Current Oncology

15 pages, 1631 KB

Open AccessArticle

Preoperative Immunonutritional Indices in Colorectal Cancer: The Contribution of Albumin, Time-Dependence of Effect, and Threshold Transportability in a Saudi Cohort

by Moaz W. Abulfaraj and Ali H. M. Farsi

Curr. Oncol. 2026, 33(9), 496; https://doi.org/10.3390/curroncol33090496 (registering DOI) - 22 Aug 2026

Abstract

Preoperative immunonutritional indices are widely reported to predict survival after colorectal cancer (CRC) resection, yet their independence varies across cohorts and no data exist from the Arab Gulf. In this retrospective cohort study we analyzed 316 patients undergoing curative resection for stage I–III [...] Read more.

Preoperative immunonutritional indices are widely reported to predict survival after colorectal cancer (CRC) resection, yet their independence varies across cohorts and no data exist from the Arab Gulf. In this retrospective cohort study we analyzed 316 patients undergoing curative resection for stage I–III colorectal adenocarcinoma at a Saudi tertiary center between 2013 and 2022, of whom 48 (15.2%) presented as emergencies. The prognostic nutritional index (PNI) and a composite albumin–neutrophil-to-lymphocyte ratio (albumin–NLR) score were assessed against overall survival (OS) and disease-free survival (DFS) using Cox models adjusted for age, sex, emergency presentation, tumor site, neoadjuvant therapy, adjuvant chemotherapy and lymphovascular invasion and stratified by stage and American Society of Anesthesiologists class. Over a median follow-up of 58.1 months there were 88 deaths and 124 DFS events. The PNI independently predicted OS (adjusted hazard ratio 0.958, 95% CI 0.929–0.987) and DFS (0.964, 0.940–0.988); the albumin–NLR score did not. Albumin alone carried the signal (OS 0.938), with lymphocytes, neutrophils and the NLR all null. The PNI effect was confined to the first 36 months (0.944 versus 1.003 thereafter), and published cut-offs classified 70.8% of the cohort as high-risk. Immunonutritional prognostication in CRC is albumin-driven, time-limited and sensitive to cut-off provenance. Full article

(This article belongs to the Special Issue Gastrointestinal Tumors: Prevention, Screening and Predictive Analytics)

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15 pages, 450 KB

Open AccessArticle

by Chan Shen, Mohammad Ikram, Shouhao Zhou, Roger Klein, Douglas Leslie and James Douglas Thornton

Curr. Oncol. 2026, 33(8), 495; https://doi.org/10.3390/curroncol33080495 - 21 Aug 2026

Abstract

Background: Emergency department (ED) use for cancer-related pain is common, particularly among patients with metastatic disease who frequently require opioid analgesia. In October 2014, the U.S. Drug Enforcement Administration rescheduled hydrocodone combination products from Schedule III to Schedule II, introducing stricter prescribing and [...] Read more.

Background: Emergency department (ED) use for cancer-related pain is common, particularly among patients with metastatic disease who frequently require opioid analgesia. In October 2014, the U.S. Drug Enforcement Administration rescheduled hydrocodone combination products from Schedule III to Schedule II, introducing stricter prescribing and dispensing requirements. We evaluated whether hydrocodone rescheduling was associated with pain-related ED visits and hospitalizations among older adults with metastatic lung cancer. Methods: We conducted a retrospective SEER–Medicare cohort study of beneficiaries aged 66 years or older diagnosed with metastatic lung cancer. Diagnoses from January 2011 through September 2014 were classified as pre-policy, October 2014 was excluded as a transition month, and November 2014 through December 2018 constituted the post-policy period. Monthly 365-day cumulative incidences were estimated using the Aalen–Johansen estimator with death treated as a competing event. Segmented interrupted time-series models estimated immediate level and slope changes. Adjusted cause-specific Cox models evaluated time to first event. Results: The cohort included 52,371 beneficiaries. For narrowly defined neoplasm-related pain ED visits, the policy was associated with an immediate increase of 0.834 percentage points (95% CI, 0.330–1.338) and a post-policy slope increase of 0.030 percentage points per month (95% CI, 0.011–0.049). Pain-related hospitalizations increased immediately by 0.946 percentage points (95% CI, 0.336–1.556), with a slope increase of 0.024 percentage points per month (95% CI, 0.005–0.042). At 12 months, fitted cumulative incidences exceeded no-policy projections by 1.193 percentage points for ED visits and 1.228 percentage points for hospitalizations. Adjusted cause-specific hazard ratios were 1.14 for pain-related ED visits (95% CI, 1.00–1.30; p = 0.054) and 1.14 for hospitalizations (95% CI, 1.00–1.29; p = 0.049). Conclusions: Hydrocodone rescheduling was temporally associated with modest increases in acute-care encounters explicitly coded for neoplasm-related pain. The findings underscore the importance of preserving timely analgesic access for patients with advanced cancer. Full article

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

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18 pages, 1067 KB

Open AccessArticle

Exploring the Social and Stigma-Related Lived Experiences of Pediatric Cancer Survivors in a Canadian Province

by Rasel Siddique, Georgia Skardasi, Kayla Crichton, Lisa Goodyear, Teri Stuckless, Holly Etchegary and Sevtap Savas

Curr. Oncol. 2026, 33(8), 494; https://doi.org/10.3390/curroncol33080494 - 20 Aug 2026

Abstract

Background: Worldwide, around 400,000 children are diagnosed with cancer every year. Understanding survivors’ social and stigma-related experiences may help address their needs and improve their outcomes. Objectives: To explore the social and stigma-related experiences, coping strategies, and support needs of pediatric [...] Read more.

Background: Worldwide, around 400,000 children are diagnosed with cancer every year. Understanding survivors’ social and stigma-related experiences may help address their needs and improve their outcomes. Objectives: To explore the social and stigma-related experiences, coping strategies, and support needs of pediatric cancer survivors in Newfoundland and Labrador, a province of Canada. Methods: This is a qualitative, cross-sectional study focusing on retrospective participant experiences. Eligibility criteria included being diagnosed with cancer before the age of 18 and being diagnosed or treated in the province. Extensive recruitment activities were employed. Data collection occurred through semi-structured virtual interviews and completion of a sociodemographic survey. Participant interviews were transcribed verbatim, and themes were identified iteratively through inductive thematic analysis. Descriptive statistics were used to define the participants’ sociodemographic characteristics. Results: Seven participants were recruited. Thematic analysis identified five major themes: (i) isolation and being treated differently; (ii) support received, coping mechanisms, and support needs; (iii) resilience and interest to give back; (iv) workplace and disability related experiences; and (v) additional impacts of cancer. Our results showed that participants received substantial social support in various ways but inadequate professional mental health support. School was a significant setting for cancer-related stigmatization. Discrimination in the workplace was rare and was disability-related rather than cancer-related. Conclusions: Our results show that there are significant issues to address, such as stigma and isolation experienced by pediatric cancer survivors as well as the need to improve the psychosocial support programs offered to them. Our results also show that the participants had distinct lived experiences compared to adult-onset cancer populations. Overall, the findings presented are expected to inform further studies and healthcare-education policies to help address these issues and improve the experiences of pediatric cancer survivors. Full article

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

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14 pages, 424 KB

Open AccessArticle

Clinical Outcomes of Breast-Involved Diffuse Large B-Cell Lymphoma Treated with R-CHOP: A Real-World Study with Insights into CNS Prophylaxis

by Thi Thu Huong Nguyen, Thi Yen Le, Thanh Tung Nguyen, Thanh Long Nguyen, Xuan Dai Nguyen, Tuan Anh Pham, Anh Tu Do, Thi Thanh Ha Lai and Van Quang Le

Curr. Oncol. 2026, 33(8), 493; https://doi.org/10.3390/curroncol33080493 - 20 Aug 2026

Abstract

This study evaluated clinical characteristics, treatment outcomes, and CNS relapse patterns in patients with breast-involved diffuse large B-cell lymphoma (DLBCL), a rare extranodal presentation with limited real-world data. We conducted a retrospective study on 33 consecutive patients with newly diagnosed breast-involved DLBCL treated [...] Read more.

This study evaluated clinical characteristics, treatment outcomes, and CNS relapse patterns in patients with breast-involved diffuse large B-cell lymphoma (DLBCL), a rare extranodal presentation with limited real-world data. We conducted a retrospective study on 33 consecutive patients with newly diagnosed breast-involved DLBCL treated from 2019 to 2024. All patients received R-CHOP. Baseline CNS screening—including neurological examination, fundoscopy, brain magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) analysis—was routinely performed. High-dose methotrexate (HD-MTX) was offered as CNS prophylaxis after completion of systemic therapy based on multidisciplinary team evaluation and clinician–patient shared decision-making according to institutional treatment protocols. Median age was 52.6 years; 84.8% had ECOG 0. Non-GCB subtype predominated (84.8%), and Ki-67 >70% was present in 69.7%. The overall response rate was 90.9%, with 84.8% complete responses. At a median follow-up of 44 months, 5-year Overall Survival (OS) and Progression-Free Survival (PFS) were 84.8% and 66.7%. CNS relapse occurred in 4 of 6 patients (66.7%) without prophylaxis, all within 5–11 months after R-CHOP, whereas no CNS relapses were observed among prophylaxis recipients (p < 0.001), although this observation should be interpreted with extreme caution given the very small non-prophylaxis subgroup (n = 6), limited statistical power, and non-randomized treatment allocation. Exploratory analyses suggested that bulky disease was associated with inferior OS. R-CHOP achieved high response rates and favorable long-term outcomes in breast-involved DLBCL. The absence of CNS relapse among HD-MTX prophylaxis recipients, contrasted with a high relapse rate in those without prophylaxis, provides only a hypothesis-generating observation that requires confirmation in larger prospective studies; this warrants further investigation of the role of systemic CNS prophylaxis. Full article

(This article belongs to the Section Hematology)

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29 pages, 358 KB

Open AccessReview

The Evolving Role of Immunotherapy in the Treatment with Curative Purpose of Early, Intermediate and Advanced Stage Hepatocellular Carcinoma

by Anastasia D. Karampa, Anna Goussia, Evangelos G. Baltagiannis, Nikolaos-Andreas T. Anastasopoulos, Dimitrios K. Christodoulou and Georgios K. Glantzounis

Curr. Oncol. 2026, 33(8), 492; https://doi.org/10.3390/curroncol33080492 - 20 Aug 2026

Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is frequently diagnosed at advanced stages, thereby limiting curative treatment options. Although interventions with curative intent, such as liver resection and ablation, are available, recurrence rates exceed 70%. Recent developments in HCC [...] Read more.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is frequently diagnosed at advanced stages, thereby limiting curative treatment options. Although interventions with curative intent, such as liver resection and ablation, are available, recurrence rates exceed 70%. Recent developments in HCC management have shifted the focus from conventional surgery and targeted therapies to immunotherapy. This review synthesizes current evidence on immunotherapy for curative purposes in HCC, including both neoadjuvant and adjuvant strategies. It evaluates completed and ongoing clinical trials of immune checkpoint inhibitors (ICIs), administered as monotherapy or in combination with anti-angiogenic agents or dual-checkpoint blockade. ICIs may transform the initial treatment paradigm for advanced HCC, although their applications remain in the investigational stage. Preliminary results from the IMbrave050 trial suggested that adjuvant immunotherapy following radical liver resection improves recurrence-free survival (RFS) in high-risk patients. However, the initially promising outcomes of the combination of atezolizumab and bevacizumab compared with active surveillance were not sustained in the median follow-up, and long-term survival results are awaited. Although several studies have demonstrated encouraging preliminary results, a clear survival benefit has not yet been established. Further studies are necessary to establish definitive conclusions. Immunotherapy has a pathophysiological basis and preliminary evidence to redefine HCC management across disease stages; its integration into pre- and post-operative strategies may increase resectability, reduce recurrence, and improve survival. Ongoing trials are expected to clarify its exact role. Full article

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

18 pages, 1611 KB

Open AccessArticle

Distinguishing Organizing Pneumonia from Malignancy During Cancer Surveillance: Predominant Diagnostic Value of Imaging over Systemic Inflammatory Biomarkers

by Hacer Boztepe Yesilcay and Asim Armagan Aydin

Curr. Oncol. 2026, 33(8), 491; https://doi.org/10.3390/curroncol33080491 - 20 Aug 2026

Abstract

Background: Distinguishing organizing pneumonia from recurrent malignancy in patients undergoing cancer surveillance remains a major clinical challenge. Although inflammatory biomarkers have emerged as potential diagnostic tools, their incremental value beyond imaging-based assessment remains uncertain. Methods: In this retrospective single-center study, we evaluated 170 [...] Read more.

Background: Distinguishing organizing pneumonia from recurrent malignancy in patients undergoing cancer surveillance remains a major clinical challenge. Although inflammatory biomarkers have emerged as potential diagnostic tools, their incremental value beyond imaging-based assessment remains uncertain. Methods: In this retrospective single-center study, we evaluated 170 patients with prior malignancy who underwent surgical assessment for suspicious lung-only pulmonary lesions between 2013 and 2023. Histopathology confirmed organizing pneumonia in 61 patients and malignancy in 109 patients. Preoperative clinical, radiologic, Positron emission tomography/computed tomography (PET/CT), and inflammatory biomarker variables were incorporated into predefined clinical, radiology-PET/CT, biomarker, and integrated models using Least absolute shrinkage and selection operator (LASSO)-penalized logistic regression with internal cross-validation. Results: The radiology/PET model demonstrated excellent discrimination (AUC 0.927), closely approximating the performance of the integrated model (AUC 0.935). The clinical and biomarker-only models showed moderate discrimination (AUC 0.764 and 0.778, respectively). Adding inflammatory biomarkers to imaging-derived features resulted in only a minimal improvement in diagnostic performance (ΔAUC = 0.009, 95% CI −0.019 to 0.037), indicating no statistically significant incremental benefit. Calibration, decision curve, and predictor stability analyses consistently identified radiologic and PET/CT-derived variables as the principal sources of predictive information. Conclusions: In patients with suspicious pulmonary lesions during cancer surveillance, diagnostic discrimination was driven predominantly by imaging-derived features, whereas conventional inflammatory biomarkers provided limited incremental value. These findings support an imaging-centered approach to preoperative risk stratification and multidisciplinary decision-making. Full article

(This article belongs to the Special Issue Advances in Thoracic Oncology: From Surgical Innovation to Outcome Optimization)

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14 pages, 834 KB

Open AccessArticle

Fagotti Score (FS) Compared with Peritoneal Cancer Index (PCI) for Preoperative Assessment of Optimal Cytoreduction in Upfront Laparoscopy

by Dimitrios Tsolakidis, Efthalia Markopoulou, Nikolaos Thomakos, Dimitris Haidopoulos, Dimitrios Zouzoulas, Vasilis Theodoulidis, Kimon Chatzistamatiou, Maria Topalidou, Eleni Timotheadou and Grigoris Grimbizis

Curr. Oncol. 2026, 33(8), 490; https://doi.org/10.3390/curroncol33080490 - 20 Aug 2026

Abstract

Background: Ovarian cancer is the eighth most common cancer in women worldwide. Prognosis in ovarian cancer patients is mainly affected by the complete resectability of the tumor at the time of surgery. Among the methods used to determine resectability are laparotomy, laparoscopy, and [...] Read more.

Background: Ovarian cancer is the eighth most common cancer in women worldwide. Prognosis in ovarian cancer patients is mainly affected by the complete resectability of the tumor at the time of surgery. Among the methods used to determine resectability are laparotomy, laparoscopy, and imaging techniques. In ovarian cancer patients, the Fagotti Score (FS) and Peritoneal Cancer Index (PCI) can be used during upfront diagnostic laparoscopy to quantify disease burden, resectability, and prognosis. Methods: The aim of this retrospective study was to assess the FS and PCI as tools for predicting optimal cytoreduction (R = 0, <1) and correctly assigning patients for primary debulking surgery (PDS) or interval debulking surgery (IDS). An ROC was used to compare the accuracy of both FS and PCI scores for assessing resectability. Diagnostic measures for both were calculated. Results: A total of 45 patients were ultimately included in this study. The area under the curve was 0.801 for the FS and 0.705 for the laparoscopic PCI, with an optimal cut-off score of 24.5. In our cohort, the FS demonstrated a sensitivity of 90%, a specificity of 64%, a PPV of 66.7%, and an NPV of 88.9%. Similarly, using a cut-off of 24.5, the PCI demonstrated a sensitivity of 80%, a PPV of 59.3%, and an NPV of 56%. Conclusions: Laparoscopic PCI is a useful tool for predicting resectability in ovarian cancer patients. However, when compared with the PCI, it seems that the FS performs better as a predictive score for resectability. Full article

(This article belongs to the Section Gynecologic Oncology)

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11 pages, 697 KB

Open AccessCase Report

Metabolic Response to an Individualized Multimodal Treatment Strategy in Advanced Pancreatic Adenocarcinoma: A Case Report

by Mehmet Salih İyikesici, Oral Oncul, Metin Hallaç, Sena Şen, Şirin Taflan, Selin Oncul, Tomas Duraj and Thomas N. Seyfried

Curr. Oncol. 2026, 33(8), 489; https://doi.org/10.3390/curroncol33080489 - 19 Aug 2026

Abstract

Background: Metastatic pancreatic adenocarcinoma carries a dismal prognosis, and treatment options after progression on standard chemotherapy remain limited. We report a metabolic response in a patient with drug-resistant disease treated with a combined multimodal regimen that paired dose-reduced (“activated”) multi-agent chemotherapy with [...] Read more.

Background: Metastatic pancreatic adenocarcinoma carries a dismal prognosis, and treatment options after progression on standard chemotherapy remain limited. We report a metabolic response in a patient with drug-resistant disease treated with a combined multimodal regimen that paired dose-reduced (“activated”) multi-agent chemotherapy with targeted agents and metabolic/microenvironmental support, set against an unusually long overall survival. Case Presentation: A 46-year-old man was diagnosed with inoperable, locally advanced/stage IV pancreatic adenocarcinoma in June 2023 and maintained disease control for approximately 2.5 years on a combined multimodal regimen, termed here metabolically controlled oncologic therapy (MCOT): dose-reduced chemotherapy given with regional hyperthermia, hyperbaric oxygen, and a carbohydrate-restricted diet. In February 2026 he developed local recurrence and diffuse liver metastases, and by May 2026 had deteriorated rapidly, with ¹⁸F-FDG PET/CT showing a peak SUVmax of 18.2 and CA 19-9 of 2788 U/mL. His regimen was intensified to a low-dose, multi-agent “activated” chemotherapy protocol combined with lenvatinib, everolimus, hyperthermia, and hyperbaric oxygen. Clinical Findings and Outcomes: One month later, his performance status had recovered from ECOG PS 2 to PS 0, CA 19-9 was 31 U/mL, and follow-up PET/CT showed a 63.7% decrease in SUVmax (from 18.2 to 6.6). Treatment-related adverse events included Grade 1 nausea, Grade 1 vomiting, and thrombocytopenia; no Grade 2 or higher non-hematological toxicity was observed. Conclusions: In selected patients who are considered to have exhausted standard options, a combined multimodal regimen pairing dose-reduced chemotherapy with metabolic and microenvironmental support may produce a well-tolerated metabolic response. As a single, uncontrolled observation, these findings cannot establish causality and require confirmation in prospective, controlled studies. Full article

(This article belongs to the Section Gastrointestinal Oncology)

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25 pages, 379 KB

Open AccessReview

Interventional Radiology in the Treatment of Musculoskeletal Tumours

by Sude Yarar and Panagiotis Tsagkozis

Curr. Oncol. 2026, 33(8), 488; https://doi.org/10.3390/curroncol33080488 - 18 Aug 2026

Abstract

Background/Objectives: Primary benign and malignant musculoskeletal tumours are generally treated with surgical excision. Metastatic musculoskeletal disease may require both systemic and local treatment. This review focuses on the use of radiofrequency ablation (RFA), cryoablation, cementoplasty, and high-intensity focused ultrasound (HIFU) in primary musculoskeletal [...] Read more.

Background/Objectives: Primary benign and malignant musculoskeletal tumours are generally treated with surgical excision. Metastatic musculoskeletal disease may require both systemic and local treatment. This review focuses on the use of radiofrequency ablation (RFA), cryoablation, cementoplasty, and high-intensity focused ultrasound (HIFU) in primary musculoskeletal tumours and bone and soft-tissue metastases. Methods: We reviewed English-language studies addressing the indications, clinical outcomes, patient selection, and complications of these techniques in patients with primary musculoskeletal tumours or bone and soft-tissue metastases. Results: RFA is the preferred minimally invasive treatment for osteoid osteoma and may be considered for selected small intraosseous tumours. In symptomatic bone metastases, RFA may provide pain relief and can be combined with cementoplasty when structural support is needed. Cryoablation is used selectively for benign, locally aggressive, recurrent, and metastatic tumours, with the advantage of visualizing the ablation zone. Cementoplasty is mainly used to relieve mechanical pain and reinforce weakened bone. HIFU has been studied mainly for pain palliation in bone metastases, while evidence in primary malignant tumours remains limited. Conclusions: Image-guided interventions can complement surgery and radiotherapy in selected patients. Treatment choice depends on tumour type, location, treatment intent, skeletal stability, and proximity to critical structures. Full article

(This article belongs to the Special Issue Advances in Interventional Radiology for Oncological Management)

16 pages, 1399 KB

Open AccessArticle

Trastuzumab Deruxtecan in HER2-Positive Metastatic Breast Cancer: Real-World Outcomes and Treatment Transition Patterns in a Chinese Cohort

by Yifei Chen, Ruyan Zhang, Ran Ran, Yaxin Liu, Jiayang Zhang, Ying Yan, Bin Shao, Xu Liang, Hanfang Jiang, Lijun Di, Guohong Song and Huiping Li

Curr. Oncol. 2026, 33(8), 487; https://doi.org/10.3390/curroncol33080487 - 18 Aug 2026

Abstract

We retrospectively analyzed consecutive patients with HER2-positive metastatic breast cancer who received T-DXd at a single Chinese cancer center between March 2023 and March 2026. Progression-free survival (PFS), overall survival (OS), systemic and intracranial response, safety, prognostic factors, and exploratory subsequent treatment strategies [...] Read more.

We retrospectively analyzed consecutive patients with HER2-positive metastatic breast cancer who received T-DXd at a single Chinese cancer center between March 2023 and March 2026. Progression-free survival (PFS), overall survival (OS), systemic and intracranial response, safety, prognostic factors, and exploratory subsequent treatment strategies were assessed. Among 173 eligible patients, 80.3% had received prior HER2-directed TKIs and 41.6% had CNS metastases. After a median follow-up of 14.3 months, median PFS and OS were 14.1 and 31.1 months, respectively. The objective response rate was 54.5% among 154 patients with measurable systemic disease, while the CNS objective response rate was 46.3% among 67 patients with measurable CNS lesions. Among patients with measurable CNS lesions, the CNS-ORR was comparable between patients with and without peri-T-DXd local treatment (53.8% vs. 44.4%, p = 0.21). Greater prior treatment exposure was associated with shorter PFS, whereas HER2 IHC 3+ disease was independently associated with longer OS and showed a trend toward improved PFS compared with HER2 IHC 2+/FISH-positive disease. Interstitial lung disease occurred in 13 patients (7.5%), all grade 1–2. Among 148 patients included in the maintenance analysis, 23 switched to alternative maintenance regimens after initial benefit from T-DXd. In an exploratory analysis, no statistically significant differences in PFS or OS were observed between patients who continued T-DXd and those who switched to maintenance therapy. However, these findings require cautious interpretation because of immortal-time bias, selection bias, and limited sample size. T-DXd demonstrated clinically meaningful systemic and intracranial activity with manageable toxicity in this heavily pretreated real-world cohort. Full article

(This article belongs to the Section Breast Cancer)

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18 pages, 2605 KB

Open AccessArticle

Deep Learning-Based Detection Model for Leukemia Cells in Peripheral Blood Smears Using YOLOv11-Large

by Johan M. Diaz, Arunima Deb, Alexandra Lyubimova, Cedric Nasnas, Leily Santos, Carla Romagnoli and Jacqueline C. Barrientos

Curr. Oncol. 2026, 33(8), 486; https://doi.org/10.3390/curroncol33080486 - 18 Aug 2026

Abstract

Background: Accurate identification and classification of white blood cell (WBC) subtypes in peripheral blood smears (PBS) is essential for the diagnosis and monitoring of hematological malignancies, including leukemia. Conventional manual microscopy, although clinically established, is labor-intensive and subject to inter- and intra-observer variability. [...] Read more.

Background: Accurate identification and classification of white blood cell (WBC) subtypes in peripheral blood smears (PBS) is essential for the diagnosis and monitoring of hematological malignancies, including leukemia. Conventional manual microscopy, although clinically established, is labor-intensive and subject to inter- and intra-observer variability. Deep learning-based object detection offers a route to automation, yet most prior studies are limited by small datasets, restricted cell taxonomies, or single-microscope acquisition. This study evaluates a YOLOv11-large (YOLOv11L) detector for simultaneous localization and classification of 13 leukemia-relevant WBC subtypes plus an artifact class (14 classes total), trained on the large-scale, multi-domain, open-source LeukemiaAttri dataset. Methods: From the LeukemiaAttri dataset, 18,664 annotated images (67,347 objects) acquired at 40× and 100× magnification were partitioned by stratified sampling into training (70%), validation (15%), and test (15%) sets. The training set was expanded to 65,785 images through extensive geometric, photometric, and AugMix augmentation. A YOLOv11L model pretrained on MS COCO was fine-tuned for 250 epochs (640 × 640 input) on a single NVIDIA H200 SXM GPU, using an auto-selected optimizer (momentum 0.9; weight decay 5 × 10⁻⁴), automatic mixed precision (AMP), and mosaic augmentation for the first 240 epochs. Results: On an internal held-out test set, the model achieved an mAP50 of 93.9%, mAP50-95 of 77.9%, precision of 94.1%, recall of 88.8%, and an F1 score of 0.913, with similar performance in the validation and test sets. Class-wise average precision (AP) ranged from 89.3% (monocyte) to 98.2% (monoblast), confirming consistent detection across morphologically diverse subtypes. Conclusions: The YOLOv11L detector achieved high performance across all 14 categories on the internal test set, with metrics exceeding those previously reported for subset-specific baselines. These findings support further evaluation of the model as a decision-support tool for peripheral blood smear analysis. External validation is required to determine its clinical utility and generalizability. Full article

(This article belongs to the Section Hematology)

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21 pages, 2379 KB

Open AccessCase Report

Standard Therapy Plus Adjunctive Vegan Lifestyle Intervention in Metastatic Prostate Cancer: A Case Report

by Boštjan Jakše, Zlatko Fras, Anno Graser and Katharina Wirnitzer

Curr. Oncol. 2026, 33(8), 485; https://doi.org/10.3390/curroncol33080485 - 18 Aug 2026

Abstract

Prostate cancer is among the most frequently diagnosed cancers in men globally, with metastatic disease contributing substantially to morbidity and mortality. While conventional therapies remain the standard of care, dietary and lifestyle behaviors are increasingly explored as potentially modifiable factors influencing clinical outcomes, [...] Read more.

Prostate cancer is among the most frequently diagnosed cancers in men globally, with metastatic disease contributing substantially to morbidity and mortality. While conventional therapies remain the standard of care, dietary and lifestyle behaviors are increasingly explored as potentially modifiable factors influencing clinical outcomes, although their role in advanced disease is not well established. We report a 60-year-old, physically active male, lifelong non-smoker without significant comorbidities, diagnosed with de novo metastatic prostate adenocarcinoma (Gleason score 9) and an initial prostate-specific antigen (PSA) of 808.3 µg/L. The patient received standard androgen deprivation therapy. By personal choice, he adopted a whole-food, low-fat (WFLF) vegan diet, structured physical activity, and periodic fasting-mimicking diet cycles. These interventions complemented, but did not replace or delay, conventional treatment. During the 14-month follow-up period, serial PSA measurements, laboratory tests, blood pressure monitoring, dietary assessment, body composition analysis, imaging, and germline genetic testing were performed. PSA declined from 808.3 µg/L to 1.7 µg/L (>99.8%), and remained suppressed throughout follow-up. Concurrent improvements were observed in body composition and metabolic biomarkers. The WFLF vegan diet increased fiber and micronutrient intake while reducing saturated fat and cholesterol. This case demonstrates the successful application and execution of an integrative oncology approach and highlights metastatic prostate cancer managed with standard therapy alongside patient-initiated lifestyle modifications. The findings should be interpreted as descriptive, exploratory, and hypothesis-generating. Given the single-patient design, the independent impact of lifestyle interventions cannot be determined. Controlled studies are warranted to clarify their potential role in advanced prostate cancer management. Full article

(This article belongs to the Section Genitourinary Oncology)

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15 pages, 1111 KB

Open AccessArticle

Patients’ Perspectives on Changes in Cancer Care During the COVID-19 Pandemic: Results of a Survey Among Patients with Gynecological Malignancies and Breast Cancer in Germany (NOGGO-S25/Expression XIII)

by Desislava Dimitrova, Jolijn Dirksje Boer, Dario Zocholl, Maja Krajewska, Hannah Woopen, Sara Nasser, Adak Pirmorady-Sehouli, Heike Jansen, Marion Kiechle and Jalid Sehouli

Curr. Oncol. 2026, 33(8), 484; https://doi.org/10.3390/curroncol33080484 - 17 Aug 2026

Abstract

Background/Objectives: The COVID-19 pandemic was a major challenge for healthcare systems and social life worldwide. During the pandemic, studies focused on examining structural changes in patient care and establishing new guidelines to manage COVID-19, but very few of them addressed patients’ perceptions and [...] Read more.

Background/Objectives: The COVID-19 pandemic was a major challenge for healthcare systems and social life worldwide. During the pandemic, studies focused on examining structural changes in patient care and establishing new guidelines to manage COVID-19, but very few of them addressed patients’ perceptions and concerns regarding changes in cancer treatment during the pandemic. This study aimed to assess the changes in their therapy situation during three waves of the pandemic and the impact on their social life. Methods: This exploratory cross-sectional multicenter survey was conducted among patients with gynecological malignancies and breast cancer at gynecological oncology centers in Germany between October 2020 and February 2022. An anonymous paper-based 50-item questionnaire, available in German, assessed medical care, treatment modifications, mental health, and socioeconomic burden during the COVID-19 pandemic. Data were analyzed descriptively. Two subgroup analyses were conducted, comparing age groups ≤70 and >70 years, as well as patients with and without a migrant background. Results: Overall, 778 patients met the inclusion criteria of the survey (median age: 59; range: 24–93). In the majority of the patients (77.1%), the treatment schedules remained unchanged during COVID-19 pandemic. Treatment appointments were modified in a small number of patients (9.0%). Changes in therapy schedules were slightly more common among the second- and third-generation migrants and among patients ≤70 years. Despite the uncertainty of the COVID-19 pandemic, most patients (83.4%) kept their trust in the healthcare system. Acceptance of preventive measures was high, and 85.9% were willing to be vaccinated against COVID-19. Psychological symptoms such as worries and fear were reported by more than half of the participants during the last 2 weeks previous to the survey and more common among patients ≤70 years. Only 8.6% were more afraid of a COVID-19 infection than their cancer disease. Conclusions: Despite major challenges in cancer care due to the COVID-19 pandemic, access to cancer treatment and adequate management at gynecological oncology centers in Germany remained stable. The increased psychological burden in crises requires new infrastructure and should be addressed to improve patient care in future crises. The acceptance of taking preventive measures against COVID-19 was high among cancer patients. Full article

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

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16 pages, 1199 KB

Open AccessReview

Systemic Inflammatory Biomarkers and Cancer-Associated Cachexia: A Narrative Review

by Shawna Landon, Jaclyn M. Hall and Saunjoo L. Yoon

Curr. Oncol. 2026, 33(8), 483; https://doi.org/10.3390/curroncol33080483 - 15 Aug 2026

Abstract

Cancer-associated cachexia (CAC) is a multifactorial syndrome characterized by systemic inflammation, muscle wasting, and progressive functional decline, affecting up to 80% of patients with advanced cancer. The inconsistent diagnostic criteria limit comparability across studies and hinder translation into clinical practice. Inflammatory biomarkers, including [...] Read more.

Cancer-associated cachexia (CAC) is a multifactorial syndrome characterized by systemic inflammation, muscle wasting, and progressive functional decline, affecting up to 80% of patients with advanced cancer. The inconsistent diagnostic criteria limit comparability across studies and hinder translation into clinical practice. Inflammatory biomarkers, including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and serum albumin, have been studied as markers of the presence, severity, and progression of CAC. This review synthesizes evidence linking these five biomarkers to key manifestations of CAC, including weight- loss, muscle depletion, fatigue, quality of life, and survival. A structured search of PubMed, Embase, and Web of Science studies published between 2000 and 2025, yielding 20 articles for final synthesis to evaluate biomarker patterns and their potential utility for early detection and risk stratification. IL-6 and CRP show consistent associations with muscle wasting and systemic inflammatory burden. Albumin and NLR demonstrate enhanced prognostic value when incorporated into composite indices such as the Cachexia index. TNF-α remains mechanistically relevant but shows limited predictive utility when assessed independently. CRP, Albumin, and NLR are derived from routine, low-cost tests, whereas IL-6 and TNF-α require specialized cytokine assays. Future research is warranted to standardize diagnostic criteria and validate biomarker thresholds to develop an accessible, multi-biomarker panel for improved detection and monitoring of CAC. Full article

(This article belongs to the Special Issue Role of Inflammation in Cancer)

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13 pages, 553 KB

Open AccessArticle

Symptom Burden, Depressive Symptoms, Resilient Coping, and Pretreatment Health-Related Quality of Life with Breast, Gynecological and Genitourinary Cancer

by Caterina Calderon, Patricia Cruz-Castellanos, Asia Ferrandez-Arias, Lucía Roncero-Sánchez, Valle Rodríguez-Morón, Rocío Galán-Moral, David Gómez-Sánchez, María Nevado-Rodríguez, Marina Gustems and Paula Jiménez-Fonseca

Curr. Oncol. 2026, 33(8), 482; https://doi.org/10.3390/curroncol33080482 - 15 Aug 2026

Abstract

Pretreatment health-related quality of life (HRQoL) may identify supportive care needs, but the joint contribution of symptom burden, depressive symptoms, and resilient coping remains insufficiently characterized. This multicenter baseline analysis included 194 adults with breast (n = 86), gynecological (n = [...] Read more.

Pretreatment health-related quality of life (HRQoL) may identify supportive care needs, but the joint contribution of symptom burden, depressive symptoms, and resilient coping remains insufficiently characterized. This multicenter baseline analysis included 194 adults with breast (n = 86), gynecological (n = 77), or genitourinary (n = 31) cancer from six Spanish hospitals before systemic therapy. Global HRQoL was assessed with the EuroQol visual analogue scale EQ-VAS; symptom burden with EORTC QLQ-C30 symptom scales/items; depressive symptoms with the Brief Symptom Inventory-18 depression subscale; and resilient coping with the Brief Resilient Coping Scale. EQ-VAS scores did not differ by tumor site (p = 0.369). Symptom burden was strongly inversely associated with HRQoL (r = −0.827, p < 0.001). In the moderated mediation model, higher symptom burden was associated with higher depressive symptoms (B = 0.275, 95% CI 0.118 to 0.431); symptom burden (B = −0.642, 95% CI −0.715 to −0.569) and depressive symptoms (B = −0.529, 95% CI −0.743 to −0.316) were associated with lower HRQoL scores. Indirect effects through depressive symptoms were statistically different from zero, but resilient coping did not significantly moderate this indirect association. These cross-sectional findings support pretreatment screening for symptoms and depressive symptoms to guide early supportive oncology care. Full article

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13 pages, 527 KB

Open AccessArticle

Intraoperative Neurophysiological Monitoring During Adult Brainstem Glioma Resection: Association Between Electrophysiological Changes and Early Neurological Outcome

by Giada Pauletto, Benjamin Skrap, Barbara Tomasino, Christian Lettieri, Elisa Ecoretti, Miran Skrap, Andrea Landi, Luca Denaro, Marco Vindigni, Massimo Robiony, Mariarosaria Valente, Tamara Ius and Lorenzo Verriello

Curr. Oncol. 2026, 33(8), 481; https://doi.org/10.3390/curroncol33080481 - 15 Aug 2026

Abstract

Intraoperative neurophysiological monitoring (IONM) is widely used during brainstem surgery to reduce the risk of neurological injury, although its prognostic value in adult brainstem glioma (BSG) surgery remains unclear. We retrospectively analyzed 22 consecutive adults who underwent surgery for BSGs with multimodal IONM [...] Read more.

Intraoperative neurophysiological monitoring (IONM) is widely used during brainstem surgery to reduce the risk of neurological injury, although its prognostic value in adult brainstem glioma (BSG) surgery remains unclear. We retrospectively analyzed 22 consecutive adults who underwent surgery for BSGs with multimodal IONM between 2010 and 2023. Monitoring included somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), brainstem auditory evoked potentials (BAEPs), corticobulbar MEPs (CoMEPs), and cranial nerves electromyography. The primary endpoint was the association between intraoperative neurophysiological changes and postoperative neurological functional status at hospital discharge, assessed with the modified McCormick Scale (mMCS). Secondary endpoints included postoperative complications and length of hospital stay. SSEP warning criteria were met in 10 patients (45.5%), while 10 patients (45.5%) experienced a ≥50% reduction in MEP amplitude in at least one monitored muscle. Despite these findings, neither SSEP nor MEP amplitude changes were significantly associated with postoperative neurological status. Transcranial MEP stimulation thresholds increased significantly during surgery (p = 0.007), and threshold elevation was associated with postoperative complications (Kendall’s τ = 0.498, p = 0.007). BAEP recordings remained stable throughout all procedures. Conventional amplitude-based IONM changes were not associated with early neurological outcome after adult BSG resection. In contrast, increases in MEP stimulation threshold may represent a sensitive indicator of postoperative complications. Further prospective studies are warranted. Full article

(This article belongs to the Special Issue Surgery and Beyond: The Evolving Landscape of Glioma Management)

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15 pages, 714 KB

Open AccessArticle

Prognostic Value of Immunonutritional Status and Radiologic Muscle Mass in Older Patients Receiving Immune Checkpoint Inhibitors: A Real-World Study

by Hülya Ertaş, Burcu Caner, Sibel Oyucu Orhan, Buket Şahin Çelik, Işıl Yüceışık and Yasemin Koç

Curr. Oncol. 2026, 33(8), 480; https://doi.org/10.3390/curroncol33080480 - 14 Aug 2026

Abstract

Background: Identifying biomarkers for biological vulnerability in older patients with cancer remains challenging. We evaluated psoas muscle index (PMI) and immunonutritional indices’ association with toxicity and overall survival (OS) in patients ≥ 65 years receiving immune checkpoint inhibitors (ICIs). Methods: This retrospective study [...] Read more.

Background: Identifying biomarkers for biological vulnerability in older patients with cancer remains challenging. We evaluated psoas muscle index (PMI) and immunonutritional indices’ association with toxicity and overall survival (OS) in patients ≥ 65 years receiving immune checkpoint inhibitors (ICIs). Methods: This retrospective study included 104 patients. Baseline sarcopenia was assessed via CT-derived PMI at the L3 level. Immunonutritional status was evaluated using the Prognostic Nutritional Index (PNI). Primary endpoint was immune-related adverse event (irAE) development; secondary endpoint was OS. Results: Median age was 71 years. Patients developing irAEs had significantly higher baseline PNI than those without (49.0 vs. 46.0, p = 0.042). OS did not differ significantly by irAE status (p = 0.859) or PMI group (p = 0.664). However, low PNI was strongly associated with poorer OS (17.0 months vs. not reached, p < 0.001). In a multivariable Cox model stratified by ICI treatment type, higher PNI remained independently associated with better OS (adjusted HR: 0.86, 95% CI: 0.81–0.93, p < 0.001). PNI correlated negatively with inflammatory markers NLR and SII. Conclusions: Baseline PNI was independently associated with OS, whereas PMI was not significantly associated with survival in this cohort. These findings support the potential prognostic utility of PNI in older patients receiving immunotherapy but should not be interpreted as demonstrating superiority over comprehensive sarcopenia assessment. Full article

(This article belongs to the Special Issue Advances in Geriatric Oncology: Toward Optimized Cancer Care)

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13 pages, 1283 KB

Open AccessArticle

Routine Inflammatory and Hematological Markers and Acute Radiation Toxicity in Patients with Prostate Cancer

by Jolanta Łuniewska-Bury, Piotr Leśniak, Adam Majchrzak, Kamil Obel, Tomasz W. Kaminski, Tomasz Ząbkowski and Tomasz Syryło

Curr. Oncol. 2026, 33(8), 479; https://doi.org/10.3390/curroncol33080479 - 14 Aug 2026

Abstract

Background: Modern radiotherapy techniques have improved the safety of prostate cancer treatment, but acute gastrointestinal and genitourinary toxicity remains a common clinical problem. Early identification of patients who are likely to develop treatment-related adverse effects may help optimize supportive care. This study evaluated [...] Read more.

Background: Modern radiotherapy techniques have improved the safety of prostate cancer treatment, but acute gastrointestinal and genitourinary toxicity remains a common clinical problem. Early identification of patients who are likely to develop treatment-related adverse effects may help optimize supportive care. This study evaluated the relationships between clinical characteristics, radiotherapy planning parameters, systemic inflammatory biomarkers, and acute pelvic toxicity during hypofractionated radiotherapy. Materials and Methods: We retrospectively analyzed 142 patients with histologically confirmed prostate cancer who underwent external beam radiotherapy at the Provincial Integrated Hospital in Płock, Poland, between October 2024 and March 2026. Clinical, laboratory, and radiotherapy planning data were obtained from institutional electronic records. Laboratory analyses included CRP, creatinine, total leukocyte, neutrophil, lymphocyte, erythrocyte and platelet counts, hemoglobin, and hematocrit. Rectal and bladder toxicity was prospectively graded according to the RTOG/EORTC criteria at 2 and 4 weeks after treatment initiation. Correlation and multivariable regression analyses were performed to identify factors associated with acute treatment-related toxicity. Results: Radiotherapy significantly reduced leukocyte and lymphocyte counts (both p < 0.001) and produced smaller reductions in erythrocyte count, hemoglobin, hematocrit, and absolute neutrophil count (all p < 0.05). Patients who reported rectal or urinary symptoms early during treatment generally continued to experience toxicity later in the treatment course. Rectal and bladder toxicities were positively correlated, indicating that patients with toxicity affecting one pelvic organ frequently developed symptoms in the other. Routine inflammatory biomarkers and most dosimetric parameters showed limited independent value for predicting clinically relevant acute toxicity. Conclusions: Early gastrointestinal and genitourinary toxicity appears to be a useful clinical indicator of persistent treatment-related symptoms during hypofractionated prostate radiotherapy. Early rectal and bladder toxicity was associated with toxicity later during treatment, whereas routine laboratory markers and most dosimetric parameters showed limited independent associations with acute pelvic toxicity. Full article

(This article belongs to the Section Oncology Biomarkers)

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18 pages, 255 KB

Open AccessArticle

Impact of Lebanon’s Economic Crisis on Cancer Care Delivery: A Multicenter Cross-Sectional Study of Treatment Initiation Delays and Incomplete Therapy

by Mohamad Ali Hachem, Nadeen Zayour, Elie Daibess, Jacqueline Najjar, Elie Jean Karam, Solay Farhat, Zeinab Hammoud, Ghadir M. Nasreddine, Mohamad Abbass, Zeinab Sleiman, Maroun Sadek, Ahmad Ibrahim, Issam Chehade and Bassam Matar

Curr. Oncol. 2026, 33(8), 478; https://doi.org/10.3390/curroncol33080478 - 14 Aug 2026

Abstract

Background/Objectives: In Lebanon, the economic crisis since 2019 has severely strained healthcare infrastructure, yet its impact on cancer treatment adherence remains incompletely characterized. This study assessed factors associated with treatment delay and regimen modification to identify barriers to optimal cancer care among [...] Read more.

Background/Objectives: In Lebanon, the economic crisis since 2019 has severely strained healthcare infrastructure, yet its impact on cancer treatment adherence remains incompletely characterized. This study assessed factors associated with treatment delay and regimen modification to identify barriers to optimal cancer care among Lebanese patients. Methods: This multicenter, cross-sectional study was conducted in five tertiary hospitals in Beirut, Lebanon, between 13 June 2024, and 27 June 2025. Demographic, clinical and treatment data were collected via a structured questionnaire. Bivariate and multivariable binary logistic regression analyses were performed to identify independent predictors of treatment delay (>2 weeks) and incomplete treatment regimens. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) are reported. Results: A total of 244 patients were enrolled in the study. The study population was predominantly female (59.0%) and aged ≥60 years (60.2%). Advanced disease was common, with 50.4% of patients presenting with stage IV disease. Financial vulnerability was widespread: 72.6% reported monthly household incomes below USD 1000, 88.1% reported a decline in income due to the economic crisis, and 39.3% relied on unstable income sources. Overall, 52.5% of patients experienced treatment initiation delays, and 9.0% received incomplete or dose-reduced regimens. On multivariable analysis, reliance on unfixed income independently predicted treatment delay (aOR 2.55, 95% CI 1.42–4.59; p = 0.002), lack of health insurance (aOR 1.91, 95% CI 1.08–3.39; p = 0.026) and pre-treatment surgical costs also increased the odds of delay (aOR 9.03, 95% CI 2.57–31.7; p = 0.001). For incomplete treatment, unfixed income remained an independent predictor (aOR 2.09, 95% CI 1.16–5.79; p = 0.015). A lack of insurance (aOR 5.62, 95% CI 1.22–25.9; p = 0.027) and high laboratory costs (>USD 150 per session) were also associated with incomplete regimens (aOR 1.62, 95% CI 1.02–2.57; p = 0.041). Conclusions: In Lebanon’s crisis context, financial instability was a key factor associated with deviations in cancer treatment. These findings highlight the need for strengthened insurance coverage and subsidization of diagnostic and treatment-related costs to ensure timely and continuous oncologic care. Full article

(This article belongs to the Special Issue Unveiling the Economic Impact of Cancer Treatment)

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