Oncology Medicine Research Articles

Factors that Influence the Need to Start Adaptive Radiotherapy.

Adaptive radiotherapy (ART) is an essential approach to account for anatomical and biological uncertainties. Adaptive radiotherapy is, however, time-consuming, and it is unclear which patients are eligible or when is the best time to start ART. This prospective study was conducted at Kasr El-Aini Center of Clinical Oncology and Nuclear Medicine, Cairo, Egypt from January 2019 to December 2020. Thirty patients with pathologically proven, limited-stage small cell or stage I-II non-small cell lung cancer who were either not fit for or refused surgery or had stage III disease were recruited and underwent treatment planning to receive 60 Gy on a conventional 3D conformal radiation schedule with platinum-based chemotherapy. All patients underwent computed tomography (CT) planning within 2 and 4 weeks of starting radiation therapy to assess the need for adaptation. Pulmonary function test and echocardiography findings were assessed at the end of treatment and at 3 and 6 months after treatment, and were compared to the baseline. We found a significant reduction in mean value of the planning target volume (PTV) in the CT scans at the second (331 cm3) and fourth (257 cm3) weeks of treatment as compared to baseline (342 cm3) (p-value < 0.0001). Adaptation decreased the dose to the organ at risk with statistical significance and with improvement of the target coverage. At week 2 of radiotherapy, the need for adaptation was correlated to the conformity index (p = 0.0473), esophageal V35 (p = 0.0488), esophageal V50 (p = 0.0295), and its mean dose (p = 0.0087). At week 4 it was correlated to forced expiratory volume in 1 second (FEV1) (p = 0.0303), ratio between the forced expiratory volume in 1 second and the forced vital capacity (FEV1/FVC) (p = 0.0024), and echocardiography (p = 0.0183). Conformity index and esophageal dose constraints can predict the need for adaptation at week 2, whereas baseline pulmonary function parameters and echocardiography can predict the need for adaptation at week 4 of radiotherapy.

Hemophagocytic lymphohistiocytosis and macrophage activation syndrome : A multidisciplinary challenge

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome that is characterized by hyperferritinemia, cytopenia, disseminated intravascular coagulopathy and functional disorders of the liver and the central nervous system. The term macrophage activation syndrome is predominantly used for secondary HLH in the context of autoimmune diseases (e.g., systemic juvenile idiopathic arthritis). In addition, malignancies and genetic inborn errors of immunity can predispose to the development of HLH. Infections (e.g., Epstein-Barr virus) in turn represent possible triggers of an acute episode. Due to the unspecific manifestation of the disease, a systematic evaluation of the organ systems is recommended in the clinical and laboratory analytical clarification of hyperinflammatory syndromes. In general, the treatment should be carried out by a multidisciplinary team with expertise in rheumatology, hematological oncology, infectious diseases and intensive care medicine. The primary treatment of HLH usually consists of glucocorticoids and in cases of a rapid deterioration of the condition anakinra (interleukin 1 block) and intravenous immunoglobulins can be employed. Treatment of the underlying disease should be consequently carried out in parallel, together with antimicrobial treatment.

Eating Behavior, Nutritional Status, and Taste Perception Alteration in Children with Cancer.

The aim of this study was to investigate eating behavior, nutritional status, and taste alterations in children with cancer. The population of the study consisted of children 8 to 18 years of age and their parents who were followed up and received chemotherapy in the pediatric hematology and oncology clinic and outpatient clinic of a University Faculty of Medicine Oncology Hospital. Data were collected using the Child Identification Form, the Children's Eating Behavior Questionnaire (CEBQ), the Taste Alteration Scale for Children Receiving Chemotherapy (TAC-TAS), and the Subjective Total Taste Acuity Scale (STTA). Body Mass Index (BMI) Z score was between -2 and +2 (normal) in 92.5% of the children and below ≤-2 (malnutrition) in 7.5%. The mean CEBQ subdimensions scores were food craving 12.48±5.36, emotional overeating 5.28±1.45, enjoyment of food 16.83±5.41, passion for drinking 9.72±5.13, satiety enthusiasm 22.93±6.65, slow eating 9.81±4.95, emotional undereating 16.38±4.41, and food selectivity 10.72±2.86, and the mean total TAC-TAS score was 8.66±10.22. A negative, moderate correlation was determined between food craving and enjoyment of food and taste alteration, with food craving and enjoyment decreasing as food alteration increased. A positive moderate correlation was observed between slow eating and taste alteration, with eating slowing down as taste alteration increased.

Integrating Immunotherapy and Nanotechnology in Advanced Drug Delivery Systems for Precision Cancer Therapy

This review article investigates recent advancements in drug delivery systems, with a specific emphasis on integrating nanotechnology and immunotherapy for precision cancer therapy. This review explores the design, development, and optimization of novel drug delivery platforms aimed at improving drug efficacy, minimizing side effects and enhancing patient outcomes. The synergistic interplay between nanocarriers and immunotherapeutic agents shows significant potential in addressing current challenges in cancer treatment, such as drug resistance and off-target effects. This article reviews recent preclinical and clinical studies, highlighting the transformative potential of these innovative approaches to reshape cancer therapeutics and facilitate the advent of personalized medicine in oncology. The research findings contribute to the ongoing initiatives aimed at refining the effectiveness and safety of pharmaceutical interventions, bringing us one step closer to more efficient and targeted cancer treatments.

Interpreting and integrating genomic tests results in clinical cancer care: Overview and practical guidance.

The last decade has seen rapid progress in the use of genomic tests, including gene panels, whole-exome sequencing, and whole-genome sequencing, in research and clinical cancer care. These advances have created expansive opportunities to characterize the molecular attributes of cancer, revealing a subset of cancer-associated aberrations called driver mutations. The identification of these driver mutations can unearth vulnerabilities of cancer cells to targeted therapeutics, which has led to the development and approval of novel diagnostics and personalized interventions in various malignancies. The applications of this modern approach, often referred to as precision oncology or precision cancer medicine, are already becoming a staple in cancer care and will expand exponentially over the coming years. Although genomic tests can lead to better outcomes by informing cancer risk, prognosis, and therapeutic selection, they remain underutilized in routine cancer care. A contributing factor is a lack of understanding of their clinical utility and the difficulty of results interpretation by the broad oncology community. Practical guidelines on how to interpret and integrate genomic information in the clinical setting, addressed to clinicians without expertise in cancer genomics, are currently limited. Building upon the genomic foundations of cancer and the concept of precision oncology, the authors have developed practical guidance to aid the interpretation of genomic test results that help inform clinical decision making for patients with cancer. They also discuss the challenges that prevent the wider implementation of precision oncology.

Genetic profiling in radiotherapy: a comprehensive review.

This comprehensive review explores the pivotal role of radiotherapy in cancer treatment, emphasizing the diverse applications of genetic profiling. The review highlights genetic markers for predicting radiation toxicity, enabling personalized treatment planning. It delves into the impact of genetic profiling on radiotherapy strategies across various cancer types, discussing research findings related to treatment response, prognosis, and therapeutic resistance. The integration of genetic profiling is shown to transform cancer treatment paradigms, offering insights into personalized radiotherapy regimens and guiding decisions in cases where standard protocols may fall short. Ultimately, the review underscores the potential of genetic profiling to enhance patient outcomes and advance precision medicine in oncology.

Synergistic applications of cyclodextrin-based systems and metal-organic frameworks in transdermal drug delivery for skin cancer therapy.

This review article explores the innovative field of eco-friendly cyclodextrin-based coordination polymers and metal-organic frameworks (MOFs) for transdermal drug delivery in the case of skin cancer therapy. We critically examine the significant advancements in developing these nanocarriers, with a focus on their unique properties such as biocompatibility, targeted drug release, and enhanced skin permeability. These attributes are instrumental in addressing the limitations inherent in traditional skin cancer treatments and represent a paradigm shift towards more effective and patient-friendly therapeutic approaches. Furthermore, we discuss the challenges faced in optimizing the synthesis process for large-scale production while ensuring environmental sustainability. The review also emphasizes the immense potential for clinical applications of these nanocarriers in skin cancer therapy, highlighting their role in facilitating targeted, controlled drug release which minimizes systemic side effects. Future clinical applications could see these nanocarriers being customized to individual patient profiles, potentially revolutionizing personalized medicine in oncology. With further research and clinical trials, these nanocarriers hold the promise of transforming the landscape of skin cancer treatment. With this study, we aim to provide a comprehensive overview of the current state of research in this field and outline future directions for advancing the development and clinical application of these innovative nanocarriers.

Harnessing BRCA Advances: Revolutionizing Breast Cancer Diagnosis and Treatment

Advancements in understanding BRCA gene mutations have reshaped breast cancer management, ushering in a new era of precision oncology. This review explores the transformative impact of BRCA research on breast cancer diagnosis and treatment strategies, emphasizing the pivotal role of genetic testing, targeted therapies, and personalized medicine approaches. Harnessing BRCA advances offers unprecedented opportunities for early detection, risk stratification, and tailored treatment modalities, fundamentally altering the landscape of breast cancer care. Central to harnessing BRCA advances is the widespread adoption of genetic testing for BRCA mutations, enabling the identification of individuals at heightened risk of hereditary breast cancer. Genetic testing informs risk stratification and facilitates personalized screening and preventive interventions, including risk-reducing surgeries and enhanced surveillance protocols. Moreover, genetic testing guide’s treatment decisionmaking by identifying candidates for targeted therapies, such as poly (ADP-ribose) polymerase (PARP) inhibitors, which have demonstrated efficacy in BRCA-mutated breast cancers, offering new avenues for precision medicine in oncology. The integration of targeted therapies tailored to BRCA-related breast cancer subtypes represents a paradigm shift in treatment approaches, providing novel strategies to optimize patient outcomes. PARP inhibitors have emerged as a promising therapeutic option for BRCA-mutated breast cancers, leading to improved progression-free survival and overall survival in metastatic settings. On-going research endeavours aim to elucidate molecular mechanisms of treatment response and resistance, paving the way for the development of innovative therapeutic strategies to address unmet clinical needs and further enhance the efficacy of precision oncology in breast cancer management.

Patients' perspectives on cancer care disparities in Central and Eastern European countries: experiencing taboos, misinformation and barriers in the healthcare system.

Despite the advancements in oncological medicine and research, cancer remains the second leading cause of death in Europe with Central and Eastern European countries, such as Slovakia and Croatia, showing the highest mortality rates and disparities in access to appropriate and comprehensive cancer care. Therefore, the primary aim of the current study is to investigate cancer patients' perspectives and experiences to understand the possible underlying reasons for cancer disparities. Croatian cancer patients (n=15) and Slovak patients (n=11) were recruited through social media platforms, patients' organisations, and hospital websites and offered participation in online focus group discussions on perceived disparities, barriers or malfunctioning during and after their cancer journey. Transcripts of video and audio recordings of the interviews were translated and analysed using Thematic analysis. Six Croatian and five Slovak themes emerged from the focus group discussions highlighting encountered barriers and perceived disparities, as well as suggestions or unmet needs. Most of the themes are common to both groups, such as the lack of information and use of the internet, and the taboos regarding cancer or psycho-oncological support. However, some themes are specific to each group, for instance, Slovak cancer patients remarked the fact that they do not mind travelling to get treatment as long as they can be treated in the west of Slovakia, while Croatian patients highlighted the need for more information after the illness and the socioeconomic impact deriving from a cancer diagnosis. Urgent intervention is needed in addressing disparities in Central and Eastern Europe. Present results could inform dedicated guidelines or better resource allocation strategies to reduce disparities in cancer care and promote inclusive healthcare.

Surgical Management of Metastatic Spine Fracture

Abstract The spine is a very frequent site of metastasis from solid tumors. World Health Organisation estimated an exponential increase of 29.4 million new cases of cancer in 2040. The incidence of solid tumors metastasizing to the spinal column is from the breast, prostate, kidney, and lung. The need for treatment lies in different factors, and proper evaluation of the disease requires a “multidisciplinary team” approach. The MDT contains tumor surgery, oncology medicine, tumor radiotherapy, radiology, and pathology departments.

Do Fibroblast Growth Factor Receptor (FGFR) 2 and 3 Proteins Play a Role in Prognosis of Invasive Urothelial Bladder Carcinoma?

Bladder carcinoma ranks second in prevalence among males in Egypt. As a family of tyrosine kinases, fibroblast growth factor receptor (FGFR) dysregulation has been linked to some malignancies in humans. The aim of this study is to analyze the clinicopathological data of patients while investigating FGFR2 and FGFR3 immunohistochemical expression in invasive urothelial bladder carcinoma. This retrospective cross-sectional study included 60 invasive urothelial carcinoma (UC) cases in the Pathology department, Faculty of Medicine, Menoufia University, from 2009 to 2020. All biopsies were stained for FGFR2 and FGFR3 antibodies. Complete clinical data were available for 44 patients treated and followed in clinical oncology and nuclear medicine departments. Advanced stage and high grade are significantly correlated with FGFR2 positivity (P=0.048 and 0.044, respectively). Cases presented with Perineural invasion showed a higher percentage of FGFR2 (P=0.023). There is a significant indirect linear correlation between FGFR3 expression and lymph node positivity (r= -0.265, P=0.041). A high FGFR2 expression could be associated with poor prognostic parameters, while high FGFR3 expression would be associated with good prognostic parameters. These findings might highlight the importance of FGFR-targeted therapy as a FGFR2 antagonist and FGFR3 agonist for the treatment of urothelial carcinoma patients.

Requirement for diagnostic medical physicists in Vietnam

This paper mentions the status of diagnostic medical physicists, estimating the lack of this work in Vietnam. The evaluation method is based on International Atomic Energy Agency documents and typical hospital models in Vietnam. In 2021, there were no diagnostic medical physicists. The roles and responsibilities of diagnostic medical physicists are currently performed by radiologists, biomedical engineers, and medical physicists in radiation oncology or nuclear medicine. This job is still a potential profession in Vietnam.

Update on the PriME-PGx initiative: evolution of pharmacogenetics in daily clinical practice.

In 2021, the Clinical Pharmacology Department of Hospital Universitario de La Princesa launched the PriME-PGx initiative (Multidisciplinary Initiative of the Hospital Universitario de La Princesa for the Implementation of Pharmacogenetics) to promote the expansion of pharmacogenetics in hospitalized patients. We establish seven pharmacogenetic profiles based on the specific needs of seven departments: Oncology, Pain Unit, Neuropsychiatry, Internal or Infectious Medicine, Cardiology, Gastroenterology and Immunosuppressants. The experience of the last 3 yearsreflects a total of 1421 reports (37.4% being oncology profiles), with a gradual increase in the number of requests each year. With this project, we aim to expand the availability and utility of pharmacogenetic biomarkers to achieve personalised therapy that avoids adverse drug reactions and therapeutic failure.

Fertility preservation counseling for women of reproductive age diagnosed with cancer: an integrative review.

This integrative review synthesizes the scientific evidence on fertility preservation counseling prior to oncological treatment for women of reproductive age diagnosed with cancer. Bibliographic research was conducted on databases PubMed, CINAHL, LILACS, EMBASE, Scopus, and Web of Science. The structured search strategy for the review question was "counseling AND antineoplastic agents AND fertility preservation". The use of controlled descriptors and keywords was adapted for each database. Study selection through the Rayyan platform was independent and blinded. The final sample comprised seven studies emphasizing the importance of clarifying factors related to the risk of infertility due to oncological treatment and fertility preservation techniques, such as success rate, pregnancy rate, cost, available options, and side-effects, as well as discussing the possibilities of adoption and surrogacy. This review provided evidence reinforcing the importance of counseling for fertility preservation, promoting motherhood for women who face oncological treatment. Organized networks linking oncology and reproductive medicine units are crucial to facilitate patient referral between these services and interprofessional communication.

I All-Russian Scientific and Practical Conference “Achievements and Prospects of Experimental Pharmacology in Oncology and Radiation Medicine”

I All-Russian Scientific and Practical Conference “Achievements and Prospects of Experimental Pharmacology in Oncology and Radiation Medicine”

In situ modified mesoporous silica nanoparticles: synthesis, properties and theranostic applications.

Over the last 20 years, mesoporous silica nanoparticles (MSNs) have drawn considerable attention in the biomedical field due to their large surface area, porous network, biocompatibility, and abundant modification possibilities. In situ MSN modification refers to the incorporation of materials such as alkoxysilanes, ions and nanoparticles (NPs) in the silica matrix during synthesis. Matrix modification is a popular approach for endowing MSNs with additional functionalities such as imaging properties, bioactivity, and degradability, while leaving the mesopores free for drug loading. As such, in situ modified MSNs are considered promising theranostic agents. This review provides an extensive overview of different materials and modification strategies that have been used and their effect on MSN properties. We also highlight how in situ modified MSNs have been applied in theranostic applications, oncology and regenerative medicine. We conclude with perspectives on the future outlooks and current challenges for the widespread clinical use of in situ modified MSNs.

Personalized Cancer Nanomedicine: Overcoming Biological Barriers for Intracellular Delivery of Biopharmaceuticals.

The success of personalized medicine in oncology relies on using highly effective and precise therapeutic modalities such as small interfering RNA (siRNA) and monoclonal antibodies (mAbs). Unfortunately, the clinical exploitation of these biological drugs has encountered obstacles in overcoming intricate biological barriers. Drug delivery technologies represent a plausible strategy to overcome such barriers, ultimately facilitating the access to intracellular domains. Here, an overview of the current landscape on how nanotechnology has dealt with protein corona phenomena as a first and determinant biological barrier is presented. This continues with the analysis of strategies facilitating access to the tumor, along with conceivable methods for enhanced tumor penetration. As a final step, the cellular barriers that nanocarriers must confront in order for their biological cargo to reach their target are deeply analyzed. This review concludes with a critical analysis and future perspectives of the translational advances in personalized oncological nanomedicine.

Process reengineering using DMAIC framework for reduction of waiting time in daycare infusion therapy for better patient experience.

Daycare infusion therapy is an integral aspect of oncology, but increased waiting time raises concerns for patients. Patient-reported experience measures prompted the need to evaluate reasons for prolonged appointment delays. This study seeks to analyze and address patients' concerns, to streamline the process flow and reduce waiting time for daycare infusion therapy thereby enhancing patient experience. The define, measure, analyze, improve, and control methodology was implemented, and its impact on reducing waiting times was evaluated. The objective is to ensure that >85% of patients enter the daycare infusion unit within an hour of their appointment time in 6 months. The baseline data for patient waiting times was measured for a period of 2 months, and the average waiting time was determined. Potential causes contributing to prolonged waiting times were identified through time-motion analysis, with a fishbone diagram categorizing potential causes and a Pareto chart prioritizing them. Plan, do, study, and act cycles were conducted for implementing the changes, and a new process flow mapped. Baseline data showed 32% average adherence to the defined turnaround time of 1 hour, with an average waiting time of 108 minutes. Forty causes were identified for increased waiting time, of which eight were key. Adherence to waiting time turnaround time improved from 32% to 89% and the average waiting time decreased by 59 minutes from 108 minutes, increasing patient satisfaction index by 7.5%. The balancing measures include an increase in operational efficiency and throughput of the unit and the inventory levels of oncology medicine were decreased, leading to a 50% reduction in inventory value, while medication error declined by 0.62%, improving patient safety. The project gained tangible and intangible benefits impacting staff, patients, and relatives while improving operational efficiency. This study, with its scientific and systematic approach, enhanced patient satisfaction, patient safety, and better utilization of resources.

Mapping the clinical practice of traditional, complementary and integrative medicine in oncology in Western countries: A multinational cross-sectional survey

BackgroundMany cancer patients seek adjunctive therapies to biomedical cancer treatments at some point of their disease trajectory. While acupuncture is increasingly recommended by leading oncological associations, limited evidence exists concerning the evidence-informed practice and adherence to current guidelines of traditional complementary and integrative medicine (TCIM) practitioners treating cancer patients. MethodsAn international online-survey assessed the demographical data, clinical practice, and sources of information used by TCIM practitioners in Austria, Germany, United States of America, Australia, and New Zealand. ResultsIn total, 404 respondents completed the survey, of which 254 (62.9%) treated cancer patients. Most practitioners were acupuncturists and herbalists (57.1%), had (16.8 ± 9.9) years of clinical experience and see a median of 2 (1, 4) cancer patients per week. Breast cancer (61.8%) is the most common cancer type seen in TCIM clinics. Adjunctive TCIM treatments are frequently concurrent with the patient’s cancer specific treatment (39.9%), which is also reflected by the main goal of a TCIM treatment to alleviate side effects (52.4%). However, only 28.0% of the respondents are in contact with the treating oncologist. According to the respondents, pain is most effectively treated using acupuncture, while herbal medicine is best for cancer-related fatigue. TCIM practitioners mostly use certified courses (33.1%) or online databases (28.3%) but often believe that experts are more reliable to inform their practice (37.0%) than research publications (32.7%). ConclusionAcupuncturists and herbalists commonly treat cancer patients. Most practitioners use TCIM as an adjunct to biomedicine as supportive care and use it largely in accordance with current oncological guidelines. Please cite this article asHuemer M, Graca S, Bitsche S, Hofmann G, Armour M, Pichler M. Mapping the clinical practice of traditional, complementary and integrative medicine in oncology in Western countries: A multinational cross-sectional survey. J Integr Med. 2024; 22(1): 64–71.

Lung cancer registry to promote person-centered care.&amp;nbsp;

Introduction: Lung cancer is a leading cause of death and major burden on healthcare systems. Patient-centered outcome measurements allow the optimization of care organization and quality improvement. The aim of this project was to outline a set of variables and outcomes to evaluate the quality of care provided to lung cancer patients. &#x0D; Methods: This project took place at Hospital Italiano de Buenos Aires, a community-based tertiary care hospital in Argentina; which provides thoracic surgery, pneumology, oncology, pathology, radiology and radiotherapy services. It also has a Lung Cancer Multidisciplinary Board. All patient information is stored in a Data Repository fed by the electronic health record (EHR).&#x0D; We established a team of experts in management, IT, thoracic surgery, pneumology, oncology, and internal medicine. We reviewed care processes and patient trajectory along the usual pathway, through a retrospective EHR analysis of a consecutive sample of lung cancer patients. &#x0D; We performed a literature review to outline possible variables and health outcomes to be collected, instruments, and frequency of measurement. We determined needs, usefulness, and feasibility of collecting variables and outcomes in group meetings. &#x0D; Results: We reviewed 15 cases of lung cancer, 53% male, median age 68 years old (range: 29-85). We detected heterogeneity in the time elapsed between critical points of management (eg first visit to diagnosis 21 to 642 days; biopsy report to chemotherapy 19 to 163). The proportion of use of the healthcare system was also variable (eg: 87% consulted pneumonolory or oncology, only 13% had pain management visits and 7% received respiratory kinesic therapy). Patient-reported outcomes were not systematically evaluated.&#x0D; The selected baseline variables were: age, sex, weight loss, smoking status, comorbidities, patient-reported health status (EORTC European Organization for Research and treatment of cancer, QLC-LC30 Core quality of life questionnaire, QLC-LC13 Lung cancer-specific quality of life questionnaire), performance status (ECOG Eastern Cooperative Oncology Group), pulmonary function (VEF1), histology, clinical and pathological stage (AJCC-TNM 8th Ed), molecular tests and treatment intent. The outcomes (collected annually): clinical staging performed before treatment, time from diagnosis to treatment, performance status, patient-reported health status, major surgical complications, major chemotherapy/radiotherapy complications, time from diagnosis to treatment, completed treatment, overall survival, cause of death, treatment-related mortality, place of death, time spent in hospital at the end of life (last 30 days).&#x0D; Discussion: Cancer registries comprise a set of systematically and prospectively collected data. Quality measurements performed in the context of cancer registries could assist in monitoring and evaluating quality of care. &#x0D; Conclusions: The project determined essential variables and outcomes to be measured, considering their relevance and feasibility.&#x0D; Lessons learnt: Teamwork is essential when developing a registry, as different stakeholders' opinions are reflected. Integrated care is a useful solution to overcome fragmentation.&#x0D; Limitations: Patients did not participate directly in this development. &#x0D; Suggestions for future research: These results will assist in outlining a care pathway for patients with lung cancer, which is currently under development. Evaluation before and after the implementation of care pathways may evidence quality improvement.