Arua Regional Cancer Centre

Background Hepatoblastoma is the most common primary malignant liver tumor in children, with peak incidence under three years of age. Tumor rupture, though rare, is a life-threatening complication that necessitates urgent intervention due to risks of hemorrhagic shock and peritoneal dissemination. This report highlights the clinical course, surgical management, and outcomes of three pediatric patients with ruptured hepatoblastoma. Methods We analyzed three cases of ruptured hepatoblastoma in children aged 1-2 years. Diagnosis was based on clinical presentation, imaging, serum alpha-fetoprotein (AFP) levels, and histopathology where required. Management strategies included neoadjuvant chemotherapy with the Super-PLADO regimen, transarterial chemoembolization (TACE) and emergency hepatic resections tailored to tumor extent and vascular involvement. Results All three patients presented with rupture either before or shortly after initiation of chemotherapy. One case involved a malignant rhabdoid variant with low AFP, necessitating biopsy for diagnosis. TACE was attempted in one case but surgical intervention was ultimately required in all due to worsening hemodynamic instability. Resections included left hepatectomy, non-anatomical segmental resection, and extended right hepatectomy. Conclusion Ruptured hepatoblastoma is a surgical emergency requiring a multidisciplinary approach. Early recognition, stabilization, and timely surgical intervention are crucial for survival. Despite the high-risk nature of tumor rupture, favorable outcomes can be achieved with individualized, aggressive management combining surgery and other modalities.

BACKGROUND:Neoadjuvant standard-of-care for HER2-positive early-stage breast cancer is trastuzumab + pertuzumab with polychemotherapy; however, existing regimens have high toxicity burdens and suboptimal outcomes. DESTINY-Breast11 assessed efficacy and safety of neoadjuvant trastuzumab deruxtecan (T-DXd) alone or followed by paclitaxel + trastuzumab + pertuzumab (THP) versus dose-dense doxorubicin + cyclophosphamide (ddAC) followed by THP for high-risk (≥cT3cN0 or cT0-4cN1-3) HER2-positive disease. PATIENTS AND METHODS:This open-label, phase III trial (147 sites, 18 countries) randomised adults 1 : 1 : 1 to T-DXd (×8 cycles), T-DXd-THP (4 + 4 cycles), or ddAC-THP (4 + 4 cycles). T-DXd-alone arm enrolment closed early following the Independent Data Monitoring Committee recommendation. The primary endpoint was pathological complete response (pCR; ypT0/is ypN0; intent-to-treat population). Secondary endpoints included event-free survival (EFS; intent-to-treat population) and safety (safety analysis set). RESULTS:Between 25 October 2021 and 12 March 2025, 286 (T-DXd), 321 (T-DXd-THP), and 320 (ddAC-THP) female patients were randomised. pCR rates were 43.0% (T-DXd, n = 123), 67.3% (T-DXd-THP, n = 216), and 56.3% (ddAC-THP, n = 180). T-DXd-THP versus ddAC-THP absolute pCR rate difference was 11.2% [95% confidence interval (CI), 4.0% to 18.3%, P = 0.003], with benefit in hormone receptor (HR)-positive [61.4% (n/N = 145/236) versus 52.3% (n/N = 123/235); difference in pCR (ΔpCR) 9.1% (95% CI 0.2% to 17.9%)] and HR-negative [83.1% (n/N = 69/83) versus 67.1% (n/N = 57/85); ΔpCR 16.1% (95% CI 3.0% to 28.8%)] subgroups. Median EFS (T-DXd-THP versus ddAC-THP, maturity 4.5%) hazard ratio was 0.56 (95% CI 0.26 to 1.17). Grade ≥3 adverse events (AE; T-DXd, 22.6% (n = 64); T-DXd-THP, 37.5% (n = 120); ddAC-THP, 55.8% (n = 174)], serious AE [T-DXd, 10.2% (n = 29); T-DXd-THP, 10.6% (n = 34); ddAC-THP, 20.2% (n = 63)], and all-grade left-ventricular dysfunction [T-DXd, 0.7% (n = 2); T-DXd-THP, 1.3% (n = 4); ddAC-THP, 6.1% (n = 19)] rates were lower for T-DXd and T-DXd-THP than ddAC-THP. All-grade adjudicated drug-related interstitial lung disease/pneumonitis rates were low and similar across arms [T-DXd, 4.9% (n = 14); T-DXd-THP, 4.4% (n = 14); ddAC-THP, 5.1% (n = 16)]. Three treatment-related deaths occurred [T-DXd-THP, 0.3% (n = 1); ddAC-THP, 0.6% (n = 2)]. CONCLUSIONS:Neoadjuvant T-DXd-THP demonstrated statistically significant and clinically meaningful pCR benefit and improved safety versus ddAC-THP.

PURPOSE:Breast cancer (BC) remains a major global health issue, influenced by modifiable factors like lifestyle and diet, and non-modifiable factors such as genetics. This study assesses their impact on BC among pre- and post-menopausal women in South India using a large, age-matched, population-based case-control design. METHODS:We analyzed epidemiological risk factors for BC overall and stratified by menopausal status. A total of 3,043 newly diagnosed BC cases from the Regional Cancer Centre, Thiruvananthapuram, and age-matched controls from the general population of Kerala, recruited through face-to-face interviews (2017-2023). Odds-ratios (OR) and 95% Confidence-Interval (CI) were estimated using conditional-logistic regression model. RESULTS:Independent modifiable risk-factors for BC (OR;CI) among all women were frequent fried-food consumption (3.9;3.2-4.7), low vigorous-activity (2.7;2.2-3.4), low moderate-activity (2.4;1.8-3.3), more light-activity (2.2;1.8-2.6), high body-mass-index (1.5;1.1-1.8) and non-modifiable risk-factors were benign-breast-disease (4.9;3.4-7.2), prior-chest radiation (3.4;1.9-5.8), prior-pesticide exposure (2.5;1.4-4.2), family-history of BC (2.0;1.5-2.6) and family-history of other cancers (1.4;1.1-1.6), post-menopause women (1.4;1.02-1.9) and early menarche (1.3;1.03-1.7). In the stratified analyses, the independent factors among pre-menopausal women were fried-food consumption, physical inactivity, high body-mass-index, benign-breast-disease, prior-pesticide exposure, prior-chest radiation, and late first delivery were significant. Among post-menopausal women, the significant factors included fried food consumption, physical inactivity, higher waist-to-hip ratio, history of abortion, thyroid disease, benign-breast-disease, family-history of BC, family-history of other cancers, prior-pesticide exposure and prior-chest radiation. CONCLUSIONS:Non-modifiable factors consistently influenced BC risk across groups, modifiable-factors were more critical among post-menopausal women. Targeted prevention strategies that promote physical activity, and weight management could significantly reduce the risk of breast cancer.

Background: Standard trastuzumab maintenance therapy is administered every 3 weeks at 6mg/kg following completion of chemotherapy. However, geographic barriers and patient compliance issues in montane terrain settings may limit adherence to this schedule. We evaluated the efficacy and safety of alternative 4-weekly dosing (8mg/kg) compared to standard 3-weekly dosing in HER2-positive breast cancer patients. Methods: This retrospective cohort study analyzed patients with HER2-positive breast cancer treated between June 2015 and January 2018 at centers serving mountainous regions. All patients received standard TCH (docetaxel, carboplatin, trastuzumab) induction therapy. For maintenance, patients chose either 3-weekly trastuzumab (6mg/kg, n=47) or 4-weekly trastuzumab (8mg/kg, n=34) based on geographic accessibility. Primary endpoints were disease-free survival (DFS) and overall survival (OS) analyzed using Kaplan-Meier methodology and log-rank tests at median 8-year follow-up. Results: Eighty-one patients were analyzed (Stage I: 17.3%, Stage II: 22.2%, Stage III: 59.3%, Oligometastatic: 1.2%). Baseline characteristics were balanced between groups (p=0.665). At median 8-year follow-up, Kaplan-Meier analysis showed non-inferior survival outcomes for 4-weekly dosing. Neither regimen reached median survival. Five-year disease-free survival was 68.1% vs 70.6% (log-rank p=0.726, HR 1.15, 95%CI 0.53-2.51) and five-year overall survival was 74.5% vs 79.4% (log-rank p=0.721, HR 1.17, 95%CI 0.49-2.79) for 3-weekly vs 4-weekly groups, respectively. Event rates were 16/47 (34.0%) vs 10/34 (29.4%) for DFS and 13/47 (27.7%) vs 8/34 (23.5%) for OS. Stage-specific analysis showed consistent trends across all stages. Conclusions: Trastuzumab maintenance at 8mg/kg every 4 weeks demonstrates non-inferiority to standard 3-weekly dosing with numerical trends favoring the alternative schedule. Kaplan-Meier survival analysis with robust statistical methodology confirms equivalent long-term outcomes. This approach offers a viable option for patients facing geographic or logistical barriers to standard dosing, potentially improving treatment adherence while maintaining efficacy. Further prospective validation is warranted. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Institutional Review Board of The Swami Ram Cancer Hospital & Research Institute, at Haldwani, Uttarakhand, India has provided ethical approval for this study titled "Trastuzumab Maintenance Every 4 Weeks versus Every 3 Weeks in HER2-Positive Breast Cancer: A Retrospective Analysis of Long-term Outcomes" I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

Papillary thyroid carcinoma and follicular thyroid carcinoma both are collectively referred as well-differentiated thyroid carcinomas (WDTC). Both carcinoma types carry an excellent prognosis except in cases with aggressive backgrounds or clinicopathological features. We herein investigated survival rates and various prognostic factors in patients with WDTC. In this retrospective study, a total of 602 patients diagnosed as having WDTC, who had undergone total thyroidectomy with or without neck dissection and had received adequate radioactive iodine treatment from January, 2006, to December, 2008 were included. Data were collected by medical record review. Size of the tumor (p < 0.001) and extrathyroidal extension (p < 0.001) were factors for developing regional lymph node metastasis. Nodal metastasis N0 (central compartment) and N1 (lateral compartment) did not adversely affect 7-year overall survival (p < 0.8). For both regional metastasis (p = 0.001) and distant metastasis (p = 0.025), age > 55 years adversely affected overall survival. No significant difference was found in 7-year overall survival between patients with gross and microscopic extrathyroidal extension (77.6% vs. 74.5%, p = 0.18), 10-year overall survival with gross and microscopic extrathyroidal extension was also non-significant (71.1% vs. 81.3%, p = 0.509). There was no role of prophylactic central compartment neck dissection in treating patients with WDTC. Overall survival at 3, 5, 7 years, and 10 years were 94.2%, 88.8%, 85.2%, and 82.7%, respectively. It can be concluded that the survival was adversely influenced by advanced age (> 55 years). Moreover, poor long-term overall survival and disease-free survival were observed in our study population owing to advanced stage carcinoma (extrathyroidal extension and lymph node metastasis) at presentation.