resolved.
Intensive research is carried out on preventing and managing invasive fungal infections.
In collaboration with the pharmaceutical industry, the Unit participates in studies to
evaluate new antifungal drugs.
43
Medicine
Day Hospital
Dr Dominique de Valeriola
Medical Oncologist,
Head of Day Hospital
Brigitte Fernez
Oncology Nurse
Dr Yassine Lalami
Medical Oncologist
Intensive Care
Missions
E veline Markiewicz
Intensive Care Nurse
andling critical complications of cancer and its treatment
H
dministering and monitoring intensive anticancer treatment
A
Treating acute diseases, such as myocardial infarction and
r Anne-Pascale Meert
D
Internist
rof Jean-Paul Sculier
P
Internist, Head of Department
asthmatic crisis, possibly unrelated to the cancer or its treatment
Monitoring postoperative recovery
ngelina De Beer
A
Pharmacist
D
epartmental organisation
Patient Care
M
issions
Maintaining a quality environ-
ment that guarantees the
privacy, autonomy and comfort
of patients
Preparing and administering
anticancer medications in the
safest possible conditions
Monitoring the administration
of treatment and managing
expected and unexpected side
effects
Providing patients with complete information about their
treatments and potential side
effects, including how to avoid
or to control them
Supervising the administration
of innovative forms of treatment being clinically tested
Key figures
E stablished in 1972, Belgium’s 1st day
hospital for cancer patients
11,500 stays in 2010
A multidisciplinary team of 25 specialised
professionals serving patients
ield, technologies
F
and methods
nticancer chemotherapies and targeted biotherapies
A
S upportive treatment and medical procedures such as the administration
of bisphosphonates; punctures for pleural effusion or ascites; and transfusions of platelets, red blood cells or immunoglobulin
P rovision of current informational materials for patients
The Intensive Care Unit (ICU) team includes 3 senior physicians, 2 physicians in training,
1 head nurse, nursing staff, 1 secretary and 1 physiotherapist. The ICU has a capacity
of 6 single and 1 double-occupancy rooms equipped with en-suite bathrooms.
The Unit is flexible to allow for adaptation where required to ensure the best possible
management of individual patients’ cases. Patients’ rooms provide optimum privacy
without compromising intensive surveillance. Laminar air flow and filter systems
make it possible to isolate patients whose conditions so require.
A physician is present 24 hours a day,
7 days a week. The Head of Unit
may be called at any time, along
with attending physicians and other
specialists.
The ICU also includes a room for ambu­
latory medical emergencies.
E ach patient is closely monitored. Critical care facilities such as mechanical
ventilation, renal replacement therapy and haemodynamic monitoring are available
at each bed. Blood pressure is measured by a non-invasive system incorporated
into each bedside monitor.
ield, technologies
F
and methods
Invasive mechanical ventilation
Nearly 15% of cancer patients (namely those with haematological mali­
gnancies, neutropaenia and/or bone marrow transplantation) will suffer
acute respiratory failure, requiring intensive care treatment.
Key figures
2 0 staff members
389 admissions in 2010
2,090 ambulatory
emergencies in 2010
Non-invasive ventilation
This has been used increasingly by the Unit during the last decade and is today
considered to be the best initial treatment for several types of respiratory
failure occurring in patients with compromised immune systems.
Departmental organisation
The Day Hospital’s multidisciplinary team consists of 3 medical oncologists, 12 specialised nurses, 3 pharmacists, 3 pharmacy assistants, 1 logistical assistant, and 3 secretaries. Psychologists, dietitians, cosmeticians, social assistants and other healthcare
specialists are also at the disposal of patients during their visit to the Day Hospital. The
13 individual rooms are all decorated with different themes inspired from bedrooms
found at home.
44
Continuous veno-venous haemodiafiltration
7% of admissions to the Unit are due to renal failure and about 5% of patients
treated require continuous veno-venous haemodiafiltration for acute renal
failure. The Unit has two continuous renal replacement machines.
Emergency room
The Unit is also responsible for outpatients who present with an emergency
condition related to cancer.
45
ANAESTHESIOLOGY & Post-operative Care
Nursing
Prof Maurice Sosnowski
Anaesthesiologist, Head of Department
Missions
eneviève De Jonghe
G
Oncology Nurse
Dr Valérie Decotennier
Anaesthesiologist
E nsuring the continuity of nursing care and the
implementation of treatment in a multidisciplinary
environment
Promoting the quality of care
Training oncology nurses and students
enise Cullus
D
Oncology Nurse, Head of Department
Dr Sonia Hontoir
Anaesthesiologist
Dr Jean-Corentin Salengros
Anaesthesiologist
epartmental
D
organisation
The team consists of 9 specialists and 4 medical
trainees in anaesthesiology & post-operative
care. The department is staffed 24 hours a day.
Patient Care
M
issions
Providing general and
locoregional anaesthesia for
cancer surgery
Managing cancer patients
after major surgery
Teaching and training for the
Université Libre de Bruxelles
(ULB)
Conducting research on pain
with the neurophysiology
laboratory of the ULB Faculty
of Medicine
Main areas
C onsultation and pre- and post-operative care for
patients undergoing cancer surgery
Anaesthesiology for inter­ventions on cancer patients
Intensive care of patients following major surgery
Pain management and supportive care
D
epartmental organisation
The department comprises 1 director, 2 departmental head nurses, 16 head nurses, 2 nurses
in charge of hospital hygiene, 7 Nursing Care Coordinators, nurses responsible for training
new team members.
F
ocus On
Nursing Care Coordinators (NCCs)
Serving as the link between patient, hospital and health-care teams, NCCs are the nur­
ses who coordinate personalised patient care. Mediators par excellence, NCCs are the
principal contacts for patients throughout the course of treatment, including the critical
time when diagnosis is communicated. Trained coaches specialised in the different types
of cancer, NCCs not only plan patient care, but also ensure that patients are able to follow their treatment plans with ease.
ield, technologies
F
and methods
A post-surgical Recovery and Intensive Care Unit (RESI) is also available for patients
who have undergone major surgery. Managed by the anaesthesiology team, this unit
has seven beds.
Efficient pain management is a key concern. Our research activities focus on this
issue.
Chemotherapy-related
pain is distressing
and impacts on rehabilitation and survival.
Although some medications seem to reduce
pain, its precise pathophysiological mechanism remains unexplained. Our department
is currently investigating the physiological,
immunochemical and histological aspects
of pain on laboratory rats.
46
The anaesthesiologists are also responsible for the post-operative pain management
and they offer tailored consultations and supportive care for patients who experience
breakthrough (episodic) pain.
A biomedical department is responsible for maintaining the instruments, monitors and
equipment used in anaesthesiology.
Thoracotomy and mastectomy can give rise to severe chronic pain that can last up
to several years or even a lifetime. Several biological processes (mediators) active
in the body’s cells play a role in this type of pain. One of our studies examines the
hypothetical influence of a specific mediator (ERK - Extracellular signal-regulated
kinases) on the pain threshold of rats. This may lead to the discovery of new medications that could alleviate chronic pain.
The influence of diet on chronic pain is also being studied.
2 60 full-time
equivalent nurses
80% nurses
specialised in
oncology
We combine empathy, experience
and know-how in a multidisciplinary environment.
The Institute’s operating suite has four theatres for major surgery (head and neck, gastrointestinal, breast and pelvic, musculoskeletal, reconstructive and dermatological, and
urological), two pre-anaesthetic rooms (minor excisions, tumourectomies, endoscopies)
and a recovery room.
lied
App
Research
Key figures
Main areas
Denise Cullus, Head of the Nursing Department
ay Hospital &
D
Chemotherapy
Radiotherapy
Surgery
Intensive care
Supportive care
Stomal therapy
and wound care
Oncogeriatry
47
SUPPORTIVE CARE
Psycho-Oncology
Dr Yves Libert
Psychologist
Dr Isabelle Merckaert
Psychologist
Françoise Daune
Psychotherapist
Prof Darius Razavi
Psychiatrist, Head of Clinic
Missions
Main areas
Offering comprehensive psychosocial support to both
inpatients and outpatients and their families through a wide
range of services that follow a multidisciplinary approach
istress screening
D
Psycho-social support for
inpatients and outpatients
and their families
Smoking cessation
programmes
Communication skills for
healthcare professionals
Helping healthcare professionals deal with patients’
Patient Care
difficulties by providing them with individual psychological
support and training that focuses on communication skills
epartmental
D
organisation
The medical team comprises 3 psychiatrists,
8 psychologists, 1 psychotherapist and 1 nurse.
On a weekly basis, the Psycho-Oncology Clinic
organises a psychosocial multidisciplinary
meeting and an internal supervision session.
Key figures
staff members
3
1,000 patients screened annually
for distress
6,500 patient interventions/year
The Psycho-Oncology Clinic aims to help patients, their families and health care professionals to cope with cancer and its consequences, with support always adapted to specific individual needs.
PROF Darius Razavi, Head of the Psycho-Oncology Clinic
lied
App
Research
Controlled studies designed to assess psychosocial interventions
Psychopharmacological interventions inves­
ti­gating the impact of antidepressants on
the treatment of patients’ psychological
distress and the role of anti-psychotic
drugs in delirium prevention
Psychobiological
studies looking at the
impact of genetic differences and their
influence on resilience and vulnerability to
stress, as well as the effect of psychosocial
and psychopharmacological interventions
on functional connectivity in the brain
Neuropsychological
studies that examine
the cognitive dysfunction experienced by
some patients as a result of treatments
such as chemotherapy and hormone
therapy. Because this side effect can be
durable and disabling, it is essential that it
is understood and addressed
48
Field, technologies and methods
Psychosocial support
for patients and their
families
Untreated, distress may have long-term
detrimental consequences for both patients
and their families. Comprehensive psychosocial
support is designed to preserve, restore or
enhance quality of life:
preventive interventions will avoid predictable
illness secondary to treatment and/or disease;
detecting problems earlier rather than later
leads to better quality of life and survival
Psychosocial support
for health care professionals
Physicians must deal with breaking bad news, informing patients about highly complex
treatment procedures, asking for informed consent, and comforting anxious and depressed
patients and family members. Beyond this, to promote patient decision-making, compliance with treatment and satisfaction, healthcare professionals need to adapt information
to each patient’s needs and therefore must take into account contextual, cognitive and
emotional barriers, a task for which they are not always adequately trained. The psychooncology team provides support and training for the development of such skills.
Smoking cessation programmes
(see p. 18)
rehabilitation
interventions are essential
when a cure is likely, and their aim is to
control or eliminate any residual cancerrelated disability; supportive rehabilitation
will lessen disability related to chronic
disease and/or to active treatment
palliative interventions aim to improve or
maintain patient comfort when curative
treatment is no longer an option.
49
supportive care
Pain Management unit
Palliative & Supportive Care
Prof Maurice Sosnowski
Anaesthesiologist
r Bénédicte Michel
D
General Practitioner
Dr Dominique Lossignol
Internist, Head of Unit
Missions
Providing palliative and supportive care to cancer patients is a high
priority at the Institute. Most of the problems encountered by patients
requiring such care relate to pain, nausea, breathing difficulties,
psychological problems, neurological disorders, nutritional
trouble, complex wounds, and requests for euthanasia.
These problems are thoroughly and respectfully addressed
in a dedicated Palliative and Supportive Care Unit staffed by a
specially trained, multidisciplinary team.
Patient Care
Key figures
Pain management
is a duty for cancer care
institutions.
Dr Dominique Lossignol, Head of the Pain Management Unit
M
issions
Managing acute and chronic
cancer pain, taking into
consideration trigger factors,
underlying syndromes and
external causes
Managing postoperative pain
Organising the functional
rehabilitation of patients, with
a view to adjustment and
reintegration
Offering psychological support
to patients
Contributing to the
development of clinical and
paraclinical protocols
Training of nurses, PhD
students and doctors
50
Supportive Care
500 patients followed-up in
>
consultations/year
8 specific protocols used for complex
clinical cases
> 50 publications in national and
international journals
ield, technologies
F
and methods
Each patient is provided with a therapeutic programme that, following assessment,
comprises medical (anti-pain medication, anaesthesiology, hypnosis, radiotherapy),
functional (physiotherapy, occupational therapy) and psychological management. Pain
is measured on a validated scale. Although the immediate aim is to reduce the intensity of the pain by at least 50% in the first 24 hours of treatment, the overall objective
is long-term control. Therapy is also provided at home and may be availed on an outpatient basis. Patients are reassessed regularly in order to ensure that their treatment
is always tailored to their particular needs.
Departmental organisation
The multidisciplinary pain team consists of 1 internist, 1 anaesthetist, 2 general practitioners, 1 pharmacist, 1 physiotherapist, 1 occupational therapist, 2 psychologists, 1 social
worker and 1 specialised nurse. The team is mobile: it operates mainly in the Palliative
and Supportive Care Unit, but can be called to other departments at their request. It also
cooperates with several external entities, such as associations for family doctors and
palliative care centers.
Key figures
00 patients treated
3
in the Unit/year
10 dedicated beds for patients
in acute need
15 members of staff
ield, technologies
F
and methods
Ethical questions such as de-escalation of therapy, the non-initiation or interruption
of treatment, and requests for euthanasia are regularly debated in multidisciplinary
meetings.
Each patient’s situation is methodically evaluated; after an analysis of needs and
expectations, therapeutic objectives are defined together with patients and their close
relatives. Each case is also discussed in detail in multi-disciplinary rounds.
Besides clinical care, the Unit carries out research and teaching activities. The Unit is
acknowledged as a reference centre by the European Society of Medical Oncology.
Applied Research
Research conducted by the Unit focuses on pain – breakthrough pain syndromes and
intractable pain – and more generally on topics in neuro-oncology, including the analgesic properties of opioids, cannabis and related molecules, the treatment of neoplastic meningitis, and brain tumours.
r Isabelle Libert
D
General Practitioner
r Dominique Lossignol
D
Internist, Head of Unit
Main areas
C ontrolling pain and cancer
related symptoms
Providing psychosocial
support
Addressing ethical questions
D
epartmental
organisation
With a capacity of 10 beds for patients in
acute need, the Unit hosts patients and their
relatives in a comfortable domestic setting.
Meetings with families and medical staff are
organised on a weekly basis.
The aim is for patients to return to their homes
as soon as their symptoms are well controlled. The Unit’s team is mobile, and specia­lised
care can be delivered elsewhere in the Institute upon request. Nurses are trained in oncology and in palliative care. Other disciplines
represented in the Unit include occupational
therapists, physiotherapists, speech therapists, and psychologists.
Close attention is paid to the psychological
stress experienced by the staff as well.
Ethical issues are of equal importance, with special emphasis given to end-of-life decisions, related communication, and patients’ rights.
Integrating specialised structures like the Unit into comprehensive cancer centres has
proved to be essential to the cancer care process and should receive increased attention in the future.
51
4
one & Connective B
Tissue Cancers
54
Brain Cancers
55
Breast Cancers 56
MULTI­
DISCIPLINARY
CANCER MANAGEMENT
Gastrointestinal Cancers 58
Gastrointestinal Cancers 60
(Endocrine Tumours)
Head and Neck Cancers 61
Gynaecological Cancers 62
Haematological Cancers 64
52
Prostate Cancers
66
Skin Cancers
68
Thoracic Cancers
69
53
Bone & Connective Tissue Cancers
Multidisciplinary Cancer Management
Prof Michael Gebhart
Orthopaedic Surgeon, Head of Surgical
Clinic for Bone & Connective Tissue
Cancers
INTRODUCTION
The Brain Tumour Clinic treats all malignant brain tumours,
whether primary or secondary. Diagnosis is made by medical
imaging (CT and/or PET scans and MRI). When there is doubt
about the exact nature of the tumour, a biopsy is carried
out. Malignant brain tumours are treated with chemotherapy
or with surgery combined with radiotherapy. Radiosurgery
(extremely precise radiotherapy using a beam of ionising
gamma rays) is also useful for tumours less than 3 cm in size.
The role of the Clinic is to define the best possible treatment(s)
according to tumour type.
Marie-Ange Lemoine
Physiotherapist
Dr Félix Shumelinsky
Orthopaedic Surgeon
INTRODUCTION
Bone and connective tissue tumours
are rare, but they vary considerably.
Malignant primary bone tumours:
osteosarcoma,
Osteosarcoma, Ewing’s sarcoma,
chondrosarcoma and others
Benign but aggressive primary
bone tumours: osteoblastoma,
chondroblastoma,
chondromyxoid
Osteoblastoma, chondroblastoma,
fibroma,
and giant
cell tumours
chondrmyxoid
fibroma,
and giant
cell
tumourssoft tissue tumours:
M
alignant
lipo-,
leiomyo-,
and other
Malignant
soft rhabdotissue tumours:
sarcomas
Lipo-, leiomyo-, rhabdo- and other
sarcomas
Benign soft tissue tumours:
tumours,
fascitis,
desmoid
Benign soft
tissuenodular
tumours:
haemangiomas
andnodular
others fascitis,
Desmoid tumours,
andtumours:
others
hemangiomas
Secondary bone
to thetumours:
bone due to
metastases
Secondary bone
cancers
originating
in thedue
breast,
Metastases
to the bone
to
lung,
prostate,
thyroid,
kidney
or
cancers
originating
in the
breast,
other
organs thyroid, kidney or
lung, prostate,
other organs
RESEARCH
Research activities cover all malignant and benign conditions of the musculoskeletal system. Special areas of interest include: phenix external magnet
growing-prostheses for children; treatments with argon gas for benign
aggressive and borderline malignant bone tumours; limb-sparing surgery;
development of custom-made prostheses.
The Institute collaborates mainly with the Soft Tissue and Bone Sarcoma Group
of the European Organisation for the Research and Treatment of Cancer, the
Orthopaedic Research Society, and the International Society of Limb Salvage.
TREATMENT, FOLLOW-UP,
REHABILITATION
Treatment
Primary bone tumours: multidisciplinary treatment combining surgery and chemo­
therapy has helped to increase survival rates by 60% to 80%. Custom-made,
modular prostheses spare most patients from amputation
Secondary
bone tumours: usually treated with radiotherapy, although surgery
may be required in some cases
T argeted chemo- or immunotherapy
72F unctional
malignant
bone
improvement and increased
survival time of
implants
tumours
diagnosed
in Belgium/year
54
Key figures
1 ,460 patients diagnosed
with malignant primary brain
tumours/year in Belgium
20% to 40% of patients with systemic
cancer develop brain metastases
r Adèle Baize
D
Radiation Therapist
andrine Vandenbossche
S
Psychologist
r Daniel Devriendt
D
Radiation Therapist,
Head of Brain Tumour Clinic
rof Denis Larsimont
P
Pathologist
The brain is a noble
organ, the preservation of
which is vital for ensuring
patient autonomy for as
long as possible.
Dr Daniel Devriendt, Head of the Brain
Tumour Clinic
TREATMENT, FOLLOW-UP,
REHABILITATION
The Clinic works together with the Neurosurgery Department of Hopital Universitaire
Erasme. Since 2000, the two departments co-manage a Gamma Knife® radiosurgery
device. This technique makes extremely localised treatment of brain tumours possible,
with limited side effects. Treatments with chemotherapy and/or radiotherapy are
carried out entirely at the Institute.
Benign but aggressive bone tumours and low grade chondrosarcomas: treated
with procedures using argon gas
Rehabilitation
Extremity lesions: use of bone cement with intramedullary devices or reconstruc-
figure
FUTURE
KeyTHE
Brain Cancers
tion of bone defects using prostheses
elvic lesions: cement modeling tied by screw and pin devices
P
pine lesions: cage injected with bone cement
S
THE
FUTURE
T argeted chemo- or immunotherapy
F unctional improvement and increased survival time of implants
RESEARCH
The Clinic participates in clinical trials of new drugs, as well as new techniques such as
the injection of medications directly into tumours. The research activities of the Clinic
also concentrate on the study of clinical, radiological and biological prognostic factors
of brain cancer.
THE
FUTURE
The cooperation of the Clinic with other hospitals, laboratories and pharmaceutical
companies will make it possible to further optimise patient treatment.
55
Breast Cancers
MULTIDISCIPLINARY CANCER MANAGEMENT
Prof Martine Piccart
Medical Oncologist
Head of Medicine Department
Dr Catherine Philipson
Radiation Oncologist
Dr Jean-Marie Nogaret
Gynaecological Surgeon,
Head of Breast Clinic
éronique Robberechts
V
Coordinating Nurse
Key figures
ortality from breast
M
cancer has declined
by 25% in the past
20 years
Introduction
Overview
Breast cancer affects one million women each year worldwide. While
the cause of the disease remains unknown, several predisposing factors
have been identified, the strongest among them being genetic. Other
predisposing factors include hormones, lifestyle and prior breast health
history. However, many patients have no identifiable predisposing factors.
Breast cancer screening relies largely on mammography, which is now
offered in Belgium on a two-yearly basis to all women between the
ages of 50 and 69. Besides offering services related to the national
screening programme, the Institute provides “individualised” screening,
choosing - according to a woman’s particular situation and risk from among physical examination, mammography, ultrasongraphy,
MRI and mammoscintigraphy. Any suspicious result requires prompt
diagnosis using biopsy techniques.
Recent evolution
Multidisciplinarity in breast
cancer patient care has been a
reality at the Institute for many
years, and is now spreading
with the creation of breast
clinics throughout Belgium.
Molecular characterisation of a breast tumour
Breast cancers with specific receptors (hormone and/or HER2
receptors) may be very effectively treated with targeted therapies.
This is why careful microscopic examination of breast biopsies
is crucial. Using the highest quality laboratory techniques, the
Institute’s Pathology Department provides the medical team with the
information needed to make decisions about the optimal treatment
for a patient.
We need to get tumour tissue throughout the course of
the disease because we know that its biological characteristics
can evolve. Our surgeons, pathologists and radiologists
understand this and collaborate closely with us.
PROF Martine Piccart, Head of the Medicine Department
Research
Treatment, follow-up, rehabilitation
Surgery.
Breast cancer surgery has undergone a revolution in recent years: the aggressive Halsted operation (radical mastectomy) has
been replaced by less mutilating operations, with a majority of patients today eligible for breast conservation. Sentinel node scintigraphy makes it
possible to avoid the removing lymph nodes under the arm when unnecessary. For women with large tumours a preliminary drug therapy results
in tumour shrinkage. As a consequence, subsequent surgery is more conservative and patients remain eligible for breast reconstruction. The tissue
around a tumour, the “margins,” must be completely clear of cancer. Our surgeons also collaborate closely with the radiation oncologists in order
to ensure that patients receive treatment optimally suited to their individual situations.
Radiotherapy.
Maintaining quality of life. Adequate symptom control and maintenance of quality
of life require the intervention of experts in pain control, nutrition and psychosocial
support. To this end, the medical team works closely with experts in the Psycho-oncology
Clinic, contributing to the optimal follow up of an increasingly number of breast cancer
survivors.
Medical treatment
The future
Radiotherapy for breast cancer has also undergone profound changes in recent years: in cases of conservative surgery,
the right dose of radiation can be delivered directly to the tumour bed and breast, with minimal irradiation of adjacent healthy organs. For patients
with small tumours, modern techniques are being implemented and can reduce treatment time from 6 weeks to 1 week or even to 1 day.
Preventing occurrence of metastasis. The primary objective of medical treatment for breast cancer is to counteract the development of
distant metastases. Once the disease has spread beyond the breast and its adjacent lymph nodes, it becomes a “chronic” illness. However, the
progression of breast cancer can be slowed down considerably by a large number of active anti-cancer medications. The most powerful of
these are used to prevent metastasis from happening, and fall into the category of “adjuvant” medical therapy.
Tailoring treatments. The Medical Oncology Clinic – in collaboration with other specialists in the Institute and research groups around the
world – works relentlessly to try to better individualise adjuvant therapy: this means offering drugs only to individuals who are truly at risk of
experiencing a relapse of their disease and selecting those drugs that are most likely to be of benefit. These drugs belong to three families:
•chemotherapeutic drugs, especially active against rapidly dividing cancer cells
•endocrine agents, which are effective for breast tumours containing hormone receptors
•biologic drugs, such a trastuzumab ((Herceptin®), the first of its kind to be active in tumours with HER2 receptors.
56
Managing advanced cancers. In advanced breast cancer, multidisciplinarity plays a key
role in managing the disease. The goal of treatment in this case is to slow disease
progression, alleviate symptoms and maintain quality of life.
The Institute’s internationally renowned breast cancer research team has acquired
expertise in high-throughput technologies such as tissue-microarrays, gene-arrays,
CGH-arrays, microRNA-arrays and bioinformatics analysis, and is continually expanding
its knowledge and experience. For example, the team has generated a significant body of
knowledge on the oestrogen receptor, on the interaction between breast cancer cells and
the bone microenvironment and, more recently, on the molecular classification of breast
cancer. Current areas of interest include the relationship between the primary tumour,
adjacent lymph nodes, circulating tumour cells and bone-narrow micrometastases:
mapping the genetic events along this route carries the hope for new and more effective
therapies to prevent the development of overt metastatic disease.
Breast cancer clinical, translational
and basic research
Powerful new technologies – such as
gene microarrays that provide information
about whether thousands of genes in an
individual tumour are “expressed” or not – are
increasingly incorporated into many studies
run by the Medical Oncology Clinic. The hope
is to accelerate the transition from empirical
oncology (all patients receive the same type of
treatment) to molecular oncology (each patient
receives the treatment that is most adapted to
the genetic make-up of her/his tumour).
The laboratory scientists at the Institute work
hand-in-hand with clinicians who treat patients
in order to improve treatment tailoring, but
they are also involved in basic research aimed
at better understanding the disease itself. New,
powerful technology platforms are now available
to allow researchers to dissect the important
molecular pathways involved in cancer growth,
invasion and metastases.
57
Gastrointestinal Cancers
Fouad Awada
Coordinating Nurse
Multidisciplinary Cancer Management
Dr Fikri Bouazza
Digestive Oncology Surgeon
Dr Daniel Debecker
Radiologist
Dr Alain Hendlisz
Gastroenterologist, Head of Clinic
R
ecent
evolutions
Introduction
Gastrointestinal (GI) oncology is one of the broadest fields in cancer
medicine, covering the most frequently occurring solid tumours
in Western countries. These include all cancers arising in the
gastrointestinal tract (oesophagus, gastro-oesophageal junction,
stomach, small intestine, large intestine, rectum), as well as in
the attached glandular organs and structures (pancreas, extra- or
intra-hepatic bile ducts, gallbladder, and liver).
Radical surgery may cure the disease. This is possible when a
localised - often early diagnosed - tumour can be fully removed. As
many as 30% of patients with metastatic disease also benefit from
surgery and may even be cured in this manner. However, surgery
is then particularly difficult, and GI oncology surgeons must be
experienced and well trained.
In case the disease has spread to the extent that surgery is no
longer possible, palliation, rather than cure, becomes the focus.
For GI cancers, as is the case for many other solid tumours, diagnosis
at an early stage is a key factor for successful treatment. This
requires a comprehensive approach to prevention, such as
that offered at the Institute.
New diagnostic tools make it possible to more
efficiently develop the drug pipeline with the
pharmaceutical industry. By redesigning clinical trials, patients will benefit from new medications more quickly and more safely.
Dr Alain Hendlisz, Head of the Gastrointestinal Cancer Clinic
TREATMENT, FOLLOW-UP, REHABILITATION
Screening
The Institute’s screening clinic participates
in the population-based regional screening
programme. In addition, it offers the most
relevant options for all individuals, whether their
cancer risk is normal or high. This includes lower
GI tract colonoscopy or flexible sigmoïdoscopy.
Diagnosis
Because of the critical need for accurate
diagnosis, the Institute makes it a priority to
use the most advanced imaging technologies
(both classical and metabolic), and it is
consequently equipped with the latest
generation of CT, MRI and PET-CT scanners.
Endoscopic ultrasonography has also become
an important diagnostic tool.
I think that the key to successful cancer treatment is to adequately define the objectives.
outcomes have dramatically improved in the last two decades. Robotic surgery,
Hyperthermic Intraperitoneal Chemotherapy, and liver surgery are carried out in the
Institute. The surgeons work in close collaboration with their colleagues at Hôpital
Universitaire Erasme, and their practice is tightly integrated into the Institute’s overall
multidisciplinary approach.
GI Medical Oncology
In oesophageal, gastro-oesophageal, gastric, and rectal tumours, treatment may begin
with chemotherapy or chemo-radiation. In contrast, treatment of colon cancer usually
begins with surgery. However, the exact treatment sequence is determined following an
analysis of individual risk factors for recurrence of the tumour.
In advanced disease, chemotherapy is often the only palliative option. Palliative treatment is decided in accordance with wishes of the patient and is carried out in close
collaboration with the Palliative and Supportive Care Unit.
R
esearch
The extensive clinical research conducted by the Gastrointestinal Cancer Clinic ensures
that patients have early access to new drugs and benefit rapidly from the latest scientific advances.
One example is the SIRT trial, which assesses the benefit of intra-hepatic injection
of radiation-loaded microspheres in colorectal cancer that has metastasised to the
liver and is unresponsive to any known drugs. This new technique requires complex
interactions of several medical teams (nuclear medicine, interventional radiologists, GI
oncologists and GI surgeons). It provides benefit and hope to patients whose medical
condition would previously have been considered impossible to treat.
Among other examples of cutting-edge research projects, the Early PET study aims
to identify better, more accurate and faster ways to determine whether a tumour will
respond to treatment with chemotherapy. The study combines expertise from medical
oncology, radiology and metabolic imaging. Ultimately such research will make it possible to quickly identify treatments that are truly effective.
Key figures
3 patients with
9
colorectal cancer
treated in 2010
72 persons per
100,000 diagnosed
with colorectal cancer
in Belgium per year
75% of colorectal
cancers are cured
Surgery
Surgery is the cornerstone of curative
treatment for GI malignancies, and its
58
59
GASTROINTESTINAL Cancers (Endocrine Tumours)
Head and Neck CANCERS
Prof Guy Andry
Head and Neck and Thoracic Surgeon,
Head of Surgery Department
Multidisciplinary Cancer Management
INTRODUCTION
Head and neck cancers include different malignant tumours,
depending on the area affected. The most common type is
squamous cell carcinoma, which arises in the cells that line the
inside of the nose, mouth, throat and larynx. It represents the
fifth most common cancer in the world and accounts for 8% of
all cancers worldwide, with nearly 600,000 new cases diagnosed
every year. It is typically related to tobacco use and alcohol
consumption, as well as human papillomavirus infection. Most head
and neck cancers produce early symptoms and clinical signs. These
include difficulty in swallowing, speaking or breathing, as well as
hoarseness, swelling, bleeding, and/or a lump in the neck.
INTRODUCTION
The treatment of neuroendocrine
tumours has improved
tremendously in recent years,
particularly with the development
of new technologies such as the
octreotide PET scan and new
biological therapies.
Key figures
1 00 octreotide PET scans/year
15 new patients/year
30 patients under treatment
TREATMENT, FOLLOW-UP,
REHABILITATION
We apply a broad
range of expertise,
skills and technologies
to determine the most
appropriate treatment for
each individual patient.
Dr Alain Hendlisz, Head of the Clinic for Endocrine Cancers
60
The screening and follow-up of neuroendocrine tumours today is carried out using
octreotide PET scans. The actual treatment given varies according to a patient’s profile
and tumour type. In addition to standard chemotherapies, new targeted therapies such
as everolimus and sunitinib are used. Inoperable metastatic tumours may be treated
with novel approaches such as octreopeptides labelled with radioactive isotopes.
Key figures
1 0 physicians from several associated
disciplines
23 staff members involved in patient
care, whether medical, social,
psychological or supportive
Prof Ahmad Awada
Medical Oncologist,
Head of Medical Oncology Clinic
r Sylvie Beauvois
D
Radiation Oncologist
ugues Vas
H
Physiotherapist
Integrating all the
available techniques and
therapies will improve the
outcome for our patients and
give them a better quality of
life with fewer side effects.
PrOF Ahmad Awada, Head of the Medical Oncology Clinic
TREATMENT, FOLLOW-UP,
REHABILITATION
A multidisciplinary team
The treatment of head and neck cancer is complex and should always be provided in a
cancer centre by a multidisciplinary team of specialists who accompany patients from
diagnosis through follow-up care. The Institute’s team consists of physicians trained in
head and neck surgery, reconstructive surgery, radiation oncology, medical oncology,
and dentistry, but also cancer nurses, speech therapists, dieticians and social workers.
Together they propose a therapeutic program tailored to the individual patient.
RESEARCH
The Institute participates actively in clinical
research led by the European Organisation
for the Research and Treatment of Cancer.
Whenever possible, patients with head and
neck cancer are enrolled in clinical trials of
new anticancer drugs or trials studying new
therapeutic approaches or strategies.
RESEARCH
Clinical research carried out at the Institute in the field of endocrine cancers puts great
emphasis on the molecular profiling of tumour types. Taking these and other patient
factors into account will make it possible to determine which treatment is most likely
to be effective.
THE
FUTURE
Many new anticancer drugs, mainly molecular-targeted therapies, are in active clinical
development. Combining new drugs with chemotherapy and/or radiotherapy is an
interesting but challenging area. Progress in radiotherapy is supported by progress
in technology and informatics. Incorporating new imaging techniques into the
management of head and neck cancer is also essential. The integration of all these
approaches is the focus of our current and future research.
61
Gynaecological cancers
Dr Jean-Marie Nogaret
Gynaecological Surgeon
Multidisciplinary Cancer Management
Prof Véronique D’Hondt
Medical Oncologist, Head of Unit
Dr Isabelle Merckaert
Psychologist
Julie Dewilde
Physiotherapist
epartmental
D
organisation
The Radiation Oncology Department comprises
8 specialized physicians based in Institut Jules
Bordet and participating in multidisciplinary
rounds in several hospital sites.
Introduction
Gynaecological cancers include cervical, endometrial, ovarian
and vaginal cancers. Collectively they account for 14% of all
solid tumours in women and 11% of deaths from these (ranking
fourth in both incidence and mortality of cancer). Worldwide,
gynaecological cancers account for an even larger share of cancer
mortality in women, since cervical cancer is a major cause of
death in developing countries, where screening and vaccination
are minimal.
Key figures
2 7 - 16 - 12 are the yearly incidence rates
(per 100,000 women) for endometrial, ovarian
and cervical cancers in Belgium
240 cases of gynaecological cancers are
treated each year at the Institute
TREATMENT, FOLLOW UP, REHABILITATION
Ovarian cancer
Ovarian cancer, the most lethal of gynaecological cancers in developed countries, is an
issue because it is not symptomatic until late
in the disease process. This cancer cannot yet
be reliably detected at an early stage. Therefore, early diagnosis and better treatment of
ovarian cancer remain a major challenge.
Treatment choice for ovarian cancer depends
upon a variety of factors. Approximately 20%
to 25% of patients with invasive epithelial
ovarian cancer are diagnosed at an early stage
(stages I and II). Prognosis for these patients
is good. When the disease is more advanced
(stages III and IV), which is unfortunately
the most frequent situation, prognosis deteriorates considerably. Despite aggressive surgery and first-line chemotherapy, the majority
of patients will relapse and die. The quality of
surgery and experience of the surgeon are
critical and affect prognosis. For this reason,
only highly experienced surgeons specialised
in oncological surgery should operate on such
tumours.
62
When relapse does occur, in the large majority of cases the disease becomes incurable,
and palliative care and symptom control are essential. Quality of life is then the main
goal of treatment.
Endometrial cancer
The endometrium is the inner mucosal coating of the uterus. Although our
understanding of endometrial cancer is limited, we can identify signs (precursor
lesions) of the most common type of the disease and can usually diagnose it early
enough to treat it successfully. However, there is an aggressive form of endometrial
cancer – serous papillary carcinoma – which, like ovarian cancer, is poorly understood.
Surgery remains the first form of treatment in most cases (by laparoscopic surgery if
possible). After surgery, radiotherapy and chemotherapy are sometimes indicated.
Cervical cancer
We are best able to understand and therefore control cervical cancer. Precursor lesions
exist that can be detected by local clinical and cytology examinations, such as the PAP
test. Such screening and the treatment of lesions that have not invaded surrounding
tissue have dramatically decreased the incidence of invasive cancer over a number of
decades. More recently, it has been shown that infection by the human papillomavirus
(HPV) is a necessary condition for the development of most, if not all, cervical cancers.
Two vaccines against HPV infection are currently available. Once cervical cancer has
become invasive, optimal treatment involves a combination of surgery, radiotherapy
and chemotherapy.
Advances in the treatment of gynaecological cancers
have been achieved thanks to great improvements made in our
knowledge of the biology of these diseases.
Prof Véronique D’Hondt, Head of the Gynaecological Cancer Unit
R
esearch
Because ovarian cancer is the leading cause of death from gynaecological cancer in Western
countries, our research efforts are mainly focused on improving the prognosis of this disease.
The way chemotherapy is administered has been shown to be very important. Given that
the peritoneum – the tissue lining the abdominal and pelvic cavities – is involved in 60%
of cases at diagnosis, it has been shown that administering chemotherapy intraperitoneally
rather than intravenously can improve the cure rate. However, this treatment is not yet
standard and is still being evaluated in clinical trials. In a study developed at the Institute
we have been exploring the advantages of chemotherapy given intraperitoneally at high
temperatures (hyperthermia) in order to increase the chances of cure.
The Institute participates in many multi-centre trials investigating new drugs to treat
ovarian, endometrial and cervical cancers.
R
ecent developments
accination to prevent cervical cancer
V
ore aggressive and better surgical management of ovarian cancer
M
Improved treatment with anti-cancer drugs for early stage ovarian cancer
Strategies focused on improving quality of life for incurable advanced ovarian
cancer
Better
understanding of precursor lesions of endometrial cancer, enabling
earlier detection
63
Haematological Cancers
Focus On
Multidisciplinary Cancer Management
Prof Pierre Heimann
Cytogeneticist
Juan Carlos Delgado
Physiotherapist
Recent
Evolutions
S tem cell transplantations with fewer side
effects
Targeted therapies for chronic myeloid
leukaemia and multiple myeloma
Genetic profiling of tumours for better
prediction of tumour aggressiveness and
response to therapy
TREATMENT,
FOLLOW UP,
REHABILITATION
Malignant haemopathies are usually treated
by chemotherapy and occasionally with
radiation. Major advances in curing these
haemopathies have been achieved by
combining immunotherapy using monoclonal
antibodies and new specific targeted
therapies, such as tyrosine kinase inhibitors
(Glivec®) in chronic myeloid leukaemia.
Allogeneic stem cell transplantation with
compatible (related) brother/sister or non
familial (unrelated) donor or cord blood are a
hallmark of our Institute and enable us to treat
and cure a large number of haematological
diseases, both malignant and non-malignant.
In addition, combining immunotherapy and
radiation therapy (radio-immunotherapy)
offers a very promising approach to treat
some types of non-Hodgkin’s lymphoma.
64
ur research results indicate that
O
donor lymphocyte infusion (DLI) can
induce remission in haematological
malignancies when relapse has occurred
after bone marrow transplantation. The
mechanism involved is a graft-versusleukaemia (GVL) effect. Unfortunately,
DLI may also induce graft-versushost-disease (GVHD) which, although
potentially associated with full remission,
can be life-threatening. Therefore, the
future resides in the dissociation of GVL
from GVHD.
Tumours express antigens that are potentially recognisable by the immune
system. WT-1 antigen is present in most
acute leukaemias and can be a target for
specific T-cells generated in the laboratory. The hope is that this research can
lead to the development of a vaccine.
Introduction
Prof Nathalie Meuleman
Haematologist
The incidence of malignant haemopathies – cancers affecting
the blood, bone marrow or lymph nodes – is rising, mainly
because of the ageing population. Lifestyle, environmental
factors and the extended use of immunosuppressive drugs also
play a role, but it remains uncertain to what extent.
However, today more than 50% of haemopathies are curable.
Research therefore now focuses on identifying those patients
whose prognosis is poor and who require more aggressive
treatment. Stem cell transplantation has also been made more
accessible to patients likely to benefit from this treatment
approach.
Key figures
In contrast with the past, modern
haemato-oncology will treat not only the
tumour but also its microenvironment and
thereby greatly improve the quality of life of
our patients.
4 ,800 new haematological malignancies each year in Belgium
The 5-year relative survival rate of leukaemias has improved from 14%
in 1960 to over 55% today
1,700 cord blood units are stored in the Institute Cord Blood Bank
Prof Dominique Bron, Head of the Haemato-Oncology Department
THE
FUTURE
RESEARCH
The Haemato-Oncology Department participates extensively in
research, internationally and locally:
Stem
cell transplantation, both for the treatment of haemopathies and the
development of new transplantation techniques
Managing
a cord blood bank and conducting research on haematopoietic stem
cells
eveloping new prognostic factors in chronic lymphocytic leukaemia
D
ssessing the role of the tumour microenvironment in the pathogenesis of chronic
A
lymphocytic leukaemia
sing mesenchymal stem cells fo GVHD resistant to treatment
U
adio-immunotherapy for non-Hodgkin’s lymphoma in collaboration
R
with the
Nuclear Medicine Department
In
collaboration with the Psycho-Oncology Clinic, studying the psychological
problems associated with malignant haemopathies, whether experienced by
patients, their families or oncology professionals
Developing
T argeted therapies adapted to the genetic signature of each tumour
Non-myeloablative stem cell transplantation based on immuno­
therapy instead of high-dose chemotherapy. Classic stem cell
transplantation is associated with considerable side effects and is
therefore restricted to young and fit patients. New, less intense forms
of treatment are the future, and the Department has been involved in
developing a national protocol for this purpose
A type of mesenchymal stromal cell in bone marrow with particularly
high potential plasticity and the ability to differentiate into various
cells (e.g., bone, muscle, neurons) has been identified. This means
there is tremendous future potential to develop therapies that will
enable the body to repair, replace or regenerate damaged or diseased
cells, tissues or organs (regenerative medicine)
a survey of older patients and specific treatments tailored to their
needs
65
Prostate Cancers
Dr Thierry Gil
Medical Oncologist
Multidisciplinary Cancer Management
Prof Roland Van Velthoven
Urologist
Prof Denis Larsimont
Pathologist
Dr Luigi Moretti
Radiation Oncologist
The Future
Current studies aim to correlate PSA expression and circulating cancer cells to study the
efficacy of new targeted therapies, which are
thought to be less toxic and possibly more effective than hormonal treatments.
Introduction
Prostate cancer is the most common cancer among men, with an
annual European incidence of 65 cases per 100,000 inhabitants,
causing 26 deaths per 100,000 each year. The median age at
diagnosis is 70, but once over 80, the disease does not necessarily
impact on survival.
Diagnosis of the disease is based on digital rectal examination (DRE)
and Prostate Specific Antigen (PSA) measured in men with prostate
complaints (incontinence, impotence). Histology is obtained after
analysis of echo-guided biopsies. Whether early screening in asymptomatic men can have an impact on survival is still being debated.
Complete assessment after diagnosis by DRE, PSA and biopsies includes CT, pelvic MRI, liver echography and bone scintigraphy in case
of pain or a PSA value above 10ng/ml.
Key figures
,800 new cases of prostate cancer
8
diagnosed each year in Belgium
165 patients with newly diagnosed
prostate cancer treated annually at
the Institute
TREATMENT, FOLLOW-UP,
REHABILITATION
Disease limited to the prostate
When prognosis is good, radical prostatectomy remains the standard procedure for
patients under age 70. Post-surgical treatment with radiotherapy is also generally
considered to be optimal. For older patients, or patients considered unsuitable for
surgery because of other reasons, radiotherapy or High Intensity Focused Ultrasound
(HIFU) – Ablatherm® – are treatment options, as is hormonal therapy.
In addition to age, treatment choice is also related to tumour characteristics – its
grade and volume – and overall prognosis. For example, brachytherapy is available for
low grade tumours in patients whose prognosis is poor or intermediate.
Metastatic disease
H
ormone sensitive cancer. Once cancer has spread beyond the prostate, and when
the disease is hormone sensitive, the reduction of male hormones through a form of
“castration” (androgen deprivation) is the usual course of treatment. Both medical
and surgical forms of castration are possible. Optionally, castration may be combined
with the use of anti-androgen tablets, leading to a total androgen blockade. This
treatment approach controls the evolution of the disease for an average of 12 to
18 months in about 80% of patients.
C
astration-resistant prostate cancer. Chemotherapy using Taxotere® (docetaxel) and
prednisone is more effective than the classic standard of mitoxantrone combined with
prednisone in patients whose cancers are resistant to medical or surgical castration.
66
Translational research will help physicians to better tailor
the approaches used in diagnosis and treatment, making it
possible to avoid the over-treatment of indolent disease and to improve the prognosis of treated tumours.
Dr Thierry Gil, Deputy Head of the Medical Oncology Clinic
R
esearch
Improving the standard treatment
of metastatic disease
The first priority of the chemotherapy clinical trials for prostate cancer in which the
Institute participates is to improve the standard treatment of metastatic disease (e.g.
combining new targeted therapies with Taxotere®). The second priority is to identify
other effective drugs to be offered to patients if treatment with Taxotere® fails. However,
clinical trials are conducted at the Institute in all clinical settings: post-surgery adjuvant
therapy, first-line treatments for hormone sensitive disease, first-line chemotherapy in
castration-resistant cases and second- and third-line therapeutic options in the event
of Taxotere® failure.
Enhancing the cure rate while reducing side effects
Research in the fields of surgery and radiotherapy aims to enhance the cure rate while
reducing side effects. New techniques such as laparoscopic surgery, robotic surgery and
conformational radiotherapy are used in the Institute. As in all research conducted by
our teams, multidisciplinarity is key.
Intermittent androgen blockade
Intermittent androgen blockade is thought to be able to delay the onset of resistance to
hormonal therapy and to enhance the quality of life in patients with metastatic disease.
The Institute is participating in a large clinical trial conducted in the US and Europe
that will compare two treatment strategies: continuous versus intermittent androgen
blockade.
67
Skin Cancers
Thoracic Cancers
INTRODUCTION
Multidisciplinary Cancer Management
Dr François Sales
Surgeon, Head of Surgical Clinic
for Skin Tumours
Lung cancers account for the majority of thoracic malignancies,
mainly as a result of tobacco exposure, whether through active or
passive smoking. Pleural mesothelioma is an uncommon tumour,
related mainly to asbestos exposure. Other rare diseases include
thymoma, thymic carcinoma and primitive sarcoma.
Prof Denis Larsimont
Pathologist
Dr Charles Renoirte
Dermatologist
Isabelle De Boeck
Coordinating Nurse
The aims of the Unit are
THE
FUTURE
Developing efficacious
adjuvant therapies
Improving prognosis and treatment
according to melanoma type
INTRODUCTION
Malignant skin tumours are the most
common cancer in people with fair
skin. In the majority of cases, they
appear as malignant epithelioma
(carcinoma) and are generally treated
fairly easily. Treatment effectiveness is
less certain when the skin tumour is a
melanoma. This disease, the incidence
of which is increasing by 5% to 10%
per year, principally affects adults
between the ages of 20 and 50.
RESEARCH
The Clinic’s research activities centre
around three main themes: improving
prognosis, adjuvant treatments and specific
immunotherapies. With regard to basic
research, the Clinic collaborates with
the Oncology and Experimental Surgery
Laboratory. Clinical research is often
coordinated by the Melanoma Group of the
European Organisation for Research and
Treatment of Cancer. The Clinic cooperates
with the Erasmus Ziekenhuis (Rotterdam), the
Sydney Melanoma Unit (Australia) and the
Institut Gustave Roussy (Paris). An example
of research in which the Clinic is involved is
a trial investigating ipilimumab, a monoclonal
antibody that stimulates an immune response
against cancer cells.
68
rof Paul Van Houtte
P
Radiation Oncologist
Key figures
1 ,600 individuals are diagnosed with
melanoma in Belgium/year
250 patients with melanoma are treated
in the Institute/year
TREATMENT, FOLLOW-UP,
REHABILITATION
Diagnostic stages
Examination of the tumour’s appearance and pathology, including type of melanoma,
tumour depth, level of dermal invasion, and presence of ulceration
Supplementary examinations using imaging (ultrasound, CT, MRI and PET) to
detect possible metastases
Sentinel lymph node biopsy to detect lymph node metastases
Treatment
The treatment of a melanoma is principally surgical and may involve:
E xtensive ablation of localised melanoma
adical or partial lymph-node dissection for cervical lesions
R
Local excision of metastases
Localised radiotherapy by gamma knife for brain metastases
Isolated limb infusion of chemotherapy (the Institute is the only one in Europe to
practise this technique, which was developed in Australia)
t o screen smokers at high risk of developing lung cancer
t o provide diagnostic, curative and palliative treatment and
ichel Hardy
M
Physiotherapist
rof Thierry Berghmans
P
Internist
rof Guy Andry
P
Head and Neck and Thoracic Surgeon
rof Jean-Paul Sculier
P
Internist
Head of the Thoracic Oncology Clinic
follow-up of malignant thoracic disease (small and non-small
cell lung cancer, pleural mesothelioma, and uncommon thoracic
malignancies). Smoking-related diseases and complications
related to anticancer therapy are also treated.
Key figures
1 50 new lung cancer cases are
treated annually in the Unit
6 ongoing prospective clinical
studies
The clinical and research
activities of the Clinic are top class,
as shown by the involvement of
its leadership in international lung
cancer activities and by its mentoring
of many PhD theses.
Prof Jean-Paul Sculier, Head of the Thoracic Oncology Clinic
TREATMENT, FOLLOW-UP,
REHABILITATION
Treatment is mainly based on the following parameters: histology, extent of the disease
(TNM classification and stage) and functional assessment
For non-small cell lung cancer (NSCLC), current conventional therapy may include
surgery, chemotherapy and/or radiotherapy, according to disease stage
THE
FUTURE
Response to chemotherapy and consequent
improvement in survival is not uniform in
NSCLC, which is why predictive factors are
needed. Recent studies have reported that in
NSCLC some biomarkers can help to predict
response to chemotherapy.
For small cell lung cancer, patients are treated with chemotherapy, plus thoracic
radiotherapy for disease limited in extent
For pleural mesothelioma, chemotherapy can be proposed, although surgery may
also be considered in specific cases
As oncology evolves, more patients can be treated in an ambulatory setting. Currently,
a majority of the Unit’s treatments are delivered at the Day Hospital. All diagnostic
procedures are performed at the Institute. The latest generation PET-CT technology
is available, in addition to all other nuclear imaging techniques. New techniques like
stereotactic radiotherapy are provided by the Radiation Oncology Department. All
other forms of treatment are also available. Patient care is carried out in the Unit and
ranges from diagnosis to symptom palliation and supportive care, the latter provided
in collaboration with the Palliative and Supportive Care Unit and the Psycho-Oncology
Clinic.
69
5
70
Social Services, Intercultural Mediation,
Cults
72
Mediation
74
Families
75
PATIENT
SUPPORT
71
Social Services
Intercultural Mediation / Religion
Introduction
Loïc Veys
Social Worker
Itself rich in cultural diversity, the Institute has a dynamic
intercultural mediation team available to work with patients
from various cultures.
Myriam Daoudi
Social Nurse
Françoise Depoortere
Social Worker, Head of Department
nne Carlier
A
Coordinator of Quality and Intercultural
Mediation
Missions
Our role is to inform, to guide, and
to accompany patients who request social
assistance and, occasionally, to intervene.
Patient Support
Françoise Depoortere, Social Worker, Head of the Social Services
Department
Introduction
The staff of the Social Services
Department is available to
support, accompany and listen
to patients and their loved ones
through whatever difficulties they
may encounter.
ield, technologies
F
and methods
eeting with patients and their families
M
reparing social services files
P
Compiling documentation and informational material
Following-up on strategies and developments related to individual
interventions
M
issions
roviding assistance with administrative procedures
P
rganising the return home
O
Providing options to facilitate travel to and from the Institute
Trying to resolve financial problems that may arise
Providing help to the extent possible in other domains
These services are available before, during and after a patient’s
hospitalisation, and are provided in complete confidence.
Key figures
100 interventions/day
>
2,500 files opened/year
Departmental organisation
The Social Services staff maintains continual contact with a great number of
other individuals and departments: floor nurses, physicians, rehabilitation and/or
palliative care specialists, the hospital ombudsperson, home assistants, the CPAS
(Public Social Assistance Centre), religious bodies, and other healthcare services.
The Department’s diversity of missions demands this multidisciplinary approach.
Facilitating the quality of interaction between patients and
the hospital
Improving understanding
Creating an environment of mutual trust
Eliminating obstacles to good communication
Our purpose is to show understanding in
our interactions with others, to help overcome
cultural and linguistic barriers, and to contribute
to a world in which boundaries are removed
while differences are respected.
Key figures
5 interventions/
6
month
20 languages spoken
Anne Carlier, Intercultural Mediation
ield,
F
technologies
and methods
Interpretation (in triad)
Conflict mediation
Administrative assistance
Supportive discussions
Religion
The Institute is a secular
establishment. Religion is kept
strictly within the private sphere
and does not play a role in the
hospital’s management. However,
out of respect for the religious
and philosophical beliefs of its
patients, the Institute can provide
patients with the assistance of a
relgious or secular counselor.
D
epartmental
organisation
5 mediators ensure that these services are
available around-the-clock.
The Social Services Department comprises 3 social workers and 1 social nurse.
72
73
Mediation
F rançoise Claessens
Hospital Ombudsperson
Families
Introduction
The Institute places great importance on the well-being and
comfort of patients. Questions, suggestions or complaints are
important ways to help the Institute improve the quality of its
treatment and services, and patients are encouraged to provide
their feedback.
In Belgium, patient’s rights became regulated by law in 2002.
Since then, hospitals are required to appoint an ombudsperson.
Emphasising patient-friendly information, clear communication,
dialogue and patients’ rights, this individual is responsible for
addressing any patient’s dissatisfaction or complaint.
lexandra Joris
A
Psychologist
Prof
Darius Razavi
Psychiatrist, Head of
Psycho-Oncology Department
J ulie Meunier
Psychologist
D
epartmental
organisation
Patient support
The Unit comprises 3 psychologists
specialised in psycho-oncology.
M
issions
Providing patients with
information about the way the
hospital is organised and about
their rights
Anticipating complaints and
encouraging better communication
Listening carefully to patients
and addressing their concerns
Taking patient feedback into
account to make recommendations to hospital management
for improving the quality of
patient care
Key figures
00 patient requests/year (0,5% of admissions)
3
82% of ombudsperson interventions lead to
a satisfying resolution
1 out of 4 patients registering a complaint
does so with the intention of improving the
quality of service
ield,
F
technologies
and methods
Protected by law, patients in Belgium have
the right to receive appropriate information, own their personal data, access their
medical files, have their privacy respected,
and register complaints with the hospital
ombudsperson.
The ombudsperson plays an independent,
neutral role, and is respectful of the privacy
of individuals. The ombudsperson listens to
and records complaints and investigates
them to find possible solutions. Occasionally,
a mediation meeting will be organised
between the practitioner, the medical care
team, and the patient concerned. When no
resolution is found, the patient is informed
about the available recourse. Analysis of all
records related to patient complaints is a
part of the hospital’s quality management
process.
74
Key figures
1 0 consultations/week with
children
15 consultations/week
with family members of
cancer patients
Missions
Supporting cancer patients’ families
to help them better cope
Helping patients to better
communicate with their families
about the various aspects of their
cancer treatment
ield, technologies
F
and methods
The diagnosis of cancer may cause stress, both for patients and
their families. The children of cancer patients may have many
concerns and sometimes may report psychological problems,
such as nightmares, difficulties at school or fear and sadness. To
respond adequately to their needs, the Family Unit has developed
four programmes:
“Being supported to better support” – Individual psychological support open to all family members
Bordet ‘n Kids – Weekly creative workshops providing a supportive environment for children 3 to 11 years old
Bordet ‘n Teens – An online platform where adolescents can
communicate in real-time with psychologists, including by
e-mail
Bordet
‘n Parents – Discussion groups organized once a
month to help parents or grandparents with cancer to communicate better with their children or grandchildren about
their illness and treatments.
75
6
L aboratory of Cell Therapy
RESEARCH
78
xperimental E
80
Haematology Laboratory
Oncology & Experimental 81
SurgeryLaboratory
reast Cancer B
82
Translational Research
Laboratory Jean-Claude
Heuson
linical Research Unit 84
C
of the Medical Oncology
Clinic
Thoracic Oncology
86
Statistics & 87
Breast European 88
Laboratory
Epidemiology Unit
Adjuvant Studies Team
(BrEAST)
reast International B
Group (BIG)
76
89
77
Laboratory of Cell Therapy
Dr Laurence Lagneaux
Biologist, Head of Laboratory
Prof Nathalie Meuleman
Haematologist
Dr Alain Delforge
Research Scientist
Missions
Studying the biological and clinical aspects of mesenchymal
stromal cells (MSCs), a fascinating component of the
microenvironment of bone marrow and other tissues
Undertaking ex vivo amplification and infusion of
haematopoietic stem cells and MSCs for various malignant
and non malignant diseases
Achieving functional characterisation of MSCs isolated from
distinct tissue sources (bone marrow, umbilical cord matrix
and adipose tissue) for their use in cell therapy
Studying interactions of MSCs with leukaemia and myeloma
cells
Main areas
Research
C ellular and molecular biology
Immunology
Cell therapy
epartmental
D
organisation
The team includes 5 full-time PhD researchers,
5 PhD students, 3 technicians and 1 quality
control manager. The laboratory works in
a close collaboration with the Department
of Haemato-Oncology. The skills of the
Laboratory’s staff and their equipment enable
translational and basic research projects to be
conducted using various approaches, such as
cellular biology, immunology, molecular onco­
logy, and molecular biology. The team possesses
excellent know-how in the microenvironment
field, in particular MSCs, as demonstrated by its
numerous scientific publications. International
collaborations are ongoing with institutions in
France, Sweden, the UK and Canada.
78
Key figures
10,000
cord blood units are stored
in Belgian biobanks
1,700 cord blood units are stored
in the Institute’s biobank
ield, technologies
F
and methods
Cord blood
A newborn’s umbilical cord blood contains a number of haematopoietic
progenitors and stem cells able to regenerate bone marrow in patients
needing such treatment. Cord blood is also used in the treatment
of patients suffering from severe blood diseases. Within
24 hours of being collected, cord blood units are delivered
to the Laboratory, where, using a BioArchive™ system,
technicians register them into the database, obtain
aliquots for testing and storage, reduce their volume and
freeze and store each unit in an individual controlledrate freezer.
Cell therapy
The Laboratory uses a unique in vitro model
to study the properties of human MSCs on a
molecular, functional and morphological basis.
Human MSCs are obtained from consenting
volunteers, both healthy donors and patients with
various malignant haemopathies.
A better understanding of cell biology associated with cell therapy will improve the outcomes and quality of life of our patients.
Dr Laurence Lagneaux, Biologist, Head of the Laboratory of Cell Therapy
Applied Research
MSCs are an ideal source for “off-the-shelf” stem cell therapy because of their unique
biological properties, including broad differentiation and immunological potential.
MSC-based cell therapy is essential in the context of
reconstituting blood cells
anaging or preventing allogeneic reactions after bone marrow transplantation, such
m
as graft-versus-host-disease
regenerative medicine (bone regeneration, tissue reconstruction)
aximizing tolerance in solid organ transplantation
m
F
ocus On
The Cord Blood Bank
Created by a Belgian inter-university association,
the Institute’s cord blood bank activities started
in 1994 and now involve 6 maternity units.
Cord blood samples donated by mothers are
collected, processed, tested and stored in order
to treat patients in need of haematopoietic
stem cell transplants.
The Laboratory is in the process of obtaining
FACT-Netcord accreditation, an internationally
recognized quality label. This guarantees that
the highest standards are being used for
cord blood storage. It improves the quality
of transplantations, standardises excellence
criteria on an international scale, and facilitates
donor search.
79
Experimental Haematology Laboratory
Missions
Dr Redouane Rouas
Researcher
Prof Philippe Martiat
Haematologist, Head of Laboratory
The major missions of the Medical Imaging Department are
Missions
To provide high quality diagnostic and therapeutic services using
Prof Philippe Lewalle
Haematologist, Researcher
Research
M
issions
M
issions
The major missions of the Medical
Imaging
Department
are
Improving
the treatment
of
leukaemias
through
basic
To provide high quality diagresearch
preclinicalservices
studies
nostic andand
therapeutic
Providing
using
high-quality
radioactive
elements.
scientific
training
for young
To carry out translational
and
postgraduates
and
mentoring
early clinical research,
with
them
to the focus
PhD level
a particular
on new
targeted treatments.
To deliver high quality preand postgraduate teaching in
nuclear oncology.
To integrate imaging into the
multidisciplinary oriented apThe Laboratory works closely with the Laboproach
to patient
care.Department
ratory of
Cell Therapy
and the
epartmental
D
organisation
of Haemato-Oncology and Transplantation.
Each research project is managed by a PhD
student. The laboratory comprises 6 PhD scientists, 5 PhD students, 1 haematologist and
1 secretary.
epartmental
D
organisation
The medical team comprises 4 nuclear medicine physicians, 1 radiopharmacist, 2 radiophysicists, 7 imaging technologists and/or
nurses, 1 data-nurse and 2 administrative
assistants.
Main areas
Malignant B-cells
Leukaemic immune
environment
80
Oncology & Experimental Surgery Laboratory
radioactive elements.
The Laboratory focuses mainly on melanoma and the biology
To carry out translational and early clinical research, with
of melanocytes.
a particular focus on new targeted treatments.
Studying prognostic factors
To deliver high quality pre- and postgraduate teaching in nuclear
Concology.
onducting research on tumour markers, including markers
of agressiveness or progression
To integrate imaging into the multidisciplinary oriented
Papproach
erfectingtonew
targeted
patient
care.antitumour therapies
Key figures
7 publications in 2010
5 international collaborations
2 PhD theses in 2010
The incidence of melanoma has doubled
every 10 to 15 years and current therapies
are still disappointing in metastatic disease.
However, much recent research holds the
promise to substantially reverse this situation.
PrOF Ghanem-Elias Ghanem, Head of the Oncology & Experimental Surgery Laboratory
ield, technologies
F
and methods
In animals, study of immune-system response in leukaemia induced by a virus
ith leukaemia patients, study of the role of suppressor lymphocytes in immuneW
system response
C omparison between leukaemia patients and healthy individuals with respect to
their global immune systems
ased on previous research carried out on immune-response suppressor
B
lymphocytes, a vaccine study involving patients with leukaemia relapse who have
not undergone bone marrow transplantation
T
he FUTURE
F ewer relapses in patients who have not been treated with bone marrow transplantation
nderstanding the mechanisms that prevent cancer cells from being eliminated,
U
despite having been identified by the immune system
ield, technologies
F
and methods
The Laboratory has two cell culture units with a bank containing hundreds of
primary cells and established cell lines, coupled with a programme for culturing,
freezing, control and traceability. The methods and techniques developed cover all
the usual areas of molecular and cell biology. The Laboratory staff is skilled in the
techniques used in large-scale protein screening (2-D difference gel electrophoresis);
studying the pharmacokinetics and bioavailability of drugs (high performance liquid
chromatography); and assessing the growth of human tumours implanted into mice.
The Laboratory is therefore involved in the screening of candidate drugs, the study of
their mechanisms of action and their preclinical assessment.
rof Ghanem-Elias Ghanem
P
Head of Laboratory
r Fabrice Journé
D
Researcher
urielle Wiedig
M
Researcher
T
he FUTURE
Two lines of translational research
in particular are under development:
sing melanoma gene profiling data
U
to identify prognostic factors and
tumour progression
S creening new targeted molecules
and elucidating their mechanisms of
action and/or resistance
D
Departmental
epartmental
organisation
organisation
The
team
consists
13 people:41 nuclear
physician,
The
medical
teamofcomprises
medi4 cine
researchers
(3 PhDs,
1 MSc), 2 PhD 2stuphysicians,
1 radiopharmacist,
radiodents,
4 technicians,
1 data
manager and
physicists,
7 imaging
technologists
and/or
1 secretary.
team has
spenurses, 1 The
data-nurse
anddeveloped
2 administrative
cial
expertise in cell culturing, the biology
assistants.
of melanogenesis (pigmentation), oxidative
stress, radiobiology and animal experimentation.
Main areas
Melanoma research (genomics and proteomics)
Large-scale cell cultures
Drug screening and mechanisms of action
New tumour markers
81
Breast Cancer Translational Research Laboratory J-C. HEUSON
Dr Stefan Michiels
Biostatistician
Dr Michail Ingnatiadis
Medical Oncologist
Prof Christos Sotiriou
Medical Oncologist, Head of Laboratory
Dr Christine Desmedt
Bioengineer
Research
epartmental
D
organisation
The Laboratory comprises 10 scientists, 4 techni­
cians and 1 administrative assistant; it is
equipped with state-of-the-art molecular
technology (2 microarray platforms, 1 next
generation sequencer, 1 CellSearch™ device
for the detection of circulating tumour cells,
and 1 real time RT-PCR machine). The Laboratory acts as a link between the basic research
laboratories and the clinical research teams at
the Institute, aiming to ensure faster application of laboratory findings to daily practice
in the clinic. The Functional Genomics Unit, a
subdivision of the Laboratory, has extensive
experience in using genomics to study changes
in gene expression correlated with prognostic
and predictive factors for breast cancer.
Missions
Gaining a better understanding of breast tumourigenesis,
metastasis and the mechanisms involved in breast cancer
drug resistance
Linking basic and clinical research to ensure faster application
of findings
Main areas
T ranslational research
Prognostic and predictive markers for response to therapy
in breast cancer
Affymetrix technology
Illumina sequencer
As a link between basic and clinical science, the Breast
Cancer Translational Research Laboratory aims to accelerate
our ability to translate findings made in basic research into
real applications at the patient’s bedside.
Prof Christos Sotiriou, Head of the Breast Cancer Translational Research Laboratory Jean-Claude Heuson
Applied Research
Research themes
Identification of prognostic and predictive markers in breast cancer using high
throughput technologies such as gene expression arrays, comparative genomic
hybridization, microRNAs, and deep sequencing.
E valuation of the role of the tumour microenvironment (including immune components)
in breast tumour invasion/dissemination.
olecular characterisation of minimal residual disease − circulating and disseminated
M
breast tumour cells (CTCs and DTCs).
S tudy of the role of the host in tumour invasion/dissemination and in the development
of distant metastases (colonisation).
S tudy of epigenetic changes associated with breast tumourigenesis and response to
different therapeutics.
S tudies of functional readouts of key molecular pathways involved in breast
tumourigenesis and response to different treatments, including targeted agents
(trastuzumab, AKT, mTOR, PI3K inhibitors, and others).
Important achievement
Current Research Activities
enetic and epigenetic characterisation of breast cancer and its associated stroma
G
using the next generation of sequencing tools.
ole of tumour microenvironment in breast cancer development and progression. This
R
research, using molecular biology to establish prognostic signatures, contributes to
a better understanding of the mechanisms that trigger the progression of tumours
according to different molecular subgroups.
olecular characterisation of CTCs and DTCs. This research is being conducted to
M
understand the metastatic progression of breast cancer as well as to refine prognosis
(natural evolution of the disease) and prediction (response to therapy) in early breast
cancer. So far, the molecular detection of peripheral CK19mRNA-positive cells in the
blood has been shown to be an independent prognostic factor for poor outcome in
women with early breast cancer.
nalysis of functional signalling output associated with major genetic aberrations in
A
breast cancer. The Laboratory is also centrally involved in prospective clinical trials that
aim to evaluate predictive markers. In one such study, new molecular markers have
been identified to predict response and resistance to anthracyclines, one of the most
commonly administered classes of chemotherapeutic drugs.
An important discovery of the Laboratory has been the “genomic grade index” (GGI),
a type of gene profiling that makes it possible to characterise early breast tumours
(proliferation, risk of metastasis and response to chemotherapy) far beyond what is
possible with the commonly used clinico-pathological parameters. The GGI is currently
commercialized by Ipsogen as the MapQuantDX ™ test.
82
83
Clinical Research Unit of the Medical Oncology Clinic
Dr Tatiana Besse
Coordinating Physician
Dr Fabienne Lebrun
Medical Oncologist
Dr Andrea Gombos
Medical Oncologist
Prof Ahmad Awada
Medical Oncologist,
Head of Medical Oncology Clinic
Missions
Research
The Clinical Research Unit of
the Medical Oncology Clinic is
dedicated to conducting pharma
and investigator-driven clinical trials
with a strong translational research
component (linking advances in basic
laboratory science with daily clinical
practice).
The Unit’s aims are to:
Advance cancer treatment and
care through clinical research
Identify new or more effective
anticancer treatments
Achieve a better understanding of the mechanisms
involved in the response and
resistance of tumour cells to
specific drugs
Provide patients participating
in clinical trials with the best
quality of care
Generate high quality data to
trial sponsors and investigators
Key figures
120
clinical trials ongoing
> 15% of the Institute’s patients
involved in clinical trials
T
he FUTURE
The Clinical Research Unit plans to make its activities more accessible to all patients, to broaden its team services and possibly to
expand further into the community while significantly contributing
to knowledge about the natural history of cancer, as well as to
clinical and laboratory research.
Main areas
evelopment of new anti­
D
cancer agents
Translational research
Biology of cancer cells and
tumours
Multidisciplinary networking
With a focus on studies that use promising new drugs and build on our knowledge of molecular biology, the work of the Clinical Research Unit contributes directly to improving the treatment and care of patients.
PROF Ahmad Awada, Head of the Clinical Research Unit
D
epartmental organisation
Field, technologies and methods
During recent years, in close collaboration with the staff oncologists of the Medical
Oncology Clinic, the Unit has developed expertise in the development and conduct of
the following types of trials:
Among other activities, the Unit is involved in major international breast cancer studies with a
special focus on neo (pre-surgery) and adjuvant (post-surgery) therapies, biologic agents and
new chemotherapy regimens.
hase I: these studies are mainly designed to determine the safe dosage range of a
P
drug, and typically involve 20 to 80 patients
Much of this research is conducted in association with the Breast Cancer Translational Research
Laboratory Jean-Claude Heuson and some falls under the auspices of the Breast International
Group. An area of particular interest is metastatic breast disease, which in recent years has been
well characterised according to HER2 status and hormone sensitivity.
hase II: recruiting 100 to 300 patients, these trials aim to establish how well a drug
P
works, as well as to continue to monitor its safety
hase III: these studies aim to compare a new treatment with standard therapy and
P
usually involve 1,000 to 5,000 patients.
Two coordinating physicians and 13 research nurses manage about 120 trials being run
at the Institute at any given time and treat more than 1,000 patients both in the hospital
and on an outpatient basis.
Each patient enrolled in a clinical trial is registered in a central database. The system
ensures the safe day-to-day monitoring of the trial and strictly protects patient privacy. Patients participating in phase I trials are accommodated in a specially equipped
Clinical Pharmacology Unit with a 3-bed capacity, where they are closely monitored by
a personal nurse.
Special treatment regimens have also now been developed for triple negative cancers (those
lacking oestrogen and progesterone receptors and HER2/neu proteins) and for metastatic brain
disease. In the field of digestive cancers, much of the Unit’s research work is carried out in close
collaboration with other Belgian hospitals. Clinical studies of skin cancers, sarcomes, genitourinary tumors, head and neck cancers, gynecological cancers and overall quality of life are also
of interest to the Unit.
Finally, some of the Unit’s research activities are offered as “expanded access protocols” to
researchers or physicians in private practice throughout the community.
The Unit’s studies are funded by external sponsors, namely the pharmaceutical industry,
academic research organisations, and charities.
84
85
Thoracic Oncology Laboratory
Statistics & Epidemiology Unit
Missions
Nathalie Leclercq
Research Nurse
Prof Thierry Berghmans
Medical Oncologist
The major
Developing
missions
andofmanaging
the Medical
theImaging
Institute’s
Department
cancer registry
are
CToontributing
to epidemiological,
andusing
provide high
quality diagnosticmethodological,
and therapeuticclinical
services
laboratory
radioactiveresearch
elements.conducted at the Institute
TDoeveloping
maintaining
Institute’s
carry outand
translational
andthe
early
clinical website
research, with
a particular focus on new targeted treatments.
To deliver high quality pre- and postgraduate teaching in nuclear
oncology.
To integrate imaging into the multidisciplinary oriented
patient care.
Theapproach
Unit wastoestablished
in 2001, and its activities are supported
by generous grants from “Les Amis de l’Institut Bordet”.
It com­prises 2 statisticians, 1 epidemiologist, 4 data managers
and 1 website manager.
Prof Jean-Paul Sculier
Internist, Head of Laboratory
L ouise Vanderweerden
Medical Secretary and Webmaster
arianne Paesmans
M
Statistician, Head of Unit
r Michel Moreau
D
Epidemiologist
L ieveke Ameye
Statistician
Departmental organisation
M
issions
Research
The major
Improving
missions
screening
of the for
Medical
Imaging
thoracic
Department
cancersare
(lung cancer,
mesothelioma and pulmonary
To provide high quality diagmetastases)
nostic and therapeutic services
Susing
tudying
the biology
of
radioactive
elements.
thoracic cancers, including
To carry out translational and
prognostic factors
early clinical research, with
aDeveloping
particular new
focustreatments
on new
and
molecular
signatures
targeted treatments.
predicting response to
To deliver high quality pretreatment
and postgraduate teaching in
nuclear oncology.
To integrate imaging into the
multidisciplinary oriented approach to patient care.
epartmental
D
organisation
The Laboratory comprises 4 specialists in
thoracic oncology, 1 research physician,
1 research nurse and 2 technicians.
T
he FUTURE
Recent studies have shown that treatment with adjuvant chemotherapy can improve
the survival of patients with completely resected stage II and III non-small cell lung
cancer. The survival of patients with stage III unresectable non-small cell lung cancer
is also improved when chemotherapy and radiotherapy are given concurrently rather
than sequentially.
ield, technologies
F
and methods
The Laboratory focuses on both basic and
translational research, including:
S tudy of precancerous lesions to identify new targets enabling the early detection
of lung cancers by non-invasive means
Study of the biology of lung cancer, from its earliest stages to metastatic disease
esearch aiming to identify biological and clinical prognostic factors for lung
R
cancer
esearch about predictive markers to evaluate the response of lung cancers to
R
targeted therapies, such as tyrosine kinase inhibitors
E valuation and study of the combination of innovative therapies with chemotherapy,
such as histone deacetylase inhibitors in mesothelioma and small cell lung cancer
The Laboratory is also involved in numerous international collaborations with
institutions and research groups such as the following:
Developing novel targeted treatments
Centre de Recherche Public-Santé (Luxembourg); Intergroupe Francophone de
Cancérologie Thoracique (France); Centre Hospitalier Universitaire de Caen (France);
Unité INSERM U774 de l’Institut Pasteur de Lille (France); University of Colorado (USA);
International Association for Lung Cancer Study; and the European Lung Cancer
Working Party.
tailored to the needs of individual
patients
The support
development
The Unit provides essential methodological
for
of imaging from structural
clinical research and develops and maintains
tools such as
to molecular and the the cancer registry, allowing us to assessongoing
the medical
activity
integration
of
of the Institute and to focus on quality. molecular
Marianne Paesmans, Statistician, Head of the Statistics & Epidemiology Unit
Establishing methods for early and noninvasive means of diagnosing thoracic
cancers
86
Recent evolution
ield, technologies
F
and methods
Cancer Registry
Set-up in 2000, the objective of the registry is to record structured information about all
cancers diagnosed and/or treated at the Institute (presently more than 33,000 cases).
The objectives of the project are multiple: describing patient profiles and tumour
characteristics; assessing the Institute’s medical activity and patient prognosis; and
contributing to research and the National Cancer Registry. Procedures, specifically
those for quality assurance and case identification, are developed continually.
Dr Marcw Lemort, Head of Medical Imaging Department
D
epartmental
organisation
The medical team comprises 4 nuclear medicine physicians, 1 radiopharmacist, 2 radiophysicists, 7 imaging technologists and/or
nurses, 1 data-nurse and 2 administrative
assistants.
Epidemiological, Methodological
and Clinical Research
The Unit contributes directly to clinical research, with its staff members working on
methodological issues related to clinical research; study design; protocol development;
randomisation procedures; data collection, management, cleaning, validation, and
analysis; and presentation and publication of results. The Unit also provides consulting
services such as review of protocols or scientific manuscripts and guidance to medical
students and physicians-in-training for their research projects. The Unit’s activities
are not restricted to the Institute but also involve collaborations with national and
international research groups. It has a special interest in prognostic factor studies, in
the development of predictive models, in the conduct of meta-analyses (literaturebased or using individual patient data) and in the elaboration of guidelines. Quality
assurance is also a main focus of the Unit.
Main areas
iostatistics
B
Epidemiology
Meta-analyses
Research methodology
Data management
87
Breast European Adjuvant Studies Team (BrEAST)
Breast International Group (BIG)
issions
M
The major missions of the Medical Imaging Department are
Missions
To provide high quality diagnostic and therapeutic services using
Stella Dolci
Project Manager
Dr Evandro de Azambuja
Medical Oncologist,
Medical Director
r Phuong Dinh
D
Medical Oncologist, Scientific Director
arolyn Straehle
C
Managing Director
upporting international
Sradioactive
elements. collaboration to conduct studies that
would
not
be
possible for and
a single
group or network
T o carry out translational
earlyresearch
clinical research,
with
to
carry out focus
on its on
own,
especially
treatments become
a particular
new
targetedas
treatments.
increasingly targeted
To deliver high quality pre- and postgraduate teaching in
Cnuclear
ombining
efforts to quickly enrol large numbers of patients
oncology.
and to share data and knowledge to efficiently answer
Timportant
o integrate
imagingquestions
into the multidisciplinary oriented
scientific
approach to patient care.
M
issions
Research
The major
Conducting
missions
international
of the Medical
Imaging
neoadjuvant
Department
or are
large adjuvant
Phase III studies in breast
To provide high quality diagcancer aiming to register new
nostic and therapeutic services
drugs
using radioactive elements.
SToetting-up
the studies, which
carry out translational and
are run in collaboration with
early clinical research, with
pharmaceutical companies
a particular focus on new
and the Breast International
targeted treatments.
Group, and managing the data
Tcollected
o deliver high quality preand postgraduate teaching in
www.br-e-a-s-t.org
nuclear oncology.
To integrate imaging into the
multidisciplinary oriented approach to patient care.
epartmental
D
organisation
D
epartmental
The medical team comprises 4 nuclear medicine physicians,
1 radiopharmacist, 2 radioorganisation
physicists, 7 imaging technologists and/or
Created in 1997 by Dr Martine Piccart from
nurses, 1 data-nurse and 2 administrative
the Institute, BrEAST has grown into a team
assistants.
of over 40 individuals, all specialised in breast
cancer trials: oncologists, data managers, IT
specialists and safety and quality assurance
experts, as well as many early-career oncology fellows from around the world.
88
Key figures
4 0+ professionals specialised in
international breast cancer trials
+/- 17,000 patients enrolled BrEAST-run
trials to date
Daily contact with 1,300 hospitals from
more than 40 countries
In running the highest quality
international breast cancer trials,
BrEAST contributes directly to the
acceleration of drug development and
delivery of benefits to patients.
Dr Evandro de Azambuja, BrEAST Medical Director
ield, technologies
F
and methods
Many BrEAST trials focus on targeted treatments for HER2-positive breast cancer:
HERA demonstrated that 1 year of treatment with trastuzumab significantly improved
disease-free and overall survival, leading to the drug being registered in Europe within
5 years of trial launch, a remarkable achievement; Neo-ALTTO, a neoadjuvant study
of lapatinib and trastuzumab, showed impressive results for combined treatment
and collected over 12,000 biospecimens for future research; ALTTO aims to give
definitive answers to questions about how to optimally use lapatinib and trastuzumab;
and APHINITY is investigating the highly promising pertuzumab combined with
trastuzumab.
Key figures
Key figures
0 groups from Europe, Canada,
5
6 900 diagnostic exams
Latin
America,
(including
3 090Asia
PET) and Australasia
Several
1,000 specialised
121 patients
have been hospitals
treated:
and- including
research
centres
worldwide
55 with thyroid cancer
- and
34 withtrials
liver cance
> 30
clinical
withr 10s of
thousands of patients
BIGThe
is unique
development
in its capacity
of imaging
to unite
from
academic
structural
groups
to molecular
from around
and the world
to conduct
ongoingbreast
integration
cancerof
research
molecular
in a way that best
serves
the needs of
Dr Marcw Lemort,
patients.
Head of Medical Imaging Department
Carolyn Straehle, Managing Director, BIG
D
epartmental organisation
F ounded in 1996 by Dr Martine Piccart from the Institute together with other
European opinion leaders, BIG now constitutes a network of 50 groups from Europe,
Canada, Latin America, Asia and Australasia linked to several thousand specialised
hospitals and cancer research centres. BIG also works closely with the US National
Cancer Institute and the North American Breast Cancer Group.
ore than 30 clinical trials are run under the BIG umbrella, involving 10s of thousands
M
of patients. Although a leader in large adjuvant trials of chemo-, hormone- and
biological therapy, BIG is also a trailblazer for research in other areas, including
programmes supported by the European Commission and neoadjuvant trials. BIG
trials incorporate a substantial translational research component and emphasise
the collection and banking of biological specimens for future research.
J ointly with the European Society for Medical Oncology, BIG hosts an annual breast
cancer conference – IMPAKT – focused on improving care and knowledge through
translational research. The event gathers leading preclinical and clinical researchers
and provides training for early career researchers (www.impakt.org).
Main areas
IG is a non-profit organisation
B
for academic breast cancer
research groups from around the
world, with its headquarters at
the Institute.
BIG facilitates breast cancer
research by stimulating
cooperation between its
members and other academic
networks, and by striving to
achieve balanced partnerships
between academia and industry
in order to best serve the needs
of patients.
www.breastinternationalgroup.org
89
7
90
Teaching
92
Seminars
93
Fellowships
93
EDUCATION
91
Work
placement
supervisors
J-P. Sculier
D. Larsimont
M. Piccart
D. Bron
G. Andry
R. van Velthoven
M. Lemort
A. Grivegnée
P. Van Houtte
M. Aoun
P. Flamen
D. Cullus
M. Sosnowski
O. Van Den Berg
INTRODUCTION
The Institute has achieved a strong reputation for the quality
of the education and training it provides: Master’s in Medicine
and other degrees, theses in medical sciences, specialisation
in oncology for nurses, training in other healthcare disciplines,
fellowships, and professional development for doctors from
Belgium and abroad. At the national level, the Institute trains
students from the Université Libre de Bruxelles (ULB), but its
programmes are also open to students from other institutions.
Many of the Institute’s physicians, nurses and paramedics,
including members of the psycho-oncology team, therefore have
teaching responsibilities. Teaching takes place in the Institute
itself, at the ULB or in other third-level schools.
Key figures
Education
ver 200 interns in medicine/year
O
25 to 40 student oncology nurses/year
40 specialists in training/year
6 Fosfom scholarship holders /year
10 medical research fellows/year
epartmental
D
organisation
The Institute’s educational activities are
organised around 3 principal areas.
Teaching
For students in medicine, surgery, psychology,
nursing, and physiotherapy, the courses
offered are theoretical and practical. As
regards practical training, students contribute
to the activities of the Institute in the context
of work placement. Each year the Institute
accommodates a large number of candidates
wishing to specialise in internal medicine,
oncology, haematology, pathology, surgery,
anaesthesia, radiology, nuclear medicine and
radiotherapy. Through a special ULB work
placement programme (Fosfom Scholarships)
the Institute trains non-European doctors
wishing to acquire 1 to 2 years’ experience
in Europe. The Institute also participates in
international university cooperation schemes,
an example of which is a haematology teaching
programme in Vietnam.
92
THE
FUTURE
With a view towards strengthening its status as an international centre of excellence
for teaching and research in cancer, the Institute intends to collaborate even more
closely with the ULB in the future. The creation of an ULB-affiliated Jules Bordet
“Canceropole” with the mandate to coordinate and promote research and education
activities in oncology is a clear step in this direction. Planning is also underway for
the Institute to move to the same site as the Hopital Universitaire Erasme and the
ULB Faculty of Medicine. These projects will make it possible to enrich capacity for
teaching and training, while multiplying the Institute’s opportunities for national and
international scientific cooperation.
Main areas
T eaching
Seminars
Fellowships
Seminars
Seminars form an integral part of the Institute’s educational activities. They are aimed
at students, the Institute’s staff, national or international medical professionals, and the
general public. Multidisciplinary discussions, overviews of various aspects of medicine,
seminars in oncological surgery, and meetings dealing with other specialised topics are
organised every week of the year. Examples include “Meet the Oncology Expert, a cycle
of monthly lectures given by internationally renowned guest speakers, the European
Lung Cancer Working Party’s Annual Days, the annual Belgian Symposium on the
Integration of Molecular Biology Advances into Oncology Clinical Practice, workshops
for general practitioners, and “Les Midis des Amis,” monthly sessions intended for the
general public.
Fellowships
As a research centre, the Institute offers many fellowship opportunities. The activities
proposed range from clinical to basic research, including translational research. The
Department of Medicine regularly hosts a large number of fellows in particular in the
context of the activities of the Breast European Adjuvant Studies Team, the Breast
International Group or the Breast Cancer Translational Research Laboratory JeanClaude Heuson. The Institute also participates in the European Society of Medical
Oncology fellowship programme, which allows specialists from around the world a
range of possibilities, from a visit of several weeks to a one- to two-year research
stay.
93
8
Les Amis de 96
F onds Jean-Claude Heuson
97
Fonds Ariane
97
Notre Boutique 98
Les Tournesols
98
l‘Institut Bordet
94
ASSOCIATIONS
95
LES AMIS DE L’INSTITUT BORDET
FOnds Jean-Claude Heuson / FOnds Ariane
Fonds Jean-Claude Heuson
Associations
Professor Jean-Claude Heuson founded a breast cancer research laboratory at Institut Jules Bordet in 1960. When he died unexpectedly in
1986, the Fonds Jean-Claude Heuson (Jean-Claude Heuson Fund) charity was established to promote and raise money for basic, translational,
and clinical research on breast cancer carried out in the Institute.
The projects funded focus on oestrogen receptors and their genetic
role in breast cancer, on biological markers of prognostic and predictive
value, and on the mechanisms of resistance and response to therapy.
The funding comes from donations made by individuals and private institutions alike. Other sources of funding include charity events that take
place throughout the year.
Contact
A
riane Cambier
Les Amis de l’Institut Bordet
1 rue Héger-Bordet
1000 Brussels
Telephone: +32-2-541.34.11
[email protected]
[email protected]
www.bordet.be
C
atherine Lesent
Fonds Jean-Claude Heuson
125 boulevard de Waterloo
1000 Brussels
Telephone: +32-2-541.30.89
[email protected]
www.heuson.be
Les amis de l’Institut Bordet
The aim of the association Les Amis de l’Institut Bordet (Friends of
the Bordet Institute) is primarily to support cancer research conducted at the Institute, but also to contribute to developing the Institute,
publicising its mission, and providing moral and material assistance.
Founded in the late 1960s, Les Amis today encompasses 10,000 supporters. This growth has been made possible because of the dynamism and volunteer work of many individuals devoted to the Institute’s cause.
Les Amis believes in a collective and multidisciplinary approach to
coping with cancer issues, which is consistent with the philosophy
of the Institute.
The association is an independent charity, the work of which is overseen by a scientific board and an ethical committee. Each year, the
organisation raises an average of 2 million Euros from donations,
events and legacies. More than 90% of this budget is dedicated to
funding the Institute’s research activities.
Bordet’n Wellness
Bordet’n Wellness is a charity that raises funds to improve patients’
well-being at the Institute. Patients’ quality of life is a key aspect
of cancer treatment. Bordet’n Wellness is an initiative of Les Amis.
Both charities follow the same strict rules and are governed by the
same bodies. The types of projects supported by Bordet’n Wellness
are numerous and include:
Premises’ renovation for more pleasant hospital stays
Specific services for patients and their families, such as an area
for patients’ children and a wellness centre providing massages
and facials
Publications for the general public
Support for artistic projects within the hospital
96
Contact
Fonds Ariane
In 1982, Ariane – a 23-year-old leukaemia victim – wanted the fight
against her disease to continue after she died. The Fonds Ariane (Ariane
Fund) was thus set up by Ariane’s parents with a view towards financially supporting activities related to improving the treatment of acute
leukaemia. Collected donations are mainly used to fund the research of
young haematologists who have decided to launch their careers at the
Institute.
Contact
N
orbert Declercq
Fonds Ariane
24 Ieperleedstraat
8432 Middelkerke
Telephone: +32-59-30.30.86
[email protected]
www.fondsariane.be
97
NOTRE BOUTIQUE/LES TOURNESOLS
Contact
A
ndrée Frenay
The non-profit organisation Notre Boutique (Our Shop) manages the
Institute’s restaurant and shop. In addition, Notre Boutique organises
fundraising activities such as greeting card sales.
The revenues generated provide grants for improving patients’ quality
of life and for supporting research according to the needs expressed by
the Institute’s medical council.
Notre Boutique’s general assembly and board of directors are all volunteers.
Associations
Notre Boutique
125 boulevard de Waterloo
1000 Brussels
Telephone: +32-2-537.33.81
Fax: +32-2-538.89.07
Notre boutique
Contact
Les Tournesols
Les Tournesols
33 avenue de la Porte de Hal
1060 Brussels
Telephone: +32-2-534.99.29
(from 9:00 to 16:00)
Fax: +32-2-544.02.07
[email protected]
Les Tournesols (The Sunflowers) is a guesthouse run by the non-profit
association Julie & Françoise Drion. The guesthouse provides friendly
accommodation for family members of hospitalised patients, or for outpatients in certain circumstances.
Les Tournesols is 5 minutes on foot from the Institute and has 11 comfortable rooms with 22 beds. Each guest participates in general housekeeping tasks and is responsible for keeping his/her room clean. Linens
are provided, and a self-service breakfast is also available. Access to the
guesthouse is restricted to guests only.
“Institut Jules Bordet” is published by Institut Jules Bordet
Editor: Dr Dominique de Valeriola
Managing Editors: Carolyn Straehle (supervision), Dr Jean-Benoît Burrion (science)
Administration: Martine Hazard
Institut Jules Bordet
1 rue Héger-Bordet
1000 Brussels
Telephone: +32-2-541.31.11
www.bordet.be
Designed and printed by
70 rue Rodenbachstraat
1190 Brussels
Telephone: +32-2-640.49.13
Fax: +32-2-640.97.56
[email protected]
www.vivio.com
At ViVio
Coordination: Hugues Henry, assisted by Claudine De Kock
Editing: Hugues Henry, Julie Van Rossom
Photos: Frédéric Raevens (interviews), archives of Institut Jules Bordet, iStockPhoto
Lay-out: Marie Bourgois
Graphics: Catherine Harmignies, Marie Lemaire
Printing: Poot Printers
All rights reserved.
No part of this brochure may be reproduced in any form without written permission of the Editor.
98
Institut Jules Bordet
1 rue Héger-Bordet
1000 Brussels
Telephone: +32-2-541.31.11
www.bordet.be