Search Results (475)

Background and Objectives: End-of-life care in oncology demands a holistic, multidisciplinary framework that pivots clinical priorities from disease-directed therapies toward symptom optimization, comfort, and patient dignity. Within this context, the present study investigated care delivery patterns among advanced cancer patients during their final week of life. Materials and Methods: A retrospective medical record review was conducted, comparing an oncology ward, an intensive care unit, an inpatient palliative unit, and a home-based palliative care setting. We analyzed aggressive interventions, end-of-life care pathways, symptom management, medication use and rationalization, and transitions between care settings. Results: Among the 306 patients studied, diagnostic testing and artificial hydration were universally administered in the oncology and intensive care unit (p < 0.001), where prescriptions focused primarily on pain management. Conversely, palliative care settings addressed a wider range of terminal symptoms. The rationalization of non-essential medications took place between 1.8 and 2.9 days before death, varying significantly across medication classes and clinical settings (p < 0.001). Additionally, intensive care unit admissions were more prevalent among patients with advanced cancer, while home-based patients underwent the greatest number of care transitions. Conclusions: These findings highlight substantial differences in care across settings, emphasizing the need for coordinated planning, continuity, and patient-centered approaches to ensure comfort and dignity in the final week of life. Full article

Background: Undifferentiated pleomorphic sarcoma (UPS) of the bone is a rare, high-grade malignancy of uncertain origin, most commonly affecting the extremities of adults. Its diagnosis may be challenging, particularly when clinical and radiological findings are confounded by trauma-related conditions. Case presentation: In this paper, the case of a 51-year-old man who sustained a high-energy trauma resulting in a diaphyseal fracture of the left tibia and fibula, initially treated with intramedullary nailing. Preoperative radiographs raised suspicion of an osteolytic lesion in the distal tibia; however, second-level imaging was performed postoperatively, suggesting a benign process. At initial evaluation at a primary Musculoskeletal Oncology Centre, strict clinical and radiological follow-up was recommended, but the patient failed to adhere. Over the following years, persistent symptoms were attributed to post-traumatic and inflammatory conditions, including suspected complex regional pain syndrome. Progressive clinical deterioration led to repeat imaging, revealing an aggressive lesion. A biopsy (March 2025) ultimately confirmed a primary bone high-grade UPS with no metastasis. Following multidisciplinary discussion, below-knee amputation was performed, achieving clear surgical margins. At one-year CT imaging follow-up, the patient remained disease-free and was able to ambulate with a prosthesis. Conclusions: High-energy trauma and later attribution of symptoms to post-traumatic conditions may complicate the diagnostic process, contributing to diagnostic delay. Early referral to specialised Musculoskeletal Oncology Centres, strict adherence to follow-up, and timely histological confirmation are essential to optimise outcomes. Suspicious bone lesions should always be fully characterised prior to surgical intervention. Full article

Background/Objectives: Oral mucositis (OM) is a serious toxicity that develops due to cancer treatment and impairs patients’ quality of life. Ankaferd Hemostat (AH), a phytotherapeutic agent, has anti-inflammatory and tissue-healing properties. This study evaluated the clinical outcomes and safety of topical AH in adult patients with solid tumors who developed grade 3 or 4 OM during systemic anticancer therapy. Methods: A single-center retrospective, single-arm study was conducted between 2020 and 2024 and included 43 patients with solid tumors. They developed OM while undergoing systemic cancer therapy and were treated with topic AH. Mucositis severity was graded using the World Health Organization (WHO) OM scale, and pain intensity was assessed using a Numeric Rating Scale (NRS) daily, from baseline until clinical resolution. Treatment response, recovery time and adverse events were analyzed. Results: Of the 43 patients included in the study, 81.4% had grade 3 OM and the others had grade 4 OM. Grade 0 was observed in 86% of patients after treatment. Among the 37 patients achieving Grade 0, median time to recovery was 4 days (IQR 4–5). The median NRS score was 5 points before treatment and 0 after treatment (p < 0.001). No Grade ≥ 2 adverse events were observed. Only one patient reported mild dry mouth. Conclusions: In this retrospective cohort, AH mouthwash was associated with rapid mucosal recovery and no severe adverse events were documented in patients with high-grade OM, supporting its potential to reduce oncological treatment toxicity; prospective controlled studies are warranted to confirm these findings. Full article

Background: Liver abscesses represent uncommon yet potentially life-threatening infections of the hepatic parenchyma. Their imaging appearances can vary widely, and—in rare instances—may closely resemble hepatocellular carcinoma (HCC) on multimodality imaging. We report a case of pyogenic liver abscess initially misclassified as advanced HCC based on imaging characteristics meeting LI-RADS 5 criteria. Case Presentation: A 45-year-old male without known cirrhosis, viral hepatitis, or diabetes presented with right upper quadrant pain, abdominal rigidity, nausea, and vomiting. He denied alcohol use, recent dental procedures, and travel to endemic areas. Contrast-enhanced computed tomography and magnetic resonance imaging demonstrated multiple exophytic hepatic masses with arterial-phase hyperenhancement and venous/delayed washout, classified as LI-RADS 5 and initially interpreted as advanced HCC (BCLC stage C). Alpha-fetoprotein (AFP) was not elevated. Hepatitis B surface antigen and anti-HIV were non-reactive. Ultrasound-guided fine-needle aspiration biopsy yielded purulent material; histopathology confirmed chronic suppurative inflammation consistent with an abscess, with negative acid-fast bacilli staining. Cultures were sterile. The patient was treated with doripenem and metronidazole. A post-drainage complication of middle hepatic artery bleeding required urgent transcatheter embolization. The patient was subsequently discharged in stable condition. Discussion: This case illustrates a recognized but uncommon diagnostic pitfall: pyogenic liver abscesses fulfil imaging criteria for HCC. LI-RADS 5 classification carries an estimated false-positive rate of approximately 5%, and its application is technically restricted to patients with established HCC risk factors (e.g., cirrhosis, chronic hepatitis B). In non-cirrhotic patients presenting with fever, leukocytosis, and an atypical or rapidly enlarging hepatic mass, tissue confirmation is essential before committing to an oncological diagnosis. Conclusions: When a hepatic mass displays imaging features fulfilling LI-RADS 5 criteria in a non-cirrhotic patient with clinical signs of infection—including fever, leukocytosis, and elevated inflammatory markers—the possibility of a liver abscess must be actively excluded. Biopsy and percutaneous drainage are essential to avoid misdiagnosis and to enable timely, appropriate treatment. Full article

Background/Objectives: Uterine adenosarcoma is a rare uterine malignancy with limited evidence on prognostic factors and long-term outcomes. We aimed to evaluate clinicopathological characteristics, treatment patterns, oncologic outcomes, and prognostic factors associated with disease-free survival (DFS) and overall survival (OS) in patients with uterine adenosarcoma. Methods: This multicenter retrospective cohort study included 43 patients with histopathologically confirmed uterine adenosarcoma who underwent primary surgery at seven tertiary referral centers in Türkiye between 2016 and 2026. Clinicopathological features, treatment modalities, recurrence patterns, and survival outcomes were assessed. Survival was analyzed using Kaplan–Meier and log-rank methods, and multivariable Cox proportional hazards regression was performed to identify independent prognostic factors. Results: The mean age at diagnosis was 59.1 ± 10.8 years, and 83.7% of patients were postmenopausal. Pelvic pain (62.8%) and abnormal uterine bleeding (60.5%) were the most common presenting symptoms. Most patients (79.1%) underwent laparotomy, and 79.1% had stage I disease. Sarcomatous overgrowth (SO) was present in 44.1% and lymphovascular space invasion (LVSI) in 18.6%. During a median follow-up of 72 months, 34.9% experienced recurrence, most commonly in the pelvis. The five-year DFS and OS rates were 59.9% and 80.4%, respectively. SO was independently associated with DFS (HR 4.41, 95% CI 1.21–16.08; p = 0.025) and OS (HR 10.23, 95% CI 1.16–89.80; p = 0.036), while LVSI was independently associated with OS (HR 11.17, 95% CI 1.34–93.14; p = 0.026). Conclusions: Uterine adenosarcoma showed favorable long-term survival but substantial recurrence risk. SO and LVSI may have potential prognostic relevance and could contribute to postoperative risk assessment and individualized follow-up. Full article

Inflammatory and nested testicular sex cord tumor (IN-TSCT) is a recently recognized, rare testicular sex cord–stromal neoplasm characterized by a recurrent EWSR1::ATF1 fusion and potentially aggressive clinical behavior. Because of its nested epithelioid morphology accompanied by prominent inflammatory infiltrates, IN-TSCT may be mistaken for seminoma, while frequent diffuse CD30 expression further complicates the differential diagnosis with lymphoma. We report a case of IN-TSCT in a 54-year-old man presenting with intermittent left testicular pain. Scrotal ultrasonography demonstrated a well-defined, heterogeneously hypoechoic intratesticular mass with minimally increased internal vascularity. Radical orchiectomy revealed a 1.5 × 1.4 cm epithelioid neoplasm arranged in nests and cords with a prominent inflammatory infiltrate. The tumor cells expressed the sex cord–stromal markers SF-1 and calretinin and showed diffuse CD30 expression. RNA-based next-generation sequencing identified an EWSR1::ATF1 fusion, establishing the diagnosis of IN-TSCT. Unexpectedly, the tumor also demonstrated strong ALK immunoreactivity with both the ALK1 and D5F3 antibody clones, despite the absence of an ALK fusion by RNA sequencing or an ALK rearrangement by fluorescence in situ hybridization. The combined expression of CD30 and ALK may mimic anaplastic large cell lymphoma and represents an important diagnostic pitfall. The patient remained free of recurrence or metastasis 18 months after orchiectomy. This case expands the recognized immunophenotypic spectrum of IN-TSCT and demonstrates that strong ALK immunoreactivity does not necessarily indicate an underlying ALK fusion or rearrangement. Given the potentially aggressive clinical behavior reported in IN-TSCT, long-term oncologic surveillance is warranted. Full article

Background and Clinical Significance: Local recurrence of extremity leiomyosarcoma after multiple operations and radiotherapy presents a major therapeutic challenge. Adequate oncologic clearance must be balanced against preservation of skeletal stability and reliable wound coverage within a scarred and poorly vascularized tissue bed; Case presentation: A 78-year-old woman presented with a painful recurrent leiomyosarcoma of the anterior proximal third of the right leg after three previous operations and adjuvant radiotherapy. Preoperative magnetic resonance imaging demonstrated a recurrent soft-tissue lesion extending to the anterior surface of the proximal tibia. Staging computed tomography of the chest, abdomen, and pelvis showed no distant metastatic disease before definitive surgery. A one-stage limb-sparing procedure was performed, including resection of the recurrent tumor bed and an approximately 7-cm anterior cortical lamella of the proximal tibia containing an area considered suspicious for neoplastic involvement. A locking tibial plate was applied prophylactically to reduce the risk of pathological fracture. The approximately 12 × 10-cm soft-tissue defect was covered with a muscle flap from the medial head of the gastrocnemius and a free skin graft harvested from the paraumbilical region. Gross pathological examination identified an 8-cm subcutaneous tumor formation. Histopathological examination demonstrated well-differentiated leiomyosarcoma; the spindle cells expressed vimentin, actin, and desmin. All examined resection lines were free of tumor infiltration. No pathogenic microorganism was isolated, and no early postoperative complication was documented. The patient mobilized with walking aids and protected weight bearing for 30 days. At approximately 16 months, the flap and skin graft provided stable coverage, no postoperative tibial fracture or clinically apparent implant-related complication had occurred, and the patient was independently ambulatory. Postoperative MRI demonstrated expected postoperative changes and a small indeterminate subcutaneous focus without diffusion restriction, requiring continued surveillance; Conclusions: This case illustrates the feasibility of combining oncologic resection, prophylactic tibial stabilization, and vascularized soft-tissue reconstruction in a previously irradiated extremity. The documented early functional and reconstructive outcome supports this individualized limb-sparing approach, although longer oncologic surveillance is required. Full article

Background/Objectives: Oxygen-enriched oils represent an emerging class of advanced dressings based on the controlled release of reactive oxygen species, with the potential to modulate the wound microenvironment and support reparative processes. Despite their increasing clinical use, the available evidence remains fragmented, and no comprehensive synthesis is currently available on their fields of application and associated outcomes. Methods: A scoping review was conducted in accordance with the Joanna Briggs Institute methodology and the PRISMA-ScR reporting guidelines. PubMed, CINAHL, Scopus, and Web of Science were searched without time restrictions. Studies conducted in patients and evaluating oxygen-enriched oil-based dressings for the management of skin wounds were included. Two independent reviewers selected the studies, extracted and narratively synthesized the data, and performed the quality appraisal. Results: The search identified 142 records; after the selection process, nine studies including a total of 501 patients were included. The studies comprised different designs, ranging from randomized controlled trials to case reports. Applications included pediatric postoperative wounds (distal hypospadias and pilonidal disease), postsurgical wounds related to hidradenitis suppurativa, angular cheilitis, and oncological wounds. The most frequently investigated outcomes included reductions in healing time, pain, local complications, and infectious burden, as well as improvements in scar quality and patient satisfaction. Conclusions: Oxygen-enriched oils represent a promising wound-care strategy in different clinical settings. Although preliminary findings are favorable, independent controlled studies with larger samples and standardized outcomes are needed to define their comparative effectiveness and role in clinical practice more precisely. Full article

Background/Objectives: This study aimed to expand the recognized clinical spectrum of Axillary Web Syndrome (AWS) by integrating illustrative oncologic and non-oncologic cases with a contemporary review of the evidence regarding its epidemiology, diagnosis, pathophysiology, and management. Methods: This study combines a retrospective case series of three patients diagnosed with AWS with a contemporary narrative review of the literature. The series included one patient following breast cancer surgery and two patients without oncologic history who developed AWS after repetitive upper-limb activity. Clinical presentation, ultrasonographic findings, treatment, and outcomes were analyzed. The literature review contextualized current evidence on the epidemiology, pathophysiological mechanisms, diagnostic approach, imaging assessment, differential diagnosis, and therapeutic management of AWS. Results: Three patients with AWS were identified, including one classic postoperative breast cancer case and two non-oncologic presentations following repetitive upper-limb activity. All patients presented with palpable subcutaneous cords, pain, and restricted shoulder abduction. Ultrasonography demonstrated no evidence of superficial thrombophlebitis or other structural abnormalities, supporting the exclusion of alternative diagnoses rather than confirming AWS. Conservative treatment consisting of physiotherapy, stretching exercises, and progressive shoulder mobilization resulted in symptom resolution and functional recovery in all cases. The literature review demonstrated that AWS may occur in a broader range of oncologic and non-oncologic settings than traditionally recognized, supporting the hypothesis that localized lymphovascular injury may contribute to a shared pathophysiological pathway across different clinical settings. Conclusions: AWS should be considered in the differential diagnosis of patients presenting with painful axillary cords and shoulder dysfunction, regardless of a history of breast cancer. Early clinical recognition, appropriate use of ultrasonography to exclude competing diagnoses, and timely conservative rehabilitation are essential to optimize functional recovery. These findings support a broader conceptual framework in which AWS may represent a clinical syndrome of localized lymphovascular injury rather than a complication restricted exclusively to breast cancer surgery. Full article

Background/Objectives: Metastatic bone disease (MBD) of the pelvis is commonly managed with open reconstruction despite substantial morbidity and high complication rates ranging from 16–32%. Percutaneous fixation techniques have emerged as a lower morbidity alternative; however, robust evaluations of outcomes remain limited. Therefore, the primary aim of this systematic review was to evaluate changes in pain and function following percutaneous fixation for pelvic MBD, and to determine the complication and reoperation rates of these procedures. Methods: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Embase, Scopus, and Cochrane Library databases were searched from inception through 15 May 2025. Studies evaluating percutaneous fixation for pelvic MBD in adults were included. Pooled estimates of visual analog scale (VAS) pain scores, Eastern Cooperative Oncology Group (ECOG) performance status scores, complication rates, and reoperation rates were generated using meta-analysis techniques. Results: Twenty-five studies were included in the final analysis. VAS pain scores were reported in 15 studies, with an average decrease of 5.0 points (95% CI: 3.9–6.1) from pre- to postoperative. ECOG performance status scores were reported in 8 studies, with an average improvement of 1.1 points (95% CI: 0.7–1.5) from pre- to postoperative. Complications were reported in 24 studies, with a pooled complication rate of 8% (95% CI: 6–12%) and reoperation rate of 4% (95% CI: 2–7%). Conclusions: Percutaneous fixation for pelvic MBD provides meaningful improvements in pain and function with relatively low complication rates. However, substantial study heterogeneity exists in the patient population, surgical techniques, and implant selection, reflecting the novelty of this treatment strategy and the absence of standardized guidelines. Full article

Background/Objectives: Cancer patients undergoing treatment experience a wide range of physical and psychological symptoms that significantly impact their quality of life. This study aimed to evaluate the occurrence and intensity of symptoms in cancer patients using the Edmonton Symptom Assessment System Revised (ESAS-R) during two distinct phases of treatment. Methods: A prospective cohort study with consecutive recruitment of eligible patients within a convenience sample was conducted in a tertiary public cancer hospital in Athens, Greece. The initial sample included 189 adult cancer patients assessed after the third chemotherapy cycle. Of these, 105 patients completed a second assessment after the final chemotherapy cycle and constituted the longitudinal follow-up sample. Symptom intensity was measured using the 10-item ESAS-R self-report tool. Results: The study population was predominantly female (77.2%), married (71.4%), and diagnosed with breast cancer (59.3%). Statistically significant changes between the two measurements (p < 0.05) were observed in pain, fatigue, and well-being. Total symptom burden scores remained relatively stable, slightly decreasing from 25.09 to 24.19. Age showed a consistent negative correlation with pain (p < 0.001) in the second measurement and nausea across both measurements (p = 0.004 and p = 0.017), indicating that younger patients reported higher symptom intensity. Logistic regression indicated that employment/housework was primarily linked to the total symptom score in Measurement A (p = 0.010), with patients less likely to have high symptom severity (Exp(B) = 0.101). Baseline symptom burden category at Measurement A was identified as a significant predictor of symptom intensity at Measurement B (p = 0.028), with patients presenting mild symptom burden at baseline being less likely to report moderate-to-high symptom burden at the final assessment. Conclusions: While pain, fatigue, and perceived well-being deteriorated from the early to the final chemotherapy cycle, the total symptom burden remained relatively stable. Younger patients appeared to experience higher symptom burden, while lower educational level was associated with higher symptom burden in the univariate analysis at the final assessment, highlighting the need for age-sensitive and educationally tailored nursing interventions to enhance symptom management in oncology settings. Full article

Surgical resection is the main curative option for non-small-cell lung cancer. Pulmonary resections have historically been performed through a highly morbid open thoracotomy. Minimally invasive approaches to pulmonary resection have revolutionized the field with reduced perioperative morbidity, including less postoperative pain, length-of-stay, and complications, while potentially enhancing oncologic outcomes. In its current generation, robotically performed video-assisted thoracoscopic surgery (R-VATS) offers numerous advantages over traditional VATS and is increasingly becoming the standard of care. In this review, we highlight the technical and clinical advantages of R-VATS compared to VATS and traditional thoracotomy. We reflect on emerging advancements in the utilization of the minimally invasive platform for single-anesthetic marking and resection of pulmonary nodules, the integration of artificial intelligence and radiomics to augment preoperative planning, and the expanding role of single-incision robotic surgery. Lastly, we discuss the financial considerations of implementing a robotic thoracic platform and identify opportunities to optimize costs. Full article

Background and Objectives: Postoperative pain after major cancer surgery contributes to pulmonary, cardiovascular, metabolic, and functional complications. Thoracic epidural analgesia [TEA] has traditionally been considered the standard analgesic technique for open thoracic and upper abdominal oncologic surgery, although minimally invasive techniques and ERAS pathways have prompted a re-evaluation of its role. Methods: This narrative review summarizes evidence from PubMed and MEDLINE published between 1995 and June 2026, emphasizing randomized trials, systematic reviews, meta-analyses, large observational studies, and selected work by the authors. Results: TEA provides superior dynamic analgesia and reduces opioid consumption, facilitating early mobilization, respiratory recovery, and gastrointestinal function. By attenuating sympathetic and neuroendocrine stress responses, it may contribute to reductions in pulmonary complications, ileus, insulin resistance, and delirium, particularly in elderly, frail, sarcopenic, and high-risk patients. Limitations include hypotension, urinary retention, technical failure, and rare but potentially serious complications such as epidural hematoma. In minimally invasive surgery, alternative regional techniques and multimodal opioid-sparing analgesia often achieve comparable postoperative outcomes with fewer hemodynamic effects, supporting selective rather than routine TEA use. Although neuraxial techniques may have immunomodulatory effects and potentially preserve immune function, randomized studies have not demonstrated a reduction in cancer recurrence or an improvement in long-term survival. Conclusions: TEA remains an effective analgesic strategy for selected patients undergoing major open thoracic and upper abdominal cancer surgery. In contemporary perioperative practice, its use should be individualized according to surgical invasiveness, patient characteristics and expected postoperative pain. Current evidence supports TEA primarily as a perioperative analgesic and recovery strategy, with no established oncologic benefit. Full article

Background: Cancer pain remains highly prevalent and undertreated despite established guidelines. In Italy, Law 38/2010 mandates systematic pain assessment, yet only 26% of clinicians routinely evaluate pain at each clinical visit, and fewer than one-quarter have received formal training in pain medicine or palliative care. A national multidisciplinary roundtable, convened in Rome in March 2025, formally identified four systemic gaps—insufficient education, fragmented care pathways, unclear professional roles, and challenges in implementing shared diagnostic and therapeutic pathways—and planned the development of a structured Delphi consensus. Methods: A Delphi consensus process was undertaken in accordance with CREDES guidelines. The Steering Committee, comprising representatives of six Italian scientific societies (AIRO, AIOM, AISD, Federdolore-SICD, SICP, ACD-SIAARTI) and a patient advocacy group (Fondazione Nora e Alberto Gentili), developed 15 clinical statements addressing pain assessment, management, referral criteria, monitoring, and documentation over five online meetings held between March and September 2025. Sixty-six Italian clinicians from various specialties were invited to participate; the survey was open from 1 October to 31 December 2025, with reminders every 10 days. Consensus was defined as ≥75% agreement (scoring 4 or 5 on a 5-point Likert scale). Results: Fifty-six clinicians completed the survey (response rate: 84.8%), representing medical oncology, radiation oncology, pain therapy, and palliative care specialties; individual statements were rated by 53–54 panelists, as skipping single items was permitted. All statements reached consensus in the first round (77.8–100%), precluding the need for a second voting round. Panelists’ qualitative comments informed minor wording refinements; substantial content was unchanged. Conclusions: The Delphi process produced a validated, multidisciplinary clinical pathway for cancer pain management in the Italian National Health System (NHS). The pathway establishes structured roles for the clinical reference physician and specialist consultants, objective decision thresholds for analgesic titration and referral, and minimum requirements for standardized pain documentation. These consensus-based statements provide actionable clinical guidance that may help address analgesic undertreatment and support the implementation of Law 38/2010 across Italian oncology centers. Full article

Objective: Subcostal uniportal robot-assisted thoracic surgery (URATS) using the da Vinci Single-Port (SP) system avoids intercostal placement of the main robotic access. This prespecified secondary analysis of a prospective trial characterized chronic postsurgical pain and health-related quality of life (HRQOL) as primary patient-reported outcomes after subcostal URATS for early-stage lung cancer, with mid-term oncological outcomes as an exploratory endpoint. Methods: Patients from the parent trial (NCT05535712) undergoing subcostal URATS were assessed at 3, 6, and 12 months by structured telephone interviews. Chronic postsurgical pain was defined by the ICD-11 criterion (Numerical Rating Scale [NRS] > 0 on any of four activity-specific items). Neuropathic features were assessed with the painDETECT Questionnaire (PDQ), and HRQOL with EORTC QLQ-C30 summary score and selected domains. Results: In 33 patients, chronic postsurgical pain declined from 33.3% at 3 months to 6.1% at 12 months (p = 0.004), was mild among symptomatic patients (median NRS 1), and showed no PDQ-defined neuropathic features. Two patients received a 7-day course of gabapentin at 3 months. Baseline HRQOL (median QLQ-C30 summary score 91.5) increased at all postoperative time points (p < 0.001). At a median 40-month follow-up, one patient had bilateral pulmonary recurrence at 13 months, all remained alive, and no delayed hernia or other access-related complication was identified. Conclusions: Subcostal URATS was feasible in this prospective cohort. Chronic postsurgical pain was mild and decreased over time, HRQOL remained well preserved, although data on mid-term oncological outcomes were preliminary. Full article