Acıbadem University

The optimal timing of radiotherapy (RT) in patients with WHO grade 2 meningiomas remains controversial, particularly following gross total resection (GTR). This multicenter study compared long-term outcomes of early RT versus late RT, focusing on progression-free survival (PFS), overall survival (OS), and tumor-related mortality. This retrospective multicenter cohort study included 263 adult patients with histopathologically confirmed WHO grade 2 meningiomas treated between 2005 and 2023. Patients were stratified by RT timing: early adjuvant RT after initial surgery versus late RT administered after radiologic or clinical progression. Outcomes were analyzed in the overall cohort and in a prespecified GTR subgroup. PFS and OS were estimated using the Kaplan–Meier method. Tumor-related mortality was assessed using cause-specific Cox and Fine–Gray competing-risk models. With a median follow-up exceeding 7 years, early RT was associated with a significant improvement in PFS compared with late RT. In the overall cohort, 10-year PFS was 84.8

PURPOSE:Spinal angiolipomas (SALs) are rare benign tumors composed of mature adipose tissue mixed with abnormal vascular structures. Because of their rarity, their natural history, recurrence patterns, and optimal treatment strategies remain incompletely characterized. We performed a systematic review of the literature on spinal angiolipomas and presented an illustrative case of recurrent long-segment cervicothoracic SAL with mediastinal extension. METHODS:A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Google Scholar, Europe PMC, and Scopus were searched for English-language reports of histologically confirmed spinal angiolipoma published between 1966 and December 2024. Reference lists of relevant articles were also screened. Patient-level demographic, clinical, radiological, surgical, pathological, and outcome data were extracted and analyzed descriptively, with exploratory comparative analyses where appropriate. RESULTS:Of 185 records screened, 125 studies met the inclusion criteria, yielding 240 patients in total, including the present illustrative case. The cohort comprised 135 females (56.3%) and 105 males (43.7%), with a mean age of 46.9 years (range, 1-81 years). The most frequently involved region was the thoracic spine (175/240, 72.9%). Non-infiltrative tumors accounted for 196/240 cases (81.7%), whereas long-segment involvement and hemorrhagic presentation were each reported in 15 cases (6.3%). Motor weakness (133/240, 55.4%) and pain (103/240, 42.9%) were the most common presenting symptoms. Gross total resection was achieved in most reported cases, and overall neurological outcomes were generally favorable. Reported recurrence was rare; however, heterogeneous and sometimes limited follow-up likely underestimates the true recurrence risk. To our knowledge, the present case is the first reported recurrent long-segment cervicothoracic spinal angiolipoma with mediastinal extension. CONCLUSIONS:Spinal angiolipomas should be considered in the differential diagnosis of epidural spinal lesions and progressive spinal cord compression. Although these tumors are generally benign and associated with favorable postoperative outcomes, infiltrative morphology may reduce the likelihood of gross total resection, and recurrence may occur in rare cases. Surgical management should prioritize safe neural decompression, and long-term clinical and radiological surveillance should be considered, particularly in infiltrative or subtotally resected lesions.

Intrapelvic entrapment of the sciatic and sacral nerve roots can cause chronic pelvic pain, sciatica, and symptoms such as dysmenorrhea, dyspareunia, dyschezia, dysuria, vulvodynia, coccygodynia, and pudendal neuralgia. Conventional spine-focused approaches often overlook this cause. This study assessed whether laparoscopic nerve decompression improves pain and related outcomes. Between November 2022 and April 2024, 25 women (median age: 36 years) with ≥ 2 years of refractory pelvic neuropathic pain underwent laparoscopic decompression of the sciatic and sacral plexus. Diagnosis was confirmed via neuropelveological exam and 3-Tesla MRI. Patient-reported outcomes—Visual Analogue Scale (VAS) for nine pain domains, SF-36, PHQ-9, and OAB-V8—were collected preoperatively and at 1, 6, and 12 months postoperatively. Operative details and complications were recorded. All surgeries were completed laparoscopically with no conversions or motor deficits. Median operative time was 143.5 min. VAS scores decreased by 70–90

Background: Trastuzumab deruxtecan (T-DXd) has transformed the treatment landscape of human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (mBC), with significant improvements in survival reported in clinical trials. However, limited data exist regarding its performance in real-world settings, particularly in lower-middle-income countries (LMICs). Objectives: To evaluate the real-world effectiveness and safety of T-DXd in patients with HER2+ mBC in Türkiye. Design: A multicenter retrospective cohort study. Methods: This multicenter, retrospective cohort study, conducted by the Turkish Oncology Group, evaluated the real-world outcomes and tolerability of T-DXd in patients with HER2+ mBC across 27 oncology centers in Türkiye. The primary endpoints were real-world progression-free survival (rwPFS) and overall survival (rwOS). Secondary endpoints included response rate, safety (with adverse events (AEs) graded according to CTCAE v5.0), and evaluation of the first post-T-DXd treatments. Results: A total of 269 patients were included. The median age was 49 years (interquartile range: 42–59), and the median follow-up was 12.9 months. The median rwPFS was 17.9 months (95% confidence interval: 13.3–22.5), and the median rwOS was 35.7 months (95% confidence interval: 27.8–43.6). The objective response rate was 71.4%, and the disease control rate was 95.2%. Patients receiving T-DXd in the second line experienced significantly longer rwPFS compared with those treated in later lines ( p < 0.001). Treatment-related AEs of any grade occurred in 68.4% of patients. Interstitial lung disease was reported in 21 patients (7.8%), with 4 cases being grade ⩾3. Conclusion: In this large national real-world cohort from an LMIC, T-DXd demonstrated robust antitumor activity and a manageable safety profile in patients with HER2+ mBC. These findings are consistent with prior clinical trial data and support the applicability of T-DXd in broader clinical settings.

Urethral stricture (US) is a frequent and challenging urological entity characterized by spongiofibrosis and luminal narrowing, often leading to recurrent infections, urinary retention, and upper tract deterioration. Despite various endoscopic and open surgical options, high recurrence rates remain a major problem, and there is no established medical therapy to prevent stricture formation. To investigate the protective effect of hyperbaric oxygen (HBO) therapy on fibrosis and stricture formation in an experimental urethral injury model in rabbits using objective endoscopic, radiologic, and histopathologic parameters. Twenty-eight male New Zealand rabbits were randomized into three groups: sham (n = 8), urethral injury without treatment (control, n = 10), and urethral injury plus HBO (HBO, n = 10). Among the 20 rabbits with urethral injury, allocation to the untreated control group (Group 2) and the HBO treatment group (Group 3) was performed in a 1:1 ratio using a computer-generated randomization list. Standardized circumferential electrocoagulation was applied to the bulbar urethra in the control and HBO groups. HBO was administered at 2 ATA, 90 min/day for 21 consecutive days starting on the day of injury. On day 28, all animals underwent urethroscopy and retrograde urethrography; urethral specimens were then harvested for histopathological evaluation. Fibrosis was graded (0–3) using Masson trichrome staining. Normal urethral diameters were similar among the groups (p = 0.604). Median stricture diameter was significantly lower in the untreated control group compared with the HBO and sham groups (2.15 mm vs. 8.05 mm and normal segment, respectively; p < 0.001). Median percentage urethral narrowing was 78.52