Search Results (1,114)

Objective: Radiotherapy remodels the tumor microenvironment (TME) and may enhance the efficacy of immunotherapy in cancer treatment, particularly in patients with large, unresectable hepatocellular carcinoma (HCC) complicated by portal vein tumor thrombus (PVTT). Because of these unique effects, a growing body of research has found that stereotactic body radiation therapy (SBRT) combined with transcatheter arterial chemoembolization (TACE) or programmed death protein 1 (PD-1) inhibitors has a synergistic impact on unresectable advanced hepatocellular carcinomas (HCCs) larger than 5 cm in diameter. We aim to explore the efficacy of these treatment modalities through a network meta-analysis (NMA). Methods and Analysis: We evaluated the efficacy and safety of different SBRT-based treatment modalities for large advanced HCCs with PVTT (tumor diameter ≥ 5 cm), with primary endpoints including overall survival (OS), progression-free survival (PFS), and grade 3–4 severe adverse events (SAEs). Results: Eighteen studies comprising 2303 patients were included. SBRT combined with transcatheter arterial chemoembolization (SBRT + TACE) demonstrated significantly superior overall survival compared with other monotherapy or combination strategies. Most other treatment regimens showed comparable PFS outcomes. Notably, SBRT alone and SBRT combined with PD 1 inhibitors (SBRT + PD 1) were associated with significantly lower incidences of severe adverse events compared with other treatment modalities; all of these reported SAEs were manageable with appropriate clinical intervention. Conclusions: For patients with large (≥5 cm) advanced HCC with PVTT, SBRT combined with TACE was associated with superior OS and PFS compared with other treatment strategies. These findings suggest potential synergistic interactions between SBRT and TACE or immunotherapy. Further high-quality prospective trials are warranted to validate these observations and clarify the underlying molecular mechanisms. Our results provide evidence to inform therapeutic decision-making in advanced HCC. Full article

Background: Stereotactic body radiotherapy (SBRT) has gained increasing interest in the treatment of locally advanced pancreatic cancer (LAPC), although its effectiveness has not been defined in randomized trials. This systematic review and meta-analysis aimed to compare clinical outcomes and treatment-related toxicity between SBRT and CFRT in LAPC. Methods: This analysis was performed in accordance with PRISMA guidelines (PROSPERO: CRD420251128943). MEDLINE and Scopus were searched for comparative studies published between January 2015 and July 2025. Five retrospective studies comprising 768 patients fulfilled the eligibility criteria. Pooled hazard ratios (HRs) were calculated for overall survival (OS) and progression-free survival (PFS), while risk ratios (RRs) were estimated for severe (grade ≥ 3) acute toxicity using random-effects models. Study quality was evaluated using the ROBINS-I tool. Results: No significant OS or PFS differences were observed between SBRT and CFRT. SBRT was associated with a lower incidence of severe acute toxicity. The overall risk of bias across studies was moderate. Conclusions: SBRT appears to achieve survival outcomes comparable to CFRT with a favorable acute toxicity profile in patients with LAPC. Nevertheless, the current evidence is limited by retrospective designs and heterogeneity, highlighting the need for prospective randomized trials to define the role of SBRT in this setting. Full article

Background/Objectives: Hemangioblastomas are rare, benign, highly vascular tumors of the central nervous system, frequently associated with von Hippel–Lindau (vHL) disease. Case Presentation: We report a 16-year-old female with vHL presenting with recurrent headaches, abdominal distension, and ocular discomfort. Imaging revealed hemangioblastomas in the fourth ventricle and retrobulbar space, alongside multiple pancreatic cysts. The patient underwent three sessions of Gamma Knife Surgery (GKS) with initial tumor regression and symptom relief. However, long-term follow-up demonstrated progressive disease, with new lesions in the cerebellum, spinal cord, and orbit, including cystic transformation. Histopathology confirmed the reticular variant of hemangioblastoma. Despite further radiosurgical and surgical recommendations, the patient and family opted for conservative management, with lesions remaining radiographically stable over nine years. Conclusions: This case demonstrates that Gamma Knife Surgery may provide temporary local disease control for selected solid hemangioblastomas in von Hippel–Lindau disease but does not alter the underlying disease course. Long-term radiographic stability should be interpreted cautiously, as hemangioblastomas exhibit saltatory growth patterns that make it difficult to distinguish treatment effect from natural tumor quiescence. These findings emphasize that radiosurgery should be regarded as a disease-control strategy rather than curative therapy, underscoring the importance of individualized management, multidisciplinary decision-making, and prolonged surveillance. Full article

Background/Objectives: Localized prostate cancer may be treated with total cryotherapy, focal cryotherapy, stereotactic body radiotherapy (SBRT), or radical prostatectomy (RP). However, the immune response to these therapies is not fully understood despite its potential importance in determining extent and timing of recovery, disease control and cancer recurrence rate. This exploratory study measured cytokine expression changes in the urine and blood of prostate cancer patients as a means of monitoring immune response to these four alternative treatments. Methods: Urine and blood multiplex ELISA cytokine assays were performed in 37 men with histologically confirmed prostate adenocarcinoma before, 2 weeks after, and 3 months after therapy. Results: Treatment method alone significantly affected levels of plasma but not urine cytokines. Both plasma and urine showed significant changes across visit number and significant interactions between treatment and visit number for some cytokines. In plasma, SBRT was associated with the highest cytokine levels when compared to RP and cryotherapy. Urinary IL-8 levels increased over time following cryoablation, whereas they remained relatively stable across visits after SBRT and RP (β = 1.51, 95% CI [0.89–2.13], p < 0.001). Urinary IL-6 levels reached their highest point at visit three following both SBRT and cryoablation, whereas after RP, the peak occurred earlier at visit two (β = 0.07, 95%CI [0.04–0.11], p < 0.001). The pattern of plasma levels of IL-10 differed by time elapsed after treatment depending upon treatment group (β = −0.05, 95%CI [−0.08–−0.01], p = 0.005). Conclusions: These findings show that the prostate cancer treatment method employed may affect post-operative inflammatory mechanisms. This small study encourages expansion to determine the prognostic utility of urine and plasma cytokine expression patterns based on prostate cancer treatment and time elapsed following treatment. Understanding these changes may inform a personalized medicine approach to prostate cancer immunotherapies. Full article

Introduction: Stereotactic radiotherapy (SRT) is increasingly used in oligometastatic non-small-cell lung cancer (NSCLC) and is known to elicit systemic immune effects, although the underlying mechanisms remain not fully understood. Methods: In this prospective pilot study, we evaluated plasma cytokine variations in 19 patients with oligometastatic or oligoprogressive NSCLC undergoing SRT. Peripheral blood samples were collected before treatment (T0) and one month after SRT (T1) and the concentrations of nine cytokines (IFN-γ, IL-1β, IL-2, IL-4, IL-6, IL-10, IL-12p70, IL-17A and TNF-α) were quantified using a multiplex Luminex assay. Non-parametric tests and Cox regression models were used to investigate associations between cytokine levels, clinical variables, systemic treatments, and survival outcomes. SRT induced significant post-treatment increases in IFN-γ, IL-2, and IL-6, consistent with systemic pro-inflammatory activation and T-cell stimulation. Cytokine dynamics were influenced by patient- and tumor-related factors: female sex was associated with higher IL-2 and TNF-α levels; oncogene-addicted tumors showed lower IL-6 levels; and oligoprogressive disease exhibited attenuated cytokine variations compared with metachronous oligometastatic disease. Tyrosine kinase inhibitors were associated with globally reduced cytokine levels and blunted IL-1/IL-2 changes, whereas patients receiving immune checkpoint inhibitors displayed higher IL-2 and IL-6 concentrations and greater post-SRT increases in IFN-γ. Oncogene-addicted status and IL-12 variation emerged as independent predictors of overall survival and a composite model integrating these variables significantly stratified prognosis. Conclusions: These findings suggest that SRT triggers measurable systemic immune activation in oligometastatic NSCLC, which is further shaped by tumor biology, disease burden, and concomitant systemic therapies. Although limited by the small sample size, this study supports the feasibility and potential utility of cytokine profiling to refine patient selection and guide biomarker-driven combinations of SRT with targeted and immune-based treatments, warranting validation in larger prospective cohorts. Full article

Background: Schwannomas of the third cranial nerve are exceedingly rare benign tumors, and standardized management guidelines are lacking. Their close relationship with critical neurovascular structures makes diagnosis and treatment challenging, with a significant risk of postoperative neurological deficits. Methods: A systematic review of the literature was conducted according to the PRISMA guidelines, including case reports and clinical studies on oculomotor nerve schwannomas (ONSs). Demographic data, clinical presentation, tumor location, diagnostic methods, treatment strategies, and functional outcomes were analyzed. In addition, an illustrative case treated with a multimodal approach is presented. Results: Ninety-six cases met the inclusion criteria. The mean age at diagnosis was 34 years, with a slight female predominance. The most common presenting symptoms were diplopia and ptosis. Contrast-enhanced magnetic resonance imaging was the diagnostic modality of choice. Surgical resection was the primary treatment in most cases but was associated with worsening oculomotor nerve function in 43.1% of surgically treated patients. Stereotactic radiotherapy demonstrated favorable tumor control with lower neurological morbidity. In the presented case, subtotal resection followed by stereotactic radiotherapy resulted in sustained tumor stability at the one-year follow-up. Conclusions: Management of oculomotor nerve schwannomas should be individualized. For small or mildly symptomatic lesions, stereotactic radiotherapy appears to be an effective and less invasive option, while surgery should be reserved for large tumors causing a mass effect or progressive neurological deterioration. Full article

This study investigates the ongoing electrical activity of local neural networks—referred to as neurodynamics—across 37 anatomically defined brain regions. We analyzed stereotactic intracranial EEG (sEEG) recordings from 106 subjects during wakeful rest, focusing on scale-free (power-law) properties to determine whether distinct brain regions exhibit unique neurodynamic signatures. Results revealed a power-law regime in two frequency ranges (approximately 0.5–4 Hz and 33–80 Hz). Notably, the power-law exponent (slope) in the high-frequency band differed significantly between cortical and subcortical areas (p < 0.01). These findings suggest that local neurodynamics, as reflected in scale-free characteristics, may serve as a functional “fingerprint” for brain region classification. This approach may contribute to functional brain parcellation efforts and offer new insights into the intrinsic organization of neuronal networks as revealed by resting-state activity analysis. Full article

Primary intracranial squamous cell carcinoma (SCC) arising from an epidermoid cyst is an exceptionally rare and aggressive malignancy with a dismal prognosis. Conventional management typically involves gross total resection followed by wide-field radiotherapy; however, this intensive approach is often unfeasible for elderly or frail patients. We present a case of primary intracranial SCC in a 75-year-old woman who presented with rapid cochleovestibular deterioration. Imaging revealed subtle enlargement of a long-standing cerebellopontine angle epidermoid cyst. Subtotal resection was performed to preserve critical neurovascular structures adherent to the infiltrative tumor. Given the patient’s poor performance status and the risk of toxicity from broad-field radiation, adjuvant Gamma Knife radiosurgery (GKS) was selected as a focal salvage modality. Despite the limited surgical margin, the patient has maintained a progression-free status with no radiographic evidence of disease progression for 18 months without neurological decline. This case highlights the diagnostic challenge of malignant transformation disguised by radiologic mimicry and demonstrates that GKS can serve as an effective and tolerable adjuvant strategy. We propose that for high-risk patients precluded from intensive multimodal therapy, focused stereotactic irradiation offers a viable alternative to secure local control while preserving quality of life and systemic immune integrity. Full article

Background: Stereotactic brain biopsy is the gold standard for the pathological diagnosis of malignant brain tumors. However, conventional procedures rely heavily on manual path planning and unintuitive navigation, which significantly increase the risk of severe complications and impose an additional cognitive burden on surgeons. Methods: We propose an augmented reality-based navigation system that synergizes multi-objective path planning with hybrid registration. Preoperatively, the system utilizes a constrained multi-objective optimization (MOO) model derived from clinical criteria to automatically calculate and visualize optimal biopsy paths within a three-dimensional anatomical environment. Intraoperatively, the system performs rapid initial alignment using quick response (QR) codes, followed by precise refinement through anatomical landmarks. This process ultimately enables the highly accurate, real-time overlay of the surgical path and anatomical models onto the patient’s operative field. Results: An expert study across four common brain tumor locations demonstrated that the MOO model significantly outperformed manual methods in satisfying safety criteria. The hybrid registration reduced the mean fiducial registration error (FRE) from 4.19 ± 1.11 mm to 2.37 ± 0.91 mm (p < 0.001), with a mean target registration error (TRE) of 2.34 ± 0.71 mm and a mean clinical setup time of 2.63 ± 0.36 min. Conclusions: This system assists stereotactic brain biopsy through automated path planning and immersive augmented reality-based guidance, highlighting its potential to support surgical workflow consistency and procedural safety. Full article

Objective: This study aims to report the early safety outcomes from an ongoing single-center, non-randomized phase 2 trial on focal salvage stereotactic radiotherapy (s-SBRT) for local prostate cancer recurrence. Materials and methods: This prospective phase 2 study includes patients with local recurrence after conventional or hypofractionated radiotherapy, ultrahypofractionated radiotherapy, or post-prostatectomy radiotherapy. The present analysis includes an initial subset of 21 out of 55 planned patients. All patients undergo mpMRI and PSMA-PET; biopsy is not required if imaging results are unambiguous. Focal s-SBRT is delivered to the recurrent lesion with a dose of 5 × 6.75 Gy. The primary endpoint is the rate of treatment-related CTCAE v5.0 grade ≥ 3 genitourinary (GU) or gastrointestinal (GI) toxicity. Secondary endpoints include early biochemical response (BR), defined as any PSA decline at 3 months. Results: With a median follow-up of 14 months (range: 4.5–25), one patient (4.8%) experienced both early and persistent late Grade 3 GU toxicity (bladder bleeding). Late Grade 2 GU and GI toxicities occurred in five (23.8%) and one (4.8%) patients, respectively. In exploratory univariable analysis, PTV volume 13 cc was identified as a marginal predictor for increased GU/GI radiation reactions (p < 0.1). Regarding efficacy, all 21 patients (100%) demonstrated an early biochemical response, with 15 patients (71.4%) achieving a PSA reduction of 50%. Conclusions: Focal s-SBRT demonstrates a favorable early safety profile and consistent biochemical response, supporting the preliminary safety of this ongoing study. Full article

Surgical resection of liver and lung metastases in breast cancer is increasingly considered a viable option for select patients with oligometastatic disease. Historically regarded as palliative, surgery is now supported by retrospective data suggesting potential survival benefits, particularly in patients with hormone receptor-positive or HER2-positive tumors, long disease-free intervals, and limited metastatic burden. This narrative review summarizes recent evidence on the surgical management of breast cancer metastases to the liver and lung, with a focus on patient selection, perioperative outcomes, and long-term survival. Liver metastasectomy has shown 5-year overall survival rates of up to 60% in well-selected patients, while pulmonary metastasectomy is associated with comparable outcomes when resection is complete and nodal involvement is absent. Minimally invasive techniques and non-surgical approaches, such as microwave ablation and stereotactic radiotherapy, expand treatment options for patients unfit for surgery. The review also explores emerging tools influencing surgical decision-making, including circulating tumor DNA for minimal residual disease detection, transcriptomic profiling to predict organotropism, and artificial intelligence (AI)-driven platforms that assist with surgical planning and multidisciplinary case evaluation. While prospective validation remains limited, these technologies may help redefine surgical candidacy through biologically informed algorithms. Ultimately, the integration of surgery within a multimodal, personalized treatment strategy—guided by systemic control, tumor biology, and evolving digital tools—represents an evolving and biologically informed direction for rigorously selected patients with visceral breast cancer metastases. Full article

Primary central nervous system lymphoma (PCNSL) is an aggressive malignancy for which early management decisions frequently occur within neurosurgical workflows prior to oncologic treatment. In this retrospective single-center study, we aimed to explore whether early neurosurgical workflow characteristics are associated with survival outcomes in patients with PCNSL. Consecutive adult patients diagnosed with PCNSL between 2012 and 2022 were included, and the variables of interest comprised pre-biopsy corticosteroid exposure, the interval between diagnostic magnetic resonance imaging (MRI) and stereotactic biopsy, and the time from biopsy to initiation of high-dose methotrexate–based induction therapy. All patients were treated under a standardized hematology protocol to limit systemic treatment heterogeneity. Overall survival (OS) and progression-free survival (PFS) were calculated from the date of diagnostic biopsy, and survival analyses were performed using Kaplan–Meier methods and log-rank testing. Twenty-nine patients met the inclusion criteria. Median OS and PFS were not reached in steroid-naïve patients, whereas pre-biopsy corticosteroid exposure was associated with consistently shorter survival trajectories, with a clear separation of the survival curves, despite conventional statistical significance not being reached. Similarly, median OS and PFS were not reached in patients undergoing biopsy within 7 days of MRI, and an MRI-to-biopsy interval exceeding 7 days demonstrated an unfavorable survival trajectory compared with earlier biopsy; biopsy-to-induction timing did not show a measurable association with early survival outcomes. Established prognostic stratification using Memorial Sloan–Kettering Cancer Center classes showed expected survival discrimination within the cohort, supporting internal validity. Given the limited sample size and retrospective design, all findings should be interpreted as exploratory associations rather than evidence of causality. These results suggest that early neurosurgical workflow characteristics, particularly empiric pre-biopsy corticosteroids avoidance and diagnostic delay minimization, may be associated with early survival trajectories in PCNSL and warrant further evaluation in larger prospective studies. Full article

Renal cell carcinoma (RCC), particularly the clear cell subtype, is a solid tumor characterized by a high degree of immune cell infiltration, progressive immune dysfunction, and favorable response to immune checkpoint inhibitors (ICIs). Dual checkpoint inhibition or single-agent ICIs with anti-angiogenic therapies have become the standard of care in the treatment of advanced and metastatic RCCs. Locally advanced and oligometastatic RCCs are distinct clinical categories that are characterized by local invasion and initially limited metastatic spread, respectively, with different therapeutic responses and prognoses compared to either localized or advanced diseases. Herein, we summarize the biology, treatment, and molecular profiling of RCCs, providing an update on the clinical trials pertaining to cancer patients with locally advanced and oligometastatic RCC. We also discuss molecular features that could contribute to a better understanding of the tumor biology driving locally advanced and oligometastatic RCC. Full article

The integration of artificial intelligence (AI) into medicine, oncology, and radiology represents a marked shift in the diagnosis, prognostication, and management of hepatocellular carcinoma (HCC), a malignancy with high global incidence and poor prognosis. This review examines the application of AI, including machine learning (ML) and deep learning (DL), across the spectrum of HCC care. As AI advances, new convolutional neural networks (CNNs) and other models are enhancing diagnostic accuracy, reducing interpretation times, and improving the characterization of liver lesions across major imaging modalities including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). Beyond diagnosis, the transformative role of AI in prognostication is also improving, where AI can now noninvasively predict critical factors such as microvascular invasion, genetic mutation status, tumor recurrence, and treatment response. Furthermore, AI has shown promise in facilitating patient-specific treatment planning by stratifying patients for interventions such as transarterial chemoembolization (TACE) and stereotactic body radiation therapy (SBRT). The review also addresses the emerging fields of pathomics and the use of AI in positron emission tomography (PET), while critically evaluating the cost-effectiveness of these technologies. Despite its promise, the widespread clinical adoption of AI faces challenges, including limited generalizability, maintaining patient privacy, ethical considerations, and the need for robust prospective validation. Ultimately, this review illustrates that the future of HCC management lies in a collaborative, hybrid-intelligence model, where AI-driven insights augment clinical expertise to optimize diagnostic pathways, personalize therapy, and improve patient outcomes. Full article

Stereotactic body radiation therapy (SBRT) for localized prostate cancer delivers high doses per fraction, making dose constraints for the rectum and other organs at risk critical during treatment planning. This study evaluated the association between prostate–rectum separation, achieved with a biodegradable balloon rectal spacer at different anatomical levels, and corresponding organ-at-risk dose patterns. Thirty-three patients underwent transperineal balloon spacer implantation followed by SBRT to 36.25 Gy in five fractions. Prostate–rectum separation at the apex, mid-gland, and base were measured on CT and/or MRI and categorized as <10 mm, 10–14 mm, or ≥14 mm. Rectal dose–volume parameters and mean doses to the rectum, bladder, and penile bulb were assessed using linear regression analyses and group comparisons at 14 mm separation. Mean prostate–rectum separation was 16.6 mm overall, with minimal high-dose rectal exposure observed. Increasing separation was associated with reduced rectal dose–volume parameters at the apex and mid-gland, while greater base separation corresponded primarily to lower bladder mean dose. Increased apical separation was also associated with reduced penile bulb mean dose. No acute gastrointestinal toxicity was observed, and genitourinary toxicity was limited to low-grade events. These findings indicate that prostate–rectum separation varies by anatomical level and is associated with distinct organ-at-risk dose relationships in prostate SBRT. Full article