Clinical oncology最新文献_第7页

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IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-10-18 DOI: 10.1016/S0936-6555(24)00407-2

引用次数: 0

Oncoflash November 2024 Edition 肿瘤快讯》2024 年 11 月版

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-10-18 DOI: 10.1016/j.clon.2024.08.013

D. Shor, R. Simões

引用次数: 0

Breast Cancer Prognosis in Young BRCA1/BRCA2 Mutation Carriers: A Retrospective Hospital-based Cohort Study 年轻 BRCA1/BRCA2 基因突变携带者的乳腺癌预后：一项基于医院的队列回顾性研究。

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-10-18 DOI: 10.1016/j.clon.2024.10.030

F. Hego , M. Barthoulot , S. Chretien , C. Pierard , M. Boulaire , S. Bécourt , L. Boulanger , L. Ceugnart , A.L. Conoy , F. Oca , A. Mailliez

Aim

Studies evaluating the prognostic impact of germline BRCA1/2 mutations (gBRCAm) in patients with breast cancer report conflicting results. Therefore, we aimed to investigate outcomes of patients with gBRCA mutations and early onset of breast cancer (<30 years) compared with those of noncarriers.

Materials and methods

This retrospective study included 149 patients recruited between 2005 and 2019. The outcomes were overall survival (OS) and disease-free survival (DFS), which were defined as the time from the first diagnosis to death from any cause and the first recurrence, second cancer, or death from any cause, respectively. Key patient data, Kaplan–Meier plots, and outcomes were described according to the BRCA mutation status. Hazard ratios (HR) were calculated using the Cox proportional hazards model.

Results

Twenty-eight patients (28/149; 18.8 %) were gBRCAm carriers. The OS median follow-up was 8.2 years. OS was 89.3% [70.4–96.4] in carriers vs 99.2% [95% CI: 94.3–99.9] in non-carrier patients at 2 years; 85.2% [65.2–94.2] vs 93.0% [86.5–96.5] at 5 years, and 76.5% [54.7–88.8] vs 85.2% [75.7–91.2] at 10 years. There was no difference in OS between groups in multivariable analysis (HR = 1.90 [0.69–5.23], p = 0.22). The DFS median follow-up was 6.6 years. Similar results were observed for DFS (HR = 1.39 [0.63–3.08], p = 0.42).

Conclusion

In this large hospital-based cohort of patients with very early-onset breast cancer, we found no clear evidence that gBRCA1/2m significantly affects OS after adjusting for known prognostic factors.

目的：评估乳腺癌患者种系 BRCA1/2 基因突变（gBRCAm）对预后影响的研究报告结果相互矛盾。因此，我们旨在调查 gBRCA 基因突变和早期乳腺癌患者的预后情况：这项回顾性研究纳入了 2005 年至 2019 年间招募的 149 名患者。研究结果为总生存期（OS）和无病生存期（DFS），分别定义为从首次诊断到死于任何原因的时间，以及首次复发、第二次癌症或死于任何原因的时间。根据 BRCA 基因突变状态对患者的关键数据、Kaplan-Meier 图和结果进行了描述。采用考克斯比例危险模型计算危险比（HR）：28名患者（28/149；18.8%）为gBRCAm携带者。OS 中位随访时间为 8.2 年。2年后，携带者的OS为89.3% [70.4-96.4] vs 99.2% [95% CI：94.3-99.9]；5年后，携带者的OS为85.2% [65.2-94.2] vs 93.0% [86.5-96.5]；10年后，携带者的OS为76.5% [54.7-88.8] vs 85.2% [75.7-91.2]。在多变量分析中，各组间的 OS 没有差异（HR = 1.90 [0.69-5.23]，P = 0.22）。DFS 中位随访时间为 6.6 年。DFS 的结果与此相似（HR = 1.39 [0.63-3.08]，P = 0.42）：结论：在这个以医院为基础的大型极早期乳腺癌患者队列中，我们没有发现明确的证据表明，在调整了已知的预后因素后，gBRCA1/2m会显著影响OS。

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引用次数: 0

OncoFlash-Research Updates in a Flash! OncoFlash - 即时研究更新！

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-10-16 DOI: 10.1016/j.clon.2024.10.031

S Parikh, K T Jayaprakash

引用次数: 0

Danish and Swedish National Data Collections for Cancer – Solutions for Radiotherapy 丹麦和瑞典国家癌症数据收集--放射治疗解决方案。

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-10-12 DOI: 10.1016/j.clon.2024.10.009

C.E. Olsson , S.L. Krogh , M. Karlsson , J.G. Eriksen , T. Björk-Eriksson , C. Grau , D. Norman , B.V. Offersen , T. Nyholm , J. Overgaard , B. Zackrisson , C.R. Hansen

Collecting large amounts of radiotherapy (RT) data from clinical systems is known to be a challenging task. Still, data collections outside the original RT systems are needed to follow-up on the quality of cancer care and to improve RT. This paper aims to describe how RT data is collected nationally in Denmark and Sweden for this purpose and gives an overview of the stored information in both countries' national data sources.

Although both countries have clinical national quality registries with broad coverage and completeness for many cancer diagnoses, some were initiated already in the seventies, and less than one in ten includes quantitative information on RT to a level of detail useful for more than basic descriptive statistics. Detailed RT data can, however, be found in Denmark's DICOM Collaboration (DcmCollab) database, initiated in 2009 and in Sweden's quality registry for RT launched in 2023 (SKvaRT). Denmark has collected raw DICOM data for all patients enrolled in clinical trials, with files being directly and automatically transferred to DcmCollab from the original data sources at each RT centre. Sweden collects aggregated RT data into SKvaRT for all patients undergoing RT in Sweden, with DICOM files being transferred and selected alpha-numeric variables forwarded via a local intermediate storage database (MIQA) at each hospital. In designing their respective solutions, both countries have faced similar challenges regarding which RT variables to collect and how to technically link clinical systems to their data repositories. General lessons about how flexibility currently is balanced with storage requirements and data standards are presented here together with future plans to harvest real-world RT data.

众所周知，从临床系统中收集大量放射治疗（RT）数据是一项具有挑战性的任务。尽管如此，仍需要收集原始 RT 系统之外的数据，以跟进癌症治疗的质量并改进 RT。本文旨在介绍丹麦和瑞典如何为此在全国范围内收集 RT 数据，并概述两国国家数据源中存储的信息。虽然这两个国家都拥有覆盖面广、完整的国家临床质量登记册，涵盖了许多癌症诊断，但其中一些登记册早在上世纪七十年代就已启动，只有不到十分之一的登记册包含有关 RT 的定量信息，其详细程度只能用于基本的描述性统计。不过，详细的 RT 数据可以在 2009 年启动的丹麦 DICOM 协作（DcmCollab）数据库和 2023 年启动的瑞典 RT 质量登记（SKvaRT）中找到。丹麦收集了所有临床试验入组患者的 DICOM 原始数据，文件从每个 RT 中心的原始数据源直接自动传输到 DcmCollab。瑞典将瑞典所有接受 RT 治疗的患者的 RT 数据汇总到 SKvaRT，通过各医院的本地中间存储数据库（MIQA）传输 DICOM 文件并转发选定的字母数字变量。在设计各自的解决方案时，两国在收集哪些 RT 变量以及如何在技术上将临床系统与其数据存储库连接起来方面都面临着类似的挑战。本文介绍了目前如何在灵活性与存储要求和数据标准之间取得平衡的一般经验，以及未来收集真实 RT 数据的计划。

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引用次数: 0

Real World Outcomes in Patients With Recurrent, Advanced, or Metastatic Endometrial Cancer Treated With Lenvatinib Plus Pembrolizumab 用伦伐替尼加 Pembrolizumab 治疗复发性、晚期或转移性子宫内膜癌患者的实际疗效。

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-10-11 DOI: 10.1016/j.clon.2024.10.008

A. Pawsey , P. Mahalingam , N. Senthivel , A. Ramessur , E. Turnbull , S. Usman , R. Browne , A. Patel , A. Stewart , L. Tookman , N. Counsell , R. Miller , S. Nicum , G. Eminowicz

Aims

Patients with endometrial cancer who progress following first line therapy have improved survival outcomes with pembrolizumab and lenvatinib (pem/len) compared with standard of care chemotherapy, as demonstrated in KEYNOTE-775. This was in a group of trial patients with good performance status and excluded those with carcinosarcoma histology. In KEYNOTE-775 pem/len was associated with significant toxicity, leading to dose reductions, treatment cessation, and patient morbidity. We set out to assess the tolerability, toxicity and outcomes following pem/len for patients with recurrent, advanced or metastatic endometrial cancer in a real-world setting.

Materials and methods

UK centres treating patients with pem/len for advanced endometrial cancer within the compassionate access programme were approached. Retrospective data were analysed for those treated between May 2022 and June 2023. Data on patient demographics, treatment, toxicity and outcomes were extracted from medical records. Toxicity and tolerability were compared in those over and under the age of 70.

Results

Seven centres returned data for 70 patients. Median age of patients was 68.5 years (range 45–85) with a performance status of 0–1 in 77.1% and of 2 in 22.9%. Histological subtypes included serous (34.3%), endometrioid (32.9%), carcinosarcoma (14.3%), clear cell (7.1%), mixed (2.9%) and other (8.6%). Grade ≥3 toxicity was reported in 55.7% with any-grade toxicity observed in 85.7%. In those aged ≥70 years (n = 30) the rate of grade ≥3 toxicity was 60.0%. Rates of dose reduction of lenvatinib were 64.3%, and toxicity-related treatment interruption was 45.7%. The 6-month progression-free and overall survival rates were 54.0% (95%CI: 39.0–66.8) and 70.1% (95%CI:56.5–80.1) respectively.

Conclusion

This real-world, observational study of pem/len showed comparable tolerability, toxicity, and outcomes to previously reported clinical trial data. Our cohort included patients with a poorer PS and a broader range of histological subtypes including carcinosarcoma.

目的：KEYNOTE-775试验表明，与标准疗法化疗相比，使用pembrolizumab和lenvatinib（pem/len）治疗一线治疗后病情进展的子宫内膜癌患者的生存率更高。这是在一组表现状况良好的试验患者中进行的，并排除了组织学为癌肉瘤的患者。在 KEYNOTE-775 试验中，pem/len 具有明显的毒性，导致剂量减少、治疗停止和患者发病。我们试图在真实世界中评估复发性、晚期或转移性子宫内膜癌患者接受 pem/len 治疗后的耐受性、毒性和疗效：我们联系了英国的一些中心，这些中心在同情性准入计划范围内使用培美/伦治疗晚期子宫内膜癌患者。对 2022 年 5 月至 2023 年 6 月期间接受治疗的患者的回顾性数据进行了分析。从医疗记录中提取了有关患者人口统计学、治疗、毒性和结果的数据。对 70 岁以上和 70 岁以下患者的毒性和耐受性进行了比较：七个中心共提供了 70 名患者的数据。患者的中位年龄为 68.5 岁（45-85 岁不等），77.1% 的患者表现为 0-1，22.9% 的患者表现为 2。组织学亚型包括浆液性（34.3%）、子宫内膜样（32.9%）、癌肉瘤（14.3%）、透明细胞（7.1%）、混合型（2.9%）和其他（8.6%）。55.7%的患者出现≥3级毒性，85.7%的患者出现任何级别的毒性。在年龄≥70岁的人群中（n = 30），≥3级毒性发生率为60.0%。来伐替尼剂量减少率为64.3%，与毒性相关的治疗中断率为45.7%。6个月无进展生存率和总生存率分别为54.0%（95%CI：39.0-66.8）和70.1%（95%CI：56.5-80.1）：这项关于 pem/len 的真实世界观察性研究显示，其耐受性、毒性和结果与之前报告的临床试验数据相当。我们的队列中包括了PS较差的患者和更广泛的组织学亚型，包括癌肉瘤。

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引用次数: 0

Early Outcomes of Preoperative Short Course Radiotherapy With Simultaneous Integrated Boost and Response-adapted Chemotherapy for Advanced Rectal Cancer 晚期直肠癌术前短程放疗与同步综合增强和反应适应化疗的早期疗效。

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-10-09 DOI: 10.1016/j.clon.2024.10.005

B. Chan , N.S.M. Wong , B.B.W. Wo , O.L. Chan , A.S. Lee

Background and purpose

Limited evidence exists for dose escalation in neoadjuvant short course radiotherapy (SCRT) for rectal cancer. With enhanced imaging and radiotherapy techniques over the past decades along with the valuable endpoint of pathological complete response (pCR), we believe SCRT with simultaneous integrated boost could potentially provide deeper pathological responses and improve local control.

Methods and Materials

Between January 2020 and December 2022, locoregional-advanced rectal cancer patients that were treated with neoadjuvant SCRT with simultaneous integrated boost up to 5.5–6Gy per fraction with five daily fractions followed by response-adapted chemotherapy was retrospectively reviewed. The pCR rates, R0 resection rates, tumor downstaging, toxicities, and early pattern of recurrence are reported.

Results

Among the 76 patients, 67 (88%) were able to undergo curative intent surgery. R0 resection was achieved in 99% (n = 66) of patients with pCR rates of 28% (n = 19). Forty-six percent (n = 31) of patients had significant pathological downstaging (ypT2N0) and 55% (n = 37) of patients had both T and N downstaging. Most common grade 3 or above radiotherapy-related side-effects were proctitis, rectal pain, and dermatitis found in 5% (n = 4), 3% (n = 2) and 3% (n = 2) of patients, respectively. Grade 3 or above surgical complications were observed in 15% (n = 10) of patients. There were no treatment-related deaths. With a median follow-up of 27 months, only 6% (n = 4) had local recurrence after surgery.

Conclusions

Neoadjuvant short course radiotherapy with simultaneous boost for rectal cancer is feasible with no added toxicities. Patients who underwent surgery achieve a high R0 resection and pCR rates. Early data suggest low rates of locoregional recurrence. Further follow-up and research is needed to validate and optimize the dose, method, and schedule of dose escalation.

背景和目的：直肠癌新辅助短程放疗（SCRT）剂量升级的证据有限。过去几十年来，随着成像和放疗技术的提高，以及病理完全反应（pCR）这一重要终点的出现，我们相信，SCRT与同步综合增强疗法有可能提供更深层次的病理反应，并改善局部控制：回顾性分析了2020年1月至2022年12月期间接受新辅助SCRT治疗的局部区域晚期直肠癌患者的情况，SCRT同时进行综合增强，每分次高达5.5-6Gy，每天分5次，然后进行反应适应性化疗。结果：76名患者中，67人（88%）接受了根治性手术。99%（66 人）的患者实现了 R0 切除，pCR 率为 28%（19 人）。46%（n = 31）的患者病理分期显著降低（ypT2N0），55%（n = 37）的患者同时出现T和N分期降低。最常见的3级或以上放疗相关副作用是直肠炎、直肠疼痛和皮炎，分别有5%（4人）、3%（2人）和3%（2人）的患者出现这些副作用。15%（10 人）的患者出现 3 级或以上手术并发症。无治疗相关死亡病例。中位随访时间为27个月，只有6%的患者（4例）在术后出现局部复发：结论：直肠癌新辅助短程放疗与同步增强疗法是可行的，且不会增加毒性。接受手术治疗的患者可获得较高的 R0 切除率和 pCR 率。早期数据显示，局部复发率较低。还需要进一步的随访和研究来验证和优化剂量、方法和剂量递增计划。

{"title":"Early Outcomes of Preoperative Short Course Radiotherapy With Simultaneous Integrated Boost and Response-adapted Chemotherapy for Advanced Rectal Cancer","authors":"B. Chan , N.S.M. Wong , B.B.W. Wo , O.L. Chan , A.S. Lee","doi":"10.1016/j.clon.2024.10.005","DOIUrl":"10.1016/j.clon.2024.10.005","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Limited evidence exists for dose escalation in neoadjuvant short course radiotherapy (SCRT) for rectal cancer. With enhanced imaging and radiotherapy techniques over the past decades along with the valuable endpoint of pathological complete response (pCR), we believe SCRT with simultaneous integrated boost could potentially provide deeper pathological responses and improve local control.</div></div><div><h3>Methods and Materials</h3><div>Between January 2020 and December 2022, locoregional-advanced rectal cancer patients that were treated with neoadjuvant SCRT with simultaneous integrated boost up to 5.5–6Gy per fraction with five daily fractions followed by response-adapted chemotherapy was retrospectively reviewed. The pCR rates, R0 resection rates, tumor downstaging, toxicities, and early pattern of recurrence are reported.</div></div><div><h3>Results</h3><div>Among the 76 patients, 67 (88%) were able to undergo curative intent surgery. R0 resection was achieved in 99% (n = 66) of patients with pCR rates of 28% (n = 19). Forty-six percent (n = 31) of patients had significant pathological downstaging (ypT2N0) and 55% (n = 37) of patients had both T and N downstaging. Most common grade 3 or above radiotherapy-related side-effects were proctitis, rectal pain, and dermatitis found in 5% (n = 4), 3% (n = 2) and 3% (n = 2) of patients, respectively. Grade 3 or above surgical complications were observed in 15% (n = 10) of patients. There were no treatment-related deaths. With a median follow-up of 27 months, only 6% (n = 4) had local recurrence after surgery.</div></div><div><h3>Conclusions</h3><div>Neoadjuvant short course radiotherapy with simultaneous boost for rectal cancer is feasible with no added toxicities. Patients who underwent surgery achieve a high R0 resection and pCR rates. Early data suggest low rates of locoregional recurrence. Further follow-up and research is needed to validate and optimize the dose, method, and schedule of dose escalation.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"Article 103653"},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589857","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}

引用次数: 0

Adjuvant Radiotherapy in Bladder Cancers: A Dosimetric Study Focusing on Ileal Conduit Sparing 膀胱癌的辅助放疗：以回肠导管疏通为重点的剂量学研究

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-10-09 DOI: 10.1016/j.clon.2024.10.006

S. Goyal , K. Periasamy , T. Dey , P. Vias , G. Trivedi , G. Ghera , R. Madan , H. Prashar , D. Khosla , R. Mavuduru , G.S. Bora

Purpose

To compare ileal conduit (IC) and other organ at risk (OAR) dosimetry between treatment techniques in a prospective cohort of patients planned for adjuvant radiotherapy (RT) after radical cystectomy and IC reconstruction.

Methods and materials

Computed tomography (CT datasets of twenty patients who underwent adjuvant RT were obtained and used prospectively for delineation of target volumes (primary and nodal) and OARs, including IC, uretero-ileal anastomosis and ileal stoma using a specified protocol for simulation including a delayed CT to identify IC. Three RT plans were generated for each patient for a dose of 54 gray (Gy) in 27 fractions (PTV V95% >95%): 3-dimensional conformal radiotherapy (3DCRT) with (3DCRT_S) and without (3DCRT_N) stoma shielding, and volumetric modulated arc therapy (VMAT), with OAR constraints specified for VMAT plans (IC: Dmax<54Gy, V50Gy < 20 cc). Constraints were given for other pelvic OARs (bowel, rectum, femur heads) as per published literature. Plans were evaluated for target coverage as well as OAR doses; in particular, IC and ileal stoma). ANOVA test was used to compare medians of achieved doses, and a p-value <0.05 was statistically significant.

Results

The median IC volume was 63.34 (55.29–82.93) cc. The cranial end of IC was at L5 or L4 vertebral level in 95% of patients and caudal level at S2 or S3 in 80% of patients. In contrast, the ileal stoma spanned from L4 or L5 vertebral level cranially (100%) to L5 level caudally (80%). PTV V95% was similar for 3DCRT_N and VMAT plans while it was significantly lower for 3DCRT_S in areas of ileal stoma shielding (99.95% vs 99.01% vs 96.29%, p < 0.01). Median IC V50Gy was comparable in 3DCRT_N (38.81 cc) and 3DCRT_S (35.62 cc) while it was significantly lower in the VMAT plan (17.05 cc, p < 0.01). IC Dmax did not differ significantly between the three plans. On the other hand, when 3DCRT_N, 3DCRT_S, and VMAT plans were compared for ileal stoma doses, Dmean was comparable (11.93 Gy vs 7.41 Gy vs 9.54 Gy, p = 0.06) while Dmax was significantly higher for 3DCRT_N plan and least for VMAT plan (35.32 Gy vs 27.57 Gy vs 24.22 Gy, p < 0.01). VMAT plans fared significantly better than both 3DCRT plans for uretero-ileal anastomosis, bowel, and rectal dosimetry.

Conclusions

Ileal stoma shielding in 3DCRT compromises PTV coverage but does not spare IC effectively. Sparing IC with VMAT is feasible without compromising PTV coverage. Dosimetric gains with VMAT are expected to benefit patients needing higher pelvic RT doses and nodal RT by reducing the risk of anastomotic and mucosal complications. Clinical benefits should be evaluated in a prospective protocol.

目的比较在根治性膀胱切除术和 IC 重建后计划接受辅助放疗 (RT) 的前瞻性队列患者中不同治疗技术的回肠导管 (IC) 和其他危险器官 (OAR) 剂量测量。方法和材料获得了 20 名接受辅助 RT 的患者的计算机断层扫描（CT）数据集，并使用指定的模拟方案（包括延迟 CT 以识别 IC）对目标体积（原发和结节）和 OAR（包括 IC、输尿管-回肠吻合口和回肠造口）进行前瞻性划分。为每位患者生成了三个RT计划，剂量为54灰度（Gy），分27次进行（PTV V95% >95%）：带（3DCRT_S）和不带（3DCRT_N）造口屏蔽的三维适形放射治疗（3DCRT），以及容积调制弧治疗（VMAT），并为 VMAT 计划指定了 OAR 限制（IC：Dmax<54Gy, V50Gy <20cc）。根据已发表的文献，还对其他盆腔 OAR（肠、直肠、股骨头）进行了限制。对计划的目标覆盖范围和 OAR 剂量进行了评估；特别是 IC 和回肠造口）。采用方差分析检验比较达到剂量的中位数，P 值为 0.05 时具有统计学意义。结果 IC 容量的中位数为 63.34 (55.29-82.93) cc。95%的患者 IC 头端位于 L5 或 L4 椎体水平，80%的患者 IC 尾端位于 S2 或 S3 椎体水平。相比之下，回肠造口的范围从头颅的 L4 或 L5 椎体水平（100%）到尾部的 L5 水平（80%）。3DCRT_N 和 VMAT 方案的 PTV V95% 相似，而 3DCRT_S 方案在回肠造口屏蔽区域的 PTV V95% 明显较低（99.95% vs 99.01% vs 96.29%，p < 0.01）。3DCRT_N (38.81 cc) 和 3DCRT_S (35.62 cc) 的 IC V50Gy 中位数相当，而 VMAT 计划的 IC V50Gy 中位数明显较低（17.05 cc，p < 0.01）。三种方案的 IC Dmax 没有明显差异。另一方面，当比较 3DCRT_N、3DCRT_S 和 VMAT 方案的回肠造口剂量时，Dmean 值相当（11.93 Gy vs 7.41 Gy vs 9.54 Gy，p = 0.06），而 Dmax 值在 3DCRT_N 方案中明显较高，在 VMAT 方案中最低（35.32 Gy vs 27.57 Gy vs 24.22 Gy，p <0.01）。在输尿管-回肠吻合口、肠道和直肠剂量测定方面，VMAT 方案明显优于 3DCRT 方案。在不影响 PTV 覆盖范围的情况下，使用 VMAT 保留 IC 是可行的。通过降低吻合口和粘膜并发症的风险，VMAT的剂量学优势有望使需要较高盆腔RT剂量和结节RT的患者受益。临床获益应在前瞻性方案中进行评估。

{"title":"Adjuvant Radiotherapy in Bladder Cancers: A Dosimetric Study Focusing on Ileal Conduit Sparing","authors":"S. Goyal , K. Periasamy , T. Dey , P. Vias , G. Trivedi , G. Ghera , R. Madan , H. Prashar , D. Khosla , R. Mavuduru , G.S. Bora","doi":"10.1016/j.clon.2024.10.006","DOIUrl":"10.1016/j.clon.2024.10.006","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare ileal conduit (IC) and other organ at risk (OAR) dosimetry between treatment techniques in a prospective cohort of patients planned for adjuvant radiotherapy (RT) after radical cystectomy and IC reconstruction.</div></div><div><h3>Methods and materials</h3><div>Computed tomography (CT datasets of twenty patients who underwent adjuvant RT were obtained and used prospectively for delineation of target volumes (primary and nodal) and OARs, including IC, uretero-ileal anastomosis and ileal stoma using a specified protocol for simulation including a delayed CT to identify IC. Three RT plans were generated for each patient for a dose of 54 gray (Gy) in 27 fractions (PTV V95% >95%): 3-dimensional conformal radiotherapy (3DCRT) with (3DCRT_S) and without (3DCRT_N) stoma shielding, and volumetric modulated arc therapy (VMAT), with OAR constraints specified for VMAT plans (IC: Dmax<54Gy, V50Gy < 20 cc). Constraints were given for other pelvic OARs (bowel, rectum, femur heads) as per published literature. Plans were evaluated for target coverage as well as OAR doses; in particular, IC and ileal stoma). ANOVA test was used to compare medians of achieved doses, and a p-value <0.05 was statistically significant.</div></div><div><h3>Results</h3><div>The median IC volume was 63.34 (55.29–82.93) cc. The cranial end of IC was at L5 or L4 vertebral level in 95% of patients and caudal level at S2 or S3 in 80% of patients. In contrast, the ileal stoma spanned from L4 or L5 vertebral level cranially (100%) to L5 level caudally (80%). PTV V95% was similar for 3DCRT_N and VMAT plans while it was significantly lower for 3DCRT_S in areas of ileal stoma shielding (99.95% vs 99.01% vs 96.29%, p < 0.01). Median IC V50Gy was comparable in 3DCRT_N (38.81 cc) and 3DCRT_S (35.62 cc) while it was significantly lower in the VMAT plan (17.05 cc, p < 0.01). IC Dmax did not differ significantly between the three plans. On the other hand, when 3DCRT_N, 3DCRT_S, and VMAT plans were compared for ileal stoma doses, Dmean was comparable (11.93 Gy vs 7.41 Gy vs 9.54 Gy, p = 0.06) while Dmax was significantly higher for 3DCRT_N plan and least for VMAT plan (35.32 Gy vs 27.57 Gy vs 24.22 Gy, p < 0.01). VMAT plans fared significantly better than both 3DCRT plans for uretero-ileal anastomosis, bowel, and rectal dosimetry.</div></div><div><h3>Conclusions</h3><div>Ileal stoma shielding in 3DCRT compromises PTV coverage but does not spare IC effectively. Sparing IC with VMAT is feasible without compromising PTV coverage. Dosimetric gains with VMAT are expected to benefit patients needing higher pelvic RT doses and nodal RT by reducing the risk of anastomotic and mucosal complications. Clinical benefits should be evaluated in a prospective protocol.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"Article 103654"},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593879","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}

引用次数: 0

Concurrent Chemoradiotherapy versus Radiotherapy Alone in the Treatment of Stage II and T3N0M0 Nasopharyngeal Carcinoma: A Systematic Review and Meta-Analysis. 治疗 II 期和 T3N0M0 鼻咽癌的同期化放疗与单独放疗：系统回顾与元分析》（Concurrent Chemoradiotherapy versus Radiotherapy Alone in the Treatment of Stage II and T3N0M0 Nasopharyngeal Carcinoma: A Systematic Review and Meta-Analysis.

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2024-10-05 DOI: 10.1016/j.clon.2024.10.004

H Zeng, H Wang, S Liu, X Xu

Aims: The efficacy of concurrent chemoradiotherapy (CCRT) for Stage II and T3N0 nasopharyngeal carcinoma (NPC), particularly during the shift from two-dimensional conventional radiotherapy (2DCRT) to intensity-modulated radiotherapy (IMRT) is debated.Therefore this study aims to systematically evaluate and meta-analyze survival benefits of CCRT versus radiotherapy alone for Stage II and T3N0 NPC, stratified by radiotherapy techniques.

Materials and methods: As of April 1, 2024, we conducted an exhaustive literature search across databases such as PubMed, Embase, Cochrane Library, and Web of Science, with the aim of identifying and screening studies that compare the efficacy of CCRT versus radiotherapy alone in the treatment of Stage II and T3N0 NPC.

Results: A total of 10 studies encompassing 5015 patients were included in this comprehensive analysis. The findings indicate that, apart from progression-free survival (PFS), CCRT did not improve survival outcomes, including overall survival (OS), distant metastasis-free survival (DMFS), local recurrence-free survival (LRRFS), and failure-free survival (FFS), with all P values exceeding 0.05. Concurrently, the incidence of grade ≥3 adverse events associated with CCRT was significantly elevated (odds ratio [OR] = 3.77, 95% confidence interval [CI] = 2.75-5.15, P < 0.0001). Subgroup analysis revealed that, compared with RT, the combination of 2DCRT with concurrent chemotherapy significantly improved OS (hazard ratio [HR] = 0.57, 95% CI = 0.46-0.71, P < 0.00001), PFS (HR = 0.65, 95% CI=0.53-0.78, P < 0.00001), DMFS (HR = 0.54, 95% CI = 0.37-0.79, P = 0.002), and LRRFS (HR = 0.63, 95% CI = 0.49-0.82, P = 0.0005). In contrast, the combination of IMRT with concurrent chemotherapy failed to demonstrate improvements in OS, PFS, DMFS, or LRRFS, with all P values exceeding 0.05.

Conclusion: In contrast with RT, CCRT did not enhance survival in stage II and T3N0 NPC patients, yet caused more adverse reactions. 2DCRT combined with concurrent chemotherapy significantly improved OS, PFS, DMFS, and LRRFS, while IMRT with concurrent chemotherapy showed no clinical benefits.

目的：对于II期和T3N0鼻咽癌（NPC）的同期化学放疗（CCRT）疗效，尤其是在从二维常规放疗（2DCRT）向调强放疗（IMRT）转变的过程中的疗效存在争议：截至2024年4月1日，我们在PubMed、Embase、Cochrane Library和Web of Science等数据库中进行了详尽的文献检索，旨在识别和筛选在治疗II期和T3N0 NPC时比较CCRT与单纯放疗疗效的研究：本次综合分析共纳入了 10 项研究，涵盖 5015 名患者。研究结果表明，除无进展生存期（PFS）外，CCRT并未改善生存结果，包括总生存期（OS）、无远处转移生存期（DMFS）、无局部复发生存期（LRRFS）和无失败生存期（FFS），所有P值均超过0.05。同时，与CCRT相关的≥3级不良事件的发生率显著升高（几率比[OR]=3.77，95%置信区间[CI]=2.75-5.15，P<0.0001）。亚组分析显示，与RT相比，2DCRT联合同期化疗可明显改善OS（危险比[HR] = 0.57，95% CI = 0.46-0.71，P＜0.00001）、PFS（HR=0.65，95% CI=0.53-0.78，P＜0.00001）、DMFS（HR=0.54，95% CI=0.37-0.79，P=0.002）和LRRFS（HR=0.63，95% CI=0.49-0.82，P=0.0005）。相比之下，IMRT与同期化疗的组合未能改善OS、PFS、DMFS或LRRFS，所有P值均超过0.05：与RT相比，CCRT并不能提高II期和T3N0鼻咽癌患者的生存率，但会引起更多不良反应。2DCRT 联合同期化疗可显著改善 OS、PFS、DMFS 和 LRRFS，而 IMRT 联合同期化疗则无临床益处。

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引用次数: 0

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 : 2024-10-05 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。

{"title":"Characteristics and Survival Outcomes of Male Breast Cancer in Brazil: A Large Population-Based Study.","authors":"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","doi":"10.1016/j.clon.2024.10.002","DOIUrl":"https://doi.org/10.1016/j.clon.2024.10.002","url":null,"abstract":"<p><strong>Aims: </strong>This study evaluated the clinicopathological characteristics, treatment trends, and overall survival (OS) in male breast cancer (BC) in Sao Paulo State of Brazil.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496325","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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