Institute Of Oncology Research Articles

A bibliometric analysis of drug resistance in immunotherapy for breast cancer: trends, themes, and research focus.

While breast cancer treatments have advanced significantly nowadays, yet metastatic, especially triple-negative breast cancer (TNBC), remains challenging with low survival. Cancer immunotherapy, a promising approach for HER2-positive and TNBC, still faces resistance hurdles. Recently, numerous studies have set their sights on the resistance of immunotherapy for breast cancer. Our study provides a thorough comprehension of the current research landscape, hotspots, and emerging breakthroughs in this critical area through a meticulous bibliometric analysis. As of March 26, 2024, a total of 1341 articles on immunology resistance in breast cancer have been gathered from Web of Science Core Collection, including 765 articles and 576 reviews. Bibliometrix, CiteSpace and VOSviewer software were utilized to examine publications and citations per year, prolific countries, contributive institutions, high-level journals and scholars, as well as highly cited articles, references and keywords. The research of immunotherapy resistance in breast cancer has witnessed a remarkable surge over the past seven years. The United States and China have made significant contributions, with Harvard Medical School being the most prolific institution and actively engaging in collaborations. The most contributive author is Curigliano, G from the European Institute of Oncology in Italy, while Wucherpfennig, K. W. from the Dana-Farber Cancer Institute in the USA, had the highest citations. Journals highly productive primarily focus on clinical, immunology and oncology research. Common keywords include "resistance", "expression", "tumor microenvironment", "cancer", "T cell", "therapy", "chemotherapy" and "cell". Current research endeavors to unravel the mechanisms of immune resistance in breast cancer through theintegration of bioinformatics, basic experiments, and clinical trials. Efforts are underway to develop strategies that improve the effectiveness of immunotherapy, including the exploration of combination therapies and advancements in drug delivery systems. Additionally, there is a strong focus on identifying novel biomarkers that can predict patient response to immunology. This study will provide researchers with an up-to-date overview of the present knowledge in drug resistance of immunology for breast cancer, serving as a valuable resource for informed decision-making and further research on innovative approaches to address immunotherapy resistance.

Integrating lifestyle medicine into cancer care: A new paradigm.

179 Background: Amid rising global cancer rates and obesity-related cancer risks, oncology must blend traditional cancer treatments with evidence-based lifestyle medicine (LM) to enhance patient outcomes. LM—evidence-based interventions in nutrition, exercise, sleep, avoiding substances, and social connection —emerges as a critical tool in the care spectrum. ASCO and ACS guidelines incorporating lifestyle interventions are limited, and existing ones have notable implementation gaps. This study advocates for integration of LM into cancer care. Such interventions, supported by growing research, offer significant promise in reducing cancer treatment side effects and improving outcomes, highlighting an urgent need for their incorporation into oncological protocols. Methods: The Department of Preventive Medicine at Cleveland Clinic Abu Dhabi (CCAD) launched an LM program at the Oncology Institute. Oncologists refer to LM physicians who assess patients using an LM-validated questionnaire. Cardiometabolic risk factors: body composition, waist circumference, lipid profile, hemoglobin A1c, high-sensitivity CRP, liver function, and liver elastography are tested at baseline and 3 months. Patients receive personalized LM treatment by certified physicians, dieticians, physiatrists, and psychologists, aimed at reducing treatment side effects and enhancing cancer outcomes while improving cardiometabolic health. Follow-ups at 6 weeks and 3 months post-intervention ensure progress tracking and reassessment. Results: Initiated in January 2021, it began as a pilot program for breast cancer patients and has since expanded to all cancer patients. To date, it enrolled 425 patients, evidencing sustainability and acceptance within the patient community. Referral rates from oncologists have shown a steady increase, reflecting the program's growing credibility and utility. Patient satisfaction levels are reported to be high. Preliminary outcomes indicate improvements in both physical and psychological health metrics, suggestive of the program's comprehensive impact. Conclusions: The pioneering oncology LM program at CCAD established a transformative model that seamlessly integrates LM into traditional oncology care and acts as a bridge to survivorship. By ensuring sustained access to lifestyle interventions from the point of diagnosis through post-treatment, the program aligns with the latest research and ASCO/ACS guidelines, pioneering a new standard in cancer treatment. It can effectively address cardiometabolic risks, including obesity, and reduce treatment-related adverse outcomes. This program demonstrates the feasibility and a replicable global model, one that merges evidence-based lifestyle practices with standard oncological care to create a unified approach that could be adopted by healthcare systems worldwide, marking a significant step in the evolution of patient-centered cancer care.

Integrating Audiovisual Immersion Into Pediatric Radiation Therapy Across Multiple Centers: Methodology, Timeliness, and Cost of the Audiovisual-Assisted Therapeutic Ambience in Radiation Therapy Prospective Multi-Institutional Trial

PurposeThe Audiovisual Assisted Therapeutic Ambience in Radiotherapy (AVATAR) trial was a prospective multicenter study (NCTXXXXXXXX) examining the combination of video immersion with radiotherapy and was successfully conducted through the collaboration of pediatric radiation oncology teams at 10 institutions independent of any preexisting consortium. We sought to analyze and report the methodology of trial conception and development, process map, and cost. Methods and MaterialsThe study enrolled patients aged 3-10 years preparing to undergo radiation therapy, integrated the combination of AVATAR-based video immersion during radiation therapy at each institution, and offered AVATAR use as an alternative to anesthesia, with rates of anesthesia use and outcomes of serial standardized anxiety and quality of life assessments assessed among the 81 children enrolled. A process map was created based on the trial timeline with the following components: study development time (time from conception of the trial to accrual of first patient, including design phase, agreement and approval phase and site preparation phase), and accrual duration time (time from the first to last accrual). Costs and institutional success rates were calculated. ResultsTime from inception of study to last accrual was 3.6 years (1313 days). The study development time was 417 days (31.7%) and accrual duration time was 896 days (68.3%), with the final 50% of accrual occurring in less than 6 months. Equipment cost was approximately $550 per institution and was covered by funding from the lead study institution. All 10 centers were successful with AVATAR implementation, defined as ≥50% of patients able to avoid anesthesia with use of AVATAR, including centers with both photon and proton therapy. ConclusionsThis report elaborates on the methodology and timeline of trial conception and development using data from a previously published supportive care study combining video immersion with radiotherapy among 10 cooperating pediatric oncology institutions. It highlights the potential for multicenter collaborations on prospective trials integrating supportive care therapies with radiotherapy.

Pelvic Exenteration in Advanced, Recurrent or Synchronous Cancers-Last Resort or Therapeutic Option?

First described some 80 years ago, pelvic exenteration remain controversial interventions with variable results and ever-changing indications. The previous studies are not homogenous and have different inclusion criteria (different populations and different disease characteristics) and methodologies (including evaluation of results), making it extremely difficult to properly assess the role of pelvic exenteration in cancer treatment. This study aims to describe the indications of pelvic exenterations, the main prognostic factors of oncologic results, and the possible complications of the intervention. Methods: For this purpose, we conducted a retrospective study of 132 patients who underwent various forms of pelvic exenterations in the Institute of Oncology "Prof. Dr. Al. Trestioreanu" in Bucharest, Romania, between 2013 and 2022, collecting sociodemographic data, characteristics of patients, information on the disease treated, data about the surgical procedure, complications, additional cancer treatments, and oncologic results. Results: The study cohort consists of gynecological, colorectal, and urinary bladder malignancies (one hundred twenty-seven patients) and five patients with complex fistulas between pelvic organs. An R0 resection was possible in 76.38% of cases, while on the rest, positive margins on resection specimens were observed. The early morbidity was 40.63% and the mortality was 2.72%. Long-term outcomes included an overall survival of 43.7 months and a median recurrence-free survival of 24.3 months. The most important determinants of OS are completeness of resection, the colorectal origin of tumor, and the presence/absence of lymphovascular invasion. Conclusions: Although still associated with high morbidity rates, pelvic exenterations can deliver important improvements in oncological outcomes in the long-term and should be considered on a case-by-case basis. A good selection of patients and an experienced surgical team can facilitate optimal risks/benefits.

Benign bone tumors in North East Indian population – A hospital-based study

Background: Primary bone tumors are relatively uncommon and constitute only 0.2–0.5% of all tumors in all ages in most series reported worldwide. Benign bone tumors are more common than the malignant bone tumors. Not many studies on benign bone tumors in the North Eastern Indian population are published in the available literature. Aims and Objectives: The current study was done with the aim to find out the epidemiological data on benign bone tumors in patients of the North-East Indian population who were admitted to the orthopedic department of a teaching institute. Materials and Methods: A hospital-based retrospective study with prospective effect was conducted on benign bone tumors in patients admitted to the Department of Orthopedics at our teaching institute from 2016 to 2020. Patients of all ages and both sexes with suspicion of bone tumors based on history and clinical examination were subjected to roentgenographic evaluation, including computed tomography (CT) scan and/or magnetic resonance imaging. Pre-operative core needle biopsy under C-arm/CT guidance or incisional biopsy was done for histological diagnosis, followed by appropriate intervention. Soft-tissue tumors and malignant bone tumors were excluded. Patients were followed up for recurrence, complications, and functional recovery. Results: Forty patients of bone tumors were treated out of 2288 patients admitted to the department (incidence of 1.75%). 29 were benign bone tumors with an incidence of 1.27%. Of 10–20 years age group was most commonly affected. Male preponderance with M: F=6.25:1. Femur (n=16) was the most commonly affected bone. Presenting features were swelling (n=18), pain (n=11), and pathological fracture (n=5). osteochondroma (n=15) was most common followed by giant cell tumor of bone (n=6). Treatment ranged from intralesional steroid to wide marginal excision based on histopathological diagnosis, the extent of tumor, anatomical location, and presenting symptoms. All patients were rehabilitated to activities of daily living at the final follow-up. No recurrence or any long-term complications were reported. Conclusion: This study gives epidemiological data on benign bone tumors, which can be used for setting up or upgrading dedicated oncological or oncosurgery institutes. A multicentric study on a large population in the future is suggested to obtain a larger data bank.

Bevacizumab-Based Therapies in Malignant Tumors-Real-World Data on Effectiveness, Safety, and Cost.

For this purpose, we conducted an open, observational, retrospective study involving all patients treated for solid malignant tumors in the Bucharest Institute of Oncology with "Prof. Dr. Al. Trestioreanu" with Bevacizumab-based systemic therapy, between 2017 and 2021. The study consisted of 657 treatment episodes in 625 patients (F/B = 1.62/1, with a median age of 57.6 years) which were treated for malignant tumors (majority colorectal, non-small cell lung, ovarian, and breast cancer). First-line treatment was administered in 229 patients, and the rest received Bevacizumab as second or subsequent lines of treatment. The overall response rate to Bevacizumab-based therapies was around 60-65% across all indication except for subsequent treatment lines in colorectal and ovarian cancers, where lower values were recorded (27.1%, and 31.5% respectively). Median PFS for the entire cohort was 8.2 months (95% CI 6.8-9.6), and the median OS was 13.2 months (95% CI 11.5-14.9). Usual bevacizumab-related toxicities were observed, including bleeding, hypertension, wound-healing complications, gastrointestinal perforation, other types of fistulas, septic complications, and thromboembolic events. Although the clinical benefits are undeniable, the addition of Bevacizumab to standard chemotherapy increased the overall treatment cost by 213%. Bevacizumab remains a high-cost therapy, but it can add to clinical benefits (like overall survival, progression-free survival, and response rate) when used in conjunction with standard chemotherapy. Similar results as those presented in various controlled trials are observable even on unselected cohorts of patients in the uncontrolled conditions of "real-world" oncological practice. Off-label usage is encountered in clinical practice, and this aspect should be monitored given the potential adverse effects of the therapy.

Assessment of Overall Treatment Time in Curative Radiotherapy

In radiotherapy, spread is a radiobiological parameter that corresponds to the total duration of treatment expressed in days. The objective of the study is to evaluate adherence to the theoretical spread among patients receiving curative irradiation.This was a prospective study conducted within the radiotherapy department at the National Oncology Institute of Rabat, including 285 patients receiving curative irradiation, regardless of tumor localization, from December 1, 2021, to February 28, 2022. Reasons for missed sessions were collected during end-of-treatment consultations.The median age of our patients was 47 years (range: 36-78 years), with 62% being female and 38% male. Among them, 47.3% were employed. Transportation methods varied; public transportation accounted for 59.2%, taxis for 9.1%, and only 8.7% used personal transportation. Travel time from home to the oncology institute was less than 20 minutes for 12.6% of patients, between 20 and 60 minutes for 75.7%, and over 60 minutes for 11.7%. The most common tumor sites were the breast in 32.2% of cases and the prostate in 23.5% of patients. The theoretical spread was adhered to in 29.8% of cases. In 56.4% of cases, the extension was between 1 and 5 days, and in 13.3% of cases, it was between 6 and 12 days.Causes of spread extension were diverse, with equipment breakdowns and maintenance accounting for 52.1% of cases, intercurrent illness for 10%, holidays for 16%, and treatment refusal for 0.6%. Evaluation of spread in radiotherapy is crucial as it represents a significant factor in local recurrence and indirectly affects distant progression, especially with prolonged treatment durations.

User-centered design of a mobile app for physical activity advice in cancer care: preliminary study in Morocco at the National Institute of Oncology

ContextUtilizing mobile apps to increase physical activity levels is now standard practice in cancer care. The study’s objective was to provide patients with precise physical activity recommendations and/or initiate self-directed exercise programs.MethodsA multidisciplinary group directed the design procedure. We adhered to the self-determination approach,and accompanying behavior modification strategies, as well as international guidelines in the field of physical activity in cancer care. The design process was user-centered and involved three steps: Understanding the user and the context, conceptualization, and evaluation of the prototype. The testing was carried out by the beneficiaries, healthcare professionals, and two experts. Three criteria were evaluated in the designed solution: usability, quality, and potential for behavior change.ResultsThe evaluation results of the designed solution showed good perception by both beneficiaries and healthcare professionals. The average system usability scale score was 90,6 (SD: 7.33) for beneficiaries, and 92.75 (SD: 3.83) for healthcare professionals. The first expert received a mean overall quality score of 4.51 on the mobile app rating scale, while the second received a score of 4.27. The results of the app behavior change scale gave the first expert a score of 17/21 and the second a score of 15/21.ConclusionBased on the criteria of usability, quality, and potential for behavior change, the designed app demonstrated positive results. This is a preliminary evaluation, which will be followed by additional, in-depth evaluations with larger sample sizes.

The state of cancer care in Russia: epidemiology and survival in patients with the most common and life-threatening solid malignant tumors. Part 1 (population study)

BACKGROUND: Solid tumors (solid — firm, non-hematopoietic, i.e. developing not from cells of the hematopoietic system) constitute the majority of malignant tumors. The most important factors for their development are: size, degree of sprouting into surrounding tissues, spread throughout the body in the form of regional and distant metastases. The most common (those having the highest incidence rate) solid malignant tumors in Russia are: lung, stomach and breast cancer. The most life-threatening (those having the worst survival rates) are liver and pancreatic cancer. We paid particular attention to the impact of coronavirus infection pandemic on morbidity, mortality as well as registration quality of patients with solid malignant tumors. In order to evaluate the effectiveness of conducted anticancer measures, we calculated survival rates of patients. AIM: To calculate and evaluate the survival rates of patients with the most common and life-threatening neoplasms in Russia. MATERIAL AND METHODS: We based our study on the data of the International Agency for Research on Cancer, reference books of Moscow Herzen Research Oncological Institute (Russia) and N.N. Petrov National Medical Research Centre of Oncology (Saint Petersburg, Russia), as well as databases of population cancer registries of Saint Petersburg and the Northwestern Federal District of Russia. Data processing was performed using licensed programs MS Excel 2013–2016 and STATISTICA 6.1. Modified Eurocare program was used to calculate survival rate, as well as mathematical, bibliographic and statistical methods. RESULTS: The first part of the study analyzed the main regularities of changes in morbidity, mortality and quality of registration of patients with the most common and life-threatening solid malignant tumors in Russia. The incidence of lung and gastric solid malignant tumors has significantly decreased, while the incidence of breast, liver and pancreas cancer has increased. A significant impact of the coronavirus infection pandemic was revealed, and the main changes in age-specific indicators were traced. CONCLUSION: Upon the background of general decrease in mortality of the Russian population from malignant tumors, an increase was noted for mortality from life-threatening localizations (liver and pancreatic cancer), which is confirmed by calculations of the index of accuracy.

Breast cancer relapse disease prediction improvements with ensemble learning approaches

Diagnosis and prognosis are especially difficult areas of medical research related to cancer due to the high incidence of breast cancer, which has surpassed all other cancers in terms of female mortality. Another factor that has a substantial influence on the quality of life of cancer patients is the fear that they may experience a relapse of their disease. The objective of the study is to give medical practitioners a more effective strategy for using ensemble learning techniques to forecast when breast cancer may recur. This research aimed to investigate the usage of deep neural networks (DNNs) and artificial neural networks (ANNs) in addition to machine learning (ML) based approaches, including bagging, averaging, and voting, to enhance the efficacy of breast cancer relapse diagnosis on two breast cancer relapse datasets. Results from the empirical study demonstrate that the proposed ensemble learning-enabled approach improves accuracies by 96.31% and 95.81%, precisions by 96.70% and 96.15%, sensitivities by 98.88% and 98.68%, specificities by 84.62% in both, F1-scores by 97.78% and 97.40%, and area under the curve (AUCs) of 0.987 and 0.978, with University Medical Centre, Institute of Oncology (UMCIO) and Wisconsin prognostic breast cancer (WPBC) datasets respectively. Consequently, these improved disease outcomes may encourage physicians to use this model to make better treatment choices.

Acute Liver Failure: Mechanisms and management approaches

A narrative review, written in lecture form and addressed to intensivists working in oncological institutions, is devoted to the analysis of modern approaches to the treatment of patients with acute liver failure based on the pathogenesis of this lifethreatening complication. Particular attention is paid to the evolution of tactics for managing such patients from the point of view of both general therapy priorities and many of its particular aspects – hemodynamics and hemostasis control, metabolic pharmacotherapy, nutrition, efferent detoxification technologies. The reader’s attention is drawn to fundamental difference between new approaches from outdated ones.

CHILDREN AND ADOLESCENTS WITH CANCER UNDERGOING RADIOTHERAPY: WHAT IS THE IMPACT ON SCHOOLING?

Introduction and Aim of the Study:When a child or adolescent is diagnosed with cancer, it represents a challenging ordeal that often brings significant changes to their daily life. School is an important concern for young patients, but a cancer diagnosis usually leads to school disruptions. The aim of our study is to evaluate the impact of radiotherapy treatment on the schooling of children and adolescents affected by cancer. Materials and Methods:This is a prospective study conducted in the Radiotherapy Department of the National Institute of Oncology in Rabat from January 2022 to December 2022, including 40 children and adolescents aged between 6 and 16 years undergoing radiotherapy or concurrent radiochemotherapy treatment for cancer. Results:The median age of our patients was 10 years, with a predominance of males (sex ratio = 2). The most common neoplasms were malignant hemopathies (35%), nasopharyngeal carcinoma (20%), soft tissue sarcoma (17.5%), brain neoplasms (15%), and others (nephroblastoma , neuroblastoma 12.5%).42.5% of the patients had previously received chemotherapy alone, 30% had chemotherapy plus surgery, and 27.5% had surgery alone.During our study, all patients received either radiotherapy alone (80%) or concurrent radiochemotherapy (20%). The average number of sessions was 22, held daily from Monday to Friday.All our patients were attending school before their diagnosis. However, 96% discontinued school at the start of their treatment, with only 4% continuing to attend school. The heaviness of the treatments received and their side effects are the main cause of school discontinuation. The distance between the treatment location and the patients home was also factor for patients undergoing radiotherapy. Conclusion:The discontinuation of schooling for children and adolescents represents a significant disruption in their daily lives, potentially impacting their psychological well-being. Furthermore, feeling different from other children their age can be challenging for them. Therefore, it is important to offer an adaptation of their schooling with specialized education to enable their social development and well-being.

CURRENT DRUG THERAPY OPTIONS FOR DISSEMINATED HER2-POSITIVE BREAST CANCER AT THE KAZAKH SCIENTIFIC RESEARCH INSTITUTE OF ONCOLOGY AND RADIOLOGY: A CLINICAL CASE

Relevance: Distant outcomes of treatment for Her2neu-positive metastatic breast cancer are improving due to access to innovative drug therapies. The study aimed to demonstrate the initial experience of treating a patient with progressive disseminated hormone receptor-positive breast cancer expressing HER2 (3+) and nearly exhausted options for anti-tumor drug therapy using trastuzumab deruxtecan. Methods: The paper describes a clinical case of a female patient born in 1977 who was diagnosed with Stage IV breast cancer (T1N1M1), invasive ductal carcinoma, and treated at the Kazakh Institute of Oncology and Radiology (Almaty, Kazakhstan). Immunohistochemical luminal subtype “B” with Her2neu (3+) expression. Metastatic involvement of skeletal bones with pain syndrome, lungs, liver, axillary, parasternal, and para-mediastinal lymph nodes. Since June 2023, monoclonal antibody conjugate trastuzumab deruxtecan therapy was initiated. The efficacy of fifth-line therapy was assessed using RECIST 1.1 before and during treatment. According to RECIST 1.1., target lesions included a conglomerate of hyperplastic axillary lymph nodes on the right, measuring 1.6 cm, parasternal lymph node 1.6 cm, a lesion in the parenchyma of the lower lobe of the left lung 1.3 cm, lesions (n=2) in the parenchyma of segment 2 of the left liver lobe 1.8 cm and 3.6 cm. Non-target lesion: hyperplastic para-mediastinal lymph nodes SLD 9.9 cm. Results: Pain syndrome was completely relieved after treatment. According to RECIST 1.1. in April 2024, after 11 courses of therapy, target lesions showed size reduction: conglomerate of hyperplastic axillary lymph nodes on the right decreased to 1.0 cm, lesion in the parenchyma of the lower lobe of the left lung increased to 2.7 cm, parasternal lymph node was not visualized, lesions (n=2) in the parenchyma of segment 2 of the left liver lobe measured 1.6 cm and 2.7 cm. Non-target lesion: hyperplastic para-mediastinal lymph nodes were not visualized. Conclusion: According to the clinical study data (DESTINY-Breast02), applying antibody-drug conjugate (ADC) demonstrates better objective response and progression-free survival time in patients previously treated with trastuzumab and taxanes.

Radiotherapy for parotid cancer: 10 years of experience in a single center

<b><br>Introduction:</b> We report our experience in the treatment of parotid cancers by radiotherapy delivered with curative intent over a period of 10 years.</br> <b><br>Aim:</b> The aim of this study was to evaluate the therapeutic results and prognostic factors.</br> <b><br>Materials and methods:</b> This is a retrospective study of patients with parotid cancer treated with radiotherapy between 2008 and 2017 at the National Institute of Oncology in Rabat. Patients who received adjuvant or exclusive radiotherapy were included in this study. We performed a multivariate analysis for the factors related to locoregional control and overall survival.</br> <b><br>Results:</b> Initially, 74 patients (45 men and 29 women), at a median age of 57 years. were identified. At the time of diagnosis, 10 (13.6%), 36 (48.6%), and 28 (37.8%) patients were in stage II, III, and IVab, respectively. Sixty patients received adjuvant radiotherapy after parotidectomy and 14 patients received exclusive radiotherapy for an unresectable tumor. At 5 years, the rate of locoregional control and overall survival were 68.2% and 53.7%, respectively. Surgical resection and negative margins were significantly correlated with locoregional control. Lymph node involvement, unresectable tumors, high-grade histological types, and cystic adenoid carcinoma were significantly correlated with poor overall survival.</br> <b><br>Conclusions:</b> Acceptable long-term results are obtained with surgery combined with radiotherapy. Surgical resection remains essential for parotid cancer, given the disappointing results of treatment with radiotherapy alone.</br>

NURS-09. FERTILITY PRESERVATION AND PALLIATIVE CARE: RECOGNIZING THE NURSING ROLE IN THE PROMPT IMPLEMENTATION OF SUPPORTIVE CARE INTERVENTIONS IN THE PEDIATRIC CENTRAL NERVOUS SYSTEM TUMOR PATIENT POPULATION

Abstract BACKGROUND Given the complexity of pediatric central nervous system (CNS) tumors, an interdisciplinary approach is necessary to incorporate supportive care interventions that complement oncologic treatment plans. However, early implementation of both palliative care and fertility preservation services presents challenges within the pediatric neuro-oncology population. METHODS An extensive literature review was conducted for articles published between 2013-2023 using PubMed, Google Scholar, and CINAHL databases. The articles focused on nurses’ roles in pediatric oncology, palliative care, fertility preservation, and barriers to supportive care. Furthermore, the review incorporated collective knowledge sharing among pediatric neuro-oncology nursing specialists. This joint initiative applied evidence-based practices to showcase the successful implementation of palliative care and fertility preservation services, broadening this project’s scope. RESULTS One prevalent theme that emerged highlighted the delay in supportive care referrals attributed to perceived obstacles by healthcare team members. The misconception that palliative care is solely for end-of-life situations or the assumption that families are not ready to acknowledge an incurable diagnosis causes delays in palliative care referrals. Fertility preservation in pediatric oncology encounters obstacles, including the urgency to commence treatment, determining optimal candidate criteria, and navigating discussions with younger patients. Nurses are uniquely positioned in their role to bridge gaps between oncologic treatment interventions and the incorporation of supportive care measures. Recognizing the supportive care needs of patients, nurses can educate families, advocate for early referrals, and coordinate integrative care. Advanced Practice Nurses (APNs) can offer clinical consultation, and order appropriate screening, testing, medications, and referrals. CONCLUSION Disseminating nursing education across pediatric oncology practices and institutions is essential for identifying perceived barriers and reforming the early supportive care intervention process. This collaborative and proactive approach is designed to optimize the overall care experience, with the goal of enhancing the delivery of supportive care for pediatric neuro-oncology patients.

Disección axilar dirigida tras tratamiento sistémico primario en cáncer de mama N1. Validación de la técnica y experiencia a los 4 años

ObjectivesTo assess the omission of systematic axillary lymphadenectomy (ALND) in patients with N1 breast cancer with axillary pathological response (APR) after primary systemic treatment (PST). Description and experience of the Technique: Target Axillary Dissection TAD. Identify which subtypes are associated with higher APR. Patients and methodsA descriptive, retrospective study of 90 patients with cT1-T3/N1/M0 stage breast carcinoma who received TSP at the Valencian Institute of Oncology (IVO), between January 2020 and December 2023; 63 received chemotherapy and/or anti-HER2 therapy and 27 received hormonal therapy. Biopsy and labeling of the suspicious lymph node (maximum 3) were performed. In the surgery, a harpoon was placed in the axillary lymph node and the sentinel lymph node (BSGC) technique was also performed with technetium-99m and methylene blue. ResultsAPR was achieved in 46/90 cases (51.2%), in 30/46 (65.2%) pCR, and in 16/46 ITC (isolated tumor cells) or micrometastases remained. Macrometastases were observed in 44/90 (48.8%) and therefore ALND or axillary Rt was performed. There have been no axillary or distant relapses. Detection of the marked node: 100%. RPA occurred in: Luminal A, 26%; Luminal B, 42%; HER2-positive, 86% and Triple Negative, 66%. ConclusionsIn the IVO, ADT is a feasible technique. More than 50% of the cohort had an APR avoiding ALND. The HER2-positive and triple negative subtypes have the highest response rate. It is an oncologically safe procedure; NOT less than ALND.

ОЦЕНКА БЕЗОПАСНОСТИ И ЭФФЕКТИВНОСТИ МЕТОДИКИ МОБИЛИЗАЦИИ И СБОРА ГЕМОПОЭТИЧЕСКИХ СТВОЛОВЫХ КЛЕТОК У ДЕТЕЙ РАЗНЫХ ВОЗРАСТНЫХ ГРУПП СО ЗЛОКАЧЕСТВЕННЫМИ НОВООБРАЗОВАНИЯМИ: ОПЫТ ОДНОГО ЦЕНТРА

High dose chemotherapy (HDCT) with autologous hematopoietic stem cell transplantation (auto-HSCT) is used currently as a consolidating stage in cancer treatment protocols for children from different age groups with various malignant neoplasms. Auto-HSCT can improve both progression-free survival and overall survival of such patients. At the same time the optimization of the collection of autologous hematopoietic stem cells (HSCs) seems to be an important factor in the successful implementation of auto-HSCT. The purpose of this research was to evaluate the safety and effectiveness of the HSCs mobilization and collection method in children from different age groups with various malignancies. Materials and methods used: a single-center retrospective cohort study of 258 pediatric patients (median body weight 20.0 [13.8; 42.0] (7.0-95.0) kg and median height 116 [97; 155] (55.0-189) cm) with various cancers aged 1 to 18 y/o (median 78.0 [36; 144] (3-215) months old) who received treatment in Jan. 2020-Jan. 2023 at the Research Institute of Pediatric Oncology and Hematology named after Academician L.A. Durnov with the N.N. Blokhin Russian Cancer Research Center (Moscow, Russia). Patients were divided into 3 age groups: younger than 1 y/o, 1 to 10 y/o and 11 to 18 y/o. Results: 242 (93.8%) of HSC apheresis procedures were successful on the first attempt, 16 patients underwent repeated apheresis (a total of 274 procedures were performed). The median number of CD34+ cells obtained was 110.95 [45.6; 276.4] (0.70-2338.2) cells/µl, median apheresis duration was 253.5 [189; 338] (82-575) min. No serious complications were observed during the HSCs mobilization and collection in any patient. None of the patients developed hemodynamic disturbances. The main criteria for effectiveness was the CD34+/kg level, the median of which was 5.1 [2.4; 12.7] (0.01-95.6)•106. One of the safety criteria for the patients from all the three age groups was the absence of hemodynamic disorders and citrate reactions in the form of numbness, cyanosis of the skin and respiratory disorders. Another important safety criteria were the absence of a significant decrease in both platelet and hemoglobin levels. The median platelet levels prior to the procedure was 125.5 [68; 210] (14.0-815)•109/l and 129 [73; 210] (17.0-823)•109/l at the end of the procedure (p<0.001). Hemoglobin levels before and after the procedure were 100 [94; 110] (75-242) g/l and 99 [93; 109] (70-142) g/l, respectively (p<0.001). Considering it safe to reduce hemoglobin (g/l) and/or platelets (•109/l) by no more than 10 units in each measurement, in 87.6±4.1% (83.0-91.1) of observed cases the procedure was safe without statistically significant differences in all age groups. The effectiveness of the HSCs mobilization and collection method proposed by the Authors in children of the older age group (11 to 18 y/o) was the lowest and was statistically significantly different from the effectiveness in the group of children aged 1 to 10 y/o (p<0.001) with cancer and amounted to 84.5±4.4% (79.6-88.4). Conclusion: with the multidisciplinary team of practitioners, HSC apheresis in children is a safe and effective technique used as part of the complex cancer treatment in patients from poor prognosis groups. The apheresis algorithm that the Authors have proposed allows high-quality collection of CD34+ positive cells in amounts sufficient for further auto-HSCT.

Еffect of Radiation Therapy on Breast Reconstruction in Breast Cancer Patients

Background. The surgical stage remains the main one in the combined and complex treatment of breast cancer. Radical mastectomy and reconstructive plastic surgery are the main option for surgical treatment of vast majority patients. Radiation therapy can lead to the development of complications after breast reconstruction, and vice versa, the reconstructed mammary gland can cause technical difficulties for the radiologist to properly adjust the required dose of irradiation. Aim — to choose the optimal method of breast reconstruction using various implants, as well as endoprostheses to minimize post-radiation complications and maintain a high level of quality of life for patients after breast cancer treatment. Methods. The retrospective study was conducted in the department of oncology and reconstructive plastic surgery of the breast and skin in the P.A. Herzen Moscow Research Oncology Institute from June 2013 to November 2017. There were performed 132 operations: 111 subcutaneous mastectomy with one-stage reconstruction with an endoprothesis and 21 mastectomy with a one-stage reconstruction with an endoprothesis. The distribution by stages: I — 57, IIA — 39, IIB — 17, IIIA — 13, IIIC 4; 2 cases of breast sarcoma. Prophylactic mastectomy of the contralateral gland was performed in 22 patients, mastopexy in 8, augmentation in 20. Polyurethane implants were applied in 82 cases (62%). Radiation therapy was performed in 47 patients with total dose 45 Gy. Bilateral reconstruction was performed in 22 patients. Results. The mean follow-up period was 28.44 ± 14.66 months (from 6 to 48 months). The most frequent complication in the postoperative period was the development of capsular contracture: seroma — 20 patients, hematoma — 2, edge necrosis — 6, protrusion — 6, infection — 2 patients. The most common capsular contracture by Baker was III degree, n = 18. The average period of development of capsular contracture was 7.6 ± 11.65 months. Conclusion. Despite the greater number of complications during the one-stage reconstruction, the implants remain in advantage in choosing a method of treating breast cancer by both the patient and the surgeon.

Molecular Spectrum of K-RAS Mutations in Colorectal Cancer Patients in Peshawar, Pakistan

Background: The global incidence of colorectal cancer (CRC) has surged, presenting a significant health challenge with an annual occurrence of 1.7 million cases. The American Cancer Society reports that KRAS and BRAF mutations contribute to 20-50% of CRC cases. This study addresses the gap in data on KRAS mutations in CRC patients in Peshawar, Pakistan. Objective: To determine the prevalence and types of KRAS mutations in colorectal cancer patients in Peshawar, Pakistan. Methods: This retrospective, cross-sectional study was conducted at the Nuclear Medicine, Oncology, and Radiotherapy Institute (NORI) Hospital in Islamabad from April to November 2022. DNA was extracted from formalin-fixed, paraffin-embedded tissue blocks of 58 CRC patients, regardless of age and gender, following informed verbal consent. KRAS mutation testing was performed using the Cobas Z480 Real-time thermal cycler. Results: Among the 58 CRC patients, 34 (58.6%) were females, and 24 (41.4%) were males. The highest CRC incidence (36.2%) was observed in the 11-25 years age group. KRAS mutations at codons 12 and 13 were found in 18% of cases, with all isolates carrying the G12D mutation. Kaplan-Meier analysis revealed a lower survival probability for patients with codon 12 mutations compared to those with codon 13 mutations. Conclusion: The study highlights the need for broader research on KRAS mutations across diverse ethnicities and geographical regions in Pakistan to better understand CRC prevalence and improve patient outcomes.

Treatment outcomes of patients with primary tracheal tumors - analysis of a large retrospective series

ObjectivePrimary tracheal tumors are very rare and their management is not definitely established. Due to its rarity, providing patient care in terms of optimal management poses a considerable challenge. The purpose of this study was to investigate treatment outcomes in patients with these rare tumors.MethodsWe carried out a retrospective analysis of 89 patients with primary tracheal tumors treated at the Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Poland, over sixteen years. The study assessed patient demographics, tumor characteristics and treatment. Different treatment options were compared in terms of overall survival, disease-free survival, and progression-free survival.ResultsA total of 89 patients were included in the study. In the group presented, 45 patients underwent primary radical treatment and 44 were qualified for palliative treatment. Surgical resection was performed in 13 patients out of radically treated patients. The 5 year OS rates in the group of patients who underwent radical treatment and in the group of patients who underwent palliative treatment were 45.9% and 2.3%, respectively. In the group of patients who underwent radical surgical treatment, the 5 year OS was 76.9% compared to 35.8% in the group of patients who underwent nonsurgical treatment.ConclusionA multidisciplinary team should decide treatment options, including in-depth consideration of surgical treatment options.