[Feasibility study: The medical imaging as a tool for therapeutic education in radiotherapy]. / Étude de faisabilité : l'utilisation de l'imagerie médicale en éducation thérapeutique en radiothérapie.

PURPOSE: Assess the feasibility of a randomized controlled trial (RCT) exploring the use of medical imaging as a therapeutic education (TPE) intervention in external radiation therapy. MATERIALS AND METHODS: Experimental feasibility trial of "RCT" type carried out in a single-center, between November 2019 and March 2020, following adult patients treated by thoracic radiotherapy. In addition to the information usually given, the experimental group benefited from an intervention consisting in the visualization of their own medical images using the open-source software "Stone of Orthanc". RESULTS: Forty-nine patients were recruited with a refusal rate of 8.16% (4/49). 20 patients were withdrawn from the study for health reasons (COVID), 10 for medical reasons. All the remaining 15 participants completed the process. Although not significant, the experimental group showed a median gain in the perception of knowledge compared to the control group (+ 1.9 (1.6 - 2.2)) vs (+ 1.4 (1.4 - 1.8)), as well as a decrease in scores related to anxiety (- 3.0 (-4.5 - (-2.0)) vs - 1.0 (-5.0 - 0.0)) and emotional distress ((- 5.0 (- 7.5 - (- 3.5)) vs (- 2.0 (- 5.0 - (- 1.0)) A significant reduction (p=0.043) is observed for the depression score ((- 2.0 (-3.0 - (-1.5)) vs (0.0 (0.0 - 0.0)). CONCLUSION: This study demonstrates the feasibility of the project, with promising preliminary results. Some adaptations in order to conduct a larger-scale RCT are highlighted.

Review of interactive digital solutions improving health literacy of personal cancer risks in the general public.

BACKGROUND: Health literacy is crucial in understanding the many risk factors for cancer. Low health literacy is associated with low adherence to medication, poor health status, and increased health care costs. Modern technology allows us to educate the general public on their risks. We focus herein on the available mobile applications and online web tools for the evaluation of cancer risk in the general public. METHODS: A systematic search was performed for cancer risk calculators mobile applications on both Google Play and the App Store and for online cancer risk calculators using Google, Bing, Yahoo! and Baidu. RESULTS: For mobile applications, out of 250 different apps found on GooglePlay, 16 Android applications were retained for evaluation in this review and for the AppStore, out of 10 different apps, 7 Android applications were retained for evaluation in this review. Only three apps were available for both Android and iOS systems. For web tools, a list of 20 tools was retained and evaluated. CONCLUSION: This review presents the most popular and prominent tools and their strengths and possible weaknesses are evaluated. We discuss not only its current state as it relates to general knowledge about cancer risks, but also barriers and future directions. It is imperative that as developers continue to create and improve such tools, health care providers remain aware of these efforts in order to properly guide patients towards appropriate resources and educate them on both their usefulness and limitations.

[Radiomics and automation in radiotherapy]. / Radiomique et automatisation en radiothérapie : un duo gagnant !

Cancer incidence is steadily progressing worldwide, in parallel with the aging of the population. Workload is increasing constantly, especially in the fields of oncology and radiotherapy. This is particularly worrysome, as there is a general shortage of skilled professionals in the field (for example in medical physics). Moreover, every single patient does represent an enormous amount of data issued from a wide range of sources. This is especially true as far a medical imaging is concerned. Extraction of morphological data (anatomical location and extent of the tumour) and functional data (tumour biology and metabolism in general) becomes laborious. Moreover, images contain information which cannot be discerned by the human eye. Therefore, to handle shortage of human resources and transform this enormous amount of data automatically, artificial intelligence becomes a «must have¼. We intend to highlight the growing importance of radiomics as a cornerstone in automation of processes in radiotherapy, especially for treatment planification and a more personalized individualized treatment approach.

L'incidence du cancer augmente chaque année suivant de très près l'augmentation de la moyenne d'âge de la population. La charge de travail ne fait qu'augmenter en oncologie, y compris en radiothérapie. Il devient difficile de recruter certains professionnels dans le secteur (comme par exemple, des physiciens). À ce manque, vient s'ajouter l'afflux massif de données pour chaque patient, provenant d'une multitude de sources possibles et, en particulier, la quantité et la complexité des informations contenues dans les différents examens d'imagerie. L'extraction des données structurelles (anatomie et extension de la maladie) et fonctionnelles (biologie et activité métabolique tumorale au sens large) devient laborieuse. De plus,certains éléments contenus dans l'image numérique ne sont tout simplement plus accessibles à nos capacités de perception visuelle. La pénurie annoncée en professionnels experts ainsi que la complexité grandissante de l'analyse de l'image méritent l'apport de l'intelligence artificielle. Nous allons faire le point de l'impact attendu de la «radiomique¼ qui permet l'automatisation des processus, en particulier pour la préparation et l'individualisation des traitements en radiothérapie.

[Palliation by radiation is also our business !] / La radiothérapie palliative, c'est aussi notre rayon !

Radiotherapy (RT), both with a curative and a palliative intent, is one of the cornerstones of oncological treatments. A variety of symptoms linked to cancer can be relieved with RT (such as pain, bleeding, compression exerted by a tumour lesion…). Very often, palliative RT is proposed when other medical treatments (painkillers, morphine…) are no longer efficient, or the patient does not tolerate them anymore. Palliative RT is an integral part of the global supportive oncological care. Indeed, patients' wishes and prognosis are taken into account in each and every step of the treatment pathway. Every treatment deserves an individualized approach and benefits from the best available techniques.

La radiothérapie, à la fois à visée curative et palliative, est l'un des piliers des traitements oncologiques. Une multitude de symptômes liés au cancer (douleurs, saignements, diverses conséquences liées à une compression exercée par une lésion tumorale…) peuvent être soulagés grâce à une radiothérapie palliative (RTP). Bien souvent, la RTP est proposée lorsque les traitements médicamenteux dits «classiques¼ ne font plus suffisamment effet ou si le patient ne les tolère plus (antidouleurs, morphine…). La RTP fait partie intégrante des soins oncologiques de support. En effet, le pronostic du patient, ainsi que ses souhaits, sont pris en compte à chacune des étapes qui constituent le trajet de soins, y compris en RTP. Ainsi, chaque traitement est individualisé et bénéficie des meilleures techniques disponibles.

[Precision medicine in oncology : where do we stand ?] / Médecine de précision en oncologie : où en sommes-nous ?

The «one size fits all¼ approach is seriously challenged by rapid progression of medical knowledge, especially in the field of individual genome expression. It is currently known that the anti-tumour effect of a given treatment and possible side effects at the level of healthy tissues, can at least partly be predicted and explained by individual variations of gene expression. However, most of us realize that these differences in response are also linked to a variety of other individual characteristics, such as for example the environment and socio-economic factors. Without any possible doubt, there are multiple problems (technical, administrative, financial, cultural and ethical) to be solved, before we witness the real irruption of precision medicine and its holistic individualized approach in our daily oncological practice. It has to start with an international effort, disregarding borders of individual countries, in order to obtain very large amounts of data (with a high degree of variability to avoid bias). This holistic approach, at both societal and individual levels, is the entrance door for a personalized approach in care, whether this is curative, predictive or preventive.

Le concept du traitement «taille unique¼ est sérieusement remis en question par la progression accélérée des connaissances du rôle prédictif du génome individuel, tant en matière de la réponse tumorale à un traitement, qu'en ce qui concerne l'apparition d'effets secondaires au niveau des tissus sains. Cette réponse au traitement ne dépend pas simplement de l'expression de quelques gènes, ni d'ailleurs du génome individuel entier. Elle est également influencée par une multitude d'autres facteurs, ce qui requiert une approche holistique prenant en compte, par exemple, l'environnement et les facteurs socio-économiques. Il y a indubitablement des problèmes techniques, administratifs, financiers, culturels et éthiques (protection de la vie privée) à surmonter avant que cette médecine de précision ne soit largement disponible en pratique oncologique journalière. Il faut surtout une collaboration allant largement au-delà des frontières géographiques d'un pays, afin d'assurer une manne suffisante et très variable de données, pour éliminer autant que possible les différents biais. Cette approche holistique, tant au niveau sociétal qu'individuel, ouvre la porte à la personnalisation des soins oncologiques dans le domaine curatif, prédictif et préventif.

[How to improve radiotherapy ? Technological developments and radiotherapy of tomorrow]. / Comment améliorer la radiothérapie ? Évolutions technologiques et radiothérapie de demain.

Radiotherapy established itself in the 20th century as an essential modality in the fight against cancer. The major technological advances of the last decades have allowed a considerable improvement in the therapeutic window. They have also paved the way for stereotactic radiotherapy and new indications. The aim of this article is to enable readers to understand external radiotherapy in 2021 and to understand the challenges of tomorrow. Three areas of improvement in the discipline will be described, the optimization of the prescribed therapeutic dose, the improvement of the distribution of this dose and, finally, the better understanding of radiobiology. For each of these axes, the current implications will be described as well as those which could/should have a major impact on the radiotherapy. FLASH radiotherapy will also be discussed.

La radiothérapie s'est installée au 20ème siècle comme une modalité incontournable dans la lutte contre le cancer. Les avancées technologiques majeures des dernières décennies ont permis une amélioration considérable de la fenêtre thérapeutique. Elles ont également ouvert la voie à la radiothérapie stéréotaxique et à de nouvelles indications. Cet article a pour objectif de permettre aux lecteurs de comprendre la radiothérapie externe en 2021 et d'en appréhender les enjeux de demain. Trois axes d'amélioration de la discipline seront décrits, l'optimisation de la dose thérapeutique prescrite, l'amélioration de la distribution de cette dose et, finalement, la meilleure compréhension de la radiobiologie. Pour chacun de ces axes, des implications actuelles seront données ainsi que celles qui pourraient/ devraient avoir un impact sur la radiothérapie future. La radiothérapie FLASH sera, par exemple, abordée.

[Dental management of head and neck irradiated patients]. / Prise en charge dentaire des patients irradiés en région cervico-faciale.

The oncological management of head and neck tumours is well known and standardized. Radiotherapy is one of the effective tools. However, it induces major changes in healthy tissues: teeth, gums, mucous membranes, salivary glands and bones. Some, like mucositis, are immediate and often reversible; others, like hyposialia or fibrosis, are late effects and often irremediable. These changes greatly affect oral health and make its management more complex. Dental management also becomes a capital element of the care path but, unfortunately, often remains neglected by the patient but also by some practitioners. It concerns all the stages of the clinical course: initial assessment, cancer treatment itself and long-term follow-up. If neglected, the patient's quality of life will be affected and complications, sometimes serious, such as osteoradionecrosis, may occur. Specific care recommendations for maintaining oral health are mentioned, especially for those patients requiring oral cavity irradiation.

La prise en charge carcinologique des tumeurs cervico-faciales est bien connue et codifiée. La radiothérapie fait partie des outils efficaces proposés. Elle entraîne cependant de profondes modifications tissulaires : dents, gencives, muqueuses, glandes salivaires, os. Certaines, comme la mucite, sont immédiates, et souvent réversibles; d'autres, comme l'hyposialie ou la fibrose, s'installent tardivement et souvent définitivement. Ces remaniements altèrent fortement la santé bucco-dentaire et rendent la prise en charge plus complexe. L'approche dentaire devient ainsi un élément capital du trajet de soins. Elle reste, malheureusement, souvent délaissée par le patient lui-même, mais aussi parfois par le praticien. Cette prise en charge concerne toutes les étapes du parcours : bilan initial, traitement carcinologique en soi et suivi à long terme. Si négligée, la qualité de vie du patient sera affectée et des complications, parfois graves, telle l'ostéoradionécrose, peuvent survenir. Sont évoquées ici des recommandations spécifiques de prise en charge bucco-dentaire dans le décours d'une irradiation portant sur la cavité buccale.

[Medical imaging professionals and related specialties : a questioning is essential!] / La médecine du futur. Professionnels de l'imagerie médicale et spécialités annexées : une remise en question s'impose.

Nowadays, we are facing an overwhelming amount of public announcements concerning the rise of artificial intelligence (AI) in the world of medical imaging (including radiology, nuclear medicine and radiotherapy). While most of the applications are still limited to specific niches, there is a general trend to build real transversal platforms. Multiple industrial players, in collaboration with the clinicians in the field, are striving to build those platforms in order to offer plenty of use cases of AI for several purposes and needs (screening/detection, diagnosis and prediction). It is already undeniable that AI far exceeds human capabilities in terms of resolution, speed of image analysis and efficiency. Negative attitudes and skepticism from concerned professionals should be banned. Colla¬boration with data scientists and engineers for the large scale development and implementation should be pushed forward for the benefit of both patients and payers.

S'il y a bien un domaine où les annonces pleuvent en matière de développement de l'intelligence artificielle (IA), c'est le secteur de l'imagerie médicale au sens large du terme (regroupant la radiologie, la médecine nucléaire et la radiothérapie). Les applications, encore souvent uti¬lisées dans des niches précises, ont tendance à devenir beaucoup plus transversales. De multiples acteurs indus¬triels, en partenariat avec les utilisateurs, s'évertuent à construire de réelles plateformes qui offrent aux cliniciens une multitude d'applications utilisables pour combler plusieurs types de demandes et besoins (détection, diagnostic et prédiction). Il est indéniable que la capacité de l'IA dépasse largement nos capacités humaines en matière de résolution de l'image, de rapidité et d'efficience de lecture et d'analyse. Une attitude de négation ou de scepticisme de la part des professionnels du secteur n'est plus de mise. Ils doivent, sans attendre, collaborer avec les spécialistes data et les ingénieurs au développement à large échelle de l'IA en imagerie médicale et ce, au profit des patients et des payeurs.

[Could we consider that radiotherapy is effective outside the irradiation area ? The abscopal effect]. / Peut-on considérer que la radiothérapie agit en dehors du site irradié ? L'effet abscopal.

Radiotherapy is known for its action on local tumoral control. However, it is also able to induce immunomodulatory effects at a systemic level. The abscopal effect (from latin ab scopus which means «away from the target¼) is an illustration of this phenomenon. It is defined as a tumor regression observed outside and at a distance of the irradiation fields. The potential application of this effect of treatment in disseminated cancers is a fast-growing field of research. The optimal therapeutic strategy to achieve this effect remains unknown.

La radiothérapie, connue pour son action sur le contrôle tumoral local, est également capable d'induire des effets immuno-modulateurs systémiques. L'effet abscopal (du latin ab scopus qui signifie «à distance de la cible¼) décrit la régression tumorale observée à distance de la zone d'irradiation. L'exploitation thérapeutique de celui-ci comme traitement des cancers disséminés est un domaine de recherche en plein essor. Actuellement, les modalités thérapeutiques optimales visant à obtenir cet effet demeurent inconnues.

[Multiple vertebral hemangiomas treated simultaneously with CyberKnife® Technology]. / Hémangiomes vertébraux multiples traites simultanément en condition stéréotaxique avec la technologie CyberKnife®.

Haemangioma are benign, vasoformative lesions of endothelial origin. A minority of patients with a vertebral location are symptomatic with neck or back pain. Neurological deficits due to spinal cord compression are rare and mostly observed at the thoracic and upper lumbar spine. Treatment is indicated in case of relevant symptomatology. Several invasive treatment modalities exist such as surgery and intralesional injections, but radiotherapy is the most common treatment for painful lesions. We report a case of a patient with symptomatic bifocal vertebral haemangioma (d9, l3) associated with dorsal and lumbar pain treated simultaneously using a cyberknife® vsi system, with a significant reduction of pain and a limited toxicity.

les hémangiomes sont des malformations vasculaires bénignes, d'origine endothéliale. Une minorité de patients avec des hémangiomes vertébraux sont symptomatiques et présentent des douleurs du cou ou du dos. Le déficit neurologique, occasionné par une compression de la moelle épinière, est rare et touche surtout la colonne thoracique et lombaire supérieure. Un traitement est indiqué si l'hémangiome vertébral est symptomatique. Les techniques invasives comme la chirurgie et les injections intra-lésionnelles peuvent être utilisées, mais la radiothérapie reste le traitement de choix pour les lésions douloureuses. Nous décrivons le cas d'un patient, présentant des douleurs dorso-lombaires, ayant deux hémangiomes localisés en d9 et l3 traités simultanément par le cyberknife® avec un certain succès, notamment du point de vue antalgique, et une toxicité très limitée.

[Comprehensive therapeutic strategy for localized esophageal cancer. Second part : interest of multimodal approaches with or without surgery]. / Comment je traite... les cancers localisés de l'œsophage. Etat actuel des données et stratégie thérapeutique. 2ème partie : l'intérêt des approches multimodales avec ou sans chirurgie.

In recent years, the treatment of esophagus cancer has been completely changed, thus competing the dogma of surgery as the cornerstone treatment. Multimodality treatments as radio-chemotherapy directly followed by surgery, or delayed surgery, significantly improve patient survival compared to surgery alone. Neoadjuvant radiochemotherapy is associated with a higher complete pathologic response rate and improved survival compared to chemotherapy alone. Immediate surgery after radio-chemotherapy is challenged for patients who present a complete clinical response, especially in case of squamous cell carcinoma. Indeed, systematic resection is associated with a significant postoperative mortality rate and has not proven any survival advantage in complete clinical responders as opposed to delayed resection in case of locally persistent or recurrent disease. In squamous cell carcinoma, this could lead to organ preservation, thus avoiding the mortality and durable functional impairment of esophagectomy. This review will discuss the positioning of the multimodality treatment strategy with neoadjuvant radiochemotherapy and chemotherapy and also the strategy of organ preservation.

Depuis quelques années, le traitement du cancer de l'œsophage est en pleine mutation, bousculant ainsi le grand dogme de la chirurgie comme pierre angulaire du traitement. Par rapport à la chirurgie seule, les traitements multimodaux de radiochimiothérapie suivis, directement ou de façon différée, par la chirurgie améliorent significativement les chances de survie prolongée des patients. Comparée à la chimiothérapie néodjuvante, la radiochimiothérapie néoadjuvante démontre un taux de réponse pathologique complet plus élevé qui résulte en une survie prolongée. Chez les très bons répondeurs cliniques, la question de la place de la résection chirurgicale d'emblée est remise en question, surtout pour les carcinomes épidermoïdes. Chez ces patients, la résection systématique par rapport à un acte différé n'offre pas d'avantage en survie, expose le patient à un risque de mortalité significatif alors qu'un certain nombre de patients n'auront jamais à être opérés. Le seul bénéfice actuellement démontré de la résection est une amélioration du contrôle local; or, le devenir du patient est principalement lié à la récidive métastatique. Dans cette revue, nous positionnons et discutons la place des différents traitements multimodaux, chimiothérapie et radiochimiothérapie néoadjuvantes, ainsi que la place de la préservation d'organe par rapport à une chirurgie d'emblée après une radiochimiothérapie.

[Comprehensive therapeutic strategy for localized esophageal cancer]. / Comment je traite... les cancers localisés de l'œsophage. Etat actuel des données et stratégie thérapeutique. 1ère partie : le point sur les approches chirurgicales et non chirurgicales.

Esophageal cancers represent a highly heterogeneous entity mixing two different tumour types : AdenoCarcinoma (ADC) and Squamous Cell Carcinoma (SSC). Developing in the same organ, they are very often considered as a unique pathology and, consequently, the same therapeutic strategy is indiscriminately applied. Esophageal cancer treatments are particularly complex and require a multidisciplinary approach. Despite impressive advances in the tumour statidifaction, surgery, radiotherapy and chemotherapy, the overall prognosis remains grim even at an early stage of the disease. In order to improve the treatment of esophageal cancers and the patient’s survival, we need to consider that ADC and SCC represent two different pathologies requiring specific therapeutic strategies. This review in two parts will present recent data from clinical trials under the scope of tumour histology to set up dedicated therapeutic strategies. In this first part, we explain the restricted role of surgical resection, the prognostic factors and the results of exclusive combined chemotherapy and radiation in localized esophageal cancer.

Les cancers de l'œsophage concernent deux entités d'histologie et de pathogenèse différentes : les carcinomes épidermoïdes (CE) et les adénocarcinomes (ADC). Ils se développent dans un même organe et sont souvent considérés comme une seule et unique maladie avec, comme conséquence, une stratégie thérapeutique identique. Leur traitement est complexe et requiert une prise en charge multidisciplinaire. Bien que les techniques de mise au point de la pathologie, de traitement par chirurgie, de radiothérapie et de chimiothérapie se soient améliorées, le pronostic de la maladie reste péjoratif, même à un stade précoce. L'amélioration de la prise en charge et de la survie des patients nécessite de considérer les CE et les ADC comme deux pathologies distinctes, impliquant des approches thérapeutiques qui leur soient spécifiquement dédiées. Cette revue en deux parties analyse les différents aspects thérapeutiques des cancers de l'œsophage sous l'angle de l'histologie et permet de dégager des stratégies spécifiques. Cette première partie est consacrée aux limites de la résection chirurgicale, aux facteurs pronostiques et aux résultats des traitements par radio-chimiothérapie exclusive des cancers localisés.

Commissioning Monte Carlo algorithm for robotic radiosurgery using cylindrical 3D-array with variable density inserts.

INTRODUCTION: To commission the Monte Carlo (MC) algorithm based model of CyberKnife robotic stereotactic system (CK) and evaluate the feasibility of patient specific QA using the ArcCHECK cylindrical 3D-array (AC) with Multiplug inserts (MP). RESULTS: Four configurations were used for simple beam setup and two for patient QA, replacing water equivalent inserts by lung. For twelve collimators (5-60mm) in simple setup, mean (SD) differences between MC and RayTracing algorithm (RT) of the number of points failing the 3%/1mmgamma criteria were 1(1), 1(3), 1(2) and 1(2) for the four MP configurations. Tracking fiducials were placed within AC for patient QA. Single lung insert setup resulted in mean gamma-index 2%/2mm of 90.5% (range [74.3-95.9]) and 82.3% ([66.8-94.5]) for MC and RT respectively, while 93.5% ([86.8-98.2]) and 86.2% ([68.7-95.4]) in presence of largest inhomogeneities, showing significant differences (p<0.05). DISCUSSION: After evaluating the potential effects, 1.12g/cc PMMA and 0.09g/cc lung material assignment showed the best results. Overall, MC-based model showed superior results compared to RT for simple and patient specific testing, using a 2%/2mm criteria. Results are comparable with other reported commissionings for flattening filter free (FFF) delivery. Further improvement of MC calculation might be challenging as Multiplan has limited material library. CONCLUSIONS: The AC with Multiplug allowed for comprehensive commissioning of CyberKnife MC algorithm and is useful for patient specific QA for stereotactic body radiation therapy. MC calculation accuracy might be limited due to Multiplan's insufficient material library; still results are comparable with other reported commissioning measurements using FFF beams.

Feasibility evaluation of prone breast irradiation with the Sagittilt© system including residual-intrafractional error assessment.

PURPOSE: Feasibility evaluation of the Sagittilt© prone breast board system (Orfit Industries, Wijnegem, Belgium) for radiotherapy focusing on patient and staff satisfaction, treatment time, treatment reproducibility with the assessment of residual-intrafractional errors. MATERIAL AND METHODS: Thirty-six patients underwent whole-breast irradiation in prone position. Seventeen received a sequential boost (breast: 42.56Gy in 16 fractions, boost: 10Gy in five fractions), while 19 patients received a concomitant boost protocol (breast/boost: 45.57/55.86Gy in 21 fractions). Treatment verification included a daily online cone-beam CT (CBCT). In order to assess the residual and residual-intrafractional errors post-treatment CBCTs were performed systematically at the first five treatment sessions. Treatment time, patient comfort, staff satisfaction were also evaluated. RESULTS: The pretreatment CBCT resulted in a population systematic error of 4.5/3.9/3.3mm in lateral/longitudinal/vertical directions, while the random error was 5.4/3.8/2.8mm. Without correction these would correspond to a clinical to planning target volume margin of 15.0/12.3/10.3mm. The population systematic and random residual-intrafractional errors were 1.5/0.9/1.7mm and 1.7/1.9/1.6mm. Patient and staffs' satisfaction were considered good and average. The mean treatment session time was 21minutes (range: 13-40min). CONCLUSION: The Sagittilt© system seems to be feasible for breast irradiation and well-tolerated by patients, acceptable to radiographers and reasonable in terms of treatment times. Set-up accuracy was comparable with other prone systems; residual errors need further investigations.

[Working conditions, stress and burnout of Belgian professionals in radiotherapy: Comparative analysis and emotional labor exploration]. / Conditions de travail, stress et burnout des professionnels belges de radiothérapie : analyse comparative et exploration du rôle du travail émotionnel.

PUPOSE: This national survey aims, on the one hand, to perform a comparative analysis of working conditions, job strain and burnout of Belgian nurses, physicists and radiation oncologists working in radiotherapy and, on the other hand, to explore the role of emotional labor in the development of stress and burnout. METHODS: We used the Working Conditions and Control Questionnaire, the Positive and Negative Occupational States Inventory, the Maslach Burnout Inventory, the negative work-home interaction subscale of the Survey Work-Home Interaction Nijmegen (NEGWHI), Perceived Organizational Support Scale and Emotional Labor Scale. One open question asked about problematic job situations. RESULTS: Ninety-eight nurses and physicists participated (33 % response rate), in addition to 66 radiation oncologists from a previous study. Although global scores of working conditions, job strain and burnout corresponded to normal scores, comparative analysis identified physicists as focus group concerning job strain and burnout. Moreover, nurses and physicists surface acting was a good predictor of job strain (ß=0.22, P=0.01), emotional exhaustion (ß=0.32, P<0.001) and depersonalization (ß=0.43, P<0.001). Nevertheless, perceived organizational support was a moderator in this relation. CONCLUSION: Radiotherapy employees were in the norms. The importance of organizational support was demonstrated to avoid potential health problems, for workers experiencing high levels of emotional demands.

Next generation sequencing to determine the cystic fibrosis mutation spectrum in Palestinian population.

An extensive molecular analysis of the CF transmembrane regulator (CFTR) gene was performed to establish the CFTR mutation spectrum and frequencies in the Palestinian population, which can be considered as an understudied population. We used a targeted Next Generation Sequencing approach to sequence the entire coding region and the adjacent sequences of the CFTR gene combined with MLPA analysis of 60 unrelated CF patients. Eighteen different CF-causing mutations, including one previously undescribed mutation p.(Gly1265Arg), were identified. The overall detection rate is up to 67%, and when we consider only CF patients with sweat chloride concentrations >70 mEq/L, we even have a pickup rate of 92%. Whereas p.(Phe508del) is the most frequent allele (35% of the positive cases), 3 other mutations c.2988+1Kbdel8.6Kb, c.1393-1G>A, and p.(Gly85Glu) showed frequencies higher than 5% and a total of 9 mutations account for 84% of the mutations. This limited spectrum of CF mutations is in agreement with the homozygous ethnic origin of the Palestinian population. The relative large portion of patients without a mutation is most likely due to clinical misdiagnosis. Our results will be important in the development of an adequate molecular diagnostic test for CF in Palestine.

Working conditions, job strain and work engagement among Belgian radiation oncologists.

PURPOSE: This national survey has measured the working conditions, work engagement, job strain, burn out, and the negative work-home interaction among Belgian radiation oncologists with validated questionnaires. In fact, previous studies had in general shown an interest to burn out and its association with working conditions among oncology workers, but not focused on radiation oncologists in particular. Moreover, few studies concerned work engagement and its association with working conditions although this could be important in preventing burn out. METHODS: We used the WOrking Conditions and Control Questionnaire, the Positive and Negative Occupational States Inventory, the Maslach Burn out Inventory, and the negative work-home interaction subscale of the Survey Work-home Interaction Nijmegen. One open question asked about problematic job situations. RESULTS: Sixty-six radiation oncologists participated (30% response rate). Median scores of most of working conditions corresponded to normal scores. Control over time management (45.8) was close to low score, while control over future (60.9) was high. Median score of job strain (48.9) was normal, whereas median score of work engagement (60) was high. Median score of burn out was low. The mean of negative work-home interactions (1.1) was higher than the mean of 0.84 in a reference sample (t=4.3; P<0.001). The most frequent problematic situations referred to work organization (e.g. time pressure) and specific resources (e.g. chief support). CONCLUSIONS: Radiation oncologists showed a very high level of work engagement and experienced several job resources. However, some resources (as supervisor support) were missing and needed to be developed. These results were discussed in the context of motivational process described in the Job Demands-Resources Model.

[The radiotherapy journey: from information to treatment]. / La radiothérapie: le parcours du patient, de l'information au traitement.

Radiotherapy is an integral part of the therapeutic arsenal in oncology and it is estimated that two-thirds of cancer patients will receive radiation therapy at some time during the course of their illness. The multiple steps undertaken in radiotherapy are often unknown by the medical profession and the purpose of this article is to trace it. From the decision to implement a radiotherapy treatment, taken by a multidisciplinary team, to the application of ionizing irradiation by the linear accelerator, there are important intermediary steps such as consultation with the radiotherapist, simulation, contouring of the volumes and planning. Setting up a radiotherapy treatment takes time and precision is required at each step. Technologies evolve constantly and we are also systematically looking for treatment optimization. Our goal is to achieve individualized radiotherapy.