Local Tumor Recurrence Research Articles

Pituitary neuroendocrine tumors treated with stereotactic radiosurgery.

Pituitary neuroendocrine tumors (pitNETs) are benign tumors that may recur after surgical resection or persist following medical management. The objective of this study was to evaluate outcomes and toxicities of patients with pitNETs treated with stereotactic radiosurgery (SRS) at a single institution. We completed a retrospective, single-institution study of patients with pitNETs treated with frame-based, single-fraction, cobalt-60 SRS between September 2005 and June 2023. The primary endpoint was local tumor control. Secondary endpoints included endocrine control (for functional tumors), overall survival, and toxicities. A total of 88 lesions in 83 patients were treated with SRS. Most lesions (70%) were non-functional tumors. Of the 26 functioning tumors, 6 patients achieved endocrine remission with SRS alone (23%), and the remainder achieved remission with combined medical management. With a median patient follow-up of 4.7 years, no local tumor recurrences were observed with an estimated local control probability of 100%. Two- and five-year overall survival estimates were 97% (95% confidence interval [CI] 89-99) and 95% (95% CI 84-98), respectively. Causes of death were unrelated to PitNET or SRS. Twelve patients (14%) developed hypopituitarism after SRS. Despite the 34 lesions that were ≤ 3mm from optic structures, no patients developed any optic neuropathy or visual decline post SRS. SRS is a highly effective modality for recurrent or residual pitNETs. This study observed a local control of 100% with no cases of optic toxicities after a median follow-up of 4.7 years. These observed findings suggest that dose de-escalation may be possible for future treatment of pitNETs.

Injectable Autocatalytic Hydrogel Triggers Pyroptosis to Stimulate Anticancer Immune Response for Preventing Postoperative Tumor Recurrence.

Modulating immunosuppression while eliminating residual microscopic tumors is critical for inhibiting the postoperative recurrence of triple-negative breast cancer (TNBC). Although immunotherapy has shown potential in achieving this goal, due to multiple immunosuppression and poor immunogenicity of apoptosis, a satisfactory anti-recurrence effect still faces the challenge. Herein, an injectable hydrogel-encapsulated autocatalytic copper peroxide (CP@Gel) therapeutic platform is designed and combine it with the clinical-grade DNA methyltransferase inhibitor decitabine (DAC) to effectively inhibit TNBC growth and postoperative recurrence via pyroptosis, killing residual cancer cells that bypass apoptosis resistance while also improving immunogenicity and modulating immunosuppression to achieve an intense anti-tumor immune response. Following injection of the CP@Gel, the sustained release of CP leads to the autocatalytic generation of reactive oxygen species, resulting in caspase-3 activation, and the pre-administered DAC inhibits the methylation of Gsdme to elevate the GSDME protein levels, leading to intense pyroptosis and anti-tumor immune responses. The in vivo results show a 67% elimination of local tumor recurrence via treatment with DAC+CP@Gel, suggesting the successful integration of sustained drug release with autocatalysis and epigenetic modification. The results thus suggest great potential for pyroptosis-based and injectable hydrogel-aided strategies for preventing the postoperative recurrence of TNBC.

Computed tomography-guided cryoablation in treating adrenal metastases: a retrospective single-center study.

To assess the effectiveness and safety of computed tomography (CT)-guided cryoablation for treating adrenal metastases (AMs). This study included 12 patients treated with 13 CT-guided cryoablation procedures for AMs between 2016 and 2020. Patients were selected based on specific criteria, including tumor size ≤5 cm and suitability for surgery. Procedures were performed by expert radiologists, with comprehensive monitoring for complications and regular post-treatment evaluations. The primary technical success rate was 91.7%, with a secondary success rate of 100% following repeat procedures. Over an 8-24-month follow-up period, local tumor recurrence was observed in 16.7% of patients, and systemic progression occurred in five (41.6%) patients. The average overall survival duration was 26.4 ± 5.6 months. CT-guided cryoablation is a feasible and effective treatment option for AMs, demonstrating high technical success rates and manageable complications. This study highlights CT-guided cryoablation as a promising treatment for AMs, offering a minimally invasive alternative to surgery with good local control and safety profile. Further research, including multi-center studies, is needed to confirm these findings.

Local recurrence and residual tumor rates following cryoablation for small early-stage breast cancers: systemic review and meta-analysis.

Cryoablation is currently being investigated as a minimally invasive alternative to breast-conserving surgery. This meta-analysis investigates the local recurrence and residual tumor rates after cryoablation for small early-stage breast cancers. A systematic search was conducted on Embase, PubMed, Google Scholar, and the International Clinical Trials Registry Platform from inception to 16 June 2024. Studies of patients with breast cancers ≤ 20mm treated with cryoablation only or cryoablation followed by surgery were included. Pooled local recurrence rates (cryoablation only) and pooled residual tumors rates (cryoablation followed by surgery) were estimated with mixed-effects models. Between-study heterogeneity was assessed using I2 statistics. Where I2 exceeded 50%, outlier and influence analysis, followed by sensitivity analysis excluding outliers, were conducted. Twelve studies met inclusion criteria, of which 7 studies (530 female patients, 531 breast tumors) reported on patients treated with cryoablation only and 5 studies (220 female patients, 222 breast tumors) reported on patients treated with cryoablation followed by surgery. For studies on cryoablation only, pooled local recurrence rate was 1.1% (95% CI 0.42-3.03%) with low between-study heterogeneity (I2 value = 0%; 95% CI 0.0-70.8%; p = 0.95). For studies on cryoablation followed by surgery, pooled residual tumor rate was 12.0% (95% CI 3.85-31.64%); however, substantial between-study heterogeneity (I2 value = 76.1%; 95% CI 41.7-90.2%; p < 0.01) was present. Influence analysis revealed 1 outlier study. When this study was excluded, pooled residual tumor rate was 8.2% (95% CI 3.84-16.68%) with improvement in heterogeneity (I2 value = 0%; 95% CI 0.0-84.7%; p = 0.64). Pooled local recurrence and residual tumor rates after cryoablation are comparable to local recurrence rates after breast-conserving therapy and re-excision rates following breast-conserving surgery, respectively. These results are encouraging but should be interpreted with caution due to lack of comparative studies.

Secukinumab May Be an Effective Treatment Option for Axial Spondyloarthritis and Psoriatic Arthritis Patients with a History of Malignancy: Multicenter Real-Life Experience from Turkey.

Background: Secukinumab is a monoclonal antibody against interleukin 17 approved for patients with axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), and psoriasis. Treating axSpA and PsA patients with a history of malignancy is a challenge. While initial results on the applicability of secukinumab in this patient group are positive, the number of studies on this topic remains limited. This study aimed to investigate the drug's survival time and the efficacy and safety of secukinumab treatment in this specific patient group. Methods: This retrospective study included 30 patients with a history of malignancy who were followed up in rheumatology outpatient clinics in 12 centers throughout Turkey and treated with secukinumab between May 2018 and March 2024 with a diagnosis of axSpA and PsA. Results: The mean follow-up time was 29.8 ± 19.3 months. The drug retention rate was 89.7% after 12 months and 80.6% after 24 months. The most common tumor in our study was papillary thyroid carcinoma (n = 5, 16.7%). During follow-up, local tumor recurrence was observed in a patient with urothelial carcinoma of the bladder. Conclusions: In the largest cohort reported to date, treatment with secukinumab in axSpA and PsA patients with a history of malignancy was not shown to cause oncologic recurrence except for one local tumor recurrence. Drug retention rates were also high, and disease activation and function improved compared to baseline. Therefore, secukinumab could be a safe and effective option for this patient group.

The Prognostic Significance of Tumor Deposits in Non-Metastatic Colorectal Cancer: Comparing Risk of Recurrence and Metastasis with High-Risk Features

Abstract Introduction/Objective Tumor deposit (TD) is a prognostic factor in colorectal cancer (CRC) patients. This study aims to determine if TD poses a similar risk of local recurrence and distant metastasis as known high-risk (HR) features in non-metastatic CRC. Methods/Case Report An analytical cross-sectional design was employed. Our hospital clinical and pathology databases were queried for stage I-III CRC patients from January 2016 to December 2018 and divided into two groups: TD only group defined by TD on histopathology and HR group defined by obstruction, perforation, or T4- stage. The following variables were collected from each case; biological factors (age, gender, race, and BMI), tumor features (tumor size, tumor grade, presence of LVI, PNI, lymph node status and TN staging) and postoperative follow up (development of recurrence, adjuvant chemotherapy, and overall survival (OS) duration). Data were analyzed using Kruskal-Wallis test for continuous variables and chi-square and Fisher’s exact test for categorical variables. Survival analysis was conducted using Kaplan-Meier estimate graphs. Results (if a Case Study enter NA) A total of 138 non-metastatic CRC patients who underwent surgery and chemotherapy were identified. The TD group consisted of 79 (57.2%) patients with a median age of 67 y (range 35 - 94 y), including 40 (50.6%) males and 39 (49.4%) females. The HR group comprised 59 (42.7%) patients with a median age of 70 y (range 28 - 103 y), including 25 (42.4%) males and 34 (57.6%) females. There were no significant demographic differences between the groups (P&amp;gt;0.05). However, tumor size, tumor grade, presence of lymphatic vessel invasion (LVI), perineural invasion (PNI), and tumor-node (TN) staging exhibited statistically significant differences between the groups (P&amp;lt;0.05). Local tumor recurrence and/ distant metastasis occurred in 29 patients (36.7%) in the TD group and 18 patients (30.5%) in the HR group, with median time for recurrence and/or metastasis 11 months and 12 months, respectively. There was no significant difference between the groups (P&amp;gt;0.05). TD patients had a median survival duration of 42 months, whereas HR group patients had a median survival of 51 months, although this difference was not statistically significant (P&amp;gt;0.05). Conclusion In non-metastatic CRC patients, TD poses a similar risk of local tumor recurrence and distant metastasis as HR factors. HR patients may have a longer survival than TD counterpart. Based on these findings both groups should be subjected to enhanced surveillance.

3D-Printed hydrogel scaffolds with drug- and stem cell-laden core/shell filaments for cancer therapy and soft tissue repair.

Treatment of local tumor recurrence and repair of the tissue defects after tumorectomy still remain clinical challenges. Currently, controlled release of therapeutic drugs is one of the widely used approaches to kill the residual and recurrent cancer cells, and stem cell-laden hydrogel scaffolds are promising candidates for soft tissue repair. However, hydrogel scaffolds with the bifunction of controlled release of therapeutic drugs for cancer therapy and loading stem cells for tissue repair are still not well established. In this study, we fabricated a biphasic hydrogel scaffold containing two types of core/shell filaments with drugs and stem cells loaded in the core part of these two filaments. Black phosphorus nanosheets were added to alginate (the shell layer) in the drug-loaded filament, endowing the scaffold with a photothermal effect under near infrared (NIR) laser irradiation. Moreover, NIR could trigger the drug release from the core/shell filaments to achieve photothermal-chemotherapy of cancer. Additionally, stem cells embedded in the core parts of the other filaments could maintain high cell viability due to the protection of the shell layer (pure alginate), which promoted soft tissue regeneration in vivo. Thus, the prepared biphasic scaffold with drug- and stem cell-laden core/shell filaments may be a potential candidate to fill the tissue defects after the surgical resection of tumors to kill the residual and recurrent cancer and repair the tissue defects.

Creation of a Prediction Model of Local Tumor Recurrence After a Successful Conventional Transcatheter Arterial Chemoembolization Using Cone-Beam Computed Tomography Based-Radiomics.

To create and evaluate prediction models of local tumor recurrence after successful conventional transcatheter arterial chemoembolization (c-TACE) via radiomics analysis of lipiodol deposition using cone-beam computed tomography (CBCT) images obtained at the completion of TACE. A total of 103 hepatocellular carcinoma nodules in 71 patients, who achieved a complete response (CR) based on the modified Response Evaluation Criteria in Solid Tumors 1month after TACE, were categorized into two groups: prolonged CR and recurrence groups. Three types of areas were segmented on CBCT: whole segment (WS), tumor segment (TS), and peritumor segment (PS). From each segment, 105 radiomic features were extracted. The nodules were randomly divided into training and test datasets at a ratio of 7:3. Following feature reduction for each segment, three models (clinical, radiomics, and clinical-radiomics models) were developed to predict recurrence based on logistic regression. The clinical-radiomics model of WS showed the best performance, with the area under the curve values of 0.853 (95% confidence interval: 0.765-0.941) in training and 0.752 (0.580-0.924) in test dataset. In the analysis of radiomic feature importance of all models, among all radiomic features, glcm_MaximumProbability, shape_MeshVolume and shape_MajorAxisLength had negative coefficients. In contrast, shape_SurfaceVolumeRatio, shape_Elongation, glszm_SizeZoneNonUniformityNormalized, and gldm_GrayLevelNonUniformity had positive coefficients. In this study, a machine-learning model based on cone-beam CT images obtained at the completion of c-TACE was able to predict local tumor recurrence after successful c-TACE. Nonuniform lipiodol deposition and irregular shapes may increase the likelihood of recurrence.

A case of salvage surgery following chemoradiotherapy and durvalumab for initially unresectable superior sulcus tumor with N3 involvement

BackgroundDurvalumab after chemoradiation (PACIFIC regimen) provides favorable treatment outcomes for unresectable stage III non-small cell lung cancer (NSCLC). The feasibility of salvage surgery after the PACIFIC regimen has been reported in some studies; however, its efficacy remains unclear. We herein present the first case of salvage surgery after the PACIFIC regimen for a superior sulcus tumor with N3 involvement, in which a pathological complete response was achieved.Case presentationA 53-year-old man with a left superior sulcus tumor with N3 (# 1L, #4R) involvement (adenocarcinoma, clinical T3N3M0/IIIC) underwent concurrent chemoradiotherapy (2 cycles of cisplatin plus vinorelbine with 60 Gy radiotherapy) followed by durvalumab treatment for 1 year at a previous hospital. The PACIFIC regimen provided a significant primary tumor shrinkage (diameter 3.1 cm to 0.5 cm) with the disappearance of 18F-fluorodeoxyglucose uptake in all nodes. Six months after the end of the PACIFIC regimen, only the primary tumor showed enlargement (diameter 0.5 cm to 2.0 cm). Accordingly, local tumor recurrence was suspected. Salvage surgery (left upper lobectomy with combined chest wall resection [1st to 4th rib]) was performed. The histological examination revealed no viable tumor cells (ypT0N0M0). At 7 months after salvage surgery, the patient remains alive with no signs of tumor recurrence.ConclusionsThe present case suggests that salvage surgery may be feasible after the PACIFIC regimen for superior sulcus tumors. A long-term follow-up is essential to determine the efficacy of salvage surgery.

Drug resistance and tumor immune microenvironment: An overview of current understandings (Review).

The use of antitumor drugs represents a reliable strategy for cancer therapy. Unfortunately, drug resistance has become increasingly common and contributes to tumor metastasis and local recurrence. The tumor immune microenvironment (TME) consists of immune cells, cytokines and immunomodulators, and collectively they influence the response to treatment. Epigenetic changes including DNA methylation and histone modification, as well as increased drug exportation have been reported to contribute to the development of drug resistance in cancers. In the past few years, the majority of studies on tumors have only focused on the development and progression of a tumor from a mechanistic standpoint; few studies have examined whether the changes in the TME can also affect tumor growth and drug resistance. Recently, emerging evidence have raised more concerns regarding the role of TME in the development of drug resistance. In the present review, it was discussed how the suppressive TME adapts to drug resistance characterized by the cooperation of immune cells, cytokines, immunomodulators, stromal cells and extracellular matrix. Furthermore, it was reviewed how these immunological or metabolic changes alter immuno‑surveillance and thus facilitate tumor drug resistance. In addition, potential targets present in the TME for developing novel therapeutic strategies to improve individualized therapy for cancer treatment were revealed.

Carbon-ion radiotherapy for adenocarcinoma of the uterine cervix: clinical outcomes of a multicenter prospective registry-based study in Japan (2016–2020)

Prognoses are poorer in cases of adenocarcinoma of the uterine cervix (AUC) than of squamous cell carcinoma. Carbon-ion radiotherapy (CIRT) outcomes for AUC have been reported in retrospective or single institutional prospective studies but not prospective multicenter studies. We present the results of CIRT for AUC in a prospective multicenter study utilizing a nationwide hospital-based registry in Japan. Patients with locally advanced untreated AUC who received CIRT at 4 Japanese centers between June 2016 and April 2020 were included in this study. In the absence of organ dysfunction, up to 5 weekly 40 mg/m2 cisplatin courses were administered. The primary endpoints were 2-year overall survival (OS) and local control (LC) rates. The secondary endpoints were 2-year disease-free survival (DFS) rate and late adverse events (AEs). Forty-two patients were enrolled with a median age of 54 years (range, 34-76 years). Patients were diagnosed with Stage IIB (n=26), IIIB (n=12), or IVA (n=4) disease. The median follow-up period was 24 months. The 2-year OS, LC, and DFS rates were 97.5% (95% confidence interval [CI] 92.7-100.0%), 80.9% (95% CI 66.9-94.8%), and 64.3% (48.1-80.4%), respectively. Two patients developed Grade 3 rectum/sigmoid AE. One patient required urinary diversion surgery during a salvage operation for local tumor recurrence (Grade 3 genitourinary AE). No other Grade 3 or worse toxicities were reported. CIRT is an effective treatment for locally advanced AUC. Further research is required to validate the safety and efficacy of CIRT for AUC.

OUTCOMES OF SHOULDER JOINT ENDOPROSTHETICS AFTER REMOVAL OF TUMORS IN THE HUMERUS

Introduction. The use of endoprostheses of the shoulder joint is possible with primary and secondary (metastatic) tumor lesions of the proximal part of the humerus. The possibility of using both individual oncological endoprostheses and modular oncological endoprostheses for tumors of the proximal part of the humerus is reported. Aim. To assess the effectiveness of restoring the function of the shoulder joint and upper limb and improving the patient's quality of life after shoulder joint arthroplasty for tumors of the proximal part of the humerus. Materials and methods. The results of the treatment of 27 patients who underwent shoulder arthroplasty in the conditions of the clinical departments of the "Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine" for tumors of the proximal part of the humerus from 2014 to 2024 were evaluated. Endoprosthesis was performed in 22 (81.5%) patients with primary tumors of the proximal part of the humerus and in 5 (18.5%) with metastatic tumors. Endoprosthesis of the shoulder joint was performed with individual oncological endoprostheses in 24 (88.9%) patients and modular oncological endoprostheses in 3 (11.1%) patients. Arthroplasty was primary in 25 (92.6%) patients and secondary in 2 (7.4%) patients. Results. During follow-up, 3 (11.1%) patients died with an average follow-up period of 10.3±1.9 months, the other 24 (88.9%) were alive, with an average follow-up period of 88.1±8.7 months. The overall frequency of complications in our study was 6 (22.2%) cases, 3 (11.1%) patients had an infectious complication in the late postoperative period after 12, 24 and 36 months, 1 (3.7%) patient had aseptic loosening of the leg of the endoprosthesis after 36 months, in 2 (7.4%) patients after 5 and 6 months, dislocation of the head of the endoprosthesis from the joint cavity was noted. Local tumor recurrence was observed in 2 (7.4%) patients. The overall mean MSTS total limb functional outcome after shoulder arthroplasty for all 27 patients was 74.2%, and of the 24 patients who survived, the mean limb functional outcome after shoulder arthroplasty was 78.4%. The patients' quality of life (according to the EORTQ-QLQ-С30 questionnaire) increased from 32 points in the preoperative period to 78 points after shoulder joint replacement. Conclusions. Endoprosthetics is a modern method for reconstructing bone segments in the surgical treatment of tumors of long bones in the limbs. This method allows for the replacement of bone defects of any size (volume) and length. Shoulder joint endoprosthetics within the framework of combination and multimodal treatment of primary and metastatic tumors of the proximal part of the humerus provides restoration of both shoulder joint functions and the upper limb as a whole, thereby improving the quality of life for this group of patients.

Outcome and Survival Analysis of Multicenter Lung Metastasectomy for Primary Liver Tumor with Pulmonary Metastasis.

Oligopulmonary metastases from primary liver tumors are typically treated surgically. We evaluated the clinical outcomes after lung metastasectomy in patients with pulmonary metastases from primary liver tumors. We retrospectively enrolled 147 consecutive patients with lung metastases from liver cancer who had undergone pulmonary metastasectomies at three medical centers between February 2007 and December 2020. All patients were pathologically confirmed to have lung metastases from liver cancer. Among the 147 patients, 110, 17, and 20 initially underwent surgical resection, radiofrequency ablation, and transcatheter arterial embolization, respectively. The 5-year overall survival (OS) in the study cohort was 22%. Univariate analysis revealed four factors associated with better OS: surgical resection as the initial primary liver tumor treatment (p = 0.004), a disease-free interval exceeding 12 months after the initial liver surgery (p = 0.036), a lower Model for End-Stage Liver Disease (MELD)-Na score (≤20) for liver cirrhosis (p = 0.044), and the absence of local liver tumor recurrence at the time of pulmonary metastasectomy (p = 0.004). Multivariate analysis demonstrated that surgical resection as the initial primary liver tumor treatment and lower MELD-Na scores significantly correlated with better OS. Our findings can assist thoracic surgeons in selecting suitable patients for surgery and predicting surgical outcomes.

Integrating surgical intervention and watch-and-wait approach in dMMR metastatic rectal cancer with pembrolizumab: a case report

BackgroundTreating rectal cancer presents challenges due to postoperative complications and reduced quality of life (QOL). Recent evidence supports the watch-and-wait (WW) approach for patients with a clinical complete response (cCR) following preoperative treatment. In this report, we discuss a case of metastatic rectal cancer with deficient mismatch repair (dMMR) treated successfully with pembrolizumab.Case presentationA 47-year-old male with dMMR rectal cancer and a single liver metastasis underwent treatment with pembrolizumab as neoadjuvant therapy. After 10 courses, the rectal lesion achieved cCR, prompting the selection of the WW approach. The liver metastasis showed significant shrinkage; however, the presence of a residual tumor was suspected, leading to a metastasectomy. A pathological complete response (pCR) was confirmed via histological examination. During a 24-month follow-up, there was no evidence of tumor regrowth, local recurrence, or distant metastasis.ConclusionsThe WW strategy is increasingly accepted for patients achieving cCR after preoperative treatment. While pCR in dMMR rectal cancer patients treated with immune checkpoint inhibitors (ICIs) has been documented, accurately predicting pCR from imaging remains challenging. This case illustrates that integrating ICI therapy, surgical interventions, and the WW approach can effectively achieve both oncological safety and improved QOL in the treatment of dMMR metastatic rectal cancer.

Defect engineering synergistically boosts the catalytic activity of Fe-MoOv for highly efficient breast mesh antitumor therapy

The demand for breast mesh with antitumor properties is critical in post-mastectomy breast reconstruction to prevent local tumor recurrence. Molybdenum-based oxide (MoOx) exhibits enzyme-like activities by catalyzing endogenous hydrogen peroxide to produce reactive oxygen species for inducing tumor cell apoptosis. However, its catalytic activity is limited by insufficient active sites. Herein, a defect engineering strategy is proposed to create redox nanozymes with multiple enzymatic activities by incorporating Fe into MoOx (Fe-MoOv). Fe-MoOv is subsequently integrated into polycaprolactone (PCL) to fabricate breast meshes for establishing an enzyme-catalyzed antitumor platform. The doping of Fe into MoOx formed numerous defect sites, including oxygen vacancies (OV) and Fe substitution sites, synergistically boosting the binding capacity and catalytic activity of Fe-MoOv. Density functional theory calculations demonstrated that the outstanding peroxidase-like catalytic activity of Fe-MoOv resulted from the synergy between OV and Fe sites. Additionally, OV contributes to the localized surface plasmon resonance effect, enhancing the photothermal capability of the PCL/Fe-MoOv mesh. Upon near-infrared laser exposure, the catalytic activity of the PCL/Fe-MoOv mesh is further improved, leading to increased generation of reactive oxygen species and enhanced antitumor efficacy, achieving 86.7% tumor cell mortality, a 264% enhancement compared to the PCL/MoOx mesh.

Outcome of Endoprosthetic Hip Reconstruction Following Resection of Malignant Bone Tumors.

Over the past few decades, tumor arthroplasty has evolved into an established therapeutic approach for addressing bone defects following tumor resection in the extremities. As the diagnosis has a significant impact on patients' lives, it is important to give clear expectations for functional recovery. Therefore, we investigated both the functional outcomes and the quality of life (QoL) after tumor arthroplasty for malignant hip tumors. This retrospective study included patients who had undergone resections of malignant hip tumors with consecutive modular hip arthroplasty between 2010 and 2018. Demographics, tumor entity, and complications stemming from both tumors and treatments were evaluated through the analysis of medical records and perioperative records. The assessment of functional outcomes was conducted with the following patient-reported outcome measures (PROMs): the Harris Hip Score (HHS), Musculoskeletal Tumor Society Score (MSTS), and the Short Form Survey 36 (SF-36). Furthermore, we performed subgroup analysis in two groups: one divided into survivors and non-survivors, as well as younger individuals (<57 years) and older individuals (>57 years). A total of 30 patients were included in the study. At the time of follow-up, 19 patients were deceased. The average duration of follow-up was 3.2 (±2.51) years. The average age at the time of surgery was 60.3 (±15.20) years. Notably, there were no cases of amputation reported (0%). Five cases of implant failure were identified (16.67%). Among these, one was attributed to infection (3.3%), while four resulted from aseptic loosening (13.3%). In terms of functional outcomes, MSTS indicated good results (18 ± 7; range: 7-28; 60%), and the HHS demonstrated moderate outcomes (75.3%). Younger survivors (<57 years) exhibited notably superior results in terms of both the MSTS and physical functioning in the SF-36 (p = 0.03). In summary, this study shows declining tumor arthroplasty-related complications and satisfying functional outcomes as well as QoL. Noteworthy aspects include the relatively low rates of amputation and local tumor recurrences, which significantly favor the selection of appropriate therapeutic options. Moreover, the findings underscore the substantial impact of patients' age on overall functionality and engagement in daily activities.

Clinical performance of implanted devices used in surgical treatment of patients with spinal tumors: a systematic review

PurposeImplanted devices used in metastatic spine tumor surgery (MSTS) include pedicle screws, fixation plates, fixation rods, and interbody devices. A material to be used to fabricate any of these devices should possess an array of properties, which include biocompatibility, no toxicity, bioactivity, low wear rate, low to moderate incidence of artifacts during imaging, tensile strength and modulus that are comparable to those of cortical bone, high fatigue strength/long fatigue life, minimal or no negative impact on radiotherapy (RT) planning and delivery, and high capability for fusion to the contiguous bone. The shortcomings of Ti6Al4V alloy for these applications with respect to these desirable properties are well recognized, opening the field for an investigation about novel biomaterials that could replace the current gold standard. Previously published reviews on this topic have exhibited significant shortcomings in the studies they included, such as a small, heterogenous sample size and the lack of a cost-benefit analysis, extremely useful to understand the practical possibility of applying a novel material on a large scale. Therefore, this review aims to collect information about the clinical performance of these biomaterials from the most recent literature, with the objective of deliberating which could potentially be better than titanium in the future, with particular attention to safety, artifact production and radiotherapy planning interference. The significant promise showed by analyzing the clinical performance of these devices warrants further research through prospective studies with a larger sample size also taking into account each aspect of the production and use of such materials.MethodsThe Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to improve the reporting of the review. The search was performed from March 2022 to September 2023.ResultsAt the end of the screening process, 20 articles were considered eligible for this study. Polyetheretherketone (PEEK), Carbon-fibre reinforced polyetheretherketone (CFR-PEEK), long carbon fiber reinforced polymer (LCFRP), Polymethylmethacrylate (PMMA), and carbon screw and rods were used in the included studies.ConclusionCFR-PEEK displays a noninferior safety and efficacy profile to titanium implanted devices. However, it also has other advantages. By decreasing artifact production, it is able to increase detection of local tumor recurrence and decrease radiotherapy dose perturbation, ultimately bettering prognosis for patients necessitating adjuvant treatment. Nonetheless, its drawbacks have not been explored fully and still require further investigation in future studies. This does not exclude the fact that CFR-PEEK could be a valid alternative to titanium in the near future.

External validation of the ability of the mRENAL nephrometry score to identify patients at risk for major adverse events or local tumor recurrence after percutaneous renal cryoablation.

The purpose of this study was to evaluate the ability of the mRENAL score to identify patients at risk of either major adverse events (AEs) and/or local tumor recurrence (LR) after percutaneous cryoablation (PCA) in an external patient population. Patient demographic data were recorded. The RENAL and mRENAL nephrometry scores were calculated. Clinical outcomes such as AEs, LR, cancer-specific survival (CSS), and overall survival (OS) were collected. AEs were classified according to SIR criteria. Continuous variables and categorical variables were analyzed using the Wilcoxon rank sum test and chi-square test, respectively. Logistic regression analysis was performed to identify variables associated with major AEs or LR. The study included 207 patients (Males: n = 117 (56.5%)) with a mean age of 65.8 (± 11.2) years (range:27-90). Overall, the mean tumor diameter, RENAL score, and mean mRENAL score were 30.1mm (± 11.4), 6.3 (± 1.7), and 6.8 (± 1.9), respectively. 14 patients (6.8%) and 13 patients (6.3%) experienced a major AE or LR after PCA, respectively. CSS and OS were 98.6% and 90.3%, respectively. For patients with major AEs after PCA, the mean tumor diameter (p < 0.0001), mean RENAL score (p = 0.03), and mean mRENAL score (p = 0.009) were all higher than those for patients without a major AE. Multi-variate regression analysis showed that only mean tumor diameter (p = 0.005) was predictive of a major AE. There were no statistically significant differences between patients with LR and patients without LR after PCA with regards to tumor size (p = 0.07), mean RENAL score (p = 0.32), or mean mRENAL score (p = 0.07). Multi-variate regression analysis showed that only mean tumor diameter (p = 0.01) was predictive of LR. The mRENAL score did not accurately identify patients at risk for either major AEs or LR. Maximum tumor diameter alone was predictive of both major AEs and LR, and should be the primary focus during patient selection.

Lipiodol accumulation patterns and their impact on survival outcomes in transarterial chemoembolization for hepatocellular carcinoma: a single institution retrospective analysis

Conventional Transarterial chemoembolization (TACE) using Lipiodol is a pivotal therapeutic modality for hepatocellular carcinoma (HCC). The link between Lipiodol accumulation patterns and patient survival outcomes remains underexplored. This study assesses the impact of these patterns on the prognosis of HCC patients undergoing TACE. We evaluated HCC patients treated with selective TACE between July 2015 and March 2020, classifying post-procedure Lipiodol accumulation observed on CT scans into four distinct patterns: homogeneous, heterogeneous, defective, and deficient. We analyzed cumulative local tumor recurrence (LTR), progression-free survival (PFS), and overall survival (OS) rates across these groups. Univariate and multivariate logistic regression analyses were performed to identify potential prognostic factors influencing PFS and OS. Among 124 HCC nodules, the distribution of Lipiodol patterns was: 65 homogeneous, 24 heterogeneous, 10 defective, and 25 deficient. Median PFS was 33.2, 9.1, 1.1, and 1.0 months, respectively, while median OS spanned 54.8, 44.5, 25.0, and 29.1 months for these groups. A significant difference in survival was found only between the homogeneous and defective patterns (hazard ratio, 2.33; confidence interval 1.25–4.36). Multivariate analyses revealed nonhomogeneous patterns as significant predictors of shorter PFS (HR 6.45, p < 0.001) and OS (HR 1.73, p = 0.033). Nonhomogeneous Lipiodol patterns in HCC following TACE significantly correlate with higher recurrence and decreased survival rates, especially with defective patterns. Early detection of these patterns may guide timely intervention strategies, potentially enhancing survival outcomes for patients with HCC.

Effect of high blood flow on heat distribution and ablation zone during microwave ablation-numerical approach.

Microwave ablation has become a viable alternative for cancer treatment for patients who cannot undergo surgery. During this procedure, a single-slot coaxial antenna is employed to effectively deliver microwave energy to the targeted tissue. The success of the treatment was measured by the amount of ablation zone created during the ablation procedure. The significantly large blood vessel placed near the antenna causes heat dissipation by convection around the blood vessel. The heat sink effect could result in insufficient ablation, raising the risk of local tumor recurrence. In this study, we investigated the heat loss due to large blood vessels and the relationship between blood velocity and temperature distribution. The hepatic artery, with a diameter of 4 mm and a height of 50 mm and two branches, is considered in the computational domain. The temperature profile, localized tissue contraction, and ablation zones were simulated for initial blood velocities 0.05, 0.1, and 0.16 m/s using the 3D Pennes bio-heat equation, temperature-time dependent model, and cell death model, respectively. Temperature-dependent blood velocity is modeled using the Navier-Stokes equation, and the fluid-solid interaction boundary is treated as a convective boundary. For discretization, we utilized elements for the wave propagation model, elements for the Pennes bio-heat model, and elements for the Navier-Stokes equation, where represents the computational domain. The simulated results show that blood vessels and blood velocity have a significant impact on temperature distribution, tissue contraction, and the volume of the ablation zone.