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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.

Background: Hepatocellular carcinoma (HCC) is a complex malignancy influenced by genetic, epigenetic and immune-related factors. The tumour immune microenvironment plays a critical role in HCC progression and response to immunotherapy. Identifying key immune-related gene signatures through clustering techniques can provide insights into tumour biology and therapeutic targets.

Methods: We employed K-means, Markov Clustering Algorithm (MCL) and density-based spatial clustering of applications with noise (DBSCAN) to analyse immune-related genes in HCC. Functional enrichment analysis was conducted using Gene Ontology (GO) biological process, cellular component and molecular function categories, along with pathway analysis from Kyoto encyclopedia of genes and genomes (KEGG) and Reactome databases. Additionally, protein-protein interaction (PPI) hub analysis and microRNAs (miRNA) target predictions were integrated to understand the regulatory networks.

Results: K-means clustering segregated immune genes into three clusters, with major histocompatibility complex (MHC) class II genes forming a distinct cluster. MCL and DBSCAN identified a more unified immune cluster incorporating both MHC class I and II molecules, suggesting their coordinated role in antigen presentation. GO analysis revealed enrichment in antigen processing and presentation pathways, immunoglobulin-mediated responses and glutamate receptor signaling. KEGG pathway analysis highlighted associations with autoimmune diseases and viral infections. PPI hub analysis identified CD4, CD74 and HLA-DQA1 as central nodes, while miRNA analysis suggested regulatory interactions affecting immune gene expression.

Conclusion: Our clustering analysis highlights distinct immune-related gene signatures in HCC, emphasising the role of antigen presentation and immune modulation in tumour progression. The findings provide a foundation for further investigation into immunotherapeutic strategies targeting key immune pathways in HCC.

Incidence and mortality rates of cervical cancer remain high in Southern Africa (SA). We explored awareness of cervical cancer symptoms and risk factors, as well as risk lay beliefs among women recently diagnosed with cervical cancer from SA and Zimbabwe. Patients were asked to complete a locally validated questionnaire with unprompted, open-ended questions to assess awareness of cervical cancer symptoms and risk factors. Among 501 women (SA 285, Zimbabwe 216), 46% (229) were able to recall one or more symptoms (SA 24%, Zimbabwe 76%) and 19% (93) were able to recall one or more risk factors of cervical cancer (SA 27%, Zimbabwe 73%). In SA, factors associated with increased symptom awareness included higher education level (completion of secondary education compared to not completing secondary education; adjusted odds ratios (aOR) 2.74, 95% confidence interval (CI) 1.17-6.43) as well as living in urban and peri-urban areas compared to living in rural areas (Urban: aOR 2.98, 95% CI 1.35-6.80; Peri-urban: aOR 3.28, 95% CI 1.13-9.35). Having a self-reported history of a chronic condition was associated with lower risk factor awareness compared to not having a self-reported chronic condition (aOR 0.07, 95% CI 0.00-0.42). In Zimbabwe, those who self-reported living with HIV were more likely to know one or more risk factors compared to those without HIV (aOR 2.69, 95% CI 1.31-5.67). Overall, 90 (18%) women mentioned at least one lay belief about risk factors for cervical cancer, with the most reported being inserting herbs, creams or objects into the vagina (9%, n = 43). The low levels of cervical cancer awareness in two Southern African countries highlight the urgent need to improve cervical cancer awareness, as low levels of awareness can impact timely cancer diagnosis and limit the uptake of cervical cancer prevention programs.

Background: Cancers in adolescents and young adults (AYAs; ages 15-39 years) differ from those in children and older adults. AYAs with cancers have received less research focus over the years despite their unique medical, psychological, socioeconomic and sexual concerns. The burden of cancer among this age group in Nigeria is unknown. This study aims to determine the pattern of cancers in AYAs seen in a radiation oncology clinic in Nigeria.

Method: A retrospective study among AYAs (15-39 years) with cancer who presented at a Radiation Oncology Clinic in Nigeria between January 2018 and December 2023.

Results: There were 529 new cancer cases among AYAs, accounting for 14.1% of all cancer cases seen during the period. The male-to-female ratio was 1:3. The majority (72.8%) were in the 30-39 age range, with a mean age of 32.06 ± 6.18 years. Females had a higher mean age (33.01 ± 5.31 years) than males (29.43 ± 7.57 years) (p < 0.001). Breast (39.1%), bone and soft tissue (12.9%) and cervix (11.6%) were the most common sites of cancer in AYAs. Among the males, bone and soft tissue (20.0%), nasopharynx (13.6%) and sinonasal (10.7%) were the most common sites, while breast (52.2%), cervix (15.4%) and bone and soft tissue (10.0%) were the most common sites among females.

Conclusion: AYAs accounted for 14.1% of all new cancer cases. Breast cancer was the most common cancer among female AYAs, while bone and soft tissue cancers were the most common among males.

Purpose: Modern radiotherapy is a complex, technology-driven process that requires precise planning and delivery to maximise tumour control and minimise harm to normal tissues. Errors in radiotherapy can result in underdosing tumours or overdosing healthy tissues, posing serious risks to patients. In the Eastern Mediterranean Region and Turkey (EMRO+T), variations in workforce expertise, institutional policies and regulatory frameworks contribute to inconsistencies in incident reporting and safety practices. While some centers adhere to international guidelines, others lack structured mechanisms for reporting and learning from errors. A regional incident learning system (ILS) could standardise reporting, enhance safety culture and improve patient outcomes.

Methods: A cross-sectional survey assessed the state of radiotherapy ILS in EMRO+T. Ethical approval was obtained (CCCRC-94-2023), and the survey was distributed via Research Electronic Data Capture to 671 radiation oncology professionals. It gathered data on institutional classification, patient volume, technologies, local ILS presence, adherence to guidelines and perceptions of a regional ILS. Responses from 135 participants across healthcare settings were analysed.

Results: Most respondents (66%) were from government hospitals, and 29.5% worked in private institutions. About 25% of centers treated over 2,000 patients annually, and advanced techniques such as intensity-modulated radiotherapy (75.2%) and stereotactic body radiotherapy (52%) were widely used. However, only 70.7% adhered to international reporting guidelines, and just 48.4% had a local ILS. Barriers included a lack of leadership support (51%) and confidentiality concerns. Although 62% supported reporting by all staff, opinions on confidentiality varied. Regular incident review occurred in 64% of institutions and 91.7% strongly supported a regional ILS.

Conclusion: A regional ILS would foster knowledge-sharing, encourage a non-punitive culture and enhance transparency, accountability and continuous quality improvement in patient safety.

Background: ehealth improves the health-related quality of life for cancer patients and their families by providing easier access to medical information, promoting self-management, and providing personalised care through digital platforms. However, there is still a dearth of comprehensive understanding of their influences in developing countries.

Objectives: To identify several ehealth interventions accessible to family caregivers of people with cancer in developing countries and to assess the impact of these interventions on their health-related quality of life.

Methods: The review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Health databases and search engines, including PubMed, Medline via Ovid, Embase via Ovid, and CINAHL via EBSCOhost, will be used. We will include quantitative or mixed method research evaluating e-health, with a particular emphasis on the health-related quality of life of family caregivers of cancer patients. Studies from developing countries, including peer-reviewed journals and grey literature, will be considered without regard to publication date.The study selection process involves screening titles and abstracts for relevance, then, doing a full-text assessment against the inclusion criteria. The Cochrane Risk of Bias tool for randomised controlled trials and ROBINS-I V2 for non-randomised studies will be employed to assess the quality of the included studies. The A Measurement Tool to Assess Systematic Reviews will assess the quality of this systematic review.

Implications: This review offers a thorough and impartial summary of current research on e-health tools and their impact on the health-related quality of life of family caregivers of cancer patients. It seeks to inform evidence-based decision-making across healthcare, policy development, and research design by identifying knowledge gaps, emphasising areas requiring further investigation, and steering future research.

Systematic review registration: PROSPERO CRD42024622302 https://www.crd.york.ac.uk/PROSPERO/view/CRD42024622302.