Abstract Background: Multigene panel testing has increased the detection of pathogenic germline variants (PV) in patients with breast cancer. The impact of PVs and variants of unknown significance (VUS) on toxicity and clinical outcomes has largely been studied in patients with BRCA1 or BRCA2 mutations, with few data on patients with other genetic alterations. In addition, few studies have characterized the impact of VUS on toxicity and/or outcomes. At our institution, a prospective Precision Medicine study was started to characterize germline and somatic mutations in breast cancer patients. Here, we present a preliminary analysis of acute toxicity rates in breast cancer patients treated with curative intent radiation therapy based on germline mutation status. Materials/Methods: This retrospective, single-institution study utilized the Precision Medicine database at our institution to identify breast cancer patients with available genetic data. Among 4400 patients with stage I-IV breast cancer, 900 received curative-intent breast radiotherapy (RT). Clinicodemographic information, RT parameters, and germline mutation status - characterized as PV, VUS, or benign - were extracted from the database. RT toxicity was prospectively documented in the electronic medical record (EMR) during the study period. The primary endpoint was the incidence of acute grade 2 or higher radiation dermatitis (G2RD). Associations between germline mutational status and toxicity rates were evaluated using the chi-square test, with significance defined as p<0.05. Results: Of the 900 patients in the Precision Medicine database who received breast RT, 396 had complete clinical, RT, and genomic data available. The median age is 57 years (IQR 47-65), with 37% Hispanic, 40% non-Hispanic White, and 15% non-Hispanic Asian. Disease stage was 29% stage I, 50 % stage II, and 17% stage III. Breast cancer subtypes were 68% HR+/HER2-, 17% HER2+, and 15% triple negative. Breast-conserving therapy was performed in 65% of cases. Radiation was delivered to the whole breast in 46% (N=182), breast/chest wall plus regional nodes (PMRT/RNI) in 45% (N=177), accelerated partial breast irradiation (APBI) in 4%, and intraoperative radiation therapy (IORT) in 5% of patients. Hypofractionated RT (≥2.66 Gy/fraction) was delivered to 45% of patients. Germline testing identified 10% PV (N=39), 57% with VUS in at least one gene (N=224), and 33% Benign (N=133). The overall incidence of G2RD was 24% (N=95) and did not differ based on germline mutation status: 28.2% for PV, 22% for VUS, and 26% for benign status (p=0.64). Among patients with PV, BRCA1/2 mutations were the most common (N=11), with a G2RD rate of 18%, similar to the entire population. MUTHY mutations were the next most common (N=9), with 0% G2RD. The one patient with PALB2 mutation did not have G2RD and no CHK2 or ATM mutations were present in the analyzed cohort. Factors significantly associated with increased G2RD were the type of RT delivered (31% in the PMRT/RNI group, 21% for whole breast only, and 3% for APBI/IORT; p=0.0006) and fractionation schedule (31.9% for conventionally fractionated RT vs 14.5% in hypofractionated RT; p<0.0001). Conclusion: In this preliminary analysis, germline pathogenic mutations or variants of unknown significance were not associated with an increased risk of acute radiation dermatitis compared to those with benign mutation status. As expected, only factors related to RT delivery were associated with the development of grade 2 dermatitis. Ongoing analysis will assess these findings in the complete dataset and evaluate local-regional recurrence by germline and somatic mutation status. Citation Format: N. Eustace, K. Ghaffarian, T. Watkins, K. Vo, L. Reynaga, J. Bonner, S. Gruber, T. Williams, J. Bazan. Germline Genetic Variants and Risk of Acute Radiation Dermatitis in Patients Receiving Curative-Intent Radiation Therapy for Breast Cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-07-21.

Lung cancer diagnosis requires multiple investigations, with delays causing increased mortality. To reduce diagnostic delays, a general practitioner (GP) referral pathway program was developed in 2016 within a rural Australian health district to assist GPs in referring patients with suspected lung cancer for further management. To assess the effectiveness of this GP cancer referral program, and the impact on high-risk patient populations. Patients who underwent curative intent radiotherapy for lung cancer at the North NSW Cancer Institute between 2012 and 2022 were included in the study. Patients were stratified based on Eastern Cooperative Oncology Group (ECOG) performance status, stage of malignancy and level of rurality. Comparison was performed between patients diagnosed between 2012-2016, 2017-2019 and 2020-2022. The diagnostic pathway was split into four steps, and the time taken between each point was mapped. Chi-squared analysis was used to assess for demographic differences. Mann Whitney U test was used to assess for differences between the three time periods and between high-risk groups for each step within the diagnostic pathway. There were 214 patients in the study cohort. There were no demographic differences between the three time periods (P > 0.05). ECOG performance status and level of rurality did not impact any step of the diagnostic timeline (P > 0.05). There was an improvement in diagnostic timelines for stage III patients compared to stage I/II patients from 2017 onwards, through multiple steps of the diagnostic pathway (P < 0.05). Implementation of a local GP intervention improves diagnostic timelines for patients with advanced stages of disease.

There is an urgent need for more systematic investigations into how image inspection and primary treatment for low-risk prostate cancer vary by type of medical institution. To investigate disparities in imaging inspections and first-line treatment depending on the type of medical institution for low-risk prostate cancer using the Japan Study Group of Prostate Cancer database. Data on patients with low-risk prostate cancer diagnosed between 2016 and 2018 from a nationwide database of the Japan Study Group of Prostate Cancer were used. Among these databases, patient and tumor characteristics, image inspections for diagnosis, and first-line treatment at clinics, community hospitals, and university hospitals were compared statistically. This analysis included patients with low-risk prostate cancer at clinics (n = 89), community hospitals (n = 1259), and university hospitals (n = 671). The three facilities had no significant differences in the performance of computed tomography scans, bone scintigraphy, and magnetic resonance imaging scans. Active surveillance was less performed in clinics and university hospitals, compared with community hospitals. Androgen deprivation therapy was significantly more common, but curative treatments, including radiation and prostatectomy, were less performed in clinics. Curative radiation was significantly more common, but androgen deprivation therapy was less performed in university hospitals. Our study analyzed data on low-risk prostate cancer obtained from a Japanese multi-institutional registry and showed differences in first-line treatment options by type of medical institution.

Cutaneous squamous cell carcinoma (cSCC) represents the second most common form of non-melanoma skin malignancy, and, when not amenable to curative surgery or radiotherapy, it is a life-threatening disease. The anti-PD-1 monoclonal antibody cemiplimab has transformed the outcome of advanced or metastatic cSCC, with response rates approaching 50% and sustained benefit beyond three years in clinical trials. Cemiplimab is now the first-line standard of care treatment for advanced disease. This retrospective observational study included consecutive adult patients with locally advanced (lac) or metastatic (m) cSCC who received cemiplimab (350 mg every three weeks) at the Center for Immuno-Oncology, University Hospital of Siena, Italy, either through an Expanded Access Program or routine clinical practice. Clinical outcome and treatment related adverse events (TRAEs) are reported. Between December 2019 and December 2023, 27 patients (24 male; median age 82 years [range 41-90]) diagnosed with lacSCC (n = 20 [74.0%]) or mcSCC (n = 7 [25.9%]) were treated with cemiplimab as first line therapy and were followed until June 2024. Head and neck were the primary tumor location for 88.8% of patients, followed by trunk (7.4%) and lower extremities (3.7%). All patients had comorbidities, including six patients (22.2%) with hematologic malignancies. With a median follow-up of 31 months (data cut-off June 2024), the ORR was 66.6% (complete response 22.2%) and the disease control rate (DCR) 77.7%. Median progression-free survival (mPFS) and overall survival (mOS) were not reached, while 2-year PFS and OS rates were 65.2% and 71%, respectively. Treatment was well-tolerated, with three (11.1%) patients experiencing grade ≥3 TRAEs, and three patients discontinuing treatment due to TRAEs. Our real-world experience confirms the high rate of durable objective responses, good tolerability and long treatment duration of cemiplimab in elderly and frail cSCC patients as well.

This study sought to determine the relationship between cervical cancer recurrence and post-treatment change in standardized uptake value (SUV) of 18F-2-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) in the cervix and lymph nodes. This retrospective cohort study included patients who received curative intent radiation therapy for biopsy-proven stage I-IVA locally advanced cervical cancer at a single tertiary referral center from 2009 to 2021. The exposure was percent change in SUV from pre- to post-treatment FDG-PET scans at the cervix and lymph nodes. The primary outcome was recurrence rate, and secondary outcomes were overall and progression-free survival. Firth's penalized logistic regression and Cox proportional hazards models were used to assess associations. 55 patients met eligibility criteria. Recurrence rate was 27% (15/55); of these, 33% had local recurrence (5/55) and 67% had distant recurrence (10/55). Median percent decrease of cervical SUV after treatment in those with and without recurrence was similar (71.4 vs 68.8, p = 0.89); this remained consistent when analyzing those with local recurrence only (70.5, p = 0.95). When the percent decrease in cervical SUV was examined in intervals (< 25%, 25-50%, 50-75%, > 75%), this was also not predictive of local (p = 0.91) or overall (p = 0.75) recurrence. Median percent decrease at the most avid and distant lymph node in those with and without recurrence was not significantly different (p > 0.05). Neither change in cervical nor lymph node SUV was associated with overall or progression-free survival. Changes in SUV after treatment may not be a reliable stand-alone marker for predicting recurrence or survival in locally advanced cervical cancer after treatment with radiation therapy.

Telomeres are protective protein-bound DNA repeat structures at the end of chromosomes, which play a critical role in maintaining chromosomal stability. With each somatic-cell division, telomeres progressively shorten, making telomere length a potential biomarker of biological aging. Ionizing radiation may accelerate telomere attrition, thereby promoting aging-related changes. In the present study, we analyzed the influence of radiotherapy on leucocyte telomere length in prostate cancer patients. A total of 314 patients treated with curative radiotherapy for prostate cancer were included in the present prospective study. Leukocyte relative telomere length (RTL) was measured by qPCR in peripheral blood samples collected before radiotherapy, at the end of radiotherapy, and at 3 and 15months post-radiotherapy. Mean RTL values were 0.65 ± 0.34 at baseline, 0.62 ± 0.31 at the end of radiotherapy, 0.67 ± 0.43, and 0.55 ± 0.26 at the first and at the second follow-up, respectively. . Paired-Samples T-Test comparisons showed a significant reduction in RTL at 15months post- radiotherapy compared to baseline (p < 0.001), end of radiotherapy (p = 0.001), and 3-month follow-up examination (p < 0.001). In our cohort, we observed a significant shortening of telomeres after radiotherapy indicating a potential contribution to accelerated cellular aging.

Non-compliance with radiotherapy (RT) is a critical barrier to effective cancer care, particularly in low- and middle-income countries like the Philippines. Despite a high national cancer burden, there is a lack of research on the specific factors driving RT non-compliance within the Philippine public health system. This study aimed to identify the independent predictors of non-compliance at a major public cancer center, to inform targeted interventions. This retrospective cohort study analysed the records of 448 patients with breast, cervical, head and neck, endometrial or rectal cancer who underwent curative intent RT at a large public cancer center in the Philippines between January 2022 and April 2024. Non-compliance was defined as missing two or more scheduled RT sessions. A hierarchical multivariable binary logistic regression model was used to identify independent predictors, assessing sociodemographic, clinical and seasonal/systemic factors in sequential blocks. The overall non-compliance rate was 42.4%. The final multivariable model revealed that non-compliance was primarily driven by a convergence of clinical and systemic factors rather than patient demographics. The strongest predictors reflected clinical severity, specifically cancer type [cervical: odds ratio (OR) = 7.43; head and neck: OR = 3.54] and the need for a treatment replan (OR = 5.60). Systemic factors were also significant predictors, including an internal referral source (OR = 1.83) and treatment timing. Specifically, the risk of non-compliance increased for patients undergoing computed tomography simulation in the third quarter (July-September) and for those starting treatment in the fourth quarter (October-December), which are periods associated with regional climatic and socioeconomic pressures. In this Philippine public cancer center, RT non-compliance is driven by clinical vulnerability and dynamic systemic pressures, not static patient demographics. These findings highlight the need to shift from passive risk assessment to proactive, risk-stratified interventions. Implementing strategies such as patient navigation and support programs, adjusted for predictable seasonal pressures, can mitigate vulnerability, improve treatment adherence and ultimately enhance cancer outcomes in resource-constrained settings.

Osteoradionecrosis of the jaw (ORNJ) is a radiation-induced late toxicity that can dramatically decrease patients’ quality of life. Recent increases in survival rates of head and neck cancers associated with human papillomavirus (HPV) infection have resulted in a higher frequency of radiation-induced toxicities, particularly ORNJ. Recent work with Normal Tissue Complication Probability (NTCP) models and a Weibull Accelerated Failure Time (WAFT) model have further developed our understanding of ORNJ clinical/dosimetric risk factors and longitudinal features, respectively. In this data descriptor, 1129 head and neck cancer (HNC) patients received curative intent radiotherapy (RT) at MD Anderson Cancer Center and were followed up with clinical and radiological assessments at 3–6, 12, 18, 24 months, and then annually following the conclusion of RT for development of ORNJ. This data, in addition to the patients’ demographic, supplementary clinical, and dosimetric information was recorded in a comma-separated value file embedded within this data descriptor. This large, longitudinal dataset is a significant resource for further systematic analysis of post-RT normal tissue outcomes in HNC.

Background: Prospective trials provide robust evidence for prostate cancer (PCa) treatment but often include highly selective populations, limiting generalizability. Real-world data (RWD) can address these gaps and inform personalized care. Objectives: This study aimed to evaluate treatment-free survival (TFS) and secondary treatment sequences after initial curative therapy for PCa using electronic health record (EHR) data and to analyze associated medication profiles. Methods: We studied 3024 patients treated with radical prostatectomy (RP), brachytherapy (BT), or curative radiotherapy (RT) at Erasmus MC (2009–2023), the Netherlands. Outcomes included TFS, treatment sequences, and medication patterns across treatment lines. Results: Median age at diagnosis was 65 years (IQR 61–69) for RP, 68 (62–73) for BT, and 72 (68–76) for RT. At 10 years, TFS was 89% (95% CI: 84.9–94.1) for BT, 85% (95% CI: 83–87) for RT, and 71% (95% CI: 65.7–75.8) for RP. Most patients remained treatment-free, but up to five treatment lines occurred, mainly in patients with low comorbidity scores. Medication profiles reflected treatment-related morbidity: alpha-blocker use increased after BT and RT, while bladder relaxants were common after RP. Comorbidity-related medication use remained low among patients undergoing multiple sequenced treatments. Conclusions: These findings highlight the real-world application of multiple secondary treatments after different primary curative therapy options for PCa and associated comorbidity and medication use patterns. They confirm the durability and long-term effectiveness of curative treatments in real-world PCa care. By combining treatment trajectories and medication profiles, RWD provides insights for personalized counseling, helping clinicians and patients anticipate long-term treatment needs, and enabling informed decisions aligned with health status and preferences.

HYpofractionated, dose-redistributed RAdiotherapy (HYDRA) versus conventional radiotherapy for head and neck cancer: planned interim analysis and dosimetric comparison from the phase I HYDRA trial

BackgroundHead and neck cancer is one of the most common cancers in India, with tobacco chewing being the predominant form of tobacco consumption. We aimed to assess the impact of superficial gland sparing on xerostomia.Materials and methodsPatients with histopathological diagnosis of head and neck cancer treated with curative intent radiotherapy with intensity-modulated radiotherapy (IMRT) to a dose of 60–70 Gy in 30–35 fractions with or without chemotherapy from June 2017 to March 2020 were included in the study. The superficial and deep lobes of the parotid were contoured retrospectively. The physician-reported Radiation Therapy Oncology Group (RTOG) xerostomia toxicity grades at two years were retrieved from records.ResultsOne hundred seventy-four patients were included in the study. Tobacco chewing was the most common form of use, followed by smoking. Tobacco chewers had significantly smaller mean parotid (53cc vs. 60cc, p = 0.02) and mean submandibular gland volumes (6 cc vs. 14 cc, p < 0.001) as compared to smokers. Bilateral or contralateral parotid sparing (mean dose < 26 Gy) was achieved in 62.7%, bilateral or contralateral superficial lobe in 27.6% and no sparing in 9.8% of patients. The xerostomia was similar in smokers and chewers (p = 0.95). Patients with bilateral or contralateral superficial lobe sparing had lower grade II/III xerostomia rates than the no-sparing group (p = 0.038).ConclusionsTobacco chewers have smaller volumes of salivary glands. Contralateral or bilateral superficial parotid sparing translated into better xerostomia scores at two years.

ABSTRACTObjectiveYoung adults (18–45 years) with head‐and‐neck cancer represent a unique population with limited data on quality of life (QoL) and return‐to‐work after radiotherapy. This bicentric study aimed to evaluate these outcomes.MethodsConducted at two comprehensive cancer centers, the study included young head‐and‐neck cancer survivors treated with curative radiotherapy between 2003 and 2023. QoL was assessed with EORTC QLQ‐C30 and HN43; distress, depression, and anxiety with the NCCN Distress Thermometer, PHQ‐9, and GAD‐7; fear of cancer progression and work ability with FoP‐Q‐SF and WAI.ResultsOut of 83 eligible patients, 58 (70%) participated. The median age at radiotherapy was 41 years, with a balanced gender distribution (40% female, 60% male). The median time from radiotherapy to questionnaire completion was 82.5 months. Mean global QoL was 65.0, comparable to the age‐ and gender‐matched reference population (67.2). Clinically relevant distress was reported by 52%, severe depressive symptoms by 12%, moderate‐to‐severe anxiety by 21%, and strong fear of cancer progression by 38%. At the time of the study, 66% had returned to work. Those who returned to work reported lower symptom scores, and less depression, anxiety, and distress. In the multiple regression analysis, gender was significantly associated with return to work, with females showing higher odds of returning.ConclusionsWhile overall QoL was comparable to the general population, young head‐and‐neck cancer survivors face psychological and work reintegration challenges. Returning to work is associated with improved QoL and reduced psychological symptoms, highlighting the need for tailored survivorship care.

This study aimed to prospectively examine the systemic effects of curative radiotherapy on dynamic thiol/disulfide homeostasis and nitrosative stress markers in patients diagnosed with lung cancer. Forty-one patients diagnosed with lung cancer and 41 healthy controls were enrolled in the study. Serum nitric oxide, 3-nitrotyrosine, total thiol, native thiol, and disulfide levels were measured from blood specimens taken from patients before radiotherapy and 24 h after radiotherapy. Nitric oxide levels were analyzed by chemiluminescence technique, 3-nitrotyrosine levels by ELISA, and thiol/disulfide homeostasis parameters by spectrophotometric methods. Serum nitric oxide (NO) and 3-nitrotyrosine levels of patients were significantly elevated in both pre-radiotherapy and post-radiotherapy periods compared to the healthy control group (p < 0.001). NO levels tended to increase after RT, but this difference did not reach statistical significance. Total thiol and native thiol levels in the pre-radiotherapy and post-radiotherapy periods were decreased when compared to the controls (p < 0.001). Post-radiotherapy disulfide levels were markedly higher than the pre-radiotherapy (p < 0.05) and the controls (p < 0.05). Similarly, while disulfide/total thiol and disulfide/native thiol ratios were increased in the post-radiotherapy period, a marked decline was observed in the native thiol/total thiol ratio in the post-radiotherapy period (p < 0.05). Since chemotherapy is also known to affect redox homeostasis, the combined treatment (chemoradiotherapy) is likely responsible for the observed biochemical changes seen in our study. Our suggest that radiotherapy further exacerbates the already imbalanced redox homeostasis in lung cancer patients by enhancing NO production and promoting thiol oxidation. Concurrent chemoradiotherapy appears to exacerbate the imbalance in redox homeostasis in lung cancer patients.

ABSTRACT Radiotherapy (RT) remains an indispensable means in cancer treatment; however, its therapeutic efficacy is often limited by tumor radioresistance and side effect of damage to healthy tissue. The advances in nanotechnology have propelled metal radiosensitizers to forefront of precision medicine. These metal‐based radiosensitizations enhance RT efficacy through multifaceted mechanisms of physical dose amplification, chemical catalysis, and biological modulation. Compared to conventional way by employing high atomic number (high‐ Z ) metal materials to enhance energy deposition, emerging strategies such as X‐ray induced radiodynamic therapy (X‐RDT) and Cerenkov radiation activated photodynamics therapy (CR‐PDT), have been developed to synergize RT with deep‐tumor reactive oxygen species (ROS) generation under lower radiation dose. In this review, we highlight recent progress in metal‐based radiosensitization for cancer therapy, discuss key challenges hindering clinical translation, and emphasize innovations in material design, combinatorial therapies, and clinical oncology. Collectively, these advances may unlock the full potential of metal‐based radiosensitizers, paving the way for curative RT with minimal damage to normal tissues.

Patient- and clinician-reported acute radiation-induced diarrhoea in patients with prostate cancer during curative external radiation therapy: A prospective observational cohort study

BackgroundThe role of external beam radiation therapy (RT) in non-surgical gastric cancer (GC) remains controversial due to conflicting trial results and a lack of large-scale real-world evidence. This study utilizes the population-based Surveillance, Epidemiology, and End Results (SEER) database to examine the association between RT and overall survival (OS) in non-surgical GC patients, while acknowledging inherent confounding factors.MethodsWe identified 29,923 non-surgical GC patients [2004–2021] from the SEER database, categorizing them into RT (n=6,629) and non-RT (n=23,294) groups. Baseline demographic and clinicopathological characteristics were collected. Survival was followed until death or censoring. Kaplan-Meier analysis, multivariable Cox regression (adjusting for age, sex, year of diagnosis, marital status, race, tumor site, grade, stage, and chemotherapy), propensity score matching (PSM), and subgroup analyses were employed.ResultsThis investigation included 29,923 patients with non-surgical GC. Of these, 6,629 (22.2%) received radiotherapy (RT), while 23,294 (77.8%) did not. Baseline characteristics differed significantly between groups (P<0.001), with the RT group having a higher proportion of patients with regional stage disease (30.9% vs. 10.5%) and receiving chemotherapy (82.4% vs. 57.3%). The results showed that the median OS was 10.5 months in both groups (P<0.001), with 3-year survival rates of 12.4% in the RT group versus 17.8% in the non-RT group. Multivariate analysis demonstrated an association between RT and OS [hazard ratio (HR), 1.11, 95% confidence interval (CI): 1.07–1.15, P<0.001], which remained significant after PSM analysis (HR, 1.10, 95% CI: 1.06–1.15). In the subgroup of metastatic patients, the association between RT and OS was attenuated (HR, 1.05, 95% CI: 0.98–1.12).ConclusionsIn this SEER-based analysis, RT was associated with reduced OS in patients with non-surgical gastric cancer. The SEER database’s lack of treatment intent and symptom data precludes causal interpretation. RT remains clinically relevant for symptom control, and individualized decision-making is paramount. Prospective studies distinguishing curative versus palliative RT are warranted.

Background/Objectives: Financial toxicity (FT) refers to the financial burden directly or indirectly caused by a patient's medical care. Patients with head and neck cancer (HNC) are particularly vulnerable to FT due to lower rates of return to work and higher out-of-pocket payments (OOPP). In this cross-sectional study, we assessed the amount and types of OOPP, as well as the prevalence of FT, in HNC patients who had completed curative radiotherapy. Methods: We included HNC patients who underwent curative-intent radiotherapy at four private clinics in Romania, within 12 months of completing treatment. Participants completed a 25-item questionnaire capturing sociodemographic information, insurance status, income, and OOPP. To assess subjective FT, we used the validated nine-item Financial Index of Toxicity (FIT), which measures three FT domains: financial stress, financial strain, and lost productivity. Each domain and the total score range from 0 to 100, with higher scores indicating greater financial toxicity. Descriptive statistics were used to summarize patient characteristics. Pearson's chi-square, t-tests, and one-way ANOVA were used to assess statistical associations, with a significance threshold of p < 0.05. Results: Among 113 patients (mean age: 59), the majority were male (74.3%) and married (74.3%), with 40% having completed university or higher education. The most frequent tumor sites were the oropharynx (29 cases), larynx (22), and oral cavity (21). Concurrent chemoradiation was the most common treatment modality (47%). The mean total FT score was 18.8. Overall, 39.8% of patients experienced financial toxicity, and 29.2% scored above the mean in financial stress. Moderate financial strain (score > 21) was reported by 39.8% of participants, and approximately one-third reported loss of productivity. Transportation and nutritional supplements were the most common OOPP categories. Notably, 42% of patients spent at least 400 euros-equivalent to Romania's monthly minimum income-on transportation during radiotherapy. FT was significantly associated with employment and marital status, but not with tumor site or treatment type. Conclusions: Among Romanian HNC patients treated with curative radiotherapy, we found substantial OOPP, particularly for transportation and nutritional supplements. While overall FT levels were moderate, divorced patients and those retired due to other chronic conditions were the most vulnerable to financial distress. Financial toxicity can directly affect treatment adherence, survival, and quality of life. By integrating financial counseling, social support, and broader coverage of treatment-related expenses, healthcare systems can mitigate FT for these patients.

The proportion of older adults with head and neck cancer is steadily rising. Treatment planning in this population is often challenging due to more frequent comorbidities; reduced physiological reserves; and, at times, differing treatment goals. Additionally, older adults have been significantly underrepresented in pivotal radiotherapy trials, making evidence-based decision-making difficult. This article strives to present current controversies in the radiotherapeutic management of older adults with head and neck cancer. Aselective literature search for studies addressing radiotherapy in elderly head and neck cancer patients was conducted via PubMed and ClinicalTrials.gov. Geriatric screening tools such as the G8 test are associated with treatment adherence and survival but are still rarely implemented in routine clinical practice. The SENIOR cohort study (NCT05337631) demonstrated asurvival benefit for the combination of radiotherapy with concurrent chemotherapy in older patients with good performance status and few comorbidities, but not for the combination with cetuximab. Current studies are investigating hypofractionated radiotherapy regimens and novel agents for patients with contraindications to cisplatin. For patients ineligible for curative treatment, effective palliative radiotherapy concepts with shortened overall treatment duration are available. The management of older adults with head and neck cancer remains challenging and requires further prospective research. Advanced age alone should not be considered acontraindication to curative radiotherapy, including concurrent chemotherapy. For patients not eligible for curative treatment, various palliative radiotherapy regimens are available.

PurposePatients with head and neck squamous cell carcinoma (HNSCC) undergoing curative radiotherapy or chemoradiotherapy often experience adverse effects affecting physical and psychosocial health, which can lead to a deconditioning cycle, worsening side effects, treatment tolerance and quality of life. This multicenter phase II study evaluated whether physical rehabilitation combined with nutritional care could improve exercise tolerance and reverse the deconditioning cycle.MethodsPatients with localized HNSCC undergoing curative radiotherapy or chemoradiotherapy were randomized into two groups. One group engaged in a physical rehabilitation (PR) program, including quadriceps electrical stimulation three times a week during treatment, followed by three weekly sessions of home-based ergocycle training for 12 weeks, while the control (CT) group received standard care. Both groups received nutritional care. Success of the PR program was defined as a 40% increase in the patient’s baseline endurance time or the ability of the patient to sustain the activity for 30 min at three months.ResultsSeventy patients were included, with 33 patients in the PR group. The success rate was higher in the PR group program (68%, CI 95% 48–84) than to the CT group (27%, CI 95% 16–48). From T0 to T2, the median endurance time changed by + 54% in PR vs. -55% in CT. No significant difference was observed regarding quality of life.ConclusionsOur results highlight that physical rehabilitation combined with nutritional care is feasible in this setting, and could improve exercise tolerance without modifying patient’s quality of life. It emphasizes the crucial role of physical activity during cancer treatment.Clinical trial registration number.NCT02135185 on February 6, 2014 (retrospectively registered).

This study aimed to evaluate the cost-effectiveness of the Prostate Cancer Patient Empowerment Program (PC-PEP), a six-month comprehensive intervention designed to enhance psychological well-being and reduce healthcare expenditures among prostate cancer patients. In a crossover randomized clinical trial of 128 men aged 50-82 years scheduled for curative prostate cancer surgery or radiotherapy (± hormone treatment), 66 men received the PC-PEP intervention immediately, while 62 were randomized to a waitlist control arm and received standard care for six months before receiving PC-PEP. The intervention included daily activities targeting physical fitness, pelvic floor training, stress management, intimacy, social support, and dietary guidance. Cost-effectiveness was assessed from a healthcare payer perspective using billing data from Nova Scotia's Medical Services Insurance (MSI) and self-reported outcomes. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs) were calculated using bootstrapped samples. Psychological distress was assessed with the Kessler Psychological Distress Scale (K10), while quality-adjusted life years (QALYs) were estimated from SF-6D utility scores. PC-PEP resulted in cost savings of $411.53 CAD per patient at six months, with a 30% reduction in clinically significant psychological distress and a QALY gain of 0.013. At 12 months, savings increased to $660.89 CAD per patient, preventing 31% of distress cases and yielding a QALY gain of 0.034. These outcomes demonstrate that PC-PEP is a dominant intervention, achieving both improved clinical outcomes and reduced healthcare expenditures. PC-PEP is a dominant, cost-effective strategy that significantly improves psychological well-being while lowering healthcare costs. Early implementation following prostate cancer diagnosis is strongly recommended to maximize both clinical and economic benefits.