Tertiary Cancer Center Research Articles

Tumor Budding as an Independent Prognostic Histopathological Marker in Oral Squamous Cell Carcinoma - An Indian Tertiary Care Center Experience.

Oral squamous cell carcinoma is the most common head and neck malignancy reported worldwide. Tumor budding represents a histopathological feature characterized by the presence of isolated single/small clusters of cancer cells dispersed within the stroma at the invasive tumor front. Its prognostic significance has not been studied much in lip and oral squamous cell carcinomas in India. The aim of this study was to investigate the prognostic role of tumor budding in a large single-center retrospective cohort of 333 patients with oral squamous cell carcinoma at a tertiary cancer center in North Kerala, India. The primary resection slides of 333 patients with oral squamous cell carcinoma from 2018 to 2020 were retrieved from the pathology archives and were evaluated by two independent pathologists for tumor budding and other histopathological parameters. The survival data were collected from the patient files. We found a significant association between tumor budding and other known histopathological prognosticators using Chi-square analysis. Univariate logistic analysis showed tumor budding, depth of invasion ( > 10 mm), worst pattern of invasion 5, and perineural invasion were significantly associated with locoregional recurrence/distant metastasis. Multivariate logistic regression analysis identified tumor budding as an independent prognostic marker for locoregional recurrence/distant metastasis. Univariate cox proportionality analysis showed that tumor budding, depth of invasion ( > 10 mm), worst pattern of invasion 5, pathological T4 stage, and perineural invasion were associated with decreased overall survival and poor disease-free survival in patients with oral squamous cell carcinoma. Multivariate cox proportionality analysis showed tumor budding as the only independent predictor for decreased overall survival and poor disease-free survival. Based on this study, we can conclude that tumor budding is a simple and a reliable independent prognosticator that facilitates personalized management in patients with oral squamous cell carcinoma.

Talicabtagene autoleucel for relapsed or refractory B-cell malignancies: results from an open-label, multicentre, phase 1/2 study.

Talicabtagene autoleucel for relapsed or refractory B-cell malignancies: results from an open-label, multicentre, phase 1/2 study.

Impact of Invasive Fungal Diseases on Treatment Outcomes in Pediatric Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma: Insights From a Single-Center Study.

Invasive fungal diseases (IFD) in children with newly diagnosed acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) are poorly characterized, especially in lower-middle-income countries (LMICs). This study aims to identify the incidence, risk factors, and outcomes of IFD in a pediatric cohort with ALL/LBL. We retrospectively analyzed pediatric patients diagnosed with ALL/LBL between January and December 2023 at a tertiary cancer center in India. Patients were risk-stratified and treated per the modified ICiCLe-ALL-14 protocol. IFDs were classified as proven, probable, and possible according to the revised EORTC/MSG consensus definition. Among 407 patients, 392(96%) had ALL. The overall incidence of IFD was 25%, with probable/proven infections in 12%. Mold infections predominated (79 cases, 77%), followed by yeast infections (21 cases, 21%). In comparison with patients without IFDs, those with IFDs were more likely to have received dexamethasone (30 vs. 20%; p=0.009), anthracycline (28vs. 14%; p=0.001) during induction and have central venous access (27 vs. 18%; p=0.008). The 6-week mortality rate of patients with IFD was 15%, rising to 26% in probable/proven cases. Coexisting bacterial infection was associated with increased mortality (odds ratio: 19.2[95%CI: 3.5-105]; p=0.001). IFDs are common in newly diagnosed ALL/LBL patients in LMICs, particularly during early phases of therapy. These infections are associated with considerable mortality, often compounded by concomitant bacterial sepsis. Given these findings, consideration of antifungal prophylaxis is warranted to mitigate morbidity and mortality due to IFDs.

How to Perform Bilateral Sentinel Lymph Node Biopsy in Vulvar Cancer with Indocyanine Green by Video-Endoscopic Approach.

The standard surgical treatment of early stage vulvar carcinoma < 4cm consists of resection of the vulvar tumor with sentinel lymph node (SLN) biopsy (Oonk in Int J Gynecol Cancer 33:1023-1043, 2023). Video-endoscopic inguinal SLN biopsy with indocyanine green (ICG) has been described (Capomacchia et al. in Int J Gynecol Cancer, 2024). However, ICG induces fleeting mapping of lymphatic pathways, making bilateral SLN mapping more challenging. The aim of this video is to show how to perform bilateral inguinal SLN biopsy with ICG by video-endoscopic approach. We present the case of an 81-year-old patient with a 3.8cm midline vulvar cancer. Bilateral inguinal SLN biopsy was performed by video-endoscopic approach using ICG along with radioactive tracer. The surgery was performed in a tertiary cancer center. The day before the surgery, radioactive tracer was injected in the peritumoral area. The procedure began with the placement of a 12mm trocar at the apex of the femoral triangle and two 5mm trocars in both thighs. The working space was developed, and a blunt dissection was bilaterally performed up to the inguinal ligament. ICG was then injected into the four cardinal points around the tumor. SLNs were bilaterally visualized and then resected. A gamma camera was used to ensure that the ones removed were the correct SLNs. There were no intra- or post-operative complications. To minimize the fleeting uptake of ICG, dye injection should be performed after bilateral positioning of the trocars and development of surgical spaces. A double check with a gamma camera is needed as radioactive tracer is still considered the standard approach for SLN biopsy in vulvar cancer.

Trends in symptom severity and complexity in patients undergoing radiation therapy

Symptom severity and complexity have considerable impact on a patient’s cancer care journey. This study describes symptom scores of radiotherapy patients across their radiotherapy care trajectory and factors associated with symptom complexity. Patients who received radiotherapy at a single tertiary cancer center, who also completed at least one symptom-reporting questionnaire, the Edmonton Symptom Assessment Scale– Revised (ESAS-r) between October 1, 2019 and April 1, 2020 were included in this retrospective analysis. Symptom assessment time points were pre-treatment, start and end of radiation treatment and post-treatment follow-up. Mean ESAS-r scores for individual symptoms were descriptively analyzed by assessment timing and tumour group. We calculated a symptom complexity score for each ESAS-r measurement, using a validated algorithm, and assigned overall symptom complexity as low, moderate or severe. We modelled the association between assessment timing, and tumor group, with symptom complexity using Generalized Estimating Equations (GEE). The study cohort consisted of 1,632 patients who completed 2,519 ESAS-r questionnaires. Patients with lung and H&N cancers reported higher mean symptom scores compared to other tumour groups. Patients at the start of treatment had significantly lower odds of having a more severe symptom complexity, compared with patients pre-treatment (OR = 0.77, 95% CI = 0.64–0.93). Patients with H&N and lung cancer and patients prior to starting radiation may benefit most from increased symptom support and management.

Ewing's Sarcoma of the Head and Neck: Outcomes of 101 Patients Treated at a Tertiary Cancer Center

Ewing's Sarcoma of the Head and Neck: Outcomes of 101 Patients Treated at a Tertiary Cancer Center

Pathogenic germline variants in cancer predisposition genes in patients with multiple primary cancers in an Asian population and the role of extended panel genetic testing.

Pathogenic germline variants in cancer predisposition genes in patients with multiple primary cancers in an Asian population and the role of extended panel genetic testing.

Short-term survivors with brain metastases have modest benefits from focal and systemic therapies and remain frequent despite improving treatment landscape.

Therapeutic options for patients with brain metastases (BM) increase. While these lead to considerable survival effects in subgroups, there is limited knowledge about characteristics, prognosticators and treatment effects in patients with BM and short survival. Patients with a survival time of≤6 months (short-term survivors, STS), diagnosed with BM between 2009-2021 at a large tertiary cancer center were analysed. Clinical and treatment characteristics, pathological data and causes of death were documented. Descriptive statistics, treatment-specific univariate Kaplan-Meier estimator analyses and multivariate Cox regression were performed. Among 1248 patients with BM, 480 (38%) were STS. 256 STS with detailed clinical records were included in this analysis. In univariate and multivariate analysis, Karnofsky Performance Status (KPS) (p<0.001) and number of BM (p=0.004) were prognostic. In 75% of patients, the ds-GPA score predicted short-term survival. Use of resection with focal radiotherapy (p<0.001) and systemic treatment (p<0.001) appeared prognostically favourable compared to whole brain radiotherapy (WBRT) alone. However, survival benefits were very modest, with a median gain of 6weeks following resection and focal radiotherapy compared to whole-brain radiotherapy, and 3weeks from systemic treatment. Systemic tumor progression was documented as the cause of death in the majority of patients. Over the examined time period, the ratio between STS and other patients remained without significant change. Within STS, KPS and number of BM are of prognostic relevance. There is benefit from local and systemic therapy to a limited extent. Shared and carefully discussed individual therapy decisions are necessary.

Real-World Implementation of Simulation-Free Radiation Therapy (SFRT-1000): A Propensity Score-Matched Analysis of 1000 Consecutive Palliative Courses Delivered in Routine Care.

The feasibility of simulation-free radiation therapy (SFRT) has been demonstrated but information regarding its routine care impact and scalability is lacking. In this single-institution, retrospective cohort study, all patients receiving palliative radiation therapy at an Australian tertiary cancer center were eligible for consideration of SFRT unless mask immobilization, a stereotactic technique, or a definitive dose was indicated. Coprimary endpoints were SFRT utilization, impact on consultation-to-RT time, and on-couch treatment duration. Timing metrics were compared with a contemporary local cohort that received simulation-based palliative radiation therapy using unadjusted Wilcoxon rank-sum tests and a propensity score-matched regression. Electronic patient-reported outcomes captured 2-week toxicity and pain response. Between April 2018 and February 2024, 2849 palliative radiation courses were delivered, of which 1904 were eligible. Of the 1904 courses, 1000 (52.5% SFRT utilization) received SFRT, including 668 using intensity-modulated radiation therapy/volumetric-modulated arc therapy. A total of 788 individual patients received SFRT and the median age was 71 years (IQR, 61-80) with 59% being male and 42% being Eastern Collaborative Oncology Group 2-4. SFRT utilization increased from 41% to 54% between years 2018-2019 and 2022-2024. SFRT reduced median consultation-to-RT time from 7.0 to 5.1 days (P < .0001) corresponding to an adjusted average treatment effect in the treated of -2.1 days (95% CI, -2.8 to -1.3). SFRT increased median on-couch treatment duration from 17.8 to 20.5 minutes (P < .0001; adjusted average treatment effect in the treated 2.6 minutes, 95% CI, 1.3-3.9). Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events grade 3 acute toxicity was 9% and at 4 weeks after RT, patients with moderate/severe pain at baseline (≥5/10) had a mean pain reduction of 3.5 points (7.1-3.6; P < .0001). Using widely available technologies, the SFRT-1000 cohort demonstrates routine care scalability with patient-centered and workflow benefits. SFRT is an attractive new paradigm implementable in most settings following adaptation to local requirements. Thus, SFRT opens new avenues to potentially improve access to palliative RT, which remains a global area of need.

Nonoperative Management of Rectal Cancer: Is "Near-Complete" Response Safe to Surveil?

Nonoperative management of rectal cancer in patients who achieve near-complete response following total neoadjuvant therapy remains controversial and understudied. This retrospective cohort study conducted at a tertiary National Cancer Institute-designated cancer center included patients with rectal cancer who initiated active surveillance after achieving near-complete response following induction radiotherapy and consolidation chemotherapy. Near-complete response was determined based on restaging endoluminal evaluation and pelvic magnetic resonance imaging. Time-to-event analyses were used to estimate regrowth-free, proctectomy-free, disease-free, and overall survival. Of 61 patients who achieved near-complete response and initiated nonoperative management between February 2017 and March 2024, 36 (59.0%) maintained organ preservation with a median follow-up of 27.1 (interquartile range [IQR] 17.4-37.4) months. Twenty-five patients (41.0%) developed local regrowth by a median of 5.7 (IQR 3.2-8.2) months. All regrowths occurred within 17.5 months of initial restaging. Twenty-one patients with regrowth underwent salvage proctectomy, of which 20 (95.2%) achieved R0 resection margins. Following salvage proctectomy, four patients (19.0%) developed local recurrence. Disease-free and overall survival 2 years from restaging were 79.2% (95% confidence interval [CI] 67.0-93.6) and 93.3% (95% CI 86.3-100), respectively. Overall survival was not significantly different between patients with versus without local regrowth (log-rank p = 0.09). Nonoperative management achieves clinically significant organ preservation rates without compromising oncologic outcomes in patients with near-complete response to total neoadjuvant therapy. Active surveillance allows time for continued evolution of tumor response and may substantially expand organ preservation in a patient population who otherwise would undergo avoidable radical surgery.

Quality of life outcomes in colorectal cancer survivors: insights from an observational study at a tertiary cancer center.

Colorectal cancer (CRC) significantly impacts the quality of life (QoL) of survivors, yet detailed assessments of long-term QoL are sparse. This study evaluates QoL among CRC survivors, examining the influence of different treatments and patient characteristics on outcomes. We conducted a cross-sectional study at a tertiary cancer center in Portugal, enrolling CRC patients who underwent curative surgery from 2013 to 2022. QoL was assessed using the EORTC QLQ-C30 and QLQ-CR29 at 1-, 3-, 5-, and 10-year follow-up intervals. Subgroup analyses were performed based on tumor location, radiotherapy administration, chemotherapy administration, presence of a stoma, and time since treatment, with sociodemographic and clinical factors examined on univariate and multivariate analysis. Of the 825 eligible patients, 324 were invited and 179 participated (response rate: 55.2%). Overall, patients reported high global QoL and functional scores with low symptom scores, comparable to those of the general population. However, rectal cancer survivors experienced poorer outcomes in role and social functioning, body image, and symptom management. Those receiving radiotherapy or chemotherapy reported more symptoms, with chemotherapy recipients showing lower functional scores. Patients with a stoma had significantly lower QoL across functional and symptom scales. Long-term survivors reported decreased physical functioning. Multivariate analysis identified female gender, open surgery, and chemotherapy as factors associated with reduced QoL. This study highlights significant disparities in QoL outcomes between CRC survivors, with QoL influenced by gender, cancer location, radiotherapy or chemotherapy, stoma presence, and survivorship duration, underscoring the need for personalized support programs and tailored care plans.

Pneumocystis jirovecii Pneumonia in Cancer Patients, a Lethal Yet Fully Preventable Disease: Insights From a Tertiary Cancer Center in East India.

Pneumocystis jirovecii pneumonia (PCP) is an unrecognized infection in non-HIV patients, particularly those with solid and hematologic malignancies. These patients experience higher mortality rates. This study aims to describe the incidence, initial characteristics, management, and outcomes of PCP at a tertiary cancer care center. This retrospective observational study included all patients who underwent P. jirovecii PCR testing at our center from January 2019 to January 2022. PCP was diagnosed in PCR-positive patients. Data on demographics, treatment, and outcomes were extracted from medical records. The primary outcomes were ICU admission and 21-day mortality. Statistical analysis compared PCR-positive and PCR-negative patients, with a specific focus on lung cancer patients, and analyzed determinants of 21-day mortality in PCP patients. Of the 345 patients suspected of PCP, 54 (15.7%) were diagnosed with PCP. PCP patients were generally older. None of the PCP patients were on prophylaxis, compared to 14.8% of PCR-negative patients. In lung cancer patients, age and radiotherapy within the past year were significantly associated with a PCP diagnosis. The 21-day mortality rate among PCP patients was 35.4%. Independent risk factors for mortality included age and hematologic malignancy, while recent chemotherapy and higher neutrophil counts were associated with lower mortality. PCP is associated with the highest mortality in patients with hematologic malignancies and lung cancer. The findings underscore the importance and efficacy of prophylaxis in at-risk groups and should raise awareness for the diagnosis of PCP in overlooked populations, such as older cancer patients and those undergoing radiotherapy.

Does Having an Individualized End-of-Life Care Record Actually Make a Difference?

Introduction: The National Institute for Health and Care Excellence (NICE) recommends an individualized approach to end-of-life care (EOLC), including an individualized record of care, which supports shared decision-making and timely rationalization of futile observations and medications. Aim: To assess the impact of the individualized record of care in supporting patients at the end of life at a UK tertiary cancer center. Method: In May 2024, we audited the case notes of 100 consecutive patients who received EOLC at our center. Data regarding clinical decision-making and rationalization were collected. Outcomes for those supported by an individualized record of care were compared to those who were not. Results: A total of 98 patient records were analyzed. 97.3% with an individualized care record had their observations rationalized compared to 75% without, and 74.3% versus 41.7% for medications, respectively (p < 0.01). Certain medications, e.g., prophylactic low molecular weight heparin (LMWH), were less likely to be rationalized. Evidence of discussion about rationalization of observations and medications was present in approximately half of the case notes and often occurred after the rationalization had taken place. Conclusion: The presence of an individualized end-of-life record of care improved rates of review and rationalization of observations and medications. Future qualitative work is needed to identify challenges regarding these conversations, including examining the role of shared decision-making on rationalization versus patients' refusal.

Clinical Outcomes for Nasopharyngeal Cancer in Non-Asian Patients: A Single-Center Experience.

Background/Objectives: According to Globocan, Romania has the highest incidence of nasopharyngeal cancer (NPC) in Europe. Our objective was to evaluate the survival data for a cohort of non-Asian patient population treated with curative intent at a tertiary cancer center in Romania. Methods: We retrospectively analyzed 161 patients with histologically proven, non-metastatic NPC treated at our institution between October 2014 and December 2021 with intensity modulated arc radiotherapy (IMRT) with or without neoadjuvant or concomitant chemotherapy according to the stage of the disease. Kaplan-Meier estimates of overall, disease-free, locoregional relapse free and distant metastasis free survival were calculated. The log-rank test was used to determine significant prognostic determinants of overall and disease-free survival. Results: The median age was 50 years (range 19-80), 88% had nonkeratinizing undifferentiated carcinoma. Epstein Barr virus status was not evaluated routinely. 42.2% of patients were stage III and 46% stage IVA disease. Induction chemotherapy was prescribed for 72.7% of patients and 89.4% received concurrent chemotherapy. After a median follow up of 44 months (range: 3.6, 104.7 months), the estimated 3 years overall, disease free, locoregional relapse free and distant metastasis free survival of the entire cohort were 82.6%, 73.3%, 83.2% and 86.3% respectively. On testing interactions, concomitant chemotherapy offered significant survival benefit (HR-0.287; 95% CI 0.137-0.603; p = 0.001) and cumulative Cisplatin dose of more than 100 mg/mp was statistically significant for survival (HR-0.350;95% CI 0.157-0.779; p = 0.01) Conclusions: This is the largest retrospective series of nasopharyngeal cancer from Romania reporting survival data. Despite the high percentage of advanced stage disease our data shows very good disease control. Compliance to optimal concomitant chemotherapy should represent a priority in clinical practice in a non-Asian patient population.

Real world evidence from a retrospective multi-center analysis on first-line therapy for metastatic renal cell carcinoma with chromophobe histology.

488 Background: Chromophobe (chRCC) renal cell carcinoma are rare cancers and obtain a worse prognosis. We evaluated real-world treatment outcomes of 1 st line treatment in these cohort in Germany. Methods: We retrospectively analyzed patients with metastatic chRCC treated at 17 German tertiary cancer centres being treated from 2008-2023. Adverse events (AE) were reported according to CTCAE 5.0, objective response rate (ORR) according to local standard of radiological and clinical judgement. Progression free survival (PFS) and overall survival (OS) were calculated from start of treatment to progression or death, respectively and determined by KM plots. Results: We included 39 patients with a median age of 59 (IQR 55-71) years. ECOG PS was 0/1/≥2 in 70/17/12%. IMDC risk was favorable/intermediate/poor in 13/61/26%. 87% received prior nephrectomy. Lymphatic (58%), pulmonary (37%) bone (34%) and metastases were the most common metastatic sites. 52% patients received first-line IO-combinations (IO-IO: 43%, TKI-IO: 57%) and 48% patients TKI-monotherapy, predominantly sunitinib. Subsequent therapy was mostly Cabozantinib (after IO-IO), Lenvatinib/Everolimus (after IO-TKI) or Nivolumab (after TKI mono). AE of all grades occurred in 59% and 71% during IO-based therapy or TKI monotherapy, and CTCAE grade ≥3 in 29% or 25%, respectively. ORR and survival outcomes with median follow-up of 14 months (IQR 7-28) are described in the table. Conclusions: IO-combinations are frequently applied in chRCC. Our data suggests that first-line IO-/TKI-based combinations yields higher ORR compared to IO-/IO-based combinations and single agent TKI, but did not translate into an improved PFS or OS. The retrospective nature and small sample size are major limitations of our analysis. However, the rarity of metastatic chRCC contributes to inconsistent findings not only in our dataset but also across previously published studies, making it difficult to establish clear treatment guidelines. Further research is essential to refine treatment strategies for patients with metastatic chRCC. ORR and survival outcomes of study population. Parameter All therapies (n=31) IO/IO (n=8) IO/TKI (n=10) TKI (n=13) ORR (CR+PR) 19% 12,5% 30% 15% SD 16% 12,5% 40% 0% PD 65% 75% 30% 85% ORR vs. SD vs. PD - p=0.05 Parameter All therapies IO/IO IO/TKI TKI mPFS, months, 95% CI 3 (0,0-10,2) 3 (2,4-3,6) 8 (0,0-19,2) 4 (0,0-10,2) - P=0.077 mOS; months, 95% CI 24 (22,7-25,3) 12 (2,3-21,7) NR (NR-NR) 24 (22,5-25,5) - p=0.183

A Novel Deep Learning-Based (3D U-Net Model) Automated Pulmonary Nodule Detection Tool for CT Imaging.

Precise detection and characterization of pulmonary nodules on computed tomography (CT) is crucial for early diagnosis and management. In this study, we propose the use of a deep learning-based algorithm to automatically detect pulmonary nodules in computed tomography (CT) scans. We evaluated the performance of the algorithm against the interpretation of radiologists to analyze the effectiveness of the algorithm. The study was conducted in collaboration with a tertiary cancer center. We used a collection of public (LUNA) and private (tertiary cancer center) datasets to train our deep learning models. The sensitivity, the number of false positives per scan, and the FROC curve along with the CPM score were used to assess the performance of the deep learning algorithm by comparing the deep learning algorithm and the radiology predictions. We evaluated 491 scans consisting of 5669 pulmonary nodules annotated by a radiologist from our hospital; our algorithm showed a sensitivity of 90% and with only 0.3 false positives per scan with a CPM score of 0.85. Apart from the nodule-wise performance, we also assessed the algorithm for the detection of patients containing true nodules where it achieved a sensitivity of 0.95 and specificity of 1.0 over 491 scans in the test cohort. Our multi-institutional validated deep learning-based algorithm can aid radiologists in confirming the detection of pulmonary nodules through computed tomography (CT) scans and identifying further abnormalities and can be used as an assistive tool. This will be helpful in national lung screening programs guiding early diagnosis and appropriate management.

Exploring the Landscape of Integrative Medicine in Pediatric Oncology: Characterization of an Outpatient Consultative Service.

Background/Objectives: Symptoms from cancer and treatments often cause pediatric patients and their families to seek complementary and integrative medicine (IM) for relief. The aim of this study was to better describe the characteristics of pediatric patients at a tertiary cancer center who utilize an IM consultative service in the outpatient setting and the associated discussions with a pediatric-focused IM physician. Methods: A retrospective study was conducted on initial IM visits for patients aged less than 19 years old at the time of the visit from January 2019 through April 2022 at a tertiary cancer center. Patient demographics, clinical characteristics, and visit information were abstracted from electronic medical records, and discussions with the provider (presenting symptoms and recommendations) were described. Results: In total, 207 patients and their associated visit discussions met the criteria. About half (47%, n = 97) of the patients were female with a mean patient age of 10 years old (median age 11 years, range 0 to 18 years). The overall most common presenting symptoms were nausea (35%, n = 72), pain (30%, n = 62), and poor appetite (26%, n = 53) with variations between age groups. The most discussed topics were supplements (94%), diet (91%), stress management (82%), IM therapies (60%), and medical cannabis (54%). Conclusions: Priority symptoms reported by patients and referred to the IM outpatient consultative service included nausea, pain, and poor appetite. Concerns were addressed during tailored discussions with patients and their families. Having an outpatient consultative IM service may benefit providers, patients, and families to facilitate receiving evidence-informed recommendations in a dedicated, consolidated setting.

The efficacy of second-line chemotherapy in the management of classic and iatrogenic Kaposi sarcoma: An analysis of real-world data.

Kaposi sarcoma (KS) is a rare angioproliferative malignancy linked to human herpesvirus 8 infection. While systemic therapy is often unnecessary for classic and iatrogenic KS, advanced cases may require chemotherapy. This study aims to evaluate the efficacy and safety of weekly paclitaxel or oral etoposide as second-line treatments for classical and iatrogenic Kaposi sarcoma. We retrospectively analyzed clinicopathological characteristics and treatment outcomes of 32 patients diagnosed with classical and iatrogenic KS at a tertiary cancer center between December 2000 and November 2022. Patients received oral etoposide (50 mg every 3 weeks for 10 days) or weekly paclitaxel (80 mg/m²). The cohort comprised 23 males (71.9%) and 9 females (28.1%), with a mean age of 63 years. Most patients (87.5%) had classical KS, while 12.5% had iatrogenic KS. The objective response rate (ORR) was 75%, with a disease control rate (DCR) of 87.5%. Median progression-free survival (PFS) was 32.1 months, and median overall survival (OS) was 110.2 months. No significant differences in PFS (P = .633) and OS (P = .456) were observed between paclitaxel and etoposide treatments. The treatment regimen was generally well tolerated. Severe hematological toxicities were less frequent, with febrile neutropenia in 1 patient (3.1%), while severe non-hematological side effects included neuropathy in 2 patients (6.2%). Two patients (6.2%) were hospitalized due to complications, with no treatment-related deaths. Weekly paclitaxel and oral etoposide regimens are effective and well-tolerated second-line treatments for classical and iatrogenic Kaposi sarcoma. Given the high ORR and DCR, these therapies represent viable options for patients who progress after initial treatment. Further studies with larger patient populations are needed to confirm these findings.

Decreased Frequency and Improved Outcomes in Invasive Aspergillosis Caused by Aspergillus terreus After the Introduction of Anti-Mold Azole Agents: A 30-Year Study at a Tertiary Cancer Center.

Invasive aspergillosis (IA) is a significant cause of morbidity and mortality in patients with hematological malignancy (HM) and hematopoietic stem cell transplant (HSCT) recipients. Aspergillus terreus is associated with worse outcomes than non-terreus Aspergillus species. Since the introduction of anti-mold azoles in 2002, there have been limited data on the etiology of IA. We retrospectively compared characteristics, antifungal treatments, and outcomes between patients with HM or HSCT infected with A. terreus and those with non-terreus Aspergillus between July 1993 and July 2023. We also examined trends over time in rates of A. terreus and outcomes of this infection. A total of 699 patients with culture-documented IA were analyzed, 537 with non-terreus species and 162 with A. terreus. Types of underlying malignancy, neutropenia, graft-versus-host disease, and anti-mold prophylaxis were similar between the groups. ICU stays and mechanical ventilation were more common among patients with A. terreus (p = 0.002 and 0.003, respectively). The rate of A. terreus decreased significantly from 35.9% during 1993-2003 to 11.2% during 2004-2013 and 16.7% during 2014-2023 (p < 0.0001 each). IA caused by A. terreus showed significant improvements in response to therapy and in overall and IA-associated mortality in the last two decades compared to the first (p < 0.0001). In conclusion, the increased use of anti-mold azoles after 2003 improved outcomes for HM patients with IA caused by A. terreus.

Microwave Ablation of T1a and T1b Renal Masses: A Retrospective Study

AbstractThe aim of this study was to evaluate the efficacy and safety of microwave ablation (MWA) for the treatment of T1a and T1b renal masses, with size ranges between 1.2 and 6.5 cm. A retrospective review was performed at a single tertiary comprehensive cancer center between June 2019 and June 2023 of 49 consecutive patients (53 total procedures) who underwent MWA for renal masses. The Solero microwave tissue ablation system (Angiodynamics, Latham, NY, United States) was utilized. Patient demographics, renal mass characteristics, and procedural outcomes were collected. Serum creatinine and estimated glomerular filtration rate (eGFR) were utilized to assess renal functional outcomes. Oncologic outcomes were assessed using evidence of local tumor recurrence on contrast-enhanced cross-sectional imaging, local recurrence-free probability at 1 and 2 years, and overall survival (OS) using the Kaplan–Meier analysis.Forty-nine patients (57% males and 43% females) with a median age of 72 years (range, 38–84 years) underwent 53 MWA procedures. The mean renal mass size was 2.8 ± 0.94 cm (range, 1.2–6.5 cm). Most of the renal tumors were T1a. Three of the 53 total renal tumors were larger than 4 cm (T1b) and the remaining 50 were less than 4 cm in size (T1a). The largest tumor that was ablated was 6.5 cm in size. All the patients were placed under general anesthesia (intubated) before the MWA procedure. A median microwave energy of 100 W (range, 60–140 W) was used. The mean duration of the MWA was 3.9 ± 1.5 minutes, with a 100% technical success rate. Four patients (8.2%) experienced complications, two (4.1%) of whom experienced a major complication. There was no clinically significant change in renal function from pre- to postablation on day 1 or at 3 months. Furthermore, local tumor recurrence was observed in three (6.1%) patients at 2.5, 15, and 25 months postablation. Local recurrence-free probability was 98 and 93% at 1 and 2 years, respectively. The OS was 98 and 87% at 1 and 2 years, respectively. MWA continues to prove to be an effective technique that can be used to treat small renal masses including oncocytomas, with high technical success, low complication rate, low risk of adverse renal functional outcomes, and encouraging results for sustained tumor control.