Stereotactic radiosurgery (SRS) has transformed neurooncological care through its precision, minimally invasive nature. SRS involves multiple, convergent beams of high energy gamma rays, X-rays, or protons at a precisely defined treatment area. As the use of SRS continues to grow in neuro-oncology, it has brought with it a range of ethical and clinical concerns. This narrative review examines how deviations from accepted clinical guidelines and inappropriate use of SRS-such as overuse in low-volume centers, financial motivations, poor compliance with protocols, and unsuitable patient selection-can lead to compromised patient care. These practices not only pose risks to patient safety and outcomes but also threaten to undermine trust in the medical system. By reviewing real-world examples, this review highlights the necessity of stronger multidisciplinary decision-making, improved oversight and training of the clinical teams involved in delivering SRS. Addressing these issues is essential to ensure that radiosurgery remains a safe, effective, and ethically sound treatment option in the neuro-oncology practice.

To determine the presentation, indications, management and clinical outcomes of patients who underwent trans-sphenoidal excision of pituitary adenomas in a tertiary care setting.

The retrospective, descriptive study was conducted at the Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, and comprised records of patients with pituitary adenoma who underwent trans-sphenoidal excision between July 2005 and September 2022. Data was analysed using STATA 15.1.

Of the 50 patients, 25(50%) were males and 25(50%) were females. The overall mean age was 43.16±12 years. In 35(70%) cases, tumours were invading the cavernous sinus and were partially resected, 32(64%) tumours were macroadenoma, and 36(72%) were non-secretory. Of the total, 29(58%) patients were discharged within eight days of surgery. Intraoperative cerebrospinal fluid leak was seen in 4(8%) patients. Postoperative complications included anterior pituitary deficiency 17(34%), posterior pituitary deficiency 13(26%) and panhypopituitarism 3(6%). Postoperatively, vision improved in 23(46%) patients. External radiation therapy was offered to 15(30%) patients, while 5(10%) had gamma knife therapy.

Patients with non-functioning pituitary adenomas mostly presented later in life, with large adenomas causing compressive symptoms.

To review the comprehensive experience of surgical and oncological management of paediatric hepatoblastoma with 5-year survival outcome.

The retrospective study was conducted at the Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data from 2011 to 2020 of primary hepatoblastoma patients aged up to 18 years. Demographic details, size and site of the primary hepatic mass, tumour markers, radiological findings, PRE-Treatment Extent of tumour staging, treatment provided, histopathological and surgical details, and outcomes were assessed. Disease-free survival and overall survival were focussed upon. Data was analysed using SPSS 20.

Of the 60 patients with mean age 2.0+1.54 years, 32(53%) were inoperable. The remaining 28(47%) patients underwent liver resection with a mean operative time of 270±118.41 minutes. Right hemi hepatectomy was performed in 14(50%) patients and the most common histology was epithelial foetal type in 16(57.1 %) patients. The five-year disease-free survival was 62%, while the five-year overall survival was 82%.

The survival rate of paediatric hepatoblastoma patients who underwent liver resections was within the acceptable range.

To examine the diagnostic accuracy of 10 serum-derived micro ribonucleic acids in the early detection of ovarian cancer.

The cross-sectional, comparative study was conducted at the Department of Physiology and Cell Biology, University of Health Sciences, Lahore, Pakistan, from February 6, 2018, to August 1, 2021, and comprised women aged 20-70 years diagnosed with ovarian cancer and tentatively planned for surgical procedures. Serum micro ribonucleic acid levels were analysed using quantitative reverse transcription polymerase chain reaction. Data was analysed using SPSS 24, while the micro ribonucleic acid expression profile was analysed using GraphPad Prism.

There were 24 women with mean age 44±9.92 years. Cancer antigen 125 had a positive correlation with HSA-miR519d-5p, HSA-miR378-3p, HSA-miR16-5p and HSA-miR21-5p (p<0.05). The diagnostic value of HSA-miR16- 5p and HSA-miR21-5p improved from CA125 baseline to CA125 follow-up (6 months after surgery but before chemotherapy), with an area under the curve of 0.56 and 0.82, respectively. The area under the curve for diagnosing cancer stages based on HSA-miR16-5p and HSA-miR21-5p was 0.37 and 0.70, respectively.

Cancer-specific micro ribonucleic acids, such as HSA-miR21-5p and HSA-miR16-5p, were found to have diagnostic potential, and could be used in combination with cancer antigen 125 for the screening of ovarian cancer.

Neuroblastoma is the most common extracranial solid tumour in children. Radiotherapy is commonly part of the multimodal treatment for high-risk patients. The aim of this study is to analyse doses to organs at risk (OAR) in comparative proton and photon treatment plans for children treated for neuroblastoma and report side effects. Patient/material and methods: All children in Sweden treated with curative intent radiotherapy for abdominal neuroblastoma in 2017-2024 with comparative proton and photon treatment plans were retrospectively identified through a national registry (RADTOX), where data on side effects were collected. Doses to OAR were compared in each patient's proton and photon treatment plans.

A total of 30 children with a median age of 45 months (range 11-150) were included. The low-dose spread was significantly lower in the proton compared to the photon treatment plans measured as Body V5Gy and V10Gy (p < 0.001). Furthermore, the mean doses to the bowel bag, kidneys, liver, pancreas, and spleen were significantly lower in the proton plans. The median follow-up was 14 months (1-61), and the 2-year overall survival was 75.3%. While acute radiotherapy related grade ≥ 2 side effects were experienced by 12 patients (40%), late side effects were experienced by 7 patients (13%). The most common side effects were haematological and from the upper gastrointestinal tract.

In selected cases, proton treatment can offer lower doses to OAR and less low-dose exposure compared to photon treatment in children treated for abdominal neuroblastoma. Whether this translates into a clinical benefit is currently unclear and should be evaluated in future studies.

Lung cancer is one of the most common malignancies worldwide and is associated with high mortality. In Finland, overall lung cancer survival is lower than in other Nordic countries. A recent Finnish Cancer Registry publication reported that only 11.8% of patients underwent surgery. We aimed to assess whether operability and surgical outcomes contribute to Finland's inferior lung cancer survival rates.

This retrospective study analysed patient data of five Finnish hospital databases. We focused on potentially operable patients, specifically those with non-small cell lung cancer in stage I-IIIA according to computer tomography. A total of 156 patients met the staging criteria, of whom 77 underwent surgery. Among potentially operable patients, 50.6% were deemed ineligible for surgery due to various factors, including poor pulmonary or cardiac function, comorbidities, or localised tumour spread.

In our material 156 out of 545 were potentially operable and 77 were operated. 2-year overall survival for operated patients was 79%.

We found that patients with lung cancer in Finland present with poorer overall health, a slightly more advanced stage distribution among potentially operable cases, and a lower overall rate of surgical treatment compared to other Nordic countries. Additionally, patients in Finland tend to undergo surgery at more advanced stages. These factors likely contribute to Finland's lower lung cancer survival rates. This study underscores that delayed diagnosis and a lower proportion of patients undergoing surgery may be key contributors to Finland's poorer treatment outcomes.

Ewing sarcoma is a rare malignant tumor with an incidence of 3 cases per 1 million inhabitants annually. Cross-disciplinary management is key to improve survival rates. The role played by intraoperative radiotherapy in terms of treatment is still to be defined.

A retrospective study of pediatric patients (up to 16 years of age) with chest wall Ewing sarcoma undergoing tumor resection surgery, intraoperative radiotherapy, and chest wall reconstruction in our institution from 2011 to 2024 was carried out. Variables such as age at surgery, sex, neoadjuvant treatment, resection type, characteristics of intraoperative radiotherapy, reconstruction type, complications, local control rate, relapses, survival, and reconstruction's functional result were collected.

8 patients were included. Mean age at diagnosis was 12.5 years. Full tumor mass removal with free margins (R0) was achieved in 100% of the cases. Reconstructive techniques with flexible patches, titanium plates, and muscle flaps were used. None of the flaps was lost. Overall survival was 87.5%, with a mean follow-up period of 6 years. 3- and 5-year overall survival rates were 100% and 80%, respectively. Local control of the disease was achieved in 100% of the cases.

This paper discusses the role of intraoperative radiotherapy as a good treatment alternative to achieve the local control of Ewing sarcoma associated with large surgical resections.

BackgroundTraditional dynamic contrast-enhanced MRI (DCE-MRI) radiomics approaches for predicting lymphovascular invasion (LVI) in invasive breast cancer (IBC) frequently neglect the importance of dynamic phase alterations, and their diagnostic efficacy is often constrained by limited sample sizes. We have developed the Tabular Prior-data Fitted Network (TabPFN) algorithm, which synergistically combines clinical and MR morphological features with delta-radiomics, thereby substantially improving the performance of binary classification.MethodIn this retrospective study, 276 IBC patients were divided into a training group (n = 193, 70%) and a validation set (n = 83, 30%). A radiomic score (Radscore) was developed using 1239 radiomic features derived from lesion masks in delta images, establishing the delta-radiomics model. To preoperatively predict LVI, we utilized the TabPFN algorithm alongside traditional machine learning methods. This approach combined the Radscore with both clinical and MR morphological features for binary classification.ResultsThe delta-radiomics model achieved an area under the curve (AUC) of 0.775. Among the evaluated machine learning models, the TabPFN algorithm demonstrated superior performance by effectively integrating the Radscore along with clinical and MR morphological features, resulting in an AUC of 0.899. Additionally, it recorded an accuracy of 0.88, a precision of 0.667, a recall of 0.571, and an F1-score of 0.615.ConclusionDelta-radiomics analysis shows potential for predicting preoperative LVI in IBC patients. To tackle small sample sizes, we developed the TabPFN algorithm, combining clinical and MR morphological features with Radscore, enhancing binary classification and demonstrating strong predictive performance.

Peripheral blood follicular helper T cells (Tfh) are essential in humoral immunity; however, their prognostic significance in hepatocellular carcinoma (HCC) patients treated with immune checkpoint inhibitors (ICIs) is not well understood. This study aimed to evaluate the predictive value of Tfh cells for short-term prognosis in 200 HCC patients undergoing ICIs. A retrospective analysis categorized patients based on their clinical outcomes at six months post-treatment: those demonstrating improvement were classified as having a favorable prognosis (n=86), while those with no remission, deterioration, or death were classified as having a poor prognosis (n=114). Key prognostic factors assessed included C-reactive protein (CRP), interleukin-6 (IL-6), Tfh cell counts, and combination therapy. Significant associations were identified between prognosis and CRP, IL-6, Tfh cell counts, and combination therapy. Multivariate analysis revealed these factors as independent predictors of short-term prognosis, explaining 78.3% of the variance. The area under the curve (AUC) for Tfh cells was 0.902 (95% CI: 0.8567-0.9477), with 100% sensitivity and 80.70% specificity at a cut-off of 1.995. Patients with elevated Tfh levels (≥1.995, n=93) had a median overall survival (OS) of 5 months, significantly earlier than those with lower levels (<1.995, n=107), whose median OS was not reached. Tfh cells are independent predictors of short-term prognosis in HCC patients receiving ICIs. Reduced Tfh levels correlate with improved outcomes, providing crucial insights for clinical decision-making.

This single-center study conducted in Turkey aims to assess the impact of preoperative nutritional status based on global leadership initiative on malnutrition criteria on 30-day postoperative surgical outcomes in patients undergoing pancreaticoduodenectomy (PD) for pancreatic head adenocarcinoma. A retrospective analysis was conducted on patients who underwent PD. Patients were classified into 2 groups based on preoperative nutritional assessments of global leadership initiative on malnutrition criteria: malnourished (n = 23; 46%) and nonmalnourished (n = 27; 54%). Preoperative data, including demographics, comorbidities, intraoperative data, final pathological results, and postoperative 30-day outcomes, including overall and major (Clavien-Dindo > II) complications, length of hospital stay (LOS), and 30-day mortality rates, were recorded and compared. A total of 50 patients were included in the study. Demographics, American Society of Anesthesiologists scores, and comorbidities were similar between the groups (P > .05). The mean Clavien-Dindo grade was 3 in the malnourished group and 2 in the nonmalnourished group (P = .001). Malnourished patients had a significantly higher rate of major complications (73.9%) compared to nonmalnourished patients (14.8%)(P = .001). The median LOS was similar between the 2 groups. The rate of postoperative transfusions was higher in the malnourished group (P = .033). Postoperative 30-day mortality was significantly higher in the malnourished group (26.1%) compared to the nonmalnourished group (0%) (P = .006). Multivariate logistic regression analysis confirmed that malnutrition was an independent predictor of postoperative major complications (OR: 16.3, 95% CI: 3.9-66.8, P = .001). Preoperative malnutrition is a strong predictor of 30-day postoperative major complications and mortality following PD in patients with pancreatic head adenocarcinoma.