Clinical oncology最新文献

{"title":"Real World Multi-centre UK Review of Nivolumab Monotherapy in Metastatic Endometrial Cancer With Mismatch Repair Deficiency During COVID-19","authors":"J. McGrane ,&nbsp;L. Eastlake ,&nbsp;D. Hadjiyiannakis ,&nbsp;S. Lalondrelle ,&nbsp;R. Bowen ,&nbsp;S. Trent ,&nbsp;M. Obeid ,&nbsp;E. Hudson ,&nbsp;R. Agarwal ,&nbsp;S. Gandhi ,&nbsp;T. Young ,&nbsp;R. Kristeleit ,&nbsp;R. Mohammed ,&nbsp;M. Rowe ,&nbsp;S. Dubey ,&nbsp;J. Forrest ,&nbsp;L. Seneviratne ,&nbsp;M. Hussain ,&nbsp;G.J. Melendez-Torres","doi":"10.1016/j.clon.2025.103899","DOIUrl":"10.1016/j.clon.2025.103899","url":null,"abstract":"<div><h3>Introduction</h3><div>Immunotherapy checkpoint inhibition has shown improvement in efficacy and survival in patients with mismatch repair deficient (MMRd) advanced endometrial cancer (mEC) compared to chemotherapy. This is combined with chemotherapy in the first-line setting or as monotherapy in later lines of therapy.</div></div><div><h3>Objective</h3><div>To assess the efficacy, survival and toxicity of nivolumab monotherapy in metastatic endometrial cancer (mEC) in both first and later lines of therapy as used in the NICE COVID-19 systemic anti-cancer (SACT) guidelines.</div></div><div><h3>Methods</h3><div>A multi-centre retrospective review of mEC patients with associated MMRd who received nivolumab as per NICE COVID NG161 at 10 NHS cancer centres. Patient demographics, molecular classification and previous treatments were recorded in addition to treatment responses, duration of response, overall survival, progression-free survival and toxicities. Kaplan-Meier curves analyse the survival data.</div></div><div><h3>Results</h3><div>52 patients were identified. Median age was 67 (37–81) years. 87.5% of patients had endometrioid histology and 75% were oestrogen receptor (ER) positive. 10.4% patients were p53 mutated. 33.3% of mEC patients were stage IV at diagnosis.</div><div>30 (62.5%) patients received nivolumab as first-line mEC therapy. 33 (68.8%) patients received nivolumab 4-weekly. Treatment response was clinician-observed in 34 (70.8%) patients, with 7 (14.5%) more having stable disease.</div><div>52%, 45% and 36% of patients were progression-free at 12, 18 and 24months, respectively. 75%, 55% and 47% of patients were alive at 12, 18 and 24 months.</div><div>There was no significant difference between survival or response whether nivolumab was given in the first line or subsequent lines.</div><div>29 (60.4%) patients have discontinued treatment with 23 (44.2%) being due to progressive disease or death. 18 (37.5%) patients developed G1-2 toxicity, and 3 (6.25%) patients discontinued due to G3 toxicity.</div></div><div><h3>Conclusions</h3><div>This retrospective cohort shows that nivolumab monotherapy has good real-world disease control of mEC patients with MMR deficiency. Toxicity rates were low, and checkpoint monotherapy may be a viable option for selected first-line MMRd mEC patients.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"45 ","pages":"Article 103899"},"PeriodicalIF":3.2,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703717","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 Clinical Decision-Making in Radiotherapy: A Comparative Analysis of Linear-Quadratic LQ and Linear-Quadratic-Linear LQL Dose Models","authors":"C. Voyant ,&nbsp;D. Julian ,&nbsp;S. Muraro ,&nbsp;V. Bodez ,&nbsp;M. Pinpin ,&nbsp;D. Leschi ,&nbsp;R. Oozeer ,&nbsp;G. Wided ,&nbsp;M.-A. Acquaviva ,&nbsp;S. Prapant ,&nbsp;O. Gahbiche ,&nbsp;N. Bouaouina","doi":"10.1016/j.clon.2025.103893","DOIUrl":"10.1016/j.clon.2025.103893","url":null,"abstract":"<div><h3>Aims</h3><div>Radiotherapy is an essential component of cancer treatment, requiring accurate dose planning to optimise tumour control while sparing healthy tissues. This study, originating from a radiobiology workshop held during the <em>27</em>th <em>Congrès National de Cancérologie et de Radiothérapie-2024</em> in Sousse, Tunisia, aims to investigate advanced dose modelling approaches, focussing on the linear-quadratic (LQ) and linear-quadratic-linear (LQL) models, to refine the calculation of biologically effective doses (BED) and improve treatment personalisation.</div></div><div><h3>Methods</h3><div>The workshop brought together experts in the field to discuss and evaluate the latest advancements in dose modelling, providing a comprehensive overview of current best practices and emerging trends. Using tools such as LQL-equiv and other BED calculators, we integrated patient-specific data (eg, fractionation schedules and organ-at-risk (OAR) constraints) to predict outcomes such as normal tissue complication probabilities (NTCPs). Unlike many theoretical studies, our approach embeds these models within a unified interface tailored to real clinical scenarios, enabling practitioners to simulate and adjust treatment plans based on complex, practical constraints.</div></div><div><h3>Results</h3><div>Through a series of clinical case studies (including treatment interruptions, palliative boosts, and re-irradiation scenarios), participant responses were analysed using the Jaccard similarity index, revealing a significant lack of consensus in treatment planning decisions (mean agreement of 25.83%). This variation illustrates the current ambiguity among clinicians regarding which model to use and how to apply it, despite access to advanced tools. This heterogeneity in decision-making could lead to divergent treatment recommendations for patients with clinically similar profiles.</div></div><div><h3>Conclusion</h3><div>While the LQ and LQL models offer promising tools for personalised radiotherapy, their interpretation and implementation remain highly variable. In addition, the question of professional responsibility in dose equivalence calculations emerged as a key issue as many departments lack clearly defined accountability frameworks. This study emphasises the need for standardised guidelines, enhanced training programs, and decision support systems to reduce interobserver variability and ensure effective clinical adoption, ultimately improving patient care. The findings underscore the importance of harmonising predictive modelling practices to achieve more consistent and effective radiotherapy outcomes.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"45 ","pages":"Article 103893"},"PeriodicalIF":3.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654994","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 and Adjuvant Strategies With Conformal Radiotherapy and Surgery in Non-small Cell Lung Cancer With Actionable Mutations.","authors":"T Wu, Z Lu, J Chen","doi":"10.1016/j.clon.2025.103891","DOIUrl":"https://doi.org/10.1016/j.clon.2025.103891","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":" ","pages":"103891"},"PeriodicalIF":3.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567200","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":"United Kingdom and Ireland Oesophagogastric Cancer Group Cancer Update 2024","authors":"H.A. Clements ,&nbsp;M.E. Booth ,&nbsp;C.W. Bleaney ,&nbsp;S.R. Markar ,&nbsp;M.A. Hawkins ,&nbsp;E.C. Smyth ,&nbsp;C.J. Peters ,&nbsp;T.D.L. Crosby ,&nbsp;UK and Ireland Oesophagogastric Cancer Group","doi":"10.1016/j.clon.2025.103889","DOIUrl":"10.1016/j.clon.2025.103889","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"45 ","pages":"Article 103889"},"PeriodicalIF":3.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571670","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":"Tumour-Specific Growth Rate as a Potential Predictor of Outcomes in Oligoprogressive Disease Treated With Stereotactic Body Radiotherapy","authors":"I. Navarro-Domenech ,&nbsp;J. Helou ,&nbsp;S. Kuruvilla Thomas ,&nbsp;L.A. Dawson ,&nbsp;A. Hosni ,&nbsp;S. Raman ,&nbsp;P. Chung ,&nbsp;R. Wong ,&nbsp;R. Glicksman ,&nbsp;P. Lindsay ,&nbsp;J. Javor ,&nbsp;J. Weiss ,&nbsp;A.J. Hope ,&nbsp;A.S. Barry","doi":"10.1016/j.clon.2025.103895","DOIUrl":"10.1016/j.clon.2025.103895","url":null,"abstract":"<div><h3>Aims</h3><div>Growing data suggest a potential progression-free survival advantage with stereotactic body radiotherapy (SBRT) in oligoprogressive disease (OPD). However, optimal candidates remain uncertain. This study aims to investigate tumour-specific growth rate as a potential predictor of outcomes in OPD.</div></div><div><h3>Materials and Methods</h3><div>Patients with ≤5 radiological OPDs were enrolled in a prospective phase II study. SBRT-treated metastases were retrospectively contoured on (1) gross tumour volume (GTV)1—pre-SBRT/baseline computed tomography (CT); (2) GTV2—SBRT planning CT, (3) GTV3—post-SBRT follow-up CT. Specific growth rate for each oligoprogressive lesion (SGR_OP) was calculated according to the literature as (ln(GTVy/GTVx)/t) %/d (t = days). SGR_OP1 was defined as pre-SBRT growth (from SBRT planning CT scan to baseline imaging) and SGR_OP2 as post-SBRT growth (from follow-up CT to planning CT). A high SGR_OP1/2 was defined as one greater than the median SGR_OP1/2 value. The primary endpoint was the impact of SGR1/2 on overall survival (OS) rate, which was estimated using the Kaplan-Meier method and Cox proportional hazards models. Local progression (LP) was progression to the treated lesion, while disease progression (DP) was progression of other nontreated metastases. Cumulative incidence function and Fine-Grey subdistribution hazard models were utilised to estimate progression rates.</div></div><div><h3>Results</h3><div>Thirty-five patients with 55 metastases grouped in gastrointestinal (GI) (40%), genitourinary (GU) (31%), and breast (29%) cancer groups were analysed. The median follow-up was 11.74 months (interquartile range [IQR]: 8.05, 15.65). The median SGR_OP1 and SGR_OP2 value was 0.007 %/d (IQR: 0.004, 0.013) and -0.009 %/d (IQR: -0.014 to 0.002), respectively. Forty-eight percent of patients had high SGR_OP1 (&gt;0.007 %/d). and 50% had high SGR_OP2 (&gt;-0.009 %/d). The 12-month OS rate was 59% (95% confidence interval [CI]: 44.2-78.1), which was significantly lower in the GI group (14% [95% CI: 4-51.5], [<em>P</em> = 0.002]) than in the GU and breast groups. A low SGR_OP1 showed higher rates of OS than high SGR_OP1 (71% vs 47%, <em>P</em> = 0.35).</div></div><div><h3>Conclusion</h3><div>SGR_OP analysis appears to demonstrate a wide range of growth rates within individual cancer group and may allow prediction of patient outcomes independent of histology. Additional validation will be required to confirm if this tool can be used to predict outcomes.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"44 ","pages":"Article 103895"},"PeriodicalIF":3.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549257","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":"The Role of Python in Enhancing Radiotherapy Department Workflow Efficiency and Promoting Open-source Software Utilisation","authors":"R.S. Chauhan ,&nbsp;A. Munshi ,&nbsp;A. Pradhan","doi":"10.1016/j.clon.2025.103897","DOIUrl":"10.1016/j.clon.2025.103897","url":null,"abstract":"<div><h3>Aim</h3><div>This review aims to explore the role of Python in enhancing the efficiency and effectiveness of radiotherapy department workflows and to examine its contribution to the adoption of open-source software (OSS) in healthcare.</div></div><div><h3>Materials and Methods</h3><div>A comprehensive analysis of current research and applications of Python-based tools in radiotherapy was conducted, focussing on automation, data accuracy, and treatment planning optimisation. The review also considered the challenges associated with integrating Python in clinical settings and the solutions proposed to address these issues.</div></div><div><h3>Results</h3><div>Python was found to significantly improve workflow efficiency in radiotherapy by automating complex processes, reducing errors, and facilitating personalised treatment planning. Additionally, Python’s alignment with OSS initiatives has supported the development of adaptable and cost-effective healthcare solutions, despite challenges in data standardisation and interoperability.</div></div><div><h3>Conclusion</h3><div>Python has a transformative impact on radiotherapy practices, driving advancements in workflow efficiency and supporting the adoption of OSS. Addressing existing challenges will be crucial to fully realising the benefits of Python in delivering high-quality, patient-centred care in radiotherapy departments.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"45 ","pages":"Article 103897"},"PeriodicalIF":3.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596733","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 Comparative Study of Initiated Chemotherapy Versus Initiated Surgery Combined with Primary-Radiotherapy in Locoregionally Advanced Hypopharyngeal Carcinoma","authors":"D.-w. Zhao ,&nbsp;H.-y. Jiang ,&nbsp;W.-j. Fan ,&nbsp;L.-l. Meng ,&nbsp;Y.-j. Qu ,&nbsp;G.-b. Ren ,&nbsp;X.-f. Guo ,&nbsp;C.-l. Liu ,&nbsp;B.-n. Cai ,&nbsp;P.-g. Wang ,&nbsp;L. Ma","doi":"10.1016/j.clon.2025.103890","DOIUrl":"10.1016/j.clon.2025.103890","url":null,"abstract":"<div><h3>Background</h3><div>Laryngeal preservation is a pivotal treatment goal in managing locally advanced hypopharyngeal carcinoma (LAHPC). This study compares the outcomes of induction chemotherapy followed by concurrent chemoradiotherapy (IcRT) and surgery followed by radiotherapy or concurrent chemoradiotherapy (SurRT) in patients with LAHPC.</div></div><div><h3>Methods</h3><div>This study included 182 patients with LAHPC treated with either IcRT (n = 137) or SurRT (n = 45). Survival with a functional larynx (SFL), overall survival (OS), progression-free survival (PFS), local failure-free survival (LFFS), locoregional failure-free survival (LRFFS), and distant metastasis-free survival (DMFS) were analyzed. Propensity score matching (PSM) was performed to balance baseline characteristics between the two treatment groups.</div></div><div><h3>Results</h3><div>The IcRT group demonstrated significantly superior 5-yr SFL compared to the SurRT group (50.4% vs. 30.5%, HR 2.38, 95% CI 1.40–4.03, P &lt; 0.001). However, there were no significant differences between the two groups in 5-yr OS (55.2% vs. 56.8%, HR 0.80, P = 0.41), PFS (48.5% vs. 45.7%, HR 0.99, P = 0.99), LFFS (55.1% vs. 57.7%, HR 0.86, P = 0.57), or DMFS (50.2% vs. 42.8%, HR 1.02, P = 0.90), in both pre- and post-PSM analyses. The IcRT group exhibited greater radiation-related toxicities but achieved better local control and distant metastasis rates, while the SurRT group had a lower rate of regional recurrence. T classification and clinical stage were identified as independent prognostic factors for survival outcomes.</div></div><div><h3>Conclusions</h3><div>IcRT may offer enhanced laryngeal preservation compared to SurRT in select patients, albeit with higher acute toxicities. Treatment decisions should prioritize both oncologic outcomes and patient tolerance.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"44 ","pages":"Article 103890"},"PeriodicalIF":3.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549256","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":"Postoperative Circulating Tumour DNA in Predicting Recurrence of Non-small Cell Lung Cancer: A Systematic Review and Meta-analysis","authors":"C. Zhang ,&nbsp;H. Zhao ,&nbsp;Q. Shi","doi":"10.1016/j.clon.2025.103892","DOIUrl":"10.1016/j.clon.2025.103892","url":null,"abstract":"<div><h3>Aims</h3><div>Circulating tumour DNA (ctDNA) has become a noninvasive biomarker for dynamic monitoring of tumours. However, available evidence on postoperative ctDNA in patients with non-small cell lung cancer (NSCLC) is limited. This systematic review and meta-analysis aims to appraise the prognostic value of postoperative ctDNA in NSCLC.</div></div><div><h3>Materials and methods</h3><div>PubMed, Cochrane, Web of Science, and Embase were retrieved until May 20, 2024, to identify potentially eligible studies. The primary outcomes were relapse-free survival (RFS) and overall survival (OS) based on the status of postoperative ctDNA. Subgroup analyses were conducted according to baseline characteristics. Data quality were appraised using the Newcastle-Ottawa scale. The meta-analysis was performed using Stata18.</div></div><div><h3>Results</h3><div>Total of 13 studies on predicting NSCLC recurrence based on postoperative ctDNA were included. According to the meta-analysis, postoperative ctDNA-positive patients had markedly shorter RFS (HR = 6.05, 95% CI: 4.48–8.18, <em>P</em> &lt; 0.01) compared to ctDNA-negative patients. Furthermore, ctDNA-positive patients exhibited a shorter OS (HR = 4.53, 95% CI: 2.56–8.02, <em>P</em> &lt; 0.01) than ctDNA-negative patients.</div></div><div><h3>Conclusion</h3><div>Postoperative ctDNA detection can predict tumour recurrence and overall survival in NSCLC patients.</div></div><div><h3>PROSPERO registration number</h3><div>CRD42024577421.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"44 ","pages":"Article 103892"},"PeriodicalIF":3.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534786","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":"Impact of Geriatric Assessment on Radiotherapy Intensity in Older Patients With Nonmetastatic Cancer: A Multi-institutional Study","authors":"K.N. Murofushi ,&nbsp;S. Kuribayashi ,&nbsp;K. Ohnishi ,&nbsp;S. Hayakawa ,&nbsp;K. Tsuchida ,&nbsp;Y. Inoue ,&nbsp;A. Ohkawa ,&nbsp;T. Ishida ,&nbsp;Y. Machitori ,&nbsp;M. Murakami ,&nbsp;D. Takizawa ,&nbsp;M. Saito","doi":"10.1016/j.clon.2025.103894","DOIUrl":"10.1016/j.clon.2025.103894","url":null,"abstract":"<div><h3>Aims</h3><div>This study prospectively investigated an appropriate geriatric assessment tool for predicting the decisions by radiation oncologists to reduce radiotherapy intensity.</div></div><div><h3>Materials and methods</h3><div>We enrolled patients with nonmetastatic cancer (aged ≥70 years) in this multicenter study. Reduced-intensity radiotherapy implied changes to the irradiation field and/or radiotherapy schedule from the standard based on the primary tumour guidelines. Geriatric assessment was performed by calculating the Geriatric 8 (G8) and Vulnerable Elders Survey (VES-13) scores before radiotherapy and at 3 to 5 and 8 to 16 weeks post radiotherapy. The primary endpoint was to evaluate the correlation between vulnerability, assessed by G8 score, and changes in radiation intensity.</div></div><div><h3>Results</h3><div>Between November 2020 and February 2022, 317 patients from 13 centres in Japan were included in this study. The median patient age was 77 years (range: 70-90 years). The primary cancer sites were the head and neck and oesophagus, lungs, breasts, pancreas, bladder, uterus, and prostate in 63 and 22, 62, 48, 6, 5, 26, and 85 patients, respectively. Reduced intensity of radiotherapy was administered to 31 patients (10%); planned radiotherapy was completed in 312 patients (98%). High-precision radiotherapy was administered to 199 patients (63%). The treatment policy was modified in 87 patients (27%). Among these, 77 patients (89%) underwent a reduction in the intensity of concurrent chemotherapy. Grade 3 or higher acute adverse events were observed in 48 patients (15%), with 26 (54%) requiring inpatient treatment. Before radiotherapy, vulnerability was found in 201 (63.4%) and 61 (19.2%) patients based on G8 and VES-13 assessments, respectively. A multivariate analysis revealed that a reduction in radiation intensity was significantly associated with vulnerability assessed using the VES-13 score (<em>P</em> = 0.03) but not the G8 score (<em>P</em> = 0.63).</div></div><div><h3>Conclusion</h3><div>Geriatric assessment by the G8 score did not predict a reduction in radiation intensity or incompletion in older patients with cancer.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"45 ","pages":"Article 103894"},"PeriodicalIF":3.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144588494","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":"Impact of Nodal Metastatic Volume on Distant Metastasis in Patients with Cervical Cancer and Para-aortic Nodal Metastases Treated With Definitive Radiation Therapy","authors":"H. Uezono ,&nbsp;K. Tsujino ,&nbsp;S. Miyazaki ,&nbsp;M. Marudai ,&nbsp;R. Bessho ,&nbsp;S. Yamaguchi ,&nbsp;Y. Ota","doi":"10.1016/j.clon.2025.103896","DOIUrl":"10.1016/j.clon.2025.103896","url":null,"abstract":"<div><h3>Aims</h3><div>To report institutional outcomes following definitive radiation therapy (RT) for cervical cancer with para-aortic lymph node (PAN) metastasis and explore the risk factors for subsequent distant metastasis (DM) and the optimal elective radiation field.</div></div><div><h3>Material and Methods</h3><div>Ninety-seven patients treated between 2011 and 2023 were evaluated. The median patient age was 60 (range, 29–86) years. The numbers of patients with International Federation of Gynecology and Obstetrics (FIGO) 2008 stages I, II, III, and IVA were 6 (6%), 32 (33%), 43 (44%), and 16 (16%), respectively. Eighty-two patients had squamous cell carcinoma. The median gross tumor volumes of primary (GTVp) and nodal metastasis (GTVn) were 110.4 (range, 20.6–340.7) cm³ and 15.3 (range, 1.0–120.6) cm³, respectively. The median GTVn/GTVp ratio was 12.8%. The elective PAN field margin above the involved node was one vertebral height or less in 68% of the cohort. Extended-field RT was delivered using conventional three-dimensional conformal RT and intensity-modulated RT in 52 and 45 patients, respectively. The median radiation doses to the metastatic and elective regions were 56 and 50 Gy, respectively. Concurrent chemotherapy was administered to 90 (93%) patients.</div></div><div><h3>Results</h3><div>With a median follow-up of 34 (range, 4–143) months, the 3-year in-field recurrence-free survival, DM-free survival, and overall survival rates were 74%, 51%, and 66%, respectively. Patients with a higher GTVn/GTVp ratio had a significantly higher risk of developing DM than their counterparts. Only two (2%) patients developed isolated PAN recurrence outside the irradiated field.</div></div><div><h3>Conclusions</h3><div>DM is the most common mode of recurrence, the risk of which is significantly higher in patients with higher GTVn/GTVp ratios. An ample margin above the involved PAN may not necessarily be required to achieve disease control in the pelvis and PAN.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"45 ","pages":"Article 103896"},"PeriodicalIF":3.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604261","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}