Towards an evidence-informed value scale for surgical and radiation oncology: a multi-stakeholder perspective
Surgery and irradiation, 2 locoregional cancer treatments, are essential to assist improve cancer outcomes, control, and palliation. The continued evolution in treatment processes, techniques, and technologies—often at considerably accrued costs—demands for direction on outcomes that are most valued by patients, and therefore the proof that’s needed before clinical adoption of those practices. 3 recently introduced frameworks—the European Society for Medical medicine Magnitude of Clinical profit Scale, the yank Society of Clinical medicine price Framework, and therefore the National Comprehensive Cancer Network Blocks—which all facilitate outline the worth of medicine treatments, were appraised with a spotlight on their strategies and definition of patient profit. during this Review, we have a tendency to investigate the relevance of those frameworks to surgical and irradiation innovations. Findings show that these frameworks don’t seem to be forthwith transferable to locoregional cancer treatments. Moreover, the dearth of stress on patient perspective and therefore the reliance on ancient, trial-based endpoints like survival, disease-free survival, and safety, needs a replacement framework that has real-world proof with target the full spectrum of patient-centred endpoints. Such associate degree evidence-informed price scale would safeguard against the proliferation of low-value innovation whereas at the same time increasing access to treatments that show important enhancements within the outcomes of cancer care. 
Novel stereotactic body radiation therapy (SBRT)-based partial tumor irradiation targeting hypoxic segment of bulky tumors (SBRT-PATHY): improvement of the radiotherapy outcome by exploiting the bystander and abscopal effects
Despite the advances in medical specialty, patients with large tumors have worse prognosis and infrequently receive solely palliative treatments. large sickness represents a vital difficult obstacle for all presently obtainable radical treatment choices together with typical therapy. the aim of this study was to assess a retrospective outcome on the employment of a fresh developed unconventional stereotactic body radiotherapy (SBRT) for PArtial growth irradiation of unresectable large tumors targeting solely their HYpoxic phase (SBRT-PATHY) that exploits the non-targeted effects of radiotherapy: spectator effects (local) and therefore the abscopal effects (distant).
Materials and ways
Twenty-three patients with large tumors received partial bulky irradiation so as to induce the native non-targeted impact of radiation (bystander effect). The hypoxic growth phase, referred to as the spectator growth volume (BTV), was outlined victimization PET and contrast-enhanced CT, as a hypovascularized-hypometabolic junctional zone between the central death and peripheral hypervascularized-hypermetabolic growth phase. supported growth website and volume, the BTV was irradiated with 1–3 fractions of 10–12 Gy prescribed to seventieth isodose-line. The pathologic humour nodes and metastases weren’t irradiated so as to assess the distant non-targeted effects of radiation (abscopal effect). No patient received any general medical care.
At the time of study, with median follow-up of nine.4 months (range: 4–20), eighty seven of patients remained progression-free. The spectator and abscopal response rates were ninety six and fifty two, severally. Median shrinkage of part irradiated large growth expressing intensity of the spectator impact was seventieth (range 30–100%), whereas for the non-irradiated metastases (intensity of the abscopal effect), it had been fiftieth (range 30–100%). No patient old acute or late toxicity of any grade.
SBRT-PATHY showed terribly inspiring results on exploitation of the radiation-hypoxia-induced non-targeted effects that require to be confirmed through our current prospective trial.
Present study has been retrospectively registered by the native ethic committee beneath study range A 26/18. 
Comparative efficacy and safety for different chemotherapy regimens used concurrently with thoracic radiation for locally advanced non-small cell lung cancer: a systematic review and network meta-analysis
It remains unknown that is that the most desirable programme used at the same time with body part radiation for regionally advanced non-small cell carcinoma (NSCLC). we have a tendency to performed a network meta-analysis to handle this vital issue.
PubMed, Embase, Cochrane Library, net of Science and major international scientific conferences were sought for relevant randomised controlled trials (RCTs). Overall survival (OS) information was the first outcome of interest, and progression-free survival (PFS), and heavy adverse events (SAEs) were the secondary outcomes of interests, rumored as hazard magnitude relation (HR) or odds ratio (OR) and ninety five confidence intervals (CIs).
14 RCTs with a complete of 2975 patients randomised to receive twelve classes of treatments were enclosed within the meta-analysis. Direct comparison meta-analysis showed that etoposide-cisplatin (EP) was more practical than paclitaxel-cisplatin/carboplatin (PC) in terms of OS (HR = 0.85, 95% CI: 0.77–0.94) and PFS (HR = 0.66, 95% CI: 0.47–0.95). In network meta-analysis, all programme comparisons didn’t turn out statistically important variations in survival. supported treatment ranking of OS and also the benefit-risk magnitude relation, S-1-cisplatin (SP) was possible to be the foremost desirable programme for its best efficaciousness and low risk of inflicting SAEs. Uracil/tegafur-cisplatin (UP) and pemetrexed-cisplatin/carboplatin (PP) were stratified the second and third severally. Gemcitabine-cisplatin (GP) and PC + Cetuximab (PC-Cet) looked as if it would be the worst and second-worst regimens for his or her poor efficaciousness and poor tolerability.
Based on efficaciousness and tolerability, SP is probably going to be the foremost desirable programme used at the same time with body part radiation for regionally advanced NSCLC, followed by UP and PP. any direct head-to-head studies are required to substantiate these findings. 
How rapid advances in imaging are defining the future of precision radiation oncology
Imaging has a necessary role within the designing and delivery of irradiation. Recent advances in imaging have light-emitting diode to the event of advanced irradiation techniques—including image-guided radiotherapy, intensity-modulated irradiation, stereotactic body irradiation and nucleon beam therapy. The best use of imaging would possibly modify higher doses of radiation to be delivered to the tumor, whereas stinting traditional close tissues. during this article, we tend to review however the mixing of existing and novel varieties of CAT, resonance imaging and antielectron emission imaging have remodeled tumor delineation within the irradiation designing method, and the way these advances have the potential to permit a a lot of personal approach to the cancer medical care. Recent knowledge recommend that imaging biomarkers that assess underlying tumor heterogeneousness will determine areas inside a tumour that are at higher risk of radio-resistance, and thus doubtless allow biologically focussed dose increase. The speedily evolving construct of reconciling irradiation, together with computing, needs imaging throughout treatment to be accustomed modify irradiation on a routine. These advances have the potential to boost clinical outcomes and cut back radiation-related long-run toxicities. we tend to define however recent technological advances in each imaging and irradiation delivery will be combined to form the long run of exactness radiation medicine.
Carotid Body Tumour a Challenging Management: Rare Case Report in Baghdad Radiation Oncology Center, Medical City, Baghdad, Iraq
Background: Paragangliomas are rare symptomless painless tumours, originating from paraganglionic bodies of autonomous nerve system. The chemoreceptor tumors are the comparatively rare tumour however represent a majority of head and neck paragangliomas regarding seventieth. These tumours are benign however possess aggressive native growth potential.
The Aim of the Study: the aim of this case report article is to introduce the difficult we have a tendency to exposed to that throughout management such cases in our country despite lack several conditions, facilities and circumstances found in different components of the globe for treatment of CBT, that is that the initial scrutiny in Al-Iraq.
Case Presentation: we have a tendency to reported a case of the 27-year-old feminine patient with a left neck swelling that had persisted for five years. She was initial diagnosed and treated surgically by native excision in 2012. Histopathology discovered the microscopic anatomy of chemoreceptor tumor. She has complained of high blood pressure, headache, and palpitation. She was discovered the gradual onset of growing and rhythmical lump on previous surgical scar web site. 5 years later, the lesion became larger, and he or she feeling pulsation on lying on left aspect leading to discomfort on sleep and consumption. On physical examination, a rhythmical firm painless mass mensuration regarding vi x five x four cm in size was found on the left aspect of her neck. Pulsations were felt on deep touching and a faint gossip was detected on diagnostic technique. physical exercise in dire straits her enclosed laboratory tests, neck US, neck CT scan, artery X-ray photography and slide review of histopathology. All recommended perennial chemoreceptor tumor.
Conclusion: Over forty years of operating during this field, we’ve solely seen three cases of CBTs, thus it’s a really rare tumor. Management of this tumor could be a difficult whether or not it’s treated by surgery or therapy. the most step in management is by excluding others tumours are often found during this region. Surgery could be a treatment of selection whereas therapy is customary treatment for perennial cases. 
 Lievens, Y., Audisio, R., Banks, I., Collette, L., Grau, C., Oliver, K., Price, R. and Aggarwal, A., 2019. Towards an evidence-informed value scale for surgical and radiation oncology: a multi-stakeholder perspective. The Lancet Oncology, 20(2), pp.e112-e123. (Web Link)
 Tubin, S., Popper, H.H. and Brcic, L., 2019. Novel stereotactic body radiation therapy (SBRT)-based partial tumor irradiation targeting hypoxic segment of bulky tumors (SBRT-PATHY): improvement of the radiotherapy outcome by exploiting the bystander and abscopal effects. Radiation Oncology, 14(1), p.21. (Web Link)
 Liu, T., He, Z., Dang, J. and Li, G., 2019. Comparative efficacy and safety for different chemotherapy regimens used concurrently with thoracic radiation for locally advanced non-small cell lung cancer: a systematic review and network meta-analysis. Radiation Oncology, 14(1), p.55. (Web Link)
 How rapid advances in imaging are defining the future of precision radiation oncology
British Journal of Cancer 120, 779–790 (2019) (Web Link)
 J. Al-Rawaq, K., A. Al-Naqqash, M., S. Al-Shewered, A. and F. Al-Awadi, A. (2018) “Carotid Body Tumour a Challenging Management: Rare Case Report in Baghdad Radiation Oncology Center, Medical City, Baghdad, Iraq”, Journal of Cancer and Tumor International, 7(3), pp. 1-6. doi: 10.9734/JCTI/2018/40034. (Web Link)