Clinical oncology最新文献

{"title":"Oncoflash – Research Updates in a Flash!","authors":"S. Parikh , 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":"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":"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":"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":"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}

{"title":"Artificial Intelligence in Health Care: A Rallying Cry for Critical Clinical Research and Ethical Thinking","authors":"S.M. Bentzen","doi":"10.1016/j.clon.2025.103798","DOIUrl":"10.1016/j.clon.2025.103798","url":null,"abstract":"<div><div>Artificial intelligence (AI) will impact a large proportion of jobs in the short to medium term, especially in the developed countries. The consequences will be felt across many sectors including health care, a critical sector for implementation of AI tools because glitches in algorithms or biases in training datasets may lead to suboptimal treatment that may negatively affect the health of an individual. The stakes are obviously higher in case of potentially life-threatening diseases such as cancer and therapies with a potential for causing severe or even fatal adverse events.</div><div>Over the last two decades, much of the research on AI in health care has focussed on diagnostic radiology and digital pathology, but a solid body of research is emerging on AI tools in the radiation oncology workflow. Many of these applications are relatively uncontroversial, although there is still a lack of evidence regarding effectiveness rather than efficiency, and—the ultimate bar—evidence of clinical utility. Proponents of AI will argue that these algorithms should be implemented with robust human supervision. One challenge here is the deskilling effect associated with new technologies. We will become increasingly dependent on the AI tools over time, and we will become less capable of assessing the quality of the AI output.</div><div>Much of this research appears almost old-fashioned in view of the rapid advances in Generative artificial intelligence (GenAI). GenAI can draw from multiple types of data and produce output that is personalised and appears relevant in the given context. Especially the rapid progress in large language models (LLMs) has opened a wide field of potential applications that were out of bounds just a few years ago. One LLM, Generative Pre-trained Transformer 4 (GPT-4), has been made widely accessible to end-users as ChatGPT-4, which passed a rigorous Turing test in a recent study. In this viewpoint, I argue for the necessity of independent academic research to establish evidence-based applications of AI in medicine. Algorithmic medicine is an intervention similar to a new drug or a new medical device. We should be especially concerned about under-represented minorities and rare/atypical clinical cases that may drown in the petabyte-sized training sets. A huge educational push is needed to ensure that the end-users of AI in health care understand the strengths and weaknesses of algorithmic medicine. Finally, we need to address the ethical boundaries for where and when GenAI can replace humans in the relation between patients and healthcare providers.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"41 ","pages":"Article 103798"},"PeriodicalIF":3.2,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143758966","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":"Sexual Dysfunction in Prostate Cancer Patients According to Disease Stage and Treatment Modality","authors":"W. Kinnaird ,&nbsp;P. Schartau ,&nbsp;M. Kirby ,&nbsp;V. Jenkins ,&nbsp;S. Allen ,&nbsp;H. Payne","doi":"10.1016/j.clon.2025.103801","DOIUrl":"10.1016/j.clon.2025.103801","url":null,"abstract":"<div><h3>Aims</h3><div>To investigate physical and psychological sexual dysfunction (SD) in prostate cancer (PCa) patients, according to disease stage and treatment modality.</div></div><div><h3>Materials and methods</h3><div>Participants diagnosed with PCa completed an online survey reporting sexual side effects across 13 domains, the importance of sexual function, and their support needs. Disease stage and treatment data were collected to identify variations in experience. Results were analysed descriptively and with chi-squared significance testing.</div></div><div><h3>Results</h3><div>Six hundred fifty-four participants diagnosed with localised (66.1%), locally advanced (25.1%), and advanced (8.9%) PCa responded to the survey. Their disease management included radical prostatectomy (RP; 49.7%), radiotherapy (RT; 45.9%), and androgen deprivation therapy (ADT; 43.6%). More than 98% reported new-onset post-treatment sexual problems. The most common physical dysfunctions were erectile dysfunction (ED; 91.0%), ejaculatory disturbance (82.9%), and anatomical penile change (70.0%). The most common psychosexual dysfunctions were loss of sexual confidence (76.2%), loss of sex drive (67.1%), and loss of self-esteem (57.1%). Participants diagnosed with advanced disease were significantly more likely to report SD than participants with localised or locally advanced disease in 5 of 13 domains (p &lt; .05). Participants whose treatment included a combination of RP, RT, and ADT were most likely to report SD in 7 of 13 domains. Overall, 78.3% of participants said sexual activity was important to them, with 61.8% placing sexual problems in their top three current concerns. Furthermore, 78.3% wanted to discuss sexual problems with a healthcare professional, with most wishing to focus on ED, loss of sexual confidence, and low libido.</div></div><div><h3>Conclusion</h3><div>SD is a common, wide-ranging, and distressing side effect of treatment, and PCa survivors place a high level of importance on sexual recovery. Those with advanced disease are among the worst affected and report high levels of psychosexual problems. Holistic rehabilitation strategies addressing a broad range of side effects would benefit all, but particularly those treated with permanent ADT.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"41 ","pages":"Article 103801"},"PeriodicalIF":3.2,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686937","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":"Age-Specific Socioeconomic Inequalities in Treatment in Patients with Stage III Colon Cancer in England 2012–2016: A Population-Based Study with Mediation Analysis","authors":"B. Kells,&nbsp;B. Rachet,&nbsp;S. Ling","doi":"10.1016/j.clon.2025.103799","DOIUrl":"10.1016/j.clon.2025.103799","url":null,"abstract":"<div><h3>Aims</h3><div>It is unclear whether inequalities in guidelines-recommended treatment among patients with stage III colon cancer existed and differed by age in England.</div></div><div><h3>Materials and methods</h3><div>Using data from cancer registry in England between 2012 and 2016, we included all patients with stage III colon cancer and applied multivariable multinominal logistic regression, including an interaction between age and deprivation, to investigate age-specific socioeconomic inequalities in receipt of the NICE-recommend treatment – surgery combined with adjuvant chemotherapy. We also examined the mediating roles of tumour factors on the inequalities in treatment.</div></div><div><h3>Results</h3><div>Among 20,368 included patients, socioeconomic inequalities in receipt of the NICE-recommend treatment were observed at all ages but wider in patients aged between 65 and 85 years old. For a 70-year-old patient, the probability of receiving the NICE-recommend treatment was 70.8% (95% CI: 68.6, 73.1) for the least vs. 59.4% (53.7, 65.1) for the most deprived quintile. When both groups were unlikely to receive the NICE-recommended treatment (85+ years old), patients from less deprived areas had a higher probability of receiving some alternative treatments like surgery while those with the most deprived backgrounds received none. Tumour factors explained little of inequalities in receipt of surgery or adjuvant chemotherapy.</div></div><div><h3>Conclusion</h3><div>Patients from deprived areas tended to receive inferior treatment options, and tumour factors explained little of these inequalities. Guidelines need to ensure that the NICE-recommended treatment modality is available to all to reduce the survival gap.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"41 ","pages":"Article 103799"},"PeriodicalIF":3.2,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791389","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}