Clinical oncology最新文献

{"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":"Expanding PARP Inhibitor Use in Prostate Cancer Beyond DNA Repair Defects","authors":"A.F. Palma dos Reis ,&nbsp;L.G. Faulkner ,&nbsp;I.W. Lai ,&nbsp;H. Dev ,&nbsp;S. Pacey","doi":"10.1016/j.clon.2025.103804","DOIUrl":"10.1016/j.clon.2025.103804","url":null,"abstract":"<div><h3>Background</h3><div>Prostate cancer (PCa) is the most common malignancy among men in the Western world and a leading cause of cancer-related mortality. Despite advances in molecularly targeted therapies for other cancers, their application in PCa remains limited, underscoring the need for more effective personalised treatments, particularly after progression following taxane-based chemotherapy. Targeted therapies are also less toxic, offering a crucial advantage for the older and frailer PCa population.</div></div><div><h3>Aims</h3><div>Poly(ADP-ribose)polymerase inhibitors (PARPi) are currently approved for PCa with DNA repair defects, which represent less than 25% of cases. Recent clinical studies suggest that combining PARPi with androgen receptor signalling inhibitors (ARSI) may extend benefits to a broader cohort, beyond those with established DNA repair deficiencies. This review aims to summarise current evidence to inform research and clinical practice.</div></div><div><h3>Materials and Methods</h3><div>Relevant publications were reviewed using PubMed, EMBASE, and Medline, focusing on the genetic landscape of PCa, PARPi mechanism of action, and pre-clinical and clinical data on PARPi use in PCa.</div></div><div><h3>Results</h3><div>PARPi/ARSI combinations elicit variable responses. BRCA-mutated PCa demonstrates consistently better outcomes, while PCa with other homologous repair defects (HRD) shows lower benefits. The benefit for non-HRD cohorts remains controversial, and may be confined to specific subsets.</div></div><div><h3>Conclusions</h3><div>The therapeutic potential must be weighed against the increased toxicity of combination therapies. Future efforts should focus on developing more tolerable PARPi, optimising combination strategies, refining diagnostic approaches for evaluating DNA repair deficiencies, and identifying molecular pathways driving PARPi response in PCa.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"44 ","pages":"Article 103804"},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501861","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}

{"title":"OncoFlash - Research Updates in a Flash!","authors":"A. Turcas ,&nbsp;K. Thippu Jayaprakash","doi":"10.1016/j.clon.2025.103803","DOIUrl":"10.1016/j.clon.2025.103803","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"40 ","pages":"Article 103803"},"PeriodicalIF":3.2,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662966","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":"Optimising HER2-positive Breast Cancer Treatment: Insights on Subcutaneous Pertuzumab-trastuzumab Transition","authors":"S. Surekha ,&nbsp;A.K. Lamiyan ,&nbsp;P. Khatri ,&nbsp;A.N. Patil","doi":"10.1016/j.clon.2025.103802","DOIUrl":"10.1016/j.clon.2025.103802","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"41 ","pages":"Article 103802"},"PeriodicalIF":3.2,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704538","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}