Current oncology最新文献

Background/Objectives: Cancer is a disease with a rising global incidence each year, and an interdisciplinary approach for both its treatment and care is needed. This study aimed to evaluate the effects of a 10-week interdisciplinary integrative oncology group-based program for patients with cancer on quality of life, fatigue, resilience, well-being, anxiety and depression. Methods: This prospective, nonrandomized intervention, waiting-list control group study evaluated the quality of life, fatigue, resilience, anxiety, depression and well-being of a total of 128 patients with cancer (intervention group: n = 86; waiting-list control group: n = 42) at baseline (week 0) and at the end of the observation period (week 10). Results: Compared with patients in the waiting-list group, patients who participated in a 10-week interdisciplinary integrative group program during or after cancer treatment had positive effects on quality of life, social/family well-being, functional well-being, resilience, fatigue, and anxiety. Specifically, significant time × group effects were observed on (FACT-G: p = 0.002, η² = 0.73; FACIT-Fatigue: p = 0.014, η² = 0.47; FACIT-F: p = 0.002, η² = 0.74), social/family well-being (p = 0.015, η² = 0.46), functional well-being (p < 0.001, η² = 0.102), with a large effect size and resilience mean scores (p = 0.003, η² = 0.069), and anxiety mean scores (p = 0.005, η² = 0.060), with a medium effect size. Conclusions: This study revealed that compared with nonparticipants, participants in the 10-week interdisciplinary program benefited more from the program.

Objective: To evaluate treatment patterns, predictors of treatment selection, and overall survival (OS) in patients with noninvasive (Ta-Tis) urothelial carcinoma of the urethra (UUC). Patients and Methods: We conducted a retrospective cohort study of adults diagnosed with noninvasive UUC (stage Ta or Tis, N0, M0) between 2018 and 2021 using the National Cancer Database. Patients were categorized into prostatic and non-prostatic urethral cohorts. Treatment groups included endoluminal ablation alone, ablation combined with topical intraluminal therapy, urethrectomy, and no subsequent treatment. Multinomial logistic regression was used to identify predictors of treatment selection. The OS was assessed using Kaplan-Meier and multivariable Cox regression, with separate models for each anatomical cohort. Results: A total of 436 patients were included (185 non-prostatic, 251 prostatic); 91.9% (n = 401) were male. Ablation alone was the most common treatment in both cohorts (non-prostatic: 57.3%; prostatic: 62.6%), followed by urethrectomy (non-prostatic: 21.1%) and ablation plus topical therapy (prostatic: 20.3%). In the non-prostatic cohort, high-grade histology (OR 15.15; 95% CI, 3.82-60.04) and Tis stage (OR 3.27; 95% CI, 1.10-9.69) were associated with increased odds of urethrectomy. In the prostatic cohort, high-grade histology was associated with increased use of urethrectomy (OR 59.29; 95% CI, 4.61-763.17) and ablation plus topical therapy (OR 3.09; 95% CI, 1.21-7.90). Tis stage was also associated with ablation plus topical therapy (OR 2.53; 95% CI, 1.14-5.62). This treatment approach was associated with improved OS compared with ablation alone (HR 0.18; 95% CI, 0.05-0.60; p = 0.005). Conclusions: Treatment selection differed substantially by tumor location, stage, and grade, reflecting both treatment selection in noninvasive UUC varied by tumor location, grade, and stage. In prostatic tumors, ablation plus topical therapy was associated with improved survival, supporting its role as a risk-adapted, organ-sparing strategy in selected patients.

Objective: The aim of this study was to assess the association between the Lung Immune Prognostic Index (LIPI) measured at diagnosis and both event-free survival (EFS) and overall survival (OS) in patients with stage III non-small cell lung cancer (NSCLC). Methods: This retrospective cohort included patients diagnosed with stage III NSCLC between September 2022 and July 2024, all of whom had a minimum follow-up duration of six months. LIPI was calculated using the derived neutrophil-to-lymphocyte ratio (dNLR) and lactate dehydrogenase levels at diagnosis. Clinical, demographic, and treatment-related data were systematically collected. Survival outcomes were estimated using the Kaplan-Meier approach, while factors associated with prognosis were examined through Cox proportional hazards models. Results: The study population consisted of 68 patients, predominantly male (86.8%), with a mean age of 63.4 ± 8.7 years. According to the Lung Immune Prognostic Index classification, 29 patients (42.6%) were categorized as having a good score, 27 (39.7%) as intermediate, and 12 (17.6%) as poor. During a median follow-up of 15.4 months, a total of 40 progressions and 22 deaths occurred. Median EFS was 17.7, 9.4, and 5.8 months for good, intermediate, and poor LIPI groups, respectively (p < 0.001). Median OS was 25.7 months in the good LIPI group, was not reached in the intermediate group due to insufficient events, and was 6.7 months in the poor group (p < 0.001). In multivariate Cox analysis, poor LIPI was independently associated with inferior survival (EFS: HR = 2.87, 95% CI: 1.85-4.46, p < 0.001; OS: HR = 2.59, 95% CI: 1.40-4.78, p = 0.002). Conclusions: LIPI calculated at diagnosis is an independent prognostic factor for both EFS and OS in stage III NSCLC. Validation in larger, prospective cohorts is warranted to further define its prognostic role in stage III NSCLC.

Purpose: Timeliness of systemic therapy initiation for advanced lung cancer is highly dependent on pathology and molecular pathology laboratory services. Here, we aimed to prospectively evaluate liquid biopsy as a potential strategy to expedite systemic therapy decision-making in lung cancer management. Patients and Methods: This prospective cohort study included consecutive patients with suspected lung cancer seen at the time of initial specialist consultation who underwent both liquid and solid tumour biopsy (group A) and patients with confirmed lung malignancy who underwent solid tumour biopsy alone (group B), between 1 February 2022 and 31 May 2023. Due to laboratory factors, liquid biopsies were processed in batches of 13, whereas solid tumour biopsies were processed individually upon receipt, as per standard practices. Co-primary endpoints included the time from solid versus liquid biopsies to biomarker reporting and palliative systemic therapy initiation. Results: A total of 324 patients were included in the study. The median time from date of blood draw to date of liquid biopsy result was 78 days. For group A (n = 50), the median time from date of solid tumour biopsy to biomarker reporting was 22 days, and the median time from date of solid tumour biopsy to palliative systemic therapy was 42 days. The median time from date of liquid biopsy blood draw to palliative systemic therapy initiation was 56 days. For group B (n = 274), the median times from date of biopsy to biomarker reporting and to palliative systemic therapy initiation in all patients were 22 and 47 days, respectively. Conclusions: While we did not demonstrate improvement in timeliness of biomarker reporting or systemic therapy initiation with liquid biopsy, several barriers leading to delay in liquid biopsy reporting were identified due to unexpected COVID-19-related supply chain disruption and the cost-limiting need to batch sample analysis. Further studies that address the identified barriers are warranted to assess the potential improvement in timeliness of care, should liquid biopsy analysis be implemented in real-time.

Breast cancer is a complex and highly heterogeneous disease, and its management is increasingly moving towards the principles of precision medicine. In this context, the androgen receptor (AR) has emerged as a promising therapeutic target, particularly within the challenging subgroup of triple-negative breast cancers (TNBCs) that express it. This scoping review provides a comprehensive and detailed analysis of the multifaceted role of AR in breast cancer. We delve into its intricate molecular structure, its differential function in ER-positive vs. TNBC subtypes, and the detailed molecular mechanisms that govern its activity. We provide a thorough examination of the landmark clinical trials with antiandrogen agents, including not only enzalutamide but also other first- and second-generation compounds, and discuss the emerging data on their efficacy. Furthermore, we will explore the critical challenges that hinder their widespread clinical adoption, such as primary and acquired resistance mechanisms, the need for robust predictive biomarkers, and the heterogeneity of AR expression. Finally, we outline future research directions, focusing on novel combination therapies and the development of next-generation agents and predictive tools to optimize patient selection and improve clinical outcomes.

Outpatient neurosurgical oncology has expanded with advances in anesthesia, imaging, and minimally invasive techniques, enabling safe same-day discharge for selected patients undergoing procedures such as stereotactic biopsy and craniotomy. In this review, we find that across multiple international series, same-day discharge rates in several studies ranging from 85 to 95%, with low complication (3-6%) and readmission rates when structured pathways, including standardized selection criteria, enhanced recovery protocols, and routine 4-h postoperative CT imaging, are used. Studies on economic analyses demonstrate substantial cost savings driven by reduced inpatient bed utilization, with no increase in adverse events. Key challenges identified include medicolegal concerns amongst physicians, patient education, and limitations in organization adoption. Telemedicine and remote monitoring are increasingly incorporated to streamline preoperative evaluation and postoperative follow-up, improving access and continuity of care. Emerging technologies such as laser interstitial thermal therapy and focused ultrasound may further expand the outpatient neuro-oncology repertoire. Overall, current evidence supports outpatient neurosurgical oncology as a safe, efficient, and patient-centered model when applied with structured clinical pathways and patient selection.

Background: Despite the availability of contouring guidelines and advanced imaging modalities, interobserver variability (IOV) in the delineation of the planning target volume and organs at risk remains a critical factor influencing treatment quality in radiotherapy. The aim of this study was to examine variations in contour delineation with respect to anatomical landmarks, as well as differences in the inclusion of lymph node levels within the PTV. Methods: Ten senior radiation oncologists from six different institutions participated in the study and contoured PTV1, PTV2 and 16 OARs in a patient with oropharyngeal carcinoma. Interobserver variation was quantified by volume statistics such as mean, standard deviation (SD) and ranges, as well as using coefficient of variance (CoV) and conformity index (CI). Results: High agreement was observed in the inclusion of the ipsilateral lymph node levels Ib-IVa and VIIa+b, whereas notable discrepancies were identified in the delineation inclusion of the cervical triangle group and lateral supraclavicular nodes. Regarding OARs, the greatest variability was observed in the delineation of the left and right inner ear, with volume ranges of 0.12-2.84 cm³ and 0.11-2.38 cm³, respectively. Conclusions: This study reaffirms the presence of significant interobserver variability in the delineation of PTVs and OARs in patients with oropharyngeal carcinoma. Especially inclusion of elective lymph node levels and definition of margins around the gross tumor volume are substantial factors for IOV. By emphasizing structured anatomical assessment as a standard approach, variability can be minimized, treatment consistency enhanced, and ultimately, patient outcomes improved.

This paper explores recent advancements in end-of-life (EOL) care in Canada, focusing on palliative care (PC) in oncology, advance care planning (ACP), and medical assistance in dying (MAiD). Despite improvements in cancer treatment, cancer remains a leading cause of death in Canada, with patients facing significant physical, psychosocial, and emotional challenges throughout the illness trajectory. Over the past few decades, PC has evolved to address serious illness from diagnosis onward, enhancing symptom management, quality of life, and patient satisfaction, while reducing hospital admissions and unnecessary treatments. However, barriers such as misconceptions about PC, late PC referrals, and limited access to PC, particularly in rural and remote areas, still exist. This perspective paper draws on the authors' collective clinical and research experience in oncology and PC, complemented by a focused review of key literature. Ongoing education for oncology nurses on EOL care, including on PC, ACP, and MAiD, as well as continued efforts to expand access to PC for all Canadians, are imperative in order to improve the EOL experience for people affected by cancer nationwide.

Background: As a newly recognized type of cell death implicated in cancer, ferroptosis plays multiple roles in tumor biology. Here, we sought to construct a prognostic framework for EC on the basis of ferroptosis-related long non-coding RNAs (FerlncRNAs), microRNAs (FermiRNAs), and mRNAs (FRGs) for endometrial cancer (EC). Methods: Transcriptomic profiles of tumors and matched clinical data for 544 EC patients were retrieved from TCGA-UCEC. A prognostic framework was generated through Cox regression, integrating ferroptosis-linked lncRNAs, miRNAs, and mRNAs. EC cases were stratified into groups with high or low predicted risk based on ferroptosis-related gene expression. The model's prognostic utility was examined through Kaplan-Meier (K-M) analysis and receiver operating characteristic curves. Results: A prognostic model based on 16 RNAs, including 10 FerlncRNAs, 2 FermiRNAs, and 4 FRGs, was developed. Analysis using K-M plots showed that high-risk patients experienced shorter overall survival than their low-risk counterparts (p < 0.001). The model's area under curve (AUC) values were 0.731, 0.749, and 0.768 at 1-, 3-, and 5-year time points, surpassing those of standard clinical parameters. Furthermore, in an external validation cohort, these signature RNAs were associated with EC prognosis. Conclusions: The novel ferroptosis-related lncRNA-miRNA-mRNA prognostic model provides a basis to assess clinical prognosis in EC patients.

Oesophageal cancer remains a significant global health burden with poor survival outcomes despite multimodal treatment. Recent advances in magnetic resonance imaging (MRI) have opened opportunities to improve radiotherapy delivery. This review examines the role of MRI and MR-guided radiotherapy (MRgRT) in oesophageal cancer, focusing on applications in staging, treatment planning, and response assessment, with particular emphasis on magnetic resonance linear accelerator (MR-Linac)-based delivery. Compared to computed tomography (CT), MRI offers superior soft-tissue contrast, enabling more accurate tumour delineation and the potential for reduced treatment margins. Real-time MR imaging during treatment can facilitate motion management, while daily adaptive planning can accommodate anatomical changes throughout the treatment course. Functional MRI sequences, including diffusion-weighted and dynamic contrast-enhanced imaging, offer quantitative data for treatment response monitoring. Early clinical and dosimetric studies demonstrate that MRgRT can significantly reduce radiation dose to critical organs while maintaining target coverage. However, clinical evidence for MRgRT in oesophageal cancer is limited to small early-phase studies, with no phase II/III trials demonstrating improvements in survival, toxicity, or patient-reported outcomes. Long-term clinical benefits and cost-effectiveness remain unproven, highlighting the need for prospective outcome-focused studies to define the role for MRgRT within multimodality treatment pathways.