Society Of Oncology Research Articles

Special entities of the head and neck region: cancers of the nasopharynx, (para)nasal cavities, salivary glands, and the thyroid gland : Post ASCO 2024

Malignancies of the nasopharynx (NPC), the (para)nasal cavities, the salivary glands, and the thyroid gland are distinct to head and neck squamous cell carcinomas (HNSCC) in the oro-/hypopharynx and larynx in terms of etiology, tumor biology, and the therapeutic concept. The contributions to the 2024 American Society of Oncology (ASCO) Annual Meeting provide insight into the latest developments in these "special entities of the head and neck region." Abstracts were examined for their clinical relevance and placed into context with current therapeutic concepts. In the treatment of locally advanced NPC, arandomized phaseIII study showed equivalence of induction (ICT) and adjuvant therapy (AT; NCT03306121). PD-1inhibitors have become established in the palliative therapy of NPC in recent years and could now also play an increasing role in curation: the phaseIII study "Dipper" showed asignificantly better 3‑year event-free survival in patients adjuvantly treated with camrelizumab versus placebo after IT and definitive platinum-containing chemoradiotherapy (dRCT; 89% vs.80%; NCT03427827). The phaseIII study "Beacon" showed complete remission in 30.5% of patients after IT with gemcitabine/cisplatin and the PD‑1 inhibitor tislelizumab (three cycles), arate almost twice as high as with gemcitabine/cisplatin alone (NCT05211232). Intensification of dRCT in NPC using EGFR and VEGF inhibitors appears promising (NCT04447326). Abstracts on salivary gland and nasal and sinus cancers emphasize the importance of targeted therapies. In anaplastic thyroid carcinoma, the combination of aPD‑1 inhibitor and aCTLA4 inhibitor showed a50% response.

Recommendations for the use of nuclear medicine imaging in patients with neuroblastoma.

Neuroblastoma (NB) is the most common extracranial solid cancer in children. Despite intensive multimodality treatment, long-term survival of patients with high-risk NB, which comprises more than half of all cases, remains poor. Nuclear medicine is key in diagnosis, staging, response assessment and long-term follow-up of NB. The emergence of novel tracers and the increasing complexity of studies require updated guidelines for nuclear medicine imaging in NB. Standardising diagnostic techniques are essential for improving study comparability and ensuring test quality. This article aims to provide a comprehensive review of NB radionuclide diagnostic imaging, including its characteristics, accuracy, advantages, and limitations. It offers practical recommendations to multidisciplinary teams responsible for treating patients with NB. This review summarises the opinions of leading experts from the Neuroblastoma Spanish Group within the Spanish Society of Paediatric Haematology and Oncology (SEHOP) and the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM).

Recent developments in marginal zone lymphoma

SummaryMarginal zone lymphoma is a relatively rare disease with a usually indolent clinical course. In clinical terms, three major subtypes—i.e., extranodal, nodal, and splenic marginal zone lymphomas—are encountered, which have specific clinical features. Clinical progress, however, has been limited in recent years as they are mostly lumped together with follicular lymphoma under the term “indolent lymphomas” in clinical trials. A talk given at the 2024 Annual Meeting of the Austrian Society of Hematology and Oncology aimed to summarize clinically relevant topics and progress in the field of marginal zone lymphoma, which is summarized in the current article.

Sharing Genomic Tumor Sequencing Results With Patients: Experiences of Advanced Practice Oncology Providers

Background: Patients with cancer routinely undergo genomic tumor sequencing, a component of molecular profiling (MP), to better characterize their cancer and identify potential targetable alterations. Targeted treatments potentially confer higher response rates and better efficacy. With increasing complexity, patients may require detailed explanations of MP results. Patient understanding of MP results increases the likelihood that eligible patients receive targeted treatment. Advanced practice providers (APPs), defined as nurse practitioners, physician assistants, and pharmacists, frequently review and discuss MP results with patients. Purpose: The aim of this study is to understand APP experiences discussing MP results with adult cancer patients. Methods: A qualitative study was conducted through virtual semi-structured interviews with APPs recruited via study invitation shared through the Advanced Practitioner Society for Hematology and Oncology (APSHO). Eligibility criteria included APPs with > 1 year of oncology experience and involvement in discussing MP results. Data were analyzed utilizing a constant comparative analysis and coded in three stages: open, axial, and selective. Results: Thirteen participants were enrolled from across the United States. Participants discussed learning to understand and explain MP findings primarily through on-the-job experiences. Barriers to patient education were also described. Initially coded participant statements (open codes) produced six themes (axial codes). Conclusions: With MP now standard practice in oncology, APPs frequently discuss these results with patients. This study highlights that additional and continuing education related to MP is needed in communicating complex results. Patient educational tools, specific to patients’ MP findings and tailored to their preferences and literacy levels, are critically needed.

Rare tumors in gynecologic oncology fellowship: A novel, longitudinal integrated curriculum initiative

Rare tumors in gynecologic oncology fellowship: A novel, longitudinal integrated curriculum initiative

Beyond grades: Factors shaping academic career trajectory in gynecologic oncology fellowship applicants

Beyond grades: Factors shaping academic career trajectory in gynecologic oncology fellowship applicants

The road less traveled: A mixed methods study of patterns and perceptions of training timelines among gynecologic oncology fellowship applicants, trainees, and graduates

The road less traveled: A mixed methods study of patterns and perceptions of training timelines among gynecologic oncology fellowship applicants, trainees, and graduates

Unconscious bias in letters of recommendation for gynecologic oncology fellowship applicants impacts entry into the field

Unconscious bias in letters of recommendation for gynecologic oncology fellowship applicants impacts entry into the field

Opportunity for increasing applicant diversity in gynecologic oncology fellowship programs

Opportunity for increasing applicant diversity in gynecologic oncology fellowship programs

Rare tumors in gynecologic oncology fellowship: A novel longitudinal integrated curriculum (LIC) initiative

Rare tumors in gynecologic oncology fellowship: A novel longitudinal integrated curriculum (LIC) initiative

Cross-sectional survey of preparedness for gynecologic oncology fellowship among recent gynecologic oncology graduates

Cross-sectional survey of preparedness for gynecologic oncology fellowship among recent gynecologic oncology graduates

Comparison of parental leave policies available to gynecologic oncology fellows in the United States

Comparison of parental leave policies available to gynecologic oncology fellows in the United States

Pumping in the OR: A mixed-methods study of family-building and parenting among current and past gynecologic oncology fellows

Pumping in the OR: A mixed-methods study of family-building and parenting among current and past gynecologic oncology fellows

Do Fellowship-educated Military Orthopaedic Oncologists Who Practice in Military Settings Treat a Sufficient Volume of Patients to Maintain Their Oncologic Expertise?

Fellowship-trained orthopaedic oncologists in the US military provide routine clinical care and also must maintain readiness to provide combat casualty care. However, low oncologic procedure volume may hinder the ability of these surgeons to maintain relevant surgical expertise. Other low-volume specialties within the Military Health System (MHS) have established partnerships with neighboring civilian centers to increase procedure volume, but the need for similar partnerships for orthopaedic oncologists has not been examined. The purpose of this study was to characterize the practice patterns of US military fellowship-trained orthopaedic oncologists. We asked the following questions: (1) What are the diagnoses treated by US military fellowship-trained orthopaedic oncologists? (2) What are the procedures performed by US military fellowship-trained orthopaedic oncologists? We queried the Military Data Repository, a centralized repository for healthcare data for all healthcare beneficiaries (active duty, dependents, and retirees) within the Defense Health Agency using the MHS's Management and Reporting Tool for all international common procedure taxonomy (CPT) codes and ICD-9 and ICD-10 codes associated with National Provider Identifier (NPI) numbers of active duty, military fellowship-trained orthopaedic oncologists. Fellowship-trained orthopaedic oncologists were identified by military specialty leaders. Then, we identified all procedures performed by the orthopaedic oncologist based on NPI numbers for fiscal years 2013 to 2022. We stratified the CPT codes by top orthopaedic procedure categories (such as amputation [performed for oncologic and nononcologic reasons], fracture, arthroplasty, oncologic) based on associated ICD codes. These were then tabulated by the most common diagnoses treated. Thirteen percent (796 of 5996) of the diagnoses were oncologic, of which 45% (357 of 796) were malignant. Forty-four percent (158 of 357) of the malignancies were primary and 56% (199 of 357) were secondary; this translates to an average of 2 patients with primary and 2.5 patients with secondary malignancies treated per surgeon per year. During the study period, nine orthopaedic oncologists performed 5996 orthopaedic procedures, or 74 procedures per surgeon per year. Twenty-one percent (1252 of 5996) of the procedures were oncologic; the remaining procedures included 897 arthroplasties, 502 fracture-related, 275 amputations for a nononcologic indication, 204 infections, 142 arthroscopic, and 2724 other procedures. Although military orthopaedic oncologists possess expert skills that are directly translatable to combat casualty care and operational readiness, within MHS hospitals they treat relatively few patients with oncologic diagnoses, and less than one-half of those involve malignancies. Despite postgraduation procedure volume raining stable over the last decade, it is unknown how many new patient visits for oncologic diagnoses and how many corresponding tumor procedures are necessary to maintain competence or build confidence after musculoskeletal oncology fellowship training. It is important to note that there are no military orthopaedic oncology fellowships, and all active duty orthopaedic oncologists undergo training at civilian institutions. Military-civilian partnerships with high-volume cancer centers may enable military orthopaedic oncologists to work at civilian cancer centers to increase their oncologic volume to ensure sustainment of operationally relevant knowledge, skills, and abilities and improve patient care and outcomes.

Diagnosis and Treatment of Iron Deficiency and Iron Deficiency Anemia in Children and Adolescents: Recommendations of the Polish Pediatric Society, the Polish Society of Pediatric Oncology and Hematology, the Polish Society of Neonatology, and the Polish Society of Family Medicine

Background/Objectives. Iron deficiency is one of the most common nutritional deficiencies worldwide and is the leading cause of anemia in the pediatric population (microcytic, hypochromic anemia due to iron deficiency). Moreover, untreated iron deficiency can lead to various systemic consequences and can disrupt the child’s development. Methods/Results. Therefore, a team of experts from the Polish Pediatric Society, the Polish Society of Pediatric Oncology and Hematology, the Polish Neonatology Society, and the Polish Society of Family Medicine, based on a review of the current literature, their own clinical experience, and critical discussion, has developed updated guidelines for the diagnosis, prevention, and treatment of iron deficiency in children from birth to 18 years of age. These recommendations apply to the general population and do not take into account the specifics of individual conditions and diseases.

Outcome of childhood ALK-positive anaplastic large cell lymphoma relapses: Real-life experience of the French Society of Pediatric Oncology (SFCE) cohort of 75 French children.

To describe treatments and outcomes of French children treated for relapsed/refractory anaplastic lymphoma kinase-positive anaplastic large cell lymphoma (ALK+ ALCL). We conducted the analysis of a series of 75 French children treated for a first relapsed/refractory ALK+ ALCL between 1999 and 2017. The median time to first relapse was 8.1months from initial diagnosis (2.9 after end of treatment), with 12 relapses during frontline treatment or within 1month of the end of treatment. Treatment of the first relapse varied according to the period of time and risk factors: 48 received multiagent chemotherapy, including 21 and 19 consolidated with allogeneic stem cell transplantation (SCT) and autologous-SCT, respectively. Twenty-one patients received weekly vinblastine, and six received ALK inhibitors (ALKi). Overall, 64/75 patients reached a second complete remission (CR2). Eight out of 11 patients who did not reach CR2 died and the other three were rescued with ALKi, vinblastine, and nivolumab. With a median follow-up of 8.2years, 60 patients are alive, 43 in CR2, 15 in CR3, two in CR4; and 15 patients died, six from toxicity and nine from disease progression. The 5-year event-free survival and overall survival after first relapse were 51.7% (95% confidence interval [CI]: 39.6%-62.6%) and 80.7% (95% CI: 69.6%-88.1%), respectively. Time to relapse greater than 12months from initial diagnosis was proven to be a prognostic factor in relapsed/refractory ALK+ ALCL. In relapsed ALK+ ALCL, high survival rate can be reached with various therapeutic strategies. The main challenge remains to prevent subsequent relapses, and to lower long-term morbidity.

Malnutrition risk screening in adult oncology outpatients: An ASPEN systematic review and clinical recommendations.

Malnutrition screening is not widely practiced in outpatient cancer centers. This review aims to determine the validity of malnutrition screening tools and provide recommendations for clinical use. Studies identified by a systematic review assessed the general validity of screening tools in adult oncology outpatients from five databases through 2022. The American Society for Parenteral and Enteral Nutrition (ASPEN) convened a working group of members from the Academy of Nutrition and Dietetics, Academy of Oncology Nurse and Patient Navigators, American Cancer Society, American Society for Clinical Oncology, American Society for Nutrition, American Society for Radiation Oncology, Association of Cancer Care Centers, and Oncology Nursing Society to answer the following questions: (1) should clinicians screen for malnutrition, (2) which malnutrition screening tools are recommended, and (3) what are the clinical applications for malnutrition risk screening in adult oncology outpatients? Twenty of 738 studies met the criteria and were reviewed. Six screening tools with specific cut-points demonstrated validity and are recommended, including the Mini Nutritional Assessment (≤23.5), Malnutrition Screening Tool (MST; MST ≥ 2 and patient-led MST ≥ 2), Malnutrition Universal Screening Tool (MUST; MUST ≥ 1 and MUST ≥ 2), Nutrition Risk Screening-2002 (NRS-2002; NRS-2002 ≥ 2 and NRS-2002 ≥ 3), NUTRISCORE ≥ 5, and Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF; PG-SGA SF ≥ 7 and PG-SGA SF ≥ 8). Six screening tools are valid for malnutrition risk identification in oncology ambulatory settings and recommended before treatment initiation and regularly thereafter, depending on treatment course. Research is needed to understand to what extent early diagnosis and management of malnutrition improves the clinical care of oncology patients.

Perioperative immunotherapy for non-small cell lung cancer: consensus and controversy (2024 edition)

Lung cancer is the malignant tumour with the highest morbidity and mortality rate in China, among which non-small cell lung cancer (NSCLC) is the main pathological type of lung cancer, accounting for about 80% to 85%. Radial surgery is the standard treatment for early-stage NSCLC, but postoperative recurrence is an inevitable problem in clinical practice. Adding perioperative chemotherapy to surgery can only increase the 5-year overall survival rate by about 5%. There is an urgent need for better systemic treatments. In recent years, immunotherapeutic drugs, represented by PD-1/PD-L1 monoclonal antibodies, have brought breakthroughs from subsequent-line treatment to front-line treatment for NSCLC. Several Phase III studies on perioperative immunotherapy have shown that adding immunotherapy during the neoadjuvant and adjuvant treatment can significantly improve survival outcomes for patients, leading to the development of a new standard treatment for resectable NSCLC. In January 2024, the first PD-1 monoclonal antibodies (Toripalimab) were approved for perioperative treatment of NSCLC in China, starting a new era of perioperative immunotherapy. At present, there is still a lack of unified consensus on the application of perioperative immunotherapy at all levels of medical institutions. In order to privide diagnostic and treatment guidance for clinicians, promote the standardization of clinical practice for immunotherapy in resectable NSCLC, and clarify the controversial opinions regarding perioperative immunotherapy, Lung Cancer Expert Committee of the Chinese Anti-Cancer Association, Chinese Thoracic Oncology Group, Lung Cancer Expert Committee of the Chinese Medical Association Oncology Society jointly published this Consensus and Controversy to provide a guidance for the standardized management of perioperative immunotherapy for NSCLC.

Surgeon perspectives on a virtual reality platform for preoperative planning in complex bone sarcomas

Background and objectivesTreatment of primary bone and soft tissue sarcomas typically includes complete surgical resection with or without adjunctive modalities. Despite best efforts, for the most challenging clinical scenarios such as axial or pelvic sarcoma, five-year survival rates are reported to be between 27 and 40 %. Since quality of resection is a key determinant of oncologic outcomes, it is critical to preoperatively plan the surgical approach to improve resection accuracy, ensure sufficient surgical margins, and reduce the risk of local or metastatic recurrence. The computer conversion of 2-dimensional (2D) computerized tomography (CT) and magnetic resonance imaging (MRI) to a three-dimensional (3D) virtual reality (VR) avatar image may allow improved preoperative estimation of tumor size, location, adjacent anatomy, and spatial understanding of the tumor without relying on surgeon experience, memory, and imagination. The purpose of this study is to investigate the utility of a virtual reality platform in preoperative planning and surgical approach in a retrospective cohort of pelvic bone sarcoma cases. MethodsThe histopathology database at our institution was queried for all historical cases of bone and soft tissue sarcoma with surgical resection failure, defined as positive gross or microscopic margins. Four cases of pelvic bone sarcoma were chosen for retrospective review by fellowship-trained orthopedic tumor specialists. For each case, participants first studied conventional 2D preoperative CT images and answered a questionnaire pertaining to objective case parameters. Participants then interacted with case-specific 3D models while wearing a VR headset and answered the same questionnaire. The VR ‘avatar’ was created with custom-developed software. After using both modalities, participants completed a Likert-scale survey aiming to evaluate the VR technology's subjective impact on understanding tumor environment, surgical plan confidence, and its ability to improve communication with colleagues and patients. Four attending orthopedic oncologists, one orthopedic oncology fellow, and one senior orthopedic oncology resident participated in the study. ResultsFour cases of failed resection were evaluated by a group of both attending surgeons and a group of trainees composed of both residents and fellows. Tumor borders were clearly delineated in 0 % and 66.6 % cases when evaluating with conventional 2D imaging and VR, respectively. Participants changed adjacent structure involvement grade 22.2 % of the time after assessing involvement grade on the VR technology, with adjacent ligamentous structure grading changed most frequently in 55.5 % of cases. Users reported they would change the surgical approach or margins 44.4 % of the time after reviewing with VR technology. Initial 6 plane resection plans were changed in every user case. Subjective responses indicated that surgeons expressed more confidence in their approach, confidence with obtaining negative margins, and provided more detail regarding structures to be resected in specific planes. ConclusionPelvic tumors present unique surgical challenges due to complex 3D anatomy, the proximity of vital structures, consistency of the tumor, and the need to alter patient position during resection procedures. Using examples of failed pelvic bone sarcoma resections, our study found that VR imaging increased understanding of the tumor environment, characteristics, and ability to communicate with patients and colleagues.

Global radiotherapy demands and corresponding radiotherapy-professional workforce requirements in 2022 and predicted to 2050: a population-based study.

Addressing the challenge of cancer control requires a comprehensive, integrated, and global health-system response. We aimed to estimate global radiotherapy demands and requirements for radiotherapy professionals from 2022 to 2050. We conducted a population-based study using data from the Global Cancer Observatory (GLOBOCAN) 2022 and predicted global radiotherapy demands and workforce requirements in 2050. We obtained incidence figures for 29 types of cancer across 183 countries and derived the cancer-specific radiotherapy use rate using the 2013 Collaboration for Cancer Outcomes Research and Evaluation model. We delineated the proportion of people with cancer who require radiotherapy and can be accommodated within the existing installed capacity, assuming an optimal use rate of 50% or 64%, in both 2022 and 2050. A use rate of 50% corresponds to the global average and a use rate of 64% considers potential re-treatment scenarios, as indicated by the 2013 Collaboration for Cancer Outcomes Research and Evaluation (CCORE) radiotherapy use rate model. We established specified requirements for teletherapy units at a ratio of 1:450 patients, for radiation oncologists at a ratio of 1:250 patients, for medical physicists at a ratio of 1:450 patients, and for radiation therapists at a ratio of 1:150 patients in all countries and consistently using these ratios. We collected current country-level data on the radiotherapy-professional workforce from national health reports, oncology societies, or other authorities from 32 countries. In 2022, there were an estimated 20·0 million new cancer diagnoses, with approximately 10·0 million new patients needing radiotherapy at an estimated use rate of 50% and 12·8 million at an estimated use rate of 64%. In 2050, GLOBOCAN 2022 data indicated 33·1 million new cancer diagnoses, with 16·5 million new patients needing radiotherapy at an estimated use rate of 50% and 21·2 million at an estimated use rate of 64%. These findings indicate an absolute increase of 8·4 million individuals requiring radiotherapy from 2022 to 2050 at an estimated use rate of 64%; at an estimated use rate of 50%, the absolute increase would be 6·5 million individuals. Asia was estimated to have the highest radiotherapy demand in 2050 (11 119 478 [52·6%] of 21 161 603 people with cancer), followed by Europe (3 564 316 [16·8%]), North America (2 546 826 [12·0%]), Latin America and the Caribbean (1 837 608 [8·7%]), Africa (1 799 348 [8·5%]), and Oceania (294 026 [1·4%]). We estimated that the global radiotherapy workforce in 2022 needed 51 111 radiation oncologists, 28 395 medical physicists, and 85 184 radiation therapists and 84 646 radiation oncologists, 47 026 medical physicists, and 141 077 radiation therapists in 2050. We estimated that the largest proportion of the radiotherapy workforce in 2050 would be in upper-middle-income countries (101 912 [38·8%] of 262 624 global radiotherapy professionals). Urgent strategies are required to empower the global health-care workforce and facilitate the fundamental human right of access to suitable health care. A collective effort with innovative and cost-contained health-care strategies from all stakeholders is warranted to enhance global accessibility to radiotherapy and address challenges in cancer care. China Medical Board Global Health Leadership Development Program, Shanghai Science and Technology Committee Fund, China Ministry of Science and Technology Department of International Cooperation High Level Cooperation and Exchange Projects, and Fudan University Office of Global Partnerships Key Projects Development Fund. For the Arabic, Chinese, French, Russian and Spanish translations of the summary see Supplementary Materials section.