The Christie School of Oncology: Christie Research Publications Repository
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Decision-making tools in prophylactic cranial irradiation for small-cell lung cancer: a narrative review of the literature
No full textSynthetic computed tomography generation using deep-learning for female pelvic radiotherapy planning
No full textSynthetic Computed Tomography (sCT) is required to provide electron density information for MR-only radiotherapy. Deep-learning (DL) methods for sCT generation show improved dose congruence over other sCT generation methods (e.g. bulk density). Using 30 female pelvis datasets to train a cycleGAN-inspired DL model, this study found mean dose differences between a deformed planning CT (dCT) and sCT were 0.2 % (D98 %). Three Dimensional Gamma analysis showed a mean of 90.4 % at 1 %/1mm. This study showed accurate sCTs (dose) can be generated from routinely available T2 spin echo sequences without the need for additional specialist sequences
Adjuvant chemoradiotherapy versus radiotherapy alone in women with high-risk endometrial cancer (PORTEC-3): 10-year clinical outcomes and post-hoc analysis by molecular classification from a randomised phase 3 trial
No full textBACKGROUND: The PORTEC-3 trial investigated the benefit of chemoradiotherapy versus pelvic radiotherapy alone for women with high-risk endometrial cancer. We present the preplanned long-term analysis of the randomised PORTEC-3 trial with a post-hoc analysis including molecular classification of the tumours. METHODS: PORTEC-3 was an open-label, multicentre, randomised, international phase 3 trial. Women were eligible if they had high-risk endometrial cancer (either International Federation of Gynecology and Obstetrics 2009 stage I, grade 3, with deep myometrial invasion and/or lymphovascular space invasion; stage II-III; or stage I-III with serous or clear-cell histology), were aged 18 years or older, and had a WHO performance score of 0-2. Participants were randomly assigned (1:1) to receive pelvic radiotherapy (48·6 Gy in 1·8 Gy fractions) or chemoradiotherapy (radiotherapy combined with two cycles of cisplatin 50 mg/m(2) intravenously in weeks one and four, followed by four cycles of carboplatin area-under-the-curve 5 and paclitaxel 175 mg/m(2) intravenously at 3-week intervals). Randomisation was done by use of biased-coin minimisation with stratification for participating centre, lymphadenectomy, stage, and histological type. We report the primary outcomes of overall survival and recurrence-free survival at 10 years. We also report primary outcomes by molecular subgroup in a post-hoc analysis. Survival was analysed in the intention-to-treat population. The study is registered with ClinicalTrials.gov (NCT00411138) and is now complete. FINDINGS: Between Nov 23, 2006, and Dec 20, 2013, 660 eligible and evaluable patients recruited at 103 centres in six clinical trial groups across seven countries were randomly assigned to chemoradiotherapy (n=330) or radiotherapy alone (n=330). Median follow-up was 10·1 years (IQR 9·8-11·0). Estimated 10-year overall survival was 74·4% (95% CI 69·8-79·4) in the chemoradiotherapy group and 67·3% (62·3-72·7) in the radiotherapy group (adjusted hazard ratio [HR] 0·73 [95% CI 0·54-0·97], p=0·032), and 10-year recurrence-free survival was 72·8% (67·2-77·6) versus 67·4% (61·7-72·4; adjusted HR 0·74 [95% CI 0·56-0·98], p=0·034). Molecular analysis was available for 411 (62%) patients (210 [64%] of 330 patients in the chemoradiotherapy group and 201 [61%] of 330 patients in the radiotherapy group), whose characteristics were similar to the overall trial population. Post-hoc analysis by molecular class showed that, for women with p53 abnormal tumours, 10-year overall survival was 52·7% (95% CI 40·8-68·1) with chemoradiotherapy versus 36·6% (25·0 to 53·7) with radiotherapy alone (adjusted HR 0·52 [95% CI 0·30-0·91], p=0·021); 10-year recurrence-free survival was 52·6% (95% CI 38·3 to 65·0) versus 37·0% (95% CI 23·7 to 50·2; HR 0·42 [95% CI 0·24 to 0·74], p=0·0027). MMRd and POLEmut cancers did not seem to benefit from chemoradiotherapy over radiotherapy alone, whereas the effects for NSMP cancers were modulated by oestrogen-receptor status. INTERPRETATION: 10-year overall survival and recurrence-free survival were improved for patients with high-risk endometrial cancer treated with adjuvant chemoradiotherapy versus radiotherapy alone, with most clinically relevant benefit suggested for p53 abnormal cancers. FUNDING: Dutch Cancer Society, Cancer Research UK, National Health and Medical Research Council Australia, Cancer Australia, Italian Medicines Agency, and the Canadian Cancer Society Research Institute
Current role of robotic inguinal lymphadenectomy in penile cancer
No full textLymph node (LN) metastases are the most significant prognostic factor in penile cancer (PeC), so timely detection and adequate treatment of LN metastases is crucial. While open inguinal LN dissection (ILND) remains the standard for most cases, its morbidity has spurred interest in robot-assisted videoendoscopic ILND (RA-VEIL). We summarize current international guidelines and evidence on the current role of RA-VEIL in LN management for PeC. RA-VEIL is feasible and has been associated with fewer wound complications and an equivalent nodal yield in comparison to open ILND. However, lymphatic complications appear to remain the same. Therefore, for nodal staging in patients with cN0 PeC, sentinel node biopsy is preferred over RA-VEIL. In node-positive patients, more studies, especially prospective studies, are needed to confirm the long-term oncological safety of RA-VEIL before it can be incorporated in guidelines as a recommended treatment option. PATIENT SUMMARY: For patients with penile cancer, spread to the lymph nodes is a crucial factor in determining probable survival. We summarize the current role of a robot-assisted telescopic technique under video guidance for lymph node management. This technique is feasible and may lead to fewer wound infections, but lymphatic complications seem to be the same as with open surgery. More studies are needed to confirm the long-term cancer control outcomes of this technique
EPIC-A: phase II trial of cemiplimab plus standard of care chemotherapy followed by maintenance cemiplimab in locally advanced or metastatic penile carcinoma
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External validation of prostate specific antigen dynamics for prediction of biochemical recurrence with variable androgen deprivation therapy duration
No full text"Hadrontherapy for life" symposium, caen, March 10/11, 2025-strategy for the future-pediatric tumors
No full textThe symposium"Hadrontherapy for life," held in Caen, on March 10 and 11, 2025, brought together over 100 international experts of heavy ions particle therapy. Clinical aspects of current indications and future strategies were discussed. If protontherapy remains the cornerstone of current strategies dealing with pediatric malignancies, in order to better spare normal tissues from deleterious effects of radiation, heavier ions such as carbon ions could play a role in selected highly radio-resistant processes such as bone and non rhabdomyosrcomas soft tissue sarcomas. A special mention should be made to helium ions tested since 2021 in Europe that mimic protons with further ballistic selectivity. If immediate and early side effects of heavy ions look modest, long-term tolerance still needs to be carefully evaluated, including risks of carcinogenesis
A national cohort study of melanoma BRAF status, testing patterns, patient and tumour characteristics, treatment and survival in England 2016-21
No full textBACKGROUND: Inadequacy of testing for melanoma BRAF status results in delayed access to systemic therapy. BRAF mutations and their association with patient/tumour characteristics and survival is poorly understood. OBJECTIVES: To report national data from England on the (1) frequency of molecular BRAF testing, (2) association of patient/tumour characteristics with BRAF mutations and (3) treatment received and survival of patients with BRAF mutations. METHODS: This national retrospective cohort study identified all new melanomas and molecular BRAF testing in England diagnosed from 2016 to 2021 using population-based data from the National Disease Registration Service. Multivariate logistic regression determined the association between a) BRAF testing with patient/tumour characteristics, b) BRAF genotype with patient/tumour characteristics. Age-standardised net survival (NS) analysed melanoma-specific mortality by BRAF genotype. RESULTS: Of new melanomas diagnosed, 14.4% (13138/91415) had a BRAF test registered. The proportion of successfully tested tumours that were BRAF mutated was 34.0% (4424/13012). The West Midlands tested the highest proportion of cutaneous tumours (22.6% (1783/7901)) compared to the lowest in Yorkshire and the Humber (11.0% (856/7760)). Females (OR 0.82, 95%CI 0.79-0.86) and patients >80 years old (OR 0.88, 95%CI 0.83-0.93) were less likely to be tested for BRAF. BRAF mutations were associated with being female (OR 1.16, 95%CI 1.07-1.26). Patients >80 years (OR 0.36, 95%CI 0.32-0.40) had lower odds of being BRAF mutated. Patients with BRAF mutations had a lower five-year NS (BRAF-mutated 5-year NS 55.9%, 95%CI 52.7-59.2 vs BRAF WT 5-year NS 66.5%, 95%CI 62.1-60.1), particularly in stage II disease. CONCLUSIONS: This study presents the largest dataset on national melanoma BRAF status published to date. The data highlight geographic and demographic variations in BRAF testing and the impact of BRAF mutations on survival rates, particularly stage II patients. This highlights the critical role of consistent, early and accurate testing to ensure equal care, guide treatment decisions and understand prognosis
