CA: A Cancer Journal for Clinicians最新文献

The therapeutic landscape for renal cell carcinoma (RCC) and urinary tract cancer (UTC) has transformed dramatically, creating complexity in treatment selection and sequencing. The 2025 Advanced Urologic Cancer Consensus Conference was convened to establish evidence-based expert consensus recommendations for optimal management. A multidisciplinary panel of 51 experts participated in a modified Delphi process addressing questions developed through iterative consensus-building covering RCC and UTC management. Voting occurred before and after the conference, and analyses focused on postmeeting responses. Consensus was defined as ≥75% agreement, with strong consensus as >90%. Strong consensus was found on the use of adjuvant pembrolizumab for higher risk RCC (pathologic T2 [pT2], grade 4; pT3–pT4, any grade; pTXN1; or fully resected metastatic disease) and on neoadjuvant therapy before cystectomy for localized UTC. There was strong consensus on the use of enfortumab vedotin plus pembrolizumab as frontline therapy for metastatic UTC and the use of platinum-based chemotherapy postprogression in biomarker-negative UTC. For RCC, there was consensus on the role of single-agent vascular endothelial growth factor receptor–tyrosine kinase inhibitor therapy after progression on frontline immune checkpoint inhibitor/vascular endothelial growth factor receptor–tyrosine kinase inhibitor therapy or dual immune checkpoint inhibitor therapy. However, there was a lack of consensus on other critical areas in the management of RCC and UTC. The 2025 Advanced Urologic Cancer Consensus Conference provides evidence-informed guidance for complex clinical scenarios while identifying critical research priorities. The group recognizes that the lack of consensus across multiple areas highlights the need for improved patient selection and prospective studies enabling optimal combination and sequencing approaches. This iterative annual process will address evolving treatment paradigms to optimize outcomes.

Radiotherapy is a cornerstone of modern oncologic care, yet its sequelae can significantly impair survivors' quality of life. Chronic radiation-induced conditions—including skin fibrosis, bone necrosis, radiation cystitis, and proctitis—pose substantial challenges for both patients and caregivers, particularly in the context of improving long-term cancer survival. Hyperbaric oxygen therapy, characterized by the promotion of angiogenesis, fibroblast activation, and tissue remodeling in hypoxic environments, has emerged as a potential adjunctive treatment for mitigating these late effects. Herein, the authors critically evaluate randomized trials, cohort studies, and real-world data while highlighting gaps in knowledge, including patient selection, optimal treatment protocols, and long-term outcomes. In addition, they discuss practical considerations and health system implications of the integration of hyperbaric oxygen therapy into survivorship care. The objective of this review is to provide clinicians with an evidence-informed framework to guide decision making in the multidisciplinary management of radiation-related late effects.

Interventional radiology (IR) is a rapidly evolving medical field that combines advanced imaging with minimally invasive techniques for both diagnosis and treatment. Interventional oncology (IO), a subspecialty of IR, focuses on the minimally invasive, image-guided intervention for cancer and cancer-related conditions. IR plays an important and increasingly recognized role within the multidisciplinary care of patients with cancer, contributing meaningfully to diagnosis, therapy, and palliation. IO therapies, particularly tumor ablation and transarterial embolization, aim to target tumors directly while preserving surrounding healthy tissue. These therapies are increasingly supported by clinical guidelines and have shown favorable outcomes in cancers such as hepatocellular carcinoma, renal cell carcinoma, and metastatic colorectal cancer. This review focuses on the role of minimally invasive, image-guided, locoregional IR therapies for patients who have cancer.

This update expands the 2020 American Cancer Society (ACS) cervical cancer screening guideline for average-risk women and individuals with a cervix who are at average risk, to include self-collection for human papillomavirus (HPV) testing and revised guidance for exiting cervical cancer screening. Self-collected vaginal specimens, a method of primary HPV testing, align with the ACS cervical cancer screening guideline. When clinician-collected cervical specimens are used for HPV testing, repeat screening is recommended every 5 years for those with a negative test. For self-collected vaginal specimens, the ACS endorses the following recommendations of the Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee (of which it is a member): (1) primary HPV screening using clinician-collected cervical specimens is preferred, and self-collected vaginal specimens are acceptable for average-risk individuals aged 25–65 years; and (2) repeat testing in 3 years is recommended after a negative result on a self-collected HPV screening test. These recommendations apply only to combinations of collection devices and HPV assays approved by the US Food and Drug Administration for HPV testing in a clinical setting or at home. The rationale notes that the use of self-collected vaginal specimens can overcome barriers to screening for many patients, but most patients who test HPV-positive will require extra follow-up steps, and data on long-term, real-world effectiveness are limited. For certain high-risk individuals, clinician-collected samples are still recommended. Furthermore, in response to high rates of cervical cancer among individuals older than 65 years and with poor implementation of current exiting screening criteria, ACS has amended the 2020 guideline to recommend HPV testing at ages 60 and 65 years, with the last HPV test at an age no younger than 65 years as a requisite to exiting screening. The revised recommendation states: To qualify for discontinuation of screening, the ACS recommends an average-risk woman or an individual with a cervix at average risk have negative primary HPV tests (preferred) or negative co-testing using HPV tests and cytology (acceptable) at ages 60 and 65 years. If primary HPV tests or co-testing are not available, three consecutive negative cytology (Papanicolaou) tests at the recommended screening interval with the last test at age 65 years are acceptable. If self-collected vaginal specimens are used for HPV testing, the 3-year testing interval should be followed. Additional screening exit stipulations relate to women at higher risk because of prior abnormal test results or current immune suppression.

Cancers of the lip, oral cavity, and pharynx (LOCP) represent a substantial public health challenge worldwide. Using GLOBOCAN national estimates of incidence, detailed cancer registry data from Cancer Incidence in Five Continents, and population statistics from the United Nations, the authors report the distribution of new cases of LOCP cancers in 185 countries by sex in 2022. Age-standardized incidence rates were calculated. For countries lacking registry data, regional averages from high-quality registries were used to impute subsite-specific estimates. Worldwide, 758,000 people were diagnosed with LOCP cancers in 2022, with oral cavity cancer accounting for approximately 42% of cases, followed by oropharynx (19.3%), nasopharynx (15.9%), hypopharynx (11.4%), salivary gland (7.3%), and lip (4.2%) cancers. Oral cavity cancer was the most frequent LOCP subsite among women in 141 countries and among men in 93 countries, and incidence rates were highest in countries in South-Central Asia. Oropharyngeal cancer was the most frequent LOCP subsite among men in 44 countries and among women in five countries across Europe, Northern America, South America, Australia, and New Zealand. Nasopharyngeal cancer was the most common subsite among men in 39 countries and women in 23 countries, mainly in Northern Africa, Middle Africa, and Eastern and South-Eastern Asia. Rates of hypopharyngeal and salivary gland cancers were low globally, although the incidence burden was greater than that of lip cancer. The authors discuss incidence patterns in relation to disease etiology and the prospects of delivering effective cancer control measures, spanning primary prevention, early detection, cancer treatment, and survivorship.