Current Oncology

14 pages, 1088 KiB

Open AccessArticle

Impact of PRECEDE–PROCEED Model Audits in Cancer Screening Programs in Lombardy Region: Supporting Equity and Quality Improvement

by Stefano Odelli, Margherita Zeduri, Maria Rosa Schivardi, Davide Archi, Liliana Coppola, Roberto Genco Russo, Maristella Moscheni, Elena Tettamanzi, Fabio Terragni, Michela Viscardi, Valentina Vitale, Anna Odone, Danilo Cereda and Silvia Deandrea

Curr. Oncol. 2024, 31(10), 5960-5973; https://doi.org/10.3390/curroncol31100445 - 3 Oct 2024

Abstract

Background: Health disparities related to socio-economic factors impact access to preventive health interventions. The PRECEDE–PROCEED model, a multidimensional approach to health promotion, has been adapted to optimise cancer screening programs in Lombardy, Italy, addressing these disparities. Methods: This study evaluated the application of [...] Read more.

Background: Health disparities related to socio-economic factors impact access to preventive health interventions. The PRECEDE–PROCEED model, a multidimensional approach to health promotion, has been adapted to optimise cancer screening programs in Lombardy, Italy, addressing these disparities. Methods: This study evaluated the application of systemic audits based on the PRECEDE–PROCEED model across Lombardy cancer screening programs. A systematic region-wide audit was performed in 2019, and follow-up audits were performed in 2022–2023. Data were collected using structured analysis methodologies, including epidemiological, behavioural, and organisational assessments. Results: The 2019 audit showed strengths in participation and quality standards but identified challenges in cervical cancer screening coverage and waiting times for assessments. Improvements plans included the digitisation of processes and stakeholder engagement. The 2022–2023 audits reported increased coverage for breast and colorectal screenings, but a slight decline in participation rates and examination coverage. Organisational improvements were noted, yet gaps in training and equity-targeted actions remained. Conclusion: The PRECEDE–PROCEED model audits led to notable improvements in the quality and equity of cancer screening programs in Lombardy. Sustained focus on digital integration, continuous re-training, and targeted equity interventions is essential for further progress. Full article

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11 pages, 958 KiB

Open AccessArticle

Integrative Biomarker Panel for Improved Lung Cancer Diagnosis Using Plasma microRNAs and Sputum Bacterial DNA

by Pushpa Dhilipkannah, Ashutosh Sachdeva, Van K. Holden and Feng Jiang

Curr. Oncol. 2024, 31(10), 5949-5959; https://doi.org/10.3390/curroncol31100444 - 2 Oct 2024

Abstract

This study aimed to evaluate if integrating diverse molecular biomarkers in plasma and sputum could improve the diagnosis of lung cancer. The study analyzed miRNAs in plasma and bacterial DNA in sputum from 58 lung cancer patients and 62 cancer-free smokers using droplet [...] Read more.

This study aimed to evaluate if integrating diverse molecular biomarkers in plasma and sputum could improve the diagnosis of lung cancer. The study analyzed miRNAs in plasma and bacterial DNA in sputum from 58 lung cancer patients and 62 cancer-free smokers using droplet digital PCR. The individual plasma miRNA and sputum bacterial biomarkers had sensitivities of 62–71% and specificities of 61–79% for diagnosing lung cancer. A panel of plasma miRNA or sputum bacterial biomarkers produced sensitivities of 79–85% and specificities of 74–82%. An integromic signature consisting of two miRNAs in plasma and three bacterial biomarkers in sputum had a higher sensitivity (87%) and specificity (89%) compared to individual biomarkers. The signature’s diagnostic value was confirmed in a validation cohort of 56 lung cancer patients and 59 controls, independent of tumor stage, histological type, and demographic factors. Integrating diverse molecular biomarkers in plasma and sputum could improve the diagnosis of lung cancer. Full article

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6 pages, 2646 KiB

Open AccessCase Report

A Case of Primary Ewing Sarcoma of the Kidney: Robotic-Assisted Nephron-Sparing Surgery, a Feasible Alternative in Treatment of Localized Disease

by Amr Ahmed, Aleksa Zubelic, Milan Radovanovic, Gjoko Stojanoski and Metin Aksünger

Curr. Oncol. 2024, 31(10), 5943-5948; https://doi.org/10.3390/curroncol31100443 - 2 Oct 2024

Abstract

Extra-skeletal Ewing sarcoma (EWS) occurs in about 12% of EWS patients; at the same time, primary involvement of the kidneys remains extremely rare. Since it was first described in 1975, only a small case series have been reported worldwide. About 95% of surgically [...] Read more.

Extra-skeletal Ewing sarcoma (EWS) occurs in about 12% of EWS patients; at the same time, primary involvement of the kidneys remains extremely rare. Since it was first described in 1975, only a small case series have been reported worldwide. About 95% of surgically treated patients with EWS of the kidney described in the literature underwent nephrectomy, and the remaining patients only had a tumor biopsy. Nephron-sparing surgery (NSS) has not been sufficiently investigated as an alternative in the local surgical treatment of localized disease, mostly as a result of technically unfeasible provisions of negative surgical margins. In this report, we present a unique case of primary EWS of the kidney with an asymptomatic course without radiographic signs that suggest a highly aggressive disease, successfully locally treated with robotic-assisted NSS. This report showcases that robotic-assisted NSS could be a feasible alternative in treatment of localized disease yielding equally good oncological results while, at the same time, creating better prerequisites for necessary adjuvant chemotherapy. Full article

(This article belongs to the Section Genitourinary Oncology)

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14 pages, 1610 KiB

Open AccessSystematic Review

The Frequency of Urination Dysfunction in Patients Operated on for Rectal Cancer: A Systematic Review with Meta-Analyses

by Dagný Halla Ágústsdóttir, Stina Öberg, Camilla Christophersen, Birthe Thing Oggesen and Jacob Rosenberg

Curr. Oncol. 2024, 31(10), 5929-5942; https://doi.org/10.3390/curroncol31100442 - 2 Oct 2024

Abstract

The frequency of long-term urination dysfunction after surgery for rectal cancer remains unclear, yet it is essential to establish this to improve treatment strategies. Randomized controlled trials (RCTs), non-RCTs, and cohort studies were included with patients having undergone sphincter-preserving total (TME) or partial [...] Read more.

The frequency of long-term urination dysfunction after surgery for rectal cancer remains unclear, yet it is essential to establish this to improve treatment strategies. Randomized controlled trials (RCTs), non-RCTs, and cohort studies were included with patients having undergone sphincter-preserving total (TME) or partial mesorectal excision (PME) for the treatment of primary rectal cancer in this review. The outcome was urination dysfunction reported at least three months postoperatively, both overall urination dysfunction and subdivided into specific symptoms. The online databases PubMed, Embase, and Cochrane CENTRAL were searched, bias was assessed using the Newcastle–Ottawa scale, and results were synthesized using one-group frequency meta-analyses. A total of 55 studies with 15,072 adults were included. The median follow-up was 29 months (range 3–180). The pooled overall urination dysfunction was 21% (95% confidence interval (CI) 12%–30%) 3–11 months postoperatively and 25% (95% CI 19%–32%) ≥12 months postoperatively. Retention and incontinence were common 3–11 months postoperatively, with pooled frequencies of 11% and 14%, respectively. Increased urinary frequency, retention, and incontinence seemed even more common ≥12 months postoperatively, with pooled frequencies of 37%, 20%, and 23%, respectively. In conclusion, one in five patients experienced urination dysfunction more than a year following an operation for rectal cancer. Full article

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10 pages, 609 KiB

Open AccessArticle

Molecular Markers in Follicular and Oncocytic Thyroid Carcinomas: Clinical Application of Molecular Genetic Testing

by Alicia Belaiche, Grégoire B. Morand, Sena Turkdogan, Esther ShinHyun Kang, Véronique-Isabelle Forest, Marc P. Pusztaszeri, Michael P. Hier, Alex M. Mlynarek, Keith Richardson, Nader Sadeghi, Marco A. Mascarella, Sabrina D. Da Silva and Richard J. Payne

Curr. Oncol. 2024, 31(10), 5919-5928; https://doi.org/10.3390/curroncol31100441 - 1 Oct 2024

Abstract

Background: Oncocytic thyroid carcinoma (OTC) was previously considered a variant of follicular thyroid carcinoma (FTC) but has recently been reclassified as a separate form of thyroid cancer. This study aimed to demonstrate that FTC and OTC are fundamentally distinct entities that can potentially [...] Read more.

Background: Oncocytic thyroid carcinoma (OTC) was previously considered a variant of follicular thyroid carcinoma (FTC) but has recently been reclassified as a separate form of thyroid cancer. This study aimed to demonstrate that FTC and OTC are fundamentally distinct entities that can potentially be differentiated preoperatively through cytology and/or molecular testing. Methods: A retrospective chart review of patients diagnosed with FTC and OTC operated upon at two university health centers from January 2016 to September 2023 (n = 3219) was conducted. Molecular testing results were correlated with histopathologic diagnosis. Results: Fifty patients met the inclusion criteria. FTC was identified in 27 (54.0%) patients, and OTC in 23 (46.0%) patients. Patients with OTC were older (61.8 years) than FTC patients (51.2 years) (p = 0.013). Moreover, aggressive tumors were found in 39.1% (9/23) of OTCs compared to 11.1% (3/27) of FTCs (p = 0.021). Amongst Bethesda category III and IV nodules, 17 out of 20 (85.0%) OTC cytology reports demonstrated an oncocytic subtype compared to only 5 out of 24 FTC cytology reports (20.8%) (p = 0.002). On molecular testing, the EIF1AX alteration was exclusively present in OTCs while the PAX8/PPARy and PTEN alterations were exclusively found in FTCs. Copy number alterations (CNAs) were found to be more prevalent in OTC (66.7%) compared to FTC (33.3%), and they were not indicative of tumor aggressiveness. Within the OTC group, all three patients who had a TP53 alteration were diagnosed with aggressive cancer. Lastly, the OTCs exhibited a higher frequency of multiple alterations on molecular testing (66.7%) compared to FTCs (33.3%). Conclusion: To our knowledge, this is the largest study to date comparing the clinical application of abnormalities found on molecular testing for FTC and OTC. It further demonstrates the distinct clinicopathological and molecular characteristics of OTC. Full article

(This article belongs to the Special Issue Insights into Special Novelties in Thyroid Oncology Management)

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11 pages, 1075 KiB

Open AccessArticle

Real-World Outcomes of Incurable Cancer Patients Treated with Unlisted Anticancer Treatments in an Academic Center in Quebec, Canada

by Adam Miller, Francois Panet, Victoria Korsos, Wilson H. Miller, Jr. and Gerald Batist

Curr. Oncol. 2024, 31(10), 5908-5918; https://doi.org/10.3390/curroncol31100440 - 1 Oct 2024

Abstract

Medical oncology is a rapidly evolving field, with new medications being discovered yearly, contributing to increased survival rates. However, accessing drugs in a timely manner can be challenging. In Quebec, Canada, a physician can prescribe an unlisted anticancer treatment through a regulated pathway [...] Read more.

Medical oncology is a rapidly evolving field, with new medications being discovered yearly, contributing to increased survival rates. However, accessing drugs in a timely manner can be challenging. In Quebec, Canada, a physician can prescribe an unlisted anticancer treatment through a regulated pathway under exceptional circumstances. We conducted a quality improvement study describing the outcomes of incurable cancer patients receiving unlisted anticancer therapy at the Jewish General Hospital between 2018 and 2019. Though our study did not include a comparator arm, unlisted anticancer therapies were associated with interesting median progression-free survival (11 months) and overall survival (25 months). Moreover, a large proportion of treatments, 44%, were subsequently reimbursed in the province of Quebec. Given the delay in anticancer drug reimbursement, this pathway is essential for timely access to oncology drugs. Such ‘special access’ programs will likely become increasingly important as precision medicine becomes the standard of practice. Full article

(This article belongs to the Special Issue New Perspectives in Real-World Drug Safety and Effectiveness in Cancer Treatment)

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12 pages, 247 KiB

Open AccessArticle

The PAR³TY Project: Revealing Unique Cancer Experiences and Insights of Teenagers and Young Adults through Patient Engagement, Participation, and Performance

by Alice O’Grady, Cheryl A. Heykoop and Will Weigler

Curr. Oncol. 2024, 31(10), 5896-5907; https://doi.org/10.3390/curroncol31100439 - 1 Oct 2024

Abstract

Cancer in teenagers and young adults (TYAs) coincides with major life transitions and presents unique psychosocial challenges. Understanding the experiences and needs of TYAs is critical. TYAs want to play an active role in improving cancer for TYAs; however, few opportunities exist for [...] Read more.

Cancer in teenagers and young adults (TYAs) coincides with major life transitions and presents unique psychosocial challenges. Understanding the experiences and needs of TYAs is critical. TYAs want to play an active role in improving cancer for TYAs; however, few opportunities exist for TYAs to do so. Using a tri-partite methodology, an international team collaborated with four TYA co-researchers in this pilot study to explore how performative staging strategies help convey TYA experiences with cancer. Using creative video, TYA co-researchers shared cancer experiences and insights in novel, impactful ways. The process provided intrinsic benefits for co-researchers to connect with other TYAs and creatively share their experiences and perspectives. Furthermore, it provided space for dialogue between TYAs and cancer care allies where TYAs could convey the nuances of their cancer experiences and how cancer care could be improved. This tri-partite methodology can support TYAs to actively engage in a process of connection, reflection, creation, and dissemination to improve cancer experiences for TYAs. Full article

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

7 pages, 196 KiB

Open AccessArticle

Prevention of Radiotherapy-Induced Enteropathy by Probiotics (PREP): Double-Blind Randomized Placebo-Controlled Trial

by Yoon Young Jo, Yeon Joo Kim, Seung Hae Lee and Young Seok Kim

Curr. Oncol. 2024, 31(10), 5889-5895; https://doi.org/10.3390/curroncol31100438 - 1 Oct 2024

Abstract

Probiotics are thought to be effective in the treatment of radiation-induced enteropathy (RIE). However, little is known regarding their efficacy in preventing RIE. In this prospective, randomized, double-blinded, placebo-controlled, single-center study, the incidence of grade 2 acute RIE was compared and the safety [...] Read more.

Probiotics are thought to be effective in the treatment of radiation-induced enteropathy (RIE). However, little is known regarding their efficacy in preventing RIE. In this prospective, randomized, double-blinded, placebo-controlled, single-center study, the incidence of grade 2 acute RIE was compared and the safety of probiotics was evaluated. Patients receiving pelvic radiotherapy for a minimum of 40 Gy at the pelvic level were randomized into two groups: (i) a probiotic group receiving Bacillus licheniformis from two weeks before radiotherapy until the end and (ii) a control group receiving a placebo with the same schedule. The toxicities of 234 patients were graded according to the Common Terminology Criteria for Adverse Events v5.0. Grade 1 RIE was observed in 65 (56%) of the probiotics group compared with 75 (64%) of the placebo group. Grade 2 RIE occurred in 30 patients (26%) in the probiotics group compared with 26 (22%) in the placebo group, indicating that probiotics failed in their preventive role compared with placebo (p = 0.493). Medication adherence rates were good, and no difference was observed between the two arms. These findings suggest that B. licheniformis does not significantly prevent RIE. Full article

16 pages, 1190 KiB

Open AccessArticle

The Experience of Patients with Endocrine Therapy for Breast Cancer: A Patient Journey Map Based on Qualitative Research

by Yingyan Yao, Ting He and Xiaoying Tian

Curr. Oncol. 2024, 31(10), 5873-5888; https://doi.org/10.3390/curroncol31100437 - 30 Sep 2024

Abstract

(1) Background: While there is extensive documentation on the medical experience of breast cancer, a thorough understanding of the various stages of endocrine therapy remains insufficient. The aim of this study was to map the experiences and coping styles of breast cancer patients [...] Read more.

(1) Background: While there is extensive documentation on the medical experience of breast cancer, a thorough understanding of the various stages of endocrine therapy remains insufficient. The aim of this study was to map the experiences and coping styles of breast cancer patients during endocrine therapy. (2) Methods: Qualitative research was conducted to gather insights into the experiences of breast cancer patients undergoing endocrine therapy. The themes were organized through content analysis and induction. Subsequently, patients were invited for face-to-face interviews at a top-three hospital in Guangzhou to supplement and validate the findings from the literature review. The patient journey was then mapped based on both the literature review and the semi-structured interviews. (3) Results: A total of 24 studies were included that described patients’ experiences and behaviors during the early, middle, and late stages of treatment, leading to the formation of a preliminary framework. Interviews were conducted with 20 patients, which confirmed and enriched the findings from the literature review. Based on these results, a stage trajectory for endocrine therapy in breast cancer was established. (4) Conclusions: The patient journey map developed in this study clearly and intuitively illustrates the thought and emotion matrix, as well as the behavior matrix, of breast cancer patients undergoing endocrine therapy. This provides a theoretical foundation for enhancing clinical services tailored to the needs of these patients. Full article

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13 pages, 1317 KiB

Open AccessArticle

Prognostic Index for Liver Radiation (PILiR)

by Laura Callan, Haddis Razeghi, Natalie Grindrod, Stewart Gaede, Eugene Wong, David Tan, Jason Vickress, John Patrick and Michael Lock

Curr. Oncol. 2024, 31(10), 5862-5872; https://doi.org/10.3390/curroncol31100436 - 29 Sep 2024

Abstract

A Prognostic Index for Liver Radiation (PILiR) for improved patient selection for stereotactic liver-directed radiotherapy (SBRT) was developed. Using a large single-center database, 195 patients treated with SBRT for local control, including 66 with hepatocellular carcinoma (HCC) and 129 with metastatic liver disease, [...] Read more.

A Prognostic Index for Liver Radiation (PILiR) for improved patient selection for stereotactic liver-directed radiotherapy (SBRT) was developed. Using a large single-center database, 195 patients treated with SBRT for local control, including 66 with hepatocellular carcinoma (HCC) and 129 with metastatic liver disease, were analyzed. Only patients ineligible for alternative treatments were included. Overall survival was 11.9 months and 9.4 months in the HCC group and metastatic groups, respectively. In the combined dataset, Child–Pugh Score (CPS) (p = 0.002), serum albumin (p = 0.039), and presence of extrahepatic disease (p = 0.012) were significant predictors of early death on multivariable analysis and were included in the PILiR (total score 0 to 5). Median survival was 23.8, 9.1, 4.5, and 2.6 months for patients with 0, 1–2, 3, and 4–5 points, respectively. In the HCC dataset, CPS (p < 0.001) and gross tumor volume (p = 0.013) were predictive of early death. In the metastatic dataset, serum albumin (p < 0.001) and primary disease site (p = 0.003) were predictive of early death. The AUC for the combined, HCC, and metastatic datasets are 0.78, 0.84, and 0.80, respectively. Poor liver function (defined by CPS and serum albumin) and extrahepatic disease were most predictive of early death, providing clinically important expected survival information for patients and caregivers. Full article

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12 pages, 444 KiB

Open AccessArticle

Progress and Challenges in Canada’s Path Toward the Elimination of Cervical Cancer

by Samara Perez

Curr. Oncol. 2024, 31(10), 5850-5861; https://doi.org/10.3390/curroncol31100435 - 29 Sep 2024

Abstract

Cervical cancer is almost entirely preventable and treatable when detected early, making its elimination within reach for Canada and the world. However, cervical cancer is now the fastest-increasing cancer (+3.7% per year since 2015) in Canada as of 2023, marking the first significant [...] Read more.

Cervical cancer is almost entirely preventable and treatable when detected early, making its elimination within reach for Canada and the world. However, cervical cancer is now the fastest-increasing cancer (+3.7% per year since 2015) in Canada as of 2023, marking the first significant increase in cervical cancer incidence since 1984. The human papillomavirus (HPV) vaccine and cervical screening are key preventive measures, with targets set by the WHO and the Canadian Partnership Against Cancer (CPAC) to eliminate cervical cancer in Canada by 2030 and 2040, respectively. These targets include increasing HPV vaccination rates, implementing primary HPV screening, and improving follow-up for abnormal HPV+ results. However, Canada’s progress has been impeded by significant challenges. As of the most recent data, HPV vaccine coverage rates in Canada range from 47% to 81%, with an estimated national HPV vaccination completion rate of 64% in Canada, far below the target of 90% by 2025 set by the CPAC. With the exception of British Columbia and Prince Edward Island, the adoption of HPV DNA testing as the primary screening method has been slow across the Canadian provinces and territories despite its superior sensitivity compared with traditional cytology. This article reviews the current state of HPV vaccination and screening in Canada, emphasizing the need for coordinated efforts, transparency, and resource sharing to overcome barriers. Key recommendations include the dissemination of accessible educational materials, partnerships, and collaboration, including nationwide task forces and roundtables, and the implementation of standardized guidelines for HPV screening. Achieving cervical cancer elimination requires a united approach involving federal, provincial, and territorial health authorities, researchers, clinicians, NGOs, community groups, and patients’ voices working together to ensure consistent, effective, timely, and meaningful cervical cancer prevention strategies are used across the country. Full article

(This article belongs to the Special Issue Action and Impact: Prevention and Screening Strategies Contributing to the Elimination of Cervical Cancer)

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12 pages, 3903 KiB

Open AccessCase Report

Personalized Immunotherapy Achieves Complete Response in Metastatic Adenoid Cystic Carcinoma Despite Lack of Conventional Biomarkers

by Ünal Metin Tokat, Ashkan Adibi, Esranur Aydın, Eylül Özgü, Şevval Nur Bilgiç, Onur Tutar, Merve Özbek Doğançay, İrem Demiray and Mutlu Demiray

Curr. Oncol. 2024, 31(10), 5838-5849; https://doi.org/10.3390/curroncol31100434 - 29 Sep 2024

Abstract

There is currently no effective treatment strategy for recurrent/metastatic adenoid cystic carcinoma (R/M ACC). Furthermore, recent single-agent and combination immunotherapy trials have failed in unselected ACC cohorts, unlike non-ACC salivary gland cancers. Genomic profiling revealed no actionable targets but NOTCH1 and KDM6A frameshift [...] Read more.

There is currently no effective treatment strategy for recurrent/metastatic adenoid cystic carcinoma (R/M ACC). Furthermore, recent single-agent and combination immunotherapy trials have failed in unselected ACC cohorts, unlike non-ACC salivary gland cancers. Genomic profiling revealed no actionable targets but NOTCH1 and KDM6A frameshift and CTCF splice site mutations (no MYB/L fusion) with a low tumor mutational burden (TMB), microsatellite stable (MSS) and negative programmed death ligand 1 (PD-L1) were observed. We recommended an anti-programmed cell death protein 1 (anti-PD-1) plus anti-Cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA-4) combination based on TMB 2-fold greater-than-median TMB in ACC, tumor harboring multiple immunogenic frameshift or splice site mutations, and PD-L1 negativity. Accordingly, we achieved a complete response in a radiotherapy (RT) and chemotherapy (CT)-refractory patient with locally recurrent lacrimal gland (LG) ACC and lung metastasis following personalized immunotherapy in combination with integrative therapeutics. Therefore, it is crucial to assess not only conventional immune biomarkers but also patient-specific parameters, especially in “immune-cold” cancer types. Full article

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

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6 pages, 1413 KiB

Open AccessCommentary

Simplifying Serious Illness Communication: Preparing or Deciding

by Jeff Myers, Leah Steinberg, Nadia Incardona, Jessica Simon, Justin Sanders and Hsien Seow

Curr. Oncol. 2024, 31(10), 5832-5837; https://doi.org/10.3390/curroncol31100433 - 28 Sep 2024

Abstract

Clinicians have a sincere desire to ensure that the decision-making processes of seriously ill patients are well informed throughout illness trajectories. A quagmire of variable terminology (e.g., advance care planning, serious illness conversations, goals-of-care discussions, etc.), however, currently predominates the field of serious [...] Read more.

Clinicians have a sincere desire to ensure that the decision-making processes of seriously ill patients are well informed throughout illness trajectories. A quagmire of variable terminology (e.g., advance care planning, serious illness conversations, goals-of-care discussions, etc.), however, currently predominates the field of serious illness communication. This creates uncertainty among clinicians as to the overall purpose, tasks, and specific outcomes of conversations that address serious illness. The Preparing or Deciding model is a unifying framework that provides conceptual clarity by helping clinicians understand their role in leading these important conversations. The Preparing or Deciding model simply posits that conversations with seriously ill patients are about either preparing or deciding. It considers these tasks to be mutually exclusive, which can help bypass many of the barriers to having these conversations. The Preparing or Deciding model compliments all existing resources and frameworks and is applicable to all healthcare practitioners in every care setting. To help move forward serious illness communication education and research, as well as process improvement efforts more effectively, here, we describe the Preparing or Deciding model. Full article

(This article belongs to the Special Issue 2023–2024 Article Series of the Canadian Association of General Practitioners in Oncology)

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11 pages, 1654 KiB

Open AccessArticle

Efficacy of Atezolizumab Plus Bevacizumab–Transcatheter Arterial Chemoembolization Sequential Therapy for Patients with Intermediate-Stage Hepatocellular Carcinoma

by Etsuko Moriyama, Shigeo Shimose, Takashi Niizeki, Hideki Iwamoto, Masatoshi Tanaka, Tomotake Shirono, Yu Noda, Masahito Nakano, Ryoko Kuromatsu, Hironori Koga and Takumi Kawaguchi

Curr. Oncol. 2024, 31(10), 5821-5831; https://doi.org/10.3390/curroncol31100432 - 27 Sep 2024

Abstract

This retrospective study aimed to evaluate the impact of atezolizumab plus bevacizumab–transcatheter arterial chemoembolization (TACE) sequential therapy in unresectable hepatocellular carcinoma (HCC), especially in patients with intermediate-stage HCC. A total of 212 patients were enrolled and categorized into the Atez/Bev-TACE sequential therapy ( [...] Read more.

This retrospective study aimed to evaluate the impact of atezolizumab plus bevacizumab–transcatheter arterial chemoembolization (TACE) sequential therapy in unresectable hepatocellular carcinoma (HCC), especially in patients with intermediate-stage HCC. A total of 212 patients were enrolled and categorized into the Atez/Bev-TACE sequential therapy (n = 23) or Atez/Bev monotherapy group (n = 189) between 2020 and 2024. Of these, patients with intermediate-stage HCC were categorized into the Atez/Bev-TACE sequential (n = 18) or Atez/Bev monotherapy group (n = 91). The best objective response rate, disease control rate, and median progression-free survival (PFS) after TACE were 73.9%, 82.6%, and 6.1 months, respectively. The PFS after TACE was significantly higher in the Atez/Bev sequential therapy group than in the no-Atez/Bev-administration group after TACE (6.9 months vs. 5.0 months, p = 0.025). The median overall survival (OS) was significantly higher in the Atez/Bev-TACE sequential therapy group than in the Atez/Bev monotherapy group for intermediate-stage HCC (34.9 months vs. 17.8 months; p = 0.016). Independent factors associated with OS were low alpha-fetoprotein levels, modified albumin–bilirubin 1 or 2a levels, and Atez/Bev-TACE sequential therapy. Atez/Bev-TACE sequential therapy improved prognosis compared with Atez/Bev monotherapy in patients with intermediate-stage HCC. Moreover, Atez/Bev should be readministered after TACE. Full article

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19 pages, 670 KiB

Open AccessArticle

Prevalence and Correlates of Depressive Symptoms among Patients with Cancer: A Cross-Sectional Study

by Wei-Zhen Yu, Hsin-Fang Wang, Nurul Huda, Yun Yen, Yen-Lin Liu, Chia-Sui Li, Yen-Chung Ho and Hsiu-Ju Chang

Curr. Oncol. 2024, 31(10), 5802-5820; https://doi.org/10.3390/curroncol31100431 - 26 Sep 2024

Abstract

The purpose of this study was to identify the correlates of depressive symptoms and the prevalence of depression, distress, and demoralization among patients with cancer in Taiwan in relation to their sociodemographics. A cross-sectional study design with convenience sampling was used to recruit [...] Read more.

The purpose of this study was to identify the correlates of depressive symptoms and the prevalence of depression, distress, and demoralization among patients with cancer in Taiwan in relation to their sociodemographics. A cross-sectional study design with convenience sampling was used to recruit 191 consecutive patients with cancer from the Cancer Center of a teaching hospital in northern Taiwan. Multiple linear regression was applied to analyze the determinants of depressive symptoms. The prevalence rates of depression (including suspected cases), distress, and demoralization were 17.8%, 36.1%, and 32.5%, respectively. The regression model explained 42.2% of the total variance, with significant predictors including marital status, life dependence, comorbidity, demoralization, and distress. The results demonstrated that higher levels of distress and demoralization were associated with more depressive symptoms. Demoralization and distress played vital roles in moderating depressive symptoms among patients with cancer. Nursing interventions should integrate appropriate mental health services, such as alleviating distress and demoralization, to prevent the occurrence of depression in patients with cancer. Full article

(This article belongs to the Section Oncology Nursing)

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13 pages, 242 KiB

Open AccessReview

The Impact of Gastrectomy on Inflammatory Bowel Disease Risk in Gastric Cancer Patients: A Critical Analysis

by Grigorios Christodoulidis, Konstantinos-Eleftherios Koumarelas, Kyriaki Tsagkidou, Eirini-Sara Agko, Dimitra Bartzi, Konstantinos Koumarelas and Dimitrios Zacharoulis

Curr. Oncol. 2024, 31(10), 5789-5801; https://doi.org/10.3390/curroncol31100430 - 25 Sep 2024

Abstract

Gastrectomy, a prevalent surgical procedure for gastric cancer, results in substantial alterations to the gastrointestinal tract, including reduced gastric acid production and significant modifications to the gut microbiota. These changes can impair postoperative recovery, influence metabolic functions, and predispose patients to inflammatory bowel [...] Read more.

Gastrectomy, a prevalent surgical procedure for gastric cancer, results in substantial alterations to the gastrointestinal tract, including reduced gastric acid production and significant modifications to the gut microbiota. These changes can impair postoperative recovery, influence metabolic functions, and predispose patients to inflammatory bowel disease (IBD). Studies have shown an increased risk of IBD, particularly Crohn’s disease (CD) and ulcerative colitis (UC), in patients following gastrectomy and bariatric surgeries such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). For instance, patients undergoing RYGB have a higher hazard ratio for developing CD, while SG patients show an increased risk for UC. The surgical alteration of the gastrointestinal tract promotes dysbiosis, with a significant increase in pathogenic bacteria and a decrease in beneficial microbial populations. This dysbiosis can impair the intestinal mucosal barrier and promote systemic inflammation. Understanding the mechanisms behind these changes and their clinical implications is essential for developing effective postoperative management strategies. Probiotics and enhanced recovery after surgery (ERAS) protocols have shown promise in mitigating these adverse effects, improving gut microbiota balance, and enhancing patient outcomes. Further research is necessary to fully elucidate the long-term impacts of gastrectomy on gastrointestinal health and to refine therapeutic approaches for postoperative care. Full article

15 pages, 3064 KiB

Open AccessArticle

Lymphopenia Induced by Different Neoadjuvant Chemo-Radiotherapy Schedules in Patients with Rectal Cancer: Bone Marrow as an Organ at Risk

by Christos Nanos, Ioannis M. Koukourakis, Admir Mulita, Raphaela Avgousti, Vassilios Kouloulias, Anna Zygogianni and Michael I. Koukourakis

Curr. Oncol. 2024, 31(10), 5774-5788; https://doi.org/10.3390/curroncol31100429 - 25 Sep 2024

Abstract

Radiotherapy (RT)-induced lymphopenia may hinder the anti-tumor immune response. Preoperative RT or chemo-RT (CRT) for locally advanced rectal cancer is a standard therapeutic approach, while immunotherapy has been approved for mismatch repair-deficient rectal tumors. We retrospectively analyzed 98 rectal adenocarcinoma patients undergoing neoadjuvant [...] Read more.

Radiotherapy (RT)-induced lymphopenia may hinder the anti-tumor immune response. Preoperative RT or chemo-RT (CRT) for locally advanced rectal cancer is a standard therapeutic approach, while immunotherapy has been approved for mismatch repair-deficient rectal tumors. We retrospectively analyzed 98 rectal adenocarcinoma patients undergoing neoadjuvant CRT with VMAT (groups A, B, C) or IMRT (group D) techniques, with four different RT schemes: group A (n = 24): 25 Gy/5 Gy/fraction plus a 0.2 Gy/fraction rectal tumor boost; group B (n = 22): 34 Gy/3.4 Gy/fraction, with a 1-week treatment break after the first five RT fractions; group C (n = 20): 46 Gy/2 Gy/fraction plus a 0.2 Gy/fraction rectal tumor boost; group D (n = 32): 45 Gy/1.8 Gy/fraction followed by 5.4 Gy/1.8 Gy/fraction to the rectal tumor. We examined the effect of the time-corrected normalized total dose (NTD-T) to the BM on lymphopenia. Groups A and B (hypofractionated RT) had significantly higher lymphocyte counts (LCs) after RT than groups C and D (p < 0.03). An inverse association between the LCs after RT and NTD-T was demonstrated (p = 0.01). An NTD-T threshold of 30 Gy delivered to 30% of the BM volume emerged as a potential constraint for RT planning, which could be successfully integrated in the RT plan. Hypofractionated and accelerated RT schemes, and BM-sparing techniques may reduce lymphocytic damage and prove critical for immuno-RT clinical trials. Full article

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12 pages, 1594 KiB

Open AccessArticle

Number of Retrieved Lymph Nodes during Esophagectomy Affects the Outcome of Stage III Esophageal Cancer in Patients Having Had Pre-Operative Chemo-Radiation Therapy

by Wei Ho, Shau-Hsuan Li, Shih-Ting Liang, Yu Chen, Li-Chun Chen, Yen-Hao Chen, Hung-I Lu and Chien-Ming Lo

Curr. Oncol. 2024, 31(10), 5762-5773; https://doi.org/10.3390/curroncol31100428 - 25 Sep 2024

Abstract

Background: Lymphadenectomy plays a crucial role in the surgical management of early- stage esophageal cancer. However, few studies have examined lymphadenectomy outcomes in advanced stages, particularly in patients who initially underwent concurrent chemoradiation therapy. This retrospective study investigates the effect of lymphadenectomy [...] Read more.

Background: Lymphadenectomy plays a crucial role in the surgical management of early- stage esophageal cancer. However, few studies have examined lymphadenectomy outcomes in advanced stages, particularly in patients who initially underwent concurrent chemoradiation therapy. This retrospective study investigates the effect of lymphadenectomy in patients diagnosed with AJCC 8th-edition clinical stage III esophageal squamous cell carcinoma who received concurrent preoperative chemoradiation. Methods: Data from 1994 to 2023 were retrieved from our retrospective database. All patients underwent a uniform evaluation and treatment protocol, including preoperative concurrent chemoradiation therapy comprising cisplatin and 5-fluorouracil, followed by esophagectomy. The analysis encompassed clinical T and N stages, tumor location, tumor grade, pathological T and N stages, pathological stage, and the extent of lymph node dissection. Overall survival, “Free-To-Recurrence”, and disease-free survival were assessed via Kaplan–Meier survival curves and the Cox regression model for multivariate analysis. Results: The dataset was stratified into two groups according to extent of lymph node dissection, with one group having <15 dissected nodes and the other having ≥15 dissected nodes. The group with <15 nodes exhibited a shorter “Free-To-Recurrence”, worse disease-free survival, and lower overall survival. In multiple-variate analysis (Cox regression model), the number of dissected lymph nodes emerged as a significant factor influencing overall survival and freedom from recurrence. Conclusions: The quantity of lymphadenectomy is a crucial determinant for patients with AJCC 8th-edition clinical stage III esophageal squamous cell carcinoma receiving preoperative concurrent chemoradiation. Full article

(This article belongs to the Topic Real-Time Monitoring for Improving Cancer Diagnosis and Prognosis)

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10 pages, 2963 KiB

Open AccessArticle

Elevated Microsatellite Alterations at Selected Tetranucleotide Repeats (EMAST) in Penile Squamous Cell Carcinoma—No Evidence for a Role in Carcinogenesis

by August Fiegl, Olaf Wendler, Johannes Giedl, Nadine T. Gaisa, Georg Richter, Valentina Campean, Maximilian Burger, Femke Simmer, Iris Nagtegaal, Bernd Wullich, Simone Bertz, Arndt Hartmann and Robert Stoehr

Curr. Oncol. 2024, 31(10), 5752-5761; https://doi.org/10.3390/curroncol31100427 - 25 Sep 2024

Abstract

Penile squamous cell carcinoma (pSCC) is a rare malignancy with a global incidence ranging from 0.1 to 0.7 per 100,000 males. Prognosis is generally favorable for localized tumors, but metastatic pSCC remains challenging, with low survival rates. The role of novel biomarkers, such [...] Read more.

Penile squamous cell carcinoma (pSCC) is a rare malignancy with a global incidence ranging from 0.1 to 0.7 per 100,000 males. Prognosis is generally favorable for localized tumors, but metastatic pSCC remains challenging, with low survival rates. The role of novel biomarkers, such as tumor mutational burden (TMB) and microsatellite instability (MSI), in predicting the response to immune checkpoint inhibitors (ICIs) has been investigated in various cancers. However, MSI has not been observed in pSCC, limiting immunotherapy options for this patient subgroup. Elevated microsatellite alterations at selected tetranucleotide repeats (EMAST) are a distinct form of genomic instability associated with deficient MSH3 expression, which has been proposed as a potential biomarker in several cancers. This study investigates EMAST and MSH3 expression in a cohort of 78 pSCC cases using PCR, fragment analysis and immunohistochemistry. For the detection of EMAST, the stability of five microsatellite markers (D9S242, D20S82, MYCL1, D8S321 and D20S85) was analyzed. None of the cases showed an instability. As for MSH3 immunohistochemistry, all analyzable cases showed retained MSH3 expression. These results strongly suggest that neither EMAST nor MSH3 deficiency is involved in the carcinogenesis of pSCC and do not represent reliable predictive biomarkers in this entity. Furthermore, these findings are in full agreement with our previous study showing a very low frequency of MSI and further support the thesis that EMAST and MSI are strongly interconnected forms of genomic instability. Further research is needed to explore novel therapeutic targets and predictive biomarkers for immunotherapy in this patient population. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Penile Cancer)

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