Institute Of Oncology Research Articles

Human Papillomavirus Genotype Richness and the Biodiversity of Squamous and Glandular Cervical Dysplasias: A Cross-Sectional Study.

The impact of multiple infections on the risk of cervical lesions is a subject of ongoing debate. This study aims to explore whether the richness of HPV genotype infections and the biodiversity of squamous and glandular cervical dysplasias could influence the progression of precancerous lesions. We conducted a cross-sectional analysis involving 469 women who attended the Colposcopy Unit at the European Institute of Oncology in Milan, Italy, from December 2006 to December 2014. HPV type richness was measured as the number of different genotypes per patient. We calculated the associations between richness and age, as well as histologic grade, along with Simpson's biodiversity index for cervical dysplasias. We observed significant inverse relationships between the richness of high-risk (HR) genotypes and both age (p = 0.007) and histologic grade (p < 0.001). Furthermore, as the histologic grade increased, the mean biodiversity index of cervical dysplasias decreased, with exceptions noted in cases of normal histology and adenocarcinoma in situ. Different histologic grades formed five clusters with distinct mean ages and mean biodiversity indices. These findings suggest that HPV genotype richness and the biodiversity of cervical dysplasias may play a crucial role in predicting the risk of high-grade cervical lesions, enabling personalized management of precancers.

Guidance letter for cardiologists of oncology institutions on the prevention of cardiovascular complications of anticancer therapy. Interdisciplinary Council of Cardio-Oncology, Russian Society of Cardiology

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502MO Target therapy matched to genomic alterations in patients with recurrent IDH wildtype glioblastoma: A real-life cohort analysis from Veneto Institute of Oncology, Padua (Italy)

502MO Target therapy matched to genomic alterations in patients with recurrent IDH wildtype glioblastoma: A real-life cohort analysis from Veneto Institute of Oncology, Padua (Italy)

Десятилетние результаты комплексного лечения больных первичным местнораспространенным раком молочной железы

Purpose: To present ten-year results of complex treatment of patients with primary locally advanced breast cancer, depending on the type of ionizing radiation used and chemotherapy regimens. Material and methods: The study included 250 patients with stage T2‒4N0‒3M0 breast cancer, aged 34–69 years (mean age 48.1±5.6 years), who underwent complex treatment (courses of NChT and AChT, hormonal and targeted therapy (according to indications), radical mastectomy and radiation therapy with various types of ionizing radiation) at the Research Institute of Oncology from 2007 to 2020. The mean follow-up period was 10±2.7 years. Main group (n=110) ‒ neutron therapy, comparison group I (n=80) ‒ photon therapy, comparison group II (n=60) ‒ electron therapy. Results: Ten-year relapse-free survival of patients with locally advanced breast cancer (PL BC) after adjuvant neutron therapy on the area of the anterior chest wall was 92.5±3.5 %, after photon therapy ‒ 70.9±5.6 %, after electron therapy ‒ 73.6±7.1 %. There were statistically significant differences between the main group and comparison groups (p&lt;0.05). Overall survival over a ten-year follow-up period in the main group was 87.5±3.8%, in comparison group I ‒ 73.6±8.6 %, in comparison group II ‒ 38.8±10.0 %. Between neutron and electron therapy – p&lt;0.05. In the group with neutron therapy and chemotherapy according to doxorubicin + taxane regimens, ten-year metastatic-free and overall survival was 72.8±10.0 % and 96.7±3.3 %, respectively, compared with neutron therapy and chemotherapy according to FAC/CAF regimens ‒ 44.0±14.7 % and 83.7±6.7 %, respectively (p&lt;0.05). Neutron therapy was well tolerated by all breast cancer patients. Radiation reactions of the skin predominantly I‒II degree. Radiation pneumonitis after neutron therapy ‒ in 6 (5.4 %) out of 110 patients, after photon therapy ‒ in 17 (21.25 %) out of 80 patients with PL BC (p=0.023). Conclusion: Thus, the use of adjuvant neutron therapy in patients with breast cancer T2‒4N0‒3M0 is a safe method and has significantly better results in ten-year relapse-free survival, which makes it possible to increase the effectiveness of complex treatment. In combination with doxorubicin + taxane chemotherapy regimens, neutron therapy increases the 10-year metastatic-free and overall survival rates.

Adenocarcinoma of the Gartner’s duct. A case from practice

Background. A malignant tumour of the Gartner’s duct is one of the rarely encountered tumours in gynaecological oncology. Only in rare cases does the epithelium of the Gartner’s duct become a source of vaginal and cervical adenocarcinoma, as the Gartner’s duct is present in 25% of women, and mesonephric cysts occur in 1% of cases.&#x0D; Purpose. To familiarise the medical community with the peculiarities of the clinical course of malignant tumours of the Gartner’s duct and methods of their treatment.&#x0D; Materials and methods. Patient L., born in 1974, who underwent special treatment at the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine» with a diagnosis of grade II adenocarcinoma of the Gartner’s duct (T2NxM0), clinical group 3.&#x0D; Results and discussion. After examination, the patient underwent two cycles of neoadjuvant polychemotherapy and a preoperative course of external beam radiation therapy (EBRT) on the vulvar area with a total radiation dose of 30 Gy. Two weeks later, surgery was performed to remove the tumour of the Gartner’s duct from the surrounding tissues. Three weeks after the surgery, the patient’s course of EBRT was extended to the total dose of 50 Gy, and 3 cycles of adjuvant polychemotherapy were performed. The follow-up period was 3 years, with no evidence of disease recurrence.&#x0D; Conclusions. The dissemination of information about this rare but serious disease will allow doctors to be informed, as well as to predict and diagnose it in a timely manner. As a result, they can plan adequate special treatment and determine the prognosis of this disease.

АНАЛИЗ ЭПИДЕМИОЛОГИЧЕСКОЙ СИТУАЦИИ ЗАБОЛЕВАЕМОСТИ РАКОМ ПРЯМОЙ КИШКИ В АРХАНГЕЛЬСКОЙ ОБЛАСТИ

Current: despite the measures taken, cancer incidence is a serious problem all over the world. Mortality from rectal cancer is one of the highest among malignant diseases. According to social prognoses, within 20 years, the indicators of oncological strain may worsen by 2-2.5 times. The aim of this study was identification of epidemiological features of the dynamics of the main indicators of the incidence of rectal cancer in the Arkhangelsk region over the past 10 years. Materials and methods. The analysis was carried out on the basis of information materials of the Federal Cancer Register, as well as the P.A. Herzen Moscow Research Oncological Institute of the Federal State Budgetary Institution "Scientific center of Radiology" of the Ministry of Health of Russia. The main indicators of the incidence of rectal cancer (C20) in the Arkhangelsk region from 2011 to 2021 (per 100,000 population) were studied. The results of the study and their discussion. The incidence of rectal cancer in the Arkhangelsk region was 10-15% (and in some years more than 30%) higher than the average in the Russian Federation. During the time period under study, two dramatic growth spurts were noted: in 2014 and 2019. The mortality rate from rectal cancer in the Arkhangelsk region is also much higher (by 20-50% in different years) than the average in Russia. The indicator of active detection in the region until 2019 was 2-3 times lower than the average in Russia. It was only in 2019 that it almost approached the average Russian values thanks to the development and implementation of a special program «Control of oncological diseases 2019-2024». Conclusion. Morbidity and mortality from rectal cancer in the Arkhangelsk region remains quite high. The measures introduced aimed at combating oncological diseases over the past 2 years, there have been positive trends in the early diagnosis of the disease and the reduction of mortality from it. High levels of morbidity and mortality in the studied territory of the Russian Federation require the search for their individual causes, and the improvement of the health system in these regions.

Immunohistochemical subtyping and evaluation of the prognosis of basal-like triple-negative breast cancer based on IDO1 protein expression

Background. Known subtypes of triple-negative breast cancer, despite the common basal-like profile, have certain features that differ in terms of the course and prognosis of the disease. Therefore, the study of molecular markers that make it possible to identify subtypes of basal-like carcinomas and evaluate a probable prognosis based on their expression indicators is relevant today.&#x0D; Aim. Conduct immunohistochemical subtyping of basal-like triple-negative breast cancer based on the assessment of IDO1 protein expression, compare the obtained data with clinical and morphological characteristics, as well as indicators of tumor sensitivity to neoadjuvant therapy.&#x0D; Material and methods. The study was retrospective and included 42 patients diagnosed with triple negative breast cancer (mean age 50.512.7 years), disease stage T14dN03M0. The patients were treated in the Departments of Chemotherapy and General Oncology of the Research Institute of Oncology of the Tomsk National Research Medical Center from 2016 to 2021. A morphological study of tumor tissue samples, breast core biopsies, and surgical material was performed. Immunohistochemical study was carried out on sections of core biopsies. The expression of markers was evaluated, the obtained data were compared with clinical and morphological characteristics, as well as with indicators of tumor sensitivity to neoadjuvant therapy. Statistical analysis was carried out using the Statistica 10.0 program, data comparison was performed using the methods of descriptive statistics and nonparametric method of Pearson's 2 test.&#x0D; Results. The immunoactivated subtype was determined with the status of CK5/6+/IDO1+ carcinomas, such tumors were dominant and accounted for 81.25% (n=26/32). In these cases (CK5/6+/IDO1+), the presence of metastatic lesions in the axillary lymph nodes was statistically significantly less common, and the frequency of complete pathomorphological regression was higher than in carcinomas, the molecular profile of which corresponds to the immunosuppressive subtype (CK5/6+/IDO1).&#x0D; Conclusion. Expression of the IDO1 protein may serve as a molecular and biological marker allowing immunohistochemical identification of subtypes of basal-like triple-negative breast cancer.

Evaluating cost savings in cytotoxic leftover management: A prospective study of vial sharing and dose rounding techniques in the Moroccan National Institute of Oncology.

Most intravenous anticancer drugs are administered in a dose per unit area or body weight, if not promptly administered to another patient cytotoxic leftover would be destroyed. To contain wastage, low-cost measures are highly desirable to contain and reduce expenditures without impairing the quality of care. The objective of the study is to evaluate the cost saved through the use of the two cytotoxic waste management techniques implemented in National Institute of Oncology's centralized chemotherapy preparation unit, vial sharing and dose rounding. A 6-month prospective single centre study from 1 February to 1 August 2023 at the National Institute of Oncology of Rabat in Morocco. The number of prepared preparations and amount of drug saved by both vial sharing and dose rounding was collected using the centralized chemotherapy preparation unit's 'leftover tracking file', the corresponding cost saved were calculated and then compared for each technique and with 2018 results. In total, 18,218 preparations were considered in the 6-month study. With the vial sharing technique 636,524.5 mg were saved corresponding to 246,031.4 (USD) saved cost, against 212,838.4 mg by dose rounding corresponding to 75,598.5 (USD) saved cost. This saving corresponded to a total of 321,629.4 (USD). Compared to the 2018 results leftovers costs saved by vial sharing corresponded to 289,972.05 (USD) by vial sharing technique for 1-year extrapolated period, and this study shows a saved cost of 321,629.9 (USD) by both vial sharing and dose rounding techniques. Dose rounding technique combined with vial sharing allowed National Institute of Oncology's centralized chemotherapy preparation unit to limit expensive cytotoxic cost wastage, highlighting these technique benefits.

Axillary ultrasound for predicting response to neoadjuvant treatment in breast cancer patients—a single institution experience

BackgroundIn node-positive breast cancer patients at diagnosis (cN +) that render node-negative after neoadjuvant systemic treatment (NAST), axillary lymph node dissection (ALND) can be avoided in selected cases. Axillary ultrasound (AUS) is most often used for re-staging after NAST. We aimed to determine sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of AUS after NAST for predicting nodal response at the Institute of Oncology, Ljubljana.MethodsBiopsy-confirmed cN + patients consecutively diagnosed at our institution between 2008 and 2021, who received NAST, followed by surgery were identified retrospectively. Only patients that underwent AUS after NAST were included. AUS results were compared to definite nodal histopathology results. We calculated sensitivity, specificity, PPV and NPV of AUS. We also calculated the proportion of patients with false-positive AUS that results in surgical overtreatment (unnecessary ALND).ResultsWe identified 437 cN + patients. In 244 (55.8%) AUS after NAST was performed. Among those, 42/244 (17.2%) were triple negative (TN), 78/244 (32.0%) Her-2 positive (Her-2 +), and 124/244 (50,8%) luminal Her-2 negative cancers. AUS was negative in 179/244 (73.4%), suspicious/positive in 65/244 (26.6%) (11/42 (26.2%) TN, 19/78 (24.4%) Her-2 + , and 35/124 (28.2%) luminal Her-2 negative cancers). On definite histopathology, nodal complete response (pCR) was observed in 89/244 (36.5%) (19/42 (45.2%) TN, 55/78 (70.5%) Her-2 + , and 15/124 (12.1%) luminal Her-2 negative cancers). Among patients with suspicious/positive AUS, pCR was observed in 20/65 (30.8%) (6/11 (54.5%) TN, 13/19 (68.4%) Her-2 + and 1/35 (2.9%) luminal Her-2 negative cancers). Sensitivity was 29.0%, specificity 77,5%, PPV 69.2%, NPV 38.5%. Specificity and PPV in TN was 68.4% and 45.4%, in Her-2 + 76.4% and 31.6%, in luminal Her-2 negative 93,3% and 97,1%, respectively.ConclusionIn approximately half of the patients, AUS falsely predicts nodal response after NAST and may lead to overtreatment in 30% of the cases (ALND). However, AUS has to be interpreted in context with tumor subtype. In luminal Her-2 negative cancers, it has a high PPV and is therefore useful.

Therapeutic results in children with brain tumors - a single center experience over 18 years.

Tumors of the central nervous system represent the main cause of death by cancer in children. The diagnosis and molecular classification of these neoplasms have seen great improvement in the past years, due to ongoing genomic advances. In general, the treatment consists of surgery, radiation therapy and chemotherapy. However, the currently available pharmacological treatment options have limited effectiveness due to the particular characteristics of the blood-brain barrier. We decided to study the therapeutic results in children treated for brain tumors in the Cluj-Napoca "Prof. dr. Ion Chiricuta" Oncology Institute, between 2001 and 2018, in order to provide a more accurate understanding of the disease and the available therapeutic options in our center. Out of the 207 cases included in this study, we recorded 98 deaths (47.3%). This is significantly less than the 5-year survival rate recorded in the US between 2012 and 2018 (74.9%). There are many factors that could explain the low survival rate, such as a very late diagnosis, the inability to implement innovative radiation therapy techniques until 2018, and the fact that between 2001 and 2010 the chemotherapy regimens in our center were not as effective as the more recent ones. The therapeutic results recorded in this study are similar to those in other middle-income countries, however, the available treatment options for pediatric brain tumors are not as effective as those currently in use for other pediatric and adult malignancies.

Bone marrow composition features and possibilities of tumor involvement diagnosing in patients with classic Hodgkin’s lymphoma

Background. Classical Hodgkin’s lymphoma is a B-cell lymphoproliferative disease, the tumor substrate of which is Berezovsky–Reed–Sternberg cells, characterized by CD30, PAX-5, CD15 expression and the absence of CD3, CD45. In some cases, tumor cells express CD20. modern anticancer therapy has increased the survival probability for most patients, not only with early but also with advanced stages of classical Hodgkin’s lymphoma. Such successes are mainly due to the distribution of patients into prognostic groups and the choice of an appropriate treatment regimen. tumor infiltration of the bone marrow suggests assigning patients to the advanced stages group, followed by the choice of an intensive therapy program. Aim. To determine the bone marrow involvement frequency according to positron emission tomography combined with computed tomography (PET/CT), with 18F-fluorodeoxyglucose (FDG) and bone marrow trephine biopsy (bmtb), to compare the results obtained with primary tumor immunophenotype and bone marrow cellular composition, and to identify of prognostic risk factors. Materials and methods. The study included 107 patients with newly diagnosed classical Hodgkin’s lymphoma, who underwent a diagnostic examination at the moscow research institute of oncology named after P. A. Herzen – a branch of the National Medical Research Center for Radiology and the “Lapino” clinical Hospital from 2015 to 2022, followed by anticancer therapy and further follow-up. Morphology of the primary tumor biopsy specimen in all patients and immunohistochemical (IHC) study using a wide panel of monoclonal antibodies (CD15, CD30, CD3, CD45, CD20, PAX-5 anti-gens; in some cases epstein–barr virus proteins expression) in most cases were performed. All patients underwent a morphological and / or IHC study of BMTB and the majority underwent aspiration biopsy and PET/CT with 18F-FDG. Results. The most common histological variant of classical Hodgkin’s lymphoma was nodular sclerosis (86.9 %). The majority of patients (51.4 %) were assigned to the advanced stage prognostic group. bone marrow tumor infiltration was statistically significantly more frequently diagnosed during PET/CT with 18F-FDG compared with the results of the BMTB – in 27.1 % and 12.1 % of cases, respectively (p &lt; 0.05). when comparing the results of both diagnostic methods, it was found that in 17.1 % of cases, bone marrow infiltration, detected during PET/CT, was not confirmed by IHC examination of the trephine biopsy. In addition, it was found that the majority of cases with CD20+/± and CD15+/± expression in the primary tumor were observed in the group of patients without bone marrow involvement. when assessing the cellular composition of bone marrow aspirates, it was revealed that in patients with bone marrow tumor infiltration, an increase in cellularity and megakaryocytes number along with a decrease in the plasma cells number is observed. Conclusion. The results suggest further study of bone marrow immunomorphological features in order to identify prognostic factors and search for new therapeutic targets. a more extended analysis of bone marrow aspirate immunomor-phological characteristics using new modern diagnostic methods, minimal residual disease status as a surrogate marker seems to be relevant and necessary to confirm the depth of the antitumor response achieved. Detection of CD20+/±- and cd15+/±-Berezovsky–Reed–Sternberg cells according to primary tumor IHC analysis indicates a low probability of bone marrow tumor infiltration, but further analysis is required on a large clinical and laboratory material.

Features of regional relapses in the central zone after surgical treatment of highly differentiated thyroid cancer

Introduction. Thyroid cancer is the most common malignant tumor of the endocrine system and comprises 33 % of malignant neoplasms of the head and neck. first echelon lymph nodes affected by this pathology are located in the central area of the neck. The metastatic process further advances into the lymph nodes in the lateral tissues of the neck. Currently, there is no consensus on the effectiveness of prophylactic central lymph node dissection and no conclusive criteria determining the risk of recurrence in the central zone.Aim. The assessment of factors influencing the risk of regional recurrence in the central zone.Materials and methods. The study included 30 patients with highly differentiated thyroid cancer, in whom metastatic nodes in the central zone were identified and verified during primary treatment. All patients previously underwent unilateral or 2-sided central lymph node dissection in various institutions. During the period of dynamic observation, these patients revealed regional recurrence in the central zone. patients were observed and treated for recurrence at the National medical Research Center of Oncology named after N.N. Blokhin of the ministry of Health of Russia.Results. primary surgical treatment in a specialized oncological institution was performed in 21 (70 %) patients, in a general surgical medical institution – in 7 (23.3 %), in an endocrinological institution – in 2 (6.7 %) patients. when assessing the influence of the morphological type and variant of thyroid cancer on the risk of developing regional recurrence, no statistical significance was found. No statistically significant factors were found in the analysis of the influence of characteristics of the primary tumor, such as tumor size, multifocal lesion, vascular invasion, extrathyroidal spread, on the risk of regional recurrence. In 16 (53.3 %) patients, recurrence occurred in the paratracheal zone of the ipsilateral side, in 7 (23.3 %) patients in the paratracheal zone of the contralateral side, bilateral lesions were observed in 2 (6.67 %) cases. 3 (10 %) patients were diagnosed with transient parathyroid insufficiency, 1 (3.3 %) – permanent parathyroid insufficiency, 1 (3.3 %) – hematoma in the area of the postoperative wound, patient, 2 (6.6 %) – injury to the recurrent laryngeal nerve.Conclusion. Residual metastatic lymph nodes after previous surgical treatment are the reason for performing a second operation, which carries both the risks of postoperative complications and the psychological burden on the patient. Thus, an adequate and radically performed primary surgical intervention is the key to reducing regional recurrences.

Definitive chemoradiation in vulvar squamous cell carcinoma: outcome and toxicity from an observational multicenter Italian study on vulvar cancer (OLDLADY 1.1)

BackgroundVulvar carcinoma is a rather uncommon gynecological malignancy affecting elderly women and the treatment of loco-regional advanced carcinoma of the vulva (LAVC) is a challenge for both gynecologic and radiation oncologists. Definitive chemoradiation (CRT) is the treatment of choice, but with disappointing results. In this multicenter study (OLDLADY-1.1), several institutions have combined their retrospective data on LAVC patients to produce a real-world dataset aimed at collecting data on efficacy and safety of CRT.MethodsThe primary study end-point was 2-year-local control (LC), secondary end-points were 2-year-metastasis free-survival (MFS), 2-year-overall survival (OS) and the rate and severity of acute and late toxicities. Participating centers were required to fill data sets including age, stage, histology, grading as well as technical/dosimetric details of CRT. Data about response, local and regional recurrence, acute and late toxicities, follow-up and outcome measures were also collected. The toxicity was a posteriori documented through the Common Terminology Criteria for Adverse Events version 5 scale.ResultsRetrospective analysis was performed on 65 patients with primary or recurrent LAVC treated at five different radiation oncology institutions covering 11-year time interval (February 2010–November 2021). Median age at diagnosis was 72 years (range 32–89). With a median follow-up of 19 months (range 1–114 months), 2-year actuarial LC, MFS and OS rate were 43.2%, 84.9% and 59.7%, respectively. In 29 patients (44%), CRT was temporarily stopped (median 5 days, range 1–53 days) due to toxicity. The treatment interruption was statistically significant at univariate analysis of factors predicting LC (p: 0.05) and OS rate (p: 0.011), and it was confirmed at the multivariate analysis for LC rate (p: 0.032). In terms of toxicity profile, no G4 event was recorded. Most adverse events were reported as grade 1 or 2. Only 14 acute G3 toxicities, all cutaneous, and 7 late G3 events (3 genitourinary, 3 cutaneous, and 1 vaginal stenosis) were recorded.ConclusionIn the context of CRT for LAVC, the present study reports encouraging results even if there is clearly room for further improvements, in terms of both treatment outcomes, toxicity and treatment interruption management.

Phyllodes Tumors of the Breast: Clinicopathological Analysis of 35 Single-Center Cases

Aim: This study was conducted with the aim of to evaluate demographics of patients with phyllodes tumor (PT), clinical and histopathologic characteristics of tumors, and to share treatment approach to PTs from the experience of our center. Method: In the study, the demographic, clinicopathological characteristics and treatment approaches of the patients who were treated between 2006 and 2017 at the Oncology Institute, Istanbul University with the diagnosis of PT were evaluated retrospectively by examining the patient files and pathology records. Results: The median age was 39.7±11.1 years. For diagnosis, 6 patients underwent excisional biopsies, 1 patient incisional biopsy, and 27 patients core biopsies. Twenty seven patients underwent breast-conserving surgery (BCS), whereas 8 patients had mastectomy. Re-excision was added to one lumpectomy, and 2 cases who had BCS were converted to mastectomy due to margin positivity. The mean PT size was 55.3 mm (13 mm - 210 mm). The PT subtypes were as follows: benign (n=15, 42.9%), borderline (n=7, 20.0%), and malignant (n=13, 37.1%). Among those with malignant PTs, 3 patients received chemotherapy (CT) and radiotherapy (RT) following mastectomy, one patient with lumpectomy had CT and RT, and 2 patients received only RT. Patients with PT were followed for an average of 70 months (12 months- 184 months). Seven local recurrences (LR) (2 benign PT, 1 borderline PT, and 4 malignant PT), 1 single distant metastasis (malignant PT), and 1 LR plus distant metastasis (malignant PT) were observed in follow-up. Conclusion: Negative surgical margin of ≥1cm is the most important step in the management of PTs. The survival benefit of adjuvant CT or RT are contraversial and need further investigation.

P17.06.B TARGETED THERAPY MATCHED TO GENOMIC ALTERATIONS (BRAFV600E, NTRK, FGFR, ROS1, PIK3CA, PTEN) IN PATIENTS WITH RECURRENT IDH WILDTYPE GLIOBLASTOMA: A REAL-LIFE COHORT ANALYSIS FROM VENETO INSTITUTE OF ONCOLOGY, PADUA (ITALY)

Abstract BACKGROUND The use of next-generation sequencing (NGS) allows the identification of subgroups of patients that may respond to personalized targeted therapies (TT). Despite the acquired deep knowledge about biology, there are only a few data available regarding TT efficacy and feasibility for patients with glioblastoma (GBM). MATERIAL AND METHODS We retrospectively analyzed a cohort of patients with recurrent GBM treated at Veneto Institute of Oncology, Padua (Italy) with TT based on their individual NGS profile. NGS was obtained with FoundationOne®CDx on formalin-fixed paraffin-embedded (FFPE) tissue samples. We identified 6 druggable genomic alterations, classified according to ESCAT (ESMO Scale for Clinical Actionability of molecular Targets): BRAFV600E mutation (IB), NTRK1-2-3 fusions (IC), FGFR1-2-3 alterations (IIB), ROS1 fusions (IIIA), PIK3CA mutations (IIIA) and PTEN loss/mutations (IIIA). TT was given as agnostic approval, part of compassionate use programs or in clinical trials. Response assessment was based on RANO (Response Assessment in Neuro-Oncology) criteria. RESULTS Between March 2020 and December 2022, 34 patients with recurrent glioblastoma received TT (19 males, 15 females, median age of 54 years at time of TT initiation). ECOG PS was 0-1 in 29 pts. All patients received radiotherapy and temozolomide as first-line therapy. The median line of therapy with TT was 3 (range 2-7). TT was dabrafenib/trametinib (9 pts), larotrectinib (2 pts), erdafitinib (4 pts), entrectinib (1 pt), alpelisib (6 pts), ipatasertib+/-atezolizumab (12 pts). At data cut-off (March 2023), 19 patients had died. In the entire cohort, median overall survival and progression-free survival (PFS) after starting TT was 8.72 and 2.14 months, respectively. The dabrafenib/trametinib subgroup had the longest median PFS (5.23 months), a disease control rate (DCR) of 77%, an objective response rate of 22%, and a median duration of response of 22.5 months. 7/9 pt had died and 2 pts are continuing dabrafenib/trametinib. The pt with ROS1-GOCP fusion maintained a complete response for 12 months with entrectinib. Among the others, no complete/partial responses were detected. DCR due to stable disease was 50% in larotrectinib and erdafitinib, 8.3% in ipatasertib+/-atezolizumab, 0% in alpelisib subgroup. No toxicities were reported in dabrafenib/trametinib subgroup. Among all patients, no grade 4 drug-related adverse events were observed and in any case TT was interrupted for toxicity. CONCLUSION Our results confirm the activity of dabrafenib/trametinib in BRAFV600E mutant glioblastoma pts and might suggest deeper explorations in targeting ROS1 and FGFR. Further correlation among patients' outcome, molecular characteristics and TT timing are still under investigation.

3D Laparoscopic Ureterolysis for Retroperitoneal Fibrosis Secondary to Radical Hysterectomy and Radiation Treatment for Cervical Cancer: Results from the Oncological Institute, Cluj Napoca.

Ureterolysis represents the surgical treatment for retroperitoneal fibrosis. The aim of the study was to review the outcomes of patients who had undergone radical hysterectomy and radiotherapy for cervical cancer that later developed retroperitoneal fibrosis, for whom 3D laparoscopic ureterolysis was performed in our department and to review current published studies. We present a series of cases consisting of 6 patients with secondary retroperitoneal fibrosis. In all cases, the intervention was performed by the same surgeon from the Oncological Institute "Prof. Dr. Ion Chiricuță" Cluj-Napoca, Romania. We carried out a literature review, searching in the PubMed and MEDLINE studies published between 2000 and 2021 relevant to the matter and a total of 12 papers were selected. We reviewed the functional outcomes of patients that underwent minimally invasive ureterolysis. 3D laparoscopic ureterolysis was performed in 6 patients. Mean operative time was 166 minutes and mean blood loss was 203 mL. No surgery required conversion. Five patients showed good functional results after ureteral stent removal. In one case, the patient developed acute pyelonephritis and the ureteral stents were kept. Laparoscopic ureterolysis for retroperitoneal fibrosis secondary to operated and radiation-treated cervical cancer represents one of the most complex and challenging surgeries in the urological field. From personal experience we conclude that in oncological centers with vast experience in laparoscopy this minimally invasive approach is feasible and safe. Published data, even though scarce, strengthens our results and the need for this surgery in patients with retroperitoneal fibrosis with urological impact. The laparoscopic approach comes with good functional results and with the advantages of faster post-operative recovery comparing to open surgery and comparable results with the precision and dexterity offered by the robotic approach, but with lower economic burden.

Aided diagnosis of thyroid nodules based on an all-optical diffraction neural network.

Thyroid cancer is the most common malignancy in the endocrine system, with its early manifestation being the presence of thyroid nodules. With the advantages of convenience, noninvasiveness, and a lack of radiation, ultrasound is currently the first-line screening tool for the clinical diagnosis of thyroid nodules. The use of artificial intelligence to assist diagnosis is an emerging technology. This paper proposes the use optical neural networks for potential application in the auxiliary diagnosis of thyroid nodules. Ultrasound images obtained from January 2013 to December 2018 at the Institute and Hospital of Oncology, Tianjin Medical University, were included in a dataset. Patients who consecutively underwent thyroid ultrasound diagnosis and follow-up procedures were included. We developed an all-optical diffraction neural network to assist in the diagnosis of thyroid nodules. The network is composed of 5 diffraction layers and 1 detection plane. The input image is placed 10 mm away from the first diffraction layer. The input of the diffractive neural network is light at a wavelength of 632.8 nm, and the output of this network is determined by the amplitude and light intensity obtained from the detection region. The all-optical neural network was used to assist in the diagnosis of thyroid nodules. In the classification task of benign and malignant thyroid nodules, the accuracy of classification on the test set was 97.79%, with an area under the curve value of 99.8%. In the task of detecting thyroid nodules, we first trained the model to determine whether any nodules were present and achieved an accuracy of 84.92% on the test set. Our study demonstrates the potential of all-optical neural networks in the field of medical image processing. The performance of the models based on optical neural networks is comparable to other widely used network models in the field of image classification.

Quality of life of lung cancer patients

Abstract Lung cancer is one of the most prevalent forms of cancer in patients in Ukraine. The objective of the study was to identify the main problems in the quality of life of patients with lung cancer in order to optimize medical care for this patient group. A survey of 411 patients of oncology institutions in nine regions of Ukraine was conducted in the period from November 2021 to February 2022. The sociological survey was performed using the EORTC QLQ-C30 and QLQ-LC29 questionnaires. As of the pre-war period, the quality of life of lung cancer patients in Ukraine amounted to 49.12 points on a 100-point scale. According to the QLQ-C30 symptom scale, the highest score among the complaints of Ukrainian patients is that of financial difficulties, the second place is occupied by fatigue. According to the QLQ-LC29 symptom scale, patients with lung cancer were most concerned with “Fear of progression”. Ukrainian patients were least concerned about diarrhea and hemoptysis. When providing medical care to cancer patients, components to ensure the proper quality of their lives and psychosocial care, including the standardization of psychological care and its introduction in all institutions that provide medical care to cancer patients; organization of social and psychological support for cancer patients and their families; as well as educational work with relatives, colleagues, medical professionals on awareness of the need for social and psychological support for patients must be taken into account.

Unchanging dynamics in posttraumatic growth in cancer patients: ways of coping and illness perception.

This study aims to address the positive changes due to traumatic experiences, such as being diagnosed with cancer and experiencing this disease for a certain period. Within this purpose, socio-demographic and disease-related variables, coping ways and illness perceptions that affect posttraumatic growth in cancer patients were examined. Secondly, the findings of this study, which is one of the first studies on posttraumatic growth in cancer patients in Turkey, were compared with the findings of current studies on the subject. Datums were collected by an interview form and three scales (Posttraumatic Growth Scale, Ways of Coping Inventory and Illness Perception Scale-R) to 78 cancer outpatients in Istanbul University Oncology Institute in 2007. Results showed that cancer patients have higher posttraumatic growth levels than the mean. According to analysis, posttraumatic growth total score between confrontive coping (t = -2.344, p < 0.05), self-controlling (t = -3.704, p < 0.001), accepting responsibility (t = -3.032, p < 0.01), escape-avoidance (t = -2.285, p < 0.05), planful problem solving (t = -2.502, p < 0.05), positive reappraisal (t = -5.241, p < 0.001), and seeking social support (t = -3.527, p < 0.01) has relationship. Also, there is a relation between posttraumatic growth subscales and the Revised form of Illness Perception Questionnaire; Change in relationships with others subscale (t = 2.887, p < 0.01) and Change in self-perception subscale (t = 2.660, p < 0.01) between timeline (acute/chronic), Change in self-perception subscale between timeline (cyclical) (t = -2.788, p < 0.01) and uncontrollable body factors (t = -1.916, p < 0.05) Change in philosophy of life subscale between external attributions (t = -2.057, p < 0.05) and Change in relationships with others subscale (t = -2.920, p < 0.01) between chance factors. It was found that positive reappraisal (F = 78.290, p < 0.001), self-controlling (F = 39.814, p < 0.001), and distancing (F = 46.311, p < 0.001) were significant predictors of posttraumatic growth total score. Results showed that ways of coping and illness perceptions were essential variables in posttraumatic growth. Studies on posttraumatic growth in Turkey and the world have significantly increased in recent years. This study aimed to examine the findings obtained from cancer patients in 2007 in discussion with the findings in the current literature. In this context, it is seen that the relevant variables affecting posttraumatic growth in cancer patients in different cultures do not change.

EGFR mutation testing from pleural effusions of non-small cell lung cancer patients at the institute for oncology and radiology of Serbia

BackgroundThe use tumor-derived cell-free DNA extracted from body fluids is being evaluated for genetic testing in lung cancer. The aim of this study was to explore the feasibility and utility of implementation of EGFR molecular testing from pleural effusions in non-small cell lung cancer in the clinical diagnostics workflow. Patients and methodsThis study included patients diagnosed with primary lung adenocarcinoma in the period July 2016 to June 2023. EGFR mutation testing was performed by qPCR (Cobas®) and dPCR. Testing was performed from 211 plasma samples when tissue was unavailable at diagnosis, and from 301 plasma samples and 18 pleural effusions at progression on first/second generation of EGFR TKIs. Descriptive methods of statistical analysis were used to summarize the sample data. Fisher's exact test, McNemar's test, Cohen's kappa tests were used for statistical analyses. Two-sided p-values <0.05 were considered statistically significant. ResultsA significantly higher detection rate of the T790M mutation in pleural effusion was obtained compared to blood (50% and 20%, p=0.047). When comparing the detection success rate of the resistant T790M mutation in pleural effusion and blood, a statistically significant difference was obtained in favor of pleural effusion (50% vs. 21.87%, p=0.01). ConclusionsSuperior performance of pleural effusions compared to blood plasma was shown both in the analysis of success rate and in the detection of the resistant T790M mutation, at progression on EGFR TKIs. Pleural effusion should be considered in this setting whenever available, especially in countries with limited health resources.