Search Results (276)

Background and Objectives: This study aims to investigate the impact of hemoglobin (Hb) level changes during radiochemotherapy (RCT) on the survival of patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Materials and Methods: A retrospective analysis was conducted on 97 patients with HNSCC, treated with definitive RCT between January 2016 and October 2021. Hb levels were monitored weekly during RCT. Kaplan–Meier and Cox regression analysis were performed. Results: There was a significant association between Hb levels at the end of RCT and overall survival (p < 0.01). Initial Hb levels and Hb level changes were not significantly associated with survival. In multivariate analysis, a lower body mass index (BMI) and Hb levels at week six were identified as significant prognostic factors. Conclusions: At the end of RCT, rather than baseline levels or changes during treatment, Hb levels are a significant prognostic factor for overall survival in patients with HNSCC. Full article

Background: Integrating deep regional hyperthermia (HT) with neoadjuvant chemoradiotherapy (CRT) may enhance treatment efficacy in locally advanced rectal cancer (LARC), yet feasibility and tolerance data remain scarce for both short-course (SCRT) and long-course (LCRT) radiotherapy (RT) regimens. Methods: In this single-center prospective observational study, 67 LARC patients received neoadjuvant RT and chemotherapy (CT) combined with deep radiative HT using a phased-array system (ALBA 4D). Patients treated with SCRT (5 × 5 Gy) were prescribed two HT sessions; those treated with LCRT (25 × 2 Gy) were prescribed ten. HT planning was guided by dedicated software, and real-time thermometry ensured precise thermal delivery. Feasibility was defined as completion of ≥50% of prescribed sessions. Tolerance and toxicity were assessed with standardized clinical scales (QMHT, UMC, CTCAE v4.03). Results: HT was feasible in both groups: 100% of SCRT and 63.6% of LCRT patients completed ≥50% of prescribed sessions. In total, 243 sessions were delivered. Most symptoms were mild and transient, predominantly localized pain. No grade ≥3 HT-related toxicities occurred. All scheduled RT and surgery proceeded without delay. Median T50 was 40.3 °C (SCRT) and 40.4 °C (LCRT); the median RT-to-HT interval was 42 min in both groups. Conclusion: This first Spanish experience shows that deep radiative HT can be seamlessly integrated into both SCRT and LCRT neoadjuvant protocols for rectal cancer. High adherence, favorable tolerance, and reliable thermal control support clinical implementation. Any between-schedule observations are descriptive only; no formal comparative testing was performed. The study was not designed or powered to establish comparative effectiveness between SCRT and LCRT, and the sample size was insufficient to detect rare HT-specific adverse events. Full article

Background: Glioblastoma (GBM) prognosis has been reported to be influenced by age and comorbidity in several investigations. Identifying factors that contribute to poor survival is crucial to optimizing and personalizing therapeutic strategies. In the present retrospective analysis, we investigated the impact of GBM patient stratification using the age adjusted Charlson Comorbidity Index (ACCI). Methods: A total of 165 patients diagnosed with IDH wild-type GBM, treated with post-operative radio or radio-chemotherapy, were evaluated. To assess the impact of comorbidities, patients were stratified into two groups according to their ACCI scores: Group A (ACCI 0–2) and Group B (ACCI >2). The Cox proportional hazards model test was used to compare overall survival (OS) between the two groups of patients and determine whether the presence of comorbidities significantly affected outcomes. Primary and secondary endpoints were OS and progression free survival (PFS), respectively. Results: The median follow-up period was 36 months, and the median OS was 14 months (95% CI 12.4–15.5). The univariate analysis evidenced that patients in Group A had a significantly longer OS compared to those in Group B, with median OS times of 18 months (95% CI 16–20) and 12 months (95% CI 10.5–13.5), respectively (p = 0.015). The OS remained statistically significant in the multivariate analysis (p = 0.015). Conclusions: The results of this study indicate that ACCI may serve as an independent prognostic factor in patients with newly diagnosed GBM. Full article

Background: Nutritional status is a recognized determinant of treatment tolerance and clinical outcomes in oncology. This study aimed to assess body composition using computed tomography (CT) and to evaluate its association with progression-free survival (PFS) and overall survival (OS) in patients with locally advanced rectal cancer (LARC) undergoing curative multimodal therapy. Methods: A total of 216 patients with LARC who underwent neoadjuvant chemoradiotherapy (CRT) were retrospectively assessed. Two radiochemotherapy protocols were used: long-course chemoradiotherapy (lcCRT) (radiation therapy administered daily at doses of 1.8 or 2.0 Gy, for a total dose of 50.4–55.8 Gy) with concurrent chemotherapy: either 5-FU with leucovorin or capecitabine and total neoadjuvant chemoradiotherapy (tnCRT)—short-course radiotherapy (5 × 5 Gy) followed by sequential chemotherapy with CAPOX or FOLFOX. Surgery was performed 6.5 weeks after completing CRT. Radiotherapy was delivered using linear accelerators based on the Intensity-Modulated Radiation Therapy technique. CT scans were used to assess nutritional status. Survival analyses were performed. Data on food consumption frequency were collected using the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN^®). Non-Healthy-Diet-Index-14 (nHDI-14) was calculated. Results: Median observation time was 58 months (range 4–118 months). VATI level and OS (HR: 0.4618 95% CI: 0.2194–0.9719, p = 0.0419), as well as SATI and OS (HR: 0.4707 95% CI: 0.2286–0.9693, p = 0.0409) were significantly associated. This association was not significant for PFS (VATI: HR: 0.7084 95% CI: 0.4055–1.2376, p = 0.2259; SATI: HR: 0.6864 95% CI: 0.3932–1.1981, p = 0.1855). SMI and PMI values were not significantly related either PFS (SMI-HR: 0.6728, 95% CI: 0.4031–1.1231, p = 0.1295; PMI-HR: 0.7385, 95% CI: 0.4628–1.1785, p = 0.2036) or OS (SMI-HR: 0.9128, 95% CI: 0.4703–1.7720, p = 0.7876; PMI-HR: 0.6592 95% CI: 0.3684–1.1794, p = 0.1603). No significant association was found between sarcopenia development and PFS (HR: 1.2733 CI: 0.7589–2.1363; p = 0.3602) or OS (HR: 1.1207; CI: 0.5681–2.2107; p = 0.7424). Significant differences between men and women in alcohol intake and nHDI-14 were observed. Conclusions: Low visceral and subcutaneous adipose tissue index were significantly associated with worse OS in patients with LARC undergoing multimodal treatment. The nHDI-14 was negatively correlated with the duration of observation and patients’ age. Full article

Background: Surgical procedures and alterations of the gastrointestinal (GI) tract increase the risk of small intestinal bacterial overgrowth (SIBO), which is associated with GI symptoms and complications that compromise postoperative recovery. However, the prevalence and clinical impact of SIBO after various upper GI surgical procedures remain poorly understood. Objective: This study aimed to evaluate the prevalence of SIBO after different types of upper GI surgery and to investigate the associated clinical factors. Methods: We conducted an observational study involving 157 patients with a history of upper GI surgery: Roux-en-Y gastric bypass (RYGB), laparoscopic single-anastomosis gastric bypass (OAGB), subtotal (STG) or total gastrectomy (TG), subtotal (SP)or total pancreatectomy (TP), cephalic duodenopancreatectomy (WR), and small bowel resection for Crohn’s disease. A glucose–hydrogen breath test was performed, and demographic, clinical, and treatment-related data were collected. Statistical analyses included t-tests, non-parametric tests, ANOVA, and correlation analyses using R software. Results: At a median follow-up of 25.7 ± 18.1 months, 31% (48/157) of patients tested positive for SIBO. The highest prevalence was observed after RYGB and OAGB (43%), followed by TG (30%), STG (29%), TP/WR (28%), and Crohn’s disease bowel resection (19%). No cases of SIBO were observed after SP. SIBO positivity was significantly associated with bloating and flatulence (p = 0.002), lactose intolerance (p = 0.047), systemic sclerosis (p = 0.042), T2D (p = 0.002), and exposure to adjuvant chemotherapy (p = 0.001) and radiotherapy (p = 0.027). In addition, the risk of SIBO increased proportionally with the duration of GI resection or exclusion (p = 0.013). Conclusions: In our study, the prevalence of SIBO after upper GI surgery was 31%, with the highest incidence (43%) observed in metabolic surgery patients. Importantly, adjuvant radio/chemotherapy was associated with an increased risk of SIBO, and extensive small bowel resection or exclusion was strongly associated with an increased risk of SIBO. Furthermore, the limitations of current diagnostic methods, which lack sufficient sensitivity and specificity, highlight the importance of early screening and standardization of diagnostic techniques to improve patient management and outcomes. Full article

Glioblastoma (GBM) is an aggressive and highly heterogeneous tumor that frequently recurs despite surgery followed by radio-chemotherapy and, more recently, TTFields. This recurrence is largely driven by glioblastoma stem cells (GSCs), which are intrinsically resistant to standard therapies. Identifying molecular targets that underlie this resistance is therefore critical. Here, we investigated whether the inhibition of FGFR1, previously identified as a key mediator of GBM radioresistance, using pemigatinib, a selective FGFR1–3 inhibitor, could enhance GSC radiosensitivity in vitro and in vivo. Pemigatinib treatment inhibited FGFR1 signaling, promoted proteasome-dependent FGFR1 degradation, and reduced the viability, neurosphere formation, and sphere size in GSCs with unmethylated MGMT, a subgroup known for poor response to standard treatments. In MGMT-unmethylated differentiated GBM cell lines, pemigatinib combined with temozolomide further enhanced radiosensitivity. Transcriptomic analysis revealed that pemigatinib treatment led to the downregulation of S100A4, a biomarker associated with mesenchymal transition, angiogenesis, and immune modulation in GBM. Functional studies confirmed that silencing S100A4 significantly improved GSCs’ response to irradiation. In vivo, pemigatinib combined with localized irradiation produced the longest median survival compared to either treatment alone in mice bearing orthotopic GSC-derived tumors, although the difference was not statistically significant. These findings support further clinical investigation to validate these preclinical findings and determine the potential role of FGFR inhibition as part of multimodal GBM therapy. Full article

Introduction: Recent randomized evidence suggests that stage II–IV non metastatic esophageal adenocarcinoma is best managed with perioperative chemotherapy (CHT) and surgery. Intensification of neoadjuvant chemotherapy and radiochemotherapy are proposed before surgery in high-volume centers with the aim of increasing both systemic and locoregional control. However, few data comparing intensified RTCHT, CHT plus RTCHT and perioperative CHT with FLOT in real-life scenarios are available. Methods: This is a multicenter, retrospective series, including three cohorts of patients treated for esophageal adenocarcinoma: Cohort A: nRTCHT; Cohort B: TCF plus RTCHT, defined as triplet chemotherapy followed by dose-reduced triplet therapy + RT; Cohort C: perioperative chemotherapy with FLOT regimen. The primary endpoint was disease-free survival (DFS), and the secondary endpoints were pathologic complete response (pCR), pathologic lymph-node complete response (ypN0), overall survival (OS), and perioperative acute toxicity. Results: From January 2013 to December 2023, 142 patients were identified. All patients received multimodal therapy with radical esophagectomy. A total of 95% of patients were male; the majority of patients presented with stage cT3cN1. A total of 63 patients were treated in Cohort A (31 cases with doublet 5FU-CDDP concurrent to 50.4 Gy and 32 cases with CROSS regimen), 36 in Cohort B, and 43 in Cohort C. After a median FU of 36 months, the 3-year DFS resulted 58.6%. pCR occurred in 26 cases (18.6%). Three-year OS had a value of 72%. At univariate analysis, ypN0 was related to better DFS; cN+ disease was related with worse OS. The treatment cohort did not impact survival outcomes; however, an effect on CR was shown, with pCR in 15% (A), 36.3% (B), 11% (C) of cases, respectively (χ: 0.008). A total of 67% of patients in Cohort B experienced a ypN0. Two treatment-related deaths occurred (one in Cohort A and one in C) with a slight increase in G3 toxicity in cohort C. Conclusions: In this real-life multicenter series, oncological results were adequate for all three neoadjuvant strategies. TCF plus RTCHT guaranteed a higher pCR and ypN0 rate without increasing toxicity. An intensified neoadjuvant schedule, such as TCF plus RTCHT, may be useful in cases where higher tumor and nodal responses are needed. Taken together, our data highlight that further investigation is warranted before abandoning radiotherapy-based neoadjuvant approaches in esophageal and GEJ adenocarcinoma. Full article

Background/Objectives: Recurrences of squamous cell carcinoma (SCC) at the base of the tongue (BoT) after primary radiochemotherapy (RT-CHT) are associated with low survival rates, poor functional outcomes, and high morbidity following salvage surgery. Transoral robotic surgery (TORS) has emerged as a less invasive alternative to open surgical approaches. This study aims to describe our clinical experience with TORS in patients with BoT SCC recurrence after RT-CHT, focusing on oncological outcomes—relapse-free survival (RFS) and disease-specific survival (DSS)—as well as functional outcomes, particularly swallowing function. Methods: We conducted a retrospective review of four patients who underwent salvage TORS for BoT recurrence between September 2013 and September 2014 at a single tertiary referral center. All patients had been previously treated with primary RT-CHT for oropharyngeal squamous cell carcinomas. Oncological events (recurrence, death) and functional endpoints (dietary limitations, MD Anderson Dysphagia Inventory [MDADI] scores) were retrieved from medical records. Results: Four patients were included. All achieved unrestricted oral intake by one month post-TORS, showing functional improvement compared to their preoperative status. Three of the four patients remained free of locoregional recurrence during follow-up. No major perioperative complications were reported. Conclusions: In selected patients with BoT SCC recurrence after primary RT-CHT, TORS may offer a viable and less morbid salvage treatment option with favorable early functional outcomes and acceptable oncologic control. Based on both our institutional experience and the supporting literature, we propose selection criteria to guide TORS indication in this clinical setting. Full article

Recent years have provided numerous reports on the mechanisms of action of psychiatric medications (antidepressants, antipsychotics, mood stabilizers, and antidementia drugs) that directly inhibit the growth of cancer cells, as well as on their indirect effects on the psyche and immune system, and their supportive effects on chemotherapeutic agents. The mechanisms of the anticancer activity of psychiatric drugs include inhibition of dopamine and N-methyl-D-aspartate receptors that work via signaling pathways (PI3K/AKT/mTOR/NF-κB, ERK, Wnt/ß-catenin, and bcl2), metabolic pathways (ornithine decarboxylase, intracellular cholesterol transport, lysosomal enzymes, and glycolysis), autophagy, Ca²⁺-dependent signaling cascades, and various other proteins (actin-related protein complex, sirtuin 1, p21, p53, etc.). The anticancer potential of psychiatric drugs seems to be extremely broad, and the most extensive anticancer literature has been reported on antidepressants (fluoxetine, amitriptyline, imipramine, mirtazapine, and St John’s Wort) and antipsychotics (chlorpromazine, pimozide, thioridazine, and trifluoperazine). Among mood stabilizers, lithium and valproates have the largest body of literature. Among antidementia drugs, memantine has documented anticancer effects, while there is limited evidence for galantamine. Of the new psychiatric substances, the antipsychotic drug brexpiprazole and the antidepressant vortioxetine have a very interesting body of literature regarding glioblastoma, based on in vitro and in vivo animal survival studies. Their use in brain tumors and metastases is particularly compelling, as these substances readily cross the blood–brain barrier (BBB). Moreover, the synergistic effect of psychiatric drugs with traditional cancer treatment seems to be extremely important in the fight against chemo- and radio-resistance of tumors. Although there are some studies describing the possible carcinogenic effects of psychiatric drugs in animals, the anticancer effect seems to be extremely significant, especially in combination treatment with radio/chemotherapy. The emerging evidence supporting the anticancer properties of psychiatric drugs presents an exciting frontier in oncology. The anticancer properties of psychiatric drugs may prove particularly useful in the period between chemotherapy and radiotherapy sessions to maintain the tumor-inhibitory effect. While further research is necessary to elucidate the mechanisms, clinical implications, dose-dependence of the effect, and clear guidelines for the use of psychiatric medications in cancer therapy, the potential for these commonly prescribed medications to contribute to cancer treatment enhances their value in the management of patients facing the dual challenges of mental health and cancer. Full article

Background/Objectives: Neoadjuvant radiochemotherapy and perioperative chemotherapy are both well-established treatment strategies for locally advanced adenocarcinoma of the esophagus (EAC) and the esophagogastric junction (AEGJ). However, recent knowledge controversially discusses whether neoadjuvant radiotherapy or perioperative chemotherapy represents superior therapeutic options to prolong survival or cause less toxicity. Methods: We retrospectively analyzed 76 patients with locally advanced EAC or AEGJ treated at our tertiary cancer center between January 2015 and March 2023. Patients received either perioperative FLOT chemotherapy (n = 36) or neoadjuvant radiochemotherapy following the CROSS protocol (n = 40), followed by surgical resection and standardized follow-up. We compared survival outcomes, toxicity profiles, treatment compliance, and surgical results between the two groups. Results: There were no statistically significant differences between FLOT and CROSS treatments in five-year loco-regional controls (LRC: 61.5% vs. 68.6%; p = 0.81), progression-free survival (PFS: 33.9% vs. 42.8%; p = 0.82), overall survival (OS: 60.2% vs. 63.4%; p = 0.91), or distant controls (DC: 42.1% vs. 56.5%; p = 0.39). High-grade hematologic toxicities did not significantly differ between groups (p > 0.05). Treatment compliance was lower in the FLOT group, with 50% (18/36) not completing all the planned chemotherapy cycles, compared to 17.5% (7/40) in the CROSS group. All the patients in the CROSS group received the full radiotherapy dose. Surgical outcomes and post-surgical tumor status were comparable between the groups. Conclusions: Although perioperative chemotherapy with FLOT has recently become a standard of care for locally advanced EAC and AEGJ, neoadjuvant radiochemotherapy per the CROSS protocol remains a well-tolerated alternative. In appropriately selected patients, both approaches yield comparable oncological outcomes. Full article

Background/Objectives: Quality of life (QoL) is a valuable tool for evaluating treatment outcomes and identifying patients who may benefit from early supportive interventions. This study aimed to determine whether specific QoL results in patients with advanced rectal cancer could identify groups with an unfavourable prognosis in long-term follow-up. Methods: A total of 570 patients with advanced rectal cancer were prospectively assessed, during and up to five years after neoadjuvant radiochemotherapy, using the QLQ-C30 and QLQ-CR38 questionnaires. We analysed 27 functional and symptom-related scores to identify associations with overall survival, once at baseline, three times during therapy, and annually from years one to five post-therapy. Results: Poor quality of life scores were consistently associated with shorter overall survival. The functional scores of physical functioning, role functioning, and global health, as well as the symptom scores of fatigue, dyspnoea, and chemotherapy side effects, were highly significant for overall survival at nearly all time points except for the immediate preoperative assessment. Patients over the age of 64 with lower QoL scores showed a significantly reduced probability of survival in the follow-up period, and patients who reported poor QoL in at least two of the first three questionnaires during the initial phase of treatment showed significantly reduced overall survival. Conclusions: Early and repeated QoL assessments, particularly within the first weeks of therapy, offer critical prognostic value in advanced rectal cancer. Identifying patients with an unfavourable prognosis might allow faster interventions that could improve survival outcomes. Integrating QoL monitoring into routine clinical practice could enhance individualised care and support risk stratification. Full article

Traditionally, the therapeutic approach to rectal cancer has involved neoadjuvant chemoradiotherapy followed by surgical resection, and, in some cases, adjuvant chemotherapy. This study aims to present current advances and ongoing controversies in the management of patients with locally advanced rectal cancer (LARC), with a particular focus on clarifying the role of total neoadjuvant therapy (TNT) in contemporary treatment strategies. Methods: We conducted a systematic literature review in Medline/PubMed using various keyword combinations, including “rectal cancer/neoplasia” and“therapy” or “neoadjuvant therapy” or “TNT”, and included articles published between 2015 and 2025. Results: The association of neoadjuvant radiochemotherapy with preoperative systemic chemotherapy has led to the current concept of total neoadjuvant therapy. The advantages of preoperative chemotherapy include better patient compliance, a decrease in the rate of local recurrence and distant metastases via the early destruction of infra-clinical micrometastases, and higher rates of pathological complete response. All of these have led to the inclusion of this strategy in treatment guidelines for patients with locally advanced rectal cancer. Conclusions: However, the selection of patients with advanced rectal tumors for optimal therapy requires comprehensive imaging assessments, molecular and genetic testing, and a multidisciplinary team to determine the most appropriate total neoadjuvant therapy approach. Full article

Background/Objectives: This retrospective study evaluates the predictive role of magnetic resonance imaging (MRI) in complications and recurrence in rectal cancer patients undergoing surgery and neoadjuvant therapy, highlighting the impact of structured reporting templates on MRI quality. Compared to traditional free-text reports, structured radiology reports offer a point-by-point evaluation, improving clarity and completeness by thoroughly addressing all relevant findings. MRI is critical in rectal cancer staging, guiding treatment based on tumor characteristics like T stage, sphincter involvement, vascular invasion, and lymph node status. Methods: A retrospective analysis of MRI and reports from 67 rectal cancer patients at the time of diagnosis, who were subsequently treated with neoadjuvant radiochemotherapy and surgery, was conducted. MRI report features, including tumor location, morphology, T stage, sphincter infiltration, mesorectal fascia involvement, lymph nodes, and extramural vascular invasion, were evaluated against European Society of Gastrointestinal and Abdominal Radiology (ESGAR) recommendations. Multivariate and univariate analyses were performed to correlate MRI findings with postoperative outcomes such as complications, local recurrence, bleeding, and 30-day anastomotic leaks. Results: Sphincter involvement showed a strong association with increased complications (multivariate β = 0.410, univariate r = 0.270). Extramural vascular invasion was linked to higher rates of local recurrence (multivariate β = 0.199, univariate r = 0.127). Lymph node involvement correlated with an elevated risk of postoperative bleeding (multivariate β = 0.133, univariate r = 0.293). Additionally, advanced T staging predicted a higher incidence of 30-day anastomotic leaks (multivariate β = 0.210, univariate r = 0.261). These findings may provide clinically relevant insights to support personalized surgical planning and improve preoperative risk stratification. Conclusions: Detailed MRI reporting, aligned with structured templates, significantly guides surgical and therapeutic strategies in rectal cancer management. However, the retrospective nature of the study and the limited sample size may affect the generalizability of the results. Full article

Platinum-based radiochemotherapy is associated with hematologic side effects, impacting patient outcomes. However, the clinical mechanisms of cisplatin and its interaction with ionizing radiation (IR), including in biodosimetry for radiotherapy, have not yet been fully clarified. For this purpose, healthy donors’ peripheral blood lymphocytes (PBLs) were pretreated with cisplatin in a pulse (1–4 h) or continuous (24 h) regimen followed by X-rays. DNA damage was assessed as DNA double-strand breaks using repair foci of γH2AX and 53BP1 after 0.5 h and 24 h in G1 PBLs and a proliferation-based cytokinesis-block micronucleus assay. Additionally, cell death and proliferation activity were measured. Unlike a 1 h pulse, a 24 h cisplatin pretreatment caused a concentration-dependent increase in cisplatin-induced foci while decreasing IR-induced foci, especially 24 h after irradiation. This was accompanied by increased apoptosis, with cisplatin and IR having additive effects. Both genotoxins alone caused a dose-dependent increase in micronuclei, while cisplatin significantly reduced binuclear cells, especially after the 24 h treatment, leading to lower micronuclei frequencies post-irradiation. Our results show that prolonged cisplatin exposure, even at low concentrations, impacts the vitality and division activity of PBLs, with significantly stronger effects post-irradiation. This has major implications and must be considered for the detection of DNA damage-associated biomarkers in PBLs used in clinical prediction or biodosimetry during radiotherapy. Full article

Background: The incidence of cancer in older patients is high, reaching 2.3 million world-wide in 2018 for patients aged over 80. Because the characteristics of this population make therapeutic choices difficult, co-management between geriatricians and other cancer specialists has gradually become essential. Methods: This narrative review aims to synthesize current data on the contribution of geriatric assessment in the management of elderly patients with non-colorectal digestive cancers. Oncogeriatric assessment is multi-domain, including the evaluation of co-morbidities, autonomy, nutrition, cognition, mood, and functional assessment. Results: Oncogeriatric parameters are predictive of mortality and adverse events. In the peri-operative phase of non-colorectal digestive cancer surgical management, geriatric management can assist in the decision-making process, identify frailties, and arrange a specific and personalized trimodal preoperative rehabilitation program, including nutritional management, adapted physical activity, and psychological care. Its aim is to limit the risks of confusion and of decompensation of comorbidities, mainly cardio-respiratory, which is associated with the highest morbidity in biliary-pancreatic surgery for older adults, facilitate recovery of previous autonomy when possible, and shorten hospital stay. For metastatic cancers, or during multimodal management, such as peri-operative chemotherapy for localized gastric cancers or pre-operative radio-chemotherapy for oesophageal or rectal cancers, specific assessment of the tolerance of chemotherapy is necessary. Neuropathic toxicity and chemobrain have a greater impact on elderly patients, with an increased loss of autonomy. Joint geriatric management can reduce the rate of grade 3–5 adverse effects of chemotherapy in particular and improve quality of life. Conclusions: Co-management between geriatricians and other specialties should be encouraged wherever possible. Full article