Oncology Cases Research Articles

Robotics and 3D modeling for precision surgery in pediatric oncology

In an attempt to minimize surgical trauma in already vulnerable patients, pediatric surgeons are increasingly using minimally invasive surgery in surgical oncology, with similar outcomes as open surgery. In addition to its technical benefits, robotic surgery allows integration of technological enhancements, such as artificial-intelligence-based software or tri-dimensional (3D) modeling, into the operating room. In this article, we report our experience in robotic-assisted surgery for the resection of pediatric tumors and present current developments in 3D modeling applied to pelvic tumors. Since 2016, 149 oncology cases have been undertaken using the robotic approach. Neuroblastic tumors account for the most part, with a median hospital stay of two days [1–7 days] and very few intraoperative events. The use of robotics was mainly extended to renal tumors (predominantly Wilms tumors) and endocrine tumors, but was found of particular interest for pelvic tumors. Our experience led us to publish a first set of guidelines on robotic surgical oncology, focusing on its apparent contraindications. 3D models derived from preoperative magnetic resonance imaging have been developed for more than 150 patients with solid tumors, but the pelvic area was made a key focus because of its anatomical complexity. In addition to their educational benefits, some of these 3D models were integrated into the robotic console as a surgical aid and proved invaluable for difficult dissections or nerve plexus preservation. As evidenced by the development of robotics and 3D modeling, pediatric oncology is leaning toward ultra-precise surgical resection tailored to the patient and the tumor.

P-546 Do patients undergoing PGT-M benefit from the Duostim protocol?

Abstract Study question Do patients undergoing PGT-M benefit from the Duostim protocol? Summary answer PGT-M patients benefit because luteal phase stimulation is as effective as follicular phase stimulation in generating transferable embryos, thereby increasing the chances of treatment success. What is known already Patients undergoing PGT-M often require a larger number of embryos for pregnancy, with 25-50% deemed ineligible for transfer based on the disease indication (recessive, dominant, or sex-linked). DuoStim emerges as a valuable strategy for improving outcomes in poor responders. Progress in blastocyst culture, genetic testing, and vitrification motivates clinicians to optimize ovarian reserve exploitation through tailored stimulation protocols. Luteal Phase Stimulation (LPS) finds success in poor prognosis or oncological cases within DuoStim, a protocol widely used for poor prognosis patients necessitating both Follicular Phase Stimulation (FPS) and LPS. The potential benefits of DuoStim for PGT-M patients remain unexplored. Study design, size, duration Retrospective controlled case-control study conducted with paired FPS- and LPS-derived cohorts of oocytes collected in the same ovarian cycle (DuoStim). The study included 26 patients aged 36.53 ± 4,59 years old, undergoing DuoStim with the indication of PGT-M between July 2022 and October 2023. Participants/materials, setting, methods FPS and LPS were performed using the same daily dose of recombinant gonadotropins in an antagonist protocol. All zygotes underwent blastocyst culture, trophectoderm biopsy, vitrification, and subsequent thawing of one unaffected euploid blastocyst for transfer. The primary outcome was the mean number of transferable blastocysts (not affected euploid ones) obtained per oocyte retrieval from paired FPS- and LPS-derived cohorts. Secondary outcomes included the mean number of oocytes, blastocysts and implantation and pregnancy rates. Main results and the role of chance FPS and LPS were comparable regarding the mean number of mature oocytes collected (7.73 ± 4.27 vs. 7.57 ± 4.56) and the mean number of blastocysts obtained (3.27 ± 2.40 vs. 2.50 ± 1.98). The mean number of transferable blastocysts per retrieval were similar (FPS: 1.21 ± 1.31 vs. LPS: 0.78 ± 0.91). No significant differences in implantation or ongoing pregnancy rates were observed after transfers of euploid single blastocysts derived from FPS or LPS: 70.0% (7/10) vs. 57.14% (4/7). Three patients out of the 26 (11.54%) had transferable embryos only in the luteal phase. Limitations, reasons for caution Our findings warrant additional assessment through studies involving larger sample sizes. While our preliminary data indicate comparable implantation/pregnancy rates for PGT-M blastocysts from both FPS and LPS, further investigation is essential, especially in populations beyond those with a reduced number of usable blastocysts Wider implications of the findings These data underscore that oocytes obtained from LPS are as competent as those derived from FPS. Patients with unaffected euploid embryos solely due to FLS would not have had any transfer without DuoStim. This protocol could be advantageous for women abroad or with time constraints, potentially reducing dropout rates. Trial registration number Not applicable

Comparative Outcomes and Failure Rates of Total Femur Replacement in Oncologic and Nononcologic Indications: A Systematic Review and Meta-analysis.

Total femur replacement (TFR) has become increasingly significant as a salvage procedure for both oncologic reconstruction and complex nononcologic conditions such as revision arthroplasty. Despite its effectiveness in limb salvage, TFR is associated with high complication and failure rates, which vary depending on the underlying indication. This systematic review and meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of MEDLINE, EMBASE, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases was conducted, focusing on studies that reported outcomes of TFR in oncologic and nononcologic cases. Primary outcomes included failure mode and rates according to the Henderson classification, functional outcomes scores, and mobility status. Data were analyzed using random-effects models and generalized linear mixed models. A total of 35 studies involving 1,002 patients were included. The majority of TFRs were performed for oncologic reasons (63.7%). The mean Musculoskeletal Tumor Society (MSTS) score was 66%, with a limb salvage rate of 89%. The meta-analysis revealed a combined failure rate of 34%. For type 4 failures (infection), nononcologic patients exhibited a significantly higher rate at 18% (95% confidence interval [CI], 12%-26%, I2 = 46%, p < 0.01) compared with 8% in oncologic patients (95% CI, 6%-12%, I2 = 0%). Regarding combined types 1 to 4 failures, oncologic patients had a rate of 20% (95% CI, 25%-52%, I2 = 60%), whereas nononcologic patients faced a higher rate of 37% (95% CI, 12%-26%, I2 = 63%) (p < 0.05), indicating a significant difference. There were no significant differences in the MSTS score. In addition, there were no notable differences when comparing failure modes 1, 2, and 3 independently. Mobility analysis showed that approximately 70% of patients required walking aids after surgery. TFR offers a valuable limb salvage option in both oncologic and nononcologic scenarios, despite its high failure rates. Although functional outcomes were similar between groups, the higher failure rate in nononcologic cases and the poor overall quality of evidence warrant further comprehensive assessments into predictors of outcomes to optimize results. Level III. See Instructions for Authors for a complete description of levels of evidence.

Application of Time-Driven Activity-Based Costing for Head and Neck Microvascular Free Flap Reconstruction.

Traditional hospital accounting fails to provide an accurate cost of complex surgical care. Here we describe the application of time-driven activity-based costing (TDABC) to characterize costs of head and neck oncologic procedures involving free tissue transfer. Retrospective cohort study. Single tertiary academic medical center. An analysis of head and neck oncologic procedures involving microvascular free flap reconstruction from 2018 to 2020 (n = 485) was performed using TDABC methodology to measure cost across operative case and postoperative admission, using quantity of time and cost per unit of each resource to characterize resource utilization. Univariate and generalized linear mixed models were used to examine associations between patient and hospital characteristics and cost of care delivery. The total cost of care delivery was $41,905.77 ± 21,870.27 with operating room (OR) supplies accounting for only 10% of the total cost. Multivariable analyses identified significant cost drivers including operative time, postoperative length of stay, number of return trips to the OR, postoperative complication, number of free flaps performed, and patient transfer from another hospital or via emergency department admission (P < .05). Operative time and postoperative length of stay, but not operative supplies, were primary drivers of cost of care for head and neck oncology cases involving free tissue transfer. TDABC offers granular cost characterization to inform cost optimization through unused capacity identification and postoperative admission efficiencies.

Understanding Preventive Health Behavior: A Mixed-Methods Study to Explore Factors Influencing the Practice of Breast Self-Examination Among Indian Medical Students.

Breast cancer (BC) is among the most prevalent oncological cases in the world, and the global burden of the disease is expected to rise further in the coming years. Strategies aiming at early diagnosis, backed by research and a well-trained healthcare cadre, can aid low- and middle-income countries (LMIC) in tackling the possible cancer-caused strain on healthcare systems. Our study aimed to evaluate the level of knowledge of medical students concerning BC and explore barriers and facilitators of breast self-examination (BSE). A sequential explanatory mixed-methods study approach to better understand factors and beliefs influencing preventive health practice in BSE was conducted among students at a medical college in rural Maharashtra, India. One hundred and two female medical students completed the quantitative phase, and 15 of them gave in-depth interviews (IDIs) for the qualitative aspect. Among the participants, 67.6% had good knowledge of risk factors, but only 10% knew the recommendations for BSE, clinical breast examination (CBE), and mammography. We found that being taught BSE by a trusted source and knowing a BC patient were significant facilitators. In contrast, lack of self-efficacy and two fear factors were found tobe acting as barriers for BSE, one being the absence of fear of ever getting BC and the other fear of detecting a lump. This study reveals a gap between knowledge of risk factors and their translation to disease prevention practice. The barriers elicited are modifiable by planning and implementing an appropriate training program covering risk factors and recommending all available screening and preventative modalities. A well-trained medical staff will be instrumental in improving the health status of our community and country.

Patient care and access to clinical trials in gynaecological oncology: global implications of the early phase of the COVID-19 pandemic

PurposeOur prospective international survey evaluated the impact of the early phase of the COVID-19 pandemic on the management gynaecological malignancies from the multidisciplinary physicians’ perspective with particular focus on clinical infrastructures and trial participation.MethodsOur survey consisted of 53 COVID-related questions. It was sent to healthcare professionals in gynaecological oncology centres across Europe and Pan-Arabian region via the study groups and gynaecological societies from April 2020 to October 2020. All healthcare professionals treating gynaecological cancers were able to participate in our survey.ResultsA total of 255 answers were collected from 30 countries. The majority (73%) of participants were gynaecological oncologists from university hospitals (71%) with at least an Intensive Care Unit with cardiopulmonary support available at their institutions. Most institutions continued to perform elective surgeries only for oncological cases (98%). Patients had to wait on average 2 weeks longer for their surgery appointments compared to previous years (range 0–12 weeks). Most cases that were prioritised for surgical intervention across all gynaecological tumours were early-stage disease (74%), primary situation (61%) and good ECOG status (63%). The radicality of surgery did not change in the majority of cases (78%) across all tumour types. During the pandemic, only 38% of clinicians stated they would start a new clinical trial. Almost half of the participants stated the pandemic negatively impacted the financial structure and support for clinical trials. Approximately 20% of clinicians did not feel well-informed regarding clinical algorithm for COVID-19 patients throughout the pandemic. Thirty percent stated that they are currently having trouble in providing adequate medical care due to staff shortage.ConclusionDespite well-established guidelines, pandemic clearly affected clinical research and patientcare. Our survey underlines the necessity for building robust emergency algorithms tailored to gynaecological oncology to minimise negative impact in crises and to preserve access to clinical trials.

The Health Arab Tourists’ Satisfaction Level of Services Provided: A Cross-sectional Study in Bangalore-Cross Sectional Study

Introduction: An indication of the quality of medical treatment is how satisfied patients are with the services received. Patient satisfaction is determined by how well they feel their care met their expectations. This survey was conducted in 2023 to assess how satisfied health tourists were with the services received from Bangalore Multispecialty hospitals. Method: It is a cross-sectional study was conducted from 21-3–2023 to 26-1-2023 at Multispecialty Hospital in Bangalore. : In this a cross-sectional study, 400 253 (63.2%) men and 147 (36.8%) women, the data collection instrument is a semi-structured questionnaire in this study. The respondents of this study are Arab tourists who received inpatient and outpatient services at least one day at hospitals. The hospitals were selected purposively but the potential respondents were chosen conveniently. These procedures ensure the researchers access a sufficient number of potential respondents from the hospitals for this study. Researchers of this study approached the respondents and requested they participate in this survey. The researchers informed participants that the information would be utilized only for research purposes and their support was anonymous and voluntary. The questionnaire has 56 general and specific items. Each of the specific items is scaled on five points; Very Good, Good, Moderate, Poor and very poor. In order to analyze the data both descriptive and inferential statistics were used Patient satisfaction and surgical outcomes were the main outcome measures. Results: 400 participants were included in the study (63.2% male and 36.85% Female). 79 of the surgeries were Neurosurgeries cases (19.8%) compared to 75 Oncology cases (18.8%). Regarding patient satisfaction, 96.8% of the patients regarding the quality of care. 66 % were satisfied with the hospital privacy and confidentiality measures. Conclusion: All of the Analyzed domains had excellent patient satisfaction rates, little problems, and successful surgical results in general. There is few things make patients unsatisfied like the waiting time for consultation so long, the method of payment in some hospital that there is limitation for cash payment ,and the language barrier the important factor play the major role.

Reliability of large language models for advanced head and neck malignancies management: a comparison between ChatGPT 4 and Gemini Advanced

PurposeThis study evaluates the efficacy of two advanced Large Language Models (LLMs), OpenAI’s ChatGPT 4 and Google’s Gemini Advanced, in providing treatment recommendations for head and neck oncology cases. The aim is to assess their utility in supporting multidisciplinary oncological evaluations and decision-making processes.MethodsThis comparative analysis examined the responses of ChatGPT 4 and Gemini Advanced to five hypothetical cases of head and neck cancer, each representing a different anatomical subsite. The responses were evaluated against the latest National Comprehensive Cancer Network (NCCN) guidelines by two blinded panels using the total disagreement score (TDS) and the artificial intelligence performance instrument (AIPI). Statistical assessments were performed using the Wilcoxon signed-rank test and the Friedman test.ResultsBoth LLMs produced relevant treatment recommendations with ChatGPT 4 generally outperforming Gemini Advanced regarding adherence to guidelines and comprehensive treatment planning. ChatGPT 4 showed higher AIPI scores (median 3 [2–4]) compared to Gemini Advanced (median 2 [2–3]), indicating better overall performance. Notably, inconsistencies were observed in the management of induction chemotherapy and surgical decisions, such as neck dissection.ConclusionsWhile both LLMs demonstrated the potential to aid in the multidisciplinary management of head and neck oncology, discrepancies in certain critical areas highlight the need for further refinement. The study supports the growing role of AI in enhancing clinical decision-making but also emphasizes the necessity for continuous updates and validation against current clinical standards to integrate AI into healthcare practices fully.

A Semi-Automated Solution Approach Recommender for a Given Use Case: a Case Study for AI/ML in Oncology via Scopus and OpenAI

Nowadays, literature review is a necessary task when trying to solve a given problem. However, an exhaustive literature review is very time-consuming in today’s vast literature landscape. It can take weeks, even if looking only for abstracts or surveys. Moreover, choosing a method among others, and targeting searches within relevant problem and solution domains, are not easy tasks. These are especially true for young researchers or engineers starting to work in their field. Even if surveys that provide methods used to solve a specific problem already exist, an automatic way to do it for any use case is missing, especially for those who don’t know the existing literature. Our proposed tool, SARBOLD-LLM, allows discovering and choosing among methods related to a given problem, providing additional information about their uses in the literature to derive decision-making insights, in only a few hours. The SARBOLD-LLM comprises three modules: (1: Scopus search) paper selection using a keyword selection scheme to query Scopus API; (2: Scoring and method extraction) relevancy and popularity scores calculation and solution method extraction in papers utilizing OpenAI API (GPT 3.5); (3: Analyzes) sensitivity analysis and post-analyzes which reveals trends, relevant papers and methods. Comparing the SARBOLD-LLM to manual ground truth using precision, recall, and F1-score metrics, the performance results of AI in the oncology case study are 0.68, 0.9, and 0.77, respectively. SARBOLD-LLM demonstrates successful outcomes across various domains, showcasing its robustness and effectiveness. The SARBOLD-LLM addresses engineers more than researchers, as it proposes methods and trends without adding pros and cons. It is a useful tool to select which methods to investigate first and comes as a complement to surveys. This can limit the global search and accumulation of knowledge for the end user. However, it can be used as a director or recommender for future implementation to solve a problem.

Assessment of socioeconomic and racial differences in patients undergoing concurrent gynecologic oncology and urogynecology surgeries: a National Inpatient Sample (NIS) database study

ObjectiveTo assess social determinants of health impacting patients undergoing gynecologic oncology versus combined gynecologic oncology and urogynecology surgeries.MethodsWe identified patients who underwent gynecologic oncology surgeries from 2016 to 2019 in...

Biomechanical evaluation of a custom-made mandibular plate

In the field of maxillofacial surgery, mandibular reconstruction with plates is one of the operations that is performed when resection of part of the jaw is unavoidable in patients suffering from pathologies such as, for example, neoplasms and osteonecrosis. Through the use of standard prostheses, which are commercially available in various models, mandibular reconstruction is possible. However, in the presence of particularly serious and complex clinical pictures, in which it is necessary to resect large parts of the mandibular bone, such as in some oncological cases, the use of serial prostheses is not always resolving. In these cases, a customized implant, designed specifically for the patient, is preferable.Aim of this work is the mechanical evaluation of a custom-made mandibular plate with an innovative bone-implant interface geometry through a finite element analysis. Three physiological loading conditions were analysed: RUC (right unilateral canine) bite, RGF (right group functional) bite and maximum opening. Finally, the maximum pull-out force acting on the fixation screws was evaluated through an experimental fatigue test.

From standard therapies to monoclonal antibodies and immune checkpoint inhibitors - an update for reconstructive surgeons on common oncological cases.

Malignancies represent a persisting worldwide health burden. Tumor treatment is commonly based on surgical and/or non-surgical therapies. In the recent decade, novel non-surgical treatment strategies involving monoclonal antibodies (mAB) and immune checkpoint inhibitors (ICI) have been successfully incorporated into standard treatment algorithms. Such emerging therapy concepts have demonstrated improved complete remission rates and prolonged progression-free survival compared to conventional chemotherapies. However, the in-toto surgical tumor resection followed by reconstructive surgery oftentimes remains the only curative therapy. Breast cancer (BC), skin cancer (SC), head and neck cancer (HNC), and sarcoma amongst other cancer entities commonly require reconstructive surgery to restore form, aesthetics, and functionality. Understanding the basic principles, strengths, and limitations of mAB and ICI as (neo-) adjuvant therapies and treatment alternatives for resectable or unresectable tumors is paramount for optimized surgical therapy planning. Yet, there is a scarcity of studies that condense the current body of literature on mAB and ICI for BC, SC, HNC, and sarcoma. This knowledge gap may result in suboptimal treatment planning, ultimately impairing patient outcomes. Herein, we aim to summarize the current translational endeavors focusing on mAB and ICI. This line of research may serve as an evidence-based fundament to guide targeted therapy and optimize interdisciplinary anti-cancer strategies.

Uncommon using of the pulmonary homograft in oncological case - three years follow up

IntroductionThere are enough cases of colorectal cancer with liver metastasis, but inferior vena cava infiltraion with dissemination to the right atrium is an infrequent event.Presentation of caseThis is the first case of surgical treatment of recurrent liver metastasis with the infiltration to the inferior vena cava and to the right atrium of the heart, using a cryopreserved pulmonary homograft.DiscussionThe choice of a cryopreserved pulmonary homograft was preferred by the need for a radical and wide resection of tissues involved in the metastasis, as well as to potentially reduce the risk of thrombosis in the short- and long-term postoperative period.ConclusionThe use of a cryopreserved homograft in operation undergoing cardiopulmonary bypass allowed us to perform the required volume of radical resection and to replace an extended section of the inferior vena cava.

Massive renal pelvis urothelial carcinoma with invasion of the descending colon and cutaneous metastases: A case report and literature review

Introduction: Skin metastases and gastrointestinal tract involvement in upper tract urothelial carcinoma (UTUC) are uncommon and associated with an adverse prognosis. This report details a case of extensive urothelial carcinoma originating from the renal pelvis, invading the descending colon, and presenting with cutaneous metastases. Case Report: A 63-year-old male patient visited the emergency department on the account of sudden onset of severe left upper abdominal pain and nausea. The computed tomography (CT) revealed soft tissue density at the mesentery adjacent to the left kidney with the involvement of the distal transverse colon. The patient underwent left radical nephroureterectomy, left hemicolectomy, and bladder cuff excision. Six weeks postoperatively, left inguinal cutaneous metastases, approximately 4 cm, were excised. Due to renal dysfunction, the patient received gemcitabine and carboplatin chemotherapy, followed by pembrolizumab for the cutaneous metastatic disease. Follow-up imaging showed no evidence of recurrence or metastasis 15 months postoperatively. Conclusion: In cases of advanced UTUC, a multidisciplinary approach combining surgical intervention, chemotherapy, and immunotherapy can alleviate symptoms and potentially improve survival rates. This integrative treatment strategy highlights the importance of a multidisciplinary approach in managing complex oncological cases.

A System for Mixed-Reality Holographic Overlays of Real-Time Rendered 3D-Reconstructed Imaging Using a Video Pass-through Head-Mounted Display-A Pathway to Future Navigation in Chest Wall Surgery.

Background: Three-dimensional reconstructions of state-of-the-art high-resolution imaging are progressively being used more for preprocedural assessment in thoracic surgery. It is a promising tool that aims to improve patient-specific treatment planning, for example, for minimally invasive or robotic-assisted lung resections. Increasingly available mixed-reality hardware based on video pass-through technology enables the projection of image data as a hologram onto the patient. We describe the novel method of real-time 3D surgical planning in a mixed-reality setting by presenting three representative cases utilizing volume rendering. Materials: A mixed-reality system was set up using a high-performance workstation running a video pass-through-based head-mounted display. Image data from computer tomography were imported and volume-rendered in real-time to be customized through live editing. The image-based hologram was projected onto the patient, highlighting the regions of interest. Results: Three oncological cases were selected to explore the potentials of the mixed-reality system. Two of them presented large tumor masses in the thoracic cavity, while a third case presented an unclear lesion of the chest wall. We aligned real-time rendered 3D holographic image data onto the patient allowing us to investigate the relationship between anatomical structures and their respective body position. Conclusions: The exploration of holographic overlay has proven to be promising in improving preprocedural surgical planning, particularly for complex oncological tasks in the thoracic surgical field. Further studies on outcome-related surgical planning and navigation should therefore be conducted. Ongoing technological progress of extended reality hardware and intelligent software features will most likely enhance applicability and the range of use in surgical fields within the near future.

Mixed Reality as a Digital Visualisation Solution for the Head and Neck Tumour Board: Application Creation and Implementation Study.

The preparation and implementation of interdisciplinary oncological case reviews are time-consuming and complex. The variety of clinical and radiological information must be presented in a clear and comprehensible manner. Only if all relevant patient-specific information is demonstrated in a short time frame can well-founded treatment decisions be made on this basis. Mixed reality (MR) technology as a multimodal interactive user interface could enhance understanding in multidisciplinary collaboration by visualising radiological or clinical data. The aim of the work was to develop an MR-based software prototype for a head and neck tumour board (HNTB) to support clinical decision-making. The article describes the development phases and workflows in the planning and creation of a MR-based software prototype that were required to meet the multidisciplinary characteristics of a HNTB.

Abstract 1771: NYU Langone Genome PACT - Genome Profiling of Actionable Cancer Targets (LG-PACT) for clinical patient molecular diagnostics and treatment

Abstract Next-generation sequencing (NGS) for the detection of somatic variants has become the tool of choice in a variety of molecular oncology fields and in the clinic. Its use ranges from sequencing entire tumor genomes and transcriptomes to targeted clinical diagnostic gene panels. The NYU Langone Genome PACT assay is a qualitative in vitro diagnostic test that uses targeted next generation sequencing of formalin-fixed paraffin-embedded (FFPE) tumor tissue matched with normal specimens from patients to detect gene alterations in a 607-gene panel. Indications for testing are cancer (solid tumors or hematological malignancies) where a mutational profile from multiple genes would be informative for disease stratification, prognosis, or treatment options including targeted therapies and eligibility for clinical trials. The test is intended to provide information on somatic mutations including point mutations, copy number aberrations, and small insertions/deletions (indels) for diagnostic and treatment decisions. LG-PACT is a United States Food and Drug Administration (FDA) approved diagnostic test. The clinical interpretation of sequencing data of molecular tumor markers from NGS encompasses automated variant calling tools with human interpretation. The final mostly manual review of data is intensive, involving highly trained scientists, encompassing literature review, interpretation and tier classification by pathologists, who then provide a complete molecular diagnostic report to the treating oncologists. Since January 2022 to present (October 2023) we have provided clinical genomic reports for 1029 oncological cases from 124 different cancers and their subtypes, including Brain (489 cases incl. meningioma, glioma and glioblastoma), Gastrointestinal (123), Lung (114), among others. We first present the technical challenges of validating an NGS oncological diagnostic targeted assay for appropriate clinical grade accuracy and sensitivity acceptable for patient care. We show how copy number alterations provide a more comprehensive description of the tumors genomic profile. We then outline the actionability of targeted panel sequencing for our current patient cohort. Where analysis of variant detection has led to 47% (490) of our clinical tumor samples containing known tier 1 therapeutic variants. We conclude with presenting case studies that identify both the clinical utility and informatic challenges of variant calling specific to gene panel sequencing e.g., i) the capture of potential targetable rare and novel indels and multivariant mutations in exons 19 and 20 of EGFR, and ii) a unique KIT tandem duplication event in a gastrointestinal stromal tumor (GIST). We demonstrate the value in precision oncology for multiple cancer types and how the capture of unique variants can provide better targeted treatment options to cancer patients. Citation Format: Varshini Vasudevaraja, Yiying Yang, Jonathan Serrano, Kazimierz Wrzeszczynski, Matija Snuderl. NYU Langone Genome PACT - Genome Profiling of Actionable Cancer Targets (LG-PACT) for clinical patient molecular diagnostics and treatment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1771.

Topical Application of Vancomycin Powder to Prevent Infections after Massive Bone Resection and the implantation of Megaprostheses in Orthopaedic Oncology Surgery.

Periprosthetic joint infection (PJI) represents a serious burden in orthopaedic oncology. Through the years, several local expedients have been proposed to minimise the risk of periprosthetic infection. In this study, we report our outcomes using topical vancomycin powder (VP) with the aim to prevent PJIs. Fifty oncological cases treated with massive bone resection and the implant of a megaprosthesis were included in our study. Among them, 22 [(GGroup A) received one gram of vancomycin powder on the surface of the implant and another gram on the surface of the muscular fascia]. The remaining 28 did not receive such a treatment (Group B). The rest of surgical procedures and the follow-up were the same for the two groups. Patients underwent periodical outpatient visits, radiographs and blood exams' evaluations. Diagnosis of PJIs and adverse reactions to topical vancomycin were recorded. None of the cases treated with topical vancomycin developed infections, whereas 6 of the 28 cases (21.4%) who did not receive the powder suffered from PJIs. These outcomes suggest that cases treated with VP had a significantly lower risk of post-operative PJI (p=0.028). None of our cases developed acute kidney failures or any other complication directly or indirectly attributable to the local administration of VP. The topical use of vancomycin powder on megaprosthetic surfaces and the overlying fascias, alongside with a correct endovenous antibiotic prophylaxis, can represent a promising approach in order to minimise the risk of periprosthetic infections in orthopaedic oncology surgery.

Assessment of the Surgical Oncology Case Volume Within the Public Sector in Tanzania.

Surgery provides vital services to diagnose, treat, and palliate patients suffering from malignancies. However, despite its importance, there is little information on the delivery of surgical oncology services in Tanzania. Operative logbooks were reviewed at all national referral hospitals that offer surgery, all zonal referral hospitals in Mainland Tanganyika and Zanzibar, and a convenience sampling of regional referral hospitals in 2022. Cancer cases were identified by postoperative diagnosis and deidentified data were abstracted for each cancer surgery. The proportion of the procedures conducted for patients with cancer and the total number of cancer surgeries done within the public sector were calculated and compared with a previously published estimate of the surgical oncology need for the country. In total, 69,195 operations were reviewed at 10 hospitals, including two national referral hospitals, five zonal referral hospitals, and three regional referral hospitals. Of the cases reviewed, 4,248 (6.1%) were for the treatment of cancer. We estimate that 4,938 cancer surgeries occurred in the public sector in Tanzania accounting for operations conducted at hospitals not included in our study. Prostate, breast, head and neck, esophageal, and bladder cancers were the five most common diagnoses. Although 387 (83%) of all breast cancer procedures were done with curative intent, 506 (87%) of patients with prostate and 273 (81%) of patients with esophageal cancer underwent palliative surgery. In this comprehensive assessment of surgical oncology service delivery in Tanzania, we identified 4,248 cancer surgeries and estimate that 4,938 likely occurred in 2022. This represents only 25% of the estimated 19,726 cancer surgeries that are annually needed in Tanzania. These results highlight the need to identify strategies for increasing surgical oncology capacity in the country.

Vitamin D Deficiency in Pediatric Oncology Patients: A Single-Center Experience in Saudi Arabia.

Background There is a lack of local studies on vitamin D deficiency in children with cancer. This study aims to estimate the prevalence of vitamin D deficiency in the pediatric oncology population at King Abdul-Aziz Medical City (KAMC) in Jeddah, addressing knowledge gaps for improved clinical practice and future research. Methods This retrospective observational studywas conducted from 2016 to 2021 at the pediatric oncology clinic in National Guard Hospital, Jeddah. The study focused on children aged 14 or younger at cancer diagnosis, data encompassed patient demographics, cancer details, and treatment information, including serum measurements of vitamin D (25(OH)D, calcium, phosphate, alkaline phosphatase). Vitamin D levels were categorized as deficient (<25 ng/ml), insufficient (25-49 ng/ml), sufficient (≥50- 125 ng/ml), or hypervitaminosis (>125 ng/ml), based on our center reference range and the validation of the assay. Results In this retrospective study of 155 pediatric oncology patients, the majority aged 0 to 10 years (78%), findings reveal a male preponderance (54.2%) and a more prevalent in patients with hematological malignancies (85%). Chemotherapy was administered to 98%, with 7% underwent radiotherapy, and 89% received steroids. Analysis of serum 25-OH vitamin D levels indicated an overall deficiency and insufficiency at diagnosis (63%) and post-therapy (43%). Age and gender had a significant influence on vitamin D levels at diagnosis, with older children and females exhibiting lower concentrations. However, these differences diminished by the end of therapy. Notably, hematological malignancy patients often presented insufficient vitamin D levels, while solid tumor patients frequently had sufficient levels. Clinical outcomes showed a high survival rate (90.7%), limited bone density assessments (18.1%), and a 14.2% prevalence of hypervitaminosis. Conclusion In summary, our study reveals that over two-thirds of pediatric oncology patients experience vitamin D deficiency and insufficiency at the time of diagnosis, particularly notable in females and older children. Notably, those with solid tumors exhibit higher baseline 25-OH vitamin D concentrations compared to counterparts with hematological malignancies. The findings underscore the importance of educating both patients and caregivers on supplementation and sun exposure to mitigate the prevalence of deficient and insufficient vitamin D levels in pediatric oncology cases.