Current Oncology

Hematopoietic stem cell transplant (HSCT) recipients are at high risk for opportunistic infections due to profound immunosuppression and graft-versus-host disease (GvHD). Molds and nontuberculous mycobacteria (NTM) pose diagnostic and therapeutic challenges, especially when infections overlap. A 42-year-old woman with prior allogeneic HSCT for acute myeloid leukemia (AML) developed pulmonary infections with Microascus spp. and Mycobacterium chimaera, later complicated by Aspergillus calidoustus and RSV infection. Initial therapy included voriconazole, amphotericin B, and a macrolide-based multidrug regimen for NTM. Modifications were required for drug resistance and hepatotoxicity. Despite partial response, recurrent fungal infection necessitated prolonged antifungal therapy, including adjunctive inhaled amphotericin B and terbinafine. Ultimately, progressive bronchiolitis obliterans prompted bilateral lung transplantation. Explant pathology revealed necrotizing granulomas positive for NTM and Microascus spp. Post-transplant prophylaxis with voriconazole, rifabutin, azithromycin, and inhaled amikacin prevented recurrence, and the patient remained clinically stable at 6-month follow-up. This case illustrates the complexity of managing overlapping mold and NTM infections in HSCT recipients, highlighting the need for individualized, multidisciplinary care. Therapeutic drug monitoring, careful adjustment for drug–drug interactions, and the use of adjunctive inhaled antifungals were critical to achieving a favorable outcome.

Electrochemotherapy is a minimally invasive treatment based on the principle of reversible electroporation of target cells in pathologic tissues in order to increase the local effect of chemotherapeutic agents. The mechanism of action relies on temporarily increasing cell permeability to increase the uptake of cytotoxic drugs in the intracellular space. Originally developed for the treatment of cutaneous malignancies, electrochemotherapy has significantly evolved over the past few decades, thanks to advancements in electrode design and image guidance, finding fertile ground in musculoskeletal oncological pathologies, such as bone and soft tissue tumors and different kinds of vascular malformations. Moreover, initial experiences have reported on the treatment of other soft tissue tumors such as desmoid fibromatosis. The aim of this review is to summarize the literature on the role of electrochemotherapy across a variety of musculoskeletal conditions, starting from established oncologic indications, such as metastatic bone or soft tissue tumors, to emerging evidence on primary musculoskeletal pathology, with particular attention paid to the results of the leading studies relating to the efficacy, complications, and recurrence rate.

This study describes concerns, positive experiences and suggestions for improvement in survivorship care from the perspectives of cancer survivors aged ≥85 years based on gender and income levels. A national Canadian survey was conducted in 2016 focusing on cancer survivors’ needs and experiences with follow-up care after treatment. This paper reports a secondary analysis drawn from the survey data reported qualitatively. In total, 581 respondents aged ≥85 years responded, of which 399 confirmed gender and annual household income. Within this group, 201 were male, and 198 were female. Two-thirds of the males (n = 134 males, 66.7%) and 80.8% of the females (n = 160) reported annual household income under $50K (CAD). Limited differences were noted between survivors’ responses according to sex and/or income levels. Concerns focused on physical challenges and body changes. Positive comments reflected appreciation of the care provided by attentive healthcare professionals. Suggestions for improvement addressed the need for improved person-centred care and availability of services for older adults. The survivors faced a range of physical, emotional and practical challenges following cancer treatment. The study highlights the importance of considering how living alone or with others, community connection, and the burden of co-morbidities compounding physical challenges after cancer intersect to create unique situations for this age group.