On behalf of the organizing committee, we are pleased to present the abstracts from the 2026 conference, “PEOC meets FORTEe”. The Third Pediatric Exercise Oncology Congress, this year meeting in person with the EU Study FORTEe (Get Strong to Fight Childhood Cancer: An Exercise Intervention for Children and Adolescents Undergoing Anti-Cancer Treatment), brought together scientists, clinicians, exercise professionals, physiotherapists, patients, families, community partners, and advocates from across the globe. Over two intensive days, 142 participants from 24 countries, guided by seven invited speakers, engaged in rigorous, wide-ranging, and interdisciplinary exchange that our field needs for sustaining growth and addressing key issues. The conference was held in Mainz, Germany, on 16–17 April 2026 and explored the growing field of evidence examining the impacts of exercise on basic biological mechanisms through to patient perspectives on quality of life. There was also a clear focus on knowledge translation, moving evidence to inform clinical integration of exercise to support beneficial outcomes across treatment trajectories. We would like to thank all of the researchers and presenters for their work and for contributing to the positive impact on patients and families who journey through a childhood or adolescent cancer diagnosis. The Congress Presidents and Scientific Committee Lead of the Third Pediatric Exercise Oncology Congress meets with FORTEe 2026. Scientific Committee co-leads included Miriam Götte, Nicole Culos-Reed, and Marie Neu. Scientific Committee members included Alejandro Lucía, Amanda Wurz, Carolina Chamorro Viña, Corina Rueegg, Elias Dreis-Mickenbecker, Emma Verwaaijen, Helen Griffith, Joachim Wiskemann, Jörg Faber, Maria Olsson, Maxime Caru, Nivedita S. Prabhu, Sara Grimshaw, and Vesile Yıldız Kabak. Congress organization was through the University Medical Center Mainz.
Background/Objectives: Myxofibrosarcoma (MFS) shows infiltrative fascial extensions that complicate margin achievement and drive local recurrence. We evaluated whether intraoperative ultrasound guidance improves negative margin achievement and oncological outcomes compared with conventional excision. Methods: In this retrospective cohort study at a single tertiary referral center, patients with MFS underwent conventional excision (2008–2013; n = 15) or ultrasound-guided excision (2014–2024; n = 50; primary comparative analysis n = 47 after excluding three patients). The primary outcome was negative margin achievement; secondary outcomes were overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS). Exploratory matching-adjusted indirect comparisons (MAICs) were performed against seven published international MFS cohorts. Results: Overall R0 (negative) margin rates did not differ between cohorts (97.9% vs. 93.3%; p = 0.428). Among R0 margins, however, a wide clearance (R0-wide, ≥1 mm) was more frequent in the US-guided cohort, whereas R0-close (<1 mm) margins predominated after conventional excision (R0-wide 83.0% vs. 46.7%; odds ratio 5.38, 95% CI 1.30–23.73; p = 0.014). Median follow-up was 49 months; five-year OS, LRFS, and DMFS were 97.5%, 94.3%, and 83.7%. In the internal historical comparison, LRFS was directionally higher with ultrasound guidance (94.3% vs. 68.2%; HR 0.26; p = 0.059). In MAICs, LRFS favored the US-guided cohort in all five comparisons and OS in two of four. Conclusions: Intraoperative ultrasound guidance was associated with a higher rate of wide (R0-wide, ≥1 mm) negative margins and favorable local disease control in MFS; whether wider microscopic clearance itself improves local control requires prospective multicenter evaluation.
Same-day surgery for mastectomy increased in Alberta from 1.7% to 73% in 2022, after implementation of a perioperative pathway in 2016. However, rates of unplanned visits to the emergency department (ED) remained >20%. Previous research explored reasons for this using administrative data but lacked patient-level data. Our study aims to explore patient-reported factors influencing unplanned ED visits after mastectomy. A survey study was conducted of patients who underwent mastectomy in Alberta between July 2021 and June 2022. Patients were identified from the Canadian Institute of Health Information database; chart review was performed to confirm ED visit details. Survey questions evaluated medical, socioeconomic, and psychologic domains, as well as patient-reported experiences of perioperative care. Of 556 patients who underwent mastectomy during the study period, 23% presented to the ED unplanned within 30 days. The survey was sent to 87 patients meeting inclusion criteria; 38% responded. Most patients presented on a weekend, stating the ED was the only choice available at the time. The most common patient concerns were related to infection (38%) and drain function (38%). Despite high postoperative ED visit rates, overall, 84% felt prepared for surgery, only 15% felt uncomfortable with drain management, and 78% of patients were satisfied with surgery. Difficulty accessing their surgical team postoperatively was reported as the main challenge. Future initiatives should focus on improved access to outpatient care and education on post-mastectomy emergencies.
(1) Background: Neoadjuvant chemotherapy (NAC) is important for breast cancer, but prognosis varies widely. Ki67 and apparent diffusion coefficient (ADC) reflect proliferation and cellularity, respectively. This study evaluated the prognostic value of the Ki67/ADC ratio (KA) and post-treatment ADC change (δADC) in breast cancer patients receiving NAC, and developed a survival prediction model incorporating these indicators. (2) Methods: Two cohorts of breast cancer patients treated with NAC were collected. Pre- and post-treatment breast MRI with diffusion-weighted imaging were obtained; ADC values were measured by two blinded radiologists. KA was calculated as pre-treatment Ki67 divided by pre-treatment ADC, and δADC as post-ADC minus pre-ADC. Disease-free survival (DFS) was the primary outcome. Cox regression and a predictive Cox model were used. (3) Results: A total of 419 patients were analyzed. Both KA and δADC were associated with survival. In multivariable analysis, KA remained an independent prognostic factor (HR 0.40, 95% CI 0.19–0.84, p = 0.015). High KA was associated with worse prognosis, particularly in patients without pathological complete response. The model incorporating KA showed better predictive performance than clinicopathological variables alone and effectively stratified high- vs. low-risk patients. (4) Conclusion: KA is a promising complementary biomarker for prognosis in breast cancer patients undergoing NAC. Its integration into a prognostic model improved survival risk prediction and may aid individualized post-treatment management.
Background: Prostate cancer substantially affects patients’ quality of life (QoL). However, whether distinct QoL profiles exist among patients remains unclear. Objective: This study aimed to identify latent QoL profiles among patients with prostate cancer and explore factors associated with profile membership. Methods: A cross-sectional study included 200 patients with prostate cancer recruited from a tertiary hospital in China between May and December 2024. QoL was assessed using the Functional Assessment of Cancer Therapy–Prostate (FACT-P). Latent profile analysis was performed using Mplus 8.3, and the optimal model was selected according to information criteria, entropy, and likelihood ratio tests. Multivariable logistic regression was used to examine factors associated with profile membership. Results: LPA identified two distinct subgroups: low QoL (32.5%) and high QoL (67.5%). Medium and heavy economic burden significantly increased odds of low QoL (OR = 4.13, 95% CI: 1.13–15.02, p = 0.032; OR = 11.12, 95% CI:1.55–79.86, p = 0.017). Urinary continence markedly reduced odds of low QoL (OR = 0.08, 95% CI: 0.02–0.25, p < 0.001). Longer diagnosis-to-treatment intervals were associated with membership in the low-QoL profile (1–3 months: OR = 2.99, 95% CI: 1.26–7.08, p = 0.013; >3 months: OR = 3.36, 95% CI: 1.02–11.07, p = 0.046). Conclusions: This study identified two QoL profiles among patients with prostate cancer. The findings suggest that person-centered QoL assessment may facilitate early identification of patients with greater supportive care needs and contribute to more individualized survivorship care.
Background: Serum calcitonin is commonly interpreted as a marker of tumor burden in medullary thyroid carcinoma (MTC), but patients with comparable tumor diameters may show markedly different calcitonin levels. This exploratory study aimed to derive cohort-specific, tumor diameter–adjusted calcitonin secretory categories and examine their relationship with invasive pathological features. Methods: This retrospective single-center study included 70 unique patients with histopathologically confirmed MTC. Seventeen patients with preoperative serum calcitonin below the assay reporting limit (<2 pg/mL) were evaluated separately. In 53 patients with detectable calcitonin, residuals from a log-linear model of calcitonin according to dominant tumor diameter were divided into tertiles to define exploratory hyposecretory, normosecretory, and hypersecretory categories. Sensitivity analyses accounted for sex, metastatic lymph-node count, documented distant metastatic disease, and restriction to patients with pN0 disease and no documented distant metastasis. Results: Preoperative calcitonin correlated with dominant tumor diameter (Spearman rho = 0.644, p < 0.001), and the primary model explained 45.2% of calcitonin variability (R2 = 0.452). The cohort-derived categories included 18 hyposecretory, 17 normosecretory, and 18 hypersecretory tumors. In a hypothesis-driven exploratory contrast, lymphovascular invasion (55.6% vs. 25.7%; nominal p = 0.040) and perineural invasion (33.3% vs. 8.6%; nominal p = 0.048) were more frequent in the hypersecretory category. However, the global three-group comparisons were not statistically significant (p = 0.135 and p = 0.117, respectively), and both false-discovery-rate-adjusted q values were 0.072. The tumor diameter–calcitonin relationship remained significant after adjustment for sex and metastatic burden and in the pN0 subgroup without documented distant metastasis. Conclusions: The exploratory, cohort-derived hypersecretory category showed hypothesis-generating enrichment for lymphovascular and perineural invasion, but these associations did not meet the false-discovery-rate-adjusted significance threshold. External validation is required before these categories can be considered biologically established or clinically applicable.
Background: Immune checkpoint inhibitors have improved outcomes in metastatic clear-cell renal cell carcinoma (mRCC), yet clinically applicable tissue biomarkers remain limited. Growth differentiation factor-15 (GDF-15) promotes tumour immune evasion and has emerged as a potential therapeutic target in immuno-oncology. We evaluated the prognostic significance of tumour GDF-15 expression in patients with intermediate-risk clear-cell mRCC treated with second-line nivolumab. Methods: Forty-six patients with intermediate-risk clear-cell mRCC who received nivolumab after one line of tyrosine kinase inhibitor therapy were retrospectively evaluated. Tumour GDF-15 expression was assessed by immunohistochemistry and classified as low (0–1+) or high (2–3+). Objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and the development of cancer-associated cachexia were compared between expression groups. Results: High tumour GDF-15 expression was observed in 23 patients (50%). ORR was significantly higher in the low-expression group than in the high-expression group (57% vs. 26%, p = 0.036). Low tumour GDF-15 expression was associated with significantly longer PFS (24.5 vs. 7.5 months; HR 0.38, 95% CI 0.18–0.80; p = 0.009) and OS (28.6 vs. 12.6 months; HR 0.43, 95% CI 0.19–0.98; p = 0.041). The association with OS remained significant after adjustment for age. The frequency of cancer-associated cachexia did not differ according to tumour GDF-15 expression (43% vs. 35%, p = 0.546). Conclusions: Low tumour GDF-15 expression was associated with better objective response and longer progression-free and overall survival in patients with intermediate-risk metastatic clear-cell renal cell carcinoma treated with second-line nivolumab, with the association with overall survival remaining significant after adjustment for age. Tumour GDF-15 represents a promising tissue biomarker for prognostic risk stratification and warrants validation in larger prospective studies.
Therapeutic options for advanced prostate cancer have expanded in recent years, incorporating multiple-system treatment approaches with differing mechanisms of action. However, comparative real-world safety data following drug approval remain limited. As such, the aim of this study is to characterize adverse events and disproportionate safety signals among advanced prostate cancer therapies using the FDA Adverse Event Reporting System (FAERS). A retrospective pharmacovigilance study of FAERS reports evaluated enzalutamide, darolutamide, apalutamide, abiraterone acetate, relugolix, niraparib/abiraterone, talazoparib, rucaparib, cabazitaxel, sipuleucel-T, and lutetium-177 vipivotide. Adverse events were categorized by System Organ Class and Preferred Terms. Reporting odds ratios (RORs) with 95% confidence intervals identified safety signals. Among 172,440 reports, most involved patients aged 65–85 years. Cabazitaxel had the highest proportion of serious reports (86.6%) and deaths (22%), whereas relugolix had the lowest (23.3% and 4.8%). Nervous system disorders predominated with enzalutamide and darolutamide, gastrointestinal disorders with abiraterone, rucaparib, and niraparib/abiraterone, and hematologic toxicities with cabazitaxel, talazoparib, and lutetium-177 vipivotide. Significant safety signals were identified for abiraterone and cabazitaxel, but not other therapies. The absence of a detected signal should not be interpreted as evidence of safety or equivalence, as reporting volume, detection bias, and statistical power varied across therapies. Overall, the therapies demonstrated distinct toxicity profiles, which may inform treatment selection, toxicity monitoring, and patient counseling.
Second-line chemotherapy is widely used in metastatic urothelial carcinoma after progression on first-line platinum-based therapy, but its independent contribution to survival, as opposed to selection of healthier patients, remains unclear. In this multicenter retrospective cohort of 142 patients treated with first-line platinum-based chemotherapy across seven Turkish centers, overall survival (OS) from first-line progression was compared between patients who received second-line chemotherapy (n = 80) and those who did not (n = 62), using multivariable Cox regression, inverse probability of treatment weighting (IPTW), propensity-score matching, landmark analysis, and a time-dependent Cox model. Median OS was 7.4 versus 4.7 months (log-rank p = 0.064). Second-line chemotherapy was independently associated with improved OS on multivariable analysis (adjusted hazard ratio [aHR] 0.620; 95% confidence interval [CI] 0.423–0.907; p = 0.014); Eastern Cooperative Oncology Group (ECOG) performance status ≥ 2 (aHR 3.881; p = 0.001) and lower albumin (aHR 0.671; p = 0.018) were also independent predictors. The association remained significant after IPTW (HR 0.648; p = 0.025) and after a time-dependent Cox model (HR 0.632; p = 0.019), and was unchanged in ECOG-restricted and Bellmunt-adjusted analyses (p = 0.008, p = 0.029); it narrowly missed significance after propensity-score matching (HR 0.645; p = 0.051) and did not reach significance in the 3-month landmark analysis (HR 0.743; p = 0.180). Power was limited (~49%). In a time-dependent Cox model—the analysis least susceptible to immortal-time bias, as it retains the full cohort and classifies pre-treatment person-time as unexposed—second-line chemotherapy remained independently associated with improved OS (HR 0.632; p = 0.019), closely consistent with the primary multivariable estimate. The conventional Cox, IPTW, and propensity-score-matched analyses, which treat second-line receipt as a baseline exposure, were directionally concordant but share a common time-related bias and are therefore not independent confirmations. ECOG performance status was a consistent predictor throughout.
Purpose: Although machine learning-based prediction of overall survival (OS) in palliative radiotherapy for bone metastases has been investigated, explainable deep learning (DL) models remain underexplored. This study aimed to develop and validate an explainable DL model to predict OS in this setting, and to examine whether this flexible model provides predictive value beyond a standard Cox model based on routinely collected baseline variables. Methods and Materials: We analyzed all 472 eligible patients who received palliative radiotherapy for bone metastases between January 2013 and August 2024; patients alive with less than one year of follow-up were retained as right-censored observations. The primary endpoint was OS over a fixed 1-year horizon. A DeepSurv model using 14 baseline predictors, including the planned prescribed dose (biologically effective dose, BED10), was developed with repeated 5-fold cross-validation (K = 5, R = 10) and compared with standard and ridge-penalized Cox models fitted on identical splits. Performance was assessed by the time-dependent concordance index (C-index), integrated Brier score (IBS), time-dependent area under the curve (AUC) at 90, 180, and 365 days, and a calibration analysis at one year; 95% confidence intervals (CI) were obtained by patient-level bootstrapping of the pooled out-of-fold predictions. Shapley Additive Explanations (SHAP) and SurvLIME were computed on the held-out test sets. Results: Within one year, 242 patients (51.3%) died; median OS was 225 days (95% CI: 189–287). The DeepSurv model achieved a pooled time-dependent C-index of 0.779 (95% CI: 0.751–0.807), an IBS of 0.135 (95% CI: 0.122–0.149), and AUCs of 0.892 (0.857–0.925), 0.862 (0.822–0.895), and 0.856 (0.814–0.895) at 90, 180, and 365 days, with an observed/expected ratio of 0.94 and a calibration slope of 1.02; discrimination was comparable to the Cox model (C-index 0.763, 95% CI: 0.737–0.789). SHAP identified poor performance status as the dominant predictor (mean |SHAP| 0.178), followed by male sex (0.067), high-risk primary tumor type (0.063), multiple bone metastases (0.047), and planned dose (0.033), the latter being the only leading feature associated with lower predicted mortality; SurvLIME gave consistent results. In multivariable Cox analysis, performance status (hazard ratio [HR] 2.21 per standard deviation [SD], p < 0.001) and planned dose (HR 0.71 per SD, p < 0.001) were independently associated with OS. Conclusions: The explainable DL model predicted OS after palliative radiotherapy for bone metastases with discrimination and calibration comparable to those of a well-specified Cox model, and its feature attributions agreed with the Cox coefficients, suggesting that the prognostic information in these baseline variables is essentially additive and can therefore be delivered at the bedside as a simple score, without dedicated AI infrastructure and without loss of predictive performance. The combined use of SHAP and SurvLIME verified that the model relies on established clinical factors, most prominently performance status, and provides patient-level explanations. Pending external validation, such prediction may support individualized decisions on treatment goals and radiation schedules.
Chemotherapy-induced nausea and vomiting (CINV) remain difficult to control after discharge despite guideline-based antiemetics. This multicenter exploratory single-arm two-stage trial evaluated patient-controlled, real-time transcutaneous electrical acupoint stimulation (TEAS) at Neiguan (PC6) as an adjunct to standard antiemetic therapy in patients with breast cancer. Forty-eight patients who had experienced CINV and were scheduled at enrollment to receive the same chemotherapy and antiemetic regimens during two consecutive cycles were analyzed. Cycle 1 served as the observation period, and cycle 2 added on-demand wrist-worn TEAS initiated by patients at nausea or vomiting onset during 0–120 h after chemotherapy. Compared with the observation period, TEAS was associated with lower nausea frequency and visual analogue scale scores on days 1–5 and higher nausea response rates on days 1–4. Vomiting frequency and severity were lower on days 1–3, but between-period differences were not significant on days 4–5. SF-36 scores increased and SAS/SDS scores decreased on day 5. Two transient local numbness events occurred, with no serious TEAS-related adverse events. These findings suggest that patient-controlled TEAS is feasible and warrants confirmation in randomized sham-controlled trials.
Background: Metastatic pancreatic adenocarcinoma carries a dismal prognosis, and treatment options after progression on standard chemotherapy remain limited. We report a metabolic response in a patient with drug-resistant disease treated with a combined multimodal regimen that paired dose-reduced (“activated”) multi-agent chemotherapy with targeted agents and metabolic/microenvironmental support, set against an unusually long overall survival. Case Presentation: A 46-year-old man was diagnosed with inoperable, locally advanced/stage IV pancreatic adenocarcinoma in June 2023 and maintained disease control for approximately 2.5 years on a combined multimodal regimen, termed here metabolically controlled oncologic therapy (MCOT): dose-reduced chemotherapy given with regional hyperthermia, hyperbaric oxygen, and a carbohydrate-restricted diet. In February 2026 he developed local recurrence and diffuse liver metastases, and by May 2026 had deteriorated rapidly, with 18F-FDG PET/CT showing a peak SUVmax of 18.2 and CA 19-9 of 2788 U/mL. His regimen was intensified to a low-dose, multi-agent “activated” chemotherapy protocol combined with lenvatinib, everolimus, hyperthermia, and hyperbaric oxygen. Clinical Findings and Outcomes: One month later, his performance status had recovered from ECOG PS 2 to PS 0, CA 19-9 was 31 U/mL, and follow-up PET/CT showed a 63.7% decrease in SUVmax (from 18.2 to 6.6). Treatment-related adverse events included Grade 1 nausea, Grade 1 vomiting, and thrombocytopenia; no Grade 2 or higher non-hematological toxicity was observed. Conclusions: In selected patients who are considered to have exhausted standard options, a combined multimodal regimen pairing dose-reduced chemotherapy with metabolic and microenvironmental support may produce a well-tolerated metabolic response. As a single, uncontrolled observation, these findings cannot establish causality and require confirmation in prospective, controlled studies.
Background/Objectives: The COVID-19 pandemic was a major challenge for healthcare systems and social life worldwide. During the pandemic, studies focused on examining structural changes in patient care and establishing new guidelines to manage COVID-19, but very few of them addressed patients’ perceptions and concerns regarding changes in cancer treatment during the pandemic. This study aimed to assess the changes in their therapy situation during three waves of the pandemic and the impact on their social life. Methods: This exploratory cross-sectional multicenter survey was conducted among patients with gynecological malignancies and breast cancer at gynecological oncology centers in Germany between October 2020 and February 2022. An anonymous paper-based 50-item questionnaire, available in German, assessed medical care, treatment modifications, mental health, and socioeconomic burden during the COVID-19 pandemic. Data were analyzed descriptively. Two subgroup analyses were conducted, comparing age groups ≤70 and >70 years, as well as patients with and without a migrant background. Results: Overall, 778 patients met the inclusion criteria of the survey (median age: 59; range: 24–93). In the majority of the patients (77.1%), the treatment schedules remained unchanged during COVID-19 pandemic. Treatment appointments were modified in a small number of patients (9.0%). Changes in therapy schedules were slightly more common among the second- and third-generation migrants and among patients ≤70 years. Despite the uncertainty of the COVID-19 pandemic, most patients (83.4%) kept their trust in the healthcare system. Acceptance of preventive measures was high, and 85.9% were willing to be vaccinated against COVID-19. Psychological symptoms such as worries and fear were reported by more than half of the participants during the last 2 weeks previous to the survey and more common among patients ≤70 years. Only 8.6% were more afraid of a COVID-19 infection than their cancer disease. Conclusions: Despite major challenges in cancer care due to the COVID-19 pandemic, access to cancer treatment and adequate management at gynecological oncology centers in Germany remained stable. The increased psychological burden in crises requires new infrastructure and should be addressed to improve patient care in future crises. The acceptance of taking preventive measures against COVID-19 was high among cancer patients.
Pretreatment health-related quality of life (HRQoL) may identify supportive care needs, but the joint contribution of symptom burden, depressive symptoms, and resilient coping remains insufficiently characterized. This multicenter baseline analysis included 194 adults with breast (n = 86), gynecological (n = 77), or genitourinary (n = 31) cancer from six Spanish hospitals before systemic therapy. Global HRQoL was assessed with the EuroQol visual analogue scale EQ-VAS; symptom burden with EORTC QLQ-C30 symptom scales/items; depressive symptoms with the Brief Symptom Inventory-18 depression subscale; and resilient coping with the Brief Resilient Coping Scale. EQ-VAS scores did not differ by tumor site (p = 0.369). Symptom burden was strongly inversely associated with HRQoL (r = −0.827, p < 0.001). In the moderated mediation model, higher symptom burden was associated with higher depressive symptoms (B = 0.275, 95% CI 0.118 to 0.431); symptom burden (B = −0.642, 95% CI −0.715 to −0.569) and depressive symptoms (B = −0.529, 95% CI −0.743 to −0.316) were associated with lower HRQoL scores. Indirect effects through depressive symptoms were statistically different from zero, but resilient coping did not significantly moderate this indirect association. These cross-sectional findings support pretreatment screening for symptoms and depressive symptoms to guide early supportive oncology care.
Cancer-associated cachexia (CAC) is a multifactorial syndrome characterized by systemic inflammation, muscle wasting, and progressive functional decline, affecting up to 80% of patients with advanced cancer. The inconsistent diagnostic criteria limit comparability across studies and hinder translation into clinical practice. Inflammatory biomarkers, including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and serum albumin, have been studied as markers of the presence, severity, and progression of CAC. This review synthesizes evidence linking these five biomarkers to key manifestations of CAC, including weight- loss, muscle depletion, fatigue, quality of life, and survival. A structured search of PubMed, Embase, and Web of Science studies published between 2000 and 2025, yielding 20 articles for final synthesis to evaluate biomarker patterns and their potential utility for early detection and risk stratification. IL-6 and CRP show consistent associations with muscle wasting and systemic inflammatory burden. Albumin and NLR demonstrate enhanced prognostic value when incorporated into composite indices such as the Cachexia index. TNF-α remains mechanistically relevant but shows limited predictive utility when assessed independently. CRP, Albumin, and NLR are derived from routine, low-cost tests, whereas IL-6 and TNF-α require specialized cytokine assays. Future research is warranted to standardize diagnostic criteria and validate biomarker thresholds to develop an accessible, multi-biomarker panel for improved detection and monitoring of CAC.
Intraoperative neurophysiological monitoring (IONM) is widely used during brainstem surgery to reduce the risk of neurological injury, although its prognostic value in adult brainstem glioma (BSG) surgery remains unclear. We retrospectively analyzed 22 consecutive adults who underwent surgery for BSGs with multimodal IONM between 2010 and 2023. Monitoring included somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), brainstem auditory evoked potentials (BAEPs), corticobulbar MEPs (CoMEPs), and cranial nerves electromyography. The primary endpoint was the association between intraoperative neurophysiological changes and postoperative neurological functional status at hospital discharge, assessed with the modified McCormick Scale (mMCS). Secondary endpoints included postoperative complications and length of hospital stay. SSEP warning criteria were met in 10 patients (45.5%), while 10 patients (45.5%) experienced a ≥50% reduction in MEP amplitude in at least one monitored muscle. Despite these findings, neither SSEP nor MEP amplitude changes were significantly associated with postoperative neurological status. Transcranial MEP stimulation thresholds increased significantly during surgery (p = 0.007), and threshold elevation was associated with postoperative complications (Kendall’s τ = 0.498, p = 0.007). BAEP recordings remained stable throughout all procedures. Conventional amplitude-based IONM changes were not associated with early neurological outcome after adult BSG resection. In contrast, increases in MEP stimulation threshold may represent a sensitive indicator of postoperative complications. Further prospective studies are warranted.
Background: Identifying biomarkers for biological vulnerability in older patients with cancer remains challenging. We evaluated psoas muscle index (PMI) and immunonutritional indices’ association with toxicity and overall survival (OS) in patients ≥ 65 years receiving immune checkpoint inhibitors (ICIs). Methods: This retrospective study included 104 patients. Baseline sarcopenia was assessed via CT-derived PMI at the L3 level. Immunonutritional status was evaluated using the Prognostic Nutritional Index (PNI). Primary endpoint was immune-related adverse event (irAE) development; secondary endpoint was OS. Results: Median age was 71 years. Patients developing irAEs had significantly higher baseline PNI than those without (49.0 vs. 46.0, p = 0.042). OS did not differ significantly by irAE status (p = 0.859) or PMI group (p = 0.664). However, low PNI was strongly associated with poorer OS (17.0 months vs. not reached, p < 0.001). In a multivariable Cox model stratified by ICI treatment type, higher PNI remained independently associated with better OS (adjusted HR: 0.86, 95% CI: 0.81–0.93, p < 0.001). PNI correlated negatively with inflammatory markers NLR and SII. Conclusions: Baseline PNI was independently associated with OS, whereas PMI was not significantly associated with survival in this cohort. These findings support the potential prognostic utility of PNI in older patients receiving immunotherapy but should not be interpreted as demonstrating superiority over comprehensive sarcopenia assessment.
Background: Modern radiotherapy techniques have improved the safety of prostate cancer treatment, but acute gastrointestinal and genitourinary toxicity remains a common clinical problem. Early identification of patients who are likely to develop treatment-related adverse effects may help optimize supportive care. This study evaluated the relationships between clinical characteristics, radiotherapy planning parameters, systemic inflammatory biomarkers, and acute pelvic toxicity during hypofractionated radiotherapy. Materials and Methods: We retrospectively analyzed 142 patients with histologically confirmed prostate cancer who underwent external beam radiotherapy at the Provincial Integrated Hospital in Płock, Poland, between October 2024 and March 2026. Clinical, laboratory, and radiotherapy planning data were obtained from institutional electronic records. Laboratory analyses included CRP, creatinine, total leukocyte, neutrophil, lymphocyte, erythrocyte and platelet counts, hemoglobin, and hematocrit. Rectal and bladder toxicity was prospectively graded according to the RTOG/EORTC criteria at 2 and 4 weeks after treatment initiation. Correlation and multivariable regression analyses were performed to identify factors associated with acute treatment-related toxicity. Results: Radiotherapy significantly reduced leukocyte and lymphocyte counts (both p < 0.001) and produced smaller reductions in erythrocyte count, hemoglobin, hematocrit, and absolute neutrophil count (all p < 0.05). Patients who reported rectal or urinary symptoms early during treatment generally continued to experience toxicity later in the treatment course. Rectal and bladder toxicities were positively correlated, indicating that patients with toxicity affecting one pelvic organ frequently developed symptoms in the other. Routine inflammatory biomarkers and most dosimetric parameters showed limited independent value for predicting clinically relevant acute toxicity. Conclusions: Early gastrointestinal and genitourinary toxicity appears to be a useful clinical indicator of persistent treatment-related symptoms during hypofractionated prostate radiotherapy. Early rectal and bladder toxicity was associated with toxicity later during treatment, whereas routine laboratory markers and most dosimetric parameters showed limited independent associations with acute pelvic toxicity.
Background/Objectives: In Lebanon, the economic crisis since 2019 has severely strained healthcare infrastructure, yet its impact on cancer treatment adherence remains incompletely characterized. This study assessed factors associated with treatment delay and regimen modification to identify barriers to optimal cancer care among Lebanese patients. Methods: This multicenter, cross-sectional study was conducted in five tertiary hospitals in Beirut, Lebanon, between 13 June 2024, and 27 June 2025. Demographic, clinical and treatment data were collected via a structured questionnaire. Bivariate and multivariable binary logistic regression analyses were performed to identify independent predictors of treatment delay (>2 weeks) and incomplete treatment regimens. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) are reported. Results: A total of 244 patients were enrolled in the study. The study population was predominantly female (59.0%) and aged ≥60 years (60.2%). Advanced disease was common, with 50.4% of patients presenting with stage IV disease. Financial vulnerability was widespread: 72.6% reported monthly household incomes below USD 1000, 88.1% reported a decline in income due to the economic crisis, and 39.3% relied on unstable income sources. Overall, 52.5% of patients experienced treatment initiation delays, and 9.0% received incomplete or dose-reduced regimens. On multivariable analysis, reliance on unfixed income independently predicted treatment delay (aOR 2.55, 95% CI 1.42–4.59; p = 0.002), lack of health insurance (aOR 1.91, 95% CI 1.08–3.39; p = 0.026) and pre-treatment surgical costs also increased the odds of delay (aOR 9.03, 95% CI 2.57–31.7; p = 0.001). For incomplete treatment, unfixed income remained an independent predictor (aOR 2.09, 95% CI 1.16–5.79; p = 0.015). A lack of insurance (aOR 5.62, 95% CI 1.22–25.9; p = 0.027) and high laboratory costs (>USD 150 per session) were also associated with incomplete regimens (aOR 1.62, 95% CI 1.02–2.57; p = 0.041). Conclusions: In Lebanon’s crisis context, financial instability was a key factor associated with deviations in cancer treatment. These findings highlight the need for strengthened insurance coverage and subsidization of diagnostic and treatment-related costs to ensure timely and continuous oncologic care.
Multiple myeloma (MM) patients with end-stage renal disease (ESRD) requiring hemodialysis (HD), who are disproportionately Black, have been excluded from all pivotal trials of BCMA-directed chimeric antigen receptor T-cell (CAR-T) therapy, leaving a critical evidence gap in a population. We conducted a multicenter retrospective analysis of all MM patients who received CAR-T therapy while on HD at two U.S. centers between June 2021 and December 2025. Of 284 CAR-T recipients, 8 (2.8%) were HD-dependent. Median age was 63 years; 62.5% were female and 75% were Black; patients had received a median of 6 prior lines. Five received ciltacabtagene autoleucel and three received idecabtagene vicleucel; lymphodepletion was bendamustine (n = 4) or dose-reduced fludarabine/cyclophosphamide (n = 4). Cytokine release syndrome occurred in 37.5% (all Grade 1), with no grade ≥ 3 events—substantially lower than pivotal trials (76–95%). All 7 evaluable patients achieved neutrophil recovery by Day 30. One patient with prolonged pre-existing cytopenia pre-CAR-T therapy developed ICAN grade 4 and died from fungal pneumonia. Median progression-free survival was 17.5 months and median overall survival was not reached. Treatment-related mortality was 12.5%. CAR-T therapy is feasible, relatively safe, and effective in carefully selected HD-dependent MM patients, supporting expanded eligibility with appropriate dose modification.
