Clinical oncology最新文献

英文中文

Characteristics and Survival Outcomes of Male Breast Cancer in Brazil: A Large Population-Based Study 巴西男性乳腺癌的特征和生存结果：基于人口的大型研究

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.clon.2024.10.002

R. de Oliveira Frederice , A.A.L. Pereira , G.V. Arruda , A.G. Gouveia , F.E.M. de Andrade , L.J. Mori , R.D.M. Linck , A.K. Shimada , S.A. Hanna , F.Y. de Moraes , G.N. Marta

Aims

This study evaluated the clinicopathological characteristics, treatment trends, and overall survival (OS) in male breast cancer (BC) in Sao Paulo State of Brazil.

Materials and methods

Men diagnosed with invasive breast cancer between January 2000 and June 2020 were identified from Fundação Oncocentro de Sao Paulo database encompasses data pertinent to 46 million residents of the Sao Paulo State of Brazil. Patients were described according to age, education level, clinical stage, treatment modalities, and medical practice. Categorical variables were described as percentages and frequencies. Demographic, treatment factors, and OS were associated using a Cox proportional hazard regression model while accounting for different lengths of participant follow-up. The Kaplan-Meier curves were used to display survival curves.

Results

A total of 907 male BC patients were included. The age distribution at diagnosis was <51 years, 51–70 years, and >70 years in 21.5%, 51.5% and 27.0% of patients, respectively. The proportions of stages I, II, III, and IV were 19.5%, 36.6%, 31.5%, and 12.3%. For each stage I, II, III, and IV, 5- and 10-years OS were 87.9% and 77.8%, 79.9% and 58.9%, 51.6% and 24.5%, 20.0% and 5.6%, respectively. Patients who received postoperative radiotherapy experienced a significant improvement in OS (HR 0.67; 95% CI 0.53–0.84; p < 0.001). In the multivariable analysis adjusted for practice (public or private), education (low or medium/high), age, stage at diagnosis, and treatment modalities, the significant independent predictor for OS was stage at diagnosis.

Conclusion

Male BC tends to be diagnosed at a more advanced stage and older age at the time of diagnosis. Age and educational level did not influence survival outcomes. Stage at diagnosis and the use of postoperative radiotherapy were factors associated with improved OS.

目的：本研究评估了巴西圣保罗州男性乳腺癌（BC）的临床病理特征、治疗趋势和总生存率（OS）：2000年1月至2020年6月期间确诊为浸润性乳腺癌的男性患者来自圣保罗肿瘤中心基金会数据库，该数据库包含巴西圣保罗州4600万居民的相关数据。根据年龄、教育程度、临床分期、治疗方式和医疗实践对患者进行了描述。分类变量以百分比和频率描述。采用考克斯比例危险回归模型将人口统计学、治疗因素和OS联系起来，同时考虑到不同的随访时间。Kaplan-Meier曲线用于显示生存曲线：结果：共纳入907名男性BC患者。诊断时年龄分布为 70 岁的患者分别占 21.5%、51.5% 和 27.0%。I、II、III 和 IV 期患者的比例分别为 19.5%、36.6%、31.5% 和 12.3%。I、II、III和IV期患者的5年和10年生存率分别为87.9%和77.8%、79.9%和58.9%、51.6%和24.5%、20.0%和5.6%。接受术后放疗的患者的OS明显改善（HR 0.67；95% CI 0.53-0.84；P < 0.001）。在对执业（公立或私立）、教育程度（低或中/高）、年龄、诊断分期和治疗方式进行调整后的多变量分析中，对OS有显著独立预测作用的因素是诊断分期：结论：男性乳腺癌患者往往在确诊时处于更晚期、年龄更大。年龄和受教育程度对生存结果没有影响。诊断时的分期和术后放疗是改善OS的相关因素。

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引用次数: 0

Impact of Multiprofessional Radiotherapy Peer Review on Multidisciplinary Team Meeting Staging in Head and Neck Cancer 多专业放疗同行评议对头颈部肿瘤多学科小组会议分期的影响。

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.clon.2024.103696

K. Chiu , A. Gupta , T. Afxentiou , A. Ashraf , R. Kanani , K. Rajaguru , N. Bhatt , P. Hoskin , S. Ghoshray

Aims

Cancer staging is routinely done in a multidisciplinary team meeting (MDM). There is however no established quality assurance (QA) for MDM-recorded cancer staging. Conversely, radiotherapy peer review is a recommended QA process. This study aimed to compare the cancer staging of the multiprofessional radiotherapy peer review (with radiologists) against the referring MDMs.

Materials and methods

All head and neck intensity-modulated radiotherapy (IMRT) cases discussed in peer review between May 2023 to April 2024 were prospectively evaluated. Any radiological disease progression (PD) on IMRT-planning scan since the diagnostic scans, and patients' cancer staging, were prospectively recorded. These were compared with the MDM-recorded outcomes data.

Results

A total of 235 IMRT cases were peer-reviewed: 166 definitive, 63 post-operative and 6 palliatives. Of the analysable definitive cases, 44/150 (29%) were found to have PD, with a mean interval from diagnostic to IMRT-planning scan of 51 days (Standard Deviation SD = 25), compared to 38 days (SD = 21) in the cohort without PD (p < 0.01). After the exclusion of 28 patients with the most advanced non-metastatic stage, 35 (30%) were upstaged with a mean interval from diagnostic to IMRT-planning of 49 days (SD = 26), compared to 39 days (SD = 23) in the cohort without upstage (p = 0.05). Twenty (57%) upstaged patients had evidence of PD, while the other 15 (43%) were upstaged despite the absence of PD. Two MDM-recorded T3-category larynx cancers were subsequently recommended for a primary laryngectomy due to T4a-category at peer review, and both were proven T4a pathologically. Three upstaged patients were recommended concomitant chemotherapy. The peer review recommended IMRT volume changes to 156 (66%) patients.

Conclusion

Discrepancies in MDM staging can occur, and a protracted diagnosis and treatment pathway too can affect final cancer staging. Routine radiologist input in peer review can provide crucial post-MDM outcome assurance and the recommended clinical management.

目的：癌症分期通常在多学科团队会议（MDM）中完成。然而，对于mdm记录的癌症分期，没有既定的质量保证（QA）。相反，放疗同行评议是推荐的QA过程。本研究旨在比较多专业放射治疗同行评审（与放射科医生）与参考MDMs的癌症分期。材料与方法：对2023年5月至2024年4月同行评议的所有头颈部调强放疗（IMRT）病例进行前瞻性评价。自诊断性扫描以来，任何imrt计划扫描的放射学疾病进展（PD）和患者的癌症分期均被前瞻性记录。将这些数据与mdm记录的结果数据进行比较。结果：共235例IMRT经同行评议：166例确诊，63例术后，6例姑息治疗。在可分析的确诊病例中，44/150（29%）被发现患有PD，从诊断到imrt计划扫描的平均间隔时间为51天（标准差SD = 25），而无PD的队列为38天（SD = 21）（p < 0.01）。在排除28例最晚期非转移期患者后，35例（30%）被抢镜，从诊断到imrt计划的平均间隔为49天（SD = 26），而未抢镜的队列为39天（SD = 23）（p = 0.05）。20例（57%）被抢风头的患者有帕金森病的证据，而另外15例（43%）在没有帕金森病的情况下被抢风头。在同行评议中，两例mdm记录的t3型喉癌因T4a型被推荐行原发性喉癌切除术，病理证实均为T4a型。三名抢风头的患者被推荐联合化疗。同行评议建议156例（66%）患者改变IMRT量。结论：MDM分期可能存在差异，长期的诊断和治疗途径也会影响最终的肿瘤分期。放射科医生在同行评审中的常规输入可以提供关键的mdm后结果保证和推荐的临床管理。

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引用次数: 0

Comparing Interfractional Stability of Heart Dose Among Three Breath-Hold Radiotherapy Techniques in Breast Cancer 三种屏气放疗治疗乳腺癌患者心脏剂量的分次稳定性比较。

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.clon.2024.103699

A.W. Chan , A. Hoang , H. Chen , M. McGuffin , A. Sheikh , D. Vesprini , L. Zhang , M. Wronski , I. Karam

Aims

Breath holding can reduce the cardiac dose in radiotherapy for left-sided breast cancer. We evaluated whether any of the existing commonly used breath-hold techniques was superior in maintaining a more reproducible mean heart dose (MHD) during treatment.

Materials and Methods

This was a single-institution, interventional, nonrandomised, three-armed prospective trial, comparing the reproducibility of MHD in breath-hold radiotherapy using voluntary deep inspiration breath hold (vDIBH), active breathing control (ABC), and surface-guided radiotherapy (SGRT). The MHDs were determined based on the anatomy in planning computed tomography (CT) and each weekly cone beam computed tomography (CBCT) during radiotherapy. The reproducibility of MHD was measured by calculating the interfractional variation of MHD (represented by the standard deviation) across the CBCT and the difference between the cumulative MHD at CBCT and at planning CT. These two measures of reproducibility were then compared among vDIBH, ABC, and SGRT.

Results

Of the 55 patients recruited, 19 had ABC, 20 had SGRT, and 16 had vDIBH. SGRT was associated with a slightly greater interfractional variation of the MHD than vDIBH (least squares mean (LSM): 28.8 cGy (SGRT) vs 10.5 cGy (vDIBH), P = 0.0052) and ABC (LSM: 28.8 cGy (SGRT) vs 15.1 cGy (ABC), P = 0.026). In the SGRT group, the cumulative MHD at CBCT was lower than that at planning CT (mean difference: -22.1 cGy, P = 0.013). No such difference existed in vDIBH and ABC. In terms of the reproducibility of cumulative MHD at CBCT as compared to that in planning CT, there was no significant difference between vDIBH (mean: -12.1 cGy), ABC (mean: -4.8 cGy), and SGRT (mean: -22.1 cGy) (P value for pairwise comparison: all >0.1).

Conclusions

SGRT was associated with a slightly greater interfractional variation of MHD than vDIBH and ABC, but the difference may not be clinically significant. All three breath-hold techniques were broadly comparable in their reproducibility of MHD at CBCT relative to the planning CT.

目的：在左侧乳腺癌放疗中，屏气可降低心脏剂量。我们评估了在治疗期间是否有任何现有常用的屏气技术在维持更可重复的平均心脏剂量（MHD）方面具有优势。材料和方法：这是一项单机构、干预性、非随机、三臂前瞻性试验，比较MHD在采用自主深吸气屏气（vDIBH）、主动呼吸控制（ABC）和表面引导放疗（SGRT）的屏气放疗中的可重复性。在放射治疗期间，通过计划计算机断层扫描（CT）和每周锥形束计算机断层扫描（CBCT）确定MHDs。通过计算整个CBCT中MHD的分数间变化（以标准差表示）以及CBCT和计划CT累积MHD之间的差异来测量MHD的可重复性。然后在vDIBH、ABC和SGRT之间比较这两个可重复性指标。结果：在招募的55例患者中，19例有ABC， 20例有SGRT， 16例有vDIBH。SGRT与MHD分数间变化的相关性略高于vDIBH(最小二乘平均值（LSM）： 28.8 cGy （SGRT) vs 10.5 cGy (vDIBH), P = 0.0052）和ABC (LSM: 28.8 cGy （SGRT) vs 15.1 cGy (ABC), P = 0.026）。SGRT组CBCT累积MHD低于计划CT（平均差值：-22.1 cGy, P = 0.013）。在vDIBH和ABC中不存在这种差异。与计划CT相比，CBCT累积MHD的再现性方面，vDIBH（平均值：-12.1 cGy）、ABC（平均值：-4.8 cGy）和SGRT（平均值：-22.1 cGy）之间无显著差异（两两比较的P值：均为0.1）。结论：SGRT与MHD分数间变化的相关性略高于vDIBH和ABC，但差异可能没有临床意义。与计划CT相比，这三种屏气技术在CBCT上的MHD再现性大致相当。

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引用次数: 0

Effects of Radiotherapy Alone Versus Concomitant Radiotherapy With Temozolomide Chemotherapy on the Outcome of IDH-wildtype Glioblastoma Patients 单纯放疗与替莫唑胺联合放疗对idh野生型胶质母细胞瘤患者预后的影响。

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.clon.2024.103741

M. Kurdi , A. Alkhotani , T. Alsinani , S. Alkhayyat , Y. Katib , Z. Jastaniah , A.J. Sabbagh , N.S. Butt , F.A. Toonsi , M. Alharbi , S. Baeesa

Background

Isocitrate dehydrogenase [IDH]-wildtype glioblastoma is an aggressive brain cancer associated with high recurrence and poor overall survival.

Aim

Our study aims to explore the prognostic effects of radiotherapy [RT] alone versus concomitant RT with temozolomide [TMZ].

Methods

A multicentre retrospective study included a cohort of 244 patients diagnosed with IDH-wildtype glioblastoma, and it was analysed from 2013 to 2020. All patients underwent complete surgical resection of the tumour followed by standard postsurgical therapies, including RT alone [group A] or concomitant RT with TMZ chemotherapy [group B]. Intra-statistical cohort data analysis was performed.

Results

The mean age of the patients was 53.9 years [SD 16.3 years], with 87 [35.7%] females and 157 [64.3%] males. Group “A” patient [n = 67, 27.5%] received RT alone, and group “B” patient [n = 177, 72.5%] received concomitant RT with TMZ chemotherapy. All patients' mean progression-free survival [PFS] was 391.8 days (13.1 months). There was a statistically significant difference in PFS between the two treatment groups [P value<0.0001]. The hazard ratio [HR] for PFS in group “b” compared with group “a” was 0.48 [95% CI: 0.36–0.64, P < 0.001] in the univariable analysis, indicating a significant benefit of the combined treatment. This benefit was maintained in the multivariable analysis with an HR of 0.50 [95% CI: 0.37–0.67, P < 0.001]. Age was found to be a significant factor in PFS, with each additional year of age increasing HR by 2% in the univariable analysis [HR: 1.02, 95% CI: 1.01–1.03, P < 0.001] and the multivariable analysis (HR of 1.01 [95% CI: 1.01–1.02, P < 0.001)].

Conclusions

Concomitant RT with TMZ chemotherapy significantly increased PFS beyond that observed from isolated RT in patients with IDH-wildtype glioblastoma.

背景：异柠檬酸脱氢酶（IDH）野生型胶质母细胞瘤是一种侵袭性脑癌，具有高复发率和较差的总生存率。目的：本研究旨在探讨单纯放疗与替莫唑胺联合放疗对预后的影响。方法：一项多中心回顾性研究纳入了244例诊断为idh野生型胶质母细胞瘤的患者，并对2013年至2020年进行了分析。所有患者均接受手术切除肿瘤后进行标准的术后治疗，包括单纯放疗[A组]或联合放疗与TMZ化疗[B组]。进行统计内队列数据分析。结果：患者平均年龄53.9岁（SD为16.3岁），其中女性87例（35.7%），男性157例（64.3%）。A组[n = 67, 27.5%]患者单独接受放疗，B组[n = 177, 72.5%]患者同时接受放疗和TMZ化疗。所有患者的平均无进展生存期（PFS）为391.8天（13.1个月）。结论：在idh野生型胶质母细胞瘤患者中，与单独放疗相比，TMZ化疗联合放疗显著提高了PFS。

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引用次数: 0

Patient Perspectives on the Value of Stereotactic Body Radiotherapy in the Management of Breast Cancer: The PERSPECTIVE Study 立体定向放疗在乳腺癌治疗中的价值：透视研究。

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.clon.2024.103738

S.K. Nagpal , G. Ross , S. Cruickshank , A.M. Kirby

Aims

Oligometastatic disease describes limited metastases amenable to therapy such as stereotactic body radiotherapy (SBRT). This study aims to understand which outcomes are most important to patients when considering SBRT as a treatment option. The insights gained will help inform future patient-directed trial endpoints and provide valuable guidance to clinicians supporting patients through their decision-making process.

Materials and Methods

We conducted a qualitative study with focus groups and individual interviews. Participants were recruited using a purposive-sampling matrix accounting for age, presence of metastatic disease, and previous experience with radiotherapy. Each focus group had at least two moderators, and all interviews were digitally recorded and then transcribed. Thematic analysis was performed using NVivo version 12.

Results

The study included 18 patients diagnosed with breast cancer, comprising two focus groups and four individual interviews. The median age was 54 years (range 38–74). 15/18 (83%) had prior radiotherapy experience, including 4/18 with previous SBRT experience. Three main themes were identified: 1) Participants' experience with radiotherapy; 2) patients' perceptions and considerations in relation to SBRT (including desired treatment outcomes); and 3) willingness to consider SBRT for its potential local control and durable pain control benefits, even in the absence of survival benefit. Participants prioritised extending their lives as the foremost desired outcome of SBRT, followed by quality of life. Those with prior SBRT experience were keen for repeat treatment, if available, and emphasised SBRT's minimal side effects compared to other interventions.

Conclusion

While extension of life was the primary desired treatment outcome of SBRT for oligometastatic breast cancer , all participants were willing to consider SBRT for its minimal side effects and potential benefits in local control and durable pain control, even in the absence of a survival benefit.

目的：少转移性疾病是指可接受立体定向体放射治疗（SBRT）等治疗的有限转移灶。本研究旨在了解患者在考虑将 SBRT 作为一种治疗方案时，哪些结果是最重要的。所获得的见解将有助于为未来以患者为导向的试验终点提供信息，并为临床医生在患者的决策过程中提供有价值的指导：我们通过焦点小组和个人访谈进行了一项定性研究。根据年龄、是否患有转移性疾病以及以往的放疗经验，采用目的性抽样矩阵招募参与者。每个焦点小组至少有两名主持人，所有访谈均进行数字录音，然后转录。使用 NVivo 12 版本进行了主题分析：研究包括 18 名乳腺癌患者，其中包括两个焦点小组和四个个人访谈。中位年龄为 54 岁（38-74 岁不等）。15/18（83%）的患者曾接受过放射治疗，其中 4/18 曾接受过 SBRT 治疗。研究确定了三大主题1）参与者的放疗经验；2）患者对 SBRT 的看法和考虑（包括期望的治疗效果）；3）即使没有生存获益，患者也愿意考虑 SBRT，因为它具有潜在的局部控制和持久的疼痛控制获益。参与者将延长生命作为 SBRT 的首要预期结果，其次是生活质量。那些曾经接受过 SBRT 治疗的人热衷于重复治疗（如果可以的话），并强调与其他干预措施相比，SBRT 的副作用极小：虽然延长生命是SBRT治疗寡转移性乳腺癌的主要预期疗效，但所有参与者都愿意考虑SBRT，因为其副作用极小，即使没有生存益处，也能在局部控制和持久疼痛控制方面带来潜在益处。

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引用次数: 0

Use of neoadjuvant EC-PC Pembrolizumab in triple negative breast cancer - Northern Ireland’s experience to date 新辅助 EC-PC Pembrolizumab 在三阴性乳腺癌中的应用--北爱尔兰迄今为止的经验

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.clon.2024.103712

C. Carson, E. Johnston, K. Crawford

引用次数: 0

Treatment of macroscopic prostate bed recurrences with a focal dose-escalated boost

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.clon.2024.10.022

K. Palmer, A. Anderson, M. Lovegrove, E. Halliday, E. Cooper, M. Prentice

引用次数: 0

Quality of Radiotherapy Workforce Training within the USA 美国放射治疗人员培训的质量

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.clon.2024.01.019

R. Mulherkar , D.C. Ling , R. Tendulkar , M.R. Kamrava , S. Beriwal

The training, competency requirements and scope of practice of professionals within a radiation oncology department vary across countries. The purpose of this review is to shed light on the current status of radiotherapy training in the USA by discussing current benchmarks for medical residency, physics residency, radiation therapy and dosimetry training programmes. Although there are notable strengths, the US radiotherapy workforce training system also faces several challenges when it comes to standardising education to develop a competent workforce that meets societal needs. Continued efforts are needed at a systemic level to improve training in areas such as brachytherapy and proton therapy, promote research involvement and develop trainees who are equipped to form a competent radiation therapy workforce.

各国对肿瘤放射科专业人员的培训、能力要求和执业范围各不相同。本综述旨在通过讨论美国医学住院医师、物理学住院医师、放射治疗和剂量学培训计划的现行基准，阐明美国放射治疗培训的现状。尽管美国的放射治疗人员培训系统有明显的优势，但在实现教育标准化以培养满足社会需求的合格人才方面，也面临着一些挑战。需要在系统层面继续努力，以改善近距离治疗和质子治疗等领域的培训，促进研究参与，并培养有能力组建一支合格的放射治疗队伍的受训人员。

引用次数: 0

Longitudinal Image Data for Outcome Modeling 用于结果建模的纵向图像数据。

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.clon.2024.06.053

J.E. van Timmeren, J. Bussink, P. Koopmans, R.J. Smeenk, R. Monshouwer

In oncology, medical imaging is crucial for diagnosis, treatment planning and therapy execution. Treatment responses can be complex and varied and are known to involve factors of treatment, patient characteristics and tumor microenvironment. Longitudinal image analysis is able to track temporal changes, aiding in disease monitoring, treatment evaluation, and outcome prediction. This allows for the enhancement of personalized medicine. However, analyzing longitudinal 2D and 3D images presents unique challenges, including image registration, reliable segmentation, dealing with variable imaging intervals, and sparse data. This review presents an overview of techniques and methodologies in longitudinal image analysis, with a primary focus on outcome modeling in radiation oncology.

在肿瘤学中，医学成像对诊断、治疗计划和治疗执行至关重要。众所周知，治疗反应复杂多样，涉及治疗、患者特征和肿瘤微环境等因素。纵向图像分析能够跟踪时间变化，有助于疾病监测、治疗评估和结果预测。这有助于加强个性化医疗。然而，纵向二维和三维图像分析面临着独特的挑战，包括图像配准、可靠的分割、处理不同的成像间隔和稀疏数据。本综述概述了纵向图像分析的技术和方法，主要侧重于放射肿瘤学的结果建模。

引用次数: 0

A single centre, retrospective audit of adherence to the IMPORT-LOW recommendations on clip placement to facilitate partial breast radiotherapy

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.clon.2024.103721

A. Mitchell, L. Alizadeh, C. Kane, E. Halliday, S. Needleman

引用次数: 0

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