Current Oncology

Introduction and Objectives: Radiofrequency is standardized for ablating small renal tumors, but evidence regarding its effects remains limited. Partial nephrectomy, the gold standard, often leads to hemorrhagic complications and irreversible renal damage due to hilum clamping. To mitigate these risks, we propose a novel technique that replaces clamping with radiofrequency ablation of the tumor for hemostasis in robot-assisted partial nephrectomy. Methods: We report on 357 consecutive patients with T1a renal tumors treated with robot-assisted surgery between 2010 and July 2024. Radiofrequency was used peri-tumorally for hemostasis, followed by complete lesion enucleation. Follow-up included ultrasound and creatinine at 1 month, CT scans at months 3 and 9, and then annually for 5 years. Results: The median age was 60.2 years, with 251 men (70.3%). The median tumor size was 22 mm, and the median blood loss was 15 mL. Hemorrhagic complications occurred in eight patients (2.2%), with one requiring a blood transfusion (0.28%). A total of 30 patients experienced transient stage 1 acute kidney disease (8.4%), with no significant change in median 74.92 mL/min/1.77 m2 vs. 78.77 mL/min/1.77 m2 vs. (p-value 0.15). The median follow-up was 48.2 months, with no tumor recurrence at the treated site. Renal cell carcinoma was found in 83.7% of tumors. Conclusions: To our knowledge, this series represent the largest global undertaking of renal tumor treatment using peripheral radiofrequency ablation without clamping, demonstrating optimal surgical and oncological outcomes, lower morbidity, and fewer complications compared to those noted in the revised literature regarding traditional clamping techniques.

Aim: The aim of this study was to analyze the clinical characteristics and prognostic factors of profound hyponatremia in solid cancer patients admitted to the oncologic emergency department. Methods: We gathered data retrospectively from cancer patients who visited the emergency department of the National Cancer Center of China between October 2019 and February 2023 with a serum sodium (Na) level of less than 125 mmol/L. The demographic and clinical characteristics, medical history, admission symptoms, laboratory parameters, and outcomes of the patients were recorded. Results: This study comprised 307 patients with severe hyponatremia in total. With 39.4% of all tumors being lung cancer (n = 121), nausea and vomiting were the most common admission symptoms for patients with severe hyponatremia. The 30-day mortality rate of profound hyponatremia cancer patients in the emergency department was 13.4%. The albumin level (p < 0.001), the hemoglobin level (p = 0.033), the TNM stage (p = 0.004), the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) score (p < 0.001), hypocalcemia (p = 0.006), renal insufficiency (p = 0.035), and the efficacy of sodium supplementation (p = 0.006) were significantly associated with 30-day mortality. Binary logistic regression analysis showed that a lower albumin level (OR 0.924, 95% CI 0.861–0.991, p = 0.028) and higher ECOG score (OR 8.443, 95% CI 3.568–19.976, p < 0.001) were independent risk factors for 30-day mortality. The overall survival of emergency cancer patients with severe hyponatremia was also examined. The results of the COX regression analysis demonstrated that the efficacy of sodium supplementation (OR = 2.643, 95% CI 1.593–4.386, p < 0.001), a low albumin level (OR = 0.654, 95% CI 0.463–0.923, p = 0.016), the TNM stage (OR = 4.606, 95% CI 2.846–7.455), and a higher ECOG score (OR = 1.738, 95% CI 1.292–2.338, p < 0.001) were independent risk factors for overall survival. Conclusions: The clinical manifestations of severe hyponatremia in emergency cancer patients are varied. Hypoalbuminemia and a higher ECOG score are independent risk factors for 30-day mortality and overall survival. Severe hyponatremia patients with a high ECOG score and/or a low albumin level should be monitored and followed more closely.

Background: Did the COVID-19 pandemic lead to delays in breast cancer management, impacting treatment recommendations? The goal of this study was to assess the pandemic’s effect on breast cancer treatment and management practices. Methods: This study aimed to assess the pandemic’s effect on breast cancer treatment from March 2018 to February 2020 (pre-pandemic) and March 2020 to February 2022 (during the pandemic) in Canada. A retrospective cohort study at The Ottawa Hospital, Ontario, Canada, compared breast cancer patients diagnosed in the two years before and after the pandemic’s onset. The study examined patient demographics, cancer stages, treatment timelines, and procedures, including neoadjuvant chemotherapy, endocrine therapy, and surgical treatment. Descriptive statistics and frequencies identified changes. The study is limited to a single institution, which may restrict generalizability. Inclusion criteria focused on female patients over 18 years with newly diagnosed breast cancer, excluding recurrent cases. Stage IV patients were included, but further details on their management are needed. Results: Breast cancer diagnoses decreased from 2577 before the pandemic to 2290 after its onset. Surgeries decreased from 1226 to 1013 (p < 0.020), while neoadjuvant endocrine therapy increased from 148 to 169, and adjuvant radiotherapy rose from 586 to 722 (p < 0.001). The study revealed a decrease in breast cancer diagnoses and surgeries during the pandemic, with a rise in non-surgical treatments. Conclusions: These changes indicate significant shifts in breast cancer management due to the pandemic. The decrease in surgical treatments and increase in non-surgical options such as endocrine therapy and radiotherapy suggest adaptations in clinical practices to cope with the challenges posed by the pandemic. Understanding these shifts is crucial for developing strategies to mitigate the impact of future disruptions on breast cancer care and ensuring optimal patient outcomes.

Purpose: Because of shared mechanisms such as decreased access to health care, rurality and poverty may act synergistically to decrease colorectal cancer (CRC) survival. Methods: We conducted a retrospective cohort analysis of SEER data (22 registries) with census tract-level measures of poverty/rurality for the period 2006–2015. Multivariable Cox proportional hazard regressions were applied to examine the independent and intersectional associations of persistent poverty and rurality on 5-year cause-specific CRC survival across five racial/ethnic groups. Results: Among 532,868 CRC patients, non-Hispanic Blacks (NHB) demonstrated lower 5-year survival probability (64.2% vs. 68.3% in non-Hispanic Whites [NHW], 66.5% in American Indian/Alaska Natives [AI/AN], 72.1% in Asian/Pacific Islanders, and 68.7% in Hispanic groups) (p-value < 0.001). In adjusted analysis, CRC patients living in rural areas with poverty were at a 1.2–1.6-fold increased risk of CRC death than those who did not live in these areas in five racial/ethnic groups. In particular, AI/AN patients living in rural areas with poverty were 66% more likely to die from CRC (95% CI, 1.32, 2.08). Conclusions: CRC patients who live in rural or poverty areas in SEER areas in the U.S. have a poorer survival compared with those who do not live in such areas regardless of race/ethnicity. Significantly greater risk of CRC death was observed in AI/ANs. Impact. Patient navigators, community education or screening, and other health care system interventions may be helpful to address these disparities by socioeconomic status, race, and geographic residence. Multi-level interventions aimed at institutional racism and medical mistrust may also be helpful.

(1) Background: This study aims to identify the sociodemographic, behavioural, and systemic predictors of colorectal cancer (CRC) screening among primary healthcare attendees in Riyadh, Saudi Arabia, to inform targeted interventions and policy strategies. (2) Methods: This cross-sectional study was conducted between March and July 2023 across 48 randomly selected primary healthcare centers in Riyadh, Saudi Arabia. The target population for this study was adults aged 18 and above attending primary healthcare centers in Riyadh. Multi-stage random sampling was used to recruit participants. Multivariate logistic regression was performed to identify independent predictors of CRC screening. (3) Results: CRC screening uptake was found to be only 4.2%. Age was a significant predictor, with individuals aged 50–75 years (adjusted odds ratio [AOR]: 1.90, 95% confidence interval [CI]: 1.50–2.42) and those aged 75 years or older (AOR: 1.37, 95% CI: 1.01–1.87) being more likely to undergo screening compared to younger individuals. Insurance coverage strongly influenced screening behaviour (AOR: 1.64, 95% CI: 1.37–1.96). Smokers were nearly four times more likely to participate in screening than non-smokers (AOR: 3.87, 95% CI: 3.21–4.69), and physical activity was positively associated with screening (AOR: 1.43, 95% CI: 1.11–1.82). (4) Conclusions: CRC screening uptake in Riyadh is critically low, highlighting the need for targeted public health interventions. Key predictors such as age, insurance coverage, smoking, and physical activity underscore the importance of addressing sociodemographic disparities and promoting health awareness. The findings emphasize the need for culturally tailored educational campaigns, improved healthcare access, and enhanced screening programs to increase uptake.

For over two decades, robotic-assisted thoracic surgery (RATS) has revolutionized thoracic oncology. With enhanced visualization, dexterity, and precision, RATS has reduced blood loss, shortened hospital stays, and sped up recovery compared to traditional surgery or video-assisted thoracoscopic surgery (VATS). The use of 3D high-definition imaging and articulated instruments allows for complex resections and advanced lymph node assessment. RATS delivers oncological outcomes similar to open surgery and VATS, with high rates of complete (R0) resections and acceptable complication rates. Its minimally invasive nature promotes quicker recovery. Advances in imaging software and augmented reality further enhance surgical accuracy and reduce intraoperative risks. However, RATS has some limitations, including high costs and a lack of tactile feedback, and certain complex procedures, such as extended resections and intrapericardial interventions, remain challenging. With growing experience and technological advances, RATS shows promise in reducing morbidity, improving quality of life, and expanding access to advanced oncologic care. This article reviews the evolution, benefits, and limitations of RATS in NSCLC treatment, highlighting its emerging role in managing complex cases.

Glioblastoma in patients affected by NF1 germline mutation (NF1-associated GBM) represents a unique heterogeneous clinical and pathological entity. We have reviewed the few cases reported in the literature and they seem to have a better response to standard therapy and overall survival than GBM in the non-NF1 population. We present two cases of long-survival NF1 patients with GBM. Case 1 was a 38-year-old woman with cerebellar GBM who underwent surgical asportation and the Stupp protocol many times with an overall survival of 117 months. Case 2 was a 47-year-old woman with GBM in the eloquent area of the right frontal lobe; she underwent surgical asportation and the Stupp protocol with an overall survival of 25 months. The data analysis demonstrates that NF1-associated GBM patients could be considered long-term survivors.

There has been a proliferation of novel treatments for the management of advanced prostate cancer (PCa), including androgen receptor pathway inhibitors (ARPI). Although there are health economic analyses of novel PCa treatments, such as ARPIs for specific health states, there is a lack of sequential analyses. Our paper aims to fill this gap. We developed a Monte Carlo Markov model to simulate the management of advanced PCa to end-of-life. We modeled patients who begin in metastatic and nonmetastatic castration-sensitive PCa (mCSPC and nmCSPC), with risk stratification for mCSPC, progressing to metastatic castration-resistant PCa (mCRPC). Using current guidelines and recent literature, we simulated admissible treatment sequences over these states along a 15-year horizon. We report the best treatment sequences in terms of efficacy and cost-effectiveness. We find that the most cost-effective use of ARPIs is early in advanced PCa for a cost-effectiveness threshold (CET) of CAD 100K per QALY. For a CET of CAD 50K per QALY, early ARPI use is most cost-effective in mCSPC-starting patients but not nmCSPC-starting. We conclude that the most cost-effective way to use ARPIs is when patients first enter advanced PCa. The most cost-effective ARPI at current Canadian prices is abiraterone, mostly due to abiraterone’s lower price level.

On behalf of the Canadian Association of Psychosocial Oncology, we are pleased to present the Abstracts from the 2025 Annual Conference, titled “Responding to the Human Experience of Cancer and Caring for the Soul: Building on 40 years of global leadership in psychosocial oncology”. The 40th Annual CAPO Conference was held in Toronto from 23 April 2025 to 25 April 2025. In an era marked by the rapid advancement of biologically focused precision medicine, it is imperative to redirect our attention towards the human experience of illness and the soul of medicine. Biomedicine has conceptualized illness in ways that have proved profoundly productive from a curative and biological point of view. But it cannot—and it does not pretend to—illuminate the experience of living with it. (Hurwitz 2009). This conference aims to delve into the intricate interplay between cutting-edge biomedical technologies inclusive of artificial intelligence and big data and the deeply personal narratives of individuals navigating illness. By shifting the focus from mere disease pathology to encompassing the holistic human experience, we aspire to foster a more compassionate and patient-centered approach to healthcare with psychosocial support at the core of humanistic care that can improve survival and well-being in all aspects of a whole-person approach to illness. Through interdisciplinary dialogue and introspection, we endeavor to illuminate the profound connection between mind, body, and spirit in the practice of medicine, reaffirming the timeless significance of empathy, understanding, and human connection in healing and psychosocial aspects of care as fundamental to living well with cancer. This conference brought together key stakeholders including multidisciplinary professionals from nursing, psychology, psychiatry, social work, spiritual care, nutrition, medicine, rehabilitation medicine, occupational health and radiation therapy for both adult and pediatric populations. Participants included clinicians, researchers, educators in cancer care, community-based organizations and patient representatives. Patients, caregivers and family members presented abstracts that speak to their role in managing cancer experiences and care. Over two hundred (200) abstracts were submitted for presentation as symposia, 20-minute oral presentations, 10-minute oral presentations, 90-minute workshops and poster presentations. We congratulate all the presenters on their research work and contribution.

Worldwide, about two million people are diagnosed with lung cancer each year, 85% of whom have non-small cell lung cancer (NSCLC). Recent progress in treating advanced/metastatic NSCLC with targeted therapies has shifted attention to early NSCLC (Stages I–IIIA) and perioperative (neoadjuvant and adjuvant) systemic therapies. However, our comprehension of how targeted therapeutics are incorporated into care and their impact on patient outcomes is just starting to unfold. Methods: This retrospective observational study used a US nationwide electronic health record-derived deidentified database spanning January 2019–March 2024 and aimed to describe (1) eNSCLC patient demographic and clinical characteristics, (2) real-world neoadjuvant and adjuvant use, and (3) patient outcomes. Results: The study population included 4841 Stage IB–IIIA NSCLC patients with a mean age of 70.9 ± 8.6 years. The majority (69.9%) received definitive treatment: surgery (n = 2280), definitive radiation (n = 320), or definitive chemoradiation (n = 783), while 30.1% (n = 1458) did not. Many definitive treatment patients received some perioperative systemic therapy (surgery: 52.6%, radiation: 52.2%, chemoradiation: 75.5%). Neoadjuvant use was limited in all groups (surgery: 8.2%, radiation: 6.1%, chemoradiation: 11.6%). Among the 54.6% receiving adjuvant, immune checkpoint inhibitors were the most common choice for definitive radiation (39.1%) and chemoradiation (73.7%) patients, while surgical patients predominantly received platinum-doublet therapy (37.0%). Surgical patient outcomes were similar across all groups, while definitive chemoradiation or radiation patients without systemic therapy had lower survival rates. Conclusions: In this study, we found that although the majority of patients underwent some form of definitive treatment, adjuvant use was limited, and neoadjuvant use was rarely included in care. A crucial initial step in improving patient outcomes is to understand and address the underutilization of neoadjuvant/adjuvant systemic therapy for eNSCLC patients.

Background: The cost and uptake of cancer medications dispensed as take-home treatments are not well understood. Therefore, in this study, we describe trends and the impact of SARS-CoV-2 on the utilization and cost of take-home cancer medications dispensed through the public payer system in Ontario, Canada. Methods: We conducted a repeated cross-sectional time-series analysis examining monthly and fiscal-year trends in the utilization and cost of take-home cancer medications reimbursed by the public payer between 1 April 2017 and 31 March 2021, in Ontario, Canada. Our primary outcome was per-beneficiary spending. Total public payer spending and the number of unique beneficiaries who were dispensed take-home cancer medications were reported as secondary outcomes. All outcomes were reported overall and stratified by drug class. We used autoregressive integrated moving average (ARIMA) models to assess the impact of the SARS-CoV-2 pandemic on the aforementioned trends. Results: Annual per-beneficiary spending on take-home cancer medications increased by 32.8% (from CAD 4422 in 2017/18 to CAD 6579 in 2020/21) over the study period. The rise in per-beneficiary spending was driven by the cost of medications within the small-molecule targeted therapy and immunotherapy drug classes, which accounted for three-quarters of total public payer spending on take-home cancer medications in 2020/21 despite being dispensed to less than 8% of beneficiaries. Upon the declaration of emergency for SARS-CoV-2, a short-term decline in per-beneficiary spending (CAD −179 per month; p-value < 0.01) was observed between March and June 2020. This temporary decline was driven by an increase in the number of beneficiaries (5582 per month; p-value < 0.01) receiving low-cost take-home cancer medications within the cytotoxic chemotherapy and hormonal therapy drug class without a corresponding rise in public payer spending. Conclusion: Future research should investigate barriers to the widespread uptake of take-home cancer medications during periods of public emergencies, particularly for high-cost drugs.

In the past few years, a new promising therapy, called bispecific T-cell engager (TCE), has been developed and is now available in many countries for patients with relapsed or refractory multiple myeloma. T-cell engagers are associated with sustained efficacy and progression-free survival benefits in patients with heavily treated myeloma. However, complications such as cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and infections complicate their administration, particularly in remote centers. This review discusses the key requirements for delivering TCEs therapies, focusing on outpatient delivery. We also outline the primary acute and chronic complications of TCE therapy and their management.

Background: A cancer diagnosis and its treatment often disrupt a child’s and adolescent’s normal level of physical activity, which plays a vital role in their development and health. They are therefore often less physically active during treatment than before the diagnosis or compared to healthy peers. Today, there is no comprehensive overview of the safety, feasibility, clinical effectiveness, and potentially long-lasting impact of physical activity (PA) interventions in this population. Methods: We conducted a systematic review in PubMed according to PRISMA guidelines to evaluate studies on PA interventions during cancer treatment in children and adolescents up to 25 years of age. We used the Joanna Briggs Institute’s critical appraisal tools to assess the risk of bias. Due to the heterogeneity in interventions and outcomes, we used descriptive approaches only to present the results. Results: Half of the 21 included studies were randomized controlled trials (10/21). PA interventions were found to be safe and feasible when tailored to the patient’s age, treatment phase, and clinical condition. Most studies reported improvements in physical fitness, strength, and quality of life, with some reductions in fatigue. Variability in interventions and outcomes, along with small sample sizes and heterogeneous patient populations, made it difficult to draw clear conclusions. Conclusions: PA appears to be a feasible and, in terms of injuries, safe adjunct to cancer treatment in children and adolescents. Despite promising trends, further large-scale, multicenter trials with standardized protocols are needed to better establish the long-term benefits and optimal interventions.

The complex pathway for new drug reimbursement in Canada has been well documented. Drugs with promising early efficacy data may receive a Notice of Compliance with Conditions (NOC/c) from Health Canada. For oncology drugs that receive NOC/c, the pathway through positive review by Canada’s Drug Agency (CDA-AMC) and subsequent public reimbursement can take over 500 days. To address this challenge, in September 2023, CDA-AMC announced a new Time-Limited Recommendation (TLR) category, and in parallel, the pan-Canadian Pharmaceutical Alliance (pCPA) developed a set of principles and conditions for a Temporary Access Process (pTAP). This accelerated access pathway, the first of its kind in Canada, enables patients with advanced diseases to gain timely access to promising therapies while managing the uncertainties and risks associated with early approvals. This report provides a first assessment of the impact of the TLR-pTAP process on the reimbursement timelines for oncology drugs approved with NOC/c. Methods: The time from NOC/c approvals for oncology drugs between 1 January 2023 to 31 December 2024, to first provincial listings, and the timelines of the Health Canada, CDA-AMC, and pCPA review processes, were collected and evaluated. Results: Nine oncology NOC/c were granted during the selected period, of which three products, Columvi, Akeega, and Epkinly, received provincial listings, and the median time from regulatory approvals to provincial listings is 509 days (IQ range 306–544 days). One drug, Epkinly, has elected to adopt the TLR-pTAP pathway. Compared to the conventional reimbursement pathway—including for the drug Columvi, whose therapeutic profile is similar to that of Epkinly—the new pathway reduced the time to first provincial listing by over 200 days. A stepwise analysis indicates that the most significant accelerator within the TLR-pTAP pathway is the pCPA’s prioritization and processing of the file in parallel to the CDA-AMC’s health technology assessment (HTA) review process, rather than subsequently. Electing to file the HTA submission pre-NOC could have further accelerated timelines. No acceleration in each agency’s review time was observed. Conclusions: Participation in the TLR-pTAP pathway can help mitigate concerns over uncertainties associated with novel therapies while providing timelier access for patients with life-threatening diseases.

Salivary gland carcinomas (SGCs) represent a rare and heterogeneous group of malignancies accounting for 3–6% of all head and neck cancers. While surgical resection and radiotherapy remain the standard for locoregional control, systemic treatment is indicated for recurrent or metastatic disease. Advances in molecular profiling have identified actionable targets such as NTRK gene fusions, HER2, immune checkpoint regulators, androgen receptors, and RET receptors. These have facilitated the development of targeted therapies, including TRK inhibitors, HER2-directed agents, and androgen receptor modulators, as well as emerging combinations of immunotherapy and chemotherapy. Despite these advancements, challenges such as resistance mechanisms and limited therapeutic efficacy persist. Overall response rates remain relatively low across most systemic therapies, reflecting a persistent unmet clinical need. This review discusses the current landscape of treatment options and explores promising clinical trials and future directions to enhance outcomes for patients with SGCs.

Breast reconstruction after mastectomy improves the quality of life for many patients with breast cancer. There is uncertainty regarding eligibility criteria for reconstruction, timing (immediate or delayed—with or without radiotherapy), outcomes of nipple-sparing compared to skin-sparing mastectomy, selection criteria and surgical factors influencing outcomes of nipple-sparing mastectomy, prepectoral versus subpectoral implants, use of acellular dermal matrix, and use of autologous fat grafting. We conducted a systematic review of these topics to be used as the evidence base for an updated clinical practice guideline on breast reconstruction for Ontario Health (Cancer Care Ontario). The protocol was registered on PROSPERO, CRD42023409083. Medline, Embase, and Cochrane databases were searched until August 2024, and 229 primary studies met the inclusion criteria. Most studies were retrospective non-randomized comparative studies; 5 randomized controlled trials were included. Results suggest nipple-sparing mastectomy is oncologically safe, provided there is no clinical, radiological, or pathological indication of nipple-areolar complex involvement. Surgical factors, including incision location, may affect rates of complications such as necrosis. Both immediate and delayed reconstruction have similar long-term outcomes; however, immediate reconstruction may result in better short to medium-term quality of life. Evidence on whether radiotherapy should modify the timing of initial reconstruction or expander-implant exchange was very limited; studies delayed reconstruction after radiotherapy by at least 3 months and, more commonly, at least 6 months to avoid the period of acute radiation injury. Radiation after immediate reconstruction is a reasonable option. Surgical complications are similar between prepectoral and dual-plane or subpectoral reconstruction; prepectoral placement may give a better quality of life due to lower rates of long-term complications such as pain and animation deformity. Autologous fat grafting was found to be oncologically safe; its use may improve quality of life and aesthetic results.

Citation:Ćeriman Krstić, V.; Soldatović, I.; Gajić, M.; Samardžić, N.; Stević, R.;Čolić, N.; Lukić, K.; Šeha, B.; Radončić, D.; Stamenić, S.; et al. Long-Term Outcomes in Patients with Locally Advanced and Metastatic Non-Small Cell Lung Cancer with High PD-L1 Expression. Curr. Oncol. 2025, 32, 229. https://doi. Abstract: Before the introduction of targeted therapy and immunotherapy, patients with metastatic non-small-cell lung cancer (NSCLC) had a 5-year overall survival (OS) rate of up to 10%. After the positive results of KEYNOTE-024, pembrolizumab was approved in a first-line setting for patients with metastatic NSCLC and PD-L1 ≥ 50%. A small number of patients had a durable response to immunotherapy, and so far it has not been discovered who will benefit. The aim of this study was to investigate the efficacy of first-line pembrolizumab in patients with locally advanced and metastatic NSCLC with high PD-L1 expression in a real-world setting. We enrolled 35 patients with locally advanced and metastatic NSCLC who had PD-L1 ≥ 50%. Progression-free survival was 9 months, 95% CI (2.6-15.4). Overall survival was 14 months, 95% CI (0-28.5). Five-year OS rate for the whole group of patients was 20%, and the six-year OS rate was 17.2%. Immunotherapy was a revolution in the treatment of NSCLC. We still do not know which patients will benefit from immunotherapy, but patients who do respond may experience long-term outcomes.

The combination of immunotherapy and radiotherapy has demonstrated synergistic potential, especially when a combination of immune checkpoint inhibitors (ICIs) is administered. Cytotoxic T-Lymphocyte-Associated Protein-4 (CTLA-4) inhibitors and Programmed Death-Ligand 1 (PD-L1) inhibitors or Programmed Cell Death Protein 1 (PD-1) inhibitors have been assessed in both clinical and preclinical studies; the addition of radiotherapy activates immunomodulatory mechanisms materialized by an effect similar to “in situ” vaccination or the “abscopal” distant response of lesions outside the irradiation field. The new therapeutic targets (T cell immune-receptor with Ig and ITIM domains (TIGIT), Lymphocyte activating gene 3 (LAG-3), and T cell Ig- and mucin-domain-containing molecule-3 (TIM-3)) associated with traditional ICIs and radiotherapy open new perspectives to the concept of immuno-radiotherapy. The dynamic evaluation of T lymphocyte expression involved in the antitumor immune response, both in the tumor microenvironment (TME) and in the tumor itself, could have biomarker value in assessing the response to combination therapy with traditional and new ICIs in association with irradiation. Preclinical data justify the initiation of clinical trials in various tumor pathologies to explore this concept.

Background: Medical care structures differ between urban and rural areas. Clinical cancer registries can depict real-world care through detailed data analysis, identifying potential regional disparities and contributing to improvements in healthcare. Methods: Data from the Brandenburg–Berlin Clinical-Epidemiological Cancer Registry for the years of diagnosis 2017–2022 were analyzed to assess the epidemiology and real-world care of gastric cancer, including cardia. Brandenburg was compared to Berlin regarding perioperative treatment regimens. The resulting survival benefits were assessed using Kaplan–Meier and Cox regression models. Results: For the years of diagnosis 2017 to 2022, 5805 cases of gastric carcinoma were documented in the cancer registry. Survival data showed no significant differences between Berlin and Brandenburg. Preoperative therapy for cT3/cT4N0 tumors was significantly more common in Berlin (72%) than in Brandenburg (68%). Perioperative therapy was associated with a survival benefit for stages T3-/T4N+ but not for stages T1N+ or T2. The lower proportion of pre-treated T3/T4N+ patients in rural Brandenburg did not result in a significant survival difference. Conclusions: The data provide a comprehensive representation of the current state of gastric cancer care in these two regions. Gastric cancer treatment outcomes, in terms of survival, are comparable between the rural region of Brandenburg and the urban center of Berlin.

Background: This study aimed to compare the clinical, pathological, and biochemical characteristics of upper rectal cancer (URC) and mid–lower rectal cancer (MLRC) in stage II and III non-metastatic rectal cancer and to identify distinct prognostic factors influencing survival and recurrence. Material and Methods: This retrospective cohort study included 100 patients with stage II and III non-metastatic rectal adenocarcinoma who underwent neoadjuvant chemoradiotherapy (nCRT) followed by curative-intent surgery between 2021 and 2024. Patients were categorized into URC (n = 53) and MLRC (n = 47) groups. Parameters analyzed included demographic factors, ASA score, surgical characteristics, pathological features (tumor stage, lymph node involvement, lymphovascular invasion (LVI), perineural invasion (PNI), tumor budding, tumor regression grade (TRG)), and biochemical markers (carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), white blood cell (WBC) count, neutrophil count, platelet count (PLT), and C-reactive protein (CRP)). One-year overall survival (OS) and disease-free survival (DFS) were analyzed using Kaplan–Meier survival curves, and Cox regression models identified independent prognostic factors. Results: Preoperative CEA levels were higher in MLRC (p = 0.05), whereas WBC count (p = 0.01), neutrophil count (p = 0.02), PLT (p = 0.01), and CRP levels (p = 0.01) were higher in URC. Pathological analysis revealed higher LVI (p = 0.04), PNI (p = 0.04), and tumor budding (p = 0.03) in MLRC. At one-year follow-up, OS rates were 82.1% (URC) vs. 80.3% (MLRC) (p = 0.85), and DFS rates were 78.6% (URC) vs. 73.4% (MLRC) (p = 0.72). Multivariate Cox regression analysis identified age (HR: 1.04, p = 0.03), ASA score (HR: 1.22, p = 0.01), CRP (HR: 1.18, p < 0.001), preoperative CEA (HR: 1.12, p = 0.02), preoperative CA19-9 (HR: 1.09, p = 0.03), LVI (HR: 1.42, p < 0.001), PNI (HR: 1.35, p = 0.02), and tumor budding (HR: 1.28, p = 0.03) as independent prognostic factors for OS. Similar trends were observed for DFS, with T stage (HR: 1.35, p = 0.01) and tumor size (HR: 1.22, p = 0.01) also being found significant. Conclusions: Inflammatory markers, tumor burden indicators (LVI, PNI, budding, tumor size, T stage), and preoperative CEA/CA19-9 were identified as significant predictors, suggesting a risk-adapted approach to rectal cancer treatment.

Thyroid carcinomas are driven by diverse molecular alterations, but the tumor suppressor gene folliculin (FLCN), best known for its role in Birt–Hogg–Dubé (BHD) syndrome, has received limited attention in thyroid tumors. Here, we describe two thyroid tumors with pathogenic FLCN alterations—one germline and one somatic—and analyze the broader prevalence and significance of FLCN in thyroid carcinomas using multiple large sequencing datasets, including ORIEN-AVATAR. Patient 1, with a germline FLCN mutation and a history of BHD syndrome, presented with a well-circumscribed oncocytic adenoma. Molecular testing confirmed biallelic FLCN inactivation, but no additional mutations or aggressive features were observed, and the patient remained disease-free post-thyroidectomy. Patient 2 harbored a somatic FLCN mutation in an oncocytic poorly differentiated thyroid carcinoma, which exhibited extensive angioinvasion, high proliferative activity, and concurrent TP53 and RB1 mutations. The tumor progressed with metastatic disease despite multimodal treatment. Thyroid carcinomas revealed FLCN alterations in 1.1% of cases. Pathogenic mutations were rare but associated with oncocytic morphology, while homozygous deletions occurred more frequently in genomically unstable tumors, including anaplastic thyroid carcinoma. These findings suggest FLCN mutations may act as early oncogenic drivers in oncocytic thyroid neoplasms, while deletions represent secondary events in aggressive tumor evolution. The lack of FLCN coverage in standard thyroid molecular panels likely underestimates its clinical relevance. Including FLCN in genetic testing could improve tumor detection and characterization, particularly in BHD patients who may benefit from routine thyroid screening. Further studies are needed to clarify FLCN’s role in thyroid cancer pathogenesis.

Background: Pancreatic cancer (PC) is among the deadliest types of cancer globally. While early detection helps avert adverse outcomes, screening is only recommended for individuals at high risk, specifically those with familial and/or genetic predispositions. The objectives of this study are to systematically review primary studies on the cost-effectiveness of PC screening and to identify the critical factors that influence cost-effectiveness. Methods: This systematic review was performed using PRISMA guidelines. Economic evaluation studies on PC screening were identified from searches on the SCOPUS and PubMed databases. The quality of reporting of the selected articles was assessed according to CHEERS 2022. Using predefined inclusion and exclusion criteria, two reviewers conducted the title–abstract review, full-text review, and data extraction to select relevant articles. The authors’ consensus was used to settle disagreements. The primary outcome was the incremental cost-effectiveness ratio, measured by cost per quality-adjusted life year and cost per life year saved. Results: Nine studies were selected for the final review. Most studies demonstrated that one-time screening for PC among high-risk individuals was cost-effective compared with no screening, while others found annual screening to also be cost-effective. High-risk was generally defined as having a >5% lifetime risk of PC and included individuals with either familial pancreatic cancer (FPC) or genetic susceptibility syndromes such as Peutz–Jeghers Syndrome, hereditary pancreatitis, hereditary non-polypoid colorectal cancer syndrome, familial adenomatous polyposis, and BRCA2 mutations. Individuals with new-onset diabetes (NOD) were also considered high-risk. Screening using mainly endoscopic ultrasound was cost-effective among FPC individuals and those with genetic syndromes. Risk-based screening was also cost-effective among patients with NOD. Conclusion: Screening for PC is cost-effective among selected high-risk individuals. However, cost-effectiveness depends on epidemiological factors, cost, the diagnostic performance of screening tools, and the overall design of studies.

Objectives: The preoperative identification of occult pleural metastasis (OPM) in lung cancer remains a crucial clinical challenge. This study aimed to develop and validate a predictive model that integrates clinical information with chest CT radiomic features to preoperatively identify patients at risk of OPM. Methods: This study included 50 patients diagnosed with OPM during surgery as the positive training cohort and an equal number of nonmetastatic patients as the negative control cohort. Using least absolute shrinkage and selection operator (LASSO) logistic regression, we identified key radiomic features and calculated radiomic scores. A predictive nomogram was developed by combining clinical characteristics and radiomic scores, which was subsequently validated with data from an additional 545 patients across three medical centers. Results: Univariate and multivariate logistic regression analyses revealed that carcinoembryonic antigen (CEA), the neutrophil-to-lymphocyte ratio (NLR), the clinical T stage, and the tumor–pleural relationship were significant clinical predictors. The clinical model alone achieved an area under the curve (AUC) of 0.761. The optimal integrated model, which combined radiomic scores from the volume of interest (VOI) with the CEA and NLR, demonstrated an improved predictive performance, with AUCs of 0.890 in the training cohort and 0.855 in the validation cohort. Conclusions: Radiomic features derived from CT scans show significant promise in identifying patients with lung cancer at risk of OPM. The nomogram developed in this study, which integrates CEA, the NLR, and radiomic tumor area scores, enhances the precision of preoperative OPM prediction and provides a valuable tool for clinical decision-making.

Bone metastases are a major concern in cancer management since they significantly contribute to morbidity and mortality. Metastatic lesions, commonly arising from breast, prostate, lung, and kidney cancers, affect approximately 25% of cancer patients, leading to severe complications such as pain, fractures, and neurological deficits. This narrative review explores contemporary approaches to bone metastases, emphasizing a multidisciplinary strategy and the evolving concept of oligometastatic disease. Oligometastases, defined by limited metastatic spread (1–5 lesions), offer a potential window for curative treatment through aggressive interventions, including stereotactic ablative radiotherapy and resection surgery. Tumor boards, integrating systemic therapies with local interventions, are crucial to optimize treatment. Despite promising results, gaps remain in defining optimal treatment sequences and refining patient selection criteria. Future research should focus on personalized approaches, leveraging biomarkers and advanced imaging to enhance outcomes and the quality of life in patients with bone metastases.

Background: Oncological care of adolescent patients is often inconsistent, as they frequently fall between pediatric and adult services. The Childhood Cancer Registry of Campania (CCRC) is the Italian largest population-based registry specializing in children 0-19 years old, with a target population of approximately 1.1 million inhabitants. Material and Methods: This report presents epidemiological indicators and clinical pathways on primary brain tumors in adolescents (15-19 years) from the Campania region. Results: Over the study period (2008-2020), the cohort included 219 adolescents with newly diagnosed central nervous system (CNS) tumors with an annual average incidence rate (IR) of 48.9 cases per million/year. The 5-year observed survival rate after diagnosis of CNS tumor was 84.8%. Overall, the most common tumor site was the pituitary gland and craniopharyngeal duct, representing 22.4% of all tumors. The most frequently occurring malignant primary CNS tumor was germinoma, while the most common non-malignant tumor was pituitary adenoma. Most patients were referred to adult services and nearly half migrated outside the region to receive cancer care. Conclusions: Challenges in the care of adolescent oncology patients include limited access to specialized care, difficulties in transitioning from pediatric to adult institutions, distinct tumor biology, and the under-representation of adolescents in clinical trials. The care of adolescents with CNS tumors is fragmented across institutions and significant variations in practice exist between adult and pediatric practitioners.