The Christie School of Oncology: Christie Research Publications Repository
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Royal College of Radiologists guidance statements on the use of auto-contouring in radiotherapy
No full textAuto-contouring systems are rapidly becoming more widely used for radiotherapy treatment planning. There is an acknowledged need for formal guidance to help healthcare professionals understand how to safely adopt this technology. The Royal College of Radiologists Artificial Intelligence in Clinical Oncology working group established a multi-disciplinary group of national experts in artificial intelligence and radiotherapy quality assurance (QA). This group has produced consensus recommendations for the safe use of the technology. These include model selection, clinical commissioning, day-to-day QA, and post-implementation monitoring. Other factors such as the impact on the multi-disciplinary team, education, and training are also considered. The healthcare professional approving auto-contours for use will have overall responsibility, and it is therefore of utmost importance that they have a good understanding of the risks of auto-contouring and how contours should be assessed to mitigate these risks. This guidance aims to enable healthcare professionals acting as operators of a medical device to understand what they need to know about auto-contouring, to facilitate safe adoption of this technology
Biology and clinical management of non-V600 BRAF alterations in NSCLC
No full textBRAF mutations are detected in approximately 3% to 8% of patients with NSCLC. In contrast to melanoma, in which most BRAF mutations occur at the V600 codon, only approximately 35% of BRAF-mutant NSCLC tumors harbor V600 mutations. Among the remaining cases, 60% to 70% present non-V600 mutations, primarily in exons 11 and 15. BRAF mutations are classified into three classes according to their kinase activity and their dependence on RAS activation. Compared with class I (V600), patients with class II and class III mutations are associated with poorer clinical outcomes partly due to the lack of effective targeted therapeutic strategies. Indeed, although dual BRAF and MEK inhibition has demonstrated clinical benefit in BRAF V600-mutant NSCLC, there is currently no consensus on treatment strategies for patients with class II and class III mutations. Beyond point mutations, other BRAF alterations (e.g., gene fusions, deletions, and amplifications) have been identified in treatment-naive tumors and in the context of acquired resistance to targeted therapies in other oncogene-driven NSCLC subtypes. However, the biology and clinical implications of these alterations remain poorly characterized. In this review, we provide a comprehensive overview on the biology, epidemiology, and therapeutic strategies of class II/III BRAF mutations, fusions, deletions, and amplifications in NSCLC. We highlight current challenges in the clinical management of BRAF-mutant NSCLC, emerging inhibitors, and combinatorial therapeutic strategies developed to treat non-V600E BRAF-driven cancers. Finally, we briefly discuss BRAF alterations in the context of resistance to targeted therapies in other oncogene-driven NSCLC
Correction: brentuximab vedotin plus chemotherapy for the treatment of front-line systemic anaplastic large cell lymphoma: subgroup analysis of the ECHELON-2 study at 5 years' follow-up
No full textNational reporting of bowel cancer care by the National Bowel Cancer Audit (NBOCA) supports hospital teams to improve care and outcomes
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Twelve tips on how to put together a successful applications for ASPIRE award for assessment of students
No full textThis paper provides twelve practical tips for institutions preparing to submit successful applications for the ASPIRE Award in the category of Assessment of Students, part of AMEE's global initiative to recognize excellence in health professions education. This paper emphasizes the importance of achieving institutional buy-in, aligning assessment systems with the school's mission and context, assembling a strong submission team, and providing explanation of the award criteria. It highlights the collection and presentation of comprehensive evidence, including metrics like psychometric analysis and construct alignment, to demonstrate standards of excellence. Engaging students in the application process is critical, as their perspectives enhance transparency, equity, and accountability. Institutions are encouraged to address inconsistencies, demonstrate impact through quality improvement cycles, and showcase their commitment to continuous learning and professional development. The tips also include the value of engaging with the ASPIRE Academy for expert support and collaboration during the application process. This paper highlights that the ASPIRE award is an opportunity to foster reflection, collaboration, and innovation, while contributing to global standards of excellence in assessment in health professions education
T-cell engager toxicity in clinical phase trials; A systematic review and meta-analysis (vol 139, 102991, 2025)
No full textRadiotherapy plan quality assurance in the ABC-07 trial of stereotactic body radiotherapy for locally advanced biliary tract cancer
No full textAIMS: The ABC-07 phase II randomised controlled trial (ISRCTN: 10639376) investigated the addition of stereotactic body radiotherapy (SBRT) to systemic chemotherapy in locally advanced biliary tract cancers (BTCs). We report the radiotherapy quality assurance (RTQA) of SBRT treatment plans in the trial. MATERIALS AND METHODS: RTQA was performed before and during accrual, including benchmark contouring and planning cases, along with prospective independent case review (ICR) of the first three patients from each centre randomised to SBRT. Prescription doses were up to 50 Gy in 5 fractions or up to 67.5 Gy in 15 fractions. Cases were reviewed for segmentation accuracy and plan quality, including target coverage and organ-at-risk (OAR) constraints being met. RESULTS: Benchmark cases: Six of seventeen contouring submissions required revision (35%), and 6/17 planning submissions were revised after feedback on what was achievable by other centres. Prospective ICR: Thirty-one of forty-one cases from all 12 recruiting centres that were randomised to SBRT underwent review in real-time, and the others were reviewed retrospectively. Eight of these prospectively reviewed cases required revisions during the review process (26%, including 7 contouring and 2 planning revisions). Nineteen of forty-one plans overall (46%) had deviations from trial protocol objectives (even after any revisions), mostly unavoidable target coverage compromise (D95% < 90%) because of proximal OARs such as duodenum (17/41) and stomach (6/41). CONCLUSION: Despite rigorous plan QA, we encountered variability in segmentation and plan coverage. The revision rate was reduced between pre-trial and on-trial cases. Radiotherapy doses in the protocol were achievable in many cases; however, target coverage was frequently compromised to maintain OAR dose constraints. Such compromises should be prespecified in future studies
An evaluation of 3D modelling in patients with locally advanced pelvic malignancy undergoing surgical resection
No full textBackground Surgery for locally advanced pelvic malignancy is complex, requiring careful operative planning and effective patient consent. Traditional two-dimensional (2D) imaging can limit understanding of tumour-organ relationships for both clinicians and patients. Three-dimensional (3D) reconstructed imaging may have a role in enhancing surgical planning, patient understanding and trainee education.Methods Adult patients with locally advanced rectal or anal cancer undergoing planned resection at a UK tertiary cancer centre were prospectively identified. CT scans were reconstructed into interactive 3D models using the Visible Patient (TM) platform. Models were reviewed by surgeons and trainees prior to outpatient consultations and then demonstrated to patients during the consent process. Surgeons, trainees, and patients completed structured questionnaires incorporating Likert-scale responses and free-text feedback. Qualitative data were analysed thematically.Results Fifteen patient-specific pelvic models were created, with feedback obtained from all surgeons and trainees and from 13 patients. Patient responses were overwhelmingly positive, with median scores of 9-10/10 for realism, understanding of disease and surgery, and perceived benefit during consultation. Thematic analysis highlighted improved understanding, empowerment, and engagement in decision making. Surgeons rated the models moderately for operative planning but highly for trainee education and patient communication. No operative plans were altered following model review. Trainees reported strong educational value, while radiologists noted limitations in segmentation accuracy for intraluminal disease.Conclusion CT-based 3D reconstructed pelvic models provide substantial benefit in patient education and shared decision making for complex pelvic cancer surgery, with additional value as a training tool. Further studies are warranted to define their role in operative planning and cost-effective implementation