The Veterans Health Administration created initiatives to enhance the monitoring of Social Determinants of Health (SDOH) among Veterans in the primary care setting. There remains suboptimal communication between primary care and cancer care specialties. In-depth interviews were conducted at a VA medical center among primary care physicians, social workers, and cancer care physicians. Participants described how SDOH affect Veterans with cancer and identified strengths and weaknesses in the current communication channels between specialties. Interviews were audio-recorded, transcribed, and coded. Key themes were identified using inductive analysis based on the grounded theory. There were four major themes: (1) social issues disrupt treatment and lead to worse outcomes; (2) social challenges drive Veterans' attention and resources away from their treatment; (3) navigating current systems requires institutional experience to overcome barriers; (4) all members of the care team have a role in addressing SDOH. The most common SDOH affecting this population include housing instability, transportation, food insecurity, and social support. SDOH and communication between care settings were considered primary barriers to care for Veterans with cancer. The opportunity to improve the social support and care for Veterans with cancer would be enhanced by a structured and purposeful discussion to include social issues before treatment begins. The findings helped to inform the development of two interventions: creating an accessible template in the electronic medical record to summarize SDOH needs and the inclusion of primary care physicians and social workers at the initial tumor board discussion for Veterans with a new diagnosis of cancer.

Existing salvage therapies for recurrent glioblastoma (rGBM) have limited efficacy, with median survival of approximately 9 months. Given the complex molecular heterogeneity of GBM, single-target approaches have consistently failed as a treatment strategy. We conducted a phase 1 clinical trial to assess the feasibility, safety, and efficacy of a genomically-tailored multi-agent regimen in 30 adults with surgically-treated rGBM. Adults with IDH-wildtype glioblastoma (n=29) or grade 4 IDH-mutant astrocytoma (n=1) were consented and underwent clinically-indicated surgery for recurrent disease. Comprehensive genomic profiling was performed on the recurrent tumors, and results for each patient were discussed at an individualized molecular tumor board to determine a personalized treatment regimen combining up to 4 FDA-approved drugs, including one cytotoxic agent as backbone. A total of 12 drugs were used in 18 combinations - the most common regimen was lomustine, afatinib, and abemaciclib (n=8). The most common toxicities included cytopenias, rash, and gastrointestinal symptoms, requiring frequent dose reductions. Measured from surgery at trial enrollment, progression-free survival at 6 months (PFS-6) was 40%, overall survival at 9 months (OS-9) was 73%, and median OS was 12.7 months. After trial therapy, genomic profiling performed on subsequent recurrent tumor specimens identified genetic evolution corresponding to putative treatment resistance mechanisms. Implementation of individualized treatment regimens in a timely fashion was feasible for patients with surgically resectable rGBM. Overall efficacy was not significantly improved compared to a contemporary patient cohort treated without experimental regimens, with full dosing of most combination therapies limited by toxicities.

Malignant peripheral nerve sheath tumors (MPNSTs) are a heterogeneous group of aggressive soft tissue sarcomas with poor prognosis. Currently there is a lack of effective treatments for MPNSTs. Here, we propose a personalized medicine approach that integrates a precision oncology strategy guided by MPNST genomic analysis, with a functional validation of treatment response in an orthotopic xenograft model (PDOX) derived from the same MPNST. Comprehensive whole genome sequencing analysis was performed in primary MPNSTs, relapses and (in one case) metastases, following disease progression in two independent individuals. Matched MPNST PDOX models were generated by orthotopically implanting tumor fragments near the sciatic nerve of immunodeficient mice. Candidate targeted combination therapies were prioritized based on genomic alterations and tested in vivo in the PDOX models. The feasibility of the developed strategy is illustrated for two MPNST patients, one Neurofibromatosis type 1 (NF1) individual that developed two independent MPNSTs and another sporadic MPNST case with multiple metastatic relapses. Genomic analysis revealed a remarkable degree of genomic stability across primary MPNSTs and their successive relapses in each patient, and even metastases in one individual. While based on a small number of cases requiring additional analyses, this finding aligns with previous evidence suggesting a fair genomic conservation throughout tumor evolution. This stability supports the identification of consistent therapeutic vulnerabilities throughout disease progression. Among the therapies tested, co-treatment of MEK inhibitor (MEKi) plus bromodomain inhibitor (BETi) elicited the highest antitumor activity, resulting in approximately 60% tumor volume reduction in the sporadic MPNST PDX model, whose patient has been receiving this therapy for eight months with sustained remission. This study demonstrates the feasibility and clinical utility of integrating genomic-driven precision oncology with PDOX-based functional testing for MPNSTs. This strategy may support molecular tumor boards (MTBs) in their treatment decisions. The observed genomic stability supports the use of longitudinal tumor profiling to guide treatment, and the success of MEKi+BETi highlights its potential as a combination therapy for MPNSTs.

Metabolic renal cell carcinomas (RCC) deficient in succinate dehydrogenase (SDH) or fumarate hydratase (FH) are rare but clinically significant entities formalized in the last WHO classification. Their recognition typically starts from morphology and is corroborated by targeted immunohistochemistry (IHC) and, where appropriate, molecular and germline testing. In routine practice, however, implementation may be uneven. Hence, we conducted a nationwide, web-based survey (made by 25 items) among members of the Italian Study Group of Uropathology (GIUP) to map real-world awareness, diagnostic pathways, and test availability across Italian centers. Twenty-one pathologists responded; 18/21 (85.7%) reported dedicated uropathology practice with heterogeneous seniority (≤ 5years, 28.6%; 5-10years, 19.0%; 10-20years, 14.3%; > 20years, 38.1%). Despite substantial renal-tumor workloads (12/20, 57.1% handled > 100 cases in the previous 5 years), direct exposure to metabolic RCCs remained limited (FH-deficient ≥ 1 case, 11/21, 52.4%; SDH-deficient ≥ 1 case, 9/21, 42.9%). Suspicion was predominantly morphology-led: for SDH-deficient RCC, morphology ranked first in 16/21 (76.2%) with the commonest sequence morphology > age > number of lesions (76.2%); for FH-deficient RCC, morphology was top-ranked in 19/21 (90.5%). Key morphologic cues were mixed architectural patterns/papillary elements/macronucleoli for FH-deficient RCC, and eosinophilic cytoplasm with solid-alveolar architecture for SDH-deficient RCC. IHC mirrored these priorities (FH top for FH-deficient, 85.7%; SDHB top for SDH-deficient, 76.2%), whereas 2-succinocysteine (2SC) was rarely available (1/21, 4.8%). Critically, this FH-loss-only workflow can miss non-truncating FH variants (FH immunoreactive but enzymatically inactive) tumors, contributing to under-recognition. Molecular testing would be requested in all suspected cases by 12/21 (57.1%); among selective users, equivocal IHC was the leading trigger (6/8, 75%). Overall, metabolic RCC recognition in Italy is primarily morphology-driven but constrained by uneven access to confirmatory IHC, particularly 2SC, and to molecular assays. The findings argue for harmonized diagnostic algorithms, regional reference laboratory networks, and routine involvement of molecular tumor boards, supported by targeted educational initiatives (including curated digital slide repositories), to standardize practice and improve patient pathways from morphologic suspicion to genetic counselling and tailored surveillance.

Background: Multidisciplinary tumor boards (MDTs) remain the foundation of gynecologic cancer management, yet increasing diagnostic complexity and rapidly evolving molecular classifications have intensified interest in artificial intelligence (AI) as a potential decision-support tool. This study aimed to evaluate the concordance between MDT-derived recommendations and those generated by ChatGPT 5.0 across a large, real-world cohort of gynecologic oncology cases. Methods: This single-center retrospective analysis included 599 consecutive patients with cervical, endometrial, ovarian, or vulvar cancer evaluated during MDT meetings over a 2-month period. Standardized anonymized case summaries were entered into ChatGPT 5.0, which was instructed to follow current ESGO guidelines. AI-generated staging and treatment recommendations were compared with MDT decisions. Discrepancies were independently assessed by two reviewers and stratified by malignancy type, disease stage, and treatment domain. Results: Overall concordance for FIGO staging was 77.0%, while treatment-related decisions demonstrated lower discordance, particularly in chemotherapy (8.2%) and targeted therapy (6.8%). The highest staging disagreement occurred in early-stage endometrial cancer (32.6%), reflecting the complexity of newly revised molecular classifications. In recurrent ovarian and cervical cancer, discrepancies were more pronounced in surgical and systemic therapy recommendations, suggesting limited AI capacity to integrate multimodal imaging, prior treatments, and individualized considerations. Vulvar cancer cases showed the highest overall agreement. Conclusions: ChatGPT 5.0 aligns with MDT decisions in many straightforward scenarios but falls short in complex or nuanced cases requiring contextual, multimodal, and patient-specific reasoning. These findings underscore the need for prospective, real-time evaluation, multimodal data integration, external validation, and explainable AI frameworks before LLMs can be safely incorporated into routine gynecologic oncology decision-making.

Establishing an Alzheimer Disease Therapeutics Clinic: Experience From a Year of Evaluations.

Comprehensive genomic profiling (CGP) tests were approved, and opportunities to consider tissue-agnostic targeted therapies based on molecular tumor profiling have increased even in the community-based medicine practice. However, low treatment success rates and regional disparities in access to investigational drugs remain significant challenges. This retrospective study aimed to evaluate the drug accessibility rate and prognostic impact of CGP testing for advanced or metastatic solid tumors at Hiroshima Prefectural Hospital, a facility located far from clinical trial sites. We analyzed data from 378 patients who underwent CGP testing between June 2019 and June 2024. Patient characteristics, specimen details, molecular tumor board (MTB) assessments of CGP results, and clinical courses were collected. Overall survival (OS) after MTB assessment was evaluated using the Kaplan-Meier method and log-rank test. The median patient age was 69 (range: 10-92) years. Lung cancer was the most common cancer type, affecting 105 patients (27.8%). CGP testing identified one or more gene mutations in 356 patients (94.2%), of whom 248 (65.6%) harbored druggable genomic alterations, and 37 (9.8%) received genomically matched therapy. Among them, 27 (73%) received approved drugs. The OS advantage observed in patients who received genomically matched therapy was statistically significant. Among patients who did not receive genomically matched therapy, approximately 20% expressed willingness to participate in clinical trials. These findings demonstrate the clinical utility of CGP testing in local medical facilities; however, the high proportion of approved drugs among genomically matched treatments highlights significant barriers to clinical trial participation.

Abstract Purpose This short communication aims to provide a technical roadmap for CT-guided dye-based markings of lung nodules in the preoperative management of patients undergoing minimally invasive, robotic-assisted resection. Methods In this single-center retrospective case series, eleven patients with lung nodules were referred to minimally invasive, lung-sparing resection by the multidisciplinary tumor board. CT-guided dye-based markings were performed preoperatively using patent blue V (PBV) and/or indocyanine-green (ICG) injections or ICG-soaked coils. Dyes and coils were placed adjacent to the target lesion, allowing for precise localization during surgery. Technical aspects of the used dye markings are described in detail in the context of available evidence to enable reproducibility. Overall performance metrics for surgical outcomes are reported as intraoperative localization, procedure duration, complication rate, and histological outcome. Results CT-guided dye-based marking and subsequent resections of 12 nodules (median 8.5 mm; IQR 7–10.5 mm) were performed in 11 patients (4 women/7 men; age range 34–77). All procedures were technically successful, with five patients receiving PBV injections (median time 7 min, IQR 5–9.5 min) and six ICG-soaked coil placements (16.5 min, IQR 8–20 min). One asymptomatic pneumothorax occurred during puncture and was managed conservatively. No conversions to open surgery or lobectomy were required due to localization failure. Complete lesion resection was achieved in all cases, revealing seven malignancies. Conclusion CT-guided dye-based markings of lung nodules provide a safe and logistically flexible solution to enhance surgical precision, underscoring the importance of multidisciplinary collaboration and the emerging role of interventional radiology in the perioperative management of these patients.

Background: Primary squamous cell carcinoma (SCC) of the parotid gland is a rare, aggressive malignancy often requiring radical parotidectomy with facial nerve sacrifice, particularly in T4b stage disease. The utility of neoadjuvant chemotherapy (NACT) in downstaging these tumors to facilitate functional nerve preservation remains controversial and under-reported in the literature. Case presentation: A 58-year-old male presented with a fixed, rapidly enlarging left preauricular mass classified as cT4bN2M0 (Stage IVA). The tumor involved the sternocleidomastoid muscle and encased the external carotid artery. Following a multidisciplinary tumor board decision, the patient underwent an extended course of six cycles of Paclitaxel and Carboplatin. The tumor exhibited a partial clinical response and significant central necrosis on imaging. Subsequently, a total parotidectomy was performed. Despite intraoperative fragility and adherence to deep vascular structures, the main trunk and primary divisions of the facial nerve were anatomically and functionally preserved. Histopathology confirmed high-grade SCC with perineural invasion limited to the distal excised branches, achieving clear margins. The patient received 66 Gy of adjuvant radiotherapy. At the 18-month follow-up, the patient remains disease-free with House-Brackmann Grade I facial function. Conclusion: Long-term facial nerve preservation is feasible in selected cases of locally advanced parotid SCC using a multimodal approach. Extended NACT may induce tumor necrosis and facilitate dissection along the neuro-vascular interface, provided that perineural invasion does not involve the main nerve trunk.

BackgroundMolecular tumor boards (MTBs) are essential for selecting therapies for patients with rare and advanced cancers. We hypothesized that integrating biomarkers beyond targeted DNA/RNA next-generation sequencing (NGS) could increase actionable findings. Human epidermal growth factor receptor 2 (HER2)-low status has emerged as a critical biomarker in breast cancer, with potential relevance across other tumor types. Homologous recombination deficiency (HRD) is pivotal for the application of Poly(ADP-Ribose)-Polymerase (PARP) inhibitors in ovarian and breast cancer, although its role in other malignancies remains unclear. Antibody–drug conjugates (ADCs) are expanding precision oncology, with promising biomarkers like Trop-2, Nectin-4, and folate receptor alpha (FRα) showing potential across multiple tumor entities.MethodsTumors were analyzed using the TSO500® panel, enabling tumor mutational burden (TMB) readout. HER2 status was assessed via immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH), alongside antibody–drug conjugate (ADC) IHC, microsatellite instability (MSI) polymerase chain reaction (PCR), mismatch repair (MMR) IHC, programmed death-ligand 1 (PD-L1) IHC, and HRD analysis. Cases were discussed weekly, and outcomes were systematically tracked. Data analysis evaluated the benefit of additional biomarker assessments.ResultsAmong 658 patients, 329 received therapy recommendations, 182 based on supplementary biomarker analyses. One hundred recommendations were implemented, with 37% attributed to supplementary diagnostics. Among 64 response-evaluable patients, the clinical benefit rate (complete response + partial response + stable disease) was 45.3%. HER2-low status notably expanded targeted therapy options across tumor types, with similar implementation rates for HER2-low and HER2-amplified tumors. HRD analysis refined stratification in tumors with mutations in homologous recombination repair (HRR) genes beyond BRCA1/2, including PALB2, ATM, and CHEK2. ADC IHC supported 20 recommendations and two therapy implementations.ConclusionsThe integration of additional biomarker assessments into MTB workflows enhances precision oncology by expanding the pool of patients eligible for targeted therapies.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12916-026-04636-y.

IntroductionWell-differentiated metastatic functioning neuroendocrine tumors (NETs), particularly of gastrointestinal origin, pose diagnostic and therapeutic challenges. Although often slow growing, they may follow an unpredictable course. Somatostatin analogues (SSAs) are the first-line therapy, while peptide receptor radionuclide therapy (PRRT) with Lu-177-DOTATATE has become an established second-line option in progressive disease. Here, we present a case of functioning NET with liver, mesenteric and bone involvement, showing favorable long-term response to initial PRRT and later re-treatment upon biochemical progression.Clinical CaseA 2019 initial evaluation revealed multiple hepatic metastases, mesenteric nodules and bone lesions. Octreoscan confirmed somatostatin receptor expression. Diagnosis: functioning NET, likely gastrointestinal origin, stage IV. The patient was started on lanreotide 120 mg/month. In 2020, PET-Ga68 demonstrated progressive disease; liver biopsy confirmed well-differentiated G1 NET (low Ki-67). The NET tumor board recommended PRRT with Lu-177-DOTATATE. Post-therapy follow-up showed biochemical improvement and radiologic stabilization. PET-Ga68 in 2022 and CT in 2023 confirmed partial tumor shrinkage with stable disease.In April 2024, PET-Ga68 revealed persistent somatostatin-avid metastases with minor radiologic progression. Despite this, the patient remained asymptomatic, with preserved renal and bone marrow functions. In early 2025, the multidisciplinary team proposed PRRT re-treatment due to favorable profile: G1 tumor, strong receptor expression, no clinical deterioration and a progression-free interval >3 years. A dosimetric evaluation was performed, and a new Lu-177 cycle was scheduled. This decision was supported by international guidance and by increasing real-world experience suggesting that PRRT re-treatment may be a safe and effective option in selected patients.ConclusionThis case underscores the importance of multidisciplinary management in advanced NETs and highlights the potential of PRRT not only in initial treatment but also as re-treatment in selected patients. Key criteria for re-treatment include sustained receptor expression, clinical stability, organ function preservation, and significant time since first PRRT. Re-treatment with Lu-177 should be considered a valuable tool in the therapeutic arsenal for NETs, especially when tumor biology and patient profile remain favorable over time. This case also illustrates the relevance of integrating functional imaging and dosimetric evaluation into personalized decision-making pathways. Individualized assessment and adherence to updated guidelines are essential for optimizing outcomes.

Background and study aimsPancreatic ductal adenocarcinoma (PDAC) is a poor prognostic malignancy. Comprehensive genomic profiling (CGP) has improved outcomes in many cancers, but widespread uptake in PDAC remains elusive. This study investigated the feasibility of using endoscopic ultrasound with fine-needle biopsy (EUS-FNB) for CGP in advanced PDAC.Patients and methods (experimental design)A multicenter prospective cohort study was conducted to assess the feasibility of using DNA and RNA extracted from fresh frozen or archival formalin-fixed paraffin-embedded (FFPE) EUS-FNB for CGP on advanced PDAC using the TSO-500 gene panel testing. Results of the CGP were reviewed at a molecular tumor board (MTB) and subsequent treatment recommendations were forwarded to the referring clinicians.ResultsCGP was successful in 129 of 143 patients (90%) enrolled between May 2020 to September 2023. Fresh frozen EUS-FNB provided suitable genetic material for CGP in 123 of 133 patients (92%). Conversely, CGP was successful on FFPE biopsy blocks from only six of 16 patients (38%). Fifty-two of 143 patients (36%) had a potentially targetable mutation detected, and eight of these patients (6%) were treated with targeted therapy based on their EUS-FNB-derived molecular profile. Patients who received personalized therapy had a significant (P< 0.0001) increase in survival versus standard or no therapy at 12 and 36 months. Median patient survival on standard therapy was 9.47 months versus > 18 months for personalized therapy.ConclusionsThis real-world study confirms the feasibility and utility of CGP using EUS-FNB in advanced PDAC. It illustrates the importance of timely access to personalized therapy informed by CGP, which can impact the treatment pathway and improve survival outcomes.

IntroductionBranchial cleft cysts (BCC) are congenital cystic lesions of the lateral neck resulting from incomplete obliteration of the branchial clefts during embryogenesis. They are typically located anterior to the sternocleidomastoid muscle and are benign in nature. Papillary thyroid carcinoma (PTC) is the most common histological subtype of thyroid malignancies. Due to its propensity for cervical lymph node metastasis, it may mimic cystic lesions of the lateral neck, posing a diagnostic challenge in adults.Clinical CaseA 35-year-old female presented to the otolaryngology clinic with a painless neck swelling. Physical examination revealed a 3cm lesion in the right level IV region. There was no history of autoimmune thyroid disease, radiotherapy, or family history of thyroid cancer. Ultrasonography showed a normal sized thyroid with a 10×8 mm isohyperechoic nodule in the left lobe, with a regular margin, halo, and peripheral vascularization. In addition, a 30×15 mm anechoic cystic lesion was detected anterior to the sternocleidomastoid muscle and was initially considered as BCC. Fine-needle aspiration biopsy was nondiagnostic. Contrast-enhanced MRI revealed a 17×22 mm well-circumscribed, dense-content lesion, again suggestive of BCC. The patient underwent surgery with this presumptive diagnosis. Histopathological examination demonstrated papillary thyroid carcinoma invasion in the cyst wall, consistent with metastatic PTC. Following multidisciplinary tumor board evaluation, total thyroidectomy with bilateral central and right lateral neck dissection was performed. Postoperative pathology revealed a 0.8 cm oncocytic variant papillary microcarcinoma in the right lobe, with capsular invasion within 0.1 cm, and metastasis in three central lymph nodes. The patient was classified as high-risk and received 150 mCi of radioactive iodine (RAI). Post-therapy I-131 scintigraphy showed uptake confined to the thyroid bed, with no evidence of distant metastasis. During follow-up, TSH was suppressed below 0.1 mIU/L. Stimulated thyroglobulin was 7 µg/L with negative anti-Tg antibodies. At the latest follow-up, thyroglobulin was 0.6 µg/L, consistent with a biochemical indeterminate response.Cystic lymph node metastases of PTC can easily be misdiagnosed as BCC, especially in adults. Several cases in the literature have reported lesions initially excised under the presumptive diagnosis of BCC that were later confirmed as metastatic PTC. Therefore, in adult patients with lateral cervical cystic lesions, careful evaluation is essential, and suspicious radiologic findings must be followed by thorough histopathological analysis. Clinical history, imaging features, and, when necessary, repeat biopsies are crucial for accurate diagnosis.ConclusionPapillary thyroid carcinoma can present as cystic lymph node metastases mimicking branchial cleft cysts; thus, this diagnosis must be considered in adults with lateral neck masses

Proton versus photon radiotherapy for patients with oropharyngeal cancer in the USA: a multicentre, randomised, open-label, non-inferiority phase 3 trial.

Values elicitation among surgical oncologists: Findings from an international survey.

Multidisciplinary tumor boards (MDTs) are central to cancer care but remain constrained by scarce experts and variable decision quality. EvoMDT employs a self-evolution loop that updates prompts, consensus weights, and retrieval scope based on expert feedback and outcome signals, improving robustness without sacrificing traceability. This matters clinically because MDT workloads and evidence shift over time, requiring adaptive yet auditable decision support. Agents perform domain-specific inference over lesion-level clinical data with structured knowledge retrieval; a consensus protocol resolves conflicts and generates traceable, evidence-linked recommendations. Evaluation spanned six public oncology QA benchmarks and four real-world datasets (breast, liver, lung, lymphoma), followed by single-blind physician assessment. Quantitative metrics (ROUGE, BERTScore) and automated safety checks assessed factuality and guideline concordance, while clinicians rated clinical appropriateness and usability. EvoMDT outperformed frontier Large Language Models (LLMs) baselines (e.g., Llama-3-70B, Claude-3, Med-PaLM 2), improving guideline concordance and semantic alignment with expert plans (BERTScore 0.62-0.68) and reducing safety violations. In physician review, EvoMDT achieved decision quality comparable to human MDTs while shortening response time by 30-40%. These results position EvoMDT as an interpretable, evidence-traceable framework that operationalizes AI reasoning for multidisciplinary oncology practice and offers a scalable foundation for trustworthy, lesion-level precision cancer care.

Squamous cell carcinoma (SCC) of the oral vestibule is associated with significant surgical challenges, often requiring extensive resections with functional and cosmetic sequelae. Interventional radiotherapy (IRT, brachytherapy) may provide a function-preserving alternative. We retrospectively analyzed clinical data from 12 patients with primary oral vestibule SCC treated between February 2022 and March 2025. Eleven underwent high-dose-rate IRT (HDR-IRT) with curative intent after multidisciplinary tumor board evaluation. Clinical outcomes, toxicity, and functional preservation were assessed. Of the 11 patients treated with HDR-IRT, ten achieved a complete response. At a mean follow-up of 20 months, nine were alive and disease-free. Two-year disease-specific survival and overall survival were 86% and 78%, respectively. Acute toxicity was limited to grade II mucositis, and long-term sequelae were minimal, with only mild skin dyschromia. No patient developed trismus or Stensen's ductdysfunction. Exclusive HDR-IRT appears to be a safe, effective, and organ-preserving therapeutic option for selected oral vestibule SCCs; however, further studies in larger cohorts are needed to validate our findings.

The number of data points per patient considered at the point-of-care in precision cancer medicine continues to increase, and it is accompanied by a growing challenge of translating these observations into clinical insights. This is a time-intensive and laborious process for oncology professionals and molecular tumour boards. As large clinicogenomic datasets and data-sharing protocols mature alongside machine learning methods, molecular diagnostic workflows have an opportunity to integrate these tools. This integration can help extract more information from next-generation sequencing data, enhance cancer variant interpretation, streamline case review and generate therapeutic hypotheses for biomarker-negative patients at the point-of-care. Although machine learning holds promise for precision oncology, responsible implementation and model evaluation remain essential for clinical adoption.

Chinese expert consensus on precision diagnosis and treatment of refractory tumors.

Neoadjuvant treatment for rectal cancer has evolved markedly with the growing adoption of total neoadjuvant therapy (TNT), organ-preservation strategies and selective omission of radiotherapy. Recent trials support risk-based personalization, but its application in real-world settings remains poorly documented. The aim was to describe current neoadjuvant treatment practices for mid-low rectal cancer in French expert centres and identify tumour- and patient-related factors influencing decisions. This observational study included patients with non-metastatic rectal adenocarcinoma ≤10 cm from the anal verge, discussed in tumour boards (October 2022 to March 2023) across GRECCAR centres. Tumours were classified as early, intermediate-risk or locally advanced rectal cancer (LARC). Neoadjuvant treatments were analysed according to tumour extension, location and age. Among 463 patients from 27 centres, the most frequent regimen was induction chemotherapy, mainly FOLFIRINOX, followed by long-course chemoradiotherapy (CRT) (65%). This approach was used in 51%, 66% and 71% of patients in the early, intermediate-risk and LARC groups, respectively (p = 0.0060). TNT was more frequently administered for low- than mid-rectal cancers, especially in LARC (86% vs. 71%, p = 0.016). In patients >75 years, CRT + consolidation chemotherapy and radiotherapy alone were proportionally more frequent. Among the early rectal cancers, those treated with induction chemotherapy + CRT had more advanced features than those treated with CRT alone (cT3: 80% vs. 43%, cN+: 62% vs. 10%, tumour size: 3.4 vs. 2.3 cm; all p < 0.001). TNT with induction chemotherapy is the predominant neoadjuvant approach in French expert centres. Tumour classification, location and patient age significantly influence treatment choices, reflecting a shift towards personalized context-specific care.