Clinical oncology最新文献

{"title":"Under-representation for Female Pelvis Cancers in Commercial Auto-segmentation Solutions and Open-source Imaging Datasets.","authors":"M Thor, V Williams, C Hajj, L Cervino, H Veeraraghavan, S Elguindi, N Tyagi, A Shukla-Dave, J M Moran","doi":"10.1016/j.clon.2024.10.003","DOIUrl":"https://doi.org/10.1016/j.clon.2024.10.003","url":null,"abstract":"<p><strong>Aim: </strong>Artificial intelligence (AI) based auto-segmentation aids radiation therapy (RT) workflows and is being adopted in clinical environments facilitated by the increased availability of commercial solutions for organs at risk (OARs). In addition, open-source imaging datasets support training for new auto-segmentation algorithms. Here, we studied if the female and male anatomies are equally represented among these solutions.</p><p><strong>Materials and methods: </strong>Inquiries were sent to eight vendors regarding their clinically available OAR auto-segmentation solutions for each gender. The Cancer Imaging Archive (TCIA) was also screened for publicly available imaging datasets specific to the female and the male anatomy.</p><p><strong>Results: </strong>All vendors provided AI based auto-segmentation solutions for the male pelvis and female breasts, while 5/8 vendors provided solutions for the female pelvis. The female breast and the female pelvis solutions were released at a median of 0.6 years and 2.3 years, respectively, after the release of the male pelvis solutions. Among 27 TCIA datasets identified, 15 involved the female anatomy (breast: 10; pelvis: 5) and 12 involved the male pelvis but no female-specific dataset included OAR segmentations, while three male pelvis datasets included OARs (ejaculatory duct, neurovascular bundle, penile bulb and verumontanum).</p><p><strong>Conclusion: </strong>Commercial AI auto-segmentation solutions and open-source imaging datasets include considerably more solutions and OAR segmentations for male cancer over female cancer sites. This gender disparity is likely to propagate throughout the RT pipeline.</p>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":" ","pages":"103651"},"PeriodicalIF":3.2,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001273","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}

{"title":"Sex-Based Bias in Artificial Intelligence-Based Segmentation Models in Clinical Oncology","authors":"F.X. Doo ,&nbsp;W.G. Naranjo ,&nbsp;T. Kapouranis ,&nbsp;M. Thor ,&nbsp;M. Chao ,&nbsp;X. Yang ,&nbsp;D.C. Marshall","doi":"10.1016/j.clon.2025.103758","DOIUrl":"10.1016/j.clon.2025.103758","url":null,"abstract":"<div><div>Artificial intelligence (AI) advancements have accelerated applications of imaging in clinical oncology, especially in revolutionizing the safe and accurate delivery of state-of-the-art imaging-guided radiotherapy techniques. However, concerns are growing over the potential for sex-related bias and the omission of female-specific data in multi-organ segmentation algorithm development pipelines. Opportunities exist for addressing sex-specific data as a source of bias, and improving sex inclusion to adequately inform the development of AI-based technologies to ensure their fairness, generalizability and equitable distribution. The goal of this review is to discuss the importance of biological sex for AI-based multi-organ image segmentation in routine clinical and radiation oncology; sources of sex-based bias in data generation, model building and implementation and recommendations to ensure AI equity in this rapidly evolving domain.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"39 ","pages":"Article 103758"},"PeriodicalIF":3.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058190","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}

{"title":"Correspondence to the Editor: Reirradiation in Paediatric Tumors of the Central Nervous System: Outcome and Side Effects After Implementing National Guidelines","authors":"K.P. Ameya,&nbsp;D. Sekar","doi":"10.1016/j.clon.2025.103759","DOIUrl":"10.1016/j.clon.2025.103759","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"39 ","pages":"Article 103759"},"PeriodicalIF":3.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032329","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}

{"title":"Comparing the Robustness of Intensity-modulated Proton Therapy and Proton-arc Therapy Against Interplay Effects of 4D Robust-optimised Plans for Lung Stereotactic Body Radiotherapy","authors":"W.G. Wei ,&nbsp;H. Yu ,&nbsp;Q. Xiao ,&nbsp;Z.B. Li ,&nbsp;J. Li ,&nbsp;X.Y. Zhang ,&nbsp;Y.C. Wu ,&nbsp;T.L. Qin ,&nbsp;X.H. Zeng ,&nbsp;Y. Song ,&nbsp;G.J. Li ,&nbsp;S. Bai","doi":"10.1016/j.clon.2025.103757","DOIUrl":"10.1016/j.clon.2025.103757","url":null,"abstract":"<div><h3>Aims</h3><div>To assess the robustness of 4D-optimised IMPT and PAT plans against interplay effects in non-small cell lung cancer (NSCLC) patients with respiratory motion over 10 mm, and to provide insights into the use of proton-based stereotactic body radiotherapy (SBRT) for lung cancer with significant tumour movement.</div></div><div><h3>Materials and methods</h3><div>Fourteen patients with early-stage NSCLC and tumour motion &gt;10 mm were selected. Three hypofraction regimens were generated using 4D robust optimisation with the IMPT and PAT techniques. The nominal plan qualities for both techniques were compared, and their robustness against setup and range uncertainties was evaluated. 4D dynamic dose and the 4D static dose were generated to calculate <span><math><mrow><mo>Δ</mo><msubsup><mi>I</mi><mi>M</mi><mi>R</mi></msubsup><mrow><mo>(</mo><mo>%</mo><mo>)</mo></mrow></mrow></math></span> for interplay effects.</div></div><div><h3>Results</h3><div>PAT plans demonstrated superior target metrics such as D₉₅ and D₂, and offered enhanced protection for organs at risk (OARs), particularly in lung metrics, across multiple fractionation schemes (<em>p</em> &lt; 0.05). The robustness of target coverage against setup and range uncertainties was better in PAT plans than IMPT, with average pass rates of 97.8% and 95.4%, respectively (<em>p</em> &lt; 0.01). The interplay effect significantly affected target metrics in single-fraction plans, decreasing with more fractions, while its effect on OAR metrics was minimal. Median values for single-fraction plans were: <span><math><mrow><mo>Δ</mo><msubsup><mi>I</mi><mrow><mi>D</mi><mn>98</mn></mrow><mrow><mi>G</mi><mi>T</mi><mi>V</mi></mrow></msubsup></mrow></math></span> was -3% for IMPT and -0.7% for PAT (<em>p</em> &lt; 0.01); <span><math><mrow><mo>Δ</mo><msubsup><mi>I</mi><mrow><mi>D</mi><mn>95</mn></mrow><mrow><mi>G</mi><mi>T</mi><mi>V</mi></mrow></msubsup></mrow></math></span> was -2.4% for IMPT and -0.6% for PAT (<em>p</em> &lt; 0.01); <span><math><mrow><mo>Δ</mo><msubsup><mi>I</mi><mrow><mi>D</mi><mn>2</mn></mrow><mrow><mi>G</mi><mi>T</mi><mi>V</mi></mrow></msubsup></mrow></math></span> was 3.2% for IMPT and 0.9% for PAT (<em>p</em> &lt; 0.05). The interplay effects resulted in median homogeneity index deviations of 9.1% and 2% for the IMPT and PAT plans, respectively (<em>p</em> &lt; 0.01). Different starting phases affected IMPT more significantly than PAT.</div></div><div><h3>Conclusion</h3><div>PAT demonstrated greater robustness to interplay effects than IMPT for hypofractionated treatments of early-stage NSCLC, particularly in single-fraction schemes. Additionally, PAT showed good resilience to variations in different starting phases.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"39 ","pages":"Article 103757"},"PeriodicalIF":3.2,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028088","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}

{"title":"Survival and Prognostic Factors in Nonmetastatic Chemorefractory Inflammatory Breast Cancer: A Comprehensive Population-based Study","authors":"P. Loap,&nbsp;Y. Kirova","doi":"10.1016/j.clon.2025.103756","DOIUrl":"10.1016/j.clon.2025.103756","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"39 ","pages":"Article 103756"},"PeriodicalIF":3.2,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058241","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}

{"title":"Intensified Total Neoadjuvant Therapy in Patients With Locally Advanced Rectal Cancer: Long-term Results of a Prospective Phase II Study","authors":"F. De Felice ,&nbsp;L. Archetti ,&nbsp;G. D'Ambrosio ,&nbsp;F. Iafrate ,&nbsp;V. Picone ,&nbsp;F.M. Magliocca ,&nbsp;D. Musio ,&nbsp;M. Roberto ,&nbsp;G. Casella ,&nbsp;I. Clementi ,&nbsp;N. Bulzonetti ,&nbsp;A. Picchetto ,&nbsp;E. Vitti ,&nbsp;E. Merenda ,&nbsp;C. Gentili ,&nbsp;M. Lanzilao ,&nbsp;M. Miccini ,&nbsp;G. Illuminati ,&nbsp;A. Delle Donne ,&nbsp;D. Crocetti ,&nbsp;E. Cortesi","doi":"10.1016/j.clon.2024.103698","DOIUrl":"10.1016/j.clon.2024.103698","url":null,"abstract":"<div><h3>Aims</h3><div>To analyze the long-term results of a prospective phase II trial testing intensified total neoadjuvant therapy (TNT) in patients with locally advanced rectal cancer (LARC).</div></div><div><h3>Materials and methods</h3><div>Patients with histologically confirmed LARC adenocarcinoma were enrolled. Intensified TNT consisted of targeted agent (bevacizumab or panitumumab/cetuximab) plus FOLFOXIRI (5-fluorouracil, leucovorin, oxaliplatin and irinotecan) induction chemotherapy followed by intensified (oxaliplatin and 5-fluorouracil) chemoradiotherapy (CRT) and surgical resection. Follow-up data were collected for all patients included in the trial. Survival outcomes were calculated using the Kaplan-Meier method and curves were compared by the log-rank test.</div></div><div><h3>Results</h3><div>Between October 2015 and September 2019, 28 LARC patients were enrolled. Follow-up data were available for all included patients. In total, 11 (39.3%) patients had a complete response (CR). At 6.3 years (median follow-up), 5-year overall survival (OS) and DFS were 74.6% and 57.1%, respectively. Five-year OS was 80.8% for CR patients and 70.1% for no-CR patients (p-value 0.07). Those patients with CR after TNT treatment had a 5-year DFS of 81.8% versus 41.2% for those with no CR (p-value 0.015).</div></div><div><h3>Conclusion</h3><div>The addition of a targeted agent to induction FOLFOXIRI and oxaliplatin to 5-fluorouracil-based CRT, with the doses and intensities used in this study, resulted in high CR rates. Patients who achieve a CR demonstrate superior DFS compared to patients without CR. Intensified TNT may have the potential to increase survival outcomes. Further research on TNT strategies in LARC is encouraged.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"Article 103698"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817349","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}

{"title":"Letter to the Editor Regarding: Stereotactic Radiosurgery With Volumetric Modulated Arc Radiotherapy: Final Results of a Multi-arm Phase I Trial (DESTROY-2)","authors":"J.P. Nesseler,&nbsp;M. Kamrava","doi":"10.1016/j.clon.2024.103703","DOIUrl":"10.1016/j.clon.2024.103703","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"Article 103703"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827368","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}

{"title":"Reconsidering the Role of Radiotherapy for Inoperable Gastric Cancer: A Systematic Review of Gastric Radiotherapy Given With Definitive and Palliative Intent.","authors":"A Case, F Williams, S Prosser, H Hutchings, T Crosby, R Adams, G Jenkins, S Gwynne","doi":"10.1016/j.clon.2024.103693","DOIUrl":"10.1016/j.clon.2024.103693","url":null,"abstract":"<p><strong>Aims: </strong>The role of radiotherapy (RT) for inoperable gastric cancer (IGC) is commonly low-dose, given reactively for symptoms (e.g. bleeding), in contrast to the oesophagus, where high quality evidence exists for higher doses of RT. This systematic review aims to evaluate the use of, and evidence for, definitive and high-dose palliative RT for IGC and whether a change in practice is warranted.</p><p><strong>Materials and methods: </strong>Following registration with PROSPERO (CRD42022297080), MEDLINE, EMBASE and The Cochrane Library were searched in accordance with PRISMA standards for studies evaluating definitive (non-metastatic disease, BED10 >45Gy) or high-dose palliative RT (for symptom/local control, minimum BED10 >30Gy). A manual search of meeting proceedings and clinical trial registries was also performed.</p><p><strong>Results: </strong>31 studies were selected for analysis. 10 definitive studies totalling n = 354 patients receiving RT with 45-50.4Gy/25-28#, showed median overall survival ranging between 11 and 26.4 months, clinical complete response range 12%-45%, G3 gastrointestinal toxicity 0-31% (range) and RT completion rates ranging from 81% to 100%. 21 high-dose palliative studies (n = 955) mostly evaluated haemostatic control and reported 38 different RT regimens (most commonly 30Gy/10#). Bleeding response rate (RR) was 59.6%-90%, pain RR 45.5-100%, obstruction RR 52.9%-100%, G3 gastrointestinal toxicity <5% and RT completion 68%-100%. An additional American National Cancer Database review >4700 non metastatic IGC patients which combined both definitive and palliative doses found significant benefit to RT in addition to chemotherapy. Evidence regarding a dose-response relationship is conflicting, limited by retrospective data. Two studies report high quality -of-life (QOL) scores following gastric RT.</p><p><strong>Conclusion: </strong>There is a body of mainly non-randomised, observational evidence showing high-dose RT is efficacious, safe and may maintain QOL for patients with IGC. A change in practice will require a prospective randomised controlled trial, which should explore the role of prophylactic, high-BED RT combined with optimal systemic therapy using modern IMRT techniques and RT quality assurance.</p>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"103693"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791053","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}

{"title":"OncoFlash: Research Updates in a Flash!","authors":"A Chowdhury, C Lorimer","doi":"10.1016/j.clon.2024.103694","DOIUrl":"10.1016/j.clon.2024.103694","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":" ","pages":"103694"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766824","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}

{"title":"REMIT: Reirradiation of Diffuse Midline Glioma Patients –A Nordic Society of Paediatric Haematology and Oncology Feasibility Study","authors":"D.E. Østergaard ,&nbsp;A. Embring ,&nbsp;A. Sehested ,&nbsp;H. Magelssen ,&nbsp;I.R. Vogelius ,&nbsp;M. Kjærsgaard ,&nbsp;K. Nysom ,&nbsp;R. Mathiasen ,&nbsp;S. Lukacova ,&nbsp;M.V. Maraldo","doi":"10.1016/j.clon.2024.103682","DOIUrl":"10.1016/j.clon.2024.103682","url":null,"abstract":"<div><div>Diffuse midline glioma (DMG) continues to be an aggressive brain stem cancer among children and young adults. It has a dismal prognosis, with less than 10% of patients alive two years after diagnosis. Radiotherapy has been demonstrated to be effective, albeit transient. Hence, radiotherapy is considered a cornerstone in the treatment. Reirradiation has, in retrospective studies, shown promising overall survival and palliative effect, but no pan-European consensus for reirradiation exists. The REMIT (<strong>Re</strong>irradiation of diffuse <strong>Mi</strong>dline glioma pa<strong>T</strong>ients) protocol evaluates safety and the palliative efficacy of reirradiation of patients with DMG (<span><span>clinicaltrials.gov</span><svg><path></path></svg></span> NCT06093165). Patients included in the protocol will be followed with 1) performance status (Karnofsky or Lansky), 2) toxicity monitored with Common Terminology Criteria for Adverse Events (CTCAE), 3) motor and functioning skill with PEDI-CAT (The Pediatric Evaluation of Disability Inventory) and 4) quantification of corticosteroid use. Furthermore, the impact on quality of life and well-being will be assessed qualitatively with interviews as well as with the Pediatric Quality of Life Inventory (PedsQl) Cancer Module questionnaire. The protocol also includes dose accumulation and contouring studies to assess standardization as well as a prescreening log to address selection bias of patients. The safety and palliative efficacy of reirradiation in DMG will be prospectively evaluated, including qualitative patient reported outcomes, through the REMIT protocol. REMIT is planned to open for inclusion in 2024.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"Article 103682"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766827","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}