e16579 Background: Neoadjuvant chemotherapy (NACT) in patients (pts) with muscle-invasive bladder cancer (MIBC) significantly improves treatment outcomes. Widely used NACT regimen based on 3-4 cycles of gemcitabine and cisplatin (GC) before radical cystectomy (RC) remained the standard of care until the complete results of the VESPER trial, which demonstrated the superiority of 6 cycles of dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC) in terms of progression-free survival (PFS), complete pathological responses (pCR) and overall survival (OS). In most clinical trials, pts with clinically positive lymph nodes (N+ according to TMN) were underrepresented. The aim of the study is to compare the effectiveness and safety of the mentioned NACT regimens in real medical practice. Methods: Pts from 7 urooncology hospitals in Poland with MIBC stage ≥T2, cM0 treated with NACT GC or ddMVAC (11/2016-09/2024) were included. Pts from clinical trials were excluded. Complete clinical data were collected. Survival analyses were performed using the Kaplan-Meier method, Log-rank and chi-square or Fisher's tests were used for comparison between groups. Data cut-off was 31/12/2024. Results: Of the 261 pts treated with NACT, 232 were included in the analysis: 132 (57%) received GC, 100 (43%) ddMVAC). There were 55 (24%) women in the study groups, the median age was 67, cT2N0: 90 (39%), N+: 61 (27%), baseline anemia of any grade: 107 (48%). In the GC group, there were significantly more ECOG performance status (PS) 2 pts, p=0.0076, other variables did not differ significantly. Median total dose of cisplatin (MTDC) was significantly higher in ddMVAC group than in GC group (280 vs 210 mg/m2), p=0.0024. Median chemotherapy period was significantly longer in GC pts: 9 vs 6.3 weeks for ddMVAC, p=0.0007. RC was not performed in 35 (15%) of pts due to adverse events (AEs), progression, or withdrawal of consent. More objective pathological responses were achieved in the ddMVAC vs GC pts, 42 vs 14%, p<0,0001, however, there were no differences in clinical response. Significant difference in mOS between GP and ddMVAC group was observed: 27 vs 39m, p=0.0203. In univariate analysis, a significant advantage was also observed for MTDC ≥250mg/m2, p=0.0093; ECOG PS 0, p=0.0018; RC, p=0.01; R0 resection, p=0.001; and pCR, p<0.0001 in terms of OS. OS did not differ significantly between cT2N0 or >cT2N0 pts, p=0.3. Multivariate analysis confirmed a statistically significant OS benefit for ECOG PS 0, higher MDTC and pCR. More hematological AEs occured in the GC vs ddMVAC group: 98% vs 84%, p=0.0007. Conclusions: The use of NACT with the ddMVAC in MIBC pts showed a statistically significant improvement of OS compared to GC with favorable toxicity. The study indicates that the best prognosis is for pts with ECOG PS 0 who received a higher MTDC (preferably in the ddMVAC regimen), responded to NACT and underwent radical surgery regardless of the primary clinical stage of T and N.
Introduction: Cryotherapy, encompassing whole-body cryotherapy (WBC) and partial-body cryotherapy (PBC), has gained increasing attention in sports, medicine, rehabilitation, and wellness for its potential anti-inflammatory, analgesic, and recovery-enhancing effects. Originally developed in Japan in the late 1970s for the treatment of rheumatoid arthritis, WBC has since evolved into a multidisciplinary therapeutic modality with a wide range of clinical and non-clinical applications. Materials and Methods: A systematic literature search of PubMed and Embase from 2013–2025 was conducted using the terms “cryotherapy,” “whole-body cryotherapy,” and “cryostimulation.” Results: The evidence suggests that WBC elicits systemic anti-inflammatory effects through modulation of cytokines (e.g., decreased IL-1β, TNF-α, and hsCRP; increased IL-10), enhances antioxidant enzyme activity, and improves markers of oxidative stress. Clinical data further indicate beneficial outcomes in conditions such as rheumatic and osteoarticular diseases, fibromyalgia, multiple sclerosis, mood disorders, chronic pain, and obesity. WBC may also support athletic recovery by reducing muscle soreness and improving performance adaptation. Despite its broad therapeutic potential, contraindications, including cardiovascular, neurological, and cold-related disorders, must be observed. Reported adverse effects are generally mild and transient. Conclusions: Overall, cryotherapy appears to be a promising adjunctive modality, though further controlled studies are warranted to establish standardised treatment protocols and confirm long-term safety and efficacy.
e21575 Background: The treatment of early-stage melanoma is rapidly changing. Recent advancements include neoadjuvant treatment in stage III clinically detected disease and adjuvant treatment in stage IIB/C melanoma. In particular, adjuvant immunotherapy for IIB/C disease has become recently available. We took this opportunity to evaluate changes in outcomes in patients diagnosed with stage II and III melanoma. Methods: We have analyzed the accessible, retrospective data on patients diagnosed with melanoma between 2015 and 2022 who underwent sentinel lymph node biopsy or therapeutic lymph node dissection in high-throughput centers in Poland. The data on primary staging, patients’ demographics, and information on follow-up and overall survival (OS) were collected. A prespecified OS Cox model with non-linear terms for age, sex, stage (II vs. III), and availability of adjuvant treatment in stage III (i.e., since 2021) was fitted. Results: There were 1970 patients (45.2% female) included in this analysis. The mean age was 62 (range:14-97). The exact stage distribution and 3-year OS rates are presented in Table 1. Patients diagnosed with stage III melanoma before 2021 had worse prognoses than stage II patients (HR: 1.33, 95%CI: 1.11-1.60, p=0.002). Since then the prognosis for stage II patients did not improve (HR: 1.13, 95%CI: 0.89-1.45, p=0.325) while the prognosis in stage III melanoma became similar to stage II after the introduction of adjuvant therapy (HR: 1.09, 95% CI: 0.78-1.53, p = 0.607). Conclusions: The introduction of adjuvant treatment improved the OS of stage III melanoma patients in this nationwide study. The modern prognosis is similar to patients with stage II melanoma without adjuvant treatment, with excellent results in stage IIIA/IIIB cases. The practitioners should be cautious when discussing historical prognosis with their patients and it implies the necessity of changes in AJCC staging. Stage distribution and 3-year survival rates. Stage Number of patients Percentage of group 3 year survial rate (%) 95% Confidence Interval (%) IIA 352 17.9 86.5 82.9 - 90.3 IIB 378 19.2 76.5 72.2 - 81.2 IIC 443 22.5 59.9 55.3 - 64.8 IIIA 84 4.3 94.3 89.1 - 99.9 IIIB 132 6.7 94.6 90.5 - 98.9 IIIC 518 26.3 68.5 64.3 - 73.1 IIID 63 3.2 53.3 42.2 - 67.4
Background: Epilepsy is the most common chronic neurological disorder in children and often affects mental health, quality of life, and various social aspects of daily living. It is essential to focus not only on seizure control but also on providing psychological and psychiatric support.Aim of the Study: This review aims to characterize the mental health challenges faced by children with epilepsy and the difficulties experienced by their families. It is crucial to draw the attention of healthcare professionals and society to the complex issues these patients and their families encounter.Material and Methods: We conducted electronic searches on PubMed, Google Scholar, and the National Institute for Health and Care Excellence (NICE) databases, which served as the primary sources of literature for this review.Results: Pediatric patients with epilepsy are at increased risk of developing mental health disorders and behavioral issues. Conditions such as depression, anxiety, autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD) occur more frequently in this group compared to the general population. These children are also at higher risk for suicidal ideation and attempts. Most children do not receive adequate mental health support, and when it is available, it is often insufficient. The condition affects not only the patient's mental health but also the well-being of the entire family, contributing to stress and stigma.Discussion: Research highlights a strong association between epilepsy and mental health disorders such as depression and ADHD, yet access to appropriate psychological and psychiatric care remains limited. This complex issue requires a multidisciplinary approach that includes medical treatment as well as social support. Future research should focus on interventions that enhance mental health and improve the quality of life for both patients and their families.Conclusions: Mental health disorders are common among pediatric epilepsy patients, emphasizing the need for comprehensive care. Early diagnosis, effective treatment, and support for both patients and their families are crucial.
