Clinical oncology最新文献

Aims: Following the successful completion of a registry-based evaluation study of patients with extracranial oligometastatic disease or hepatocellular carcinoma treated with stereotactic ablative body radiotherapy (SABR), National Health Service (NHS) England and NHS Improvement funded an implementation and expansion programme in 2020 to increase SABR provision to 51 radiotherapy centres. This report details the integration of structured mentoring and radiotherapy quality assurance (RT QA) as core components for a safe and effective national SABR implementation programme.

Materials and methods: Six members of the UK SABR Consortium developed a framework for effective mentoring that experienced SABR centres could follow to mentor those with limited or no experience. In parallel, the National Radiotherapy Trials Quality Assurance Group delivered an accreditation programme for completion by those centres comprising a facility questionnaire, contouring and planning benchmarks, end-to-end dosimetry audit and individual case review.

Results: Sixteen experienced centres mentored thirty-three new SABR sites, covering a range of techniques and equipment. A large multidisciplinary team of 25 individuals, consisting of clinical oncologists, medical physicists and therapeutic radiographers developed and delivered the RT QA programme. As of April 2025, all centres are accredited for lung, bone and nodes; the programme for the remaining anatomical sites is ongoing. Nearly 24,000 patients have been treated since the NHSE 2020 programme commenced.

Conclusion: This is the first nationally funded programme demonstrating how structured mentorship and RT QA have been beneficial in the safe, effective and timely implementation of SABR services in England. The programme, developed through a multi-professional inter-group collaboration of SABR experts, ensured that radiotherapy centres were trained and supported to deliver consistent, high-quality SABR.

Although retreatment of locoregional recurrence offers a critical window of opportunity for curative intervention, it poses a significant clinical challenge due to its complex nature and the scarcity of high-level evidence to guide optimal treatment. This article provides a clinical perspective on approaches to salvage treatment, emphasising the need for personalised strategies. Key considerations include determining the intent of treatment (curative vs palliative), differentiating between true recurrence and de novo primary tumours, and understanding the impact of previous treatments on salvage options. The role of adjuvant and neoadjuvant systemic therapy is also discussed, highlighting the need for further research in this area.

Aims: Precise patient positioning is critical for successful radiotherapy (RT) in right-sided breast cancer, ensuring adequate tumour coverage while sparing organs at risk (OARs). Conventional tattoo-based setups can cause patient distress. Surface-guided radiotherapy (SGRT) using systems like AlignRT offers a promising, noninvasive alternative. This prospective single-centre study compared the accuracy and reproducibility of SGRT versus conventional tattoo-based positioning for right-sided breast cancer RT.

Materials and methods: Eligible patients underwent a crossover study design, receiving both positioning methods at different points in their treatment. Setup errors were quantified from pretreatment cone-beam computed tomography (CT) registrations. Observations were analysed for each group. Data were analysed using the Shapiro-Wilk test for normality and independent two-sample t-tests to compare positioning errors.

Results: A total of 52 patients were enrolled, and a total of 136 observations were analysed for each group. SGRT positioning resulted in significantly lower mean errors compared to the tattoo-based method across all three directions: longitudinal (P < 0.001), vertical (P < 0.001) and lateral (P = 0.044). Box plot analysis confirmed SGRT had less inter-fraction variability and fewer clinically significant outliers (errors >1 cm), demonstrating superior setup stability.

Conclusions: SGRT with AlignRT provides superior accuracy and reproducibility for patient positioning in right-sided breast cancer RT. This approach enhances treatment precision, reduces setup variability, and improves patient experience by eliminating the need for permanent tattoos. Future studies are warranted to confirm these findings and assess long-term clinical outcomes.

Aims: Effective oncology data management through oncology information systems (OIS) is essential for high-quality cancer care, yet adoption across the Asia-Pacific (APAC) region varies widely. This study benchmarked OIS utilisation, data capture, and integration across APAC to identify gaps and inform targeted improvements.

Materials and methods: A regional survey was distributed to radiotherapy professionals in 19 APAC countries. The questionnaire assessed OIS utilisation, data capture, IT support, training, and system integration. Responses were analysed descriptively and stratified by World Bank income group: low-middle-income countries (L-MIC), upper-middle-income countries (U-MIC), and high-income countries (HIC).

Results: A total of 149 responses were analysed. OIS functionality was limited in L-MICs and U-MICs, with only 34% and 59% of centres, respectively, using OIS beyond basic record-and-verify functions. Basic demographic data such as date of birth (83% L-MIC, 90% U-MIC) and sex at birth (98% L-MIC, 91% U-MIC) were consistently captured, but equity-related data were poorly documented (ethnicity 48% U-MIC, 59% HIC; disadvantaged group status rarely recorded in 78% of L-MICs). Radiotherapy data including treatment site (84% to 98%), intent (77% to 90%), and modality (86% to 95%) were consistently documented. However, the location of data capture varied: radiotherapy data were more frequently entered into OIS structured fields (35% L-MIC/U-MIC, 50% HIC), while demographic and diagnosis data showed lower structured capture in OIS (18% to 24% in L-MICs). Reliance on paper records remained widespread in L-MICs and U-MICs.

Conclusion: Marked disparities in OIS utilisation and data quality exist across APAC. Regional strategies should prioritise comprehensive training and standardised datasets to improve cancer care quality and equity.