Clinical oncology最新文献

{"title":"Avoiding Adjuvant Prophylactic Neck Irradiation in Lateralized Oral Cavity Cancer (APRON)","authors":"S. Sinha ,&nbsp;S. Ghosh Laskar ,&nbsp;S. Dhingra ,&nbsp;A. Kumar ,&nbsp;S. Mohanty ,&nbsp;A. Budrukkar ,&nbsp;M. Swain ,&nbsp;P.N. Bishnu ,&nbsp;I. Joy ,&nbsp;R. Ali ,&nbsp;S. Kannan ,&nbsp;N. Mummudi","doi":"10.1016/j.clon.2025.103980","DOIUrl":"10.1016/j.clon.2025.103980","url":null,"abstract":"<div><div>Oral cavity squamous cell carcinoma (OCSCC) is the second most common cancer in India with an age standardised ratio of 10.3 per 100,000 (both sexes combined) (1). Most patients (60%-80%) present in advanced stages with a high risk of nodal involvement. The current standard of care involves surgery followed by adjuvant radiotherapy (RT), often including elective nodal irradiation (ENI) even in pathologically node-negative patients. However, recent evidence suggests that well-selected patients with adequate surgical clearance may be adequately treated with limited volumes of ENI, potentially sparing them unnecessary toxicity.</div><div>The APRON study is a single-arm, phase II trial evaluating whether limiting ENI is non-inferior to standard adjuvant RT in carefully selected patients with lateralized oral cavity cancers. Eligible patients are adults with biopsy-proven squamous cell carcinoma of the bucco-alveolar region or oral tongue who have undergone margin-negative resection and adequate elective nodal dissection (≥18 nodes). Only well-lateralized tumours (≥1 cm from midline for tongue cancers) are included. The primary endpoint is regional control at 2 years, defined as any nodal recurrence (ipsilateral or contralateral). Secondary endpoints include swallowing function (MD Anderson Dysphagia Inventory; modified barium swallow), local and regional recurrence-free survival, disease-free and overall survival, acute/chronic toxicity, quality of life, salvage rates for recurrence, and dosimetry comparisons. The study also assesses the safety and efficacy of moderate hypofractionation (50 Gy/20 fractions) in the adjuvant setting.</div><div>A sample size of 106 patients is planned, with early stopping rules for safety. Statistical analysis will use the Clopper–Pearson method for nodal failure rates and propensity score matching with historical controls for non-inferiority testing. By limiting ENI in well-selected patients, APRON aims to reduce treatment-related morbidity while maintaining oncologic efficacy, potentially improving functional outcomes and preserving regional immune function. The study is expected to provide valuable evidence for de-escalated adjuvant strategies in OCSCC management.</div></div><div><h3>CTRI Number</h3><div>CTRI/2025/03/082341.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"49 ","pages":"Article 103980"},"PeriodicalIF":3.0,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145721382","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}

{"title":"Liquid Biopsy: A Gentler Window Into Paediatric Brain Tumours","authors":"H. Raza,&nbsp;M. Mehfooz,&nbsp;A. Javed,&nbsp;Y. Ejaz","doi":"10.1016/j.clon.2025.103979","DOIUrl":"10.1016/j.clon.2025.103979","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"49 ","pages":"Article 103979"},"PeriodicalIF":3.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145687098","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}

{"title":"Geriatric Oncology in Italy. Where we are. A CIPOMO (Italian College of Primary Hospital Medical Oncologists)-Gioger (Italian Group of Geriatric Oncology) Survey","authors":"S. Barni ,&nbsp;A. Luciani ,&nbsp;P. Tralongo ,&nbsp;L. Cavanna ,&nbsp;G. Aprile ,&nbsp;S. Leo ,&nbsp;C. Aschele ,&nbsp;M. Giordano ,&nbsp;R.R. Silva ,&nbsp;C. Ortega ,&nbsp;M.G. Sarobba ,&nbsp;F. Artioli ,&nbsp;A. Scanni ,&nbsp;L. Fioretto","doi":"10.1016/j.clon.2025.103965","DOIUrl":"10.1016/j.clon.2025.103965","url":null,"abstract":"<div><h3><em>Aims</em></h3><div>By the year 2040, the population of adult individuals aged 65 years and older is expected to reach 44%. Understanding the impending global demographic change is important for all stakeholders along the oncology pathway.</div></div><div><h3><em>Materials and</em> <em>methods</em></h3><div>CIPOMO (Italian College of Primary Hospital Medical Oncologists) with Gioger (Italian Group of Geriatric Oncology) conducted a survey by sending a questionnaire to the directors of oncology departments to get a picture of the situation and to be able to devise plans to improve care, fill gaps in research, education, and implementation, in essence to undertake major health care management changes. The questionnaire included eight questions: the presence and type of figures dedicated to geriatric oncology, the presence of a geriatrics department, the use of a geriatric assessment, which one is used and when it is performed, when a patient is geriatric, and whether there are clinical trials reserved for the elderly population.</div></div><div><h3><em>Results</em></h3><div>A total of 159 questionnaires were sent and 144 responses were obtained, with a response rate of 90.5%. The analysis shows that in less than 38.97% of hospitals there are figures dedicated to geriatric oncology; when these figures are present in 80.65% are oncologist, 62.9% geriatrician, and 22.58% nurses. Regarding the minimum age to consider an elderly patient, 44.85% set the limit at 70 years and 47.06% at 75 years. Eighty percent state that a geriatric assessment is performed in their wards, the G8 questionnaire is used by 65.77%, the multidimensional geriatric assessment by 29.73%, and 1.8% use the <strong>erythrocyte sedimentation rate (</strong>ESR-13) or other instruments. Regarding when the geriatric assessment is done, in 40.44% it is done at the first access to oncology, in 16.91% ‘on demand’, in 15.44% in cases of deciding on medical treatment, and in 13.24% at first access and periodically afterwards. The presence in hospital of a geriatrics department is 44.85% and 25.74% the availability of a geriatrician; in 30%, no specific figure is available. When asked about the availability of clinical trials specific to the elderly population, in 87.5% the answer is negative.</div></div><div><h3><em>Conclusion</em></h3><div>The results show the shortage of professionals trained or assigned to geriatric oncology (including oncologists, geriatricians, nurses, or other dedicated staff), a growing but still insufficient specific cultural preparation, and as is known, very few clinical trials dedicated to elderly oncology patients.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"49 ","pages":"Article 103965"},"PeriodicalIF":3.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145660216","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}

{"title":"Radiotherapy for Oesophageal Cancer in the United Kingdom: Patterns of Practice and Quality Indicators","authors":"C.W. Bleaney ,&nbsp;K. Aitken ,&nbsp;T.D.L. Crosby ,&nbsp;G. Radhakrishna ,&nbsp;R. Roy ,&nbsp;K. Spencer ,&nbsp;C.M. Jones","doi":"10.1016/j.clon.2025.103978","DOIUrl":"10.1016/j.clon.2025.103978","url":null,"abstract":"<div><h3>Aims</h3><div>There is limited guidance relating to the provision of radiotherapy for patients with oesophageal cancer. Given this, we sought to assess variation in patterns of care in the UK and to devise quality improvement metrics to support future treatment standardisation.</div></div><div><h3>Materials and Methods</h3><div>We undertook a cross-sectional survey using a bespoke online survey to explore geographical variation in radiotherapy use for oesophageal cancer across the United Kingdom (UK) National Health Service (NHS). These data were combined with an observational registry analysis using the National Disease Registration Service Radiotherapy Dataset to explore temporal variation in radiotherapy utilization from January 2020 – June 2024.</div></div><div><h3>Results</h3><div>Survey responses were received from 75% (n = 45/60) of UK centres. These demonstrate considerable variation in the interpretation of radiotherapy indications, particularly in the non-curative setting, as well as in radiotherapy technique; with, for instance, one third (n = 15/45) of centres reporting that they do not use motion management strategies for lower third or junctional tumours. Induction chemotherapy use differs between centres and by concurrent regimen, with 93–96% (n = 42–43/45) of centres using induction treatment prior to concurrent platinum/fluoropyrimidine and 56–62% (n = 25–28/45) using it prior to concurrent platinum/taxane. Post-treatment surveillance and follow-up measures also differed with little evidence for more intensive surveillance in patients fit for salvage resection. Most centres reported the use of intensity modulated or volumetric arc therapy (IMRT/VMAT) for radical plans, which was supported by NDRS data demonstrating that the median proportion of patients in each centre treated using IMRT/VMAT increased from 60% (range 14.3–100%) in January-June 2020 to 91.7% (range 16.7–100%) in January-June 2024.</div></div><div><h3>Conclusions</h3><div>There is substantial variation in the radiotherapy-based care of patients with oesophageal cancer in the UK. Formal national guidance is required to build on the quality metrics outlined here.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"49 ","pages":"Article 103978"},"PeriodicalIF":3.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145667199","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}

{"title":"The QuinteT Recruitment Intervention and its Role in Oncology Randomised Controlled Trials","authors":"L. Wallis ,&nbsp;J. Wade ,&nbsp;N. Farrar ,&nbsp;L. Rooshenas ,&nbsp;C. Conefrey ,&nbsp;N. Mills ,&nbsp;V. Shepherd ,&nbsp;L.S. Nixon ,&nbsp;M. Carucci ,&nbsp;A. White ,&nbsp;C.A. Harwood ,&nbsp;A. Rembielak","doi":"10.1016/j.clon.2025.103976","DOIUrl":"10.1016/j.clon.2025.103976","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"49 ","pages":"Article 103976"},"PeriodicalIF":3.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145660224","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}

{"title":"Age or Fitness? Distinguishing Undertreatment From Appropriate De-escalation in Elderly Patients With Non–Small Cell Lung Cancer","authors":"M.M. Haroon","doi":"10.1016/j.clon.2025.103977","DOIUrl":"10.1016/j.clon.2025.103977","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"49 ","pages":"Article 103977"},"PeriodicalIF":3.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145667196","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}

{"title":"Quality Assurance in Multi-Modality Oesophago-Gastric Cancer Clinical Trials: Past, Present and Future Perspectives","authors":"J. Helbrow ,&nbsp;M.E. Booth ,&nbsp;B. Vadhwana ,&nbsp;R. Adams ,&nbsp;K.G. Foley ,&nbsp;C.J. Peters ,&nbsp;R.D. Petty ,&nbsp;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}

{"title":"ACE-RT, A Cloud-Based Tool for Remote Radiotherapy Contouring Support in Lower-Resourced Settings: A Pilot Evaluation","authors":"T. Hope-Johnson ,&nbsp;G.B. Prajogi ,&nbsp;E. Addison ,&nbsp;A. Cameron ,&nbsp;B. Chanda M'ule ,&nbsp;T. Dembrey ,&nbsp;S. Hughes ,&nbsp;T.M. Khaled ,&nbsp;P.J. Lewis ,&nbsp;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}

{"title":"Cure or Truce? Rethinking Cancer Dormancy in Modern Oncology","authors":"M. Mehfooz,&nbsp;H. Raza,&nbsp;A. Javed,&nbsp;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}

{"title":"Refining Prognostic Assessment in Elderly Non–small Cell Lung Cancer: The Importance of Dynamic Comorbidities and Comprehensive Biomarker Profiling","authors":"F. Huang ,&nbsp;M. Fang","doi":"10.1016/j.clon.2025.103969","DOIUrl":"10.1016/j.clon.2025.103969","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"49 ","pages":"Article 103969"},"PeriodicalIF":3.0,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621685","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}