Clinical oncology最新文献

{"title":"Improving the experience of returning to clinical oncology training through an educational day for out-of-programme trainees","authors":"Wahyu Wulaningsih , Clare Kane , Rubyyat-A Hakim , Sarah Needleman","doi":"10.1016/j.clon.2025.103814","DOIUrl":"10.1016/j.clon.2025.103814","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"40 ","pages":"Article 103814"},"PeriodicalIF":3.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143830045","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":"Improving the palliative radiotherapy training experience of junior clinical oncology trainees","authors":"Alexandra Maling, Jenny Mckeon","doi":"10.1016/j.clon.2025.103819","DOIUrl":"10.1016/j.clon.2025.103819","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"40 ","pages":"Article 103819"},"PeriodicalIF":3.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143828494","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":"Third Course of Radical Intent Conformal Radiation in Patients with Primary Brain Tumors","authors":"M. Jeeva ,&nbsp;A. Dasgupta ,&nbsp;A. Chatterjee ,&nbsp;A. Sahu ,&nbsp;E. Sridhar ,&nbsp;A. Moiyadi ,&nbsp;G. Chinnaswamy ,&nbsp;T. Gupta","doi":"10.1016/j.clon.2025.103841","DOIUrl":"10.1016/j.clon.2025.103841","url":null,"abstract":"<div><h3>Aims</h3><div>Reirradiation is increasingly considered in patients with recurrent primary brain tumours. However, second course of radical reirradiation (RT2) or third course of radiation (RT3) delivering higher doses is uncommon. The current study was undertaken to report the clinical outcomes after the third course of radical radiation.</div></div><div><h3>Materials and methods</h3><div>The patients undergoing three courses of cranial radiation were obtained from the radiation oncology database. The clinical and treatment details were obtained by reviewing electronic medical records and radiation charts and plans when available. Treatment outcomes, including disease status and radionecrosis, were assessed by reviewing imaging. Analysis was done using descriptive statistics and survival outcomes using Kaplan–Meier survival plots.</div></div><div><h3>Results</h3><div>Eight patients were identified between 2015 and 2023 treated with a third course of radiotherapy (second reirradiation). Histopathology included ependymoma in seven and glioblastoma in one patient. The median age during first radiation was 13.5 years (range: 4–31 years) with interquartile range (IQR) of 7–26 years, and during RT3 was 22 years (range: 9–43 years, IQR: 14–32 years). The median doses at RT1, RT2, and RT3 were 59.4 Gy (IQR: 54.80–60 Gy), 54 Gy (IQR: 51.3–54.0 Gy), and 50.4 Gy (IQR: 50.0–50.4 Gy), respectively. The median interval between RT1 and RT2 was 37 months (IQR: 29–63 months), RT2 and RT3 was 39 months (IQR: 25–67 months). The median cumulative EQD2 from three courses was <span><math><mrow><msub><mrow><mn>153</mn><mspace></mspace><mi>G</mi><mi>y</mi></mrow><mrow><mn>2</mn><mspace></mspace></mrow></msub></mrow></math></span> (IQR: 148.7–159.1 <span><math><mrow><msub><mrow><mi>G</mi><mi>y</mi></mrow><mn>2</mn></msub></mrow></math></span>). After 3rd course, the median follow-up was 25 months (IQR: 15–37 months) with a 2-year overall survival of 85%. One patient had developed symptomatic radionecrosis 14 months after RT3 and was treated with bevacizumab.</div></div><div><h3>Conclusion</h3><div>The third course of radical dose of radiation can be considered a reasonable approach for tumours with local recurrence after a reasonable interval of at least two years between each course, allowing for tissue recovery.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"42 ","pages":"Article 103841"},"PeriodicalIF":3.2,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874397","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":"Is the Juice Worth the Squeeze? Overall Survival Gain per Unit Treatment Time as a Metric of Clinical Benefit of Systemic Treatment","authors":"V. Bamunuarachchi ,&nbsp;V. Peiris ,&nbsp;S. Wijeskera ,&nbsp;D. Rajapakse ,&nbsp;S. Gunasekera ,&nbsp;N. Joseph","doi":"10.1016/j.clon.2025.103840","DOIUrl":"10.1016/j.clon.2025.103840","url":null,"abstract":"<div><h3><em>Aims</em></h3><div>Novel systemic therapeutic options such as enzyme inhibitors and monoclonal antibodies have transformed the practice of medical oncology in the recent past. However, survival gains remain modest in most cases. Quantifying the magnitude of benefit against financial and nonfinancial toxicity of treatment is pivotal in deciding treatment. We describe a novel metric which can be used to assess effectiveness of novel therapeutics for incurable cancers along with other established tools.</div></div><div><h3><em>Materials and methods</em></h3><div>Sixty indications of 30 novel therapeutic agents were selected for analysis. The median overall survival gain was divided by the median duration of treatment to obtain the overall survival gain per treatment time, which was the primary end-point of the study. This parameter was compared with the European Society of Medical Oncology Magnitude of clinical benefit scale (ESMO-MCBS) score. Spearman’s rank correlation coefficient was used to test the association between the novel metric and the ESMO-MCBS scores.</div></div><div><h3><em>Results</em></h3><div>The median overall survival per unit treatment time ranged from 0.68 (range: 0.2–0.51). Only 18/60 indications had a ratio greater than 1, while 13/60 indications had a ratio less than 0.5. The median treatment duration was not mentioned in 12 indications and median progression-free survival was substituted for the analysis. The ESMO-MCBS score was available for 49 of the indications. The Spearman’s rank correlation coefficient was 0.44575 and showed a statistically significant association between survival gain per unit treatment time and the ESMO-MCBS score (<em>P</em> = 0.00133).</div></div><div><h3><em>Conclusion</em></h3><div>Along with other metrics, the ratio of survival gain over treatment duration is a useful parameter to assess effectiveness of novel therapeutics in the palliative setting.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"42 ","pages":"Article 103840"},"PeriodicalIF":3.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870137","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":"S. Parikh ,&nbsp;R. Simoes","doi":"10.1016/j.clon.2025.103838","DOIUrl":"10.1016/j.clon.2025.103838","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"41 ","pages":"Article 103838"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791387","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":"Neuroendocrine Deficits and Weight Development Before and After Proton Therapy in Children With Craniopharyngioma","authors":"M. Bischoff ,&nbsp;J. Beckhaus ,&nbsp;D.A. Khalil ,&nbsp;F. Sen ,&nbsp;S. Frisch ,&nbsp;B. Koska ,&nbsp;C. Kiewert ,&nbsp;B. Bison ,&nbsp;R.-D. Kortmann ,&nbsp;C. Friedrich ,&nbsp;H.L. Müller ,&nbsp;B. Timmermann","doi":"10.1016/j.clon.2025.103837","DOIUrl":"10.1016/j.clon.2025.103837","url":null,"abstract":"<div><h3>Aims</h3><div>Our objective was to analyse tumour- and treatment-related factors influencing endocrine morbidity and obesity pre- and post-proton beam therapy (PBT) in paediatric patients with craniopharyngioma.</div></div><div><h3>Materials and methods</h3><div>A total of 65 patients at the onset of PBT were included in the analysis within our prospective registry study. The data pertaining to endocrine deficits and BMI prior to PBT were retrieved from the medical records on a retrospective basis. Cumulative incidences (CI) of endocrinopathies, age- and sex-adjusted BMI standard deviation scores (BMI-SDS) were calculated.</div></div><div><h3>Results</h3><div>Before PBT, 90.8% had ≥1 neuroendocrine deficit. Diabetes insipidus (DI) was attributed to surgery in 96%. Patients with postoperative DI had a higher 3-year CI of adrenocorticotropic hormone and thyroid-stimulating hormone deficiency rates compared to those without DI (<em>p</em> &lt; .001). At PBT start, 47.7% had already panhypopituitarism compared to 67.7% at the last follow-up (FU). Median FU post-PBT was 3.2 years (range, 1.0–9.6). Post-PBT, 38.2% remained free of additional hormone deficiencies. A trend towards lower endocrine morbidity scores for patients who received PBT during their primary treatment compared to irradiation at progression did not reach statistical significance (<em>p</em> = .068). The BMI-SDS increase from diagnosis to the start of radiotherapy was significantly greater than from the start of PBT to the end of FU (mean BMI-SDS increase: 0.61, ±1.16 vs. 0.13, ±0.84, <em>p</em> = 0.019), with a median time of 10.2 and 38.4 months, respectively. In the multivariate analysis, hypothalamic involvement (<em>p</em> = .042) and the BMI-SDS level at diagnosis (<em>p</em> = .006) were identified as clinical factors indicating severe obesity at FU (BMI-SDS ≥+2).</div></div><div><h3>Conclusions</h3><div>Panhypopituitarism is frequently observed in paediatric patients with craniopharyngioma prior to PBT. The potential benefits of early PBT on endocrine outcomes require further investigation through longer FU periods. The greatest increase in weight occurred before radiotherapy. Endocrine deficiencies and weight gain are multifactorial and require close monitoring.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"42 ","pages":"Article 103837"},"PeriodicalIF":3.2,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143830326","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":"RCR meetings","authors":"","doi":"10.1016/S0936-6555(25)00088-3","DOIUrl":"10.1016/S0936-6555(25)00088-3","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"40 ","pages":"Article 103833"},"PeriodicalIF":3.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143696024","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":"Regional Lymph Node Delineation variability and its Dosimetric Impact in Breast Cancer Radiotherapy","authors":"Z. Nabi ,&nbsp;D. Megias ,&nbsp;P. Diez ,&nbsp;A. Caraman ,&nbsp;R. Mir ,&nbsp;D. Wheatley ,&nbsp;M. Maclennan ,&nbsp;J. Bliss ,&nbsp;J. Haviland ,&nbsp;M.A. Sydenham ,&nbsp;E. Spezi ,&nbsp;Y. Tsang ,&nbsp;A.M. Brunt","doi":"10.1016/j.clon.2025.103836","DOIUrl":"10.1016/j.clon.2025.103836","url":null,"abstract":"<div><h3><em>Aims</em></h3><div>To quantify the interobserver variability of regional lymph node delineation for breast cancer radiotherapy (RT) and establish whether a relationship exists between contouring variations and dosimetry using the FAST-Forward (FF) pre-trial RT quality assurance (QA) benchmark cases.</div></div><div><h3><em>Materials and methods</em></h3><div>As part of the pre-trial RT QA, local site principal investigators (PIs) were asked to complete a single outlining QA benchmark case involving the delineation of axillary lymph node clinical target volumes (LNCTVs) levels 1–4. These contours were evaluated for concordance against an expert defined consensus gold standard (GS) volume using various conformity indices (CIs): discordance index (DI), geographical miss index (GMI), Jaccard index (JCI), mean distance to conformity (MDC) for both over- and under- contouring. Descriptive statistics including interquartile range (IQR) was used to evaluate interobserver variation. Wilcoxon signed-rank tests were used to establish if there were any statistically significant differences in the dosimetric parameters between plans conforming to GS volume and the volumes from the individual PI.</div></div><div><h3><em>Results</em></h3><div>Pre-trial outlining QA benchmark cases from 29/33 PIs were assessed. The median submitted LNCTV volume was 131.4 cc (IQR: 112.4 – 145.3) compared with the GS volume of 105.46 cc. For conformity indices, the median DI was 0.37 (IQR: 0.31 – 0.40), the median GMI was 0.21 (IQR: 0.13 – 0.28), the median JCI was 0.53 (IQR: 0.49 – 0.56), MDC_under was -0.43 (IQR: -0.64 - -0.32) and MDC_over was 0.46 (IQR: 0.43 – 0.53). A dosimetric analysis showed all plans met the mandatory planning dose constraints but not the optimal objectives for target volumes as required in the trial protocol. Statistically significant differences were found in 7/13 organs at risk dosimetric parameters between plans conformed to individual PI volumes and the GS volume.</div></div><div><h3><em>Conclusion</em></h3><div>Analysis of the FF pre-trial QA outlining benchmark case highlights the interobserver variation that exists in axillary nodal CTV (levels 1–4) delineation. Conformity indices demonstrated moderate agreement with a median Jaccard conformity index of 0.53, with both under- and over-contouring observed. All QA submissions achieved the mandatory planning dose constraints but not all optimal dose objectives of the FF trial despite the interobserver variation in target volume contouring.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"42 ","pages":"Article 103836"},"PeriodicalIF":3.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143844128","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 Treatment of Rectal Cancer: A Repeat UK-wide Survey After Implementation of National Intensity Modulated Radiotherapy Guidance","authors":"A. Macnair ,&nbsp;R. Adams ,&nbsp;A. Appelt ,&nbsp;M. Beavon ,&nbsp;K. Drinkwater ,&nbsp;C.R. Hanna ,&nbsp;S.M. O'Cathail ,&nbsp;R. Muirhead","doi":"10.1016/j.clon.2025.103835","DOIUrl":"10.1016/j.clon.2025.103835","url":null,"abstract":"<div><h3>Aims</h3><div>Rectal cancer management has changed significantly in the last decade with the introduction of total neoadjuvant therapy (TNT), minimally invasive surgery, brachytherapy, and organ preservation. A national survey of intensity modulated radiotherapy (IMRT) was carried out in 2020 to support the development of national Royal College of Radiologists (RCR) guidance, published in 2021. We performed a repeat survey in collaboration with the RCR, to inform iterations of the RCR Guidance and establish treatment patterns across the UK to facilitate future research and development.</div></div><div><h3>Materials and Methods</h3><div>A web-based survey was developed and tested by the authors prior to dissemination by the RCR to all UK radiotherapy centres. The repeat survey requested details and strategies of current radiotherapy techniques, including details on setup, doses, organs at risk, peer review, and verification, and asked for the standard management of 5 clinical cases within each multidisciplinary team (MDT) serving that radiotherapy centre. Descriptive statistical analysis was carried out.</div></div><div><h3>Results</h3><div>In total, 42 of 60 (70%) of the NHS centres across the UK answered the repeat IMRT rectal survey, which reflected 70 MDTs answering the clinical scenarios questions. 100% of centres that responded are routinely using IMRT, with 95% of centres using it in all patients. Variation in treatment delivery has reduced since the previous survey. The greatest difference is still in the use of simultaneous integrated boost and definition of organs at risk. The management for the clinical cases was widely different, with answers generally equally distributed between 2-4 options. The highest-scoring treatment strategies ranged from 24% to 57%.</div></div><div><h3>Conclusion</h3><div>RCR guidance has helped standardise the delivery of radiotherapy to treat rectal cancer in the UK. The variation in neoadjuvant treatment represents an exciting, evolving time in rectal cancer management. Clinical trials are needed to further homogenise treatment, but a degree of national variation is likely to continue.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"41 ","pages":"Article 103835"},"PeriodicalIF":3.2,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808322","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":"Bridging Gaps in Cancer Care With Quality Indicators in Radiotherapy","authors":"J. Jose Manjali ,&nbsp;T. Gupta ,&nbsp;S. Vinod ,&nbsp;J.P. Agarwal","doi":"10.1016/j.clon.2025.103831","DOIUrl":"10.1016/j.clon.2025.103831","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"41 ","pages":"Article 103831"},"PeriodicalIF":3.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143838447","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}