Clinical oncology最新文献

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Comment on 'Feasibility Study Exploring the Effect of Pelvic Radiotherapy on the Intestinal Microbiome and Metabolome to Improve the Detection and Management of Gastrointestinal Toxicity'. 评论“探讨盆腔放疗对肠道微生物组和代谢组的影响以改善胃肠道毒性检测和管理的可行性研究”。

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2026-01-22 DOI: 10.1016/j.clon.2026.104060

C Maji, P R Kokiwar, A Biradar, R Jauhari

引用次数: 0

The Relationship Between Prostate Cancer Treatments and Changes to Musculature: A Systematic Review. 前列腺癌治疗与肌肉组织改变的关系：系统综述。

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2026-01-22 DOI: 10.1016/j.clon.2026.104050

L Partridge, A Vickers, D McSweeney, J Shortall, A McWilliam

Aims: The aim of this systematic review is to investigate how androgen deprivation therapy (ADT) and radiotherapy (RT), for men with prostate cancer (PCa), receiving curative intent treatment, affect musculature, and if these changes consequently affect mortality and progression-free survival.

Methods: Embase and Medline were searched via Ovid using appropriate keywords andBoolean operators, between 2014 and 2024. The PRISMA guidelines were followed, and articles were removed if they did not meet inclusion criteria on review. Bias was assessed in line with an established quality assessment tool: the National Institute of Health (2021): Study Quality Assessment Tools.

Results: 509 studies were identified, with eight studies meeting the inclusion criteria. Of these eight studies included in narrative synthesis, 1176 patients were included in total. Despite limitations within individual studies, namely small cohort sizes, some studies identified significant relationships between PCa treatment outcomes and musculature. An indirect relationship was noted between declining skeletal muscle and increased risk of non-cancer death, with one study estimating a 1% decline in skeletal muscle index (SMI) was independently associated with a 9% increase in non-cancer death. Results emphasise the need for consistency in definitions of sarcopenia and further research into the associations between muscle and survival for men with prostate cancer.

Conclusions: The lack of a consistent definition of sarcopenia means studies cannot be directly compared, limiting generalisability of results. The relationship between changes in musculature and ADT and/or radiotherapy stresses the importance of screening for sarcopenia. However, current best practices are not established to provide guidance on how to identify patients for targeted interventions to minimise the risk of increased mortality and decreased quality of life.

目的：本系统综述的目的是研究雄激素剥夺治疗（ADT）和放疗（RT）如何影响前列腺癌（PCa）患者的肌肉组织，以及这些变化是否会影响死亡率和无进展生存期。方法：2014 ~ 2024年通过Ovid检索Embase和Medline，使用合适的关键词和布尔运算符进行检索。遵循PRISMA指南，不符合纳入标准的文章将被删除。根据既定的质量评估工具评估偏倚：美国国立卫生研究院（2021年）：研究质量评估工具。结果：共纳入509项研究，其中8项研究符合纳入标准。在这8项纳入叙事综合的研究中，共纳入1176例患者。尽管个体研究存在局限性，即队列规模较小，但一些研究确定了PCa治疗结果与肌肉组织之间的显著关系。骨骼肌下降与非癌症死亡风险增加之间存在间接关系，一项研究估计骨骼肌指数（SMI）下降1%与非癌症死亡风险增加9%独立相关。结果强调了对肌肉减少症定义的一致性和对前列腺癌患者肌肉与生存之间关系的进一步研究的必要性。结论：缺乏一致的肌少症定义意味着研究不能直接比较，限制了结果的普遍性。肌肉组织变化与ADT和/或放疗之间的关系强调了肌少症筛查的重要性。然而，目前的最佳做法尚未确立，无法为如何确定患者进行有针对性的干预以尽量减少死亡率增加和生活质量下降的风险提供指导。

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引用次数: 0

Breast Cancer Adjuvant Radiotherapy Without Tattoos: Comparison Between Surface Imaging and Four-point Localisation 乳腺癌无文身辅助放疗：表面显像与四点定位的比较。

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2026-01-21 DOI: 10.1016/j.clon.2026.104052

C. Lenci, F. De Felice, M. Tomaciello, R. Caiazzo, S. Arcieri, M. Fantoni, G. Montalto, A.L. Magnante, G. Minniti

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.

目的：精确的患者定位是右侧乳腺癌成功放疗（RT）的关键，确保足够的肿瘤覆盖，同时保留危险器官（OARs）。传统的纹身装置会给病人带来痛苦。使用像AlignRT这样的系统的表面引导放射治疗（SGRT）提供了一种有前途的、无创的替代方案。本前瞻性单中心研究比较了SGRT与传统纹身定位治疗右侧乳腺癌rt的准确性和可重复性。材料和方法：符合条件的患者进行交叉研究设计，在治疗的不同时间点接受两种定位方法。通过预处理锥形束计算机断层扫描（CT）配准来量化设置误差。对每组的观察结果进行分析。数据分析采用夏皮罗-威尔克正态性检验和独立双样本t检验比较定位误差。结果：共纳入52例患者，每组共分析136项观察结果。与基于纹身的方法相比，SGRT定位在纵向（P < 0.001）、纵向（P < 0.001）和横向（P = 0.044）三个方向上的平均误差显著降低。箱形图分析证实，SGRT具有较小的分数间变异性和较少的临床显著异常值（误差>.1 cm），显示出优越的设置稳定性。结论：SGRT联合AlignRT为右侧乳腺癌患者定位提供了更高的准确性和可重复性。这种方法提高了治疗精度，减少了设置的可变性，并通过消除永久纹身的需要改善了患者的体验。未来的研究有必要证实这些发现并评估长期临床结果。

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引用次数: 0

Strengthening Oncology Data Systems for Equitable Care in Asia-Pacific: Current Practices and Future Directions 加强肿瘤学数据系统在亚太地区的公平护理：目前的做法和未来的方向。

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2026-01-21 DOI: 10.1016/j.clon.2026.104051

V. Batumalai , M. Zhou , M. Chilkuri , S. Costello , D. Fraser , S. Ghosh-Laskar , Handoko , A. Liao , A. Teyateeti , G. Xiong , M.L. Yap

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.

目的：通过肿瘤信息系统（OIS）进行有效的肿瘤数据管理对于高质量的癌症治疗至关重要，但亚太地区（APAC）的采用差异很大。本研究对整个亚太地区的OIS利用率、数据捕获和集成进行了基准测试，以确定差距并告知有针对性的改进。材料和方法：对亚太地区19个国家的放射治疗专业人员进行了区域调查。问卷评估了OIS的使用、数据采集、IT支持、培训和系统集成。对反馈进行了描述性分析，并按世界银行收入组进行了分层：中低收入国家（L-MIC）、中高收入国家（U-MIC）和高收入国家（HIC）。结果：共对149份问卷进行分析。OIS功能在l - mic和u - mic中受到限制，分别只有34%和59%的中心在基本的记录和验证功能之外使用OIS。基本的人口统计数据，如出生日期（83%的L-MIC， 90%的U-MIC）和出生性别（98%的L-MIC， 91%的U-MIC）得到了一致的记录，但与公平相关的数据记录很少（种族48%的U-MIC， 59%的HIC； 78%的L-MIC很少记录弱势群体的地位）。放疗数据包括治疗部位（84%至98%）、意图（77%至90%）和方式（86%至95%）均被一致记录。然而，数据捕获的位置各不相同：放疗数据更频繁地进入OIS结构化领域（35% L-MIC/U-MIC, 50% HIC），而人口统计学和诊断数据显示OIS的结构化捕获较低（L-MIC为18%至24%）。在l - mic和u - mic中，对纸质记录的依赖仍然很普遍。结论：亚太地区在OIS利用和数据质量方面存在显著差异。区域战略应优先考虑全面培训和标准化数据集，以提高癌症护理的质量和公平性。

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引用次数: 0

The B-Raf proto-oncogene, serine/threonine kinase (BRAFV600E) Mutation Enhances Age-Based Prognostic Stratification in Radioiodine-Treated Papillary Thyroid Cancer: A Retrospective Cohort Study B-Raf原癌基因丝氨酸/苏氨酸激酶（BRAFV600E）突变增强了放射性碘治疗的乳头状甲状腺癌基于年龄的预后分层：一项回顾性队列研究。

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2026-01-14 DOI: 10.1016/j.clon.2026.104046

H. Ali

引用次数: 0

Bleeding Complications of BRAF Inhibitors BRAF抑制剂的出血并发症

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2026-01-14 DOI: 10.1016/j.clon.2026.104045

G. Gurumurthy , J. Kropidlowska , L. Reynolds , R. Parkar

Targeted inhibition of the mitogen-activated protein kinase (MAPK) pathway with BRAF inhibitors has been crucial in improving outcomes for BRAF-variant melanoma. However, clinically significant bleeding has recently been reported in the literature. Bleeding on BRAF inhibitors is uncommon but heterogeneous. Across trials, any-grade bleeding has been reported. Grade ≥3 events and fatal intracranial haemorrhage are rare but noted. Mechanistically, BRAF inhibitors can paradoxically activate MAPK signalling in the normal endothelium. This destabilises junctions and promotes microvascular leak. In addition, BRAF inhibitors may reduce tissue factor (TF)–dependent procoagulant activity. Management should focus on regimen-specific labelling with general haemorrhage principles. A baseline appraisal of bleeding risk, assessing for central nervous system (CNS) disease and concomitant antithrombotics use, should be undertaken prior to therapy initiation. Patients should be counselled on bleeding symptoms. There is a paucity of evidence in the literature to guide BRAF therapy use in bleeding events. In general, prompt intervention for bleeding events includes local haemostasis control and continuation for low-grade mucosal bleeds. Therapy should be suspended and multidisciplinary care input sought for major and intracranial haemorrhage. Evidence to guide rechallenge is sparse. Resumption after minor events may be reasonable with dose modification and close monitoring, whereas major or intracranial bleeding generally warrants discontinuation unless a compelling oncologic indication exists and multidisciplinary consensus supports cautious reinitiation after shared-decision making.

使用BRAF抑制剂靶向抑制丝裂原活化蛋白激酶（MAPK）通路对于改善BRAF变异性黑色素瘤的预后至关重要。然而，临床上显著的出血最近在文献中有报道。BRAF抑制剂的出血并不常见，但存在异质性。在试验中，任何级别的出血都有报道。≥3级事件和致死性颅内出血很少见，但值得注意。从机制上讲，BRAF抑制剂可以矛盾地激活正常内皮中的MAPK信号。这会破坏连接处的稳定，促进微血管渗漏。此外，BRAF抑制剂可能降低组织因子（TF）依赖性促凝活性。管理应侧重于方案特异性标签与一般出血原则。出血风险的基线评估，评估中枢神经系统（CNS）疾病和伴随的抗血栓药物的使用，应该在治疗开始之前进行。应告知患者出血症状。文献中缺乏指导BRAF治疗出血事件的证据。一般来说，对出血事件的及时干预包括局部止血控制和低级别粘膜出血的持续治疗。对于大出血和颅内出血应暂停治疗并寻求多学科护理投入。指导重新挑战的证据很少。轻微事件后恢复治疗在剂量调整和密切监测下可能是合理的，而大出血或颅内出血通常需要停药，除非存在令人信服的肿瘤指征，并且多学科共识支持在共同决策后谨慎重新开始治疗。

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引用次数: 0

Immune Checkpoint Inhibitor Therapy for Advanced, Unresectable Esophageal Squamous Cell Carcinoma: A Series of Patient-level Meta-analyses From Phase III Trials 免疫检查点抑制剂治疗晚期不可切除食管鳞状细胞癌：来自III期试验的一系列患者水平荟萃分析

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2026-01-07 DOI: 10.1016/j.clon.2026.104032

M.S. Beshr , R.H. Shembesh , M.V. Nounou , M.E. Ali , E.C. Smyth , M. Abdelrahim , F. Pietrantonio , M. Elhadi , M. Moehler

Aim

This study reconstructed patient-level data to provide updated evidence on survival outcomes across PD-L1 expression subgroups.

Materials and Methods

A systematic search was conducted on March 2, 2025, using PubMed, Embase, Web of Science, Cochrane, and Scopus for RCTs comparing ICIs to chemotherapy in advanced ESCC. Kaplan-Meier curves were reconstructed using a time-to-event algorithm for all patients and for PD-L1 subgroups. KMSubtraction was used to retrieve unpublished survival data. A patient-level meta-analysis was performed using a stratified Cox model.

Results

Thirteen phase III trials (6,672 patients) were included. In the first-line setting, patients with TPS <1% (from CheckMate-648 and ESCORT-1st) showed no overall survival (OS) benefit (HR: 0.88, p = 0.187), whereas those with TPS ≥1% from the same trials showed a significant benefit (HR: 0.61, p < 0.001).

For a combined positive score (CPS) ≥10, pooled data from ASTRUM-007, KEYNOTE-590, ORIENT-15, and GEMSTONE-304 showed significant OS benefit (HR: 0.60, p < 0.001). CPS <10 (KEYNOTE-590, ORIENT-15, and GEMSTONE-304) also showed benefit (HR: 0.81, p = 0.02), but no survival benefit was seen in CPS 1–9 (ASTRUM-007 and GEMSTONE-304) (HR: 0.82, p = 0.117).

Conclusion

PD-L1 appears to be a useful biomarker in advanced ESCC. Patients with PD-L1 levels of 10 or higher consistently showed survival benefits. For PD-L1 <10, treatment decisions may be less clear; further research on combining PD-L1 with other biomarkers is needed. Patients with PD-L1 <1 showed minimal benefit and should be informed about the limited efficacy of ICIs.

目的本研究重建了患者水平的数据，为PD-L1表达亚组的生存结果提供最新证据。材料与方法系统检索于2025年3月2日，使用PubMed、Embase、Web of Science、Cochrane和Scopus检索比较ICIs与晚期ESCC化疗的rct。使用时间-事件算法重建所有患者和PD-L1亚组的Kaplan-Meier曲线。使用KMSubtraction检索未发表的生存数据。采用分层Cox模型进行患者水平荟萃分析。结果纳入13项III期试验（6672例患者）。在一线环境中，TPS和lt；1%的患者（来自CheckMate-648和escort -1）没有显示总生存（OS）获益（HR: 0.88, p = 0.187），而来自相同试验的TPS≥1%的患者显示出显著的获益（HR: 0.61, p < 0.001）。对于合并阳性评分(CPS)≥10，来自ASTRUM-007、KEYNOTE-590、ORIENT-15和GEMSTONE-304的汇总数据显示出显著的OS获益（HR: 0.60, p < 0.001）。CPS <10 （KEYNOTE-590、ORIENT-15和GEMSTONE-304）也显示出获益（HR: 0.81, p = 0.02），但CPS 1-9 （ASTRUM-007和GEMSTONE-304）未见生存获益（HR: 0.82, p = 0.117）。结论pd - l1在晚期ESCC中可能是一个有用的生物标志物。PD-L1水平为10或更高的患者始终表现出生存益处。对于PD-L1 <；10，治疗决策可能不太明确；PD-L1与其他生物标志物的联合应用有待进一步研究。PD-L1 <；1患者获益最小，应告知ICIs的有限疗效。

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引用次数: 0

Customized Non-invasive Brachytherapy With Tailored Surface Moulds: An Experience From a Tertiary Care Centre 定制无创近距离治疗与定制表面模具：来自三级护理中心的经验。

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2026-01-07 DOI: 10.1016/j.clon.2026.104033

N. Lall , S. Choudhary , L.M. Aggarwal , A. Mourya , G. Priean V , S. Sachin , G. Bui , D. Nandi , A.K. Jaiswal , R. Ranjan

Aim

Surface mould brachytherapy (SMBT) is an effective non-invasive treatment option for patients with skin cancer and other superficial tumours. We describe the detailed technique of uniquely treated patients of various histology using customized tailor-made surface moulds and evaluated clinical outcomes, toxicity profile, and quality of life of patients treated with SMBT.

Materials and methods

In this retrospective study, we have evaluated nine patients treated with surface moulds using iridium-192-based high-dose-rate brachytherapy.

Results

The median age was 34 years. The histopathological diagnosis included squamous cell carcinoma (n=4), followed by giant cell tumour (n=2), and 1 each of angiosarcoma, dermatofibrosarcoma protuberans, and clear cell sarcoma. The most common radiotherapy dose schedule was 60–66 Gray at 2 Gray per fraction. After a median follow-up of 24 months, local control was 100%. At the end of five years, overall survival (OS) and disease-free survival (DFS) were 88.89%. The maximum acute skin and subcutaneous toxicity grade II was observed in 5 (55.6%) patients and grade III in 4 (44.4%) patients, maximum late toxicity was grade III in 3 (33.3%) patients. Poorer Dermatology Life Quality Index scores were statistically significantly associated with higher overdose index (>0) (P=.039), and V_150% >40% (P=.039).

Conclusion

SMBT is an effective modality to achieve excellent local control in patients of skin and superficial tumours. After five years, OS and DFS both were 88.89%. It was well tolerated with manageable grade II,III acute and late skin toxicities.

目的：表面霉菌近距离放射治疗（SMBT）是一种有效的非侵入性治疗皮肤癌和其他浅表肿瘤的选择。我们描述了使用定制的定制表面模具对不同组织学患者进行独特治疗的详细技术，并评估了SMBT治疗患者的临床结果、毒性特征和生活质量。材料和方法：在这项回顾性研究中，我们评估了9例使用基于铱-192的高剂量近距离放射治疗表面模具的患者。结果：中位年龄34岁。组织病理学诊断为鳞状细胞癌（n=4），其次是巨细胞瘤（n=2），血管肉瘤、隆突性皮肤纤维肉瘤和透明细胞肉瘤各1例。最常见的放疗剂量计划是60-66格雷，每分数2格雷。中位随访24个月后，局部控制率为100%。5年后，总生存期（OS）和无病生存期（DFS）为88.89%。急性皮肤和皮下毒性最大为II级5例（55.6%），III级4例（44.4%），晚期毒性最大为III级3例（33.3%）。较差的Dermatology Life Quality Index评分与较高的用药过量指数（>）（P= 0.039）和V150% >40% （P= 0.039）有统计学意义。结论：SMBT是一种有效的局部控制皮肤及浅表肿瘤的方法。5年后，OS和DFS均为88.89%。耐受性良好，II级、III级急性和晚期皮肤毒性可控。

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引用次数: 0

‘Letter to Editor: Impact of Treatment Decisions on Survival Outcomes in Elderly Patients With Non–small Cell Lung Cancer: A Retrospective Real-World Study’ 致编辑：治疗决定对老年非小细胞肺癌患者生存结果的影响：一项回顾性现实世界研究

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2026-01-07 DOI: 10.1016/j.clon.2026.104030

A. Irfan

引用次数: 0

Authors’ Response to Re-evaluating the 30 Gy Dose for Chest Wall-Abutting Tumours in Single-Fraction Stereotactic Ablative Radiotherapy: Evidence From a Population-Based Study 作者对在单次立体定向消融放疗中重新评估30 Gy胸壁邻近肿瘤剂量的反应：来自人群研究的证据。

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2026-01-07 DOI: 10.1016/j.clon.2026.104031

J.M. Callueng , M. Liu , B. Mou

引用次数: 0

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