Current Oncology

8 pages, 766 KB

Open AccessCase Report

Acquired Resistance to Afatinib Mediated by EGFR T790M in Lung Adenocarcinoma Patients Harboring EGFR-KDD: A Case Report and Literature Review

by Qian Liu, Lu Lv, Guanchao Pang and Pingli Wang

Curr. Oncol. 2026, 33(4), 214; https://doi.org/10.3390/curroncol33040214 - 14 Apr 2026

Abstract

Epidermal growth factor receptor (EGFR)-kinase domain duplication (KDD) represents an atypical mutation distinct from classical EGFR mutations in lung adenocarcinoma (LUAD). Although first- and second-generation EGFR-tyrosine kinase inhibitors (TKIs) have demonstrated clinical activity in EGFR-KDD, the mechanisms of acquired resistance in this setting [...] Read more.

Epidermal growth factor receptor (EGFR)-kinase domain duplication (KDD) represents an atypical mutation distinct from classical EGFR mutations in lung adenocarcinoma (LUAD). Although first- and second-generation EGFR-tyrosine kinase inhibitors (TKIs) have demonstrated clinical activity in EGFR-KDD, the mechanisms of acquired resistance in this setting remain poorly characterized. Herein, we present a LUAD patient with EGFR-KDD who achieved a sustained initial response to afatinib lasting 67 months before developing acquired resistance. Re-biopsy with next-generation sequencing (NGS) uncovered EGFR T790M, accompanied by EGFR amplification and EGFR M766T. The patient was switched to firmonertinib, with subsequent tumor regression. We reviewed published EGFR-KDD cases that had both acquired resistance to first- or second-generation EGFR-TKIs and corresponding repeat biopsy findings. Five of the eleven cases harbored EGFR T790M, yielding a prevalence of 45%, which is similar to that seen in classical EGFR mutations. This case suggests that EGFR T790M mediates acquired resistance to first- and second-generation EGFR-TKIs in EGFR-KDD, mirroring the resistance pattern observed in classical EGFR mutations. Full article

(This article belongs to the Section Thoracic Oncology)

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13 pages, 505 KB

Open AccessArticle

Improving Quality of End-of-Life Care Through the K-HOPE Consultative Palliative Care Model: A Prospective Study in a Tertiary Hospital

by Yoo Jeong Lee, In Cheol Hwang, Eun Jeong Lee, Soon-Young Hwang and Youn Seon Choi

Curr. Oncol. 2026, 33(4), 213; https://doi.org/10.3390/curroncol33040213 - 13 Apr 2026

Abstract

As population aging accelerates, the demand for high-quality end-of-life (EOL) care continues to rise. However, a substantial proportion of patients with terminal cancer still experience death in acute-care hospitals without adequate palliative care. Consultative palliative care (CPC) represents a feasible model for delivering [...] Read more.

As population aging accelerates, the demand for high-quality end-of-life (EOL) care continues to rise. However, a substantial proportion of patients with terminal cancer still experience death in acute-care hospitals without adequate palliative care. Consultative palliative care (CPC) represents a feasible model for delivering palliative care without requiring dedicated inpatient units, yet evidence evaluating its clinical impact remains limited. In this study, we developed a structured hospital-based CPC model tailored to the Korean healthcare system, the Korea Holistic Optimized Palliative care for End-of-life (K-HOPE) model, and prospectively evaluated its clinical impact. K-HOPE was delivered by an interdisciplinary CPC team in a tertiary hospital. Unmet needs were assessed using the Integrated Palliative care Outcome Scale (IPOS), and longitudinal changes were analyzed using mixed-effects models for repeated measures. Among patients who died during hospitalization, quality of death was evaluated using the Good Death Scale (GDS). A total of 84 patients with terminal cancer received K-HOPE. The total IPOS score significantly decreased over time (β = −10.4, 95% CI −12.8 to −8.0; p < 0.001), indicating reduced overall burden and unmet needs. Significant improvements were observed in psychological distress (p = 0.010) and communication and information needs (p < 0.001), whereas changes in physical symptoms and practical concerns were not statistically significant. Among 22 patients who died during hospitalization, 59.1% achieved a good quality of death (GDS ≥ 12). Longer duration of CPC involvement was significantly associated with higher quality of death and remained an independent predictor in multivariable analysis. These findings suggest that the K-HOPE CPC model improves communication and overall EOL care experiences among hospitalized patients with terminal cancer, indicating that meaningful improvements in EOL care can occur even during short periods of CPC involvement. Structured CPC integrated into routine oncology practice represents a feasible strategy for improving EOL care in tertiary hospitals, and a standardized CPC framework may enhance the consistency and reproducibility of care delivery within the Korean healthcare system. Full article

(This article belongs to the Special Issue Palliative Care in Oncology: Current Advances)

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12 pages, 669 KB

Open AccessArticle

Axillary Reverse Mapping Improves Quality of Life by Significantly Reducing Clinically Relevant Lymphedema After Axillary Lymph Node Dissection in Older Women with Breast Cancer

by Merve Tokocin, Turan Pehlivan and Atilla Celik

Curr. Oncol. 2026, 33(4), 212; https://doi.org/10.3390/curroncol33040212 - 10 Apr 2026

Abstract

Background: Breast cancer-related lymphedema (BCRL) is one of the most debilitating long-term morbidities after axillary lymph node dissection (ALND), severely impairing quality of life through reduced mobility, independence, and chronic burden, especially in older women. Axillary reverse mapping (ARM) aims to preserve upper [...] Read more.

Background: Breast cancer-related lymphedema (BCRL) is one of the most debilitating long-term morbidities after axillary lymph node dissection (ALND), severely impairing quality of life through reduced mobility, independence, and chronic burden, especially in older women. Axillary reverse mapping (ARM) aims to preserve upper extremity lymphatics while maintaining oncologic safety. Evidence in older adult populations with long-term follow-up remains limited. Methods: This retrospective cohort study included 138 female patients (median age 72.5 years) undergoing ALND for invasive breast cancer between January 2018 and January 2024. Patients were divided into ARM (n = 72) and non-ARM (n = 66) groups. BCRL was graded 0–3 according to adapted International Society of Lymphology (ISL) criteria (2013 consensus document). Assessments were performed preoperatively and at 3, 6, 12, 24, 36, 48, and 60 months using blinded circumference measurements and bioimpedance spectroscopy. Results: Baseline characteristics were comparable. Mean follow-up was 46.5 ± 8.8 months. Clinically relevant BCRL (Grades 2–3) was dramatically lower in the ARM group (18.1% vs. 60.6%, p < 0.0001), while subclinical changes (Grade 1) were similar (31.9% vs. 27.3%, p = 0.55). Kaplan–Meier analysis showed significantly better clinically relevant lymphedema-free survival with ARM (log-rank p = 0.00019), with curve separation after 30–40 months—indicating a sustained long-term benefit for quality of life in this frail population. Recurrence rates were comparable (8.3% vs. 10.6%, p = 0.776). Multivariable Cox regression confirmed ARM as an independent protective factor (adjusted HR 0.22, 95% CI 0.11–0.44, p < 0.0001). Conclusions: In older women with breast cancer, ARM significantly reduces clinically relevant lymphedema—a major determinant of long-term quality of life—without compromising oncologic safety. These findings support the routine consideration of ARM during ALND to preserve upper-extremity function, mobility, and independence in this vulnerable population, thereby balancing aggressive oncologic treatment with enhanced long-term quality of life and reduced treatment-related morbidity. Full article

(This article belongs to the Special Issue Quality of Life in Surgical Oncology Patients)

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22 pages, 1042 KB

Open AccessArticle

Mixed-Methods Evaluation of the Delivery of Cancer Care to Teenagers and Young Adults in England and Wales: BRIGHTLIGHT_2021

by Rachel M. Taylor, Elysse Bautista-Gonzalez, Julie A. Barber, Jamie Cargill, Rozalia Dobrogowska, Richard G. Feltbower, Laura Haddad, Nicolas Hall, Maria Lawal, Martin G. McCabe, Sophie Moniz, Louise Soanes, Dan P. Stark, Bethany Wickramasinghe, Cecilia Vindrola-Padros and Lorna A. Fern

Curr. Oncol. 2026, 33(4), 211; https://doi.org/10.3390/curroncol33040211 - 10 Apr 2026

Abstract

Background: Healthcare policy in the United Kingdom recognizes that teenagers and young adults (TYAs: 16–24 years at diagnosis) require specialist care. In England, Principal Treatment Centers (PTCs) exist, delivering enhanced care exclusively within the PTC or as ‘joint care’ with designated hospitals (DHs). [...] Read more.

Background: Healthcare policy in the United Kingdom recognizes that teenagers and young adults (TYAs: 16–24 years at diagnosis) require specialist care. In England, Principal Treatment Centers (PTCs) exist, delivering enhanced care exclusively within the PTC or as ‘joint care’ with designated hospitals (DHs). Central to this is the TYA multidisciplinary team (MDT) and an outreach model coordinating care between hospitals. We previously reported similar outcomes regardless of care location. Aims: To compare TYA experiences of care with healthcare professionals’ perspectives of the service they deliver. Methods: Mixed methods across England and Wales were used. The TYA-MDT identified TYAs who then received a postal invite to a cross-sectional survey capturing experiences of places of care, treatment, healthcare professional support (HCP), mental health, sexuality/fertility, clinical trials and care coordination. Comparisons were made based on exposure to care in a specialist TYA environment within 6 months of diagnosis: all-TYA-PTC (all care in the TYA-PTC, n = 70, 28%), no-TYA-PTC (no care in the TYA-PTC (n = 87, 35%): care delivered in a children/adult unit only), and joint care (care in a TYA-PTC and in a children’s/adult unit, n = 91, 36%). HCP perspectives were captured by rapid ethnography. Results: A total of 250/1056 (24%) TYAs participated. Overall, 200 (80%) rated their teams as excellent/good for helping them prepare for treatment. No evidence of significant differences existed between categories of care for proportions receiving support from key TYA-related professionals: TYA cancer nurse specialists (all-TYA-PTC n = 58, 91%; joint care n = 71, 88%; no-TYA-PTC n = 64, 82%) and social workers (all-TYA-PTC n = 30, 55%; joint care n = 36, 48%; no-TYA-PTC n = 28, 38%). A trend of diminishing support from youth support co-coordinators existed (all-TYA-PTC 63%; joint care 49%; no-TYA-PTC 40%, p = 0.069). This may explain why few differences in patient experiences existed across categories of care. Forty-nine HCPs participated. They were more critical in their interpretation of care, highlighting inequity in resources and challenges in some pathways and coordination. Conclusions: Similar access to age-appropriate support across care settings is likely to reflect recruitment methods. When TYAs are known to the MDT, age-appropriate care can be mobilized beyond TYA units, which could explain the equitable outcomes observed across different care locations in young people who responded to the survey. Nevertheless, gaps persist in communication and coordination, particularly within joint care models, and in the involvement of allied health professionals such as dieticians and physiotherapists, whose input is essential for rehabilitation and return to normal life. Strengthening these areas will require continued investment in workforce capacity and digital infrastructure to support genuinely coordinated, developmentally appropriate TYA cancer care. Full article

(This article belongs to the Section Childhood, Adolescent and Young Adult Oncology)

17 pages, 1627 KB

Open AccessArticle

Co-Occurrence of Nuclear-Catenin and H3K27me3 Expression in Advanced Colorectal Cancer: A Retrospective Observational Study

by Ramona Abrudan, Luca Abrudan, Andreea Cămărășan, Ovidiu Camarasan, Corina Florica Ioniță, Luca Vilceanu and Ovidiu Laurean Pop

Curr. Oncol. 2026, 33(4), 210; https://doi.org/10.3390/curroncol33040210 - 8 Apr 2026

Abstract

Colorectal cancer is a heterogeneous malignancy characterized by alterations in oncogenic signaling pathways and epigenetic mechanisms involved in gene regulation. Aberrant activation of the Wnt/β-catenin pathway represents a central molecular event in colorectal tumorigenesis, while histone-associated epigenetic modifications may contribute to tumor progression [...] Read more.

Colorectal cancer is a heterogeneous malignancy characterized by alterations in oncogenic signaling pathways and epigenetic mechanisms involved in gene regulation. Aberrant activation of the Wnt/β-catenin pathway represents a central molecular event in colorectal tumorigenesis, while histone-associated epigenetic modifications may contribute to tumor progression and variability. This study aimed to investigate the relationship between Wnt pathway activation and histone H3 lysine 27 trimethylation in colorectal cancer and to examine their associations with clinicopathological and molecular characteristics. A retrospective observational study was performed on 83 colorectal adenocarcinoma cases using immunohistochemical evaluation of nuclear β-catenin and H3K27me3 expression in formalin-fixed, paraffin-embedded tumor samples, together with molecular analysis of KRAS, NRAS, and BRAF mutations and microsatellite instability status. Nuclear β-catenin expression was observed in 39.8% of cases, while H3K27me3 exhibited negative, mosaic, or diffuse nuclear staining patterns. Nuclear β-catenin expression was significantly associated with patient sex and age, whereas H3K27me3 expression patterns were significantly associated with tumor location, histological grade, disease stage, and metastatic status. These results indicate that Wnt pathway activation and H3K27me3-associated epigenetic alterations frequently coexist in colorectal cancer and support the value of integrated molecular and epigenetic assessment. Full article

(This article belongs to the Special Issue Bridging Borders: A Global Perspective on Colorectal Cancer Research and Prevention)

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12 pages, 236 KB

Open AccessArticle

Linking Inflammation to Reduced Food Intake in Advanced Cancer: A Prospective Observational Study

by Asta Bye, Trude Rakel Balstad, Ida Ervik Raaness, Tora Skeidsvoll Solheim, Ragnhild Habberstad, Pål Klepstad, Erik Torbjørn Løhre, Olav Faisal Dajani, Stein Kaasa, Nina Aass and Ola Magne Vagnildhaug

Curr. Oncol. 2026, 33(4), 209; https://doi.org/10.3390/curroncol33040209 - 8 Apr 2026

Abstract

Background: Undernutrition and cachexia are common in advanced cancer and often linked to systemic inflammation. While inflammation is associated with poorer prognosis, accelerated weight loss, and reduced treatment tolerance, its direct impact on food intake remains insufficiently investigated. Aim: To examine [...] Read more.

Background: Undernutrition and cachexia are common in advanced cancer and often linked to systemic inflammation. While inflammation is associated with poorer prognosis, accelerated weight loss, and reduced treatment tolerance, its direct impact on food intake remains insufficiently investigated. Aim: To examine the association between systemic inflammation and energy and protein intake over time in patients with advanced cancer. Methods: A total of 170 patients from the Palliative Radiotherapy and Inflammation Study were included. Nutritional status was assessed using PG-SGA SF. Dietary intake was recorded using repeated 24 h recalls. Systemic inflammation was defined as CRP > 10 mg/L. Mixed linear models were applied to evaluate the association between inflammation energy and protein intake over time. Results: Systemic inflammation (CRP >10 mg/L) was present in 87 (51%) patients and associated with significantly lower energy (−3.6 kcal/kg, p = 0.04) and lower protein intake (−0.25 g/kg, p = 0.003). Patients with inflammation were more often undernourished and had shorter survival. Conclusions: Systemic inflammation is likely associated with clinically relevant reductions in energy and protein intake in advanced cancer. CRP may help identify patients for whom standard nutritional support is insufficient. Full article

(This article belongs to the Special Issue Palliative Care in Oncology: Current Advances)

9 pages, 229 KB

Open AccessArticle

Minimizing Lymphatic Morbidity: Incidence of Lower Extremity Lymphedema After vNOTES-Assisted Sentinel Node Mapping in Endometrial Cancer

by Duygu Kurtulus, Kevser Arkan, Ali Deniz Erkmen, Gul Cavusoglu Colak, Sedat Akgol and Behzat Can

Curr. Oncol. 2026, 33(4), 208; https://doi.org/10.3390/curroncol33040208 - 7 Apr 2026

Abstract

Background: Endometrial cancer is the most common gynecologic malignancy in developed countries. Sentinel lymph node (SLN) mapping has emerged as a less invasive alternative to systematic lymphadenectomy and is increasingly incorporated into surgical staging algorithms. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) [...] Read more.

Background: Endometrial cancer is the most common gynecologic malignancy in developed countries. Sentinel lymph node (SLN) mapping has emerged as a less invasive alternative to systematic lymphadenectomy and is increasingly incorporated into surgical staging algorithms. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) provides transvaginal access to the retroperitoneum and may facilitate SLN mapping while potentially reducing postoperative morbidity, including lower extremity lymphedema (LEL). Objective: This study aimed to evaluate the feasibility of vNOTES hysterectomy with bilateral salpingo-oophorectomy (BSO) and retroperitoneal SLN mapping and to report early postoperative lymphedema outcomes in patients with newly diagnosed endometrial cancer. Methods: This retrospective cohort study included 113 patients who underwent vNOTES-assisted hysterectomy with BSO and SLN mapping using methylene blue dye at a tertiary referral center between January 2022 and January 2023. Lymphedema was evaluated using the Gynecologic Cancer Lymphedema Questionnaire at 6 and 12 months postoperatively, supported by clinical examination. Descriptive statistical analyses were performed to summarize clinical characteristics and symptom profiles. Results: The mean patient age was 55.0 ± 10.5 years and the mean BMI was 30.94 ± 2.54 kg/m². Endometrioid adenocarcinoma was the most common histological subtype (75.5%), and most tumors were grade 1 (57.1%). SLN mapping was successful in 102 of 113 patients (overall detection rate 90.3%), with bilateral detection in 79.6% and unilateral detection in 10.6% of cases. Limb swelling was reported in 4.1% of patients, while only one patient (1.0%) met the criteria for self-reported mild lymphedema. No clinical signs of inguinal lymphedema were detected. Conclusions: vNOTES hysterectomy combined with retroperitoneal SLN mapping was associated with a low incidence of postoperative lower extremity lymphedema in this single-arm cohort. These findings suggest that vNOTES-assisted SLN mapping may represent a feasible minimally invasive approach for nodal assessment in selected patients with endometrial cancer. Prospective comparative studies are required to confirm these findings and to evaluate long-term oncologic and lymphatic outcomes. Full article

(This article belongs to the Section Gynecologic Oncology)

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11 pages, 970 KB

Open AccessArticle

Impact of a Multimodal Prehabilitation Program on Perioperative Outcomes in Hepatopancreatobiliary Surgery: A Retrospective Cohort Study

by Pipit Burasakarn, Nattaporn Maneepairoj, Vachiraluck Chalokool, Anuparp Thienhiran, Sermsak Hongjinda and Pusit Fuengfoo

Curr. Oncol. 2026, 33(4), 207; https://doi.org/10.3390/curroncol33040207 - 5 Apr 2026

Abstract

Background: Major hepatopancreatobiliary (HPB) surgeries cause significant physical stress. In this study, we evaluated how a 4-week multimodal prehabilitation program affects perioperative outcomes across different types of HPB procedures. Methods: We conducted a retrospective cohort study of 359 patients undergoing HPB [...] Read more.

Background: Major hepatopancreatobiliary (HPB) surgeries cause significant physical stress. In this study, we evaluated how a 4-week multimodal prehabilitation program affects perioperative outcomes across different types of HPB procedures. Methods: We conducted a retrospective cohort study of 359 patients undergoing HPB surgery (162 historical controls and 197 in the prehabilitation group). To accurately assess the clinical benefits of various procedures, patients were stratified into specific surgical groups: major and minor hepatectomy, pancreatoduodenectomy (PD), and left pancreatectomy (LP). Results: The prehabilitation program significantly improved preoperative nutrition, demonstrated by increased serum albumin levels on the day of surgery (p < 0.001), and the clinical benefits were most pronounced in pancreatic surgeries. Patients undergoing PD in the prehabilitation group had a significantly shorter median hospital stay (8 versus 13 days, p < 0.001). LP patients also experienced shorter hospital stays (5 versus 9 days, p = 0.001) and reduced blood loss (p = 0.002). For minor hepatectomies, the intervention significantly lowered the need for blood transfusions (8.3% versus 18.9%, p = 0.033). The length of stay and complication rates for major hepatectomies remained comparable between groups. Importantly, major morbidities and 90-day mortality were low and similar across all cohorts. Conclusions: Multimodal prehabilitation successfully optimizes preoperative nutrition and accelerates hospital discharge, especially after highly stressful pancreatic surgeries. Because benefits vary by surgical magnitude, prehabilitation pathways should be tailored to prioritize high-risk patients facing complex operations. Full article

(This article belongs to the Section Gastrointestinal Oncology)

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11 pages, 290 KB

Open AccessArticle

Controlled Ovarian Stimulation After Fertility-Sparing Surgery for Borderline Ovarian Tumors: An Exploratory Cohort Study on Recurrence and Reproductive Outcomes

by Sofia Thiella, Giacomo Corrado, Paola Villa, Inge Peters, Diana Giannarelli, Rossella Letizia Mancusi, Tina Pasciuto, Lucrezia Massaro, Maria Luisa Di Pietro, Maria Lucia Specchia and Anna Fagotti

Curr. Oncol. 2026, 33(4), 206; https://doi.org/10.3390/curroncol33040206 - 3 Apr 2026

Abstract

Borderline ovarian tumors often affect women of reproductive age for whom fertility preservation may be a major concern. While fertility-sparing surgery is widely accepted, the safety of controlled ovarian stimulation for oocyte cryopreservation after surgery remains uncertain due to potential recurrence risk. This [...] Read more.

Borderline ovarian tumors often affect women of reproductive age for whom fertility preservation may be a major concern. While fertility-sparing surgery is widely accepted, the safety of controlled ovarian stimulation for oocyte cryopreservation after surgery remains uncertain due to potential recurrence risk. This retrospective single-center cohort study explored the association between controlled ovarian stimulation following fertility-sparing surgery and both recurrence risk and reproductive outcomes. Patients treated between January 2011 and June 2024 were included. Baseline characteristics, surgical details, and reproductive outcomes were compared using non-parametric and exact tests. Progression-free survival was assessed with Kaplan–Meier estimates and Cox proportional hazards models, modeling stimulation as a time-dependent covariate, and using a 10-month landmark analysis to account for immortal time bias. Of 45 included patients, 19 underwent ovarian stimulation after surgery, with a median interval of 9.9 months to stimulation. Median follow-up was 34.4 months. Recurrence occurred in 21.1% of stimulated patients versus 38.5% of non-stimulated patients (p = 0.338). After adjustment for time-dependent exposure, ovarian stimulation was not associated with increased recurrence risk (HR 0.95, 95% CI 0.22–4.09; p = 0.944). Eleven patients (24.4%) achieved at least one pregnancy, 81.8% of which were spontaneous. Controlled ovarian stimulation for oocyte cryopreservation after fertility-sparing surgery for borderline ovarian tumors did not show an increased recurrence risk, although larger studies are needed. Full article

(This article belongs to the Section Gynecologic Oncology)

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15 pages, 1405 KB

Open AccessArticle

Instability in Pentanucleotide Markers in a Subset of Microsatellite Instability-High Colorectal Cancer

by Ahmet Yilmaz, Wendy L. Frankel, Benjamin J. Swanson, Kristin Miller, Jason Bacher, Christopher Bigley, Lori Nelsen, Matthew F. Kalady, Joshua F. Coleman, Rachel Pearlman and Heather Hampel

Curr. Oncol. 2026, 33(4), 205; https://doi.org/10.3390/curroncol33040205 - 2 Apr 2026

Abstract

Microsatellite instability (MSI) testing is frequently used to screen patients for the early detection of Lynch syndrome, the most common hereditary colorectal cancer syndrome. MSI testing compares microsatellite repeat lengths in tumor DNA with those in matched normal tissue from the same patient. [...] Read more.

Microsatellite instability (MSI) testing is frequently used to screen patients for the early detection of Lynch syndrome, the most common hereditary colorectal cancer syndrome. MSI testing compares microsatellite repeat lengths in tumor DNA with those in matched normal tissue from the same patient. Therefore, precise sample identification is critical for obtaining reliable test results. The Penta-C and Penta-D pentanucleotide markers are widely used for sample identification in MSI testing. We investigated instability, defined as allelic mismatches or shifts, discordant fragment sizes, or the appearance of alleles in tumor DNA that were absent in the corresponding normal DNA, in the Penta-C and Penta-D loci across 2609 paired colorectal tumor and matched normal tissue or blood DNA samples. The allele sizes of both markers did not match in 0.3% of microsatellite-stable (MSS) and 12.3% of microsatellite instability-high (MSI-H) patients (p < 0.001, difference in proportions, 12.0% (95% CI, 8.9–15.1%)). Non-matching allele sizes in 12.3% of the MSI-H tumors suggest that other repeat markers may also be unstable and not suitable for sample identification in these tumors. Full article

(This article belongs to the Section Gastrointestinal Oncology)

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8 pages, 2530 KB

Open AccessCase Report

Merkel Cell Carcinoma of the Thigh Presenting as a Hemorrhagic Mass: A Rare Case Report and Literature Review

by Hüseyin Emre Tepedelenlioğlu, Özlem Orhan, Şefik Murat Arıkan and Güldal Esendağlı

Curr. Oncol. 2026, 33(4), 204; https://doi.org/10.3390/curroncol33040204 - 1 Apr 2026

Abstract

Background: Merkel cell carcinoma (MCC) is a rare, aggressive primary cutaneous neuroendocrine carcinoma with a marked propensity for early regional lymph node metastasis. Although MCC most often arises on sun-exposed head and neck skin in older adults, tumors of the lower extremity are [...] Read more.

Background: Merkel cell carcinoma (MCC) is a rare, aggressive primary cutaneous neuroendocrine carcinoma with a marked propensity for early regional lymph node metastasis. Although MCC most often arises on sun-exposed head and neck skin in older adults, tumors of the lower extremity are uncommon and may be mistaken for benign hemorrhagic lesions. Case presentation: A 54-year-old woman developed a rapidly enlarging, hemorrhagic mass in the left suprapatellar thigh. Magnetic resonance imaging demonstrated an extracompartmental subcutaneous soft-tissue mass without quadriceps muscle invasion. Wide local excision including the quadriceps fascia was performed. Histopathologic examination showed a dermal/subcutaneous small blue round cell neoplasm with brisk mitotic activity. Immunohistochemistry demonstrated diffuse cytoplasmic synaptophysin positivity, paranuclear dot-like CK20 reactivity, chromogranin A positivity, and negative MCPyV staining; TTF-1, S100, melan-A, HMB-45, and hematolymphoid markers were negative. Staging positron emission tomography/computed tomography identified ipsilateral inguinal nodal involvement. Therapeutic inguinal lymph node dissection revealed metastatic MCC in one of four lymph nodes without extranodal extension. The final stage was pT3 pN1b cM0 (AJCC 8th edition), corresponding to stage IIIB disease. Adjuvant radiotherapy (57 Gy in 20 fractions) was delivered to the primary bed and ipsilateral inguinal basin. The patient remains disease-free at 5-year follow-up. Conclusions: Lower-extremity MCC can mimic hemorrhagic or post-traumatic lesions, contributing to diagnostic delay. Persistent or rapidly enlarging “hematoma-like” lesions warrant early biopsy, and timely pathologic nodal staging is essential. Multimodal management can achieve durable control even in node-positive disease Full article

(This article belongs to the Section Dermato-Oncology)

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10 pages, 447 KB

Open AccessArticle

The Yield of Staging Investigations in Patients with Breast Cancer Planned for Neoadjuvant Chemotherapy

by Kadhim Taqi, Camelia Ursu, Susan Isherwood, Rabia Raheel, Julia Downey, Jeffrey Q. Cao, Sasha Lupichuk, Omar Khan, Nancy Nixon, May Lynn Quan and Alison Laws

Curr. Oncol. 2026, 33(4), 203; https://doi.org/10.3390/curroncol33040203 - 1 Apr 2026

Abstract

Background: Patients with breast cancer planned for neoadjuvant chemotherapy (NAC) represent a diverse population including high-risk early breast cancer (EBC) and locally advanced breast cancer (LABC). Staging investigations are routinely performed, but the clinical utility is unclear. Methods: Using a provincial cancer registry, [...] Read more.

Background: Patients with breast cancer planned for neoadjuvant chemotherapy (NAC) represent a diverse population including high-risk early breast cancer (EBC) and locally advanced breast cancer (LABC). Staging investigations are routinely performed, but the clinical utility is unclear. Methods: Using a provincial cancer registry, we identified breast cancer patients referred for NAC between 2020 and 2022. Patients with staging investigations were stratified into EBC (anatomic clinical stage I–II) and LABC (stage III). Rates of metastatic (M1) disease and associated factors were assessed. Results: Among 529 EBC patients, 515 (97.4%) underwent staging. The M1 disease rate was 5.4%. The M1 rate for cT1-2N0 was 1.1%, and for cT1-2N1 it was 7.9%. In multivariable analysis, cT1N1 (OR 5.31; 95% CI 1.05–27.0; p = 0.044) and cT2N1 (OR 4.59; 95% CI 1.02–20.67; p = 0.047) were associated with M1 disease in EBC. All 320 LABC patients underwent staging. The M1 disease rate was 22.8%, significantly higher than in EBC (p < 0.001). A higher cT/N stage correlated with M1 disease in LABC, although most subgroups demonstrated rates of ≥10%. Conclusions: These findings support a risk-adapted approach to pre-treatment staging in patients planned for NAC, omitting staging in asymptomatic cT1–2N0 disease, considering it for node-positive EBC, and performing it routinely in LABC. Full article

(This article belongs to the Section Breast Cancer)

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0 pages, 782 KB

Open AccessReview

Resuscitation in Oncology: Limits, Ethics, Practice, and Humanity

by Lea Andjelković, Milan Krnojelac and Iztok Potočnik

Curr. Oncol. 2026, 33(4), 202; https://doi.org/10.3390/curroncol33040202 - 31 Mar 2026

Abstract

Introduction: Cardiopulmonary resuscitation (CPR) is one of the most consequential decisions in clinical medicine—a pivotal moment between life and death where science, ethics, and humanity intersect. Although advances in systems of care, technology, and training have refined technique and logistics, outcomes do not [...] Read more.

Introduction: Cardiopulmonary resuscitation (CPR) is one of the most consequential decisions in clinical medicine—a pivotal moment between life and death where science, ethics, and humanity intersect. Although advances in systems of care, technology, and training have refined technique and logistics, outcomes do not consistently result in meaningful, neurologically intact survival. In oncology—where disease trajectories are heterogeneous, treatment burdens substantial, and organ reserve often limited—these tensions are especially pronounced. Methods and approaches: This manuscript examines resuscitation as a medical, ethical, and human process, with explicit focus on patients with cancer. We review contemporary strategies for early recognition of deterioration (MEWS, NEWS, MET activation), team preparedness through Immediate Life Support (ILS), and structured decision-making at the boundaries of resuscitation. We also address communication with patients and families, the legal framework of Do-Not-Resuscitate (DNR) orders, and the distinctions among treatment forgoing, palliative sedation, and euthanasia, emphasising oncology-specific considerations such as metastatic burden, treatment intent (curative vs. palliative), performance status, and organ reserve. Results and discussion: The overall effectiveness of resuscitation remains modest (approximately 5–20% survival), highlighting the importance of prevention and early intervention. In cancer care, the limits of resuscitation are both clinical and ethical, requiring proportionality between the likely benefit and the risks of prolonging suffering, careful attention to prognosis and expected neurological outcomes, and rigorous alignment with goals of care. Early and ongoing involvement of palliative services, along with robust long-term care pathways, provides humane, value-concordant alternatives for patients with advanced disease. Psychotherapists and chaplains play integral roles in supporting families and clinical staff. Structured post-event debriefing and system-level safeguards are essential to mitigate burnout and moral distress within oncology teams. Initiating or discontinuing resuscitation in oncology requires expertise, empathy, and moral clarity. Dignity-preserving care depends on aligning interventions with patient values and realistic clinical endpoints. Acceptance of the natural course of dying represents an important component of responsible and patient-centred medical care. Full article

(This article belongs to the Special Issue Palliative Care in Oncology: Current Advances)

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0 pages, 1891 KB

Open AccessReview

Metabolomic Insights into Head and Neck Cancer: Recent Advances and Future Directions

by Srikanth Ponneganti, Kousalya Lavudi, Maharshi Thalla, Gayatri Narkhede, Reva Dwivedi, Rekha Kokkanti and Prashant Pandey

Curr. Oncol. 2026, 33(4), 201; https://doi.org/10.3390/curroncol33040201 - 31 Mar 2026

Abstract

Head and neck squamous cell carcinoma (HNSCC) continues to pose a major global health challenge, with over 600,000 new cases diagnosed annually and persistently poor survival outcomes despite advances in surgery, radiotherapy, and immunotherapy. Growing evidence implicates metabolic reprogramming, including enhanced glycolysis, glutaminolysis, [...] Read more.

Head and neck squamous cell carcinoma (HNSCC) continues to pose a major global health challenge, with over 600,000 new cases diagnosed annually and persistently poor survival outcomes despite advances in surgery, radiotherapy, and immunotherapy. Growing evidence implicates metabolic reprogramming, including enhanced glycolysis, glutaminolysis, lipid synthesis, and one-carbon/redox flux as a central driver of HNC initiation, progression, and therapy resistance. In contrast, metabolic crosstalk within the hypoxic, acidic tumor microenvironment (TME) further shapes immune evasion and stromal support. Recent innovations in mass spectrometry platforms (LC-MS, GC-MS, NMR) have attracted attention in clinical therapeutics, and spatial metabolomics imaging techniques now enable high-resolution in situ mapping of metabolites, revealing intratumoral heterogeneity and offering new insights into tumor-immune–stromal interactions and potential biomarkers for precision oncology. In this review, we integrate critical methodological considerations from sample collection and data-analysis workflows to analytical pitfalls with a balanced, pathway-focused analysis of HNSCC dysmetabolism, examine tumor immune stromal metabolic interactions, and highlight translational opportunities through emerging biomarkers, targeted inhibitors, and cutting-edge approaches such as single-cell and AI-driven metabolomics to chart a roadmap toward precision oncology for HNSCC. Full article

(This article belongs to the Section Head and Neck Oncology)

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0 pages, 1649 KB

Open AccessGuidelines

Guidance for Canadian Breast Cancer Practice: National Consensus Recommendations for the Systemic Treatment of Patients with HER2+ Breast Cancer in Both the Early and Metastatic Settings (2025 Update)

by Aalok Kumar, Katarzyna J. Jerzak, Karen A. Gelmon, Jean-François Boileau, Nathaniel Bouganim, Christine Brezden-Masley, Jeffrey Q. Cao, David W. Cescon, Stephen Chia, Scott Edwards, Anil Abraham Joy, Kara Laing, Nathalie LeVasseur, Sandeep Sehdev, Christine Simmons, Marc Webster, Mita Manna and on behalf of Patient Advocacy, Breast Cancer Canada

Curr. Oncol. 2026, 33(4), 200; https://doi.org/10.3390/curroncol33040200 - 31 Mar 2026

Abstract

Human epidermal growth factor receptor 2-positive (HER2+) breast cancer is an aggressive subtype associated with a poor prognosis when not optimally treated. Over the past year, major advances—including results from DESTINY-Breast05, DESTINY-Breast09, DESTINY-Breast11, PATINA, and long-term APHINITY follow-up—have changed the treatment landscape regarding [...] Read more.

Human epidermal growth factor receptor 2-positive (HER2+) breast cancer is an aggressive subtype associated with a poor prognosis when not optimally treated. Over the past year, major advances—including results from DESTINY-Breast05, DESTINY-Breast09, DESTINY-Breast11, PATINA, and long-term APHINITY follow-up—have changed the treatment landscape regarding the place in therapy of antibody–drug conjugates and the optimal sequencing of systemic therapies. These developments prompted the need for updated evidence-informed consensus recommendations to support consistent, high-quality care across Canada. Research Excellence, Active Leadership Canadian Breast Cancer Alliance (REAL Alliance), comprising clinical-academic oncologists from across Canada and Breast Cancer Canada, updated its 2024 HER2+ recommendations through a modified Delphi process with up to three rounds of anonymous voting. Consensus was defined a priori as ≥75% agreement. This 2025 update incorporates new data in early-stage, metastatic, and central nervous system-involved disease, including revisions to neoadjuvant and adjuvant treatment pathways and expanded guidance on the clinical use of antibody–drug conjugates. Full article

(This article belongs to the Special Issue REAL Canadian Breast Cancer Alliance Collection)

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0 pages, 477 KB

Open AccessSystematic Review

The Benefits and Harms of Screening for Prostate Cancer in Adults Aged 18 Years and Older: A Systematic Review

by Alexandria Bennett, Niyati Vyas, Nicole Shaver, Faris Almoli, Taddele Kibret, Andrew Loblaw, Lisa Del Giudice, Xiaomei Yao, Becky Skidmore, Melissa Brouwers, Julian Little and David Moher

Curr. Oncol. 2026, 33(4), 199; https://doi.org/10.3390/curroncol33040199 - 31 Mar 2026

Abstract

Given ongoing uncertainty about the benefits and harms of prostate-specific antigen (PSA) screening, this systematic review updates the evidence to inform guideline recommendations for adults aged ≥ 18 years in primary care. We searched multiple bibliographic databases from inception to 30 May 2022, [...] Read more.

Given ongoing uncertainty about the benefits and harms of prostate-specific antigen (PSA) screening, this systematic review updates the evidence to inform guideline recommendations for adults aged ≥ 18 years in primary care. We searched multiple bibliographic databases from inception to 30 May 2022, with an update on 24 July 2024, for randomized controlled trials (RCTs) and comparative observational studies evaluating PSA-based screening with or without adjunctive technologies such as magnetic resonance imaging (MRI). Studies were selected in duplicate, with data extraction and quality assessment verified by a second reviewer; risk of bias and evidence certainty were assessed using study design-specific tools and GRADE. Four RCTs and one cohort study (17 articles) were included: ERSPC, PLCO and CAP compared PSA screening with no screening, while STHLM3-MRI evaluated a risk-based test combined with MRI targeted biopsy. Meta-analysis showed 0.96 fewer prostate cancer deaths per 1000 individuals invited to screen, corresponding to a 12% relative reduction over 9.5–22 years (RR 0.88, 95% CI 0.81–0.95). One trial estimated 2.3% to 10.3% overdiagnosis over 10–14 years. Overall certainty of evidence was low or very low. PSA screening may offer a small mortality benefit, but uncertainty and variable harms limit confidence, underscoring the need for high-quality evidence, particularly for MRI and risk-based screening strategies. Full article

(This article belongs to the Section Genitourinary Oncology)

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20 pages, 1818 KB

Open AccessReview

Preclinical Rationale, Clinical Efficacy, and Safety of the Selective AKT Kinase Inhibitor Capivasertib in Metastatic Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Breast Carcinoma: A Practical Narrative Review

by Maria Rosaria Valerio, Daniela Sambataro, Federica Martorana, Martina Greco, Chiara Mesi, Vittorio Gebbia, Paolo Vigneri and Giuseppa Scandurra

Curr. Oncol. 2026, 33(4), 198; https://doi.org/10.3390/curroncol33040198 - 31 Mar 2026

Abstract

Most patients with advanced/metastatic hormone receptor-positive, HER2-negative breast cancer receive first-line therapy with cycline-dependent kinase 4/6 inhibitors plus endocrine therapy. Almost universally, these patients eventually progress due to the emergence of resistant cancer clones. Targeting the PIK3CA/AKT1/PTEN pathway is a way of overcoming [...] Read more.

Most patients with advanced/metastatic hormone receptor-positive, HER2-negative breast cancer receive first-line therapy with cycline-dependent kinase 4/6 inhibitors plus endocrine therapy. Almost universally, these patients eventually progress due to the emergence of resistant cancer clones. Targeting the PIK3CA/AKT1/PTEN pathway is a way of overcoming resistance. Recently, the oral, selective AKT kinase inhibitor capivasertib has been approved for the treatment of estrogen receptor-positive/human HER2-growth factor receptor-2 advanced BC with alterations in PIK3CA/AKT1/PTEN, in combination with fulvestrant after progression on endocrine therapy. We performed a narrative review to recapitulate the available evidence about capivasertib in the management of advanced hormone receptor-positive, HER2-negative breast cancer, focusing on studies that address preclinical rationale, pharmacology, and clinically relevant problems. Full article

(This article belongs to the Special Issue Advances in Endocrine Therapy for Breast Cancer)

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12 pages, 492 KB

Open AccessArticle

Wilms Tumor with Inferior Vena Cava Thrombus: Comparative Analysis of Clinical Characteristics and Outcomes

by Rahaf Al-Hasan, Rula Al-Qawabah, Khalil Ghandour, Ahmad Kh. Ibrahimi, Nasim Sarhan, Iyad Sultan and Hadeel Halalsheh

Curr. Oncol. 2026, 33(4), 197; https://doi.org/10.3390/curroncol33040197 - 31 Mar 2026

Abstract

Background: An inferior vena cava thrombus (IVCT) occurs in approximately 4–10% of Wilms tumor (WT) cases. The presence of an IVCT complicates surgical management and potentially affects patient outcomes. We reviewed all patients with a WT with and without an IVCT treated at [...] Read more.

Background: An inferior vena cava thrombus (IVCT) occurs in approximately 4–10% of Wilms tumor (WT) cases. The presence of an IVCT complicates surgical management and potentially affects patient outcomes. We reviewed all patients with a WT with and without an IVCT treated at our center, comparing their characteristics and outcome. Patients and Methods: We retrospectively reviewed pediatric patients with a WT treated between November 2014 and July 2023. Patients were categorized according to the presence or absence of an IVCT. Data on demographics, clinical presentation, imaging findings, treatment modalities, and outcomes were collected. Group comparisons for categorical data were carried out using Chi-square tests, Event-free survival (EFS) and overall survival (OS) were estimated using Kaplan–Meier curves, and differences between groups were assessed with the log-rank test. Results: Among 110 children with a unilateral WT, 17 (15.4%) had an IVCT at presentation. Their median age at diagnosis was 4.2 years. Females predominated (65%) and 11 (65%) had distant metastasis. Thrombus levels were infra-hepatic (52.9%), retro-hepatic (23.6%), supra-hepatic (5.9%), and intra-cardiac (17.6%). Thrombus resolution following neo-adjuvant chemotherapy was achieved in 41.2% of patients, most frequently in infra-hepatic thrombi. Local control followed neo-adjuvant chemotherapy that included doxorubicin. Favorable histology was observed in 70% of patients with an IVCT. Compared with patients without an IVCT, children with an IVCT tend to present at an older age, have hematuria, a larger tumor, positive lymph node (LN) involvement, and metastatic disease (p value, 0.019, 0.008, 0.01, 0.014, and 0.002, respectively). On univariable analysis, older age, the presence of metastatic disease, IVCT, LN involvement, and diffuse anaplasia were associated with inferior EFS and OS. Five-year EFS and OS were significantly lower in patients with IVCT compared to those without (51% ± 12.5% vs. 74.5% ± 4.6%, p = 0.021 and 53.8% ± 15.4% vs. 82% ± 4.9%, p = 0.012, respectively). Conclusions: We observed a higher proportion of IVCT than previously reported. Consistent with prior studies, an IVCT was associated with more aggressive disease features. Although survival was worse in patients with an IVCT, the mere presence of a thrombus as an independent prognostic factor requires evaluation in larger patient cohorts. Full article

(This article belongs to the Section Surgical Oncology)

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10 pages, 847 KB

Open AccessCase Report

Lattice Radiation Therapy Plays a Synergistic Role in the Radical Treatment of Bulky Cervical Cancer: A Case Report and Literature Review

by Feifei Wang, Qianru Zhan, Zhitao Dai, Huijuan Zhang, Miao Peng, Zhijian Chen, Jing Jin and Xiugui Sheng

Curr. Oncol. 2026, 33(4), 196; https://doi.org/10.3390/curroncol33040196 - 31 Mar 2026

Abstract

Background: An increasing number of reports showed patients with bulky tumors after lattice radiation therapy (LRT) treatment achieved good local control. However, in these reports, LRT was previously used primarily for palliation. We reported a case that LRT plays a synergistic role in [...] Read more.

Background: An increasing number of reports showed patients with bulky tumors after lattice radiation therapy (LRT) treatment achieved good local control. However, in these reports, LRT was previously used primarily for palliation. We reported a case that LRT plays a synergistic role in the radical treatment of locally advanced bulky cervical cancer (LABCC) combined with INTERLACE study protocol. Methods: The patient was a 54-year-old female with LABCC and treated with LRT combined with the INTERLACE study protocol. She received three fractions of 3 Gy each to the gross tumor volume (GTV) and three fractions of 9 Gy each to the lattice therapy volume (LTV), on an emergent basis, using volumetric modulated arc therapy (VMAT). Subsequently, according to the INTERLACE study protocol, chemotherapy and radiotherapy were carried out and the standard follow-up examinations were conducted. Adverse events (AEs) were assessed according to the Common Terminology Criteria for AEs (CTCAE) version 5.0. Results: The patient initially received LRT, which reduced the tumor burden and controlled bleeding. After this was combined with the INTERLACE study protocol, the complete clinical response (cCR) was achieved and they maintained this status for 13 months after the completion of concurrent chemoradiotherapy (CCRT), with only manageable grade IV hematological toxicity observed after the completion of CCRT. During this period, only manageable grade IV hematological toxicity (platelet count 16 × 10⁹/L, white blood cell count 0.33 × 10⁹/L) was observed. Conclusions: In this case, LRT combined with INTERLACE study protocol appears to be a safe and effective for the treatment of LABCC which improved the patient’s quality of life without uncontrolled treatment-related toxicity. Full article

(This article belongs to the Topic Cancer Biology and Radiation Therapy: 2nd Edition)

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