Clinical Oncology RSS feed: Current Issue. Clinical Oncology is essential reading for all those with an active interest in the treatment of cancer. Its multidisciplinary approach allows readers to keep up-to-date with developments in their own as well as related fields. Each issue is carefully selected to provide a combination of high quality original research, informative editorials and state-of-the-art reviews. The Journal covers all aspects of the clinical management of cancer patients and its authors are drawn from leading international centres. The Journal features papers on all types of malignant disease including pathology, diagnosis and therapy, including radiotherapy, and systemic treatment. http://www.clinicaloncologyonline.net/?rss=yesElsevier Inc.en © 2012 The Royal College of Radiologists. Published by Elsevier Inc. All rights reserved. Clinical Oncology0936-6555245June 2012 © 2012 The Royal College of Radiologists. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.clinicaloncologyonline.net/article/PIIS0936655512000696/abstract?rss=yesAbstract: Extra-nodal lymphomas may arise in any organ, and different histological subtypes occur in distinct patterns. Prognosis and treatment depend not only on the histological subtype and disease extent, but also on the particular involved extra-nodal organ. The clinical course and response to treatment for the more common extra-nodal organs, e.g. stomach, Waldeyer's ring, skin and brain, are fairly well known and show significant variation. A few randomised trials have been carried out testing the role of radiotherapy in these lymphomas. However, for most extra-nodal lymphomas, randomised trials have not been carried out, and treatment decisions are made on small patient series and extrapolations from nodal lymphomas. Hopefully, wide international collaboration will make controlled clinical trials possible in the less common extra-nodal lymphomas.Modern highly conformal radiotherapy allows better coverage of extra-nodal lymphomatous involvement with better sparing of normal tissues. The necessary radiation doses and volumes need to be defined for the different extra-nodal lymphoma entities. The challenge is to optimise the use of radiotherapy in the modern multimodality treatment of extra-nodal lymphomas.Radiotherapy Studies and Extra-nodal Non-Hodgkin Lymphomas, Progress and ChallengesL. Specht10.1016/j.clon.2012.02.008Clinical Oncology 24, 5 (2012)2012-03-19Clinical Oncology2012-03-19245S0936-6555(12)X0005-0313318http://www.clinicaloncologyonline.net/article/PIIS0936655512000404/abstract?rss=yesAbstract: In the management of extra-nodal lymphomas it is important to determine whether the tumour has disseminated and whether lymph nodes are involved. Some extra-nodal lymphomas may be the result of random spread of nodal lymphoma. Specific homing, however, determines the site of many extra-nodal lymphomas, as exemplified by cutaneous T-cell lymphomas, which seem to be derived from skin-homing T-cells and mucosa-associated lymphoid tissue lymphomas that show features of the mucosal immune system. Enteropathy-associated T-cell lymphoma is derived from mucosal T-cells in patients with coeliac disease. Immunological sanctuary accounts for the localisation of primary brain, eye and testicular lymphoma. Mantle cell lymphoma frequently causes tumours in the gastrointestinal tract. Random biopsies have shown that a high proportion of patients with this lymphoma have extensive occult involvement of the gastrointestinal tract at the time of first diagnosis. Follicular lymphoma occurs at both nodal and extra-nodal sites, but uncommonly at both sites at the same time. Extra-nodal follicular lymphomas frequently lack t(14;18)(q32;q21) and do not express bcl-2, which are characteristics of the nodal disease. At extra-nodal sites, follicular lymphoma is more likely to be curable than nodal follicular lymphoma. The behaviour of extra-nodal lymphomas cannot be assumed to follow that of their nodal counterparts.Pathology of Extra-nodal non Hodgkin LymphomasD.H. Wright10.1016/j.clon.2012.02.004Clinical Oncology 24, 5 (2012)2012-04-05Clinical Oncology2012-04-05245S0936-6555(12)X0005-0319328http://www.clinicaloncologyonline.net/article/PIIS0936655512000702/abstract?rss=yesAbstract: Primary central nervous system lymphoma is an aggressive lymphoma with a molecular biology and genetic profile that appears to be distinct from other types of diffuse large B-cell lymphoma. The median survival after whole brain radiotherapy alone is poor, but is significantly improved after high-dose methotrexate-based combination chemotherapy. The rarity of primary central nervous system lymphoma means that randomised studies have proved challenging, particularly as many patients are elderly and more susceptible to the toxic effects associated with these treatments. Promising treatment strategies are emerging and, wherever possible, patients should be treated within clinical trials. Quality of life and neurocognitive data should be collected prospectively to assess the effect of the disease and treatment.Primary Central Nervous System LymphomaE. Gallop-Evans10.1016/j.clon.2012.02.009Clinical Oncology 24, 5 (2012)2012-03-29Clinical Oncology2012-03-29245S0936-6555(12)X0005-0329338http://www.clinicaloncologyonline.net/article/PIIS0936655512000726/abstract?rss=yesAbstract: Lymphomas of the orbit and eye are rare conditions that should be treated as separate entities due to the differences in presumed aetiology, investigations, management and outcomes. Orbital lymphoma is most often of low-grade histology; thyroid eye disease may predispose and chlamydial infection has been suggested as a trigger. Commonly, stage IE, in most cases, can be managed with radiotherapy alone using either a kilovoltage portal for conjunctival disease or a wedged pair of megavoltage beams for more infiltrative disease to a dose of 30 Gy in 15 fractions over 3 weeks. However, medical therapy is being investigated, including a rituximab-only approach for conjunctival-only presentations. The cure rate for stage IE disease is very high. In contrast, primary ocular lymphoma is often of high-grade histology, in particular diffuse large B-cell lymphoma, and can be regarded as one end of primary central nervous system lymphoma — both eyes and brain being at risk. Immunosuppression predisposes to the disease. Management consists of an initial high-dose chemotherapy regimen with methotrexate. In most cases, this should be followed by radiotherapy to the whole brain and globes to a dose of 30–36 Gy with a boost to bulk/presenting disease. Cure rates are rarely above 50%.Primary Lymphoma of the Ocular Adnexa (Orbital Lymphoma) and Primary Intraocular LymphomaD.K. Woolf, M. Ahmed, P.N. Plowman10.1016/j.clon.2012.03.001Clinical Oncology 24, 5 (2012)2012-04-23Clinical Oncology2012-04-23245S0936-6555(12)X0005-0339344http://www.clinicaloncologyonline.net/article/PIIS0936655512000714/abstract?rss=yesAbstract: The most common sites for extra-nodal lymphoma of the head and neck are Waldeyer's ring, most frequently the tonsil, and the salivary glands, usually the parotid. Most are B-cell malignancies and stage IE or IIE at diagnosis. Marginal zone lymphoma of mucosa-associated lymphoid tissue type is particularly associated with inflammatory conditions in the thyroid and salivary glands. The management of extra-nodal lymphoma in the head and neck is similar to nodal B-cell lymphoma with R-CHOP chemotherapy followed by radiotherapy, recommended for early-stage high-grade disease, and radiotherapy alone for localised low-grade lymphoma. The notable exception is NK/T-cell lymphoma of nasal type where radiotherapy is critically important and recommended to a higher dose, partly because of poor response to anthracycline-based chemotherapy regimens like CHOP. Given the higher doses required and the proximity of critical normal structures, intensity-modulated radiotherapy should be considered for these tumours.Lymphoma of the Thyroid and Head and NeckM.J. Beasley10.1016/j.clon.2012.02.010Clinical Oncology 24, 5 (2012)2012-04-04Clinical Oncology2012-04-04245S0936-6555(12)X0005-0345351http://www.clinicaloncologyonline.net/article/PIIS0936655512000398/abstract?rss=yesAbstract: The most common site of extra-nodal non-Hodgkin's lymphoma (NHL) is the gastrointestinal tract, of which the stomach is the most common site. With the exception of extra-nodal marginal zone lymphoma of gastric mucosa-associated lymphoid tissue (MALT), where excellent long term results can be achieved by radiotherapy, the published literature lacks high quality studies evaluating the role, optimal dose and technique of such treatment in the management of gastro-intestinal lymphoma. Non-randomised studies support organ preservation and a role for local radiotherapy in gastric lymphoma.Lymphomas of the Upper GI Tract: The Role of RadiotherapyStephen Falk10.1016/j.clon.2012.02.003Clinical Oncology 24, 5 (2012)2012-03-05Clinical Oncology2012-03-05245S0936-6555(12)X0005-0352357http://www.clinicaloncologyonline.net/article/PIIS0936655512000416/abstract?rss=yesAbstract: Primary testicular non-Hodgkin lymphoma (PTL) comprises around 9% of testicular cancers and 1–2% of all non-Hodgkin lymphomas. Its incidence is increasing and it primarily affects older men, with a median age at presentation of around 67 years. By far the most common histological subtype is diffuse large B-cell lymphoma, accounting for 80–90% of PTLs. Most patients present with a unilateral testicular mass or swelling. Up to 90% of patients have stage I or II disease at diagnosis (60 and 30%, respectively) and bilateral testicular involvement is seen in around 35% of patients. PTL demonstrates a continuous pattern of relapse and propensity for extra-nodal sites such as the central nervous system and contralateral testis. Retrospective data have emphasised the importance of prophylactic radiotherapy in reducing recurrence rates within the contralateral testis. Recent outcome data from the prospective IELSG-10 trial have shown far better progression-free and overall survival than historical outcomes. This supports the use of orchidectomy followed by Rituximab- cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP), central nervous system prophylaxis and prophylactic radiotherapy to the contralateral testis with or without nodal radiotherapy in patients with limited disease. Central nervous system relapse remains a significant issue and future research should focus on identifying the best strategy to reduce its occurrence. Here we discuss the evidence supporting combination chemotherapy and radiotherapy in PTL.Primary Testicular LymphomaS.S. Ahmad, S.F. Idris, G.A. Follows, M.V. Williams10.1016/j.clon.2012.02.005Clinical Oncology 24, 5 (2012)2012-03-19Clinical Oncology2012-03-19245S0936-6555(12)X0005-0358365http://www.clinicaloncologyonline.net/article/PIIS0936655512000635/abstract?rss=yesAbstract: Primary bone lymphoma is a distinct clinical entity that accounts for 5% of extra-nodal lymphoma. Most patients have diffuse large B-cell lymphoma and present with bone pain, a mass or both. The involvement could be in a single focus or disseminated. There are no prospective clinical studies in this disease. Patients have been treated with radiotherapy, chemotherapy or a combination. There is a trend towards improved outcome with combined modality treatment and further improvement with the addition of rituximab. Assessment of response may be difficult with current imaging techniques. The prognosis of primary bone lymphoma is generally good. Here, the current evidence for the optimal treatment of primary bone lymphoma is reviewed and questions for future investigation are addressed.Primary Bone LymphomaN.G. Mikhaeel10.1016/j.clon.2012.02.006Clinical Oncology 24, 5 (2012)2012-03-09Clinical Oncology2012-03-09245S0936-6555(12)X0005-0366370http://www.clinicaloncologyonline.net/article/PIIS0936655512000684/abstract?rss=yesAbstract: Lymphoma arising from the skin is the second most common site of extra-nodal non-Hodgkin's lymphoma. Over the last 25 years, the incidence has been rising. There is now a new World Health Organization/European Organization for Research and Treatment of Cancer joint classification for cutaneous lymphomas and new proposed International Society for Cutaneous Lymphomas/European Organization for Research and Treatment of Cancer staging systems. This overview examines the role of radiotherapy in the current management of cutaneous T- and B-cell lymphomas encompassing technological advances, new systemic therapies and novel radio-enhancing therapies now available. Modern total skin electron beam radiotherapy and the current low-dose and combination approaches are reviewed. Radiotherapy has remained the most successful treatment for cutaneous lymphoma over the last 50 years and with the technological advances and combination approaches available now and in the future will remain so for the next 50 years.Skin LymphomaS.L. Morris10.1016/j.clon.2012.02.007Clinical Oncology 24, 5 (2012)2012-04-06Clinical Oncology2012-04-06245S0936-6555(12)X0005-0371385