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Current Oncology
Volume 30
Issue 3
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Curr. Oncol., Volume 30, Issue 3 (March 2023) – 77 articles

Cover Story (view full-size image): AKI is common after hematopoietic cell transplantation with associated increased morbidity and mortality. The etiology of AKI is often multifactorial, including kidney hypoperfusion, drug nephrotoxicity, and other transplant-related complications, such as transplant-associated thrombotic microangiopathy and sinusoidal obstructive syndrome. Initial management includes the early identification of AKI etiology, preventing kidney hypoperfusion, adjusting nephrotoxic medications, and avoiding fluid overload. Some patients will require kidney replacement therapy to manage the fluid overload and AKI. Long-term follow-up and monitoring of renal function (glomerular filtration rate and microalbuminuria) is required, along with the management of hypertension to prevent chronic kidney disease. View this paper
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14 pages, 1806 KiB  
Article
Alcoholic Liver Disease-Related Hepatocellular Carcinoma: Characteristics and Comparison to General Slovak Hepatocellular Cancer Population
by Dominik Šafčák, Sylvia Dražilová, Jakub Gazda, Igor Andrašina, Svetlana Adamcová-Selčanová, Radovan Barila, Michal Mego, Marek Rác, Ľubomír Skladaný, Miroslav Žigrai, Martin Janičko and Peter Jarčuška
Curr. Oncol. 2023, 30(3), 3557-3570; https://doi.org/10.3390/curroncol30030271 - 22 Mar 2023
Cited by 3 | Viewed by 2900
Abstract
Hepatocellular carcinoma (HCC) has multiple molecular classes that are associated with distinct etiologies and, besides particular molecular characteristics, that also differ in clinical aspects. We aim to characterize the clinical aspects of alcoholic liver disease-related HCC by a retrospective observational study that included [...] Read more.
Hepatocellular carcinoma (HCC) has multiple molecular classes that are associated with distinct etiologies and, besides particular molecular characteristics, that also differ in clinical aspects. We aim to characterize the clinical aspects of alcoholic liver disease-related HCC by a retrospective observational study that included all consequent patients diagnosed with MRI or histologically verified HCC in participating centers from 2010 to 2016. A total of 429 patients were included in the analysis, of which 412 patients (96%) had cirrhosis at the time of diagnosis. The most common etiologies were alcoholic liver disease (ALD) (48.3%), chronic hepatitis C (14.9%), NAFLD (12.6%), and chronic hepatitis B (10%). Patients with ALD-related HCC were more commonly males, more commonly had cirrhosis that was in more advanced stages, and had poorer performance status. Despite these results, no differences were observed in the overall (median 8.1 vs. 8.5 months) and progression-free survival (median 4.9 vs. 5.7 months). ALD-HCC patients within BCLC stage 0–A less frequently received potentially curative treatment as compared to the control HCC patients (62.2% vs. 87.5%, p = 0.017); and in patients with ALD-HCC liver function (MELD score) seemed to have a stronger influence on the prognosis compared to the control group HCC. Systemic inflammatory indexes were strongly associated with survival in the whole cohort. In conclusion, alcoholic liver disease is the most common cause of hepatocellular carcinoma in Slovakia, accounting for almost 50% of cases; and patients with ALD-related HCC more commonly had cirrhosis that was in more advanced stages and had poorer performance status, although no difference in survival between ALD-related and other etiology-related HCC was observed. Full article
(This article belongs to the Special Issue Hepatocellular Carcinoma: Epidemiology, Pathogenesis and Treatment)
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<p>Flowchart of the study analysis according to STROBE guidelines.</p> Full article ">Figure 2
<p>Overall survival according to study groups by Kaplan–Meier analysis.</p> Full article ">Figure 3
<p>Kaplan–Meier survival curves for the whole cohort, split by systemic inflammatory index categories.</p> Full article ">Figure 4
<p>Kaplan–Meier survival curves for whole cohort, split by neutrophil–lymphocyte ratio categories.</p> Full article ">Figure 5
<p>Kaplan–Meier survival curves for whole cohort, split by thrombocyte–lymphocyte ratio categories.</p> Full article ">
8 pages, 589 KiB  
Communication
The Effect of the COVID-19 Pandemic on Unrelated Allogeneic Hematopoietic Donor Collections and Safety
by Gaganvir Parmar, David S. Allan, Gail Morris, Nicholas Dibdin, Kathy Ganz, Karen Mostert, Kristjan Paulson, Tanya Petraszko, Nora Stevens and Matthew D. Seftel
Curr. Oncol. 2023, 30(3), 3549-3556; https://doi.org/10.3390/curroncol30030270 - 22 Mar 2023
Cited by 2 | Viewed by 1970
Abstract
Background and Objectives: The COVID-19 pandemic profoundly influenced unrelated donor (UD) allogeneic peripheral blood stem cell (PBSC) collections. Changes included efforts to minimize COVID-19 exposure to donors and cryopreservation of products. The extent to which the efficacy and safety of PBSC donations were [...] Read more.
Background and Objectives: The COVID-19 pandemic profoundly influenced unrelated donor (UD) allogeneic peripheral blood stem cell (PBSC) collections. Changes included efforts to minimize COVID-19 exposure to donors and cryopreservation of products. The extent to which the efficacy and safety of PBSC donations were affected by the pandemic is unknown. Methods: Prospective cohort analysis of PBSC collections comparing pre-pandemic (01 April 2019–14 March 2020) and pandemic (15 March 2020–31 March 2022) eras. Results: Of a total of 291 PBSC collections, cryopreservation was undertaken in 71.4% of pandemic donations compared to 1.1% pre-pandemic. The mean requested CD34+ cell dose/kg increased from 4.9 ± 0.2 × 106 pre-pandemic to 5.4 ± 0.1 × 106 during the pandemic. Despite this increased demand, the proportion of collections that met or exceeded the requested cell dose did not change, and the mean CD34+ cell doses collected (8.9 ± 0.5 × 106 pre-pandemic vs. 9.7 ± 0.4 × 106 during the pandemic) remained above requested targets. Central-line placements were more frequent, and severe adverse events in donors increased during the pandemic. Conclusion: Cryopreservation of UD PBSC products increased during the pandemic. In association with this, requested cell doses for PBSC collections increased. Collection targets were met or exceeded at the same frequency, signaling high donor and collection center commitment. This was at the expense of increased donor or product-related severe adverse events. We highlight the need for heightened vigilance about donor safety as demands on donors have increased since the pandemic. Full article
(This article belongs to the Section Cell Therapy)
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<p>Requested and collected CD34<sup>+</sup> cell doses per kg recipient weight in pre-pandemic and pandemic collections. <span class="html-italic">N</span> = 291. Means indicated ± SEM. * = <span class="html-italic">p</span> &lt; 0.05.</p> Full article ">
12 pages, 1086 KiB  
Article
Implementation of a Web-Based Communication System for Primary Care Providers and Cancer Specialists
by Bojana Petrovic, Jacqueline L. Bender, Clare Liddy, Amir Afkham, Sharon F. McGee, Scott C. Morgan, Roanne Segal, Mary Ann O’Brien, Jim A. Julian, Jonathan Sussman, Robin Urquhart, Margaret Fitch, Nancy D. Schneider and Eva Grunfeld
Curr. Oncol. 2023, 30(3), 3537-3548; https://doi.org/10.3390/curroncol30030269 - 21 Mar 2023
Viewed by 1905
Abstract
Healthcare providers have reported challenges with coordinating care for patients with cancer. Digital technology tools have brought new possibilities for improving care coordination. A web- and text-based asynchronous system (eOncoNote) was implemented in Ottawa, Canada for cancer specialists and primary care providers (PCPs). [...] Read more.
Healthcare providers have reported challenges with coordinating care for patients with cancer. Digital technology tools have brought new possibilities for improving care coordination. A web- and text-based asynchronous system (eOncoNote) was implemented in Ottawa, Canada for cancer specialists and primary care providers (PCPs). This study aimed to examine PCPs’ experiences of implementing eOncoNote and how access to the system influenced communication between PCPs and cancer specialists. As part of a larger study, we collected and analyzed system usage data and administered an end-of-discussion survey to understand the perceived value of using eOncoNote. eOncoNote data were analyzed for 76 shared patients (33 patients receiving treatment and 43 patients in the survivorship phase). Thirty-nine percent of the PCPs responded to the cancer specialist’s initial eOncoNote message and nearly all of those sent only one message. Forty-five percent of the PCPs completed the survey. Most PCPs reported no additional benefits of using eOncoNote and emphasized the need for electronic medical record (EMR) integration. Over half of the PCPs indicated that eOncoNote could be a helpful service if they had questions about a patient. Future research should examine opportunities for EMR integration and whether additional interventions could support communication between PCPs and cancer specialists. Full article
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<p>PCP survey responses ((<b>1-1</b>–<b>1-3</b>) correspond to items 1, 2 and 3 on the survey, respectively).</p> Full article ">Figure 2
<p>PCP survey responses ((<b>2-1</b>,<b>2-2</b>) correspond to items 4 and 5 on the survey, respectively).</p> Full article ">
8 pages, 2004 KiB  
Case Report
An Unusual Case of Hemophagocytic Lymphohistiocytosis Associated with Mycobacterium chimaera or Large-Cell Neuroendocrine Carcinoma
by Tejaswi Venigalla, Sheila Kalathil, Meena Bansal, Mark Morginstin, Vinicius Jorge and Patricia Perosio
Curr. Oncol. 2023, 30(3), 3529-3536; https://doi.org/10.3390/curroncol30030268 - 21 Mar 2023
Viewed by 2760
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare and very dangerous condition characterized by abnormal activation of the immune system, causing hemophagocytosis, inflammation, and potentially widespread organ damage. The primary (genetic) form, caused by mutations affecting lymphocyte cytotoxicity, is most commonly seen in children. Secondary [...] Read more.
Hemophagocytic lymphohistiocytosis (HLH) is a rare and very dangerous condition characterized by abnormal activation of the immune system, causing hemophagocytosis, inflammation, and potentially widespread organ damage. The primary (genetic) form, caused by mutations affecting lymphocyte cytotoxicity, is most commonly seen in children. Secondary HLH is commonly associated with infections, malignancies, and rheumatologic disorders. Most current information on diagnosis and treatment is based on pediatric populations. HLH is a disease that should be diagnosed and treated promptly, otherwise it is fatal. Treatment is directed at treating the triggering disorder, along with symptomatic treatment with dexamethasone and etoposide. We present a 56-year-old patient who was admitted with worsening weakness, exertional dyspnea, dry and nonproductive cough, and a 5-pound weight loss associated with loss of appetite. This is among the rare disorders that are not commonly encountered in day-to-day practice. Our differential diagnoses were broad, including infection, such as visceral leishmaniasis, atypical/tuberculous mycobacteria, histoplasmosis, Ehrlichia, Bartonella, Brucella, Adenovirus, disseminated herpes simplex virus (HSV), hematological-like Langerhans cell histiocytosis, or multicentric Castleman disease; drug reaction, such as drug rash with eosinophilia and systemic symptoms (DRESS); and metabolic disorder, including Wolman’s disease (infantile lysosomal acid lipase deficiency) or Gaucher’s disease. Based on our investigations as described in our case report, it was narrowed down to hemophagocytic lymphohistiocytosis and COVID-19. Two COVID-19 tests were negative. His lab abnormalities and diagnostic testing revealed hemophagocytic lymphohistiocytosis. He was empirically started on antibiotics and dexamethasone, to be continued for 2 weeks then tapered if the patient showed continued improvement. Dexamethasone was tapered over 8 weeks. He improved on just one of the Food and Drug Administration (FDA)-approved medications, proving that treatment should be tailored to the patient. In addition, in this case study, we included the background, etiology, pathogenesis, diagnosis, management, and prognosis of HLH. Full article
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<p>Clot section, macrophages. Hemotoxylin and Eosin (H and E) staining with 40× objective magnification.</p> Full article ">Figure 2
<p>Core biopsy, showing loose aggregates of macrophages next to bone. Hemotoxylin and Eosin (H and E) staining with 40× objective magnification.</p> Full article ">Figure 3
<p>Aspirate smear, the arrow pointing marrow cells engulfed by macrophage. Giemsa stained at 100× oil immersion.</p> Full article ">
13 pages, 953 KiB  
Article
CXCL1 and CXCL6 Are Potential Predictors for HCC Response to TACE
by Maximilian N. Kinzler, Katrin Bankov, Julia Bein, Claudia Döring, Falko Schulze, Henning Reis, Scherwin Mahmoudi, Vitali Koch, Leon D. Grünewald, Angelika Stehle, Dirk Walter, Fabian Finkelmeier, Stefan Zeuzem, Peter J. Wild, Thomas J. Vogl and Simon Bernatz
Curr. Oncol. 2023, 30(3), 3516-3528; https://doi.org/10.3390/curroncol30030267 - 20 Mar 2023
Cited by 4 | Viewed by 2282
Abstract
Distinct immune patterns of hepatocellular carcinoma (HCC) may have prognostic implications in the response to transarterial chemoembolization (TACE). Thus, we aimed to exploratively analyze tumor tissue of HCC patients who do or do not respond to TACE, and to identify novel prognostic biomarkers [...] Read more.
Distinct immune patterns of hepatocellular carcinoma (HCC) may have prognostic implications in the response to transarterial chemoembolization (TACE). Thus, we aimed to exploratively analyze tumor tissue of HCC patients who do or do not respond to TACE, and to identify novel prognostic biomarkers predictive of response to TACE. We retrospectively included 15 HCC patients who had three consecutive TACE between January 2019 and November 2019. Eight patients had a response while seven patients had no response to TACE. All patients had measurable disease according to mRECIST. Corresponding tumor tissue samples were processed for differential expression profiling using NanoString nCounter® PanCancer immune profiling panel. Immune-related pathways were broadly upregulated in TACE responders. The top differentially regulated genes were the upregulated CXCL1 (log2fc 4.98, Benjamini–Hochberg (BH)-p < 0.001), CXCL6 (log2fc 4.43, BH-p = 0.016) and the downregulated MME (log2fc −4.33, BH-p 0.001). CD8/T-regs was highly increased in responders, whereas the relative number of T-regs to tumor-infiltrating lymphocytes (TIL) was highly decreased. We preliminary identified CXCL1 and CXCL6 as candidate genes that might have the potential to serve as therapeutically relevant biomarkers in HCC patients. This might pave the way to improve patient selection for TACE in HCC patients beyond expert consensus. Full article
(This article belongs to the Special Issue Hepatocellular Carcinoma: Epidemiology, Pathogenesis and Treatment)
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<p>STARD flowchart of patient inclusion into the study. Abbreviations: standards for reporting diagnostic accuracy studies (STARD).</p> Full article ">Figure 2
<p>NanoString analysis reveals broad upregulation in immune pathway scores in TACE responders. (<b>a</b>) Unsupervised t-SNE plots of all normalized mRNA and (<b>b</b>) trend plot of pathway signatures. Abbreviations: messenger ribonucleic acid (mRNA), transarterial chemoembolization (TACE), T-distributed stochastic neighbor embedding (t-SNE).</p> Full article ">Figure 3
<p>Differentially expressed genes between responders and non-responders to TACE. (<b>a</b>) Volcano plot of all differentially expressed genes or (<b>b</b>) only strong and significantly deregulated genes (log2fc ≤ −2 or ≥2 and <span class="html-italic">p</span>-value &lt; 0.05 with Benjamini–Hochberg correction). Volcano plot displaying each gene’s -log10(<span class="html-italic">p</span>-value) and log2 fold-change with the selected covariate. Statistically significant genes fall at the top of the plot above the horizontal line, and highly differentially expressed genes fall to either side. The horizontal line indicates BH-<span class="html-italic">p</span> &lt; 0.05. Abbreviations: transarterial chemoembolization (TACE).</p> Full article ">Figure 4
<p>Cell type profiling reveals increased immune infiltrates in responders. (<b>a</b>) Absolute and (<b>b</b>) relative cell type scores are shown in responders (true) and non-responders (false). The nCounter<sup>®</sup> advanced analysis module of the PanCancer immune profiling panel uses genes whose expression is largely specific to certain immune cell populations to measure the abundance of these cell types. The module assumes that each cell type’s characteristic genes are expressed exclusively and consistently within the cell type. Under this model, a cell type’s abundance can be measured as the average log-scale expression of its characteristic genes. The cell type abundance measurements are plotted against response. True = responder, false = non-responder.</p> Full article ">
16 pages, 3025 KiB  
Review
Complex Vascular Resections for Retroperitoneal Soft Tissue Sarcoma
by Nicolas A. Devaud, Jean M. Butte, Juan C. De la Maza, Sebastian von Mühlenbrock Hugo and Kenneth Cardona
Curr. Oncol. 2023, 30(3), 3500-3515; https://doi.org/10.3390/curroncol30030266 - 20 Mar 2023
Cited by 6 | Viewed by 2619
Abstract
Retroperitoneal sarcomas (RPSs) are locally aggressive tumors that can compromise major vessels of the retroperitoneum including the inferior vena cava, aorta, or main tributary vessels. Vascular involvement can be secondary to the tumor’s infiltrating growth pattern or primary vascular origin. Surgery is still [...] Read more.
Retroperitoneal sarcomas (RPSs) are locally aggressive tumors that can compromise major vessels of the retroperitoneum including the inferior vena cava, aorta, or main tributary vessels. Vascular involvement can be secondary to the tumor’s infiltrating growth pattern or primary vascular origin. Surgery is still the mainstay for curing this disease, and resection of RPSs may include major vascular resections to secure adequate oncologic results. Our improved knowledge in the tumor biology of RPSs, in conjunction with the growing surgical expertise in both sarcoma and vascular surgical techniques, has allowed for major vascular reconstructions within multi-visceral resections for RPSs with good perioperative results. This complex surgical approach may include the combined work of various surgical subspecialties. Full article
(This article belongs to the Special Issue New Frontiers in the Management of Retroperitoneal Soft Tissue Sarcoma)
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<p>(<b>a</b>) Vollmann’s IVC-LMS classification; (<b>b</b>) type 2 IVC-LMS.</p> Full article ">Figure 2
<p>Mesenteric artery LMS: angio-CT and 3D reconstruction.</p> Full article ">Figure 3
<p>IVC partial resection with patch repair.</p> Full article ">Figure 4
<p>Iliac artery and vein reconstruction after DD-LPS resection.</p> Full article ">
6 pages, 653 KiB  
Case Report
Exon-18-EGFR Mutated Transformed Small-Cell Lung Cancer: A Case Report and Literature Review
by Nunzio Digiacomo, Tommaso De Pas, Giovanna Rossi, Paola Bossi, Erika Stucchi, Fabio Conforti, Emilia Cocorocchio, Daniele Laszlo, Laura Pala, Emma Zattarin and Chiara Catania
Curr. Oncol. 2023, 30(3), 3494-3499; https://doi.org/10.3390/curroncol30030265 - 20 Mar 2023
Viewed by 2434
Abstract
Small-cell lung cancer (SCLC) transformation from EGFR mutant adenocarcinoma is a rare entity that is considered to be a new phenotype of SCLC. While transformation from adenocarcinoma (ADC) with EGFR exon 19 deletions and exon 21 L858R point mutations has been described, to [...] Read more.
Small-cell lung cancer (SCLC) transformation from EGFR mutant adenocarcinoma is a rare entity that is considered to be a new phenotype of SCLC. While transformation from adenocarcinoma (ADC) with EGFR exon 19 deletions and exon 21 L858R point mutations has been described, to our knowledge, no cases of transformation to SCLC from exon-18-mutated ADC have been reported. We reported a clinical case of a patient with exon-18-EGFR-transformed SCLC, and we performed a systematic review of the literature. Full article
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<p>Tumor biopsy before ((<b>A</b>): adenocarcinoma) and after ((<b>B</b>): SCLC) progression to osimertinib.</p> Full article ">
10 pages, 265 KiB  
Article
Is It Possible to Notice the Unmet Non-Medical Needs among Cancer Patients? Application of the Needs Evaluation Questionnaire in Men with Lung Cancer
by Karolina Osowiecka, Marcin Kurowicki, Jarosław Kołb-Sielecki, Anna Gwara, Marek Szwiec, Sergiusz Nawrocki and Monika Rucińska
Curr. Oncol. 2023, 30(3), 3484-3493; https://doi.org/10.3390/curroncol30030264 - 20 Mar 2023
Cited by 4 | Viewed by 1707
Abstract
Background: Lung cancer is the most common cause of cancer death worldwide. It is the most frequently diagnosed cancer in men. Lung cancer causes not only physical symptoms related to the disease itself and its treatment but also numerous mental, social and spiritual [...] Read more.
Background: Lung cancer is the most common cause of cancer death worldwide. It is the most frequently diagnosed cancer in men. Lung cancer causes not only physical symptoms related to the disease itself and its treatment but also numerous mental, social and spiritual problems. The aim of the study was to assess non-medical needs among male lung cancer patients during oncological treatment. Materials and Methods: The study was conducted on a group of 160 men (mean age 67 years) treated for lung cancer from June 2022 until November 2022 in 5 oncological centers in Poland. The Needs Evaluation Questionnaire (NEQ) was used. The NEQ explores five areas of patients’ needs: informative, connected with assistance/care, relational, material and psycho-emotional support. Results: All participants (except one) expressed some unmet non-medical needs (mean and median 11). Male lung cancer patients indicated informative needs most frequently. There were no significant differences between expressed unmet needs based on age, place of residence, professional activity or marital status. Conclusions: The NEQ seems to be a proper instrument to explore the non-medical needs of cancer patients. Adequate measures to address the unmet needs of lung cancer patients could contribute to an improved quality of life. Full article
(This article belongs to the Section Psychosocial Oncology)
11 pages, 573 KiB  
Article
Proton Radiotherapy for Vestibular Schwannomas in Patients with NF2-Related Schwannomatosis: A Case Series
by Jules P. J. Douwes, Kimberley S. Koetsier, Victor S. van Dam, Scott R. Plotkin, Frederick G. Barker, D. Bradley Welling, Jeroen C. Jansen, Erik F. Hensen and Helen A. Shih
Curr. Oncol. 2023, 30(3), 3473-3483; https://doi.org/10.3390/curroncol30030263 - 20 Mar 2023
Viewed by 2747
Abstract
(1) Background: This study aimed to evaluate the efficacy and treatment-related toxicity of proton radiotherapy (PRT) for vestibular schwannoma (VS) in patients with neurofibromatosis type 2-related schwannomatosis (NF2). (2) Methods: Consecutive NF2 patients treated with PRT for VS between 2004 and 2016 were [...] Read more.
(1) Background: This study aimed to evaluate the efficacy and treatment-related toxicity of proton radiotherapy (PRT) for vestibular schwannoma (VS) in patients with neurofibromatosis type 2-related schwannomatosis (NF2). (2) Methods: Consecutive NF2 patients treated with PRT for VS between 2004 and 2016 were retrospectively evaluated, focusing on tumor volume, facial and trigeminal nerve function, hearing, tinnitus, vestibular symptoms, and the need for salvage therapy after PRT. (3) Results: Eight patients were included (median age 36 years, 50% female). Median follow-up was 71 months. Five (63%) patients received fractionated PRT and three (38%) received PRT radiosurgery for VS. Six patients (75%) received prior VS surgery; three also received bevacizumab. Six patients (75%) did not require salvage therapy after PRT. Two patients (25%) with residual hearing lost it after PRT, and six had already lost ipsilateral hearing prior to PRT. Tumor and treatment-related morbidity could be evaluated in six patients. Following PRT, conditions that occurred or worsened were: facial paresis in five (83%), trigeminal hypoesthesia in two (33%), tinnitus in two (33%), and vestibular symptoms in four patients (67%). (4) Conclusion: After PRT for VS, the majority of the NF2 patients in the cohort did not require additional therapy. Tumor and/or treatment-related cranial nerve deficits were common. This is at least partly explained by the use of PRT as a salvage treatment after surgery or bevacizumab, in the majority of cases. There remains the further opportunity to elucidate the efficacy and toxicity of proton radiotherapy as a primary treatment. Full article
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<p>Three examples of the radiological follow-up of Neurofibromatosis Type 2-related vestibular schwannomas treated with proton radiotherapy (PRT). Each row (<b>A</b>–<b>C</b>) represents MR imaging of one patient over time: the baseline MR image (<b>1</b>), the MR image one year after PRT (<b>2</b>), and the most recent MR image (<b>3</b>). Patient (<b>A</b>): the tumor of interest remained stable during the follow-up of 60 months (<b>A1</b>–<b>A3</b>). Patient (<b>B</b>): the initial tumor shrinkage achieved with PRT and adjuvant bevacizumab therapy (<b>B1</b>), was followed by tumor progression (<b>B2</b>) that required additional treatments with bevacizumab (<b>B3</b>). Patient (<b>C</b>): the initial tumor shrinkage (<b>C1</b>,<b>C2</b>) was followed by significant tumor progression (<b>C3</b>), requiring salvage surgery at 87 months after PRT.</p> Full article ">
12 pages, 607 KiB  
Article
Pain and Interventions in Stage IV Non-Small Cell Lung Cancer: A Province-Wide Analysis
by Vivian S. Tan, Michael C. Tjong, Wing C. Chan, Michael Yan, Victoria Delibasic, Gail Darling, Laura E. Davis, Mark Doherty, Julie Hallet, Biniam Kidane, Alyson Mahar, Nicole Mittmann, Ambika Parmar, Hendrick Tan, Frances C. Wright, Natalie G. Coburn and Alexander V. Louie
Curr. Oncol. 2023, 30(3), 3461-3472; https://doi.org/10.3390/curroncol30030262 - 18 Mar 2023
Cited by 3 | Viewed by 2401
Abstract
Pain is a common symptom in stage IV non-small cell lung cancer (NSCLC). The objective of the study was to examine the use of interventions and factors associated with interventions for pain. A population-based cohort study in Ontario, Canada was conducted with patients [...] Read more.
Pain is a common symptom in stage IV non-small cell lung cancer (NSCLC). The objective of the study was to examine the use of interventions and factors associated with interventions for pain. A population-based cohort study in Ontario, Canada was conducted with patients diagnosed with stage IV NSCLC from January 2007 to September 2018. An Edmonton Symptom Assessment System (ESAS) score of ≥4 defined moderate-to-severe pain following diagnosis. The study cohort included 13,159 patients, of which 68.5% reported at least one moderate-to-severe pain score. Most patients were assessed by a palliative care team (85.4%), and the majority received radiation therapy (73.2%). The use of nerve block was rare (0.8%). For patients ≥65 years of age who had drug coverage, 59.6% received an opiate prescription. Patients with moderate-to-severe pain were more likely to receive palliative assessment or radiation therapy compared to patients with none or mild pain. Patients aged ≥70 years and with a greater comorbidity burden were associated with less likelihood to receive radiation therapy. Patients from rural/non-major urban residence and with a greater comorbidity burden were also less likely to receive palliative care assessment. Factors associated with interventions for pain are described to inform future symptom management in this population. Full article
(This article belongs to the Section Thoracic Oncology)
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<p>Study cohort.</p> Full article ">Figure 2
<p>Intervention use stratified by patient-reported pain score. Standardized difference (SD).</p> Full article ">
14 pages, 729 KiB  
Article
Is It Safe to Switch from a Standard Anterior to Retzius-Sparing Approach in Robot-Assisted Radical Prostatectomy?
by Edward Lambert, Charlotte Allaeys, Camille Berquin, Pieter De Visschere, Sofie Verbeke, Ben Vanneste, Valerie Fonteyne, Charles Van Praet and Nicolaas Lumen
Curr. Oncol. 2023, 30(3), 3447-3460; https://doi.org/10.3390/curroncol30030261 - 17 Mar 2023
Cited by 4 | Viewed by 2405
Abstract
Background: Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has been shown to lead to better outcomes regarding early continence compared to standard anterior RARP (SA-RARP). The goal of this study was to assess the feasibility and safety of implementing RS-RARP in a tertiary center with [...] Read more.
Background: Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has been shown to lead to better outcomes regarding early continence compared to standard anterior RARP (SA-RARP). The goal of this study was to assess the feasibility and safety of implementing RS-RARP in a tertiary center with experience in SA-RARP. Methods: From February 2020, all newly diagnosed non-metastatic prostate cancer patients for whom RARP was indicated were evaluated for RS-RARP. Data from the first 100 RS-RARP patients were prospectively collected and compared with data from the last 100 SA-RARP patients. Patients were evaluated for Clavien Dindo grade ≥3a complications, urinary continence after 2 and 6 weeks, 3, 6 and 12 months, erectile function, positive surgical margins (PSMs) and biochemical recurrence (BCR). Results: There was no significant difference in postoperative complications at Clavien-Dindo grade ≥3a (SA-RARP: 6, RS-RARP: 4; p = 0.292). At all time points, significantly higher proportions of RS-RARP patients were continent (p < 0.001). No significant differences in postoperative potency were observed (52% vs. 59%, respectively, p = 0.608). PSMs were more frequent in the RS-RARP group (43% vs. 29%, p = 0.034), especially in locally advanced tumors (pT3: 64.6% vs. 43.8%, p = 0.041—pT2: 23.5% vs. 15.4%, p = 0.329). The one-year BCR-free survival was 82.6% vs. 81.6% in the SA-RARP and RS-RARP groups, respectively (p = 0.567). The median follow-up was 22 [18–27] vs. 24.5 [17–35] months in the RS-RARP and SA-RARP groups, respectively (p = 0.008). Conclusions: The transition from SA-RARP to RS-RARP can be safely performed by surgeons proficient in SA-RARP. Continence results after RS-RARP were significantly better at any time point. A higher proportion of PSMs was observed, although it did not result in a worse BCR-free survival. Full article
(This article belongs to the Special Issue Surgery for Prostate Cancer: Recent Advances and Future Directions)
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<p>Comparison of the relative continence rate at 2 weeks, 6 weeks, 3 months, 6 months and 12 months after surgery after RS-RARP (green line) and SA-RARP (blue line). A significant difference in continence rate was observed between both groups at any time point after surgery (<span class="html-italic">p</span> &lt; 0.001).</p> Full article ">Figure 2
<p>Comparison of biochemical recurrence free-survival between RS-RARP (green line) and SA-RARP (blue line).</p> Full article ">
15 pages, 1116 KiB  
Article
Future of Artificial Intelligence Applications in Cancer Care: A Global Cross-Sectional Survey of Researchers
by Bernardo Pereira Cabral, Luiza Amara Maciel Braga, Shabbir Syed-Abdul and Fabio Batista Mota
Curr. Oncol. 2023, 30(3), 3432-3446; https://doi.org/10.3390/curroncol30030260 - 16 Mar 2023
Cited by 12 | Viewed by 6197
Abstract
Cancer significantly contributes to global mortality, with 9.3 million annual deaths. To alleviate this burden, the utilization of artificial intelligence (AI) applications has been proposed in various domains of oncology. However, the potential applications of AI and the barriers to its widespread adoption [...] Read more.
Cancer significantly contributes to global mortality, with 9.3 million annual deaths. To alleviate this burden, the utilization of artificial intelligence (AI) applications has been proposed in various domains of oncology. However, the potential applications of AI and the barriers to its widespread adoption remain unclear. This study aimed to address this gap by conducting a cross-sectional, global, web-based survey of over 1000 AI and cancer researchers. The results indicated that most respondents believed AI would positively impact cancer grading and classification, follow-up services, and diagnostic accuracy. Despite these benefits, several limitations were identified, including difficulties incorporating AI into clinical practice and the lack of standardization in cancer health data. These limitations pose significant challenges, particularly regarding testing, validation, certification, and auditing AI algorithms and systems. The results of this study provide valuable insights for informed decision-making for stakeholders involved in AI and cancer research and development, including individual researchers and research funding agencies. Full article
(This article belongs to the Special Issue Optimizing Integrated Cancer Care from Diagnosis to Survivorship)
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<p>Demographic profile of the respondents.</p> Full article ">Figure 2
<p>Likelihood of expected future events derived from the use of AI in cancer care.</p> Full article ">Figure 3
<p>Average ranking of AI applications most likely to be successful in cancer care in the next ten years. Ranking on a 5-point scale, where 1 is the most likely and 5 is the least likely. SurveyMonkey calculated the ranking result. Applying weights in reverse, SurveyMonkey calculates the average ranking for each respondent’s choice to determine the most preferred choice overall (SurveyMonkey: <a href="https://help.surveymonkey.com/en/surveymonkey/create/ranking-question/" target="_blank">https://help.surveymonkey.com/en/surveymonkey/create/ranking-question/</a>, accessed on 20 November 2022).</p> Full article ">Figure 4
<p>Areas of interest most likely to benefit from AI in the next ten years.</p> Full article ">Figure 5
<p>Barriers to the use of AI in cancer care.</p> Full article ">
11 pages, 1144 KiB  
Article
Real-Time Urethral and Ureteral Assessment during Radical Cystectomy Using Ex-Vivo Optical Imaging: A Novel Technique for the Evaluation of Fresh Unfixed Surgical Margins
by Francesco Prata, Umberto Anceschi, Chiara Taffon, Silvia Maria Rossi, Martina Verri, Andrea Iannuzzi, Alberto Ragusa, Francesco Esperto, Salvatore Mario Prata, Anna Crescenzi, Roberto Mario Scarpa, Giuseppe Simone and Rocco Papalia
Curr. Oncol. 2023, 30(3), 3421-3431; https://doi.org/10.3390/curroncol30030259 - 15 Mar 2023
Cited by 6 | Viewed by 1830
Abstract
Background: Our study aims to assess the feasibility and the reproducibility of fluorescent confocal microscopy (FCM) real-time assessment of urethral and ureteral margins during open radical cystectomy (ORC) for bladder cancer (BCa). Methods: From May 2020 to January 2022, 46 patients underwent ORC [...] Read more.
Background: Our study aims to assess the feasibility and the reproducibility of fluorescent confocal microscopy (FCM) real-time assessment of urethral and ureteral margins during open radical cystectomy (ORC) for bladder cancer (BCa). Methods: From May 2020 to January 2022, 46 patients underwent ORC with intraoperative FCM evaluation. Each specimen was intraoperatively stained for histopathological analysis using FCM, analyzed as a frozen section (FSA), and sent for traditional H&E examination. Sensitivity, specificity, positive predictive value (PPV), and the negative predictive value (NPV) of FCM and FSA were assessed and compared with H&E for urethral and ureteral margins separately. Results: The agreement was evaluated through Cohen’s κ statistic. Urethral diagnostic agreement between FCM and FSA showed a κ = 0.776 (p < 0.001), while between FCM and H&E, the agreement was κ = 0.691 (p < 0.001). With regard to ureteral margins, an overall agreement of κ = 0.712 (p < 0.001) between FCM and FSA and of κ = 0.481 (p < 0.001) between FCM and H&E was found. Conclusions: FCM proved to be a safe, feasible, and reproducible method for the intraoperative assessment of urethral and ureteral margins during ORC. Compared to standard FSA, FCM showed adequate diagnostic performance in detecting urethral and ureteral malignant involvement. Full article
(This article belongs to the Special Issue Radical Surgery Advances in Oncology)
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<p>Macroscopic image of resection margin prepared with acridine orange for Vivascope analysis: (<b>a</b>) from a ureter, and (<b>b</b>) from the urethra.</p> Full article ">Figure 2
<p>Fluorescent (FCM) digital microscopic images showed in Hematoxylin and Eosin (H&amp;E) pseudo-colors: (<b>a</b>,<b>b</b>) from a positive ureter margin with high-grade urothelial cell carcinoma, low (×20) and high (×40) power field, respectively. (<b>c</b>,<b>d</b>) from a negative ureter margin, low (×5) and high (×10) power field, respectively.</p> Full article ">
30 pages, 1317 KiB  
Systematic Review
Relation of Mean Platelet Volume (MPV) with Cancer: A Systematic Review with a Focus on Disease Outcome on Twelve Types of Cancer
by Paraskevi Detopoulou, George I. Panoutsopoulos, Marina Mantoglou, Periklis Michailidis, Ifigenia Pantazi, Spyros Papadopoulos and Andrea Paola Rojas Gil
Curr. Oncol. 2023, 30(3), 3391-3420; https://doi.org/10.3390/curroncol30030258 - 14 Mar 2023
Cited by 13 | Viewed by 10947
Abstract
Inflammatory proteins activate platelets, which have been observed to be directly related to cancer progression and development. The aim of this systematic review is to investigate the possible association between Mean Platelet Volume (MPV) and cancer (diagnostic capacity of MPV, relation to survival, [...] Read more.
Inflammatory proteins activate platelets, which have been observed to be directly related to cancer progression and development. The aim of this systematic review is to investigate the possible association between Mean Platelet Volume (MPV) and cancer (diagnostic capacity of MPV, relation to survival, the severity of the disease, and metastasis). A literature review was performed in the online database PubMed and Google Scholar for the period of 2010–2022. In total, 83 studies including 21,034 participants with 12 different types of cancer (i.e., gastric cancer, colon cancer, esophageal squamous cell carcinoma, renal cancer, breast cancer, ovarian cancer, endometrial cancer, thyroid cancer, lung cancer, bladder cancer, gallbladder cancer, and multiple myeloma) were identified. The role of MPV has been extensively investigated in several types of cancer, such as gastric, colon, breast, and lung cancer, while few data exist for other types, such as renal, gallbladder cancer, and multiple myeloma. Most studies in gastric, breast, endometrium, thyroid, and lung cancer documented an elevated MPV in cancer patients. Data were less clear-cut for esophageal, ovarian, and colon cancer, while reduced MPV was observed in renal cell carcinoma and gallbladder cancer. Several studies on colon cancer (4 out of 6) and fewer on lung cancer (4 out of 10) indicated an unfavorable role of increased MPV regarding mortality. As far as other cancer types are concerned, fewer studies were conducted. MPV can be used as a potential biomarker in cancer diagnosis and could be a useful tool for the optimization of treatment strategies. Possible underlying mechanisms between cancer and MPV are discussed. However, further studies are needed to elucidate the exact role of MPV in cancer progression and metastasis. Full article
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Graphical abstract

Graphical abstract
Full article ">Figure 1
<p>PRISMA flow diagam.</p> Full article ">Figure 2
<p>The bidirectional relation of cancer and MPV. Parts of the figure were drawn using pictures from Servier Medical Art. Servier Medical Art by Servier is licensed under a Creative Commons Attribution 3.0 Unported License (<a href="https://creativecommons.org/licenses/by/3.0/" target="_blank">https://creativecommons.org/licenses/by/3.0/</a>, accessed on 13 March 2023).</p> Full article ">
18 pages, 3998 KiB  
Article
Persisting Deficits in Health-Related Quality of Life of Colorectal Cancer Survivors 14–24 Years Post-Diagnosis: A Population-Based Study
by Melissa S. Y. Thong, Daniela Doege, Linda Weißer, Lena Koch-Gallenkamp, Lina Jansen, Heike Bertram, Andrea Eberle, Bernd Holleczek, Alice Nennecke, Annika Waldmann, Sylke Ruth Zeissig, Hermann Brenner and Volker Arndt
Curr. Oncol. 2023, 30(3), 3373-3390; https://doi.org/10.3390/curroncol30030257 - 14 Mar 2023
Cited by 6 | Viewed by 2706
Abstract
(1) Background: The health-related quality of life (HRQOL) of colorectal cancer (CRC) survivors >10 years post-diagnosis is understudied. We aimed to compare the HRQOL of CRC survivors 14–24 years post-diagnosis to that of age- and sex-matched non-cancer controls, stratified by demographic and clinical [...] Read more.
(1) Background: The health-related quality of life (HRQOL) of colorectal cancer (CRC) survivors >10 years post-diagnosis is understudied. We aimed to compare the HRQOL of CRC survivors 14–24 years post-diagnosis to that of age- and sex-matched non-cancer controls, stratified by demographic and clinical factors. (2) Methods: We used data from 506 long-term CRC survivors and 1489 controls recruited from German population-based multi-regional studies. HRQOL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Core-30 (EORTC QLQ-C30) questionnaire. We estimated differences in the HRQOL of CRC survivors and controls with multiple regression, adjusted for age at survey, sex, and education, where appropriate. (3) Results: CRC survivors reported poorer social functioning but better health status/QOL than controls. CRC survivors, in general, had higher levels of symptom burden, and in particular diarrhea and constipation, regardless of demographic or clinical factors. In stratified analyses, HRQOL differed by age, sex, cancer type, and having a permanent stoma. (4) Conclusions: Although CRC survivors may have a comparable health status/QOL to controls 14–24 years after diagnosis, they still live with persistent bowel dysfunction that can negatively impact aspects of functioning. Healthcare providers should provide timely and adapted follow-up care to ameliorate potential long-term suffering. Full article
(This article belongs to the Special Issue Cancer Survivorship Research, Practice and Policy)
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<p>Flowchart of inclusion of CRC survivors.</p> Full article ">Figure 2
<p>Mean EORTC QLQ-C30 scores of colorectal cancer (CRC) survivors and controls. Models are adjusted for age at survey, sex, and education. All results are based on 25 imputations of missing values.</p> Full article ">Figure 3
<p>Mean EORTC QLQ-C30 scores of colorectal cancer (CRC) survivors and controls, stratified by age at survey. Models are adjusted for age at survey, sex, and education. Asterisks (*) indicate significantly differences (<span class="html-italic">p</span> &lt; 0.05) between the subgroups. All results are based on 25 imputations of missing values.</p> Full article ">Figure 4
<p>Mean EORTC QLQ-C30 scores of colorectal cancer (CRC survivors) and controls, stratified by education. Models are adjusted for age at survey and sex. Asterisks (*) indicate significantly significant differences (<span class="html-italic">p</span> &lt; 0.05) between the subgroups. All results are based on 25 imputations of missing values.</p> Full article ">Figure 5
<p>Mean EORTC QLQ-C30 scores of survivors (colon and rectal cancer) and controls, stratified by sex. Models are adjusted for age at survey and education. The <span class="html-italic">p</span>-values shown indicate the global comparison between cancer survivors and controls, separated by sex. The line spans and asterisks (*) indicate the subgroups that showed significant differences in pairwise comparison. For example, the line span for physical functioning in male colon survivors is across three columns, indicating that male colon survivors reported significantly higher physical functioning when compared with male controls. All results are based on 25 imputations of missing values.</p> Full article ">Figure 6
<p>Mean EORTC QLQ-C30 scores of colorectal cancer (CRC) survivors with and without permanent stoma, and controls. Models are adjusted for age at survey, sex, and education. The <span class="html-italic">p</span>-values shown indicate the global comparison between cancer survivors with and without stoma and controls. The line spans and asterisks (*) indicate the subgroups that showed significant differences in pairwise comparison. For example, the line span for global health/QOL is across three columns, indicating that stoma-free CRC survivors reported significantly higher global health/QOL when compared with controls. All results are based on 25 imputations of missing values.</p> Full article ">Figure 7
<p>Mean EORTC QLQ-C30 scores of colorectal cancer (CRC) survivors by disease status, and controls. Models are adjusted for age at survey, sex, and education. Disease-free: stage I–III at diagnosis and remaining disease-free at follow-up according to self-report; active disease: stage IV at diagnosis or reported subsequent recurrence, metastasis, or primary cancer. The <span class="html-italic">p</span>-values shown indicate the global comparison between cancer survivors with and without active disease and controls. The line spans and asterisks (*) indicate the subgroups that showed significant differences in pairwise comparison. For example, the line span for global health/QOL is across three columns, indicating that disease-free CRC survivors reported significantly higher global health/QOL when compared with controls. All results are based on 25 imputations of missing values.</p> Full article ">
7 pages, 751 KiB  
Communication
Conventional versus Reduced-Frequency Follow-Up in Early-Stage Melanoma Survivors: A Systematic Review with Meta-Analysis
by Karolina Richter, Tomasz Stefura, Nikola Kłos, Jonasz Tempski, Marta Kołodziej-Rzepa, Michał Kisielewski, Tomasz Wojewoda and Wojciech M. Wysocki
Curr. Oncol. 2023, 30(3), 3366-3372; https://doi.org/10.3390/curroncol30030256 - 14 Mar 2023
Viewed by 1855
Abstract
To date, there have been multiple studies and clinical guidelines or recommendations for complex management of melanoma patients. The most controversial subjects included the frequency of follow-up. This study provides a coherent and comprehensive comparison of conventional vs. reduced-frequency follow-up strategies for early-stage [...] Read more.
To date, there have been multiple studies and clinical guidelines or recommendations for complex management of melanoma patients. The most controversial subjects included the frequency of follow-up. This study provides a coherent and comprehensive comparison of conventional vs. reduced-frequency follow-up strategies for early-stage melanoma patients. The value of our study consists in the precise analysis of a large collection of articles and the selection of the most valuable works in relation to the topic according to rigorous criteria, which allowed for a thorough study of the topic. The search strategy was implemented using multiple databases. The inclusion criteria were randomized clinical trial or cohort studies that compared the outcomes of a conventional follow-up schedule versus a reduced-frequency follow-up schedule for patients diagnosed with melanoma. In this study, authors analyzed recurrence and 3-year survival. Meta-analysis of outcomes presented by Deckers et al. and Moncrieff et. al. did not reveal a significant difference favoring one of the groups (OR 1.14; 95%CI: 0.65–2.00; p = 0.64). The meta-analysis of 3-year overall survival included two studies. The statistical analysis showed no significant difference in favor of the conventional follow-up group. (OR 1.10; 95%CI: 0.57–2.11; p = 0.79). Our meta-analysis shows that there is no advantage in a conventional follow-up regimen over a reduced-frequency regimen in early-stage melanoma patients. Full article
(This article belongs to the Section Surgical Oncology)
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<p>PRISMA flow diagram of the study inclusion process.</p> Full article ">Figure 2
<p>Melanoma recurrence—forest plot [<a href="#B13-curroncol-30-00256" class="html-bibr">13</a>,<a href="#B14-curroncol-30-00256" class="html-bibr">14</a>].</p> Full article ">Figure 3
<p>3-year melanoma survival—forest plot [<a href="#B13-curroncol-30-00256" class="html-bibr">13</a>,<a href="#B14-curroncol-30-00256" class="html-bibr">14</a>].</p> Full article ">
11 pages, 8999 KiB  
Case Report
Renal Cell Carcinoma Unclassified with Medullary Phenotype in a Patient with Neurofibromatosis Type 2
by Sanila Sarkar, Whitney Throckmorton, Racheal Bingham, Pavlos Msaouel, Giannicola Genovese, John Slopis, Priya Rao, Zsila Sadighi and Cynthia E. Herzog
Curr. Oncol. 2023, 30(3), 3355-3365; https://doi.org/10.3390/curroncol30030255 - 14 Mar 2023
Cited by 4 | Viewed by 2821
Abstract
We present, to our knowledge, the first reported case of germline neurofibromatosis Type 2 (NF2) associated with renal cell carcinoma unclassified with medullary phenotype (RCCU-MP) with somatic loss by immunohistochemistry of the SMARCB1 tumor suppressor gene located centromeric to NF2 on chromosome 22q. [...] Read more.
We present, to our knowledge, the first reported case of germline neurofibromatosis Type 2 (NF2) associated with renal cell carcinoma unclassified with medullary phenotype (RCCU-MP) with somatic loss by immunohistochemistry of the SMARCB1 tumor suppressor gene located centromeric to NF2 on chromosome 22q. Our patient is a 15-year-old with germline neurofibromatosis Type 2 (NF2) confirmed by pathogenic mutation of c.-854-??46+??deletion. Her NF2 history is positive for a right optic nerve sheath meningioma, CNIII schwannoma requiring radiation therapy and post gross total resection of right frontotemporal anaplastic meningioma followed by radiation. At age 15 she developed new onset weight loss and abdominal pain due to RCCU-MP. Hemoglobin electrophoresis was negative for sickle hemoglobinopathy. Chemotherapy (cisplatin, gemcitabine and paclitaxel) was initiated followed by radical resection. Given the unique renal pathology of a high grade malignancy with loss of SMARCB1 expression via immunohistochemistry, and history of meningioma with MLH1 loss of expression and retained expression of PMS2, MSH2 and MSH6, further germline genetic testing was sent for SMARCB1 and mismatch repair syndromes. Germline testing was negative for mutation in SMARCB1. Therefore, this is the first reported case of RCCU-MP associated with germline NF2 mutation. This suggests the importance of closer surveillance in the adolescent and young adult population with NF2 with any suspicious findings of malignancy outside of the usual scope of practice with NF2. Full article
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<p>Right optic nerve sheath tumor. Arrow is pointing to the right optic nerve sheath tumor as stated in the figure title.</p> Full article ">Figure 2
<p>Right frontotemporal anaplastic meningioma.</p> Full article ">Figure 3
<p>Left adrenal nodule.</p> Full article ">Figure 4
<p>Right renal tumor.</p> Full article ">Figure 5
<p>Right lung nodule.</p> Full article ">Figure 6
<p>Post right nephrectomy.</p> Full article ">Figure 7
<p>High grade carcinoma with necrosis; tumor cells have a rhabdoid morphology.</p> Full article ">Figure 8
<p>Pancytokeratin stain is positive in the tumor.</p> Full article ">Figure 9
<p>PAX8 is positive in the tumor.</p> Full article ">Figure 10
<p>INI-1 (BAF47) is negative in the tumor. Lymphocytes serve as an internal positive control.</p> Full article ">
11 pages, 7925 KiB  
Article
Adaptive Volumetric-Modulated Arc Radiation Therapy for Head and Neck Cancer: Evaluation of Benefit on Target Coverage and Sparing of Organs at Risk
by Ciro Franzese, Stefano Tomatis, Sofia Paola Bianchi, Marco Pelizzoli, Maria Ausilia Teriaca, Marco Badalamenti, Tiziana Comito, Elena Clerici, Davide Franceschini, Pierina Navarria, Luciana Di Cristina, Damiano Dei, Carmela Galdieri, Giacomo Reggiori, Pietro Mancosu and Marta Scorsetti
Curr. Oncol. 2023, 30(3), 3344-3354; https://doi.org/10.3390/curroncol30030254 - 13 Mar 2023
Cited by 2 | Viewed by 2258
Abstract
Background: Radiotherapy is essential in the management of head–neck cancer. During the course of radiotherapy, patients may develop significant anatomical changes. Re-planning with adaptive radiotherapy may ensure adequate dose coverage and sparing of organs at risk. We investigated the consequences of adaptive radiotherapy [...] Read more.
Background: Radiotherapy is essential in the management of head–neck cancer. During the course of radiotherapy, patients may develop significant anatomical changes. Re-planning with adaptive radiotherapy may ensure adequate dose coverage and sparing of organs at risk. We investigated the consequences of adaptive radiotherapy on head–neck cancer patients treated with volumetric-modulated arc radiation therapy compared to simulated non-adaptive plans: Materials and methods: We included in this retrospective dosimetric analysis 56 patients treated with adaptive radiotherapy. The primary aim of the study was to analyze the dosimetric differences with and without an adaptive approach for targets and organs at risk, particularly the spinal cord, parotid glands, oral cavity and larynx. The original plan (OPLAN) was compared to the adaptive plan (APLAN) and to a simulated non-adaptive dosimetric plan (DPLAN). Results: The non-adaptive DPLAN, when compared to OPLAN, showed an increased dose to all organs at risk. Spinal cord D2 increased from 27.91 (21.06–31.76) Gy to 31.39 (27.66–38.79) Gy (p = 0.00). V15, V30 and V45 of the DPLAN vs. the OPLAN increased by 20.6% (p = 0.00), 14.78% (p = 0.00) and 15.55% (p = 0.00) for right parotid; and 16.25% (p = 0.00), 18.7% (p = 0.00) and 20.19% (p = 0.00) for left parotid. A difference of 36.95% was observed in the oral cavity V40 (p = 0.00). Dose coverage was significantly reduced for both CTV (97.90% vs. 99.96%; p = 0.00) and PTV (94.70% vs. 98.72%; p = 0.00). The APLAN compared to the OPLAN had similar values for all organs at risk. Conclusions: The adaptive strategy with re-planning is able to avoid an increase in dose to organs at risk and better target coverage in head–neck cancer patients, with potential benefits in terms of side effects and disease control. Full article
(This article belongs to the Topic Advances in Radiotherapy and Prognosis)
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<p>Representation of a transverse slice for a patient submitted to adaptive re-planning for a cT3N2c right tonsil squamous cell carcinoma HPV-. From the left to the right: scenario 1 (OPLAN); scenario 2 (APLAN); scenario 3 (DPLAN). The dose (≥35 Gy) is shown in color wash.</p> Full article ">Figure 2
<p>Box plot of dose-volume histogram indicators for parotid glands. Different scenarios are indicated as follows: 1, original plan and simulation CT (OPLAN); 3, original plan and second simulation CT (DPLAN). Differences between scenarios were found to be significant (<span class="html-italic">p</span> &lt; 0.01) for all parameters, except mean dose (not significant).</p> Full article ">Figure 3
<p>Box plot of dose-volume histogram indicators for spinal cord, larynx and oral cavity. Different scenarios are indicated as follows: 1, original plan and simulation CT (OPLAN); 3, original plan and second simulation CT (DPLAN). Differences between scenarios were found to be significant (<span class="html-italic">p</span> &lt; 0.05) for all parameters.</p> Full article ">
15 pages, 841 KiB  
Review
Kidney Injury in Children after Hematopoietic Stem Cell Transplant
by Vinson James, Joseph Angelo and Lama Elbahlawan
Curr. Oncol. 2023, 30(3), 3329-3343; https://doi.org/10.3390/curroncol30030253 - 13 Mar 2023
Cited by 2 | Viewed by 2844
Abstract
Hematopoietic cell transplant (HCT), used for treatment of many malignant and non-malignant pediatric diseases, is associated with serious complications, limiting this therapy’s benefit. Acute kidney injury (AKI), seen often after HCT, can occur at different stages of the transplant process and contributes to [...] Read more.
Hematopoietic cell transplant (HCT), used for treatment of many malignant and non-malignant pediatric diseases, is associated with serious complications, limiting this therapy’s benefit. Acute kidney injury (AKI), seen often after HCT, can occur at different stages of the transplant process and contributes to morbidity and mortality after HCT. The etiology of AKI is often multifactorial, including kidney hypoperfusion, nephrotoxicity from immunosuppressive and antimicrobial agents, and other transplant-related complications such as transplant-associated thrombotic microangiopathy and sinusoidal obstructive syndrome. Early recognition of AKI is crucial to prevent further AKI and associated complications. Initial management includes identifying the etiology of AKI, preventing further kidney hypoperfusion, adjusting nephrotoxic medications, and preventing fluid overload. Some patients will require further support with kidney replacement therapy to manage fluid overload and AKI. Biomarkers of AKI, such as neutrophil gelatinase-associated lipocalin can aid in detecting AKI before a rise in serum creatinine, allowing earlier intervention. Long-term kidney dysfunction is also prominent in this population. Therefore, long-term follow-up and monitoring of renal function (glomerular filtration rate, microalbuminuria) is required along with management of hypertension, which can contribute to chronic kidney disease. Full article
(This article belongs to the Special Issue A Multi-disciplinary Approach to the Prevention and Management of Cancer-Related Toxicities)
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<p>Etiologies of AKI in children following HCT. SOS, sinusoidal obstructive syndrome; TMA, thrombotic microangiopathy; aGVHD, acute graft versus host disease; CART, Chimeric antigen receptor (CAR) T-cell therapy.</p> Full article ">
14 pages, 6114 KiB  
Article
Evaluation of Classic and Quantitative Imaging Features in the Differentiation of Benign and Atypical Lipomatous Soft Tissue Tumors Using a Standardized Multiparametric MRI Protocol: A Prospective Single-Centre Study in 45 Patients
by Leonhard Gruber, Christian Kremser, Bettina Zelger, Anton Schwabegger, Ena Josip, Dietmar Dammerer, Martin Thaler and Benjamin Henninger
Curr. Oncol. 2023, 30(3), 3315-3328; https://doi.org/10.3390/curroncol30030252 - 13 Mar 2023
Cited by 1 | Viewed by 2087
Abstract
Background: Discrimination between benign and atypical lipomatous tumors (ALT) is important due to potential local complications and recurrence of ALT but can be difficult due to the often-similar imaging appearance. Using a standardized MRI protocol, this study aimed to rank established and quantitative [...] Read more.
Background: Discrimination between benign and atypical lipomatous tumors (ALT) is important due to potential local complications and recurrence of ALT but can be difficult due to the often-similar imaging appearance. Using a standardized MRI protocol, this study aimed to rank established and quantitative MRI features by diagnostic value in the differentiation of benign and atypical lipomatous tumors and to develop a robust scoring system. Methods: Patients with clinical or sonographic suspicion of a lipomatous tumor were prospectively and consecutively enrolled from 2015 to 2019 after ethic review board approval. Histology was confirmed for all ALT and 85% of the benign cases. Twenty-one demographic and morphologic and twenty-three quantitative features were extracted from a standardized MRI protocol (T1/T2-proton-density-weighting, turbo-inversion recovery magnitude, T2* multi-echo gradient-echo imaging, qDIXON-Vibe fat-quantification, T1 relaxometry, T1 mapping, diffusion-weighted and post-contrast sequences). A ranking of these features was generated through a Bayes network analysis with gain-ratio feature evaluation. Results: Forty-five patients were included in the analysis (mean age, 61.2 ± 14.2 years, 27 women [60.0%]). The highest-ranked ALT predictors were septation thickness (gain ratio merit [GRM] 0.623 ± 0.025, p = 0.0055), intra- and peritumoral STIR signal discrepancy (GRM 0.458 ± 0.046, p < 0.0001), orthogonal diameter (GRM 0.554 ± 0.188, p = 0.0013), contrast enhancement (GRM 0.235 ± 0.015, p = 0.0010) and maximum diameter (GRM 0.221 ± 0.075, p = 0.0009). The quantitative features did not provide a significant discriminatory value. The highest-ranked predictors were used to generate a five-tiered score for the identification of ALTs (correct classification rate 95.7% at a cut-off of three positive items, sensitivity 100.0%, specificity 94.9%, likelihood ratio 19.5). Conclusions: Several single MRI features have a substantial diagnostic value in the identification of ALT, yet a multiparametric approach by a simple combination algorithm may support radiologists in the identification of lipomatous tumors in need for further histological assessment. Full article
(This article belongs to the Special Issue Radiologic Approach to Soft Tissue Sarcomas)
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<p>Box plots comparisons of (<b>a</b>) maximum/minimum diameters and volume and (<b>b</b>) sphericity and circularity of benign (B) tumors and atypical lipomatous tumors (ALT).</p> Full article ">Figure 2
<p>Bar plots demonstrating the distribution of (<b>a</b>) localization, (<b>b</b>) border definition and (<b>c</b>) border contour for benign (B) tumors and atypical lipomatous tumors (ALT).</p> Full article ">Figure 3
<p>Bar plots demonstrating (<b>a</b>) septation morphology compared to surrounding fatty tissue and (<b>b</b>) maximum septation thickness in benign (B) tumors and atypical lipomatous tumors (ALT). Outliers are depicted as circles.</p> Full article ">Figure 4
<p>Comparison of (<b>a</b>) intralesional short-tau inversion recovery (STIR) signal distribution, (<b>b</b>) presence of surrounding STIR signal and (<b>c</b>) presence of intratumoral signal without surrounding fluid in benign (B) tumors and atypical lipomatous tumors (ALT).</p> Full article ">Figure 5
<p>Comparison of (<b>a</b>) presence of contrast-enhancement, (<b>b</b>) contrast-enhancement patterns and (<b>c</b>) ADC alterations, defined as areas of discernible low ADC signal, (<b>d</b>) ADC pattern distribution in benign (B) tumors and atypical) lipomatous tumors (ALT.</p> Full article ">Figure 6
<p>(<b>a</b>) Comparison of T1w, (<b>b</b>) T2w, (<b>c</b>) T2*, (<b>d</b>) R2* and (<b>e</b>) ADC signal intensity values as well as (<b>f</b>) fat fractions for benign (B) tumors and atypical (ALT) lipomatous tumors (ALT). Outliers are depicted as circles.</p> Full article ">Figure 7
<p>Comparison of (<b>a</b>) average score based on tumor volume, sphericity, maximum septation thickness, intra-tumoral without peritumoral STIR signal, presence of contrast enhancement and ADC signal alterations and (<b>b</b>) distribution of cases with benign or atypical differentiation by their score.</p> Full article ">Figure 8
<p>Examples of a benign (BL, (<b>upper row</b>)) and an atypical lipomatous tumor (ALT, (<b>lower row</b>)) in T1-weighted (<b>1st column</b>), short-tau inversion recovery T1-weighted (<b>2nd column</b>), diffusion-weighted (<b>3rd column</b>) images, ADC maps (<b>4th column</b>) and T1 VIBE Dixon images after intravenous contrast administration (<b>5th column</b>). Both tumors are predominantly composed of fat, yet the larger ALT shows intratumoral areas of patchy T1w signal decrease, STIR signal increase, atypical septation and patchy contrast enhancement.</p> Full article ">
14 pages, 516 KiB  
Article
The Potential of Adding Mammography to Handheld Ultrasound or Automated Breast Ultrasound to Reduce Unnecessary Biopsies in BI-RADS Ultrasound Category 4a: A Multicenter Hospital-Based Study in China
by Wenhui Ren, Xuelian Zhao, Xiaowei Zhao, Huijiao Yan, Shangying Hu, Youlin Qiao, Zhijian Xu and Fanghui Zhao
Curr. Oncol. 2023, 30(3), 3301-3314; https://doi.org/10.3390/curroncol30030251 - 13 Mar 2023
Cited by 1 | Viewed by 2444
Abstract
The appropriate management strategies for BI-RADS category 4a lesions among handheld ultrasound (HHUS) remain a matter of debate. We aimed to explore the role of automated breast ultrasound (ABUS) or the second-look mammography (MAM) adjunct to ultrasound (US) of 4a masses to reduce [...] Read more.
The appropriate management strategies for BI-RADS category 4a lesions among handheld ultrasound (HHUS) remain a matter of debate. We aimed to explore the role of automated breast ultrasound (ABUS) or the second-look mammography (MAM) adjunct to ultrasound (US) of 4a masses to reduce unnecessary biopsies. Women aged 30 to 69 underwent HHUS and ABUS from 2016 to 2017 at five high-level hospitals in China, with those aged 40 or older also accepting MAM. Logistic regression analysis assessed image variables correlated with false-positive lesions in US category 4a. Unnecessary biopsies, invasive cancer (IC) yields, and diagnostic performance among different biopsy thresholds were compared. A total of 1946 women (44.9 ± 9.8 years) were eligible for analysis. The false-positive rate of category 4a in ABUS was almost 65.81% (77/117), which was similar to HHUS (67.55%; 127/188). Orientation, architectural distortion, and duct change were independent factors associated with the false-positive lesions in 4a of HHUS, whereas postmenopausal, calcification, and architectural distortion were significant features of ABUS (all p < 0.05). For HHUS, both unnecessary biopsy rate and IC yields were significantly reduced when changing biopsy thresholds by adding MAM for US 4a in the total population (scenario #1:BI-RADS 3, 4, and 5; scenario #2: BI-RADS 4 and 5) compared with the current scenario (all p < 0.05). Notably, scenario #1 reduced false-positive biopsies without affecting IC yields when compared to the current scenario for ABUS (p < 0.001; p = 0.125). The higher unnecessary biopsy rate of category 4a by ABUS was similar to HHUS. However, the second-look MAM adjunct to ABUS has the potential to safely reduce false-positive biopsies compared with HHUS. Full article
(This article belongs to the Section Breast Cancer)
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<p>Flow chart of the study design. Abbreviations: ABUS: automated breast ultrasound; BI-RADS: Breast Imaging Reporting and Data System; HHUS: handheld ultrasound; MAM: mammography; US: ultrasound.</p> Full article ">
12 pages, 1319 KiB  
Article
A Nomogram for Preoperative Prediction of the Risk of Lymph Node Metastasis in Patients with Epithelial Ovarian Cancer
by Huiling Xiang, Fan Yang, Xiaojing Zheng, Baoyue Pan, Mingxiu Ju, Shijie Xu and Min Zheng
Curr. Oncol. 2023, 30(3), 3289-3300; https://doi.org/10.3390/curroncol30030250 - 13 Mar 2023
Cited by 5 | Viewed by 2207
Abstract
Objective: To develop a nomogram for predicting lymph node metastasis (LNM) in patients with epithelial ovarian cancer (EOC). Methods: Between December 2012 and August 2022, patients with EOC who received computed tomography (CT) and serological examinations and were treated with upfront staging or [...] Read more.
Objective: To develop a nomogram for predicting lymph node metastasis (LNM) in patients with epithelial ovarian cancer (EOC). Methods: Between December 2012 and August 2022, patients with EOC who received computed tomography (CT) and serological examinations and were treated with upfront staging or debulking surgery were included. Systematic pelvic and para-aortic lymphadenectomy was performed in all patients. Univariate and multivariate analysis was used to identify significant risk factors associated with LNM. A nomogram was then constructed to assess the risk of LNM, which was evaluated with respect to its area under the receiver operating characteristic curve (AUC), calibration, and clinical usefulness. Results: Of 212 patients enrolled in this study, 78 (36.8%) had positive LNs. The nomogram integrating CT-reported LN status, child-bearing status, tumour laterality, and stage showed good calibration and discrimination with an AUC of 0.775, significantly improving performance over the CT results (0.699, p = 0.0002) with a net reclassification improvement of 0.593 (p < 0.001) and integrated discrimination improvement of 0.054 (p < 0.001). The decision curve analysis showed the nomogram was of clinical use. Conclusions: A nomogram was constructed and internally validated, which may act as a decision aid in patients with EOC being considered for systemic lymphadenectomy. Full article
(This article belongs to the Section Surgical Oncology)
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<p>Risk factors in the multivariate regression analysis. Abbreviations: CT, computed tomography; LN, lymph node; cFigo, clinical International Federation of Obstetrics and Gynaecology; OR, odds ratio; CI, confidence interval.</p> Full article ">Figure 2
<p>A nomogram combining the CT-reported LN status and clinical variables to identify patients with epithelial ovarian cancer having a high risk of LNM. Abbreviations: CT, computed tomography; LN, lymph node; cFigo, clinical International Federation of Obstetrics and Gynaecology.</p> Full article ">Figure 3
<p>Receiver operating characteristic curve of the nomogram indicating an area under the curve of 0.775 (95% confidence interval, 0.713–0.829) in predicting LNM in patients with epithelial ovarian cancer. Abbreviations: LNM, lymph node metastasis.</p> Full article ">Figure 4
<p>The plotted calibration curve shows good agreement between the predictive probability of the nomogram and the actual LN status. The red line indicates the performance of the nomogram, whereas the black dashed line indicates the actual LN status, as confirmed by the pathology results. Abbreviations: LN, lymph node.</p> Full article ">Figure 5
<p>Decision curve analysis to assess the clinical utility of the proposed nomogram. The grey (All) and black (None) lines indicate the assumptions of all of the patients with and without LNM, respectively. The red line represents the performance of the nomogram and shows that the net clinical benefits can be achieved over a wide range of threshold possibilities. Abbreviations: LNM, lymph node metastasis; nomo, nomogram.</p> Full article ">
12 pages, 4429 KiB  
Technical Note
Optimizing Growth of the Future Liver Remnant and Making In-Situ Liver Transsection Safe—A Standardized Approach to ISLT or ALPPS
by Andrea Alexander, Nadja Lehwald-Tywuschik, Alexander Rehders, Levent Dizdar, Georg Fluegen, Sami Alexander Safi and Wolfram Trudo Knoefel
Curr. Oncol. 2023, 30(3), 3277-3288; https://doi.org/10.3390/curroncol30030249 - 13 Mar 2023
Cited by 4 | Viewed by 1909
Abstract
In-situ splitting of the liver before extended resection has gained broad attention. This two-step procedure requires several measures to make an effective and safe procedure. Although the procedure is performed in many institutions, there is no consensus on a uniform technique. The two [...] Read more.
In-situ splitting of the liver before extended resection has gained broad attention. This two-step procedure requires several measures to make an effective and safe procedure. Although the procedure is performed in many institutions, there is no consensus on a uniform technique. The two steps can be divided into different parts and a standardized technique may render the procedure safer and the results will be easier to evaluate. In this paper, we describe a detailed approach to in-situ splitting that allows making both procedures safe, avoids liver necrosis, and is easily reproducible. In the first procedure the portal branches to segments I and IV to VIII are divided, the arterial branches and bile ducts to these segments are preserved and encircled and the parenchyma between segments II/III and IVa/b is divided. This avoids necrosis and bile leaks of segments I and IV and avoids urgent completion operations. In particular, the handling of vital structures close to the dissection line seems important to us. Complete splitting and securing the right and middle hepatic vein will make the second step of this procedure a minimal-risk procedure at a stage where the patient is still recovering from the more demanding first step. Full article
(This article belongs to the Topic Hepatobiliary and Pancreatic Diseases: Novel Strategies of Diagnosis and Treatments)
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<p>A patient with a multilocular, large hepatocellular carcinoma, a small left lobe that would not suffice to avoid liver insufficiency after resection, and insufficient portal venous embolization.</p> Full article ">Figure 2
<p>Frequently, even after careful portal venous embolization, the left lobe remains too small to enable a safe resection of the right lobe.</p> Full article ">Figure 3
<p>A complete transsection between liver segments II/III and I/IV is recommended to render the second procedure as easy as possible. (<b>A</b>): During the first procedure. The vena cava is easily seen. (<b>B</b>): During the second procedure after division of the arteries and bile ducts to the right and caudate lobe. Removal of the resection specimen is safe and fast without further preparation or dissection.</p> Full article ">Figure 4
<p>After transsection of the liver the middle and right hepatic veins are marked with a blue vessel loop each. This facilitates division of these vessels after regeneration of the left lobe.</p> Full article ">Figure 5
<p>After transection of the liver and marking of the middle and left hepatic veins, all vessels to the right and caudate lobe in the hilum that need to be divided during the second operation are marked with red or yellow vessel loops. Only arteries and bile ducts are remaining. (woven polyester tape: WPT; left bile duct: LBD; right bile duct: RBD; portal vein: PV.</p> Full article ">Figure 6
<p>The functional residual liver volume (FRLV) is measured on a weekly basis until a sufficient volume is reached.</p> Full article ">Figure 7
<p>On re-exploration of the abdominal cavity, the plastic foil remains inert to the surrounding tissue and is easily removed, giving access to the remaining vasculature to the right liver lobe.</p> Full article ">Figure 8
<p>After dividing the arteries and bile ducts to the right liver lobe and segment I, the middle and right hepatic vein are very easily accessed and divided between vascular clamps. This completes the removal of segments I and IV–VIII.</p> Full article ">Figure 9
<p>After resection is completed, only a relatively small wound surface remains and the left liver lobe is often already adherent to the surrounding structures, avoiding kinking of the left hepatic vein. If that is not the case, it is recommended to stabilize the left liver lobe by stitching Teres’ ligament to the median abdominal wall.</p> Full article ">
14 pages, 416 KiB  
Review
Vitamin D and Multiple Myeloma: A Scoping Review
by Naghmeh Mirhosseini, Athanasios Psihogios, Meagan D. McLaren and Dugald Seely
Curr. Oncol. 2023, 30(3), 3263-3276; https://doi.org/10.3390/curroncol30030248 - 11 Mar 2023
Cited by 6 | Viewed by 2558
Abstract
As the global incidence of multiple myeloma (MM) increases, the identification of modifiable risk factors for disease prevention becomes paramount. Maintaining optimal vitamin D status is a candidate for prevention efforts, based on pre-clinical evidence of a possible role in disease activity and [...] Read more.
As the global incidence of multiple myeloma (MM) increases, the identification of modifiable risk factors for disease prevention becomes paramount. Maintaining optimal vitamin D status is a candidate for prevention efforts, based on pre-clinical evidence of a possible role in disease activity and progression. A structured scoping review was performed to identify and describe human-level research regarding the association between vitamin D and MM risk and/or prognosis. Searches of three databases (OVID-Medline, OVID-Embase, and OVID-Cochrane Library) yielded 15 included publications. Vitamin D deficiency is fairly common among patients with MM, with 42.3% of participants in the studies identified as having a vitamin D deficiency. No included publication reported on vitamin D status and the risk of developing or being newly diagnosed with MM. Possible associations with vitamin D that warrant future exploration include the incident staging of MM disease, the occurrence of peripheral neuropathy, and survival/prognosis. Vitamin D receptor (VDR) polymorphisms associated with MM also warrant further investigation. Overall, this scoping review was effective in mapping the research regarding vitamin D and MM and may help support new hypotheses to better describe this association and to better address identified knowledge gaps in the literature. Full article
(This article belongs to the Topic Non Herbal Nutraceutical, Probiotic, Vitamins and Fatty Acids in Cancer)
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<p>PRISMA flowchart.</p> Full article ">
12 pages, 1262 KiB  
Article
Descriptive Analysis of First-Line Non-Small Cell Lung Cancer Treatment with Pembrolizumab in Tumors Expressing PD-L1 ≥ 50% in Patients Treated in Quebec’s University Teaching Hospitals (DALP-First Study)
by Ghislain Bérard, Chantal Guévremont, Nathalie Marcotte, Coleen Schroeder, Nicole Bouchard and Raghu Rajan
Curr. Oncol. 2023, 30(3), 3251-3262; https://doi.org/10.3390/curroncol30030247 - 11 Mar 2023
Cited by 1 | Viewed by 2637
Abstract
Since July 2017, pembrolizumab has been approved as a first-line treatment of metastatic non-small cell lung cancer (NSCLC) in patients with a PD-L1 score ≥ 50% in Quebec. Study objectives were to describe and assess the real-world use of pembrolizumab; report progression-free survival [...] Read more.
Since July 2017, pembrolizumab has been approved as a first-line treatment of metastatic non-small cell lung cancer (NSCLC) in patients with a PD-L1 score ≥ 50% in Quebec. Study objectives were to describe and assess the real-world use of pembrolizumab; report progression-free survival (PFS), overall survival (OS), and immune-related adverse events (IRAEs); and compare outcomes between a fixed dose (FD) and a weight-based capped dose (WCD). Medical records of patients treated in one of Quebec’s four adult university teaching hospitals who received pembrolizumab between 1 November 2017 and 31 October 2019 were reviewed and followed until 29 February 2020. Two hundred and seventy-nine patients were included. The median real-world PFS and OS were 9.4 (95% CI, 6.6 to 11.2) and 17.3 months (95% CI, 12.9 to not reached), respectively. IRAEs causing delays or treatment interruptions were seen in 34.4% of patients. Initiating treatment with a FD (49 patients) or using a WCD (230 patients) does not appear to affect PFS, OS, or the occurrence of IRAEs. The use of a WCD strategy allowed approximately CAD 5.8 million in savings during the course of our study. These findings support the effectiveness and safety of pembrolizumab in a real-world setting. The use of a WCD does not appear to have a negative impact on patient outcomes. Full article
(This article belongs to the Special Issue Immunotherapy in Thoracic Malignancies)
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<p>Progression-free survival and overall survival of the study population (<span class="html-italic">n</span> = 279).</p> Full article ">Figure 2
<p>Progression-free survival and overall survival of the study population with regards to pembrolizumab dose used (<span class="html-italic">n</span> = 279).</p> Full article ">Figure 3
<p>Survival probability of ETD vs. non-ETD.</p> Full article ">
19 pages, 692 KiB  
Review
Anal Cancer: The Past, Present and Future
by Talha Ashraf Gondal, Noman Chaudhary, Husnaat Bajwa, Aribah Rauf, Duc Le and Shahid Ahmed
Curr. Oncol. 2023, 30(3), 3232-3250; https://doi.org/10.3390/curroncol30030246 - 11 Mar 2023
Cited by 20 | Viewed by 6627
Abstract
Anal cancer is a rare cancer that accounts for about 2% of all gastrointestinal tract malignancies. Among anal cancer, squamous cell cancer is the most common malignancy. The incidence of all stages of anal squamous cell cancer has been increasing. Human papillomavirus infection [...] Read more.
Anal cancer is a rare cancer that accounts for about 2% of all gastrointestinal tract malignancies. Among anal cancer, squamous cell cancer is the most common malignancy. The incidence of all stages of anal squamous cell cancer has been increasing. Human papillomavirus infection and immunosuppression are major risk factors for anal cancer. The management of anal cancer has evolved over the past several decades and continues to do so. Chemoradiation therapy remains the mainstay for treatment for most patients with early-stage disease, whereas systemic therapy is the primary treatment for patients with metastatic disease. Patients with persistent disease or recurrence following chemoradiation therapy are treated with salvage surgery. Access to novel cytotoxic combinations and immunotherapy has improved the outcomes of patients with advanced disease. This review provides an overview of advances in the management of anal cancer over the past two decades. This paper reviews the epidemiology, risk factors, pathology, diagnosis, and management of localized and advanced anal squamous cell cancer, highlights current knowledge gaps in the management of anal cancer, and discusses future directions. Full article
(This article belongs to the Section Gastrointestinal Oncology)
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<p>Treatment algorithm of localized and advanced anal cancer. APR = abdominoperineal resection; CRT = chemoradiation therapy.</p> Full article ">
9 pages, 752 KiB  
Communication
Survival Benefits of Adjuvant Chemotherapy for Positive Soft Tissue Surgical Margins Following Radical Cystectomy in Bladder Cancer with Extravesical Extension
by Prithvi B. Murthy, Shreyas Naidu, Facundo Davaro, Philippe E. Spiess, Logan Zemp, Michael Poch, Rohit Jain, Aram Vosoughi, G. Daniel Grass, Alice Yu, Wade J. Sexton, Scott M. Gilbert and Roger Li
Curr. Oncol. 2023, 30(3), 3223-3231; https://doi.org/10.3390/curroncol30030245 - 10 Mar 2023
Viewed by 1670
Abstract
Introduction and Objective: Muscle invasive bladder cancer with extravesical extension is an aggressive disease entity that requires multimodal therapy. The benefits of adjuvant chemotherapy (AC) in patients with a positive soft-tissue surgical margin (STSM), however, are relatively unknown due to exclusion of this [...] Read more.
Introduction and Objective: Muscle invasive bladder cancer with extravesical extension is an aggressive disease entity that requires multimodal therapy. The benefits of adjuvant chemotherapy (AC) in patients with a positive soft-tissue surgical margin (STSM), however, are relatively unknown due to exclusion of this population in randomized controlled trials of AC. We sought to define survival benefits in this patient population through our institutional bladder cancer database. Methods: Retrospective review of all patients undergoing radical cystectomy for urothelial carcinoma of the bladder from 2004–2020 with ≥pT3b disease irrespective of neoadjuvant chemotherapy (NAC) use was conducted. Progression-free survival (PFS) and overall survival (OS) estimates were obtained using the Kaplan-Meier method with log-rank test, and the Cox-proportional hazards model was used to identify predictors of improved PFS and OS. AC was defined by any chemotherapy use within 90 days of cystectomy, regardless of STSM status. Results: 476 patients with pT3b disease or worse were identified. Median follow-up was 12.3 months. An amount of 21% of patients were treated with AC. An amount of 24% of patients had positive STSM. Median OS for patients with positive STSM was 8.4 months [95% CI 7–11.5] and 18.3 months [95% CI 15.6–20.8] (p < 0.001) for patients with negative STSM. In the overall cohort, positive STSM (HR 1.93, 95% CI 1.45–2.57, p < 0.001), AC use (HR 0.68, 95% CI 0.51–0.90, p = 0.007), and pN1–3 disease (HR 1.47, 95% CI 1.16–1.87, p = 0.002) were independent predictors of OS when adjusted for performance status, pT-stage, and neoadjuvant chemotherapy use. In patients with positive STSM, median survival was seven months [95% CI 5.2–8.4] without AC, compared to 16.2 months [95% CI 11.5–52.5] with AC (p = 0.0038). For patients with negative STSM, median survival was 17.4 months [95% CI 14–20.1] without AC compared to 22.3 months [95% CI 17.2–36.9] with AC (p = 0.23). In patients with positive STSM, AC use was the only factor associated with an OS benefit with a HR of 0.41 (95% CI 0.21–0.78, p = 0.007). In patients with negative STSM, pT4 and pN1–3 disease were the only factors associated with worse overall survival with a HR of 1.32 (95% CI 1.00–1.74, p = 0.050) and 1.97 (95% CI 1.49–2.60, p < 0.001), respectively. Conclusions: Administration of adjuvant chemotherapy is of particular benefit in patients with positive STSM following radical cystectomy for gross extravesical disease. Positive STSM may be a representative of “early metastatic” or micrometastatic disease. Full article
(This article belongs to the Special Issue Current and Future Bladder Cancer Landscape)
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<p>(<b>a</b>) Progression-free survival and (<b>b</b>) overall survival stratified by soft tissue surgical margin (STSM) status in patients undergoing radical cystectomy.</p> Full article ">Figure 2
<p>Progression-free survival stratified by adjuvant chemotherapy following radical cystectomy in (<b>a</b>) patients with positive soft tissue surgical margins and (<b>b</b>) patients with negative soft tissue surgical margins; overall survival stratified by adjuvant chemotherapy following radical cystectomy in (<b>c</b>) patients with positive soft tissue surgical margins and (<b>d</b>) patients with negative soft tissue surgical margins.</p> Full article ">
6 pages, 208 KiB  
Communication
Primary Prophylaxis Lapelga® in Early Breast Cancer: A Real-World Experience
by Fahad Khan, Morgan Black, Alaina Charlton and Jawaid Younus
Curr. Oncol. 2023, 30(3), 3217-3222; https://doi.org/10.3390/curroncol30030244 - 9 Mar 2023
Cited by 2 | Viewed by 1977
Abstract
Background: Lapelga® was approved by Health Canada as a pegfilgrastim biosimilar in 2019 and remains the most commonly used biosimilar in Ontario and is fully reimbursed under the Ontario Drug Benefit program in this category. We explored the efficacy and tolerability of [...] Read more.
Background: Lapelga® was approved by Health Canada as a pegfilgrastim biosimilar in 2019 and remains the most commonly used biosimilar in Ontario and is fully reimbursed under the Ontario Drug Benefit program in this category. We explored the efficacy and tolerability of Lapelga® in a retrospective analysis of patients with early breast cancer who underwent adjuvant chemotherapy supported with Lapelga® as a primary prophylaxis. Methods: Adult patients with early breast cancer treated with adjuvant chemotherapy at the London Regional Cancer Program in London, ON, Canada between May 2019 and June 2022 were included. All of these patients were supported with Lapelga® as the primary prophylaxis. Patients’ age, tumour, and nodal status, their type of chemotherapy, co-morbid conditions, and incidence of febrile neutropenia (FN) and its related details as well as any reported side effects to Lapelga® were collected. Results: A total of 201 patients were included in this review with majority (78%) of patients under 65 years of age. One third of patients were treated with the adriamycin and cyclophosphamide (AC)-Paclitaxel dose dense chemotherapy and a quarter of patients with either a docetaxel and cyclophosphamide (TC) combination or an AC-dose dense with Paclitaxel weekly, and 10% or less patients had FEC-D (5-fluorouracil, epirubicin, and cyclophosphamide) and AC chemotherapy. FN incidence was only 3.48% in this review (7/201 patients). Patients with FN were admitted to hospital and recovered completely with no mortality reported. No cases of a switch to a different granulocyte colony growth factor were seen. The most frequent side effects from Lapelga® included musculoskeletal pain, fever, and headache. However, the majority of patients (88.6%; 178/201) did not have any reported side effects specifically assigned to Lapelga®. Conclusions: In this single centre retrospective study, early breast cancer patients (n = 201) treated with adjuvant chemotherapy supported with primary prophylaxis with Lapelga® had a low incidence of FN (3.48%). This supports Lapelga® being an effective strategy as the primary prophylaxis when used with common chemotherapy regimens in the real-world setting. Full article
(This article belongs to the Section Medical Oncology)
11 pages, 962 KiB  
Article
Survival Benefit of Experience of Liver Resection for Advanced Recurrent Hepatocellular Carcinoma Treated with Sorafenib: A Propensity Score Matching Analysis
by Kuan-Chun Hsueh, Cheng-Chun Lee, Pi-Teh Huang, Chih-Yu Liang and Shun-Fa Yang
Curr. Oncol. 2023, 30(3), 3206-3216; https://doi.org/10.3390/curroncol30030243 - 9 Mar 2023
Viewed by 1585
Abstract
Several studies have shown that liver resection (LR) confers better survival outcomes in intermediate- and advanced-stage hepatocellular carcinoma (HCC) patients. However, the postoperative recurrence rate is high, and little is known about the survival benefits of LR for recurrent HCC patients who have [...] Read more.
Several studies have shown that liver resection (LR) confers better survival outcomes in intermediate- and advanced-stage hepatocellular carcinoma (HCC) patients. However, the postoperative recurrence rate is high, and little is known about the survival benefits of LR for recurrent HCC patients who have already received systemic treatment. This study aimed to evaluate the impact of LR on recurrent advanced-stage HCC patients who received sorafenib as a systemic treatment. In this study, 147 advanced HCC patients were enrolled between 1 January 2012 and 31 December 2019. Two study groups were classified, based on whether they underwent LR or not. To reduce the possible selection bias, a propensity score matching (PSM) analysis was performed. The primary study endpoint was set as overall survival (OS), and the secondary endpoint was set as progression-free survival (PFS). Our study results revealed that advanced HCC patients who received sorafenib with LR had a longer OS than did those without LR, whether before or after PSM (15.0 months vs. 6.0 months, HR 0.45, 95% CI 0.31–0.67, p < 0.001; 15.0 months vs. 5.0 months, HR 0.46, 95% CI 0.28–0.76, p = 0.001). Similar results were obtained in PFS, before or after PSM (4.14 months vs. 2.60 months, HR 0.60, 95% CI 0.40–0.89, p = 0.01; 4.57 months vs. 2.63 months, HR 0.58, 95% CI 0.34–0.97, p = 0.037). Multivariate analysis showed that the experience of LR was independent of other factors associated with better OS and PFS, whether before or after PSM (p < 0.05). Therefore, advanced HCC patients who have undergone liver resection should be encouraged to continue sorafenib treatment to improve prognosis. Full article
(This article belongs to the Special Issue New Insights of Liver Cancer and Its Treatment)
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<p>Flow chart of the study.</p> Full article ">Figure 2
<p>(<b>A</b>) Cumulative incidence of overall survival before propensity score matching. (<b>B</b>) Cumulative incidence of overall survival after propensity score matching.</p> Full article ">Figure 3
<p>(<b>A</b>) Cumulative incidence of progression-free survival before propensity score matching. (<b>B</b>) Cumulative incidence of progression-free survival after propensity score matching.</p> Full article ">
5 pages, 199 KiB  
Editorial
Progress and Remaining Gaps in the Early Detection and Treatment of Breast Cancer
by Jean M. Seely
Curr. Oncol. 2023, 30(3), 3201-3205; https://doi.org/10.3390/curroncol30030242 - 8 Mar 2023
Viewed by 2174
Abstract
Breast cancer affects too many of us [...] Full article
(This article belongs to the Special Issue Breast Cancer Imaging and Therapy)
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