Clinical Oncology Research Articles

Bibliometric analysis of global research trends and prospects on circulating tumor DNA in colorectal cancer

BackgroundColorectal cancer (CRC) is one of the most commonly diagnosed advanced-stage malignancies worldwide and places a substantial burden on both the economic and social development of numerous countries.ObjectiveThis manuscript aims to synthesize the existing evidence and explore potential avenues for future scholarly research on ctDNA in CRC.MethodsBibliometric analyses were performed using the bibliometrix package in R, along with CiteSpace and VOSviewer software. The search was restricted to publications up to 31 March 2024, using the following terms: (“ctDNA” OR “circulating tumor DNA”) AND (“colorectal cancer” OR “colorectal tumor”) from the Web of Science Core Collection (WoSCC) database.ResultsUltimately, we identified 1,310 documents published in 353 journals authored by 7,683 researchers from 2,417 institutions across 66 countries. The USA was the most productive country. The Journal of Clinical Oncology was the most prolific, publishing 111 articles with 3,396 citations. The top five keywords were “colorectal cancer,” “circulating tumor DNA,” “acquired resistance,” “cell-free DNA,” and “plasma.” The top five cluster labels for references were “advanced cancer,” “metastatic colorectal cancer,” “liquid biopsy,” “colorectal cancer,” and “human colorectal cancer xenograft.”ConclusionsThe collaborative networks are primarily composed of highly productive authors, prestigious institutions, and leading countries. Additionally, the advancement of detection technologies, the development of standardized protocols, the exploration of circulating tumor DNA (ctDNA) dynamics in CRC, and the implementation of large-scale clinical trials for ctDNA-guided precision therapy in CRC are expected to become major research priorities in the future.

Advanced 2D Nanomaterials for Phototheranostics of Breast Cancer: A Paradigm Shift.

Breast cancer is the leading cause of women's deaths and associated comorbidities. The advanced and targeted strategies against breast cancer have gained considerable attention due to their potential enhanced therapeutic efficacy over conventional therapies. In this context, phototherapies like photodynamic therapy (PDT) and photothermal therapy (PTT) have shown promise as an effective and alternative strategy due to reduced side effects, noninvasiveness, and spatiotemporal specificity. With the advent of nanotechnology, several types of nanomaterials that have shown excellent prospects in increasing the efficacy of photo therapies have been exploited in cancer treatment. In recent years, 2D nanomaterials have stood out promising because of their unique ultrathin planar structure, chemical, physical, tunable characteristics, and corresponding remarkable physiochemical/biological properties. In this review, the potential and the current status of several types of 2D nanomaterials such as graphene-based nanomaterials, Mxenes, Black phosphorous, and Transition Metal Dichalcogenides for photo/thermo and combination-based imaging and therapy of breast cancer have been discussed. The current challenges and prospects in terms of translational potential in future clinical oncology are highlighted.

Immune checkpoint inhibitor therapy as a neoadjuvant treatment for muscle-invasive bladder carcinoma

Abstract Background and objectives Immunotherapy has become a standard treatment for patients with advanced urothelial carcinoma, and neoadjuvant immunotherapy is being extensively explored. This review highlights the initial findings and key clinical therapeutic insights on immune checkpoint inhibitors in the early treatment of muscle-invasive bladder cancer across diverse patient populations. Materials and methods Relevant trials were retrieved from PubMed/MEDLINE and clinical trials databases. In addition, abstracts of major international oncology meetings (American Society of Clinical Oncology, American Association for Cancer Research, European Society of Medical Oncology, and European Council of Clinical Oncology) were reviewed until the European Society of Medical Oncology 2023 congress. The review also incorporated results from several exploratory investigations disclosed in recent years. Results This review focused on neoadjuvant immune checkpoint inhibitor monotherapy, combination therapy, and clinical biomarkers in relation to cisplatin-based chemotherapy tolerance. Most available literature consists of clinical investigations involving small sample, single-arm Phase II trials, with the primary endpoint being the pathologic complete response rate. The preliminary results from these studies are promising, demonstrating stage reduction rates comparable to or even exceeding those of standard chemotherapy, without compromising subsequent radical cystectomy. Conclusions Early results of immune checkpoint inhibitors in the neoadjuvant treatment of bladder cancer have demonstrated promising efficacy. However, these findings require confirmation in large Phase III clinical trials, with particular emphasis on long-term survival benefits and identifying patients who respond to treatment.

Understanding and modeling human-AI interaction of artificial intelligence tool in radiation oncology clinic using deep neural network: a feasibility study using three year prospective data

Objective.Artificial intelligence (AI) based treatment planning tools are being implemented in clinic. However, human interactions with such AI tools are rarely analyzed. This study aims to comprehend human planner's interaction with the AI planning tool and incorporate the analysis to improve the existing AI tool.Approach.An in-house AI tool for whole breast radiation therapy planning was deployed in our institution since 2019, among which 522 patients were included in this study. The AI tool automatically generates fluence maps of the tangential beams to create anAI plan. Human planner makes fluence edits deemed necessary and after attending physician approval for treatment, it is recorded asfinal plan. Manual modification value maps were collected, which is the difference between theAI-planand thefinal plan. Subsequently, a human-AI interaction (HAI) model using full scale connected U-Net was trained to learn such interactions and perform plan enhancements. The trained HAI model automatically modifies theAI planto generate AI-modified plans (AI-m plan), simulating human editing. Its performance was evaluated against originalAI-planandfinal plan. Main results. AI-m planshowed statistically significant improvement in hotspot control over theAI plan, with an average of 25.2cc volume reduction in breast V105% (p= 0.011) and 0.805% decrease in Dmax (p< .001). It also maintained the same planning target volume (PTV) coverage as thefinal plan, demonstrating the model has captured the clinic focus of improving PTV hot spots without degrading coverage.Significance.The proposed HAI model has demonstrated capability of further enhancing theAI planvia modeling human-AI tool interactions. This study shows analysis of human interaction with the AI planning tool is a significant step to improve the AI tool.

Trop2-Targeted Molecular Imaging in Solid Tumors: Current Advances and Future Outlook.

Trophoblast cell surface antigen 2 (Trop2), a transmembrane glycoprotein, plays a dual role in physiological and pathological processes. In healthy tissues, Trop2 facilitates development and orchestrates intracellular calcium signaling. However, its overexpression in numerous solid tumors shifts its function toward driving cell proliferation and metastasis, thus leading to a poor prognosis. The clinical relevance of Trop2 is underscored by its utility as both a biomarker for diagnostic imaging and a target for therapy. Notably, the U.S. Food and Drug Administration (FDA) has approved sacituzumab govitecan (SG), a novel Trop2-targeted agent, for treating triple-negative breast cancer (TNBC) and refractory urothelial cancer, highlighting the significance of Trop2 in clinical oncology. Molecular imaging, a powerful tool for visualizing and quantifying biological phenomena at the molecular and cellular levels, has emerged as a critical technique for studying Trop2. This approach encompasses various modalities, including optical imaging, positron emission tomography (PET), single photon emission computed tomography (SPECT), and targeted antibodies labeled with radioactive isotopes. Incorporating Trop2-targeted molecular imaging into clinical practice is vital for the early detection, prognostic assessment, and treatment planning of a broad spectrum of solid tumors. Our review captures the latest progress in Trop2-targeted molecular imaging, focusing on both diagnostic and therapeutic applications across diverse tumor types, including lung, breast, gastric, pancreatic, prostate, and cervical cancers, as well as salivary gland carcinomas. We critically evaluate the current state by examining the relevant applications, diagnostic accuracy, therapeutic efficacy, and inherent limitations. Finally, we analyze the challenges impeding widespread clinical application and offer insights into strategies for advancing the field, thereby guiding future research endeavors.

Implementing Screening for Eating Disorders in Adolescents and Young Adults with a History of Cancer.

Eating disorders are prevalent in the adolescent and young adult (AYA) population, with 2.7% of adolescents effected. AYAs with cancer possess several risk factors for eating disorders that may place them at an even higher risk. Since these patients see their oncology team frequently, oncology clinics are opportune settings for eating disorder screening. Here, we describe a study to implement screening for eating disorders in AYA patients in an oncology clinic. During regularly scheduled oncology visits, eligible patients were given the SCOFF questionnaire. A total of 163 eligible patients filled out the SCOFF questionnaire with 11 positive results (6.75%). Eating disorder screening was successfully implemented in our pediatric oncology clinic. With a rate more than double than the general population, we observed that AYA patients with a history of cancer are at a higher risk for eating disorders and should undergo routine screening in oncology clinics.

Saturation profiling of drug-resistant genetic variants using prime editing.

Methods to characterize the functional effects of genetic variants of uncertain significance (VUSs) have been limited by incomplete coverage of the mutational space. In clinical oncology, drug resistance arising from VUSs can prevent optimal treatment. Here we introduce PEER-seq, a high-throughput method based on prime editing that can evaluate the functional effects of single-nucleotide variants (SNVs). PEER-seq introduces both intended SNVs and synonymous marker mutations using prime editing and deep sequences the endogenous target regions to identify the introduced SNVs. We generate and functionally evaluate 2,476 SNVs in the epidermal growth factor receptor gene (EGFR), including 99% of all possible variants in the canonical tyrosine kinase domain. We determined resistance profiles of 95% of all possible EGFR protein variants encoded in the whole tyrosine kinase domain against the common tyrosine kinase inhibitors afatinib, osimertinib and osimertinib in the presence of the co-occurring substitution T790M, in PC-9 cells. Our study has the potential to substantially improve the precision of therapeutic choices in clinical settings.

Efficacy and safety of multi-day antiemetic treatment for patients undergoing multi-day chemotherapy: a systematic review of Clinical Practice Guidelines for Antiemesis 2023 from Japan Society of Clinical Oncology.

A standardized multi-day antiemetic regimen for multi-day chemotherapy remains elusive. This systematic review evaluated the efficacy and safety of multi-day antiemetic regimens in patients undergoing multi-day intravenous chemotherapy. We conducted a comprehensive search of PubMed, Cochrane Library, and Ichushi-Web databases for relevant studies published from January 1990 to December 2020. We included studies comparing multi-day and single-day antiemetic regimens for preventing chemotherapy-induced nausea and vomiting. No studies directly comparing multi-day versus single-day antiemetic regimens were found. Despite expanding control group criteria beyond "single-day antiemetic therapy" limited high-quality studies and variations in cancer types, chemotherapy regimens, and antiemetic treatments precluded meta-analysis. Among the included studies, some randomized controlled trials (RCTs) focused on complete response and vomiting rates. Two studies comparing two- and three-drug combinations reported higher complete response and no-vomiting rates with the three-drug regimen. Limited RCTs explored "nausea control" and "cost," and assessing "adverse events" proved challenging due to inconsistent reporting. The research on multi-day antiemetic therapy is limited, necessitating further investigation. Nonetheless, our findings suggest that three-drug combination therapy, including aprepitant, may offer superior antiemetic efficacy compared to two-drug regimens. Multi-day antiemetic therapy is strongly recommended during multi-day intravenous administration of cytotoxic anticancer drugs.

Axillary Surgery for Patients With Residual Isolated Tumor Cells (ypN0i+) After Neoadjuvant Systemic Therapy for Early Breast Cancer.

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.

Modification and Validation of the System Causability Scale Using AI-Based Therapeutic Recommendations for Urological Cancer Patients: A Basis for the Development of a Prospective Comparative Study

The integration of artificial intelligence, particularly Large Language Models (LLMs), has the potential to significantly enhance therapeutic decision-making in clinical oncology. Initial studies across various disciplines have demonstrated that LLM-based treatment recommendations can rival those of multidisciplinary tumor boards (MTBs); however, such data are currently lacking for urological cancers. This preparatory study establishes a robust methodological foundation for the forthcoming CONCORDIA trial, including the validation of the System Causability Scale (SCS) and its modified version (mSCS), as well as the selection of LLMs for urological cancer treatment recommendations based on recommendations from ChatGPT-4 and an MTB for 40 urological cancer scenarios. Both scales demonstrated strong validity, reliability (all aggregated Cohen’s K &gt; 0.74), and internal consistency (all Cronbach’s Alpha &gt; 0.9), with the mSCS showing superior reliability, internal consistency, and clinical applicability (p &lt; 0.01). Two Delphi processes were used to define the LLMs to be tested in the CONCORDIA study (ChatGPT-4 and Claude 3.5 Sonnet) and to establish the acceptable non-inferiority margin for LLM recommendations compared to MTB recommendations. The forthcoming ethics-approved and registered CONCORDIA non-inferiority trial will require 110 urological cancer scenarios, with an mSCS difference threshold of 0.15, a Bonferroni corrected alpha of 0.025, and a beta of 0.1. Blinded mSCS assessments of MTB recommendations will then be compared to those of the LLMs. In summary, this work establishes the necessary prerequisites prior to initiating the CONCORDIA study and validates a modified score with high applicability and reliability for this and future trials.

DDDR-06. ENHANCING GLIOBLASTOMA TREATMENT WITH MOLYBDENUM DISULFIDE(MOS2) NANOMATERIALS AND ULTRASOUND-TRIGGERED TUMOR GROWTH INHIBITION

Abstract INTRODUCTION Glioblastoma, known for its high mortality rate and limited treatment options, poses a persistent challenge in oncology. Despite advances in surgery, radiation, and chemotherapy, patient outcomes have seen only marginal improvements, with ongoing issues of high recurrence and low survival rates. The advent of nanotechnology, particularly the emergence of Molybdenum disulfide (MoS2) nanoparticles, offers new perspective in semiconductors, energy storage as well as cancer therapies. With its unique physical and chemical properties, MoS2 nanoparticles might be promising in its potential roles in the battle against cancer. We aimed to see whether ultrasound-treated MoS2 nanoparticles can interfere with growth of glioblastoma cells. METHODS MoS2 nanoparticles were added to the medium of glioblastoma cells and ultrasound treatments were given. We monitor the cell count as well as cell migration after the treatments. RESULTS MoS2 nanoparticles was found to significantly interfere with tumor cell proliferation and boost the production of reactive oxygen species (ROS). These reactive oxygen species were crucial for the apoptosis of brain tumor cells when in the right concentration. Our analysis also demonstrated that MoS2 impedes cell migration and infiltration, effectively halting tumor expansion. Additionally, Comet assay techniques confirmed extensive DNA damage in the treated cells, highlighting MoS2’s potent DNA-altering capabilities which promote programmed cell death. CONCLUSION The implications of these findings are significant, establishing a solid scientific basis for employing MoS2 nanoparticles as a targeted anti-cancer agent for brain tumors. While this study underscores the transformative potential of MoS2 nanoparticles in clinical oncology, it also acknowledges limitations such as the need for further clinical trials to evaluate efficacy and safety in humans. Key Words: MoS2 nanoparticles, Ultrasound treatment, Reactive oxygen species, Comet assay, Programmed cell death

NIMG-03. USE OF ARTERIAL SPIN LABELING TO DIFFERENTIATE ICTAL PHENOMENON FROM TUMOR PROGRESSION IN HIGH GRADE ASTROCYTOMA

Abstract A 39-year-old female with grade-3 left parietal IDH-mutant astrocytoma following resection presented with convulsive status. EEG showed electrographic seizures arising from the left parietal region. MRI-brain showed the left temporoparietal post-treatment bed without any contrast enhancement (Fig-1A). Arterial spin labeling (ASL) – MR perfusion showed markedly increased cerebral blood flow (CBF) in the left temporoparietal lobe (Fig-1 C, D) with corresponding diffusion restriction (Fig-1B). Repeat imaging two weeks after the seizure control showed complete resolution (Fig-2) suggesting the imaging abnormalities to be a peri-ictal phenomenon.1 ASL-MR perfusion is a highly sensitive marker of increased CBF with its emerging application in distinguishing tumor progression (increased CBF) from post-treatment changes such as radiation necrosis (reduced CBF).1,2 This case highlights the utility of ASL-MR perfusion in differentiating peri/post-ictal phenomenon (increased CBF without T1-contrast enhancement) from tumor progression (increased CBF with T1-contrast enhancement) when employed routinely in clinical oncology practice.

Ki-67 With MRI in Predicting the Complete Pathological Response Post-neoadjuvant Chemotherapy.

Neoadjuvant chemotherapy (NAC) is increasingly used for high-risk breast cancer to achieve pathologic complete response (pCR), an indicator of event-free survival and favorable survival outcomes. Integrating MRI and Ki-67 biomarker analysis into predictive models offers a promising approach to optimize NAC response assessment and guide personalized treatment strategies. This study evaluates the validity of combined MRI and Ki-67 metrics for predicting pCR. We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, including studies on NAC-treated breast cancer patients assessed by MRI and Ki-67. The predictive models were evaluated based on key parameters, including MRI-based tumor size reduction and Ki-67 levels, with outcomes measured by area under the receiver operating characteristic curve (AUC) and calibration metrics. Findings across ten studies consistently show that high Ki-67 levels and significant tumor size reduction on MRI are predictive of pCR, achieving AUCs near 0.90. The analysis highlighted that models integrating MRI with Ki-67 metrics outperformed single-modality approaches, showing enhanced predictive accuracy and calibration. However, high heterogeneity (I² = 77%) was noted, suggesting variability in imaging and Ki-67 assessment protocols across studies. Thisstudy underscores the combined utility of MRI and Ki-67 for the non-invasive prediction of pCR, offering both structural and biological insights into tumor responsiveness. The results align with prior research, affirming the role of Radiomic-clinicopathological models in providing a more comprehensive assessment compared to individual markers. Further refinement of imaging and biomarker protocols could improve model reproducibility and applicability. Our findings highlight the robust predictive accuracy of MRI-Ki-67 integrated models for assessing pCR, marking a significant step toward personalized cancer care. Future studies should focus on refining these models with additional biomarkers and standardized protocols, facilitating their integration into routine clinical oncology to enhance treatment decision-making and patient outcomes.

SURG-08. A PHASE III RANDOMIZED TRIAL OF GROSS TOTAL RESECTION VERSUS POSSIBLE RESECTION OF FLAIR HYPERINTENSITY LESION ON MR IMAGE FOR NEWLY DIAGNOSED SUPRATENTORIAL GLIOBLASTOMA (JCOG2209)

Abstract BACKGROUND Complete resection of contrast-enhanced lesion (gross total resection: GTR) without severe neurological deficits has been generally accepted as the goal of surgery. However, it remains unclear if additional resection of surrounding FLAIR hyper-intense lesion combined with GTR (FLAIRectomy) has survival advantage of primary glioblastoma patients. Purpose: Multicenter, open-label, randomized phase III trial was commenced to confirm the superiority of FLAIRectomy to GTR alone followed by radiotherapy with concomitant and adjuvant temozolomide in terms of overall survival (OS) for primary glioblastoma IDH-wildtype patients. This trial investigates not only survival but also postoperative neurological and neurocognitive deficits in detail. METHODS We assumed a 2-year OS of 50% in the GTR arm and expected a 15% improvement in the FLAIRectomy arm. A total of 130 patients is required with a one-sided alpha of 5%, power of 70%, and will be accrued from 49 Japanese institutions in 4 years and follow-up will last 2.5 years. Patients 18-75 years of age will be registered and randomly assigned to each arm with 1:1 allocation. The primary endpoint is OS, and the secondary endpoints are progression-free survival, frequency of adverse events, proportion of Karnofsky performance status preservation, proportion of National Institutes of Health stroke scale preservation, proportion of mini-mental state examination preservation and proportion of health-related quality of life preservation. The Japan Clinical Oncology Group Protocol Review Committee approved this study protocol in May 2023. Ethics approval was granted by the National Cancer Center Hospital Certified Review Board. Patient enrollment began in July 2023. DISCUSSION If FLAIRectomy is superior to GTR alone, aggressive surgery will become a standard surgical treatment for glioblastoma with resectable contrast-enhanced lesion. Trial registration: Registry number: jRCT1031230245. Date of registration: 19/July/2023. Date of first participant enrollment: 28/July/2023. Funding for this study is provided by National Cancer Center Research and Development Fund (2023-J-03).

The combination of lenvatinib and pembrolizumab in the treatment of patients with metastatic kidney cancer and factors of poor prognosis: experience of clinics in Moscow: A prospective observational study

Background. Combination therapy is the standard of care for intermediate and poor prognosis metastatic renal cell carcinoma. In the IMDC prognostic classification, tumor stage and histological type are not considered due to the lack of independent impact on overall survival. The CLEAR study demonstrated the efficacy of lenvatinib and pembrolizumab combination in long-term treatment outcomes, including overall survival in poor prognosis compared to sunitinib. The KEYNOTE-B61 study demonstrated high efficacy of this combination in patients with non-clear cell renal cell carcinoma. Aim. To evaluate the efficacy of the combination of lenvatinib and pembrolizumab in patients with high tumor burden and non-clear cell histotypes. Materials and methods. This prospective observational study included 54 patients with metastatic renal cell carcinoma who received a combination of lenvatinib and pemrolizumab in the first line between 2022 and May 2024 in oncology clinics of the Moscow Department of Health. Clear cell histotype was represented in 79.6% of cases, 14.8% had papillary cancer, and 5.6% of patients had chromophobe cancer. The primary endpoint was the objective response rate. Results. The objective response was assessed in 50 patients. The objective response rate was 38%, including 2% complete response according to RECIST 1.1, disease progression was in 8% of patients. The median depth of response was -25% (from -100% to +28). The median time to response was 12.4 weeks (1.1–38.3). Conclusion. The efficacy of the combination of lenvatinib and pembrolizumab in real-life clinical practice outside the inclusion criteria of the CLEAR study is clinically significant and allows us to expect improvement even in patients with a large volume of metastatic process and non-clear cell histotype, but the expected benefit in patients with unsatisfactory somatic status remains disputed.

Patient-Reported Goals of Care in the Preoperative Clinic: Barriers to and Facilitators of Patient Values Elicitation and Documentation.

Infrequent preoperative goals of care (GOC) documentation leads to challenges in medical decision-making when patients experience postoperative complications. We evaluated the feasibility of enhancing GOC documentation through a patient portal-based values questionnaire. A patient values questionnaire (PVQ) was distributed to patients before their Gynecologic Surgical Oncology clinic appointments via an electronic health record (EHR)-based portal from June to October 2023. Surgeons and advanced practice providers were encouraged to address PVQ responses during clinic appointments. Patient acceptability surveys were sent to PVQ respondents and clinicians were interviewed to assess feasibility and acceptability. PVQ response rate was 225/383 (59%); 29% of all patients had an established cancer diagnosis. Clinicians deemed preoperative GOC documentation important and the PVQ valuable to prepare for unexpected postoperative complications. Accessing questionnaire responses through the EHR was a technical barrier. Clinicians agreed that GOC should be addressed after diagnosis and treatment discussions, but before surgery. Ninety percent of patients felt comfortable discussing GOC at their first clinic appointment. Patient portals facilitate preoperative GOC documentation, however, clarifying and integrating values into care require ongoing discussions between clinicians and patients. Optimal timing of GOC elicitation is posttreatment planning and before surgery when the patient is most informed.

Current technologies of response assessment in rectal cancer after neoadjuvant treatment: A review

Improvement of the multidisciplinary approach to the treatment of rectal cancer over recent years has led to the fact that in specialized high-volume oncology clinics it is possible to achieve a complete pathomorphological response to neoadjuvant therapy in a third of patients. The emergence of new knowledge about the development of tumor complete response and the accumulation of clinical experience opens up possibility for the wider use of an organ-sparing approach. Undoubtedly, making such a critical strategic decision requires reliable and effective tools for complete response predicting. This review is devoted to methods for assessing tumor response in patients diagnosed with rectal cancer. A look at the problem is presented from the perspective of modern methods of medical imaging, molecular and genetic studies, the study of the characteristics of the immune response, and a new look at clinical data. New data can form the basis for new patient selection algorithms for personalized treatment protocols for rectal cancer, thereby improving long-term results and quality of life for patients.

The food environment and postdiagnosis weight gain among Black women breast cancer survivors in Maryland.

Weight management is included in the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guidelines for its clinical impact on breast cancer (BC) survivorship. Few studies have examined the impact of neighborhood-level factors associated with postdiagnosis weight change among Black BC survivors. We recruited 100 Black female BC survivors to complete an online survey, including demographic, clinical characteristics, and lifestyle factors, between January 5, 2022 and August 18, 2022. We utilized the 2023 County Health Rankings Food Environment Index (FEI), which ranges from 0 (worst) to 10 (best), to capture the food environment as the primary exposure for postdiagnosis weight gain. We calculated postdiagnosis weight gain as percent weight change from time at diagnosis to time of survey. Participants were grouped into categories of stable weight (within ± 3%) or weight loss (≤ -3%) compared to weight gain (≥ 3%). We calculated adjusted odds ratios (aORs) for the associations between county-FEI, clinical factors, and postdiagnosis weight gain. Among the 95 women who reported weight measurements, we observed that women living in counties with an FEI ≥ 8.8 (at or above median) were significantly less likely to experience weight gain (aOR 0.09; 95% CI 0.01-0.77). Stage, age at diagnosis, years since BC diagnosis, and BC treatments were not significantly associated with weight gain. Postdiagnosis weight gain is associated with poorer food environments among Black BC survivors in Maryland. Our findings will inform larger prospective studies and future interventions among this population.

Clinical Presentation, Treatment, and Outcomes of Pediatric Brain Tumors: A 5-Year Single-Center Experience in Istanbul

Background: Brain tumors are the most common solid tumors in childhood. With the help of increased clinical awareness, improvements in imaging methods, and the identification of molecular characteristics, advances have been made in both diagnosis and treatment. Objectives: In our study, we aimed to discuss the childhood brain tumor cases followed in our clinic, along with their clinical and epidemiological features and treatment outcomes. Methods: The study group comprised children younger than 18 years old who were followed in the Pediatric Hematology and Oncology Clinic of Istanbul Medical Faculty and diagnosed with a brain tumor over the past 5 years (2018 - 2023). Symptoms, age at diagnosis, treatment options (surgery, radiotherapy, chemotherapy), and side effects were reviewed retrospectively. Results: Thirty children were diagnosed with brain tumors. Of the patients, 14 (47%) were male and 16 (53%) were female. The mean age of the children was 8.8 ± 3.1 years, and the mean age at diagnosis was 65.6 ± 37.7 months. The most common symptom was vomiting (40%). The mean duration between the onset of symptoms and diagnosis was 3.8 months, with a median of 1 month. Of the patients, 60% were diagnosed with glial tumors and 40% with non-glial tumors. Gross total resection (GTR) was performed in 26% of patients, subtotal resection (STR) in 37%, and 37% of patients did not undergo surgery. Seventy-seven percent of the patients received chemotherapy, and 57% received radiotherapy. Of the patients, 57% were considered responsive to treatment (complete/partial), 30% had stable disease, and 13% had progressive disease. The overall brain tumor mortality rate in our clinic was 13%. While 73% of our 26 patients had no or mild neurological deficits, 27% had moderate to severe disabilities (gait impairment, hearing impairment, visual impairment). Conclusion: Although the sample size was limited, it may be speculated that the surgery rate was low and long-term side effects were notable. Insufficient surgical resection can affect the treatment response and increase the risk of neurological sequelae and functional impairment. Molecular profiling should be expanded, and a palliative care team should be involved as early as possible to address long-term side effects and improve the quality of life for patients.

Highlights of the 2024 ASCO Annual Meeting: radiotherapy of head and neck cancer

At the 2024 Annual Meeting of the American Society of Clinical Oncology (ASCO), several important studies on radiotherapy for head and neck squamous cell carcinoma (HNSCC) were presented. There were two Chinese phaseIII trials on treatment escalation for locally advanced nasopharyngeal carcinoma: adjuvant immune checkpoint inhibition with camrelizumab after induction chemotherapy and cisplatin-based chemoradiotherapy (RCT) in the DIPPER trial reached the primary endpoint of improved event-free survival (EFS) but did not improve overall survival (OS). Simultaneous and adjuvant administration of the angiogenesis inhibitor endostar in addition to cisplatin-based RCT for locally advanced nasopharyngeal carcinoma led to asignificant improvement in progression-free survival (PFS) and OS. Another major focus was on treatment optimization and deintensification for oropharyngeal cancer (OPC): using intensity-modulated proton therapy (IMPT), aphaseIII trial demonstrated noninferiority in definitive RCT for OPC compared to photon-based intensity-modulated radiotherapy (IMRT). In adjuvant treatment of human papillomavirus-positive (HPV+) OPC, the long-term results of the E3311 phaseII study confirmed that individually deintensified radiotherapy is feasible. Lee etal. showed with the results of aphaseII study that HPV+ OPC might be treatable with chemoradiotherapy to atotal dose of only 30 Gy if no hypoxia is detected in the 18F‑fluoromisonidazole positron-emission tomography-computed tomography (F-MISO-PET) scan. Both the deintensified treatment of HPV+ OPC as well as additive immune checkpoint and angiogenesis inhibition in chemoradiotherapy of nasopharyngeal carcinoma require further studies before they can be recommended in clinical practice.