Background: The primary purpose of integrative oncology is to appreciate the patients' desire for complementary medicine and to combine these treatment methods with the conventional medicine-dominated therapy of hematological and oncological neoplasms. However, the level of evidence for complementary treatment methods is often weak; therefore, physicians tend to doubt their purpose or neglect their use. Methods: This article presents basic features of integrative oncology, based on complementary and standard methods, and their value. Finally, a case of a breast tumor patient abandoning standard therapy for alternative methods is discussed using the four principles of clinical bioethics. Conclusion: To avoid serious interactions with standard medication, an open and cautious dialogue with the patients and their relatives is strongly recommended. It is crucial that right fromthe start of the treatment, the attending physician discusses the possible benefits, limitations and hazards of complementary methods.

The integration of artificial intelligence, particularly Large Language Models (LLMs), has the potential to significantly enhance therapeutic decision-making in clinical oncology. Initial studies across various disciplines have demonstrated that LLM-based treatment recommendations can rival those of multidisciplinary tumor boards (MTBs); however, such data are currently lacking for urological cancers. This preparatory study establishes a robust methodological foundation for the forthcoming CONCORDIA trial, including the validation of the System Causability Scale (SCS) and its modified version (mSCS), as well as the selection of LLMs for urological cancer treatment recommendations based on recommendations from ChatGPT-4 and an MTB for 40 urological cancer scenarios. Both scales demonstrated strong validity, reliability (all aggregated Cohen’s K > 0.74), and internal consistency (all Cronbach’s Alpha > 0.9), with the mSCS showing superior reliability, internal consistency, and clinical applicability (p < 0.01). Two Delphi processes were used to define the LLMs to be tested in the CONCORDIA study (ChatGPT-4 and Claude 3.5 Sonnet) and to establish the acceptable non-inferiority margin for LLM recommendations compared to MTB recommendations. The forthcoming ethics-approved and registered CONCORDIA non-inferiority trial will require 110 urological cancer scenarios, with an mSCS difference threshold of 0.15, a Bonferroni corrected alpha of 0.025, and a beta of 0.1. Blinded mSCS assessments of MTB recommendations will then be compared to those of the LLMs. In summary, this work establishes the necessary prerequisites prior to initiating the CONCORDIA study and validates a modified score with high applicability and reliability for this and future trials.

BACKGROUND Cervical lymphadenopathy can be benign or malignant. Its accurate diagnosis is necessary to determine appropriate treatment. Ultrasound-guided core needle biopsies (US-CNBs) are frequently used as a percutaneous sampling approach. OBJECTIVES Our aim was to identify the efficacy and safety of US-CNBs in 125 patients with cervical lymphadenopathy and clinically suspected head and neck cancer during the COVID-19 pandemic with limited surgical resources. METHODS US-CNBs of pathological lymph nodes were performed in 146 lymph nodes on 125 patients. Biopsies were performed ultrasound-guided with a reusable gun core biopsy system and a 10-cm-long 16-G needle. Standard of reference for the histological findings were panendoscopy, clinical and sonographic follow-up, surgical biopsy or a repeat US-CNB. RESULTS Adequate material for histologic diagnosis was obtained in 111 patients (89%), of these 83 patients (75%) were diagnosed as malignant, whereas benign lymphadenopathy accounted for 28 patients (25%). Therefore, US-CNB was able to identify malignant or benign lymphadenopathy with an overall accuracy of 88% and 90%, respectively. CONCLUSIONS Percutaneous US-CNB is a safe and effective alternative to surgical biopsy in the management of cervical lymphadenopathy in patients with clinically suspected head and neck cancer in a setting with limited resources.

Es ist das zentrale Anliegen der integrativen Onkologie, den Wunsch von Tumorpatient*innen nach komplementärmedizinischen Behandlungsverfahren anzuerkennen und ihn mit der schulmedizinisch dominierten Therapie von hämatologischen und onkologischen Neoplasien in Deckung zu bringen. Die Evidenzlage für komplementäre Behandlungsmethoden ist jedoch häufig gering und wird aus diesem Grund von Ärzt*innen häufig nicht angeboten oder deren Nutzen bezweifelt. Im vorliegenden Übersichtsartikel werden die Grundlagen der auf komplementären und schulmedizinischen Methoden basierenden integrativen Onkologie dargestellt und deren Stellenwert beleuchtet. Unter Anwendung der 4 bioethischen Grundprinzipien der Medizin wird ein Fallbericht einer Brustkrebspatientin diskutiert, die sich von einer leitliniengerechten, schulmedizinischen Therapie abwendet und sich ausschließlich auf die alternative Medizin verlässt. Um schädliche oder den Therapierfolg negativ beeinflussende Wechselwirkungen zu vermeiden, ist eine offene, wohlwollende Kommunikation mit den Patient*innen und deren Angehörigen unabdingbar. Für eine vertrauensvolle Verknüpfung der Patientenautonomie mit der ärztlichen Fürsorge ist es entscheidend, zu Beginn der Behandlung im Rahmen des Therapiezielgesprächs mögliche komplementäre Verfahren, deren Benefit, Limitation oder auch Gefahren zu besprechen.

(1) Background: cervical cancer is one of the leading causes of cancer-related deaths and the fourth most common cancer among women worldwide. Magnetic resonance imaging (MRI) is the modality of choice for loco-regional staging of cervical cancer in the primary diagnostic workup beginning with at least stage IB. (2) Methods: we retrospectively analyzed 16 patients with histopathological proven cervical cancer (FIGO IB1–IVA) for the diagnostic accuracy of standard MRI and standard MRI with diffusion-weighted imaging with background body signal suppression (DWIBS) for the correct pre-therapeutic assessment of the definite FIGO category. (3) Results: In 7 out of 32 readings (22%), DWIBS improved diagnostic accuracy. With DWIBS, four (13%) additional readings were assigned the correct major (I–IV) FIGO stages pre-therapeutically. Interobserver reliability of DWIBS was weakest for parametrial infiltration (k = 0.43; CI-95% 0.00–1.00) and perfect for tumor size <2 cm, infiltration of the vaginal lower third, infiltration of adjacent organs and loco-regional nodal metastases (k = 1.000; CI-95% 1.00–1.00). (4) Conclusions: the pre-therapeutic staging of cervical cancer has a high diagnostic accuracy and interobserver reliability when using standard MRI but can be further optimized with the addition of DWIBS sequences when reporting is performed by an experienced radiologist.