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Childhood cancers represent approximately 1% of all malignancies, with improved therapeutic strategies leading to an 80% long-term survival rate. However, these advancements come with potential long-term sequelae, among which fertility impairment is a major concern. Gonadotoxic treatments, including chemotherapy, radiotherapy and mutilating surgery, significantly impact reproductive potential, necessitating fertility preservation strategies. Minimally invasive surgery (MIS) plays a crucial role in preserving fertility in paediatric patients. Ovarian and genital tract-sparing surgery should be prioritised for benign ovarian tumours, which constitute 90% of childhood ovarian lesions, to avoid unnecessary loss of ovarian reserve. Ovarian transposition is recommended for patients requiring pelvic radiotherapy, relocating the ovaries outside the radiation field to mitigate ovarian damage. Additionally, uterine transposition has been explored to protect reproductive organs from radiation exposure. Ovarian tissue cryopreservation remains a promising option, particularly for prepubertal patients undergoing gonadotoxic treatments. Cryopreserved ovarian fragments can later be used for autografting or in vitro maturation, though the risk of malignant cell transmission remains a challenge. MIS contraindications are limited, primarily related to tumour size and the risk of rupture during laparoscopic procedures. A multidisciplinary approach involving oncologists, surgeons, radiotherapists and fertility specialists is essential for optimising outcomes. This chapter discusses the indications, techniques and challenges associated with MIS in fertility preservation, emphasising its role in ensuring reproductive potential while maintaining oncological safety in paediatric cancer patients.

The role of minimally invasive surgery (MIS) in paediatric pulmonary metastasectomy is evolving, reflecting advances in imaging, localisation and instrumentation. Compared with thoracotomy, thoracoscopy offers benefits of reduced postoperative pain, shorter recovery and easier reoperation. However, limitations include anaesthetic challenges in smaller children and lack of manual palpation, which may miss subpleural nodules, which is particularly important in chemoresistant tumours such as osteosarcoma and nonrhabdomyosarcoma soft tissue sarcoma. MIS is most suitable for limited disease, peripheral nodules and histologies where complete manual exploration is unnecessary. Indications depend on tumour type, number and location of lesions, as well as patient stability and institutional expertise. Advances in nodule localization-such as wire or coil marking, fluorescence imaging and radiotracers-have improved thoracoscopic precision. Wedge resection remains preferred for peripheral nodules, with anatomic resection reserved for central or larger lesions. MIS contraindications include extensive disease, inability to tolerate single-lung ventilation or lack of required resources. Optimal outcomes depend on experienced multidisciplinary teams and readiness to convert to open surgery when needed. Overall, thoracoscopy is a safe, effective option in selected paediatric patients, providing therapeutic benefit while minimising morbidity when applied judiciously to tumour biology and disease extent.

The Role of Minimally Invasive Surgery (MIS) in Paediatric Mediastinal Masses and Thoracic Tumours. MIS has transformed paediatric surgical oncology. This chapter explores the pivotal role of MIS in managing thoracic and mediastinal tumours in children, emphasising diagnostic and therapeutic advancements. Video-assisted thoracoscopic surgery has demonstrated significant utility, allowing for precise tumour resections and reduced morbidity. The techniques' feasibility and efficacy are underscored across a range of tumour types, including thymic, neurogenic and germ cell tumours, with promising outcomes in both high-resource and low- and middle-income countries (LMICs). The chapter pretends to be a practical guide for surgeons treating children with mediastinal and thoracic tumours, describing types of neoplasms, diagnostic approaches and treatment principles and options, with particular focus on surgical nuances and intraoperative advice. Despite its benefits, the chapter highlights critical challenges, including the limitations posed by large, invasive tumours and resource constraints in LMICs. The role of MIS in pulmonary metastases, particularly in osteosarcoma, is also discussed, with a focus on the balance between minimally invasive approaches and open surgeries for complete resection. Key principles for patient selection, surgical planning and the integration of advanced imaging and technology are emphasised, aiming for optimal outcomes. The chapter also addresses contraindications, different surgical techniques, anaesthetic considerations and the importance of global collaboration to expand access to MIS. It concludes with a call for continued innovation and equitable distribution of minimally invasive technologies worldwide, ensuring that the benefits of these techniques are accessible to all children with cancer, irrespective of geographical and economic barriers.

Surgery is a corner stone of treatment in children with nephroblastoma. Over recent years, the evolution of surgical guidelines has added to the improvement of treatment results in affected children. Minimally invasive surgery (MIS) has been described as part of this evolution. The present article summarises the current recommendations for MIS in nephroblastoma based on the relevant global treatment protocols.

Minimally invasive surgery (MIS) has become increasingly important in paediatric surgical oncology for the diagnosis and staging of solid tumours, due to its advantages in reducing morbidity, pain and hospitalisation times compared to traditional open surgery. While ultrasound-guided core needle biopsy (USCNB) typically remains the primary method for tissue sampling, MIS becomes essential in cases where USCNB is impractical or ineffective, such as with inaccessible tumour locations or where detailed staging information is required. Recent studies highlight the effectiveness of MIS in obtaining high-quality biopsy samples in neuroblastoma, thoracic tumours, hepatoblastoma and rhabdomyosarcoma, frequently outperforming open surgical methods regarding sample adequacy and complication rates. Video-assisted thoracoscopic surgery has demonstrated particular efficacy with minimal complications across various thoracic malignancies. Additionally, laparoscopic and robotic approaches for retroperitoneal lymph node dissection in rhabdomyosarcoma have proven beneficial by significantly reducing postoperative complications and hospital stays compared to open methods. Innovative adjunct technologies such as indocyanine green (ICG) fluorescence imaging have further advanced MIS by providing superior visualisation of tumour margins, metastases and lymphatic structures, enhancing the precision and safety of procedures. Overall, the integration of MIS techniques, supported by advanced imaging methods like ICG, represents a significant advancement in paediatric oncology, offering reliable diagnostic and staging options with reduced patient morbidity. These approaches provide critical clinical advantages, positioning MIS as an essential component of contemporary paediatric surgical oncology practice.

Minimally invasive surgical techniques are increasingly adopted for the management of hepatic masses in children. Laparoscopic liver biopsy can be used to obtain tissue diagnosis while avoiding the risks of open surgery and providing improved cosmesis. Laparoscopic or robotic liver resection has more gradually been adopted in children than in adults but can be utilized for appropriately located tumours as long as oncologic principles are maintained. Patient size is a factor when choosing whether to perform liver resection via a minimally invasive approach. Laparoscopic radiofrequency ablation offers an alternative strategy to surgery for paediatric patients with small masses or can serve as a bridge to transplant.

Introduction: There are multiple dose fractionation schedules for palliative radiotherapy (RT) of patients belonging to incurable locally advanced head and neck squamous cell carcinoma (LAHNSCC), but none is accepted as standard of care. In this study, we have compared three palliative RT schedules: Quad shot versus Christie versus conventional.

Aim and objectives: To assess and compare the toxicity, tolerance and effectiveness of three palliative RT regimens for incurable LAHNSCC.

Methods: A total 105 patients were randomised equally 1:1:1 in 3 arms with 35 patients each. Arm A: 14.8 Gy in 4 fractions with 3.7 Gy per fraction in 2 fractions per day 6 hours apart for 2 consecutive days for 3 sessions at 3 weekly interval. Total dose was 44.4 Gy in 12 fractions over 6.2 weeks. Arm B: 50 Gy in 16 fractions over 3.1 weeks with 3.125 Gy per fraction with 5 fractions per week.ARM C: 20 Gy in 5 fractions with 4 Gy per fraction with 5 fractions per week in 2 sessions at 3 weekly interval. Total dose was 40 Gy in 10 fractions over 3.5 weeks. All the patients were assessed pre RT, post RT and at 1 month follow up.

Results: All three arms had similar baseline characteristics 80% patients in arm A, 80% in arm B and 72% in arm C completed intended treatment. Drop out rate was 20%, 20% and 28%, respectively. Defaulters were excluded from the study. Mean ± standard deviation scores of individual domains of quality of life (QOL) (pre and post RT) have been calculated. Tumour response was partial in 92.8% patients of Arm A, 92.8% of Arm B, 96% of Arm C. Complete nodal response was seen in 71.4% patients of Arm A, 85.7% of Arm B, 60% of Arm C with Grade 3 mucositis observed in only 1 patient of Arm A and 4 patients of Arm B. Median overall survival was highest in Arm B, i.e., 6 months.

Conclusion: Statistically significant objective response and improvement in all QOL parameters, along with performance status, was observed in all the 3 arms. However, Christie arm patients had more symptomatic relief with better loco-regional control and prolonged overall survival as compared to other arms with acceptable toxicities. Therefore, as per this study, Christie schedule may be considered for adequate palliation of incurable LAHNSCC patients.

Transitional cell carcinoma of the prostatic urethra was first described and reported in 1963. Primary urothelial carcinoma of the prostate is an extremely rare disease, often misdiagnosed with other entities, particularly with urothelial carcinoma of the bladder involving the prostatic tissue. There are only dozens of cases of primary urothelial carcinoma in the prostate reported in the literature. The prognosis after diagnosis is reported to be poor and there is no consensus among experts concerning its proper treatment and follow-up. Herein, we report two cases of patients diagnosed with this entity with a median follow-up of 14 months.

Introduction: Breast cancer is the most common malignancy in women worldwide, with significant geographic variation in incidence. Adjuvant radiotherapy (RT) improves outcomes but can cause underrecognised toxicities such as radiation-induced nausea, vomiting (RINV) and esophagitis. This study aims to correlate RINV and esophagitis with organ-at-risk (OAR) dose constraints and clinical factors.

Materials and method: This prospective observational study analysed upper gastrointestinal (GI) toxicity in breast cancer patients receiving adjuvant RT. Patient demographics, clinical characteristics and dose-volume parameters for the stomach and esophagus were recorded. Statistical analyses identified predictors of RINV and esophagitis using univariate and multivariate models. Significant correlations were reported with a p-value <0.05.

Results: The study included 110 female breast cancer patients (mean age 51 years), with volumetric modulated arc therapy (VMAT) as the predominant radiation technique and moderate hypofractionation (42.56 Gy/16 fractions) as the most prescribed regimen. Acute upper GI toxicity was observed in 60.9% of patients, with 3.6% experiencing Grade 3 toxicity. Higher stomach dose exposure (D10, D30 and D60cc) significantly correlated with increased toxicity (p < 0.001). Free breathing was associated with a higher risk of GI toxicity compared to deep inspiration breath-hold (DIBH) (p = 0.035), which showed a protective effect. Dysphagia was reported in 70% of patients, with esophageal mean dose strongly predicting severity (p < 0.001). Multivariate analysis confirmed stomach D30 cc and esophageal mean dose as independent predictors of high-grade toxicity. VMAT was associated with slightly higher toxicity compared to three-dimensional conformal RT.

Conclusion: Radiation technique, dose-volume parameters and breathing strategy significantly influence acute upper GI toxicity and dysphagia in breast cancer RT. DIBH reduces GI toxicity risk, while higher stomach and esophageal doses correlate with increased toxicity. Incorporating the stomach as an OAR and optimising treatment planning can enhance tolerability and improve patient outcomes.

Health problems in the Latin American and Caribbean (LAC) region are mainly associated with noncommunicable diseases, with cardiovascular disease and cancer being the leading causes of death. However, knowledge and training opportunities in cardio-oncology, as well as active cardio-oncology groups, are mainly limited to large academic institutions or isolated private groups. To contribute to the implementation of viable strategies to ensure equitable access to care for all, it is essential to understand the current situation. This publication assesses the epidemiological situation of cancer in LAC and discusses the development of cardio-oncology in the region. It analyses the results of the survey on knowledge and medical action in cardio-oncology carried out among a group of physicians involved in the care of oncology patients and proposes recommendations based on the results obtained.