Tumor Resectability Research Articles

Prognostic value of manual versus automatic methods for assessing extents of resection and residual tumor volume in glioblastoma.

The extent of resection (EOR) and postoperative residual tumor (RT) volume are prognostic factors in glioblastoma. Calculations of EOR and RT rely on accurate tumor segmentations. Raidionics is an open-access software that enables automatic segmentation of preoperative and early postoperative glioblastoma using pretrained deep learning models. The aim of this study was to compare the prognostic value of manually versus automatically assessed volumetric measurements in glioblastoma patients. Adult patients who underwent resection of histopathologically confirmed glioblastoma were included from 12 different hospitals in Europe and North America. Patient characteristics and survival data were collected as part of local tumor registries or were retrieved from patient medical records. The prognostic value of manually and automatically assessed EOR and RT volume was compared using Cox regression models. Both manually and automatically assessed RT volumes were a negative prognostic factor for overall survival (manual vs automatic: HR 1.051, 95% CI 1.034-1.067 [p < 0.001] vs HR 1.019, 95% CI 1.007-1.030 [p = 0.001]). Both manual and automatic EOR models showed that patients with gross-total resection have significantly longer overall survival compared with those with subtotal resection (manual vs automatic: HR 1.580, 95% CI 1.291-1.932 [p < 0.001] vs HR 1.395, 95% CI 1.160-1.679 [p < 0.001]), but no significant prognostic difference of gross-total compared with near-total (90%-99%) resection was found. According to the Akaike information criterion and the Bayesian information criterion, all multivariable Cox regression models showed similar goodness-of-fit. Automatically and manually measured EOR and RT volumes have comparable prognostic properties. Automatic segmentation with Raidionics can be used in future studies in patients with glioblastoma.

Dose-Escalated SBRT for Borderline and Locally Advanced Pancreatic Cancer: Resectability Rate and Pathological Results of a Multicenter Prospective Study

Objective: We demonstrated for the first time the safety and feasibility of escalating up to 55 Gy/11 Gy/fr/5fr in borderline (BRPC)/unresectable locally advanced pancreatic cancer (LAPC), using the standard LINAC platform. The aim of the present study is to assess for the first time the impact of this high-dose neoadjuvant stereotactic ablative radiotherapy (SABRT) protocol on tumor resectability and pathological responses. Materials/Methods: From June 2017 to December 2022, patients with BRPC/LAPC were treated with neoadjuvant chemotherapy (ChT) and SABRT-escalated doses of SIB at 45 Gy, 50 Gy, and up to 55 Gy (BED ≥ 100). Radiological evaluation was conducted with a CT scan 6-8 weeks post-treatment to determine resectability status based on established criteria (SAR/APA2014). Surgical decisions were made by the multidisciplinary tumor board of the participating institutions. Pathological assessments post-surgery used criteria from the College of American Pathologists (CAP), categorizing resection status as R0 (negative margins), R1 (microscopic tumor margins), and R2 (macroscopic tumor margins). Tumor response was evaluated with the Tumor Response Scoring (TRS) system, as G0 (no viable cancer cells), G1 (single cells or rare small groups), G2 (residual cancer with evident regression), and G3 (extensive residual cancer). Results: Thirty-three patients (p) were included: 39.4% (13p) BRPC/60.6% (20p) LAPC. After ChT-SABRT, 45.5% (15p) were considered resectable, with 11/13 (84.6%) BRPC and 4/20 (20%) LAPC (p &lt; 0.0001). One patient refused surgery and other patient died of COVID sepsis. Two more patients had disseminated disease at surgery. Among the 11 patients who underwent full surgery, all patients achieved either clean margins R0: 72.7% (8p) or microscopic affected margins R1: 27.3% (3p). TRS scores were G1: 27.3% (3p), G2: 54.5% (6p), and G3: 18.2% (2p). The present follow-up (FUP) was closed on 1 November 2024 (23.55 months, range: 6–71 months). The mean freedom from local progression as the first cause of disease failure was 43.30 ± 3.09 (37.23–49.38), and the median was not reached. The actuarial 1- and 2-year rates for freedom from local relapse as a first cause of disease failure were 92.3% (87.7–93.3%) and 79.7% (79.7–87.7%), respectively. Conclusions: Neoadjuvant ChT-SABRT in LAPC improves resectability rates and induces relevant tumor regression. These promising findings should be validated by larger sample sizes and extended follow-up.

Questionnaire on the surgical indications for intrahepatic cholangiocarcinoma administered to Japanese board-certified expert hepatobiliary and pancreatic surgeons and instructors.

Treatment of intrahepatic cholangiocarcinoma (ICC) remains challenging owing to the lack of clear guidelines on surgical resection. The 2021 ICC guidelines have not fully resolved the ongoing debate between surgical and nonsurgical treatment options. This study aimed to identify trends and issues in ICC treatment strategies in the clinical field by surveying the attitudes of hepatobiliary and pancreatic (HBP) surgeons. A survey was conducted among 235 board-certified HBP surgeons affiliated with the Japanese Society of Hepato-Biliary-Pancreatic Surgery. This survey explored the perspectives on tumor conditions that define resectable, borderline resectable, and unresectable diseases, focusing on tumor size, number, and vascular invasion. Notable variability was observed in the criteria for oncological resectability. While 42.1% of the respondents considered a maximum tumor diameter of 5 cm as resectable, 37.5% indicated no size limit for resectability. Opinions regarding the resectability of tumors with lymph node involvement and vascular invasion vary widely, highlighting the need for standardized criteria. This survey revealed diverse approaches for defining resectability in ICC, emphasizing the necessity for more precise guidelines. Further research and expert consensus are required to establish standardized criteria that can guide clinical decision-making and improve patient outcomes.

Sociodemographic and clinical predictors of quality-of-life outcome in children and young people with primary brain tumour in Karachi, Pakistan: a prospective cohort study

BackgroundChildren and young people (CYP) with primary brain tumour (PBT) are at high risk for developing late effects, potentially affecting long-term quality of life (QoL). In low-income and middle-income countries,...

Suprasellar Anterior-Posterior Diameter Optimizes the Use of Intraoperative MRI in Patients Undergoing Endoscopic Pituitary Surgery.

Intraoperative MRI (iMRI) has been demonstrated to improve the extent of resection of pituitary neuroendocrine tumors resected using endoscopic endonasal approaches. We sought to establish if preoperative clinicoradiological parameters could be used to predict which patients are most likely to benefit from iMRI and thus allow more efficient use of this technology. A prospectively maintained surgical database of all endoscopic pituitary tumor resections with iMRI guidance performed between May 2017 and September 2023 was accessed. Data were collected on clinical and radiological parameters that may predict reintervention after iMRI. Logistic regression models were constructed to assess the relationship between predictor variables and reintervention after iMRI. Seventy-three patients were included in the study. After review of the iMRI, 24/73 (33%) patients underwent surgical reintervention. The combined rate of gross total resection/near total resection was 64/73 (88%). The rate of biochemical cure of endocrine disease after surgery for a hormonally active tumor was 15/21 (71%). On univariate logistic regression analysis, the only factor significantly associated with reintervention after iMRI was the suprasellar anterior-posterior diameter (odds ratio 1.1, 95% CI 1.01-1.2, P = .030). Suprasellar anterior-posterior diameter ≥15 mm predicts the requirement for reintervention after endoscopic resection of pituitary neuroendocrine tumor. Use of this easily obtained radiological parameter will allow iMRI to be used in those patients who are most likely to benefit.

Embolize, supercharge, resect: Embolization to enhance hepatic vascularization prior to en-bloc pancreas and arterial resection

IntroductionEmbolization could increase the resectability of pancreatic tumors by supercharging visceral arterial perfusion prior to pancreatic surgery with arterial en-bloc resection. Its indications, however, are controversial. MethodsWe retrospectively analyzed the results of a single-center database of patients undergoing pancreatic surgery with arterial resection (AR) after preoperative arterial embolization (PAE) to increase hepatic vascular flow and spare arterial reconstruction. ResultsPAE was planned in 15 patients with arterial involvement due to pancreatic tumors. Three patients were excluded due to the finding of irresectable disease during surgery. Twelve cases were resected because of pancreatic cancer (10), distal cholangiocarcinoma (1), and pancreatic neuroendocrine tumor (1). Arterial involvement in these cases required embolization of the substitute right hepatic artery (RHA) (5), left hepatic artery (1), and common hepatic artery (CHA) (6) to enhance liver vascularization. Two patients presented migration of the vascular plug after PAE. Six pancreatoduodenectomies and 6 distal pancreatectomies were performed, the latter associated with en-bloc celiac trunk and CHA resection. R0 was achieved in 7 out of 12 patients, and pathological vascular involvement was confirmed in 8. Postoperative complications included one patient who developed gastric ischemia and underwent gastrectomy, and one patient who underwent reoperation for acute cholecystitis with liver abscesses. ConclusionPreoperative arterial embolization before pancreatic surgery with hepatic arterial resection enables surgeons to precondition hepatic vascularization and prevent hepatic ischemia. In addition, this avoids having to perform arterial anastomosis in the presence of pancreatic suture.

ASPECTOS DE IMAGEM NO HEPATOBLASTOMA: REVISÃO DE LITERATURA.

Hepatoblastoma (HB) is a considerably rare primary malignant liver neoplasm of embryonic origin, and the most prevalent hepatic carcinoma among children, primarily affecting individuals under five years old. Objective: to investigate the prevalence and characteristics of imaging findings in hepatoblastoma described in the scientific literature between 2019 and 2024. Method: A literature review was conducted in the PubMed, Scopus, Web of Science, and SciELO databases over the past 5 years. Results and Discussion: Nine studies were found, predominantly on computed tomography and abdominal ultrasound. The morphological patterns presented in the imaging aspects by USG, CT, and MRI differ between the methods, highlighting the complexity of hepatoblastoma and the variability of presentation in imaging examinations. However, all studies demonstrated the importance of imaging methods in staging and defining tumor resectability criteria. Conclusion: There is a scarcity of studies on the imaging findings of Hepatoblastoma, as well as the variety of imaging characteristics in the different evaluated methods. The importance of using imaging methods for the adequate staging of hepatoblastoma and consequent definition of therapeutic conduct is also highlighted.

Strategies for Recurrent Colorectal Liver Metastases Based on Prognostic Factors and Resectability: Potential Benefit of Multidisciplinary Treatment.

Colorectal liver metastasis (CLM) is classified into technical and oncologic categories, with recommended treatments for each resectability category. However, the classification of recurrent CLM has not been established to date. This study evaluated patients with CLM who underwent initial liver resection between 2006 and 2020 and subsequently experienced liver recurrence. Long-term outcomes and prognostic factors associated with recurrent CLM were investigated. From 949 patients who underwent an initial liver resection, the analysis included 392 patients with liver recurrence. Repeat liver resection was associated with a significantly longer prognosis than non-resection (5-year overall survival [OS] from initial liver resection: 66.3 % vs 27.2 %, p < 0.0001). Multivariable analysis indicated the following independent prognostic factors: four or more recurrent tumors (p = 0.015), tumor 5 cm or larger in size (p = 0.004), and presence of extrahepatic diseases (p = 0.003). The patients were stratified into resectable, borderline resectable, and unresectable recurrent CLM groups based on these criteria. The prognosis varied significantly across the groups, with 5-year OS rates of 67.3 % for resectable recurrent CLM, 30.8 % for borderline resectable recurrent CLM, and 2.6 % for unresectable recurrent CLM (p < 0.0001). Patients with borderline resectable recurrent CLM who did not receive adjuvant chemotherapy after initial liver resection had a positive prognostic impact of preoperative chemotherapy (p = 0.049). The significant independent predictors of recurrent CLM prognosis were four or more tumors, tumor size of 5 cm or larger, and the presence of extrahepatic diseases at recurrence. It is critical to onsider the current condition and tumor resectability at the time of recurrence, and tailored treatments could further improve recurrent CLM outcomes.

Comparison of clinical outcomes between conventional and underwater endoscopic mucosal resection for duodenal neuroendocrine tumors.

Duodenal neuroendocrine tumors are relatively rare subepithelial tumors that arise from cells of the neuroendocrine system. Small duodenal neuroendocrine tumors can be treated endoscopically because of their low potential for metastasis. This study aimed to evaluate the clinical outcomes of conventional and underwater endoscopic mucosal resection for duodenal neuroendocrine tumors. Between March 2009 and March 2023, 15 patients with duodenal neuroendocrine tumors resected using conventional (n = 7) and underwater (n = 8) endoscopic mucosal resections were retrospectively enrolled. The median specimen size and median tumor size were 1.0 cm (interquartile range: 0.8-1.2 cm) and 0.6 cm (interquartile range: 0.4-0.6 cm), respectively. More than half of duodenal neuroendocrine tumors were located in the duodenal bulb (9/15, 60%). The en bloc and complete resection rates of both conventional and underwater endoscopic mucosal resections were 100%. Only one perforation event occurred in the conventional endoscopic mucosal resection group (14.3%). The patient with the perforation was treated with endoscopic clipping. The median follow-up period was 39.5 months (interquartile range: 19.5-57.3 months). There was no local recurrence or distant metastasis during the follow-up period. Underwater endoscopic mucosal resection is a safe and effective treatment option for small duodenal neuroendocrine tumors and is the preferred treatment option for flat-type duodenal neuroendocrine tumors.

A Tandem-Locked Fluorescent Probe Activated by Hypoxia and a Viscous Environment for Precise Intraoperative Imaging of Tumor and Instant Assessment of Ferroptosis-Mediated Therapy.

Noninvasive fluorescence detection of tumor-associated biomarker dynamics provides immediate insights into tumor biology, which are essential for assessing the efficacy of therapeutic interventions, adapting treatment strategies, and achieving personalized diagnosis and therapy evaluation. However, due to the absence of a single biomarker that effectively reflects tumor development and progression, the currently available optical diagnostic agents that rely on "always-on" or single pathological activation frequently show nonspecific fluorescence responses and limited tumor accumulation, which inevitably compromises the accuracy and reliability of tumor imaging. Herein, based on intramolecular charge transfer (ICT) and twisted intramolecular charge-transfer (TICT) hybrid mechanisms, we report a tandem-locked probe, NTVI-Biotin, for simultaneously specific imaging-guided tumor resection and ferroptosis-mediated tumor ablation evaluation under the coactivation of nitro reductase (NTR)/viscosity. The dual-stimulus-responsive design strategy ensures that NTVI-Biotin exclusively activates near-infrared (NIR) fluorescence signals upon interaction with both NTR and elevated viscosity levels through triggering ICT on while inhibiting the TICT process. Meanwhile, functionalization with a tumor-targeting hydrophilic biotin-poly(ethylene glycol) moiety enhances tumor accumulation. The probe's dual-response and tumor-targeting design minimizes nonspecific tissue activation, allowing for precise tumor identification and lesion removal with a superior tumor-to-normal tissue (T/N > 6) ratio. More importantly, NTVI-Biotin was capable of evaluating ferroptosis-mediated chemotherapeutics by real-time monitoring of the alternations of NTR/viscosity levels. The results reveal that the increased tumor signals of NTVI-Biotin following the combination of ferroptosis and chemotherapy correlate well with the tumor growth inhibition, demonstrating the potential of NTVI-Biotin to assess therapeutic efficacy.

NIMG-39. THE “RESECTABILITY INDEX” AS A NOVEL OBJECTIVE PREDICTOR OF SURVIVAL FOR PATIENTS WITH ADULT-TYPE DIFFUSE GLIOMAS

Abstract Extent of resection (EOR) is a strong prognostic factor for patients with adult-type diffuse gliomas. Whole brain tractography (WBT) allows visualization of tumors in relation to functional subcortical white matter tracts connecting eloquent cortex. We developed a preoperative metric, the resectability index (RI), to estimate tumor resectability based on pre-resection volume (PRV) and unresectable tumor volume (UTV). We explore if RI predicts progression-free survival (PFS) and overall survival (OS). We retrospectively reviewed the charts of consecutive patients with adult-type diffuse gliomas resected from 2013-2020. Only patients with pre-operative DTI MRIs were included. UTV was the total overlapping volume of tumor with functionally significant tracts (corticospinal, arcuate, optic, fornix) and deep structures (basal ganglia, thalamus, brainstem). RI was (PRV-UTV)/PRV. Seventy-nine patients were included with an average age of 56 years at time of surgery. Glioblastoma was the most common histology (68%). Tumors were located in the left hemisphere (LH) (48%), right hemisphere (RH) (39%), and bilateral hemispheres or midline (BHM) (13%). EOR for LH, RH, and BHM tumors was 0.8, 0.91, and 0.29, respectively (P = 0.1^7). RI for LH, RH, and BHM tumors was 0.86, 0.912, and 0.44, respectively (P = 0.00021). Cox regression was used to model PFS and OS based on age, preoperative KPS, WHO grade, EOR, and RI. Age, recurrent status, bilaterality, residual tumor volume (RTV) and UTV predicted PFS (CI = 1.01 – 1.06, P = 0.002). For OS, UTV and RI were more strongly predictive than RTV or EOR. In a Cox regression model consisting only of preoperative variables, RI was independently predictive of OS. RI is a novel metric with potential efficacy for preoperative survival prognostication in patients with diffuse gliomas. RI may enable neurosurgeons to provide HGG patients with more accurate information about expected benefits of surgical intervention than is currently possible. RI will also enable more valid comparisons of HGG patient cohorts treated at different institutions.

Preoperative assessment of pancreatic cancer with [68Ga]Ga-DOTA-FAPI-04 PET/MR versus [18F]-FDG PET/CT plus contrast-enhanced CT: a prospective preliminary study.

To assess the diagnostic performance of [68Ga]Ga-DOTA-FAPI-04 PET/MR imaging in the preoperative evaluation of pancreatic cancer and compare it with that of [18F]-FDG PET/CT plus contrast-enhanced CT (CECT). Thirty-one patients with pancreatic cancer underwent preoperative [68Ga]Ga-DOTA-FAPI-04 PET/MR, [18F]-FDG PET/CT, and CECT imaging. Two nuclear medicine physicians independently reviewed two sets of images (set 1, [68Ga]Ga-DOTA-FAPI-04 PET/MR; set 2, [18F]-FDG PET/CT plus CECT) and reached a consensus on tumour resectability, N staging (N0 or N positive) and M staging (M0 or M1). Based on the above indices, the resectability of the tumour was determined according to a five-point scale. Clinical, operative, and pathological findings were used as a reference standard to compare the diagnostic performance of the two imaging sets via the McNemar test. The diagnostic performance of [68Ga]Ga-DOTA-FAPI-04 PET/MR imaging was not significantly different from that of [18F]-FDG PET/CT plus CECT imaging in the assessment of tumour resectability (area under the receiver operating characteristic curve: 0.854 vs. 0.775, p = 0.192), N staging [accuracy: 82.4% (14 of 17 patients) vs. 58.8% (10 of 17 patients), p = 0.125] and M staging [accuracy: 100% (31 of 31 patients) vs. 90.3% (28 of 31 patients), p = 0.250]. However, compared with [18F]-FDG PET/CT plus CECT imaging, [68Ga]Ga-DOTA-FAPI-04 PET/MR imaging changed the M stage in three patients by upstaging from M0 to M1 in 2 patients and downstaging from M1 to M0 in 2 patients. In 13 patients with liver metastases, the number of liver metastases detected via [68Ga]Ga-DOTA-FAPI-04 PET/MR imaging was greater than that detected via [18F]-FDG PET/CT plus CECT imaging (324 vs. 240). In 3 patients with peritoneal metastases, [68Ga]Ga-DOTA-FAPI-04 PET/MR imaging detected more peritoneal metastases than did [18F]-FDG PET/CT plus CECT imaging. [68Ga]Ga-DOTA-FAPI-04 PET/MR imaging has diagnostic accuracy comparable to [18F]-FDG PET/CT plus CECT in terms of preoperative staging and assessment of resectability in pancreatic cancer; additionally, it exhibits superior capability in detecting liver and peritoneal metastases. Consequently, [68Ga]Ga-DOTA-FAPI-04 PET/MR has the potential to become a one-stop imaging tool for the preoperative evaluation of pancreatic cancer.

075. The Use of Tyrosine Kinase Inhibitor as Neoadjuvant Therapy in Patients with Thyroid Carcinoma: A Literature Review

Background: Papillary thyroid carcinoma (PTC) and medullary thyroid cancer (MTC) are the most common thyroid cancers in Indonesia, with an increasing incidence in recent years. The primary treatment for PTC is surgery, but it often faces challenges in managing invasive tumors. Tyrosine kinase inhibitors (TKI) have shown potential as neoadjuvant therapy to shrink tumors before surgery, though their use remains experimental. This study aims to evaluate the effectiveness of TKI as neoadjuvant therapy in patients with unresectable thyroid carcinoma, specifically PTC and MTC. Methods: Following PRISMA 2020 guidelines, a literature review was conducted using databases such as Cochrane, PubMed, EMBASE, and Scopus. The study selection was based on inclusion and exclusion criteria, with a risk of bias assessment performed using Joanna Briggs Institute tools. Data from case reports were extracted and analyzed qualitatively. Results: Eight case reports demonstrated that TKI, including Sunitinib, Lenvatinib, and Sorafenib, effectively reduced tumor size, allowing previously unresectable tumors to be surgically removed. Despite showing significant tumor shrinkage, adverse effects such as hypertension and gastrointestinal issues were noted, requiring careful management during treatment. Additionally, the duration of TKI therapy varied among the cases, but all showed notable improvements in tumor resectability. Conclusion: TKI shows promise as an effective neoadjuvant therapy for reducing tumor size in invasive PTC and MTC, making surgery more feasible. However, evidence is still limited to case reports, and further research is required to confirm the safety and effectiveness of TKI in this setting and to determine the appropriate patient selection criteria.

The feasibility and clinical outcome of endoscopic transorbital transcavernous approaches with or without petrosectomy for petroclival lesions.

Petroclival tumors such as petroclival meningiomas or trigeminal schwannomas extending to the posterior cranial fossa are challenging to treat due to their deep-seated location and proximity to critical neurovascular structures. This study aimed to evaluate the feasibility, safety, and clinical outcomes of endoscopic transorbital surgery for the resection of central skull base tumors involving the petroclival area. The authors conducted a retrospective analysis of 32 patients with petroclival tumors including meningiomas and trigeminal schwannomas who underwent endoscopic transorbital surgery between September 2017 and December 2022. Preoperative clinical and radiological data were collected, and patients were followed up postoperatively for a median period of 34.7 months. Surgical technique, complications, and clinical outcomes were assessed. Endoscopic transorbital surgery provided a minimally invasive and direct corridor to the petroclival region. All 32 patients successfully underwent tumor resection, with gross-total or near-total tumor resection achieved in 28 patients. The mean tumor diameter was 3.5 cm. Based on tumor pathology, the endoscopic transorbital transcavernous trans-Meckel's cave approach (21 cases) or transorbital anterior transpetrosal approach (11 cases) was selected. The most common complication was facial paresthesia in 4 of 21 patients with trigeminal schwannomas and in 1 of 11 patients with petroclival meningiomas. Diplopia due to fourth cranial nerve injury occurred in 3 of 11 patients with petroclival meningiomas. Postoperative clinical improvement in neuralgic pain was observed in 3 of 4 patients. One patient developed a temporary facial palsy (House-Brackmann grade III) and another patient had transient paraparesis after removal of petroclival meningioma. Endoscopic transorbital surgery appears to be a safe and effective technique for the resection of petroclival lesions, offering excellent visualization and access to the tumor while minimizing morbidity. However, further studies with larger patient cohorts and longer follow-up are warranted to validate the long-term efficacy and safety of this approach. This study contributes to the growing body of evidence supporting the utility of endoscopic transorbital techniques in skull base surgery.

A 3-arm randomized control trial to compare the efficacy of re-circulant hyperthermic intravesical chemotherapy versus conventional intravesical mitomycin C and BCG therapy for intermediate-risk non-muscle invasive bladder cancer.

To evaluate the efficacy and side effects of re-circulant hyperthermic intravesical chemotherapy versus conventional treatments for intermediate risk non-muscle invasive bladder cancer (NMIBC). A randomized 3-arm, parallel group trial was conducted at a single tertiary care centre. 135 patients with low-grade intermediate-risk cancer, having undergone complete resection of bladder tumor were included. Patients were assigned 1:1:1, to receive intra-vesical chemo-hyperthermia (C-HT), mitomycin-C (MMC) or BCG therapy. There was no treatment crossover. Patients were followed up with check cystoscopy every 3 months for histopathological recurrence. The three arms were comparable in terms of age, gender, tumor size, number of tumors and clinical stage or grade of tumors. Mean tumor size was 2.58 (± 0.88) cm and the mean number of tumors resected was 2.04 (± 1.02) (Range 1-5). There was no significant difference between the various groups for tumor recurrence (χ2 = 1.96, p = 0.375) or time to recurrence (13.6 vs. 10.8 vs. 9.8 months, p = 0.844)though incidence of non-healing necrotic area was higher with C-HT (22.2% vs. 11.1% and 4.8%, χ2 = 6.093, p = 0.048). Median (IQR) follow up period was 26 (12-52) months. Treatment discontinuation or drug intolerance was significantly higher in BCG arm (p = 0.03). Intravesical C-HT with MMC, conventional MMC and BCG are equally effective and comparable alternatives for intravesical therapy in low-grade intermediate-risk NMIBC. Higher incidence of non-healing resection site with C-HT and higher local symptoms with BCG are a concern.

Prognosis related to treatment plan in patients with biliary tract cancer: A nationwide database study

BackgroundBiliary tract cancer (BTC) is a malignancy characterized by a low 5-year survival rate (<20 %). Clinical aspects such as tumor resectability, Eastern Cooperative Oncology Group performance status score (ECOG-PS), and molecular profiling are used to determine the treatment for these patients. Diagnosis and treatment are typically established by a multidisciplinary team (MDT). However, standardized practices for BTC are lacking, and there is a need to assess the impact of current MDT treatment decisions on BTC outcomes. The purpose of this study was to investigate the role of the treatment plan proposed by the first MDT conference on survival in patients with BTC, and to identify risk factors for poor survival in this population. MethodThis nationwide, multicenter, retrospective cohort study examined data from the Danish Liver Cancer Group (2013–2020) with confirmed BTC diagnoses. Multiple imputation was used to handle missing data. Survival and variable-survival rate relationships were analyzed using the Kaplan-Meier estimator, and the Cox regression model, respectively. ResultsEligible BTC-confirmed cases: n=1923. The overall median survival was 7.7 months (95 % CI: 7.1–8.5), with a 5-year survival rate of 16.3 %. Patients over 70 years of age, with ECOG-PS 3 or 4, non-operable cases, and with unresectable tumors had lower survival rates. Surgery as the first therapeutic option showed the highest median survival (33.1 months, 95 % CI: 27.2–41.6; p < 0.0001). Multivariable analysis showed that poor ECOG-PS, palliative and neoadjuvant chemotherapy, stereotactic radiotherapy, and best supportive care significantly increased mortality risk in patients with BTC (p=0.05). ConclusionAmong the therapeutic options prescribed by the MDT for patients with BTC, surgery offered the best survival rates, likely due to patient-related prognostic factors. High ECOG-PS was linked to an increased mortality risk regardless of age, highlighting the importance of this criterion in treatment decisions.

Circulating miR-18a and miR-532 Levels in Extrahepatic Cholangiocarcinoma.

Background: Cholangiocarcinoma (CCA) is a highly aggressive cancer of the bile ducts with a poor prognosis and limited diagnostic markers. This study aims to investigate the potential of miR-18a and miR-532 as biomarkers for CCA by exploring their correlations with clinical parameters and traditional tumor markers such as CA19.9, CEA, and AFP. Methods: This study involved a cohort of patients diagnosed with CCA. Serum levels of miR-18a and miR-532 were measured and analyzed in relation to various clinical parameters, including age, tumor markers, and histological features. Results: Serum levels of miR-18a and miR-532 were upregulated in patients with extrahepatic cholangiocarcinoma (eCCA) compared to healthy controls (p < 0.05). MiR-18a and miR-532 levels were correlated with each other (p = 0.011, Spearman's rho = 0.482) but showed no significant correlation with age or traditional tumor markers (CA19.9, CEA, AFP). No significant differences in miR-18a and miR-532 levels were observed concerning tumor localization or histological grading. For predicting tumor resectability, miR-532 at a cut-off point of 2.12 showed a sensitivity of 72.73%, specificity of 81.25%, and an AUC of 71.3%, while miR-18a, at a cut-off of 1.83, had a sensitivity of 63.64%, specificity of 75%, and an AUC of 59.7%. ROC curve analysis suggested moderate diagnostic potential for miR-18a and miR-532, with AUC values of 0.64 and 0.689, respectively. Conclusions: Although miR-18a and miR-532 showed significant upregulation in eCCA patients compared to healthy controls, they did not demonstrate significant associations with key clinical parameters, limiting their effectiveness as standalone diagnostic biomarkers. Further research involving larger, multi-center cohorts and additional molecular markers is necessary to validate these findings and explore the broader diagnostic potential of miRNAs in CCA.

Clinical features and surgical treatments of neurofibromas associated with neurofibromatosis type 1

To explore the clinical features, surgical treatment, and effectiveness of neurofibromas associated with neurofibromatosis type 1 (NF1). A clinical data of 41 patients with NF1 admitted between December 2018 and April 2024 was retrospectively analyzed. There were 15 males and 26 females, with an average age of 27.5 years (range, 5-61 years). Only one type of neurofibroma existed in 3 patients and the rest of the patients had more than two types of neurofibromas. Fourteen patients had total resection of multiple cutaneous neurofibromas (CNF). Eighteen patients of diffuse neurofibromas underwent total, near-total, or subtotal resection. Among the 13 patients of localized nodular neurofibromas, 9 of benign tumors underwent total sub-capsular resection and 4 of malignant peripheral nerve sheath tumor (MPNST) underwent maginal resection, and only 1 underwent postoperative radiotherapy and chemotherapy. Among the 15 patients of plexiform neurofibromas (PNF), 5 patients underwent both superficial and deep PNF resection, 2 underwent the superficial PNF resection, and 8 underwent the large nodular lesions in the deep PNF resection. There were 8 MPNST, of which 7 cases underwent total sub-capsular resection and large tumor capsule resection under neurophysiological monitoring, and 1 case with the tumor located on the top of the head underwent wide resection and skin grafting. One patient underwent proton knife therapy after surgery, 2 patients did not receive radiotherapy, and the remaining patients received conventional radiotherapy. All patients were followed up after surgery, and the follow-up time was 3-66 months, with an average of 25.0 months. Patients with CNF recovered satisfactorily after surgery, and there was no recurrence during follow-up. Patients with diffuse neurofibromas relieved preoperative symptoms after surgery. Three patients with diffuse neurofibromas located in the head and face recurred during follow-up. The patients with benign localized nodular neurofibromas recovered well after surgery, and only 1 patient had transient regional neuralgia after surgery. Among the patients with MPNST, 2 patients died of recurrence and lung metastasis, while the remaining 2 patients had no recurrence and metastasis during follow-up. All preoperative symptoms disappeared in patients with benign PNF, and no tumor recurrence was observed during follow-up. Two patients with PNF located in the brachial plexus had difficulty in shoulder abduction after surgery, 1 patient with PNF located in vagus developed hoarseness after surgery. Among the 8 patients with MPNST in PNF, 1 died of lung metastases and 1 died of systemic failure. The remaining 6 patients were in stable condition during follow-up, and no tumor recurrence or metastasis was observed. According to the clinical features of neurofibromas in patients with NF1, choosing appropriate surgical approaches can obtain good effectiveness. Because of the difficulty of completely resection, diffuse neurofibromas, especially those located in the head and face, are prone to recurrence after surgery. MPNST has the worst prognosis, high incidence of recurrence/metastasis, and short survival period. Total resection combined with radiotherapy can decrease local recurrence.

Early Outcomes of Preoperative Short Course Radiotherapy With Simultaneous Integrated Boost and Response-adapted Chemotherapy for Advanced Rectal Cancer

Background and purposeLimited evidence exists for dose escalation in neoadjuvant short course radiotherapy (SCRT) for rectal cancer. With enhanced imaging and radiotherapy techniques over the past decades along with the valuable endpoint of pathological complete response (pCR), we believe SCRT with simultaneous integrated boost could potentially provide deeper pathological responses and improve local control. Methods and MaterialsBetween January 2020 and December 2022, locoregional-advanced rectal cancer patients that were treated with neoadjuvant SCRT with simultaneous integrated boost up to 5.5–6Gy per fraction with five daily fractions followed by response-adapted chemotherapy was retrospectively reviewed. The pCR rates, R0 resection rates, tumor downstaging, toxicities, and early pattern of recurrence are reported. ResultsAmong the 76 patients, 67 (88%) were able to undergo curative intent surgery. R0 resection was achieved in 99% (n = 66) of patients with pCR rates of 28% (n = 19). Forty-six percent (n = 31) of patients had significant pathological downstaging (ypT2N0) and 55% (n = 37) of patients had both T and N downstaging. Most common grade 3 or above radiotherapy-related side-effects were proctitis, rectal pain, and dermatitis found in 5% (n = 4), 3% (n = 2) and 3% (n = 2) of patients, respectively. Grade 3 or above surgical complications were observed in 15% (n = 10) of patients. There were no treatment-related deaths. With a median follow-up of 27 months, only 6% (n = 4) had local recurrence after surgery. ConclusionsNeoadjuvant short course radiotherapy with simultaneous boost for rectal cancer is feasible with no added toxicities. Patients who underwent surgery achieve a high R0 resection and pCR rates. Early data suggest low rates of locoregional recurrence. Further follow-up and research is needed to validate and optimize the dose, method, and schedule of dose escalation.

THE ROLE OF CA 19.9 IN PREDICTING THE OPERABILITY OF CARCINOMA PANCREAS

Objectives: Adenocarcinoma of the pancreas remains a relatively incurable disease despite advances in surgical care. Approximately 25% of patients will be found to have unresectable tumors during surgery even though computed tomography (CT) has demonstrated that they are resectable. There is a controversy regarding the use of cancer antigen 19-9 (CA 19-9) to decide the resectability of pancreatic adenocarcinoma [1]. Our aim is to study the use of CA 19-9 in determining the operability of carcinoma pancreas [2]. Methods: This was a prospective study which included 69 patients and the study period was from December 2021 to December 2022. Data were collected from all patients with carcinoma of the pancreas who underwent surgical management. CA 19-9 levels were measured and recorded [3]. During surgery, the operative findings on resectability were documented and tabulated against corresponding CA 19-9 levels and contrast-enhanced CT (CECT) findings. Results: Of the 69 patients who were operated on, 38 patients had resectable tumors and underwent the Whipples procedure and 31 of them had non-resectable tumors and had to undergo palliative bypass procedures. Among the 31 patients whose tumors were non-resectable, only four were diagnosed non-resectable preoperatively with CECT, and the other 27 were found to be non-resectable only during surgery. That shows the relevance of this study. Of the 31 non-resectable cases, 14 (45.2%) patients had elevated CA 19-9 values of more than 501, and the rest 17 (54.8%) patients had low CA 19-9 values. Among the 38 resectable cases, 12 patients (31.6%) had elevated CA 19-9 more than 501, and 26 patients (68.4%) had low values. In conclusion, among non-resectable cases, 45.2% had raised CA 19-9, and among operable cases, 31.6% showed raised CA 19-9. Hence, CA 19-9 seems to be an insignificant predictor of tumor resectability [4]. Conclusion: It was found that the need for a pre-operative predictor for resectability of carcinoma pancreas is relevant while considering mortality and morbidity in operating carcinoma pancreas cases. On evaluating CA 19-9 as a pre-operative predictor, we found that CA 19-9 has no significant role as an indicator of local advancement or metastasis. Hence, we cannot consider CA 19-9 as a predictor of resectability of carcinoma pancreas preoperatively [5].