Oncology-New York最新文献

Artificial intelligence (AI) is transforming health care by enhancing diagnostics, treatment planning, and patient monitoring. In palliative oncology, particularly for hematologic malignancies, AI has shown promise in improving symptom management, prognostication, and personalized care. AI-driven models utilizing electronic health records, wearable devices, and predictive analytics aid in the early detection of symptoms, optimization of pain management, and streamlining of clinical decision-making. Machine learning algorithms have also enhanced risk stratification in leukemia, lymphoma, and multiple myeloma by integrating genomic data, imaging, and treatment responses to refine prognostic models. Additionally, AI-powered tools support cancer survivorship by monitoring late-treatment effects and aiding end-of-life care through predictive analytics for timely palliative interventions. Despite these advancements, challenges remain, including data bias, ethical concerns, and the need for prospective validation in clinical settings. Addressing these limitations will be crucial for fully integrating AI into palliative oncology and hematologic malignancy care.

Objective: Given disparities in incidence and outcomes among racial and ethnic groups, and differences in patient characteristics among the 3 main types of gynecologic cancer, we examined whether clinical trial availability at a large, high-enrolling National Cancer Institute-designated Comprehensive Cancer Center reflects the clinical volume of each cancer in the catchment area. We also assessed whether the patients who consented to the trials reflected the racial and ethnic distribution of each cancer type.

Methods: Patients who consented to ovarian, uterine, and cervical cancer clinical trials at the UCLA Jonsson Comprehensive Cancer Center in Los Angeles, California, from 2013 through 2018 were included. Clinical trial and patient-level data were collected. Los Angeles County cancer incidence data were used to represent disease burden in the catchment area. χ-Square and Fisher exact tests were used to compare proportions.

Results: Twenty-four gynecologic oncology clinical trials were identified: 16 (67%) ovarian, 5 (21%) uterine, and 3 (12%) cervical cancer trials. Compared with corresponding county incidence rates, respectively, the proportion of patients with ovarian (82% vs 25%), uterine (9% vs 59%), or cervical (9% vs 6%) cancer who consented for clinical trials differed significantly ( P  < .001). The racial/ethnic distribution of patients also differed for ovarian ( P  < .001) and cervical cancer trials ( P  = .005). Patients who were Black or Asian were underrepresented in ovarian and cervical cancer trials; Hispanic patients were underrepresented in ovarian trials.

Conclusions: The distribution of clinical trials and patients who consented did not reflect the incidence or racial and ethnic makeup of gynecologic cancers in the catchment area. Greater efforts are needed to align trial availability and enrollment with disease burden and population diversity.

Purpose: To present a rare case of proximal-type epithelioid sarcoma (PES) of the vulva and highlight the importance of a multidisciplinary approach in its diagnosis and treatment, especially in the context of SMARCB1 loss.

Methods: A 41-year-old woman presented with a painless mass in the right labia majora. An MRI, PET/CT, histopathology, and immunohistochemistry confirmed the diagnosis of PES with loss of SMARCB1 expression. The patient underwent wide local excision followed by re-excision and inguinal lymphadenectomy. Adjuvant radiotherapy was initiated but discontinued at 46 Gy due to grade 2 skin reactions and wound dehiscence.

Results: Posttreatment PET/CT imaging posed challenges in distinguishing between recurrence and radiation-induced changes. Despite these challenges, the patient remained disease free during the 2-year follow-up period. This case underscores the diagnostic and therapeutic complexities involved in treating PES, particularly in sensitive anatomical regions such as the vulva. The loss of SMARCB1 served as a key molecular marker guiding diagnosis and therapeutic decisions.

Conclusion: The case underscores the importance of a comprehensive, individualized treatment approach, including surgery, radiotherapy, and advanced imaging, for managing rare malignancies such as vulvar PES.

Interim fluorodeoxyglucose (FDG)-PET is currently the most used predictor of early response to treatment in advanced-stage Hodgkin lymphoma. Patients with a negative PET after 2 cycles of chemotherapy (PET2) have a better treatment outcome than their counterparts. The objective of this review was to assess how PET-adapted treatment approaches have enhanced the management of advanced-stage Hodgkin lymphoma by adapting treatment according to initial response. PubMed, Web of Science, ScienceDirect, Google Scholar, Scopus, and the Cochrane Library were systematically searched using randomized controlled trials, phase 2/3 clinical trials, and systematic reviews between 2000 and 2024. Keywords used were "Hodgkin lymphoma," "PET-adapted treatment," "ABVD," "BEACOPP," "interim PET," and "treatment escalation/de-escalation." PET-adapted treatment strategies decrease PET2-negative patient treatment, decreasing adverse effects with no reduction in effectiveness, as evidenced by the RATHL, AHL2011, and HD18 trials. In PET2-positive patients, trials such as SWOG S0816 and HD0607 prove that the early intensification of treatment improves survival. Novel treatments, such as brentuximab vedotin and nivolumab, are promising options.

Despite significant advances in cancer research, the complexity of signaling pathways remains a major challenge in precision oncology. Tumors harbor a diverse array of genetic alterations; however, these often converge onto a limited set of core signaling pathways, notably RAS/RAF/MEK/ERK (MAPK), PI3K/AKT/mTOR (PAM), and Wnt/β-catenin. Concurrently, these pathways diverge extensively downstream, driving therapeutic resistance through mechanisms such as epithelial-mesenchymal transition, immune evasion, and metabolic reprogramming. Unlike previous literature that largely provides descriptive accounts of pathway alterations, this review uniquely synthesizes convergent and divergent signaling into a clinically actionable diagnostic and therapeutic framework. It critically assesses current precision oncology strategies, identifies gaps, and proposes a dual-axis model that integrates static genomic profiling with dynamic signaling evolution to inform precision therapy. By highlighting opportunities for combination therapy informed by pathway interdependencies and adaptive resistance mechanisms, this perspective provides novel clinical insights and tangible directions for future research in overcoming resistance in cancer treatment.

Adult granulosa cell tumor (GCT) of the ovary is a rare sex cord-stromal neoplasm characterized by potential for late recurrence. Hepatic metastases from GCT are exceedingly uncommon. We report a case of late hepatic relapse occurring 15 years post primary treatment. A 66-year-old woman with obesity presented with right upper quadrant pain of 1-month duration. She had a history of stage T1aN0M0 right ovarian GCT treated 15 years prior with total abdominal hysterectomy, bilateral oophorectomy, omentectomy, and adjuvant chemotherapy, with no follow-up. Imaging revealed extensive perihepatic and intrahepatic lesions and a midabdominal mass. Laparotomy confirmed an abdominal mass greater than 15 cm and multiple hepatic lesions. Excisional histopathology demonstrated metastatic GCT of the liver and peritoneum. This case emphasizes the need for lifelong surveillance in patients with GCT due to its latent recurrence potential even beyond a decade.

A 76-year-old man presented with a subtle, non-mass-like right insular and temporal opercular T2 FLAIR hyperintensity that remained stable for over 2 years before showing interval progression. Resection revealed mildly hypercellular atypical glial cells with a Ki-67 index of approximately 1% and no necrosis or microvascular proliferation. Immunohistochemistry was negative for IDH1 R132H. Next-generation sequencing identified a TERT promoter mutation, EGFR amplification, and CDKN2A deletion. Methylation profiling confirmed glioblastoma, IDH wild-type, World Health Organization grade 4. Despite lacking classic histologic features, the integrated molecular findings established the diagnosis. The patient underwent near-total resection, followed by hypofractionated radiotherapy with concurrent temozolomide, maintenance temozolomide, and tumor treating fields therapy. This case highlights the essential role of molecular diagnostics in accurately classifying diffuse gliomas with atypical histology.

Background: The rising incidence of oral cancer necessitates widespread implementation of preventive measures, particularly in resource-challenged settings where visual examination and patient education are more feasible. Addressing the reluctance of patients clinically diagnosed with leukoplakia and reinforcing the importance of follow-up care is imperative. The study aims to assess the impact of patient information leaflets (PILs) and habit cessation counseling (HCC) on clinically diagnosed patients with leukoplakia.

Materials and methods: The study included 60 clinically diagnosed cases of leukoplakia and was divided into 3 groups (20 participants each). Group 1 received an expert-designed PIL, group 2 had HCC, and group 3 received both PILs and HCC. All groups underwent follow-up assessments, including lesion reexamination and a structured questionnaire.

Results: Group 3 demonstrated the highest level of understanding and application of the information, as reflected in both their attitude and practice toward their habits, and group 2 did better than group 1.

Conclusion: The combination of a PIL and an HCC can effectively support reluctant patients with leukoplakia, fostering habit cessation and promoting lifestyle modifications through increased awareness.

The COVID-19 pandemic has exposed significant vulnerabilities among patients who are immunocompromised, who remain at increased risk for severe disease despite widespread vaccination in the general population. This commentary reviews insights from Dorry L. Segev's, MD, PhD, keynote lecture at MedNews Week, highlighting reduced vaccine efficacy, prolonged viral shedding, and increased severity of COVID-19 in this population. Emerging strategies such as monoclonal antibody prophylaxis, oral antivirals, personalized vaccine approaches, and T cell-based therapies show promise in mitigating these risks. Additionally, the commentary discusses the implications of hybrid immunity and the potential for within-host viral evolution to generate resistant variants, underscoring the need for targeted genomic surveillance. Ethical considerations are raised regarding the use of advanced oncologic treatments with marginal survival benefits but substantial toxicity in the context of COVID-19 vulnerability. To effectively protect immunocompromised patients, tailored public health measures, dedicated vaccination programs, and integrative lifestyle interventions are required. Synergistic efforts among clinicians, researchers, and policy makers are essential to ensure equitable access to preventive and therapeutic strategies, strengthening health care resilience for vulnerable populations during the ongoing pandemic and beyond.