Search Results (65)

Organ-preserving strategies have gained increasing relevance in the management of rectal cancer, driven by the improved ability of neoadjuvant therapies to induce major and complete tumor regression. The introduction of Total Neoadjuvant Therapy (TNT), delivered through induction and/or consolidation chemotherapy combined with radiotherapy, has substantially increased both pathological and clinical complete response rates. This progress has renewed interest in non-operative management—namely Watch-and-Wait (W&W)—and in local excision (LE) as potential alternatives to total mesorectal excision (TME). However, the W&W strategy raises important oncologic concerns, including a non-negligible rate of local regrowth—consistently reported at approximately 20–30%—which is associated with inferior distant metastasis-free survival and overall survival. These limitations underscore the inherent uncertainty in reliably defining a true clinical complete response. Within this context, LE may serve as a valuable diagnostic and therapeutic modality by confirming the pathological response, improving local control through removal of residual resistant tumor clones, and enabling more accurate stratification of patients suitable for organ preservation versus those requiring completion TME. Overall, while TNT has expanded the therapeutic opportunities for rectal preservation, LE appears to play a critical role in reducing the discordance between clinical and pathological assessment, thereby offering a more oncologically secure pathway toward organ preservation. This narrative review discusses the current role, benefits, and limitations of organ-preserving approaches after TNT in both locally advanced and early rectal cancer. Full article

Effective spare parts management (SPM) is imperative for equipment-intensive organizations to reduce equipment downtime through maintenance. Despite the extensive availability of data-driven SPM methodologies, decision-makers are challenged and tend to rely on tacit knowledge and simple approaches due to extensive data-gathering requirements and fragmented information across multiple organizational IT systems and departmental knowledge silos. A review of 60 academic SPM contributions demonstrated that data remains siloed and that research is limited in integrating data across SPM-relevant knowledge areas. This study proposes an empirical SPM data model to address this gap by consolidating and linking spare parts with maintenance, logistics, inventory, and equipment data, thus forming a coherent database across the identified SPM knowledge areas to bridge data silos and reduce data-gathering requirements. A case study assesses the effects of model implementation for decision-making on 10,843 spare parts and shows that model implementation led to a 15.1% stock value reduction, a 76–91% full-time equivalent resource improvement, a 4–5% decision quality improvement, and an enhancement of decision-maker engagement. The data model reduces data-gathering efforts, enhances data accessibility, and improves decision quality and consistency. Full article

Background: Liver transplantation (LT) continues to evolve with techniques aimed at minimizing perioperative complications associated with caval and portal vein clamping. Caval-sparing approaches, such as the piggyback technique, preserve hemodynamic stability; however, portal clamping remains necessary and may trigger postreperfusion syndrome, endotoxemia, and hepatic microcirculatory disturbances. Temporary portocaval shunts (PCSs) have been developed to maintain portal flow during LT, mitigating these adverse effects and allowing for hemodynamic stability and a reduced intraoperative bleeding. Portocaval Shunts: Various PCS techniques—including end-to-side, right-branch, portosaphenous, mesenterico-saphenous, iliac-venous conduit interposition, portoumbilical, and Rex-saphenous shunts—allow an individualized approach based on patient anatomy and surgical complexity. Review of Evidence: Available evidence demonstrates that PCS improves intraoperative hemodynamic stability, reduces blood transfusion requirements, and preserves renal function, particularly in patients with high portal flow or severe portal hypertension. PCS may also shorten warm ischemia time, facilitate hepatectomy, and enhance outcomes in extended criteria donor grafts or marginal organs. Meta-analyses and randomized studies support its role in reducing intraoperative blood loss, improving early graft function, and accelerating postoperative recovery. However, the effect of PCS on long-term survival and major postoperative morbidity remains variable, likely due to heterogeneity in patient populations, donor types, and perioperative management. Conclusions: Overall, PCS represents a safe and feasible adjunct in LT, offering significant hemodynamic and technical advantages. Its use should be individualized based on patient risk factors, intraoperative hemodynamics, and anticipated intraoperative challenges. PCS provides a practical strategy to preserve portal flow, minimizing intraoperative complications and facilitating the hepatectomy. However, the decision to create a PCS during LT still depends on the surgeon’s preference. Postoperative outcomes and impact on long-term survival require further investigation. Full article

Background: This study was designed as a dosimetric feasibility analysis to compare hippocampal-avoidance whole-brain radiotherapy (HA-WBRT) using 3D-CRT, IMRT, and VMAT techniques, with particular attention to clinical applicability in resource-limited settings. While 3D-CRT was used as a reference for conventional WBRT, the primary aim was to determine whether IMRT can serve as an effective and accessible alternative to VMAT for HA-WBRT in centers without advanced technology infrastructure. Methods: Fifteen patients undergoing WBRT for symptom relief were planned using 3D-CRT, IMRT, and VMAT on the Elekta Monaco 6.1.4.0 system. Key organs at risk (OARs) such as the optic nerves, chiasm, eyes, and lenses were considered in the treatment planning. Plans were evaluated based on PTV dose distribution, Conformity Index (CI), Homogeneity Index (HI), and OAR dose constraints (RTOG 0933, NRG-CC001). Gamma pass rate analysis (3%/3 mm) was performed for the IMRT and VMAT plans. Results: IMRT and VMAT significantly reduced the hippocampal dose compared to 3D-CRT, with similar PTV coverage and OAR sparing. The mean D_max for the hippocampus was 15.4 Gy for IMRT and 15.5 Gy for VMAT compared to 31.2 Gy for 3D-CRT. The D100% for the hippocampus was 7.5 Gy for IMRT and 7.6 Gy for VMAT, both well below the RTOG 0933 threshold of 9 Gy, while 3D-CRT delivered 30.3 Gy. Additionally, IMRT and VMAT delivered lower doses to the optic nerves and chiasm. QA results showed gamma pass rates above 96% for all plans. This study focused solely on treatment-planning and dosimetric feasibility without evaluating patient outcomes or clinical follow-up. Conclusions: HA-WBRT with IMRT and VMAT significantly reduced the hippocampal dose while maintaining optimal PTV coverage. VMAT is preferred for its balance of efficacy, protection, and treatment time, while IMRT represents a feasible approach for facilities without VMAT, though it requires stricter dose control and longer treatment times. Full article

Background: Gastrointestinal (GI) sarcoidosis is a rare manifestation of systemic disease, with limited evidence to guide diagnosis and treatment. Methods: A 75-item international survey was completed by 132 clinicians from multiple specialties and hospital settings. Statistical analysis was performed using Jamovi version 2.6.44 (The Jamovi Project, Sydney, Australia). Results: Most clinicians (72.0%) preferred a comprehensive diagnostic approach integrating clinical, imaging and histopathological assessment, with differences by hospital type (p < 0.05). Inflammatory bowel disease was frequently considered in the differential diagnosis, and concern regarding excluding inflammatory conditions remained consistently high. Significant specialty-related variation was observed for specific organ involvement and in the management of glucocorticoid-refractory disease, including use of alternative immunosuppressants, combination regimens, glucocorticoid-sparing agents, and biologic therapies. Expectations regarding response timelines and indications for surgery were largely concordant. Conclusions: Clinicians reported high awareness but heterogeneous management practices for GI sarcoidosis, particularly beyond first-line glucocorticoids. These findings highlight the need for multidisciplinary consensus and the development of standardized clinical guidelines. Full article

Esophageal cancer (EC) continues to pose a major global health burden, ranking as the ninth most common malignancy and sixth leading cause of cancer mortality, with over 600,000 new cases and 500,000 deaths annually as of 2025. While esophagectomy has long been the standard for curative intent in resectable disease, organ preservation strategies have advanced significantly, offering viable alternatives for patients with locally advanced esophageal squamous cell carcinoma (ESCC) or those unsuitable for surgery due to comorbidities. These approaches encompass definitive chemoradiotherapy (dCRT), neoadjuvant chemoradiotherapy (nCRT) followed by active surveillance (“watch-and-wait”), and innovative integrations of immunotherapy and targeted therapies. This narrative review synthesizes evidence from recent clinical trials, systematic reviews, and international guidelines up to 2025, demonstrating that organ-sparing protocols can achieve comparable overall survival (OS) rates—often exceeding 50% at 5 years in selected cohorts-while substantially enhancing quality of life (QoL) by preserving esophageal function. For instance, the SANO trial (2025) confirmed non-inferiority of active surveillance post-nCRT, with 2-year OS of 74% versus 71% for standard surgery. Key challenges include imprecise response assessment, locoregional recurrences (20–30%), and treatment-related toxicities such as esophageal strictures. Emerging trials like ESOSTRATE and PALACE3 are evaluating immunotherapy-enhanced regimens, potentially expanding organ preservation to esophageal adenocarcinoma (EAC). With genomic biomarkers and novel modalities like proton therapy, personalized organ preservation promises to broaden applicability, reduce morbidity, and improve outcomes across histological subtypes. Additionally, recent studies emphasize the role of liquid biopsies, such as circulating tumor DNA (ctDNA), in monitoring treatment response and guiding surveillance, potentially reducing the need for invasive procedures and improving detection of minimal residual disease. The aim of this review is not only to summarize recent trials but to synthesize them into an operational framework that clinicians and researchers can apply: a decision algorithm for selecting organ preservation candidates. This is the novel element that distinguishes this work from prior narrative reviews. Full article

The management of large bulky tumors is very challenging. The current treatment options for effective palliation of symptoms are limited. These tumors often present a large burden at the time of diagnosis, growing along critical bony and neural structures and preventing surgical resection in most of the cases. These tumors are also known to be relatively resistant to chemotherapy, with very low response rates. In addition, conventional photon-based radiotherapy has a limited effect due to their radioresistance, the use of large treatment fields, and the impossibility of delivering high doses because of the higher risk of normal tissue toxicity. Therefore, more effective radiation treatments for palliation are needed to achieve greater local control rates. A recent approach called partial ablative radiotherapy (PART) has been shown to be potentially able to improve the effectiveness of radiotherapy. This technique is based on the ability of recent advanced delivery techniques to deliver a high “ablative” dose to the central part of the tumor, maintaining a very low and safe dose profile at the periphery to spare the surrounding organs at risk. Although this technique has been evaluated only in small studies and case reports, it showed notable treatment responses and safety profiles. The present narrative review describes the rationale for PART, the current and forthcoming state of evidence, the existing studies, and the future directions for the development of this approach, including the associated challenges. Full article

The proliferation of multidrug-resistant (MDR) ESKAPE pathogens—Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.—constitutes a critical global health crisis, rendering conventional antibiotics increasingly ineffective. This comprehensive review evaluates the re-emerging potential of bacteriophage therapy as a personalized treatment for infections caused by these organisms. Phages, being viruses that specifically infect and lyse bacteria, offer significant advantages, including high specificity that spares host microbiota, self-replication at the infection site, and potent activity against biofilms. This paper synthesizes current preclinical and clinical evidence, including compassionate-use cases, for phage therapy against each of the ESKAPE pathogens. While case reports and small studies demonstrate considerable success, particularly in salvage therapy for otherwise untreatable infections, significant challenges remain. These include the narrow host range of phages, the potential for bacterial resistance, unpredictable pharmacokinetic and pharmacodynamic parameters, and a complex, non-harmonized regulatory landscape. The review highlights that phage–antibiotic synergy and the use of phage cocktails are promising strategies to overcome some of these limitations. Future progress in phage therapy will depend on standardized manufacturing, robust clinical trials to establish dosing and efficacy, and the development of adaptive regulatory pathways. Phage therapy is positioned not as a replacement for antibiotics but as a vital adjunctive tool in the armamentarium against MDR infections, heralding a move towards a more personalized approach to infectious disease management. Full article

Background/Objectives: This study investigates the dosimetric impact of a 3D-printed applicator integrating multilayer catheter geometry and high-density shielding, designed for contact interventional radiotherapy (IRT) in non-melanoma skin cancer (NMSC) treatment. The aim is to assess its potential to enhance target coverage and reduce doses in organs at risk (OARs). Methods: A virtual prototype of a multilayer applicator was designed using 3D modeling software and realized through fused deposition modeling. Dosimetric simulations were performed using both TG-43 and TG-186 formalisms on CT scans of a water-equivalent phantom. A five-catheter array was reconstructed, and lead-cadmium-based alloy shielding of varying thicknesses (3–15 mm) was contoured. CTVs of 5 mm and 8 mm thickness were analyzed along with a neighboring OAR. Dosimetric endpoints included V95%, V100%, V150% (CTV), D_2cc (OAR), and therapeutic window (TW). Results: Compared to TG-43, the TG-186 algorithm yielded lower OAR doses while maintaining comparable CTV coverage. Progressive increase in shielding thickness led to improved V95% and V100% values and a notable reduction in OAR dose, with an optimal trade-off observed between 6 and 9 mm of shielding. The TW remained above 7 mm across all configurations, supporting its use in lesions thicker than conventional guidelines recommend. Conclusions: The integration of multilayer catheter geometry with high-density shielding in a customizable 3D-printed applicator enables enhanced dose modulation and OAR sparing in superficial IRT. This approach represents a step toward personalized brachytherapy, aligning with the broader movement in radiation oncology toward patient-specific solutions, adaptive planning, and precision medicine. Future directions should include prototyping and mechanical testing of the applicator, experimental dosimetric validation in phantoms, and pilot clinical feasibility studies to translate these promising in silico results into clinical practice. Full article

Sarcoidosis is a chronic inflammatory disease of unknown etiology that can involve virtually any organ, with pulmonary involvement seen in over 90% of cases. Although many patients experience spontaneous remission, approximately 10–30% develop progressive pulmonary disease, which may lead to fibrocystic changes, respiratory failure, and death. Oral glucocorticoids remain the cornerstone of treatment for symptomatic patients with pulmonary infiltrates and abnormal pulmonary function tests, with typical starting doses ranging from 20 to 40 mg/day followed by a slow taper over 6–18 months based on clinical and radiographic response. However, prolonged glucocorticoid therapy is associated with significant toxicity, and many patients require additional immunosuppressive agents for disease control or steroid-sparing purposes. Antimetabolites such as methotrexate, azathioprine, mycophenolate mofetil, and leflunomide are commonly used second-line therapies. For refractory disease, particularly in those with metabolically active lesions on FDG-PET, anti-tumor necrosis factor (TNF) agents like infliximab may be effective but carry risks of serious adverse effects. In select cases, newer strategies—including RCI, rituximab, JAKi or investigational regimens—are being explored. Management must also account for non-inflammatory complications such as sarcoidosis-associated pulmonary hypertension and bronchiectasis, which can mimic disease progression and require distinct therapeutic approaches. Given the heterogeneity of sarcoidosis and lack of robust clinical trial data, a stepwise and individualized approach to immunosuppression remains essential in optimizing outcomes while minimizing treatment-related harm. Full article

Immunoglobulin G4–related disease (IgG4-RD) is an uncommon fibro-inflammatory process characterized by the infiltration of tissues and organs and a typically dramatic response to glucocorticoids. Its relapsing–remitting course, multisystemic involvement, and variability in epidemiological and prognostic features pose a significant diagnostic challenge for clinicians. Despite their effectiveness in symptom relief, prolonged glucocorticoid use remains a challenge in IgG4-RD management, prompting the search for steroid-sparing alternatives. Although rituximab has recently demonstrated efficacy in the treatment of IgG4-RD, no consensus exists regarding the optimal maintenance regimen. The emergence of new B-cell–targeted therapies and other immunomodulators represents a promising step toward more personalized treatment approaches. In this review, we provide an updated and integrative overview of the emerging treatment strategies for IgG4-RD, highlighting future directions towards individualized management. Full article

Background: Sexuality in women with muscle-invasive bladder cancer (MIBC) undergoing radical treatment represents a crucial aspect of their overall quality of life, which is increasingly recognized as a key component of patient-centered care and long-term well-being. This review aimed to analyze the available literature to provide a comprehensive overview of the effects of treatments on female sexual function. Methods: We included all qualitative and quantitative studies addressing sexual function in patients treated for MIBC. Excluded were narrative reviews, case reports, conference abstracts, systematic reviews, and meta-analyses. The included studies involved women undergoing either robot-assisted radical cystectomy (RARC) or open RC (ORC), often with nerve-sparing, vaginal-sparing, or pelvic organ-preserving techniques. Data on oncological and functional outcomes were collected. Results: A systematic review of 29 studies including 1755 women was conducted. RC was performed via robotic/laparoscopic approaches in 39% of cases and open techniques in 61%. Urinary diversions included orthotopic neobladders (48%), ileal conduits (42%), ureterocutaneostomies (3%), and Indiana pouches (7%). Radiotherapy, used in 6% of patients, was mainly applied in a curative, trimodal setting. Sexual function was evaluated using various pre- and/or postoperative questionnaires, most commonly the EORTC QLQ-C22, FACT-BL, Bladder Cancer Index (BCI), LENT SOMA, and Female Sexual Function Index (FSFI). Radiotherapy was associated with reduced sexual function, though outcomes were somewhat better than with surgery. Among surgical approaches, no differences in sexual outcomes were observed. Conclusions: Further qualitative research is essential to better understand the experience of FSD after treatment. Incorporating both patient and clinician perspectives will be key to developing tailored interventions. In addition, efforts should be made to standardize the questionnaires used to assess female sexual dysfunction, in order to improve comparability across studies and ensure consistent evaluation. Full article

By 2030, millions of new cancer cases will be diagnosed, as well as millions of cancer-related deaths. Traditional drug delivery methods have limitations, so developing smart drug delivery systems (SDDs) has emerged as a promising avenue for more effective and precise cancer treatment. Nanotechnology, particularly nanomedicine, provides innovative approaches to enhance drug delivery, including the use of nanoparticles. One such type of SDD is thermosensitive nanoparticles, which respond to internal and external stimuli, such as temperature changes, to release drugs precisely at tumor sites and minimize off-target effects. On the other hand, hyperthermia is a cancer treatment mode that goes back centuries and has become popular because it can target cancer cells while sparing healthy tissue. This paper presents a comprehensive review of smart thermosensitive nanoparticles for cancer treatment, with a primary focus on organic nanoparticles. The integration of hyperthermia with temperature-sensitive nanocarriers, such as micelles, hydrogels, dendrimers, liposomes, and solid lipid nanoparticles, offers a promising approach to improving the precision and efficacy of cancer therapy. By leveraging temperature as a controlled drug release mechanism, this review highlights the potential of these innovative systems to enhance treatment outcomes while minimizing adverse side effects. Full article

Background: Rectal cancer management involves surgery, chemotherapy (CT), radiotherapy (RT), and patient care strategies, all of which significantly affect health-related quality of life (HRQoL). Understanding these effects is critical for optimizing treatment protocols. This review aimed to systematically analyze the impact of rectal cancer treatment on HRQoL. Methods: Four databases, Scopus, EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials, were searched for randomized controlled trials (RCTs) published between January 2013 and December 2023. RCTs specifically focusing on rectal cancer treatments (surgical interventions, pre- and/or post-CT and/or RT, and patient care strategies) were included. An abstract review, data extraction, and a risk-of-bias assessment were independently conducted by two reviewers. Results: The 41 included studies comprised 9240 patients: 16 evaluated surgical interventions (3507 patients), 15 evaluated pre- and/or post-CT and/or RT protocols (5114 patients), and 10 focused on patient-care strategies (619 patients). Sphincter-sparing procedures were associated with better HRQoL than abdominoperineal resection, and rectal-sparing techniques were associated with better overall HRQoL than rectal resection. RT was associated with a poorer HRQoL. Continuity-of-care interventions improved HRQoL in ostomy patients, whereas transanal irrigation improved HRQoL after ostomy closure. Conclusions: This systematic review of RCTs underscores the importance of organ-sparing strategies, such as rectum-sparing approaches and continuity-of-care packages, in improving HRQoL in patients with rectal cancer. Although RT negatively affects HRQoL, treatment regimens should be individualized. Tailored organ-preservation approaches and structured follow-up care are essential for optimizing HRQoL in patients with rectal cancer. Full article

Renal cell carcinoma (RCC) is the most prevalent solid organ malignancy among kidney transplant recipients, demonstrating substantially higher incidence rates compared to those in the general population. Although RCC is most commonly diagnosed in native kidneys, its development in transplanted kidneys has an infrequent occurrence. The use of immunosuppressive therapies, pre-existing chronic kidney disease and the unique anatomical characteristics of transplanted kidneys represent considerable therapeutic challenges in managing RCC within this patient cohort. Open radical transplantectomy plays a crucial role in curative treatment for localized RCC, whereas nephron-sparing surgery (NSS), in selected cases, can provide similar oncologic benefits while preserving allograft function. Recently, laparoscopic and robotic surgical procedures have demonstrated favorable outcomes as viable alternatives to conventional open surgery. Furthermore, ablative therapies like radiofrequency ablation and cryoablation can be considered therapeutic alternatives for small renal masses, offering the benefit of preserving allograft function, especially in high-risk surgical candidates. Limited data exist regarding the management of metastatic RCC in transplant recipients. Surgery, withdrawal of immunosuppression and systemic adjuvant therapy could be considered. Management of RCC in transplanted kidneys requires a multidisciplinary approach considering patient-specific characteristics, tumor features and the developing landscape of both surgical and non-surgical options. Further research is needed to refine therapeutic strategies in order to achieve optimal oncological outcomes while preserving allograft function. Full article