Clinical oncologyPub Date : 2025-02-11DOI: 10.1016/j.clon.2025.103788
K. Narang, T. Kataria, S.S. Bisht, D. Gupta, S. Banerjee, M. Mayank, S. Shishak, V. Kaliyaperumal, S. Tamilselvan, D. Kamaraj, S. Abraham
{"title":"Contemporary Long-term Survival Outcomes and Prognostic Factors in Adult grade 4 Astrocytoma: An Institutional Analysis","authors":"K. Narang, T. Kataria, S.S. Bisht, D. Gupta, S. Banerjee, M. Mayank, S. Shishak, V. Kaliyaperumal, S. Tamilselvan, D. Kamaraj, S. Abraham","doi":"10.1016/j.clon.2025.103788","DOIUrl":"10.1016/j.clon.2025.103788","url":null,"abstract":"<div><h3>Aims</h3><div>Astrocytoma grade 4 without isocitrate dehydrogenase (IDH)-based characterisation has been called glioblastoma (GBM) in historical cohorts. There have been significant advancements in diagnostic radiology and pathology, and in the technical aspects of surgery, radiation therapy, and temozolomide (TMZ) used for treatment of this disease. We analysed the outcomes of 267 adult astrocytoma grade 4/GBM patients, consecutively treated between December 2010 and November 2018 using modern techniques at our institute.</div></div><div><h3>Materials and methods</h3><div>All patients underwent surgical resection, histopathology review, and O6-methylguanine-DNA methyltransferase (MGMT) methylation testing, volumetric modulated arc therapy (VMAT)-based radiation therapy using institute-specific target-delineation guidelines and image guidance, and TMZ according to Stupp protocol. Serial multiparametric magnetic resonance imaging–based follow-up ensured early detection of disease progression. Appropriate salvage therapy was determined based on clinicopathological attributes. Kaplan-Meier survival plots, log-rank test, and Cox regression analysis were performed on the prospectively recorded dataset to estimate survival and the factors affecting it.</div></div><div><h3>Results</h3><div>At a median follow-up of 72 months, the median progression-free survival (PFS), 1-year PFS, and 2-year PFS were 10 months, 37.8%, and 17.5%, respectively. MGMT-methylation, a radiation dose ≥54 Gy, and ≥4 adjuvant TMZ cycles were associated with favourable PFS. Median overall survival (OS), 2-year OS and 5-year OS were 24 months, 48%, and 18%, respectively. MGMT-methylation and 1-year disease control were associated with favourable OS. Salvage treatment could be offered to 69.2% patients, with use of all the three treatment modalities in 12.4%. Salvage reirradiation could be used in 30.8% patients. Haematological toxicity ≥grade 2 was evident in 6% patients during concurrent radiation-TMZ phase and in 9% patients in adjuvant TMZ phase. Postradiation neurocognitive deficits were noted in 20.1% patients, with onset at a median duration of 10 months.</div></div><div><h3>Conclusion</h3><div>Modern diagnostic and therapeutic techniques affected a near-doubling of survival and acceptable late toxicity, as compared to historical data.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"40 ","pages":"Article 103788"},"PeriodicalIF":3.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clinical oncologyPub Date : 2025-02-11DOI: 10.1016/j.clon.2025.103789
H. Hourfar , P. Taklifi , M. Razavi , B. Khorsand
{"title":"Machine Learning–Driven Identification of Molecular Subgroups in Medulloblastoma via Gene Expression Profiling","authors":"H. Hourfar , P. Taklifi , M. Razavi , B. Khorsand","doi":"10.1016/j.clon.2025.103789","DOIUrl":"10.1016/j.clon.2025.103789","url":null,"abstract":"<div><h3>Aims</h3><div>Medulloblastoma (MB) is the most prevalent malignant brain tumour in children, characterised by substantial molecular heterogeneity across its subgroups. Accurate classification is pivotal for personalised treatment strategies and prognostic assessments. In this study, we aimed to build machine learning models to classify MB subgroups.</div></div><div><h3>Materials and Methods</h3><div>This study utilised machine learning (ML) techniques to analyse RNA sequencing data from 70 paediatric MB samples. Five classifiers—K-nearest neighbors (KNN), decision tree (DT), support vector machine (SVM), random forest (RF), and naive Bayes (NB)—were used to predict molecular subgroups based on gene expression profiles. Feature selection identified gene subsets of varying sizes (750, 75, and 25 genes) to optimise classification accuracy.</div></div><div><h3>Results</h3><div>Initial analyses with the complete gene set lacked discriminative power. However, reduced feature sets significantly enhanced clustering and classification performance, particularly for group 3 and group 4 subgroups. The RF, KNN, and SVM classifiers consistently outperformed the DT and NB classifiers, achieving classification accuracies exceeding 90% in many scenarios, especially in group 3 and group 4 subgroups.</div></div><div><h3>Conclusion</h3><div>This study highlights the efficacy of ML algorithms in classifying MB subgroups using gene expression data. The integration of feature selection techniques substantially improves model performance, paving the way for enhanced personalised approaches in MB management.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"40 ","pages":"Article 103789"},"PeriodicalIF":3.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143508866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clinical oncologyPub Date : 2025-02-08DOI: 10.1016/j.clon.2025.103787
A. Viswanathan, P.S. Ganesh, R.K. Gopal
{"title":"Letter to the Editor Regarding the Article “PTV Margins in MR-guided and Beam-gated SBRT of Liver Metastases: GTV Dose Escalation Can Reduce the Required PTV”","authors":"A. Viswanathan, P.S. Ganesh, R.K. Gopal","doi":"10.1016/j.clon.2025.103787","DOIUrl":"10.1016/j.clon.2025.103787","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"40 ","pages":"Article 103787"},"PeriodicalIF":3.2,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clinical oncologyPub Date : 2025-02-07DOI: 10.1016/j.clon.2025.103786
J.J. Jobsen , H. Struikmans , E. Siemerink , J. van der Palen
{"title":"Clinical Relevance of Immunohistochemical Subtypes in Early-Stage, Lymph Node-negative Breast Cancer. Results of a Large Cohort Study","authors":"J.J. Jobsen , H. Struikmans , E. Siemerink , J. van der Palen","doi":"10.1016/j.clon.2025.103786","DOIUrl":"10.1016/j.clon.2025.103786","url":null,"abstract":"<div><h3>Aims</h3><div>This study aimed to provide the association of immunohistochemical (IHC) subtypes of early-stage, lymph node–negative breast cancer with clinical outcomes. The relevance of adjuvant systemic therapy (AST) with respect to triple-negative cancers was given special attention.</div></div><div><h3>Materials and methods</h3><div>We used the data of 1,959 breast-conserving therapies (BCTs) in 1,861 women diagnosed with early-stage unilateral, lymph node–negative breast cancer treated between 2004 and 2015.</div></div><div><h3>Results</h3><div>Overall, IHC subtypes were not associated with disease-specific survival (DSS) or overall survival (OS) in multivariate analyses. Looking at the influence of AST, administered according to current guidelines, we noted that triple-negativity compared to luminal A demonstrated a better DSS (hazard ratio [HR]: 0.4, 95% confidence interval [CI]: 0.1-1.1). For those without AST, outcomes for all subtypes did not differ. Difference in outcome of triple-negative tumours for without and with AST was mainly due the presence of patients bearing histological grade 3 cancers in those without AST.</div></div><div><h3>Conclusion</h3><div>In early-stage, lymph node–negative breast cancer treated with BCT and AST, according to existing guidelines, triple-negativity demonstrated a better outcome in DSS. However, for those without AST, no differences were seen in outcome between the various subtypes.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"40 ","pages":"Article 103786"},"PeriodicalIF":3.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clinical oncologyPub Date : 2025-02-06DOI: 10.1016/j.clon.2025.103783
J. Shen, X. Ye, H. Hou, Y. Wang
{"title":"Efficacy and Safety of Immunochemotherapy in Advanced Triple-negative Breast Cancer: A Meta-analysis of Randomised Clinical Trials","authors":"J. Shen, X. Ye, H. Hou, Y. Wang","doi":"10.1016/j.clon.2025.103783","DOIUrl":"10.1016/j.clon.2025.103783","url":null,"abstract":"<div><h3>Aims</h3><div>Based on the existing controversial clinical research results, this study conducted a comprehensive meta-analysis of relevant literature to clarify the benefits of immunochemotherapy (ICT)—which combines immune checkpoint inhibitors and chemotherapy (CT)—for patients with advanced triple-negative breast cancer (aTNBC).</div></div><div><h3>Materilas and methods</h3><div>A thorough literature search was conducted up to February 15, 2024. Subsequently, meta-analyses were performed to aggregate hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS), odds ratios (ORs) for objective response rate (ORR) and relative risks (RRs) for adverse events (AEs).</div></div><div><h3>Results</h3><div>Six randomised clinical trials (RCTs) involving 3,105 patients met the inclusion criteria. In comparison with CT, ICT yielded significant enhancements in PFS (HR, 0.80; 95%CI: 0.73–0.87), OS (HR, 0.87; 95%CI: 0.80–0.96), and ORR (OR, 1.34; 95%CI: 1.15–1.55) in the intention-to-treat population. However, ICT also exhibited an increase in grade ≥3 AEs (RR, 1.11; 95%CI: 1.04–1.19) and severe AEs (RR, 1.40; 95%CI: 1.18–1.66). Subgroup analyses revealed that ICT significantly improved PFS (HR, 0.67; 95%CI: 0.58–0.77), OS (HR, 0.75; 95%CI: 0.64–0.87), and ORR (OR, 1.47; 95%CI: 1.16–1.84) within the PD-L1-positive subgroup, whereas no statistically significant differences were detected for PD-L1-negative population.</div></div><div><h3>Conclusion</h3><div>ICT demonstrates superior efficacy over conventional CT in the treatment of aTNBC, albeit accompanied by heightened toxicity. Notably, the assessment of PD-L1 status may serve as a valuable biomarker in discerning aTNBC patients who are particularly predisposed to derive benefit from ICT.</div></div><div><h3>PROSPERO number</h3><div>CRD42024513270.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"40 ","pages":"Article 103783"},"PeriodicalIF":3.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143421089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clinical oncologyPub Date : 2025-02-01DOI: 10.1016/j.clon.2024.103733
M. Boutros , G. Sands , T. Sullivan , R. Ackwerh , N. Bal , E. Gill , M.-E. Bardwell , N. Smeulders , A. Cho , P.S. Lim , G. Eminowicz , P.J. Hoskin , M.N. Gaze
{"title":"Technical Aspects of a National Service for Paediatric Pelvic Brachytherapy","authors":"M. Boutros , G. Sands , T. Sullivan , R. Ackwerh , N. Bal , E. Gill , M.-E. Bardwell , N. Smeulders , A. Cho , P.S. Lim , G. Eminowicz , P.J. Hoskin , M.N. Gaze","doi":"10.1016/j.clon.2024.103733","DOIUrl":"10.1016/j.clon.2024.103733","url":null,"abstract":"<div><h3>Aims</h3><div>Brachytherapy is advantageous for localised rhabdomyosarcomas in children compared with external beam radiotherapy, sparing close organs at risk with highly conformal dosimetry. A methodology for planning and delivering fractionated high-dose-rate paediatric pelvic brachytherapy is detailed, and the dosimetric parameters are presented. This provides a practical template for radiotherapy departments with a similar patient cohort to implement this treatment technique.</div></div><div><h3>Materials and Methods</h3><div>Patients with localised pelvic rhabdomyosarcomas underwent transrectal ultrasound image-guided transperineal percutaneous implantation of brachytherapy catheters or insertion of intracavitary applicators. Clinical target volumes were delineated on computed tomography imaging, extended cranially to form an internal target volume (ITV) to allow for perineal oedema, and peer reviewed. Dosimetry was manually adjusted to achieve optimal coverage. The prescription dose was 27.5 Gy in five fractions. The dose to 90% (D90%) of the ITV, and the conformity number (CN) were calculated. Replanning was undertaken if measurements or imaging showed suboptimal dosimetry due to internal anatomical changes.</div></div><div><h3>Results</h3><div>Thirty-five patients, aged 8 months to 17 years 6 months (median 2 years 10 months), were treated between 2009 and 2023. The median ITV was 18.5 cc. The median ITV D90% was 5.9 Gy per fraction. The majority of plans had a CN greater than 0.5. Replanning was required in two-thirds of patients.</div></div><div><h3>Conclusion</h3><div>Intraoperative transperineal interstitial implantation of flexible catheters, cervical intrauterine tubes, or vaginal applicators resulted in highly conformal plans, achieving excellent coverage with a D90% exceeding 90% of the prescribed dose in 34 out of 35 cases. Technical and practical measures are crucial for an optimal treatment for each child.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"38 ","pages":"Article 103733"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}