Current oncology最新文献

Hereditary predisposition substantially shapes prevention and management across urologic oncology. This narrative review synthesizes contemporary, practice-oriented guidance on whom to test, what to test, how to act on results, and how to implement care equitably for hereditary forms of prostate cancer, renal cell carcinoma (RCC), urothelial carcinoma, pheochromocytoma/paraganglioma (PPGL), and adrenocortical carcinoma (ACC). We delineate between forms of indication-driven germline testing (e.g., universal testing in metastatic prostate cancer; early-onset, bilateral/multifocal, or syndromic RCC; reflex tumor mismatch repair (MMR)/microsatellite instability (MSI) screening in upper-tract urothelial carcinoma (UTUC); universal testing in PPGL; universal TP53 testing in ACC) and pair these strategies with minimum actionable gene sets and syndrome-specific surveillance frameworks. Key points include targeted prostate-specific antigen screening in BRCA2 carriers and the impact of BRCA/ATM variants on reclassification during active surveillance; major hereditary RCC syndromes with genotype-tailored surveillance and pathway-directed therapy (e.g., HIF-2α inhibition for von Hippel-Lindau disease); UTUC/bladder cancer in Lynch syndrome with tumor MMR/MSI screening, annual urinalysis (selective cytology), and immunotherapy opportunities in deficient MMR disease/MSI-H; PPGL management emphasizing universal germline testing, intensified surveillance for SDHB, cortical-sparing adrenalectomy, and emerging HIF-2α inhibition; and ACC care modified by Li-Fraumeni syndrome (minimization of radiation/genotoxic therapy with whole-body imaging surveillance). Testicular germ cell tumor remains largely polygenic, with no routine germline testing in typical presentations. Finally, we provide pre-/post-test genetic-counseling checklists and mainstreamed workflows with equity metrics to operationalize precision care and close real-world access gaps.

Magnesium is essential for cellular metabolism, and its deficiency has been associated with adverse outcomes in various cancers. The MDS, which considers factors such as diuretic and proton pump inhibitor use, alcohol consumption, and kidney function, is a practical indicator of Mg deficiency. This retrospective cohort study assessed 200 patients with EC treated between 2010 and 2024 to explore the prognostic value of MDS. Patients were divided into low (0-1), intermediate (2), and high (≥3) MDS risk categories. Higher MDSs were significantly associated with older age, comorbid conditions, hypertension, diabetes, and reduced serum magnesium and vitamin D levels (all p < 0.001). Kaplan-Meier analysis revealed that patients with high MDSs experienced notably shorter overall and progression-free survival than those with lower scores. Multivariate Cox regression analysis identified age, tumor grade, lymphovascular invasion, and stage as independent prognostic factors, excluding those for MDS. These results indicate that although MDS is associated with comorbidities, biochemical deficiencies, and poorer unadjusted survival, it does not independently predict the prognosis of EC. The MDS could be a straightforward and cost-effective tool for identifying metabolically vulnerable patients, especially among the elderly, and merits further validation in prospective studies.

Accessible health information is essential to promote patient engagement and informed participation in clinical research. Brief summaries on ClinicalTrials.gov are indented for lay people; however they are often written at a reading level that is too advanced for the public. This study evaluated the performance of a Generative Artificial Intelligence (GAI)-powered tool-Pub2Post-in producing readable and complete layperson brief summaries for urologic oncology clinical trials. Twenty actively recruiting clinical trials on prostate, bladder, kidney, and testis cancers were retrieved from ClinicalTrials.gov. For each, a GAI-generated summary was produced and compared with its publicly available counterpart. Readability indices, grade-level indicators, and text metrics were analyzed alongside content inclusion across eight structural domains. GAI-generated summaries demonstrated markedly improved readability (mean FRES 73.3 ± 3.5 vs. 17.0 ± 13.1; p < 0.0001), aligning with the recommended middle-school reading level, and achieved 100% inclusion of guideline-defined content elements. GAI summaries exhibited simpler syntax and reduced lexical complexity, supporting improved comprehension. These findings suggest that GAI tools such as Pub2Post can generate patient-facing summaries that are both accessible and comprehensive.

Background: Multidisciplinary team (MDT) care is now recognized as the most effective approach to managing lung cancer treatment. While MDTs aim to improve coordination, decision-making, and patient outcomes, their impact on patient-reported outcomes, particularly quality of life (QoL), remains unclear.

Objective: This systematic review aimed to examine how the involvement of a multidisciplinary team (MDT) in the care of patients with lung cancer affects patient-reported outcomes and to investigate the enablers and barriers for implementing and running MDT care in lung cancer management.

Methods: We systematically searched Medline, Embase, Cochrane, and Scopus (up to March 2024) to identify studies comparing QoL outcomes in patients with lung cancer managed with and without MDT care. The review was conducted and reported in accordance with the PRISMA 2020 guidelines. Risk of bias was assessed using the CASP tool, and findings were synthesized narratively. QoL outcomes were grouped into physical, functional, emotional, and social domains, and quantitative and qualitative data were synthesized narratively due to heterogeneity across studies.

Results: Eleven studies met the inclusion criteria, comprising a total of 10,341 patients, with 3760 in MDT groups and 6581 in non-MDT groups. The methodological quality of the studies varied, with 10 papers rated as moderate to high quality. The findings suggest that MDT care may contribute positively to emotional support, and physical well-being. Better patient satisfaction and communication in MDT settings.

Limitation: Heterogeneity and the lack of standardized PRO tools in outcome measures and study design limited comparability.

Conclusions: MDT care may have a beneficial impact on certain aspects of quality of life in patients with lung cancer, particularly emotional and physical well-being. However, more robust and standardized research is needed to determine the full extent of its benefits on patient-reported outcomes.

Recent advances in systemic therapies have improved clinical outcomes for patients with unresectable hepatocellular carcinoma (uHCC), as shown in randomized phase 3 clinical trials. Given the availability of alternative systemic regimens, an early imaging biomarker of treatment efficacy is crucial to avoid delays in deciding whether to continue the current regimen or switch to another therapy. We report two cases of uHCC that demonstrated patchy pooling of contrast material within the tumor on early follow-up contrast-enhanced computed tomography after the initiation of atezolizumab combined with bevacizumab (AB therapy), an imaging feature consistent with the vascular lake-like phenomenon. In both cases, this imaging feature appeared at the first response assessment after several cycles, and each patient achieved a partial response as the best overall response per Response Evaluation Criteria in Solid Tumors version 1.1. Subsequently, each patient underwent or was considered for conversion therapy. The vascular lake-like phenomenon may represent an early imaging biomarker of treatment efficacy following AB therapy.

Anal canal squamous cell cancer (ASCC) is commonly treated with chemoradiotherapy (CRT). Inflammatory bowel disease (IBD) is a relative contraindication to pelvic radiotherapy due to toxicity concerns. Advances in treatment planning since the 2000s have resulted in lower radiation doses delivered to nearby at-risk organs. We systematically reviewed the literature to answer the question "Do IBD patients with ASCC treated with CRT have different outcomes than non-IBD patients in the present era?". We searched the Medline, Web of Science, Cochrane, ClinicalTrials.gov, and CINAHL databases for English-language articles published between 1 January 2001 and 1 January 2025. We included patients with ASCC treated curatively with CRT. This systematic review is registered in the PROSPERO international systematic review registry (CRD420251062114). A total of 220 unique articles were identified. Two reviewers independently screened titles and abstracts, which was followed by full-text screening. Eleven publications, comprising 24 patients, were included in the systematic review. The local recurrence rate following CRT was 25%, and 30% of patients had documented late toxicity. The included literature consists of case reports and small case series. Despite the limitations, our review shows toxicity, local control, and survival outcomes for IBD patients with ASCC treated with CRT that are comparable to those of non-IBD patients.

Circulating tumor DNA (ctDNA) analysis has emerged as a powerful and minimally invasive approach for genomic profiling of metastatic castration-resistant prostate cancer (mCRPC), enabling real-time detection of tumor-derived mutations that guide therapy. Approximately 20% of mCRPC patients harbor alterations in homologous recombination repair (HRR) genes, most commonly BRCA1/2 and ATM, which are actionable with different poly-(ADP-ribose) polymerase inhibitors (PARPIs) used as monotherapy or in combination with androgen receptor signaling inhibitors (ARSIs). A smaller subset of patients with mismatch repair deficiency (MMRd) or microsatellite instability-high (MSI-high) tumors may benefit from immune checkpoint blockade with pembrolizumab. Different FDA-approved liquid biopsy assays detect these actionable alterations when tissue biopsies are unavailable or insufficient. This review summarizes current evidence on ctDNA-based genotyping in mCRPC, highlighting clinically actionable mutations, corresponding targeted therapies, and technical and analytical considerations for clinical implementation. By capturing DNA shed from multiple metastatic sites, ctDNA profiling provides a comprehensive view of tumor heterogeneity and enables serial monitoring of molecular evolution. Overall, ctDNA analysis represents a transformative advance in precision oncology, supporting personalized treatment selection and ongoing assessment of therapeutic response in mCRPC.

Sarcomas are a group of aggressive cancers, primarily affecting the soft tissue or bone [...].

Renal Cell Carcinoma (RCC) is a common malignancy, often diagnosed incidentally. In recent years, the prognosis of metastatic disease has been improved due to the development of immune checkpoint inhibitors (ICI) and tyrosine kinase inhibitors (TKI) as first-line treatments. However, when progression occurs, the therapeutic options are limited. Understanding crucial biological pathways could lead to a greater understanding of the natural history of the disease, which could help to overcome the mechanism of resistance and to develop new treatments. The clinical significance of homologous recombination deficiency (HRD) in RCC remains to be investigated. To improve the knowledge about this topic, we conducted a narrative review to summarize the current evidence on HRD-related variations and signatures in RCC, together with their prognostic and predictive implications. Preliminary evidence indicates that canonical HRD variants (BRCA1/2) are infrequent in RCC, while broader DNA damage response (DDR) alterations like BAP1, PBRM1, ATM, and SETD2 are more prevalent. Elevated HRD genomic scores in clear-cell RCC correlate with a worse prognosis and an immunologically exhausted microenvironment. From a therapeutic point of view, PARP inhibitor monotherapy has exhibited initial efficacy in small cohorts with high levels of DDR mutation, yet remains investigational for RCC.

To assess the outcomes of a modified surgical approach for the treatment of uveal melanoma involving endoresection with intentional residual tumor at the margins, combined with adjuvant ruthenium-106 brachytherapy. This technique aims to reduce surgical morbidity, while preserving visual function and maintaining effective local tumor control and survival. We conducted a retrospective observational study including 33 patients with choroidal melanoma treated between January 2017 and August 2024 at a single tertiary ocular oncology center in Spain. Patients underwent pars plana vitrectomy and endoresection leaving residual tumor followed by ruthenium-106 brachytherapy. Clinical, functional, and oncological outcomes were analyzed, including tumor recurrence, metastasis, visual acuity, complications, and cytogenetic findings. Kaplan-Meier analysis was used to estimate survival and recurrence rates. After a mean follow-up of 41.7 months, local tumor recurrence occurred in 2 patients (6.06%) and enucleation was performed in 1 patient (3.03%). Two patients (6.06%) developed metastases, with one disease-specific death, resulting in a 5-year survival rate of 97%. Visual acuity of 20/200 or better was preserved in 60.61% of patients. The most frequent complications were retinal detachment (36.36%) and macular edema (45.45%). Cytogenetic analysis showed a significant association between chromosome 1p loss and both recurrence and metastasis (p = 0.032). No cases of phthisis bulbi or severe hypotony were observed. This modified endoresection technique with intentional tumor residuals and adjuvant ruthenium-106 brachytherapy offers a safe and function-preserving option for selected patients with choroidal melanoma. It achieves good tumor control and visual outcomes, with a low rate of enucleation and metastasis. Further studies are required to validate its long-term efficacy.