Delineating the CTVboost in postoperative breast radiation therapy (RT) may be challenging after preoperative systemic therapy (PST), due to treatment-induced anatomical changes and the potential discordance between the postoperative surgical cavity, as identified by surgical clips, and the spatial extent of the pretreatment tumor. The objective of this study was to assess whether [18F]-FDG PET/CT (PET/CT)-guided delineation using deformable image registration (DIR) improves inter-observer reproducibility compared to conventional strategies relying primarily on surgical clips and anatomical landmarks. Fifty-eight patients treated with PST, surgery, and postoperative RT were retrospectively included. Three radiation oncologists performed four delineation strategies per patient: (1) CTVCLI, based on clips and anatomical landmarks; (2) CTVPET, a 10mm isotropic expansion around the PET-defined biological tumor volume (BTV); (3) CTVCOM, generated by a 15-20mm isotropic expansion around the BTV centroid and adapted to pathological features; and (4) CTVINT, manually refined volumes integrating clips, PET signal, and registration accuracy. Inter-observer variability (IOV) was assessed using the Dice similarity coefficient (DSC) and Hausdorff distance (HD). All patients underwent lumpectomy after PST, with a mean age of 53.9 years, and 44.2% had triple-negative tumors. The mean volume of the CTVCLI was 34.4cm3, compared to 36.5cm3 for CTVPET, 21.2cm3 for CTVCOM, and 43.6cm3 for CTVINT. Mean DSCs were 0.86 for both CTVPET and CTVCOM, 0.77 for CTVINT, and 0.62 for CTVCLI (p<10-8). PET/CT-guided delineation after DIR significantly improves inter-observer reproducibility of CTVboost definition after PST compared with conventional methods.

Prognostic factors of oropharyngeal minor salivary gland carcinoma in Southern China: a long-term follow-up observational study.

This study characterizes longitudinal changes in health-related quality of life (HRQoL) following radiotherapy in patients with head and neck cancer (HNC) and quantifies associated toxicity burden to inform future health technology assessments (HTA). HNC patients receiving definitive, postoperative radiotherapy, or chemoradiation at the University Medical Center Groningen from March 2007 to September 2022 were included. Health status and utility were assessed using EQ-5D-3 L and EQ-VAS, while patient-reported HRQoL and symptom burden were evaluated with EORTC QLQ-C30 and QLQ-H&N35. Toxicities were rated by physicians using CTCAE v4.0 and the UMCG dysphagia scale. Assessments were conducted before radiotherapy, at 12 weeks, and 6, 12, 18, 24, 30, 36, 48, and 60 months post-treatment. Generalized Estimating Equations (GEE) analyzed health utility values. Among 1,851 patients, HRQoL declined during radiotherapy and partially recovered within the first year, remaining stable up to 60 months. Model-estimated EQ-5D utility decreased during treatment and recovered to above baseline levels by 12 months. Dry mouth and sticky saliva persisted at long-term follow-up. In multivariable GEE models, CTCAE Grade 3 xerostomia and dysphagia were associated with utility decrements of -0.051 and -0.062, respectively, while grade 3 pharyngolaryngeal pain showed the largest reduction (-0.106). Increasing physician-rated toxicity severity was consistently associated with greater disutility. Xerostomia, pharyngolaryngeal pain, oral pain, , and dysphagia significantly impacted EQ-5D-derived utility values. Disutility increased with higher CTCAE-rated toxicities. Symptoms persisted for up to five years post-treatment. These findings can inform QALY-based health economic evaluations and suggest interventions targeting key toxicities to improve patient HRQoL.

Navigating controversies in stage III NSCLC: a multidisciplinary case discussion on evolving treatment paradigms.

The Diagnostic Role of Prostate-specific Membrane Antigen Positron Emission Tomography for Patients with Rising PSA After Radical Prostatectomy and Postoperative Radiotherapy: A Systematic Review and Meta-analysis.

Postoperative regional nodal irradiation (RNI) is a standard treatment for breast cancer at high risk of regional recurrence; however, the necessity of including the internal mammary node (IMN) region in the radiation field remains unclear. This study aimed to evaluate treatment outcomes in a large cohort of patients who received postoperative radiotherapy with RNI excluding the IMN region. This study included patients with breast cancer who underwent surgery followed by RNI without IMN irradiation between 2007 and 2018. The primary endpoint was disease-free survival (DFS), and the secondary endpoints were overall survival (OS), breast cancer-specific mortality (BCM), distant metastasis-free survival (DMFS), recurrence patterns, and treatment-related adverse events. In total, 799 patients were included. The 5-year DFS, OS, BCM, and DMFS rates were 75.9, 88.3, 9.7, and 77.1%, respectively. Worse outcomes were associated with a higher number of positive lymph nodes and estrogen receptor (ER)-negative disease. Medial/central tumor location and younger age were each significantly associated with poorer outcomes, being associated with worse DFS and DMFS. Bone was the most common recurrence site. ER-negative disease, a higher number of positive lymph nodes, medial/central location, and younger age were significant risk factors for recurrence, particularly distant metastasis. IMN recurrence was rare. In this cohort, medial/central tumor location, ER-negative disease, and extensive nodal involvement were associated with poorer outcomes, suggesting that these factors may identify patients who can benefit from IMN irradiation. These findings may serve as important reference data when determining the indication for IMN irradiation on an individual patient basis.

Surgical outcomes of cerebellar liponeurocytomas: A systematic review and individual patient data meta-analysis.

Recurrent endometrial carcinoma involving major pelvic vasculature poses significant surgical challenges, particularly when residual disease persists after systemic therapy and radiation is contraindicated. Robotic-assisted surgery offers a minimally invasive solution for precise tumor dissection near critical vessels. A 67-year-old woman with recurrent endometrial carcinoma presented with deep vein thrombosis and pulmonary embolism 3 years after primary treatment with hysterectomy, chemotherapy, and brachytherapy. Imaging revealed a 5-cm pelvic mass encasing the right external iliac vessels and two lung nodules. After six cycles of carboplatin and liposomal doxorubicin, lung lesions resolved, but the pelvic mass persisted. A multidisciplinary team, including gynecologic oncologists and vascular surgeons, performed a robotic-assisted secondary cytoreductive surgery. A prophylactic iliac vein balloon was placed by the vascular team but remained uninflated. The procedure involved adhesiolysis, retroperitoneal dissection, and careful tumor separation from the external and internal iliac vessels with vascular preservation. Metal clips were applied to guide postoperative radiation planning. The tumor was completely resected without vascular injury. The patient recovered uneventfully and was discharged on postoperative Day 1. This case underscores the feasibility and safety of a multidisciplinary robotic-assisted approach for pelvic tumor resection involving major vasculature. Preoperative vascular planning and endovascular readiness enhance surgical safety, while minimally invasive techniques offer improved recovery and precision in managing recurrent endometrial carcinoma.

While yoga is known to benefit depression in breast cancer patients, its efficacy as an adjunct to diverse treatment regimens remains unclear. This study evaluated yoga's efficacy in alleviating depression during varied breast cancer therapies and supports its clinical integration as a complementary intervention. Following PRISMA 2020 guidelines, we systematically searched for RCTs in English and Chinese. Literature quality was assessed using the Cochrane Risk of Bias tool. Data were analyzed with Review Manager 5.4.1, including subgroup analyses by treatment type and assessment scale. Analysis of 21 studies showed yoga significantly reduced depression levels [SMD = -0.58, 95% CI (-0.83, -0.32), P < 0.00001]. Subgroup analyses revealed a significant combined mean difference among the surgery group [SMD: -1.04], the postoperative radiotherapy group [SMD: -2.47], and the postoperative chemotherapy group [SMD: -0.46]. The group receiving postoperative radiotherapy demonstrated a significantly greater improvement in depression. Subgroup analyses of scale-assessed effects confirmed the validity of the Beck Depression Inventory (BDI), the Center for Epidemiologic Studies Depression Scale (CESD), the Hospital Anxiety and Depression Scale (HADS), and the Zung Self-Rating Depression Scale (SDS). The HADS demonstrated a greater effect size [SMD = -1.19, 95% CI (-2.13, -0.24), P = 0.01]. The impact varied among those undergoing different treatment regimens. Notably, the degree of improvement in depression appeared to be greater in the postoperative radiotherapy group. HADS is a practical self-assessment scale that has demonstrated considerable improvement and is recommended for use in breast cancer patients with depression.

Despite advantages of titanium mesh, hardware exposure affects up to 25% of cases reported in the literature. We aim to identify risk factors associated with titanium mesh exposure following cranioplasty and characterize early wound changes that may signal impending hardware exposure. A review of 34 patients who underwent titanium mesh cranioplasty between 2015 and 2025 was performed. Seventeen patients with hardware exposure were matched 1:1 with 17 controls. Data on demographics, comorbidities, operative details, and postoperative complications were collected. Statistical analysis included Fisher exact test and t tests, with significance set at P<0.05. Significant risk factors for titanium hardware exposure included a history of metal allergy and reconstruction with advancement flaps. Significant protective factors included patients undergoing postoperative radiation therapy and reconstruction with rotational flaps. Titanium mesh exposure risk increases with metal allergy history, postoperative radiotherapy, and use of advancement flaps for reconstruction. Recognition of early wound changes is crucial for timely intervention. These findings support individualized surgical planning and highlight the need for close postoperative monitoring to reduce complications and improve reconstructive outcomes.

Long-term locoregional control and pattern of recurrences after implementation of highly conformal flank target volumes and image-guided Intensity-Modulated Arc Therapy for pediatric Wilms tumors.

The impact of surgical excision modalities of Merkel cell carcinoma of the head and neck on recurrence, survival, and quality of life: A systematic review.

Reconstructive surgery with a flap makes the definition of postoperative radiotherapy volumes challenging. It may also result in errors in automatic segmentation atlases of organ-at-risk and nodal volumes. Automating flap segmentation process could assist clinicians in planning radiotherapy and enable characterization of flap evolution over time and after radiotherapy. Flaps vary significantly in shape, volumes and associated artefacts. We therefore enriched a previously built training dataset with challenging cases to obtain a more robust real-world flap segmentation. Within the framework of the state-of-the-art nnU-Net deep learning architecture, we investigated whether constructing a training dataset with enhanced representation of challenging cases, often associated with poor segmentation performance or outright failures, could improve the overall accuracy and robustness of automated flap segmentation, based on Dice scores compared through paired Wilcoxon signed-rank tests. Clinical trial and real-world data were selected to increase the heterogeneity and enrich the training set with rare challenging cases (such as pedicled flaps, small flaps, unusual location including maxillary flaps, bone resection, presence of dental artefacts or bite block). This enriched training dataset led to improved performance of the nnU-Net model, increasing the mean Dice scores from 0.66 ± 0.29 to 0.74 ± 0.20 (p < 0.001), with median Dice scores rising from 0.76 to 0.80. Robust flap segmentation was achieved without modifying the neural network architecture, loss function, or algorithmic structure, through enrichment of the training set with anatomically and visually challenging cases. This model can be used for detailed analysis of geometrical and textural flap changes over time.

Clinicopathological characteristics and prognosis of central nervous system solitary fibrous tumor: An analysis of 271 cases.

Surgical stabilization followed by postoperative radiotherapy (RT) is the standard of care for impending pathologic fractures due to bone metastases. Compared with conventional RT, stereotactic body RT (SBRT) provides more durable tumor control and palliation, but treatment volume constraints often preclude postoperative use. Preoperative SBRT limited to the tumor volume offers a solution by delivering an ablative dose before intraoperative tumor dissemination, but its safety is not established. We conducted a phase I, nonrandomized clinical trial at a quaternary care cancer center, with accrual between June 2021 and April 2024. Eligible patients (N=38) had pelvic or long bone metastases with impending pathologic fractures requiring surgical stabilization. Patients received preoperative SBRT (27-30 Gy in 3 fractions or 18-24 Gy in 1 fraction) followed by surgical stabilization within 1 week. The primary endpoint was rate of wound complications within 6 weeks after preoperative SBRT and surgical stabilization. Secondary endpoints were rates of tumor recurrence and grade ≥3 treatment-related toxicities within 1 year. A total of 7 patients were excluded due to inability to receive treatment or death prior to the primary endpoint. Thirty-one patients were evaluated at 6 weeks postoperatively, 26 at 3 months, and 16 at 1 year. The median age was 66 years (IQR, 59-71), and 15 (48%) patients were male. At 6 weeks, 2 of 31 patients (6.5%; 95% CI, 0.79-21.4) experienced wound complications. At 3 months, 1 of 26 patients (3.8%; 95% CI, 0.10-19.6) experienced grade ≥3 treatment-related toxicity. At 12 months, 1 of 16 patients (6.3%; 95% CI, 0.16-30.2) had tumor recurrence. Preoperative SBRT is associated with a low risk of wound complications and durable local tumor control. A randomized controlled trial examining its efficacy, potential to facilitate less invasive surgery, and impact on functional outcomes is warranted. gov identifier: NCT05038124.

The optimal surgical management of high-grade parotid carcinoma confined to the superficial lobe remains controversial, with limited evidence comparing total and superficial parotidectomy in this setting. To compare oncologic outcomes and complications between total parotidectomy with postoperative radiotherapy (TP + PORT) and superficial parotidectomy with postoperative radiotherapy (SP + PORT). Multicentre retrospective cohort study. Adult patients (> 18 years) with high-grade parotid carcinoma confined to the superficial lobe treated between 2011 and 2023 were identified at tertiary centres. Exclusion criteria included preoperative facial nerve palsy, metastatic disease to the parotid gland, prior head and neck radiotherapy, receipt of concurrent chemoradiation and follow-up < 12 months. A total of 108 patients were included (TP + PORT, n = 63; SP + PORT, n = 45) with a median follow-up of 53 months. Baseline characteristics were comparable except for older age and a higher proportion of Milan category VI cytology in the TP + PORT group (p < 0.05). Local, regional and distant recurrence rates and mortality did not differ significantly between groups (p = 0.55, 0.26, 1.00 and 0.36, respectively). All local recurrences occurred within 24 months (mean: 7.2 months). Age and positive resection margins were independent predictors of mortality (p < 0.01). Five-year overall survival was 73.0% in the TP + PORT group and 81.5% in the SP + PORT group. IPTW-adjusted analyses confirmed no significant differences in recurrence or mortality between groups (hazard ratio for mortality, 0.78; 95% CI: 0.32-1.90; p = 0.59). Permanent facial nerve palsy was significantly more common after TP + PORT (14.3% vs. 2.2%, p < 0.001), while other complications were similar. Superficial parotidectomy with adequate margins followed by PORT achieves comparable oncologic outcomes with significantly fewer complications and may be preferred for high-grade parotid carcinoma confined to the superficial lobe. 2d (JBI).

The surgical management of sporadic optic pathway glioma (OPG) remains controversial due to its unpredictable visual outcomes and uncertain risk-benefit balance. This study aimed to identify key clinical and surgical determinants of long-term visual preservation following tumor debulking in children with sporadic OPG. A total of 192 pediatric patients who underwent initial partial resection for sporadic OPG at Beijing Tiantan Hospital between 2011 and 2023 were retrospectively analyzed. Two complementary outcomes were assessed: follow-up visual acuity (VA) of the better-eye defined at baseline and individual visual change. Ordinal and binary logistic regression analyses were performed to identify predictors, supplemented by trend and visualization analyses. Baseline VA was the strongest predictor of follow-up VA of the baseline-defined better-eye (OR = 5.88, P < 0.001). Poorer outcomes were associated with younger age (< 3 years), delayed surgery, extent of resection ≥ 50%, and postoperative radiotherapy. Among patients with moderate baseline VA, a greater resection extent showed a trend toward worse outcomes. The anterior interhemispheric approach was linked to higher risk of visual deterioration, whereas transcallosal and frontotemporal approaches were protective. Early intervention, limited resection, and careful avoidance of high-risk surgical corridors were associated with better long-term visual preservation. Preoperative baseline VA determines postoperative visual potential, while surgical timing, extent, and approach critically shape long-term outcomes. Patients with moderate baseline VA are the most intervention-sensitive subgroup. These findings support early, conservative, and function-oriented surgical strategies to optimize visual outcomes in pediatric sporadic OPG.

HPV-positive oropharyngeal squamous cell carcinoma: risk-adapted treatment strategies and biomarker-guided individualization.

Sinonasal mucosal melanoma: REFCOR guidelines for diagnosis, treatment and follow-up.

There is a lack of prospective clinical trials on the therapy of salivary gland cancer (SGC) due the rarity and large variety of histological subtypes. This study aimed to compare overall survival (OS) after primary surgery of SGC followed by postoperative radiotherapy (PORT) versus radiochemotherapy (PORCT) in curative intent. A systematic review and meta-analysis were performed on studies reporting OS after the two postoperative therapy modalities using hazard ratios (HRs) or allowing to calculate the HRs from the data. These studies were identified from PubMed, Web of Science, and Cochrane Library databases until October 2024. Pooled HR with 95% confidence interval (CI) is reported with random-effects or fixed-effects models. The search yielded 1,074 publications, of which 11 retrospective clinical studies with 26,612 adult patients could be included. None of the studies found a statistically significant difference between PORT and PORCT. Likewise, this meta-analysis revealed no statistically significant difference between PORT and PORCT. The pooled HR based on a common effect model was 1.065 (CI: 0.998-1.137) with low between study heterogeneity (I²=24.1%) and heterogeneity variance τ2 = 0.009. A meta-regression only revealed one factor with influence on the HR. The proportion of T4 patients in the total study shows a HR = 1.153 for a 10% change 95% CI: 1.014,1.314). This meta-analysis, based on a highly confounded observational setting, does not permit a reliable conclusion as to whether PORCT leads to better OS than PORT as adjuvant therapy for patients with SGC. PORCT might be beneficial for high-risk subgroups. However, this was not possible to determine in this meta-analysis as all included studies were retrospective and heterogeneous leading to a high degree of uncertainty about the therapy effects. More robust data from high-quality cohort studies or randomized controlled studies are needed. There is an urgent need for alternative and more effective multimodal treatment concepts for SGC.