LBA5500 Background: Optimal timing of cytoreduction in non-frail patients (pts) with seemingly resectable stage IIIB-IVB ovarian, tubal, and peritoneal carcinoma (OC) remains controversial. Methods: TRUST is an international randomized multicenter phase III trial in pts with stage IIIB-IVB OC and good performance status (ECOG 0/1) comparing primary cytoreductive surgery (PCS) followed by 6 cycles of intravenous (iv) chemotherapy to 3 cycles of neoadjuvant iv chemotherapy (NACT) followed by interval cytoreductive surgery (ICS) and 3 further iv cycles. Maintenance treatment with bevacizumab and/or PARP inhibitors was allowed if selection criteria was similar for both arms. Pts were eligible for the study if preoperative clinical and radiologic assessment identified them as potential candidates for PCS. To ensure surgical quality, participating centers complied with an onsite surgery quality assurance audit, had adequate infrastructure, surgical proficiency (complete resection rates ≥50% in PCS) and sufficient volume (≥36 PCS/year). The intent to treat analysis population included all eligible pts with confirmed stage IIIB-IVB disease. The primary endpoint was overall survival (OS). Superiority was tested using a two-sided stratified log-rank test with significance level 0.05. Secondary endpoints were progression-free survival (PFS) and surgical complications. Results: A total of 688 eligible pts (median age: 63y; range: 32-83) underwent randomization: 345 were assigned to PCS and 343 to NACT/ICS. 91% had high-grade serous histology. Complete resection was achieved in 61.7%/62.9% of all randomized/all operated pts in the PCS group and 72%/76.6% in the ICS group. Median PFS was 22.2 months in the PCS group, and 19.7 months in the ICS group (HR 0.80 95%CI: 0.66-0.96; p=0.02). Median OS was 54.3 months in the PCS group and 48.3 months in the ICS group (HR 0.89 95%CI: 0.74-1.08; p=0.24). Pts with complete cytoreduction after PCS had the most favorable outcome, with a median PFS and OS of 27.9 and 67.0 months, respectively. A long-term benefit from PCS was seen in all analyzed subgroups. The benefit of PCS was most prominent in stage III pts (n=468): median PFS for PCS vs ICS, 26.3 vs 21.4 mos; median OS for PCS vs ICS, 63.7 vs 53.2 months. Major postoperative complication rates were acceptable, with a 30-day postoperative mortality rate of < 1% in both groups. Conclusions: In expert centers with proven surgical quality, PCS followed by iv chemotherapy resulted in a significantly longer median PFS and a numerically longer OS compared to NACT/ICS in non-frail OC pts. Although statistical significance in the primary endpoint was not reached, this is the first randomized trial to show a benefit of PCS over ICS. This benefit is likely to be associated with the high complete resection rate, reinforcing PCS as a standard of care in non-frail pts with seemingly resectable advanced OC. Clinical trial information: NCT02828618 .
Conventional age-based breast cancer screening ignores substantial inter-individual risk variation, contributing to overdiagnosis, false positives, and missed opportunities for earlier detection in high-risk women. Mammography-based artificial intelligence (AI) may enable risk-stratified screening and more efficient workflows. To systematically review evidence on mammography-based AI for personalized breast cancer screening, covering risk prediction, detection/triage, decision support, and associated ethical, economic, and equity implications. We searched MEDLINE/PubMed, Embase, Scopus, Web of Science, and the Cochrane Library (January 2015–November 2025) for studies evaluating AI-enabled personalization in breast cancer screening. Two reviewers independently screened 612 records, assessed 77 full texts, and included 30 studies; data were synthesized narratively. Image-based deep-learning risk models consistently outperformed traditional clinical risk tools and enriched future cancers within small high-risk strata, including cancers presenting as interval cancers in recent validations. Prospective trials and real-world implementations indicate that AI-supported reading can maintain or modestly improve cancer detection while reducing radiologist workload by roughly 40–50
Gastric bleeding is a major symptom of locally advanced gastric cancer and a significant cause of mortality. Management options include surgery, endoscopic interventions, embolization and radiotherapy (RT). Although palliative RT appears effective for hemorrhage control, evidences are limited to underpowered retrospective studies from Asia, with issues of patient heterogeneity and response evaluation criteria. This study is a multicenter retrospective analysis carried out across Italian radiation oncology centers to evaluate real-world outcomes of hemostatic RT in patients with bleeding gastric cancer. Clinical and dosimetric data were retrospectively collected for patients with active bleeding gastric cancer treated across twelve Italian radiation oncology centers. The primary endpoint was to evaluate hemoglobin stabilization or improvement at four weeks post-treatment. Secondary outcomes included treatment parameters, acute toxicity profile and time to rebleeding. Between January 2018 and October 2024, 100 patients receiving hemostatic RT were collected for the analysis. The median age was 77 years, 68
The widespread use of cross-sectional imaging has increased the incidental detection of small renal masses (SRMs). In this context, overtreatment represents a major concern, particularly for lesions < 2 cm. Most evidence derives from retrospective registries, whereas prospective data remain limited. This multi-center, prospective, non-randomized clinical trial was conducted in five European centers between January 2015 and July 2021. Seventy-six patients aged > 50 years with asymptomatic, unilateral SRM < 2 cm were enrolled and followed under a structured prospective active surveillance (AS) protocol with periodic axial imaging. Active treatment was recommended according to predefined progression criteria or patient preference. The primary endpoint was event-free survival (EFS); secondary endpoints included treatment-free survival (TFS), overall survival (OS), and cancer-specific mortality (CSM). 69 patients were included in the analyses. After a median follow-up of 88 months, 8-year EFS and TFS were 66
The prognosis of intracranial ependymoma correlates to complete surgery followed by focal irradiation(RT).No standard therapies exist at relapse. We analyzed relapsed patients between 2009 and 2023 both diagnosed in our institution as well as referred. Patients were 33 (females 12), median age 3.3 years. All treated according to AIEOP1st -2nd or SIOP 2nd protocol, i.e., operated and focally irradiated; some had chemotherapy (VEC or VEC/cisplatin + VCR) either after surgery(#13 for residual disease) or after radiotherapy(#10)0.25 tumors originated in posterior fossa,29 were grade 3,23 were tumor-free at RT. Relapses appeared at median 31 months after diagnosis: local in 22 cases, disseminated/combined in 11.21 tumors classified as PFA,8 as RELA/ZFTA.19 patients were again completely operated,16 received hypofractionated reirradiation at 8–16 Gy in 2/4 fractions,6 standard re-RT at 18–54 Gy,10 36 Gy craniospinal irradiation for dissemination; one no treatment. We evaluated the first EFS, OS, and post-first relapse EFS/OS (EFS2/OS2). Median EFS, OS, EFS2 and OS2 were 31.1,66.4,13.6 and 31.5 months, respectively. EFS was positively associated to female sex, grade 3,complete resection at diagnosis/at relapse(also of single metastatic relapse). RELA/ZFTA molecular subgroup tumors affected positively on OS2. Supratentorial location and RELA/ZFTA showed an association that approached statistical significance on EFS2. Type of re-RT had no impact on analyses, with craniospinal radiotherapy adopted only for disseminated/combined relapse. In mutivariable analysis RELA/ZFTA subgroup and complete resection at relapse were associated with improved OS. 13/33 patients survived more than 7 years: 9 alive and 7 tumor-free. Complete resection is a therapeutic resource also after relapse, ideal re-RT has to be found; outcome differed by molecular subgroup in our cohort.
