The Christie School of Oncology: Christie Research Publications Repository
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Drug re-purposing to improve outcomes in the management of prostate cancer - aims, outcome measures and design of current phase III trials
No full textAcute oncology: the care of older patients in the emergency department
No full textPURPOSE OF REVIEW: There has been a notable rise in cancer-related emergencies, especially in older patients, due to an increase in those undergoing complex therapies. In this review, we consider the management and clinical workup of the older cancer patient in the emergency department (ED). We will reflect on clinical features of older patients with cancer, as well as fall, delirium, febrile neutropenia (FN), and immune checkpoint inhibitor toxicity. RECENT FINDINGS: Older patients with cancer are more likely to require admission to hospital following ED attendance. The most common emergency presentations are fever, pain and gastrointestinal symptoms. The complexity of common presentations, such as falls and delirium, is often overlooked in older cancer patients. FN in older patients is associated with increased mortality and a higher likelihood of requiring inpatient care. Despite their therapeutic benefits in older patients, the broad spectrum of immune-related toxicities even at lower grades, can lead to functional decline and the need to discontinue therapy. SUMMARY: The number of older people with cancer presenting to emergency care is expected to rise. In response to this growing and complex demand, a comprehensive, individualised, and multi-disciplinary approach is essential. Clinicians need to be aware of the increasingly broad spectrum of diagnoses in this population and tailor their assessment and management strategies accordingly
From Simple Scores to Intelligent Systems: Encouraging the Development, Validation and Adoption of Robust Prognostic Tools in Small Cell Lung Cancer
No full textSmall cell lung cancer (SCLC) is an aggressive malignancy with poor prognosis. No validated prognostic score has been established to guide clinical decisions in the extensive stage (ES). This narrative review critically examines the evolution of prognostic models in SCLC. We aim to highlight current gaps and propose directions for the development of clinically actionable tools. We conducted a comprehensive review of the literature on SCLC prognostic models, focusing on historical context, model design, variables used, validation methods, and real-world applicability. Comparative strengths and limitations were analysed across different model types. We analysed early scoring systems, modern nomograms, inflammation-based and nutritional scores, as well as integrative models. Historical tools are often limited to disease stage, performance status, basic laboratory values, most lack external validation, are retrospective, or were developed on chemotherapy-only cohorts. Recent models incorporate broader clinical data and, in some cases, nomograms or web-based calculators. Yet, few have undergone external validation or demonstrated utility in diverse clinical settings. The absence of dynamic, personalized models prevents integration into contemporary practice. Although numerous prognostic tools have been proposed, a reliable, validated tool is still lacking. Future prognostic models must move beyond static clinical parameters. Incorporating molecular biomarkers, real-world data, and machine learning could enable the development of validated, adaptive tools with true clinical relevance. Collaborative, prospective efforts will be critical to achieve this goal
A rare case of repeat severe facial dog bite injuries requiring two free flap reconstructions
No full textWhilst the majority of dog bites result in minor injuries requiring treatment with antibiotics and washout, those requiring microsurgical reconstruction are rare. We report the unique case of an adult patient who sustained two severe dog bite injuries from his own dog, several years apart, which necessitated free flap reconstructions. This case presented a unique reconstructive challenge and raises important questions regarding current legislation around dangerous dogs
How can a radiation oncology society support its members and the community to help reduce the carbon footprint of radiation oncology?
No full textBACKGROUND: Climate change is an escalating crisis with significant implications for public health and healthcare services. We aimed to survey radiation oncology (RO) professionals on their understanding and concerns about climate change and the role of ESTRO in addressing the crisis. MATERIALS AND METHODS: A 14-item survey covering environmental impact of RO activities, personal actions, and expectations of ESTRO's responses to the climate crisis was developed, validated, and disseminated to RO professionals by email and online platforms. RESULTS: 706 responses were received out of 9,781 ESTRO members. Concern about climate change was indicated by 90% of respondents and 94% had changed their personal lives to help combat the climate crisis. Yet 50% of respondents could not identify RO's main contributors to climate change. 39% reported positive attitudes to online conferences and 79% agreed that ESTRO should offer digital participation to reduce the carbon impact of travel. Reported barriers to digital participation were mainly related to lack of face-to-face interaction. Although additional time was the most common barrier to reducing flying for work-related trips, 47 % of respondents were willing to travel by train for ≥ 7 h to an ESTRO conference. The majority of respondents (82 %) agreed that ESTRO should 'Increase engagement with manufacturers around environmental sustainability'. CONCLUSION: Our results reveal strong concern about the climate crisis among RO professionals, willingness to implement change, lack of knowledge about climate impact of RO and support for ESTRO actions to support its members and the community in these efforts
Treatment-related outcomes and patterns of relapse in secondary CNS involvement by large B-cell lymphoma
No full textSecondary central nervous system (CNS) large B-cell lymphoma (SCNSL) occurs in the de novo setting, as a CNS-isolated relapse, or synchronous (concomitant CNS and systemic) relapse. SCNSL is a devastating event without therapeutic consensus. Thus, we aimed to evaluate treatment outcomes in an international cohort. Progression-free survival (PFS), overall survival (OS) and cumulative incidence of relapse (CIR, estimated using competing-risk models) were reported. Prognostic factors were identified in a 6-month landmark multivariate analysis. Outcomes following thiotepa autologous stem cell transplant (ASCT) and chimeric antigen receptor T-cell therapy (CAR-T) delivered at relapse were compared following propensity score matching (PSM). A total of 1139 patients were included in the analysis (de novo: 537; relapsed SCNSL: 602). 2-year PFS estimates were 40.4%, 43.9% and 16.2% for de novo SCNSL, CNS-isolated relapse, and synchronous relapse respectively. Patients with CNS-isolated relapse demonstrated low rates of systemic recurrence (24-month CIR 6%). Thiotepa-ASCT correlated with longer survival in de novo SCNSL (PFS: HR=0.57; P=0.005; and OS: HR=0.62; P=0.023) and CNS-isolated relapses (PFS: HR=0.55; P=0.002; and OS: HR=0.39; P<.0001) in 6-month multivariable landmark analysis. ASCT (thiotepa or non-thiotepa) also associated with improved survival in synchronous relapses (PFS: HR=0.57; P=0.023; and OS: HR=0.48; P=0.019). Higher survival with thiotepa-ASCT compared to CAR-T was observed in survival analyses following PSM (PFS: HR=0.45; P=0.005 and OS: HR=0.41; P=0.014). These data support thiotepa-ASCT in eligible patients, particularly de novo disease and CNS-isolated relapses. CNS-isolated relapse was infrequently associated with systemic recurrence, supporting treatment regimens adopted from primary CNS lymphoma
Anesthesia in pediatric radiotherapy: a systematic literature review by the SIOP Europe working group on pediatric anesthesia in radiation therapy
No full textRadiotherapy (RT) is essential in pediatric cancer treatment and often requires complete immobility. In younger or noncompliant children, this is typically achieved through sedation or general anesthesia (GA), which raises concerns about acute complications and potential long-term neurodevelopmental effects. Despite widespread use, standardized anesthesia protocols for pediatric RT are lacking. To support the development of practice recommendations, the SIOPE Working Group on Pediatric Anesthesia in Radiation Therapy conducted a systematic literature review. Studies from Medline and Embase were reviewed (March-September 2024) according to PRISMA guidelines, focusing on sedation and GA in pediatric RT. Thirty-nine studies were included, mostly retrospective and of low to moderate quality. Considerable heterogeneity was observed in anesthetic techniques, staffing, and monitoring. Propofol-based sedation was most frequently reported, with favorable safety when delivered by experienced pediatric anesthetists. Complication rates varied widely and were often poorly defined. Additional concerns included long-term neurocognitive impact, vascular access, and procedural burden, especially in resource-limited settings. Evidence supports the safe use of sedation/GA in pediatric RT, but current literature is limited and inconsistent. Standardized protocols and prospective studies are urgently needed to better define safety, long-term outcomes, and staffing requirements
Epcoritamab, lenalidomide, and rituximab versus lenalidomide and rituximab for relapsed or refractory follicular lymphoma (EPCORE FL-1): a global, open-label, randomised, phase 3 trial
No full textBACKGROUND: An unmet need persists for chemotherapy-free regimens that induce durable responses for relapsed or refractory follicular lymphoma. Lenalidomide and rituximab (R(2)) is an accepted standard of care in this population. The EPCORE FL-1 trial aimed to evaluate the efficacy and safety of epcoritamab plus R(2) versus R(2) in participants with relapsed or refractory follicular lymphoma after at least one previous line of chemoimmunotherapy. METHODS: In this multicountry, open-label, phase 3 trial, participants were randomly allocated (1:1) to fixed-duration epcoritamab plus R(2) or R(2) for up to 12 cycles. Epcoritamab was administered weekly in cycles 1-3 and every 4 weeks in cycles 4-12, lenalidomide once daily during cycles 1-12 (days 1-21), and rituximab weekly during cycle 1 and monthly in cycles 2-5. The dual primary endpoints were overall response rate and progression-free survival by independent review committee. The data reported here are from a planned interim analysis carried out after 78% of progression-free survival events had occurred. This study is registered with ClinicalTrials.gov, NCT05409066, and EudraCT, 2021-000169-34, and is ongoing (closed to recruitment). FINDINGS: Out of 668 participants screened for eligibility across 189 academic and non-academic centres in 30 countries across Africa, Asia, Australia, Europe, North America, and South America, a total of 488 participants were randomly allocated, 243 to epcoritamab plus R(2) and 245 to R(2). The trial met its dual primary endpoints, showing superiority of epcoritamab plus R(2) over R(2) in overall response rate and progression-free survival. With a median follow-up of 14·8 months (IQR 11·4-19·0), overall response rate was 95% (95% CI 92-97) with epcoritamab plus R(2) versus 79% (74-84; p<0·0001) with R(2). Progression-free survival was longer with epcoritamab plus R(2) versus R(2) (hazard ratio 0·21 [95% CI 0·14-0·31], p<0·0001); estimated 16-month progression-free survival favoured epcoritamab plus R(2) (85·5% vs 40·2%). Grade 3 or higher adverse events were more frequent with epcoritamab plus R(2) (219 [90%] of 243 participants) versus R(2) (161 [68%] of 238 participants). Cytokine release syndrome was low grade with epcoritamab plus R(2) (grade 1 in 28 [21%] participants and grade 2 in seven [5%] participants) and manageable, and all events were resolved. INTERPRETATION: Epcoritamab plus R(2) resulted in significantly higher response rate and longer progression-free survival versus R(2) among participants with follicular lymphoma who had received at least one line of therapy. Epcoritamab plus R(2) had more grade 3 or higher adverse events versus R(2). Adverse events were manageable and consistent with the established safety profiles of the individual components, with no new safety findings identified. These findings position epcoritamab plus R(2) as a new standard of care for second-line or subsequent treatment of follicular lymphoma. FUNDING: AbbVie and Genmab
Defining the clinical target volume in postoperative thymic epithelial tumours - a clinical practice guide for UK clinical oncologists
No full textBackground: Thymic epithelial tumours (TETs) are rare tumours, and most patients undergo curative resection. A minority require post-operative radiotherapy (PORT); however, current published guidelines provide differing recommendations. With few cases, a new staging system, increasing use of minimally invasive operative techniques, and challenging histopathology, postoperative radiotherapy planning is increasingly difficult with significant national variation. To bridge this gap, the multidisciplinary British Thoracic Oncology Group (BTOG) Thymic Malignancies Special Interest Group convened a working group to produce a user-friendly, practical guideline for TET postoperative radiotherapy. Methods: Through synthesis of current published guidelines, expert multidisciplinary opinions (radiologists, surgeons, histopathologists, and clinical oncologists), and a blinded clinical target volume (CTV) contouring assessment, areas of agreement and best practice were identified. Results: Subsequently, mandatory, and optional, recommendations were agreed for all steps of the postoperative radiotherapy planning process, including which areas to treat, radiotherapy planning techniques, and radiotherapy dose fractionation. Conclusion: Implementation of this national guideline will improve clinician knowledge related to postoperative radiotherapy for TETs and should reduce unwarranted variations in practice. (c) 2025 The Author(s). Published by Elsevier Ltd on behalf of The Royal College of Radiologists. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/)
Retroperitoneal lymph node dissection for growing teratoma syndrome in testicular cancer: a systematic review of surgical outcomes
No full textPurpose Growing Teratoma Syndrome (GTS) is a rare entity occurring in patients with non-seminomatous germ cell tumours (NSGCT) following chemotherapy. GTS is resistant to chemotherapy and radiotherapy, making retroperitoneal lymph node dissection (RPLND) the mainstay of treatment. This review aims to synthesize evidence on the surgical management and oncological outcomes of retroperitoneal GTS. Methods A systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251233173). PubMed and Embase were searched from inception to November 2025. Risk of bias was assessed using the ROBINS-I tool. Results Fifteen studies comprising 156 patients with NSGCT-associated retroperitoneal GTS treated with RPLND were included. The reported incidence ranged from 2.8% to 7.6%. Median patient age across studies was 16-38 years. Mixed NSGCT was present in 73-100% of orchidectomy specimens, with a teratoma component identified in 40-100%. The interval to RPLND ranged from 2 to 30 months and median operative time ranged from 160 to 432 min, and estimated blood loss from 225 to 2500 mL. Adjunctive procedures were required in 10-100% of patients, and postoperative complications occurred in 12.5-44%, with Clavien-Dindo >= III complications in 12.5-25%. Median length of hospital stay ranged from 5 to 15 days. Disease-free survival varied between 41.7% and 100%, and overall survival between 73.7% and 100% with follow-up ranging from 8 to 103 months. Conclusions RPLND is a complex procedure with effective oncological outcomes for GTS. Multicentric registries are needed for generating high-quality standardised data