Clinical Oncology (CLIN ONCOL-UK )

Publisher: Royal College of Radiologists (Great Britain), Elsevier

Description

Clinical Oncology is: a well established journal covering all aspects of the clinical management of cancer patients reflecting the current multi-disciplinary approach to therapy: a journal of the Royal College of Radiologists

  • Impact factor
    2.86
  • 5-year impact
    2.64
  • Cited half-life
    5.60
  • Immediacy index
    0.98
  • Eigenfactor
    0.01
  • Article influence
    0.89
  • Website
    Clinical Oncology website
  • Other titles
    Clinical oncology (Royal College of Radiologists (Great Britain): Online)
  • ISSN
    1433-2981
  • OCLC
    50820375
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Elsevier

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Voluntary deposit by author of pre-print allowed on Institutions open scholarly website and pre-print servers
    • Voluntary deposit by author of authors post-print allowed on institutions open scholarly website including Institutional Repository
    • Deposit due to Funding Body, Institutional and Governmental mandate only allowed where separate agreement between repository and publisher exists
    • Set statement to accompany deposit
    • Published source must be acknowledged
    • Must link to journal home page or articles' DOI
    • Publisher's version/PDF cannot be used
    • Articles in some journals can be made Open Access on payment of additional charge
    • NIH Authors articles will be submitted to PMC after 12 months
    • Authors who are required to deposit in subject repositories may also use Sponsorship Option
    • Pre-print can not be deposited for The Lancet
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Here we review current practices in target volume delineation for radical radiotherapy planning for gliomas. Current radiotherapy planning margins for glioma are informed by historic data of recurrence patterns using radiological imaging or post-mortem studies. Radiotherapy planning for World Health Organization grade II-IV gliomas currently relies predominantly on T1-weighted contrast-enhanced magnetic resonance imaging (MRI) and T2/fluid-attenuated inversion recovery sequences to identify the gross tumour volume (GTV). Isotropic margins are added empirically for each tumour type, usually without any patient-specific individualisation. We discuss novel imaging techniques that have the potential to influence radiotherapy planning, by improving definition of the tumour extent and its routes of invasion, thus modifying the GTV and allowing anisotropic expansion to a clinical target volume better reflecting areas at risk of recurrence. Identifying the relationships of tumour boundaries to important white matter pathways and eloquent areas of cerebral cortex could lead to reduced normal tissue complications. Novel magnetic resonance approaches to identify tumour extent and invasion include: (i) diffusion-weighted magnetic resonance metrics; (ii) diffusion tensor imaging; and (iii) positron emission tomography, using radiolabelled amino acids methyl-11C-L-methionine and 18F-fluoroethyltyrosine. Novel imaging techniques may also have a role together with clinical characteristics and molecular genetic markers in predicting response to therapy. Most significant among these techniques is dynamic contrast-enhanced MRI, which uses dynamic acquisition of images after injection of intravenous contrast. A number of studies have identified changes in diffusion and microvascular characteristics occurring during the early stages of radiotherapy as powerful predictive biomarkers of outcome.
    Clinical Oncology 05/2014;
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    ABSTRACT: The purpose of this overview is to describe radiotherapy retreatment of primary central nervous system tumours from a practical clinical management perspective, including patient selection, choice of radiation technique, dose and fractionation. Useful relief of clinical symptoms and occasionally prolonged survival can follow retreatment. Further analysis of a previously published data set shows that the duration of remission after initial radiotherapy does not correlate with the duration of the remission after retreatment. Also there is no clear relationship between delivered tissue and tumour biological effective dose (BED) and duration of second remission. 'Recovery' of radiation tolerance with time is important and the radiobiological experiments that show this phenomenon have important limitations. To improve the decision as to how much recovery safely occurs with increasing time after radiotherapy, a new mathematical formulation is proposed. This is essentially conservative in its intent, compatible with experimental data sets, and provides a method for tentative calculation of retreatment dose and fractionation. Worked examples are provided of such calculations. As an increasing number of relatively young patients are now retreated, it is important to extend the experimental and human evidence base. A nationally co-ordinated analysis of patients already retreated would be valuable, in order to make future retreatment as safe and effective as possible, with validation of the permissible retreatment schedules for the particular radiation technique used. A national register and task force is proposed to facilitate this.
    Clinical Oncology 05/2014;
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    ABSTRACT: Recent clinical series suggest that treating patients with isotoxic twice-daily radiotherapy may be beneficial. This dosimetric planning study compared the use of intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DRT) to deliver isotoxic treatment for non-small cell lung cancer (NSCLC) patients. Twenty patients with stage II/III NSCLC were selected. A dose-escalated plan was produced retrospectively for each using three different methods: (i) three to five beams 3DRT; (ii) seven beams inverse-planned conformal radiotherapy; (iii) seven beams IMRT. The starting point for dose escalation was 55.8 Gy in 1.8 Gy per fraction twice-daily. The number of fractions was then increased until one or more organ at risk tolerance dose was exceeded or a maximum dose of 79.2 Gy was reached. The median escalated doses were 70.2, 66.6 and 64.8 Gy for IMRT, 3DRT and inverse-planned conformal radiotherapy, respectively. IMRT allowed a significant dose increase in comparison with the other two methods (P < 0.05), whereas no significant difference was found between 3DRT and inverse-planned conformal radiotherapy. IMRT was more successful at escalating dose in patients where the brachial plexus and spinal canal were close to the planning target volume. IMRT did not allow the escalation of dose beyond 70.2 Gy (82.8 Gy BED10, 69 Gy EQD2) due to the proximity of disease to the great vessels and the proximal bronchial tree. IMRT allows increased dose escalation compared with conformal radiotherapy. However, there is limited opportunity to escalate the prescription dose beyond 70.2 Gy twice-daily in disease close to the central mediastinal structures.
    Clinical Oncology 05/2014;
  • Clinical Oncology 04/2014;
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    ABSTRACT: Advances in technology are allowing a molecular characterisation of human brain tumours that is providing a wealth of new information. In this short overview, a summary of the histopathology of the common gliomas is integrated with some molecular data. In some instances, the data are proving clinically relevant with conventional therapies. Some single histological entities are being found to contain a number of molecular subtypes, whereas in others, different histological entities are found to be molecularly similar. The introduction of targeted therapies will necessitate a complete reassessment of the way we characterise tumours, and particularly the adequacy of our pathology reports in a new clinical environment.
    Clinical Oncology 04/2014;
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    ABSTRACT: Medical treatments for glioblastoma face several challenges. Lipophilic alkylators remain the mainstay of treatment, emphasising the primacy of good blood-brain barrier penetration. Temozolomide has emerged as a major contributor to improved patient survival. The roles of procarbazine and vincristine in the procarbazine, lomustine and vincristine (PCV) schedule have attracted scrutiny and several lines of evidence now support the use of lomustine as effective single-agent therapy. Bevacizumab has had a convoluted development history, but clearly now has no major role in first-line treatment, and may even be detrimental to quality of life in this setting. In later disease, clinically meaningful benefits are achievable in some patients, but more impressively the combination of bevacizumab and lomustine shows early promise. Over the last decade, investigational strategies in glioblastoma have largely subscribed to the targeted kinase inhibitor paradigm and have mostly failed. Low prevalence dominant driver lesions such as the FGFR-TACC fusion may represent a niche role for this agent class. Immunological, metabolic and radiosensitising approaches are being pursued and offer more generalised efficacy. Finally, trial design is a crucial consideration. Progress in clinical glioblastoma research would be greatly facilitated by improved methodologies incorporating: (i) routine pharmacokinetic and pharmacodynamic assessments by preoperative dosing; and (ii) multi-stage, multi-arm protocols incorporating new therapy approaches and high-resolution biology in order to guide necessary improvements in science.
    Clinical Oncology 04/2014;
  • Clinical Oncology 04/2014;
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    ABSTRACT: To investigate patterns of practice in palliative radiotherapy in Africa. Fifteen centres in Africa provided detailed information about radiotherapy in both metastatic and locally advanced disease via a questionnaire. Information included general information (institution status, equipment, staff, patient number), radiotherapy and other treatment characteristics in bone metastasis, brain metastasis, metastatic spinal cord compression, lung and liver metastasis, as well as locally advanced tumours. The number of patients annually seen/treated ranged from 285 to 5000. Breast, cervix, head and neck, gastrointestinal and prostate cancer were the top five cancers overall. Eight (53%) institutions were without linear accelerators, four (27%) had a single one, whereas one institution each had two, three and four linear accelerators. The number of cobalt machines ranged from 0 to 2 (median 1). Most centres still prefer to use fractionated radiotherapy regimens over single-fraction regimens in bone metastasis, although most centres are now using single-fraction radiotherapy in retreatments. Radiotherapy in brain metastasis and metastatic spinal cord compression mostly conform to worldwide standards. Lung and liver metastases are rarely irradiated, largely as a consequence of the lack of modern radiotherapy technology. Locally advanced disease in various tumour sites was mostly palliated, in agreement with current evidence-based practices. African countries still lack adequate staffing and equipment to adequately address their clinical burden, being palliative in most cases. Emphasis should also be made on more rationally using existing capacities by using more of the single-fraction radiotherapy regimens, especially in bone metastasis.
    Clinical Oncology 04/2014;
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    ABSTRACT: To measure the difference in cumulative doses received by the bladder (target) and integral doses with different clinical target volume (CTV) to planning target volume (PTV) margins, comparing set-up to skin tattoos versus image-guided radiotherapy to bone or soft tissue. Four plans were generated on each planning computed tomography dataset using the CTV with 5, 10, 15, 20 mm PTV margins using a three-dimensional conformal four-field technique. Set-up data based on skin, bone and soft tissue to the bladder on pre-treatment cone beam computed tomography (CBCT) were recorded. In total, 316 CBCTs were evaluable from 10 bladder cancer patients. Each CBCT was fused to the planning computed tomography dataset using the isocentre corresponding to each of the three pre-treatment matching conditions. The target was contoured on each CBCT and called the CTV of the day and the plan was re-calculated to determine the dose to this. The mean D95 with CTV to PTV margins of 5, 10, 15 and 20 mm for skin set-up was 89.4, 93.0, 97.2, 98.6; for bone 88.8, 92.6, 96.7, 98.6; and for soft tissue 96.3, 98.6, 98.7, 99.5. With soft-tissue matching, the mean (standard deviation) volume of normal tissue receiving 5 Gy with 5, 10, 15 and 20 mm margins was 3899 (1022), 4561 (1142), 5663 (1304) and 6315 (1426) in cm(3). Soft-tissue matching results in superior target coverage and a reduced integral dose to the surrounding tissues. With soft-tissue matching, increasing CTV to PTV margins progressively beyond 5 mm results in modest improvement in CTV coverage, but a large increase in integral dose.
    Clinical Oncology 04/2014;
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    ABSTRACT: To describe patterns of treatment for those who receive more than one episode of megavoltage radiotherapy (retreatment) by cancer type for better service planning and benchmarking. Institutional databases of all patients who received their first megavoltage radiotherapy for any type of cancer at the Liverpool and Macarthur Cancer Therapy Centres (LM), New South Wales, Australia, Royal Brisbane and Women's Hospital (RBWH), Queensland, Australia and Radiotherapeutic Institution Friesland (RIF), Leeuwarden, the Netherlands, over the period 1991-2009 were examined. Radiotherapy retreatment was defined as any radiotherapy episode, to any body site, after an initial episode of radiotherapy, for the same cancer diagnosis. The total retreatment rate was defined as the number of retreatment episodes of radiotherapy divided by the number of cases in the cohort. In total, 62 270 patients (RBWH 38581, LM 9654, RIF 14035) received 77 762 episodes of radiotherapy, giving a total retreatment rate of 0.25; 52 351 patients (84%) received only one episode of treatment and 9919 (16%) received two or more episodes of treatment. Overall retreatment rates for LM, RBWH and RIF were 0.24, 0.25 and 0.26, respectively. For the five most common cancer types treated, the median time between treatment episodes was longest for breast cancer (11.3 months), then head and neck cancer (9.7 months), colorectal cancer (7.2 months), prostate cancer (4.4 months) and lung cancer (4.1 months). Ninety-one per cent of all fractions were delivered in the first episode of treatment. The retreatment rate was very similar between the three facilities, suggesting agreement about the indications for retreatment.
    Clinical Oncology 04/2014;
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    ABSTRACT: Squamous cell cancer of the anal canal is a rare tumour for which there remains uncertainty regarding optimal therapy. A systematic review was conducted to summarise the evidence examining concurrent chemotherapy and radiotherapy or different chemotherapy regimens in combination with radiotherapy. MEDLINE, EMBASE and conference proceedings were searched for relevant randomised controlled trials. Outcomes of interest were colostomy rate, local failure, overall survival, disease-free survival, adverse effects and quality of life. Six randomised controlled trials were identified. Two trials reported lower colostomy and local failure rates for concurrent 5-fluorouracil (5-FU) plus mitomycin C (MMC) and radiotherapy compared with radiotherapy alone. The omission of MMC from this regimen resulted in higher colostomy and local failure rates and lower disease-free survival. Induction chemotherapy followed by concurrent 5-FU plus cisplatin and radiotherapy resulted in a higher colostomy rate than concurrent 5-FU plus MMC and radiotherapy. Haematological toxicity rates were lower in patients who received radiotherapy with 5-FU alone or 5-FU plus cisplatin compared with 5-FU plus MMC. No benefit was seen for the addition of induction or maintenance chemotherapy to concurrent chemoradiotherapy. The available evidence continues to support the use of radiotherapy with concurrent 5-FU and MMC as standard treatment for cancer of the anal canal to decrease colostomy and local failure rates.
    Clinical Oncology 04/2014;
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    ABSTRACT: Brain tumours in the elderly show differences from the general population in their spectrum of incidence, their molecular profile and their response to treatment. Furthermore, this population also finds it more difficult to tolerate the treatments applied to younger patients. For these reasons it is justified to investigate older patients separately and to devise treatments applicable specifically to this population. In recent years important information has come from the research literature that allows us to make specific recommendations for the management of elderly patients with brain tumours. Here we review the important publications and document these recommendations.
    Clinical Oncology 04/2014;
  • Clinical Oncology 03/2014;
  • Clinical Oncology 03/2014;
  • Clinical Oncology 03/2014;
  • Clinical Oncology 03/2014;
  • Clinical Oncology 03/2014;
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    ABSTRACT: Recent drug discovery developments in the field of small molecule targeted agents have led to much interest in combining these with radiotherapy. There are good preclinical data to suggest this approach worthy of investigation and in this review we discuss how this has translated into recent clinical trials. The outcome of clinical trials investigating radiotherapy/targeted drug combinations published in the last 5 years is discussed, as are trials in progress. The perceived future opportunities and challenges in the development of this exciting area are considered.
    Clinical Oncology 03/2014;
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    ABSTRACT: Hypoxia was identified as a microenvironmental component of solid tumours over 60 years ago and was immediately recognised as a potential barrier to therapy through the reliance of radiotherapy on oxygen to elicit maximal cytotoxicity. Over the last two decades both clinical and experimental studies have markedly enhanced our understanding of how hypoxia influences cellular behaviour and therapy response. Furthermore, they have confirmed early assumptions that low oxygenation status in tumours is an exploitable target in cancer therapy. Generally such approaches will be more beneficial to patients with hypoxic tumours, necessitating the use of biomarkers that reflect oxygenation status. Tissue biomarkers have shown utility in many studies. Further significant advances have been made in the non-invasive measurement of tumour hypoxia with positron emission tomography, magnetic resonance imaging and other imaging modalities. Here, we describe the complexities of defining and measuring tumour hypoxia and highlight the therapeutic approaches to combat it.
    Clinical Oncology 03/2014;
  • Clinical Oncology 03/2014;

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