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

Complex situations in lung cancer:multifocal disease, oligoprogression and oligorecurrence

With the emergence of lung cancer screening programmes and newly detected localised and multifocal disease, novel treatment compounds and multimodal treatment approaches, the treatment landscape of non-small cell lung cancer is becoming increasingly complex. In parallel, in-depth molecular analyses and clonality studies are revealing more information about tumorigenesis, potential therapeutical targets and the origin of lesions. All can play an important role in cases with multifocal disease, oligoprogression and oligorecurrence. In multifocal disease, it is essential to understand the relatedness of separate lesions for treatment decisions, because this information distinguishes separate early-stage tumours from locally advanced or metastatic cancer. Clonality studies suggest that a majority of same-histology lesions represent multiple primary tumours. With the current standard of systemic treatment, oligoprogression after an initial treatment response is a common scenario. In this state of induced oligoprogressive disease, local ablative therapy by either surgery or radiotherapy is becoming increasingly important. Another scenario involves the emergence of a limited number of metastases after radical treatment of the primary tumour, referred to as oligorecurrence, for which the use of local ablative therapy holds promise in improving survival. Our review addresses these complex situations in lung cancer by discussing current evidence, knowledge gaps and treatment recommendations.</p

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

Complex situations in lung cancer:multifocal disease, oligoprogression and oligorecurrence

With the emergence of lung cancer screening programmes and newly detected localised and multifocal disease, novel treatment compounds and multimodal treatment approaches, the treatment landscape of non-small cell lung cancer is becoming increasingly complex. In parallel, in-depth molecular analyses and clonality studies are revealing more information about tumorigenesis, potential therapeutical targets and the origin of lesions. All can play an important role in cases with multifocal disease, oligoprogression and oligorecurrence. In multifocal disease, it is essential to understand the relatedness of separate lesions for treatment decisions, because this information distinguishes separate early-stage tumours from locally advanced or metastatic cancer. Clonality studies suggest that a majority of same-histology lesions represent multiple primary tumours. With the current standard of systemic treatment, oligoprogression after an initial treatment response is a common scenario. In this state of induced oligoprogressive disease, local ablative therapy by either surgery or radiotherapy is becoming increasingly important. Another scenario involves the emergence of a limited number of metastases after radical treatment of the primary tumour, referred to as oligorecurrence, for which the use of local ablative therapy holds promise in improving survival. Our review addresses these complex situations in lung cancer by discussing current evidence, knowledge gaps and treatment recommendations.</p

Trends in the epidemiology of small-cell lung cancer:a Dutch nationwide population-based study over 1989–2020

Introduction: This study describes the evolving characteristics of patients with small-cell lung cancer (SCLC) from 1989 to 2020 in the Netherlands to analyse how the population of patients with SCLC has changed in the last decades, hypothesising that this might explain the little progress made in SCLC. Methods: Patients with SCLC diagnosed from 1989 to 2020 were selected from the Dutch cancer registry. Incidence, patient and disease characteristics, treatments, and overall survival (OS) were analysed. Joinpoint analyses were used to test annual percentage changes for statistical significance. Results: A total of 52,527 patients were diagnosed with SCLC. The absolute numbers of patients with SCLC remained equal over the years; however, the incidence rates decreased from 15.01 to 8.93 per 100,000 person-years. The proportion of women increased from 22% to 50%, and those aged ≥75 years increased from 20% to 25%. The latter coincided with a higher proportion receiving only the best supportive care (BSC) over the years (18–24%). The use of surgery in stage I increased from 2% to 37%. The proportion of patients diagnosed with stage IV increased from 46% to 70% due to better staging. The OS improved for all stages, with a 2-year OS rate for stage IV doubling from 3% to 6%.Conclusion: The incidence of SCLC has significantly decreased over the last 30 years, with an increasing proportion of elderly and women. The male–female ratio became similar, and the OS improved. As a consequence of more elderly and probably more vulnerable patients, more patients received only the BSC.</p

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).