Tuesday, 29 December 2020

Top papers for 2020 - Radiation Oncology

Read here the most important papers in Radiation Oncology this year.
Source: Top Papers for 2020 - Radiation Oncology (shared collection) [Internet]. Read.qxmd.com. 2020 [cited 29 December 2020]. Available from: https://read.qxmd.com/collection/22121?sid=adea2753-d897-4e24-bd70-dad41e492317.

Saturday, 26 December 2020

Thymoma and thymic carcinoma staging systems

Masaoka-Koga staging system of thymic tumors:

Source: Jukna A, Jasa M, Mezvevere M, et al. Inside the Mediastinum: the Morphological Spectrum and Stages of Thymic Tumours. Acta Chir Latv. 2016; 16(1):3-8. Available at: https://doi.org/10.1515/chilat-2016-0010.

Source: Detterbeck FC, Nicholson AG, Kondo K, et al. The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol. 2011 Jul;6(7 Suppl 3):S1710-6. Available at: https://doi.org/10.1097/jto.0b013e31821e8cff.

The modified Masaoka staging system separates stage III in IIIa (without invasion of great vessels) and IIIb (with the invasion of great vessels).
Bibliographic reference: NCCN Clinical Practice Guidelines In Oncology (NCCN Guidelines), Thymomas and Thymic Carcinomas, Version 1.2021 - December 4, 2020 [Internet]. Nccn.org. 2020 [cited 26 December 2020]. Available from: https://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf.

The 8th edition thymic TNM stage classifications:

Source: Detterbeck FC. Clinical implication of the new TNM classification of thymic malignancies. J Thorac Dis. 2018 Aug;10(Suppl 22):S2692-S2695. Available at: https://doi.org/10.21037/jtd.2018.08.36.

Source: Detterbeck FC, et al.; Staging and Prognostic Factors Committee; Members of the Advisory Boards; Participating Institutions of the Thymic Domain. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol. 2014 Sep;9(9 Suppl 2):S65-72. Available at: https://doi.org/10.1097/jto.0000000000000290.

Relationship between the 8th edition thymic TNM stage and the Masaoka-Kogan system:
Source: Liang G, et al.; Members of the Chinese Alliance for Research in Thymomas. Comparison of the Masaoka-Koga staging and the International Association for the Study of Lung Cancer/the International Thymic Malignancies Interest Group proposal for the TNM staging systems based on the Chinese Alliance for Research in Thymomas retrospective database. J Thorac Dis. 2016 Apr;8(4):727-37. Available at: https://doi.org/10.21037/jtd.2016.03.22.

Friday, 11 December 2020

Castration resistant prostate cancer (CRPC)

It is defined as medical or surgical castration, with castrate serum testosterone < 50 ng/dl, or < 1.7 nmol/l, plus one of the following types of progression [1]:
  • Biochemical progression:
    • Three consecutive rises in total prostate-specific antigen (PSA), at least 1 week apart, resulting in two 50% increases over the nadir, and at least one total PSA > 2 ng/ml [1];
    • Or a rising total PSA that is greater than 2 ng/mL higher than the nadir, the rise has to be at least 25% over nadir and the rise has to be confirmed by a second total PSA at least three weeks later [2];
    • For CRPC diagnosis, PSA progresses despite secondary hormonal manipulations, including anti‐androgen withdrawal for at least 4 weeks [3].
  • Radiologic progression: The appearance of new lesions, either two or more new bone lesions on bone scan or a soft tissue lesion using the Response Evaluation Criteria in Solid Tumours (RECIST).
Bibliographic reference:
[1] Cornford P, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part II: Treatment of Relapsing, Metastatic, and Castration-Resistant Prostate Cancer. Eur Urol. 2017 Apr;71(4):630-642. Available at: https://doi.org/10.1016/j.eururo.2016.08.002.
[2] Scher HI, Halabi S, Tannock I, et al.; Prostate Cancer Clinical Trials Working Group. Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone: recommendations of the Prostate Cancer Clinical Trials Working Group. J Clin Oncol. 2008 Mar 1;26(7):1148-59. Available at: https://doi.org/10.1200/jco.2007.12.4487.
[3] Heidenreich A, Aus G, Bolla M, et al.; European Association of Urology. EAU guidelines on prostate cancer. Eur Urol. 2008 Jan;53(1):68-80. Available at: https://doi.org/10.1016/j.eururo.2007.09.002.

Sunday, 15 November 2020


Dx is defined as the minimum dose to the x% volume of an organ or target receiving the highest dose [1]. Dx is the dose to x% of the organ [2]. Dx is the dose that covers x percent of the structure [3].
Bibliographic references:
[1] Huang EX, Bradley JD, El Naqa I, et al. Modeling the risk of radiation-induced acute esophagitis for combined Washington University and RTOG trial 93-11 lung cancer patients. Int J Radiat Oncol Biol Phys. 2012 Apr 1;82(5):1674-9. Available at: https://doi.org/10.1016/j.ijrobp.2011.02.052.
[2] Chan C, Lang S, Rowbottom C, Guckenberger M, Faivre-Finn C; IASLC Advanced Radiation Technology Committee. Intensity-modulated radiotherapy for lung cancer: current status and future developments. J Thorac Oncol. 2014 Nov;9(11):1598-608. Available at: https://doi.org/10.1097/JTO.0000000000000346.
[3] Livingston GC, Last AJ, Shakespeare TP, et al. Toxicity and dosimetric analysis of non-small cell lung cancer patients undergoing radiotherapy with 4DCT and image-guided intensity modulated radiotherapy: a regional centre's experience. J Med Radiat Sci. 2016 Sep;63(3):170-8. Available at: https://doi.org/10.1002/jmrs.159.

Friday, 30 October 2020

Computed tomography (CT) versus magnetic resonance imaging (MRI) "shades of grey"

Drawing created and kindly provided by @instant.oncologyWang, L., 2020. Login • Instagram. [online] Instagram.com. Available at: <https://www.instagram.com/p/B-d8KlUAhCP/> [Accessed 30 October 2020].
: proportional to; DWI: diffusion-weighted imaging; STIR: short-T1 inversion recovery; Rx: x-rays; Z: atomic number or proton number.

"CT (...) uses kilovoltage x-rays, which interact with matter via photoelectric interactions, and are attenuated depending on the Z-number of the material. (...). Metalwork (such as hip prostheses or dental implants) can also lead to substantial artifacts because they attenuate the x-rays so much that a surrounding “shadow” is created. (...).
MRI (...) does not involve radiation exposure, but (...) [is] also highly prone to artifact by metal implants, even more so than CT. Artifacts tend to affect only CT axial slices containing the implant; but with MRI the distortion can extend to several slices above and below the implant. (...)."

Bibliographic referenceWang, L., 2020. Login • Instagram. [online] Instagram.com. Available at: <https://www.instagram.com/p/B-d8KlUAhCP/> [Accessed 30 October 2020].

Monday, 12 October 2020

Cutaneous areas at risk for non-melanoma skin cancer

The National Comprehensive Cancer Network (NCCN) guidelines (squamous cell carcinoma [1] and basal cell carcinoma [2]) classify high-risk lesions by size and location, as follows:

  • 2 cm or more in diameter in low-risk locations (areas L):
    • trunk and extremities, but not including the pretibia, hands, feet, ankles, and nail units.
  • 1 cm or more in diameter in moderate-risk locations (area M):
    • cheeks, forehead, scalp, neck, and pretibia.
  • The area H, independent of size:
    • The "mask area" of the face:
      • Central face, eyelids, eyebrows, periorbital, nose, lips (cutaneous and vermillion), chin, mandible, preauricular and postauricular skin/sulci, temple, and ear.
    • Genitalia, hands, and feet.

Head and neck H and M areas:
Source: [3]

Source: [4]

Body H, M, and L areas [3]:

Bibliographic references:
[1] NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines), Squamous Cell Skin Cancer, Version 2.2020 - July 14, 2020 [Internet]. Nccn.org. 2020 [cited 12 October 2020]. Available at: https://www.nccn.org/professionals/physician_gls/pdf/squamous.pdf.
[2] NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines), Basal Cell Skin Cancer, Version 1.2020 - October 24, 2020 [Internet]. Nccn.org. 2020 [cited 12 October 2020]. Available at: https://www.nccn.org/professionals/physician_gls/pdf/nmsc.pdf.
[3] Blechman et al. Application of Mohs micrographic surgery appropriate-use criteria to skin cancers at a university health system. J Am Acad Dermatol. 2014 Jul;71(1):29-35. Available at: https://doi.org/10.1016/j.jaad.2014.02.025.
[4] Dębski T, et al. Basal cell carcinoma. Current views (Part II). Diagnostics and treatment. Borgis - Postępy Nauk Medycznych 2009;9:706-13 [cited 12 October 2020]. Available at: http://ksiaznica.home.pl/pnm/spnm.php?ktory=518.

Sunday, 4 October 2020

Castleman disease

It «is a rare disease of lymph nodes and related tissues. It was first described by Dr. Benjamin Castleman in the 1950s. It is also known as Castleman’s disease, giant lymph node hyperplasia, and angiofollicular lymph node hyperplasia (AFH). Castleman disease is not cancer. Instead, it is called a lymphoproliferative disorder. This means there is an abnormal overgrowth of cells of the lymph system that is similar in many ways to lymphomas (cancers of lymph nodes).
Even though Castleman disease is not officially cancer, one form of this disease (known as multicentric Castleman disease) acts very much like lymphoma. In fact, many people with this disease eventually develop lymphomas. And like lymphoma, Castleman disease is often treated with chemotherapy or radiation therapy.»
«Castleman disease is classified by how much of the body it affects. The main forms of Castleman disease are called localized and multicentric.»
«Infection with certain viruses plays a role in at least some cases of Castleman disease.
Multicentric Castleman disease is more common in people infected with HIV (human immunodeficiency virus), (...). Doctors sometimes group patients with multicentric Castleman disease into those who are infected with HIV (HIV positive) and those who are not infected (HIV negative).
In recent years, it’s become clear that another virus, known as human herpesvirus-8 (HHV-8) or Kaposi sarcoma herpesvirus (KSHV), is often found in the lymph node cells of people with multicentric Castleman disease. In fact, HHV-8 is found in the lymph nodes of nearly all Castleman disease patients who are HIV positive. Some doctors have suggested classifying Castleman disease based on whether the cells contain HHV-8.»

Bibliographic reference: The American Cancer Society medical and editorial content team, 2018. What Is Castleman Disease? [online] Cancer.org. Available at: <https://www.cancer.org/cancer/castleman-disease/about/what-is-castleman-disease.html> [Accessed 4 October 2020].

FoundationOne® Heme test

It «is a comprehensive genomic profiling test combining DNA (deoxyribonucleic acid) sequencing of 406 genes and RNA (ribonucleic acid) sequencing of 265 genes for patients with hematologic malignancies, sarcomas or solid tumors where RNA sequencing is desired [1].» It «detects known, novel, and complex fusion events as well as other common genomic alterations [2]» «(base substitutions, insertion and deletions [indels], [...] copy number alterations [CNAs] [3], and copy number variations [CNVs]) (...) to identify potential targeted therapy options, detect alterations in prognostic genes, and sub-classify sarcoma diagnoses [2].» It identifies «somatic genomic alterations in genes known to be unambiguous drivers of hematologic malignancies (...) and sarcomas [3].» It «is validated to detect the four main classes of genomic alterations in more than 400 cancer-related genes [4].»

Bibliographic references:
[1] Foundation Medicine. 2020. Foundationone Heme. [online] Available at: <https://corpsite.foundationmedicine.com/genomic-testing/foundation-one-heme> [Accessed 4 October 2020].
[2] Foundationmedicine.com. 2020. Foundationone Heme | Foundation Medicine. [online] Available at: <https://www.foundationmedicine.com/test/foundationone-heme> [Accessed 4 October 2020].
[3] Foundationmedicineasia.com. 2017. Foundationone®Heme - Technical Information. [online] Available at: <https://www.foundationmedicineasia.com/content/dam/rfm/apac_v2-en/FoundationOne_Heme_Technical_Information.pdf> [Accessed 4 October 2020].
[4] Foundation Medicine. 2020. Foundation Medicine. [online] Available at: <https://www.foundationmedicine.ca/foundationOneHeme.aspx> [Accessed 4 October 2020].

Monday, 20 July 2020

Tumor budding

Tumor budding is defined as a single tumor cell or a cell cluster of up to 4 tumor cells, it is an independent predictor of lymph node metastasis in pT1 colorectal cancer and an independent predictor of survival in stage II colorectal cancer, and it should be taken into account along with other clinicopathologic factors in a multidisciplinary setting [1].
Tumor budding is counted on hematoxylin-eosin.
Intratumoral tumor budding in colorectal cancer has been shown to be related to lymph node metastasis and it should be included in guidelines/protocols for colorectal cancer reporting [1].
Tumor budding and tumor grade are not the same.
Tumor budding is graded according to its number in a microscopic field with a ×20 objective lens (0.785 mm2) in the hotspot. Tumors with less than five, five to nine, and 10 or more budding foci as classified as grades BD1, BD2, and BD3, respectively [2]. Category BD3 is subclassified as BD3a for tumors with 10 to 19 and BD3b for those with 20 or more budding foci in the hotspot (in a field of 0.785 mm2) at the invasive front [2].

Bibliographic references:
[1] Cho SJ, Kakar S. Tumor Budding in Colorectal Carcinoma: Translating a Morphologic Score Into Clinically Meaningful Results. Arch Pathol Lab Med. 2018;142(8):952-957. Available at: https://doi.org/10.5858/arpa.2018-0082-RA.
[2] Ueno H, et al. Prospective Multicenter Study on the Prognostic and Predictive Impact of Tumor Budding in Stage II Colon Cancer: Results From the SACURA Trial. J Clin Oncol. 2019;37(22):1886-1894. Available at: https://doi.org/10.1200/JCO.18.02059.

Haggitt classification of colorectal polyps

Source: Bujanda L, et al. Malignant colorectal polyps. World J Gastroenterol. 2010;16(25):3103-3111. Available at: https://doi.org/10.3748/wjg.v16.i25.3103.

Narrow‐band imaging (NBI) International Colorectal Endoscopic (NICE) classification of colorectal tumors

WHO: World Health Organization.
Source: Sano Y, et al. Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Dig Endosc. 2016;28(5):526-533. Available at: https://doi.org/10.1111/den.12644.

Wednesday, 8 July 2020

Liver segments

Couinaud classification of liver anatomy:
Source: Chen Y, et al. Functional Region Annotation of Liver CT Image Based on Vascular Tree. Biomed Res Int. 2016;2016:5428737. Available at: https://doi.org/10.1155/2016/5428737.