Search Results (465)

Background/Objectives: Primary cytoreductive surgery for advanced ovarian cancer is associated with a high risk of postoperative complications, particularly surgical site infections, which may delay recovery and adjuvant treatment. This study aimed to evaluate the impact of a revised infection-prevention bundle, centered on chlorhexidine-alcohol skin antisepsis, on surgical site infection rates and cost-effectiveness. Methods: In this single-center cohort study, 636 patients undergoing primary cytoreductive surgery between January 2019 and December 2023 were included. A historical control group (n = 300) received povidone-iodine for intraoperative skin preparation, while a prospective intervention group (n = 336) received chlorhexidine gluconate 2% in 70% isopropyl alcohol. Both groups were managed within a standardized perioperative care pathway. Surgical site infections within 30 days were defined according to established criteria. Comparative and descriptive statistical analyses were performed. Results: Baseline clinicopathological characteristics were comparable between groups. The overall surgical site infection rate was significantly lower in the chlorhexidine-alcohol group compared with the povidone-iodine group (8.3% vs. 14.0%; p = 0.0226). The reduction was particularly evident in procedures lasting more than 180 min (9.5% vs. 17.1%; p = 0.0199), while no significant difference was observed in shorter procedures. Cost analysis demonstrated a net saving of approximately EUR 451 per procedure in the chlorhexidine group, driven by reduced infection-related costs and improved operating room efficiency. Conclusions: Baseline clinicopathological characteristics were comparable between groups. The overall surgical site infection rate was significantly lower in the chlorhexidine-alcohol group compared with the povidone-iodine group (8.3% vs. 14.0%; p = 0.0226). The reduction was particularly evident in procedures lasting more than 180 min (9.5% vs. 17.1%; p = 0.0199), while no significant difference was observed in shorter procedures. Cost analysis demonstrated a net savings of approximately EUR 451 per procedure in the chlorhexidine group, driven by reduced infection-related costs and improved operating room efficiency. Full article

Objectives: Endometrial carcinoma (EC), the most common gynecological malignancy, is associated with unfavorable survival in advanced stages. Treatment strategies now include cytoreductive surgery (CRS) and (neo)adjuvant chemotherapy, but survival rates remain limited. This study evaluates overall survival (OS) and surgical outcomes, including outcomes of CRS and surgical complications, over a 20-year period at the Erasmus MC. Methods: This retrospective cohort study includes women diagnosed with FIGO stage III or IV EC between 2000 and 2020 who received treatment at the Erasmus MC. Data were collected from the Netherlands Comprehensive Cancer Organization and supplemented by medical record reviews. Statistical analyses were conducted to evaluate differences in OS based on FIGO stage, histological type, molecular characteristics, CRS outcome, and type of CRS. Results: A total of 188 patients were included, with a median age of 66 years. Most patients received surgery and additional chemotherapy and radiotherapy. A total of 64 patients (59.3%) underwent primary CRS, and 44 patients (40.7%) underwent interval CRS. Patients with complete CRS had a significant survival advantage over patients with optimal and incomplete CRS (HR 0.56; 95% CI 0.33–0.96, p = 0.036). Comparison between primary and interval CRS revealed no significant difference in OS (HR 1.42; 95% CI 0.82–2.44, p = 0.207). Surgical complications occurred in 33.1% of patients, with infections most common. Two patients died from severe complications. Conclusions: This study highlights the predominant role of surgery in the management of advanced EC. Complete CRS is often achievable and offers significant survival advantage. However, approximately one-third of patients experience surgical complications. Full article

Objective: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is an aggressive locoregional treatment for selected patients with peritoneal surface malignancies. Although its oncological role has been widely discussed, longitudinal data focusing on postoperative quality-of-life (QoL) trajectories remain limited. This study aimed to describe longitudinal QoL trajectories during the first two years after CRS/HIPEC and to provide exploratory descriptive comparisons according to selected clinical characteristics. Methods: This retrospective single-center cohort study included 144 consecutive adult patients who underwent CRS/HIPEC between January 2018 and July 2022. Patients were evaluated preoperatively and postoperatively at day 14 and at 1, 3, 6, 12, 18, and 24 months. QoL was assessed during routine follow-up primarily using the EORTC QLQ-C30 questionnaire; the EORTC QLQ-CR29 was also administered in institutional practice as a supplementary instrument in selected settings. Repeated QLQ-C30 measurements were analyzed descriptively using the Friedman test with post hoc Nemenyi comparisons. Results: Questionnaire completion rates were 100% at baseline, postoperative day 14, and month 1; 96.5% at months 3 and 6; 91.0% at month 12; 81.9% at month 18; and 75.7% at month 24. Longitudinal analyses demonstrated significant time effects across multiple QoL domains, including global health status, physical functioning, emotional functioning, role functioning, cognitive functioning, social functioning, pain, fatigue, and diarrhea. The most pronounced deterioration was observed in the early postoperative period, particularly at postoperative day 14. Thereafter, several domains improved gradually; however, recovery was domain-specific and did not consistently return to preoperative levels during follow-up. In exploratory descriptive analyses, patients with major postoperative complications showed more pronounced early impairment in global health status, physical functioning, and social functioning, together with greater pain and fatigue burden, particularly at postoperative day 14 and month 1. Exploratory subgroup comparisons also suggested heterogeneity in recovery patterns according to primary tumor origin. Later follow-up findings should be interpreted cautiously in view of attrition over time and the absence of adjusted longitudinal modeling. Conclusions: Quality of life declines substantially during the early postoperative period after CRS/HIPEC, followed by gradual but incomplete recovery over time. This recovery pattern is non-linear and varies across domains. Exploratory descriptive findings suggested that early postoperative QoL impairment may be greater in patients with major complications, but these subgroup patterns require confirmation in prospectively designed studies using adjusted longitudinal models. Longitudinal QoL assessment may provide clinically meaningful insight into postoperative recovery after CRS/HIPEC. Full article

Background and Clinical Significance: Rare adnexal tumors with Wolffian or sex cord-like differentiation may undergo major diagnostic reclassification after integrated histologic and molecular review. The contribution of minimally invasive surgery to this process has rarely been described in detail. Case Presentation: We focused on the case of a 33-year-old woman underwent laparoscopic right salpingectomy in October 2021 for a right-sided tubo-adnexal lesion initially diagnosed as adult granulosa cell tumor and later reinterpreted as high-grade endometrioid carcinoma. Completion staging in February 2022 was negative. Positron emission tomography/computed tomography in January 2023 raised concern for recurrence, and exploratory laparoscopy in March 2023 documented peritoneal metastatic disease, followed by four cycles of cisplatin given within the then-prevailing carcinoma-based diagnostic framework. A second laparoscopic reassessment in October 2023 was negative. Because of multifocal abdominal relapse, the patient underwent major cytoreductive surgery in October 2024. Integrated pathologic and molecular review then documented serine/threonine kinase 11 alteration together with forkhead box L2 negativity, favoring classification within the STK11-altered adnexal tumor spectrum. After external review, everolimus plus anastrozole was started in May 2025. Imaging in late 2025 documented persistent pelvic recurrence, and salvage xipho-pubic laparotomy in December 2025 revealed extensive disease involving both ureters, the bladder base, the rectosigmoid wall, and parietal peritoneum; recurrent tissue showed cluster of differentiation 117 positivity. At the most recent available follow-up in April 2026, the patient had no documented death and remained under postoperative surveillance. Discussion and Conclusions: This case illustrates the diagnostic importance of repeated tissue reassessment and the practical value of minimally invasive surgery as a relatively low-burden means of resection, restaging, and tissue acquisition in a rare molecularly reclassified adnexal tumor. Full article

Background: Accurate intraoperative identification of ovarian cancer is challenging, as standard techniques such as visual inspection, palpation, and histopathology often fail to detect microscopic disease. Residual tumor contributes to poor cytoreductive outcomes, high recurrence rates, and chemoresistance. Near-infrared (NIR) imaging using tumor-specific biomarkers has emerged as a promising approach to enhance intraoperative visualization and improve tumor margin delineation. Methods: A focused literature review was conducted using PubMed to identify preclinical and clinical studies evaluating NIR image-guided strategies in ovarian cancer. Studies involving tumor-targeted probes against folate receptor alpha, α3-integrin, mesothelin, and CA125 were included, with emphasis on probe design, delivery, imaging performance, safety, and clinical relevance. Results: Targeted NIR probes consistently demonstrated improved tumor-to-background contrast, higher lesion detection sensitivity, and enhanced intraoperative guidance compared to conventional imaging. Preclinical and early clinical data indicate favorable safety profiles and minimal off-target toxicity. Evidence suggests that NIR-guided surgery may reduce residual disease burden and potentially improve recurrence-free survival. Conclusions: Tumor-specific NIR imaging represents a promising pharmaceutics-based strategy for improving surgical outcomes in ovarian cancer. Despite encouraging results, challenges such as biomarker heterogeneity, limited fluorophore availability, and cost must be addressed. Further large-scale, randomized trials are required to validate efficacy and integrate these approaches into clinical practice. Full article

Background/Objectives: High-grade serous ovarian carcinoma (HGSOC) is associated with high relapse rates despite aggressive multimodal treatment. BRCA mutations, present in a substantial subset of patients, confer homologous recombination deficiency and increased sensitivity to platinum-based chemotherapy. This study evaluated the association between BRCA mutation status and clinical outcomes, focusing on dissemination patterns, treatment allocation, perioperative parameters, and progression-free survival (PFS). Methods: This prospective single-center cohort included 133 consecutive patients with newly diagnosed HGSOC treated between January 2020 and December 2025. Primary treatment strategy (primary debulking surgery [PDS] or neoadjuvant chemotherapy [NACT]) was determined by multidisciplinary assessment. BRCA testing was performed using tumor tissue or germline analysis. Patients were followed for 24 months. PFS was analyzed using Kaplan–Meier estimates and Cox regression models. Results: Pathogenic BRCA mutations were identified in 39.1% of patients. BRCA-mutated tumors demonstrated significantly lower rates of peritoneal carcinomatosis (50% vs. 77.77%, p = 0.001) and were more frequently managed with PDS (59.6% vs. 41.8%, p = 0.048). Perioperative outcomes were comparable between groups. Disease progression occurred less frequently in BRCA-mutated patients (32.69% vs. 51.85%, p = 0.017). In univariate analysis, BRCA mutation was associated with a 48% reduction in progression risk (HR 0.52, 95% CI 0.27–0.99, p = 0.048). After adjustment for age, FIGO stage, and residual disease, BRCA mutation was not independently associated with progression (HR 0.57, p = 0.124), although a protective trend was observed, while residual disease remained a significant predictor. Conclusions: In this prospective cohort, BRCA mutation status was associated with distinct dissemination patterns and a significant reduction in progression risk in HGSOC. Although residual disease remained the strongest independent prognostic factor after multivariable adjustment, a trend toward improved PFS observed among BRCA-mutated patients supports the role of homologous recombination deficiency as a meaningful modifier of disease trajectory. These findings reinforce the clinical relevance of molecular stratification in the contemporary management of HGSOC. Full article

Background: Cytoreductive surgery (CRS) combined with intraperitoneal chemotherapy (IPC) is an established treatment for select patients with colorectal peritoneal metastases. However, the impact of evolving treatment strategies and accumulating institutional experience on oncological outcomes remains poorly understood. This study aimed to characterise temporal changes in treatment approaches over a decade at a single high-volume centre and evaluate their association with outcomes by comparing early and later patient cohorts. Methods: A total of 160 patients who underwent CRS with IPC for colorectal peritoneal metastases between 2011 and 2019 were retrospectively analysed and categorised into early (2011–2013, n = 42) and late (2014–2019, n = 118) cohorts. Overall survival (OS) and disease-free survival (DFS) were compared between the groups. Prognostic factors were assessed using Cox proportional hazard regression models. Results: The later cohort demonstrated significantly improved OS compared to the early cohort (median OS, 25.1 vs. 13.8 months; 5-year OS, 25.9% vs. 11.9%; log-rank p = 0.015). DFS showed a non-significant trend toward improvement (p = 0.176). In the multivariate analysis, cohort period (HR 0.63, p = 0.029), completeness of cytoreduction (HR 4.51, p < 0.001), tumour location, preoperative CEA level, and receipt of preoperative systemic chemotherapy were independently associated with OS. Conclusions: These findings suggest that accumulated institutional experience and changes in treatment strategies may be associated with improved OS in patients undergoing CRS with IPC for colorectal peritoneal metastases. Full article

Background and Objective: This study aimed to identify preoperative and intraoperative factors associated with thoracic complications after bilateral diaphragmatic stripping during cytoreductive surgery for advanced ovarian cancer. Materials and Methods: A retrospective observational study was conducted at the Gynecologic Oncology Unit of the National Cancer Institute “G. Pascale”, Naples, Italy. We included patients who underwent bilateral diaphragmatic stripping between July 2023 and October 2025. Demographic, surgical, and anesthesiologic parameters were recorded. Univariate logistic regression was performed, and a restricted multivariate model including only variables significant at univariate analysis was used to assess predictors of thoracic complications. Results: Forty-seven patients were analyzed, 10 (21%) of whom developed postoperative thoracic complications. Patients with thoracic complications had a higher body mass index (median 28.4 kg/m², IQR 26.4–29.3 vs. 23.9 kg/m², IQR 22.8–27.3; p = 0.003) and higher ASA scores (p = 0.033). In univariate analysis, ASA (odds ratio [OR] 3.90, 95% confidence interval [CI] 1.12–17.94, p = 0.046) and BMI (OR 1.45, 95% CI 1.14–2.02, p = 0.009) were significantly associated with thoracic complications. In multivariate analysis, only BMI remained an independent predictor (OR 1.599, 95% CI 1.13–2.68, p = 0.027). Conclusions: Elevated BMI was independently associated with an increased risk of thoracic complications after bilateral diaphragmatic stripping in cytoreductive surgery for ovarian cancer. Careful perioperative management and preventive strategies should be considered in overweight patients. Full article

Background/Objectives: Peritoneal metastasis represents the most frequent and prognostically unfavorable metastatic pattern in gastric cancer, largely due to limited sensitivity of conventional imaging, delayed diagnosis, and insufficient response assessment. The aim of this review is to provide an overview of the current evidence on the diagnosis and treatment of gastric cancer with peritoneal metastases and to address current treatment limitations and options. Methods: This review was designed as a narrative review and is based on an extensive literature search in established databases. Results: Systemic chemotherapy remains the cornerstone of palliative treatment, improving the survival and quality of life compared with the best supportive care; however, outcomes in peritoneally metastatic disease remain poor. Advances in molecularly targeted and immune-based therapies have extended survival in selected patient populations, yet favorable molecular profiles are mainly unknown in peritoneal metastases. Staging laparoscopy and semi-quantitative assessment using the Peritoneal Cancer Index (PCI) are therefore essential for accurate diagnosis, prognostication, and treatment selection. Growing evidence from retrospective studies, multi-institutional cohorts, and selected randomized trials suggests that a multimodal approach—combining systemic therapy with intraperitoneal or bidirectional chemotherapy—may improve survival and quality of life. In carefully selected patients whose primary gastric tumor and peritoneal lesions respond to systemic treatment, complete cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) may further enhance outcomes and, in rare cases, achieve long-term survival. These potential benefits appear to be limited to highly selected patients with a low peritoneal tumor burden (PCI ≤ 6–7), positive cytology, good performance status, controlled extraperitoneal disease, and a high likelihood of achieving complete macroscopic cytoreduction (CC-0). Conclusions: Although the treatment intent in metastatic gastric cancer remains primarily palliative, carefully selected patients with limited peritoneal metastases may benefit from intensified multimodal treatment strategies when managed in specialized centers. Interdisciplinary evaluation, accurate staging, and individualized treatment planning are essential to optimize outcomes in this challenging disease setting. Full article

Background: Owing to significant clinical heterogeneity, the achievement of accurate survival forecasting for individuals with colorectal cancer and peritoneal metastasis continues to be a complex undertaking. We aimed to transcend traditional prognostic limitations by evaluating machine learning boosting models against standard regression-based methods in terms of estimating overall survival (OS). Methods: Utilizing a multi-institutional registry of 150 patients diagnosed with synchronous peritoneal metastasis of colorectal cancer, we integrated 124 clinicopathological variables to refine our predictive models. Beyond standard preprocessing—including standardization and median imputation—we rigorously compared XGBoost and LightGBM against Ridge, Lasso, and linear regression via five-fold cross-validation. To specifically address right-censoring, an XGBoost Cox model was implemented and validated using Harrell’s C-index, with SHAP and LIME providing essential model interpretability. Results: Boosting models consistently outperformed linear alternatives, which struggled with high error rates and negative R2 values. Specifically, XGBoost achieved an MAE of 475 ± 60 and an RMSE of 585 ± 88. The XGBoost Cox model reached a C-index of 0.64 ± 0.06. SHAP analysis highlighted inflammatory markers and peritoneal disease extent as the most influential prognostic drivers. Conclusions: While boosting models offer a clear accuracy advantage over linear methods, their prognostic power remains moderate. These findings underscore the potential of ensemble learning in oncology, yet mandate external validation before these tools can be integrated into clinical decision-making. Full article

Background and Clinical Significance: Modern neuro-oncologists encounter a major challenge when dealing with glioblastomas located in the dominant hemisphere’s temporo-basal area, because their invasive nature disrupts the proximity to eloquent cortical areas (language and speech), as well as skull base venous structures, which can lead to a quick decline in function from the disruptions in these networks and the disconnection of corridor-level pathways. This manuscript illustrates the application of metric-based phenotyping, anatomically defined imaging, and venous-anchored microsurgical techniques that can aid in preserving the remaining functional reserve in patients with dominant hemisphere glioblastomas and demonstrate measurable outcomes through longitudinal follow-up data. Case Presentation: A 48-year-old right-handed male patient presented with a four-week history of progressively worsening symptoms consistent with a dominant hemisphere syndrome, resulting in a significant decrease in his independence (mRS 0 → 4; BI 55/100; IADL 2/8). His symptoms included non-fluent expressive aphasia with a marked inability to generate words and respond to verbal cues (BNT 8/30; SF 4 WPM). Additionally, he experienced prolonged lateralizing hemisensory decompensation and corticospinal tract dysfunction. Imaging studies revealed a large multiloculated cystic lesion located in the left temporo-basal region. The lesion displayed a thick irregular peripheral enhancement pattern with mural nodules and septa, and surrounding T2 hyperintensity extending into the temporal associative white matter, indicating disruption of the lexical–semantic networks and corridor-level tracts. Utilizing continuous SSEPS/MEPs during surgery, a skull base parallel ventral temporal corridor was developed to allow decompression of the cyst first, followed by cyst evacuation, inside-out cytoreduction, subpial dissection, and specific preservation of both superficial and deep temporal veins using selective capsular preservation at venous interface locations where necessary. Postoperative CT scans performed on POD #3 and POD #7 indicated stable decompression without hemorrhage or hydrocephalus complications, followed by rapid quantitative improvement in NIHSS (8 → 2), MoCA (18 → 26), BNT (8 → 26), SF (4 → 12), mRS (2 at discharge, 1 at follow-up), BI (85 at discharge, 95 at follow-up), and IADL (6/8 at discharge, 8/8 at follow-up). Histopathological examination confirmed a diagnosis of glioblastoma. Conclusions: This case study supports a model of a network- and vein-constrained glioblastoma of the dominant hemisphere in the temporo-basal region that can result in substantial restoration of language capabilities and preservation of functional reserves for additional therapies using venous-anchored subpial microsurgical approaches. The use of objective and quantifiable measures of phenotyping and longitudinal follow-up tracking could provide a reproducible method for measuring the degree of recovery of the affected network(s) and establishing safe boundaries for temporal glioma surgery. Full article

Background: The optimal timing of adjuvant chemotherapy after cytoreductive surgery in epithelial ovarian cancer remains uncertain, and perioperative wound-healing responses may transiently create a pro-tumorigenic and drug-resistant microenvironment. This study aimed to characterize time-dependent wound-induced transcriptomic alterations and to identify pharmacologic agents capable of reversing these responses. Methods: An ID8 murine ovarian cancer model was used to compare no treatment, anesthesia alone, and anesthesia plus surgical wounding mimicking futile laparotomy. Tumors were collected at baseline, 1 day (T1), 1 week (T2), and 2 weeks (T3) after intervention. RNA sequencing was performed, and wound-specific differentially expressed genes (WsDEGs) were defined by excluding anesthesia- and progression-related signatures. Functional enrichment analyses were conducted, followed by transcriptome-based drug repurposing using the REMEDY platform to identify compounds predicted to reverse wound-induced gene expression profiles. Results: Surgical wounding significantly increased tumor burden at T1. Transcriptomic analyses revealed distinct, time-dependent wound-associated programs. At T1, WsDEGs were enriched in inflammatory signaling, coagulation, angiogenesis, and immune cell migration, with Vorinostat and Homoharringtonine identified as top candidates to counteract these signatures. At T2, pathways related to cell survival, adhesion, and morphogenesis predominated, with LY-2090314, Artesunate, and Birinapant emerging as potential modulators. At T3, cell-cycle regulation and lipid metabolic pathways were dominant, and Fulvestrant, Atorvastatin, Imatinib, and ABT-737 were predicted to inhibit these processes. Conclusions: Perioperative surgical wounding induces dynamic, stage-specific transcriptomic programs that may promote ovarian cancer progression and alter drug responsiveness. These findings support time-adapted perioperative pharmacologic strategies to optimize postoperative cancer therapy. Full article

Surgical resection remains a cornerstone in the multidisciplinary management of central nervous system (CNS) tumors, particularly diffuse gliomas. Traditionally, the role of surgery has been evaluated primarily through quantitative metrics such as extent of resection and its association with survival outcomes. However, despite maximal and radiologically complete resections, recurrence remains nearly universal in malignant CNS tumors, suggesting that surgical cytoreduction alone does not fully account for post-surgical disease dynamics. Emerging biological and molecular evidence indicates that surgery represents not merely a technical intervention, but a biologically active event that profoundly reshapes tumor evolution and treatment response. In this review, we propose a conceptual framework that redefines surgery as a key biological driver in CNS tumor progression. We synthesize evidence demonstrating that surgical trauma induces inflammation, hypoxia, vascular remodeling, immune modulation, and extracellular matrix reorganization, collectively reprogramming the residual tumor microenvironment. These changes create selective pressures that favor the survival and expansion of adaptive tumor cell subpopulations, including invasive and stem-like phenotypes. From an evolutionary perspective, surgical resection functions as an acute selective bottleneck acting on heterogeneous tumor ecosystems, contributing to clonal selection and molecular divergence at recurrence. We further examine the dissociation between surgical (anatomical) margins and molecular (biological) margins, highlighting how biologically active tumor cells infiltrate beyond radiologically defined boundaries. This discrepancy provides a biological explanation for marginal and distant recurrences and challenges anatomy-based paradigms of surgical completeness. Importantly, we discuss how surgery-induced biological changes influence postoperative radiotherapy and systemic therapies, affecting radiosensitivity, target delineation, and therapeutic vulnerability. Finally, we outline future directions toward surgery-integrated precision neuro-oncology, emphasizing the potential of spatial profiling, liquid biopsy, advanced imaging, and artificial intelligence to capture perioperative tumor evolution. By reframing surgery as a biological inflection point rather than a neutral prelude to adjuvant treatment, this review advocates for a dynamic, biology-driven continuum of care aimed at anticipating tumor adaptation and improving long-term disease control in CNS tumors. Full article

Ovarian cancer (OC) is frequently diagnosed at an advanced stage and characterized by high rates of recurrence despite aggressive cytoreductive surgery and chemotherapy. Relapse is driven by microscopic residual tumors that are disseminated most often throughout the peritoneal cavity, posing significant challenges with conventional systemic therapy. Targeted alpha-particle therapy (TAT) combines molecular targeting with alpha-emitting radionuclides to deliver highly potent and localized cellular damage, uniquely suited for the eradication of small OC tumor clusters within the peritoneal cavity. We conducted an extensive literature search for clinical trials (clinicaltrials.gov) and pre-clinical studies (PubMed, Scopus, Google Scholar) between September 2025 and November 2025. Peer-reviewed articles published in English over the past 20 years that used OC mouse models with reported treatment data were included. Review articles without original data and clinical trials that have been terminated or withdrawn were excluded. In this review, we (1) summarize the biological and physical rationale supporting the use of TAT in OC, (2) discuss the relevant molecular and immunological anti-tumor mechanisms, and (3) critically evaluate early treatment outcomes of 19 pre-clinical and four clinical studies with respect to efficacy, safety, and feasibility. Despite the progress and promising survival outcomes, several challenges remain, including heterogeneous antigen expression, delivery and retention within the peritoneal cavity, off-target toxicity, radiation resistance, radionuclide availability, dosimetry uncertainties, and limitations in clinical trial design. We highlight future directions to overcome these barriers and the continued multidisciplinary efforts essential to translate TAT into effective clinical strategies to treat advanced stages of OC and other solid tumors resistant to conventional treatment. This work was supported with funding available to Kurt R. Zinn as the Hickman Family Endowed Chair in Oncology at Michigan State University. Full article

Background: Clear cell renal cell carcinoma (ccRCC) constitutes 75–80% of all renal cell carcinomas and exhibits aggressive behavior with high metastatic potential. Common metastatic sites include lungs, bones, lymph nodes, and liver, while urinary bladder involvement is exceedingly rare. Early detection of atypical metastases is critical for risk stratification, surgical planning, and systemic therapy selection. Methods: We report a 69-year-old male presenting with recurrent, painless gross hematuria and dysuria. Contrast-enhanced computed tomography revealed a left renal mass with bilateral pulmonary nodules, regional lymphadenopathy, and a bladder lesion. The patient underwent transurethral resection (TUR) of the bladder lesion, followed by robot-assisted left nephro-adrenalectomy with para-aortic lymphadenectomy. Histopathology and immunohistochemistry (PAX8+, CD10+, CAIX+, CK7−, GATA3−) confirmed ccRCC with synchronous bladder metastasis. Postoperatively, combined immune checkpoint inhibitor (ICI) therapy and tyrosine kinase inhibitors (TKIs) were initiated. Results: TUR provided symptomatic relief and diagnostic confirmation. Robot-assisted surgery enabled precise, oncologically safe excision of the primary tumor and regional metastases with minimal blood loss and no perioperative complications. Pathological staging was pT3aN1M1, ISUP grade 2, with lymphovascular invasion, confirming advanced disease requiring systemic therapy. Early initiation of ICI plus TKI therapy targeted residual micrometastases to potentially prolong survival. Conclusions: This case highlights the rare occurrence of ccRCC with synchronous bladder metastasis and underscores the importance of comprehensive imaging, detailed morphologic and immunohistochemical evaluation, and a multidisciplinary approach. Robot-assisted cytoreductive surgery combined with modern systemic therapy represents an effective strategy for advanced ccRCC, emphasizing the need for individualized treatment and long-term follow-up in atypical metastatic scenarios. Full article