Chemotherapy is associated with differential survival outcomes in apocrine carcinoma: A nationwide cohort study from the Japanese National Clinical Database-Breast Cancer Registry.

Explainable machine learning to predict muscle loss during radiotherapy for oral cavity cancer.

Survival outcomes after inadvertent surgery in low-risk early-stage cervical cancer.

Impact of lymphadenectomy on survival outcomes for stage I malignant ovarian germ cell tumors.

Five-year overall survival in JCOG1205/1206: irinotecan or etoposide plus cisplatin for resected high-grade neuroendocrine carcinoma of the lung.

Chemotherapy-induced peripheral neuropathy (CIPN) is a complication caused by some drugs used to treat cancers including metastatic spine and malignant nerve tumors. Debilitating denervation may result from such tumors directly or from their surgical resection. The inhibitory effects of adjuvant chemotherapy on nerve regeneration in peripheral neurotization surgeries are poorly understood and must be inferred from known mechanisms of CIPN. This narrative review aims to create an index of chemotherapeutics that may cause chemotherapy-associated neurotization failure (CANF) to better inform preoperative counseling, operative timing, and postoperative prognostication by peripheral nerve surgeons. A narrative review of published English-language literature on CIPN was performed, focusing on its known pathogenic mechanisms and its clinical manifestations including onset, duration of dysfunction, and effect size. The literature was also searched for existing evidence on the effects of the same agents on nerve regeneration and outcomes after peripheral nerve surgery. CIPN can manifest with sensory, motor, and/or autonomic dysfunction. Platinum-based compounds, taxanes, vinca alkaloids, antimetabolites, and proteasome inhibitors are implicated drug classes, all of which have distinct neurotoxicity profiles. CIPN phenotypes vary in timing, severity, and nerve modalities affected. Some agents are associated with a "coasting" phenomenon, where neuropathy persists even after the offending drug's discontinuation. The neurotoxic milieu induced by chemotherapy likely impairs nerve regeneration, but this has not been addressed in the literature. Data on neurotoxic chemotherapy agents were synthesized and used to create an index and risk-stratified decision tree based on inferred likelihood of CANF. Denervated patients on neurotoxic adjuvant chemotherapy regimens pose unique challenges to peripheral nerve surgeons. At least a cursory understanding of CIPN-implicated drugs, mechanisms of neurotoxicity, presentations, and the inferred risk of CANF is recommended before pursuing neurotization surgery. This index serves as a resource for peripheral nerve surgeons in this clinical conundrum.

Impact of contrast-enhanced computed tomography surveillance frequency on survival outcomes in patients with stage I-III colorectal cancer: A propensity score-matched retrospective cohort study.

In vivo performance of 5-fluorouracil encapsulated on bacterial nanocellulose in an azoxymethane-dextran sulphate sodium induced colorectal cancer: Drug release profiles, histological and biomarkers analysis.

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) may lead to financial toxicity (FT), potentially impairing survivors' quality of life (QoL). We assessed FT from the perspective of CRS/HIPEC candidates and survivors, hypothesizing an association with QoL, and explored its dynamics and drivers. A cross-sectional, single-center study used in-person Comprehensive Score for Financial Toxicity (COST) (FT) and Functional Assessment of Cancer Therapy-General (FACT-G) (QoL) surveys among CRS/HIPEC candidates/survivors with various primary tumors up to 5 years postoperatively. Spearman correlation between COST and FACT-G was assessed. Risk factors for FT were identified using a generalized linear model with forward selection among clinical, sociodemographic, and financial variables, as well as time from CRS/HIPEC. Overall, 248 surveys were analyzed: 55 (22.2%) candidates and 193 (77.8%) survivors. Mean ± standard deviation (SD) age was 59 ± 11 years, and 75% were female individuals. Appendix cancer was the most prevalent (42.3%), followed by ovarian (33.9%), colon (14.5%), and other (9.3%). The mean ± SD COST score was 29.7 ± 10.7 (range: 0-44), with 31.0% experiencing moderate-to-severe FT (COST ≤ 25). COST and FACT-G scores were strongly correlated (rho = 0.51, p < 0.001). Risk factors for greater FT (p < 0.05) included preoperative (β = -3.7) and adjuvant chemotherapy (β = -3.2), identifying as Black, Indigenous, or person of color (β = -5.4), being single (β = -3.5), and higher co-pays within 90 days before/after CRS/HIPEC (β range: -3.0 to -3.9). FT decreased over time (p = 0.008), reaching its lowest levels by 1 year postoperatively. FT is strongly associated with poorer QoL among CRS/HIPEC candidates/survivors. Risk factors include perioperative chemotherapy, higher co-pays from perioperative care, and sociodemographic disadvantages. Financial well-being improves by 1 year post-CRS/HIPEC.

Lymph node involvement, surgery and adjuvant treatment in primary Endometrioid Ovarian carcinoma PAtients with eaRly-stage Disease (LEOPARD) - a multinational team initiative.

Mapping of DOG1 expression in colorectal carcinomas.

Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype characterized by lack of estrogen receptor expression, progesterone receptor expression, and human epidermal growth factor 2 overexpression/amplification. Given its generally aggressive biology, current guidelines recommend systemic therapy for most patients, with anthracycline- and taxane-based regimens being historically preferred. However, the clinical outcomes of patients with stage I TNBC and the benefit (or lack thereof) of (neo)adjuvant chemotherapy have not been prospectively evaluated as this population has largely been excluded from prospective randomized clinical trials. As such, management decisions for stage I TNBC are typically extrapolated from trials enrolling patients with stage II or III TNBC or based on retrospective analyses. Currently, the primary factor influencing systemic therapy decisions is the anatomic stage, without other biomarkers clinically used to guide systemic therapy. This review summarizes the existing evidence supporting current and emerging systemic therapy strategies for stage I TNBC, with a special focus on treatment de-escalation and promising biomarkers that can advance personalized treatment selection.

Mandibular reconstruction with fibula free flaps commonly requires fixation using titanium osteosynthesis plates. In patients receiving adjuvant radiotherapy, scatter radiation effects from metallic hardware may alter dose distribution and affect biological responses, but systematic evidence remains limited. This experimental study examined the influence of plate geometry on scatter radiation and cell proliferation. A three-dimensional printed mandibular phantom, generated from patient CT data and combined with a water phantom, was used to simulate clinical irradiation conditions. Irradiation was performed with an Ethos linear accelerator, and dose modifications in the vicinity of different plate designs were analyzed. Human mesenchymal stromal cells (hMSC) and human umbilical vein endothelial cells (HUVEC) were irradiated under identical conditions, and proliferation was assessed using MTS assays. Distinct dose increases were detected anterior to the plates, with dose reductions in the shadowing region, depending on plate diameter and geometry. These physical changes correlated with significant differences in hMSC and HUVEC proliferation. The results indicate that osteosynthesis plate design affects both dosimetric distribution and cellular responses during radiotherapy. These findings suggest that reduced metal volume and specific plate geometries may contribute to lower local radiation perturbations and should be considered in reconstructive planning for patients undergoing adjuvant radiotherapy.

From evidence to practice: Real-world implementation of ESGO 2023 guidelines for adjuvant radiotherapy in vulvar cancer.

Hardware exposure after microvascular free tissue transfer (MFTT) for mandibular reconstruction is a significant complication. While osteocutaneous MFTTs are the preferred option, some patients require soft tissue-only MFTTs due to medical or anatomic limitations. Data comparing hardware exposure risk between these approaches are limited. This study compares the rate and timing of hardware exposure between osteocutaneous and soft tissue MFTTs. We conducted a retrospective review of patients undergoing MFTT for mandibular defects at a tertiary care center (11/2011-6/2023). Patients with non-mandibular defects or under age 18 were excluded. The primary exposure was flap type (osteocutaneous vs. soft tissue). The primary outcome was time to hardware exposure; the secondary outcome was exposure rate at defined follow-up intervals. One hundred and seventy-eight patients met inclusion criteria. At 1 year, hardware exposure occurred in 5.2% of osteocutaneous and 8.7% of soft tissue MFTT patients. At 3 years, exposure increased to 14.2% and 17.4%, respectively. After adjustment, there was no significant difference in time to hardware exposure between flap types at 1 year [HR 1.69 (95% CI 0.34-8.37), p = 0.520] or 3 years [HR 1.69 (95% CI 0.59-4.43), p = 0.346]. Adjuvant radiation and/or chemoradiation was associated with increased hazard of hardware exposure at 1 year [HR 7.72 (95% CI 0.97-61.4), p = 0.053] and at 3 years [HR 3.68 (95% CI 1.38-9.78), p = 0.009]. Flap type was not associated with differences in hardware exposure timing, but adjuvant therapy significantly increased exposure risk. Exposure rates rose by ~10% from 1 to 3 years postoperatively.

This exploratory analysis investigated whether the disease-free survival (DFS) benefit seen with adjuvant alectinib versus chemotherapy in patients with resected, ALK-positive non-small cell lung cancer (NSCLC) from the phase III ALINA study (NCT03456076) was maintained across surgical characteristic subgroups and when re-classifying patients according to the 8th edition of the Cancer Staging Manual of the American Joint Committee on Cancer (AJCC) and Union for International Cancer Control (UICC). ALINA is a global, open-label, randomized trial. Eligible patients≥18years old with resected, ALK-positive NSCLC of stage IB (≥4 cm), II, or IIIA (per AJCC/UICC 7th edition) were randomized 1:1 to receive alectinib 600mg twice daily for 24months or four 21-day cycles of platinum-based chemotherapy. investigator-assessed DFS. Endpoints of this exploratory analysis included DFS by stage (8th edition AJCC/UICC), nodal status, tumor size, and other surgical characteristics, in the primary analysis population. Patient characteristics were generally well balanced across both treatment arms; most patients had a tumor measuring≤3 cm (n=147 [57.4%]), stage IIIA disease (n=134 [52.1%]), and regional lymph node stage N2 (n=130 [50.6%]). Consistent with the primary results, patients receiving alectinib had longer DFS versus those who received chemotherapy, irrespective of disease stage (AJCC/UICC 8th edition), nodal status, tumor size, or other surgical characteristics. Alectinib is the first ALK inhibitor to show a consistent DFS benefit over chemotherapy in patients with resected early-stage ALK-positive NSCLC, regardless of disease stage per AJCC/UICC 7th or 8th edition, nodal status, or tumor size. NCT03456076.

Age-related real-world treatment patterns and outcomes of localised, high-grade osteosarcoma.

Pancreatic cancer entails poor prognosis and high physical and psychosocial burden for patients and their caregivers. Supportive care needs remain insufficiently addressed. This study aimed to identify supportive care needs and potential directions for future research based on perspectives of patients, caregivers, and healthcare professionals. A qualitative design was applied using focus group interviews. Participants were patients with pancreatic cancer receiving chemotherapy ((neo)adjuvant and palliative), caregivers, and HCPs (oncologists, nurses, physiotherapists, and dieticians). Six focus group interviews were conducted, audio-recorded, transcribed, and analyzed. Identified themes were categorized, described and translated into potential research questions. Nine patients, eight caregivers, and eight health care professionals participated. Twenty-one themes were identified, organized, and consolidated into 10 themes representing patient and caregiver needs. These included: 1) Nutritional guidance beyond generic advice, 2) Information and guidance for self-management of side effects, 3) Supporting caregivers' self-care, 4) Clear information on treatment trajectory and prognosis, 5) Peer support and network, 6) Support for exercise, 7) Existential support, 8) Support and facilitation of family communication, 9) Navigating the treatment trajectory, and 10) Supporting energy management. These themes informed the development of exploratory and interventional research questions intended to guide future supportive care research. The findings highlight a broad range of supportive care needs among patients with pancreatic cancer and their caregivers. While exploratory in nature, the study identifies potential areas for future research and underscores the importance of addressing caregiver burden and family communication within supportive care interventions.

Adjuvant radiotherapy lowers regional recurrence in breast cancer but may cause arm symptoms. We compared photon (XRT) and proton therapy (PT) doses to eight shoulder structures, including seven muscles and the axillary-lateral thoracic junction (ALTJ). We consecutively included all patients treated with PT in our centre for whom paired XRT-PT plans (2019-2024) were available. Eight shoulder structures were autodelineated with manual correction of the ALTJ region. For each parameter, medians (Q1-Q3) were calculated, and paired differences were defined as Δᵢ = XRTᵢ - PTᵢ and summarized by the median of Δᵢ for subject i; Statistical inference used the Wilcoxon signed-rank test with Hodges-Lehmann estimates (95% confidence intervals). Multiple comparisons were adjusted using the Benjamini-Hochberg procedure. Exploratory subgroup analyses were stratified by Regional nodal irradiation (RNI) levels. Analyses were performed in R (version 4.5.2). In 128 paired plans, XRT delivered significantly higher doses than PT to all shoulder muscles. For the five key muscles, XRT delivered 10.0-21.1Gy higher Dmean and 29.6-64.6% higher V15Gy, indicating a high advantage for PT. A significant moderate advantage was observed for the latissimus dorsi, with minimal yet significant for the trapezius and ALTJ. Subgroup analyses further showed that XRT delivered significantly higher doses than PT to the five key muscles in patients receiving RNI at levels III-IV or I-IV. PT offers substantial dosimetric advantages for five shoulder muscles compared with XRT. The clinical relevance of these dosimetric differences requires further study.

Osteoradionecrosis (ORN) incidence after head and neck cancer (HNC) directed radiation therapy has recently been reported to be 1%-40%. The objective of this study is to establish contemporary incidence of ORN for patients treated with IMRT exclusively for oral cavity squamous cell carcinoma (OCSCC). This study is a retrospective chart review of 172 patients treated for OCSCC at a single institution from 2013 to 2022. All patients received adjuvant radiation with or without chemotherapy. Patient charts were reviewed to identify ORN. ORN was defined as exposure of bone with radiographic findings and/or physical exam findings. Data collected including age, gender, smoking status, AJCC 8th edition stage, mandibulectomy or maxillectomy as part of surgery, hospitalization in between surgery and RT, and concurrent chemotherapy. Mean follow up for the entire cohort was 46.1 months. The incidence of ORN in our cohort of patients was 24% at 3 years. 51.5% of patients underwent mandibulectomy or maxillectomy prior to radiation. 28.4% of patients with mandibulectomy or maxillectomy developed ORN. 18.1% of the patients treated without mandibulectomy or maxillectomy went on to develop ORN. Hazard ratio for development of ORN when patients underwent mandibulectomy or maxillectomy was 1.93. ORN development is higher in oral cavity SCC when compared to published ORN rates in mixed HNC cohorts. Mandibulectomy and/or maxillectomy as part of surgical treatment for OCSCC increases risk for ORN development. Level 3.