Current oncology最新文献

Purpose: Cancer survivors in rural and underserved areas face barriers such as limited access to oncology exercise programs and limited facilities, contributing to health inequities in cancer survivorship. This study explored cancer survivors' thoughts on exercise and mobile technology for exercising with a mobile application (app) during and after treatment in rural and remote areas.

Methods: Three online focus groups were conducted in February 2024 using semi-structured interviews with 12 open-ended questions. Eligible participants were adult cancer survivors or caregivers living in medically underserved areas, English-speaking, consented to being audiotaped, and attended one 60-min group interview. The discussions were transcribed verbatim and analyzed via a content analysis approach with consensus.

Results: Fifteen participants attended from four States. None of the participants were advised to exercise; availability of exercise resources depended on geographic location and a cancer-specific exercise app was desired. They understood the benefits of exercise after diagnosis but expressed a need for more guidance during treatment. Geographic location shaped their activities, with most engaging in daily physical tasks rather than structured exercise. Most participants were receptive to using an exercise app to manage fatigue. Suggested key features to exercise with an app included live trainers, exercise checklists, visual benchmarks, and programs tailored to different fitness levels.

Conclusions: These results emphasize the need for personalized resources, guidance, and on-demand accessibility to an exercise oncology app. A cancer-specific exercise mobile app will mitigate health inequities for cancer survivors residing in rural and remote areas.

The antitumor activity of immunotherapy is strongly influenced by the presence of driver gene mutations/translocations. For this reason, knowledge of the predictive value of specific genetic alterations in relation to anti-PD(L)1 activity is highly useful for the clinical decision making process in many solid tumors, particularly in Non-Small Cell Lung Cancer. Although data on the correlation between genetic alterations and response to immunotherapy are available in the majority of common cancers, data are lacking in the subset of patients with KIT-mutated Thymic Carcinoma (TC). As a consequence, although immunotherapy is a standard treatment for TC patients, the lack of this knowledge leads to uncertainty when proposing immunocheckpoint inhibitors in this subset of patients. Here we describe the first report of a patient with KIT-mutated TC who received the anti-PD1 agent pembrolizumab, which caused a sustained partial response. This case report of a sustained partial response achieved with pembrolizumab in a patient with KIT-mutated TC after progression to chemotherapy and imatinib may be supportive during clinical decision making for this extremely rare disease.

Episiotomy is a perineal incision enlarging the vaginal opening during labor, preventing severe perineal/vaginal/ano-rectal lacerations. We performed a systematic literature review (PRISMA guidelines; Pubmed, Scopus and Web of Science databases) of primary malignant tumors arising from the episiotomy site. Thirteen primary carcinomas were reported, mainly endometriosis-related histotypes (77%) (nine clear cell, CCC; one endometrioid, EC) with only two vulvar invasive squamous cell carcinomas and one adenoid cystic carcinoma of Bartholin's gland. No sarcomas, melanomas or malignant trophoblastic tumors were described. Endometriosis was associated with tumors or reported in history (62%). Malignant transformation occurred 3 to 27 (mean 16) years after diagnosis of endometriosis. Patients were usually post-/peri-menopausal (eight cases, 61%) (age range: 31-70 years, mean 50). Imaging should exclude distant (0% in our series) or lymph node metastases (three cases, 23%), looking for potential invasion of vagina (five cases, 39%), anus (including sphincter) (four cases, 31%) and/or other deep pelvic soft tissues (five cases, 39%). All patients underwent surgery, except for a CCC-patient (only chemoradiation) subsequently progressing and dying of disease. Adjuvant chemotherapy and/or radiotherapy were administered to five (39%) cases, neoadjuvant therapy to four cases (31%). Globally, three (23%) cases recurred or progressed, and two-thirds (15%) died of disease (1 CCC, 1 EC). Radical surgery with lymph node status evaluation and eventual excision should be performed when possible. Chemotherapy and/or radiotherapy can be considered in an adjuvant and/or neoadjuvant setting (or as only treatment in inoperable patients). However, the role of different treatments should be studied in further larger multicenter series.

Belzutifan is a new HIF-α inhibitor mainly used in two different indications: von Hippel-Lindau syndrome-associated renal cell carcinoma, haemangioblastomas and pancreatic neuroendocrine tumours, as well as sporadic advanced pre-treated renal cell carcinoma. Although efficacy has been demonstrated in phase II and III studies, belzutifan is still not approved in many countries. In addition, von Hippel-Lindau syndrome is a rare disease. Therefore, there is virtually no real-world experience data of belzutifan efficacy available. We aim to determine the real-world efficacy and tolerability of belzutifan in patients with von Hippel-Lindau syndrome-associated tumours and in patients with sporadic advanced tyrosine kinase- and immune checkpoint inhibitors pre-treated for renal cell carcinoma. A retrospective analysis of five patients treated with belzutifan between 2023 and 2024 at a Swiss cancer centre was conducted. In this case series, all patients consistently benefitted from belzutifan with response to treatment. This case series provides real-world evidence that belzutifan is an effective and well-tolerated treatment option for patients with von Hippel-Lindau syndrome-associated renal cell carcinoma, haemangioblastomas and sporadic advanced pre-treated renal cell carcinoma.

Phyllodes tumors account for 2-3% of all fibroepithelial breast tumors and less than 1% of all breast cancers. These tumors are categorized into benign, borderline, or malignant based on cellular atypia, mitotic activity, and stromal overgrowth. Surgical excision with clear margins, ideally greater than 1 cm, is the primary treatment for phyllodes tumors to ensure effective local control. Preoperative diagnosis is challenging due to the clinical and radiological similarities between phyllodes tumors and fibroadenomas. The efficacy and role of adjuvant treatments remain subjects of ongoing debate and investigation. Borderline phyllodes tumors exhibit biological characteristics that straddle the line between benign and malignant, presenting significant clinical and surgical management challenges. Given the rarity of this specific subgroup and the ambiguity of the risk of recurrence or progression to malignant phyllodes, this narrative review aims to provide a comprehensive overview of the recurrence risk associated with these tumors.

Background: A total of 50% of patients with AL amyloidosis have t(11;14) translocation, allowing us to use the selective oral BCL-2 inhibitor venetoclax in their treatment. Case presentation: Our patient was admitted to the gastroenterology department due to weight loss and abdominal pain. An abdominal CT scan revealed some enlarged lymph nodes; therefore, he was referred to the hematology department. A bone marrow biopsy showed massive amorphous amyloid deposition. The sample was positive on Congo red staining and exhibited double refraction under a polarized light microscope. Serum-free light chains and the difference between involved and uninvolved free light chains (dFLCs) were elevated. Using fluorescent in situ hybridization, we detected t(11;14) translocation. Further examinations confirmed the involvement of the liver, colon and heart. Stage II AL amyloidosis was confirmed. Our patient received combined induction therapy with CyBorD and venetoclax due to the presence of the t(11;14) translocation. After six cycles, the patient achieved complete remission. Autologous stem cell transplantation (ASCT) was performed. At 100 days post-ASCT, the patient had complete hematologic remission. Venetoclax maintenance treatment was initiated. The follow-up examinations showed that the patient is in very good partial remission. Conclusions: In the case of our AL amyloidosis patient with t(11;14) translocation, the combined treatment with CyBorD and venetoclax was well tolerated and effective.

Symptom burden is known to be high in patients with hematologic malignancies and can adversely impact patients' quality of life. The aims of this retrospective observational cohort study were to explore symptoms in patients with hematologic malignancies, including during the last year of life, to explore symptom profiles in patients with hematologic malignancies, and to explore associations among symptoms/symptom profiles and demographic, clinical, and treatment-related variables. Symptom prevalence and severity and symptom profiles were explored in patients with hematologic malignancies who completed patient-reported outcome measures (n = 6136) between October 2019 and April 2020. Emergency department visits and hospital admissions during the study period were reviewed. Chart audits were undertaken for patients who died within a year of completing patient-reported outcome measures (n = 432) to explore symptoms and healthcare utilization in the last year of life. Patients with hematologic malignancies in this study reported multiple symptoms co-occurring, with more than 50% of patients reporting four or more symptoms. Classes of co-occurring symptoms (symptom profiles) were associated with demographic and clinical factors as well as with healthcare utilization, particularly emergency department visits. The most reported symptoms were tiredness, impaired well-being, and drowsiness. The findings emphasize the need for more supports for patients with hematologic malignancies, particularly for symptom management.

Ethos adaptive radiotherapy is employed frequently in the pelvis to improve treatment accuracy by adapting to daily anatomical changes. The use of this CBCT-guided platform for abdominal treatments is made challenging by motion-related image artifacts that are detrimental to the Ethos auto-contouring process. We present a preliminary in silico study enabled by synthetic CBCT data of Ethos adaptive radiotherapy for pancreatic cancer. Simulation CT and daily CBCT images were collected from nonadaptive patients treated on Ethos. Contoured CBCTs drove structure-guided deformable registration from the CT to daily CBCTs, providing an approximate daily CT used to produce synthetic CBCT data. Two adaptive workflows were simulated using an Ethos emulator. Over 70 fractions across 10 patients in a solely deformation-based workflow, PTV prescription coverage increased by 23.3±9.4% through plan adaptation. Point doses to the stomach were reduced by 10.2±9.3%. Ultimately, un-adapted plans satisfied target coverage and OAR constraints in 0% and 6% of fractions while adapted plans did so in 80% of fractions. Anatomical variation led to poor performance in rigidly aligned un-adapted plans, illustrating the promise of Ethos adaptive radiotherapy in this region. This promise is balanced by the need for artifact reduction and questions regarding auto-contouring performance in the abdomen.

In this article, we share our findings on patients' experiences creating digital stories about living with advanced cancer, represented through found poetry. Over a period of 12 months, patients from the program "Managing Cancer and Living Meaningfully" (CALM) completed digital stories about their experiences living with cancer. Digital stories are short, personalized videos that combine photographs, imagery, narration, and music to communicate a personal experience about a topic of inquiry. Patient interviews were conducted about the digital storytelling process. Found poetry guided the analysis technique. It is a form of arts-based research that involves using words and phrases found in interview transcripts to create poems that represent research themes. This article begins with a brief overview of the psychosocial intervention CALM, arts in healthcare, and found poetry, followed by the project background. The found poems represent themes of emotional impact, legacy making, and support and collaboration. Findings also indicate the inherently relational aspect of digital storytelling as participants emphasized the integral role of the digital storytelling facilitator. What follows is a discussion on digital storytelling, which considers the role of found poetry in representing patient voices in the research process.

Background: Breast cancer (BC) is the most common malignancy affecting women globally, significantly impacting their quality of life (QoL). This study aimed to assess the prevalence and severity of symptoms in newly diagnosed BC patients undergoing chemotherapy in Oman using the Edmonton Symptom Assessment System (ESAS-A); Materials and Methods: A cross-sectional study was conducted between December 2022 and February 2024 at the Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), University Medical City, Oman. The study included 105 Omani women, aged 18 to 60, diagnosed with stage I to III BC and undergoing chemotherapy. Symptom evaluation was performed using ESAS-A. Descriptive statistics were employed to summarize socio-demographic characteristics and clinical outcomes, while the Mann-Whitney U test and multiple linear regression analysis were used to examine associations between independent variables and symptom scores; Results: Out of 127 invited participants, 105 (82.6%) agreed to participate. The average age was 43.6 years (SD = 7.2). Fatigue (37.1%), poor well-being (30.5%), and drowsiness (27.6%) were the most commonly reported symptoms. Anxiety and depression affected 21.9% and 17.1% of participants, respectively. Linear regression analysis showed that having children was linked to higher fatigue and shortness of breath, while inversely associated with pain. A family history of chronic disease was significantly correlated with higher depression scores; Conclusions: This study is the first in Oman to utilize ESAS-A for assessing symptom burden in newly diagnosed BC patients undergoing chemotherapy. The findings highlight the importance of personalized symptom management and enhanced supportive care to improve patient well-being.