Newly published data from the NHS Targeted Lung Health Check (TLHC) programme confirm that over 75% of screen-detected lung cancers are now diagnosed at stage I or II, a shift that has already driven a 20% annual increase in resections, from 6547 in 2023 to 7878 in 2024. With the programme set to perform nearly one million annual scans by 2030, resection demand will continue to rise steeply. Scaling surgical throughput within existing theatre infrastructure, without opening new units, is therefore both an operational and oncological priority. The High-Intensity Theatre (HIT) list model, a structured, back-to-back operating framework that uses parallel anaesthetic pathways, has transformed throughput in urology and general surgery but had not been applied to major anatomical thoracic resection. We describe the first two HIT lists for robot-assisted thoracic surgery (RATS) at a high-volume UK centre. Fifteen patients underwent major anatomical resection across two lists, including lobectomies, bilobectomy, and complex segmentectomies. All 15 resections achieved R0 status. Median console time was 35 minutes. Thirty-day mortality was nil. Five patients (33%) developed complications, consistent with published RATS benchmarks. These early data suggest that the HIT model is feasible for high-complexity thoracic surgery, with an acceptable early safety profile, and that it may offer a replicable, cost-neutral way to help protect curative intent at population scale. As this is a small, single-centre proof-of-concept series with no control group, it establishes feasibility rather than efficacy.
Tumour bed boost irradiation has long represented a cornerstone of breast-conserving treatment, improving local control at the cost of increased fibrosis, poorer cosmetic outcomes, and reduced quality of life. However, the landscape of early breast cancer has changed profoundly. Modern systemic therapies and the widespread adoption of neoadjuvant treatment have made pathological complete response (pCR) an increasingly common and clinically meaningful endpoint, consistently associated with excellent long-term outcomes. Despite this biological revolution, local treatment strategies remain largely unchanged and continue to follow standards developed in the pre-neoadjuvant era. Yet, pCR likely reflects not only treatment efficacy but also favourable tumour biology and intrinsic radiosensitivity, raising the question of whether all patients who achieve pCR still derive a meaningful incremental benefit from routine tumour bed boost irradiation. As survivorship becomes an increasingly important outcome, minimizing treatment-related toxicity without compromising local control is a major priority. Prospective trials evaluating response-adapted boost strategies are therefore urgently needed. Radiotherapy should evolve alongside systemic therapy, moving from a ‘one-size-fits-all’ approach toward truly biology-driven personalization.
Introduction: Pediatric B non-Hodgkin lymphoma (B-NHL) often presents with complex karyotypes (CK), co-occurring high-risk mutations, and treatment resistance, leading to poor outcomes. Case description: We describe a child with a CK including MYC::IGH translocation, MYC inversion, TP53 deletion, BCL6 gain, and BCL2 loss, exhibiting a high tumor burden and a partial response to standard therapy, requiring treatment intensification. Conclusion: This case emphasizes the critical role of comprehensive cytogenetic and molecular profiling to guide diagnosis, risk stratification, and therapy selection. Recognition of high-risk genetic features can inform early intensification or targeted approaches. Pediatric MYC -rearranged B-NHL with complex cytogenetics remains under-characterized but clinically aggressive, underscoring the need for multicenter studies to define its genetic spectrum, refine prognostic models, and optimize individualized treatment strategies.
Background: The optimal follow-up strategy for head and neck squamous cell carcinoma (HNSCC) remains uncertain, with inconsistent international guidelines regarding routine radiological surveillance. Methods: A systematic search of PubMed/MEDLINE, EMBASE, and CENTRAL (to April 2025) identified studies including adults with HNSCC undergoing different follow-up modalities. Primary outcomes were overall (OS) and disease-free survival (DFS); secondary outcomes included recurrence detection mode, salvageability, and diagnostic accuracy. Results: Eighteen retrospective studies met inclusion criteria. Most recurrences (61.5%) were symptom-detected, followed by clinical (24%) and imaging (14.5%) surveillance. Salvageable recurrences were more frequent in symptom-based (60%) than clinical (45%) or imaging (30%) strategies. Across eight studies with survival data, no significant OS or DFS differences emerged between radiological and non-radiological strategies. Conclusion: Available evidence does not demonstrate a survival advantage associated with routine radiological surveillance after curative treatment for HNSCC. and may be limited to symptomatic cases, inaccessible sites, or early post-treatment assessment.
Objective: To evaluate the association between baseline metastatic tumor volume measured on computed tomography (CT) and survival outcomes in patients with metastatic renal cell carcinoma (mRCC) receiving nivolumab as second line or later line therapy. Materials and Methods: We retrospectively analyzed 43 patients with mRCC treated with nivolumab between August 2013 and March 2022. Baseline metastatic tumor volume was measured on CT scans obtained within 30 days before treatment initiation. The cohort median (117 cm 3 ) was used as an exploratory, data derived cut-off to define low- and high-volume groups. Progression free survival (PFS) and overall survival (OS) were evaluated using Kaplan–Meier analysis and Cox proportional hazards models. Results: Median PFS and OS were 26.97 and 28.11 months, respectively. Median PFS was 40.62 months in the low-volume group and 9.74 months in the high-volume group (p=0.012), while median OS was 46.9 and 12.89 months, respectively (p=0.006). High tumor volume and multiple metastatic sites were associated with poorer survival outcomes. Baseline imbalances in IMDC risk classification and nivolumab treatment line were observed between groups. Conclusion: Higher baseline metastatic tumor volume was associated with poorer survival outcomes in patients with mRCC treated with nivolumab. CT-based tumor volumetry may provide complementary prognostic information; however, these exploratory findings require validation in larger, prospective cohorts.
