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Background: Chemotherapy (CT) combined with radiotherapy is the standard treatment of 'limited-stage' small-cell lung cancer. However, controversy persists over the optimal timing of thoracic radiotherapy and CT., Materials and Methods: We carried out a meta-analysis of individual patient data in randomized trials comparing earlier versus later radiotherapy, or shorter versus longer radiotherapy duration, as defined in each trial. We combined the results from trials using the stratified log-rank test to calculate pooled hazard ratios (HRs). The primary outcome was overall survival., Results: Twelve trials with 2668 patients were eligible. Data from nine trials comprising 2305 patients were available for analysis. The median follow-up was 10 years. When all trials were analysed together, 'earlier or shorter' versus 'later or longer' thoracic radiotherapy did not affect overall survival. However, the HR for overall survival was significantly in favour of 'earlier or shorter' radiotherapy among trials with a similar proportion of patients who were compliant with CT (defined as having received 100% or more of the planned CT cycles) in both arms (HR 0.79, 95% CI 0.69-0.91), and in favour of 'later or longer' radiotherapy among trials with different rates of CT compliance (HR 1.19, 1.05-1.34, interaction test, P < 0.0001). The absolute gain between 'earlier or shorter' versus 'later or longer' thoracic radiotherapy in 5-year overall survival for similar and for different CT compliance trials was 7.7% (95% CI 2.6-12.8%) and -2.2% (-5.8% to 1.4%), respectively. However, 'earlier or shorter' thoracic radiotherapy was associated with a higher incidence of severe acute oesophagitis than 'later or longer' radiotherapy., Conclusion: 'Earlier or shorter' delivery of thoracic radiotherapy with planned CT significantly improves 5-year overall survival at the expense of more acute toxicity, especially oesophagitis., (© The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Focuses on a study which compared standard chemotherapy with alternating chemotherapy in patients with extensive small cell lung cancer. Selection of patients for the study; Protocols in chemotherapy; Characteristics of patient in the randomization process.

The article presents a summary of the National Institute for Clinical Excellence (NICE) guidance for the diagnosis and treatment of advanced breast cancer. Recommendations for diagnosis and assessment include an imaging assessment using diagnostic imaging such as computed tomography and bone scintigraphy, a pathological assessment which includes assessing human epidermal growth factor receptor 2 (HER2) status and biopsy in the absence of tumour tissue from the primary tumour. Systemic disease modifying therapy including endocrine therapy, aromatase inhibitors, and tamoxifen are discussed. Conditions for which chemotherapy is appropriate are also examined. Guidelines for complications including lymphoedema, cancer related fatigue, bone metastases, and brain metastases are also included.

A patient with primary B cell non-Hodgkin's lymphoma of the sciatic nerve is described. He presented with neuropathic symptoms in the left leg, initially diagnosed as tarsal tunnel syndrome. Magnetic resonance imaging (MRI) identified the abnormality in the sciatic nerve. A fascicular biopsy of the sciatic nerve showed a diffuse large B cell non-Hodgkin's lymphoma. The patient was treated with chemotherapy and rituximab (anti-CD20 monoclonal antibody). Four months later he was in remission, and remains so 48 months from presentation. Primary lymphoma of single peripheral nerves may be a unique subtype of extranodal lymphoma, which usually follows an aggressive course and has a variable response to current therapeutic strategies. MRI is useful, alongside electrophysiological studies, in patients with atypical peripheral nerve symptoms. [ABSTRACT FROM AUTHOR]

Background: With treatment leading to nearly uniform cure in clinical stage I nonseminomatous testicular cancer (CSI-NSGCT), diminishing treatment-related morbidity has become the primary concern. This study examined feasibility and outcome of active surveillance as treatment in an unselected CSI patient population. [ABSTRACT FROM PUBLISHER]

Background: Bevacizumab, a humanised monoclonal antibody which targets vascular endothelial growth factor (VEGF), has shown promising anti-tumour effect when given concurrently with taxane-based chemotherapy in breast cancer. However two neoadjuvant breast cancer trials have produced conflicting results. The GEPARQUINTO trial reported significant benefit only in the triple negative patients (pCR 27.8% vs 36.4% p = 0.021). The NSABP-B40 study showed significant benefit for bevacizumab only in the ER+ve patients (pathological complete response (pCR) in ER+ve population 15.2% vs 23.3%, p = 0.008). Trial design: ARTemis is a phase III randomised trial to determine whether the addition to neo -adjuvant chemotherapy of bevacizumab is more effective than standard chemotherapy alone in patients with HER2-negative early breast cancer. A total of 400 patients will be randomised into each of the two treatment arms which will allow an absolute difference in the pCR rates in excess of 10% to be detected at the 5% (2-sided) level of significance with an 85% power. Primary outcome is pathological complete response rates after neo-adjuvant chemotherapy, i.e. no residual invasive carcinoma in the breast, and no evidence of metastatic disease within the lymph nodes. Secondary outcomes are disease free survival, overall survival, complete pathological response rates in breast alone, radiological response after 3 and 6 cycles of chemotherapy and rate of breast conservation and toxicities. Translational work (ARTemis-Science): collection of blood samples, and paraffin-embedded formalin-fixed and fresh tissue samples to investigate whether markers for chemotherapy response/resistance, and pharmacogenetic and pharmacogenomic markers can be correlated with outcomes (pathCR and RFS) in patients randomised to receive bevacizumab versus those that do not. Eligibility criteria: Histologically confirmed HER2-negative invasive breast cancer; T2 to T4 tumour and/or large/fixed axillary nodes (>20mm/clinical N2 or N3), or inflammatory disease; suitable for, and fit to receive neo-adjuvant chemotherapy and an anti-angiogenic. [ABSTRACT FROM AUTHOR]