Hypofractionated Accelerated Concurrent Chemoradiotherapy in Inoperable Stage III Non-small Cell Lung Cancer: SOCCAR. A Large Single-Centre Experience
Madam — Recent Royal College of Radiologists' treatment guidelines for lung cancer during the COVID-19 pandemic [1] motivated us to share the findings of our recent audit of accelerated hypofractionated concurrent chemoradiotherapy in inoperable stage III non-small cell lung cancer (NSCLC; SOCCAR regime n): 55 Gy in 20 fractions over 26 days with concomitant chemotherapy (cisplatin and vinorelbine) [2]. (Source: Clinical Oncology)
Source: Clinical Oncology - July 11, 2020 Category: Radiology Authors: A. Patibandla, C. Featherstone, V. Maclaren, G. Lumsden, S. Harrow, R. Jones, A.J. Chalmers, P. McLoone, J. Hicks Tags: Letter Source Type: research

Permanent Hair Loss Associated with Taxane Chemotherapy Use in Breast Cancer: a Retrospective Review at Two Tertiary UK Cancer Centres
Purpose: Permanent chemotherapy-induced alopecia (pCIA) is an increasingly recognised complication of taxane-based chemotherapy that may be associated with significant psychological morbidity [1]. The prevalence of pCIA following docetaxel is poorly understood and there are no published data on paclitaxel chemotherapy. Here we analyse prevalence and patterns of pCIA in patients who received docetaxel or paclitaxel across two UK tertiary cancer centres. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: H. Adderley, J. Chan, M. Alameddine, C. Kelly, Z. Salih, K.H.J. Lim, R. Fox, C. Tetlow, D. Arundell, H. Wong, M. Harries, A. Armstrong, N. Thorp Source Type: research

Is Universal Patient Access to Fulvestrant in Hormone Receptor-positive Advanced Breast Cancer Justified? A UK Retrospective Multicentre Study
Purpose: Fulvestrant is a selective oestrogen receptor (ER) downregulator used to treat postmenopausal women with hormone receptor-positive advanced breast cancer. Given that patient access to this drug across the UK is variable, we sought to investigate its efficacy. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: A. Lerner, K. Keshwani, B. Sanderson, R.E. Board, M. Flynn, E. Sharkey, A. Okines, A. Konstantis, R. Roylance, D. Hanna, J. King, R. Murphy, F. Rehman, A. Guppy, C. Westbury, E. Takeuchi, E. Spurrell, F. Raja Source Type: research

The Immune Microenvironment in Young Patients with Triple Negative Breast Cancer
Purpose: Triple negative breast cancers (TNBC) comprise 15 –20% of breast cancers and are associated with adverse outcomes; the prognosis for younger women is worse [1,2]. Tumour-infiltrating lymphocytes (TILs) significantly correlate with improved survival in many cancers [3]. Conversely, tumour cell expression of PD-L1 is associated with T-cell exhausti on and is commonly a negative prognostic marker [4]. Mechanisms suppressing the immune response in TNBC remain unclear. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: H. McKenzie, G. Martland, M. Ellis, D. Eccles, S. Harris, S. Thirdborough, E. Copson, G. Thomas Source Type: research

Real Life Experience of the Use of CDK 4/6 Inhibitors in the First Line Treatment of Metastatic ER+ Her2 – Breast Cancer: Focus in Neutropenia and Dose Reduction
Purpose: To assess the benefit of routine blood counts within the first 2 cycles of initiation of CDK 4/6 inhibitor therapy and following 6 cycles of therapy. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: C. Blake, S. Cleator, A. Brown Source Type: research

The Use of the Virtual Environment for Radiotherapy Training (VERT) Improves Understanding and Reduces Anxiety in Patients Undergoing Breast Radiotherapy: a Single-centre Experience
This study investigated the impact of this intervention on patient understanding and anxiety levels relating to the radiotherapy. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: A. Chander, V. Gandhi, S. Kuthpady, S. Needleman Source Type: research

A Single-centre Audit of Time from Surgery to Adjuvant Radiotherapy in Breast Cancer Patients Treated at the Royal Free Hospital
Purpose: Adjuvant radiotherapy is a key component in breast cancer management. Following multidisciplinary discussion and wound healing, patients are counselled for postoperative radiotherapy by a clinical oncologist, then proceed to radiotherapy planning. The London Cancer Alliance 2016 guidance stipulates breast irradiation should be commenced as soon as possible following surgery, but no later than 12 weeks [1]. This audit aimed to determine our centre ’s compliance with this guidance and identify any reversible factors causing delay. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: K. Durno, R. Chandler, S. Needleman Source Type: research

A Single-centre, Retrospective Audit of Adherence to the Updated Royal College of Radiology (RCR) Guidelines for the Treatment Duration of Adjuvant Breast Radiotherapy
Purpose: Adjuvant breast cancer radiotherapy forms a vital part of breast cancer management. This is delivered as 40.05 Gy/15 fractions and should complete within 19 days. Cancer cells can repopulate between treatments and overall treatment time should be minimised. Gaps in treatment can facilitate repopulation, potentially leading to lower cure rates [1]. Radical radiotherapy courses should not be interrupted; if unavoidable, these delays should be compensated for. In January 2019, the Royal College of Radiologists (RCR) published updated guidance on the recommended treatment duration for adjuvant breast cancer radiothera...
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: K. Durno, A. Chander, S. Needleman Source Type: research

The Assessment of Bone Mineral Density (BMD) and Fracture Risk after 3 Years of Adjuvant Zoledronic Acid in Postmenopausal (ER+) Early Breast Cancer
Purpose: The use of adjuvant bisphosphonate (AB) has been recommended in postmenopausal women with early breast cancer to improve breast cancer outcome [1 –3]. Recent evidence indicates the use of extended adjuvant aromatase inhibitor (AI) beyond 5 years [4]. Bone health assessment after the completion of 3 years of AB therapy is therefore of interest to guide further management. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: G. Eslamian, C. Harper-Wynne Source Type: research

Retrospective Evaluation of Baseline Charlson Co-morbidity Index and Chemotherapy Toxicity in Elderly Patients Receiving Adjuvant Breast Chemotherapy – a Review of Practice at Weston Park Hospital, Sheffield
Purpose: Adjuvant breast chemotherapy in elderly patients causes toxicity relative to their existing co-morbidities [1]. Use of baseline geriatric assessment tools, including Charlson Co-morbidity Index (CCI), can predict tolerability [2], enabling modification of dose intensity. A baseline CCI of 5 indicates minimal co-morbidities, with increasing scores reflecting increased burden of concurrent illnesses. We retrospectively evaluated CCI and toxicities in older patients who received adjuvant breast chemotherapy regimens in our locality. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: K. Garadi, L. Smith, C. Wilson Source Type: research

Review of Outcomes in North East England for Patients Receiving Neoadjuvant Chemotherapy for Breast Carcinoma
Purpose: Neoadjuvant chemotherapy can allow for breast conserving surgery to be undertaken and for assessment of tumour response to therapy, inferring prognostic implications. We reviewed outcomes for all patients receiving neoadjuvant chemotherapy, in terms of pathological complete response (pCR) rates, to see if these were comparable with published data [1]. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: A. Gault, C. Dobeson, S. Haney, J. Graham, A. Humphreys Source Type: research

Leptomeningeal Disease in Breast Cancer, Bristol Experience
Purpose: Diagnosis of leptomeningeal disease (LMD) in breast cancer patients is associated with poor prognosis [1]; median overall survival is usually less than 12 months. Diagnosis of LMD can be elusive and requires a high level of clinical suspicion. Cerebrospinal fluid (CSF) cytology is considered the gold standard to diagnose LMD but lack of malignant cells in CSF even in symptomatic patients can be a diagnostic dilemma [2]. Magnetic resonance imaging (MRI) of the head can help diagnose LMD. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: G. Gullick, V. Mohan, L. Gibbs, C. Comins, J. Braybrooke, J. Jenkins, A. Bahl, C. Caws Source Type: research

Experience with Vinorelbine in Patients with Breast Cancer and Hyperbilirubinaemia Secondary to Liver Metastases
Purpose: Patients with hepatic dysfunction as a consequence of breast cancer with liver metastases have a very poor prognosis and limited systemic treatment options [1]. Pharmacokinetic studies suggest vinorelbine can be administered safely in patients with hyperbilirubinaemia [2]; however, very few data are available on the efficacy of this approach. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: J. Howells, M. Gyi, E. Blaiklock, T. Gulliford, K. Bradley, J. Gale, C. Archer, C. Coyle Source Type: research

Eribulin Use and Palliative Care Referral Rates in Metastatic Breast Cancer: Kent Oncology Centre Experience
Purpose: Eribulin is NICE approved in patients with metastatic breast cancer (MBC) who have received two chemotherapies, based on improved overall survival (OS) with Eribulin compared with treatment of physician ’s choice (13.1 versus 10.6 months) observed in the EMBRACE trial [1,2]. However, retrospective institutional series show that outcomes and survival rates after third-line chemotherapy for MBC are poor; median survival is frequently less than 1 year [3–5]. We reviewed Kent Oncology Centre (KOC) patient outcomes and evaluated whether patients receiving third or subsequent line Eribulin had been referred ...
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: J. Little, R. Burcombe, E. Parsons, C. Ryan Source Type: research

North East Experience on Pertuzumab, Trastuzumab and Docetaxel in Metastatic Breast Cancer
Purpose: Phase III randomised data from the Cleopatra trial showed significant improvement in median progression free [1] and overall survival [2] with the addition of pertuzumab to docetaxel and traztuzumab. The aims of this audit were: (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: L. Mariappan, J. Veeratterapillay, N. Cresti, M. Verrill, D. Lee, R. Todd Source Type: research

Delays to Adjuvant Breast Cancer Radiotherapy Resulting from Oncotype Dx Testing in Patients with Low/Intermediate Recurrence Risk Scores
Purpose: Oncotype Dx is a 21 gene recurrence score assay that risk stratifies patients who have completed primary surgical treatment for breast cancer to low or intermediate (adjuvant chemotherapy not routinely recommended) versus high risk of recurrence (adjuvant chemotherapy recommended). 73% of patients tested are stratified to the low/intermediate risk of recurrence group [1]. However, a proportion of these patients may have delays to commencing adjuvant radiotherapy. The current median time to adjuvant radiotherapy following surgery is recorded as 60 days [2]. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: Y. Odding, C. Meehan, M. Beresford Source Type: research

A Network Breast Nodal Radiotherapy Survey 2019: The Practice of Breast Clinical Oncologists from Five Centres in North-East and North-Central London
Purpose: Multimodality treatment has significantly improved breast cancer outcomes and reduced local recurrence rates. Management of the axilla has evolved over the last decade towards less invasive measures. Variation in surgical and radiotherapy locoregional nodal management exists between centres. We conducted a survey of oncologists to review treatment decisions in our network. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: S. Patel, G. Anand Source Type: research

Review of the Pathway for Breast Cancer Patients Receiving Neoadjuvant Chemotherapy in a District General Hospital
Purpose: Care of patients receiving neoadjuvant chemotherapy is shared between a number of specialties. Timely coordination of their investigations, appointments and treatments is crucial in ensuring optimal outcomes. We reviewed the current pathway at Great Western Hospital, Swindon, identified particular delays and developed a multidisciplinary protocol to improve record keeping and to prompt clinicians regarding next steps in treatment. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: D. Scott, K. Litton, A. Kendall Source Type: research

Post-mastectomy Radiotherapy Bolus Across the North and East London Radiotherapy Network
Purpose: Post-mastectomy radiotherapy decreases locoregional recurrence and reduces breast cancer mortality in a select group [1 –4]. Recurrence is most common at the chest wall, and bolus is used to increase skin surface dose [1,2]. Studies have shown huge variability in bolus use post-mastectomy, with no proven optimum regimen [1,2,5]. When using skin bolus, thickness and frequency of use increases skin toxicity [1,2,6]. Severe toxicity including pain, or moist desquamation, can lead to treatment cessation, resulting in inferior local control [1,2]. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: E. Scott, S. Needleman Source Type: research

Clinicopathological Features and Survival Outcomes of Breast Cancer Patients with Brain Metastases: a Single Centre Experience
Purpose: Routine brain imaging in asymptomatic metastatic breast cancer (m-BC) patients is not standard of care. However, early diagnosis of brain metastases resulting in early intervention with stereotactic radiosurgery/radiotherapy could reduce the need for significant interventional procedures, such as whole-brain radiotherapy (WBRT) or extensive surgical resection, improve quality of life and delay neurological deaths. The aim of this study is to identify the clinicopathological characteristics of breast cancer patients who are at high risk of developing brain metastases and may benefit from early brain screening. (Sou...
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: C. Stavraka, C. Gousis, M. Kapiris, E. Tsotra, J. Clark, S. Ravindra, I. Sandri, A. Swampillai Source Type: research

A Retrospective Analysis of the Dose-intensity and Toxicities of Accelerated Versus Standard-schedule Chemotherapy for Early Breast Cancer in a Real-world Setting
Purpose: The 10-year mortality benefit of dose-dense over standard-schedule chemotherapy in early breast cancer was established in an EBCTCG meta-analysis published this year [1]. We sought to compare dose-intensity and toxicities in a real-world setting. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: J.D. Towler, K. Ball, Z. Hu, P. Riddle Source Type: research

Pathological Complete Response Rate (pCR) in Patients with Triple Negative Breast Cancer (TNBC) who Received Either Platinum and Taxane Containing Regimen or Taxane Containing Regimen Alone, Along with Anthracyclines: Real Life Results from South East London Accountable Cancer Network
Purpose: To determine the pCR in patients with TNBC according to the neoadjuvant chemotherapy (NACT) they received; taxane-based chemotherapy alone and anthracyclines or taxane-based chemotherapy together with carboplatin and antracyclines. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: E. Tsotra, R. Hale, N. Yoganayagam, R. Nathan Source Type: research

Radiological Staging in Early Breast Cancer: the Third Audit
Purpose: In 2015 [1] and 2016 [2] audits were completed of Ysbyty Gwynedd ’s multidisciplinary team’s (MDT) use of radiological staging in newly diagnosed breast cancer and a local guideline was developed providing clarity to the MDT. Three years later and a re-audit was completed assessing adherence to the guideline. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: T. Woolley, S. Massalha, C. Bale Source Type: research

The Role of Adjuvant Radiotherapy to the Ipsilateral or Bilateral Neck for pN0 Oral Cavity Squamous Cell Carcinoma
Madam — It is common practice to avoid contralateral neck dissections for non-central oral cavity squamous cell carcinomas (OCSCC). In our series [1], 27/101 patients underwent bilateral neck dissections, of whom only five did not receive bilateral adjuvant neck radiotherapy; no sentinal node biopsies w ere carried out. Therefore, these data do not inform on the safety of omitting contralateral neck radiotherapy following surgical contralateral neck staging. (Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: R.J.D. Prestwich Tags: Letter Source Type: research

Evidence is Lacking for the NHS England Interim Guidance for Managing Metastatic Non-small Cell Lung Cancer in the COVID-19 Pandemic
(Source: Clinical Oncology)
Source: Clinical Oncology - July 8, 2020 Category: Radiology Authors: M. Choudhury, S. Nageshwaran, D. Muthukumar Tags: Letter Source Type: research

Palliative Radiation Therapy in Older Adults With Cancer: Age-Related Considerations
There are many additional considerations when treating older adults with cancer, especially in the context of palliative care. Currently, radiation therapy is underutilised in some countries and disease sites, but there is also evidence of unnecessary treatment in other contexts. Making rational treatment decisions for older adults necessitates an underlying appraisal of the person's physiological reserve capacity. This is termed ‘frailty’, and there is considerable heterogeneity in its clinical presentation, from patients who are relatively robust and suitable for standard treatment, to those who are frail and...
Source: Clinical Oncology - July 6, 2020 Category: Radiology Authors: A. O'Donovan, L. Morris Tags: Overview Source Type: research

Health Economic and Health Service Issues of Palliative Radiotherapy
Palliative radiotherapy (PRT) makes up about half of all courses delivered in radiotherapy departments. It is effective in the management of common complications of cancer and is relatively inexpensive. About one third of cancer patients receive PRT within the last 2 years of life. One quarter of all patients who receive radiotherapy will undergo a second or subsequent course, mostly for palliative indications. There is considerable variation in practice, both within and between jurisdictions. This has been attributed to inconsistencies in guidelines, physician variation and differing financial incentives. (Source: Clinical Oncology)
Source: Clinical Oncology - July 6, 2020 Category: Radiology Authors: M. Barton, V. Batumalai, K. Spencer Tags: Overview Source Type: research

Stereotactic Pelvic Reirradiation for Locoregional Cancer Relapse
Up to 40% of patients who have received radiation for a pelvic malignancy will develop locoregional recurrence in the previously irradiated volume. Stereotactic body radiotherapy (SBRT) has been used in the oligometastatic setting, and provides an ablative approach ideal for reirradiation. The purpose of this study was to evaluate the outcomes after SBRT reirradiation of extraosseous recurrences in the pelvis. (Source: Clinical Oncology)
Source: Clinical Oncology - July 5, 2020 Category: Radiology Authors: R. Kinj, J. Doyen, J.M. Hannoun-L évi, A.O. Naghavi, M.E. Chand, G. Baudin, J.M. Ferrero, E. François, L. Evesque, D. Borchiellini, K. Benezery, P.Y. Bondiau Tags: Original Article Source Type: research

Nurturing a Research-active Clinical Oncology Workforce: A Trainee Perspective
The past decade has seen substantial growth in radiotherapy-related research within the UK [1]. This welcome increase in activity has been accompanied by considerable development of the UK radiation oncology and radiobiology research landscape. One major example is the establishment in 2019 of a Cancer Research UK Radiotherapy Research Network [2]. The success of initiatives such as this and the continued expansion of the UK radiotherapy research effort are predicated on the availability of an appropriately skilled workforce. (Source: Clinical Oncology)
Source: Clinical Oncology - July 4, 2020 Category: Radiology Authors: C.M. Jones, K. Spencer Tags: Editorial Source Type: research

Consent Consensus: Time for a National Site-Specific Consent Form for Radiotherapy?
Informed consent ( ‘consent’) is defined in the Cambridge English Dictionary as ‘agreement or permission to do something from someone who has been given full information about the possible effects or results’. Clinical oncologists obtain consent regularly as part of routine clinical practice, including when pl anning treatment with radiotherapy. Radiotherapy delivered with either curative or palliative intent comes with the risk of serious adverse effects, both in the long and short term. This makes the process of taking consent particularly important. (Source: Clinical Oncology)
Source: Clinical Oncology - July 2, 2020 Category: Radiology Authors: E. Kenney-Herbert, M. Mylonas, J. Todd, K. Tipples Tags: Editorial Source Type: research

Consensus Guidelines for the Management of Melanoma during the COVID-19 Pandemic: Surgery, Systemic Anti-cancer Therapy, Radiotherapy and Follow-up
(Source: Clinical Oncology)
Source: Clinical Oncology - July 1, 2020 Category: Radiology Authors: S.H. Nahm, A. Rembielak, H. Peach, P.C. Lorigan, Contributing Clinicians Tags: Editorial Source Type: research

Lapatinib plus Capecitabine versus Trastuzumab plus Capecitabine in the Treatment of Human Epidermal Growth Factor Receptor 2-positive Metastatic Breast Cancer with Central Nervous System Metastases for Patients Currently or Previously Treated with Trastuzumab (LANTERN): a Phase II Randomised Trial
Brain (central nervous system; CNS) metastases occur in 30 –50% of patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC). A substantive evidence base for treatment is lacking, but activity with lapatinib plus capecitabine (lap-cap) has been reported. We compared lap-cap with trastuzumab plus capecitabine (tr as-cap) in patients with HER2-positive MBC with CNS metastases previously treated with trastuzumab. (Source: Clinical Oncology)
Source: Clinical Oncology - June 27, 2020 Category: Radiology Authors: J.F. Seligmann, A. Wright-Hughes, A. Pottinger, G. Velikova, J.B. Oughton, G. Murden, M. Rizwanullah, C. Price, H. Passant, P. Heudtlass, H. Marshall, S. Johnston, D. Dodwell Tags: Original Article Source Type: research

Palliative Lung Radiotherapy: Higher Dose Leads to Improved Survival?
Choosing the optimal palliative lung radiotherapy regimen is challenging. Guidance from The Royal College of Radiologists recommends treatment stratification based on performance status, but evidence suggests that higher radiotherapy doss may be associated with survival benefits. The aim of this study was to investigate the effects of fractionation regimen and additional factors on the survival of palliative lung cancer radiotherapy patients. (Source: Clinical Oncology)
Source: Clinical Oncology - June 26, 2020 Category: Radiology Authors: T.S. Lewis, J.A. Kennedy, G.J. Price, T. Mee, D.K. Woolf, N.A. Bayman, C. Chan, J.H. Coote, C. Faivre-Finn, M.A. Harris, A.M. Hudson, L.S. Pemberton, A. Salem, H.Y. Sheikh, H.B. Mistry, D.C.P. Cobben Tags: Original Article Source Type: research

Obesity and Cancer Treatment Outcomes: Interpreting the Complex Evidence
A wealth of epidemiological evidence, combined with plausible biological mechanisms, present a convincing argument for a causal relationship between excess adiposity, commonly approximated as body mass index (BMI, kg/m2), and incident cancer risk. Beyond this relationship, there are a number of challenges posed in the context of interpreting whether being overweight (BMI 25.0 –29.9 kg/m2) or obese (BMI ≥ 30.0 kg/m2) adversely influences disease progression, cancer mortality and survival. Elevated BMI (≥ 25.0 kg/m2) may influence treatment selection of, for example, the approach to surgery; the choice ...
Source: Clinical Oncology - June 25, 2020 Category: Radiology Authors: C.G.V. Slawinski, J. Barriuso, H. Guo, A.G. Renehan Tags: Overview Source Type: research

Authors' Response to Young et al: Re Stage III Non-small Cell Lung Cancer Management in England
Madam — We would like to thank Young and colleagues [1] for their letter noting that data supplied to the National Cancer Registration and Analysis Service (NCRAS) and used in analyses by the National Lung Cancer Audit (NLCA) from their own institutions may not have been accurate. They question whether this problem may exist at a wider scale, potentially calling into question the results and conclusions of our recently published analysis of the management and outcome of stage III non-small cell lung cancer [2]. (Source: Clinical Oncology)
Source: Clinical Oncology - June 24, 2020 Category: Radiology Authors: S.V. Harden, J.B. Adizie, N. Navani, P. Beckett Tags: Letter Source Type: research

Multimorbidity in Cancer Patients: the ‘New Normal’
Cancer care is changing; cancer patients are becoming older and most patients will have one or more comorbidities. In high-income countries, the population of cancer survivors is growing at a rate of about 2% per year, and the coexistence of several chronic diseases is increasing dramatically [1]. ‘Multimorbidity’ is a broad term used to describe the existence of two or more chronic conditions within an individual patient, which can include mental as well as physical conditions, ongoing conditions such as learning disability, symptom complexes such as frailty or chronic pain, sensory impa irment such as sight o...
Source: Clinical Oncology - June 24, 2020 Category: Radiology Authors: D. Weller, S.W. Mercer Tags: Editorial Source Type: research

Emerging Precision Oncology Applications of Liquid Biopsy using Circulating Tumour DNA and Methylome Profiling
Since the discovery of cancer genetic biomarkers, many, such as BRCA1/BRCA2, EGFR and BRAF, have been incorporated into standard of care treatment decision-making. Rapid genomic screening is now possible with advances in next generation sequencing, enabling biomarker discovery through large-scale sequencing initiatives such as The Cancer Genome Atlas and International Cancer Genome Consortium. Analysis of large cancer cohorts has uncovered new biomarker classes to guide targeted and immune therapy. (Source: Clinical Oncology)
Source: Clinical Oncology - June 23, 2020 Category: Radiology Authors: E.Y. Zhao, S.V. Bratman Tags: Editorial Source Type: research

Patient-derived Xenograft Models of Small Cell Lung Cancer for Therapeutic Development
Lung cancer is the highest mortality cancer, leading to more deaths due to cancer than other histologies, including breast, prostate, colon, ovarian and pancreas [1,2]. Smoking is a major risk factor for lung cancer; however, a growing incidence of lung cancer in never-smokers has been observed. Lung cancer can be classified into two main categories: non-small cell lung cancer (NSCLC), comprising about 85% of all cases, and small cell lung cancer (SCLC), making up the remaining 15% [1]. Several novel targeted and immunotherapy agents have been incorporated into the treatment paradigm for NSCLC over the past two decades, bu...
Source: Clinical Oncology - June 18, 2020 Category: Radiology Authors: V. Vidhyasagar, S. Ul Haq, B.H. Lok Tags: Editorial Source Type: research

Optimising Medications for Patients With Cancer and Multimorbidity: The Case for Deprescribing
The majority of patients diagnosed with cancer are aged over 65 years and have two or more chronic conditions in addition to cancer and the risk of chronic conditions increases further after cancer. The presence of multimorbidity adds complexity to care, as patients' goals of care and the focus of treatment can change with a diagnosis of cancer. Multimorbidity is frequently associated with polypharmacy, the use of potentially inappropriate medications, the presence of adverse drug reactions and potential drug –drug interactions: all of which impact on health outcomes and the cost of care. (Source: Clinical Oncology)
Source: Clinical Oncology - June 17, 2020 Category: Radiology Authors: J.P. Turner, K. Kantilal, K. Kantilal, H.M. Holmes, B. Koczwara Tags: Original Article Source Type: research

Positron Emission Tomography-Computed Tomography Surveillance after (Chemo)Radiotherapy in Advanced Head and Neck Squamous Cell Cancer: Beyond the PET-NECK Protocol
To evaluate the implementation of 18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) surveillance after (chemo)radiotherapy, to compare outcomes for those who achieved a complete (CR), equivocal (EQR) and incomplete (ICR) nodal response on 12-week PET-CT according to their human papillomavirus (HPV) status, and to assess the safety of ongoing surveillance beyond 12 weeks in the HPV-positive EQR group. (Source: Clinical Oncology)
Source: Clinical Oncology - June 16, 2020 Category: Radiology Authors: S. Zhou, R. Rulach, F. Hendry, D. Stobo, A. James, M.-F. Dempsey, D. Grose, C. Lamb, S. Schipani, M. Rizwanullah, C. Wilson, Y.C. Lau, C. Paterson Tags: Original Article Source Type: research

Trends and Correlates of Mean Lung Dose in Patients Receiving Breast Radiotherapy in a Single Institution from 2014 to 2018
This study examined MLD in a single institution from 2014 to 18 to assess trends in median MLD (Gy) over time and factors associated with higher MLD to determine best practices for limiting lung toxicity. (Source: Clinical Oncology)
Source: Clinical Oncology - June 12, 2020 Category: Radiology Authors: E. McKenzie, Y. Razvi, M. Wronski, L. Zhang, S. Bosnic, D. Vesprini, L. Paszat, E. Rakovitch, L. Drost, C. Yee, S. Russell, C. McCann, E. Chow Tags: Original Article Source Type: research

In Response to Adizie et  al. Stage III Non-small Cell Lung Cancer Management in England
Madam — We would like to thank Adizie et al. [1] for collating and analysing the UK National Lung Cancer Audit (NLCA) data for stage III non-small cell lung cancer management. Their work showed significant variation in practice in the management of stage III patients between NHS Trusts, potentially ind icating that stage III patients are missing out on optimal treatment. The authors' work inspired us independently at Maidstone and Tunbridge Wells NHS Trust (MTW) and University Hospitals Plymouth NHS Trust (UHPNT) to audit our own management of this patient group. (Source: Clinical Oncology)
Source: Clinical Oncology - June 12, 2020 Category: Radiology Authors: T. Young, C. Pollock, C. Daneshvar, T. Sevitt, B. Goranov Tags: Letter Source Type: research

Personal View: Low-dose Lung Radiotherapy for COVID-19 Pneumonia – The Atypical Science and the Unknown Collateral Consequence
The novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a devastating impact, with the number of deaths worldwide by June 2020 over 400  000 [1]. There are currently no proven, effective treatments, so there is an urgent need for clinical trials to test new therapeutic interventions that may be of benefit. (Source: Clinical Oncology)
Source: Clinical Oncology - June 11, 2020 Category: Radiology Authors: H. Tharmalingam, P. D íez, Y. Tsang, A. Hawksley, J. Conibear, N. Thiruthaneeswaran Tags: Editorial Source Type: research

Adjuvant Systemic Anti-cancer Therapy in Early Breast Cancer During the COVID-19 Pandemic: Differences between Clinicians and Patients in Perception of Treatment Risks and Benefits
(Source: Clinical Oncology)
Source: Clinical Oncology - June 8, 2020 Category: Radiology Authors: E.R. Gatfield, M.B. Mukesh, S.W. Loo Tags: Letter Source Type: research

COVID-19 Pandemic and Nationwide Lockdown – Implications of the Double Trouble on Radiotherapy Practice in India
(Source: Clinical Oncology)
Source: Clinical Oncology - June 8, 2020 Category: Radiology Authors: N. Mummudi, S. Ghosh-Laskar, A. Tibdewal, J.P. Agarwal Tags: Letter Source Type: research

Looking a Gift Horse in the Mouth: Observations on NHS England's Interim Guidance on Pembrolizumab in Head and Neck Squamous Cell Cancer
The novel severe acute respiratory syndrome coronavirus-2 (n-SARS-CoV2) that causes COVID-19 has played havoc with normal medical care. Patients with or suspected of having cancer have experienced significant knock-on effects on referral, investigation, diagnosis, treatment and follow-up. Those with relapsed and/or metastatic disease who should be receiving palliative systemic anti-cancer therapy (SACT) have been particularly affected. (Source: Clinical Oncology)
Source: Clinical Oncology - June 5, 2020 Category: Radiology Authors: K.J. Harrington, S.A. Bhide, M.D. Forster, J.S. Good, L. Gunn, A. Kong, A.A. Melcher, R. Metcalf, P. Nenclares, K.L. Newbold, C.M. Nutting, R. Prestwich, J.J. Sacco, H. Soliman, K.H. Wong Tags: Editorial Source Type: research

Coronavirus Disease 2019: the Pivotal Role of UK Clinical Oncology and the UK Coronavirus Cancer Monitoring Project
(Source: Clinical Oncology)
Source: Clinical Oncology - June 5, 2020 Category: Radiology Authors: J. Best, T. Starkey, A. Chaterjee, D. Fackrell, L. Pettit, N. Srihari, H. Tween, A. Olsson-Brown, V. Cheng, D.J. Hughes, A.J.X. Lee, K. Purshouse, R. Arnold, C. Palles, S. Sivakumar, J.-B. Cazier, L.Y.W. Lee Tags: Editorial Source Type: research

Incidence and Outcome of Second Malignancy in Primary Treated Head and Neck Cancer
Madam — Second malignancies have become one of the salient late side-effects of cancer treatment and also carry a poor prognosis and lead to premature mortality [1,2]. Head and neck cancers (HNC) constitute a significant proportion of the cancer burden in India [3]. Most of them present in advanced stag es, where chemoradiation (CTRT) is the treatment of choice [4]. The lacunae in the current literature on the incidence and treatment of second malignancies after CTRT in HNC patients justifies the present analysis. (Source: Clinical Oncology)
Source: Clinical Oncology - June 4, 2020 Category: Radiology Authors: V. Noronha, V.M. Patil, G.K. Singh, A. Joshi, N. Menon, S.G. Lashkar, V. Mathrudev, K.N. Satam, S.A. Mukadam, K. Prabhash Tags: Letter Source Type: research

NOTCH: The National Oncology Trainees Collaborative for Healthcare Research
The National Oncology Trainees Collaborative for Healthcare Research (NOTCH) is a grassroots research collaborative formed by and for aspiring and current medical and clinical oncology trainees across the UK. Here we outline the steps taken to establish this collaborative, as well as its objectives and position in the oncology research training landscape. (Source: Clinical Oncology)
Source: Clinical Oncology - May 30, 2020 Category: Radiology Authors: C.M. Jones, A. Olsson-Brown, C. Dobeson, the Trainee Board of the National Oncology Trainees Collaborative for Healthcare Research Tags: Editorial Source Type: research

The Impact of the Acute Phase of COVID-19 on Radiotherapy Demand in South East Wales
Madam — The coronavirus epidemic presents significant challenges to providing cancer care. Radiotherapy services need to depart from established pathways and protocols [1]. Here we summarise how COVID-19 has impacted local radiotherapy services. (Source: Clinical Oncology)
Source: Clinical Oncology - May 26, 2020 Category: Radiology Authors: E. Higgins, S. Walters, E. Powell, J. Staffurth Tags: Letter Source Type: research