Clinical Oncology Research Articles

Highlights on gastroesophageal tumors: the comeback of FLOT

Summary This article aims to summarize the highlights of the two largest global congresses of 2024 with respect to gastroesophageal tumors. The triplet chemotherapy combination known as FLOT (5-fluorouracil, leucovorin, oxaliplatin, docetaxel), used as perioperative chemotherapy, was demonstrated to improve overall and disease-free survival in resectable gastroesophageal cancer patients some time ago. Despite being standard for this patient population, many questions for different scenarios remain open: Is FLOT also efficacious in patients with esophageal or gastroesophageal junction adenocarcinoma when compared to neoadjuvant chemoradiotherapy? Is FLOT a feasible chemotherapy option for oligometastatic patients, thereby contributing to the overall survival as “neoadjuvant” treatment before palliative resection? Can the efficacy of FLOT be strengthened by applying additional radiation treatment to patients with gastroesophageal adenocarcinoma? Is FLOT really necessary in the adjuvant setting for all patients, or can the adjuvant treatment be guided based on pathological response rates? These questions were answered to some extent in the ESOPEC and RENAISSANCE trials at the American Society of Clinical Oncology (ASCO) meeting and the TOPGEAR and SPACE-FLOT trials at European Society for Medical Oncology (ESMO) meeting. Many other FLOT-related studies for resectable as well as metastatic gastroesophageal cancer patients are yet to come.

Cost‐effectiveness analysis of postoperative surveillance for stage IV colorectal cancer in Japan: An economic modeling study

AbstractBackgroundThe optimal postoperative surveillance strategy after curative resection in patients with stage IV colorectal cancer remains unclear. The present study aimed to assess the cost‐effectiveness of postoperative surveillance strategies recommended by the various academic societies for stage IV colorectal cancer after curative resection.MethodsThis economic evaluation used a Markov state‐transition model to compare the cost‐effectiveness of postoperative surveillance programs proposed in guidelines published by the American Society of Clinical Oncology, American Society of Colon and Rectal Surgeons, European Society for Medical Oncology, National Comprehensive Cancer Network, and Japanese Society for Cancer of the Colon and Rectum. Model parameters were extracted from our retrospective data for patients with colorectal cancer who had synchronous liver and/or lung metastases and underwent curative resection. Cost‐effectiveness was assessed using an incremental cost‐effectiveness ratio for quality‐adjusted life years, with a maximum acceptable value of 5 000 000–6 000 000 JPY/33333–40 000 USD. Uncertainty in the model was assessed by probabilistic sensitivity analyses.ResultsFor patients with stage IV colorectal cancer after curative resection, the JSCCR‐strategy was the most cost‐effective, with an incremental cost‐effectiveness ratio of 2 888 628 JPY/19256 USD compared with the next most cost‐effective program. Probabilistic sensitivity analysis showed that the JSCCR‐strategy was most likely to be selected as the most cost‐effective (76.1%–77.9%).ConclusionsThis modeling analysis found that the JSCCR‐strategy was the most cost‐effective strategy for stage IV colorectal cancer. Our findings suggest that intensive postoperative surveillance is acceptable for stage IV colorectal cancer.

Finding the Right Partner: Triplet Therapy for First-Line Advanced Biliary Tract Cancers.

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.

Maximising efficacy in HER2-positive breast cancer: immunoliposomal co-delivery of miR155 inhibitor and paclitaxel for targeted therapy.

Breast cancer, particularly the HER2 positive subtype, presents a formidable challenge in clinical oncology, necessitating innovative therapeutic strategies. Here, we present a novel immunoliposome-based formulation designed for targeted delivery of paclitaxel and miRNA inhibitors to HER2-positive breast cancer cells. Through a rigorous preclinical evaluation encompassing in vitro cellular studies and an in vivo tumor xenograft model, we demonstrate the formulation's remarkable efficacy in inhibiting cell proliferation, inducing apoptosis, and suppressing tumor growth. Histopathological assessments reveal a favourable safety profile with minimal adverse effects on normal tissues. Furthermore, the study unveils the synergistic interaction between paclitaxel and miRNA inhibitor within the formulation, offering a potential avenue for combination therapy. The novelty of the study lies in the development of a precise and targeted therapeutic approach tailored to HER2-positive breast cancer, addressing critical gaps in current treatment modalities. Our findings underscore this innovative formulation's clinical relevance and translational potential, paving the way for personalised and effective therapies in HER2-positive breast cancer management.

A metal-phenolic nanotuner induces cancer pyroptosis for sono-immunotherapy.

Although ultrasound therapy is efficacious and safe in clinical oncology, its capacity to elicit an anti-tumor immune response is constrained by ultrasound-induced apoptosis. Pyroptosis, which releases immunogenic damage-associated molecular patterns (DAMPs), can significantly enhance immune activation. It necessitates robust Gasdermin E (GSDME) expression in cancer cells for caspase-3-mediated pyroptosis. An epigenetic strategy is introduced to induce cancer pyroptosis during sonotherapy using a nanocoordinator (HTA) constructed through metal-phenolic coordination involving Aza (a DNA methyltransferase inhibitor), TiO2 nanoparticles, and polyphenol-modified hyaluronic acid. While Aza restores GSDME expression, TiO2 generates reactive oxygen species (ROS) under ultrasound stimulation, activating caspase-3 and inducing pyroptosis via GSDME cleavage. In an orthotopic breast cancer model, HTA enhanced anti-tumor immunity and improved the efficacy of sonodynamic therapy (SDT). This approach presents a novel strategy for augmenting SDT through epigenetically induced pyroptosis.

Identification of the atypical antipsychotic Asenapine as a direct survivin inhibitor with anticancer properties and sensitizing effects to conventional therapies.

Therapy resistance in human cancers is a major limitation in Clinical Oncology. In this regard, overexpression of anti-apoptotic proteins, such as survivin, has been described in several tumors, contributing to this clinical issue. Survivin has a dual role in key cellular functions, inducing cell cycle progression and inhibiting apoptosis; thus, survivin is an attractive target for cancer therapy. Therefore, we focused on identifying and validating a novel specific, directly binding survivin inhibitor for cancer treatment and tumor sensitization to conventional proapoptotic therapies. In this work, we conducted a structure-based high-throughput virtual screening at the survivin homodimerization domain. Asenapine Maleate (AM), an approved drug for central nervous system diseases, was identified as a direct binder of the survivin homodimerization domain and it significantly affected cell viability of lung, colon, and brain cancer cell lines. Direct interaction of AM to survivin protein was corroborated by surface plasmon resonance and a specific survivin protein decrease was observed in cancer cells, compared to other inhibitors of apoptosis proteins. Therapeutic in vivo studies showed an impairment of tumor growth in AM-treated mice. Finally, a synergistic anticancer effect was detected in vitro when combined with different conventional chemotherapies, and in vivo studies showed higher antitumor effects when combined with cisplatin. Altogether, our results identify AM as a specific direct binding inhibitor of survivin, showing anticancer properties in vitro and in vivo and sensitizing effects when combined with cisplatin, opening the possibility of repositioning this approved drug for cancer treatment.

Assessing the Use and Acceptability of Virtual Reality to Assist Coping in Children Undergoing Clinical Procedures.

Virtual reality is used as a distraction tool during medical procedures that can cause anxiety and pain. We assessed the usefulness, engagement, value and feasibility of virtual reality to help children cope with routine clinical procedures. Quality improvement study. Children, 4-16 years old, were given the option to use virtual reality during their procedure in oncology, immunology or diabetes clinics, or during an induction of general anesthesia. The emotional state of the child was documented using the children's emotional manifestation scale. We assessed feedback from patients, parents, and clinicians. Across all clinics, children responded positively to the virtual reality and 80% would choose to use virtual reality again for health-related procedures. Parents and clinicians, respectively, reported that virtual reality helped children tolerate the procedure (82% and 87%), engaged children well (82% and 89%) and was a valuable tool (85% and 98%). Clinicians (90%) endorsed the feasibility of using virtual reality during procedures. This project demonstrated that virtual reality can be implemented as a useful, engaging and feasible tool to help children tolerate a variety of routine medical procedures. However, ensuring comfortable fit of virtual reality devices and diversifying the visual content is necessary.

Relationship between social support, self-esteem and sense of masculinity among geriatric Patients with Prostatic Cancer

Background: Most geriatric patients with prostate cancer experience not only external discomfort but also negative psychological consequences such as reduced feelings of masculinity and diminished self–esteem. Social support is a protective factor for dealing with and adapting to these stressors, which enhances quality of life. Aim: To identify the relationship between social support, self-esteem, and sense of masculinity among geriatric patients with PC. Method: The study is a cross-sectional survey adopting a descriptive correlational design. A convenience sample of one hundred ten (110) geriatric patients diagnosed with PC attending the oncology and urology outpatient clinics of Damanhur Oncology Center in El-Beharia Governorate, Egypt. Four tools were used: subjects' basic information, The Personal Resources Questionnaire (PRQ-2000), the Rosenberg Self-esteem Scale (RSE), and The Masculine Self-esteem scale (MSES). Results: 74.6 % of the studied geriatric patients had high levels of social support, 86.4 % had moderate levels of self-esteem, and 55.4 % had low masculine self-esteem. Also, the relationship was a statistically significant between social support and self-esteem (p = .002), between social support and sense of masculinity (p = .038), and between self-esteem and sense of masculinity (p = .029).Conclusion: social Support and self-esteem were significant predictors of high sense of masculinity with social support positively influencing and self-esteem negatively influencing the sense of masculinity.

Genetic signatures of ERCC1 and ERCC2 expression, along with SNPs variants, unveil favorable prognosis in SCLC patients undergoing platinum-based chemotherapy.

Platinum chemotherapy (CT) remains the backbone of systemic therapy for patients with small-cell lung cancer (SCLC). The nucleotide excision repair (NER) pathway plays a central role in the repair of the DNA damage exerted by platinum agents. Alteration in this repair mechanism may affect patients' survival. We conducted a retrospective analysis of data from 38 patients with extensive disease (ED)-SCLC who underwent platinum-CT at the Clinical Oncology Unit, Careggi University Hospital, Florence (Italy), from 2015 to 2020. mRNA expression analysis and single nucleotide polymorphism (SNP) characterization of three NER pathway genes-namely ERCC1, ERCC2, and ERCC5-were performed on patient tumor samples. Overall, elevated expression of ERCC genes was observed in SCLC patients compared to healthy controls. Patients with low ERCC1 and ERCC5 expression levels exhibited a better median progression-free survival (mPFS = 7.1 vs. 4.9 months, p = 0.39 for ERCC1 and mPFS = 6.9 vs. 4.8 months, p = 0.093 for ERCC5) and overall survival (mOS = 8.7 vs. 6.0 months, p = 0.4 for ERCC1 and mOS = 7.2 vs. 6.2 months, p = 0.13 for ERCC5). Genotyping analysis of five SNPs of ERCC genes showed a longer survival in patients harboring the wild-type genotype or the heterozygous variant of the ERCC1 rs11615 SNP (p = 0.24 for PFS and p = 0.14 for OS) and of the rs13181 and rs1799793 ERCC2 SNPs (p = 0.43 and p = 0.26 for PFS and p = 0.21 and p = 0.16 for OS, respectively) compared to patients with homozygous mutant genotypes. The comprehensive analysis of ERCC gene expression and SNP variants appears to identify patients who derive greater survival benefits from platinum-CT.

Recommendations from Imaging, Oncology, and Radiology Organizations to Guide Management in Prostate Cancer: Summary of Current Recommendations.

Prostate cancer is the second most common malignancy among male individuals in the United States and requires careful imaging approaches because of its varied presentations. This review examines prostate cancer imaging guidelines from leading organizations, including the American College of Radiology, American Urological Association, European Association of Urology, American Society of Clinical Oncology, and National Comprehensive Cancer Network, and serves as a reference highlighting commonalities and divergences in current imaging recommendations across prostate cancer states. We outline these organizations and their methods, focusing on their approaches to panel expertise, guideline development, evidence grading, and revision schedules. We then compare and contrast the role of various imaging modalities across states of prostate cancer management in the following categories: clinically suspected prostate cancer, clinically established prostate cancer: active surveillance or staging, monitoring metastatic disease, and posttreatment follow-up: recurrent or residual disease. Overall, there is consensus on the importance of multiparametric MRI in diagnosis and staging prior to active surveillance and the emerging role of prostate-specific membrane antigen (PSMA) PET/CT in metastatic and recurrent disease. However, there is disparity in imaging recommendations for detecting metastases in unfavorable intermediate-risk prostate cancer and views on current applications of PSMA PET/CT. Ultimately, variations in radiologic expertise exist among guideline panels, and there continue to be inconsistencies in imaging recommendations in prostate cancer. Keywords: Prostate, Genital/Reproductive, Oncology Supplemental material is available for this article. © RSNA, 2025.

Patient access to perioperative chemotherapy with fluorouracil, leucovorin, oxaliplatin and docetaxel in patients with resectable gastric cancer in the Netherlands.

The FLOT4 trial demonstrated superior survival of perioperative chemotherapy with 5-fluorouracil, oxaliplatin, and docetaxel (FLOT) compared to anthracycline triplets for resectable gastric cancer. These results were presented at the American Society of Clinical Oncology (ASCO) congress in June 2017 and published in April 2019. However, adoption of novel treatments in clinical practice often encounters delays. This study assesses the patterns of perioperative chemotherapy utilization and FLOT uptake in clinical practice within the Netherlands. A retrospective cohort study was conducted with resectable gastric cancer patients (cT1-4a,XcNallcM0) between 2015-2020 from the Netherlands Cancer Registry. Descriptive statistics, Cochran-Armitage tests, Fisher's exact or unpaired T-tests, and Jonckheere-Terpstra tests were used to analyze chemotherapy trends and FLOT uptake across hospitals. Among 3290 included patients, 42.9% received neoadjuvant treatment. In 2015, 43.6% of patients received perioperative chemotherapy versus 43.5% in 2020 (p=0.63). 40 out of 62 hospitals (64.5%) adopted FLOT between the ASCO presentation and the full publication. FLOT increased from 42.9% before publication to 86.8% after publication (p<0.0001), while anthracycline triplet use decreased to 0.9% (p<0.0001). Higher hospital volume was associated with fewer days to adoption (p=0.04) but not with adoption of FLOT before publication (p=0.14). Timing of FLOT adoption varied among Dutch hospitals, leading to unequal patient access to effective treatments. Establishing (inter)national guidelines on provisional treatment adjustment pending publication is crucial to reduce variation in access. Moreover, rapid publication of final trial results is imperative to reduce variation in practice and ensure fair patient treatment.

The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of colorectal cancer, 2024 update.

The 2024 updates of the Chinese Society of Clinical Oncology (CSCO) Clinical Guidelines for the diagnosis and treatment of colorectal cancer emphasize standardizing cancer treatment in China, highlighting the latest advancements in evidence-based medicine, healthcare resource access, and precision medicine in oncology. These updates address disparities in epidemiological trends, clinicopathological characteristics, tumor biology, treatment approaches, and drug selection for colorectal cancer patients across diverse regions and backgrounds. Key revisions include adjustments to evidence levels for intensive treatment strategies, updates to regimens for deficient mismatch repair (dMMR)/ microsatellite instability-high (MSI-H) patients, proficient mismatch repair (pMMR)/ microsatellite stability (MSS) patients who have failed standard therapies, and rectal cancer patients with low recurrence risk. Additionally, recommendations for digital rectal examination and DNA polymerase epsilon (POLE)/ DNA polymerase delta 1 (POLD1) gene mutation testing have been strengthened. The 2024 CSCO Guidelines are based on both Chinese and international clinical research, as well as expert consensus, ensuring their relevance and applicability in clinical practice, while maintaining a commitment to scientific rigor, impartiality, and timely updates.

Prognostic factors and surgical approaches for long bone sarcomas: a comprehensive narrative study

This study aimed to evaluate the outcomes of various surgical interventions for bone sarcoma, focusing on survival rates, functional outcomes, complication rates, and quality of life. A systematic review and analysis were conducted on six primary surgical interventions, including limb salvage surgery, wide resection, amputation, endoprosthetic reconstruction, biological reconstruction, and rotationplasty. Limb salvage surgery demonstrated the highest functional outcomes (85%) and quality of life scores (8.0/10), while endoprosthetic reconstruction achieved the highest survival rate (75%) but with a higher complication rate (30%). Amputation, despite the lowest complication rate (15%), showed reduced functional scores (65%) and survival rates (55%). Recovery times varied significantly, with biological reconstruction requiring the longest rehabilitation period (16 weeks) and wide resection the shortest (8 weeks). Psychological challenges were notable in amputation cases, with 15% of patients experiencing psychological issues. In conclusion: Limb-sparing procedures, where feasible, offer superior functional and quality-of-life outcomes compared to amputation, though they carry higher complication risks. The choice of surgical intervention should be individualized, balancing oncological and functional considerations. Future research should focus on reducing complication rates, improving prosthetic designs, and standardizing rehabilitation protocols to enhance patient outcomes. Long bone sarcomas, a rare and aggressive group of malignancies, primarily affect the skeletal system and pose significant challenges in clinical oncology. These tumors, which include osteosarcoma, Ewing sarcoma, and chondrosarcoma, are most commonly diagnosed in children, adolescents, and young adults, often leading to substantial morbidity and mortality. Despite advancements in diagnostic imaging, surgical techniques, and systemic therapies, the prognosis for patients with long bone sarcomas remains variable and is influenced by a multitude of factors.

Exploring the associations of sleep bruxism and obstructive sleep apnea with migraine among patients with temporomandibular disorder: A polysomnographic study

AbstractBackgroundMigraine is the most common disabling headache disorder in the world. Temporomandibular disorders (TMDs) are a group of conditions characterized by pain/dysfunction of masticatory muscles or their associated structures. There is a lack of studies concerning the association between sleep disorders such as sleep bruxism (SB), obstructive sleep apnea (OSA), migraine, and TMD, despite the increased prevalence of these conditions in TMD patients.ObjectiveOur case–control study assesses the potential relationship among SB, OSA, and migraine using polysomnography (PSG) among the group with TMD.MethodsOne hundred nineteen patients with TMD were recruited and hospitalized in the Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension, and Clinical Oncology at Wroclaw Medical University. Their sleep parameters were assessed by PSG according to American Academy of Sleep Medicine guidelines. Migraine diagnosis was based on the third edition of the International Classification of Headache Disorders. The group of 30 patients with median age 35.0 years (interquartile range [IQR]: 26.0, 41.0) were diagnosed with migraine and this group consisted of 17 without aura (MwoA) and 13 with aura (MwA). Thirty patients with migraine were compared to 89 patients with TMD without migraine (controls) with median age 37.0 years (IQR: 26.0, 44.0).ResultsSleep bruxism was detected in 86% of the migraine group and 71.9% of control participants. The median bruxism episode index (BEI) among patients with migraine was 3.8 n/h (IQR: 2.7, 5.8) and 3.5 n/h (IQR: 1.8, 6.0) in the control group. SB and severe SB (respectively, BEI &gt; 2 and BEI &gt; 4) were not associated with migraine (odds ratio [OR] = 2.68, 95% confidence interval [CI]: 0.84–8.55, p = 0.095; OR = 0.98, 95% CI: 0.42–2.32, p = 0.966). However, mixed bruxism episodes were more frequent in the migraine group compared to study participants not experiencing migraine (median 0.7 n/h [IQR: 0.4, 1.6] vs. median 0.5 n/h [IQR: 0.2, 0.9], p = 0.044; OR = 1.96 with 95% CI: 1.16–3.32, p = 0.013). The median average duration of SB episodes in the migraine group was longer than in the controls (7.0 s [IQR: 5.5, 8.4] vs. 5.9 s [IQR: 5.1, 6.6], p = 0.005). The apnea–hypopnea index (AHI) value was not associated with migraine compared to controls (OR = 1.01, 95% CI: 0.96–1.06, p = 0.605), but MwoA had significantly increased AHI values compared to MwA (mean AHI = −0.1, standard deviation [SD] = 1.5 for MwA vs. mean AHI = 0.9 with SD = 1.3 for MwoA, p = 0.049).ConclusionSleep bruxism may not be associated with migraine among patients with TMD; however, mixed bruxism episodes were more frequent in the migraine group. The increased duration of SB episodes in patients with migraine may suggest the common background of these conditions. OSA is also not associated with migraine; however, MwoA might increase the odds of OSA. There is a need to further explore sleep disturbances and migraine, especially in groups with their increased prevalence, such as patients with TMD.

Renal Insufficiency in Cancer Patients and Associated Demographic, Clinical and Treatment Characteristics at Kenyatta National Hospital, Nairobi, Kenya

Renal insufficiency is sub-optimal kidney function, affecting approximately 10% of the world population. In sub-Saharan Africa, it is approximated at 14% of the population whereas the kidney disease burden in Kenya is estimated to be at 4%. Studies show that at least 27.1% of cancer patients are suffering from renal insufficiency and need some chemotherapeutic drug adjustment. The objective of this study was to establish the prevalence of renal insufficiency and the associated clinical, demographic and treatment factors among cancer patients at KNH. A cross-sectional study where data was collected using a structured interviewer-administered questionnaire and hospital records. Systematic random sampling without replacement was used to select eligible 330 participants (patients) from Oncology wards and clinics at KNH. The information from the questionnaires was entered into a computer, cleaned, coded and loaded into R version 4.1.2 statistical software for analysis. Calculation of estimated GFR was done by CKD-Epi in micromole/l using a medical calculator to diagnose renal insufficiency and classify accordingly. The data was analyzed using both descriptive and bivariate/ multivariate regression analysis. All p-values were two-sided and the results were considered statistically significant at p &lt; 0.05. A total of 56.1% were females and others were male. Of the 330 study participants, 42.7% were aged between 41-60, 41.5% above 60 years and the rest below 41 years. The prevalence of renal insufficiency was 38% (95% CI 33, 44%). Age above 60 years and the use of taxanes were significantly associated with renal insufficiency before and after adjustment (p-values &lt;0.05). In conclusion, the prevalence of renal insufficiency among patients with cancer was high in this study of which the majority had stage 2 renal failures. Patients aged above 60 years had significantly higher odds of renal insufficiency while patients on taxanes had significantly lower odds of renal insufficiency

Correlation Between Serum CA-125 Levels and Age in Advanced-Stage Epithelial Ovarian Cancer Patients at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia (2021-2022)

Ovarian cancer is a gynecological malignancy that originates in the ovaries. Symptoms of ovarian cancer often remain unnoticed in its early stages, leading to a diagnosis at an advanced stage. CA-125 is a widely recognized biomarker used in ovarian cancer for diagnosis, monitoring treatment response, and predicting prognosis. Research has shown that CA-125 levels can vary with age and are influenced by multiple biological factors, including hormonal changes and the progression of ovarian cancer. Age-related factors can influence CA-125 levels, which may affect the interpretation of such examination results. This study aims to determine the correlation between serum CA-125 levels and ages in advanced-stage epithelial ovarian cancer patients. This research is a retrospective study using the comparative analytic research method by taking the medical record data of epithelial ovarian cancer with advanced-stage patients treated in oncology clinic of Dr. Soetomo General Hospital Surabaya for January 1, 2021 – December 2022. Based on the analysis of 61 patient subjects categorized into three age groups, the median serum CA-125 levels for patients aged &lt;40 years were 172.85 U/mL, for those aged 40-50 years the median was 261 U/mL, and for patients aged &gt;50 years the median was 116.2 U/mL. The Kruskal-Wallis test (p-value) yielded a result of 0.518, indicating that there was no statistically significant relationship between serum CA-125 levels of patients and patients’ age (p = 0.518). In addition, there is no correlation between serum CA-125 levels and age in advanced-stage epithelial ovarian cancer patients at Dr. Soetomo General Hospital, Surabaya.

Safety of the Off-Label Use of Antitumor Drugs in Real Clinical Practice: Experience of Oncologists of the Russian Federation

Introduction. One of the key issues associated with the off-label use of antitumor drugs is safety. Typically, the advantages of such prescriptions in oncology are linked to the potential clinical benefits outweighing the risks of complications.Aim. To assess the safety of the off-label antitumor drug therapy in comparison with the on-label drug administration in the context of real clinical practice among oncologists in the Tula region.Materials and methods. The study was conducted at the Tula Regional Clinical Oncology Center, Russia. Over a six-month period in 2019, clinical data, provided by the regional information system, were analyzed for 919 completed treatment cases of 201 patients over 18 years of age who received antitumor drug therapy for malignant neoplasms. The study enrolled patients who had at least one hospitalization and got off-label antitumor drug therapy, as well as those receiving on-label drug treatment. The study assessed the safety of the off-label antitumor drug therapy in comparison with that of the on-label treatment, estimating the frequency of adverse events (AEs), spectrum of adverse events, severity of adverse events, fatal outcomes, treatment delays and discontinuations, and hospitalizations due to toxicity. A comparative analysis involved the results of using off-label and on-label antitumor drug therapy in terms of the aforementioned parameters. Results and discussion. No unforeseen adverse events were revealed in the study. The spectrum of adverse events encompassed 40 clinical and laboratory abnormalities with varying frequencies across the studied groups. Adverse events were observed in the majority of patients across both studied groups (83% and 86%). A predominance of grade I and II toxicity was noted. In some instances, therapy was discontinued and treatment was suspended; however, the frequency of these occurrences was significantly lower compared to current literature data. One fatal outcome due to complications from the administered therapy was recorded. All adverse events were reported in both studied groups with similar frequencies. The most commonly observed adverse events in both groups included hepatotoxicity, anemia, thrombocytopenia, nephropathy, cephalalgia, leukocytosis, skin toxicity, dyslipidemia, hypertension, bone pain syndrome, and dizziness. Other adverse events occurred sporadically with similar frequency. The most severe presentations were noted in the following adverse events: thrombocytopenia, gastrointestinal toxicity, leukocytosis, hyperglycemia, and immune-mediated diabetes mellitus with ketoacidotic coma.Conclusion. In real clinical practice, the safety of off-label and on-label antitumor drug therapy reveals no significant difference.

A PROGNOSTIC MODEL FOR SURGICAL SITE INFECTION

The aim of the study is to determine the incidence of surgical site infection (SSI), risk factors for its development and to evolve a prognostic model for stratifying patients according to its level. Materials and Methods. The study was conducted at Ulyanovsk Regional Clinical Hospital and Ulyanovsk Regional Clinical Oncology Center. A total of 1,500 planned laparotomies were performed (database registration certificate No. 2024623300) including 190 gastrectomies with D2 lymph node dissection, 882 colon resections, and 428 total hysterectomies. A retrospective analysis of the results was carried out during the postoperative period according to a single protocol. StatTech v. 4.5.0 (Stattech, Russia) and SPSS 26 for Mac (IBM Corp.), R Statistics 3.6.1 were used for statistical analysis of the study results. Results. The incidence of SSI was 4.93 % (74/1500). There were 12 fatal outcomes (16.2 %) in the group with SSI and 15 ones (1.1 %) in the group without SSI. The most significant factors influencing the development of postoperative infectious complications in the surgical site are age (p=0.007), diabetes mellitus (p&lt;0.001), subcutaneous fat thickness (p&lt;0.001), neutrophil-to-lymphocyte ratio (p&lt;0.001), body mass index (p&lt;0.001), and surgery duration (p&lt;0.001). Multivariate analysis showed that only the following parameters influence the SSI development after laparotomy: colon surgery (OR 8.66 (95 % CI 3.74–21.7); diabetes mellitus (OR 9.36 (95 % CI 4.22–21.65); BMI (OR 1.55 (95 % CI 1.42–1.71) and neutrophil-to-lymphocyte ratio (OR 0.07 (95 % CI 0.03–0.13). A prognostic model for the risk of SSI development was created and programmed as an HTML application using the JavaScript programming language. Conclusion. The incidence of postoperative infectious complications in the surgical site after standard midline laparotomy for elective surgery was 4.93 % (74/1500). The authors created a prediction model to stratify patients according to the risk of SSI development.

Optimization of systemic treatment in patients with bladder, ureter, and renal pelvis cancer — expert opinion of the Polish Society of Clinical Oncology

Optimization of systemic treatment in patients with bladder, ureter, and renal pelvis cancer — expert opinion of the Polish Society of Clinical Oncology

Telemedicine in Orthopedic Oncology: An Opportunity for Cost Savings Without Compromising Clinical Outcomes.

Prior work has demonstrated that telemedicine in orthopedic surgery is cost-effective and can yield good clinical outcomes with high patient satisfaction. However, few studies have investigated the use of telemedicine in orthopedic oncology. In this study, we assessed the effect of telemedicine on (1) potential cost savings for orthopedic oncologic patients and (2) clinical outcomes as measured by unexpected in-person clinic visits and missed complications. A total of 308 patients who had 528 telemedicine visits in the orthopedic oncology clinic from May 2020 to August 2023 were identified. Demographic and clinical information, travel distance/time to clinic, complications, and instances where a telemedicine visit prompted an in-person evaluation were collected and reported with descriptive statistics. Cost savings were calculated based on travel distance and lost productivity. Patients with and without a complication or an unexpected in-person clinic visit were compared to identify risk factors for these clinical outcomes. Cost analysis demonstrated that telemedicine offers patients a potential cost savings of up to $475.2±$242.9 per visit. For 4.5% of the patients, a telehealth visit prompted an in-person evaluation. A complication was experienced by 5.5% of the patients. No complications were missed because of telemedicine. A diagnosis of a malignant tumor was associated with a higher rate of complications (P=.01) and unexpected in-person clinic visits (P=.03). Telemedicine can reduce the financial burden of treatment for orthopedic oncologic patients without negatively impacting clinical outcomes. Care should be taken when considering telehealth for patients with malignant tumors given their higher risk for adverse outcomes. [Orthopedics. 202x;4x(x):xx-xx.].