Type of publication:
Service improvement case study
Author(s):
*Claire Carr
Citation:
SaTH Improvement Hub, November 2025
SMART Aim:
To improve the triage system for patients on the faster diagnosis pathway for suspected gynaecological cancers by 1st October 2025 as evidenced by more people being seen within the 28 days target.
Type of publication:
Conference abstract
Author(s):
Webb E.J.; Twiddy M.; Noutch S.; Adapala R.; Bach S.P.; Brown S.; Burnett C.; Burrage A.; Gilbert A.; Hawkins M.; Howard D.; Hudson E.; Jefford M.; Kochhar R.; Saunders M.; Seligmann J.; Smith A.; Teo M.; West N.; Sebag-Montefiore D.; *Gollins S.; Appelt A.L.
Citation:
Radiotherapy and Oncology. Conference: ESTRO 2025. Vienna Austria. 206(Supplement 1) (pp S1253-S1255), 2025. Date of Publication: 01 May 2025.
Abstract:
Purpose/Objective: Dose-escalation may increase the chance of successful non-surgical rectal cancer management, but requires an understanding of acceptable trade-offs between chance of cure and toxicity risks. This study is the first to measure patient preferences for non-surgical management (NOM) of rectal cancer using a discrete choice experiment (DCE). Material/Methods: A prospective, multicentre study conducted in seven UK radiotherapy centres. Patients consented to participation prior to initiation of radiotherapy-based NOM for rectal cancer (any stage), and completed the survey pre-treatment and 6 months post-treatment. The DCE was developed with qualitative patient input and had a Bayesian D-efficient design. Patients made repeated choices between hypothetical NOM treatments, described using six attributes: treatment length; chance of being cancer-free two years post-treatment; side effect risks during and two years posttreatment; support available. Participants indicated preferences for non-surgical vs. surgical treatment on a Likert scale. Baseline responses were analysed using mixed logit, quantifying trade-offs between attributes, using preference for chance of cure as the unit of measurement. Post-estimation, individual preferences conditional on choices were estimated. Changes in mean preferences pre/post-treatment were analysed using multinomial logit, with the delta method used to test for pre/post-treatment differences. Differences in preferences for surgical/nonsurgical management were assessed using Mann-Whitney U tests. Result(s): There were 96 participants recruited, and 51 completed follow-up. Participants had a mean baseline age of 68.4 and were 38.9% female. There were no significant differences between characteristics of people who did/did not complete follow-up. Figure 1 shows distributions of patients' baseline preferences. Patients on average required a 0.34 percentage point (pp) higher chance of cure to accept a 1pp higher chance of short-term side effects, compared to 0.78pp for a 1pp higher chance of long-term side effects, and 3.3pp higher chance of cure to accept support from usual GP rather than a dedicated nurse. The mean chance of cure patients would trade for shorter treatment lengths was not significantly different from 0 (p=.900). Preferences for treatment attributes did not change significantly pre/post-treatment (p-values between.374 and.759, Figure 2a). There was a significant shift in preferences towards non-surgical vs. surgical management post-treatment (p=.017, Figure 2b). Conclusion(s): Participants would accept extra toxicity in exchange for better chances of cure, suggesting most would accept treatment intensification, including dose-escalation. Participants were more concerned about long-term than shortterm side effects, highlighting the need for long-term follow-up of toxicity, and for clinical decision-making to take account of individual patients' preferences.
DOI: 10.1016/S0167-8140%2825%2901971-1
Type of publication:
Conference abstract
Author(s):
Sebag-Montefiore D.; Samuel L.; *Gollins S.; Glynne-Jones R.; Harte R.; West N.; Quirke P.; Myint A.S.; Bach S.; Falk S.; Parsons P.; Dhadda A.; Misra V.; Brown G.; Harrison M.; White L.; Duggan M.; Begum R.; Chang E.; Musleh R.; Lopes A.; Adams R.
Citation:
Radiotherapy and Oncology. Conference: ESTRO 2025. Vienna Austria. 206(Supplement 1) (pp S1192-S1194), 2025. Date of Publication: 01 May 2025
Abstract:
Purpose/Objective: To determine if the addition of irinotecan to capecitabine chemoradiation (CRT) improves disease-free survival in MRI-defined locally advanced rectal cancer (LARC). Material/Methods: ARISTOTLE (ISRCTN:09351447) is a phase III, multi-centre, open-label trial that randomly assigned (1:1) patients with MRI-defined LARC threatening or involving resection margins without metastases to pre-operative radiotherapy:45Gy/25 fractions combined with either capecitabine 900mg/m2 (CRT) or 650 mg/m2 bd weekdays with Irinotecan iv once-weekly 60mg/m2 (IrCRT) weeks 1-4. The primary endpoint is disease-free survival (DFS). Result(s): 75 UK sites randomised 564 eligible patients from 10/2011 to 07/2018; 284 to CRT and 280 to IrCRT. 66% male; median age 61 years (range:24-83). Radiological staging in both arms was similar:mrT3(77%), mrT4(16%); mrCRM involved(49%);resection margin threatened <=1mm(38%). Median follow-up is 62.1 months.Compared with CRT, IrCRT patients were less likely to receive 45Gy RT: 208(75%) vs 251(89%), p < 0.001; or receive >=90% capecitabine dose:187(68%) in IrCRT vs 253(89%) CRT, p < 0.001. 205(74%) IrCRT patients received >=90% irinotecan dose. >=Gd 3 non-haematological adverse events included fatigue 17(6%) vs 8(3%) p=0.06; diarrhoea:14% vs 4% p<0.001; abdominal pain 5% vs <1% p=0.001 for IrCRT and CRT respectively. >=Gd 3 haematological adverse events included leucopaenia: 9% vs 2%, p<0.001; neutropaenia: 10% vs 1%,p<0.001; and febrile neutropaenia: 1% vs <1% for IrCRT and CRT respectively. 5 patients had a grade 5 adverse event (3 lrCRT,2 CRT). The median time from the end of RT to surgery was 10.6 weeks. 238(85%) and 243(86%) patients underwent surgery in the IrCRT and CRT arms. The R0 resection rate was 90% vs 89% p=0.75 for IrCRT and CRT respectively. The pCR rate was 20% for IrCRT vs 18% for CRT p = 0.52. The rate of any post-surgical complications was similar in both arms:94(39%) for IrCRT and 91(37%) for CRT p=0.65). There is no evidence of a difference in loco-regional failure free (HR 0.94 [0.46-1.90]p=0.86, distant metastasis free (HR 0.89 [0.63-1.25] p=0.51), disease free HR 0.87 [0.64-1.18] p=0.37) or overall survival (HR 0.91[0.63-1.30],p=0.59) when IrCRT is compared with CRT. Conclusion(s): For patients with MRI-defined high risk LARC, low rates of CRM involvement and 36 month loco-regional failure were observed.The addition of irinotecan to CRT was associated with decreased radiotherapy and chemotherapy compliance and a higher rate of adverse events.There is no evidence of a difference in the pCR rate,36 month locoregional recurrence free or disease-free survival.
DOI: 10.1016/S0167-8140%2825%2900901-6
Link to full-text
Type of publication:
Conference abstract
Author(s):
Iddenden J.; Howard D.; Hudson E.; Teo M.; Diez P.; Miles E.; Turtle L.; Patel R.; Appelt A.; *Gollins S.
Citation:
Radiotherapy and Oncology. Conference: ESTRO 2024. Glasgow United Kingdom. 194(Supplement 1) (pp S5977-S5980), 2024. Date of Publication: 01 May 2024.
Abstract:
Purpose/Objective: APHRODITE (ISRCTN16158514), funded by Yorkshire Cancer Research, is a phase II randomised controlled trial comparing radical (chemo)radiotherapy (CRT) alone versus dose-escalated CRT with a simultaneous integrated boost (SIB). Patients with early stage rectal cancer, who are considered by their multidisciplinary team as unsuitable for radical total mesorectum excision or have a strong preference for organ preservation, will all receive 50.4Gy in 28 fractions to a small mesorectal-only planning target volume (PTV). Those in the experimental dose-escalation arm also receive up to 62Gy SIB to the primary tumour volume (PTVp). The trial is currently in active recruitment with a target sample size of 104 patients. Few studies exist detailing dose-volume constraints applied in this setting and none which examine the frequency to which they are achieved1. Anonymised trial plans were retrospectively reviewed to determine if the optimal organ at risk (OAR) dose-volume constraints as set out in the trial protocol are achievable. The conformity of the target volumes coverage was also assessed. Material/Methods: All centres completed the pre-trial radiotherapy quality assurance programme prior to recruiting. Radiotherapy planning data was requested for all patients. To date, 8 centres have recruited patients, with plan data for 46 out of 73 trial patients available at the time of analysis. Radiotherapy was planned according to their randomisation following APHRODITE dose-volume constraints. All plans were retrospectively reviewed on Velocity version 4.1 (Varian Medical Systems, Inc.) and dose-volume constraints extracted from DVH data. Conformity indices, as defined by RTOG (95% isodose volume/volume of PTV), were calculated for all PTVs. The standard deviation was calculated for optimal OAR dose-volume constraints and target volume conformity. Mann-Whitney U tests (two-tailed) were performed to test differences between the standard and dose-escalated arms. Result(s): Dose-volume constraints for the APHRODITE trial were developed from a retrospective mesorectum only planning study for a cohort of early-stage rectal cancer patients2. All constraints were considered optimal, rather than mandatory, due to the paucity of data on normal tissue dose limits in the setting of rectal cancer organ preservation. In all cases, the V95% >= 99% for both PTV and PTVp (dose-escalated arm only) were achieved. Table 1 demonstrates that centres were able to meet the optimal OAR dose-volume constraints in both trial arms in the majority of cases. Randomisation to receive a 62Gy boost did not have a statistically significant impact on achieving optimal OAR dosevolume constraints when compared to the standard arm dose. Evaluation of conformity indices in Table 2 suggested that there was a negligible difference in the conformity of PTV coverage between standard and dose-escalated patients. Mean conformity index for the mesorectal PTV was 1.15 for standard arm patients and 1.16 for patients in the escalated arm (p=0.67). For comparison, mean conformity index for the boost PTVp in the escalated arm was 1.18. The analysis of the target volume conformity test showed that 95% dose conformity is widely achievable across both trial arms in this multi-centre study. Table 2: Conformity indices of target volume and standard deviation Target Volume Mean Conformity Index Standard Deviation Standard (PTV) 1.15 0.06 Escalated (PTV) 1.16 0.05 Escalated (PTVp) 1.18 0.11 Conclusion(s): Delivering a SIB dose of up to 62.0Gy to the primary tumour volume does not have a statistically significant impact on the achievability of optimal OAR dose-volume constraints set out in the APHRODITE trial. Retrospective analysis of available plan data has shown that highly conformal SIB plans can be produced in a multi-centre setting, with resulting dose distributions being comparable to those in the standard arm.
DOI: 10.1016/S0167-8140%2824%2902083-8
Type of publication:
Conference abstract
Author(s):
*Patel A.; Albaladejo M.M.; Puchades V.P.; Amores D.R.; Arteaga J.S.; Gonzalez A.O.; Berna A.S.
Citation:
Radiotherapy and Oncology. Conference: ESTRO 2024. Glasgow United Kingdom. 194(Supplement 1) (pp S4770-S4773), 2024. Date of Publication: 01 May 2024.
Abstract:
Purpose/Objective: The purpose of this study is to demonstrate the experience in commissioning and optimising Varian's Mobius3D secondary dosimetry software for IMRT/VMAT patient specific QA using Varian TrueBeam HD-MLC and Ethos linacs, performed in the radiotherapy department at Complejo Hospitalario Universitario de Cartagena (CHUC). Material/Methods: Mobius3D provides an independent plan check against the TPS using a separate beam model and dose algorithm. This can be quantified with a 3D gamma pass rate (3%, 3mm threshold at CHUC), as well as point dose differences of seven positions within a Mobius Verification Phantom (MVP), which can be practically verified using a Semiflex 3D ionisation chamber (PTW 31021). For every plan at CHUC, this is initially done in the phantom's central position. Mobius3D was commissioned following Varian's guide for Ethos (energy 6FFF) and TrueBeam (energies 6X and 6FFF) linacs, which included a reference point dose calculation, and verification of the PDD curves, output factors, wedge factors, off-axis ratios, and the CT electron density table. The system was then evaluated against simple conformal plans, followed by more complex clinical VMAT/SBRT/SRS plans. As per the Mobius3D commissioning guidance provided by Varian, if plans are systematically returned with target volumes too hot or too cold with respect to the TPS then it is recommended that the model's dosimetric leaf gap (DLG) correction value is adjusted, which may be different for VMAT and IMRT techniques. For optimisation, Varian recommends using a small ionization chamber within an MVP insert to measure the delivered point dose from 5-10 clinical plans and comparing against the values returned by Mobius3D. This was performed on 8 IMRT plans over a range of DLG correction values. However, as the 3D gamma pass rate metric is generally more often used for comparing dose distributions, it may be more beneficial to optimise against this rather than the point dose difference. This was therefore also performed following the point dose optimisation. Result(s): The results following commissioning from plans on the Ethos linac were promising; for the default DLG values the target volume doses agreed to a sufficient degree, the 3D gamma pass rate (3%, 3mm) had a median of 99.5%, and the point dose difference had a median of -0.1%, as shown in Figure 1 (left and centre) for approximately 200 plans. This was also similar for VMAT plans on the TrueBeam linac. However, the Mobius3D results for IMRT treatments on the TrueBeam model gave target dose distributions which were consistently lower than those provided by the Eclipse TPS (AcurosXB v16). Additionally, the 3D gamma pass rates (3%, 3mm) were below the tolerance of 95%, with a median of 83.1% (n = 21), also shown in Figure 1 (right side). This therefore required optimisation of the DLG values. In this last scenario, the average point-dose difference between the plans was found for each DLG value. A trendline was plotted using linear regression, as depicted in Figure 2, and the DLG corresponding to a 0% point-dose difference was found to be 1.48 +/- 0.05mm. Similarly, the 3D gamma (3%, 3mm) pass rates were also found for each DLG value. Polynomial regression was performed to fit a cubic function to this data, also depicted in Figure 2, which gave a maximum corresponding to a DLG of 1.25 +/- 0.4mm. Considering the results from both methods, the DLG correction on the Mobius3D system for this TrueBeam and both energies was set as the average 1.4mm for IMRT, and 0mm for both VMAT and Ethos. This first value aligns closely with the value used for TrueBeam plans on the Eclipse TPS. From analysing plans following this optimisation, it was observed that the gamma3D (3%, 3mm) pass rates significantly improved, with a new higher median of 96.5% (n = 28, p < 0.001), as shown in Figure 1 (right). Conclusion(s): There is the need to optimize the DLG value for IMRT treatment plans on TrueBeam HD-MLC. Following this adjustment, the Mobius3D software gave satisfactory agreements to the TPS dose distribution for TrueBeam IMRT plans, with a substantial increase in 3D gamma (3%, 3mm) median pass rates. Ethos plans gave strong agreements without the need for optimisation, as did TrueBeam VMAT plans for the software default DLG values. It can therefore be concluded that the Mobius3D software offers a rigorous independent dose check against the TPS and is suitable for clinical use on Ethos and TrueBeam platforms, provided that a proper verification and optimization process has been previously performed.
DOI: 10.1016/S0167-8140%2824%2901289-1
Type of publication:
Conference abstract
Author(s):
*Wilson R.; *Shah J.; *Shittu S.; *Goh Y.L.; *Ball W.
Citation:
British Journal of Surgery. Conference: Annual Congress of the Association of Surgeons of Great Britain and Ireland. Edinburgh United Kingdom. 112(Supplement 13) (pp xiii69), 2025. Date of Publication: 01 Aug 2025.
Abstract:
Aim: To evaluate outcomes of patients dying within 12 months of colorectal cancer diagnosis in Shropshire County. Method(s): A single-centre retrospective review was conducted on patients who died within 12 months of diagnosis between 2020 and 2024. Patient demographics, performance status, time from referral to imaging, diagnosis, MDT, death, and treatment intent were collected. Result(s): A total of 103 patients (44 male, 59 female), with a mean age of 74 (range 32-96) years. Most had a performance status of 1 and lived in their own home (92%). Geographically, 60% lived in Shrewsbury, 34% in Telford, and 9% in Wolverhampton. Referral sources were mainly from GPs (55%), with 74% seen within two weeks. Other referral sources include emergency admission to SAU (20%) and AMU (16%). All patients underwent CT imaging, and 57% had endoscopic procedures. The average age at death was 75 (range 34-97), with the most common cause being distant metastatic sigmoid cancer. The average time from diagnosis to death was 4.4 months. Treatment intent was palliative for 90% of patients (44% best supportive care, 56% oncology), and 59% of those referred to oncology received palliative treatment. Eight patients with curative intent died due to emergency presentation with sepsis and multiorgan failure (2), prior to commencing treatment (1), complications of treatment (3), or declined treatment (2). Conclusion(s): This audit highlights that colorectal cancer patients in Shropshire are predominantly elderly, over 70 years, with significant co-morbidities and a performance status of at least 1.
DOI: 10.1093/bjs/znaf166.263
Type of publication:
Conference abstract
Author(s):
Ahad A.; Kumar S.; Kolomar H.; Wang J.; Mylavarapu M.; *Yateem D.; Sadeghzadegan A.; Abdallah A.; Chowdhury D.; Alnajar F.; Hassan M.J.; Kharel P.; Ali M.;
Citation:
Journal of Clinical Oncology. Conference: 2025 ASCO Annual Meeting I. Chicago, IL United States. 43(16 Supplement) (no pagination), 2025. Date of Publication: 01 Jun 2025.
Abstract:
Background: Pembrolizumab, a checkpoint inhibitor, has demonstrated safety and efficacy in various cancers, primarily melanomas and non-small cell lung cancers. However, its safety profile in Head and Neck Squamous Cell Carcinoma (HNSCC) remains inadequately studied. This meta-analysis aims to evaluate adverse events (AEs) associated with pembrolizumab in patients with advanced HNSCC. Method(s): A systematic search was conducted using PubMed, Embase, Cochrane Library, Web of Science, and clinicaltrials.gov. Randomized controlled trials (RCTs) evaluating pembrolizumab monotherapy in patients with advanced HNSCC were included. Primary outcomes included overall AEs, grade 3-5 AEs, immune-related AEs, and treatment discontinuation due to AEs. Random effects models were used for analysis. Statistical analysis was performed using Review Manager 5.4 (RevMan). A p-value <= 0.05 was considered statistically significant. Result(s): A total of 1,900 patients (mean age: 59.86 +/- 9.1 years; females: 16.73%) with advanced HNSCC were included from three RCTs. Patients receiving pembrolizumab monotherapy had higher odds of experiencing overall AEs (OR 2.00, 95% CI 1.04-3.83, p = 0.04), grade 3-5 AEs (OR 1.13, 95% CI 0.68-1.86, p = 0.63), immune-related AEs (OR 1.49, 95% CI 0.44-5.08, p = 0.53), and lower odds of treatment discontinuation due to AEs (OR 0.77, 95% CI 0.34-1.75, p = 0.53) compared to the control group. However, only overall AEs were statistically significant. Conclusion(s): Pembrolizumab is associated with a higher risk of AEs in patients with advanced HNSCC compared to the control group. Interestingly, the likelihood of treatment discontinuation due to AEs was lower in the pembrolizumab group; however, this difference was not statistically significant. Further research, including larger RCTs with longer follow-up periods, is necessary to evaluate the safety profile of pembrolizumab in patients comprehensively. Additionally, studies should focus on identifying specific patient subgroups at greater risk for AEs and exploring strategies to mitigate these risks.
Type of publication:
Journal article
Author(s):
Omorphos, Nicolas; Mohsin, Mohamed Shamil; *Mok, Spencer; Kitchen, Mark; Ho, Kuo J.
Citation:
Cureus. 17(7):e87174, 2025 Jul.
Abstract:
A 43-year-old male presented to the emergency department with a seven-year history of progressive left-sided scrotal swelling. On examination, a large mass was palpable in the left hemiscrotum, accompanied by eczema-like skin changes and a decubitus ulcer. Tumor markers were significantly elevated, particularly lactate dehydrogenase, and an urgent ultrasound confirmed the presence of a testicular tumor. CT revealed a scrotal mass originating from the left testis, along with bilateral inguinal lymphadenopathy. The patient underwent a left inguinal orchidectomy, and histopathological analysis confirmed a 3,550 g classical seminoma. He was subsequently referred to oncology for adjuvant chemotherapy.
DOI: 10.7759/cureus.87174
Link to full-text [open access - no password required]
Type of publication:
Conference abstract
Author(s):
*Shah J.; *Shittu S.; *Goh Y.L.; *Ball W.;
Citation:
British Journal of Surgery. Conference: 49th ASiT Annual Surgical Conference. Belfast United Kingdom. 112(Supplement 10) (pp x64), 2025. Date of Publication: 01 Jun 2025.
Abstract:
Aim: Evaluate outcomes of patients dying within 12 months from diagnosis of colorectal cancer in Shropshire County. Method(s): Single-centre retrospective review of patients who died within 12 months of diagnosis between 2020-2024.Each patient's hospital records were reviewed, and data were collected on patient demographics, performance status, time from referral to imaging, diagnosis, MDT, death and treatment intent. Result(s): A total of 103(44 male: 59 female) patients,with a mean age at referral of 74 (range 32 – 96) years old. Most patients had a performance status of 1 and lived in their own home (92%). 60% of patients lived in Shrewsbury, 34% in Telford and 9% in Wolverhampton. Referral sources were mainly from GP (55%), emergency admission to SAU (20%) and AMU (16%).74% of GP referrals were seen within two weeks. All patients underwent CT imaging. Endoscopic procedures were performed in 57% of patients. The average age of death is 75 (range 34 – 97) years old, most commonly from distant metastatic sigmoid cancer. The average time between diagnosis and death was 4.4 months.Treatment intent was palliative in 90% (BSC in 44% and oncology in 56%).59% who were referred to oncology received palliative treatment. Eight patients were treated with curative intent but died due to sepsis and multiorgan failure(2), died prior to commencing treatment (1), complications from treatment (3) or declined treatment (2). Conclusion(s): This snapshot audit demonstrates that patients in Shropshire County newly diagnosed with colorectal cancer were elderly, aged over 70 years old with significant cardiovascular co-morbidities and performance status of at least 1.
DOI: 10.1093/bjs/znaf128.248
Link to full-text [no password required]
Type of publication:
Conference abstract
Author(s):
*Arunachalam J.
Citation:
Annals of Oncology. Conference: The ESMO Gastrointestinal Cancers Congress. Barcelona Spain. 36(Supplement 1) (pp S87), 2025. Date of Publication: 01 Jul 2025.
Abstract:
Background: Basaloid squamous cell carcinoma (BSCC) of the anorectal region is a rare and aggressive variant of squamous cell carcinoma, arising primarily in the transitional zone of the anal canal and lower rectum. Historically referred to as cloacogenic carcinoma, BSCC is characterized by distinctive histological features. Chemoradiation remains the standard of care. Given its rarity, data on survival outcomes and demographic disparities are limited. We aimed to assess clinical characteristics and survival outcomes using a large U.S. population-based dataset. Method(s): We conducted a retrospective analysis using the SEER database (2000-2021) to identify patients with BSCC, defined by ICD codes 8083/3 and 8124/3, located in C21.0, C20.9, C21.1, C21.2, and C21.8. Variables extracted included age, sex, race, tumor stage, and treatments. Kaplan-Meier survival analyses were used to assess overall survival (OS) and cancer-specific survival (CSS). Group comparisons were evaluated using the log-rank test. Result(s): A total of 3,446 patients were identified. At diagnosis, 54% were under 65 years, 75% were female, and 80% were White. Metastatic disease was present in 11%. Median OS (mOS) was 120 months. The 1-, 3-, and 5-year CSS rates were 91.1%, 78.9%, and 73.3%, respectively; 10- and 20-year CSS rates were 67.4% and 61.5%. Male patients had poorer survival (mOS 66 months) compared to females (mOS 143 months; p < 0.0001; HR 1.595, 95% CI 1.420-1.791). Patients aged >=65 had a mOS of 72 months versus 219 months for those <65 (p < 0.0001; HR 2.124, 95% CI 1.926-2.342). Median OS by stage was 25 months (metastatic), 124 months (regional), and 175 months (localized) (p < 0.0001). Patients undergoing surgery had a mOS of 154 months, and those receiving radiation therapy had a mOS of 134 months. Lack of chemotherapy was associated with worse survival (mOS 50 months; HR 1.780, 95% CI 1.570-2.020; p < 0.0001). Race was not significantly associated with survival differences. Conclusion(s): Favorable outcomes were associated with younger age, female sex, early stage, and chemotherapy. Future studies should refine treatment strategies and explore targeted therapies in BSCC to guide precision medicine. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
DOI: 10.1016/j.annonc.2025.05.230
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Shrewsbury and Telford Hospital NHS Trust has an active Improvement Hub.
Find out more by visiting either the Improvement Hub Intranet pages (only available on a Trust PC) or the Improvement Hub page on the SaTH website.