Clinical oncology最新文献

英文中文

UK Cancer Healthcare Professionals Collaborating With Colleagues in Low- and Middle-Income Countries: Mapping the Extent and Nature of Partnerships; Future Implications 英国癌症医疗保健专业人员与中低收入国家同行的合作：绘制合作伙伴关系的范围和性质图；未来影响。

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-05-31 DOI: 10.1016/j.clon.2024.05.015

Aims

In 2020 the UK Global Cancer Network (UKGCN) was formed to unite those in the UK interested in Global Oncology and to strengthen collaborative partnerships with stakeholders working across low- and middle-income countries (LMICs) in cancer health systems, governance, and care. The UKGCN undertook a mapping exercise to document collaborations to inform the UK's global oncology strategy.

Materials and methods

A semi-structured survey was developed and disseminated using a snowball method over ten weeks from February 2021 across the UK's cancer community, to identify individuals and institutions engaged in clinical practice, research, and/or education with partners in LMICs. The survey was sent to individuals in NHS hospitals, charities, universities, other organisations, UKGCN members, and to contacts identified by a literature and web search.

Results

A total of 639 invitations were sent, and 88 responses were received. Results demonstrate a range of collaborative efforts spanning many areas of cancer control: health promotion, prevention, diagnosis and treatment, survivorship, and palliative care. A wide range of countries were represented from Sub-Saharan Africa, South America, the MENA region, China, and South-East Asia. The projects included education and training (146), clinical practice/care (144), and research (226).

Conclusion

This mapping exercise demonstrated considerable UK collaboration with stakeholders in LMICs across all three domains of education, clinical care, and research. The survey results provide an initial framework from which to promote in-depth strategic intelligence on the broad range of activities undertaken by the UK global oncology community. This information has been used as a catalyst to create new partnerships and connect colleagues working in similar geographical settings, encouraging bidirectional learning. The UKGCN will galvanise endeavours to improve equitable access to cancer services globally.

目的：2020 年，英国全球癌症网络（UKGCN）成立，旨在联合英国对全球肿瘤学感兴趣的人士，加强与中低收入国家（LMICs）癌症医疗系统、治理和护理领域利益相关者的合作伙伴关系。英国全球肿瘤学网络进行了一次摸底调查，以记录合作情况，为英国的全球肿瘤学战略提供信息：从 2021 年 2 月起的十周内，我们采用滚雪球的方法在英国癌症界开展了一项半结构式调查，以确定与低收入国家/地区的合作伙伴一起从事临床实践、研究和/或教育的个人和机构。调查对象包括英国国家医疗服务系统（NHS）医院、慈善机构、大学、其他组织、英国癌症研究网络（UKGCN）成员，以及通过文献和网络搜索找到的联系人：结果：共发出 639 份邀请函，收到 88 份回复。结果表明，合作范围涵盖癌症控制的多个领域：健康促进、预防、诊断和治疗、幸存者和姑息治疗。来自撒哈拉以南非洲、南美洲、中东和北非地区、中国和东南亚的众多国家都参与了这些项目。这些项目包括教育和培训（146 个）、临床实践/护理（144 个）和研究（226 个）：此次调查显示，英国与低收入国家的利益相关者在教育、临床护理和研究三个领域都开展了大量合作。调查结果提供了一个初步框架，可据以促进对英国全球肿瘤学界开展的广泛活动进行深入的战略情报分析。这些信息被用作建立新合作伙伴关系的催化剂，并将在相似地理位置工作的同事联系起来，鼓励双向学习。英国全球肿瘤学网络将激励人们努力改善在全球范围内公平获得癌症服务的机会。

{"title":"UK Cancer Healthcare Professionals Collaborating With Colleagues in Low- and Middle-Income Countries: Mapping the Extent and Nature of Partnerships; Future Implications","authors":"","doi":"10.1016/j.clon.2024.05.015","DOIUrl":"10.1016/j.clon.2024.05.015","url":null,"abstract":"<div><h3>Aims</h3><p>In 2020 the UK Global Cancer Network (UKGCN) was formed to unite those in the UK interested in Global Oncology<span> and to strengthen collaborative partnerships with stakeholders working across low- and middle-income countries (LMICs) in cancer health systems, governance, and care. The UKGCN undertook a mapping exercise to document collaborations to inform the UK's global oncology strategy.</span></p></div><div><h3>Materials and methods</h3><p>A semi-structured survey was developed and disseminated using a snowball method over ten weeks from February 2021 across the UK's cancer community, to identify individuals and institutions engaged in clinical practice, research, and/or education with partners in LMICs. The survey was sent to individuals in NHS hospitals, charities, universities, other organisations, UKGCN members, and to contacts identified by a literature and web search.</p></div><div><h3>Results</h3><p>A total of 639 invitations were sent, and 88 responses were received. Results demonstrate a range of collaborative efforts spanning many areas of cancer control: health promotion<span><span>, prevention, diagnosis and treatment, survivorship, and </span>palliative care. A wide range of countries were represented from Sub-Saharan Africa, South America, the MENA region, China, and South-East Asia. The projects included education and training (146), clinical practice/care (144), and research (226).</span></p></div><div><h3>Conclusion</h3><p>This mapping exercise demonstrated considerable UK collaboration with stakeholders in LMICs across all three domains of education, clinical care, and research. The survey results provide an initial framework from which to promote in-depth strategic intelligence on the broad range of activities undertaken by the UK global oncology community. This information has been used as a catalyst to create new partnerships and connect colleagues working in similar geographical settings, encouraging bidirectional learning. The UKGCN will galvanise endeavours to improve equitable access to cancer services globally.</p></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141440268","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}

引用次数: 0

Assessing a Suitable Radiotherapy Utilisation Benchmark for Older Patients With Head and Neck Cancer 为老年头颈癌患者评估合适的放疗利用率基准。

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-05-31 DOI: 10.1016/j.clon.2024.05.014

Aims

To (i) determine the actual radiotherapy utilization (RTU) stratified by age, (ii) develop an age- and co-morbidity adjusted optimal RTU model and (iii) examine the tolerance and toxicity of treatment of older patients with head and neck cancer.

Materials and methods

A retrospective cohort study based on New South Wales Cancer Registry records (2010–2014) linked to radiotherapy data (2010–2015) and admitted patient data (2008–2015) for patients diagnosed with head and neck cancer. We calculated the actual RTU, defined as the proportion of patients who received at least one course of radiotherapy within a year of diagnosis, by age group, including patients aged 80+ years. We also calculated the age and comorbidity-adjusted optimal RTU. For treatment tolerance, the radiotherapy dose for each age group and the completion rate for a seven week 70 Gray (Gy) course of curative intent radiotherapy were computed. The number of emergency department (ED) presentations were used as a surrogate measure of acute treatment toxicity for patients receiving 70 Gy.

Results

Of the 5966 patients diagnosed with head and neck cancer, 814 (13.6%) were aged 80+ years. For all age groups, the actual RTU was less than the optimal RTU. The age- and comorbidity-adjusted optimal RTU for patients aged 80+ was 52% (95% CI: 51%–53%), and the actual RTU was 40% (95% CI: 37%–44%). Only 4.4% of patients aged 80+ received 70 Gy, and the completion rate for a 70 Gy course of radiotherapy for these patients was 92%. The ED presentation rate was similar for all age groups.

Conclusion

The actual RTU was less in the 80+ years patients and across all age groups. Fewer patients in the 80+ group received curative intent schedules compared to the actual RTU rate for younger age groups, despite similar rates of completion of curative intent radiotherapy and acute toxicity.

目的：(i) 确定按年龄分层的实际放射治疗利用率（RTU）；(ii) 建立一个根据年龄和并发症调整的最佳RTU模型；(iii) 研究老年头颈癌患者对治疗的耐受性和毒性：根据新南威尔士州癌症登记记录（2010-2014 年）、放射治疗数据（2010-2015 年）和入院患者数据（2008-2015 年），对确诊为头颈部癌症的患者进行回顾性队列研究。我们按年龄组（包括 80 岁以上的患者）计算了实际 RTU，即在确诊后一年内接受至少一个疗程放疗的患者比例。我们还计算了年龄和合并症调整后的最佳 RTU。在治疗耐受性方面，我们计算了每个年龄组的放疗剂量和为期七周的 70 克瑞（Gy）治愈性放疗疗程的完成率。急诊科（ED）就诊人数被用作接受 70 Gy 治疗的患者急性治疗毒性的替代指标：在 5966 名确诊为头颈部癌症的患者中，有 814 人（13.6%）的年龄在 80 岁以上。在所有年龄组中，实际 RTU 均小于最佳 RTU。经年龄和合并症调整后，80 岁以上患者的最佳 RTU 为 52%（95% CI：51%-53%），实际 RTU 为 40%（95% CI：37%-44%）。只有 4.4% 的 80 岁以上患者接受了 70 Gy 的放疗，这些患者 70 Gy 放疗疗程的完成率为 92%。各年龄组的急诊室就诊率相似：结论：在所有年龄组中，80 岁以上患者的实际 RTU 都较低。结论：尽管治愈性放疗的完成率和急性毒性相似，但与较年轻年龄组的实际 RTU 相比，80 岁以上年龄组接受治愈性放疗的患者较少。

{"title":"Assessing a Suitable Radiotherapy Utilisation Benchmark for Older Patients With Head and Neck Cancer","authors":"","doi":"10.1016/j.clon.2024.05.014","DOIUrl":"10.1016/j.clon.2024.05.014","url":null,"abstract":"<div><h3>Aims</h3><p>To (i) determine the actual radiotherapy utilization (RTU) stratified by age, (ii) develop an age- and co-morbidity adjusted optimal RTU model and (iii) examine the tolerance and toxicity of treatment of older patients with head and neck cancer.</p></div><div><h3>Materials and methods</h3><p>A retrospective cohort study based on New South Wales Cancer Registry records (2010–2014) linked to radiotherapy data (2010–2015) and admitted patient data (2008–2015) for patients diagnosed with head and neck cancer. We calculated the actual RTU, defined as the proportion of patients who received at least one course of radiotherapy within a year of diagnosis, by age group, including patients aged 80+ years. We also calculated the age and comorbidity-adjusted optimal RTU. For treatment tolerance, the radiotherapy dose for each age group and the completion rate for a seven week 70 Gray (Gy) course of curative intent radiotherapy were computed. The number of emergency department (ED) presentations were used as a surrogate measure of acute treatment toxicity for patients receiving 70 Gy.</p></div><div><h3>Results</h3><p>Of the 5966 patients diagnosed with head and neck cancer, 814 (13.6%) were aged 80+ years. For all age groups, the actual RTU was less than the optimal RTU. The age- and comorbidity-adjusted optimal RTU for patients aged 80+ was 52% (95% CI: 51%–53%), and the actual RTU was 40% (95% CI: 37%–44%). Only 4.4% of patients aged 80+ received 70 Gy, and the completion rate for a 70 Gy course of radiotherapy for these patients was 92%. The ED presentation rate was similar for all age groups.</p></div><div><h3>Conclusion</h3><p>The actual RTU was less in the 80+ years patients and across all age groups. Fewer patients in the 80+ group received curative intent schedules compared to the actual RTU rate for younger age groups, despite similar rates of completion of curative intent radiotherapy and acute toxicity.</p></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0936655524002097/pdfft?md5=82e526f012c2de7a0249944d624a1803&pid=1-s2.0-S0936655524002097-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626136","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}

引用次数: 0

Current Management Practices for Endometrial Cancer (EC) in the UK: A National Healthcare Professional Survey (KNOW-EC). 英国子宫内膜癌 (EC) 目前的管理实践：全国医疗保健专业人员调查（KNOW-EC）。

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-05-31 DOI: 10.1016/j.clon.2024.05.017

A George, R A Herbertson, A Stillie, S McCormack, A M Drean, A Wesselbaum, E Hudson, T Miles, N A J Ryan, H Maxwell, L Le Treust, M McCormack

The clinical landscape for endometrial cancer in the UK is evolving to include new management guidelines and targeted treatment options. An understanding of current treatment and management practices in the UK will help services plan and adapt to upcoming changes.

Aim: The purpose of this survey was to understand current and anticipated real-world practices for endometrial cancer care in the UK and potential areas for optimisation.

Materials and methods: Telephone interviews were conducted in November/December 2021 with UK-based healthcare professionals involved in endometrial cancer management. Questions were aligned with the British Gynaecological Cancer Society/European Society for Medical Oncology recommendations, covering the pathway from diagnosis and treatment to follow-up.

Results: A total of 63 healthcare professionals (HCPs) involved in the management of patients with endometrial cancer participated in telephone interviews. The results highlighted variations in management and treatment practices for endometrial cancer and suggest that current UK practice appears to diverge from national and international guidance in some instances. While somatic mismatch repair deficiency testing was used by 89.7% of respondents as mainstream testing, the survey highlighted a lack of access to other key molecular biomarker tests, such as polymerase epsilon (POLE) sequencing (used by only 9.8% of HCPs at the time of the survey).

Conclusion: The results highlighted several perceived practical barriers to the swift adoption of new therapeutic options, including funding access, limited staff, treatment-related resources, staff education, and support. Our findings support the need for better access to biomarkers that could enable more effective and targeted treatments.

英国的子宫内膜癌临床状况正在发生变化，包括新的管理指南和有针对性的治疗方案。了解英国目前的治疗和管理实践将有助于服务部门规划和适应即将到来的变化。目的：本调查旨在了解英国目前和预期的子宫内膜癌治疗的实际实践以及潜在的优化领域：于 2021 年 11 月/12 月对英国参与子宫内膜癌治疗的医护人员进行了电话采访。问题与英国妇科癌症协会/欧洲肿瘤内科学会的建议一致，涵盖了从诊断、治疗到随访的整个过程：共有 63 名参与管理子宫内膜癌患者的医护人员（HCPs）参加了电话访谈。结果表明，子宫内膜癌的管理和治疗方法存在差异，并表明英国目前的做法在某些情况下似乎与国内和国际指南存在偏差。虽然89.7%的受访者将体细胞错配修复缺陷检测作为主流检测方法，但调查强调了其他关键分子生物标记检测方法的缺乏，如聚合酶ε（POLE）测序（调查时仅有9.8%的初级保健医生使用）：调查结果表明，在迅速采用新的治疗方案方面存在一些明显的实际障碍，包括资金获取、人员有限、治疗相关资源、人员教育和支持。我们的研究结果表明，有必要更好地获取生物标记物，以便进行更有效、更有针对性的治疗。

{"title":"Current Management Practices for Endometrial Cancer (EC) in the UK: A National Healthcare Professional Survey (KNOW-EC).","authors":"A George, R A Herbertson, A Stillie, S McCormack, A M Drean, A Wesselbaum, E Hudson, T Miles, N A J Ryan, H Maxwell, L Le Treust, M McCormack","doi":"10.1016/j.clon.2024.05.017","DOIUrl":"https://doi.org/10.1016/j.clon.2024.05.017","url":null,"abstract":"<p><p>The clinical landscape for endometrial cancer in the UK is evolving to include new management guidelines and targeted treatment options. An understanding of current treatment and management practices in the UK will help services plan and adapt to upcoming changes.</p><p><strong>Aim: </strong>The purpose of this survey was to understand current and anticipated real-world practices for endometrial cancer care in the UK and potential areas for optimisation.</p><p><strong>Materials and methods: </strong>Telephone interviews were conducted in November/December 2021 with UK-based healthcare professionals involved in endometrial cancer management. Questions were aligned with the British Gynaecological Cancer Society/European Society for Medical Oncology recommendations, covering the pathway from diagnosis and treatment to follow-up.</p><p><strong>Results: </strong>A total of 63 healthcare professionals (HCPs) involved in the management of patients with endometrial cancer participated in telephone interviews. The results highlighted variations in management and treatment practices for endometrial cancer and suggest that current UK practice appears to diverge from national and international guidance in some instances. While somatic mismatch repair deficiency testing was used by 89.7% of respondents as mainstream testing, the survey highlighted a lack of access to other key molecular biomarker tests, such as polymerase epsilon (POLE) sequencing (used by only 9.8% of HCPs at the time of the survey).</p><p><strong>Conclusion: </strong>The results highlighted several perceived practical barriers to the swift adoption of new therapeutic options, including funding access, limited staff, treatment-related resources, staff education, and support. Our findings support the need for better access to biomarkers that could enable more effective and targeted treatments.</p>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757544","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}

引用次数: 0

RCR Meetings RCR 会议

IF 3.4 3区医学 Q1 Medicine

Clinical oncology

Pub Date : 2024-05-30 DOI: 10.1016/S0936-6555(24)00196-1

引用次数: 0

OncoFlash-Research Updates in a Flash! OncoFlash - 即时研究更新！

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-05-27 DOI: 10.1016/j.clon.2024.05.013

D.J. Hughes , C. Lorimer

引用次数: 0

Dose-Painting Proton Radiotherapy Guided by Functional MRI in Non-enhancing High-Grade Gliomas 在功能磁共振成像引导下对非增强型高级别胶质瘤进行剂量绘制质子放疗

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-05-25 DOI: 10.1016/j.clon.2024.05.011

Aims

This study aimed to demonstrate the feasibility and evaluate the dosimetric effect and clinical impact of dose-painting proton radiotherapy (PRT) guided by functional MRI in non-enhancing high-grade gliomas (NE-HGGs).

Materials and methods

The 3D-ASL and T2 FLAIR MR images of ten patients with NE-HGGs before radiotherapy were studied retrospectively. The hyperintensity on T2 FLAIR was used to generate the planning target volume (PTV), and the high-perfusion volume on 3D-ASL (PTV-ASL) was used to generate the simultaneous integrated boost (SIB) volume. Each patient received pencil beam scanning PRT and photon intensity-modulated radiotherapy (IMRT). There were five plans in each modality: (1) Uniform plans (IMRT60 vs. PRT60): 60Gy in 30 fractions to the PTV. (2)–(5) SIB plans (IMRT72, 84, 96, 108 vs. PRT72, 84, 96, 108): Uniform plan plus additional dose boost to PTV-ASL in 30 fractions to 72, 84, 96, 108 Gy. The dosimetric differences between various plans were compared. The clinical effects of target volume and organs at risk (OARs) were assessed using biological models for both tumor control probability (TCP) and normal tissue complication probability (NTCP).

Results

Compared with the IMRT plan, the D2 and D50 of the PRT plans with the same prescription dose increased by 1.27–4.12% and 0.64–2.01%, respectively; the R30 decreased by > 32%; the dose of brainstem and chiasma decreased by > 27% and >32%; and the dose of normal brain tissue (Br-PTV), optic nerves, eyeballs, lens, cochlea, spinal cord, and hippocampus decreased by > 50% (P < 0.05). The maximum necessary dose was 96GyE to achieve >98% TCP for PRT, and it was 84Gy to achieve >91% TCP for IMRT. The average NTCP of Br-PTV was 1.30% and 1.90% for PRT and IMRT at the maximum dose escalation, respectively. The NTCP values of the remaining OARs approached zero in all PRT plans.

Conclusion

The functional MRI-guided dose escalation using PRT is feasible while sparing the OARs constraints and demonstrates a potential clinical benefit by improving TCP with no or minimal increase in NCTP for tissues outside the PTV. This retrospective study suggested that the use of PRT-based SIB guided by functional MRI may represent a strategy to provide benefits for patients with NE-HGGs.

目的：本研究旨在证明在功能磁共振成像（MRI）引导下对非增强型高级别胶质瘤（NE-HGGs）进行剂量绘制质子放疗（PRT）的可行性，并评估其剂量学效果和临床影响：回顾性研究了10例NE-HGG患者放疗前的3D-ASL和T2 FLAIR MR图像。T2 FLAIR上的高密度用于生成计划靶体积（PTV），3D-ASL（PTV-ASL）上的高灌注体积用于生成同步综合增强（SIB）体积。每位患者都接受了铅笔束扫描放疗（PRT）和光子调强放疗（IMRT）。每种模式有五种计划：（1）统一计划（IMRT60 与 PRT60）：60Gy 分 30 次照射 PTV。(2)-(5) SIB计划（IMRT72、84、96、108 vs. PRT72、84、96、108）：统一计划加上对 PTV-ASL 的额外剂量提升，分 30 次达到 72、84、96、108 Gy。比较了不同计划之间的剂量学差异。使用肿瘤控制概率（TCP）和正常组织并发症概率（NTCP）的生物学模型评估了靶体积和危险器官（OARs）的临床效果：与IMRT计划相比，在处方剂量相同的情况下，PRT计划的D2和D50分别增加了1.27%-4.12%和0.64%-2.01%；R30减少了>32%；脑干和脊髓的剂量分别减少了>27%和>32%；正常脑组织（Br-PTV）、视神经、眼球、晶状体、耳蜗、脊髓和海马的剂量减少了>50%（P<0.05）。PRT达到>98%的TCP所需的最大剂量为96GyE，IMRT达到>91%的TCP所需的最大剂量为84Gy。在最大剂量升级时，PRT 和 IMRT 的 Br-PTV 平均 NTCP 分别为 1.30% 和 1.90%。在所有PRT计划中，其余OAR的NTCP值均接近零：结论：在功能磁共振成像引导下使用 PRT 进行剂量升级是可行的，同时还能避免 OARs 的限制，并通过改善 TCP 而不增加或仅增加极少 PTV 外组织的 NCTP，显示出潜在的临床益处。这项回顾性研究表明，在功能磁共振成像的指导下使用基于 PRT 的 SIB 可能是一种为 NE-HGG 患者带来益处的策略。

{"title":"Dose-Painting Proton Radiotherapy Guided by Functional MRI in Non-enhancing High-Grade Gliomas","authors":"","doi":"10.1016/j.clon.2024.05.011","DOIUrl":"10.1016/j.clon.2024.05.011","url":null,"abstract":"<div><h3>Aims</h3><p>This study aimed to demonstrate the feasibility and evaluate the dosimetric effect and clinical impact of dose-painting proton radiotherapy (PRT) guided by functional MRI in non-enhancing high-grade gliomas (NE-HGGs).</p></div><div><h3>Materials and methods</h3><p>The 3D-ASL and T2 FLAIR MR images of ten patients with NE-HGGs before radiotherapy were studied retrospectively. The hyperintensity on T2 FLAIR was used to generate the planning target volume (PTV), and the high-perfusion volume on 3D-ASL (PTV-ASL) was used to generate the simultaneous integrated boost (SIB) volume. Each patient received pencil beam scanning PRT and photon intensity-modulated radiotherapy (IMRT). There were five plans in each modality: (1) Uniform plans (IMRT60 vs. PRT60): 60Gy in 30 fractions to the PTV. (2)–(5) SIB plans (IMRT72, 84, 96, 108 vs. PRT72, 84, 96, 108): Uniform plan plus additional dose boost to PTV-ASL in 30 fractions to 72, 84, 96, 108 Gy. The dosimetric differences between various plans were compared. The clinical effects of target volume and organs at risk (OARs) were assessed using biological models for both tumor control probability (TCP) and normal tissue complication probability (NTCP).</p></div><div><h3>Results</h3><p>Compared with the IMRT plan, the D2 and D50<span><span> of the PRT plans with the same prescription dose increased by 1.27–4.12% and 0.64–2.01%, respectively; the R30 decreased by > 32%; the dose of brainstem and chiasma decreased by > 27% and >32%; and the dose of normal </span>brain tissue<span> (Br-PTV), optic nerves, eyeballs<span>, lens, cochlea, spinal cord, and hippocampus decreased by > 50% (P < 0.05). The maximum necessary dose was 96GyE to achieve >98% TCP for PRT, and it was 84Gy to achieve >91% TCP for IMRT. The average NTCP of Br-PTV was 1.30% and 1.90% for PRT and IMRT at the maximum dose escalation, respectively. The NTCP values of the remaining OARs approached zero in all PRT plans.</span></span></span></p></div><div><h3>Conclusion</h3><p>The functional MRI-guided dose escalation using PRT is feasible while sparing the OARs constraints and demonstrates a potential clinical benefit by improving TCP with no or minimal increase in NCTP for tissues outside the PTV. This retrospective study suggested that the use of PRT-based SIB guided by functional MRI may represent a strategy to provide benefits for patients with NE-HGGs.</p></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141320685","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}

引用次数: 0

Stereotactic Magnetic Resonance-Guided Daily Adaptive SABR (SMART) for Localised Non-Metastatic Pancreatic Cancer: First Reported Clinical Outcomes From the UK 用于局部非转移性胰腺癌的立体定向磁共振引导的每日适应性 SABR (SMART)：英国首次临床结果报告。

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-05-25 DOI: 10.1016/j.clon.2024.05.012

Aims

Prognosis of locally advanced pancreatic cancer (LAPC) remains poor with limited therapeutic options. Radiation therapy in pancreatic cancer has been restricted by the disease's proximity to radiosensitive organs at risk (OAR). However, stereotactic magnetic resonance-guided adaptive radiation therapy (SMART) has demonstrated promise in delivering ablative doses safely. We sought to report clinical outcomes from a UK-based Compassionate Access Programme that provided access to SMART to patients with LAPC.

Materials and methods

This was a registry retrospective study conducted at a single centre with access to SMART. Patients with LAPC were treated with prescription dose of 40 Gy in 5 fractions. The planning objective was that 98% of PTV received ≥95% of the prescribed dose, prioritising duodenal, stomach and bowel UK SABR consortium constraints. Daily online adaptation was performed using magnetic resonance guidance and on-table re-optimisation. 0–3 months and > 3-month post-treatment-related toxicities, local progression-free survival, metastatic-free survival and overall survival were evaluated.

Results

55 patients were treated with SMART at our institution from 2020 to 2022. Median follow-up from date of diagnosis was 17 months (range 5–37 months). Median age was 69.87% of patients underwent induction chemotherapy. 71% of patients reported 0–1 grade acute toxicity only. No grade >3 acute toxicity was reported. 5 patients (9%) reported a grade 3 toxicity (fatigue, nausea, abdominal pain, duodenal stricture). No grade >3 toxicity after 3 months was reported. 6 (10%) of patients had grade 3 toxicity (fatigue, nausea, abdominal pain, duodenal haemorrhage). Median local PFS post diagnosis was 17 months (95% CI 15.3–18.7). Median OS post diagnosis was 19 months (95% CI 15.9–22.1). One-year local control post SMART was 65%.

Conclusion

This is the first UK-reported experience of MR-guided daily adaptive pancreatic SABR. SMART shows promise in delivering ablative doses with acceptable toxicity rates and good clinical outcomes.

目的：局部晚期胰腺癌（LAPC）的预后仍然不佳，治疗方案有限。胰腺癌的放射治疗一直受到该疾病靠近放射敏感风险器官（OAR）的限制。不过，立体定向磁共振引导的自适应放射治疗（SMART）在安全地提供消融剂量方面已显示出前景。我们试图报告英国一项 "同情获取计划"（Compassionate Access Programme）的临床结果，该计划为LAPC患者提供了接受SMART治疗的机会：这是一项登记在册的回顾性研究，在一家可使用 SMART 的中心进行。LAPC 患者接受了处方剂量为 40 Gy、分 5 次进行的治疗。计划目标是98%的PTV接受≥95%的处方剂量，优先考虑十二指肠、胃和肠英国SABR联盟的限制。利用磁共振引导和台上再优化进行每日在线调整。对治疗后0-3个月和3个月以上的相关毒性反应、局部无进展生存期、无转移生存期和总生存期进行了评估：2020年至2022年，55名患者在我院接受了SMART治疗。自诊断之日起的中位随访时间为17个月（5-37个月）。中位年龄为69.87%的患者接受了诱导化疗。71%的患者仅报告了0-1级急性毒性。没有 >3 级急性毒性的报告。5名患者（9%）报告了3级毒性（疲劳、恶心、腹痛、十二指肠狭窄）。3 个月后，没有出现 3 级以上毒性的报告。6名患者（10%）出现3级毒性（疲劳、恶心、腹痛、十二指肠出血）。确诊后当地中位 PFS 为 17 个月（95% CI 15.3-18.7）。确诊后的中位OS为19个月（95% CI 15.9-22.1）。SMART 后一年的局部控制率为 65%：这是英国首次报道MR引导下的日常适应性胰腺SABR。SMART在提供消融剂量、可接受的毒性率和良好的临床效果方面显示出前景。

{"title":"Stereotactic Magnetic Resonance-Guided Daily Adaptive SABR (SMART) for Localised Non-Metastatic Pancreatic Cancer: First Reported Clinical Outcomes From the UK","authors":"","doi":"10.1016/j.clon.2024.05.012","DOIUrl":"10.1016/j.clon.2024.05.012","url":null,"abstract":"<div><h3>Aims</h3><p>Prognosis of locally advanced pancreatic cancer (LAPC) remains poor with limited therapeutic options. Radiation therapy in pancreatic cancer has been restricted by the disease's proximity to radiosensitive organs at risk (OAR). However, stereotactic magnetic resonance-guided adaptive radiation therapy (SMART) has demonstrated promise in delivering ablative doses safely. We sought to report clinical outcomes from a UK-based Compassionate Access Programme that provided access to SMART to patients with LAPC.</p></div><div><h3>Materials and methods</h3><p>This was a registry retrospective study conducted at a single centre with access to SMART. Patients with LAPC were treated with prescription dose of 40 Gy in 5 fractions. The planning objective was that 98% of PTV received ≥95% of the prescribed dose, prioritising duodenal, stomach and bowel UK SABR consortium constraints. Daily online adaptation was performed using magnetic resonance guidance and on-table re-optimisation. 0–3 months and > 3-month post-treatment-related toxicities, local progression-free survival, metastatic-free survival and overall survival were evaluated.</p></div><div><h3>Results</h3><p>55 patients were treated with SMART at our institution from 2020 to 2022. Median follow-up from date of diagnosis was 17 months (range 5–37 months). Median age was 69.87% of patients underwent induction chemotherapy. 71% of patients reported 0–1 grade acute toxicity only. No grade >3 acute toxicity was reported. 5 patients (9%) reported a grade 3 toxicity (fatigue, nausea, abdominal pain, duodenal stricture). No grade >3 toxicity after 3 months was reported. 6 (10%) of patients had grade 3 toxicity (fatigue, nausea, abdominal pain, duodenal haemorrhage). Median local PFS post diagnosis was 17 months (95% CI 15.3–18.7). Median OS post diagnosis was 19 months (95% CI 15.9–22.1). One-year local control post SMART was 65%.</p></div><div><h3>Conclusion</h3><p>This is the first UK-reported experience of MR-guided daily adaptive pancreatic SABR. SMART shows promise in delivering ablative doses with acceptable toxicity rates and good clinical outcomes.</p></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0936655524001882/pdfft?md5=49f3cd2554f7a0672950d89ca35cf338&pid=1-s2.0-S0936655524001882-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431550","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}

引用次数: 0

United Kingdom and Ireland Oesophagogastric Cancer Group Cancer Update 2023 英国国际OG 癌症最新信息 2023

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-05-24 DOI: 10.1016/j.clon.2024.04.013

引用次数: 0

OncoFlash – Research Updates in a Flash! OncoFlash - 即时研究更新！

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-05-18 DOI: 10.1016/j.clon.2024.05.010

引用次数: 0

Radiology Training for Clinical Oncology Trainees 临床肿瘤学学员的放射学培训

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-05-15 DOI: 10.1016/j.clon.2024.05.008

引用次数: 0

首页上一页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Clinical oncology

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀