Cancer-related cognitive impairment (CRCI), also known as chemobrain or chemofog, is characterized by subjective and/or objective changes in attention, executive functions, memory, and processing speed in patients with non-CNS cancers, particularly women with breast cancer. This structured narrative review synthesizes current evidence on mechanisms, neuropsychological assessment, neuroimaging correlates, clinical and demographic risk factors, emerging artificial intelligence and machine learning applications, and non-pharmacological approaches to CRCI in breast cancer. A structured literature search was conducted using PubMed/MEDLINE, PsycInfo, and Clinical Key up to May 2026, with emphasis on studies published between 2023 and 2026. Peer-reviewed English-language studies involving adult breast cancer populations and addressing predefined thematic domains of CRCI were considered. Given the heterogeneity of study designs, assessment tools, interventions, and outcomes, the findings were synthesized narratively. Current evidence supports a multifactorial model of CRCI involving neurobiological, treatment-related, psychological, and behavioral mechanisms. Neuroinflammation, endocrine disruption, oxidative stress, glial alterations, and structural or functional brain changes may contribute to cognitive symptoms; however, the strength of evidence varies, and many findings remain correlational or preclinical. Non-pharmacological interventions, including cognitive training, physical activity, mindfulness-based and psychological approaches, and multimodal digital programs, appear promising as supportive strategies. However, evidence remains heterogeneous, with benefits more consistently reported for patient-reported outcomes, fatigue, emotional distress, and quality of life than for objective neuropsychological performance. CRCI in breast cancer should be approached as a heterogeneous condition requiring early recognition, standardized assessment, and multidisciplinary supportive care. Future research should prioritize longitudinal designs, harmonized endpoints, and a clearer distinction between subjective and objective outcomes.

PURPOSE:Psychological stress, here used as an umbrella term encompassing depression, anxiety, psychosocial stress, stressful life events, perceived stress, and job strain, is hypothesized to influence cancer development and prognosis, yet epidemiologic evidence is inconsistent. This umbrella review with secondary quantitative synthesis evaluated associations between stress-related exposures and cancer incidence and mortality. METHODS:PubMed was searched from inception to March 1, 2026, alongside Scopus, the Cochrane Library, citation tracking, and manual screening. Eligible studies included systematic reviews, meta-analyses, or pooled individual participant data analyses assessing depression, anxiety, psychosocial stress, stressful life events, perceived stress, or job strain in relation to cancer incidence or mortality, reporting adjusted HRs, RRs, or ORs. Random-effects models were used for secondary pooling. Overlap was assessed with corrected covered area, and evidence credibility with the Ioannidis framework. RESULTS:Fifteen publications met inclusion criteria; eight were quantitatively synthesized, representing over four million participants. Psychological stress was not significantly associated with overall cancer incidence (pooled RR/HR 1.06; 95% CI 0.99-1.14; I2 = 72.5%) or breast cancer incidence (RR/OR 1.13; 95% CI 0.95-1.34; I2 = 77.8%). In contrast, cancer mortality was consistently elevated across 4 analyses (RR/HR 1.23; 95% CI 1.19-1.27; I2 = 0%). Site-specific mortality risks ranged from HR 1.15 for lung cancer to HR 3.86 for leukemia. Review overlap was moderate (7.4%). Associations between depression/anxiety and cancer mortality reached Class I evidence. CONCLUSION:Psychological stress-related exposures were not significantly linked to cancer incidence in the available meta-analytic evidence, whereas depression, anxiety, and related distress were consistently associated with increased cancer mortality. These findings should be interpreted cautiously because residual confounding and measurement heterogeneity remain important limitations.

Genitourinary malignancies are characterized by marked heterogeneity in tumor biology, clinical behavior and therapeutic outcomes. Despite significant progress in surgical and systemic treatments, resistance to therapy remains a major challenge, highlighting the need to identify additional host-related determinants of disease progression and treatment response. Within this framework, converging experimental and clinical evidence indicates that host-associated microbial ecosystems may influence key biological processes involved in tumor-host interactions, including immune modulation, metabolic regulation and inflammatory pathways. Altered microbial profiles have been associated with oncogenic signaling, changes in the tumor microenvironment and differences in clinical benefit from systemic therapies, particularly immunotherapeutic approaches. This review brings together preclinical, translational and clinical evidence on the involvement of microbiota in renal, prostate, bladder and testicular cancers, with attention to biological mechanisms and clinically meaningful correlations with disease characteristics. While current data are largely observational, early interventional studies suggest that modulation of microbial ecosystems may influence therapeutic activity in selected clinical settings. Collectively, these findings support microbiota as a relevant component of genitourinary cancer biology with potential implications for precision medicine approaches.

BACKGROUND:Epidemiological and retrospective studies suggest that letrozole may improve outcomes in low-grade serous carcinoma of the ovary (LGSCO) by targeting estrogen-driven tumor progression. METHODS:We designed a multicenter, randomized, open-label, phase III trial to compare letrozole versus standard chemotherapy (carboplatin plus paclitaxel) in prolonging progression-free survival (PFS). Secondary endpoints include overall survival (OS), objective response rate (ORR), quality of life (MENQoL), and musculoskeletal pain (BPI-SF). Translational objectives explore mutational and expression profiles (NGS, RAD51/BRCA1 foci) and circulating tumor DNA (ctDNA) as markers of treatment response. Eligible patients are postmenopausal women with stage III-IV ER/PgR-positive LGSCO after primary cytoreductive surgery. Patients are randomized 1:1 to letrozole 2.5 mg daily until progression or unacceptable toxicity, or to carboplatin-paclitaxel for 6-8 cycles. Disease progression is assessed by RECIST, CA-125, and imaging every 3-6 months. RESULTS:As of March 2025, 46 patients have been randomized (23 per arm). Preliminary analysis shows a favorable safety profile for letrozole compared with chemotherapy. CONCLUSIONS:Early findings suggest letrozole is well tolerated and may represent a viable therapeutic option for hormone receptor-positive LGSCO. Ongoing molecular and clinical analyses will clarify its role in this rare subtype. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT05601700; https://clinicaltrials.gov/study/NCT05601700.

OBJECTIVE:Recurrent gynecological tumors (e.g., endometrial, and ovarian cancers) are incurable diseases; therefore, new treatment options are urgently needed. The PTEN-AKT-PI3K pathway is frequently altered in these tumors, representing a potential treatment target. Alpelisib is an α-specific PI3K inhibitor approved in PIK3CA-mutated advanced breast cancer. We report outcomes from a large series of patients with PIK3CA-mutated gynecological cancers prospectively treated with alpelisib within a controlled program. METHODS:From April 2021 to December 2022, 36 patients with PIK3CA-mutated advanced gynecological cancers received alpelisib 300 mg orally once daily. Objective response (ORR) and disease control (DCR) rates provided measure of the antitumor activity of alpelisib, the primary objective of the study. RESULTS:Included patients had endometrial (17/36 [47%]), ovarian (10/36 [28%]), or other gynecological cancers (9/36 [25%]). Most patients had received 2-3 prior systemic treatments (endometrial, 47·2%; ovarian, 60%; other, 56%), and presented with visceral metastases at baseline (82%, 70%, and 56%, respectively). Overall, 17 different PIK3CA mutations were found, including 53% in the kinase domain (most commonly H1047R) and 36% in the helical domain (most commonly E545K). Overall, the ORR was 28% and DCR was 61%, with the greatest benefit observed in patients with endometrial cancer (35% and 71%, respectively). CONCLUSION:Alpelisib represents an active treatment option in patients with recurrent gynecological cancers harboring a PIK3CA mutation. These findings support the need of biomarker-driven randomized trials of PI3K inhibitors in gynecological cancers.

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect that occurs in 20% of ovarian cancer patients treated with the combination of carboplatin/paclitaxel (CP). This toxicity is directly correlated with the dose of paclitaxel administered. Several studies have investigated whether different formulations of taxane can induce this side effect at a lower rate, but, unfortunately, no significant improvement was obtained. CIPN can be disabling in the daily lives of patients and can cause dose reduction or early termination of the treatment. Neuropathy can last for months and even years after its onset. Moreover, patients responsive to CP treatment are candidates for a reintroduction of the same drugs when disease relapse occurs, and residual neuropathy can affect the continuation of treatment. There are no approved drugs that mitigate or prevent the onset of CIPN. In this review, we summarize the evidence regarding the incidence of CIPN with different taxane formulations, regimen schedules and prevention systems. In particular, the Hilotherm® Chemo care device is a regional cooling system that lowers the temperature of the hands and feet to reduce the flow of chemotherapy into the capillaries. We used hilotherapy during chemotherapy infusion to prevent the onset of CIPN. Updated data from 44 ovarian cancer patients treated with 6 cycle of CP show that hilotherapy was well tolerated; only two patients (4.5%) stopped hilotherapy because of cold intolerance, and only one patient (2.2%) experienced grade ≥ 2 CIPN.

Small cell tumors arise from the neuroendocrine cell system and they are most frequently found in the lung (SCLC). Small cell tumor could occasionally arise in other body sites, such as the cervix, prostate, gastrointestinal tract, and very rarely from other sites. Metastatic SCLC patients present with metastatic disease in 80% of cases, and the metastases typically are reported in brain, liver, lung, and bone; they rarely could be found in the ovary. Differently, primitive small cell carcinoma of the ovary of pulmonary type is a rare and highly aggressive tumor arising from the ovarian cells; no suitable treatment strategy has been established yet. In this paper, we talk about a 72-year-old woman who presented with abdominal bleeding and a large mass in her pelvic region. A primary ovarian carcinoma was suspected, and she underwent hysterectomy with laparoscopic surgery and bilateral oophorectomy, lymph node resection, omentectomy, complementary appendix and sigmoid resection. The postoperative pathologic diagnosis was a differential diagnosis between small cell ovarian carcinoma of the pulmonary type and metastasis of SCLC.

The association between antibiotic use and risk of cancer development is unclear, and clinical trials are lacking. We performed a systematic review and meta-analysis of observational studies to assess the association between antibiotic use and risk of cancer. PubMed, the Cochrane Library and EMBASE were searched from inception to 24 February 2019 for studies reporting antibiotic use and subsequent risk of cancer. We included observational studies of adult subjects with previous exposure to antibiotics and available information on incident cancer diagnoses. For each of the eligible studies, data were collected by three reviewers. Risk of cancer was pooled to provide an adjusted odds ratio (OR) with a 95% confidence interval (CI). The primary outcome was the risk of developing cancer in ever versus non-antibiotic users. Cancer risk’s association with antibiotic intake was evaluated among 7,947,270 participants (n = 25 studies). Overall, antibiotic use was an independent risk factor for cancer occurrence (OR 1.18, 95%CI 1.12–1.24, p < 0.001). The risk was especially increased for lung cancer (OR 1.29, 95%CI 1.03–1.61, p = 0.02), lymphomas (OR 1.31, 95%CI 1.13–1.51, p < 0.001), pancreatic cancer (OR 1.28, 95%CI 1.04–1.57, p = 0.019), renal cell carcinoma (OR 1.28, 95%CI 1.1–1.5, p = 0.001), and multiple myeloma (OR 1.36, 95%CI 1.18–1.56, p < 0.001). There is moderate evidence that excessive or prolonged use of antibiotics during a person’s life is associated with slight increased risk of various cancers. The message is potentially important for public health policies because minimizing improper antibiotic use within a program of antibiotic stewardship could also reduce cancer incidence.

BACKGROUND:Several studies report that practicing Yoga may lead to numerous psychophysiological benefits in patients undergoing treatment for cancer. Moreover, it may result in an effective alternative for coping with sleep disturbances, anxiety, depression and fatigue symptoms. A study based on the "Yoga in Oncology" project of the Foundation Poliambulanza was carried out, and it was designed to explore the benefits of Yoga, therefore corroborating Yoga as a therapeutic activity that can have a beneficial impact on patients diagnosed with cancer.METHODS:Seventy patients were recruited, of whom 20% were males and 80% were females 18 years of age and older. All patients were being treated at the oncology department for gastrointestinal, mammary or genital carcinoma, and the disease was metastatic in 80% of patients. Data were collected between April 2013 and May 2017. The protocol consisted of a weekly 90-minute Yoga lesson for 8 consecutive weeks, and the data collection was carried out in 2 phases: (T0) preprotocol assessment and (T1) postprotocol assessment. Psychophysiological assessment was carried out with the following scales: the (BFI) Brief Fatigue Inventory, (HADS) Hospital Anxiety and Depression Scale and (PSQI) Pittsburgh Sleep Quality Index.RESULTS:Data analysis showed a significant difference between the (T0) and (T1) HADS (Hospital Anxiety and Depression Scale) scores. The constructs of this scale consist of psychological variables for the assessment of anxiety and depression. In contrast, scores from the (BFI) Brief Fatigue Inventory and (PSQI) Pittsburgh Sleep Quality Index did not show significant differences between (T0) and (T1): such scales are relative to psychophysiological variables for an assessment of the perception of fatigue and quality of sleep.CONCLUSION:It is noteworthy that the data, once analyzed, showed a significant difference between preprotocol and postprotocol levels of anxiety and depression but not for the perception of fatigue or the quality of sleep. In accordance with the scientific literature, data from this study highlight that practicing Yoga may promote changes in the levels of perceived anxiety and depression in patients undergoing treatment for cancer, thus positively affecting their (QoL). It is clear that the difference in significance between the psychological and physiological variables considered here and the statistical significance found only in levels of anxiety and depression encourage further studies to account for the nature of fatigue and sleep disturbances and how to address these symptoms in oncological patients. Moreover, other points of interest for future clinical research regard the evaluation of the reason for the possible denial to participate to this kind of study, as well as the social-cultural differences in patients' behavior.

Aims and Background: The main purpose of our psycho-educational groups was to help women with breast cancer, learn how to cope with the physical, emotional, and lifestyle changes associated with cancer as well as with medical treatments that can be painful and traumatic. With this study, we wanted to detect the effects that group action had on the women who participated in it. Methods: We studied a total of 97 patients who participated in 13 psycho-education groups. The whole sample was female patients who had breast cancer with no recurrence or metastases. Results: All patients were evaluated with the Hospital Anxiety and Depression Scale (HADS) and the Body Image Scale (BIS). We found no significant effect on anxiety and body image for the brief psycho-educational group for women with breast cancer in this study. It is possible to highlight a statistical difference and hence an improvement between the results of the HADS depression test at T0 (first evaluation at the first meeting) and T1 (retest in the final meeting). Conclusion: The tests did not show a significant effect on anxiety and body image perception, but the patients reported that the psycho-educational group was an important intervention for their life. Outcome measurement is more complex in psychosocial research because many variables come into play and each phase of treatment is characterized by different types of problems for the patient: physical, relational and psychological aspects are involved.

Nasopharyngeal carcinoma (NPC) is an epithelial malignancy, with a high metastatic potential. Epstein-Barr virus (EBV) infection plays a fundamental role, even if it is not well understood. The diagnosis of the disease in its early stage is infrequent. Imaging studies, positron emission tomography scans in addition to clinical examination, endoscopic examination, and biopsy provide information on the extent of the disease. The application of neoadjuvant chemotherapy followed by concomitant chemoradiation can improve the control of NPC. In March 2016, a 54-year-old male with NPC cT1 cN2 cM0, stage III (8th edition of American Joint Committee on Cancer (AJCC) staging system) underwent to a two-step treatment: induction chemotherapy by TPF regimen (docetaxel, cisplatin, 5-fluorouracil), followed by concomitant chemoradiotherapy (weekly cisplatin). The quantity of free plasma EBV-DNA can be related to the disease stage, and the detection of EBV-DNA during follow-up can be predictive of distant metastases. Especially, either plasma or serum EBV-DNA titer is estimated to reflect tumor volume. Biologically, such EBV-DNA reflects reproduced or released DNA from dead or dying tumor cells. On the other hand, EBV-specific DNA released as exosome may reflect the biological feature of the alive NPC tumor cell. The follow-up is ongoing after 21 months from a complete response.

Background: The fear of loss of dignity is a recurring concern among oncological patients, especially in the advanced stage of illness, for those who are in advanced stage of their disease. Chochinov has made the model of Dignity Therapy (DT) used primarily with people who were terminally ill. It consists of a short-term psychotherapy intervention that includes 3 major issues: physical aspects related to the disease and symptoms; existential/spiritual based on the patient's life history; social relationships linked to the quality of the relationship between the patient, practitioners and family members. The DT is a multi-dimensional psychosocial intervention for patient-centered care and it depends on experiences of generativity and the pursuit of purpose and meaning. It invites patients to discuss issues that matter most or that they would (most) want mainly to remember. Methods: Since 2016 we applied to 4 patients the DT in the perspective of simultaneous care with metastatic disease, in psychological therapy and still in chemotherapy. We are using the Italian validate version of semi-structured interview. The intervention takes place in 3-4 meetings, lasting 1 hour each, after informed consent. The interview uses 10 core questions and the responses are used to create a written legacy document to family members. The DT session is audio-recorded, transcribed, edited and given back to the patient. Content includes lifetime events that are most significant in the life of the patient, who can later personalize adding photos, images, titles or more. Results: Because the our small sample, we do not have a statistically relevant data, but we have noticed that the common themes that emerge in patients mainly concern the attributed value to the affections and the family and the experiences that have contributed to building their identity. The introduction of topics such as dignity, searching for meaning, has proved to be a valuable tool for the development of the true meaning of one's life, despite the changes in the disease. Moreover, in some cases, it has contributed to allowing the person to find a way of self-reliance in relation to loved ones. Conclusion: In our experience, DT showed to be a new promising therapeutic intervention for suffering and distress at the end of life. The literature review finds robust evidence for DT's overwhelming acceptability, rare for any medical intervention, especially in psychosocial-spiritual care.

Introduction: The introduction of biological agents in cancer therapy is changing the progression of metastatic colorectal cancer. Currently, resistance to biological agents is an emerging problem; the progression of the disease is caused by the development of resistant clones. According to some authors, these clones can be re-sensitized to traditional and previously utilized chemotherapy agents. The results of the CORRECT study demonstrated the efficacy of regorafenib monotherapy in both KRAS wild type and mutant pretreated patients (pts). Two recent reports showed the potential of reintroduction of chemotherapy, even after treatment with regorafenib.Patients and methods: We performed a retrospective review of clinical data from patients treated with regorafenib at our institution between March 2012 and March 2013. We analysed patient characteristics, KRAS/NRAS status, response to treatment (evaluated by RECIST v1.1 criteria) and survival.Results: Regorafenib was administered to 128 patients, and 11 (8.6%) received post-regorafenib therapy (to our knowledge). Seven (63.6%) patients were wild type for KRAS/NRAS. Post-regorafenib therapy represented for all the patients at least the fourth line: all the pts received both oxaliplatin- and irinotecan-based chemotherapy, all of them were treated with bevacizumab, and 7 patients also received cetuximab. Eight patients (72.7%) were treated with standard chemotherapy after regorafenib (irinotecan monotherapy, capecitabine plus oxaliplatin or irinotecan, dacarbazine or raltitrexed), while 3 patients received an experimental therapy (clinical trial). Nine of the 11 (81.8%) patients had PD and 2 patients had SD. The median progression-free survival was 1.6+ months (range 0.5-3.5), the median OS post-regorafenib was 2.1+ months (range 0.5-10.2) and the 6-month OS was 27.3%.Conclusion: Our retrospective analysis showed that after regorafenib therapy, re-introduction of chemotherapy is possible. Unfortunately, we reported a high percentage of disease progression beyond regorafenib, which is likely due to the high percentage of heavily pretreated patients (some received four or five types of therapy before regorafenib). We think that regorafenib could represent a chemotherapy resensitizing agent; however, additional studies are needed in patients who have received less pretreatment.

OBJECTIVE:Recent scientific approaches to cancer patients draw attention to the psychological aspects of the disease and the involvement of their families, who are forced to reorganize themselves in order to manage the patient's illness. Functional responses to a stressful event facilitate open communication between family members and empathy for the patient's children, who need to be involved and informed about the illness in a clear and open fashion. The primary goal of this observational study was to explore the communication styles used by cancer-stricken parents with their children and to identify a correlation with the patient's levels of anxiety and depression and their ability to cope. We also sought to understand whether location, severity, and time from diagnosis influenced communication, coping, anxiety, or depression.METHOD:From September of 2011 to July of 2015, 151 questionnaires were given to patients who had received at least one course of chemotherapy. The instruments that we employed were the Openness to Discuss Cancer in the Nuclear Family Scale, the Hospital Anxiety and Depression Scale, and the Mini-Mental Adjustment to Cancer Scale. Our sample included patients with children aged from 3 to 18 years. The patients had different types of cancer, mainly gastrointestinal and breast cancer. Their disease was at the metastatic stage in approximately 20% of patients.RESULTS:Our results showed statistically significant correlations between higher levels of anxiety and depression and more closed communication styles. The coping styles "hopelessness/helplessness," "cognitive avoidance," and "anxious preoccupation" were associated with a closed communication style that is correlated with higher levels of anxiety and depression. Tumor location, time from diagnosis, and stage of disease did not show statistically significant correlations with anxiety, depression, coping mechanisms, or communication styles.SIGNIFICANCE OF RESULTS:Our study confirmed what has been reported in the literature: high levels of anxiety and depression affect communication among family members. Not surprisingly, the "fighting spirit" coping style engenders open communication.

Metastatic pancreatic cancer still represent one of the most deadly disease for which there are few therapeutic options, especially in second line and beyond setting. Nabpaclitaxel plus gemcitabine activity was demonstrated in first line setting, but there are no clear evidence suggesting its use after that. We report a retrospective data analysis of 23 patients who received nab-paclitaxel plus gemcitabine after first line treatment at our Oncology Department. We observed a significant clinical benefit (43,5%) with a median overall survival of 5 months. In addition, manageable side effects were reported. Our data, despite the small sample, seem to indicate that nab- paclitaxel plus gemcitabine is an active and well tolerated regimen even in pretreated patients.

Background: In recent years, literature has reported an increase in the use of Complementary Alternative Medicine (CAM) by cancer patients to manage symptoms related to the disease or side effects of the treatments. Yoga is one of the most widely used complementary and alternative medicine therapies to cope with the most common symptoms of cancer as anxiety, depression, fatigue and sleep disorders. Recent studies conducted with cancer patients indicate that Yoga is associated with improvement in overall QOL, emotional well-being, physical symptoms and distress. In April 2013 we started the "Yoga project in Oncology " which involved the use of specific exercises of this discipline as a complement of cancer treatments. The aim of this study was to evaluate the impact of Yoga training on mood, fatigue and sleep quality in metastatic cancer patients. Material and methods: The Yoga intervention used the Yoga Ratna approach, consisting of pranayama (breathing exercises), gentle yoga asanas (postures) and meditation. The program includes 8 weekly group meetings lasting 1.5 hours, trained by a Yoga professional teacher with a psychologist. At the beginning (T0) and at the end (T1) of the training we administered the following tests: Hospital Anxiety and Depression Scale (HADS) to evaluate anxiety and depression; Fatigue Symptom Inventory (FSI) to assess fatigue symptoms; Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. Results: Sample consisted of 35 patients with metastatic cancer receiving chemotherapy. The majority of the patients were women (65.7%), the mean age was 55 years, 62.8% of patients were married and 45.7% were employed with a medium-high level of education (57.1%). All patients had advanced disease: 54.3% breast cancer, 31.4% colorectal cancer; 8.6% others gastrointestinal tumors and 5.7% pancreatic cancer. The preliminary results showed a not statistically significant trend concerning anxiety and depression improvement and a better sleep quality. In addition, we found an increase of fatigue symptoms. Conclusions: These results don't show statistically significant correlations probably because the still small sample treated so far. Moreover patients continued to receive medical treatment (chemotherapy) during Yoga training and this condition could have influenced their fatigue perception. Nevertheless, every participant expressed a very positive evaluation of this experience concerning a better body awareness and anxiety control.

Abstract Objective: Caregivers play a key role in the management of patients with cancer. However, some studies have suggested that caregivers have even more unmet needs than the patients. Method: To better identify the needs and changes in the lifestyles of the caregivers in our practice and to plan a targeted support project to decrease caregiver burden, we administered the Caregiver's QoL Index–Cancer (CQoLC) to 200 consecutive caregivers. This questionnaire assesses psychological well-being, the relationship with healthcare professionals, administration of finances, lifestyle disruption, and positive adaptation. Results: Our data showed that being a caregiver to a patient with metastatic disease negatively affected females mostly with regard to mental and emotional burden, while men complained more about their sexual life (42.3 vs. 33.6%), although this result was not significant. Some 93.5% of caregivers reported that they were pleased with their role, while 83.4% were concerned about financial difficulties. Significance of results: We strongly believe that early supportive care directed not only at patients but also to caregivers may improve the quality of life (QoL) in this population. We are currently developing a targeted support project to decrease caregiver burden.

Aim: Limited information is still available on the role of TT for mRCC in elderly pts to inform their use in clinical practice.

Ectopic thymic tissue can be present in the thyroid gland and a carcinoma showing thymus-like differentiation（CASTLE） may arise from such tissue. We are reported the case of a 26-year-old man with CASTLE, with cervical subcutaneous nodules relapse, who showed a good response to treatment with surgery, chemotherapy and radiotherapy. The problematic aspect of this case was the diagnosis; only on review were we able to make a final diagnosis. CASTLE is a very rare neoplasm. It is important to differentiate this cancer from others tumors such as primary or metastatic squamous cell carcinoma of the head and neck or squamous cell thyroid carcinoma, because the therapy and prognosis are different.Diagnosis is complicated and requires careful histological analysis（CD5- and P63-positive with presence of Hassall’s corpuscles）; unfortunately there is no gold standard treatment so, in this case, we administered a sandwich of chemotherapy and radiotherapy.