Pub Date : 2025-02-01DOI: 10.1016/j.clon.2024.10.029
A. Vickers, A. Choudhury, A. McWilliam, D.M. McSweeney, G. Price, J. Weaver
{"title":"Sarcopenia does not predict increased acute or late radiotherapy related toxicities in prostate cancer patients","authors":"A. Vickers, A. Choudhury, A. McWilliam, D.M. McSweeney, G. Price, J. Weaver","doi":"10.1016/j.clon.2024.10.029","DOIUrl":"10.1016/j.clon.2024.10.029","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"38 ","pages":"Pages 9-10"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428969","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 : 2025-02-01DOI: 10.1016/j.clon.2024.103715
H. Jones, F. Fathima, M. Nandhabalan, J. Brock, F. Andleeb
{"title":"Receptor status discordance in Breast Cancer Brain Metastasis at Oxford University Hospitals (OUH) NHS Foundation Trust","authors":"H. Jones, F. Fathima, M. Nandhabalan, J. Brock, F. Andleeb","doi":"10.1016/j.clon.2024.103715","DOIUrl":"10.1016/j.clon.2024.103715","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"38 ","pages":"Article 103715"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429148","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 : 2025-02-01DOI: 10.1016/j.clon.2024.07.002
W.A.C. van Amsterdam , S. Elias , R. Ranganath
Oncologists are faced with choosing the best treatment for each patient, based on the available evidence from randomized controlled trials (RCTs) and observational studies. RCTs provide estimates of the average effects of treatments on groups of patients, but they may not apply in many real-world scenarios where for example patients have different characteristics than the RCT participants, or where different treatment variants are considered. Causal inference defines what a treatment effect is and how it may be estimated with RCTs or outside of RCTs with observational – or ‘real-world’ – data. In this review, we introduce the field of causal inference, explain what a treatment effect is and what important challenges are with treatment effect estimation with observational data. We then provide a framework for conducting causal inference studies and describe when in oncology causal inference from observational data may be particularly valuable. Recognizing the strengths and limitations of both RCTs and observational causal inference provides a way for more informed and individualized treatment decision-making in oncology.
{"title":"Causal Inference in Oncology: Why, What, How and When","authors":"W.A.C. van Amsterdam , S. Elias , R. Ranganath","doi":"10.1016/j.clon.2024.07.002","DOIUrl":"10.1016/j.clon.2024.07.002","url":null,"abstract":"<div><div>Oncologists are faced with choosing the best treatment for each patient, based on the available evidence from randomized controlled trials (RCTs) and observational studies. RCTs provide estimates of the average effects of treatments on groups of patients, but they may not apply in many real-world scenarios where for example patients have different characteristics than the RCT participants, or where different treatment variants are considered. Causal inference defines what a treatment effect is and how it may be estimated with RCTs or outside of RCTs with observational – or ‘real-world’ – data. In this review, we introduce the field of causal inference, explain what a treatment effect is and what important challenges are with treatment effect estimation with observational data. We then provide a framework for conducting causal inference studies and describe when in oncology causal inference from observational data may be particularly valuable. Recognizing the strengths and limitations of both RCTs and observational causal inference provides a way for more informed and individualized treatment decision-making in oncology.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"38 ","pages":"Article 103616"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.clon.2024.103729
D. Kukreja , M. Verma
{"title":"Novel Therapies in Triple-negative Breast Cancer: Can less be More?","authors":"D. Kukreja , M. Verma","doi":"10.1016/j.clon.2024.103729","DOIUrl":"10.1016/j.clon.2024.103729","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"38 ","pages":"Article 103729"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881405","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 : 2025-02-01DOI: 10.1016/j.clon.2024.103743
P. Loap, Y. Kirova
{"title":"Risk of Breast Diffuse Large B-cell Lymphoma (DLBCL) Following Implant-Based Reconstruction After Mastectomy","authors":"P. Loap, Y. Kirova","doi":"10.1016/j.clon.2024.103743","DOIUrl":"10.1016/j.clon.2024.103743","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"38 ","pages":"Article 103743"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143174220","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 : 2025-02-01DOI: 10.1016/j.clon.2024.103740
J. Evers , M.J.C. van der Sangen , M.C. van Maaren , J.H. Maduro , L. Strobbe , M.J. Aarts , M.C.W.M. Bloemers , J. Wesseling , D.H.J.G. van den Bongard , H. Struikmans , S. Siesling
Aims
Ductal Carcinoma In Situ (DCIS) treated by breast-conserving surgery followed by radiotherapy aims to decrease the probability of locally recurrent disease. The role of whole breast irradiation, specifically in DCIS having low recurrence risk and low risk of becoming invasive, is increasingly debated. Also, the added value of applying boost irradiation in DCIS has been questioned. Hence, we evaluated the nationwide radiotherapy use in DCIS treatment in the Netherlands.
Materials and Methods
Women diagnosed with DCIS in 2008–2022 were identified in the Netherlands Cancer Registry. Their primary treatment was presented over time and for age groups, stratified for DCIS grade I-II and III. Factors associated with radiotherapy use after breast-conserving surgery and boost irradiation use in whole breast irradiation after breast-conserving surgery were identified.
Results
In women with DCIS grade I-II (N = 16,653), the use of breast-conserving surgery without radiotherapy increased from ∼11% in 2008–2013 to ∼26% in 2017–2022. Furthermore, post-breast-conserving surgery radiotherapy increasingly concerned whole breast irradiation without a boost or partial breast irradiation. Moreover, surgery was omitted more often in recent years (30% in 2022). In DCIS grade III (N = 13,534), the use of breast-conserving surgery without radiotherapy only slightly increased in the most recent years in older patients, while boost irradiation was increasingly omitted. Whole breast irradiation and boost irradiation following breast-conserving surgery were more often applied in case of a higher risk of recurrences: young age, larger lesions, or irradical resection. Variation was observed for hospital-characteristics but not for regions.
Conclusion
In DCIS, the process of omitting breast irradiation after breast-conserving surgery is clearly ongoing. Boost irradiation was administered less frequently. Furthermore, the use of partial breast irradiation was introduced in recent years. These effects are more prominent in older women and those with grade I-II DCIS.
{"title":"Deintensification of Radiotherapy Use in Treatment of Ductal Carcinoma In Situ in the Netherlands–A Nationwide Overview From 2008 Until 2022","authors":"J. Evers , M.J.C. van der Sangen , M.C. van Maaren , J.H. Maduro , L. Strobbe , M.J. Aarts , M.C.W.M. Bloemers , J. Wesseling , D.H.J.G. van den Bongard , H. Struikmans , S. Siesling","doi":"10.1016/j.clon.2024.103740","DOIUrl":"10.1016/j.clon.2024.103740","url":null,"abstract":"<div><h3>Aims</h3><div>Ductal Carcinoma In Situ (DCIS) treated by breast-conserving surgery followed by radiotherapy aims to decrease the probability of locally recurrent disease. The role of whole breast irradiation, specifically in DCIS having low recurrence risk and low risk of becoming invasive, is increasingly debated. Also, the added value of applying boost irradiation in DCIS has been questioned. Hence, we evaluated the nationwide radiotherapy use in DCIS treatment in the Netherlands.</div></div><div><h3>Materials and Methods</h3><div>Women diagnosed with DCIS in 2008–2022 were identified in the Netherlands Cancer Registry. Their primary treatment was presented over time and for age groups, stratified for DCIS grade I-II and III. Factors associated with radiotherapy use after breast-conserving surgery and boost irradiation use in whole breast irradiation after breast-conserving surgery were identified.</div></div><div><h3>Results</h3><div>In women with DCIS grade I-II (N = 16,653), the use of breast-conserving surgery without radiotherapy increased from ∼11% in 2008–2013 to ∼26% in 2017–2022. Furthermore, post-breast-conserving surgery radiotherapy increasingly concerned whole breast irradiation without a boost or partial breast irradiation. Moreover, surgery was omitted more often in recent years (30% in 2022). In DCIS grade III (N = 13,534), the use of breast-conserving surgery without radiotherapy only slightly increased in the most recent years in older patients, while boost irradiation was increasingly omitted. Whole breast irradiation and boost irradiation following breast-conserving surgery were more often applied in case of a higher risk of recurrences: young age, larger lesions, or irradical resection. Variation was observed for hospital-characteristics but not for regions.</div></div><div><h3>Conclusion</h3><div>In DCIS, the process of omitting breast irradiation after breast-conserving surgery is clearly ongoing. Boost irradiation was administered less frequently. Furthermore, the use of partial breast irradiation was introduced in recent years. These effects are more prominent in older women and those with grade I-II DCIS.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"38 ","pages":"Article 103740"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945766","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 : 2025-02-01DOI: 10.1016/j.clon.2024.103739
E.J. Zhang , M. Knox , M.J. Veness , M. Abdul-Razak , E. Wong , E.J. Hwang , M. Carlino , P. Sundaresan
Aims
Unresectable cutaneous squamous cell cancer of the head and neck (HNcSCC) poses treatment challenges in elderly and comorbid patients. Radiation therapy (RT) is often employed for locoregional control. This study aimed to determine progression-free survival (PFS) and overall survival (OS) outcomes achieved with upfront RT in unresectable HNcSCC. It also aimed to determine the impact of varying RT dose regimes on disease outcomes.
Methods
A retrospective cohort study was conducted of patients with unresectable HNcSCC treated with first-line RT at a tertiary teaching hospital in Sydney, Australia between 2015-2024. Patient, disease, treatment and follow-up data were extracted from the electronic records.
Results
Of 36 patients, 67% were male, median age was 81 years, and median Charlson Comorbidity Index was 6.5. Median follow-up was 21 months. 83% of RT courses were delivered via intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT). Objective response rate was 97%. Patients were grouped into low-dose RT receiving biologically equivalent dose (BED) <60Gy (n = 18) or high-dose RT (BED ≥ 60Gy, n = 18). Infield progression-free survival (PFS) at 6 months was 56% and 78%, respectively. Overall survival at 6 months was 83% and 89%, and by 24 months 31% and 65%, respectively.
Conclusion
RT is an efficacious treatment that can be tailored to individual patient contexts with unresectable HNcSCC. It has a high response rate overall, with higher doses producing longer disease control. Some patients with poorer functional status receiving low-dose RT can still achieve a sustained response. Future comparisons of outcomes and cost-effectiveness with emerging treatments such as immunotherapy will be important in guiding management for frail patients with unresectable disease.
{"title":"Outcomes With Radiation Therapy as Primary Treatment for Unresectable Cutaneous Head and Neck Squamous Cell Carcinoma","authors":"E.J. Zhang , M. Knox , M.J. Veness , M. Abdul-Razak , E. Wong , E.J. Hwang , M. Carlino , P. Sundaresan","doi":"10.1016/j.clon.2024.103739","DOIUrl":"10.1016/j.clon.2024.103739","url":null,"abstract":"<div><h3>Aims</h3><div>Unresectable cutaneous squamous cell cancer of the head and neck (HNcSCC) poses treatment challenges in elderly and comorbid patients. Radiation therapy (RT) is often employed for locoregional control. This study aimed to determine progression-free survival (PFS) and overall survival (OS) outcomes achieved with upfront RT in unresectable HNcSCC. It also aimed to determine the impact of varying RT dose regimes on disease outcomes.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted of patients with unresectable HNcSCC treated with first-line RT at a tertiary teaching hospital in Sydney, Australia between 2015-2024. Patient, disease, treatment and follow-up data were extracted from the electronic records.</div></div><div><h3>Results</h3><div>Of 36 patients, 67% were male, median age was 81 years, and median Charlson Comorbidity Index was 6.5. Median follow-up was 21 months. 83% of RT courses were delivered via intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT). Objective response rate was 97%. Patients were grouped into low-dose RT receiving biologically equivalent dose (BED) <60Gy (n = 18) or high-dose RT (BED ≥ 60Gy, n = 18). Infield progression-free survival (PFS) at 6 months was 56% and 78%, respectively. Overall survival at 6 months was 83% and 89%, and by 24 months 31% and 65%, respectively.</div></div><div><h3>Conclusion</h3><div>RT is an efficacious treatment that can be tailored to individual patient contexts with unresectable HNcSCC. It has a high response rate overall, with higher doses producing longer disease control. Some patients with poorer functional status receiving low-dose RT can still achieve a sustained response. Future comparisons of outcomes and cost-effectiveness with emerging treatments such as immunotherapy will be important in guiding management for frail patients with unresectable disease.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"38 ","pages":"Article 103739"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962128","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 : 2025-02-01DOI: 10.1016/j.clon.2024.103711
A.M. Berner , K.C. Sit , P.E. Hall
{"title":"The management of ER low HER2 negative breast cancer in the United Kingdom: A survey of current clinical practice","authors":"A.M. Berner , K.C. Sit , P.E. Hall","doi":"10.1016/j.clon.2024.103711","DOIUrl":"10.1016/j.clon.2024.103711","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"38 ","pages":"Article 103711"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429347","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 : 2025-02-01DOI: 10.1016/j.clon.2024.103691
V. Apte , A. Ghose , C.A. Linares , S. Adeleke , M. Sheriff , E. Rassy , S. Boussios
Radiotherapy is commonly used to treat paediatric cancers, but is associated with long-term side effects in children. Anatomical models have key applications in radiotherapy, notably to help understand the relationship between radiation dosage and the development of side effects. This review analyses whether age-specific computational phantoms, developed from healthy and paediatric cancer patient data, are adequate to model a paediatric population. The phantoms used in the study were International Commission on Radiological Protection (ICRP) and 4D extended cardiac torso (XCAT), which were also compared to literature data. Organ volume data for 19 organs was collected for both phantoms and literature. ICRP was treated as the reference for comparison, and percentage differences (P.Ds) for the other phantom was calculated relative to ICRP. Overall comparisons were made for each age category (1, 5, 10, 15) and for each organ. Statistical analysis was performed using Microsoft Excel (version 16.59). Literature had a smaller P.D to ICRP (-17.4%), whereas XCAT had a larger P.D (26.6%). The rectum had the largest average P.D (477.7%) and the brain had the smallest (-1.7%). The P.D was 67.8% for age 1 but this decreased down to 30.9% by age 15. Linear regression analysis showed correlation between organ volume and age to be the strongest for ICRP (R2 = 0.943) and weakest for XCAT (R2 = 0.676).
The phantoms are similar enough to ICRP for potential use in modelling paediatric populations. ICRP and XCAT could be used to model a healthy population, but may not necessarily be ideal for a population undergoing/after radiotherapy.
{"title":"Paediatric Anatomical Models in Radiotherapy Applications","authors":"V. Apte , A. Ghose , C.A. Linares , S. Adeleke , M. Sheriff , E. Rassy , S. Boussios","doi":"10.1016/j.clon.2024.103691","DOIUrl":"10.1016/j.clon.2024.103691","url":null,"abstract":"<div><div>Radiotherapy is commonly used to treat paediatric cancers, but is associated with long-term side effects in children. Anatomical models have key applications in radiotherapy, notably to help understand the relationship between radiation dosage and the development of side effects. This review analyses whether age-specific computational phantoms, developed from healthy and paediatric cancer patient data, are adequate to model a paediatric population. The phantoms used in the study were International Commission on Radiological Protection (ICRP) and 4D extended cardiac torso (XCAT), which were also compared to literature data. Organ volume data for 19 organs was collected for both phantoms and literature. ICRP was treated as the reference for comparison, and percentage differences (P.Ds) for the other phantom was calculated relative to ICRP. Overall comparisons were made for each age category (1, 5, 10, 15) and for each organ. Statistical analysis was performed using Microsoft Excel (version 16.59). Literature had a smaller P.D to ICRP (-17.4%), whereas XCAT had a larger P.D (26.6%). The rectum had the largest average P.D (477.7%) and the brain had the smallest (-1.7%). The P.D was 67.8% for age 1 but this decreased down to 30.9% by age 15. Linear regression analysis showed correlation between organ volume and age to be the strongest for ICRP (R<sup>2</sup> = 0.943) and weakest for XCAT (R<sup>2</sup> = 0.676).</div><div>The phantoms are similar enough to ICRP for potential use in modelling paediatric populations. ICRP and XCAT could be used to model a healthy population, but may not necessarily be ideal for a population undergoing/after radiotherapy.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"38 ","pages":"Article 103691"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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