Clinical oncology最新文献

英文中文

Radiotherapy for Oesophageal Cancer in the United Kingdom: Patterns of Practice and Quality Indicators 英国食管癌放疗：实践模式和质量指标。

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-11-14 DOI: 10.1016/j.clon.2025.103978

C.W. Bleaney , K. Aitken , T.D.L. Crosby , G. Radhakrishna , R. Roy , K. Spencer , C.M. Jones

Aims

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.

Materials and Methods

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.

Results

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.

Conclusions

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.

目的：有关食管癌患者放疗的指导是有限的。鉴于此，我们试图评估英国护理模式的变化，并设计质量改进指标，以支持未来的治疗标准化。材料和方法：我们采用一项定制的在线调查进行了一项横断面调查，以探索英国国民健康服务体系（NHS）食管癌放疗使用的地理差异。这些数据与使用国家疾病登记服务放射治疗数据集的观察性登记分析相结合，以探索2020年1月至2024年6月放射治疗利用的时间变化。结果：75% （n = 45/60）的英国中心收到了调查回复。这表明对放疗适应症的解释存在相当大的差异，特别是在非治疗性环境中，以及在放疗技术方面；例如，三分之一（n = 15/45）的中心报告说，他们不使用运动管理策略治疗下三分之一或结膜肿瘤。诱导化疗的使用在不同的中心和不同的并行方案之间有所不同，93-96% （n = 42-43/45）的中心在铂/氟嘧啶并行治疗之前使用诱导治疗，56-62% （n = 25-28/45）的中心在铂/紫杉烷并行治疗之前使用诱导治疗。治疗后监测和随访措施也存在差异，几乎没有证据表明适合进行补救性切除的患者需要更强化的监测。大多数中心报告使用强度调节或体积弧治疗（IMRT/VMAT）进行根治性计划，NDRS数据支持这一点，表明每个中心使用IMRT/VMAT治疗的患者中位数比例从2020年1月至6月的60%（范围14.3-100%）增加到2024年1月至6月的91.7%（范围16.7-100%）。结论：在英国，食管癌患者的放疗护理存在很大差异。需要正式的国家指导，以这里概述的质量指标为基础。

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引用次数: 0

The QuinteT Recruitment Intervention and its Role in Oncology Randomised Controlled Trials 五重奏招募干预及其在肿瘤学随机对照试验中的作用。

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-11-13 DOI: 10.1016/j.clon.2025.103976

L. Wallis , J. Wade , N. Farrar , L. Rooshenas , C. Conefrey , N. Mills , V. Shepherd , L.S. Nixon , M. Carucci , A. White , C.A. Harwood , A. Rembielak

引用次数: 0

Age or Fitness? Distinguishing Undertreatment From Appropriate De-escalation in Elderly Patients With Non–Small Cell Lung Cancer 年龄还是健康？老年非小细胞肺癌患者治疗不足与适当降压治疗的区别。

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-11-13 DOI: 10.1016/j.clon.2025.103977

M.M. Haroon

引用次数: 0

Quality Assurance in Multi-Modality Oesophago-Gastric Cancer Clinical Trials: Past, Present and Future Perspectives 多模式食管胃癌临床试验的质量保证：过去，现在和未来的观点

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-11-08 DOI: 10.1016/j.clon.2025.103971

J. Helbrow , M.E. Booth , B. Vadhwana , R. Adams , K.G. Foley , C.J. Peters , R.D. Petty , S. Gwynne

Clinical trials must ensure the quality of both standard and interventional treatments to rigorously evaluate potential benefits, avoid adverse outcomes, and maintain the integrity of results. Quality assurance (QA) endeavours to achieve this and is fundamental to all clinical trial elements, though variation exists between specialties. For radiotherapy (RT) in the UK, the NIHR-funded national Radiotherapy Trials Quality Assurance (RTTQA) group has centralised trial RTQA processes across the RT pathway enabling a robust, consistent, efficient and multidisciplinary approach, replacing piecemeal, trial-by-trial application for QA funding. Meanwhile, the surgical community are moving towards standardised QA processes but has yet to achieve this universally. For SACT, though the importance of QA is recognised, under-reporting persists, and the increasing number and diversity of agents used pose challenges. QA in pathology and radiology is also growing as the complexity of clinical trials increases. Internationally, the EORTC has developed QA processes across domains, but uncertainty and challenges in QA implementation remain. Additionally, while the benefits of trial QA are now recognised, the potential negative effects of QA need to be recognised. Using illustrative examples from contemporary oesophago-gastric cancer studies, we further explore the current status of clinical trial QA across these specialties.

临床试验必须确保标准和介入治疗的质量，以严格评估潜在的益处，避免不良后果，并保持结果的完整性。质量保证（QA）努力实现这一目标，是所有临床试验要素的基础，尽管不同专业之间存在差异。对于英国的放射治疗（RT），由英国国立卫生研究院资助的国家放射治疗试验质量保证（RTTQA）小组在整个放疗途径中集中了试验RTQA流程，实现了稳健、一致、高效和多学科的方法，取代了零散的、逐个试验的质量保证资助申请。与此同时，外科社区正在朝着标准化的质量保证过程发展，但尚未普遍实现这一目标。对于SACT，尽管QA的重要性得到了认可，但低报现象仍然存在，并且使用的代理数量和多样性的增加带来了挑战。随着临床试验的复杂性增加，病理学和放射学的质量保证也在增加。在国际上，EORTC已经开发了跨领域的QA流程，但QA实施中的不确定性和挑战仍然存在。此外，虽然现在认识到试用QA的好处，但QA的潜在负面影响也需要认识到。通过当代食管癌-胃癌研究的实例，我们进一步探讨了这些专业临床试验QA的现状。

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引用次数: 0

ACE-RT, A Cloud-Based Tool for Remote Radiotherapy Contouring Support in Lower-Resourced Settings: A Pilot Evaluation ACE-RT，低资源环境下远程放疗轮廓支持的基于云的工具：试点评估

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-11-07 DOI: 10.1016/j.clon.2025.103967

T. Hope-Johnson , G.B. Prajogi , E. Addison , A. Cameron , B. Chanda M'ule , T. Dembrey , S. Hughes , T.M. Khaled , P.J. Lewis , A. Aggarwal

Aims

Digital learning tools designed to improve radiotherapy contouring skills could help to increase training capacity in low- and middle-income countries (LMICs), where trainees face barriers to learning such as few clinicians and high workloads. Previous efforts to implement software to remotely review radiotherapy plans in LMICs have faced challenges such as poor internet connectivity and insufficient information technology infrastructure. We developed and evaluated a new cloud-based software to support radiotherapy planning, designed specifically for use in lower-resourced settings.

Materials and methods

A cloud-based training software, ‘ACE-RT’, was co-designed with radiotherapy professionals in Ghana, Zambia and the United Kingdom to facilitate remote feedback on contours and form a portfolio to record a clinician's skill development. The co-development involved assessing bandwidth, user interface, and functionality to meet needs in an LMIC setting. The software is noncommercial, designed for educational use. ACE-RT was evaluated by a radiation oncology consultant and trainee in Indonesia between April and September 2023.

Results

The resident successfully uploaded and received feedback on six plans over the evaluation period. Both consultant and trainee found ACE-RT made it easier to provide and receive tailored feedback compared to their previous practice and that the quality of feedback improved. The trainee reported that the quantity of feedback was greater when using ACE-RT. Both found the portfolio function useful, appreciating the educational value of reviewing previous contours. The main implementation barriers identified were poor internet connectivity and the complexity of exporting files from the treatment planning system.

Conclusion

This evaluation of a cloud-based educational portfolio tool to improve training in radiotherapy contouring found it to be feasible, acceptable, and appropriate for use in a resource-limited setting. Unstable internet connectivity was the main barrier identified. Further work is recommended to improve the software’s performance with variable internet speeds and evaluate the implementation in a range of centres.

旨在提高放射治疗轮廓技能的数字学习工具可以帮助提高低收入和中等收入国家（LMICs）的培训能力，在这些国家，受训者面临着学习障碍，如临床医生少和工作量大。以前在中低收入国家实施远程审查放射治疗计划的软件的努力面临着诸如互联网连接不良和信息技术基础设施不足等挑战。我们开发并评估了一种新的基于云的软件来支持放疗计划，该软件是专门为资源匮乏地区设计的。材料和方法基于云的培训软件“ACE-RT”是与加纳、赞比亚和英国的放射治疗专业人员共同设计的，以促进对轮廓的远程反馈，并形成一个组合来记录临床医生的技能发展。共同开发涉及评估带宽、用户界面和功能，以满足LMIC设置中的需求。该软件是非商业性的，是为教育用途而设计的。ACE-RT于2023年4月至9月在印度尼西亚由一名放射肿瘤学顾问和实习生进行评估。结果在评估期间，该居民成功上传并收到了6个方案的反馈。咨询师和受训者都发现，与之前的实践相比，ACE-RT更容易提供和接受量身定制的反馈，反馈的质量也得到了提高。学员报告说，当使用ACE-RT时，反馈的数量更大。两人都发现组合函数很有用，并欣赏回顾以前轮廓的教育价值。确定的主要实施障碍是互联网连通性差和从治疗计划系统导出文件的复杂性。结论对基于云的教育组合工具进行评估，以改善放疗轮廓的培训，发现它是可行的，可接受的，并且适合在资源有限的环境中使用。不稳定的互联网连接是确定的主要障碍。建议进一步开展工作，以改善软件在不同互联网速度下的性能，并评估在一系列中心的实施情况。

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引用次数: 0

Cure or Truce? Rethinking Cancer Dormancy in Modern Oncology 治愈还是休战？重新思考现代肿瘤学中的癌症休眠。

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-11-07 DOI: 10.1016/j.clon.2025.103973

M. Mehfooz, H. Raza, A. Javed, M. Aslam

引用次数: 0

Refining Prognostic Assessment in Elderly Non–small Cell Lung Cancer: The Importance of Dynamic Comorbidities and Comprehensive Biomarker Profiling 改进老年非小细胞肺癌的预后评估：动态合并症和综合生物标志物分析的重要性

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-11-06 DOI: 10.1016/j.clon.2025.103969

F. Huang , M. Fang

引用次数: 0

Beyond Parametric Boundaries: Rethinking the Distributed Lag Nonlinear Model in Meteorological Modelling for Oncology Emergencies 超越参数边界：对肿瘤突发事件气象建模中分布滞后非线性模型的再思考

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-11-06 DOI: 10.1016/j.clon.2025.103970

S. Oka , K. Yoshida , Y. Takefuji

引用次数: 0

Safety and Efficacy of Atezolizumab in Combination With nab-Paclitaxel in Patients With PD-L1 Positive Metastatic or Locally Advanced Triple-Negative Breast Cancer: A UK-Wide Cancer Centre Experience Atezolizumab联合nab-紫杉醇治疗PD-L1阳性转移性或局部晚期三阴性乳腺癌的安全性和有效性：全英国癌症中心的经验

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-11-05 DOI: 10.1016/j.clon.2025.103968

J.V. Waterhouse , A. Holdich , F. Mina , M. Obeid , K. Joshi , S. Barrett , L. Rajakumar , G. McCormick , S. Seymour , P. Koliou , R. Sylva , O. Ayodele , A. Gautam , J. Smith , J. McKeon , T. Strawson-Smith , R. Douglas , A. Borley , A. Konstantis , S. McGrath

Aims

First-line atezolizumab and nab-paclitaxel for patients with advanced triple-negative breast cancer and programmed death-ligand expression ≥1% prolongs progression-free survival (PFS) and overall survival (OS). Toxicities may impact upon quality of life, resulting in treatment discontinuation. This National Service Evaluation aimed to assess safety and efficacy in a “real-world” dataset.

Material and methods

Data from patients treated between March 9, 2019, and March 9, 2022, across 10 UK cancer centres were analysed. Toxicities were recorded conforming to the Common Terminology Criteria for Adverse Events version 5.0 scoring system. Local approval and data sharing agreements were gained. Kaplan–Meier curves for PFS and OS were calculated.

Results

One hundred twenty-nine patients with median age of 55.0 were eligible; 21.7% had de novo metastatic disease and 76.7% received prior neo-/adjuvant treatment. Overall, 85.3% had an adverse event with 7% leading to treatment withdrawal. Of all, 21.7% of patients had grade 3 or 4 AEs, notably decreased neutrophil count (10.1%), pyrexia (2.3%), alanine aminotransferase rise (2.3%), colitis (2.3%), and hepatitis (2.3%). The median PFS was 5 months (95% CI: 1.0, 6.0) and OS was 14 months (95% CI: 3.0, 17.0).

Conclusion

Atezolizumab/nab-paclitaxel toxicity was comparable to the literature; however, PFS and OS were shorter and a higher number of grade ≥3 colitis and hepatitis were noticed.

目的：atezolizumab和nab-紫杉醇用于晚期三阴性乳腺癌和程序性死亡配体表达≥1%的患者，可延长无进展生存期（PFS）和总生存期（OS）。毒性可能影响生活质量，导致停止治疗。这项全国服务评估旨在评估“现实世界”数据集中的安全性和有效性。材料和方法分析了2019年3月9日至2022年3月9日期间英国10个癌症中心接受治疗的患者的数据。毒性记录符合不良事件通用术语标准5.0版评分系统。获得了地方批准和数据共享协议。计算PFS和OS的Kaplan-Meier曲线。结果纳入患者129例，中位年龄55.0岁；21.7%为新发转移性疾病，76.7%既往接受过新/辅助治疗。总体而言，85.3%的患者出现不良事件，其中7%导致停药。其中，21.7%的患者出现3级或4级ae，主要表现为中性粒细胞计数减少（10.1%）、发热（2.3%）、丙氨酸转氨酶升高（2.3%）、结肠炎（2.3%）和肝炎（2.3%）。中位PFS为5个月（95% CI: 1.0, 6.0）， OS为14个月（95% CI: 3.0, 17.0）。结论atezolizumab /nab-紫杉醇毒性与文献相当；PFS和OS较短，≥3级结肠炎和肝炎发生率较高。

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引用次数: 0

One Week, One Boost, One Goal: Feasibility, Safety and Local Control in Breast Ductal Carcinoma In Situ With Ultra-hypofractionated Radiotherapy and Simultaneous Integrated Boost 一周，一次强化，一个目标：超低分割放疗和同步综合强化治疗乳腺导管原位癌的可行性、安全性和局部控制

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-11-05 DOI: 10.1016/j.clon.2025.103966

A. Montero , R. Ciervide , B. Alvarez , I. Ratosa , M. Garcia-Aranda , J. Valero , T. Alaverdashvili , X. Chen-Zhao , M. Lopez , L. Alonso , O. Hernando , E. Sánchez , A. Martinez , R. Alonso , P. Fernandez-Leton , C. Rubio

Aims

Data on feasibility and safety of ultra-hypofractionated radiotherapy (UHF-RT) for ductal carcinoma in situ (DCIS) remain limited, particularly regarding its use with a simultaneous integrated boost (SIB).

Materials and methods

This prospective cohort study included 100 women with histologically confirmed DCIS treated between April 2020 and May 2024. Ninety patients underwent breast-conserving surgery, and 10 received postmastectomy radiotherapy due to high-risk features. All patients received UHF-RT to 26 Gy in five fractions, with SIB to 29-32 Gy delivered using three-dimensional conformal radiotherapy or volumetric modulated arc therapy. Acute and late toxicities were assessed per Common Terminology Criteria for Adverse Events, version 5.0, and recurrence-free survival was analysed using Kaplan–Meier estimates.

Results

At a median follow-up of 44 months, all patients were alive and disease-free except one, who experienced in situ recurrence at 31 months and was successfully salvaged. The 48-month actuarial local control rate was 98.8%. Acute toxicity was mostly grade 1 dermatitis (57%) or oedema (10%). No grade ≥3 toxicity was observed. Fat necrosis occurred in 11% of patients, all asymptomatic. Late events included hyperpigmentation (9%), fibrosis (6%), and mild pain (28%). No clinical or dosimetric variables were significantly associated with toxicity.

Conclusion

Ultra-hypofractionated whole-breast radiotherapy with SIB is feasible, safe, and well-tolerated in patients with DCIS, including those at high risk postmastectomy. These findings provide early evidence supporting its use, pending results from ongoing randomised trials.

目的：关于超低分割放疗（UHF-RT）治疗导管原位癌（DCIS）的可行性和安全性的数据仍然有限，特别是关于其与同步集成增强（SIB）的使用。材料和方法该前瞻性队列研究包括100名组织学证实的DCIS患者，于2020年4月至2024年5月接受治疗。90例患者行保乳手术，10例患者因高危特征行乳房切除术后放疗。所有患者分五次接受26 Gy的UHF-RT，其中SIB为29-32 Gy，采用三维适形放疗或体积调制电弧治疗。根据不良事件通用术语标准5.0版评估急性和晚期毒性，并使用Kaplan-Meier估计分析无复发生存期。结果中位随访时间为44个月，除1例患者在31个月时原位复发并成功抢救外，其余患者均存活且无病。48个月精算局部控制率为98.8%。急性毒性主要为1级皮炎（57%）或水肿（10%）。未见≥3级毒性。11%的患者出现脂肪坏死，均无症状。晚期事件包括色素沉着（9%）、纤维化（6%）和轻度疼痛（28%）。没有临床或剂量学变量与毒性显著相关。结论SIB超低分割全乳放疗在DCIS患者，包括高危的乳腺切除术后患者中是可行、安全且耐受性良好的。这些发现提供了支持其使用的早期证据，等待正在进行的随机试验的结果。

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