Pancreatic ductal adenocarcinoma (PDAC) carries a poor prognosis and significantly affects health-related quality of life (HRQoL). In borderline resectable (BR) and locally advanced (LA) PDAC, neoadjuvant FOLFIRINOX may enable surgical resection, but its toxicity can further compromise HRQoL. Evidence on longitudinal HRQoL changes during FOLFIRINOX in this context remains limited. This study evaluated HRQoL trajectories in patients with BR and LA PDAC receiving neoadjuvant chemotherapy (NACT) within a surgical selection strategy. This longitudinal analysis included patients from the multicenter prospective PeRFormanCe trial (NCT05298722), investigating outcomes in BR and LA PDAC treated with FOLFIRINOX as NACT. HRQoL was assessed at baseline and after 4, 8, and 12 NACT cycles using EORTC QLQ-C30 and PAN26 questionnaires. Changes over time were analyzed using linear mixed-effect models. Clinically meaningful differences were defined as ≥10-point mean changes with 95% confidence intervals. Twenty patients were included (35% female), 12 (60%) had LA PDAC. The median number of NACT cycles was 8 (IQR 7-12). Sixteen patients (80%) underwent surgical exploration, and 11 (55%) achieved resection. During NACT, patients reported improvements in insomnia, pain, hepatic symptoms, bloating and appetite loss. Muscle weakness, cognitive deterioration, and side effects increased. Among patients completing 12 cycles, weight loss and flatulence decreased, global health status (baseline 64, SE 4.05) and fatigue scores improved. In patients with BR and LA PDAC treated with FOLFIRINOX as NACT, HRQoL can be preserved over time despite variations in symptoms. These findings contribute to informed, patient-centered decision-making in the neoadjuvant setting. ClinicalTrials.gov Identifier NCT05298722. Date of registration March 28, 2022.

OX40+ regulatory T cells suppress neoadjuvant chemotherapy response in NSCLC and reversed by combination of PD-1 blockade therapy.

Interobserver agreement with MRI vs. CT for pancreatic tumour size measurement before and after neoadjuvant therapy.

Perioperative and oncologic outcomes of vascular resection after neoadjuvant therapy in intrahepatic cholangiocarcinoma.

Neoadjuvant chemotherapy (NACT) prior to cytoreductive surgery (CRS) and heated intraperitoneal chemoperfusion (HIPEC) for patients with metachronous colorectal peritoneal metastases (CRPM) carries theoretical advantages but thus far has not demonstrated survival benefit. We conducted a retrospective single institution study of patients with CRPM undergoing CRS/HIPEC ± NACT from 2002 to 2022. A total of 199 patients with metachronous CRPM were identified; 128 patients (64.3%) underwent NACT while 71 patients (35.7%) underwent upfront CRS/HIPEC. The majority of patients were white (92.5%) and male (53.3%) with a median age of 57 years. There was an average of 19.5 months from initial colon cancer diagnosis to the development of CRPM, and 155 patients (77.9%) had undergone previous systemic chemotherapy in their disease course prior to development of CRPM. Patients who received NACT demonstrated no difference in PCI (median 12 vs. 10, p = .19) or rate of undergoing complete cytoreduction (81.2% vs. 93%, p = .08) versus those who underwent upfront CRS/HIPEC. Patients undergoing NACT+CRS/HIPEC experienced a significantly higher rate of major perioperative complications (25% vs. 12.7%, p = .04) and increased hospital length of stay (12 vs. 10 days, p < 0.01). There was no significant difference in median recurrence-free survival (18.7 vs. 20.3 months, p = .283) or overall survival (35.3 vs. 32.9 months, p = .513) between the groups. Utilizing NACT prior to CRS/HIPEC for patients with metachronous CRPM did not demonstrate survival benefit. NACT was, however, associated with increased rates of perioperative complications and length of hospital stay. Further studies are needed to better evaluate the optimal role and timing of systemic chemotherapy.

This study aimed to investigate the clinical and biological significance of neoadjuvant chemotherapy (NAC) by assessing Ki-67 expression in pancreatic ductal adenocarcinoma (PDAC). This single-center retrospective study enrolled 213 patients who had curative pancreatic resection with or without NAC between January 2004 and December 2022. Surgical specimens, evaluated via immunohistochemical staining for Ki-67, were divided into the high (≥ 20%) (n = 97) and low (< 20%) (n = 116) expression groups. Of the 213 patients, 118 underwent upfront surgery (US), while 95 were treated with NAC followed by surgery. In the entire cohort, high Ki-67 expression was an independent poor prognostic factor for overall survival (OS) (hazard ratio [HR]: 1.709, P = 0.005) by multivariate Cox regression analyses. The NAC group showed significantly less high Ki-67 expressions than the US group (31.4% and 57.6%, respectively) ( P < 0.0001). Furthermore, in the NAC group, the persistently high Ki-67 expressions showed poorer OS relative to the low Ki-67 expressions (3-year OS: 24.1% vs. 53.0%, P = 0.005) and was an independent poor prognostic factor for OS (HR: 2.120, P = 0.006). The high Ki-67 expression was also robustly associated with low SMAD4 and high c-Myc expressions via immunostaining ( P = 0.035 and 0.0002, respectively). NAC diminishes Ki-67 overexpression, and persistent overexpression even after NAC is an independent poor prognostic factor of PDAC after pancreatectomy. The Ki-67 overexpression may mirror a high malignant state due to the low SMAD4 and high c-Myc expression.

Blood Oxygenation Level-Dependent MRI for Predicting Lymphovascular Space Invasion in Cervical Squamous Cell Carcinoma Treated with Neoadjuvant Chemotherapy: A Prospective Study.

Purpose To develop a deep learning-based deformable registration method for dynamic contrast-enhanced (DCE) breast MRI that preserves tumor regions while maintaining global anatomic alignment during neoadjuvant chemotherapy (NAC) response assessment. Materials and Methods This retrospective study included internal and external cohorts of patients with breast cancer who were undergoing NAC. The internal cohort comprised patients who underwent DCE MRI from 2017 to 2020, and the external cohort was derived from the I-SPY2 trial. A conditional pyramid registration network integrating unsupervised keypoint detection with a volume-preserving mechanism was developed. Registration performance was evaluated using the Dice similarity coefficient (DSC), average landmark error, and tumor volume difference. A local-global biomarker derived from registered images was evaluated for predicting pathologic complete response (pCR) using the area under the receiver operating characteristic curve (AUC) and accuracy. Paired t tests were used for statistical comparisons. Results In 314 patients (all female; age, 50.6 years ± 12.0 [SD]) with 1630 scans in the internal cohort, the proposed method achieved a DSC of 0.95 ± 0.02, an average landmark error of 5.35 mm ± 3.46, and a tumor volume difference of 11.0% ± 10.7. In 100 patients (all female; age, 48.5 years ± 12.3) with 372 scans in the external cohort, the method achieved a DSC of 0.91 ± 0.09 and a tumor volume difference of 15.5% ± 13.8. Improvements in landmark distance and tumor preservation were statistically significant (P < .05) compared with most methods. For pCR prediction, incorporation of the proposed biomarker achieved an AUC of 0.81 ± 0.04 and an accuracy of 72.1% ± 5.0. Conclusion The proposed framework improved anatomic alignment while preserving tumor volume in longitudinal DCE breast MRI during NAC response assessment and enabled a registration-based biomarker for predicting treatment response. Keywords: MR Imaging, Image Postprocessing, Breast, Neural Networks, Radiomics, Prognosis, DCE Breast MRI, Deep Learning, Deformable Registration, Neoadjuvant Chemotherapy, Unsupervised Keypoint Detection Supplemental material is available for this article. © RSNA, 2026 See also the commentary by Zhang in this issue.

Short-term efficacy and safety of neoadjuvant chemotherapy plus immune checkpoint inhibitors vs chemotherapy alone in locally advanced gastric cancer: a real-world propensity score-matched analysis.

Habitat-based MRI heterogeneity radiomics for predicting neoadjuvant chemotherapy response in osteosarcoma.

Cure probabilities of patients with pancreatic ductal adenocarcinoma in the United States: A Surveillance, Epidemiology, and End Results-based analysis.

Prognostic factors and the role of GnRHa in premenopausal HR+/HER2+ breast cancer achieving pathologic complete response after neoadjuvant chemotherapy.

Accurate identification and localization of axillary lymph node involvement in breast cancer before therapeutic interventions, such as neo-adjuvant chemotherapy or surgery, are for optimal disease management. This study evaluates the concordance between charcoal-based localization of axillary lymphadenopathy and sentinel lymph node biopsy. In this cohort study, 70 patients with breast cancer and up to three metastatic axillary lymph nodes were enrolled at Omid Hospital's radiology department. Nodes were marked with 0.2-0.3 mL charcoal injection under ultrasound guidance. After completion of neoadjuvant chemotherapy, preoperative lymphoscintigraphy was performed. The frequency of positive lymph nodes identified by charcoal staining was compared with the sentinel lymph node findings during surgery. Post-surgical pathology identified charcoal in 89 nodes across 64 patients, yielding a detection rate of 91.4% (95% CI: 85-98%). Among the 64 patients with charcoal- contained nodes, 56 were SLNs containing charcoal, and 8 were non-SLNs, resulting in a concordance rate of 87.5% (95% CI: 79.4%-96%). A chi-square test confirmed a significant association between charcoal-tattooed nodes and SLNs concordance (χ² = 12.3, p < 0.001). This study demonstrated that ultrasound-guided charcoal tattooing of metastatic axillary lymph nodes before Neoadjuvant chemotherapy is a safe, low-cost, and effective technique for localization of limited nodal involvement in breast cancer patients, with high concordance with sentinel lymph node biopsy.

Liquid biopsy to inform adjuvant decisions during neoadjuvant chemotherapy - a full-circle moment for nasopharyngeal cancer.

Blocking CEMIP2-mediated low-molecular-weight hyaluronic acid -TGFβ signaling inhibits chemotherapy-associated lymphatic metastasis in gastric cancer.

Oxaliplatin-based regimens are increasingly used in total neoadjuvant therapy (TNT) for locally advanced rectal cancer, frequently causing dose-limiting chemotherapy-induced peripheral neuropathy (CIPN), whose extent and impact on health-related quality of life (HrQoL) remain insufficiently characterized. The optimal duration and intensity of chemotherapy within TNT for tumor response and toxicity remain unclear. This retrospective multicenter study (DRKS00033000) assessed the dose-response relationship of CIPN with cumulative oxaliplatin dose (cOXAd) and its impact on HrQoL. A total of 227 patients (164 men) with a median age of 63 (Q1-Q3: 54-68) years, who underwent oxaliplatin-based TNT between 2015 and 2024, were analyzed. HrQoL was assessed cross-sectionally during follow-up using the EORTC QLQ-C30 and QLQ-CIPN20 questionnaires. Multivariable logistic regression was applied to evaluate the relationship between cOXAd and CIPN grade ≥2, and known-group comparisons examined differences in HrQoL scores. At follow-up, 61 patients (26.9%) experienced CIPN grade ≥2 after a median cOXAd of 758.8 mg/m2. Higher cOXAd was associated with an increased likelihood of CIPN grade ≥2 (adjusted OR 1.004, 95% CI: 1.002-1.007), corresponding to a 7.8% higher probability per additional FOLFOX cycle (+85 mg/m2 cOXAd). Patients with CIPN grade ≥2 reported lower mean QLQ-C30 Global Health Scores and Summary Scores (-13.0 and -12.4 points; Cohen's d = -0.59 and -0.68) and higher QLQ-CIPN20 Summary Scores (+23.9 points; Cohen's d = 1.65) compared to those without CIPN. These findings indicate that CIPN is a common dose-dependent toxicity of oxaliplatin-based TNT, associated with considerably reduced HrQoL and markedly increased neuropathy-related symptom burden at follow-up.

ASO Visual Abstract: Association Between Clinical Tumor Stage and Response to Total Neoadjuvant Therapy in Rectal Cancer: Outcomes in cT3 Versus cT4 Disease.

Watch and Wait in practice: Adherence to surveillance after nonoperative management for rectal cancer.

The aim of this work is to update the practical guidelines for adjuvant radiotherapy of the regional lymphatics in breast cancer, originally issued in 2014 by the Breast Cancer Expert Panel of the German Society of Radiation Oncology. Acomprehensive literature review concerning regional nodal irradiation (RNI) was performed using the search terms "breast cancer," "radiotherapy," and "regional node irradiation." Furthermore, data from recently published meta-analyses and international breast cancer society guidelines-providing new insights since 2014-served as the basis for defining evidence-based recommendations. This paper delineates the indications and dose-fractionation strategies for radiotherapy targeting the regional lymphatic pathways following breast cancer surgery. The guideline was updated to reflect current evidence regarding radiotherapy of the lymphatic drainage system. The recommendations are categorized according to two primary objectives for RNI: (1)improving oncological outcomes; (2)enabling de-escalation of axillary surgery. The update distinguishes between clinical scenarios with and without neoadjuvant chemotherapy (NACT). Specifically, it addresses the increasingly relevant topic of treatment de-escalation following pathologic complete response (pCR) after NACT in initially node-positive patients. The updated guidelines address current developments and ongoing challenges in RNI. They provide clinically oriented recommendations for establishing indications in both the primary (upfront) surgery setting and following neoadjuvant therapy.

To investigate MRI-based breast edema patterns as biomarkers of tumor aggressiveness and their predictive value for pathological response to neoadjuvant chemotherapy (NAC) in invasive breast cancer. This retrospective study evaluated 235 female patients (mean age, 52 ± 12 years) with biopsy-proven invasive breast cancer who underwent pre-NAC breast MRI. After excluding 19 patients (10 for inadequate image quality, 9 for post-biopsy imaging), 216 patients were analyzed. Breast edema score (BES) was independently assessed by two radiology residents to evaluate interobserver agreement. Subsequently, a breast radiologist reviewed all cases to establish the definitive dataset. The differences in clinicopathological characteristics between the two groups and between different BES were compared. Interobserver agreement for BES classification was very high (92.6% concordance). Edema presence correlated significantly with larger tumor size (p = 0.001), higher histological grade (p = 0.001), axillary lymph node metastasis (p = 0.015), hormone receptor negativity (p < 0.001), lymphovascular invasion (p = 0.031), and elevated Ki-67 (p = 0.001). Higher BES groups (BES 2-4) showed stronger associations with aggressive features: tumor size (p < 0.001), grade (p = 0.022), hormone receptor negativity (p = 0.001), non-luminal subtypes (p = 0.001), and intratumoral necrosis (p = 0.002). Neither edema nor BES predicted pathological response to NAC (p = 0.999, p = 0.299). BES and edema are robust imaging biomarkers of tumor aggressiveness but demonstrate no predictive value for NAC response. MRI-based edema scoring holds clinical relevance for noninvasive tumor phenotyping and risk stratification in breast cancer management. Question Can MRI-based breast edema patterns predict tumor aggressiveness and pathological response to neoadjuvant chemotherapy in invasive breast cancer patients, aiding noninvasive risk stratification? Findings BES correlates with aggressive tumor features (larger size, higher grade, hormone negativity; all p < 0.050 but shows no predictive value for NAC response (p = 0.299). Clinical relevance BES serves as a practical imaging biomarker for risk stratification and tumor phenotyping, guiding individualized therapy. However, it shows no utility in predicting NAC response, emphasizing the need for complementary predictive tools in treatment planning.