Organizations: Division of Cancer Sciences, The University of Manchester, Manchester, UK · The Christie NHS Foundation Trust, Manchester, UK · Department of Computer Science, The University of Manchester, Manchester, UK
Real-world outpatient oncology notes contain specialised terminology, tumour staging expressions, treatment names, toxicity descriptions, and institution-specific de-identification markers that may not be represented efficiently by general biomedical or adjacent clinical language models. We developed and evaluated oncology-specific BERT-style encoders using a governed UK outpatient oncology corpus comprising 290,026 notes from 21,564 patients treated for lung and head-and-neck cancer. We compared RadBERT and PathologyBERT with two local strategies: OncoNote-RadBERT, produced by continued masked language model pretraining, and OncoNoteBERT, trained from scratch with an oncology WordPiece tokenizer. Models were evaluated using masked language modelling loss and perplexity on the validation set, tokenizer fragmentation metrics, clinical term tokenisation, masked-token probes, and exploratory representation analysis. Both external encoders fit the oncology corpus poorly in zero-shot evaluation (perplexity 113.04 for RadBERT; 2035.03 for PathologyBERT), while continued pretraining produced the strongest fit (2.10 for OncoNote-RadBERT). OncoNoteBERT achieved perplexity 2.83 but produced the most efficient tokenisation, with lower subword fertility and shorter normalised sequence length. It also returned a clinically acceptable prediction for 12 of 13 masked-token probes, compared with 7 of 13 for OncoNote-RadBERT. This divergence between corpus-level fit and masked-token performance was partly attributable to tokenizer fragmentation rather than learned semantics alone. Both locally developed models represented the institutional placeholder as a single learnable token. These findings show that continued adaptation and bespoke tokenisation provide complementary benefits, and that representation-layer design matters before adjacent-domain encoders are applied to oncology NLP.
Figures & tables
Figure 1: Study workflow for data preparation, encoder development, and intrinsic representation evaluation. All evaluations were performed on the validation split of patient data and did not alter model parameters.
Figure 2: Model groups, tokenizers, and training strategies
Figure 3: Perplexity across the four encoders evaluated on the validation dataset. Lower perplexity indicates better language-model fit. Panel (a) shows the perplexity for all evaluated models on a log scale. Notice the substantially higher PathologyBERT perplexity. Panel (b) shows the perplexity of the two locally trained oncology models (group B) on a linear scale.
Figure 4: Tokenizer efficiency across the four encoders. The figure compares subword fertility, continuation-token rate, unknown-token rate, and normalised sequence length on the shared document sample. For all these metrics, lower values indicate better performance.
Figure 5: Masked-token probe performance across encoders. The scorecard reports the number of prompts for which at least one prespecified clinically acceptable answer appeared among the five highest-ranked predictions. Higher values indicate better performance.
We present OntoBook, a method that converts medical ontology structure into pretraining signal for encoder language models. Our approach has three stages: random walks through ontology graphs capture hierarchical and causal relations between medical codes, a large language model reformulates these walks into fluent textbook-style prose, and the resulting text is used to train ModernCamemBERT, a 149M-parameter French encoder, with two objectives on the same data: masked language modeling and relation prediction between code pairs. On three French medical coding benchmarks (FRACCO, Cantemist-FR, Distemist-FR), OntoBook achieves significant improvements over MLM-only pretraining, with +2.5 micro-F1 on FRACCO and +8.0 micro-F1 on Distemist. We find that alignment between objectives is necessary: misaligned training, where each task uses different data, causes a 30-point degradation. We release 1.3 million LLM-reformulated medical textbooks across three French ontologies (CIM-10, CCAM, ATC) and pretrained model checkpoints.
Rian Touchent, Éric de la Clergerie
ALMAnaCH · Inria, Sorbonne Université · rue Barrault 75013 Paris, 21 rue de l’école de médecine 75006 Paris
Large language models are increasingly used in oncology applications, but their predictions are often weakly grounded in explicit medical structure. We present TRACE, a deployable tree-relational enhancement framework for oncology LLMs. TRACE separates expensive offline structure learning from lightweight online inference: oncology concepts and relations are organized into an updatable tree-relational structure, refined using LM-loss-derived evidence, and retrieved at inference time as compact prompt evidence. This design supports task-adaptive evidence selection without requiring supervised labels in the zero-shot setting. Across ten oncology classification tasks and one MedQuAD CancerGov QA benchmark, TRACE improves both label-free evaluation and supervised fine-tuning. Additional analyses show that TRACE improves over vanilla RAG and generic GraphRAG, remains useful under leakage-controlled METABRIC inputs, and produces interpretable evidence paths aligned with clinical reasoning. These results suggest that explicit, updatable medical structure is a practical path toward more accurate and auditable oncology LLM deployment.
We introduce MrBERT, a family of 150M-300M parameter encoders built on the ModernBERT architecture and pre-trained on 35 languages and code. Through targeted adaptation, this model family achieves state-of-the-art results on Catalan- and Spanish-specific tasks, while establishing robust performance across specialized biomedical and legal domains. To bridge the gap between research and production, we incorporate Matryoshka Representation Learning (MRL), enabling flexible vector sizing that significantly reduces inference and storage costs. Ultimately, the MrBERT family demonstrates that modern encoder architectures can be optimized for both localized linguistic excellence and efficient, high-stakes domain specialization. We open source the complete model family on Huggingface.
Daniel Tamayo, Iñaki Lacunza, Paula Rivera-Hidalgo +4