This study compares the surgical and oncological outcomes of minimally invasive robotic (RLP) and laparoscopic (LLP) left pancreatectomy in pancreatic cancer (PC) patients.

Data from patients who underwent minimally invasive left pancreatectomy between 2013 and 2023 were analyzed. Two groups were identified: RLP and LLP. Perioperative outcomes were compared, including operative time, blood loss, conversion rate, and postoperative complications. Oncological outcomes included margin status, lymph node retrieval, lymph node status, overall survival (OS), and disease-free survival (DFS).

Fifty-four patients were divided into the LLP (n = 39) and RLP (n = 15) groups. The median operative time was shorter for LLP than RLP [260 min vs. 366 min, p = 0.007]. Blood loss and conversion rates were comparable (p > 0.05). In the LLP group, significantly more lymph nodes were harvested (29 vs. 19, p = 0.05), and a higher percentage of positive lymph nodes was noted (72% vs. 40%, p = 0.033). No significant difference was found in the R0 resection status (82% vs. 73%, p = 0.358). After a median follow-up of 26 months, OS (23 months vs. 34 months, p = 0.812) and DFS (17 months vs. 16 months, p = 0.635) were similar.

RLP provides outcomes identical to LLP in treating body-tail pancreatic cancer, with further studies needed to confirm its long-term oncological efficacy.

Immunotherapy has a defined role in the treatment of both early- and late-stage triple-negative breast cancer (TNBC) and is under active exploration in human epidermal receptor 2-positive as well as high-risk hormone-receptor-positive subtypes. It is critical to balance the efficacy and toxicity of immunotherapy while keeping the cost and duration of treatment in check. In addition to the immunohistochemistry testing of PD-L1 expression, which only predicts the efficacy of immunotherapy in metastatic TNBC, there is a lack of biomarkers that are better standardized to predict efficacy and treatment response, detect early relapse, and guide prognosis in breast cancer patients treated with immunotherapy. Circulating tumor DNA (ctDNA) is a minimally invasive, dynamic, real-time, blood-based biomarker that has shown promising value in the management of solid tumors, including breast cancer. This review discusses the emerging evidence for the potential application of ctDNA to further refine patient-centered care and personalize treatment based on a molecularly defined risk assessment for breast cancer patients treated with immunotherapy-based approaches. We further discuss the challenges and barriers to widespread adoption of this promising tool in the management of breast cancer patients requiring immunotherapy.

The geriatric nutritional risk index (GNRI), a composite metric of serum albumin and body weight, has emerged as a prognostic tool in various cancers. However, its relevance in nasopharyngeal carcinoma (NPC) patients treated with volumetric modulated arc therapy (VMAT) remains unexplored. The aim of this study was to assess the effect of the GNRI in the prediction of the prognosis of nasopharyngeal carcinoma in the era of VMAT.

This retrospective study analyzed 498 newly diagnosed, non-metastatic NPC patients treated with VMAT between 2010 and 2011. The GNRI was calculated using serum albumin and body weight ratios, with receiver operating characteristic (ROC) curve analysis determining its optimal prognostic cutoff. Patients were stratified into training (70%) and validation (30%) cohorts. Cox regression identified independent prognostic factors, which were integrated into a nomogram predicting 3- and 5-year overall survival (OS). Model performance was assessed via the concordance index (C-index), calibration curves, and decision curve analysis (DCA).

In the study, 348 patients were included in the training cohort and 150 patients were included in the validation cohort according to a ratio of 7:3. The median follow-up was 68 months, with 5-year OS rates of 79.3%. A GNRI > 102 independently predicted improved survival (HR = 0.64; p = 0.044), alongside tumor volume, age, and N-stage. The nomogram demonstrated strong discrimination (C-index: 0.757-0.762 for training; 0.737-0.744 for validation) and calibration, aligning closely with observed survival. DCA confirmed superior clinical utility over default strategies. NPC patients treated with VMAT with a high GNRI, female sex, and a lower N-stage exhibited significantly better OS (p < 0.05).

The GNRI is a robust prognostic marker for NPC patients receiving VMAT, reflecting the interplay of nutrition, inflammation, and treatment response. The validated nomogram provides a practical tool for individualized risk stratification, enhancing clinical decision-making in the era of precision radiotherapy.

The impact of adjuvant chemotherapy (AC) on outcomes in real-world patients with locally advanced rectal cancer (LARC) remains uncertain.

Consecutive patients with LARC (stage II/III) undergoing neoadjuvant chemoradiation before curative-intent surgery from 2005 to 2013 were identified in the Canadian Health Outcomes Research Database. The impact of AC on clinical outcomes, including disease-free survival (DFS) and overall survival (OS), was evaluated using the Kaplan-Meier method and Cox proportional hazards modeling.

A total of 1448 patients had sufficient data available to be included for analysis with 1085 (74.9%) receiving AC. Of AC patients, 40.5% received oxaliplatin-based treatments. With a median follow-up of 66.43 months, the 5-year DFS rate was 67.7% (95% CI: 64.5-70.1%) vs. 58.7% (95% CI: 52.8-64.2%) in the AC group and non-AC group, respectively (p < 0.001). The 5-year OS rate of the whole cohort was 74.3% (95% CI: 71.5-76.85%) while the 5-year OS rate of the AC group was 77.8% (95% CI: 74.7-80.6%) compared with 63.8% (95% CI: 57.9-69.2%) for the non-AC group (p < 0.001). On multivariate analysis, patients who received AC had improved DFS (HR 0.6, 95% CI: 0.49-0.73, p < 0.001) and OS (HR 0.46, 95% CI: 0.36-0.58, p < 0.001).

This large multi-institutional database analysis supports the use of AC in real-world LARC patients treated with nCRT followed by surgical resection.

Current yoga programs for cancer survivors do not meet participants' needs and are rarely implemented in community-based settings, despite reported benefits. The aim of the current study was to implement a co-created 12-week bi-modal Hatha-based yoga program for adults diagnosed with gynecologic cancer in the community and assess the feasibility and acceptability of the program and study methods.

Using a mixed methods series N-of-1 A₁BA₂ research design, participants were recruited from The Ottawa Hospital. Participants self-selected a morning or evening program, completed surveys 9 to 11 times and were interviewed post-program. The yoga instructor was interviewed post-program about her experience delivering the program. Quantitative feasibility outcomes were tracked throughout the study. Qualitative acceptability outcomes were explored during post-program semi-structured interviews. Audio and video recordings of the yoga classes and data from the instructor interview were used to assess fidelity outcomes to determine whether the protocol could be adhered to consistently.

Forty-one individuals were screened for eligibility and 20 consented (48.7%). Seventeen participants (85.0%) completed the final survey. Participants attended 83.1% (19.9/24) of classes with varied engagement with optional features. The instructor was 61.3% adherent to the prescribed protocol, using recommended behaviors 44.6% of the time. Participants shared barriers and facilitators that influenced the success of the trial methods and program.

The program was well-received and trial methods were moderately successful, but refinements are warranted before a large-scale trial. Community-based yoga programs could be feasible and acceptable for women with gynecologic cancer.

People with head and neck cancer are up to three times more likely to die by suicide than the general population. There is an urgency to understand and address the growing rates of suicidality within this population. The objectives of this review are (1) to explore the risk factors for thoughts of suicide and self-harm, and suicide completion in patients with head and neck cancer, and (2) to understand the challenges and needs of patients impacted by head and neck cancer who have had thoughts of self-harm and suicide.

Mixed-methods systematic review following the PRISMA protocol. Electronic databases and grey literature searches were completed using MeSH terms and key word searches. A total of 3665 recorded were identified; with 36 studies included. Of these, 22 focussed on suicide completion, with sufficient data to conduct a meta-analysis on several important risk factors for suicide completion. These are sex, age, time since diagnosis and marital status. The remaining 14 studies reported on suicide ideation for this population, with the findings analysed within a narrative synthesis. Findings and clinical implications were refined with input from nine members of a head and neck cancer patient and public involvement group.

Risk of suicide ideation and suicide completion was greatest in male patients. Suicide completion was highest in patients within the first 6-months of diagnosis, who were widowed, or had cancer of the hypopharynx. Suboptimal pain and symptom management appeared related to a higher risk of suicide ideation. A therapeutic and supportive relationship with health and social care professionals was helpful in managing experiences of suicidal ideation.

Health and social care professionals should identify, assess, support and follow-up regarding thoughts of suicide for patients with head and neck cancer. Clear pathways are necessary for the management of suicidality, to include appropriate referrals to psychiatry/psychology, supportive interventions to include medications that can help with pain, distress or other symptoms.

In recent years, the thoracoacromial artery perforator (TAAP) flap has emerged as a promising option for the reconstruction of facial defects, typically utilized in the form of a pedicled flap. However, there remains relatively limited experience in using a free TAAP to repair facial defects. This case describes the first application of a free bilobed TAAP for one-stage reconstruction of multiple facial defects after resecting cutaneous squamous cell carcinomas (cSCC). The patient was a 76-year-old man who noticed progressive enlargement of two black neoplasms around the left and right nose for over 1 year and 3 months, respectively. A preoperative biopsy confirmed both lesions as cSCC. During surgery, two skin and soft tissue defects, measuring approximately 6.5 cm × 3.0 cm and 3.5 cm × 2.0 cm, were left in the bilateral paranasal regions after the removal of tumors. A free bilobed TAAP flap of the appropriate size was designed and harvested to repair these defects. The postoperative course was uneventful, and the patient recovered without complications. Good esthetic and functional outcomes were achieved during a 14-month follow-up period. This report suggests that a free bilobed TAAP flap may be an option for reconstructing multiple facial defects caused by trauma, tumor resection, or other lesions.

Systemic therapy for advanced hepatocellular carcinoma (HCC) includes multi-kinase inhibitors with anti-vascular endothelial growth factor (VEGF) activity and anti-VEGF monoclonal antibodies in combination with immune checkpoint inhibitors. This study aimed to investigate and compare the chronological changes in liver volume between patients who received atezolizumab plus bevacizumab (Atezo/Bev) and those who received lenvatinib.

We enrolled patients who received initial treatment with either Atezo/Bev or lenvatinib for advanced HCC between October 2018 and May 2023. Patients underwent periodic computed tomography (CT) or magnetic resonance imaging (MRI) to evaluate systemic therapy effects. Patients with portal vein thrombosis or prior liver resection/transplantation were excluded. Liver volume was measured at baseline and at 8 and 16 weeks after the initiation of treatment using commercially available software. Liver volume at each time point was expressed as a proportion relative to baseline. A linear regression analysis was used to analyze the chronological changes in liver volume.

Seventy-three patients (40 in the Atezo/Bev group and 33 in the lenvatinib group) were included in this retrospective study. Liver volume decreased in 54 patients (74%) at week 8; the average volume relative to baseline was 0.92 (95% confidence interval: 0.90-0.94, p < 0.01). Liver volume decreased in patients with both shrinking and enlarged tumors. Multivariate analysis indicates that the decrease in nontumoral liver volume was more significant in the lenvatinib group than in the Atezo/Bev group (p = 0.04).

Anti-angiogenic therapy for advanced HCC can lead to liver atrophy.

To compare the long-term survival of patients with locally advanced low rectal cancer (LALRC), receiving neoadjuvant chemoradiotherapy (NCRT) versus adjuvant chemoradiotherapy (ACRT).

This retrospective observational study included 1169 patients with LALRC (Stage II/III disease located ≤ 5 cm from the anal verge) who underwent diagnosis and treatment at Fudan University Shanghai Cancer Center from February 2006 to March 2021. In Stage II/III low rectal cancer patients, one-to-one matched pairs were created from the ACRT and NCRT groups using propensity score matching (PSM) based on baseline characteristics. OS and DFS were evaluated using the Kaplan-Meier method alongside the univariate Cox regression model.

In Stage II patients, 65 received ACRT and 107 received NCRT. For Stage III, 282 received ACRT and 715 received NCRT. After PSM, 45 paired Stage II patients and 243 paired Stage III patients were selected. In Stage II patients, there was no significant difference in OS and DFS between the groups. For Stage III, the 5- and 10-year OS rates were 79.61% and 77.67% in the NCRT group, compared to 61.08% and 44.57% in the ACRT group (p < 0.001). The 5- and 10-year DFS rates were 69.93% and 65.26% in the NCRT group, versus 48.07% and 40.77% in the ACRT group (p < 0.001). Additionally, in Stage III patients, NCRT was associated with a significant reduction in the risk of death and recurrence compared to ACRT (OS: HR = 0.47, p = 0.0001; DFS: HR = 0.55, p = 0.0001).

For patients with Stage III low rectal cancer, NCRT significantly improved the long-term DFS rate and OS rate, in comparison to adjuvant chemoradiotherapy.

Siblings of children with cancer may be vulnerable to compromised long-term health. We aimed to describe the frequency (prevalence, incidence) of adverse physical health outcomes and healthcare service utilization among siblings of children with cancer and compare the risk of the above outcomes to siblings of children without cancer.

We searched Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and Clarivate Web of Science through June 15, 2024. We included English and French-language studies, both with and without a healthy control population, that reported adverse physical health outcomes and/or healthcare service utilization outcomes among siblings of children with cancer. Studies focusing exclusively on mental health or quality of life were excluded. Abstracts were screened by two reviewers; full-text articles underwent data abstraction and risk of bias assessment. Results were synthesized descriptively.

Of 26,570 studies screened, 44 were included. Heterogeneity was observed in all reported outcomes: mortality; cancer; organ system disease; overweight/obesity; pain; congenital anomalies; comorbidities; infections; amputations; adverse health behavior (smoking, alcohol consumption); infertility; healthcare service utilization (hospitalization, emergency department/urgent care visits, prescriptions). We detected a trend toward increased risk of cancer, hospitalizations, and prescription medication use compared to control siblings. Significant study heterogeneity rendered meta-analyses inappropriate.

Siblings of children with cancer are likely vulnerable to various adverse health outcomes. However, the published literature is widely heterogeneous regarding study design, populations, and outcomes measurements, limiting our comprehensive analysis of risk. Future research with homogenized methodology is needed to better quantify risk, which would inform targeted surveillance guidelines and interventions.