Pub Date : 2024-07-01DOI: 10.1016/j.clon.2024.07.002
W. A. van Amsterdam, Sjoerd Elias, Rajesh Ranganath
{"title":"Causal inference in oncology: why, what, how and when","authors":"W. A. van Amsterdam, Sjoerd Elias, Rajesh Ranganath","doi":"10.1016/j.clon.2024.07.002","DOIUrl":"https://doi.org/10.1016/j.clon.2024.07.002","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-01","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-27DOI: 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.
{"title":"Longitudinal Image Data for Outcome Modeling.","authors":"J E van Timmeren, J Bussink, P Koopmans, R J Smeenk, R Monshouwer","doi":"10.1016/j.clon.2024.06.053","DOIUrl":"https://doi.org/10.1016/j.clon.2024.06.053","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603330","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 : 2024-06-27DOI: 10.1016/j.clon.2024.06.054
Aims
Pediatric posterior fossa tumor (PFT) survivors experience long-term cognitive sequelae, including memory disorders, for which irradiation is one of the main risk factors. The aims of the present study were to (1) explore the profile of impairment in episodic, semantic, working and procedural memory systems in irradiated versus nonirradiated PFT survivors, and (2) test whether an autobiographical questionnaire and a two-phase ecological test (Epireal) assessing episodic memory are more sensitive to radiation-induced hippocampal damage than commonly used tests.
Materials and methods
A total of 60 participants (22 irradiated PFT survivors, 17 nonirradiated PFT survivors, and 21 controls) were included in the prospective IMPALA study. They all underwent a broad battery of tests assessing the different memory systems in two 2-day sessions 3 weeks apart. We performed between-groups comparisons and analyzed impairment profiles, using -1.65 SDs as a cut-off. For irradiated patients, correlations were calculated between mean radiation doses to key brain structures involved in memory (hippocampus, cerebellum, and striatum) and corresponding memory scores.
Results
PBT survivors performed significantly more poorly than controls (p < 0.001) on conventional tests of episodic, semantic and working memory: 64% of irradiated patients and 35% of nonirradiated patients had a deficit in at least two memory systems, with episodic memory impairment being more specific to the irradiated group. Epireal had a larger effect size than the other episodic memory tests, allowing us to detect deficits in a further 18% of irradiated patients. These deficits were correlated with the mean radiation dose to the left hippocampus.
Conclusion
Memory impairment is a frequent long-term cognitive sequela in PFT survivors, especially after radiation therapy. New ecological tests of episodic memory that are more sensitive to radiation-induced deficits than conventional tests could yield specific markers of the toxicity of medial temporal lobe irradiation.
{"title":"Exploring Memory Systems After Pediatric Posterior Fossa Tumor: From Memory Profile Comparisons in Nonirradiated Versus Irradiated Patients to Episodic Memory Tests Capable of Detecting Radiation-induced Hippocampal Damage","authors":"","doi":"10.1016/j.clon.2024.06.054","DOIUrl":"10.1016/j.clon.2024.06.054","url":null,"abstract":"<div><h3>Aims</h3><p>Pediatric posterior fossa tumor (PFT) survivors experience long-term cognitive sequelae, including memory disorders, for which irradiation is one of the main risk factors. The aims of the present study were to (1) explore the profile of impairment in episodic, semantic, working and procedural memory systems in irradiated versus nonirradiated PFT survivors, and (2) test whether an autobiographical questionnaire and a two-phase ecological test (Epireal) assessing episodic memory are more sensitive to radiation-induced hippocampal damage than commonly used tests.</p></div><div><h3>Materials and methods</h3><p>A total of 60 participants (22 irradiated PFT survivors, 17 nonirradiated PFT survivors, and 21 controls) were included in the prospective IMPALA study. They all underwent a broad battery of tests assessing the different memory systems in two 2-day sessions 3 weeks apart. We performed between-groups comparisons and analyzed impairment profiles, using -1.65 <em>SD</em>s as a cut-off. For irradiated patients, correlations were calculated between mean radiation doses to key brain structures involved in memory (hippocampus, cerebellum, and striatum) and corresponding memory scores.</p></div><div><h3>Results</h3><p>PBT survivors performed significantly more poorly than controls (p < 0.001) on conventional tests of episodic, semantic and working memory: 64% of irradiated patients and 35% of nonirradiated patients had a deficit in at least two memory systems, with episodic memory impairment being more specific to the irradiated group. Epireal had a larger effect size than the other episodic memory tests, allowing us to detect deficits in a further 18% of irradiated patients. These deficits were correlated with the mean radiation dose to the left hippocampus.</p></div><div><h3>Conclusion</h3><p>Memory impairment is a frequent long-term cognitive sequela in PFT survivors, especially after radiation therapy. New ecological tests of episodic memory that are more sensitive to radiation-induced deficits than conventional tests could yield specific markers of the toxicity of medial temporal lobe irradiation.</p></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0936655524002784/pdfft?md5=a95a6b0f4f029ea3a2726643fb192cc5&pid=1-s2.0-S0936655524002784-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603328","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 : 2024-06-26DOI: 10.1016/j.clon.2024.06.050
Aims
This national study investigated hospital quality and patient factors associated with treatment location for systemic anticancer treatment (SACT) in patients with metastatic cancers.
Materials and methods
Using linked administrative datasets from the English NHS, we identified all patients diagnosed with metastatic breast and bowel cancer between 1 January 2016 and 31 December 2018, who subsequently received SACT within 4 months from diagnosis. The extent to which patients bypassed their nearest hospital was investigated using a geographic information system (ArcGIS). Conditional logistic regression models were used to estimate the impact of travel time, hospital quality and patient characteristics on where patients underwent SACT.
Results
541 of 2,364 women (22.9%) diagnosed with metastatic breast cancer, and 2,809 of 10,050 (28.0%) patients diagnosed with metastatic bowel cancer bypassed their nearest hospital providing SACT. There was a strong preference for receiving treatment at hospitals near where patients lived (p < 0.001). However, patients who were younger (p = 0.043 for breast cancer; p < 0.001 for bowel cancer) or from rural areas (p = 0.001 for breast cancer; p < 0.001 for bowel cancer) were more likely to travel to more distant hospitals. Patients diagnosed with rectal cancer were more likely to travel further for SACT than patients with colon cancer (p = 0.002). Patients were more likely to travel to comprehensive cancer centres (p = 0.019 for bowel cancer) and designated Experimental Cancer Medicine Centres (ECMCs) although the latter association was not significant. Patients were less likely to receive SACT in hospitals with the highest readmission rates (p = 0.046 for bowel cancer).
Conclusion
Patients with metastatic cancer receiving primary SACT are prepared to travel to alternative more distant hospitals for treatment with a preference for larger comprehensive centres providing multimodal care or hospitals which offer early phase cancer clinical trials.
目的:这项全国性研究调查了与转移性癌症患者全身抗癌治疗(SACT)治疗地点相关的医院质量和患者因素:利用英国国家医疗服务系统(NHS)的关联行政数据集,我们确定了2016年1月1日至2018年12月31日期间确诊为转移性乳腺癌和肠癌的所有患者,这些患者随后在确诊后4个月内接受了SACT治疗。我们使用地理信息系统(ArcGIS)调查了患者绕过最近医院的程度。利用条件逻辑回归模型估算了旅行时间、医院质量和患者特征对患者接受SACT的影响:结果:2364 名女性转移性乳腺癌患者中有 541 人(22.9%)和 10,050 名转移性肠癌患者中有 2,809 人(28.0%)绕过了距离最近的提供 SACT 的医院。患者强烈倾向于在居住地附近的医院接受治疗(p < 0.001)。然而,年龄较轻(乳腺癌患者 p = 0.043;肠癌患者 p < 0.001)或来自农村地区(乳腺癌患者 p = 0.001;肠癌患者 p < 0.001)的患者更倾向于前往较远的医院接受治疗。与结肠癌患者相比,直肠癌患者更有可能前往更远的医院接受 SACT 治疗(p = 0.002)。患者更有可能前往综合癌症中心(肠癌患者 p = 0.019)和指定的实验癌症医学中心(ECMC),但后者的相关性并不显著。患者不太可能在再入院率最高的医院接受SACT治疗(肠癌患者的P = 0.046):结论:接受初级 SACT 治疗的转移性癌症患者愿意前往其他较远的医院接受治疗,他们更倾向于选择提供多模式治疗的大型综合中心或提供早期癌症临床试验的医院。
{"title":"Hospital Factors Influencing the Mobility of Patients for Systemic Therapies in Breast and Bowel Cancer in the Metastatic Setting: A National Population-based Evaluation","authors":"","doi":"10.1016/j.clon.2024.06.050","DOIUrl":"10.1016/j.clon.2024.06.050","url":null,"abstract":"<div><h3>Aims</h3><p>This national study investigated hospital quality and patient factors associated with treatment location for systemic anticancer treatment (SACT) in patients with metastatic cancers.</p></div><div><h3>Materials and methods</h3><p>Using linked administrative datasets from the English NHS, we identified all patients diagnosed with metastatic breast and bowel cancer between 1 January 2016 and 31 December 2018, who subsequently received SACT within 4 months from diagnosis. The extent to which patients bypassed their nearest hospital was investigated using a geographic information system (ArcGIS). Conditional logistic regression models were used to estimate the impact of travel time, hospital quality and patient characteristics on where patients underwent SACT.</p></div><div><h3>Results</h3><p>541 of 2,364 women (22.9%) diagnosed with metastatic breast cancer, and 2,809 of 10,050 (28.0%) patients diagnosed with metastatic bowel cancer bypassed their nearest hospital providing SACT. There was a strong preference for receiving treatment at hospitals near where patients lived (p < 0.001). However, patients who were younger (p = 0.043 for breast cancer; p < 0.001 for bowel cancer) or from rural areas (p = 0.001 for breast cancer; p < 0.001 for bowel cancer) were more likely to travel to more distant hospitals. Patients diagnosed with rectal cancer were more likely to travel further for SACT than patients with colon cancer (p = 0.002). Patients were more likely to travel to comprehensive cancer centres (p = 0.019 for bowel cancer) and designated Experimental Cancer Medicine Centres (ECMCs) although the latter association was not significant. Patients were less likely to receive SACT in hospitals with the highest readmission rates (p = 0.046 for bowel cancer).</p></div><div><h3>Conclusion</h3><p>Patients with metastatic cancer receiving primary SACT are prepared to travel to alternative more distant hospitals for treatment with a preference for larger comprehensive centres providing multimodal care or hospitals which offer early phase cancer clinical trials.</p></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0936655524002747/pdfft?md5=cdf54b37ca8764f24045ef607daaf9dc&pid=1-s2.0-S0936655524002747-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603329","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 : 2024-06-26DOI: 10.1016/j.clon.2024.06.052
{"title":"Hidden Neoplasm Detection in Patients With Venous Thromboembolism: An Unresolved Dilemma","authors":"","doi":"10.1016/j.clon.2024.06.052","DOIUrl":"10.1016/j.clon.2024.06.052","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141589784","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 : 2024-06-26DOI: 10.1016/j.clon.2024.06.051
Anatomical models have key applications in radiotherapy, notably to help understand the relationship between radiation dose and risk of developing side effects. This review analyses whether age-specific computational phantoms, developed from healthy subjects 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), 4D extended cardiac torso (XCAT) and Radiotherapy Paediatric Atlas (RT-PAL), which were also compared to literature data. Organ volume data for 19 organs was collected for all phantoms and literature. ICRP was treated as the reference for comparison, and percentage difference (P.D) for the other phantoms were calculated relative to ICRP. Overall comparisons were made for each age category (1, 5, 10, 15) and each organ. Statistical analysis was performed using Microsoft Excel (version 16.59). The smallest P.D to ICRP was for Literature (-17.4%), closely followed by XCAT (26.6%). The largest was for RT-PAL (88.1%). The rectum had the largest average P.D (1,049.2%) and the large bowel had the smallest (2.0%). The P.D was 122.6% at age 1 but this decreased to 43.5% by age 15. Linear regression analysis showed a 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, whereas RT-PAL could be used for a population undergoing/after radiotherapy.
{"title":"Paediatric Anatomical Models in Radiotherapy Applications","authors":"","doi":"10.1016/j.clon.2024.06.051","DOIUrl":"10.1016/j.clon.2024.06.051","url":null,"abstract":"<div><p>Anatomical models have key applications in radiotherapy, notably to help understand the relationship between radiation dose and risk of developing side effects. This review analyses whether age-specific computational phantoms, developed from healthy subjects 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), 4D extended cardiac torso (XCAT) and Radiotherapy Paediatric Atlas (RT-PAL), which were also compared to literature data. Organ volume data for 19 organs was collected for all phantoms and literature. ICRP was treated as the reference for comparison, and percentage difference (P.D) for the other phantoms were calculated relative to ICRP. Overall comparisons were made for each age category (1, 5, 10, 15) and each organ. Statistical analysis was performed using Microsoft Excel (version 16.59). The smallest P.D to ICRP was for Literature (-17.4%), closely followed by XCAT (26.6%). The largest was for RT-PAL (88.1%). The rectum had the largest average P.D (1,049.2%) and the large bowel had the smallest (2.0%). The P.D was 122.6% at age 1 but this decreased to 43.5% by age 15. Linear regression analysis showed a 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). 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, whereas RT-PAL could be used for a population undergoing/after radiotherapy.</p></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0936655524002759/pdfft?md5=7e6fecdd3145630c0e40ded025e5dcb8&pid=1-s2.0-S0936655524002759-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626159","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 : 2024-06-22DOI: 10.1016/j.clon.2024.06.049
{"title":"Shared Decision-Making, Frailty and Comorbidities in Older Patients With Head and Neck Cancer","authors":"","doi":"10.1016/j.clon.2024.06.049","DOIUrl":"10.1016/j.clon.2024.06.049","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579141","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 : 2024-06-20DOI: 10.1016/j.clon.2024.06.048
{"title":"The Impact of National Radiotherapy Guidelines: The UK Anal Cancer Story","authors":"","doi":"10.1016/j.clon.2024.06.048","DOIUrl":"10.1016/j.clon.2024.06.048","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723258","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 : 2024-06-18DOI: 10.1016/j.clon.2024.06.043
{"title":"Pushing the Borders: One at a Time. Reply to C. Onal, A. Elmaliy, P. Hurmuz's Letter to Editor Re: Patterns of Failure After Prostate-Only Radiotherapy in High-Risk Prostate Cancer: Implications for Refining Pelvic Nodal Contouring Guidelines in Regard to Singh et al.","authors":"","doi":"10.1016/j.clon.2024.06.043","DOIUrl":"10.1016/j.clon.2024.06.043","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141537617","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 : 2024-06-18DOI: 10.1016/j.clon.2024.06.046
{"title":"Exploring the Potential Link Between COVID-19, MiRNA Dysregulation, and Oral Cancer Risk in Tobacco Chewers","authors":"","doi":"10.1016/j.clon.2024.06.046","DOIUrl":"10.1016/j.clon.2024.06.046","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141537616","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}