Clinical oncology最新文献

{"title":"Factors Affecting D90 High-risk Clinical Target Volumes (HR-CTV dose) of Intracavitary and Interstitial Brachytherapy in Locally Advanced Cervical Cancer.","authors":"P Chitmanee, T Sampaongen, N Klomjit","doi":"10.1016/j.clon.2024.103701","DOIUrl":"10.1016/j.clon.2024.103701","url":null,"abstract":"<p><strong>Aims: </strong>Intracavitary brachytherapy alone covers a limited target volume; however, intracavitary and interstitial brachytherapy (IC/IS) can increase the dose coverage. We aim to assess the factors that impact D90 high-risk clinical target volume (HR-CTV) dose. We also assess clinical outcomes and toxicities for 3D image-based brachytherapy.</p><p><strong>Materials and methods: </strong>We included a total of 424 cervical cancer patients with FIGO stage IB1 to IVA who received chemoradiation and high-dose-rate brachytherapy between 2014 and 2023. Target delineation was per GEC-ESTRO guidelines with the aim to achieve total dose of ≥85 Gy (D90 HR-CTV) in equivalent dose (EQD2). Implantation, tumour size, lateral extension, and HR-CTV volume were analysed.</p><p><strong>Results: </strong>The median follow-up time was 24 months (range 1-107). The overall 2-year local control, progression-free survival, and overall survival rate were 90.3%, 75%, and 95.5%, respectively. Of 424 patients, 86.8% received a total dose of at least 85 Gy of D90 HR-CTV in EQD2. In multivariate analysis, IC/IS brachytherapy and HR-CTV volume were significant factors associated with HR-CTV D90 ≥ 85Gy in EQD2 (P = 0.012 and P = 0.000, respectively). Subgroup analysis of patients with HR-CTV volume >35 ml found that IC/IS was a significant factor in achieving HR-CTV D90 ≥ 85Gy in EQD2 (P = 0.017). At the median follow-up, patients with D90 HR-CTV ≥85 Gy achieved local control rates of 72.08% in small volume (<20 cm³) group, 68.42% in intermediate volume (21-30 cm³) group, 71.68% in high intermediate volume (31-60 cm³) and 17.67% in larger volume (>60 cm³) group (P = 0.005). Grade 3 toxicities including proctitis, cystitis, and vaginal stenosis were 7.1%, 1.9% and 0.2%, respectively.</p><p><strong>Conclusion: </strong>IC/IS brachytherapy may be used in patients with HR-CTV volumes greater than 35 ml to achieve total doses of D90 HR-CTV ≥85 Gy in EQD2. IC/IS brachytherapy also provide good local control with favorable toxicity profile.</p>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"103701"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142821913","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":"Quality-of-Life Analysis of a Phase II Randomised Controlled Trial Comparing Three-Dimensional Conformal Radiotherapy and Intensity-Modulated Radiotherapy in Locally Advanced Rectal Cancer.","authors":"R L Geary, C Gillham, G McVey, J Armstrong, M Cunningham, G Rangaswamy, D Sharma, N Wallace, C Skourou, M Dunne, M Mahon, S Bradshaw, L O'Sullivan, J Marron, I Parker, A M Shannon, R McDermott, S Toomey, B T Hennessy, B O'Neill","doi":"10.1016/j.clon.2024.103695","DOIUrl":"10.1016/j.clon.2024.103695","url":null,"abstract":"<p><strong>Aims: </strong>Neoadjuvant radiotherapy is an integral part of the management of locally advanced rectal cancer. Radiotherapy can be delivered using three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) techniques. We herein compare the quality-of-life (QOL) outcomes of patients who received radiotherapy using these techniques in a randomised trial.</p><p><strong>Materials and methods: </strong>A phase II randomised trial was conducted in patients with locally advanced rectal cancer. Patients staged as T3-4, N (any), or circumferential resection margin at risk were eligible. All patients underwent neoadjuvant chemoradiotherapy with 50.4 Gy given in 28 fractions with concomitant fluorouracil or capecitabine. Patients were randomly allocated, in a 1:1 ratio, to 3DCRT or IMRT planning techniques. QOL, a secondary objective of the study, was evaluated using the European Organisation for Research and Treatment for Cancer (EORTC) Quality of Life Questionnaire (QLQ) C30 and QLQ CR29 questionnaires at baseline, during the final week of radiotherapy and, at six months after radiotherapy. The impact of the treatment arm on QOL scores was evaluated using analysis of covariance after adjusting for the preintervention scores.</p><p><strong>Results: </strong>94 patients were accrued between October 2014 and March 2020. The trial was terminated early due to futility of the primary outcome, acute gastrointestinal toxicity, at interim analysis. Eighty-six (91%) patients completed the baseline questionnaire and one other timepoint of assessment. Median follow-up was 1.9 years. Overall, both during the final week of radiotherapy and at six months, emotional functioning had improved, but physical, role, and social functionings had declined compared to that at baseline. At baseline, there was no difference in QOL scores between the two arms. During the final week of radiotherapy, the IMRT arm was associated with better adjusted mean physical (p = 0.04) and role functioning (p = 0.01) scores.</p><p><strong>Conclusion: </strong>IMRT is associated with limited QOL benefits compared to 3DCRT in patients undergoing neoadjuvant chemoradiotherapy for locally advanced rectal cancer.</p>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"103695"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853314","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":"Neoadjuvant Chemoradiotherapy in Locally Advanced and Locally Recurrent Colon Cancer","authors":"R.A.F. Agas ,&nbsp;M. Fahey ,&nbsp;R.R. Gosavi ,&nbsp;J.C.H. Kong ,&nbsp;J. Tan ,&nbsp;J. Chu ,&nbsp;T. Leong ,&nbsp;S. Warrier ,&nbsp;A. Heriot ,&nbsp;S.Y. Ngan","doi":"10.1016/j.clon.2024.103692","DOIUrl":"10.1016/j.clon.2024.103692","url":null,"abstract":"<div><h3><em>Aims</em></h3><div>While systemic management of high risk colon cancer is well addressed, advances in local management remain incremental. This study aims to identify a group of colon cancer patients where local management remains a challenge, and where intensifying local treatment with radiotherapy is potentially beneficial to minimise the risk of an R1 resection.</div></div><div><h3><em>Materials and methods</em></h3><div>The patients with select cT4 locally advanced primary colon (LAPC) (n = 40) and locally recurrent colon (LRC) (n = 48) adenocarcinomas who received neoadjuvant radiotherapy from 2005 to 2020 were studied. Radiotherapy prescription was 45–50.4 Gy in conventional fractionation. The estimated median follow-up time was 8.1 years and 6.3 years for the LAPC and LRC groups, respectively.</div></div><div><h3><em>Results</em></h3><div>The most common primary site was the sigmoid colon (n = 61). In the LAPC group, surgery was performed in 90% (n = 36), 81% (n = 29) of which were R0 resections, with pathologic downstaging occurring in 66.7% (n = 24). In the LRC group, surgery was possible in 79.2% (n = 38), 65.8% (n = 25) of which were R0 resections. For the LAPC group, 13% (n = 5) had local failures (hazard rate 3%, 95% CI 1–6%), 38% (n = 14) had any disease progression (hazard rate 9%; 95% CI 5–14), and 55% (n = 22) were alive at the end of the follow-up period (hazard rate 8%; 95% CI 5–13). For the LRC group, 35% (n = 17) had local failures (5-year local failure-free survival: 53%; 95% CI: 37–74), and 61% (n = 30) had any disease progression (5-year progression-free survival: 28%; 95% CI: 17%–48%). Five-year overall survival for the LRC group was 50% (95% CI: 37–68). There was no 30-day mortality.</div></div><div><h3><em>Conclusion</em></h3><div>Local management of high risk colon cancer remains a challenge. Future studies in neoadjuvant chemoradiation and systemic therapy, and staging methodology in identifying the high risk group are urgently needed.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"Article 103692"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812294","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 Endpoints: Patient-Reported Experience Measures and Patient-Reported Outcome Measures as Quality Indicators for Outcomes","authors":"B. Chacko ,&nbsp;N. Jose ,&nbsp;C.T. Kainickal","doi":"10.1016/j.clon.2024.103744","DOIUrl":"10.1016/j.clon.2024.103744","url":null,"abstract":"<div><div>Heterogeneity of cancer necessitates individualised cancer care as well as tailored survival endpoints-one size no longer fits all. In the past few years, apart from the standard clinical efficacy endpoints, patient reported outcomes have gathered a momentum as one among the quality indicators in the realm of practice changing oncology. These standardised and validated self-reporting instruments use a patients' viewpoint to assess the status of their health and their experience whilst receiving health care. This review explores the relevance of patient reported measures in the present clinical scenario and issues regarding its implementation amidst the barriers and challenges. These measures should be judiciously accounted as surrogate markers along with survival endpoints; for providing value based, highly comprehensive cancer care. New policy guidelines incorporating patient reported outcomes should be planned and formulated for future practice in oncology.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"39 ","pages":"Article 103744"},"PeriodicalIF":3.2,"publicationDate":"2024-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022240","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":"A Systematic Approach to Prioritise Diagnostically Useful Findings for Inclusion in Electronic Health Records as Discrete Data to Improve Clinical Artificial Intelligence Tools and Genomic Research","authors":"P. Guillod ,&nbsp;A. Savvas ,&nbsp;P.N. Robinson ,&nbsp;D. Nai ,&nbsp;K.N. Naresh ,&nbsp;G. Ott ,&nbsp;A. Schuh ,&nbsp;W.A. Sewell ,&nbsp;M. Anderson ,&nbsp;N. Matentzoglu ,&nbsp;D. Durgavarjhula ,&nbsp;M.L. Xu ,&nbsp;M.J. Druzdzel ,&nbsp;J.M. Astle","doi":"10.1016/j.clon.2024.103737","DOIUrl":"10.1016/j.clon.2024.103737","url":null,"abstract":"<div><h3>Aims</h3><div>The recent widespread use of electronic health records (EHRs) has opened the possibility for innumerable artificial intelligence (AI) tools to aid in genomics, phenomics, and other research, as well as disease prevention, diagnosis, and therapy. Unfortunately, much of the data contained in EHRs are not optimally structured for even the most sophisticated AI approaches. There are very few published efforts investigating methods for recording discrete data in EHRs that would not slow current clinical workflows or ways to prioritise patient characteristics worth recording. Here, we propose an approach to identify and prioritise findings (phenotypes) useful for differentiating diseases, with an initial focus on relatively common small B-cell lymphomas.</div></div><div><h3>Materials and methods</h3><div>A website enabling crowd-sourced recording of diseases and phenotypes was developed. An expert committee in the field of B-cell lymphomas standardised phenotype terminology for use in digital resources, and select terms were included in the Human Phenotype Ontology (HPO). A total of 100 patient lymph node biopsy samples were evaluated, and phenotypes were recorded as discrete data. Bayesian networks (BNs) were developed based on these data, and their diagnostic accuracy and ability to prioritise these phenotypes for inclusion in EHRs were assessed.</div></div><div><h3>Results</h3><div>Out of 146 phenotypes identified from the website as potentially useful for differentiating four different lymphomas from each other and from benign lymph nodes, 70–75 were included in BNs. The diagnostic accuracy of different naïve BNs was 96.3% for non–marginal zone lymphoma cases and 50% for marginal zone lymphoma cases when all of the included phenotypes were used and 93.8% for non–marginal zone lymphoma cases and 27.5% for marginal zone lymphoma cases when only 15 phenotypes were included in the BNs.</div></div><div><h3>Conclusion</h3><div>This pilot provides a starting point for systematic improvement and a dataset for comparing related approaches.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"39 ","pages":"Article 103737"},"PeriodicalIF":3.2,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001236","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":"Tumour-infiltrating Lymphocytes and Radiation Therapy in Rectal Cancer: Systematic Review and Meta-analysis","authors":"J. Klein ,&nbsp;W.T. Tran ,&nbsp;S. Viswanathan ,&nbsp;R. Salgado ,&nbsp;P. Poortmans ,&nbsp;M. Machiels","doi":"10.1016/j.clon.2024.103742","DOIUrl":"10.1016/j.clon.2024.103742","url":null,"abstract":"<div><h3>Aim</h3><div>Tumour-infiltrating lymphocytes (TILs) represent a promising cancer biomarker. Different TILs, including CD8+, CD4+, CD3+, and FOXP3+, have been associated with clinical outcomes. However, data are lacking regarding the value of TILs for patients receiving radiation therapy (RT). We conducted a systemic review and meta-analysis of available data evaluating TILs for patients receiving curative-intent therapy including RT.</div></div><div><h3>Materials and Methods</h3><div>Eligible studies presented a defined cohort of patients who all received curative-intent therapy, including RT, and also reported the relationship between any TIL score and either tumour response or survival outcomes. After comprehensive search of online databases (PubMed, EMBASE, Cochrane, and Web of Science), 2 authors conducted title, abstract, and whole-text review for quality and risk of bias following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Data from publications that met quality criteria were grouped via (1) TIL analysed, (2) pre- or post-RT TIL assessment, and (3) clinical outcome measured.</div></div><div><h3>Results</h3><div>Initial search yielded 669 unique studies. Thirty-one studies met quality criteria, of which 20 studied rectal cancer (RC), 4 oesophageal, 3 pancreas, 2 lung, cervical/uterine 1 each. We conducted systematic review and meta-analysis of the RC publications. All except 2 were single-institutional cohort studies. After meta-analysis, the pre-RT epithelial CD8+ (<em>p</em> = 0.04) and stromal FOXP3+ (<em>p</em> = 0.01) counts were associated with survival without disease, while pre-RT epithelial (<em>p</em> = 0.02) and stromal (<em>p</em> = 0.001) FOXP3+ TILs were associated with overall survival. On post-RT analysis, epithelial (<em>p</em> = .04) and stromal (<em>p</em> = 0.02) CD8+ TILs were associated with survival without disease and epithelial CD8+ TILs were associated with overall survival (<em>p</em> = 0.01).Preoperative CD8+ and FOXP3+ TILs were generally associated with tumour response to RT, but meta-analysis was not conducted due to heterogeneity of response measurement techniques.</div></div><div><h3>Conclusion</h3><div>TILs represent a useful parameter for tumour response and survival outcomes for patients receiving curative-intent therapy, including RT for RC. Future work should aim to standardise TIL measurement and quantification methods and to develop protocols to clarify clinical application of these findings.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"39 ","pages":"Article 103742"},"PeriodicalIF":3.2,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032186","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":"Effects of Radiotherapy Alone Versus Concomitant Radiotherapy With Temozolomide Chemotherapy on the Outcome of IDH-wildtype Glioblastoma Patients.","authors":"M Kurdi, A Alkhotani, T Alsinani, S Alkhayyat, Y Katib, Z Jastaniah, A J Sabbagh, N S Butt, F A Toonsi, M Alharbi, S Baeesa","doi":"10.1016/j.clon.2024.103741","DOIUrl":"https://doi.org/10.1016/j.clon.2024.103741","url":null,"abstract":"<p><strong>Background: </strong>Isocitrate dehydrogenase [IDH]-wildtype glioblastoma is an aggressive brain cancer associated with high recurrence and poor overall survival.</p><p><strong>Aim: </strong>Our study aims to explore the prognostic effects of radiotherapy [RT] alone versus concomitant RT with temozolomide [TMZ].</p><p><strong>Methods: </strong>A multicentre retrospective study included a cohort of 244 patients diagnosed with IDH-wildtype glioblastoma, and it was analysed from 2013 to 2020. All patients underwent complete surgical resection of the tumour followed by standard postsurgical therapies, including RT alone [group A] or concomitant RT with TMZ chemotherapy [group B]. Intra-statistical cohort data analysis was performed.</p><p><strong>Results: </strong>The mean age of the patients was 53.9 years [SD 16.3 years], with 87 [35.7%] females and 157 [64.3%] males. Group \"A\" patient [n = 67, 27.5%] received RT alone, and group \"B\" patient [n = 177, 72.5%] received concomitant RT with TMZ chemotherapy. All patients' mean progression-free survival [PFS] was 391.8 days (13.1 months). There was a statistically significant difference in PFS between the two treatment groups [P value<0.0001]. The hazard ratio [HR] for PFS in group \"b\" compared with group \"a\" was 0.48 [95% CI: 0.36-0.64, P < 0.001] in the univariable analysis, indicating a significant benefit of the combined treatment. This benefit was maintained in the multivariable analysis with an HR of 0.50 [95% CI: 0.37-0.67, P < 0.001]. Age was found to be a significant factor in PFS, with each additional year of age increasing HR by 2% in the univariable analysis [HR: 1.02, 95% CI: 1.01-1.03, P < 0.001] and the multivariable analysis (HR of 1.01 [95% CI: 1.01-1.02, P < 0.001)].</p><p><strong>Conclusions: </strong>Concomitant RT with TMZ chemotherapy significantly increased PFS beyond that observed from isolated RT in patients with IDH-wildtype glioblastoma.</p>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"38 ","pages":"103741"},"PeriodicalIF":3.2,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913841","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":"Patient Perspectives on the Value of Stereotactic Body Radiotherapy in the Management of Breast Cancer: The PERSPECTIVE Study.","authors":"S K Nagpal, G Ross, S Cruickshank, A M Kirby","doi":"10.1016/j.clon.2024.103738","DOIUrl":"https://doi.org/10.1016/j.clon.2024.103738","url":null,"abstract":"<p><strong>Aims: </strong>Oligometastatic disease describes limited metastases amenable to therapy such as stereotactic body radiotherapy (SBRT). This study aims to understand which outcomes are most important to patients when considering SBRT as a treatment option. The insights gained will help inform future patient-directed trial endpoints and provide valuable guidance to clinicians supporting patients through their decision-making process.</p><p><strong>Materials and methods: </strong>We conducted a qualitative study with focus groups and individual interviews. Participants were recruited using a purposive-sampling matrix accounting for age, presence of metastatic disease, and previous experience with radiotherapy. Each focus group had at least two moderators, and all interviews were digitally recorded and then transcribed. Thematic analysis was performed using NVivo version 12.</p><p><strong>Results: </strong>The study included 18 patients diagnosed with breast cancer, comprising two focus groups and four individual interviews. The median age was 54 years (range 38-74). 15/18 (83%) had prior radiotherapy experience, including 4/18 with previous SBRT experience. Three main themes were identified: 1) Participants' experience with radiotherapy; 2) patients' perceptions and considerations in relation to SBRT (including desired treatment outcomes); and 3) willingness to consider SBRT for its potential local control and durable pain control benefits, even in the absence of survival benefit. Participants prioritised extending their lives as the foremost desired outcome of SBRT, followed by quality of life. Those with prior SBRT experience were keen for repeat treatment, if available, and emphasised SBRT's minimal side effects compared to other interventions.</p><p><strong>Conclusion: </strong>While extension of life was the primary desired treatment outcome of SBRT for oligometastatic breast cancer , all participants were willing to consider SBRT for its minimal side effects and potential benefits in local control and durable pain control, even in the absence of a survival benefit.</p>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"38 ","pages":"103738"},"PeriodicalIF":3.2,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930103","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":"PTV Margins in MR-guided and Beam-gated SBRT of Liver Metastases: GTV Dose Escalation Can Reduce the Required PTV","authors":"I. Wahlstedt ,&nbsp;E. van der Bijl ,&nbsp;K. Boye ,&nbsp;S. Ehrbar ,&nbsp;M. van Overeem Felter ,&nbsp;S. Winther Hasler ,&nbsp;T.M. Janssen ,&nbsp;S.L. Risumlund ,&nbsp;J.E. van Timmeren ,&nbsp;I.R. Vogelius ,&nbsp;C.P. Behrens","doi":"10.1016/j.clon.2024.103736","DOIUrl":"10.1016/j.clon.2024.103736","url":null,"abstract":"<div><h3>Aims</h3><div>Determining appropriate PTV margins for SBRT of liver metastases is a non-trivial task, especially with motion management included. The widely used analytical van Herk margin recipe (van Herk <em>et al.,</em> 2000) could break down due to (i) a low number of fractions, (ii) non-Gaussian errors, or (iii) non-homogenous dose distributions. We evaluated the validity of the analytical margin recipe in this setting for two very different guidelines for SBRT of liver metastases in three fractions – one with a relatively homogenous dose within the PTV (British) and one allowing much steeper dose gradients within the PTV (Danish).</div></div><div><h3>Materials and methods</h3><div>We extracted sagittal motion traces for nineteen consecutive MR-guided and beam-gated treatments (57 fractions) on an MR-linac. We used these motion traces to calculate analytical van Herk GTV-to-PTV margins to account for intrafractional motion according to both British and Danish guidelines. We used the same motion traces to validate the analytical margins with motion-compensated dose accumulation in dose distributions obtained from British and Danish plans with varying PTV margins.</div></div><div><h3>Results</h3><div>Analytical margins for the British guidelines were 2.4 mm superior-inferiorly (SI) and 3.2 mm anterior-posteriorly (AP). For the Danish guidelines, analytical margins were 1.7 mm SI and 2.7 mm AP. Dose accumulation validation showed that a margin of 3 mm SI and 1.5 mm AP would have been sufficient for British plans to ensure 95% of the prescription dose to at least 99% of the GTV in 90% of the treatments (same criterion as used in the analytical calculation) of the patients. No PTV margin was needed to achieve the same with Danish guidelines.</div></div><div><h3>Conclusion</h3><div>GTV dose escalation can reduce the required motion-related PTV margins in SBRT with motion management. The van Herk margin recipe overestimates PTV margins in SBRT with inhomogeneous target dose distributions and becomes less applicable when the inhomogeneity increases.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"39 ","pages":"Article 103736"},"PeriodicalIF":3.2,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001216","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":"Best Practice for Patient-centred Radiotherapy in Clinical Trials and Beyond—A National Multidisciplinary Consensus","authors":"H. Green ,&nbsp;R. Rieu ,&nbsp;F. Slevin ,&nbsp;L. Ashmore ,&nbsp;H. Bulbeck ,&nbsp;P. Gkogkou ,&nbsp;S. Ingram ,&nbsp;C. Kelly ,&nbsp;H. Probst ,&nbsp;R. Shakir ,&nbsp;T. Underwood ,&nbsp;J. Wolfarth ,&nbsp;M.J. Merchant ,&nbsp;N.G. Burnet ,&nbsp;CTRad Working Group 4","doi":"10.1016/j.clon.2024.103732","DOIUrl":"10.1016/j.clon.2024.103732","url":null,"abstract":"<div><h3>Aims</h3><div>Patient-centred radiotherapy refers to an approach where patients' needs and preferences are prioritised. Guidelines for this personalised approach are lacking. We present a multidisciplinary national consensus with the aim to provide recommendations for best practice in patient-centred radiotherapy for both clinical trials and routine practice.</div></div><div><h3>Materials and methods</h3><div>A multidisciplinary working group was formed, comprising of healthcare professionals and patient advocates with lived experience of radiotherapy. Three interlinking themes were identified around patient-centred radiotherapy: information, decision-making, and outcomes. Scoping reviews were carried out for each theme, considering current challenges and recommendations for best practice. Recommendations were shaped through consultation with 12 patient advocates.</div></div><div><h3>Results</h3><div>There is a pressing need to better support patients prior to, during, and following radiotherapy. Radiotherapy-related patient information is often complex and challenging to understand. Information resources should be cocreated with patient advocates and individualised wherever possible, including for patients from under-served groups.</div><div>Shared decision-making (SDM) processes may enhance treatment satisfaction and reduce decision-regret, but these are not widely implemented. SDM requires prepared patients, trained teams, alongside adequate resources and should be offered as per patients' preferences.</div><div>Healthcare system data offer complementary information to clinical trials, with the potential to provide additional insight into long-term benefits and risks of radiotherapy within ‘real-world’ conditions. Patient-reported outcome measures may provide greater insight regarding toxicity and impact on quality of life and should be used in synergy with clinician-reported outcomes. Outcome measures should be collected in the long term, and results should be widely disseminated to both the public and professional communities. Equity of access to radiotherapy, clinical trials, and survivorship services is a priority.</div></div><div><h3>Conclusion</h3><div>Patients rightly expect more from healthcare professionals, and it is important that the radiotherapy community recognises this and embraces changes which will enhance patient-centred care. Our recommendations aim to guide best practice for patient-centred radiotherapy.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"39 ","pages":"Article 103732"},"PeriodicalIF":3.2,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001239","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}