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DisclaimerThis article is based on recommendations from the 12th WALT Congress, Nice, October 3-6, 2018, and a follow-up review of the existing data and the clinical observations of an international multidisciplinary panel of clinicians and researchers with expertise in the area of supportive care in cancer and/or PBM clinical application and dosimetry. This article is informational in nature. As with all clinical materials, this paper should be used with a clear understanding that continued research and practice could result in new insights and recommendations. The review reflects the collective opinion and, as such, does not necessarily represent the opinion of any individual author. In no event shall the authors be liable for any decision made or action taken in reliance on the proposed protocols.ObjectiveThis position paper reviews the potential prophylactic and therapeutic effects of photobiomodulation (PBM) on side effects of cancer therapy, including chemotherapy (CT), radiation therapy (RT), and hematopoietic stem cell transplantation (HSCT).BackgroundThere is a considerable body of evidence supporting the efficacy of PBM for preventing oral mucositis (OM) in patients undergoing RT for head and neck cancer (HNC), CT, or HSCT. This could enhance patients’ quality of life, adherence to the prescribed cancer therapy, and treatment outcomes while reducing the cost of cancer care.MethodsA literature review on PBM effectiveness and dosimetry considerations for managing certain complications of cancer therapy were conducted. A systematic review was conducted when numerous randomized controlled trials were available. Results were presented and discussed at an international consensus meeting at the World Association of photobiomoduLation Therapy (WALT) meeting in 2018 that included world expert oncologists, radiation oncologists, oral oncologists, and oral medicine professionals, physicists, engineers, and oncology researchers. The potential mechanism of action of PBM and evidence of PBM efficacy through reported outcomes for individual indications were assessed.ResultsThere is a large body of evidence demonstrating the efficacy of PBM for preventing OM in certain cancer patient populations, as recently outlined by the Multinational Association for Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). Building on these, the WALT group outlines evidence and prescribed PBM treatment parameters for prophylactic and therapeutic use in supportive care for radiodermatitis, dysphagia, xerostomia, dysgeusia, trismus, mucosal and bone necrosis, lymphedema, hand-foot syndrome, alopecia, oral and dermatologic chronic graft-versus-host disease, voice/speech alterations, peripheral neuropathy, and late fibrosis amongst cancer survivors.ConclusionsThere is robust evidence for using PBM to prevent and treat a broad range of complications in cancer care. Specific clinical practice guidelines or evidence-based expert consensus recommendations are provided. These recommendations are aimed at improving the clinical utilization of PBM therapy in supportive cancer care and promoting research in this field. It is anticipated these guidelines will be revised periodically.

Purpose The purpose of this study was to investigate the effectiveness of photobiomodulation (PBM) therapy for the prevention of chemotherapy-induced peripheral neuropathy (CIPN) in breast cancer patients. Methods A prospective, randomized placebo-controlled pilot trial (NEUROLASER) was set up with 32 breast cancer patients who underwent chemotherapy (ClinicalTrials.gov; NCT03391271). Patients were randomized to receive PBM (n = 16) or placebo treatments (n = 16) (2 × /week) during their chemotherapy. The modified Total Neuropathy Score (mTNS), six-minute walk test (6MWT), Numeric pain Rating Scale (NRS), and Functional Assessment of Cancer Therapy/Gynecologic Oncology Group Taxane (FACT/GOG-Taxane) were used to evaluate the severity of CIPN and the patients’ quality of life (QoL). Outcome measures were collected at the first chemotherapy session, 6 weeks after initiation of chemotherapy, at the final chemotherapy session, and 3 weeks after the end of chemotherapy (follow-up). Results The mTNS score increased significantly over time in both the control and the PBM group. A significantly higher score for FACT/GOG-Taxane was observed in the PBM group during chemotherapy compared to the control group. Questions of the FACT/GOG-Taxane related to sensory peripheral neuropathy symptoms showed a significant increase in severeness over time in the control group, whereas they remained constant in the PBM group. At follow-up, a (borderline) significant difference was observed between both groups for the 6MWT and patients’ pain level, in benefit of the PBM group. Conclusions This NEUROLASER trial shows promising results concerning the prevention of CIPN with PBM in breast cancer patients. Furthermore, a better QoL was observed when treated with PBM.

BackgroundImmune-related adverse events are increasingly prevalent in the oncologist’s practice. Cardiac adverse events are rare but can be life-threatening. Case reports of immune checkpoint inhibitor (ICI)–related pericarditis are scarce and so is the scientific evidence for its management. This is the first report of a steroid-dependent pericarditis.Case summaryWe present a case of a woman with lung metastatic melanoma who developed pericarditis after two infusions of pembrolizumab. The initial response to steroids and colchicine was favourable, and steroids were successfully tapered, after which the immunotherapy was reintroduced. A complete metabolic remission was achieved after six cycles of pembrolizumab, but pericarditis symptoms recur each time the steroid dose is lowered below 10 mg. After introduction of azathioprine, steroids were successfully tapered over the course of 6 months.DiscussionBecause of the chronicity of the pericarditis, it was hypothesized that an underlying auto-immune pericarditis was triggered by the checkpoint inhibitor and the general guidelines for recurrent idiopathic pericarditis were followed, successfully adding azathioprine to taper steroids to stop.

Objective: A narrative review of the available scientific evidence to identify the current proposals relating the use of photobiomodulation (PBM) to treat acute radiodermatitis (ARD), to guide future research. Background data: A devastating side effect of radiotherapy (RT) is ARD, defined as an inflammatory skin reaction induced by RT. Currently, there is still no standard of care for ARD. PBM is a non-invasive light therapy that is a growing modality in the field of supportive cancer care. There is a need for identifying the therapeutic irradiation windows in this field, based on the available literature. Methods: An electronic search of original articles in the PubMed database was performed with the following keywords: “photobiomodulation therapy,” “low-level light therapy,” “low-level laser therapy,” “acute radiodermatitis,” and “radiotherapy” until December 2019. Randomized controlled trials, prospective non-randomized, case report, cohort, cross-over, and retrospective studies were selected for this review. Results: Nine clinical trials that investigated the use of photobiomodulation therapy (PBMT) in ARD were available for evaluation. Results demonstrate that PBMT could significantly reduce the severity of ARD and the accompanying discomfort and pain in patients with cancer. Conclusions: Based on the available evidence of the narrative review, PBM might be an effective therapy for the prevention and management of ARD in patients with cancer. More research is needed to confirm this finding. Foundation Limburg Sterk Merk Province of Limburg Flemish government Hasselt University Ziekenhuis Oost-Limburg Jessa Hospital Kom op Tegen Kanker Limburgse Kankerfonds ASA Srl

associations of EPHA3 mutations with tumor mutation burden (TMB), PD-L1 expression, microsatellite instability-high (MSI-H), tumor-infiltrating lymphocytes (TILs), and clinical response to ICIs. This will be very helpful for identifying patients who may benefit from immunotherapy. Methods: The ICIs cohort from the MSKCC was used for exploring the associations between EPHA3 mutations and ICIs efficacy. The relationships between EPHA3 mutations and TMB, PD-L1 expression, and MSI-H were investigated in our Chinese cohort. The TCGA cohort was used for analyzing the link between EPHA3 mutations and TILs. Results: First, we analyzed the associations between EPHA3 mutations and overall survival (OS) after ICIs therapy. For all enrolled patients, those who harbored EPHA3 mutations had a relatively longer OS compared to those without mutations (40 vs 18 months, P ¼ 0.0102). However, EPHA3 mutations displayed divergent predictive roles in different cancer types. The median OS was significantly longer in the Mut group compared to the WT group for NSCLC (36 vs 11 months, P ¼ 0.0167). There were no associations between EPHA3 mutations and ICIs efficacy for patients with melanoma, glioma, bladder, colorectal, esophagogastric, breast, and head and neck cancers. Second, the results from our cohort showed that the median TMB was higher in the Mut group for NSCLC (14.6 vs 6.6 muts/Mb, P < 0.0001). And we did not find the associations of EPHA3 mutations with PD-L1 expression and MSI-H. Third, the analysis in the TCGA cohort revealed that NSCLC patients with EPHA3 mutations were infiltrated with increased activated natural killer cells (P ¼ 0.0131). Conclusions: Our data indicated that EPHA3 mutations were associated with prolonged OS in NSCLC, rather than other cancer types, suggesting that it might act as a predictive biomarker for ICIs therapy in NSCLC. EPHA3 mutations were also correlated with higher TMB and increased activated natural killer cells in NSCLC. Background: Dovitinib is a tyrosine kinase inhibitor that inhibits VEGFR1-3, PDGFR, FGFR1-3, c-KIT, FLT3 and topoisomerase 1 and 2. Dovitinib is in development with a tumor agnostic biomarker based on 58 genes associated with sensitivity and resistance to dovitinib. The most advanced development is in renal cell carcinoma (RCC), which is presented here. De Stichting Tegen Kanker; AstraZeneca; Kom op Tegen Kanker

Multiple myeloma (MM), characterized by malignant plasma cells in the bone marrow, is consistently preceded by asymptomatic premalignant stage monoclonal gammopathy of undetermined significance (MGUS). These MGUS patients have an annual risk of 1% to progress to MM. Clinical, imaging, and genomic (genetic and epigenetic) factors were identified, whose presence increased the risk of progression from MGUS to MM. In this systematic review we summarize the currently identified clinical, imaging, and genomic biomarkers suggested to increase the progression risk or shown to be differentially expressed/present between both cohorts of patients. Despite the wide range of proposed markers, there are still no reliable biomarkers to individually predict which MGUS patient will progress to MM and which will not. Research on biomarkers in the progression from MGUS to MM will give more insight in the unknown pathogenesis of this hematological malignancy. This would improve research by elucidating new pathways and potential therapeutic targets as well as clinical management by closer follow-up and earlier treatment of high-risk MGUS patients. (C) 2018 Elsevier Inc. All rights reserved. This project was supported by the Limburg Clinical Research Program UHasselt-ZOL-Jessa, the foundation Limburg Sterk Merk, Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital.

Cancer patients are at an increased risk of venous thromboembolism (VTE). The current standard initial treatment of an acute episode of VTE in cancer patients consists of the administration of three to six months of subcutaneous low molecular weight heparin (LMWH) at a dose adjusted to the body weight. The efficacy and safety profile of LMWHs are well established, but a drawback of these agents is that they require daily subcutaneous administration. In addition, they are mainly cleared through the kidneys, and their use in patients with severe renal insufficiency may require dose reduction or monitoring of the anti-Xa activity. To address the issues with LMWH, several direct oral anticoagulants (DOAC) have been developed for the treatment of VTE. In contrast to LMWHs and vitamin K antagonist, DOACs directly interfere with thrombin or activated factor X (FXa). DOACs have now become standard treatment options in the general management of VTE, but until recently, there were no results of clinical trials specifically assessing the role of DOACs in the treatment of cancer-associated thrombosis. Recently, the Hokusai VTE cancer study and preliminary data from the Select-D trial demonstrated that DOACs are non-inferior to LMWH in preventing recurrent VTE. However, both studies also show that this comes at the cost of an increased rate of both major and clinically-relevant non-major bleeding. Especially in the subgroup of patients with gastrointestinal cancer, the benefit in VTE recurrence with the DOAC seems to be outbalanced by a significantly increased bleeding risk. Based on the available results, DOACs might represent an interesting alternative for LMWH in certain subgroups of patients, but with an important list of exceptions. It seems reasonable not to use DOACs in patients with a high bleeding risk, and especially in patients with gastrointestinal cancer, DOACs should not be the first-line choice. In summary, while LMWHs are currently the standard of care in the acute management of cancer-associated thrombosis, the advent of DOACs is welcomed for patients at a low bleeding risk who are in need of long-term anticoagulation. ACKNOWLEDGEMENT: This article was previously published in the Belgium Journal of Medical Oncology (BELG J MED ONCOL 2019;13(2):46-53)

Background The aim is to evaluate the effectiveness of photobiomodulation therapy (PBMT) in the prevention of acute radiodermatitis (RD) in breast cancer patients undergoing radiotherapy (RT). Study Design/Materials and Method This randomized, placebo-controlled trial enrolled 66 breast cancer patients that underwent an identical RT regime post-lumpectomy. Patients were randomly assigned to the laser (n=34) or placebo group (n=32). There were no significant differences between the two groups with respect to patient- and treatment-related characteristics. Laser or placebo was applied two days a week, immediately after the RT session, starting at the first day of RT. PBMT was delivered using a class IV MLS® M6 laser that combines two synchronized laser diodes in the infrared range (808-905 nm) with a fixed energy density (4 J/cm2). Clinical scoring of RD (Radiation Therapy Oncology Group (RTOG) grading scale) and biophysical measurements (skin hydration, transepidermal water loss (TEWL), and degree of erythema) were determined at the first day, at fraction 20 and at the end of RT. In the results section, only preliminary results of the RTOG scores are shown. Results At fraction 20 of RT, there was no significant difference between the groups in the distribution of RTOG grades (p= .524), with most of the patients presenting RTOG grade 1. Towards the end of RT, the skin reactions worsened in the placebo group (p= 0.016), while they remained stable in the laser group (p= .207). There was a significant difference in the severity of RD between the two groups (p= .021) with a larger percentage of patients experiencing RTOG grade 2 or higher (e.g. moist desquamation) in the placebo group (28.1% vs. 5.9%, for the placebo and laser group, resp.) at the last day of RT. Conclusion The preliminary results of this first randomized, placebo-controlled trial show that PBMT can prevent aggravation of acute RD in breast cancer patients. LCRP; Limburgs Kankerfonds; ASA srl

Breast cancer is the most common cancer in women worldwide, with an incidence of 1.7 million in 2012. Breast cancer and its treatments can bring along serious side effects such as fatigue, skin toxicity, lymphedema, pain, nausea, etc. These can substantially affect the patients’ quality of life. Therefore, supportive care for breast cancer patients is an es- sential mainstay in the treatment. Low-level light therapy (LLLT) also named photobiomodulation therapy (PBMT) has proven its efficiency in general medicine for already more than 40 years. It is a noninvasive treatment option used to stimulate wound healing and reduce inflammation, edema, and pain. LLLT is used in different medical settings ranging from dermatology, physiotherapy, and neurology to dentistry. Since the last twenty years, LLLT is becoming a new treat- ment modality in supportive care for breast cancer. For this review, all existing literature concerning the use of LLLT for breast cancer was used to provide evidence in the following domains: oral mucositis (OM), radiodermatitis (RD), lymph- edema, chemotherapy-induced peripheral neuropathy (CIPN), and osteonecrosis of the jaw (ONJ). The findings of this re- view suggest that LLLT is a promising option for the manage- ment of breast cancer treatment-related side effects. However, it still remains important to define appropriate treatment and irradiation parameters for each condition in order to ensure the effectiveness of LLLT. This study is part of the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital. Additionally, this research is supported by the foundation Limburgs Kankerfonds.

Photobiomodulation therapy is based on the application of visible and/or (near-)infrared light on the target tissue. We performed a review of 34 articles on the use of photobiomodulation therapy in the management of cancer related lymphoedema, oral mucositis, radiodermatitis, chemotherapy-induced peripheral neuropathy, osteonecrosis of the jaw, and xerostomia/hyposalivation. The findings suggest that photobiomodulation therapy is a promising option for the management of these cancer therapy-related side effects. This study is part of the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. Additionally, this research is supported by the foundations Limburgs Kankerfonds, Kom op Tegen Kanker and ASA srl.

Rationale, aims, and objectives The systematic assessment of cancer patients well-being and care needs is internationally recommended to optimize comprehensive cancer care. The Cancer Rehabilitation Evaluation System (CARES) is a psychometrically robust quality of life and needs assessment tool of US origin, developed in the early 1990s. This article describes Belgian patients' view on the content validity and feasibility of the CARES for use in current cancer care. Methods Participants were cancer patients recruited through media. Data were gathered in 4 focus groups (n = 26). The focus group discussions were facilitated with key questions. A moderator and an observer conducted and followed up the discussion. The audio file was transcribed verbatim and afterwards analyzed thematically. Results Participants experience concerns and needs in a wide range of life domains such as physical, emotional, cognitive, social, relational, sexual, financial, and work-related and in the interaction with care professionals. According to participants, the items of the CARES are all relevant to capture the possible life disruption that cancer patients and survivors experience. One important theme is missing in the CARES, namely, the well-being of loved ones. The completion time of the CARES was judged to be feasible, and according to participants, only a few items need a reformulation. Conclusions In general, the results of this study support the content validity and feasibility of the CARES. However, little adjustments in formulation and a few extra items are needed. The instrument can be used to obtain a comprehensive assessment of a cancer patients' overall well-being and care needs to take dedicated action in care. Our gratitude goes out to the team of Huis Erika Thijs for their hospitality and for the provision of facilities during the FGs. We would like to thank Willem van de Esschert for his practical support in conducting the FGs, Noemie Aubert Bonn for editing the manuscript for the English language, and Limburg Sterk Merk (L.S.M.) for funding the PhD-research project of Bojoura Schouten.

Introduction: The role of postoperative radiation therapy (PORT) in patients with completely resected non-small cell lung cancer (NSCLC) with pathologically involved mediastinal lymph nodes (N2) remains unclear. Despite a reduction of local recurrence (LR), its effect on overall survival (OS) remains unproven. Therefore we conducted a review of the current literature. Methods: To investigate the benefit and safety of modern PORT, we identified published phase III trials for PORT. We investigated modern PORT in low-risk (ypN0/1 and RO) and high-risk (ypN2 and/or R1/2) patients with stage III-N2 NSCLC treated with induction chemotherapy and resection. Results: Seventeen phase III trials using PORT were selected. Of all PORT N2 studies, 4 were eligible for evaluation of LR, all in high-risk patients only. In these high-risk patients receiving PORT, the mean LR rate at 5 years was 20.9% (95% CI 16-24). Two trials were suitable to assess LR rates after chemotherapy and surgery without PORT. In these low-risk patients, the mean 5-year LR was 33.1% (95% CI 27-39). No significant difference in non-cancer deaths between PORT vs. non-PORT patients was observed in N2 NSCLC. Conclusion: PORT is worth the controversy because data illustrate that PORT may increase the OS. However, prospective randomized trials are needed to verify this. (C) 2016 Elsevier Ltd. All rights reserved. This study is part of the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital; This work was supported by the Limburg Cancer Foundation and Kom op tegen Kanker.

Factor solutions exploring CARES subscales. (DOC 167Â kb)

CARES Patient profile. (PDF 173Â kb)

Summary of needs assessment tools and psychometric properties. The table in this file displays a summary of 24 needs assessment tools and their psychometric properties. Items, domains, validity (content validity and other types of validity), reliability (internal consistency and reproducibility), responsiveness and feasibility are discussed. (DOCX 44Â kb)

CARES Validity Ratings. (DOC 45Â kb)

CARES Questionnaire. (PDF 7917Â kb)

Lung cancer is the second most common cancer in men and the third in women. Moreover, lung cancer is the leading cause of cancer death. In 2008, approximately 951.000 men and 427.000 women died from lung cancer worldwide. However, screening for lung cancer remains a challenge. Consequently, lung cancer is often diagnosed at a metastatic stage. New screening tools that would allow the detection of lung cancer at an early stage could possibly lead to a reduction in the mortality rate of this cancer. In this perspective, recent studies indicate that the determination of the metabolic profile of a blood sample by means of nuclear magnetic resonance spectroscopy has the potential for early disease detection. For several diseases, changes in metabolite concentrations have been shown to correlate with the presence of a certain disease. Identifying which changes in the metabolite concentrations correlate with the presence of lung cancer could allow us on the long-term to easily detect the presence of lung cancer in a simple blood sample. We hypothesize that metabolic phenotype analyses by NMR spectroscopy permit the detection of lung cancer and that the metabolic changes, detected in the blood of lung cancer patients, correlate with metabolic alterations at the tumor site. These metabolic changes in the tumor are measured by means of 18-fluorodeoxyglucose-positron emission tomography-computed tomography. Previous studies have shown that the uptake of 18F-FDG is substantially increased in most types of cancer, reflecting an elevated glucose consumption by tumor cells. Venous blood samples of 29 patients with confirmed lung cancer (before treatment or surgery) and 29 control subjects were collected. All patients had fasted for at least 6 hours and their blood glucose levels were lower than 200 mg/dl. To determine the correlation between metabolic changes in the blood and metabolic alterations at the tumor site, the patients in this study underwent a whole-body CT- and a PET-scan one hour after administration of 18F-FDG. The degree of tumoral 18F-FDG uptake was measured by the standardized uptake value, normalized for lean body mass (SUL). Application of supervised orthogonal partial least squares-discriminant analysis on a well-defined and selected panel of metabolites, allowed us to discriminate lung cancer patients from control subjects with a sensitivity of 93% and a specificity of 96%. These results are very promising, however, further validation with additional samples of lung cancer patients and controls is necessary. Furthermore, regression analysis between the SUL and all the metabolites present in the metabolic fingerprint will be performed to determine the correlation between the metabolic changes at the tumor site and changes in the blood.

Objective: The aim of this study was to investigate the epidemiology and antibiotic susceptibility profiles of isolated bacterial organisms in relation to empiric treatment of neutropenic fever over a 15-year period. Methods: All patients with or at risk for febrile neutropenia and treated in the hematology ward of the Antwerp University Hospital during 1994–2008 were prospectively included. Skin, blood, and urine cultures were taken. Oral quinolone prophylaxis was started in patients with neutropenia without fever. Empiric starting therapy consisted of amikacin in combination with cefepime. Results: A total of 3624 bacteria were isolated. The most common pathogens were coagulasenegative Staphylococci (46%), followed by Escherichia coli (25%), Enterobacteriaceae (15.6%), Staphylococcus aureus (7.2%), and Pseudomonas aeruginosa (3.8%). The balance between Gram-positive and Gram-negative bacteria remained stable, with a majority of Gram-positive bacteria. A shift from oxacillin-sensitive to oxacillin-resistant coagulase-negative Staphylococci was observed. Regarding susceptibility patterns, no vancomycin resistance was detected in coagulase-negative Staphylococci or in S. aureus. The E. coli susceptibility rates remained stable. However, 66% of bloodstream infections were ciprofloxacin-resistant. A reduced susceptibility of P. aeruginosa strains to meropenem was noticed. Conclusions: Improvement in antibiotic susceptibility of inducible Enterobacteriaceae following a switch of empiric antibiotic therapy was maintained 15 years after starting the latter treatment. Further improvement in antibiotic susceptibility of these bacteria to ceftazidime was observed, but continuous vigilance is warranted. The statistical analysis was supported with a grant from the quality fund at Jessa Hospital, Hasselt, Belgium. The authors would like to thank Dr I Gyssens, infectious diseases, for revision of manuscript, and Dr R Saenen and Dr L Luyten, medical registration, for providing patient data.

Objectives: The evidence demonstrating the efcacy of photobiomodulation (PBM) therapy for preventing and managing acute radiation dermatitis (ARD) is growing steadily. The question that arises from many clinicians is, if PBM is safe for oncologic patients. This study aimed to evaluate the diseasefree survival (DFS), cancerfree survival (CFS), and overall survival (OS) of breast cancer patients treated with PBM for ARD. Methods: Clinical data of 120 breast cancer patients treated with prophylactic PBM (n = 60, 2x/week, 808−905 nm, 4 J/cm 2) or placebo (n = 60) during conventional fractionation (CF) radiotherapy (RT) between April 2015 and June 2017 were retrospectively analyzed (TRANSDERMIS trial). During followup (April 2015 to May 2022), patients underwent a complete clinical evaluation every 6 months and blood analysis and mammography yearly in the rst 5 years after the end of RT. The DFS, CFS, and OS were estimated. Results: At a median followup time of 66 months (range 4−81), there was no signicant difference in DFS (73.7% vs. 98.3%, resp., p = 0.54), CFS (68.4% vs. 77.8%, resp., p = 0.79), and OS (87.9% vs. 98.3%, resp., p = 0.30) between the placebo and PBM group. Conclusions: This paper is the rst to describe the results of a longterm followup in earlystage breast cancer patients who underwent PBM for ARD. Results suggest that using PBM in breast cancer patients undergoing CF RT does not inuence the locoregional recurrence, the development of new primary tumors, or OS. We would like to thank all patients, doctors, and nurses for their participation in TRANSDERMIS trial. In addition, we want to thank Jessa Hospital and Hasselt University for providing the needed infrastructure and software packages. This study is part of the Limburg Clinical Research Center (LCRC)UHasselt‐ZOL‐Jessa, financially supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost‐Limburg, and Jessa Hospital. Additionally, this study is supported by Kom op Tegen Kanker (Stand up to Cancer), the Flemish cancer society, LimburgsKankerfonds, and ASA Srl.

ObjectiveBecause elderly patients with ovarian cancer are underrepresented in randomized studies, this study aimed to expand our knowledge on the safety and effectiveness of frontline treatment with bevacizumab in combination with standard carboplatin and paclitaxel chemotherapy in patients aged 70 years and older with a diagnosis of Federation of Gynecology and Obstetrics (FIGO) stage IV ovarian cancer in routine clinical practice in Belgium.MethodsPatients aged 70 years and older with FIGO stage IV ovarian cancer were included in a multicenter, non-interventional prospective studyto evaluate the safety and effectiveness of treatment with bevacizumab in combination with frontline carboplatin and paclitaxel chemotherapy. Comprehensive geriatric assessments were performed at baseline and during treatment.ResultsThe most frequently reported adverse events for bevacizumab were hypertension (55%), epistaxis (32%) and proteinuria (21%). The Kaplan-Meier estimate of progression-free survival was 14.5 months. The results of the comprehensive geriatric assessments during treatment indicated a slight improvement in the geriatric eight health status screening tool score for general health status and the mini-nutritional assessment score for nutritional status. The median change from baseline score was close to zero for the instruments measuring independency, activity of daily living and instrumental activities of daily living, and for the mobility-tiredness test measuring self-perceived fatigue.ConclusionsNo new safety signals were registered in this study in patients aged 70 years and older treated with bevacizumab and frontline carboplatin and paclitaxel for FIGO stage IV ovarian cancer. Elderly patients should not be excluded from treatment for advanced ovarian cancer based on age alone.EU PAS registerENCEPP/SDPP/13849.ClinicalTrials.gov identifierNCT02393898.

Background and purpose The purpose of this study was to investigate the effectiveness of photobiomodulation therapy (PBMT) for the prevention of acute radiation dermatitis (ARD) in head and neck cancer (HNC) patients. Materials and methods A randomised, placebo-controlled trial (RCT) with 46 HNC patients who underwent radiotherapy (RT) with or without concomitant chemotherapy was set up (DERMISHEAD trial). Patients were randomised to receive PBM or placebo treatments from the first day of RT (2×/week) alongside the institutional skincare. The severity of skin reactions was assessed by the National Cancer Institute-Common Terminology Criteria for Adverse Events version 4.03 (NCI-CTCAE v4.03) and the Radiotherapy-Induced Skin Reaction Assessment Scale (RISRAS). Quality of life (QoL) was evaluated using the Skindex-16 questionnaire. Results PBMT significantly reduced NCI-CTCAE grade 2–3 ARD with 49% at the end of RT. Conclusion The results of the first RCT in HNC patients showed that PBMT is an effective method to prevent the development of severe ARD. These results support the implementation of PBM in the clinical oncology – radiotherapy practice. This research is part of the Limburg Clinical Research Center (LCRC) UHasselt-ZOL-Jessa, financially supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish Government, Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital. Additionally, this research project is funded by Kom op tegen Kanker (Stand up to Cancer), the Flemish Cancer Society, Limburgs Kankerfonds, and ASA Srl.

PRECISION is an initiative from the Belgian Society of Medical Oncology (BSMO) in collaboration with several stakeholders, encompassing four programs that aim to boost genomic and clinical knowledge with the ultimate goal to offer patients with metastatic solid tumors molecularly guided treatments. The PRECISION 1 study has led to the creation of a clinico-genomic database. The Belgian Approach for Local Laboratory Extensive Tumor Testing (BALLETT) and GeNeo studies will increase the number of patients with advanced cancer that have comprehensive genotyping of their cancer. The PRECISION 2 project consists of investigator-initiated phase II studies aiming to provide access to a targeted drug for patients whose tumors harbor actionable mutations in case the matched drug is not available through reimbursement or clinical trials in Belgium. This work was supported by grants from the 1 study and grants from the Belgian Foundation against Cancer and Kom op Tegen Kanker to the PRECISION 1 and 2 studies and the Biltema Foundation (no grant number). GeNeo is funded by a grant from Roche (no grant number). BALLETT is funded by grants from Illumina and OncoDNA (no grant number).

The aim of this Letter to the Editor was to report some methodological shortcomings in the recently published article “Application of red light phototherapy in the treatment of radioactive dermatitis in patients with head and neck cancer” by Zhang et al. There are some issues regarding the incomplete photobiomodulation (PBM) parameters, the chosen outcome measures, and some missing reference articles. In conclusion, the results of this study should be interpreted with caution and further research is necessary. JR and JM received funding from the following organisations: Limburg Clinical Research Program supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital. ASA srl. Limburgs Kankerfonds Kom op Tegen Kanker

Purpose The purpose of this study was to evaluate objectively the effectiveness of photobiomodulation therapy (PBMT) for the prevention of acute radiation dermatitis (ARD) by using biophysical skin measurements. Methods A randomized, placebo-controlled trial with 120 breast cancer patients who underwent an identical radiotherapy (RT) regimen post-lumpectomy was performed (TRANSDERMIS trial). Patients were randomized to receive PBM (808 nm CW/905 nm pulsed, 168 mW/cm2, spot size 19.6 cm2, fluence 4 J/cm2) or placebo treatments from the first day of RT (2×/week). Biophysical skin measurements were collected to assess the skin pigmentation and barrier function. Measurements were collected at the first day of RT, a RT dose of 40 Gray (Gy), and the end of RT (66 Gy). Results The incidence of moist desquamation was significantly higher in the control than in the PBMT group at the end of RT (30 vs. 7%, respectively, odds ratio = 6, p = 0.004). The biophysical skin measures showed that the mean percentage change from the baseline transepidermal water loss (TEWL), erythema, and melanin values was significantly higher in the control than in the PBMT group at the end of RT (ps 800 cc) breast volume (odds ratio = 4, p = 0.017). Conclusions This is the first randomized controlled trial demonstrating by objective measurements that PBMT is effective in reducing the incidence of moist desquamation in breast cancer patients undergoing RT. Additionally, a large breast volume is an important risk factor for the development of moist desquamation. This research is part of the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, financially supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital. Additionally, this research is supported by Kom op Tegen Kanker, Limburgs Kankerfonds, and ASA Srl.