Pub Date : 2025-12-06DOI: 10.1016/j.clon.2025.103997
J.M. Callueng , S. Baker , N. Chng , J.P. Abrina , D. Hoegler , D. Petrik , E.M. Dunne , I. Mohamed , R. Halperin , S. Atrchian , A. Lin , A. Ye , F. Hsu , D. Schellenberg , M. Liu , B. Mou
Aims
Single-fraction stereotactic ablative radiotherapy (SF-SABR) was introduced in British Columbia (BC), Canada, during the COVID-19 pandemic. It persists as a standard treatment owing to its comparable outcomes with fractionated regimens in two randomised phase II trials and advantages in resource utilisation and patient convenience. This study evaluated the clinical outcomes and toxicities in patients treated with SF-SABR for early stage non-small lung cancer (NSCLC) in BC.
Materials and methods
This multi-institution population-based retrospective study included all patients treated with SF-SABR for early stage NSCLC between March 2020 and August 2023 in BC. All lesions were peripheral T1-T2 tumours, less than 5 cm in diameter. All patients were medically inoperable or declined surgery. Prescription doses were either 30 Gy or 34 Gy in one fraction. Assessed clinical outcomes included 2-year local failure (LF), distant failure (DF), and overall survival (OS). Toxicity endpoints were graded according to Common Terminology Criteria for Adverse Events version 5.0.
RESULTS
A total of 179 lesions in 166 patients were included. The median follow-up was 23.0 months. The median age was 75 years. The majority (95%) of tumours were T1. The median tumour diameter was 1.5 cm. Prescription doses of 30 Gy and 34 Gy were delivered to 103 (57.5%) and 76 (42.5%) lesions, respectively. The 2-year LF, DF, and OS rates were 7.1%, 14.1%, and 81.5%, respectively. No grade 4 or 5 toxicities were reported. Crude rates of grade 2 and 3 toxicities were 17.3% and 2.2%, respectively. Grade 2 and 3 chest wall toxicity (CWT) rates were 5.6% and 0.6%, respectively. Chest wall abutment, diabetes, and prior thoracic radiation were significant predictors for CWT on univariate analysis.
CONCLUSIONS
This multi-institution population-based study demonstrated that SF-SABR for early stage NSCLC had favourable early clinical outcomes and low toxicity rates comparable to data from other SF-SABR and multi-fraction lung SABR studies. Long-term follow-up of outcomes and toxicity for SF-SABR are warranted.
{"title":"Population-Based Outcomes of Single-Fraction Stereotactic Ablative Radiotherapy for Early Stage Non-small Cell Lung Cancer","authors":"J.M. Callueng , S. Baker , N. Chng , J.P. Abrina , D. Hoegler , D. Petrik , E.M. Dunne , I. Mohamed , R. Halperin , S. Atrchian , A. Lin , A. Ye , F. Hsu , D. Schellenberg , M. Liu , B. Mou","doi":"10.1016/j.clon.2025.103997","DOIUrl":"10.1016/j.clon.2025.103997","url":null,"abstract":"<div><h3><em>Aims</em></h3><div>Single-fraction stereotactic ablative radiotherapy (SF-SABR) was introduced in British Columbia (BC), Canada, during the COVID-19 pandemic. It persists as a standard treatment owing to its comparable outcomes with fractionated regimens in two randomised phase II trials and advantages in resource utilisation and patient convenience. This study evaluated the clinical outcomes and toxicities in patients treated with SF-SABR for early stage non-small lung cancer (NSCLC) in BC.</div></div><div><h3><em>Materials and methods</em></h3><div>This multi-institution population-based retrospective study included all patients treated with SF-SABR for early stage NSCLC between March 2020 and August 2023 in BC. All lesions were peripheral T1-T2 tumours, less than 5 cm in diameter. All patients were medically inoperable or declined surgery. Prescription doses were either 30 Gy or 34 Gy in one fraction. Assessed clinical outcomes included 2-year local failure (LF), distant failure (DF), and overall survival (OS). Toxicity endpoints were graded according to Common Terminology Criteria for Adverse Events version 5.0.</div></div><div><h3>RESULTS</h3><div>A total of 179 lesions in 166 patients were included. The median follow-up was 23.0 months. The median age was 75 years. The majority (95%) of tumours were T1. The median tumour diameter was 1.5 cm. Prescription doses of 30 Gy and 34 Gy were delivered to 103 (57.5%) and 76 (42.5%) lesions, respectively. The 2-year LF, DF, and OS rates were 7.1%, 14.1%, and 81.5%, respectively. No grade 4 or 5 toxicities were reported. Crude rates of grade 2 and 3 toxicities were 17.3% and 2.2%, respectively. Grade 2 and 3 chest wall toxicity (CWT) rates were 5.6% and 0.6%, respectively. Chest wall abutment, diabetes, and prior thoracic radiation were significant predictors for CWT on univariate analysis.</div></div><div><h3>CONCLUSIONS</h3><div>This multi-institution population-based study demonstrated that SF-SABR for early stage NSCLC had favourable early clinical outcomes and low toxicity rates comparable to data from other SF-SABR and multi-fraction lung SABR studies. Long-term follow-up of outcomes and toxicity for SF-SABR are warranted.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"50 ","pages":"Article 103997"},"PeriodicalIF":3.0,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924222","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}
Pub Date : 2025-12-04DOI: 10.1016/j.clon.2025.103993
D.J. Eaton , D.H. Brand , N. Hava , M. Harrison , A. Lopes , P. Manoharan , G. Radhakrishna , S. Shelly , M.A. Hawkins
Aims
The ABC-07 phase II randomised controlled trial (ISRCTN: 10639376) investigated the addition of stereotactic body radiotherapy (SBRT) to systemic chemotherapy in locally advanced biliary tract cancers (BTCs). We report the radiotherapy quality assurance (RTQA) of SBRT treatment plans in the trial.
Materials and methods
RTQA was performed before and during accrual, including benchmark contouring and planning cases, along with prospective independent case review (ICR) of the first three patients from each centre randomised to SBRT. Prescription doses were up to 50 Gy in 5 fractions or up to 67.5 Gy in 15 fractions. Cases were reviewed for segmentation accuracy and plan quality, including target coverage and organ-at-risk (OAR) constraints being met.
Results
Benchmark cases: Six of seventeen contouring submissions required revision (35%), and 6/17 planning submissions were revised after feedback on what was achievable by other centres. Prospective ICR: Thirty-one of forty-one cases from all 12 recruiting centres that were randomised to SBRT underwent review in real-time, and the others were reviewed retrospectively. Eight of these prospectively reviewed cases required revisions during the review process (26%, including 7 contouring and 2 planning revisions). Nineteen of forty-one plans overall (46%) had deviations from trial protocol objectives (even after any revisions), mostly unavoidable target coverage compromise (D95% < 90%) because of proximal OARs such as duodenum (17/41) and stomach (6/41).
Conclusion
Despite rigorous plan QA, we encountered variability in segmentation and plan coverage. The revision rate was reduced between pre-trial and on-trial cases. Radiotherapy doses in the protocol were achievable in many cases; however, target coverage was frequently compromised to maintain OAR dose constraints. Such compromises should be prespecified in future studies.
{"title":"Radiotherapy Plan Quality Assurance in the ABC-07 Trial of Stereotactic Body Radiotherapy for Locally Advanced Biliary Tract Cancer","authors":"D.J. Eaton , D.H. Brand , N. Hava , M. Harrison , A. Lopes , P. Manoharan , G. Radhakrishna , S. Shelly , M.A. Hawkins","doi":"10.1016/j.clon.2025.103993","DOIUrl":"10.1016/j.clon.2025.103993","url":null,"abstract":"<div><h3>Aims</h3><div>The ABC-07 phase II randomised controlled trial (ISRCTN: 10639376) investigated the addition of stereotactic body radiotherapy (SBRT) to systemic chemotherapy in locally advanced biliary tract cancers (BTCs). We report the radiotherapy quality assurance (RTQA) of SBRT treatment plans in the trial.</div></div><div><h3>Materials and methods</h3><div>RTQA was performed before and during accrual, including benchmark contouring and planning cases, along with prospective independent case review (ICR) of the first three patients from each centre randomised to SBRT. Prescription doses were up to 50 Gy in 5 fractions or up to 67.5 Gy in 15 fractions. Cases were reviewed for segmentation accuracy and plan quality, including target coverage and organ-at-risk (OAR) constraints being met.</div></div><div><h3>Results</h3><div>Benchmark cases: Six of seventeen contouring submissions required revision (35%), and 6/17 planning submissions were revised after feedback on what was achievable by other centres. Prospective ICR: Thirty-one of forty-one cases from all 12 recruiting centres that were randomised to SBRT underwent review in real-time, and the others were reviewed retrospectively. Eight of these prospectively reviewed cases required revisions during the review process (26%, including 7 contouring and 2 planning revisions). Nineteen of forty-one plans overall (46%) had deviations from trial protocol objectives (even after any revisions), mostly unavoidable target coverage compromise (D95% < 90%) because of proximal OARs such as duodenum (17/41) and stomach (6/41).</div></div><div><h3>Conclusion</h3><div>Despite rigorous plan QA, we encountered variability in segmentation and plan coverage. The revision rate was reduced between pre-trial and on-trial cases. Radiotherapy doses in the protocol were achievable in many cases; however, target coverage was frequently compromised to maintain OAR dose constraints. Such compromises should be prespecified in future studies.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"50 ","pages":"Article 103993"},"PeriodicalIF":3.0,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908803","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}
Pub Date : 2025-11-29DOI: 10.1016/j.clon.2025.103992
Z Iyizoba-Ebozue, K Njoku, A Fatimilehin, P Mbanu, S Adeleke
{"title":"Disparity in Cancer Screening Among Black and Other Ethnic Minority Groups in the UK.","authors":"Z Iyizoba-Ebozue, K Njoku, A Fatimilehin, P Mbanu, S Adeleke","doi":"10.1016/j.clon.2025.103992","DOIUrl":"https://doi.org/10.1016/j.clon.2025.103992","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":" ","pages":"103992"},"PeriodicalIF":3.0,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793480","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}
Pub Date : 2025-11-29DOI: 10.1016/j.clon.2025.103991
D.M. Favara
{"title":"Weathering the Storm: The Impact of Weather Events, Lockdowns and Holidays on Oncology and General Emergency Presentations to a United Kingdom Tertiary Centre: A 7.5-year Review","authors":"D.M. Favara","doi":"10.1016/j.clon.2025.103991","DOIUrl":"10.1016/j.clon.2025.103991","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"49 ","pages":"Article 103991"},"PeriodicalIF":3.0,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793403","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}
Pub Date : 2025-11-27DOI: 10.1016/j.clon.2025.103989
R G Hikmet, L B J Thorsen, H K Rose, P Rossen, T Baad-Hansen, T B Nyeng, B E Engelmann, N Aggerholm-Pedersen
{"title":"Response to the Letter (CLINONC-2025-990) Regarding Our Study on Functional Outcomes in Extremity Soft Tissue Sarcoma Survivors.","authors":"R G Hikmet, L B J Thorsen, H K Rose, P Rossen, T Baad-Hansen, T B Nyeng, B E Engelmann, N Aggerholm-Pedersen","doi":"10.1016/j.clon.2025.103989","DOIUrl":"https://doi.org/10.1016/j.clon.2025.103989","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":" ","pages":"103989"},"PeriodicalIF":3.0,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773817","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}
Pub Date : 2025-11-27DOI: 10.1016/j.clon.2025.103990
P Díez, R Patel, A Haridass, M Kroiss, C H Clark, M Hussein, R Muirhead, M Q Hatton, A C Tree, J Conibear, G Radhakrishna, K Aitken, C Dean, A Baker, J Lilley, Y M Tsang, C Brooks, N van As, S Mukherjee, K Fell, F McDonald
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.
{"title":"Establishing a National SABR Service: A Model for Safe and Effective Clinical Implementation.","authors":"P Díez, R Patel, A Haridass, M Kroiss, C H Clark, M Hussein, R Muirhead, M Q Hatton, A C Tree, J Conibear, G Radhakrishna, K Aitken, C Dean, A Baker, J Lilley, Y M Tsang, C Brooks, N van As, S Mukherjee, K Fell, F McDonald","doi":"10.1016/j.clon.2025.103990","DOIUrl":"https://doi.org/10.1016/j.clon.2025.103990","url":null,"abstract":"<p><strong>Aims: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":" ","pages":"103990"},"PeriodicalIF":3.0,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780558","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}
Pub Date : 2025-11-25DOI: 10.1016/j.clon.2025.103987
U. Yaseen
{"title":"Reflections on “Radiating Excellence: A Decade of Pioneering Radiotherapy Trials and Collaborative Leadership at Leeds Cancer Research UK Clinical Trials Unit”","authors":"U. Yaseen","doi":"10.1016/j.clon.2025.103987","DOIUrl":"10.1016/j.clon.2025.103987","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"49 ","pages":"Article 103987"},"PeriodicalIF":3.0,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793407","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}
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