Search Results (12,665)

Background: Lattice Radiotherapy (LRT), a spatially fractionated stereotactic radiotherapy (SBRT) technique, has shown promising results in the palliative treatment of large tumors. The focus of our first analysis of 56 lesions >/=7cm was on the extent of shrinkage following palliative LRT (mean 50%) and assessment of its effect duration (: mean 6 months). Herewith we present an updated analysis of our single-center LRT cohort, with a focus on LRT outcome across diagnoses and applied LRT regimens. Methods: We assessed the clinical outcome following LRT in 66 patients treated for 81 lesions between 01.2022 and 05.2025. LRT protocols included simultaneous integrated boost (sib-) LRT in 49 lesions (5 × 4–5 Gy to the entire mass with sib of 9–13 Gy to lattice vertices). Alternatively mainly in pre-irradiated and/or very large lesions—a single-fraction stereotactic LRT (SBRT-LRT) of 1 × 20 Gy to vertices only was delivered to 26 lesions. In six cases with modest response to single fraction SBRT-LRT, the sib-LRT schedule was added 4–8 weeks later. Results: The median age was 68 years (18–93). Main tumor locations were abdomino-pelvic (n = 34) and thoracic (n = 17). Histopathological diagnoses included carcinoma (n = 34), sarcoma (n = 31), and melanoma (n = 16). 31% of all lesions have been previously irradiated. 73% of cases underwent concurrent or peri-LRT systemic therapy. The mean/median overall survival (OS) time of the cohort was 7.6/4.6 months (0.4–40.2), 11.9/5.8 months in 16/66 alive, and 6.4/4.3 months in deceased patients, respectively. 82% of symptomatic patients reported immediate subjective improvement (PROM), with a lifelong response duration in most cases. Progressive disease (PD: >10% increase in initial volume) was found in 9%, stable disease (SD +/−10% of initial volume) in 19% of scanned lesions, and shrinkage (>10% reduction in initial volume) in 75%, with a mean/median tumor volume reduction of 51/60%. The extent of shrinkage was found to be 11–30%/31–60%/61–100% in 38/24/38% of lesions. Response rates (PD, SD, shrinkage) following the two applied LRT regimens, as well as those related to sarcoma and carcinoma diagnoses, were found to be comparable. Treatment tolerance was excellent (G0-1). Conclusions: Palliative LRT provides rapid subjective relief in ~80% of symptomatic patients. Radiologic shrinkage was stated in 75% of FU-scanned lesions, with a lifelong effect duration in most patients. LRT was found effective across histologies, with a similar extent of shrinkage in carcinoma and sarcoma following 1F SBRT- and 5F sib-LRT regimens, respectively. Full article

Background: The optimal surgical approach for malignant pleural mesothelioma (PM) remains a topic of debate. While extrapleural pneumonectomy (EPP) offers radical resection, it is associated with significant morbidity. Pleurectomy/decortication (P/D) is less extensive but may offer comparable oncologic outcomes with reduced perioperative risk. This study aimed to conduct a comprehensive systematic review and meta-analysis to systematically evaluate and quantitatively compare survival outcomes, 30-day postoperative mortality, and baseline characteristics between patients undergoing P/D and EPP for PM. Methods: A systematic review was conducted in accordance with the PRISMA guidelines. MEDLINE, Embase, and Scopus were searched up to May 2025. Studies comparing EPP and P/D in PM that reported on survival, mortality, or baseline demographics were included. Data from 24 retrospective studies were extracted. Pooled estimates were calculated using random-effects models. Meta-regression and subgroup analyses were performed by geographic region and publication year. Results: P/D was associated with a significantly improved overall survival compared to EPP in the primary analysis (mean difference = 7.01 months; 95% CI: 1.15–12.86; p = 0.018), with substantial heterogeneity (I² = 98.5%). In a sensitivity analysis excluding one statistical outlier, the survival benefit remained significant (mean difference = 4.31 months; 95% CI: 1.69–6.93), and heterogeneity was markedly reduced. The 30-day mortality rate was also significantly lower for P/D (odds ratio = 0.34; 95% CI: 0.13–0.88; p = 0.027). Patients undergoing P/D were, on average, 3.78 years older than those undergoing EPP (p < 0.001), whereas no significant difference was observed in the sex distribution between groups. Subgroup analyses by region and publication year confirmed the robustness of the findings. Meta-regression did not reveal substantial modifiers of survival. Conclusions: P/D demonstrates superior overall survival and reduced perioperative mortality compared to EPP, without evidence of baseline demographic confounding. These findings, derived from retrospective comparative studies, support the preferential use of P/D in eligible patients, particularly in high-volume centers, given its favorable safety profile and superior median survival. However, the absence of randomized trials directly comparing P/D and EPP and the potential influence of patient selection warrant cautious interpretation, and surgical decisions should be tailored to individual patient factors within a multidisciplinary setting. Full article

Background/Objectives: Recurrent meningiomas remain difficult to manage due to the absence of effective systemic therapies and comparatively high treatment failure rates, particularly in high-grade tumors. Stereotactic radiosurgery (SRS) offers a minimally-invasive and precise option, particularly for tumors in surgically complex locations. However, the risks associated with re-irradiation, and recent changes in the WHO classification of CNS tumors highlight the need for more personalized and strategic treatment approaches. This systematic review evaluates the safety, efficacy, and clinical considerations for use of SRS for recurrent meningiomas. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature search was conducted using the PubMed, Scopus, and Web of Science databases for studies reporting outcomes of SRS in recurrent, pathologically confirmed intracranial meningiomas. Studies were excluded if they were commentaries, reviews, case reports with fewer than three cases, or had inaccessible full text. The quality and risk of bias of the included studies were assessed using the modified Newcastle-Ottawa Scale. Data on patient and tumor characteristics, SRS treatment parameters, clinical outcomes, adverse effects, and statistical analysis results were extracted. Results: Sixteen studies were included. For WHO Grade I tumors, 3- to 5-year progression-free survival (PFS) ranged from 85% to 100%. Grade II meningiomas demonstrated more variable outcomes, with 3-year PFS ranging from 23% to 100%. Grade III tumors had consistently poorer outcomes, with reported 1-year and 2-year PFS rates as low as 0% and 46%, respectively. SRS performed after surgery alone was associated with superior outcomes, with local control rates of 79% to 100% and 5-year PFS ranging from 40.4% to 91%. In contrast, tumors previously treated with radiotherapy, with or without surgery, showed substantially poorer outcomes, with 3- to 5-year PFS ranging from 26% to 41% and local control rates as low as 31%. Among patients with prior radiotherapy, outcomes were particularly poor in Grade II and III recurrent tumors. Toxicity rates ranged from 3.7% to 37%, and were generally higher for patients with prior radiation. Predictors of worse PFS included prior radiation, older age, and Grade III histology. Conclusions: SRS may represent a reasonable salvage option for carefully selected patients with recurrent meningioma, particularly following surgery alone. Outcomes were notably worse in high-grade recurrent meningiomas following prior radiotherapy, emphasizing the prognostic significance of both histological grade and treatment history. Notably, the lack of molecular and genetic data in most existing studies represents a key limitation in the current literature. Future prospective studies incorporating molecular profiling may improve risk stratification and support more personalized treatment strategies. Full article

Immune checkpoint inhibitors (ICIs) have emerged as first-line therapy for advanced-stage HCC with modest response rates (<33%). Combination treatments offer the potential to improve response rates while improving outcomes. This study evaluates the safety and outcomes of first-line Yttrium-90 plus ICI (⁹⁰Y-ICI). A retrospective, multi-center study was conducted in HCC patients receiving first-line ⁹⁰Y-ICI with atezolizumab plus bevacizumab (Atezo/Bev) or tremelimumab plus durvalumab (Treme/Durva). Treatment response was evaluated at follow-up for planned ⁹⁰Y treatment cycle. Time-to-event measures of time to progression (TTP), progression-free survival (PFS), and overall survival (OS) served as primary endpoints, with first cycle response rates and AEs as secondary outcomes. This study included 37 patients receiving ⁹⁰Y-ICI from 2021 to 2024 (16-month median follow-up). The cohort was predominantly Child-Pugh A (92%) with HCV-related cirrhosis (67%), advanced stage (54%), and a median index HCC size of 8.0 cm (IQR: 6—12 cm). Grade 3–4 AEs occurred in six patients (16%). The target objective response (OR) rate was 83%, with a 50% target complete response (CR) rate. Overall OR was 61% with an overall CR of 39%. Median PFS was 11 months with 1-year rates of 50%. Patients with a target CR had improved TTP (p = 0.004), PFS (p = 0.003), and OS (p = 0.003). The cohort’s 2-year OS was 41% with a median OS of 19 months (CI: 12–37 months). First-line ⁹⁰Y-ICI therapy in HCC is safe and effective, with no deviation in anticipated results. Patients achieving target CR showed significantly improved TTP, PFS, and OS, supporting target CR as an optimal treatment target. Full article

Background: The guidelines recommend mitral valve repair whenever possible in patients undergoing surgical treatment for active infective endocarditis of the native mitral valve. However, the impact of causative microorganisms in relation to treatment strategies, especially Staphylococcus aureus, has not been studied. In this study, we aimed to compare the outcomes of mitral valve repair versus replacement in patients with native mitral valve infective endocarditis caused by methicillin-susceptible Staphylococcus aureus. Methods: Consecutive patients with definitive active infective endocarditis of the native mitral valve caused by methicillin-susceptible Staphylococcus aureus undergoing cardiac surgery between 2012 and 2022 were selected. Patients were classified according to the treatment received in two groups: repair and replacement. Inverse propensity treatment weighting was employed to correct for confounders. The endpoints were all-cause mortality, incidence of recurrent endocarditis, reoperation rate, and event-free survival at two-year follow-up. Results: Among 170 operated-upon patients with active infective endocarditis of the native mitral valve, 44 cases were caused by methicillin-susceptible Staphylococcus aureus. A total of 23 patients underwent mitral valve repair and 21 patients received mitral valve replacement. Weighted 30-day mortality in the repair group was 43%, versus 27% in the replacement group (p = 0.15). Two-year mortality increased to 57% in the repair group and 32% in the replacement group (p = 0.02). Three patients developed recurrent endocarditis in the repair group, while no recurrent endocarditis occurred in the replacement group. Three patients in the repair group required reoperation due to recurrence and one patient in the replacement group underwent re-operation due to paravalvular leakage. Weighted two-year event-free survival was 29% in the repair group and 59% in the replacement group (p < 0.01). Conclusions: Mortality in patients with mitral valve infective endocarditis caused by Staphylococcus aureus is extremely high, especially in patients undergoing mitral valve repair. The risk of recurrent endocarditis and mid-term mortality seems to be higher in mitral valve repair, resulting in poor event-free survival during two-year follow-up. However, the sample size was likely insufficient for drawing definitive conclusions. Full article

Background: chordomas are characterized as locally aggressive yet infrequently metastasizing malignant neoplasms of bone, primarily arising in the axial skeleton, with a notable prevalence in the sacral region. En bloc resection is recognized as the standard treatment for sacral chordoma; however, its feasibility is not universally guaranteed. Therefore, definitive proton, carbon ion, or photon therapy is often utilized as an alternative to surgical intervention or as a (neo-)adjuvant measure in conjunction with surgery, owing to their role in enhancing local control. Methods: a search of PubMed yielded 127 articles, with 18 that were ultimately included in the review. This review aims to systematically evaluate clinical outcomes and complications associated with hadron therapy in cases of sacral chordomas. The review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, including publication dates up to January 2025. Results: data extraction showed promising outcomes for patients treated with hadron therapy alone or when hadron therapy was used as an adjuvant for surgery, even if complications are described. The 5-year overall survival estimated from evaluating 10 of 18 articles was 82.4%, although some articles reported different results in shorter follow-up periods. Skin ulceration and pain were described in 323 (29%) and 186 (16%) patients, respectively. Chronic complications reported were sacral fractures, metastasis, rectal disorders, urinary disorders, and peripheral motor and sensory neuropathy. Conclusions: hadron therapy represents a highly effective and promising treatment for sacral chordomas. In cases of inoperable tumors, it has demonstrated outcomes comparable to surgery while significantly reducing treatment-related morbidity. Hadron therapy is also viable as adjuvant therapy and provides superior outcomes for patients who undergo surgery with positive margins compared to those treated with surgery alone, improving local control and overall prognosis. Full article

Early diagnosis of cystic fibrosis (CF) through newborn screening (NBS) improves clinical outcomes, but in countries like India, delayed diagnosis increases morbidity, mortality, and likely underestimates infant deaths from CF. We performed a retrospective study at a single center in south India from 2017 to 2025 reviewing children diagnosed with CF before one year of age. Patient demographic, clinical, and genetic data were analyzed to characterize early clinical features and identify factors linked to mortality. Of 56 infants diagnosed with CF, 59% survived (median current age 55 months) while 41% died (median age of death 5 months). Key clinical indicators included sibling death with CF-like symptoms, rapid weight loss, and persistent respiratory or nutritional complications. Mortality risk under one year was significantly linked to hypoalbuminemia (OR 9.7), severe malnutrition (OR 4.4), severe anemia (hemoglobin < 7 g/dL) requiring blood transfusions (OR 3.0), and peripheral edema (OR 4.2). A triad of anemia, hypoalbuminemia, and edema was found to strongly predict death (OR 4.2). Integrating clinical checklists of these manifestations into primary healthcare may improve prompt referrals for earlier diagnosis and treatment. Continued education and advocacy for NBS are essential to reduce potentially preventable CF-related deaths in young children. Full article

Background: Pancreatic solid pseudopapillary neoplasms (SPNs) are rare exocrine tumours with predominance in young women. These tumours are of low malignant potential, become considerably large before causing symptoms and are associated with good prognosis. This study aimed to present and analyse clinicopathological features and surgical outcome of SPNs. Methods: A retrospective analysis of 22 patients who underwent pancreatic surgery for SPNs in a single high-volume surgical centre in 2014–2023 was performed. Results: SPN was the most frequent in females (n = 21, 95.45%) in a mean age of 34 ± 11.09 (18–55) years. Fourteen (63.64%) patients were asymptomatic, and eight (36.36%) presented with symptoms. The most common clinical symptom was abdominal pain (n = 7, 31.82%). The majority of tumours were located in the pancreatic body (n = 8, 36.36%), and most patients underwent distal pancreatectomy (n = 11, 50%). The median tumour size was 3.6 cm (IQR = 4.9; range: 1.3–14). The median duration of hospitalisation was 12.5 days, and the postoperative complication rate was 40.91%. R0 resection was achieved in 18 (81.82%) patients. Postpancreatectomy acute pancreatitis (PPAP) was the most common postoperative complication. No adjuvant therapy in any patient was needed. One-year overall survival (OS) equalled 100% and five-year OS reached 85%. None of the patients developed diabetes or signs of impaired pancreatic secretion in the follow-up period. Histopathology showed features like perineural invasion in 72.73% of cases, pseudocapsule (59.09%), haemorrhage (45.45%), vascular invasion (40.91%), mucosal metaplasia (40.91%), necrosis (31.82%), and calcification in the capsule (31.82%). Ki67 did not exceed 7%. In one case (4.55%), metastasis to a lymph node was found. Clinical suspicion agreed with histopathological results in only 10 (45.45%) cases. Conclusions: SPN most often occurs in young females. The majority of cases are asymptomatic accidental findings. The final diagnosis of SPN can be based just on analysis of histopathological examination results. Full article

Background: Bioelectrical impedance analysis has been used to evaluate phase angle, which predicts cellular health and may even predict survival in people living with HIV. However, the relationship between the phase angle and geriatric syndromes is unclear. This study aims to evaluate geriatric syndromes and how they interact with issues affecting HIV patients by conducting a full geriatric evaluation and comparing phase angles. Methods: Fifty people living with HIV and 52 participants without HIV were included in the study. All participants underwent a comprehensive geriatric assessment. BIA was used to determine the phase angle, which was then predicted from impedance measurements. Results: The mean age of people living with HIV was 60.0 ± 12.0 years, and that of participants without HIV was 60.0 ± 5.0 years in participants without HIV (p = 0.93). The number of drugs used by people living with HIV infection was considerably higher than that used by those in the HIV-negative group (p = 0.018). There was a statistically significant difference in the phase angle between without HIV and with HIV. The median [interquartile range (IQR)] phase angle was 7.4 [4.0] degrees, and it was 5.7 [3.2] degrees (p = 0.004). Conclusions: Phase angle measurements between people living with HIV and without HIV could provide valuable insights into overall health status treatment response and prognosis. Further large-scale research is to corroborate our findings. Full article

Background/Objectives: Coronavirus disease 2019 (COVID-19) is associated with gastrointestinal (GI) symptoms. Small intestinal bacterial overgrowth (SIBO) is emerging as a significant GI sequela post-COVID-19 infection. This study aimed to evaluate the prevalence and incidence of SIBO post-COVID-19 infection across different age groups and to identify associated risk factors in a global cohort. Methods: A retrospective study utilized the TriNetX database and included adult patients (≥18 years) diagnosed with SIBO following COVID-19 infection (1 January 2022–30 May 2024). A propensity score matching (1:1) was used to adjust for demographics and SIBO risk factors. Kaplan–Meier survival analysis assessed the SIBO incidence within 12 months. Results: Among 1,660,092 COVID-19 patients and 42,322,017 controls, SIBO was diagnosed in 353 COVID-19 patients without hydrogen breath tests (BT) and 78 with BT, compared to 3368 controls without BT and 871 with BT. Age-specific analysis demonstrated a clear, progressive increase in the SIBO incidence, becoming distinctly significant by 6 months and highest at 12 months post-infection. The highest risks were noted in ages 60–69 (0.011% vs. 0.004%, OR 2.6, p = 0.0003) and 70–79 (0.011% vs. 0.005%, OR 2.0, p = 0.0004), with younger age groups (30–49 years) also showing significantly increased risks. The medication analysis revealed strong associations with chronic opioid, proton pump inhibitor, and antidiarrheal medication. Conclusions: COVID-19 significantly increased the risk of SIBO, particularly within the first 12 months post-infection, across various age groups and, notably, in association with certain chronic medications. Clinical vigilance and targeted management strategies are recommended to mitigate long-term GI consequences. Full article

Coral reef degradation has spurred the development of artificial structures to mitigate losses in coral cover. These structures serve as substrates for coral transplantation, with the expectation that growing corals will attract reef-associated taxa—while the substrate’s ability to directly support biodiversity is often neglected. We evaluated a novel 3D-printed modular tile made of porous terra cotta, designed with complex surface structures to enhance micro- and cryptic biodiversity, through a restoration project in Hong Kong. Over four years, we monitored 378 outplanted coral fragments using diver assessments and photography, while biodiversity changes were assessed through visual surveys and eDNA metabarcoding. Coral survivorship was high, with 88% survival after four years. Visual surveys recorded seven times more fish and almost 60% more invertebrates at the restoration site compared to a nearby unrestored area. eDNA analyses revealed a 23.5% higher eukaryote ASV richness at the restoration site than the unrestored site and 13.3% greater richness relative to a natural reference coral community. This study highlights the tiles’ dual functionality: (1) supporting coral growth and (2) enhancing cryptic biodiversity, an aspect often neglected in traditional reef restoration efforts. Our findings underscore the potential of 3D-printed ceramic structures to improve both coral restoration outcomes and broader reef ecosystem recovery. Full article

The germination and elongation of maize in the early growth stage are closely related to the elongation of the mesocotyl, which is one of the earlier parts that are able to sense external temperature, except for the coleoptile. And, low-temperature (LT) stress can significantly influence the survival and growth of maize seedlings. In addition, the brassinosteroids (BRs) have also been applied to alleviate the damage suffered by various plants in LT in recent years. However, the interaction relationship among LT, BRs, and sugar remains unclear. Therefore, we examined the changing relationships among the contents of glucose, sucrose, and starch, as well as the changes in differentially expressed genes (DEGs) in the starch and sucrose metabolism and glycolysis/gluconeogenesis pathways. Herein, compared to CK (0 μM 24-epibrassinolide (EBR) application at 25 °C), the contents of glucose and sucrose all increased by 0.26, 0.47, and 0.70 mg g⁻¹ FW and 0.80, 0.30, and 0.61 mg g⁻¹ FW, respectively, under the CKE (2.0 μM 24-epibrassinolide (EBR) application at 25 °C), LT (0 μM 24-epibrassinolide (EBR) application at 10 °C), and LTE (2.0 μM 24-epibrassinolide (EBR) application at 10 °C) treatments, but the contents of starch decreased under LT and LTE treatments by −0.54% and −0.20%, compared to CK. This suggested that not only did the sugar signaling and metabolism play key roles in regulating LT tolerance but the application of EBR can also alleviate the damage caused by LT by regulating the sugar accumulation level. Meanwhile, 108 DEGs in the starch and sucrose metabolism pathway and 65 DEGs in the glycolysis pathway were identified at the transcriptome level. The common Zm00001d042146 in both pathways is always down-regulated, and the down-regulation multiple when EBR is added is less than the LT. In addition, key genes such as Zm00001d021598, Zm00001d034017, and Zm00001d029091, were all differentially expressed under LT, and the expression multiples decreased when EBR was added. In conclusion, our results provide new insights into the molecular mechanism by which exogenous application of EBR enhances the low-temperature tolerance of maize seedlings. The germination and elongation of maize in the early growth stage are closely related to the elongation of the mesocotyl, which is one of the first parts to sense external temperature, aside from the coleoptile. Low-temperature (LT, 10~15 °C) stress can significantly affect the survival and growth of maize seedlings. Additionally, brassinosteroids (BRs) have been used in recent years to help alleviate damage caused by LT in various plants. However, the interaction among LT, BRs, and sugar remains unclear. Therefore, we examined the relationships among the contents of glucose, sucrose, and starch, along with the changes in differentially expressed genes (DEGs) involved in starch and sucrose metabolism and glycolysis/gluconeogenesis pathways. Compared to CK (0 μM 24-epibrassinolide (EBR) application at 25 °C), the contents of glucose and sucrose increased by 0.26, 0.47, and 0.70 mg g⁻¹ FW and 0.80, 0.30, and 0.61 mg g⁻¹ FW, respectively, under the CKE (2.0 μM 24-epibrassinolide (EBR) application at 25 °C), LT (0 μM 24-epibrassinolide (EBR) application at 10 °C), and LTE (2.0 μM 24-epibrassinolide (EBR) application at 10 °C) treatments. However, starch contents decreased under LT and LTE treatments, by −20.54% and −0.20%, respectively, compared to CK. This suggests that sugar signaling and metabolism play key roles in regulating LT tolerance, and the application of EBR may alleviate LT damage by regulating sugar accumulation levels. Furthermore, 108 DEGs were identified in the starch and sucrose metabolism pathways, along with 23 in glycolysis, with 65 DEGs at the transcriptome level. The common Zm00001d042146 (hexokinase-3) in both pathways is usually down-regulated, and the degree of down-regulation when EBR is added is less than under LT alone. Additionally, key genes such as Zm00001d021598 (glucan endo-1,3-beta-glucosidase 3), Zm00001d034017 (uncharacterized LOC541703), and Zm00001d029091 (sucrose synthase 2) were differentially expressed under LT, with their expression levels decreasing further when EBR was added. In conclusion, our results provide a new direction into the molecular mechanisms by which exogenous EBR application enhances low-temperature tolerance in maize seedlings. Full article

Although the calcium-dependent proteases, calpains, were discovered more than 60 years ago, we still know very little regarding their functions, mostly because very few studies are addressing questions related to specific members of this relatively large family of cysteine proteases. The “classical calpains”, calpain-1 and calpain-2, are ubiquitous and have received more attention because of the special roles they play in the brain. The authors have been studying the properties and functions of these two calpain isoforms in the brain for over 45 years, and this review will focus on what has been learned over this period of time. In particular, we will discuss the numerous studies that have led to the notion that calpain-1 and calpain-2 play opposite functions in the brain on processes ranging from neuronal survival or death, synaptic plasticity, and learning and memory to neurogenesis. Mechanisms underlying these opposite functions are starting to be understood and the findings support the notion that such opposite functions might be a general feature of these two isoforms in any type of cell. This review concludes with a discussion of the potential benefits of selective calpain-2 inhibitors for the treatment of a variety of neurological disorders. Full article

Background: Ampullary adenocarcinoma is a rare cancer for which there are no standard adjuvant treatment recommendations due to the lack of randomized clinical trials. The primary aim of this analysis is to investigate the efficacy of adjuvant FOLFIRINOX treatment in patients with resected ampullary adenocarcinoma. Materials and Methods: This multicenter retrospective cohort study was conducted at 15 institutions in Turkey between August 2007 and January 2024, involving 211 patients with resected, non-metastatic ampullary adenocarcinoma receiving adjuvant chemotherapy with various chemotherapy regimens with or without chemoradiation. Clinicopathological and treatment-related parameters were recorded. Disease-free survival (DFS) and overall survival (OS) were analyzed by using Kaplan–Meier estimates. Cox proportional hazards regression was used to identify covariates associated with OS. Results: The median follow-up time was 52 months, and 116 patients (55.2%) were alive at the time of the analysis. The median age was 61 years (32–82). mFOLFIRINOX was administered to 16.6% of the patients (n = 35). The 3-year DFS rate was 79.41% in the FOLFIRINOX-treated arm and 53.9% in the other treatment arm (p = 0.034 for mDFS). The median OS was non-reached in patients receiving mFOLFIRINOX treatment, while it was 51 months in patients receiving other treatments (p = 0.071). While no statistically significant results were reached, a trend toward statistically significant survival times was observed in the FOLFIRINOX arm. After adjustment for other prognostic parameters, mFOLFIRINOX remained an independent statistically significant parameter for better OS (HR; 95% CI: 3.24; 1.02–10.9; p = 0.046). Conclusions: FOLFIRINOX treatment has shown efficacy in the adjuvant treatment of ampullary cancer, independent of histological subtype. The findings should be validated in large prospective trials. Full article

Background: The treatment landscape for advanced hepatocellular carcinoma (HCC) has evolved significantly recently; however, access to novel agents remains limited because of high costs. This study aimed to evaluate the systemic treatment patterns and survival outcomes for advanced HCC across different systemic treatment sequences under real-world resource constraints. Methods: This retrospective study was conducted at a tertiary center in Southern Thailand. The medical records of patients (n = 330) with advanced HCC treated with systemic therapy between 2010 and 2024 were reviewed. Outcomes included overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). Prognostic factors for OS were investigated. Results: First-line therapies included tyrosine kinase inhibitor (TKI; 69.7%), chemotherapy (23.3%), immunotherapy (IO)/targeted therapy (3.6%), dual IO (1.8%), and IO monotherapy (1.5%). The median OS, PFS, and ORR for each cohort were 7.2, 5.2, 10.9, 8.5, and 8.6 months; 3.94, 3.22, 3.48, 6.19, and 2.69 months; and 9.6%, 10.4%, 16.7%, 0%, and 20.0%, respectively. OS improved with increasing lines of therapy (4.5, 12.2, 19.4, and 40.7 months for one to four lines, respectively). Portal vein tumor thrombus, ascites, elevated bilirubin level, high alpha-fetoprotein level, and poor Eastern Cooperative Oncology Group performance status were associated with poor prognosis; multiple treatment lines and overweight status were associated with improved OS. Conclusions: In this large real-world cohort, TKIs remained the mainstay effective treatment option because of limited access to IO-based regimens. Sequential systemic therapy significantly improved survival, emphasizing the importance of preserving treatment eligibility and multidisciplinary team involvement. Chemotherapy could be considered a viable option in resource-limited settings. Full article