Viral hepatitis infections can complicate treatment in patients with cancer. Chronic hepatitis infections such as HBV,HCV, and CMV should be diagnosed and treated before oncological treatment. Moreover, latent infections that canbe reactivated (especially HBV infection) during oncological treatment should be taken into consideration. Duringtreatment, acute hepatitis infections such as HAV and HEV affect treatment and blood test results. This article presentsthe natural course of viral hepatitis, which should be suspected in cases of increased liver enzyme activity.
INTRODUCTION: Re-irradiation for locoregional recurrence or second primary tumors in previously irradiated regions isconstrained by cumulative organ-at-risk tolerance. Proton therapy may improve dose conformality and spare criticalstructures. MATERIAL AND METHODS: We retrospectively reviewed 91 patients treated with repeat proton beam radiotherapybetween 2017 and 2023. Patients (37 women, 54 men; age 28–90 years) were not eligible for salvage surgery, had histopathologicallyconfirmed local failure, and had no distant metastases on PET. Recurrence was present in 67 patients(74%) and second primary tumors in 24 (23%). Re-irradiation was delivered with SIB IMPT at 1.8–2.0 Gy relative biologicaleffectiveness (RBE)/fraction to 20–78 Gy(RBE) (mean 63.6). Treatment planning reconstructed the primary radiotherapyplan and applied cumulative dose limits to organs at risk using an ALARA-based approach. RESULTS: Eighty-nine patients (98%) completed the planned course; two discontinued due to deterioration in generalcondition. Acute toxicity included grade 3 skin reactions in 7% and grade 2 in 74%, and grade 3 mucosal reactionsin 12% and grade 2 in 59%. Two patients required packed red blood cell transfusions for grade 3 anemia during treatment.Three-month MRI demonstrated disease stabilization in 50%. Median overall survival (OS) was 16.9 months; OSwas 48% at 1 year, 40% at 2 years, and 28% at 5 years. OS did not differ by sex, T or N category, or recurrence versussecond primary tumor, but varied by primary tumor location (p = 0.008), with the most favorable survival in chordoma. CONCLUSIONS: Repeat proton beam therapy enabled radical re-irradiation in selected patients across diverse sites withacceptable acute toxicity and clinically meaningful survival. Longer follow-up and prospective validation are warrantedto refine selection and cumulative dose constraints.
Complementary and alternative medicine (CAM) use is widespread among cancer patients, and has been linked todelayed conventional care, often leading to late-stage presentation. This study aimed to synthesize current evidenceon the association between CAM use and delays in cancer diagnosis and treatment. The literature search using Pub-Med and Google Scholar with search terms “delay,” “diagnostic delay,” “treatment delay,” “complementary and alternativemedicine,” and “cancer” was conducted. Included studies focused on assessing CAM use as a factor associated withdiagnostic or treatment delay among cancer patients. It was found that the duration of diagnostic and treatmentdelays ranged from 14 days to 4 months. Herbal medicine and homeopathy were the most commonly reported CAMmodalities. Pooled analysis showed that CAM use was associated with higher diagnostic delay [OR = 2.12 (95% CI1.59–2.83)] and treatment delay [OR = 2.00 (95% CI 1.03–3.90)], but the small number of studies and patients limitsthe results of heterogeneity analysis. These findings highlight the need for healthcare providers to discuss CAM usewith patients and to strengthen early detection and timely initiation of therapy.
Head and neck cancers are a complex group of diseases defined by a variety of histological features, anatomical locationsand etiologies. Stage IV disease may be classified as resectable, unresectable, or metastatic. The standard treatmentof resectable, stage III–IVb disease is surgery with or without adjuvant radiotherapy or adjuvant radiochemotherapy.Another solution is primary RT-CHX. However, over 50% of patients with HNSCC will be diagnosed with locoregionallyadvanced and unresectable disease, or the resection will result in significant mutilation or unacceptable functional outcome.Some may also present with a high risk of non-radical resection. Given this shift in site of recurrence, therapeuticstrategies to suppress distant metastases may be the next goal for further improvement of survival. In this contextthe use of induction chemotherapy in the setting of locally advanced disease — both resectable and unresectable iswarranting reassessment.
INTRODUCTION: Acral melanoma (AM) presents a diagnostic challenge. Despite the prevalence of the BRAAFF algorithmin the field of dermoscopic assessment of acral lesions, concerns remain regarding its efficacy in advanced AM. Givenconcerns that BRAAFF-based assessment may under-detect advanced AM, the study specifically evaluated whetherextensive or nodular lesions exhibit altered dermoscopic patterns that no longer align with the meet establisheddiagnostic features. MATERIAL AND METHODS: This retrospective case series encompassed a clinical, dermoscopic and histopathologicalevaluation of seven cases. Eligible participants were patients with histopathologically confirmed AM, measuring atleast one centimetre in diameter. RESULTS: Dermoscopic features of AM change in the context of aggressive nodular growth, and may lack the classicalcriteria defined by the BRAAFF algorithm. CONCLUSIONS: Future research should focus on validating algorithms across various populations and melanoma subtypes,improving diagnostic accuracy in subtle cases, and optimising strategies for early diagnosis rather than developingnew criteria for late-stage tumors.
INTRODUCTION: Prostate cancer is the second most commonly diagnosed malignancy among men, with an increasingincidence of early-stage disease detection over recent decades. Accurate diagnosis remains crucial, particularly in distinguishingclinically significant cancers from indolent tumors, thus avoiding overtreatment and unnecessary complications.The introduction of multiparametric magnetic resonance imaging (mpMRI) targeted fusion biopsy representsa significant advancement in diagnostic pathways; however, there is ongoing debate regarding its superiority overtraditional systematic biopsy (SBx). MATERIAL AND METHODS: A narrative literature review was conducted using PubMed and Elsevier (ScienceDirect) databases,supplemented by current European Association of Urology guidelines from March 2025. From an initial searchyielding 451 articles, 32 were evaluated in-depth, and ultimately nine studies were selected for detailed analysis. Dataregarding diagnostic yield, clinical significance of detected cancers, cost-effectiveness, biopsy accuracy, and overallhealthcare implications were extracted. RESULTS: Magnetic resonance imaging targeted fusion biopsy demonstrated superior detection of clinically significantprostate cancer compared with systematic biopsy in several studies. Notably, targeted biopsies (TBx) identified fewercases of clinically insignificant disease, thereby reducing the risk of overtreatment. However, meta-analyses revealedvariability in outcomes, with certain studies reporting no significant difference in overall cancer detection rates betweenfusion and SBx. Economic analyses indicated that mpMRI-targeted approaches reduced healthcare costs throughdecreased unnecessary procedures. Furthermore, studies evaluating biopsy core proximity to MRI-visible lesionsemphasized improved diagnostic accuracy with targeted sampling. DISCUSSION: Current literature highlights ongoing discrepancies in the comparative effectiveness of fusion and SBxmethods, influenced by methodologic variations, patient selection criteria, and biopsy technique differences. AlthoughTBx consistently shows benefits in detecting clinically significant cancers, definitive evidence correlating biopsyoutcomes to final histopathology following prostatectomy remains limited. Additional high-quality studies are requiredto confirm the true clinical advantage of fusion biopsy and establish its role in standard clinical practice. CONCLUSIONS: Magnetic resonance imaging targeted fusion biopsy offers clear advantages in identifying clinicallysignificant prostate cancer and minimizing overtreatment compared to traditional SBx. Despite this, variability in resultsand the lack of robust correlation with final pathologic outcomes underline the necessity for further prospectiveresearch. Continued investigation is essential to refine biopsy strategies, improve diagnostic accuracy, and optimizehealthcare resource utilization in prostate cancer management.
INTRODUCTION: The FAST-Forward trial shows that 26 Gy delivered in 5 fractions over 1 week is non-inferior to the 3-week whole breast irradiation (WBI) regimen. This study compared dynamic tangential volumetric modulated arc therapy (t-VMAT) plans using flattening filter (FF) and flattening filter-free (FFF) beams for ultra-hypofractionated WBI. MATERIAL AND METHODS: Treatment plans for 40 early-stage breast cancer patients undergoing deep inspiration breath-hold (DIBH) were analyzed. Parameters included target coverage, organs at risk sparing, homogeneity index (HI), conformity index (CI), beam-on time, monitor units (MUs), dose rate, and gamma passing rate (GPR). RESULTS: For left-sided cases, t-VMAT-FFF significantly reduced maximum doses to the heart and left anterior descending coronary artery and lowered mean dose to the contralateral breast. Beam-on time decreased by 33.7% (left) and 37.1% (right) (p < 0.05). No significant differences were found in target coverage, HI, CI, or GPR. CONCLUSIONS: Shortened beam-on time with FFF beams was achieved without compromising target coverage or increasing organ doses, which supports the broader implementation of ultra-hypofractionation.
Chimeric antigen receptor T cell (CAR-T) therapy represents a significant advancement in the treatment of hematologicmalignancies, allowing for targeted recognition and elimination of tumor cells. This review summarizes currentknowledge on immunoeffector cell-associated hematotoxicity (ICAHT), cytokine release syndrome (CRS) and immuneeffector cell-associated neurotoxicity syndrome (ICANS), which constitute the main complications following CAR-T celladministration. Particular emphasis is placed on pharmacotherapeutic strategies reported in the literature for managingthese toxicities. The review also discusses recent findings on potential biomarkers that may predict the onset of CRSand ICANS, enabling early intervention and mitigation of symptoms. Furthermore, attention is given to novel approachesdescribed in recent studies, including the use of the CRISPR-Cas9 system for generating “off-the-shelf” CAR-Tcells, editing immune checkpoint regulators, and developing dual-target or logic-gated CAR constructs to enhancetumor specificity and safety.
INTRODUCTION: The purpose of this study is to evaluate the influence of the neutrophil-lymphocyte ratio (NLR) and the systemic immune-inflammation index (SII) on the survival of EGFR-mutated vs. ALK/ROS rearranged non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: Only patients with EGFR-mutated (N = 64) or ALK/ROS-rearranged (N = 29) metastatic NSCLC treated with tyrosine kinase inhibitors (TKI) were enrolled. The Cox regression model was used to assess the impact of selected variables on survival, including the influence of NLR and SII. RESULTS: The NLR and SII did not significantly influence survival in patients with EGFR-mutated NSCLC. On the contrary, NLR and SII significantly influenced survival in patients with ALK/ROS rearranged NSCLC. CONCLUSIONS: Despite previously accomplished studies on this subject, the influence of inflammatory markers on the outcome of patients treated with TKI deserves further attention. Hypothesized herein is that NLR and SII may be helpful in stratification of patients with ALK/ROS rearrangements for clinical trials on combinations of immune checkpoint inhibitors (ICI) and TKI.
The standard management of resectable colorectal liver metastases (CRLM) includes systemic therapy and surgery.Ablative techniques until recently were only considered for unresectable CRLM patients. In the recent decadehowever, the volume of data suggesting non-inferior results of ablation compared to standard surgical approachstarted to emerge. The lower complication rate of ablative therapies compared to surgery raises the questionwhether ablation has the potential to replace the role of surgery in the treatment of colorectal cancer metastasesto the liver. In this review the author addresses the current evidence on the topic and its possible impact on futuremanagement of CRLM patients.
Harm reduction strategies aim to minimize the health and social consequences of psychoactive substance use. Recently,electronic cigarettes (e-cigarettes) and heated tobacco products have been promoted as “safer” alternativesto conventional cigarettes. Evidence regarding their safety is inconsistent: while some studies suggest lower levelsof certain toxicants, many indicate substantial health risks, including exposure to novel toxic compounds absent in traditionalcigarette smoke. Long-term effects remain unknown. The growing use of these products among adolescents,young adults, and never-smokers, combined with messaging framing them as harm reduction tools, raises significantpublic health concerns. Moreover, these products often perpetuate nicotine dependence rather than support completecessation, unlike evidence-based interventions such as nicotine replacement therapy (NRT). Economic interestsof the tobacco industry further complicate their promotion. Current evidence does not support e-cigarettes or heatedtobacco products as legitimate harm reduction tools. Public health priorities should focus on proven cessation strategies,regulatory control, and preventing initiation among youth.
INTRODUCTION: Understanding real-world breast cancer treatment patterns is crucial for optimizing patient care. Thisretrospective study analyzed treatment strategies and outcomes in a Polish cohort. MATERIAL AND METHODS: Data from 587 breast cancer patients (diagnosed ≥ 2018) were obtained via the DonateYour Data Foundation (Fundacja Podaruj Dane) (March 2023–June 2024). Anonymized medical records from oncologycenters in the Lodz Voivodeship were analyzed, considering center size, disease stage (TNM), and therapies (surgery,chemo, hormone therapy, radio, targeted therapy-drug program). RESULTS: Most patients were treated in small entities, managing mainly stage I–IIIA cancers. Initial outpatient treatmentoften involved hormone therapy, while hospital-based care included surgery/chemotherapy. Neoadjuvant treatmentprioritized chemotherapy. Adjuvant therapy used hormone therapy and radiotherapy frequently. Breast-conservingsurgery (BCT) was the most common initial surgery, especially in early stages and hormone receptor positive (HR+),human epidermal growth factor receptor 2-negative (HER2–) patients. Standard chemotherapies included cyclophosphamide,doxorubicin, and paclitaxel. Letrozole and tamoxifen were prevalent in adjuvant hormone therapy.The national drug program for targeted therapies was significantly utilized in neoadjuvant and adjuvant settings. Mostpatients experienced stable disease based on TNM dynamics. CONCLUSIONS: This study provides insights into breast cancer treatment in the Lodz Voivodeship, highlighting diversestrategies across stages and center sizes. Chemotherapy played a significant role across treatment lines, BCT was commonin early stages, and targeted therapies were integrated via a national drug program. Further research should exploretreatment pattern variations and optimize advanced therapy utilization in the Polish healthcare system.
The development of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC)has transformed the landscape of treatment for peritoneal surface malignancies. It has become increasingly clear thatoncological surveillance strategies must adapt to the unique challenges posed by this therapeutic approach. Innovationsin diagnostic tools, such as advanced imaging techniques and biomarker analysis, have begun to play a pivotalrole in tailoring follow-up protocols. Additionally, comprehensive guidelines that integrate tumor-specific characteristicsand outcomes from high-volume centers are critical to optimizing long-term care and improving patient prognosis. This article reviews current surveillance practices after CRS + HIPEC, including tumor-specific protocols, internationalguidelines and the role of multidisciplinary teams. It also addresses systemic challenges, the importance of specializedcenters and emerging diagnostic tools such as liquid biopsy and AI-assisted imaging.
With the improvements in oncological treatment, the number of cancer survivors each year increases. The mostoften utilized surgery, radio-, and chemotherapy are associated with a number of adverse effects, which often persistand significantly worsen patient’s quality of life (QoL). Cancer treatment often causes impairment of cardiorespiratoryfitness, increased fatigue and decline of psychological health. A wide variety of rehabilitation and physical therapyinterventions are available to reduce the intensity and prevalence of those effects, with various strength of evidencesupporting their use. This review aims to highlight interventions supported by evidence base, used for the treatmentof the most commonly occurring adverse effects of cancer therapy. Since the guidelines for rehabilitation and therapypost oncological treatment is lacking, we present evidence on why scientific efforts should be made to implementthe most promising interventions.
In the present paper author makes an attempt to answer to the question whether this house believes in that the retrospectiveradiotherapy have had a major impact on the progress in radiotherapy or rather randomized clinical trials(RCTs). Among many retrospective studies there are deliberately selected those which have provided significantand paramount progress in radiotherapy, and they are discussed in details. On the other hand, analyses of the RCTsare focused not only on their clinical benefits, but also on some uncertainties and pitfalls. An average local tumor control(LTC) estimates may often lead to misleading conclusions, because despite precise randomization, large geneticand molecular heterogeneities often impacted the results. Therefore, the author discusses advantages of the hierarchicalclustering taxonomy, which allows to select specific genetic and molecular patterns, which significantly correlate withoptimal LTC benefit, instead of an average end points. Finally, the author concludes that this house should believein both, retrospective and randomized trials, but of the highest quality and clinical implications.
Sinonasal carcinoma (SNC) is the most common malignant tumor of the nasal cavity and paranasal sinuses. Sinonasalcarcinoma includes seven main histopatological subtypes and three most common have been presented in Part 1of this manuscript. In the following, Part 2 of the manuscript the remaining four even more rare subtypes like olfactoryneuroblastoma (ONB), sinonasal neuroendocrine carcinoma (snNEC), nuclear protein in testis carcinoma (NUT)and sinonasal undifferentiated carcinoma (snUC) are presented and discussed as to the epidemiology, etiology, clinicalcourse, methods of treatment and outcome. It should be emphasized however that patients suspected of having a rarecancer should be directed to oncology centers with proven expertise in managing these uncommon malignancies.
