Current Oncology

11 pages, 1191 KiB

Open AccessArticle

The Role of Frailty and Myosteatosis in Predicting All-Cause Mortality in Older Adults with Cancer

by Efthymios Papadopoulos, Andy Kin On Wong, Sharon Hiu Ching Law, Sarah Costa, Angela M. Cheung, Dmitry Rozenberg and Shabbir M. H. Alibhai

Curr. Oncol. 2024, 31(12), 7852-7862; https://doi.org/10.3390/curroncol31120578 - 6 Dec 2024

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Abstract

Frailty and myosteatosis are each prognostic of all-cause mortality (ACM) in patients with cancer. However, it is unclear whether myosteatosis adds value to frailty for predicting ACM. We assessed whether myosteatosis improves the predictive ability of frailty for ACM in older adults undergoing [...] Read more.

Frailty and myosteatosis are each prognostic of all-cause mortality (ACM) in patients with cancer. However, it is unclear whether myosteatosis adds value to frailty for predicting ACM. We assessed whether myosteatosis improves the predictive ability of frailty for ACM in older adults undergoing chemotherapy. This was a retrospective study of older adults (≥65 years) initiating chemotherapy between June 2015 and June 2022. Frailty was assessed using a 24-item frailty index (FI). Myosteatosis was evaluated via computed tomography scans at the third lumbar vertebra (L3).. Multivariable Cox regression and Uno’s c-statistic determined the predictive performance of the FI and myosteatosis. In total, 115 participants (mean age: 77.1 years) were included. Frailty alone (adjusted hazards ratio (aHR) = 1.68, 95% confidence intervals (CIs) = 1.03–2.72, p = 0.037) and myosteatosis alone (aHR = 2.14, 95%CI = 1.07–4.30, p = 0.032) exhibited similar performance (c-statistic = 0.66) in predicting ACM in multivariable analyses adjusted for age, sex, body mass index, and treatment intent. However, the highest predictive performance for ACM was observed after inclusion of both myosteatosis and frailty in the multivariable model (c-statistic = 0.70). Myosteatosis improves the performance of frailty for predicting ACM in older adults with cancer. Prospective studies to assess the effect of exercise on myosteatosis in older patients are warranted. Full article

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24 pages, 520 KiB

Open AccessSystematic Review

Peripheral Neuropathy Instruments for Individuals with Cancer: A COSMIN-Based Systematic Review of Measurement Properties

by Silvia Belloni, Arianna Magon, Chiara Giacon, Francesca Savioni, Gianluca Conte, Rosario Caruso and Cristina Arrigoni

Curr. Oncol. 2024, 31(12), 7828-7851; https://doi.org/10.3390/curroncol31120577 - 6 Dec 2024

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Abstract

Although the literature on patient-reported outcomes (PROMs) continues to expand, challenges persist in selecting reliable and valid instruments for assessing peripheral neuropathy (PN) in patients with cancer. This systematic review aimed to identify all validated self-report PN scales and critically appraise their measurement [...] Read more.

Although the literature on patient-reported outcomes (PROMs) continues to expand, challenges persist in selecting reliable and valid instruments for assessing peripheral neuropathy (PN) in patients with cancer. This systematic review aimed to identify all validated self-report PN scales and critically appraise their measurement properties. This review was conducted using the COSMIN methodology for PROMs and the PRISMA statement. Five databases were searched from inception to August 2024, identifying 46 eligible studies and 16 PROMs. Evidence quality ranged from “very low” to “moderate”, with notable inconsistencies in the content and structural validity phases of most instruments. Instruments such as the Chemotherapy-induced peripheral neuropathy assessment tool and the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group–Neurotoxicity demonstrated moderate quality and potential utility in clinical practice, while others, including the Location-based assessment of sensory symptoms in cancer and the Measure of Ovarian Symptoms and Treatment, had insufficient evidence to support their use. Importantly, all PROMs focused on chemotherapy-induced peripheral neuropathy, highlighting a significant gap in instruments addressing other PN causes, such as radiotherapy or tumor-related nerve damage. Further research should prioritize developing and validating instruments for distinct cancer populations, ensuring robust psychometric properties and clinical applicability. Full article

8 pages, 1437 KiB

Open AccessArticle

Oncologic and Operative Outcomes of Robotic Staging Surgery Using Low Pelvic Port Placement in High-Risk Endometrial Cancer

by Jeeyeon Kim and Jiheum Paek

Curr. Oncol. 2024, 31(12), 7820-7827; https://doi.org/10.3390/curroncol31120576 - 5 Dec 2024

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Abstract

Upper para-aortic lymph node dissection (PALND) is one of the most challenging gynecologic robotic procedures. This study aimed to evaluate the oncologic and operative outcomes of robotic staging surgery, including upper PALND, using low pelvic port placement (LP3) in 22 patients with high-risk [...] Read more.

Upper para-aortic lymph node dissection (PALND) is one of the most challenging gynecologic robotic procedures. This study aimed to evaluate the oncologic and operative outcomes of robotic staging surgery, including upper PALND, using low pelvic port placement (LP3) in 22 patients with high-risk endometrial cancer. High-risk was defined as patients who showed deep myometrial invasion with grade III, cervical involvement, or high-risk histology. The mean patient age and body mass index were 58 years and 24 kg/m². The mean operative time was 263 min. The mean number of total LNs and upper PALNs obtained was 31 and 10. Two patients received lymphangiography to reduce the amount of drained lymphatic fluid after surgery. The recurrence rate was 13.6% (3/22). There were two LN recurrences and one at the peritoneum in the intra-abdominal cavity. Robotic staging surgery using LP3 was feasible for performing PALND as well as procedures in the pelvic cavity simultaneously. It provides important techniques for performing optimal surgical procedures when surgeons decide to perform comprehensive PALND in instances of isolated recurrence or unexpected LN enlargement as well as high-risk endometrial cancer. Consequently, surgeons can achieve surgical consistency and reproducibility for PALND, leading to improved operative and survival outcomes in high-risk endometrial cancer. Full article

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11 pages, 262 KiB

Open AccessArticle

Implementation of an Oncogeriatric Unit for Frail Older Patients with Breast Cancer: Preliminary Results

by Helena Hipólito-Reis, Joana Santos, Paulo Almeida, Luciana Teixeira, Fernando Rodrigues, Nuno Teixeira Tavares, Darlene Rodrigues, Jorge Almeida and Fernando Osório

Curr. Oncol. 2024, 31(12), 7809-7819; https://doi.org/10.3390/curroncol31120575 - 4 Dec 2024

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Abstract

(1) Background: Breast cancer (BC) has a high incidence in Europe, particularly in older adults. Traditionally under-represented in clinical trials, this age group is often undertreated due to ageism. This study aims to characterize frail older adults (≥70 years) with BC based on [...] Read more.

(1) Background: Breast cancer (BC) has a high incidence in Europe, particularly in older adults. Traditionally under-represented in clinical trials, this age group is often undertreated due to ageism. This study aims to characterize frail older adults (≥70 years) with BC based on a comprehensive geriatric assessment, to guide individualized treatment decision-making. (2) Methods: A descriptive analysis of older adults with BC treated from January 2021 to December 2022 was performed. Data were analyzed based on anonymized electronic medical records. (3) Results: Of 123 patients (mean age 84.0 ± 5.6 years), 122 (99.2%) were women. The mean G8 screening score was 12.1 ± 2.5. Most had functional dependence (69.9% Barthel Index, 81.3% Lawton/Brody Scale) and a moderate-to-high risk of falling (76.4% Tinetti index). Cognitive impairment and malnutrition risk were present in 15.4% and 30.1%, respectively. Prehabilitation inclusive strategies led to adapted treatment in 55.3% of cases. Endocrine therapy, surgery, radiotherapy, and chemotherapy was used in 99.2%, 56.1%, 35.0%, and 8.9% of patients, respectively. (4) Conclusions: Our comprehensive oncogeriatric strategy promotes personalized oncologic treatment, improves outcomes by addressing frailty, and enhances treatment tolerability in older patients with BC, validating the expansion of this combined team approach to other cancer types and institutions. Full article

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Open AccessArticle

Survival Outcomes with Regorafenib and/or Trifluridine/Tipiracil Sequencing to Rechallenge with Third-Line Regimens in Metastatic Colorectal Cancer: A Multicenter Retrospective Real-World Subgroup Comparison from the ReTrITA Study

by Carlo Signorelli, Maria Alessandra Calegari, Annunziato Anghelone, Alessandro Passardi, Giovanni Luca Frassineti, Alessandro Bittoni, Jessica Lucchetti, Lorenzo Angotti, Emanuela Di Giacomo, Ina Valeria Zurlo, Cristina Morelli, Emanuela Dell’Aquila, Adele Artemi, Donatello Gemma, Domenico Cristiano Corsi, Alessandra Emiliani, Marta Ribelli, Federica Mazzuca, Giulia Arrivi, Federica Zoratto, Mario Giovanni Chilelli, Marta Schirripa, Maria Grazia Morandi, Fiorenza Santamaria, Manuela Dettori, Antonella Cosimati, Rosa Saltarelli, Alessandro Minelli, Emanuela Lucci-Cordisco and Michele Basso Show full author list Hide full author list

Curr. Oncol. 2024, 31(12), 7793-7808; https://doi.org/10.3390/curroncol31120574 - 4 Dec 2024

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Abstract

Background: There is ongoing discussion around the optimal course of treatment for metastatic colorectal cancer (mCRC) following the second line. Trifluridine/tipiracil (T) and regorafenib (R) have been the mainstay of therapy in this situation, as they both increased overall survival (OS) in comparison [...] Read more.

Background: There is ongoing discussion around the optimal course of treatment for metastatic colorectal cancer (mCRC) following the second line. Trifluridine/tipiracil (T) and regorafenib (R) have been the mainstay of therapy in this situation, as they both increased overall survival (OS) in comparison to a placebo. Despite the paucity of evidence, therapy rechallenge is also recognized as an option for practical use. In the third-line scenario of mCRC, we planned to investigate the survival outcomes using (T) and (R), both with and without prior rechallenge treatment. Materials and methods: Between 2012 and 2023, we examined the medical records of 1156 patients with refractory mCRC who were enrolled in the multicenter retrospective ReTrITA study. We then separated the patients into two cohorts based on the rechallenge therapy that was given before regorafenib and/or trifluridine/tipiracil at 17 Italian centres. Results: A total of 981 patients underwent T and/or R therapy, while 175 patients had therapy rechallenge before T and/or R. The median overall survival (mOS) for patients treated with T/R and R/T sequences in the rechallenge therapy cohort was 14.5 months and 17.6 months, respectively (p = 0.1955). A statistically significant survival benefit was observed in patients who received monotheraphy with R (mOS: 6 months) compared to the T group (mOS: 4.2 months) (p = 0.0332). In the same cohort, a median progression-free survival (mPFS) benefit was demonstrated in favour of the R/T group (11.3 months) vs. 9 months of the reverse sequence (p = 0.4004). In the no-rechallenge cohort, the mOS was statistically longer in the R/T sequence than in the T/R sequence (16.2 months vs. 12.3 months, respectively; p = 0.0014). In terms of the mPFS, we saw the same significant result for the adoption of R/T treatment (11.5 months vs. 8.4 months, respectively; p < 0.0001). The two monotherapy groups did not reveal any significant differences. Conclusions: This study suggests that rechallenge therapy may improve survival rates in the third-line treatment of mCRC, particularly if it is administered before sequential R/T treatment. This could allow for the extension of mCRC treatment choices until prospective studies are finished or randomised trials are performed. Full article

(This article belongs to the Section Gastrointestinal Oncology)

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Graphical abstract

6 pages, 1282 KiB

Open AccessCase Report

Planned Abscopal Effect with Concurrent Pembrolizumab and Ablative Radiotherapy to Pulmonary Metastasis: A Case Report and Review of the Literature

by Yu-Ting Lee, Chien-Chin Chen, Hsiya Chao, Chih-Chia Chang and Cheng-Yen Lee

Curr. Oncol. 2024, 31(12), 7787-7792; https://doi.org/10.3390/curroncol31120573 - 4 Dec 2024

Viewed by 211

Abstract

Most abscopal effects are reported as sporadic and unpredictable events following radiotherapy at symptomatic sites. Herein, we report a case in which a planned abscopal effect was induced following deliberate radiotherapy and concurrent systemic immunotherapy. A 53-year-old man with a combined positive score [...] Read more.

Most abscopal effects are reported as sporadic and unpredictable events following radiotherapy at symptomatic sites. Herein, we report a case in which a planned abscopal effect was induced following deliberate radiotherapy and concurrent systemic immunotherapy. A 53-year-old man with a combined positive score ≥10 developed extensive metastatic bladder cancer after progressing on conventional chemotherapy. Extensive metastases were identified in his liver, lungs, and bones. He later had four cycles of single-agent pembrolizumab and planned hypofractionated radiotherapy at an ablative dose to selected metastatic lung tumors and developed complete remission of disease even when pembrolizumab was discontinued. This is a clear demonstration that the abscopal effect could be harnessed in a systematic manner with a combined positive score and aggressive local radiotherapy. Full article

(This article belongs to the Section Genitourinary Oncology)

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17 pages, 2567 KiB

Open AccessReview

Canadian Consensus Recommendations for Predictive Biomarker Testing in Gastric and Gastroesophageal Junction Adenocarcinoma

by Christine Brezden-Masley, Pierre O. Fiset, Carol C. Cheung, Thomas Arnason, Justin Bateman, Martin Borduas, Gertruda Evaristo, Diana N. Ionescu, Howard J. Lim, Brandon S. Sheffield, Sara V. Soldera and Catherine J. Streutker

Curr. Oncol. 2024, 31(12), 7770-7786; https://doi.org/10.3390/curroncol31120572 - 4 Dec 2024

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Abstract

Gastric cancer is common globally and has a generally poor prognosis with a low 5-year survival rate. Targeted therapies and immunotherapies have improved the treatment landscape, providing more options for efficacious treatment. The use of these therapies requires predictive biomarker testing to identify [...] Read more.

Gastric cancer is common globally and has a generally poor prognosis with a low 5-year survival rate. Targeted therapies and immunotherapies have improved the treatment landscape, providing more options for efficacious treatment. The use of these therapies requires predictive biomarker testing to identify patients who can benefit from their use. New therapies on the horizon, such as CLDN18.2 monoclonal antibody therapy, require laboratories to implement new biomarker tests. A multidisciplinary pan-Canadian expert working group was convened to develop guidance for pathologists and oncologists on the implementation of CLDN18.2 IHC testing for gastric and gastroesophageal junction (G/GEJ) adenocarcinoma in Canada, as well as general recommendations to optimize predictive biomarker testing in G/GEJ adenocarcinoma. The expert working group recommendations highlight the importance of reflex testing for HER2, MMR and/or MSI, CLDN18, and PD-L1 in all patients at first diagnosis of G/GEJ adenocarcinoma. Testing for NTRK fusions may also be included in reflex testing or requested by the treating clinician when third-line therapy is being considered. The expert working group also made recommendations for pre-analytic, analytic, and post-analytic considerations for predictive biomarker testing in G/GEJ adenocarcinoma. Implementation of these recommendations will provide medical oncologists with accurate, timely biomarker results to use for treatment decision-making. Full article

(This article belongs to the Section Gastrointestinal Oncology)

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5 pages, 519 KiB

Open AccessBrief Report

Brief Report: Trends in Incidence, Mortality, and Disability-Adjusted Life Years for Early-Onset Colorectal Cancer in Canada Between 1990 and 2019

by Igor Stukalin, Mehul Gupta, Katherine Buhler, Nauzer Forbes, Steven J. Heitman and Christopher Ma

Curr. Oncol. 2024, 31(12), 7765-7769; https://doi.org/10.3390/curroncol31120571 - 4 Dec 2024

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Abstract

Background: Colorectal cancer is the third most common malignancy globally. Early-onset colorectal cancer (EOCRC) is becoming a growing healthcare focus globally, particularly in North America. We estimated trends in incidence, mortality, and disability-adjusted life years (DALYs) for EOCRC in Canada between 1990 and [...] Read more.

Background: Colorectal cancer is the third most common malignancy globally. Early-onset colorectal cancer (EOCRC) is becoming a growing healthcare focus globally, particularly in North America. We estimated trends in incidence, mortality, and disability-adjusted life years (DALYs) for EOCRC in Canada between 1990 and 2019. Methods: We used the Global Burden of Diseases Study to evaluate trends in incidence, mortality, and DALYs for EOCRC in Canada between 1990 and 2019. Rates were estimated per 100,000 persons at risk with associated uncertainty intervals (UIs). Annual percentage changes (APC) were estimated using joinpoint regression with 95% confidence intervals (CIs). Results: In 2019, the incidence, mortality, and DALYs rates for EOCRC were 10.89 (95% UI 8.09, 14.34), 2.24 (95% UI 2.00, 2.51), and 111.37 (95% UI 99.34, 124.78) per 100,000 individuals, respectively. Incidence increased during the study period by 1.12%/year (95% CI 1.03%, 1.22%; p < 0.001). The largest increase in incidence in EOCRC occurred between 1990 and 2007, with an APC of 2.23% (95% CI 2.09%, 2.37%; p < 0.001). Mortality (APC 2.95%, 95% CI 1.89%, 4.02%; p < 0.001) and DALY (APC 2.96%, 95% CI 1.84%, 4.09%; p < 0.001) rates increased for males between 2001 and 2006. Conclusions: Our study reveals a substantial burden in EOCRC in Canada, with a significant increase in incidence. Full article

(This article belongs to the Section Gastrointestinal Oncology)

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11 pages, 399 KiB

Open AccessArticle

Vulnerability in Colorectal Cancer: Adjusted Gross Income and Geography as Factors in Determining Overall Survival in Colorectal Cancer: A Single-Center Study Across a Broad Income Inequality in an American Context

by Cataldo Doria, Patrick G. De Deyne and Papachristou Charalampos

Curr. Oncol. 2024, 31(12), 7754-7764; https://doi.org/10.3390/curroncol31120570 - 3 Dec 2024

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Abstract

Introduction: Regional differences in socioeconomic status (SES) are well known, and we believe that the use of geocoding (zip code) can facilitate the introduction of targeted interventions for underserved populations. This is a single-center, retrospective analysis of data extracted from the cancer [...] Read more.

Introduction: Regional differences in socioeconomic status (SES) are well known, and we believe that the use of geocoding (zip code) can facilitate the introduction of targeted interventions for underserved populations. This is a single-center, retrospective analysis of data extracted from the cancer registry at the Capital Health Cancer Center in Pennington, N. The Capital Health Cancer Center in central New Jersey primarily serves two counties, catering to a diverse patient population from a wide range of socioeconomic backgrounds. Methods: We abstracted 1269 consecutive cases of colorectal cancer (CRC) diagnosed and treated between 2000 and 2019 from the Cancer Registry of the Capital Health Cancer Center (CHCC). Using the definition of SES based on previously published work, and zip codes (geocoding), we created four SES levels. We stratified our subjects according to their stage at diagnosis, age at diagnosis, race, and ethnicity. The primary outcome variable was overall survival (OS). Results: There was a statistically significant difference in OS based on SES, with the highest overall survival (OS) in the high-SES group (47 months) and the shortest OS in the low and mid-low-SES groups (40.4 and 30 months, respectively). Subjects living in high-SES areas were predominantly white (88.2%) and diagnosed at a later age (mean of 68.9 years of age) compared to individuals who lived in a low-SES area, who were predominantly non-white (72.6%) and diagnosed somewhat earlier in life (65.1 years of age). White people were diagnosed later in life (70.9 years of age) compared to non-white populations, including Black (66.5), Asian (61.7), and Hispanic (58.5) (p = 0.001) populations, but this did not lead to a significant difference in OS (p = 0.56). Stage at diagnosis was a significant predictor of OS, but was unrelated to SES (p = 0.066). A Cox proportional hazard ratio (HR) model showed that the risk of dying from colorectal cancer decreases with a higher socioeconomic status (SES). Those from mid-high-SES backgrounds had a 19% lower risk (HR 0.81), and those from high-SES areas had a 45% lower risk (HR 0.55) compared to individuals from low-SES areas. Conclusions: The vulnerability of patients with CRC in central New Jersey is a complex issue, influenced by many different variables. Our results indicate that SES is the most critical factor affecting OS after being diagnosed with CRC. Full article

(This article belongs to the Section Gastrointestinal Oncology)

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16 pages, 576 KiB

Open AccessGuidelines

Management of Ductal Carcinoma In Situ: An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline

by Muriel Brackstone, Lisa Durocher-Allen, Nadia Califaretti, Andrea Eisen, Sarah Knowles, Abeer Salim, Taude Plexman and C. Anne Koch

Curr. Oncol. 2024, 31(12), 7738-7753; https://doi.org/10.3390/curroncol31120569 - 3 Dec 2024

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Abstract

(1) Background: To make recommendations on the most effective therapy options for Ductal Carcinoma of the Breast (DCIS) patients; (2) Methods: MEDLINE, EMBASE, Cochrane Library, PROSPERO databases, and main relevant guideline websites were searched. Draft versions of the guideline went through formal internal [...] Read more.

(1) Background: To make recommendations on the most effective therapy options for Ductal Carcinoma of the Breast (DCIS) patients; (2) Methods: MEDLINE, EMBASE, Cochrane Library, PROSPERO databases, and main relevant guideline websites were searched. Draft versions of the guideline went through formal internal and external reviews, with a final approval by the Program in Evidence Based Care and the DCIS Expert Panel. The Grading of Recommendations, Assessment, Development, and Evaluation approach was followed; (3) Results: Based on the current evidence from the systematic review and this guideline authors’ clinical opinions, initial draft recommendations were developed to improve the management of patients with DCIS. After a comprehensive internal and external review process, ten recommendations and 27 qualifying statements were eventually made. This guideline includes recommendations for the primary treatment of DCIS with surgical treatment and/or radiation therapy and the management of DCIS after primary treatment for patients with DCIS, including DCIS with microinvasion (<1 mm through the duct); (4) Conclusions: The current guideline was created after a systematic review and a comprehensive internal and external review process. We believe this guideline provides valuable insights that will be useful in clinical decision making for health providers. Full article

27 pages, 557 KiB

Open AccessReview

Braf-Mutant Melanomas: Biology and Therapy

by Elvira Pelosi, Germana Castelli and Ugo Testa

Curr. Oncol. 2024, 31(12), 7711-7737; https://doi.org/10.3390/curroncol31120568 - 3 Dec 2024

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Abstract

The incidence of melanoma, the most lethal form of skin cancer, has increased mainly due to ultraviolet exposure. The molecular characterization of melanomas has shown a high mutational burden led to the identification of some recurrent genetic alterations. BRAF gene is mutated in [...] Read more.

The incidence of melanoma, the most lethal form of skin cancer, has increased mainly due to ultraviolet exposure. The molecular characterization of melanomas has shown a high mutational burden led to the identification of some recurrent genetic alterations. BRAF gene is mutated in 40–50% of melanomas and its role in melanoma development is paramount. BRAF mutations confer constitutive activation of MAPK signalling. The large majority (about 90%) of BRAF mutations occur at amino acid 600; the majority are BRAF^V600E mutations and less frequently BRAF^{v600K, V600D} and ^V600M. The introduction of drugs that directly target BRAF-mutant protein (BRAF inhibitors) and of agents that stimulate immune response through targeting of immune check inhibitor consistently improved the survival of melanoma BRAF^V600-mutant patients with unresectable/metastatic disease. In parallel, studies in melanoma stage II-III patients with resectable disease have shown that adjuvant therapy with ICIs and/or targeted therapy improves PFS and RFS, but not OS compared to placebo; however, neoadjuvant therapy plus adjuvant therapy improved therapeutic response compared to adjuvant therapy alone. Full article

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14 pages, 549 KiB

Open AccessSystematic Review

Features of the Nurse-Patient Relationship: Insights from a Qualitative Review Using Artificial Intelligence Interpretation

by Elsa Vitale, Luana Conte, Roberto Lupo, Stefano Botti, Annarita Fanizzi, Raffaella Massafra and Giorgio De Nunzio

Curr. Oncol. 2024, 31(12), 7697-7710; https://doi.org/10.3390/curroncol31120567 - 2 Dec 2024

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Abstract

Introduction: This qualitative literature review explored the intersection of art, creativity, and the nurse–patient relationship in the context of oncology nursing. It delved into the perceptions and reflections of nurses as captured by Generative Artificial Intelligence (GAI) analysis from two specialized nursing databases. [...] Read more.

Introduction: This qualitative literature review explored the intersection of art, creativity, and the nurse–patient relationship in the context of oncology nursing. It delved into the perceptions and reflections of nurses as captured by Generative Artificial Intelligence (GAI) analysis from two specialized nursing databases. Methods: The protocol was registered on the Open Science Framework (OSF) Platform. A comprehensive search was conducted in CINAHL, the British Nursing Database, and the Nursing & Allied Health Database, using keywords related to art, cancer, creativity, nursing, and relationships. The extracted qualitative research studies were then analyzed using GAI to identify key themes and insights. Results: The analysis revealed profound considerations regarding the role of nurses in oncology and palliative patient care. Nurses acknowledged the spiritual dimension through religious and spiritual practices, while emphasizing authentic presence and empathic communication. They actively addressed patient concerns, adapted to challenges, and engaged in continuous professional development. The insights from the GAI interpretation underscored the significance of empathy, creativity, and artistry in nurturing meaningful nurse–patient connections. Conclusions: The GAI-enabled exploration provided valuable insights into several dimensions of care, emphasizing the importance of spiritual sensitivity, empathic communication, and ongoing professional growth. As technology and human care converge, integrating artistry into the nurse–patient relationship could enhance patient experiences, improve outcomes, and enrich the oncology nursing practice. Full article

(This article belongs to the Special Issue Feature Reviews in Section "Oncology Nursing")

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11 pages, 1261 KiB

Open AccessArticle

The Impact of Cancer Status on Anxiety in Prostate Cancer Patients: A Network Analysis

by Christopher F. Sharpley, Kirstan A. Vessey, Vicki Bitsika, Wayne M. Arnold and David R. H. Christie

Curr. Oncol. 2024, 31(12), 7686-7696; https://doi.org/10.3390/curroncol31120566 - 1 Dec 2024

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Abstract

Prostate cancer (PCa) patients often also suffer from comorbid anxiety, which can impede treatment efficacy as well as be intrinsically unpleasant. Identification of the associations between particular symptoms of anxiety that are most likely to occur at different points in the PCa diagnosis–treatment [...] Read more.

Prostate cancer (PCa) patients often also suffer from comorbid anxiety, which can impede treatment efficacy as well as be intrinsically unpleasant. Identification of the associations between particular symptoms of anxiety that are most likely to occur at different points in the PCa diagnosis–treatment journey can inform anxiety treatment choices and potentially influence their overall treatment outcomes. Although simple correlational analyses and ANOVA models of data analysis have been used to address this issue, the possibility of confounds due to the inter-relationships between other anxiety symptoms argues for the use of network analysis, which calculates each symptom–symptom connection while also taking into account the entire range of symptom relationships. Responses to the GAD-10 self-report scale for Generalised Anxiety Disorder were collected from 415 PCa patients who were grouped according to whether (1) their PCa was just diagnosed and undergoing initial treatment; (2) their cancer was in remission; or (3) their cancer was recurring after initial treatment. The results of the network analysis indicated several areas where clinically relevant differences were present between the three PCa groups, but caution was applied to the results of statistical tests due to unequal sample sizes. Individual GAD symptom–symptom association differences are discussed in terms of their implications for directed and individualised anxiety-management treatment models. Full article

(This article belongs to the Special Issue New and Emerging Trends in Prostate Cancer)

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23 pages, 1787 KiB

Open AccessArticle

Symptom Burden and Dietary Changes Among Older Adults with Cancer: A Cross-Sectional Study

by Lea Büthe, Gina Westhofen, Andrea Hille and Judith Büntzel

Curr. Oncol. 2024, 31(12), 7663-7685; https://doi.org/10.3390/curroncol31120565 - 1 Dec 2024

Viewed by 301

Abstract

Background: Malnutrition has a direct impact on both the toxicities of cancer therapy and the overall survival of oncological patients. However, its prevalence amongst vulnerable groups such as older patients (age ≥ 65 years) is often underestimated. Screening tools recognizing patients at risk [...] Read more.

Background: Malnutrition has a direct impact on both the toxicities of cancer therapy and the overall survival of oncological patients. However, its prevalence amongst vulnerable groups such as older patients (age ≥ 65 years) is often underestimated. Screening tools recognizing patients at risk are well established, yet they do not take into account that cancer therapy may lead to changes in dietary habits or that therapy’s side effects may negatively influence nutritional status. Methods: To close this gap, we combined the validated Nutritional Risk Score 2002 (NRS-2002) and G8 screening tools with short questionnaires addressing diet changes and symptom load and screened 300 cancer inpatients between 12/2022 and 12/2023. Descriptive statistics (Fisher’s exact, Student’s t-test) as well as heat mapping were applied for data analysis. Results: Overall, two in three inpatients ≥65 years were at risk for malnutrition, and the majority of patients (87.67%) scored ≤14 points on the G8 and were considered frail. Surprisingly, the symptom complex of oral discomfort was most often mentioned by patients (xerostomia—178/300 patients, loss of appetite: 122/300 patients, dysgeusia: 93/300 patients). Diet changes were also common, with patients mainly avoiding certain foods (122/300 patients) or using dietary supplements (106/300 patients). Conclusions: Taken together, older cancer inpatients are frail and have a high risk of malnutrition. Screening should not only consider energy intake but also symptom burden and dietary changes to optimize supportive care. Full article

(This article belongs to the Section Palliative and Supportive Care)

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16 pages, 2138 KiB

Open AccessArticle

Longitudinal Assessment of FT3 to FT4 Conversion Ratio in Predicting the Efficacy of First-Line Pembrolizumab-Based Therapy in Advanced Non-Small Cell Lung Cancer: A Propensity-Score Matching Analysis of Data from the National Drug Monitoring Agency

by Fabrizio Nelli, Enzo Maria Ruggeri, Marta Schirripa, Antonella Virtuoso, Diana Giannarelli, Armando Raso, Daniele Remotti and Agnese Fabbri

Curr. Oncol. 2024, 31(12), 7647-7662; https://doi.org/10.3390/curroncol31120564 - 1 Dec 2024

Viewed by 340

Abstract

Baseline thyroid function, as measured by the fT3 to fT4 ratio, has been shown to influence the prognosis of advanced cancer patients receiving active treatments. Although immune checkpoint blockade can alter the balance of thyroid hormones, this interaction has not been thoroughly investigated. [...] Read more.

Baseline thyroid function, as measured by the fT3 to fT4 ratio, has been shown to influence the prognosis of advanced cancer patients receiving active treatments. Although immune checkpoint blockade can alter the balance of thyroid hormones, this interaction has not been thoroughly investigated. The present research sought to determine whether changes in the fT3/fT4 ratio could affect the survival outcomes of patients with advanced non-small cell lung cancer (NSCLC) who were undergoing pembrolizumab-based therapies. This study included patients with metastatic NSCLC who received pembrolizumab as upfront treatment, either alone or in combination with platinum-based chemotherapy. Relevant data were gathered before the start (time point 1) and after 12 weeks (time point 2) of treatment. From April 2018 to May 2023, we enrolled 258 eligible patients, 156 (60.5%) and 102 (39.5%) of whom were treated with single-agent or combination therapy, respectively. We stratified patients into two groups based on baseline fT3 and fT4 values [euthyroid cohort defined by fT3 and fT4 both within the normal range vs. euthyroid sick syndrome cohort defined by low fT3 and/or fT4 levels]. We examined the differences in progression-free survival (PFS) and overall survival (OS) by univariate and multivariate analyses. After applying propensity-score matching, we considered 88 relevant cases in each cohort. Longitudinal comparison of fT3/fT4 ratios showed a significant increase in the median value after pembrolizumab-based therapy (p < 0.001). We computed ROC curves to analyze the correlation between fT3/fT4 ratios and survival outcomes. The relative AUC values were not viable in predicting a positive outcome at the first time point. Conversely, assessment at the second time point revealed a significant association with PFS [AUC 0.82 (95% CI 0.75–0.89), p < 0.001] and OS [AUC 0.81 (95% CI 0.75–0.88), p < 0.001]. After a median follow-up of 20.2 (95% CI 16.2–24.2) months, the median PFS for the low and high fT3/fT4 ratio groups was 4.1 (95% CI 3.0–5.1) and 15.3 (95% CI 10.3–20.1) months, respectively (p < 0.001). The median OS for the low and high fT3/fT4 ratio groups was 6.7 (95% CI 4.9–8.5) and 19.6 (95% CI 16.4–22.8) months, respectively (p < 0.001). The multivariate analysis revealed that a low fT3/fT4 ratio was independently associated with shorter PFS [HR 2.51 (1.66–3.78); p < 0.001] and OS [HR 2.18 (1.43–3.34); p < 0.001]. After the optimal weighting of prognostic factors according to thyroid function impairment, the fT3/fT4 ratio at baseline did not affect the survival of patients receiving immune checkpoint blockade for advanced NSCLC. Patients with an increased fT3/fT4 ratio experienced a significantly decreased risk of disease progression and mortality. The longitudinal assessment of fT3/fT4 ratio may play a predictive role in this specific therapeutic setting. Full article

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16 pages, 332 KiB

Open AccessReview

Potential Benefits from Physical Exercise in Advanced Cancer Patients Undergoing Systemic Therapy? A Narrative Review of the Randomized Clinical Trials

by Federico Bozzetti

Curr. Oncol. 2024, 31(12), 7631-7646; https://doi.org/10.3390/curroncol31120563 - 1 Dec 2024

Viewed by 359

Abstract

Design. The purpose of this review is the analysis of the literature concerning the effects of physical exercise in cancer patients undergoing medical oncologic treatment. Papers were retrieved from the scrutiny of 15 reviews/meta-analyses published in the last 2 years, which, however, pooled [...] Read more.

Design. The purpose of this review is the analysis of the literature concerning the effects of physical exercise in cancer patients undergoing medical oncologic treatment. Papers were retrieved from the scrutiny of 15 reviews/meta-analyses published in the last 2 years, which, however, pooled different populations of patients (surgical and medical patients, receiving or not an oncologic therapy, harboring a cancer, or being survivors). Results. We reviewed the data of 35 RCTs on the use of physical exercise in cancer patients, distinguishing well-nourished from malnourished patients. The conclusions of our study are the following: No major difference between well-nourished and malnourished patients as regards compliance/adherence with physical exercise and outcomes. Compliance with physical exercise was reported in about 70% of the studies. Compared with a control group receiving the usual care, in patients who practiced physical exercise, a benefit in some parameters of physical function and quality of life and lean body mass (LBM) was reported in 61%, 47%, and 12%, respectively, of the studies in non-malnourished patients, and in 50%, 100%, and 36%, respectively, of the studies in malnourished patients. The benefit in LBM was more frequently reported in weight-losing patients. There was no strict association among the results of different outcomes (muscle function vs. quality of life vs. LBM). There are still some ill-defined issues, including the optimal physical regimen (with some authors favoring high-intensity interval training and resistance) and the place of exercising (patients usually preferring home exercises, which, however, have been proved less efficacious). Full article

(This article belongs to the Special Issue Diet and Physical Activity Management during Cancer)

6 pages, 597 KiB

Open AccessCase Report

Personalized Ultra-Fractionated Stereotactic Adaptive Radiotherapy for Non-Small Cell Lung Cancer Using Varian Ethos Therapy System

by Vanda Leipold, Blanka Jakšić, Asmir Avdičević, Domagoj Kosmina, Hrvoje Kaučić, Ivana Alerić, Karla Schwarz, Mihaela Mlinarić, Giovanni Ursi, Adlan Čehobašić and Dragan Schwarz

Curr. Oncol. 2024, 31(12), 7625-7630; https://doi.org/10.3390/curroncol31120562 - 1 Dec 2024

Viewed by 389

Abstract

We present a patient treated with personalized ultra-fractionated stereotactic adaptive radiotherapy (PULSAR) for non-small cell lung cancer (NSCLC) using the adaptive Varian Ethos™ system equipped with the novel HyperSight imaging platform. Three pulses of 12 Gy were separated by a pause of four [...] Read more.

We present a patient treated with personalized ultra-fractionated stereotactic adaptive radiotherapy (PULSAR) for non-small cell lung cancer (NSCLC) using the adaptive Varian Ethos™ system equipped with the novel HyperSight imaging platform. Three pulses of 12 Gy were separated by a pause of four weeks during which the tumor was given enough time to respond to treatment. Only initial planning computed tomography (CT) was acquired on a CT simulator (Siemens Somatom Definition Edge), whereas other pulses were adapted using online cone beam computed tomography (CBCT) images (iCBCT Acuros reconstruction) acquired while the patient was lying on the treatment couch and delivered immediately. Significant tumor reduction was achieved between pulses, resulting in improved organs-at-risk sparing. In addition, the on-couch plan optimization based on CBCT greatly reduced the patient’s stay at the clinic and the duration of treatment preparation. Full article

(This article belongs to the Topic Innovative Radiation Therapies)

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12 pages, 1067 KiB

Open AccessReview

Methadone in Cancer-Related Neuropathic Pain: A Narrative Review

by Faten Ragaban, Om Purohit and Egidio Del Fabbro

Curr. Oncol. 2024, 31(12), 7613-7624; https://doi.org/10.3390/curroncol31120561 - 1 Dec 2024

Viewed by 447

Abstract

Background and Objective: Cancer-related neuropathic pain (CRNP) is often a significant burden on patients’ quality of life. There are limited treatment guidelines for cancer-related neuropathic pain outside of CIPN. Although opioids are considered a third-line treatment option, no consensus exists on which opioid [...] Read more.

Background and Objective: Cancer-related neuropathic pain (CRNP) is often a significant burden on patients’ quality of life. There are limited treatment guidelines for cancer-related neuropathic pain outside of CIPN. Although opioids are considered a third-line treatment option, no consensus exists on which opioid is most effective, either as a single agent or in combination with other medications. Our aim is to review and update the literature for methadone use in CRNP, since the last review was conducted in 2006. Methods: A comprehensive literature search was performed to evaluate the use of methadone in cancer-related neuropathic pain. Articles were identified from PubMed, Google Scholar, and Cochrane Library using the following keywords: “methadone AND cancer pain AND neuropathic pain” and “cancer-related opioid treatment”. Results: Studies were included if they evaluated methadone’s efficacy or safety in neuropathic pain management for patients with cancer. This review focused on randomized controlled trials (RCTs), systematic reviews, meta-analyses, and observational studies published between 2000 and 2024. Studies were excluded if they lacked specific data on cancer-related neuropathic pain or were case reports. Conclusions: The unique mechanisms of action and preliminary clinical trials support methadone’s status as the first opioid to consider for CRNP when non-opioid first-line treatments have failed to alleviate patient symptoms. Methadone can also be considered as a first-line opioid in patients with mixed nociceptive–neuropathic pain and any of the following features: renal dysfunction; administration of opioids through a feeding tube; a lack of financial resources/insurance; and a switch from another high-dose opioid. More research is needed regarding methadone for CRNP and methadone’s preferential use in specific sub-groups of patients. Full article

(This article belongs to the Section Palliative and Supportive Care)

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10 pages, 233 KiB

Open AccessArticle

by Pauline Holmer, Brianna Henry, Jenny Duong, Oluwaseyi A. Lawal, Miranda M. Fidler-Benaoudia, Kathleen Reynolds, Gisela Michel, Vicky Lehmann and Fiona S. M. Schulte

Curr. Oncol. 2024, 31(12), 7603-7612; https://doi.org/10.3390/curroncol31120560 - 30 Nov 2024

Viewed by 332

Abstract

Survivors of childhood cancer face reduced fertility, which can be a significant cause for concern. Our study aimed to assess the prevalence of fertility-related concerns and identify associated factors. Self-report data were collected with the Long-Term Survivor Questionnaire at the Alberta Children’s Hospital’s [...] Read more.

Survivors of childhood cancer face reduced fertility, which can be a significant cause for concern. Our study aimed to assess the prevalence of fertility-related concerns and identify associated factors. Self-report data were collected with the Long-Term Survivor Questionnaire at the Alberta Children’s Hospital’s Long-Term Survivor Clinic (LTSC) between January 2021 and September 2023. Eligible participants were diagnosed before the age of 21 years, ≥2 years off therapy, and ≥13 years old. We analyzed fertility-related concerns cross-sectionally for the whole sample and longitudinally for a subsample of participants that completed three questionnaires. We included N = 311 survivors (49.2% female; mean age = 22.7 years, range = 13.9–42.1; mean time since diagnosis = 14.5 years, range = 2.7–38.4), of whom 21.2% reported fertility-related concerns. Those with additional health concerns and those who were sexually active were more likely to report fertility-related concerns, whereas lymphoma survivors were least likely to report concerns. In the subsample who completed three questionnaires (n = 80), 30% reported having concerns at least once, whereas 9% expressed persistent concerns. Fertility-related concerns are highly prevalent among young survivors of childhood cancer and warrant attention from healthcare professionals. Services that systematically address fertility-related concerns throughout long-term follow-up are urgently needed. These services should provide a space to discuss concerns, provide education, and initiate fertility consultations if desired. Full article

(This article belongs to the Section Psychosocial Oncology)

17 pages, 577 KiB

Open AccessReview

Fear of Cancer Recurrence and Fear of Cancer Progression, Digital Resource Engagement and Health Literacy: A Review

by Maebh Kenny-Jones, Paul Nankivell, Hisham Mehanna and Gozde Ozakinci

Curr. Oncol. 2024, 31(12), 7586-7602; https://doi.org/10.3390/curroncol31120559 - 29 Nov 2024

Viewed by 388

Abstract

Cancer care is evolving, and digital resources are being introduced to support cancer patients throughout the cancer journey. Logistical concerns, such as health literacy and the emotional experience of cancer, need to be considered. Fear of cancer recurrence (FCR) and fear of cancer [...] Read more.

Cancer care is evolving, and digital resources are being introduced to support cancer patients throughout the cancer journey. Logistical concerns, such as health literacy and the emotional experience of cancer, need to be considered. Fear of cancer recurrence (FCR) and fear of cancer progression (FOP) are relevant emotional constructs that should be investigated. This scoping review explored two main objectives: first, the link between FCR/FOP and engagement with digital resources, and second, the link between FCR/FOP and health literacy. A database search was conducted separately for each objective. Relevant papers were identified, data were extracted, and a quality assessment was conducted. Objective 1 identified two relevant papers that suggested that higher levels of FCR were correlated with lower levels of engagement with digital resources. Objective 2 identified eight relevant papers that indicated that higher FCR/FOP is correlated with lower health literacy. However, one paper with a greater sample size and a more representative sample reported no significant relationship. There may be important relationships between the constructs of FCR/FOP, resource engagement, and health literacy and relationships may differ across cancer type and sex. However, research is limited. No studies examined the relationship between FOP and engagement or FCR/FOP and digital health literacy, and the number of studies identified was too limited to come to a firm conclusion. Further research is needed to understand the significance and relevance of these relationships. Full article

(This article belongs to the Special Issue Health Behaviours, Illness Representations, Quality of Life, Coping, and Fear of Cancer Recurrence in Those Affected by Cancer)

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11 pages, 1987 KiB

Open AccessArticle

Brain Metastases in Gynaecologic Cancer: A Retrospective Cohort Study Evaluating Treatment Outcomes, Prognostic Factors, and Overall Survival

by Carly M. Cooke, M. Ege Babadagli, Hillary Wilson, Vimoj J. Nair, Krystine Lupe, Shawn Malone, Laura Burgess, Wylam Faught, Rajiv Samant and Tien Le

Curr. Oncol. 2024, 31(12), 7575-7585; https://doi.org/10.3390/curroncol31120558 - 28 Nov 2024

Viewed by 303

Abstract

(1) Background: The objectives of this study were to assess survival of patients with a diagnosis of brain metastases secondary to gynaecologic malignancy and the impact of clinicopathological factors on prognosis in this population. (2) Methods: A retrospective cohort of patients with gynaecologic [...] Read more.

(1) Background: The objectives of this study were to assess survival of patients with a diagnosis of brain metastases secondary to gynaecologic malignancy and the impact of clinicopathological factors on prognosis in this population. (2) Methods: A retrospective cohort of patients with gynaecologic cancers diagnosed with brain metastases treated with radiation at a tertiary care centre from 1 January 2004 until 30 September 2023 was studied. Kaplan–Meier method and log-rank test were used to evaluate survival, and cox regression was used to identify significant predictive factors of survival. (3) Results: In total, 103 patients were included in this study. Median age at diagnosis of brain metastases was 59 (range 30–94). Median survival time following diagnosis of brain metastases was 3.6 months (range 0.4–183.8). Survival was significantly longer for patients treated with surgery combined with radiation compared to radiation alone and with stereotactic radiosurgery (SRS) compared to whole brain radiation therapy (WBRT). Cox regression revealed that primary ovarian malignancy, extracranial disease at diagnosis, and ≥3 brain metastases were associated with poorer prognosis, and complete response to prior treatment was associated with more favourable prognosis. (4) Conclusions: Data from this study will assist in providing evidence-based prognostic information to patients with gynaecologic malignancy diagnosed with brain metastases. Full article

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9 pages, 963 KiB

Open AccessCommentary

Accuracy and Outcomes of Sentinel Lymph Node Biopsy in Male with Breast Cancer: A Narrative Review and Expert Opinion

by Calogero Cipolla, Vittorio Gebbia, Eleonora D’Agati, Martina Greco, Chiara Mesi, Giuseppa Scandurra, Daniela Sambataro and Maria Rosaria Valerio

Curr. Oncol. 2024, 31(12), 7566-7574; https://doi.org/10.3390/curroncol31120557 - 27 Nov 2024

Viewed by 454

Abstract

Male breast cancer (MBC) is a rare disease, accounting for less than 1% of all breast cancer cases. Sentinel lymph node biopsy (SLNB) has emerged as a less invasive alternative to axillary lymph node dissection (ALND) for axillary staging in breast cancer, offering [...] Read more.

Male breast cancer (MBC) is a rare disease, accounting for less than 1% of all breast cancer cases. Sentinel lymph node biopsy (SLNB) has emerged as a less invasive alternative to axillary lymph node dissection (ALND) for axillary staging in breast cancer, offering reduced morbidity and comparable accuracy. However, the application of SLNB in MBC remains underexplored, with limited male-specific data and treatment protocols often extrapolated from female breast cancer studies. Available evidence suggests that SLNB in men demonstrates high diagnostic accuracy, with low false-negative rates and a high sentinel lymph node identification rate. Despite this, there is ongoing debate about its long-term impact on clinical outcomes, particularly for patients with sentinel node metastasis, where ALND may still provide superior survival outcomes in some cases. Predictive tools are being developed to identify better patients who may benefit from SLNB alone, potentially reducing the need for more invasive procedures. As the role of SLNB continues to evolve in MBC management, further prospective research is needed to refine its application and assess its long-term oncologic outcomes. Full article

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11 pages, 4983 KiB

Open AccessCase Report

Primary Central Nervous System Lymphoma (PCNSL) Following Thyroid Cancer Surgery: A Case Report of Misdiagnosed Brain Metastasis and Literature Review

by Yilin Li, Tingyu Liang, Hao Xing, Yu Wang, Kuanyu Wang and Wenbin Ma

Curr. Oncol. 2024, 31(12), 7555-7565; https://doi.org/10.3390/curroncol31120556 - 26 Nov 2024

Viewed by 359

Abstract

Objectives: This article reports a rare case of primary central nervous system lymphoma (PCNSL) found in a patient with thyroid cancer after surgery. Methods: The patient was initially misdiagnosed with brain metastases, and the diagnosis of PCNSL was later confirmed by pathology. Results: [...] Read more.

Objectives: This article reports a rare case of primary central nervous system lymphoma (PCNSL) found in a patient with thyroid cancer after surgery. Methods: The patient was initially misdiagnosed with brain metastases, and the diagnosis of PCNSL was later confirmed by pathology. Results: The analysis of this case and review of the relevant literature explores the possible mechanisms of the coexistence of thyroid cancer and PCNSL, as well as their diagnostic, differential diagnostic, and therapeutic challenges. Conclusions: The article suggests a possible correlation between the coexistence of multiple cancers and autoimmune diseases and emphasizes that disease cannot be only considered in a monolithic way. Full article

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32 pages, 1661 KiB

Open AccessReview

How Arterial Embolization Is Transforming Treatment of Oncologic and Degenerative Musculoskeletal Disease

by Nicolas Papalexis, Giuliano Peta, Michela Carta, Simone Quarchioni, Maddalena Di Carlo, Marco Miceli and Giancarlo Facchini

Curr. Oncol. 2024, 31(12), 7523-7554; https://doi.org/10.3390/curroncol31120555 - 26 Nov 2024

Viewed by 507

Abstract

Background: Arterial embolization is a minimally invasive treatment that occludes blood vessels supplying pathological tissue. Developed to control bleeding without surgery, it has evolved over decades and is now applied in musculoskeletal oncology as a preoperative treatment, palliative care, or standalone therapy for [...] Read more.

Background: Arterial embolization is a minimally invasive treatment that occludes blood vessels supplying pathological tissue. Developed to control bleeding without surgery, it has evolved over decades and is now applied in musculoskeletal oncology as a preoperative treatment, palliative care, or standalone therapy for select tumors. Recently, its use has expanded globally in treating chronic pain syndromes and osteoarthritis. Materials and Methods: We reviewed the literature on arterial embolization in various musculoskeletal conditions. The focus was on established oncologic indications for primary and metastatic bone or soft tissue tumors, and emerging evidence on degenerative diseases like osteoarthritis, inflammatory musculoskeletal pathology, and intractable pain. Emphasis was placed on leading studies regarding efficacy, complications, and recurrence rates. Discussion: Arterial embolization has progressed from bleeding control to a versatile therapeutic option in musculoskeletal medicine. It offers symptom relief, reduces tumor size, and improves quality of life. Applications include oncologic interventions and management of degenerative and inflammatory conditions. Despite its benefits, variations in complications and recurrence rates highlight the need for standardized protocols and further research. Conclusions: Arterial embolization is a safe and effective minimally invasive tool in the multidisciplinary management of a wide range of musculoskeletal pathologies. Ongoing research is crucial to understand long-term efficacy, optimize protocols, and broaden its applications. Full article

(This article belongs to the Section Bone and Soft Tissue Oncology)

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12 pages, 2670 KiB

Open AccessArticle

An Evaluation of 90Y Bremsstrahlung SPECT Image Quality in the Presence of 99mTc: A Technical Perspective on Same-Day Radioembolization

by Grace Keane, Rob van Rooij, Marnix Lam, Arthur Braat, Maarten Smits and Hugo de Jong

Curr. Oncol. 2024, 31(12), 7511-7522; https://doi.org/10.3390/curroncol31120554 - 26 Nov 2024

Viewed by 513

Abstract

In same-day radioembolization, 99mTc-MAA SPECT/CT, 90Y radioembolization, and post-treatment 90Y SPECT/CT procedures are conducted on the same-day, resulting in a dual-isotope environment of 90Y and 99mTc during post-treatment imaging. This study aimed to quantify the impact of 99mTc on 90Y bremsstrahlung-SPECT/CT image quality [...] Read more.

In same-day radioembolization, 99mTc-MAA SPECT/CT, 90Y radioembolization, and post-treatment 90Y SPECT/CT procedures are conducted on the same-day, resulting in a dual-isotope environment of 90Y and 99mTc during post-treatment imaging. This study aimed to quantify the impact of 99mTc on 90Y bremsstrahlung-SPECT/CT image quality and to establish an optimised imaging protocol for both clinical practice, and with advanced reconstruction techniques. Utilising a NEMA IQ phantom, contrast recovery coefficients (CRCs) were measured to evaluate the 90Y image quality degradation caused by 99mTc. SPECT/CT scans of 90Y-only and 90Y with varying amounts of 99mTc were conducted using a standard protocol (90–120 keV energy window, high-energy collimator) and various dual-isotope protocols. The standard protocol resulted in a marked CRC reduction, with the largest sphere’s CRC decreasing from 0.21 (90Y-only) to 0.05 when 99mTc activity was 5% of 90Y. For an optimised protocol (160–200 keV energy window, high-energy collimator) CRC values were 0.16 for 90Y-only and 0.15 for 90Y+99mTc. The highest CRC values were achieved with an advanced Monte Carlo-based reconstruction, showing 0.58 for 90Y-only and 0.46 for 90Y+99mTc. Image quality degradation was noted in dual-isotope settings even when using an optimised protocol. Advanced reconstruction techniques markedly improved post-treatment image quality. Full article

(This article belongs to the Special Issue Radioembolization for Hepatocellular Carcinoma)

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17 pages, 972 KiB

Open AccessArticle

Key Risk Factors, Sex Differences, and the Influence of High-Intensity Exercise on Colorectal Carcinogenesis: A 10-Year Cohort Study Based on 1,120,377 Individuals from the NHISS Data

by Hyunseok Jee

Curr. Oncol. 2024, 31(12), 7494-7510; https://doi.org/10.3390/curroncol31120553 - 25 Nov 2024

Viewed by 313

Abstract

Colorectal cancer (CRC) is the third most common cancer globally. Therefore, this study aims to examine data from the National Health Insurance Sharing Service (NHISS) to investigate factors influencing colon cancer incidence, focusing on key variables and optimal cutoff points. The patient cohort [...] Read more.

Colorectal cancer (CRC) is the third most common cancer globally. Therefore, this study aims to examine data from the National Health Insurance Sharing Service (NHISS) to investigate factors influencing colon cancer incidence, focusing on key variables and optimal cutoff points. The patient cohort from the NHISS database included 1,120,377 individuals aged 1–85 years. CRC data were retrieved using diagnostic codes from the Korean Standard Classification of Diseases and Causes of Death. Analyses included logistic regression and receiver operating characteristic curve assessments. In this retrospective cohort study, 1,120,377 patients were analyzed for over 10 years, including 2802 with CRC via propensity score matching (PSM). Key risk factors were blood pressure, fasting blood sugar, liver somatic index, alcohol consumption, smoking duration, and hemoglobin levels. Patients with CRC showed sex differences in gamma-glutamyl transpeptidase (GGT). High-intensity exercise (3 days/week) reduced CRC risk by 26% (p < 0.05). Optimal threshold points for GGT and Charlson Comorbidity Index (CCI) were 23.50 U/L (AUC, 0.52) and 1.50 (AUC, 0.58), respectively. CCI scores were higher in patients with cancer, especially men with peptic ulcers and both sexes with metastatic cancer (p < 0.01). Our findings reveal new risk factors and interventions, including tailored exercise programs for CRC management, highlighting the importance of enhanced preventive strategies and personalized care. Full article

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18 pages, 2955 KiB

Open AccessArticle

The Potential of PD-1 and PD-L1 as Prognostic and Predictive Biomarkers in Colorectal Adenocarcinoma Based on TILs Grading

by Nur Rahmah Rasyid, Upik Anderiani Miskad, Muhammad Husni Cangara, Syarifuddin Wahid, Djumadi Achmad, Suryani Tawali and Mardiati Mardiati

Curr. Oncol. 2024, 31(12), 7476-7493; https://doi.org/10.3390/curroncol31120552 - 25 Nov 2024

Viewed by 409

Abstract

Aim: Colorectal cancer (CRC) is a prevalent malignancy with a high mortality rate. Tumor-infiltrating lymphocytes (TILs) play a crucial role in the immune response against tumors. Programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) are key immune checkpoints regulating T cells in the [...] Read more.

Aim: Colorectal cancer (CRC) is a prevalent malignancy with a high mortality rate. Tumor-infiltrating lymphocytes (TILs) play a crucial role in the immune response against tumors. Programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) are key immune checkpoints regulating T cells in the tumor microenvironment. This study aimed to assess the relationships among PD-1 expression on TILs, PD-L1 expression in tumors, and TIL grading in colorectal adenocarcinoma. Methods: A cross-sectional design was employed to analyze 130 colorectal adenocarcinoma samples. The expression of PD-1 and PD-L1 was assessed through immunohistochemistry. A semi-quantitative scoring system was applied. Statistical analysis with the chi-square test was performed to explore correlations, with the data analyzed in SPSS version 27. Results: PD-1 expression on TILs significantly correlated with a higher TIL grading (p < 0.001), while PD-L1 expression in tumors showed an inverse correlation with TIL grading (p < 0.001). Conclusions: The expression of PD-1 on TILs and PD-L1 on tumor cells correlated significantly with the grading of TILs in colorectal adenocarcinoma. This finding shows potential as a predictive biomarker for PD-1/PD-L1 blockade therapy. Further studies are needed to strengthen these results. Full article

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17 pages, 6256 KiB

Open AccessSystematic Review

Spinal Metastases in Non-Seminomatous Germ Cell Testicular Tumors: Prognosis and Integrated Therapeutic Approaches—A Systematic Review with an Institutional Case Illustration

by Gianluca Scalia, Gianluca Ferini, Zubayer Shams, Francesca Graziano, Giancarlo Ponzo, Eliana Giurato, Maria Grazia Galasso, Vitalinda Pumo, Martina Caruso, Gianluca Galvano, Salvatore Marrone, Jessica Naimo, Giovanni Federico Nicoletti and Giuseppe Emmanuele Umana

Curr. Oncol. 2024, 31(12), 7459-7475; https://doi.org/10.3390/curroncol31120551 - 24 Nov 2024

Viewed by 485

Abstract

(1) Background: Testicular cancer, although accounting for only 0.5% to 1% of all solid male cancers, is the most common malignancy in males aged 15 to 35 years. Non-seminomatous germ cell tumors (NSGCT) represent nearly half of all testicular germ cell tumors and [...] Read more.

(1) Background: Testicular cancer, although accounting for only 0.5% to 1% of all solid male cancers, is the most common malignancy in males aged 15 to 35 years. Non-seminomatous germ cell tumors (NSGCT) represent nearly half of all testicular germ cell tumors and are associated with a more aggressive clinical course. Spinal metastases, while rare, pose significant challenges due to their potential to cause spinal cord compression, neurological deficits, and severe pain. This systematic review aims to evaluate prognosis and treatment approaches for spinal metastases in NSGCT, with a focus on multidisciplinary care and treatment outcomes. (2) Methods: A systematic review was conducted following PRISMA guidelines. PubMed, Scopus, and Embase were searched on 18 September 2024, using the Boolean search strategy [(Nonseminomatous germ cell tumor (NSGCT) AND (spinal OR vertebral metastases)]. Case reports, case series, and cohort studies providing detailed patient data were included. Data on patient demographics, tumor histology, metastatic site, treatments, and outcomes were extracted for analysis. (3) Results: A total of 164 cases of NSGCT with spinal metastases were analyzed, with patients aged 23 to 40 years (median: 31.5 years). The lumbar spine was involved in all cases, and spinal cord compression occurred in 59.8% of patients, often causing severe neurological symptoms such as cauda equina syndrome. Chemotherapy, primarily cisplatin-based, was administered in all cases, while surgical interventions, including laminectomy and vertebrectomy, were performed in cases of spinal compression and instability. Complete remission occurred in only 2.4% of patients. Progressive improvement was observed in 56.7% of cases, while 20.1% of patients died. Outcomes varied, highlighting the importance of individualized, multidisciplinary care to manage both systemic and localized disease. (4) Conclusions: Spinal metastases in NSGCT represent a complex clinical scenario, requiring a combination of chemotherapy, surgery, and in some cases, radiotherapy. Chemotherapy remains essential, but surgery is critical for addressing spinal compression and instability. A multidisciplinary approach is vital for optimizing outcomes, as prognosis is variable, with some patients achieving improvement while others face progressive disease or death. Further research is needed to refine the role of radiotherapy and improve long-term treatment strategies for this rare complication. Full article

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14 pages, 1086 KiB

Open AccessSystematic Review

Prevalence and Significance of Incidental PET/CT Findings of Cancer Detected in Patients Evaluated for Their Primary Hematologic Malignancy: A Systematic Review

by Jessie Luo, Nizar J. Bahlis, Denise Chan, Peter Duggan, Victor H. Jimenez-Zepeda, Holly Lee, Sylvia McCulloch, Paola Neri and Jason Tay

Curr. Oncol. 2024, 31(12), 7445-7458; https://doi.org/10.3390/curroncol31120550 - 24 Nov 2024

Viewed by 431

Abstract

In the evaluation of a patient’s primary hematologic malignancy, positron emission tomography/computed tomography (PET/CT) imaging may incidentally detect a concerning abnormality suggestive of a second concurrent cancer. Despite accounting for nearly 10% of all cancers diagnosed in Canada, there has yet to be [...] Read more.

In the evaluation of a patient’s primary hematologic malignancy, positron emission tomography/computed tomography (PET/CT) imaging may incidentally detect a concerning abnormality suggestive of a second concurrent cancer. Despite accounting for nearly 10% of all cancers diagnosed in Canada, there has yet to be a systematic review focused on the prevalence and significance of these incidental PET/CT findings in the context of primary hematologic malignancies. As such, a systematic search strategy was employed on MEDLINE and Embase to document the prevalence and clinical significance of incidental PET/CT findings suggestive of a second concurrent cancer detected in patients evaluated for their primary hematologic malignancy. Thirteen studies published between 2008 and 2022 were reviewed, including conference abstracts (n = 8) and journal articles (n = 5). Clinically significant incidental cancers were detected with a median of 2.4% (range: 1.1–10.3%) in patients with myeloma/plasma cell disorders, compared to a median of 1.5% (range: 0.3–2.8%) in patients with lymphoproliferative diseases. The most common anatomic regions of clinically significant incidental malignancies were identified in the gastrointestinal tract (44.4%), followed by the thyroid gland (22.2%) and lungs (7.9%). In most cases, early detection of incidental cancers led to successful early interventions. PET/CT scans occasionally identify second primary malignancies that require additional attention. These findings may affect the treatment of a patient’s primary hematologic malignancy, and as such, timely coordinated management is important for improved outcomes. This review may inform physicians and administrators of the risk of incidental second malignancies and may highlight a need for enhanced cancer treatment pathways. Full article

(This article belongs to the Section Hematology)

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Open AccessCommunication

High Fracture Risk of Femoral Bone Metastasis Treated with Palliative Radiotherapy in Recent Years

by Kenji Makita, Hidehiro Hojo, Hidekazu Oyoshi, Takeshi Fujisawa, Masaki Nakamura, Gyo Uchida, Yume Koike, Yuzheng Zhou, Kento Tomizawa, Keiko Fukushi and Sadamoto Zenda

Curr. Oncol. 2024, 31(12), 7437-7444; https://doi.org/10.3390/curroncol31120549 - 22 Nov 2024

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Abstract

Bone-modifying agents (BMAs) have been widely used to reduce skeletal-related events, including pathological fractures. Herein, we aimed to clarify the incidence of pathological fractures caused by high-risk femoral bone metastases after palliative radiotherapy (RT) in the BMA era and evaluate the necessity of [...] Read more.

Bone-modifying agents (BMAs) have been widely used to reduce skeletal-related events, including pathological fractures. Herein, we aimed to clarify the incidence of pathological fractures caused by high-risk femoral bone metastases after palliative radiotherapy (RT) in the BMA era and evaluate the necessity of prophylactic surgical stabilization. We assessed 90 patients with high-risk femoral bone metastases, indicated by Mirels’ scores ≥ 8, without pathological fractures and surgical fixations, who received palliative RT at our institution between January 2009 and December 2018. Pathological fracture incidence was analyzed using the Kaplan–Meier method and was 22.8% and 31.0% at 2 and 6 months, respectively. Pathological fractures were caused by 17 of 65 lesions (26.2%) and 9 of 25 lesions (36.0%) in patients who received BMAs and those who did not, respectively (p = 0.44). Additionally, 17 of 42 lesions (40.5%) and 9 of 48 lesions (18.8%) with axial cortical involvement ≥30 and <30 mm, respectively, caused pathological fractures (p = 0.02). The incidence of pathological fractures was high among patients with high-risk femoral bone metastases treated with palliative RT, particularly those with axial cortical involvement ≥30 mm. Therefore, aggressive indications for prophylactic surgical stabilization are warranted for high-risk femoral metastases despite BMA administration. Full article

(This article belongs to the Special Issue 2nd Edition: Treatment of Bone Metastasis)

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Curr. Oncol., Volume 31, Issue 12 (December 2024) – 31 articles

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