Abstract This guideline aims to provide evidence-based recommendations for the prevention, screening, assessment, diagnosis, treatment decision, and survivorship care of older adults with cancer. The CACA Geriatric Oncology Society convened expert panels to plan, write, and revise the manuscript. These experts engaged in in-depth discussions to propose clinical practice recommendations for geriatric oncology. The guideline highlights the increasing prevalence and mortality of cancer among the older adults in China, driven by an aging population. It emphasizes that a comprehensive geriatric assessment is critical for optimal treatment decision-making. Additionally, the use of traditional Chinese Medicine is suggested to minimize toxicity, alleviate symptoms, and enhance immune function. In conclusion, integrative and multidisciplinary approaches are essential to achieving both increased longevity and improved quality of life for older patients with cancer.

International patterns and disparities in functional sequelae (FUSE) follow-up after pediatric solid tumor resection: A report from the International Society of Pediatric Surgical Oncology.

This joint Clinical Consensus Statement on the safety and feasibility of concomitant urogynecologic and gynecologic oncology surgical procedures reflects statements drafted by content experts from the American Urogynecologic Society and the Society of Gynecologic Oncology. The writing group used a Delphi process to evaluate statements developed from a structured literature search and assessed consensus. A total of 35 statements were assessed in the following categories: (1) background, (2) treatment options, (3) timing of concurrent surgery, (4) risk factors, and (5) value-based care. Of the 35 statements, 28 reached consensus on initial review. Three statements were omitted, and 4 statements were revised and reached consensus following second review utilizing the Delphi process.

This article details the 2025 consensus update from the Brazilian Group for Pediatric Bone Marrow Transplantation and the Brazilian Society for Pediatric Oncology regarding hematopoietic stem cell transplantation (HSCT) for pediatric acute lymphoblastic leukemia (ALL). Allogeneic HSCT is the standard treatment for high-risk or relapsed ALL. Key indications include, in first remission, very high risk patients defined by primary induction failure or positive minimal residual disease (MRD) after consolidation. In second remission, it is indicated for early bone marrow relapse, early isolated extramedullary B-cell relapse, and all T-cell ALL relapses. The consensus recommends myeloablative conditioning as standard, preferring total body irradiation based regimens for children over 2–3 years old. The preferred donor hierarchy is a matched sibling, followed by a matched unrelated donor, with bone marrow being the preferred cell source. Post-HSCT monitoring of MRD is critical for guiding interventions and identifying relapse. This document serves as an essential, updated guide for clinical decision-making in this field.

Since its inception, surgical oncology training has emphasized the treatment of complex tumors without restriction to a specific anatomic region. As the complexity of cancer care increases, it is unclear whether this broad-based training model remains optimal. We set out to characterize how fellowship prepares graduates for clinical practice and to identify trends in surgical oncology training and practice. A 24-item survey was sent to graduates of an academic surgical oncology training program between the years 1981 and 2022. Questions focused on preparedness for practice upon graduation, current clinical and non-clinical activities, and the evolution of respondents' practice since completion of fellowship. Respondents indicated that they felt generally well prepared to treat a wide range of malignancies. Post-2013 graduates, felt significantly better prepared to treat peritoneal surface and gynecologic malignancies and to perform robotic surgery. In contrast, pre-2013 graduates indicated greater preparedness for the treatment of melanoma, extremity sarcoma, head and neck, esophageal and thoracic malignancies (p 0.05). Respondents practiced broadly, treating a median of 5 disease sites, although 36% dedicated more than half of their time to a single site. Despite the lack of formalized leadership training, 40.9% of graduates were involved in leadership positions. Our findings confirm that the existing surgical oncology training positions trainees well for practice, even in a landscape with many partially overlapping and competing surgical fellowships. In addition, many graduates are engaged in administrative and leadership roles suggesting that surgical oncologists may benefit from formalized leadership training during fellowship.

Existing guidelines for the management of cancer-related fatigue (CRF) differ in scope, evidence strength, and implementation strategies, limiting consistent integration into post-treatment survivorship care. This study systematically evaluates and compares recommendations to identify best practices, highlight evidence gaps, and provide actionable insights for clinicians and policymakers. A systematic search was conducted across PubMed, the Cochrane Library, and professional society websites. Included were all guidelines from professional oncology societies addressing CRF management in adult cancer survivors and published in English between 2000 and December 2024. From 524 references screened, eleven (11) guidelines from eight (8) professional societies met the inclusion criteria and were analysed. The quality of the guidelines was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) criteria. Recommendations, their strength of evidence and strength of recommendations were extracted and standardized into the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The screening, grading, and extraction process was performed by two reviewers independently. The quality of the eleven guidelines was high in three (27%), moderate in seven (64%), and poor in one (9%). Based on a moderate level of evidence, CRF should be screened at every patient encounter by all healthcare providers, with positive screens followed by referral to appropriate professionals for further assessment using one of several validated tools. A strong recommendation based on moderate evidence was for exercise. In particular, aerobic and resistance training of low to moderate intensity, three times per week for 12weeks was recommended. Guidelines consistently issued a strong recommendation for CBT (moderate evidence), and for psychotherapy (variable evidence). CBT was recommended, especially with structured coping strategies or web-based delivery. Guidelines cautiously recommended mind-body interventions such as Yoga, Tai Chi, and Qigong based on variable strength of evidence and recommendation. Education andcounselling (particularly for depression-related fatigue) are mainly based on expert consensus rather than strong clinical trials. Other options may be considered in individual patients but are not supported by strong evidence. This guideline analysis demonstrates broad support for continued CRF screening during survivorship care, followed by assessment of contributing factors when fatigue is identified. Exercise, especially low- to moderate-intensity aerobic and resistance training, and cognitive behavioral therapy are consistently recommended across guidelines as effective interventions. Psychoeducation and counselling are also beneficial, especially for fatigue linked to mental health conditions. Pharmacological treatments are not recommended due to insufficient evidence and side effects. Cancer survivors are encouraged to report ongoing fatigue and seek supportive care, given the availability of effective non-drug interventions.

Oncofertility, a multidisciplinary field that integrates oncology and reproductive medicine, is a vital component of comprehensive cancer care. This review compares fertility-related recommendations for adults with newly diagnosed cancer who are considering fertility preservation (FP) before treatment. Guidelines reviewed include the 2025 National Comprehensive Cancer Network (NCCN) Survivorship Guideline, 2025 ASCO Guideline on FP, 2022 Clinical Oncology Society of Australia (COSA) FP Guideline, and 2020 European Society for Medical Oncology (ESMO) Clinical Practice Guideline. Recent guidelines from NCCN, ASCO, COSA, and ESMO were reviewed and compared for recommendations on fertility risk discussions, female and male preservation methods, multidisciplinary care, future pregnancy, and contraception. All guidelines emphasize early, patient-centered discussions about fertility risks and preservation options before initiating cancer treatment. Embryo and oocyte cryopreservation are universally recommended as standard and effective FP methods for women. Ovarian tissue cryopreservation and ovarian transposition are recommended as alternative options. Sperm cryopreservation is strongly recommended, with ASCO and NCCN additionally supporting testicular sperm extraction for post-treatment FP. The use of gonadotropin-releasing hormone agonists is supported by COSA, ESMO, and NCCN in people with breast cancer at diagnosis, while ASCO limits its recommendation to adjunct use alongside established FP techniques. All guidelines highlight the importance of multidisciplinary care, including specialized oncofertility counseling and referrals to fertility and mental health specialists. Pregnancy after cancer treatment is generally considered safe across all guidelines, and only COSA and ESMO provide specific recommendations regarding contraception. There is a strong consensus on FP methods and the importance of early counseling. However, further high-quality research is necessary to strengthen the evidence base and improve guideline recommendations for fertility in people with cancer.

Stereotactic Body Radiation Therapy With Continued First-Line PD-1 Inhibitor-based Therapy as a Resistance-Overcoming Strategy in Oligoprogressive Hepatocellular Carcinoma: A Prospective Phase 2 Clinical Study.

The 2025 endometrial carcinoma risk classification by the European Society of Gynaecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) integrates new pathologic and molecular features. We evaluated its clinical impact and prognostic performance in comparison with the 2021 system. This retrospective single-center cohort study included patients categorized according to the 2021 and 2025 risk classifications. Immunohistochemistry and POLE sequencing were conducted for molecular classification and estrogen receptor determination. We identified 1115 patients with 2021 and 2025 risk classifications (median follow-up: 66 months; range; 0-136). The update re-classified 117 patients (10.5%) into a different risk group: 68 (6.1%) downward, 24 (2.2%) upward, 16 (1.4%) from uncertain to defined, and 9 (0.8%) from defined to uncertain. Both classification systems were prognostic (pooled p < .001 across strata). In pairwise comparisons, the 2025 system did not distinguish high-intermediate-risk from high-risk disease (p = .15 and p = .25 for progression-free survival and disease-specific survival). The 2021 system showed better progression-free survival for high-intermediate-risk compared with high-risk disease (p = .026), but not disease-specific survival (p = .06). Estrogen receptor negativity, which modifies risk in localized low-grade no-specific-molecular-profile carcinomas, was rare in this category (4 [1.3%] negative vs 307 [98.7%] positive). Lymph node involvement (stage IIIC1i-IIIC2ii) differed across molecular tumor categories: 3.0% in POLE-ultra-mutated, 8.7% in mismatch repair-deficient, 5.0% in low-grade and estrogen receptor-positive no-specific-molecular-profile, 13.0% in high-grade or estrogen receptor-negative no-specific-molecular-profile, and 16.5% in p53-abnormal tumors (p < .001). The ESGO-ESTRO-ESP 2025 classification re-assigns approximately one-tenth of patients, with a meaningful impact on adjuvant therapy. The rarity of estrogen receptor negativity limits its role in no-specific-molecular-profile stratification. Variation in lymph node involvement across molecular tumor categories highlights opportunities for individualized surgical staging.

Safety and feasibility of concomitant urogynecologic and gynecologic oncology surgical procedures.

Surgical Oncology Breast Fellowship Websites: A Critical Analysis of Accessibility and Content for Society of Surgical Oncology (SSO)-Approved Program Websites.

Evidence-based AGIHO guideline update on prophylaxis of infectious complications with granulocyte-stimulating factors (G-CSF) for the treatment of adult patients with cancer.

In 2023, the European Society of Gynaecological Oncology (ESGO), jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP), published evidence-based guidelines for the management of patients with cervical cancer. Acknowledging that limitations exist even in high-income countries, some of these established standards of care are not applicable in clinical practice in some areas of the world. Following a global ESGO survey involving 256 clinicians from 57 countries, which pointed out potential limitations, barriers, and missing guidelines, ESGO decided to develop alternative management strategies for situations when optimal resources are unavailable or limited. A multi-disciplinary international development group consisting of 22 experts, utilizing feedback from the survey conducted mostly in low- and middle-income regions, identified potential limitations to the standards of care as defined in the updated ESGO-ESTRO-ESP guidelines published in 2023 and suggested alternative approaches. New resource-stratified guidelines on the management of women living with the human immunodeficiency virus have been newly proposed. To ensure a global perspective, the guidelines were reviewed by 188 independent international practitioners from Asia, Africa, Europe, and South, Central, and North America. These resource-stratified guidelines focus on achieving the best patient outcomes, with alternative management strategies based on expert opinions in areas with limited evidence. They should be used as a guide for the next best alternatives in multi-disciplinary care settings such as diagnostics, pathology, surgery, radiotherapy, systemic therapy, palliative care, and follow-up management. Efforts should always focus on providing optimal available care. In the absence of key resources, the primary effort should be directed toward consulting and referring patients to other facilities that provide better conditions.

Addition of androgen-receptor pathway inhibitors to standard of care in metastatic hormone-sensitive prostate cancer: A systematic review and meta-analysis.

Gynecologic malignancies remain a leading cause of death among women in low- and middle-income countries. In 2017, the International Gynecologic Cancer Society (IGCS) started the Global Gynecologic Oncology Fellowship Program in countries without existing training. This 2-year structured program allows fellows to train locally with support from international mentors through in-person visits, virtual mentorship, and didactic instruction. Fellows participate in monthly tumor boards, conduct research, complete international observerships, log surgical cases, and complete an oral exam upon graduation. Our objective was to characterize the growth of this program from 2017 to 2024 and determine best practices and areas for improvement. Between February and April 2024, 40 IGCS fellowship graduates were invited via email to complete a 38-question survey about their training and post-fellowship experiences. Data were analyzed using descriptive statistics and thematic analysis. Since 2017, the IGCS fellowship program has expanded from 5 pilot sites to 22 training sites in 18 countries. To date, 52 fellows have graduated and 38 are currently in training. There are 40 international mentors and 53 local supervisors, of whom 15 are previous graduates. Twenty fellows (50%) completed the survey. Nineteen respondents (95.0%) reported practicing as gynecologic oncologists, with an average of 70% of their clinical work focused on this area. However, most reported continuing to provide obstetric and benign gynecology care. Six respondents (30%) reported being the sole gynecologic oncologist at their hospital. Half of respondents never visited their international mentor's site, although 70% reported consistent virtual support. All graduates expressed a need for post-fellowship support, including mentorship, meetings with other graduates, advanced surgical training, and sub-specialty collaboration. The IGCS fellowship program has significantly expanded gynecologic oncology capacity in low-resource settings. Graduates report valuable training experiences but desire ongoing post-fellowship support, a next step in growth for the IGCS fellowship program.

Objectives: Ultra-hypofractionated radiation is a widely adopted treatment for low- and intermediate-risk prostate cancer and is typically given for a duration of five treatments in the United States. There is interest in developing a shorter two-treatment course. We conducted a pilot study of two-fraction ultra-hypofractionated radiation therapy for low- to intermediate-risk prostate cancer to determine safety and preliminary efficacy.Methods: A total of 12 patients were prospectively enrolled in a single-arm pilot study of two-fraction ultra-hypofractionated radiation therapy. Patients were treated with 12.5 Gy in two fractions separated by 2-3 days. All patients had placement of a rectal spacer. Biochemical response was evaluated with prostate-specific antigen (PSA) monitoring, with recurrence defined using the American Society for Therapeutic Radiology and Oncology (ASTRO) Phoenix criteria. Toxicity was graded using the Common Terminology Criteria for Adverse Events (CTCAE) v5.0.Results: Median follow-up was 4.8 years. This cohort consisted of National Comprehensive Cancer Network (NCCN) intermediate-risk patients (seven NCCN favorable intermediate and five NCCN unfavorable intermediate). The median prostate volume was 30 cc. The median PSA nadir was 0.14 (range <0.01 to 0.82). No patient experienced a biochemical recurrence. No patient experienced grade 2 or worse gastrointestinal (GI) acute or late toxicity. Three of the 12 patients experienced acute grade 2 genitourinary (GU) toxicity, and two of the 12 patients experienced late grade 2 toxicity. No patient experienced grade 3 toxicity.Conclusions: Two-fraction ultra-hypofractionated radiation to 25 Gy is tolerable with a low rate of long-term toxicity and promising biochemical control. Further research is indicated to evaluate two-fraction regimens for prostate radiation.

Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor, typically affecting infants. Kasabach-Merritt phenomenon (KMP) is a frequent and serious complication of KHE. The study aimed to analyze clinical manifestations, treatment strategies, and outcomes in children with KHE treated in Poland between 2007 and 2024. Clinical data of 42 children with KHE treated in 15 Polish pediatric hematology/oncology and surgery centers between 2007 and 2024 were analyzed retrospectively. KMP was present in 27/42 children (64.3%). The median age at diagnosis in children with and without KMP was 2.5 and 8 months, respectively. A male predilection was observed (61.9%), particularly in patients without KMP (13/15, 86.7%). Diagnosis of KHE required a tumor biopsy in 20 patients, including 14/15 (93.3%) of patients without KMP. Treatment strategies varied significantly between patients, institutions, and treatment periods. Systemic treatment was administered in 39 (92.9%) children, with predominating role of chemotherapy and glucocorticoids in the first period (2007-2013), and with gradually increasing importance of sirolimus in the years 2014-2018 and 2019-2024. Three children were successfully treated with surgery only. Salvage therapies ultimately controlled KHE progression/relapse in 14/17 (82.4%) patients. Only one child with metastatic, treatment-resistant cardiac KHE died of disease progression. Management of childhood KHE is challenging since no unified treatment recommendations exist. To optimize KHE therapy in Poland, the Section of Childhood Vascular Anomalies was established in June 2021 as part of the Polish Society of Pediatric Oncology and Hematology. Its aim is to standardize therapeutic guidelines and provide education on vascular anomalies in Poland.

In this narrative medicine essay, a pediatric oncology fellow at first feels awkward when parents of gravely ill children ask her about her pregnancy until she opens up and finds herself sharing in the love parents have for their children.

Introduction: The term healthcare disparity describes differences in access to medical care between population groups. Minimizing the care gap and improving access to care for historically minoritized populations will require a multifaceted approach. Increasing diversity in the healthcare workforce has the potential to lead to significant improvements aimed at minimizing inequity. Fellowship training programs in Gynecologic Oncology serve as the gatekeeper for the workforce of Gynecologic Oncologists. Efforts at improving diversity at the fellowship level are necessary to increase the diversity of practicing physicians. The objective of this study is to assess Gynecologic Oncology fellowship websites for information emphasizing a commitment to diversity and inclusion in hiring practices and identify opportunities for improvement. Methods: All ACGME- (Accreditation Council for Graduate Medical Education) accredited Gynecologic Oncology programs in the United States were included in this study (n=64). The Society of Gynecologic Oncology (SGO) website was used to locate 64 fellowship websites. Two reviewers searched 64 websites to assess for program criteria relating to program description, addressing healthcare disparities, fellow/faculty/alumni information, and inclusion of diversity and inclusion statement in hiring practices. Results: All 64 Gynecologic Oncology programs included in the study had a fellowship program website, and all websites (100%, n=64) included content regarding program overview or description. 40% (n=26) of programs met criteria for inclusion of a diversity statement. 63% of programs (n=40) included a statement on their website addressing healthcare disparities which impact the unique populations served by their institution. Faculty information (81%) was more commonly included on websites than fellow (77%) or alumni (41%) information. Discussion: Increasing diversity in the healthcare workforce requires intentional and ongoing systematic effort. This study analyzed the current state of diversity-oriented recruitment efforts in Gynecologic Oncology fellowship programs to highlight areas where individual programs could improve their diversity and inclusiveness.

Clinical practice, barriers to implementation, and priorities for equitable access of Stereotactic Body Radiation Therapy: An analysis of the global status by the ESTRO SBRT Focus Group