The lancet oncology
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The lancet oncology · May 2017
Multicenter StudyDNA methylation-based classification and grading system for meningioma: a multicentre, retrospective analysis.
The WHO classification of brain tumours describes 15 subtypes of meningioma. Nine of these subtypes are allotted to WHO grade I, and three each to grade II and grade III. Grading is based solely on histology, with an absence of molecular markers. Although the existing classification and grading approach is of prognostic value, it harbours shortcomings such as ill-defined parameters for subtypes and grading criteria prone to arbitrary judgment. In this study, we aimed for a comprehensive characterisation of the entire molecular genetic landscape of meningioma to identify biologically and clinically relevant subgroups. ⋯ German Cancer Aid, Else Kröner-Fresenius Foundation, and DKFZ/Heidelberg Institute of Personalized Oncology/Precision Oncology Program.
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The lancet oncology · May 2017
ReviewProton therapy for head and neck cancer: expanding the therapeutic window.
Use of proton beam therapy has expanded, with the number of proton centres rapidly increasing not only in the USA but also worldwide. The physical characteristics of the proton beam offer important advantages versus widely used photon techniques in terms of radiation precision. ⋯ Comparisons of radiation dose distributions between photon and proton techniques suggest considerable benefit in terms of toxicity sparing, but this has only recently been confirmed by substantial clinical data. In this Review, we attempt to define the role of this method in the contemporary multidisciplinary management of various types of head and neck cancer.
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The lancet oncology · May 2017
ReviewManagement of elderly patients with locoregionally confined head and neck cancer.
Head and neck cancer in elderly patients represents a major health burden because its management provides unique and complex challenges for multidisciplinary teams, such as reduced treatment tolerance, multiple comorbidities, and altered pharmacokinetics and pharmacodynamics. Despite the prominent challenges involved, high-level evidence for the management of this group of patients is scarce. ⋯ Evaluation of age-specific factors such as life expectancy, impaired functional status, and cognitive decline warrant consideration as part of the management decision process. In this Review, we provide an update of the available evidence on the management of locoregionally confined head and neck cancer in elderly patients and propose a practical treatment algorithm for clinicians to help manage this patient population.
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The lancet oncology · May 2017
Multicenter StudyAvelumab for patients with previously treated metastatic or recurrent non-small-cell lung cancer (JAVELIN Solid Tumor): dose-expansion cohort of a multicentre, open-label, phase 1b trial.
Avelumab, a human Ig-G1 monoclonal antibody targeting PD-L1 and approved in the USA for the treatment of metastatic Merkel cell carcinoma, has shown antitumour activity and an acceptable safety profile in patients with advanced solid tumours in a dose-escalation phase 1a trial. In this dose-expansion cohort of that trial, we assess avelumab treatment in a cohort of patients with advanced, platinum-treated non-small-cell lung cancer (NSCLC). ⋯ Merck KGaA and Pfizer.
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The lancet oncology · May 2017
ReviewPotential for low-value palliative care of patients with recurrent head and neck cancer.
Curative treatment for patients with advanced head and neck cancer can be associated with many side-effects, and many patients suffer from persistent treatment-related side-effects. Patients with recurrent cancer bear the burden of these effects along with additional symptoms attributed to the recurrent tumour. To better understand the benefits and burden of palliative treatments for patients with recurrent head and neck cancer, we reviewed the evidence on commonly used palliative treatments and their effect on quality of life. ⋯ Moreover, if these treatments are not congruent with a patient's end-of-life goals, they could constitute low-value care. We recommend that patients with advanced and recurrent cancer should be offered early, comprehensive palliative and supportive services to maximise benefit. The principles of beneficence and respect for patients in the context of shared decision making must prevail if the trust of this vulnerable patient population is to be honoured.