Clinical oncology最新文献

{"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}

{"title":"Natural Language Processing to Extract Head and Neck Cancer Data From Unstructured Electronic Health Records","authors":"T. Young ,&nbsp;J. Au Yeung ,&nbsp;K. Sambasivan ,&nbsp;D. Adjogatse ,&nbsp;A. Kong ,&nbsp;I. Petkar ,&nbsp;M. Reis Ferreira ,&nbsp;M. Lei ,&nbsp;A. King ,&nbsp;J. Teo ,&nbsp;T. Guerrero Urbano","doi":"10.1016/j.clon.2025.103805","DOIUrl":"10.1016/j.clon.2025.103805","url":null,"abstract":"<div><h3>Aims</h3><div>Patient data is frequently stored as unstructured data within Electronic Health Records (EHRs), requiring manual curation. AI tools using Natural Language Processing (NLP) may rapidly curate accurate real-world unstructured EHRs to enrich datasets. We evaluated this approach for Head and Neck Cancer (HNC) patient data extraction using an open-source general-purpose healthcare NLP tool (CogStack).</div></div><div><h3>Materials and Methods</h3><div>CogStack was applied to extract relevant SNOMED-CT concepts from HNC patients' documents, generating outputs denoting the identifications of each concept for each patient. Outputs were compared to manually curated ground truth HNC datasets to calculate pre-training performance. Supervised model training was then performed using SNOMED-CT concept annotation on clinical documents, and the updated model was re-evaluated. A second training cycle was performed before the final evaluation. A thresholding approach (multiple detections needed to qualify a concept as ‘present’) was used to increase precision. The final model was evaluated on an unseen test cohort. F1 score (harmonic mean of precision and recall) was used for evaluation.</div></div><div><h3>Results</h3><div>Pre-training, the F1 score was incalculable for 19.5% of concepts due to insufficient recall. Following one training cycle, F1 score became calculable for all concepts (median 0.692). After further training, the final model demonstrated improvement in the median F1 score (0.708). Test cohort median F1 score was 0.750. Thresholding analysis developed a concept-specific best threshold approach, resulting in a median F1 score of 0.778 in the test cohort, where 50 out of 109 SNOMED-CT concepts met pre-set criteria to be considered adequately fine-tuned.</div></div><div><h3>Conclusions</h3><div>NLP can mine unstructured cancer data following limited training. Certain concepts such as histopathology terms remained poorly retrieved. Model performance is maintained when applied to a test cohort, demonstrating good generalisability. Concept-specific thresholding strategy improved performance. Fine-tuning annotations were incorporated into the NLP parent model for future performance. CogStack has been applied to extract data for 50 concepts with validated performance for our entire retrospective HNC cohort.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"41 ","pages":"Article 103805"},"PeriodicalIF":3.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785239","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":"Prognostic Implications of HPV Cell-Free DNA Serial Testing During Follow-Up of p16 Positive Oropharyngeal Squamous Cell Carcinoma After Curative-Intent Treatment","authors":"V. Salati ,&nbsp;M. Adamowicz ,&nbsp;L. McKean ,&nbsp;D. Noble ,&nbsp;D. Srinivasan ,&nbsp;J. MacKenzie ,&nbsp;S. Linton ,&nbsp;C. Callaghan ,&nbsp;C. Robert ,&nbsp;K. Cuschieri ,&nbsp;B. Conn ,&nbsp;A. Hay ,&nbsp;T.J. Aitman ,&nbsp;I.J. Nixon","doi":"10.1016/j.clon.2025.103807","DOIUrl":"10.1016/j.clon.2025.103807","url":null,"abstract":"<div><h3>Introduction</h3><div>Plasma circulating HPV cell-free DNA has high sensitivity and specificity for the detection of HPV-mediated oropharyngeal squamous cell carcinoma. We investigated the clinical significance of serial testing after curative-intent treatments.</div></div><div><h3>Materials and Methods</h3><div>Patients with concordant p16 positive tumour or neck node biopsy and positive high-risk HPV plasma cell-free DNA were prospectively recruited. HPV cell-free DNA were obtained using digital droplet polymerase chain reaction (ddPCR) and were collected at diagnosis and at every clinical follow-up. Three months after completion of curative-intent treatments, patients were stratified according to treatment response on computed tomography. Complete responders (CR) were followed-up clinically, partial responders (PR) underwent further imaging and surgical/medical management if appropriate, patients with progressive disease (PD) received palliative treatments.</div></div><div><h3>Results</h3><div>A hundred and fourteen patients were included and 717 HPV cfDNA ddPCR samples were analysed during a median follow-up of 103 weeks (IQR, 40.2–147.8). Ninety (78.9%) patients were classified as CR, 18 (15.8%) as PR and all except one, who was rapidly diagnosed with PD, had negative HPV ddPCR at 12 weeks follow-up; 6 (5.3%) had PD and all except one had positive HPV ddPCR. Eleven had recurrent disease, 6 in the CR group (6.6%) and 5 among PR (27.7%). Ninety patients had consistently negative HPV ddPCR at all time points and one developed a recurrence (NPV 99%, 95% C.I., 93.2–99.8%). Eighteen patients developed positive HPV ddPCR and 10 developed recurrent disease (PPV 55%, 95% C.I., 38.6–71.4%). Ten patients had two consecutively positive HPV ddPCR and all had proven disease (PPV 100%, 95% C.I., 69.2–100%). Nine patients had transiently positive HPV ddPCR and none developed disease at that time.</div></div><div><h3>Conclusions</h3><div>Post-treatment HPV ddPCR reflected treatment response on imaging and serial testing had high PPV and NPV in detecting recurrent disease.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"41 ","pages":"Article 103807"},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791388","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":"Known Unknowns: Making Sense of Head and Neck Squamous Cell Carcinoma of Unknown Primary","authors":"A. Young ,&nbsp;A. Williamson ,&nbsp;J. Hardman ,&nbsp;V. Paleri ,&nbsp;B. O'Leary","doi":"10.1016/j.clon.2025.103806","DOIUrl":"10.1016/j.clon.2025.103806","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"41 ","pages":"Article 103806"},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143838446","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}