70th anniversary. Comprehensive cancer centre From 1939 to now

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1 70th anniversary Comprehensive cancer centre From 1939 to now

2 Ci-contre : The Institut Jules Bordet in 1950 Editor : Dominique de Valeriola Haldorp 29, 1630 Linkebeek Editorial staff : Louise Vanderweerden / Jean-Benoît Burrion / Martine Hazard / Dominique de Valeriola / Marianne Paesmans Design : The design of this brochure was entrusted to Bérengère Bordet, first cousin twice removed of Jules Bordet Bérengère Bordet Chaussée d Alsemberg 950, 1180 Brussels /

3 [ Editorial ] Institut Jules Bordet is proud to celebrate its 70th anniversary, having spent its entire existence battling cancer. Since its creation in 1939, the Institut Jules Bordet has never relinquished its pioneering role in the fight against this complex and difficult disease. With cancer, the fate of patients and medical staff not only overlap they are intermeshed. Testimony to this is the support that Bordet Institute receives from its patients and their families to continue our task: "Together, let s help life win". On the occasion of this anniversary, we have taken a moment to reflect upon the progress achieved so far. We make no claims to exhaustivity. Indeed, we make no claims at all, except to say that we will continue to turn our eyes to the future, with pride in our past. And we do this in the certain knowledge that the women and men of today and yesterday represent the very essence of Institut Jules Bordet. They include not only our doctors, nurses, researchers, paramedics, psychologists, administrative staff and technicians, so passionate about their work and assiduous in their duties, but also our patients, all confronted with both the advances and the uncertainties of science: without all these women and men, the progress described in this brochure would not have been possible at all. Dominique de Valeriola, General Medical Director. [ About the Jules Bordet Institute ] Situated at the heart of Europe, the Jules Bordet Institute (Institut Jules Bordet) is one of Europe s first ever cancer centres. Belgium s only independent hospital dedicated entirely to cancer, Institut Jules Bordet s multidisciplinary strategy encompasses its three key missions: patient care, research and teaching. Institut Jules Bordet brings together all the medical and paramedical disciplines at a single site, enabling it to provide the full range of cancer prevention, screening, diagnosis, treatment and rehabilitation services. The Institute is essentially a pioneer and innovator, ensuring that it always uses cutting-edge technology and the very latest therapeutic approaches, as well as those in development. With a capacity of 154 hospital beds and 13 outpatient beds, the Institut Jules Bordet handles 6,000 hospital stays and 12,000 outpatient visits annually. It provides more than 70,000 consultations per year, including around 14,000 screenings. The Institute employs a staff of 900, including 150 doctors and 100 researchers. Its major translational, clinical and basic research activities result in an average of 200 top-level scientific articles per year. Institut Jules Bordet works with a number of European and American institutions, including the United States National Cancer Institute (NCI), the European Organisation for Research and Treatment of Cancer (EORTC) and the Organisation of European Cancer Institutes (OECI). Olivier Van Tiggelen, General Director. June Together, let s help life win.

4 [ ] 1923 Radium for Belgium. The Belgian mining company, Union Minière du Haut Katanga (formerly operating in Upper Katanga in what is now the Democratic Republic of Congo), leases 8 grammes of radium bromide to the University Foundation for use by Belgium s four leading universities Creation of a tumour centre at Brugmann Hospital. The Brussels Brugmann Hospital, recently built by famous Belgian architect Victor Horta, opens a brand new 20-bed tumour centre. It includes three departments (surgery, radiotherapy and anatomical pathology) and a research unit (physics, biology and instant clinical research). This new centre is headed by a scientific council comprising three clinicians (Doctors Depage, Vandervelde and Bayet) and four scientists (the physicist Piccard, the bacteriologist Bordet, the biochemist Slosse and the anatomical pathologist Dustin). The centre is placed under the authority of a higher council composed of representatives from the non-denominational university of Brussels - Université Libre de Bruxelles (ULB) - and from Belgium's Public Welfare Commission (CAP). The Institut Jules Bordet still operates under the auspices of the Université Libre de Bruxelles and the Brussels public social welfare centre (CPAS) Decision to build a national cancer centre. This centre includes screening, consultation, treatment and research departments. It is given the name Jules Bordet in recognition of the renowned researcher s involvement in the Tumour Centre s scientific management since 1924, his discoveries in the field of microbiology (1919 Nobel Prize) and his brilliant teaching skills. Institut Jules Bordet was built following what were then revolutionary rules of hospital architecture. The vertical circulation of people via a very wide helical ramp was a new concept in hospital buildings. Former operating theatre. Professor Suzanne Simon, head of the Radiotherapy Department in 1945, was aware of Germany s possible interest in the radium her department was using. So she bought a shopping basket, hid the radium under some fresh vegetables and calmly went home to her house in Auderghem (Brussels), where she buried her valuable booty in the garden Construction of Institut Jules Bordet. The buildings are built in an L-shape, one part of which (H-wing) is reserved for hospital in-patients and the other (T-wing) for treatments. Two reputed architects, Gaston Brunfaut and Stanislas Jasinski, are commissioned for the task. Brunfaut is in placed in charge of the H-wing and Jasinski, of the T-wing. Between the two World Wars, hospital architecture undergoes a revolution as a result of technical advances and the development during the 19th century of new building materials such as concrete, glass and iron. The new hygiene rules require rounded corners and no embellishments. The trend is also towards practicality and spatial rationalisation (abandonment of pavilion-style hospital construction with segregated units for patients suffering from different diseases in favour of the single-unit style). Gaston Brunfaut played a key role in the dissemination of these new architectural principles, drawing inspiration from Heinrich Schmieden s treatise on modern hospital architecture, Krankenhausbau in neuer Zeit (1930) Discovery of penicillin Brussels World Fair The Belgian Corneille Heymans wins the Nobel Prize in Medicine Discovery of blood Rhesus factors

5 [ ] 1939 Inauguration of Institut Jules Bordet. World War II prevents it from being put into immediate operation: the hospital is used first by the German Wehrmacht and, after Liberation, by the British Army. The Institut Jules Bordet is finally opened to the public in Creation of a clinical research laboratory in the Department of Internal Medicine. The first clinical trials begin with new chemotherapeutics The Institut Jules Bordet s modern history begins with the arrival of Professor Albert Claude (1974 Nobel Prize). Professor Claude is appointed scientific director of the Institut Jules Bordet when he returns from the Rockefeller Institute in New York (USA) Professor Henri Tagnon joins Albert Claude. On his return from the Memorial Hospital of New York (USA), Henri Tagnon reforms oncology practice in Belgium. He lays the foundations for high-level clinical research and endows Institut Jules Bordet with an outstanding national and international reputation. Henri Tagnon imports three new concepts from the United States. > The single patient record > Full-time medical activity > Multidisciplinary diagnostic and therapeutic approaches Creation of the Department of Internal Medicine. New chemotherapy and immunotherapy treatments are used alongside surgical treatments and radiotherapy. The Institut Jules Bordet opens its Department of Internal Medicine. Introduction of new diagnostic tools. Anatomical pathology emerges from the autopsy room and enters the operating theatre, taking on a new diagnostic role. The Institut Jules Bordet acquires Belgium s first ever electronic microscope. Several innovative radiology techniques are introduced over the years: conventional tomography and complex tomography (MIMER cerebral angiography, angiography, thermography, xerography and ultrasonography...). A nuclear medicine laboratory is created in It would become the Department of Nuclear Medicine in 1986, under the impetus of Professor Janos Frühling. From the very outset, therapeutic doses of iodine-131 and of phosphorus-32 are administered there. Photo 1 above: In 1950, Albert Claude commissioned Paul Delvaux to paint a portrait of Jules Bordet. The artist decided to paint the scientist in his laboratory at night. Jules Bordet was 85 years old at the time. Photo 2 above: Doctor P. Dor (standing), with Professors A. Claude, H. Tagnon and J. Henry. Above left: Professor Albert Claude. Above right: A hospital room in P. Denoix devises the TNM Classification of Malignant Tumours. Hiroshima Belgian women get the vote Creation of the World Health Organization (WHO) Watson and Crick discover the structure of DNA Administration of the first polio vaccine Development of the first artificial heart valve The Soviet Union launches Sputnik I

6 [ ] 1959 Acquisition of Belgium s first betatron. A bunker is built for the safe deployment of this particle accelerator Oncologist Jean-Claude Heuson, in close collaboration with surgeon Wolrad Mattheiem, introduces integrated breast cancer care. A breast clinic is created at Institut Jules Bordet before the term was even invented First Belgian initiative for early cancer screening with the opening of the Screening Clinic Institut Jules Bordet becomes one of the founders of the European Organisation for Research and Treatment of Cancer (EORTC). Henri Tagnon chairs the EORTC in Keen on rigour in the evaluation of clinical trials, he organises EORTC cooperative groups around a data centre to coordinate vast international studies and creates a Institut Jules Bordet liaison office with the United States National Cancer Institute (NCI). He also sets up a programme for the identification of new anti-cancer drugs to test substances on a variety of animal tumours. Even in those early days, the liaison office would foster exchanges of researchers between the United States and Europe. Creation of the Belgian Association for Cancer Research (BACR). Professors Henri Tagnon and Yvon Kenis are among the founders of the BACR, initially called ABEC (Association Belge d'etude contre le Cancer) The wife of Professor Henri Tagnon and Mrs Jacqueline Van Halteren found the non-profit association Les Amis de l Institut Bordet. The association aims to support research and enhance patient welfare. It provides Institut Jules Bordet with funding of around EUR 2 million per year. Above left: The Screening Clinic reception in Above right: The Secretary-General (Ariane Cambier) and President (Baron Janssen) and of Les Amis de l Institut Bordet (Friends of Bordet Institut) at the restaurant charity event Les 101 Tables pour la Vie (101 tables for Life) in Creation of one of Belgium s first cytapheresis facilities. The unit is created by Professor Pierre Stryckmans. It uses a blood-cell separation technique which enables Institut Jules Bordet to supply several Belgian hospitals with white corpuscles and platelets. Harvesting blood stem cells for autologous or allogenic transplants for treating leukaemia soon becomes one of the unit's main activities. Creation of the Microbiology Laboratory and Clinic for Infectious Diseases. These are essential for the proper care of patients who are immunosuppressed by cancer and its treatment. Empirical antibiotic treatment of patients with febrile neutropenia. This new concept involves administering broad-spectrum antibiotic therapy immediately when an immunosuppressed patient develops a fever. Introduced to Institut Jules Bordet by Professor Jean Klastersky, this world-pioneering concept would drastically reduce the morbidity and mortality caused by cancer treatments. Early model of a sterile unit. The unit allows badly immunocompromised patients to be isolated and treated. The first sterile room equipped with laminar airflow would appear in A model 12-bed sterile unit containing six beds with laminar airflow units would be built in Brussels World s Fair Development of synthetic penicillin Congo gains independence Synthesis of DNA Humans first set foot on the Moon (Apollo XI). The contraceptive pill is put on sale Identification of the oestrogen receptor Synthesis of a complete gene First heart transplant

7 [ ] 1972 Creation of Belgium s first oncology outpatient unit. This avoids the need for patients to be admitted to hospital for chemotherapy treatment Foundation of the non-profit association Notre Boutique. This non-profit association promotes patient welfare. It still sustains patients and visitors with its cafeteria and snack bar First autologous bone marrow transplants. Re-infusion of the patient s own haematopoietic stem cells. Development of a method for measuring the oestrogen receptor (ER) in breast cancers. This sensitive and inexpensive charcoal/dextran technique can predict a patient s response to hormonotherapy. It underlines the benefit of combining cytotoxic chemotherapy with hormonotherapy Ohio Nuclear Deltascan. First x-ray scanner in continental Europe to scan the entire body using computed tomography. Prior to that, scanners explored only the skull. Creation of the Experimental Surgical Oncology Laboratory. It mainly studies malignant melanomas. Photo 1 above: The cytapheresis machine harvests blood stem cells for autologous or allogenic transplants. Photo 2 above: A laminar airflow system allows patients to remain isolated in a sterile unit. Below: Her Majesty Queen Fabiola of Belgium attends the inauguration of the linear accelerator in The Radiotherapy Department acquires a linear accelerator. It already had cobalt and betatron accelerators Construction of Hôpital Erasme Bruxelles Discovery of the drug Taxol. Nobel Prize in Medicine for Albert Claude, Christian de Duve and George Emile Palade for their discovery of the cell ultrastructure The United States approves tamoxifen for the treatment of breast cancer Magnetic resonance imaging (MRI) is developed

8 [ ] 1978 Creation of Belgium s very first ethics committee. The Ethics Committee s functions are to advise on protocols for human testing; to provide advice and guidance on the ethical aspects of hospital-based care; and to aid decision-making on ethical aspects of individual cases. Institut Jules Bordet has always taken an active part in the euthanasia debate, owing to its doctors reputations for ethical rigour and commitment. Creation of a cooperative group at Institut Jules Bordet, which is the forerunner of the European Lung Cancer Working Party (ELCWP). The ELCWP will be founded by Professor Jean Klastersky in In Europe, lung cancer is one of the commonest and most deadly cancers. The aim of this group of oncologists and pneumologists drawn from several Belgian hospitals is to develop lung cancer research and provide doctors and nurses with inservice training. The Belgian group grows rapidly and is joined by centres from several other countries First allogenic transplants at Institut Jules Bordet. These transplants between siblings or other compatible donors give many leukaemia patients new hope for a cure. Institut Jules Bordet helps to develop new antiemetic treatments. In the 1980s, the development of antiemetics enhances patient tolerance of chemotherapeutics. Creation of the ASTI intensive care unit for the administration and monitoring of intensive cancer treatments. It is unique in Belgium: prior to this, it was considered pointless to admit patients with inoperable tumours into an intensive care unit, owing to their dismal prognosis. 1980s First oncology nurse training modules organised by Institut Jules Bordet nursing department. In 1989, an oncology nurse training course is created (a partnership between the Institut Jules Bordet, the French Belgian association of oncology nurses [Société des Infirmières en Oncologie SIO] and the ULB School of Nursing). This training still exists for graduate nurses wishing to specialise in oncology. The courses are given by doctors and nurses from the Institut Jules Bordet. Acquisition of the first therapeutic laser in Belgium. Laser is used primarily for early-stage cervical cancers but is sometimes used to excise other types of voluminous tumours. Creation of the Organisation of European Cancer Institutes (OECI). Institut Jules Bordet is a founder member of OECI Development of celioscopy. Already used for minor non-cancerous surgery, in the 1980s celioscopy was extended to the surgical treatment of certain gynaecological tumours and to reduce post-operative discomfort in patients. The healthcare team in action at the ASTI intensive care unit The first test-tube baby is conceived by artificial insemination (Louise Brown) Discovery of the Prostate Specific Antigen (PSA) Identification of oncogenes in human tumour cells Immunohistochemistry

9 to draw blood samples from patients with a deficient venous system. This new technique facilitates administration and improves tolerance to treatments. Implantable venous access systems make it easier to deliver treatments. [ ] 1981 Professor Yvon Kenis creates an association for the right to die in dignity (Association pour le Droit de Mourir dans la Dignité - ADMD). This project is extremely important because it lays the foundations for Belgium s 2002 euthanasia legislation. Doctors from Institut Jules Bordet continue to be involved in this important ethical and philosophical debate. Creation of the European Society of Surgical Oncology (ESSO). Professor Worald Mattheiem is one of the founders. Institut Jules Bordet would house the ESSO Secretariat for 20 years Creation of the Ariane Fund. This helps finance research into acute leukaemia. Ariane, a 23-year-old leukaemia victim, wanted the fight against her disease to continue after she died. When 23-year-old Ariane died, she left behind a foundation named after her Implantable venous access systems. Institut Jules Bordet is one of the first hospitals in Belgium to use the Port-a-Cath, a new implantable venous access system inserted under the skin, which is used to administer injectable drugs, blood products and nutritional solutions and Creation of the French-Belgian Association of Oncology Nurses (SIO). This pioneering association in Belgium is an initiative of Institut Jules Bordet nurses. It immediately joins the European Oncology Nursing Society (EONS), whose famous founding member, Rosette Poletti, inspired the Belgian initiative Creation of the first psycho-oncology unit in Belgium. This multidisciplinary unit brings together psychiatrists and psychologists to provide patients and their families with psychological support, as well as to conduct intensive research into the psychological problems arising from cancer diagnosis and treatments. Institut Jules Bordet creates Europe s very first breast clinic. Legislation on breast clinics would come much later, in Creation of the Jean-Claude Heuson Fund. Following Professor Heuson s death, a special fund is set up to help finance breast cancer research at Institut Jules Bordet. Institut Jules Bordet holds the first congress on supportive care. The congress is held in St Gallen, Switzerland, by the International Consensus on Supportive Care in Oncology (ICSCO), which, in 1990, would become the Multinational Association of Supportive Care in Cancer (MASCC). The MASCC was created at Institut Jules Bordet, which would chair it from 1990 to The MASCC is the first international organisation to focus on supportive care for cancer patients, which currently includes experts from more than 60 countries and publishes an international scientific journal, Supportive Care in Cancer. One of MASCC s main fields is the control of one of the commonest severe complications in patients undergoing chemotherapy or radiotherapy: febrile neutropenia (fever in patients with too few white corpuscles) Identification of the AIDS virus Identification of the human papilloma virus (HPV) as an agent of cervical cancer. It would take more than 20 years to develop an effective vaccine Chernobyl nuclear accident

10 The Institut Jules Bordet in 2009.

11 [ ] 1987 Creation of a urology clinic. This is a novel feature of Institut Jules Bordet, as a urology clinic does not normally form part of a cancer centre. The clinic develops laser techniques for the excision of bladder polyps, as well as for transrectal ultrasound. In the late 1990s, laparoscopic surgery would take over from conventional surgery for resecting prostate tumours. As laparoscopy mastery improved, the technique would subsequently be adopted for other cases requiring minimally invasive surgery, such as cystectomies or complete nephrectomies (excision of bladder or kidney) Institut Jules Bordet is the first Belgian hospital to perform intraoperative radiotherapy. During the surgical procedure, breast tumours are treated with brachytherapy and abdominopelvic tumours are treated using a linear accelerator A pain clinic is opened at Institut Jules Bordet. It is the first of its kind in Belgium. It combines the expertise of anaesthetists, internists, neurologists and nurses. Creation of a rehabilitation unit. Comprehensive, multidisciplinary care for distressed patients improves their quality of life and facilitates their return to work and resuming a social life following treatment. Institut Jules Bordet becomes Belgium s national leader in radiation protection. The expertise developed by Professor Janos Fühling gives the Department of Nuclear Medicine this new role Emergence of the translational research concept. Translational (or bench-to-bedside ) research aims to integrate the results of basic laboratory research into clinical research at the very earliest stage, for the benefit of patients. The translational research concept, which is highly developed at Institut Jules Bordet, would lead to numerous therapeutic advances. The DEXA bone densitometry system. Creation of the Biostatistics, Epidemiology and Prevention Unit (UBEP). UBEP will change its name to Data Centre in It takes part in the epidemiologic research for determining cancer risk factors and for organising prevention. It takes also part in translational and clinical research for better understanding what cancer is and for optimising efficacy of care. Successful administration of tumour necrosis factor alpha (TNF-alpha) in combination with an alkylating agent. Certain tumours, such as malignant melanoma, are often localised on the arms or legs. Patients with melanoma of an extremity can be treated during surgery using hypothermic isolated limb perfusion, enabling a high drug dose to be administered that the entire body would be unable to withstand. This technique is possible only with the close collaboration between surgeons and medical oncologists. A nicotine detoxification programme is created for company employees. In 2000, it would become the Nicotine Detoxification Centre (Centre de Désintoxication Tabagique), with funding from Les Amis de l Institut Bordet Acquisition of the dual-energy X-ray absorbtionmetry (DEXA) system. The DEXA HOLOGIC QDR 1000 is used for whole-body bone densitometry. This imaging technique is important for osteoporosis screening in cancer treatments. It is also used to automatically measure vertebral collapse. Medical records begin to be computerised. In 2001, this would become a multimedia computerised medical record (DMI) using the ORIbase oncology database programme. Developed at Institut Jules Bordet, ORIbase won a prize at the COMMON Europe and IBM System i Innovation Awards in London in Discovery of the Human Epidermal growth factor Receptor 2 (HER2/Neu), which is over-expressed in certain breast cancers Fall of the Berlin Wall Creation of the Belgian bone marrow transplant registry San Luis Obispo, in California USA, is the first city in the world to ban smoking in public places Belgium legalises abortion Breakup of the Soviet Union

12 [ ] 1994 Creation and installation at Institut Jules Bordet of Belgium s first umbilical cord blood bank (Belgian Cord Blood Bank) with financial assistance from the 'Télévie' charity appeal. Creation of the Breast International Group (BIG). Set up at the initiative of Professor Martine Piccart and other European experts, BIG is an international non-profit association that conducts large-scale clinical trials in the field of breast cancer. Headquartered at Institut Jules Bordet, BIG has a membership of nearly 50 academic collaborative research groups from around the world linked to more than 3,000 hospitals. TransBIG, founded and coordinated by BIG, is a network of 40 institutions from 21 countries, which is partly financed by the European Commission under the Framework VI Programme. TransBIG s aim is to promote translational research, and it is responsible for developing, with the EORTC, the first clinical trial to determine a therapeutic strategy for early-stage breast cancer based on a tumour s genomic signature ; the study is called MINDACT (Microarray In Node negative and 1 to 3 positive lymph node Disease may Avoid ChemoTherapy) (www.breastinternationalgroup.org). Institut Jules Bordet s Breast European Adjuvant Study Team (BrEAST), which was set up in 1997, operates as a major data centre for BIG. In collaboration with the pharmaceutical industry, it conducts mainly large phase-iii registration trials in early breast cancer which are crucial for the improvement of patient care. The BioArchive System makes it possible to store and manage samples of frozen umbilical cord blood Acquisition of the Laser Imaging Fluorescence Endoscope (LIFE) System. The LIFE system is the leading European lung cancer screening system, based on the principle of autofluorescence, whereby abnormal tissues have the natural ability to fluoresce when exposed to a specific wavelength of light. The LIFE system uses a blue laser light transmitted through a flexible fibre-optic bronchoscope to induce autofluroescence. It allows for the early diagnosis of certain bronchial tumours that are impossible to detect using conventional bronchoscopy. Institut Jules Bordet joins the Regional Inter- Hospital Network of Care Infrastructure (IRIS), which includes five public hospitals in the Brussels-Capital Region. Institut Jules Bordet operates as an independent association with legal and budgetary autonomy, in accordance with Heading 12 of the law on Brussels public social welfare centres (CPAS). réseau iris The United States Environmental Protection Agency identifies secondhand smoke inhalation as carcinogenic Death of Belgium s King Baudouin

13 [ ] 1997 Institut Jules Bordet s anatomical pathology laboratory is the first in Belgium to use fluorescence in situ hybridisation (FISH) analysis to seek HER2 antigen expression in breast cancer. Creation of the five-bed Acute Supportive Care Unit (UASS). This unit provides patients with supportive and palliative care. Above : The children s zone logo Bordet n Kids financed by Les Amis de l Institut Bordet. Below : Kids zone: patients children also receive care. Introduction of the sentinel lymph node biopsy technique. Institut Jules Bordet is the first in Belgium and one of the first in Europe to use this technique to spare numerous patients from unnecessary lymph node dissections, especially in the case of breast cancer Creation of a children s zone called Espace Enfants. Through play activities, patients children are given the chance to be heard and supported. This project is conducted in collaboration with the non-profit associations Cancer et Psychologie and Les Amis de l Institut Bordet Institut Jules Bordet performs Belgium s first ever haplo-identical bone marrow transplant (transplant from a semi-mismatched family donor) in a leukaemia patient. Another Belgian first at Institut Jules Bordet: a radical prostatectomy is performed entirely by laparoscopy. Another new, less radical, surgical technique used in urology is cryotherapy (a minimally invasive treatment that applies extreme cold to freeze and destroy diseased tissue, including cancer cells). Cryotherapy is introduced in the 1990s for treating kidney cancer: first argon and then helium are injected into needles inserted into the lesion. The alternating heat and cold destroys the tumour, leaving only a scar Introduction into the guidelines of the Infectious Diseases Society of America (IDSA) of the MASCC (Multinational Association of Supportive Care in Cancer) risk index score. The MASCC score predicts the risk of complications in patients with febrile neutropenia. This concept, initiated by Institut Jules Bordet, has simplified patient care. Where the score predicts a low risk, the patient can return home with a course of oral antibiotics Introduction of the EURO

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