Pub Date : 2025-12-24DOI: 10.1016/j.clon.2025.104009
NBOCA Project Team, A. Rashid , S. Cook , K. Darley , A. Kuryba , L. Watton , O. Almilaji , N. Fearnhead , M. Braun , J. van der Meulen , K. Walker
{"title":"National Reporting of Bowel Cancer Care by the National Bowel Cancer Audit (NBOCA) Supports Hospital Teams to Improve care and Outcomes","authors":"NBOCA Project Team, A. Rashid , S. Cook , K. Darley , A. Kuryba , L. Watton , O. Almilaji , N. Fearnhead , M. Braun , J. van der Meulen , K. Walker","doi":"10.1016/j.clon.2025.104009","DOIUrl":"10.1016/j.clon.2025.104009","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"50 ","pages":"Article 104009"},"PeriodicalIF":3.0,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975266","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 : 2025-12-18DOI: 10.1016/j.clon.2025.104004
K. Mackay , K. Banfill , D. Bernstein , J. Daniel , P. Diez , S. Gwynne , A. Hoole , R. Jena , T. Marchant , M. Nix , G. Price , M. Teo , I. Boon , S. Hindocha , J. Wang , K. Zucker , A. Taylor
Auto-contouring systems are rapidly becoming more widely used for radiotherapy treatment planning. There is an acknowledged need for formal guidance to help healthcare professionals understand how to safely adopt this technology. The Royal College of Radiologists Artificial Intelligence in Clinical Oncology working group established a multi-disciplinary group of national experts in artificial intelligence and radiotherapy quality assurance (QA). This group has produced consensus recommendations for the safe use of the technology. These include model selection, clinical commissioning, day-to-day QA, and post-implementation monitoring. Other factors such as the impact on the multi-disciplinary team, education, and training are also considered.
The healthcare professional approving auto-contours for use will have overall responsibility, and it is therefore of utmost importance that they have a good understanding of the risks of auto-contouring and how contours should be assessed to mitigate these risks. This guidance aims to enable healthcare professionals acting as operators of a medical device to understand what they need to know about auto-contouring, to facilitate safe adoption of this technology.
{"title":"Royal College of Radiologists Guidance Statements on the Use of Auto-contouring in Radiotherapy","authors":"K. Mackay , K. Banfill , D. Bernstein , J. Daniel , P. Diez , S. Gwynne , A. Hoole , R. Jena , T. Marchant , M. Nix , G. Price , M. Teo , I. Boon , S. Hindocha , J. Wang , K. Zucker , A. Taylor","doi":"10.1016/j.clon.2025.104004","DOIUrl":"10.1016/j.clon.2025.104004","url":null,"abstract":"<div><div>Auto-contouring systems are rapidly becoming more widely used for radiotherapy treatment planning. There is an acknowledged need for formal guidance to help healthcare professionals understand how to safely adopt this technology. The Royal College of Radiologists Artificial Intelligence in Clinical Oncology working group established a multi-disciplinary group of national experts in artificial intelligence and radiotherapy quality assurance (QA). This group has produced consensus recommendations for the safe use of the technology. These include model selection, clinical commissioning, day-to-day QA, and post-implementation monitoring. Other factors such as the impact on the multi-disciplinary team, education, and training are also considered.</div><div>The healthcare professional approving auto-contours for use will have overall responsibility, and it is therefore of utmost importance that they have a good understanding of the risks of auto-contouring and how contours should be assessed to mitigate these risks. This guidance aims to enable healthcare professionals acting as operators of a medical device to understand what they need to know about auto-contouring, to facilitate safe adoption of this technology.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"50 ","pages":"Article 104004"},"PeriodicalIF":3.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923785","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 : 2025-12-18DOI: 10.1016/j.clon.2025.104005
Y. Yanthan , L. Pandey , A. Pandey , R. Pasricha , D. Joseph , S. Gupta , A. Sehrawat , A. Dhyani , M. Gupta
Aims
Concurrent cisplatin-based chemoradiotherapy (CCRT) is the standard treatment for locally advanced head and neck cancer (LAHNC); however, it also results in substantial treatment-related toxicities. Oxaliplatin has similar radiosensitisation mechanisms to cisplatin and, if found to have equivalent efficacy in LAHNCs, has the potential to replace cisplatin in CCRT protocols.
Materials and methods
This prospective trial compared weekly oxaliplatin 50 mg/m2 to weekly cisplatin 40mg/m2 in CCRT protocols for the treatment of non-nasopharyngeal LAHNCs. The primary endpoint was to compare the toxicity profile; secondary endpoints were compliance, locoregional control (LRC), disease-free survival (DFS), and overall survival (OS).
Results
Between January 2019 and June 2020, we randomly assigned 70 LAHNC patients, 35 in each arm, to receive radical CCRT. At a median follow-up of 18 months (range: 3-72), acute toxicities of grade 3 or higher occurred in 31% of patients in the oxaliplatin arm and 77% of patients in the cisplatin arm (P = 0.007). The estimated 3-year LRC, DFS, and OS in the oxaliplatin and cisplatin arms were 32.3% vs 35.9%, 28.7% vs 35.9% and 35.1% vs 37.3%, respectively, while the 5-year LRC, DFS, and OS were 32.3% vs 32.4%, 28.7% vs 28.8%, and 31.2% vs 30.5%, respectively. The absolute differences observed were not statistically significant.
Conclusion
The CCRT with oxaliplatin in non-nasopharyngeal LAHNC exhibits a better toxicity profile and appears comparable to cisplatin in terms of disease control. It may be worthwhile exploring this approach in a larger trial to gather LRC and survival data.
{"title":"Phase II Open-Label Randomised Controlled Trial Comparing Oxaliplatin and Cisplatin Based Concurrent Chemoradiotherapy in Locally Advanced Head and Neck Cancers","authors":"Y. Yanthan , L. Pandey , A. Pandey , R. Pasricha , D. Joseph , S. Gupta , A. Sehrawat , A. Dhyani , M. Gupta","doi":"10.1016/j.clon.2025.104005","DOIUrl":"10.1016/j.clon.2025.104005","url":null,"abstract":"<div><h3>Aims</h3><div>Concurrent cisplatin-based chemoradiotherapy (CCRT) is the standard treatment for locally advanced head and neck cancer (LAHNC); however, it also results in substantial treatment-related toxicities. Oxaliplatin has similar radiosensitisation mechanisms to cisplatin and, if found to have equivalent efficacy in LAHNCs, has the potential to replace cisplatin in CCRT protocols.</div></div><div><h3>Materials and methods</h3><div>This prospective trial compared weekly oxaliplatin 50 mg/m2 to weekly cisplatin 40mg/m<sup>2</sup> in CCRT protocols for the treatment of non-nasopharyngeal LAHNCs. The primary endpoint was to compare the toxicity profile; secondary endpoints were compliance, locoregional control (LRC), disease-free survival (DFS), and overall survival (OS).</div></div><div><h3>Results</h3><div>Between January 2019 and June 2020, we randomly assigned 70 LAHNC patients, 35 in each arm, to receive radical CCRT. At a median follow-up of 18 months (range: 3-72), acute toxicities of grade 3 or higher occurred in 31% of patients in the oxaliplatin arm and 77% of patients in the cisplatin arm (<em>P</em> = 0.007). The estimated 3-year LRC, DFS, and OS in the oxaliplatin and cisplatin arms were 32.3% vs 35.9%, 28.7% vs 35.9% and 35.1% vs 37.3%, respectively, while the 5-year LRC, DFS, and OS were 32.3% vs 32.4%, 28.7% vs 28.8%, and 31.2% vs 30.5%, respectively. The absolute differences observed were not statistically significant.</div></div><div><h3>Conclusion</h3><div>The CCRT with oxaliplatin in non-nasopharyngeal LAHNC exhibits a better toxicity profile and appears comparable to cisplatin in terms of disease control. It may be worthwhile exploring this approach in a larger trial to gather LRC and survival data.</div></div><div><h3>Clinical Trials Registry India</h3><div>CTRI/2019/01/017198.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"50 ","pages":"Article 104005"},"PeriodicalIF":3.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965324","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 : 2025-12-16DOI: 10.1016/j.clon.2025.104003
N. Varmenot , K. Sjögreen Gleisner , J. Taprogge , G.D. Flux
In recent years the treatment of cancer with radioactive drugs, here termed molecular radiotherapy (MRT), has emerged to take a place alongside other treatment modalities, particularly non-radioactive drugs (NRDs) and external beam radiotherapy (EBRT). A purpose-built tool was developed within the Python programming environment to review the evolution of clinical trials performed in the first quarter of the century as recorded by the ClinicalTrials.gov database. It was found that the number of MRT trials registered on ClinicalTrials.gov increased by 15-fold from 6 trials in 2000 to 89 in 2024. The ratio of MRT clinical trials relative to EBRT has remained constant at approximately 1:5. Although the number of MRT trials has remained comparatively low, their frequency in relation to NRD trials has doubled over the 25-year period. All modalities have been investigated in a similar spread of early and late phase trials, with a slightly higher proportion for early phase trials in MRT. The registration of trials has increased for almost all indications, particularly for prostate, neuroendocrine and liver cancers, although the number of trials for lymphoma has declined. The diversity and number of radionuclides involved in MRT clinical trials have increased, with beta-minus emitting radionuclides accounting in 2024 for approximately 89% of studies compared to 11% for alpha-emitters.
{"title":"Clinical Trials in Molecular Radiotherapy: An Overview of the Landscape","authors":"N. Varmenot , K. Sjögreen Gleisner , J. Taprogge , G.D. Flux","doi":"10.1016/j.clon.2025.104003","DOIUrl":"10.1016/j.clon.2025.104003","url":null,"abstract":"<div><div>In recent years the treatment of cancer with radioactive drugs, here termed molecular radiotherapy (MRT), has emerged to take a place alongside other treatment modalities, particularly non-radioactive drugs (NRDs) and external beam radiotherapy (EBRT). A purpose-built tool was developed within the Python programming environment to review the evolution of clinical trials performed in the first quarter of the century as recorded by the ClinicalTrials.gov database. It was found that the number of MRT trials registered on ClinicalTrials.gov increased by 15-fold from 6 trials in 2000 to 89 in 2024. The ratio of MRT clinical trials relative to EBRT has remained constant at approximately 1:5. Although the number of MRT trials has remained comparatively low, their frequency in relation to NRD trials has doubled over the 25-year period. All modalities have been investigated in a similar spread of early and late phase trials, with a slightly higher proportion for early phase trials in MRT. The registration of trials has increased for almost all indications, particularly for prostate, neuroendocrine and liver cancers, although the number of trials for lymphoma has declined. The diversity and number of radionuclides involved in MRT clinical trials have increased, with beta-minus emitting radionuclides accounting in 2024 for approximately 89% of studies compared to 11% for alpha-emitters.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"51 ","pages":"Article 104003"},"PeriodicalIF":3.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146036223","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 : 2025-12-13DOI: 10.1016/j.clon.2025.104002
S. Haider
{"title":"From Numbers to Movement: Making the Toronto Extremity Salvage Score a Living Measure in Soft-tissue Sarcoma Survivorship","authors":"S. Haider","doi":"10.1016/j.clon.2025.104002","DOIUrl":"10.1016/j.clon.2025.104002","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"50 ","pages":"Article 104002"},"PeriodicalIF":3.0,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923738","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 : 2025-12-12DOI: 10.1016/j.clon.2025.104000
S.D. Robinson , S. Kingdon , M. Williams
{"title":"Access to Stereotactic Radiosurgery Centres Across the United Kingdom—An Investigation of Travel Time","authors":"S.D. Robinson , S. Kingdon , M. Williams","doi":"10.1016/j.clon.2025.104000","DOIUrl":"10.1016/j.clon.2025.104000","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"50 ","pages":"Article 104000"},"PeriodicalIF":3.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923735","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 : 2025-12-11DOI: 10.1016/j.clon.2025.104001
L. Cheng , M. Gajda , A. Tran , N. Jones-Anderson , S. Iqbal , J. Wadsley , K. Newbold
Aims
Differentiated thyroid cancer (DTC) patients with intermediate- or high-risk of recurrence are commonly treated with radioactive iodine (RAI). Although the utility of serum thyroglobulin (Tg) levels after surgery and RAI ablation is the standard of care in dynamic risk stratification, its role prior to RAI ablation remains undefined. We evaluated the relationship between post-operative, pre-RAI unstimulated Tg levels and persistent or recurrent structural disease in intermediate- or high-risk patients, postulating that it may help identify patients who may not require RAI.
Materials and methods
Patients diagnosed with DTC from three UK cancer centres were retrospectively identified from hospital electronic health records. Data collected included patient characteristics and clinical parameters such as unstimulated, post-operative and pre-RAI Tg levels and follow-up clinical and imaging results. The remaining 301 patients were analysed using univariable and multivariable logistic regression to explore the association between postoperative Tg and structural disease recurrence or persistence.
Results
Three hundred and one patients were included in the final analysis. The cohort included 209 (69%) females and 92 (31%) males, with 21 cases of recurrent or persistent disease. Univariable analysis and multivariable logistic regression both showed that unstimulated, post-operative Tg was an independent predictor of structural disease recurrence/persistence. Receiver operator characteristic curve suggested a post-operative unstimulated Tg cutoff of 1.05 ug/L (odds ratio [OR] 1.016, 95% confidence interval [CI] 1.005 to 1.042, p = 0.011). Notably, 17 (81%) of the 21 recurrences had a post-operative Tg levels above this cut-off.
Conclusion
Low postoperative unstimulated Tg levels are associated with a low risk of structural recurrence in intermediate- and high-risk DTC patents. Postoperative Tg may enhance current risk stratification in patients who could safely avoid RAI, but prospective trials are needed to validate this.
目的：分化型甲状腺癌（DTC）中、高危复发患者通常采用放射性碘（RAI）治疗。尽管手术和RAI消融后血清甲状腺球蛋白（Tg）水平是动态风险分层的标准，但其在RAI消融前的作用仍不明确。我们评估了中高危患者术后、RAI前未刺激Tg水平与持续性或复发性结构性疾病之间的关系，假设它可能有助于确定可能不需要RAI的患者。材料和方法回顾性分析了来自英国三家癌症中心的诊断为DTC的患者，这些患者来自医院的电子健康记录。收集的数据包括患者特征和临床参数，如未刺激、手术后和rai前的Tg水平以及随访的临床和影像学结果。其余301例患者采用单变量和多变量logistic回归分析，探讨术后Tg与结构性疾病复发或持续的关系。结果301例患者纳入最终分析。该队列包括209例（69%）女性和92例（31%）男性，其中21例复发或持续性疾病。单变量分析和多变量logistic回归均显示，术后未刺激的Tg是结构性疾病复发/持续的独立预测因子。受试者操作者特征曲线显示术后未刺激Tg截止值为1.05 ug/L（优势比[OR] 1.016, 95%可信区间[CI] 1.005 ~ 1.042, p = 0.011）。值得注意的是，21例复发患者中有17例（81%）术后Tg水平高于该临界值。结论低术后非刺激Tg水平与低结构复发风险相关。术后Tg可能会增强可以安全避免RAI的患者的当前风险分层，但需要前瞻性试验来验证这一点。
{"title":"Role of Post-operative Thyroglobulin in Predicting Disease-recurrence in Differentiated Thyroid Cancer","authors":"L. Cheng , M. Gajda , A. Tran , N. Jones-Anderson , S. Iqbal , J. Wadsley , K. Newbold","doi":"10.1016/j.clon.2025.104001","DOIUrl":"10.1016/j.clon.2025.104001","url":null,"abstract":"<div><h3>Aims</h3><div>Differentiated thyroid cancer (DTC) patients with intermediate- or high-risk of recurrence are commonly treated with radioactive iodine (RAI). Although the utility of serum thyroglobulin (Tg) levels after surgery and RAI ablation is the standard of care in dynamic risk stratification, its role prior to RAI ablation remains undefined. We evaluated the relationship between post-operative, pre-RAI unstimulated Tg levels and persistent or recurrent structural disease in intermediate- or high-risk patients, postulating that it may help identify patients who may not require RAI.</div></div><div><h3>Materials and methods</h3><div>Patients diagnosed with DTC from three UK cancer centres were retrospectively identified from hospital electronic health records. Data collected included patient characteristics and clinical parameters such as unstimulated, post-operative and pre-RAI Tg levels and follow-up clinical and imaging results. The remaining 301 patients were analysed using univariable and multivariable logistic regression to explore the association between postoperative Tg and structural disease recurrence or persistence.</div></div><div><h3>Results</h3><div>Three hundred and one patients were included in the final analysis. The cohort included 209 (69%) females and 92 (31%) males, with 21 cases of recurrent or persistent disease. Univariable analysis and multivariable logistic regression both showed that unstimulated, post-operative Tg was an independent predictor of structural disease recurrence/persistence. Receiver operator characteristic curve suggested a post-operative unstimulated Tg cutoff of 1.05 ug/L (odds ratio [OR] 1.016, 95% confidence interval [CI] 1.005 to 1.042, p = 0.011). Notably, 17 (81%) of the 21 recurrences had a post-operative Tg levels above this cut-off.</div></div><div><h3>Conclusion</h3><div>Low postoperative unstimulated Tg levels are associated with a low risk of structural recurrence in intermediate- and high-risk DTC patents. Postoperative Tg may enhance current risk stratification in patients who could safely avoid RAI, but prospective trials are needed to validate this.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"50 ","pages":"Article 104001"},"PeriodicalIF":3.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923736","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 : 2025-12-09DOI: 10.1016/j.clon.2025.103994
C.C. Henson , K. Green , R. Slater , J. McLaughlin , M. Hann , L. Barraclough , S. Burden , L. Gillespie , T. Ward , C. Probert
Aims
Eighty percent patients develop gastrointestinal (GI) symptoms during pelvic radiotherapy. The triggering event is a known enabling identification of pathophysiological changes. The focus of this study was feasibility (identification, recruitment, and retention), however, exploratory microbiome and metabolome analyses were performed.
Materials and methods
Patients undergoing pelvic radiotherapy underwent faecal sampling (baseline, week 4, and 6 months), with assessment of GI toxicity using the Imflammatory Bowel Disease Questionnaire (IBDQ) bowel (IBDQB) subset. Participants were split into 2 groups based on IBDQB at week-4. Exploratory analysis was performed to identify differences in metabolome (gas chromatography-mass spectrometry) and microbiome (16s rRNA sequencing).
Results
Two hundred twenty-seven patients were screened, 69 were approached, and 17 were recruited over 18 months (mean age: 61.6 ± 15.3 years; 14 female; 1 withdrawal).
Metabolome analysis showed lower heptanal and octanal in baseline samples of patients with higher GI toxicity; lower (methyltrisulfanyl)methane in week-4 samples of patients with higher GI toxicity; and higher butanoic acid and benzaldehyde in month 6 samples in patients with higher GI toxicity.
Whole-group microbiome analysis showed a trend towards decreased alpha diversity at 4 weeks; no differences in beta diversity; and a trend towards increase in Lachnoclostridium and decrease in Ruminococcaceae Incertae sedis at week 4. Microbiome analysis split by GI toxicity showed lower alpha diversity for the high GI toxicity group (each timepoint); no significant difference in beta diversity between groups; more genera differentially abundant between the GI toxicity groups at 4 weeks, than at other timepoints.
Conclusion
Recruitment was lower than anticipated. Attrition was low. Exploratory analysis suggests heptanal and octanal may have a role as a biomarker for GI toxicity, and lower alpha diversity may predict GI toxicity, with Lachnoclostridium and Ruminococcaceae Incertae sedis as bacteria of interest.
{"title":"Feasibility Study Exploring the Effect of Pelvic Radiotherapy on the Intestinal Microbiome and Metabolome to Improve the Detection and Management of Gastrointestinal Toxicity","authors":"C.C. Henson , K. Green , R. Slater , J. McLaughlin , M. Hann , L. Barraclough , S. Burden , L. Gillespie , T. Ward , C. Probert","doi":"10.1016/j.clon.2025.103994","DOIUrl":"10.1016/j.clon.2025.103994","url":null,"abstract":"<div><h3><em>Aims</em></h3><div>Eighty percent patients develop gastrointestinal (GI) symptoms during pelvic radiotherapy. The triggering event is a known enabling identification of pathophysiological changes. The focus of this study was feasibility (identification, recruitment, and retention), however, exploratory microbiome and metabolome analyses were performed.</div></div><div><h3><em>Materials and methods</em></h3><div>Patients undergoing pelvic radiotherapy underwent faecal sampling (baseline, week 4, and 6 months), with assessment of GI toxicity using the Imflammatory Bowel Disease Questionnaire (IBDQ) bowel (IBDQB) subset. Participants were split into 2 groups based on IBDQB at week-4. Exploratory analysis was performed to identify differences in metabolome (gas chromatography-mass spectrometry) and microbiome (16s rRNA sequencing).</div></div><div><h3><em>Results</em></h3><div>Two hundred twenty-seven patients were screened, 69 were approached, and 17 were recruited over 18 months (mean age: 61.6 ± 15.3 years; 14 female; 1 withdrawal).</div><div>Metabolome analysis showed lower heptanal and octanal in baseline samples of patients with higher GI toxicity; lower (methyltrisulfanyl)methane in week-4 samples of patients with higher GI toxicity; and higher butanoic acid and benzaldehyde in month 6 samples in patients with higher GI toxicity.</div><div>Whole-group microbiome analysis showed a trend towards decreased alpha diversity at 4 weeks; no differences in beta diversity; and a trend towards increase in <em>Lachnoclostridium</em> and decrease in Ruminococcaceae <em>Incertae sedis</em> at week 4. Microbiome analysis split by GI toxicity showed lower alpha diversity for the high GI toxicity group (each timepoint); no significant difference in beta diversity between groups; more genera differentially abundant between the GI toxicity groups at 4 weeks, than at other timepoints.</div></div><div><h3><em>Conclusion</em></h3><div>Recruitment was lower than anticipated. Attrition was low. Exploratory analysis suggests heptanal and octanal may have a role as a biomarker for GI toxicity, and lower alpha diversity may predict GI toxicity, with <em>Lachnoclostridium</em> and Ruminococcaceae <em>Incertae sedis</em> as bacteria of interest.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"50 ","pages":"Article 103994"},"PeriodicalIF":3.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923737","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 : 2025-12-09DOI: 10.1016/j.clon.2025.103999
J.D. Towler, C. David, O. Willis, N. Lalli, H. Grimes, F. Le Grange, A. Pilar, B.M. Seddon, M. Ahmed
Aims
While surgery is the primary treatment for soft tissue sarcomas (STS) and primary bone sarcomas, a notable proportion of patients with non-extremity tumours do not undergo resection. Outcome data for definitive radiotherapy in this context are limited, as is evidence on the use of hypofractionation at non-extremity sites near sensitive organs at risk. We report our institutional experience delivering moderately hypofractionated definitive radiotherapy (MHDRT) to patients with inoperable non-extremity STS and bone sarcomas including those who were unfit for, or declined, surgery.
Materials and Methods
Fifty-nine adult sarcoma patients received MHDRT to non-extremity disease between July 2021 and September 2024 in 60 treatment courses (54 photon, 6 proton). Radiotherapy was delivered over 28 fractions at two dose levels, with 50.4 Gy to the low-dose target volume and a simultaneous integrated boost (SIB) to the high-dose target volume of 63 Gy for STS and 70 Gy for bone sarcomas. Two patients received treatment over 30 fractions to a comparable dose with a SIB of ≥2.2 Gy per fraction.
Results
With a median follow-up of 17.7 months, local control at 1 year was 90.8% for STS (n = 37), 100% for chordoma (n = 14) and 55.6% for high-grade primary bone sarcomas (n = 9). Acute and late grade 3 toxicities were observed in 5 (8.3%) and 6 (10%) patients respectively.
Conclusion
These data indicate that MHDRT can be delivered to inoperable non-extremity sarcomas with acceptable toxicity and encouraging early local control rates, representing an important radical treatment option in this patient group.
{"title":"Local Control With Moderately Hypofractionated Definitive Radiotherapy Delivered With a Simultaneous Integrated Boost Technique to Non-extremity Soft Tissue and Bone Sarcomas","authors":"J.D. Towler, C. David, O. Willis, N. Lalli, H. Grimes, F. Le Grange, A. Pilar, B.M. Seddon, M. Ahmed","doi":"10.1016/j.clon.2025.103999","DOIUrl":"10.1016/j.clon.2025.103999","url":null,"abstract":"<div><h3>Aims</h3><div>While surgery is the primary treatment for soft tissue sarcomas (STS) and primary bone sarcomas, a notable proportion of patients with non-extremity tumours do not undergo resection. Outcome data for definitive radiotherapy in this context are limited, as is evidence on the use of hypofractionation at non-extremity sites near sensitive organs at risk. We report our institutional experience delivering moderately hypofractionated definitive radiotherapy (MHDRT) to patients with inoperable non-extremity STS and bone sarcomas including those who were unfit for, or declined, surgery.</div></div><div><h3>Materials and Methods</h3><div>Fifty-nine adult sarcoma patients received MHDRT to non-extremity disease between July 2021 and September 2024 in 60 treatment courses (54 photon, 6 proton). Radiotherapy was delivered over 28 fractions at two dose levels, with 50.4 Gy to the low-dose target volume and a simultaneous integrated boost (SIB) to the high-dose target volume of 63 Gy for STS and 70 Gy for bone sarcomas. Two patients received treatment over 30 fractions to a comparable dose with a SIB of ≥2.2 Gy per fraction.</div></div><div><h3>Results</h3><div>With a median follow-up of 17.7 months, local control at 1 year was 90.8% for STS (n = 37), 100% for chordoma (n = 14) and 55.6% for high-grade primary bone sarcomas (n = 9). Acute and late grade 3 toxicities were observed in 5 (8.3%) and 6 (10%) patients respectively.</div></div><div><h3>Conclusion</h3><div>These data indicate that MHDRT can be delivered to inoperable non-extremity sarcomas with acceptable toxicity and encouraging early local control rates, representing an important radical treatment option in this patient group.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"51 ","pages":"Article 103999"},"PeriodicalIF":3.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146075316","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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