Pub Date : 2025-11-08DOI: 10.1016/j.clon.2025.103971
J. Helbrow , M.E. Booth , B. Vadhwana , R. Adams , K.G. Foley , C.J. Peters , R.D. Petty , S. Gwynne
Clinical trials must ensure the quality of both standard and interventional treatments to rigorously evaluate potential benefits, avoid adverse outcomes, and maintain the integrity of results. Quality assurance (QA) endeavours to achieve this and is fundamental to all clinical trial elements, though variation exists between specialties. For radiotherapy (RT) in the UK, the NIHR-funded national Radiotherapy Trials Quality Assurance (RTTQA) group has centralised trial RTQA processes across the RT pathway enabling a robust, consistent, efficient and multidisciplinary approach, replacing piecemeal, trial-by-trial application for QA funding. Meanwhile, the surgical community are moving towards standardised QA processes but has yet to achieve this universally. For SACT, though the importance of QA is recognised, under-reporting persists, and the increasing number and diversity of agents used pose challenges. QA in pathology and radiology is also growing as the complexity of clinical trials increases. Internationally, the EORTC has developed QA processes across domains, but uncertainty and challenges in QA implementation remain. Additionally, while the benefits of trial QA are now recognised, the potential negative effects of QA need to be recognised. Using illustrative examples from contemporary oesophago-gastric cancer studies, we further explore the current status of clinical trial QA across these specialties.
{"title":"Quality Assurance in Multi-Modality Oesophago-Gastric Cancer Clinical Trials: Past, Present and Future Perspectives","authors":"J. Helbrow , M.E. Booth , B. Vadhwana , R. Adams , K.G. Foley , C.J. Peters , R.D. Petty , S. Gwynne","doi":"10.1016/j.clon.2025.103971","DOIUrl":"10.1016/j.clon.2025.103971","url":null,"abstract":"<div><div>Clinical trials must ensure the quality of both standard and interventional treatments to rigorously evaluate potential benefits, avoid adverse outcomes, and maintain the integrity of results. Quality assurance (QA) endeavours to achieve this and is fundamental to all clinical trial elements, though variation exists between specialties. For radiotherapy (RT) in the UK, the NIHR-funded national Radiotherapy Trials Quality Assurance (RTTQA) group has centralised trial RTQA processes across the RT pathway enabling a robust, consistent, efficient and multidisciplinary approach, replacing piecemeal, trial-by-trial application for QA funding. Meanwhile, the surgical community are moving towards standardised QA processes but has yet to achieve this universally. For SACT, though the importance of QA is recognised, under-reporting persists, and the increasing number and diversity of agents used pose challenges. QA in pathology and radiology is also growing as the complexity of clinical trials increases. Internationally, the EORTC has developed QA processes across domains, but uncertainty and challenges in QA implementation remain. Additionally, while the benefits of trial QA are now recognised, the potential negative effects of QA need to be recognised. Using illustrative examples from contemporary oesophago-gastric cancer studies, we further explore the current status of clinical trial QA across these specialties.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"49 ","pages":"Article 103971"},"PeriodicalIF":3.0,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577366","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 : 2025-11-07DOI: 10.1016/j.clon.2025.103967
T. Hope-Johnson , G.B. Prajogi , E. Addison , A. Cameron , B. Chanda M'ule , T. Dembrey , S. Hughes , T.M. Khaled , P.J. Lewis , A. Aggarwal
Aims
Digital learning tools designed to improve radiotherapy contouring skills could help to increase training capacity in low- and middle-income countries (LMICs), where trainees face barriers to learning such as few clinicians and high workloads. Previous efforts to implement software to remotely review radiotherapy plans in LMICs have faced challenges such as poor internet connectivity and insufficient information technology infrastructure. We developed and evaluated a new cloud-based software to support radiotherapy planning, designed specifically for use in lower-resourced settings.
Materials and methods
A cloud-based training software, ‘ACE-RT’, was co-designed with radiotherapy professionals in Ghana, Zambia and the United Kingdom to facilitate remote feedback on contours and form a portfolio to record a clinician's skill development. The co-development involved assessing bandwidth, user interface, and functionality to meet needs in an LMIC setting. The software is noncommercial, designed for educational use. ACE-RT was evaluated by a radiation oncology consultant and trainee in Indonesia between April and September 2023.
Results
The resident successfully uploaded and received feedback on six plans over the evaluation period. Both consultant and trainee found ACE-RT made it easier to provide and receive tailored feedback compared to their previous practice and that the quality of feedback improved. The trainee reported that the quantity of feedback was greater when using ACE-RT. Both found the portfolio function useful, appreciating the educational value of reviewing previous contours. The main implementation barriers identified were poor internet connectivity and the complexity of exporting files from the treatment planning system.
Conclusion
This evaluation of a cloud-based educational portfolio tool to improve training in radiotherapy contouring found it to be feasible, acceptable, and appropriate for use in a resource-limited setting. Unstable internet connectivity was the main barrier identified. Further work is recommended to improve the software’s performance with variable internet speeds and evaluate the implementation in a range of centres.
{"title":"ACE-RT, A Cloud-Based Tool for Remote Radiotherapy Contouring Support in Lower-Resourced Settings: A Pilot Evaluation","authors":"T. Hope-Johnson , G.B. Prajogi , E. Addison , A. Cameron , B. Chanda M'ule , T. Dembrey , S. Hughes , T.M. Khaled , P.J. Lewis , A. Aggarwal","doi":"10.1016/j.clon.2025.103967","DOIUrl":"10.1016/j.clon.2025.103967","url":null,"abstract":"<div><h3>Aims</h3><div>Digital learning tools designed to improve radiotherapy contouring skills could help to increase training capacity in low- and middle-income countries (LMICs), where trainees face barriers to learning such as few clinicians and high workloads. Previous efforts to implement software to remotely review radiotherapy plans in LMICs have faced challenges such as poor internet connectivity and insufficient information technology infrastructure. We developed and evaluated a new cloud-based software to support radiotherapy planning, designed specifically for use in lower-resourced settings.</div></div><div><h3>Materials and methods</h3><div>A cloud-based training software, ‘ACE-RT’, was co-designed with radiotherapy professionals in Ghana, Zambia and the United Kingdom to facilitate remote feedback on contours and form a portfolio to record a clinician's skill development. The co-development involved assessing bandwidth, user interface, and functionality to meet needs in an LMIC setting. The software is noncommercial, designed for educational use. ACE-RT was evaluated by a radiation oncology consultant and trainee in Indonesia between April and September 2023.</div></div><div><h3>Results</h3><div>The resident successfully uploaded and received feedback on six plans over the evaluation period. Both consultant and trainee found ACE-RT made it easier to provide and receive tailored feedback compared to their previous practice and that the quality of feedback improved. The trainee reported that the quantity of feedback was greater when using ACE-RT. Both found the portfolio function useful, appreciating the educational value of reviewing previous contours. The main implementation barriers identified were poor internet connectivity and the complexity of exporting files from the treatment planning system.</div></div><div><h3>Conclusion</h3><div>This evaluation of a cloud-based educational portfolio tool to improve training in radiotherapy contouring found it to be feasible, acceptable, and appropriate for use in a resource-limited setting. Unstable internet connectivity was the main barrier identified. Further work is recommended to improve the software’s performance with variable internet speeds and evaluate the implementation in a range of centres.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"49 ","pages":"Article 103967"},"PeriodicalIF":3.0,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621684","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 : 2025-11-07DOI: 10.1016/j.clon.2025.103973
M. Mehfooz, H. Raza, A. Javed, M. Aslam
{"title":"Cure or Truce? Rethinking Cancer Dormancy in Modern Oncology","authors":"M. Mehfooz, H. Raza, A. Javed, M. Aslam","doi":"10.1016/j.clon.2025.103973","DOIUrl":"10.1016/j.clon.2025.103973","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"49 ","pages":"Article 103973"},"PeriodicalIF":3.0,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145602528","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 : 2025-11-06DOI: 10.1016/j.clon.2025.103970
S. Oka , K. Yoshida , Y. Takefuji
{"title":"Beyond Parametric Boundaries: Rethinking the Distributed Lag Nonlinear Model in Meteorological Modelling for Oncology Emergencies","authors":"S. Oka , K. Yoshida , Y. Takefuji","doi":"10.1016/j.clon.2025.103970","DOIUrl":"10.1016/j.clon.2025.103970","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"49 ","pages":"Article 103970"},"PeriodicalIF":3.0,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577367","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 : 2025-11-05DOI: 10.1016/j.clon.2025.103968
J.V. Waterhouse , A. Holdich , F. Mina , M. Obeid , K. Joshi , S. Barrett , L. Rajakumar , G. McCormick , S. Seymour , P. Koliou , R. Sylva , O. Ayodele , A. Gautam , J. Smith , J. McKeon , T. Strawson-Smith , R. Douglas , A. Borley , A. Konstantis , S. McGrath
Aims
First-line atezolizumab and nab-paclitaxel for patients with advanced triple-negative breast cancer and programmed death-ligand expression ≥1% prolongs progression-free survival (PFS) and overall survival (OS). Toxicities may impact upon quality of life, resulting in treatment discontinuation. This National Service Evaluation aimed to assess safety and efficacy in a “real-world” dataset.
Material and methods
Data from patients treated between March 9, 2019, and March 9, 2022, across 10 UK cancer centres were analysed. Toxicities were recorded conforming to the Common Terminology Criteria for Adverse Events version 5.0 scoring system. Local approval and data sharing agreements were gained. Kaplan–Meier curves for PFS and OS were calculated.
Results
One hundred twenty-nine patients with median age of 55.0 were eligible; 21.7% had de novo metastatic disease and 76.7% received prior neo-/adjuvant treatment. Overall, 85.3% had an adverse event with 7% leading to treatment withdrawal. Of all, 21.7% of patients had grade 3 or 4 AEs, notably decreased neutrophil count (10.1%), pyrexia (2.3%), alanine aminotransferase rise (2.3%), colitis (2.3%), and hepatitis (2.3%). The median PFS was 5 months (95% CI: 1.0, 6.0) and OS was 14 months (95% CI: 3.0, 17.0).
Conclusion
Atezolizumab/nab-paclitaxel toxicity was comparable to the literature; however, PFS and OS were shorter and a higher number of grade ≥3 colitis and hepatitis were noticed.
{"title":"Safety and Efficacy of Atezolizumab in Combination With nab-Paclitaxel in Patients With PD-L1 Positive Metastatic or Locally Advanced Triple-Negative Breast Cancer: A UK-Wide Cancer Centre Experience","authors":"J.V. Waterhouse , A. Holdich , F. Mina , M. Obeid , K. Joshi , S. Barrett , L. Rajakumar , G. McCormick , S. Seymour , P. Koliou , R. Sylva , O. Ayodele , A. Gautam , J. Smith , J. McKeon , T. Strawson-Smith , R. Douglas , A. Borley , A. Konstantis , S. McGrath","doi":"10.1016/j.clon.2025.103968","DOIUrl":"10.1016/j.clon.2025.103968","url":null,"abstract":"<div><h3><em>Aims</em></h3><div>First-line atezolizumab and <em>nab</em>-paclitaxel for patients with advanced triple-negative breast cancer and programmed death-ligand expression ≥1% prolongs progression-free survival (PFS) and overall survival (OS). Toxicities may impact upon quality of life, resulting in treatment discontinuation. This National Service Evaluation aimed to assess safety and efficacy in a “real-world” dataset.</div></div><div><h3><em>Material and methods</em></h3><div>Data from patients treated between March 9, 2019, and March 9, 2022, across 10 UK cancer centres were analysed. Toxicities were recorded conforming to the Common Terminology Criteria for Adverse Events version 5.0 scoring system. Local approval and data sharing agreements were gained. Kaplan–Meier curves for PFS and OS were calculated.</div></div><div><h3><em>Results</em></h3><div>One hundred twenty-nine patients with median age of 55.0 were eligible; 21.7% had <em>de novo</em> metastatic disease and 76.7% received prior neo-/adjuvant treatment. Overall, 85.3% had an adverse event with 7% leading to treatment withdrawal. Of all, 21.7% of patients had grade 3 or 4 AEs, notably decreased neutrophil count (10.1%), pyrexia (2.3%), alanine aminotransferase rise (2.3%), colitis (2.3%), and hepatitis (2.3%). The median PFS was 5 months (95% CI: 1.0, 6.0) and OS was 14 months (95% CI: 3.0, 17.0).</div></div><div><h3><em>Conclusion</em></h3><div>Atezolizumab/<em>nab-</em>paclitaxel toxicity was comparable to the literature; however, PFS and OS were shorter and a higher number of grade ≥3 colitis and hepatitis were noticed.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"49 ","pages":"Article 103968"},"PeriodicalIF":3.0,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577368","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 : 2025-11-05DOI: 10.1016/j.clon.2025.103966
A. Montero , R. Ciervide , B. Alvarez , I. Ratosa , M. Garcia-Aranda , J. Valero , T. Alaverdashvili , X. Chen-Zhao , M. Lopez , L. Alonso , O. Hernando , E. Sánchez , A. Martinez , R. Alonso , P. Fernandez-Leton , C. Rubio
Aims
Data on feasibility and safety of ultra-hypofractionated radiotherapy (UHF-RT) for ductal carcinoma in situ (DCIS) remain limited, particularly regarding its use with a simultaneous integrated boost (SIB).
Materials and methods
This prospective cohort study included 100 women with histologically confirmed DCIS treated between April 2020 and May 2024. Ninety patients underwent breast-conserving surgery, and 10 received postmastectomy radiotherapy due to high-risk features. All patients received UHF-RT to 26 Gy in five fractions, with SIB to 29-32 Gy delivered using three-dimensional conformal radiotherapy or volumetric modulated arc therapy. Acute and late toxicities were assessed per Common Terminology Criteria for Adverse Events, version 5.0, and recurrence-free survival was analysed using Kaplan–Meier estimates.
Results
At a median follow-up of 44 months, all patients were alive and disease-free except one, who experienced in situ recurrence at 31 months and was successfully salvaged. The 48-month actuarial local control rate was 98.8%. Acute toxicity was mostly grade 1 dermatitis (57%) or oedema (10%). No grade ≥3 toxicity was observed. Fat necrosis occurred in 11% of patients, all asymptomatic. Late events included hyperpigmentation (9%), fibrosis (6%), and mild pain (28%). No clinical or dosimetric variables were significantly associated with toxicity.
Conclusion
Ultra-hypofractionated whole-breast radiotherapy with SIB is feasible, safe, and well-tolerated in patients with DCIS, including those at high risk postmastectomy. These findings provide early evidence supporting its use, pending results from ongoing randomised trials.
{"title":"One Week, One Boost, One Goal: Feasibility, Safety and Local Control in Breast Ductal Carcinoma In Situ With Ultra-hypofractionated Radiotherapy and Simultaneous Integrated Boost","authors":"A. Montero , R. Ciervide , B. Alvarez , I. Ratosa , M. Garcia-Aranda , J. Valero , T. Alaverdashvili , X. Chen-Zhao , M. Lopez , L. Alonso , O. Hernando , E. Sánchez , A. Martinez , R. Alonso , P. Fernandez-Leton , C. Rubio","doi":"10.1016/j.clon.2025.103966","DOIUrl":"10.1016/j.clon.2025.103966","url":null,"abstract":"<div><h3><em>Aims</em></h3><div>Data on feasibility and safety of ultra-hypofractionated radiotherapy (UHF-RT) for ductal carcinoma <em>in situ</em> (DCIS) remain limited, particularly regarding its use with a simultaneous integrated boost (SIB).</div></div><div><h3><em>Materials and methods</em></h3><div>This prospective cohort study included 100 women with histologically confirmed DCIS treated between April 2020 and May 2024. Ninety patients underwent breast-conserving surgery, and 10 received postmastectomy radiotherapy due to high-risk features. All patients received UHF-RT to 26 Gy in five fractions, with SIB to 29-32 Gy delivered using three-dimensional conformal radiotherapy or volumetric modulated arc therapy. Acute and late toxicities were assessed per Common Terminology Criteria for Adverse Events, version 5.0, and recurrence-free survival was analysed using Kaplan–Meier estimates.</div></div><div><h3><em>Results</em></h3><div>At a median follow-up of 44 months, all patients were alive and disease-free except one, who experienced <em>in situ</em> recurrence at 31 months and was successfully salvaged. The 48-month actuarial local control rate was 98.8%. Acute toxicity was mostly grade 1 dermatitis (57%) or oedema (10%). No grade ≥3 toxicity was observed. Fat necrosis occurred in 11% of patients, all asymptomatic. Late events included hyperpigmentation (9%), fibrosis (6%), and mild pain (28%). No clinical or dosimetric variables were significantly associated with toxicity.</div></div><div><h3><em>Conclusion</em></h3><div>Ultra-hypofractionated whole-breast radiotherapy with SIB is feasible, safe, and well-tolerated in patients with DCIS, including those at high risk postmastectomy. These findings provide early evidence supporting its use, pending results from ongoing randomised trials.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"49 ","pages":"Article 103966"},"PeriodicalIF":3.0,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577369","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 : 2025-10-25DOI: 10.1016/j.clon.2025.103963
K Datta, A Byrne, D Holland-Hart
Aims: Oesophago-gastric cancers are the fifth most common in the UK. Most patients present with advanced disease and are unsuitable for curative surgery, instead receiving palliative treatment to improve prognosis and symptom burden. Treatment resilience refers to the ability of patients to tolerate their anti-cancer treatment. Palliative chemotherapy can result in significant toxicity; almost 40% of patients are unable to complete their chemotherapy regimen, with this proportion rising significantly in older and frailer patients. Despite most cases occurring in patients over 70, older and frailer patients are often excluded from clinical trials, resulting in limited evidence to guide which patients are most likely to benefit from palliative chemotherapy. This review therefore aimed to appraise evidence regarding treatment resilience to guide clinicians in identifying the most suitable candidates for palliative chemotherapy.
Materials and methods: This study was conducted using modified systematic methods. Search results were limited to articles from the last 10 years. Pretreatment characteristics influencing treatment resilience were assessed, as measured by completion rates, dose reductions and toxicities.
Results: Of the 931 papers returned, 14 reports of 13 studies were included in this review. Factors assessed included age, performance status, frailty, lymphopenia and sarcopenia. Frailty and body composition appear potentially reliable indicators of chemotherapy toxicity. Poor performance status may be a possible indicator of treatment non-completion. There was no clear relationship between treatment resilience and age or lymphopenia.
Conclusion: Although this review was unable to specify patient characteristics to reliably predict patient tolerance of palliative chemotherapy, potential factors were identified. Future research should focus on prospective investigation of these factors to support a precision medicine algorithmic approach by multidisciplinary teams in assessing treatment resilience. Age should not necessarily be a barrier to receiving chemotherapy. Decisions regarding palliative treatment may be guided by these factors as well as patient preference.
{"title":"Factors Affecting Treatment Resilience in Patients With Oesophago-gastric Cancers Undergoing Palliative Chemotherapy: A Rapid Review.","authors":"K Datta, A Byrne, D Holland-Hart","doi":"10.1016/j.clon.2025.103963","DOIUrl":"https://doi.org/10.1016/j.clon.2025.103963","url":null,"abstract":"<p><strong>Aims: </strong>Oesophago-gastric cancers are the fifth most common in the UK. Most patients present with advanced disease and are unsuitable for curative surgery, instead receiving palliative treatment to improve prognosis and symptom burden. Treatment resilience refers to the ability of patients to tolerate their anti-cancer treatment. Palliative chemotherapy can result in significant toxicity; almost 40% of patients are unable to complete their chemotherapy regimen, with this proportion rising significantly in older and frailer patients. Despite most cases occurring in patients over 70, older and frailer patients are often excluded from clinical trials, resulting in limited evidence to guide which patients are most likely to benefit from palliative chemotherapy. This review therefore aimed to appraise evidence regarding treatment resilience to guide clinicians in identifying the most suitable candidates for palliative chemotherapy.</p><p><strong>Materials and methods: </strong>This study was conducted using modified systematic methods. Search results were limited to articles from the last 10 years. Pretreatment characteristics influencing treatment resilience were assessed, as measured by completion rates, dose reductions and toxicities.</p><p><strong>Results: </strong>Of the 931 papers returned, 14 reports of 13 studies were included in this review. Factors assessed included age, performance status, frailty, lymphopenia and sarcopenia. Frailty and body composition appear potentially reliable indicators of chemotherapy toxicity. Poor performance status may be a possible indicator of treatment non-completion. There was no clear relationship between treatment resilience and age or lymphopenia.</p><p><strong>Conclusion: </strong>Although this review was unable to specify patient characteristics to reliably predict patient tolerance of palliative chemotherapy, potential factors were identified. Future research should focus on prospective investigation of these factors to support a precision medicine algorithmic approach by multidisciplinary teams in assessing treatment resilience. Age should not necessarily be a barrier to receiving chemotherapy. Decisions regarding palliative treatment may be guided by these factors as well as patient preference.</p>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":" ","pages":"103963"},"PeriodicalIF":3.0,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145494839","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 : 2025-10-24DOI: 10.1016/j.clon.2025.103964
S. Haider
{"title":"Beyond ECOG: Digital Biomarkers to Redefine Fitness in Elderly NSCLC","authors":"S. Haider","doi":"10.1016/j.clon.2025.103964","DOIUrl":"10.1016/j.clon.2025.103964","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"49 ","pages":"Article 103964"},"PeriodicalIF":3.0,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145476259","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 : 2025-10-20DOI: 10.1016/j.clon.2025.103962
D. Johnston , O. McLaughlin , J. Tee , B.Ó. Kearney , G.M. Walls , C. Thompson , G. Calvert , T. Flannery , J. Harney , D. Conkey , C.K. McGarry
Aims
Stereotactic radiosurgery (SRS) has been adopted as an important component of brain metastasis management. Appropriate patient selection and prognostication can prove to be challenging. We set out to analyse SRS outcomes at our tertiary referral centre in order to validate a novel prognostic tool, the Royal Marsden Hospital SRS Survival Score (RMH-SSS), using this independent data set.
Materials and methods
Patients treated with brain SRS at a regional referral centre between 2017 and 2023 were identified. Records were reviewed for details regarding demographics, primary tumour type and systemic therapy, and SRS treatment planning. The RMH-SSS was calculated, based on age, performance status, number and volume of brain metastases, the presence of extracranial disease, primary tumour histology, and molecular subtype. Kaplan-Meier time-to event analyses were undertaken according to prospectively defined clinically relevant strata.
Results
Outcomes for 242 patients with 421 metastases were analysed. All treatments were delivered by frameless LINAC-based SRS. Ten patients had radiological evidence of radionecrosis identified on magnetic resonance imaging (MRI). Median overall survival (mOS) was 15.4 months. A higher RMH-SSS was associated with improved mOS (score: 6-11 vs 0-2, hazard ratio = 0.22, 95% confidence interval [CI] = 0.14-0.36, P=<0.001).
Conclusion
RMH-SSS had prognostic value in assessment of overall survival in this external, validatory cohort comprising contemporary SRS treatment and therefore may inform patient selection for brain SRS in the clinic.
目的：立体定向放射外科（SRS）已成为脑转移治疗的重要组成部分。适当的患者选择和预测是具有挑战性的。我们开始分析我们三级转诊中心的SRS结果，以验证一种新的预后工具，即皇家马斯登医院SRS生存评分（RMH-SSS），使用这一独立数据集。材料和方法：选取2017年至2023年间在区域转诊中心接受脑SRS治疗的患者。回顾了有关人口统计学、原发肿瘤类型和全身治疗以及SRS治疗计划的详细记录。RMH-SSS是根据年龄、运动状态、脑转移的数量和体积、颅外疾病的存在、原发性肿瘤组织学和分子亚型来计算的。Kaplan-Meier时间-事件分析根据前瞻性定义的临床相关层进行。结果：对242例421例转移患者的预后进行了分析。所有治疗均采用基于linac的无框SRS。10例患者在磁共振成像（MRI）上发现放射性坏死的放射学证据。中位总生存期（mOS）为15.4个月。较高的RMH-SSS与改善的mOS相关(评分：6-11 vs 0-2，风险比= 0.22,95%置信区间[CI] = 0.14-0.36， P=结论：RMH-SSS在评估包括当代SRS治疗在内的外部验证队列的总生存率方面具有预后价值，因此可以为临床患者选择脑SRS提供信息。
{"title":"External Validation of the Royal Marsden Hospital Stereotactic Radiosurgery Survival Score for Patients With Brain Metastases Treated With Stereotactic Radiosurgery","authors":"D. Johnston , O. McLaughlin , J. Tee , B.Ó. Kearney , G.M. Walls , C. Thompson , G. Calvert , T. Flannery , J. Harney , D. Conkey , C.K. McGarry","doi":"10.1016/j.clon.2025.103962","DOIUrl":"10.1016/j.clon.2025.103962","url":null,"abstract":"<div><h3>Aims</h3><div>Stereotactic radiosurgery (SRS) has been adopted as an important component of brain metastasis management. Appropriate patient selection and prognostication can prove to be challenging. We set out to analyse SRS outcomes at our tertiary referral centre in order to validate a novel prognostic tool, the Royal Marsden Hospital SRS Survival Score (RMH-SSS), using this independent data set.</div></div><div><h3>Materials and methods</h3><div>Patients treated with brain SRS at a regional referral centre between 2017 and 2023 were identified. Records were reviewed for details regarding demographics, primary tumour type and systemic therapy, and SRS treatment planning. The RMH-SSS was calculated, based on age, performance status, number and volume of brain metastases, the presence of extracranial disease, primary tumour histology, and molecular subtype. Kaplan-Meier time-to event analyses were undertaken according to prospectively defined clinically relevant strata.</div></div><div><h3>Results</h3><div>Outcomes for 242 patients with 421 metastases were analysed. All treatments were delivered by frameless LINAC-based SRS. Ten patients had radiological evidence of radionecrosis identified on magnetic resonance imaging (MRI). Median overall survival (mOS) was 15.4 months. A higher RMH-SSS was associated with improved mOS (score: 6-11 vs 0-2, hazard ratio = 0.22, 95% confidence interval [CI] = 0.14-0.36, <em>P</em>=<0.001).</div></div><div><h3>Conclusion</h3><div>RMH-SSS had prognostic value in assessment of overall survival in this external, validatory cohort comprising contemporary SRS treatment and therefore may inform patient selection for brain SRS in the clinic.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"48 ","pages":"Article 103962"},"PeriodicalIF":3.0,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145457803","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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