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Background and purpose: A high-quality treatment planning process is crucial in advanced radiotherapy techniques to ensure adequate dose to the target volume (TV) and sparing of organs at risk (OARs). This process often requires intensive labor, creating barriers for deployment in low- and middle-income countries (LMICs). We aimed to establish the feasibility of implementing knowledge-based auto-planning to facilitate clinical efficiency and increase patient throughput in an LMIC.

Materials and methods: We evaluated 60 randomly selected VMAT manual plans (VMPs), including 10 for each of the following sites: head and neck, oesophagus, breast, prostate, cervical, and rectal cancers. Using the same CT-structure datasets, volumetric modulated arc therapy auto-plans (VAPs), which involved matching the patient's CT-structure datasets with corresponding model structures before optimisation, were generated using RapidPlan^® knowledge-based models. The plans were compared using different dosimetric parameters, average planning times (APT) and plan scores, the latter of which was used for quantification of plan quality.

Results: The APT was 29.5 ± 3.0 minutes for VAPs compared to 43.2 ± 12.0 minutes for VMPs (p < 0.01), an approximate 33.0% time saving. The average plan scores were 73.9% ± 9.5% and 74.8% ± 10.5% for VAPs and VMPs, respectively (p = 0.50). The average homogeneity and conformity indices were 0.12 ± 0.05 and 0.93 ± 0.04 for VAPs compared to 0.09 ± 0.04 and 0.94 ± 0.03 for VMPs, respectively. For prostate and breast cases, both methods achieved the rectum's V50Gy ≤ 50% and spinal cord's Dmax ≤ 39.0 Gy constraints; however, VAPs projected lower doses than the corresponding VMPs (16.5 ± 4.3 versus 30.6 ± 13.1: p = 0.01) and (6.0 ± 1.6 versus 19.6 ± 2.3: p < 0.01).

Conclusion: The knowledge-based VAP-generated technique offers adequate dose coverage, homogeneity and conformity to the TV while sparing OARs, is less dependent on the planner's experience, saves planning time and holds tremendous potential for improving radiotherapy workflow in LMICs.

Introduction: Acute lymphoblastic leukaemia (ALL) is the most common childhood leukaemia and a significant cause of paediatric mortality worldwide. Morocco, as part of the World Health Organisation (WHO) Global Initiative for Childhood Cancer, aims to achieve a 60% survival rate for paediatric cancers by 2030.

Objective: This study evaluates survival rates and prognostic factors for paediatric ALL patients treated according to the MARALL 2006 protocol at the University Hospital Centre Ibn Sina in Rabat, Morocco.

Methods: A retrospective cohort study analysed data from 512 children diagnosed with ALL between June 2006 and December 2017. Sociodemographic, clinical and therapeutic data were collected. Kaplan-Meier and Cox regression analyses identified survival rates and prognostic factors.

Results: Among the patients, 56.2% achieved complete remission after first-line treatment and 20.9% experienced relapse. The 1-, 3- and 5-year overall survival rates were 83%, 67% and 63%, respectively. Significant prognostic factors included age ≥10 years, white blood cell count >50,000/mm³ and elevated lactate dehydrogenase levels. Standard risk classification and B-cell immunophenotype were associated with better survival outcomes.

Conclusion: This study highlights encouraging survival rates for paediatric ALL patients in Morocco, exceeding the WHO target of 60%. However, achieving the national goal of 80% survival requires further improvements in early diagnosis, treatment access and adoption of advanced therapies.

Background: Multidisciplinary tumour boards (MTBs) are regular meetings of various specialist physicians and healthcare professionals who reach a consensus on diagnostic or therapeutic next steps in a cancer patient's care. They have been used for cancer care worldwide. The benefits of these MTBs are well established in the treatment of cancer, leading to higher rates of care completion and improved overall survival. The authors of this study set out to launch an MTB specifically for liver cancer in Tanzania.

Methodology: In 2023, a multidisciplinary liver tumour board (MLTB) was established at Muhimbili National Hospital in Tanzania. This was designed to promote maximum engagement among medical specialties and international collaborators.

Results: MLTB meetings were held weekly in-person and virtually, where members submit patient cases for review of clinical presentation, imaging, pathology and presumed diagnosis to allow discussion of next steps in diagnosis or treatment. A consensus recommendation is then communicated to the involved departments and the presenting physician proceeds with scheduling the patient for completion of the recommendations.

Conclusion: This MLTB model aims to facilitate a comprehensive multidisciplinary treatment strategy for patients diagnosed with liver cancer. MLTBs are expected to enhance the quality of care provided to patients and promote the utilisation of advanced therapeutic options available in these nations.

Background: Prostate cancer (PCa) is one of the most heritable human cancers and it is the second most frequent malignancy in men worldwide. It accounts for a significant morbidity and mortality throughout the world. PCa with mismatch repair (MMR) deficiency often has aggressive clinical and histological features, but its rarity prevents the analysis of the underlying biology. Therefore, in this study, we aimed to evaluate the immunohistochemical expression of MMR proteins and P53 in PCa.

Materials and methods: Fifty cases of PCa were histologically examined. The MMR proteins and P53 immunoexpression were assessed. Also, P53 serum concentration levels using ELIZA was measured and pre-operative prostatic specific antigen (PSA) serum levels were obtained.

Results: There was a significant positive relation between mutS homologue 2 (MSH2) immunoexpression and both PSA serum level and P53 serum concentration (p value 0.001*). Also, there was a significant relation between MSH2 immunoexpression and tumour size, nodal metastasis, distant metastasis and grade grouping. While mutL homologue 1 (MLH1) immunoexpression showed a significant relation with human P53 serum concentrations only (p value 0.035*). Moreover, MLH1 immunoexpression showed only significant relation with nodal metastasis and tumour burden, p value was 0.033* and 0.001*, respectively.

Conclusion: MMR protein loss, especially MSH2, was seen in a significant subset of PCa. Interestingly, it was associated with significantly higher levels of serum PSA and p53. Moreover, it may be associated with unfortunate prognostic features as large tumour size, higher grade grouping and finally nodal and distant metastasis.

There is a consensus on delivering prevention, early detection and palliative care services as effective cancer control strategies in primary healthcare settings; however, examples of practical application are few. The study describes the implementation of integrated delivery of preventive, early detection and palliative care needs assessment through the frontline healthcare workers at the Health and Wellness Centre. The study employed a master trainer team of dentist and nurses trained in prevention and needs assessment of palliative care services who would further provide the handhold training to the Community Health Officers (CHO), multi purpose workers and Accredited Social Health Activist for awareness, prevention and generalist palliative care needs assessment. 2106 households with 256 people were screened as a result, with an average of around 30 screenings a day. Screen positivity rates was found to be 3.1% for the oral cancer, for breast cancer it was 1.8% while for cervical cancer it was 3.4%. While 0.5% households were identified in need of palliative care, all screened positive cases were provided counselling for further diagnostics and care at the cancer centre in the district. The ambulance services of 102 available in the state were arranged for people willing to undergo the diagnostics. The evidence generated has the potential for practical application with further testing and strengthening in the field.

Background: Colorectal adenocarcinoma (CRC) remains a leading cause of cancer-related mortality worldwide, with variable patient outcomes despite treatment advances. Traditional prognostic methods based on clinicopathological variables alone do not fully capture the biological complexity of the disease. This study aims to develop a risk scoring system based on genes associated with tumour-infiltrating immune cells (TIIC-associated genes) to improve prognostic assessment in CRC.

Methods: RNA-seq gene expression and clinicopathological data from The Cancer Genome Atlas Colorectal Adenocarcinoma (TCGA-CRC) database (647 tumour samples, 51 normal tissues) were analysed to identify differentially expressed TIIC-associated genes through comparison with the CIBERSORTx database. Univariate and multivariate Cox analyses were performed to screen for prognostic markers. A Gaussian mixture model was applied to cluster prognostic models and select the model with the most robust gene combination. The resulting risk scoring system was validated in an external cohort (GSE39582) and integrated with clinicopathological variables to develop a prognostic nomogram.

Results: From 128 TIIC-associated genes, an optimal prognostic model comprising CCL8 and Tyrosinase (TYR) was identified. The risk score was calculated as 0.152 × Exp(CCL8)-0.516 × Exp(TYR). Kaplan-Meier analysis confirmed significant survival differences between high-risk and low-risk groups in both TCGA-CRC and GSE39582 (p < 0.05). Time-dependent receiver operating characteristic analysis showed area under the curve (AUC) values ranging from 0.605 to 0.696 for 1-, 3- and 5-year survival in TCGA-CRC and GSE39582. Multivariate Cox analysis identified tumour (T stage), node (N stage) and risk score as independent prognostic factors.

Conclusion: Our risk scoring system based on CCL8 and TYR effectively stratifies CRC patients into distinct prognostic groups and could guide treatment decisions, particularly when integrated with TNM staging in a nomogram.

Background: Potentially avoidable emergency department (ED) visits are considered an indicator of the quality of cancer care.

Objective: To investigate the causes of ED visits of patients with advanced cancer.

Methods: We included in this analysis the visits to the ED of patients with advanced cancer in a tertiary cancer center in Mexico City, registered the reasons for their visit, and classified them as potentially avoidable or not by three independent observers.

Results: Seventy-seven patients were included, and 69% had at least one visit to the ED. Fifty-seven percent of visits were classified as potentially avoidable. The most common causes of visiting the ED were: pain, gastrointestinal disorders and ascites. Patients with gastrointestinal and genitourinary tumours had a higher frequency of unavoidable ED visits compared to patients with other tumours (43.3% versus 20.7%, p 0.03).

Conclusion: A significant proportion of patients with advanced cancer visit the ED and many of these visits were classified as potentially avoidable based on expert judgment and adapted criteria. These findings highlight the need for further research and context-specific strategies, such as care and early palliative integration, to safely reduce unnecessary ED use and enhance quality of life in low- and middle-income settings.

Background: Breast cancer (BC) care faces challenges in early detection, timely diagnosis and comprehensive management. Disparities persist, with underserved populations facing the greatest barriers. Addressing these requires policies that support consistent, evidence-based practices and enhance healthcare capacity and technology advancements. This document presents the development of the Breast Cancer Care Quality Index (BCCQI), supported by evidence to promote equitable care and improve BC outcomes globally, and discusses its adoption as a strategic tool within National Cancer Control Plans.

Methods: A two-part methodology identified challenges in BC care and defined dimensions, targets and indicators for the BCCQI, aligned with the World Health Organization Global Breast Cancer Initiative. A literature review and analysis of existing United Nations (UN) frameworks informed the initial structure of the index, which was later refined through expert feedback from a multidisciplinary panel representing diverse backgrounds and geographies.

Findings: The BCCQI is organised into four dimensions, comprising 10 targets and 23 indicators to guide the development of country-specific roadmaps. It should promote progress across key domains: health equity, patient centricity, universal access, care quality and treatment effectiveness. The Index is conceived as a dynamic tool, continuously refined through real-world application and emerging evidence.

Interpretation: Despite the previous initiatives, progress has been slow, likely due to practical details and country-specific guidance remaining limited due to scarce real-world evidence. Promoting national ownership and empowering action aligned with local challenges and opportunities, a flexible, strategic framework may help address these gaps.

Background: The incidence of colorectal cancer has been increasing worldwide. Middle- and low-income countries are also experiencing surge. This is due to a rapidly growing population.

Methods: All patients diagnosed and presenting to Indira Gandhi Medical College, Shimla, the sole tertiary cancer care centre in Himachal Pradesh, India, during the study period from January 2017 to December 2018, were included in the study and were followed till 60 months. Data were collected on clinical characteristics, pathology, treatment received and survival outcomes, specifically overall survival (OS) and disease-free survival (DFS). A Kaplan-Meier survival curve was constructed and multiple regression analysis was conducted to identify factors influencing survival, with a significance level set at p < 0.05.

Results: A total of 165 patients participated in the study, with a predominance of male subjects, a median age of 60 years and 34% of participants being under 50 years of age. The most prevalent symptoms were anorexia and weight loss, affecting 97% of the cohort, with the rectum identified as the most common site of involvement in 42% of cases. Histopathological analysis revealed signet ring-type morphology in 15% of the cases. The majority of patients presented with advanced stages, specifically stage 3 (36%) and stage 4 (32%). A multimodal treatment strategy was employed, involving collaboration among radiation oncologists, surgeons and medical oncologists. After a follow-up period of 60 months, 22 patients were lost to follow-up and only 23 patients remained alive. Multiple regression analysis indicated that only the stage of the disease significantly influenced overall survival (OS) and DFS.

Conclusion: Limited health awareness, coupled with the challenging topography of the region, has led to a significant number of defaulters. This, in conjunction with the advanced stage of the disease and inadequate access to healthcare, has contributed to suboptimal OS and DFS rates. Further epidemiological investigations, including genetic analyses, are necessary to better characterise the presentation of this disease.

Background: Cancer remains a significant public health challenge, being the second leading cause of death in urban areas and the fourth in rural regions of India. The estimated 1.15 million new cancer cases in 2018 are projected to double by 2040. Despite the critical importance of early detection, cancer screening rates in rural India remain alarmingly low. This study investigates barriers to breast and cervical screening among women in remote villages of Karnataka using the Health Belief Model (HBM) as a theoretical framework.

Methods: A community-based screening program for oral, breast and cervical cancer, was implemented in three taluks of Chikkaballapur district, Karnataka, from September to November 2021. Quantitative data from 4,974 screened women were complemented by qualitative interviews with 292 women who did not consent to screening, particularly for breast and cervical cancer. Interviews were guided by HBM constructs perceived susceptibility, severity, barriers, benefits, cues to action and self-efficacy and analysed thematically.

Results: Out of the 4,974 women who participated in screening clinics, less than 10% consented to clinical breast examination and none to cervical screening. Major barriers to screening included socio-cultural factors (stigma, lack of awareness, peer pressure), economic constraints (work priorities and financial insecurity), psychological barriers (fear of outcomes and lack of healthcare trust) and physical challenges (accessibility and seasonal constraints). Fear of treatment outcomes and financial implications were prominent psychological deterrents. Mitigation strategies were noted to address these barriers, including awareness campaigns, flexible camp timings and local stakeholder engagement.

Conclusion: Addressing barriers to cervical and breast cancer screening requires a holistic, community-centred approach informed by theoretical models like HBM. Sustainable interventions must prioritise awareness, accessibility and affordability to bridge critical healthcare gaps and reduce the burden of cancer in rural India.