Search Results (141)

When non-functioning pituitary adenomas (NFPAs) behave aggressively or recur after first-line surgical treatment, it can be challenging to decide whether and how to escalate therapy. Up to 47% of patients with residual tumor after transsphenoidal surgery will show disease recurrence or progression and may require an intervention. Repeat surgical resection can be attempted in select cases if the tumor is accessible; for the remainder of patients, non-surgical treatment options may need to be considered. Radiotherapy can control tumor growth in 75% of NFPAs, but confers increased risk of hypopituitarism and other disorders. Currently, there are no medical therapies approved for patients with recurrent or aggressive NFPA. However, several have been investigated, including temozolomide, somatostatin receptor ligands, dopamine agonists, immune checkpoint inhibitors, vascular endothelial growth factor inhibitors, and peptide receptor radionuclide therapy. We present a review of the available evidence to provide guidance for pituitary endocrinologists and neuro-oncologists when treating patients with recurrent or aggressive NFPA. Full article

Background: Gynaecological oncology (GO) surgery involves a wide range of procedures, from minor diagnostic interventions to highly complex cytoreductive operations. Accurate perioperative diagnostics—particularly in major surgery—are critical to optimise patient care, predict morbidity, and facilitate shared decision-making. This study aimed to evaluate current practices in perioperative risk assessment amongst UK GO specialists, focusing on the use, perception, and applicability of diagnostic risk prediction tools. Methods: A national multicentre survey was distributed via the British Gynaecological Cancer Society (BGCS) to consultants, trainees, and nurse specialists. The questionnaire examined clinician familiarity with and use of existing tools such as POSSUM, P-POSSUM, and ACS NSQIP, as well as perceived reliability and areas for improvement. Results: Fifty-four clinicians responded, two-thirds of whom were consultant gynaecological oncologists. While 51.9% used morbidity prediction tools selectively, only 7.4% used them routinely for all major surgeries. The most common models were P-POSSUM (39.6%) and ACS NSQIP (25%), though over 20% did not use any formal tool. Despite this, 80% of respondents expressed a desire for more accurate, GO-specific models. Conclusions: This study reveals a gap between available perioperative diagnostics and real-world clinical use in GO surgical planning. There is an urgent need for validated, user-friendly, and GO-specific risk prediction tools—particularly for high-risk, complex surgical cases. Further research should focus on prospective validation of tools such as ACS NSQIP and their integration into routine practice to improve outcomes in gynaecological oncology. Full article

Goblet cell adenocarcinomas (GCAs) are an exceedingly rare subtype of tumors, almost exclusively occurring in the appendix, and characterized by features overlapping both adenocarcinomas and neuroendocrine tumors (NETs), which has historically led to confusion and varied nomenclature. This study presents a comprehensive review of the literature highlighting particularities of this type of malignancy, starting from a rare case of a 54-year-old female operated on in our clinic for an appendiceal tumor, initially suspected to be a mucinous neoplasm based on colonoscopic biopsy, which was ultimately confirmed to be goblet cell adenocarcinoma on both intraoperative frozen section and definitive pathological examination. Exhibiting signs and symptoms associated with an abdominal mass, she underwent a right hemicolectomy with partial omentectomy for locally advanced, high-grade, invasive goblet cell adenocarcinoma of the appendix with lymphatic macro metastases and epiploic invasion, categorized as AJCC stage IVb carcinomatosis. The patient received FOLFOX adjuvant. Six months later, she required reoperation due to the progression of carcinomatosis, which was again confirmed histopathologically. A second-line oncological protocol comprising irinotecan, capecitabine, and bevacizumab was initiated. Given the rarity of GCAs and the absence of a consensus on nomenclature, classification, and diagnostic criteria, we conducted a comprehensive literature review to highlight current trends related to this entity, including its classification within different systems (Tang, Yozu, WHO, AJCC), as well as the therapeutic surgical approaches—ranging from simple appendectomy to extensive multiorgan resection, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC), and the use of systemic therapy. Adhering to these recommendations will enhance communication among pathologists, surgeons, and oncologists regarding the natural history and prognosis of this rare malignancy. Full article

Introduction: Metastatic spinal cord compression (MSCC) is a life-threatening complication caused by the involvement of the spinal cord or nerve roots. It can result in severe neurological deficits, including paralysis, sensory loss, and bladder or bowel dysfunction, significantly affecting patients’ quality of life. Prompt diagnosis and intervention are critical to minimizing these outcomes and improving neurological recovery. This study evaluates the efficacy of a diagnostic and therapeutic protocol introduced at our institution in 2022, designed to enhance early detection, optimize management, and improve outcomes for patients with MSCC. Materials and Methods: The protocol was developed through a multidisciplinary collaboration involving emergency physicians, oncologists, spine surgeons, neuroradiologists, and radiation oncologists. Each specialty contributed its expertise to create a streamlined approach emphasizing early symptom recognition, rapid diagnostic imaging, and timely therapeutic interventions, such as surgical decompression and radiotherapy. To assess the protocol’s effectiveness, a retrospective analysis was conducted. Clinical data from the pre-implementation period (years 2019–2021) were compared to the post-implementation period (2022–2024). Results: The implementation of the algorithm significantly improved MSCC management, increasing outpatient consultations from 671 to 828 (+23%). Comparing the pre- to post-implementation periods, emergency consultations rose from 14% to 23%, while intrahospital consultations decreased from 20% to 16%. Surgical procedures increased slightly, from 60 to 66 (+10%), including 26 emergency surgeries (+4%) and 40 elective delayed surgeries (+14%). Conclusions: The introduction of a multidisciplinary diagnostic and therapeutic protocol significantly improved outpatient management of patients with metastatic spine disease, demonstrated by a significant increase in urgent outpatient consultations and a reduction in intrahospital consultations. The number of surgical interventions for metastatic spinal cord compression slightly increased after the protocol’s adoption, although the proportion of elective surgeries remained unchanged. Neurological presentation at the time of surgery did not show a statistically significant difference between the pre- and post-implementation periods. These findings highlight the protocol’s effectiveness in optimizing patient flow and triaging, while further research is needed to evaluate its long-term clinical impact. Full article

Advances in artificial intelligence (AI), multi-omic profiling, and sophisticated imaging technologies have significantly advanced personalized medicine in gastrointestinal surgical oncology. These technological innovations enable precise patient stratification, tailored surgical strategies, and individualized therapeutic approaches, thereby significantly enhancing clinical outcomes. Despite remarkable progress, challenges persist, including the standardization and integration of diverse data types, ethical concerns regarding patient privacy, and rigorous clinical validation of predictive models. Addressing these challenges requires establishing international standards for data interoperability, such as Fast Healthcare Interoperability Resources, and adopting advanced security methods, such as homomorphic encryption, to facilitate secure multi-institutional data sharing. Moreover, ensuring model transparency and explainability through techniques such as explainable AI is critical for fostering trust among clinicians and patients. The successful integration of these advanced technologies necessitates strong multidisciplinary collaboration among surgeons, radiologists, geneticists, pathologists, and oncologists. Ultimately, the continued development and effective implementation of these personalized medical strategies complemented by human expertise promise a transformative shift toward patient-centered care, improving long-term outcomes for patients with gastrointestinal cancer. Full article

Radical hysterectomy continues to be the standard treatment for early-stage cervical cancer. Accurate staging plays an important role in the management of cervical cancer, and preoperative imaging is indispensable to ensure appropriate stage assignment and to identify the surgical patient. Many studies have highlighted the need to consider the low-risk patient in a markedly different way from the intermediate- or high-risk patient. The aim of this study is to highlight the most urgent divergences to be addressed in low-risk early cervical cancer patients, such as reducing the radicality of the surgery, avoiding parametriectomy with tumors smaller than 2 cm, replacing bilateral lymphadenectomy with sentinel lymph node dissection, persistence of MIS instead of laparotomy, and preserving fertility. All this evidence is the result of the progress that has been made in recent decades in the early diagnosis, staging, and treatment of cervical cancer, made possible not only by the ever-increasing experience of gynecological oncologists but above all by the increasingly sophisticated imaging techniques that support the work of the clinician. Full article

Soft tissue sarcoma (STS) has an 2–8% incidence for all malignant tumors in the adolescent and young adult (AYA) population, which are patients from ages 15 to 39. As most STS tumors are aggressive, they require multimodal management with surgery, radiation and chemotherapy. This article discusses the survivorship considerations in this young population of cancer patients who complete therapy. The lasting side effects include surgical and radiation-related morbidity, chemotherapy toxicity, early and late secondary effects on other organ systems, such as cardiac and endocrine dysfunction, and the development of secondary cancers. The long-term psychologic and practical impacts for those who have received a sarcoma diagnosis in the prime of their life include fertility, mental health, relationship, education and career implications. Although there is a paucity of data in some of these areas, we present existing management guidelines as available. This article serves as a comprehensive review of this wide array of treatment effects intended for all providers participating in the care of AYA sarcoma survivors, to include oncologists, primary care providers and therapists. Full article

Gorlin–Goltz syndrome, also known as nevoid basal cell carcinoma syndrome (NBCCS), is a rare, inherited autosomal dominant disorder primarily caused by mutations in the PTCH1 gene, which regulates the Hedgehog signaling pathway. This genetic defect leads to the uncontrolled proliferation of basal cells, resulting in the formation of multiple basal cell carcinomas (BCCs) and odontogenic keratocysts (OKCs). This study aims to present a complex clinical case of a patient with Gorlin–Goltz syndrome who developed multiple recurrent metastatic basal cell carcinomas on the facial region, detailing the multidisciplinary treatment strategies employed and the challenges encountered during the management of the disease. The patient, diagnosed with a pathogenic PTCH1 gene mutation, underwent a series of treatment interventions over several years. These included multiple surgical excisions aimed at tumor removal, diverse radiotherapy approaches for residual or inoperable lesions, and systemic targeted therapy with Hedgehog pathway inhibitors to control tumor progression. The recurrent and aggressive nature of the basal cell carcinomas resulted in extensive facial tissue loss, posing significant challenges for radical tumor excision and subsequent reconstructive procedures. Multimodal therapeutic strategies, including Mohs micrographic surgery for precise tumor clearance and targeted systemic therapy with vismodegib, were implemented. However, the aggressive progression of lesions required ongoing surgical interventions, highlighting the limitations of current treatment modalities in achieving long-term disease control. This case underscores the critical need for a comprehensive, multidisciplinary approach to managing Gorlin–Goltz syndrome. Successful management requires close collaboration between dermatologists, oncologists, maxillofacial surgeons, and plastic surgeons to balance effective tumor control with optimal functional and aesthetic outcomes. The integration of advanced surgical techniques and targeted molecular therapies shows promise in improving patient outcomes. Nonetheless, early diagnosis, rigorous follow-up, and patient education remain essential components in minimizing disease progression and enhancing the quality of life for affected individuals. Full article

Breast cancer treatment has evolved significantly in recent decades, with personalized care models gaining prominence both for the optimization of oncological outcomes and aesthetic results. At the Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome, Italy, we have developed a multidisciplinary, evidence-based model for the management of breast cancer patients, called ROME (Radiological and Oncoplastic Multidisciplinary Evaluation). This innovative model integrates the expertise of various specialists in a seamless, patient-centered approach to improve treatment planning and outcomes. ROME involves a collaborative framework between radiologists, oncologists, surgeons, pathologists, oncoplastic specialists and psychologists. The process begins with the detailed radiological evaluation of tumors using advanced imaging techniques, which is then complemented by an oncoplastic assessment to evaluate potential surgical approaches that ensure optimal oncological resections while preserving or enhancing breast aesthetics. The combination of these evaluations allows the team to tailor treatment plans according to the patient’s specific clinical profile, including tumor characteristics, genetic factors, and aesthetic considerations. A key feature of the ROME model is the continuous integration of evidence-based guidelines with real-time multidisciplinary input. This enables the personalization of surgical strategies, ensuring that each patient receives a treatment plan that balances the need for effective cancer control with the desire for an optimal aesthetic result. Since its implementation, ROME has demonstrated significant improvements in both oncological and cosmetic outcomes, leading to enhanced patient satisfaction and quality of life. The success of ROME underscores the importance of a holistic and collaborative approach to breast cancer treatment, one that integrates clinical, radiological, and aesthetic perspectives to offer a truly personalized and patient-focused care experience. As evidence continues to accumulate, ROME stands as a model for personalized breast cancer surgery, setting a new standard for care in multidisciplinary oncology settings. Full article

Objective: Providing high-quality, safe, and consistent care for patients with cancer in the emergency department (ED) poses unique challenges. To better understand these challenges, we surveyed oncologists and emergency medicine (EM) physicians across five institutions to identify key areas for improvement in oncologic EM. Methods: In this multi-institutional, cross-sectional qualitative study, a semi-structured survey was administered to EM attending and resident physicians and medical and surgical oncologists across five institutions in 2023. We assessed the open-ended questionnaire responses using thematic analysis; codes were created and collated to generate initial themes. The themes were then reviewed according to specialty for coherence and non-repetition and finalized. Results: Of the 302 surveys accessed, 185 (61.3%) had complete responses. Three main domains of issues emerged: systems-based challenges, direct patient care-related issues, and knowledge gaps. The issues most frequently perceived by oncologist survey respondents were long delays in care (41%), variability in care (25%), and communication issues between the EM physician and oncologist (14%). The issues most frequently perceived by EM physician survey respondents were knowledge gaps in cancer therapeutics (40%) and in general oncologic emergencies (23%); physician comfort level (14%); the timing and/or location of initial discussions about goals of care (13%); and challenges with the follow-up process (12%). Conclusions: Incorporating an interdisciplinary approach to patient care in the ED, improved EM oncologic education, and the development of oncologic specialized EDs may enhance the quality, safety, and consistency of care for patients with cancer in the ED. Full article

Background: Breast cancer in women aged 80 years and older accounts for about 12% of cases, but its management is challenging due to the population’s heterogeneity and the lack of relevant evidence-based guidelines. Treatment decisions must consider biological age, comorbidities, life expectancy, therapy-related toxicities, and tumor biology. This study evaluates the clinical outcomes of elderly breast cancer patients treated with a multidisciplinary approach, including oncologists, surgeons, and geriatric specialists. Materials and Methods: A retrospective analysis of breast cancer patients aged ≥80 years treated at Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome, Italy, from January 2016 to December 2020 was conducted. The study reviewed clinicopathological data, surgery, adjuvant therapies, and clinical outcomes. Treatment decisions were guided by multidisciplinary evaluations, including onco-geriatric assessments (GA) and guided treatment decisions. Primary outcomes included overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS). Surgical and treatment-related complications were also documented. Results: A total of 238 patients aged ≥80 years were included in the study. Of these, 203 (85.3%) underwent breast-conserving surgery, while 35 (14.7%) underwent mastectomy. Axillary surgery was performed in 129 (54%) cases. Regarding adjuvant treatments, 93 (39.1%) patients received radiotherapy, and 101 (42.4%) received endocrine therapy alone. Chemotherapy was administered to six high-risk patients following GA, with no reported toxicities. Over a median follow-up of 42.3 months, the study reported one local recurrence (0.5%), one regional node recurrence (0.5%), and 19 cases of distant metastases (9%). A total of 19 patients (9%) died due to breast cancer. The overall complication rate was low, with 10% experiencing wound dehiscence, hematoma, lymphedema, or similar issues. Five-year survival outcomes were OS 73.3%, DFS 66.6%, and CSS 88.5%. Conclusions: This study highlights that a multidisciplinary approach to breast cancer management in patients aged ≥80 years yields favorable clinical outcomes with low recurrence, metastasis, and complication rates. The personalized treatment strategies, guided by onco-geriatric assessments, balance survival benefits with quality of life while minimizing risks of overtreatment or undertreatment. These findings emphasize the importance of individualized care in this complex patient population and offer valuable insights for optimizing management strategies as the elderly demographic continues to grow. Full article

Background/Objectives: Fertility-sparing surgery (FSS) is a standard practice for managing early stage cervical cancer, yet significant variation exists in clinical approaches worldwide. Our objective was to ascertain current practices and preferences for cerclage use among expert centers globally regarding FSS in patients with early stage cervical cancer. Methods: We conducted a cross-sectional survey from May to July 2023 involving expert centers identified through their scientific contributions and participation in international workgroups and conferences.. The survey, comprising 27 questions, evaluated existing practices in FSS. Results: Out of the centers surveyed, 21 (36.2%) gynecologic oncologists responded. For tumors <2 cm, 86% of centers preferred radical trachelectomy, primarily via the vaginal approach, while 13.6% favored a simple trachelectomy. Three experts preferred simple trachelectomy (13.6%). For tumors >2 cm, 47.6% utilized neoadjuvant chemotherapy before trachelectomy. Others did not offer FSS or performed an abdominal radical trachelectomy. Over time, there has been a shift towards less radical surgeries for tumors <2 cm and increased use of neoadjuvant chemotherapy for larger tumors. Some abandoned the minimally invasive surgical approach. Nearly all experts (90.5%) placed a cerclage immediately following trachelectomy. Conclusions: The majority of experts opt for radical trachelectomy in early stage cervical cancer, with immediate cerclage placement being a common practice. However, considerable international variations highlight the urgent need for standardized guidelines and further research to optimize treatment strategies, balancing oncological safety with fertility outcomes. Full article

Background: Immunotherapy (IO)-based strategies have been demonstrated to significantly prolong survival in the perioperative setting of non-oncogene-addicted non-small cell lung cancer (NSCLC). The adoption of such strategies in clinical practice depends on heterogeneous regulatory approvals and on the agreement between medical oncologists and thoracic surgeons on patients’ selection. Methods: An Expert Panel Meeting of medical oncologists and thoracic surgeons was held virtually by the Italian Association of Thoracic Oncology (AIOT) to discuss results of pivotal clinical trials with perioperative chemo-immunotherapy and reach agreement on open issues for the topic, formulating specific statements based on initially proposed discussion questions. Results: Overall, panelists found agreement on seven statements. With regard to tissue and biomarker analysis, the role of increasing PD-L1 expression in predicting IO efficacy was recognized, whereas ctDNA and pCR were mainly attributed a prognostic role, in the absence of dedicated studies. The panelists acknowledged direct relationship between the benefit of neoadjuvant chemo-immunotherapy approaches and the local burden of disease/mediastinal node involvement, supporting the inclusion of these factors, together with PD-L1, in selecting upfront surgery or induction treatment. The panelists agreed that the current literature data do not answer the issue of assessing the role of the adjuvant phase within a perioperative treatment strategy. Surgical considerations on the role of pneumonectomy and other approaches were also discussed. Conclusions: This experience highlights the importance of a synergistic approach between oncologists and surgeons to leverage the unmet needs in translating results of IO-perioperative clinical trials into clinical practice in patients with resectable NSCLC. Full article

Over the past two decades, minimally invasive approaches in rectal surgery have changed the landscape of surgical interventions, impacting both malignant and benign pathologies. The dynamic nature of rectal cancer treatment owes much to innovations in surgical techniques, reflected in the expanding literature on available treatment modalities. Local excision, facilitated by minimally invasive surgery, offers curative potential for patients with early T1 rectal cancers and favorable pathologic features. For more complex cases, laparoscopic and robotic surgery have demonstrated significant efficacy and provided precise, durable outcomes while reducing perioperative morbidity and enhancing postoperative recovery. Additionally, advancements in imaging, surgical instrumentation, and enhanced recovery protocols have further optimized patient care. The integration of multidisciplinary care has also emerged as a cornerstone of treatment, emphasizing collaboration among surgeons, oncologists, and radiologists to deliver personalized, evidence-based care. This narrative review aims to elucidate current minimally invasive surgical techniques and approaches for rectal pathologies, spanning benign and malignant conditions, while also exploring future directions in the field, including the potential role of artificial intelligence and next-generation robotic platforms. Full article

Recently, homologous recombination deficiency (HRD) has become a new target for hereditary cancers. Molecular-based approaches for hereditary cancers in the clinical setting have been reviewed. In particular, the efficacy of the PARP inhibitor has been considered by several clinical trials for various kinds of hereditary cancers. This indicates that the PARP inhibitor can be effective for any kind of BRCA mutated cancers, regardless of the organ-specific cancer. Homologous recombination deficiency (HRD) has become a new target for hereditary cancers, indicating the necessity to confirm the status of HRD-related genes. ARID1A, ATM, ATRX, PALB2, BARD1, RAD51C and CHEK2 are known as HRD-related genes for which simultaneous examination as part of panel testing is more suitable. Both surgical and medical oncologists should learn the basis of genetics including HRD. An understanding of the basic mechanism of homologous repair recombination (HRR) in BRCA-related breast cancer is mandatory for all surgical or medical oncologists because PARP inhibitors may be effective for these cancers and a specific strategy of screening for non-cancers exists. The clinical behavior of each gene should be clarified based on a large-scale database in the future, or, in other words, on real-world data. Firstly, HRD-related genes should be examined when the hereditary nature of a cancer is placed in doubt after an examination of the relevant family history. Alternatively, HRD score examination is a solution by which to identify HRD-related genes at the first step. If lifetime risk is estimated at over 20%, an annual breast MRI is necessary for high-risk screening. However, there are limited data to show its benefit compared with BRCA. Therefore, a large-scale database, including clinical information and a long-term follow-up should be established, after which a periodical assessment is mandatory. The clinical behavior of each gene should be clarified based on a large-scale database, or, in other words, real-world data. Full article