Villa Voortman : carte blanche or not?

Purpose - Influenced by evolutions in mental health, a meeting house, "Villa Voortman", was recently developed. It is based on an integration of therapeutic community (TC) and psychoanalytical Lacanian thinking. The purpose of this paper is to investigate the position of Villa Voortman in the treatment continuum for dually diagnosed clients. Two research questions are addressed: how does Villa Voortman operate ? and how do clients perceive the Villa? Design/methodology/approach - The first question was tackled by a personal account of the founders of Villa Voortman. The second question was addressed by a qualitative study using video-material of 19 visitors' personal accounts. Findings - The visitors mentioned three themes: social inclusion, personal development and equality. These aspects are further refined into sub-themes including the provision of "asylum"; the instalment of a warm and welcoming atmosphere; the focus on real human encounter; a permissive, supportive and "waiting" environment; a minimal but "good enough" structure; the necessity of a place where persons can develop themselves; the striving for social inclusion and future perspectives; and the support in becoming inclusive citizens again. Originality/value - The value of the paper lies in disclosing the visitors' lived experience. This is an essential part of shedding light on the "active ingredients" of support, In reference to the title, visitors nor treatment staff have "carte blanche" with regard to how support develops, as this is driven by the dialectal course of everything that occurs during the support process

SHOULD PATIENT SETUP IN LUNG CANCER BE BASED ON THE PRIMARY TUMOR? AN ANALYSIS OF TUMOR COVERAGE AND NORMAL TISSUE DOSE USING REPEATED POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY IMAGING

PURPOSE: Evaluation of the dose distribution for lung cancer patients using a patient set-up procedure based on the bony anatomy or the primary tumor. METHODS AND MATERIALS: For 39 (non-)small cell lung cancer patients the planning FDG-PET/CT scan was registered to a repeated FDG-PET/CT scan made in the second week of treatment. Two patient set-up methods were analyzed: bony anatomy or primary tumor set-up. The original treatment plan was copied to the repeated scan, and target and normal tissue structures were delineated. Dose distributions were analyzed using dose-volume histograms for the primary tumor, lymph nodes, lungs and spinal cord. RESULTS: One patient showed decreased dose coverage of the primary tumor due to progressive disease and required re-planning to achieve adequate coverage. For the other patients, the minimum dose to the primary tumor did not significantly deviate from the planned dose: −0.2±1.7% (p=0.71) and −0.1±1.7% (p=0.85) for the bony anatomy and primary tumor set-up, respectively. For patients (N=31) with nodal involvement, 10% showed a decrease in minimum dose larger than 5% for the bony-anatomy set-up and 13% for the primary tumor based set-up. Mean lung dose exceeded the maximum allowed 20 Gy in 21% of the patients for the bony-anatomy and in 13% for the primary tumor set-up, whereas for the spinal cord this occurred in 10% and 13% of the patients, respectively. CONCLUSIONS: In 10% and 13% of patients with nodal involvement, set-up based on bony anatomy or primary tumor, respectively, lead to important dose deviations in nodal target volumes. Overdosage of critical structures occurred in 10-20% of the patients. In case of progressive disease, repeated imaging revealed underdosage of the primary tumor. Development of practical ways for set-up procedures based on repeated high-quality imaging of all tumor sites during radiotherapy should therefore be an important research focus

Combination of Immunotherapy and Radiotherapy-The Next Magic Step in the Management of Lung Cancer?

none4sinoneHendriks L.E.L.; Menis J.; De Ruysscher D.K.M.; Reck M.Hendriks, L. E. L.; Menis, J.; De Ruysscher, D. K. M.; Reck, M

Privacy-Preserving Predictive Models for Lung Cancer Survival Analysis

MAASTRO clinic, the Netherlands. Privacy-preserving data mining (PPDM) is a recent emergent research area that deals with the incorporation of privacy preserving concerns to data mining techniques. We consider a real clinical setting where the data is horizontally distributed among different institutions. Each one of the medical institutions involved in this work provides a database containing a subset of patients. There is recent work that shows the potential of the PPDM approach in medical applications. However, there is few work in developing/implementing PPDM for predictive personalized medicine. In this paper we use real data from several institutions across Europe to build models for survival prediction for non-small-cell lung cancer patients while addressing the potential privacy preserving issues that may arise when sharing data across institutions located in different countries. Our experiments in a real clinical setting show that the privacy preserving approach may result in improved models while avoiding the burdens of traditional data sharing (legal and/or anonymization expenses).

Individualized Positron Emission Tomography-Based Isotoxic Accelerated Radiation Therapy Is Cost-Effective Compared With Conventional Radiation Therapy: A Model-Based Evaluation

Purpose: To evaluate long-term health effects, costs, and cost-effectiveness of positron emission tomography (PET)-based isotoxic accelerated radiation therapy treatment (PET-ART) compared with conventional fixed-dose CT-based radiation therapy treatment (CRT) in non-small cell lung cancer (NSCLC). Methods and Materials: Our analysis uses a validated decision-model, based on data of 200 NSCLC patients with inoperable stage I-IIIB. Clinical outcomes, resource use, costs, and utilities were obtained from the Maastro Clinic and the literature. Primary model outcomes were the difference in life-years (LYs), quality-adjusted life-years (QALYs), costs, and the incremental cost-effectiveness and cost/utility ratio (ICER and ICUR) of PET-ART versus CRT. Model outcomes were obtained from averaging the predictions for 50,000 simulated patients. A probabilistic sensitivity analysis and scenario analyses were carried out. Results: The average incremental costs per patient of PET-ART were V569 (95% confidence interval [CI] (sic)-5327-(sic)6936) for 0.42 incremental LYs (95% CI 0.19-0.61) and 0.33 QALYs gained (95% CI 0.13-0.49). The base-case scenario resulted in an ICER of (sic)1360 per LY gained and an ICUR of (sic)1744 per QALY gained. The probabilistic analysis gave a 36% probability that PET-ART improves health outcomes at reduced costs and a 64% probability that PET-ART is more effective at slightly higher costs. Conclusion: On the basis of the available data, individualized PET-ART for NSCLC seems to be cost-effective compared with CRT

Immunotherapy in small cell lung cancer:One step at a time: A narrative review

Chemotherapy with or without radiotherapy has been the standard of care for many years for patients with small cell lung cancer (SCLC). Despite exceptionally high responses (up to 80%) with chemotherapy, the majority of patients relapse rapidly within weeks to months after treatment completion. Therefore, new and better treatment options are necessary. Recently, synergistic activity has been reported for the addition of immune checkpoint inhibitors (ICI) to standard platinum-based chemotherapy in the therapeutic strategy of advanced SCLC. For the first time after several decades, a significant survival improvement was achieved for this population. However, the overwhelming majority of patients do not respond to ICI, or relapse rapidly. There is need for better knowledge about the biology, histopathologic features, and molecular pathways of SCLC. This can probably help to identify the optimal predictive biomarkers, which are warranted to develop an individual therapeutic strategy including the rational use of a combination of immunotherapeutic agents. Here, we provide an overview of the rationale for and clinical results of the completed and ongoing trials using different strategies of immunotherapy in SCLC. In addition, opportunities for further improvement of therapies will be discussed, including the addition of radiotherapy, co-stimulatory antibodies, and other immune modifying agents.</p

Fatal bilateral pneumonitis after locoregional thoracic chemoradiation in a transplanted patient under immunosuppressive therapy

Background: After thoracic radiotherapy a pneumonitis may occur, mostly confined to the irradiated volume of the lung. In general, it resolves spontaneously without long-term effects. Case Report: A 68-year-old man was diagnosed with a stage IIIA adenocarcinoma of the lung and was treated with sequential chemoradiation. He had a heart and kidney transplant for which an immunosuppressant was taken. During the fourth week of radiotherapy, he developed a bilateral interstitial pneumonia. Despite antibiotics and steroids, the patient died twelve days after the onset of complaints due to respiratory failure. Autopsy showed in all pulmonary lobes extensive diffuse alveolar damage, probably leading to respiratory insufficiency and death. Literature and Conclusion: Bilateral pneumonitis after radiotherapy is thought to be an immunologically-mediated response, which usually resolves without long-term effects. Since in radiation pneumonitis an increase in T-cells is described, the suppression of these cells by an immunosuppressant might have exaggerated the pulmonary toxicity