Search Results (60)

In recent years, several randomized controlled trials have been published regarding cervical cancer therapy and significantly changed the treatment landscape. Recent advances have improved the treatment options and allow personalized treatment concepts with escalation of treatment in high-risk disease and de-escalation with reduction in morbidity in selected low-risk patients. This review aims to provide a comprehensive analysis of the latest landmark studies that are poised to significantly influence clinical practice. Personalized treatment concepts with careful patient selection allow de-escalation in the surgical treatment of cervical cancer. In low-risk cervical cancer patients (lesions of ≤2 cm with limited stromal invasion), simple hysterectomy (SH) was non-inferior to radical hysterectomy in terms of 3-year incidence of pelvic recurrence and was associated with a lower risk of urinary incontinence or retention and improved sexual health and quality of life. Furthermore, sentinel lymphadenectomy is constantly replacing systematic pelvic lymphadenectomy in patients with low-risk cervical cancer. In addition, further studies are necessary to clarify the role of postoperative therapy for patients with intermediate-risk cervical cancer. Starting in 2008, the EMBRACE studies assess the role of Image guided adaptive brachytherapy (IGABT) in LACC in addition to modern external beam radiotherapy concurrent to chemotherapy. The publication of the results of the EMBRACE I prospective study established MRI guided IGABT as state-of-the-art brachytherapy for LACC. EMBRACE II and additional prospective studies emerging from this consortium will address important questions in modern radiotherapy for LACC. Immune checkpoint inhibitors (CPIs) have been evaluated across various clinical settings and are expected to be utilized in numerous scenarios due to several positive randomized trials. Particularly, the combination of platinum-based chemotherapy and pembrolizumab, with or without bevacizumab, has been established as the new standard treatment for primary metastatic or recurrent PD-L1 positive high-risk cervical cancer. In locally advanced cervical cancer, two new treatment escalation regimens—neoadjuvant chemotherapy and adjuvant CPI therapy—have been evaluated in addition to chemoradiation. Furthermore, antibody-drug conjugates, such as tisotumab-vedotin, represent a promising future therapeutic option for recurrent cervical cancer. Full article

Background: Locally advanced prostate cancer (PCa) is commonly treated with multimodal therapy; however, long-term outcomes of surgery alone are poorly defined. We investigated the potential and limitations of robot-assisted radical prostatectomy (RARP) as primary treatment without perioperative systemic therapy in patients with locally advanced PCa. Methods: We retrospectively analyzed 258 patients who underwent RARP with extended pelvic lymph node dissection between 2012 and 2022 with locally advanced PCa, defined as present if at least one of the following was met: clinical stage cT3b–T4; primary Gleason pattern 5; >4 biopsy cores with Grade Group 4 or 5; or more than one NCCN high-risk characteristic. Patients who received neoadjuvant or adjuvant therapy were excluded. Endpoints included biochemical recurrence-free survival, metastasis-free survival, cancer-specific survival, and predictors of persistent PSA. Results: Median follow-up was 60.6 months. Pathological stage ≥ pT3a occurred in 63.6% and nodal involvement (pN1) in 27.1%. Five-year BRFS, MFS, and CSS were 36.6%, 88.9%, and 98.3%, respectively. Persistent PSA occurred in 21.3%. Preoperative predictors included PSA > 40 ng/mL, clinical stage ≥ cT3a, and >4 biopsy cores with a Gleason score of 8–10; patients with ≥2 features had significantly poorer BRFS and MFS. Postoperative predictors of recurrence were pathological stage, lymphovascular invasion, and nodal involvement. Conclusions: RARP alone provided durable long-term cancer control in selected men with locally advanced PCa, whereas patients with multiple adverse features were unlikely to be cured with surgery alone. Careful risk stratification may identify candidates for surgical monotherapy and help avoid overtreatment, while others may benefit from multimodal therapy. Full article

Intraoperative radiotherapy (IORT) is a radiation technique that allows for the delivery of a high radiation dose to the target while preserving the surrounding structures, which can be displaced during the surgical procedure. An important limitation of this technique is the lack of real-time image guidance, which is one of the main achievements of modern radiation therapy because it allows for treatment optimization. IORT can be delivered by low-energy X-rays or by accelerated electrons. The present review describes the most relevant clinical applications for IORT and discusses the potential advantages of using artificial intelligence (AI) to overcome some of the current limitations of IORT. In recent decades, IORT has proven to be an effective treatment in several cancer types. In breast cancer, IORT can be used to deliver a single dose of radiation (partial breast irradiation) or as a boost in high-risk patients. In locally advanced rectal cancer, a single dose to the tumor bed can improve local control and prevent pelvic relapse in primary and recurrent tumors. In sarcomas, IORT enables the delivery of high doses, achieving good functional outcomes with low toxicity in tumors located in the retroperitoneum and extremities. In pancreatic cancer, IORT shows promising results in borderline resectable and unresectable cases. Ongoing technological advances are addressing current challenges in imaging and radiation planning, paving the way for personalized, image-guided IORT. Recent innovations such as CT- and MRI-equipped hybrid operating theaters allow for real-time imaging, which could be used for AI-assisted segmentation and planning. Moreover, the implementation of AI in terms of machine learning, deep learning, and radiomics can improve the interpretation of imaging, predict treatment outcomes, and optimize workflow efficiency. Full article

Introduction: Total pelvic exenteration (TPE) is a radical procedure for advanced pelvic malignancies involving adjacent organs. The Hugo™ RAS System is a novel robotic platform, but its application in TPE has not previously been reported. We describe the first case of robotic-assisted TPE using Hugo™ RAS in a patient with locally advanced rectal cancer invading the prostate. Methods: A 69-year-old male with mucous and bloody stools was diagnosed with cT4b (prostate, levator ani muscle) N0M0 rectal cancer. After short-course radiotherapy (25 Gy/5 fractions), robotic-assisted TPE was performed. Port placement was planned to coincide with future colostomy and urostomy sites to minimize abdominal wall trauma. En bloc resection was achieved, followed by pelvic reconstruction with a gluteus maximus musculocutaneous flap and fascia lata autograft. Urinary diversion was completed with a robotic intracorporeal Wallace-type ileal conduit. Results: The operation lasted 17 h 56 min, with 175 mL blood loss. Postoperatively, Clavien–Dindo grade IIIa paralytic ileus occurred but was managed conservatively. Pathology revealed pT4b (prostate) N1a M0 disease with negative circumferential margin (11 mm). No recurrence was observed at 9 months. Conclusions: This case highlights the technical feasibility and safety of Hugo™ RAS-assisted TPE. Further clinical experience is needed to confirm reproducibility and oncologic safety. Full article

Introduction: Recurrence after pelvic exenteration remains a significant concern in patients with locally advanced rectal cancer (LARC). Therefore, there is a need for improved non-invasive predictive tools to aid in patient selection. Radiomics, which extracts quantitative imaging features, may help identify patients at greater risk of recurrence. This study aimed to develop and validate a radiomics-based nomogram using pre-treatment MRI to predict postoperative recurrence risk in LARC. Methods: The largest multicenter retrospective radiomics analysis of 191 patients with pathologically confirmed LARC treated at fourteen centres (2016–2018) was performed. All patients received neoadjuvant chemoradiotherapy followed by curative-intent exenterative surgery. Manual tumour segmentation was performed on pre-treatment T2-weighted MRI. Feature selection employed LASSO regression with 5-fold cross-validation across 1000 bootstrap samples. The most frequently selected features were used to construct a logistic regression model via stepwise backward selection. Model performance was assessed using ROC analysis, calibration plots, decision curve analysis, and internal validation with 1000 bootstraps. A nomogram was generated to enable individualized recurrence risk estimation. Results: Postoperative recurrence occurred in 51% (n = 98) of cases. Five radiomic features reflecting tumour heterogeneity, morphology, and texture were included in the final model. In multivariable analysis, all selected features were significantly associated with recurrence, with odds ratios ranging from 0.63 to 1.64. The model achieved an optimism-adjusted AUC of 0.70, indicating fair discrimination. Calibration plots showed good agreement between predicted and observed recurrence probabilities. Decision curve analysis confirmed clinical utility across relevant thresholds. A clinically interpretable nomogram was developed based on the final model. Conclusions: A radiomics-based model using preoperative MRI can predict recurrence in LARC. The derived nomogram provides a practical tool for preoperative risk assessment. Prospective validation is necessary. Full article

Introduction: Pelvic exenteration (PEx) was first described in the 1940s as a palliative procedure in managing cervical cancer. Since then, advancements in perioperative care have transformed the options available to patients. This highly morbid procedure now offers a “cure” in a select cohort of patients with locally advanced and recurrent pelvic cancers. The large volume of literature in this field has resulted in a heterogeneity of data reporting, making comparative analysis extremely difficult. As such, we set out to examine the current literature and identify currently reported outcomes to guide development of a core information set (CIS) for data reporting for PEx in non-rectal cancers. Methods: A systematic review was carried out. Studies reporting on outcomes following PEx for advanced and recurrent gynecological, urological, and other non-rectal malignancies were included. Standardized outcomes were extracted and mapped to pre-determined domains. Results: Forty-four studies were found to meet our inclusion criteria. A total of 1735 data elements (DEs) were extracted verbatim, and these were assimilated into 111 standard DEs across nine domains. A wide range of reporting frequencies was observed, with the pathological domain containing the highest overall frequencies of DE reporting. Conversely, patient-reported and functional outcomes were noted to be the domain with the lowest frequency. Conclusions: This review highlights recent trends of increased reporting in the field of PEx and how this had invariably resulted in heterogeneous data reporting. We aim to guide the development of a CIS for reporting in non-rectal pelvic malignancies to help standardize future reporting. Full article

Rectal cancer remains a significant clinical challenge due to its complex anatomy and the critical need to balance oncological radicality with functional preservation. Multimodal treatment strategies, including neoadjuvant therapy, advanced endoscopic techniques, and precise surgical approaches, have evolved to optimize patient outcomes. Neoadjuvant chemoradiotherapy improves resectability and local control in locally advanced tumors, while endoscopic treatment offers organ-preserving options for carefully selected early-stage cancers. Surgical resection, primarily through total mesorectal excision (TME), remains the cornerstone of curative therapy, with minimally invasive and transanal approaches enhancing precision and recovery. In advanced and recurrent cases, extended procedures such as pelvic exenteration provide potential for cure despite substantial morbidity. This review summarizes current evidence on the indications, techniques, and outcomes of neoadjuvant, endoscopic, and surgical treatments for rectal cancer, emphasizing individualized treatment planning to achieve optimal oncological and functional results. Full article

Introduction: Pelvic exenteration (PEx) is a radical procedure used in the treatment of locally advanced (LARC) and locally recurrent rectal cancer (LRRC). With recent advancements in perioperative treatment regimens, there has been renewed interest in this procedure as it offers the opportunity for complete tumour resection in a select cohort. This has resulted in large heterogeneity in outcome reporting, making comparing and conducting a meta-analysis of published results challenging. Standardising outcome reporting will ensure meaningful data reporting and allow the cross-centre comparison of data. Aims: To conduct a systematic review of the current literature, to identify the various outcomes reported for PEx in rectal cancer, and to develop a standard outcome reporting set. Methods: A systematic review was carried out following the PRISMA guidelines. Relevant domains were identified first. Data elements (DEs) were extracted verbatim prior to standardisation and mapping to relevant domains. Results: There has been a noticeable trend of increased literature on PEx in the last decade. Forty-nine papers were identified. A total of 1549 DEs were extracted verbatim. These were standardised to 119 unique DEs mapped to ten distinct domains capturing the patient care journey. There was large variation in the frequency of reporting, with some key outcomes reported in a limited number of studies. Conclusions: There is considerable heterogeneity at present in data reporting for PEx in LARC and LRRC. Standardisation of outcomes is the first step in guiding the development of a core information set to overcome heterogeneity and guide future research development. Full article

Background: Invasive BC patients are at risk of loco-regional recurrence, distant MTS, and the development of second primary tumors. SPMs comprise the sixth most common group of malignancies. Material and methods: The records of 125 consecutive patients with primary invasive TCC of the bladder seen in the Oncology Department of Soroka University Medical Center were reviewed between January 2016 and December 2023. We recorded demographic details, the type of primary treatment, tumor site, time to diagnosis of MTS, and occurrence of SPMs. Results: The primary treatments included RC in 58 patients (median age 66 years, range 43–86), PC in 9 patients (median age 64 years, range 22–73), and XRT in 23 patients (median age 74 years, range 22–87). Five patients from the PC group were also treated by XRT. A total of 90 (72%) patients developed MTS or SPMs, with 66 of these developing MTS and 24 developing SPMs. The median age was 70 years (range 22–87). The most frequent site of MTS was in the pelvic LNs (34 patients), followed by bone (18 patients), liver (8 patients), and lung (6 patients), with 4 patients developing synchronous MTS in the pelvic LNs and liver. The median time from diagnosis to MTS was 14.3 months. The distribution of MTS varied according to primary treatment. After RC, 17 patients developed LN MTS, 7 liver, 6 bone, and 3 lung MTS. The average times for developing MTS were as follows: LNs, 14.8 months, liver, 59.7 months, bone, 6.8 months, and lung, 16 months. Following XRT, LN MTS developed in 17 patients: 12 bone, 3 lung, and 1 liver. The most frequent SPMs were prostate cancer with 11 patients and lung cancer with 6 patients, with the median time from TCC diagnosis of 54 months. Conclusion: A regular extended follow-up for invasive BC patients is vital to ensure the early detection of frequently occurring MTS and SPMs. Through the early diagnosis of local recurrences, MTS, and SPMs, treatment results and patient prognosis can be significantly improved. Full article

Rectal cancer management necessitates a rigorous multidisciplinary strategy, emphasizing precise staging and detailed risk stratification to inform optimal therapeutic decision-making. Obtaining an accurate histological diagnosis before initiating treatment is essential. Comprehensive staging integrates clinical evaluation, thorough medical history analysis, assessment of carcinoembryonic antigen (CEA) levels, and computed tomography (CT) imaging of the abdomen and thorax. High-resolution pelvic magnetic resonance imaging (MRI), utilizing dedicated rectal protocols, is critical for identifying recurrence risks and delineating precise anatomical relationships. Endoscopic ultrasound further refines staging accuracy by determining the tumor infiltration depth in early-stage cancers, while preoperative colonoscopy effectively identifies synchronous colorectal lesions. In early-stage rectal cancers (T1–T2, N0, and M0), radical surgical resection remains the standard of care, although transanal local excision can be selectively indicated for certain T1N0 tumors. In contrast, locally advanced rectal cancers (T3, T4, and N+) characterized by microsatellite stability or proficient mismatch repair are optimally managed with total neoadjuvant therapy (TNT), which combines chemoradiotherapy with oxaliplatin-based systemic chemotherapy. Additionally, tumors exhibiting high microsatellite instability or mismatch repair deficiency respond favorably to immune checkpoint inhibitors (ICIs). The evaluation of tumor response following neoadjuvant therapy, utilizing MRI and endoscopic assessments, facilitates individualized treatment planning, including non-operative approaches for patients with confirmed complete clinical responses who comply with rigorous follow-up. Recent advancements in molecular characterization, targeted therapies, and immunotherapy highlight a significant evolution towards personalized medicine. The effective integration of these innovations requires enhanced interdisciplinary collaboration to improve patient prognosis and quality of life. Full article

Background/Objectives: The management of localized prostate cancer with regional lymph node involvement (N1M0) presents significant clinical challenges. While once considered indicative of systemic disease, improved imaging and evolving treatment paradigms have redefined node-positive disease as potentially curable. This systematic review aims to assess current evidence regarding treatment modalities and outcomes for patients with localized N1M0 prostate cancer. Methods: A systematic review was conducted to identify studies evaluating therapeutic strategies for N1M0 prostate cancer. Eligible studies included randomized controlled trials, retrospective analyses, and consensus guidelines. Treatment approaches reviewed included radical prostatectomy (RP) with pelvic lymph node dissection (PLND), whole pelvic radiotherapy (WPRT), prostate-only radiotherapy (PORT), androgen deprivation therapy (ADT), and metastasis-directed therapy (MDT), including stereotactic body radiotherapy (SBRT). Key outcomes included overall survival (OS), biochemical recurrence-free survival (bRFS), disease-free survival (DFS), and treatment-related toxicity. Results: Multimodal approaches—particularly the combination of ADT with WPRT or adjuvant radiotherapy following RP—were associated with improved survival outcomes. Patients with limited nodal burden and undetectable postoperative prostate-specific antigen (PSA) levels derived the most benefit. The use of prostate-specific antigen membrane positron-emission tomography/computed tomography (PSMA PET/CT) enhanced detection and guided MDT in oligorecurrent disease. SBRT, simultaneous integrated boost (SIB), and hypofractionated regimens demonstrated promising efficacy with acceptable toxicity profiles. Conclusions: Node-positive localized prostate cancer is optimally managed with individualized, multidisciplinary strategies. Combining systemic and locoregional treatments improves outcomes in selected patients. Ongoing prospective studies are warranted to refine patient selection, optimize treatment sequencing, and integrate novel imaging and systemic agents. Full article

Background/Objective: Iatrogenic ureteral injury is a rare but serious complication of colorectal cancer surgery. Although prophylactic ureteral catheterization (PUC) is used to facilitate intraoperative ureter identification and reduce the risk of ureteral injury, its efficacy is debated. We aimed to evaluate the clinical utility and outcomes of PUC in colorectal cancer surgery. Methods: This retrospective study included 42 patients who underwent PUC before colorectal cancer surgery at the Tohoku University Hospital between February 2010 and September 2024. Preoperative ureteral stents were inserted via cystoscopy under general anesthesia. Patient demographics, surgical techniques, indications for catheterization, and post-procedural complications were reviewed. Results: PUC was most frequently performed in patients with left-sided colorectal cancer (61.9%) and local recurrence of rectal cancer (31%). Ureteral catheterization was indicated in patients with a history of pelvic surgery (47.6%) or tumor proximity to the ureter (26.2%). Open surgery was performed in 90.5% of the cases, whereas robotic surgery with fluorescent ureteral catheters was used in selected patients. No intraoperative ureteral injury was observed in the stent group. Catheter-related complications, including hematuria (14.3%) and urinary tract infections (9.5%), were minor and resolved before discharge. Conclusions: PUC may be beneficial in patients with a history of pelvic surgery or local recurrence of rectal cancer, in whom the risk of ureteral injury is inherently higher. Full article

Background: The risk of recurrence of early-stage cervical cancer (CC) is associated with prognostic factors such as tumor size, lymphovascular space invasion (LVSI), and deep stromal invasion (DSI). However, the adjuvant pelvic radiotherapy (RT) following surgery to reduce the risk of recurrence in “intermediate risk” remains controversial. This study aims to evaluate the role of adjuvant RT in the recurrence and identify prognostic factors. Methods: A systematic search of PubMed, Embase, and Cochrane databases was performed to identify studies comparing adjuvant RT versus no adjuvant treatment in early-stage CC patients with intermediate-risk factors defined by GOG-92 criteria. Outcomes were recurrence, local recurrence, death, 5-year overall survival (5y-OS), and 5-year disease-free survival (5y-DFS). Tumor size ≥ 4 cm, LVSI, and DSI were also evaluated as prognostic factors for recurrence. Statistical analysis was performed using Review Manager 7.2.0. Heterogeneity was assessed with I² statistics. Results: A total of 1504 patients from nine studies were included; only one study was a randomized controlled trial, while the others were retrospective cohorts. Adjuvant RT was used to treat 781 patients (52%). Median follow-up ranged from 48 to 120 months. Recurrence (OR 0.75; 95% CI 0.38–1.46; p = 0.39), local recurrence (OR 0.73; 95% CI 0.44–1.20; p = 0.22), death (OR 0.97; 95% CI 0.52–1.80; p = 0.91), 5y-OS (OR 1.22; 95% CI 0.36–4.18; p = 0.75), and 5y-DFS (OR 0.78; 95% CI 0.42–1.43 p = 0.42) revealed no statistically significant differences between adjuvant RT and observation groups. TS ≥ 4 cm was an independent prognostic risk factor for recurrence (HR 1.83; 95% CI 1.12–2.97; p = 0.02). Conclusions: Our findings suggest that adjuvant RT does not reduce recurrence risk in early-stage cervical cancer. Consider TS ≥ 4 cm as a significant prognostic factor for recurrence. Adjuvant RT in intermediate-risk patients should be considered with caution due the lack of significant improvement in recurrence until the CERVANTES and GOG-0263 trial results become available. Full article

Objectives: In patients undergoing a radical hysterectomy, uterine corpus invasion worsens cervical cancer prognosis. However, the prognostic role of the invasion in locally advanced stages remains elusive. Due to the inadequacy of typical corpus biopsies, corpus invasion is diagnosed using magnetic resonance imaging (MRI). In this study, we investigated the prognostic role of MRI-detected uterine corpus invasion in patients undergoing radiotherapy for cervical cancer. Methods: This retrospective analysis involved 259 patients without extrapelvic metastases, diagnosed with FIGO 2009 stages IB–IVA cervical carcinoma from January 2011 to December 2020. The corpus invasion extent was classified as exocervical-confined (group 1), endocervical (group 2), or uterine corpus invasion (group 3). The rates of overall survival, cancer-specific survival, locoregional recurrence, para-aortic lymph node recurrence, and extrapelvic metastases after pelvic radiotherapy were analyzed. Kaplan–Meier and Cox regression analyses were used to determine recurrence-associated risks. Optimal risk stratification was predicted using a receiver operating characteristic curve with the area under the curve. Results: Groups 1, 2, and 3 included 66.0%, 18.9%, and 15.1% of patients, respectively. The 5-year para-aortic lymph node recurrence rates were 6.3%, 17.2%, and 34.2% (p < 0.001). Uterine corpus invasion was an independent factor for overall survival, cancer-specific survival, locoregional recurrence, extrapelvic metastases, and para-aortic lymph node recurrence. Including uterine corpus invasion in the risk stratification led to higher areas under the curve for overall survival, cancer-specific survival, locoregional recurrence, extrapelvic metastases, and para-aortic lymph node recurrence than using single parameters. Conclusions: In cervical cancer, following pelvic radiotherapy, uterine corpus invasion is a significant prognostic factor. More-aggressive treatments such as extended-field radiotherapy, adjuvant chemotherapy, and immune checkpoint inhibitors as an alternative to standard pelvic radiotherapy with concurrent chemotherapy may be considered in these patients. Full article

Over the past two decades, surgical techniques in colorectal cancer (CRC) have improved patient outcomes through precision and reduced invasiveness. Open colectomy, laparoscopic surgery, robotic-assisted procedures, and advanced rectal cancer treatments such as total mesorectal excision (TME) and transanal TME are discussed in this article. Traditional open colectomy offers reliable resection but takes longer to recover. Laparoscopic surgery transformed CRC care by improving oncological outcomes, postoperative pain, and recovery. Automated surgery improves laparoscopy’s dexterity, precision, and 3D visualisation, making it ideal for rectal cancer pelvic dissections. TME is the gold standard treatment for rectal cancer, minimising local recurrence, while TaTME improves access for low-lying tumours, preserving the sphincter. In metastatic CRC, palliative procedures help manage blockage, perforation, and bleeding. Clinical examples and landmark trials show each technique’s efficacy in personalised care. Advanced surgical techniques and multidisciplinary approaches have improved CRC survival and quality of life. Advances in CRC treatment require creativity and customised surgery. Full article