PubMed · 11637799
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C De Backer. 1983. [Not Available].. https://pubmed.ncbi.nlm.nih.gov/11637799/
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PURPOSE: Precision medicine, also known as personalized medicine, enables the provision of tailored health services to patients. In the prevention, early detection, and treatment of cancers, precision medicine is highly promising, given the increasing use of genomic profiling for diagnosis and adapting therapies in several tumor types. Artificial Intelligence (AI) can support this process by analyzing vast amounts of relevant data. However, high-quality data and financial investments in the health system are essential for the implementation of precision medicine and AI solutions in routine cancer care. DESIGN/METHODOLOGY/APPROACH: Building on the quantitative outcomes of a foresight exercise published in another study, this article collects qualitative data to gain more detailed insights into the future of precision oncology in Belgium and discusses the role of AI in this field. It reports the results of a series of expert workshops, focusing on four hypothetical future scenarios that are centered around technological and economic issues that must be overcome for the widespread use of precision oncology in Belgium. FINDINGS: The study concludes that all four scenarios discussed in the workshops would require supportive policy measures in Belgium, which should go beyond mere technological and economic considerations, such as involving patient associations and the public in policy design or creating multi-disciplinary expert groups for precision medicine. ORIGINALITY/VALUE: To the best of our knowledge, this is the first study to employ foresight methodology to illustrate possible future scenarios, scrutinize feasible approaches for implementing precision oncology in Belgium, and discuss the use of AI in this context.
PURPOSE/OBJECTIVE: Rotterdam and Brussels have independently published guidelines for the definition and delineation of CT-based neck nodal Levels I-VI. This paper first reports on the adequacy of contouring of the Rotterdam delineation protocol. Rotterdam and Brussels differed slightly in translating the original surgical level definitions as proposed by the 2002 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) to CT guidelines. To adapt to the surgical level definitions to come to a unifying concept, adjustments of both CT-based classifications are proposed. METHODS AND MATERIALS: The clinical neck nodal target volumes of patients irradiated in Rotterdam by three-dimensional conformal radiotherapy (3D-CRT) between December 1998 and March 2001 were reviewed. Thirty-four patients with N0 and 27 patients with N+ disease with primary tumors located in the oral cavity (n = 1) oropharynx (n = 24), hypopharynx (n = 7), and larynx (n = 29) were evaluated. Seven patients underwent unilateral (3 N0 patients, 4 N+ patients) and 54 underwent bilateral (31 N0 patients, 23 N+ patients) irradiation of the neck. In 11 N+ patients, 3D-CRT of the neck was followed by unilateral neck dissection. The dose to the primary and nonresected N+ necks was 70 Gy and to the N0 neck was 46 Gy. Neck levels were analyzed for adequacy of contouring, dose distribution, and patterns of relapse. The mean dose and the percentage of the volume receiving a minimum of 95% (V95) or >107% (V107) of the prescribed dose was computed. RESULTS: In 4 patients treated with bilateral 3D-CRT, contouring was not in concordance with the guidelines of the protocol. The V95 and V107 in the 81 adequately contoured N0 necks (63 irradiated N0 necks from 33 N0 patients, 18 irradiated N0 necks from 24 N+ patients) was 95.6% and 6.3%, respectively. For the 26 N+ necks (15 N+ necks from 13 N+ RT-only patients, 11 N+ necks from 11 preoperatively irradiated patients), the V95 and V107 was 94.6% and 6.7%, respectively. With a median follow-up of 29 months, in 4 (8.6%) of 46 patients treated by 3D-CRT only, regional relapse was found. An actuarial regional and locoregional relapse-free survival and disease-free survival rate at 3 years of 90%, 78%, and 68%, respectively, was observed. All regional relapses were observed in the N0 necks of patients with supraglottic laryngeal carcinoma. Taking the surgical 2002 AAO-HNS classification as a reference, adjustments are proposed for the Rotterdam and Brussels delineation protocols to arrive at a unified CT-based neck nodal classification. CONCLUSION: Adequate dose coverage for the Rotterdam CT-based contours of the neck nodal levels was found. In the RT-only patients, only four failures were observed: one regional and three locoregional relapses. As a next step in optimizing the current Rotterdam and Brussels CT-based delineation protocols, adaptations are proposed to resolve the discrepancies compared with the 2002 AAO-HNS surgical classification.
A limited number of different foods were analysed for dioxin-like compounds by the CALUX bioassay which is an in vitro luciferase reporter gene assay measuring chemical activation of the aryl hydrocarbon receptor. Sixty-two milk samples were obtained from a surveillance campaign, 34 meat samples and 34 fishery products were purchased from the Belgian market. Bio-analytical and chemo-analytical dioxin toxicity equivalents (TEQ) values of the same milk samples were compared. Spearman's Rank correlation coefficients of 0.72, 0.67, 0.73 were obtained respectively between CALUX-TEQ and PCDD/F-TEQ, DL-PCB-TEQ and PCDD/F+DL-PCB-TEQ. The bioassay limit of detection was 0.1 pg TEQ from 1 g animal lipid, the limit of quantification was 0.4 pg TEQ. The repeatability of the CALUX bioassay (variability of butter fat samples analysed in the same run) showed a coefficient of variation (CV) of 10%, intra laboratory reproducibility based on independent runs of the same butter fat samples showed more variation (CV of 26% for samples above 2 pg TEQ/g lipid). All milk samples with a chemical TEQ value above the current limit value in Belgium showed an elevated CALUX-TEQ concentration, above 6 pg TEQ/g lipid. No false negative results were obtained. Based on the good correlation between CALUX-TEQ and chemically measured TEQ levels, the CALUX bioassay can be recommended as a screening tool for routine measurement of potentially toxic PHAHs in milk samples. Chemical analyses could then largely be restricted to positive samples, in order to identify the nature and to quantify the concentration of the chemicals that give the positive signal. Meat samples showed lower CALUX-TEQ values per gram lipid compared to fish samples. The fish samples showed a wider range of CALUX-TEQ values than the meat samples.