Background:Early onset cancer is defined as cancer in patients < 50 years of age. The global incidence of Early Onset (EO) is increasing for unknown reasons. EO Gastrointestinal (GI) cancers, which account for approximately 27% of newly diagnosed cancer cases and 37% of cancer deaths, present distinct challenges in areas including sexual health, finance, career and family. We aimed to assess the holistic needs of these patients attending St James's Hospital Dublin, a national upper GI referral centre and Ireland's first OECI Comprehensive Cancer Centre, through a mixed methods approach. Methods:The primary aim of the needs analysis study was to elicit experiences of patients with EO GI malignancies diagnosed between 2014-2024 attending a single institution. Methods included an anonymous survey and Focus Group Discussions (FGD). 236 surveys were sent to patient's homes. The survey encompassed 21 domains addressing experiences with guidance and support pertaining to sexual health and function, psychosocial and financial challenges, as well as implications of diagnosis for career trajectory and reintegration into the workforce. Patients were also questioned re preferred timing of referral for speciality services. FGDs used nominal group technique to deepen the analysis. Results:102 participants responded via survey and 10 participated in an FGD. The mean age at diagnosis was 43 years. 84% of participants reported they would have benefitted from a conversation about fertility, sexual health/function (81%) and financial supports (81%) at diagnosis. 93% of patients were out of work during cancer treatment with average length of time >1 year. 65% were diagnosed late at stages 3 and 4. On average it took 3-6 months before a diagnosis was made and took 2 visits to their GP before speciality referral. 82% did not receive a dedicated referral for care giver supports, with 18% independently engaged in care giver support services. Conclusion:This needs analysis highlights the importance of specialised clinical pathways, for early onset GI cancer patients focusing on these unique and complex needs. Financial supports, conversations regarding sexual health/function, fertility preservation and psychosocial support are critical areas requiring structured intervention.

75 Background: Immunohistochemical analysis of mismatch repair deficient (dMMR) status in colorectal (CRC) cancers is standard of care due to superiority of immune checkpoint blockade (ICB) over chemotherapy in the metastatic and potentially early-stage disease setting. Cercek et al reported complete clinical response in 100% rectal, 65% colon dMMR patients (pts) treated with ICB, most proceeding with nonoperative management. NICHE-2 showed 95% major pathological response (MPR), 68% pathological complete response (pCR) post dual ICB. NEOPRISM-CRC stratified pts to 1 or 3 cycles ICB with 59% pCR. However optimal ICB duration has not been defined and longer-term consequences of nonoperative management remain to be confirmed. Methods: A national, multicentre retrospective study involving data from 5 sites in Republic of Ireland. Standardised data collection tools were used, data was anonymised and centrally compiled by 3 independent assessors. Pts were eligible if had histologically confirmed locally advanced dMMR colon or rectal cancer and received minimum 1 cycle ICB. Results: Analysis data was available for 32 pts, with collection ongoing. Origin 25% (N=8) rectal, 75% (n=24) colon. 17 had proceeded to/ awaited surgery, 6 ongoing treatment, 4 active surveillance, 5 stopped treatment due to progression of disease (POD) or death. 40% (n=13) had germline testing with 18% (n=6) confirmed Lynch syndrome. 31% (n=10) BRAF V600 mutated. Four received chemotherapy pre ICB due to access. Median number of cycles was 4 (range 2-12). At radiological restaging after minimum 2 cycles ICB, 8 had complete radiological response (CRR), 9 partial radiological response (PRR). 3 of 4 pts on surveillance had CRR. At surgery 9 had pCR, 3 MPR. Ten grade 1-3 toxicities reported, 1 Grade 4 after 1 cycle ICB. Five pts died after 1, 2, 3, 4 cycles respectively; 3 due to POD, 1 after stopped treatment post grade 4 toxicity, 1 due to bowel obstruction. Conclusions: This real-world cohort dMMR CRC had 100% MPR, 75% pCR at surgery post ICB. Toxicity profile was comparable to literature. 5 pts had pCR with 4 or less cycles, indicating optimal treatment duration is still unclear. Concordance of radiological response with pathological response was not 100%, reflecting a challenge of selecting pts for nonoperative management. Duration of treatment by cycle (n=) 2-4 = 156-8 = 610-12 = 3Ongoing = 5NA = 3 MMR protein loss (n=) MLH1/PMS2 = 16MSH2/MSH6 = 6Single protein = 6NA = 1 Somatic mutation status (n=) BRAF = 10KRAS = 6 Radiological response (n=) Complete = 8Partial = 9Progression = 3NA/ Pending = 13 Pathological response (n=) Complete = 9Residual = 3Pending = 13NA = 7 Adverse events by grade (n=) G1 = 2 TFTd, 1 rashG2 = 3 TFTd, 2 adrenal insufficiencyG3 = 1 rash, 1 face swellingG4 = 1 myositis, myasthenia gravis, myocarditis Surgical complications (n=) Stricture = 3Perforation = 2Post-operative collection = 1 TFTd = thyroid dysfunction.

Total neoadjuvant therapy (TNT) has become a standard treatment approach for rectal cancer, providing higher rates of pathological complete response and improved long-term survival. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown significant advantages in weight loss, systemic metabolic regulation, and anti-inflammatory effects. Emerging evidence also points to possible anticancer properties, with observational data suggesting a lower incidence of obesity-related cancers, including colorectal cancer. This narrative review aims to examine the biological basis and potential therapeutic benefits of combining GLP-1 RAs with TNT for the management of locally advanced rectal cancer. We explore how GLP-1 RAs may affect tumour biology and treatment tolerance, including their impact on visceral fat, insulin resistance, and systemic inflammation. Preclinical and clinical data are reviewed to determine whether GLP-1-induced metabolic changes can improve the effectiveness of chemotherapy and enhance surgical and oncological results. Although evidence is evolving, the integration of GLP-1 receptor agonists into rectal cancer treatment pathways represents a promising area for further investigation, particularly in metabolically vulnerable populations.

BACKGROUND:Pelvic exenteration (PE) is a highly complex surgical procedure associated with significant morbidity and prolonged recovery. Although prehabilitation has been shown to improve perioperative outcomes in colorectal and other major oncologic surgeries, its role in PE remains unclear. This study aims to evaluate the potential application and clinical relevance of prehabilitation for patients undergoing PE. METHODS:A narrative review of the literature was conducted to examine the role of prehabilitation in major oncologic surgery, with a focus on its applicability to pelvic exenteration. Relevant studies were identified through searches of PubMed, Embase, and Google Scholar. Evidence from colorectal and other surgical populations was included when direct PE-specific data were lacking. RESULTS:Prehabilitation programs, typically incorporating exercise, nutritional optimization, and psychological support, have been shown to improve functional capacity, reduce postoperative complications, and shorten hospital stays in colorectal surgery. However, no studies were identified that specifically evaluate prehabilitation in the PE population. Patients undergoing PE often present with significant physiological and psychological burdens, suggesting a potentially greater benefit from prehabilitation. Key challenges include treatment-related toxicity, nutritional deficits, and the complexity of coordinating multimodal interventions within constrained preoperative timelines. CONCLUSIONS:The physiological rationale and supporting data from related surgical populations suggest that prehabilitation would confer meaningful benefits for patients undergoing pelvic exenteration. Prospective studies are needed to assess the "best" type of exercise and rehabilitation programs prior to PE.

INTRODUCTION:Neoadjuvant systemic and immunotherapy strategies in non-metastatic colon cancer have demonstrated high pathological response rates, raising interest in surgery-sparing approaches. Circulating tumour DNA (ctDNA) is an emerging biomarker for treatment response and minimal residual disease, but its role in guiding surgical omission in colon cancer remains unclear. This systematic review evaluates the diagnostic and prognostic accuracy of ctDNA in predicting pathological response following neoadjuvant therapy in non-metastatic colon cancer. METHODS:A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase/MEDLINE, Scopus, and the Cochrane Register were searched from inception to 21 October 2025. Eligible studies included adults with non-metastatic colon cancer treated with neoadjuvant therapy who had serial ctDNA assessment prior to surgery. RESULTS:Three cohort studies comprising 100 patients met inclusion criteria. Baseline ctDNA detection ranged from 42% to 84%. Across studies, ctDNA clearance following neoadjuvant therapy was consistently associated with major pathological response or pathological complete response, whereas persistent ctDNA strongly predicted residual viable tumour at resection. In the largest prospective cohort, 5 of 26 patients (19%) achieved ctDNA clearance prior to surgery; all were pathological responders, while 19 of 26 patients (73%) with persistent ctDNA demonstrated no pathological response. No study reported pathological complete response in the presence of persistently positive ctDNA. No prospective trial formally evaluated ctDNA-guided surgical omission. CONCLUSIONS:Current evidence does not support the use of ctDNA alone to guide omission of surgery after neoadjuvant therapy in non-metastatic colon cancer-even in patients who show complete pathological response. While persistent ctDNA reliably identifies patients with residual disease, ctDNA clearance lacks sufficient positive predictive value to safely forego surgery. Prospective trials with standardised ctDNA platforms and predefined non-operative management protocols are required before ctDNA-guided organ preservation can be recommended.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have revolutionized the management of type 2 diabetes and obesity by providing sustained improvements in glycemic control, weight loss, and cardiovascular outcomes. These benefits have led to increasing interest in their potential role in cancer treatment. Obesity and metabolic dysfunction are well-known factors that promote the development, progression, and resistance to therapy in various cancers, suggesting that drugs targeting these pathways may have anticancer effects. Emerging epidemiologic and clinical evidence shows that GLP-1RA therapy is linked to a lower risk of several obesity-related cancers, including GI, breast, endometrial, ovarian, prostate, and hematologic malignancies. Mechanistic studies also reveal effects on insulin signaling, long-term inflammation, angiogenesis, and immune system modulation. This comprehensive review integrates current knowledge of GLP-1RAs in cancer care, covering drug action, epidemiology, underlying mechanisms, and clinical application. We evaluate evidence for cancer prevention, their use as complementary treatments, and outcomes in patients with existing cancer. Overall, the evidence suggests that GLP-1RAs could become a novel class of agents linking metabolic health and cancer therapy, with potential applications in neoadjuvant treatment strategies, particularly in settings where prolonged neoadjuvant intervals allow for metabolic optimization before definitive surgical intervention.

Background/Objectives: To systematically review computed tomography (CT)-derived body composition and morphological predictors of incisional hernia (IH) following colorectal cancer (CRC) resection. Methods: PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and CINAHL were searched from inception to May 2026, supplemented by grey literature searching. Studies reporting CT-derived predictors of IH after CRC resection were eligible. Two independent reviewers screened records, extracted data, and assessed risk of bias using the Newcastle–Ottawa Scale. Given heterogeneity in CT metrics, exposure definitions, and statistical models, findings were synthesised narratively, and certainty of evidence was assessed using GRADE. Results: Nine retrospective cohort studies including 2392 patients met the inclusion criteria. IH incidence ranged from 4.5% to 33.6%. Visceral adiposity was the most frequently evaluated predictor, although only two studies reported standalone adjusted odds ratios for the elevated visceral fat area. Subcutaneous adiposity, sarcobesity, and novel umbilical morphological metrics, including umbilical fat, intraperitoneal thickness, and enlargement of the umbilical orifice, were independently associated with IHs in individual studies. Umbilical fat showed the largest adjusted effect estimate (hazard ratio 6.56; 95% CI 2.73–15.70). Quantitative pooling was not performed as fewer than three studies reported comparable adjusted estimates for any predictor. Certainty of evidence was low to very low across all predictor categories. Conclusions: Preoperative CT may provide clinically useful, but currently low-certainty, body composition data for IH risk stratification after CRC resection. Prospective multicentre validation using standardised CT protocols is required before routine clinical implementation.

INTRODUCTION:Accurate staging is essential in anal cancer to guide therapy and prognostication. While MRI remains the modality of choice for local staging, its limitations in assessing nodal and distant metastases have prompted evaluation of FDG PET/CT as an adjunct. The American College of Radiology recommends FDG-PET/CT as a complementary modality for initial staging, particularly for nodal assessment. METHODS:A systematic search of PubMed, EMBASE, Web of Science and Scopus was conducted up to August 2025 following PRISMA guidelines (PROSPERO ID: CRD1149778). Studies included reported adult patients with biopsy-proven anal squamous cell carcinoma who underwent both MRI and FDG-PET/CT for initial staging. Primary outcomes included per-patient sensitivity/specificity for metastasis, changes in TNM staging and therapeutic outcomes, including management modification. RESULTS:Six studies (n = 246) met the inclusion criteria. Five studies reported on staging changes, where FDG-PET/CT altered staging in 22.5% (95% CI: 12.3-34.7) of patients, more commonly through upstaging than downstaging (16.2% [95% CI: 10.7-22.5] vs. 6.3% [95% CI: 1.5-14.2]). Upstaged patients were predominantly nodal (74.6% [95% CI: 63.2-83.1]). Previously occult metastases were identified with FDG PET/CT in 3% (95% CI: 1.1-6.9) of patients. Management changes occurred in 20.7% (95% CI: 14.9-27.4), predominantly through radiotherapy field expansion or dose modifications. CONCLUSION:FDG-PET/CT following MRI provides incremental diagnostic and therapeutic value in anal cancer staging, through refining nodal and metastatic staging and influencing radiotherapy planning, supporting its routine integration to optimise staging accuracy and management decisions. TRIAL REGISTRATION:PROSPERO: CRD42023446290.

Abstract The standard treatment for rectal cancer is radical surgery with total mesorectal excision (TME). However, the management of early-stage rectal cancer or complex rectal polyps should be balanced between good oncological control, and acceptable risk of morbidity for the patient. As a result, transanal surgery for both benign and early malignant lesions has gained considerable traction over the last two decades. The development of new endoscopic platforms has facilitated better resection, with less impact on functional, urological, and sexual outcomes. It has also been associated with lower rates of permanent stoma formation. The aim of this chapter is to describe the various transanal platforms, the setup for operations, and tips to avoid pitfalls of the procedure.

PURPOSE:The incidence of early-onset colorectal cancer (EOCRC; CRC diagnosed before age 50 years) is increasing globally. This study analyses the trend in the Republic of Ireland over a 28-year period. METHODS:Epidemiologic data on CRC incidence were obtained from the National Cancer Registry of Ireland (NCRI) from January 1994 until December 2021. Additional information on age of diagnosis and tumor sidedness for the entire period was obtained, while data relating to stage and sex were available for the study period 1999-2018. Incidence rates were stratified by sex, age group (20-34, 35-49, and ≥ 50 years), and tumor location. RESULTS:Between 1994 and 2021, there were 61,180 cases of CRC among adults older than 20 years in the Republic of Ireland. The age-specific rate (ASPR) annual percentage change (APC) in patients younger than 50 years was 0.97 (95% CI, 0.30 to 1.76) in females and 0.57 (95% CI, 0.08 to 1.30) in males, while in patients age 50 years or older, it was -0.60 (95% CI, -1.03 to -0.15) in females and -0.70 in males (95% CI, -1.18 to -0.16), respectively. CONCLUSION:In line with global trends, the incidence of EOCRC is increasing in Ireland. Further studies investigating the etiology and optimal treatment strategies for this cohort are necessary.

Introduction: Pelvic exenteration is a radical operation for advanced or recurrent pelvic malignancies, requiring urinary and faecal diversion. The ileal conduit (IC) remains the standard urinary diversion, while the double-barrel uro-colostomy (DBUC) has re-emerged as an alternative that avoids small bowel anastomosis and consolidates diversion into a single stoma. Aims: To evaluate comparative outcomes of DBUC versus IC to clarify relative risks and potential benefits. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD420251090885). PubMed, Scopus, EMBASE, and Medline were searched to March 2025 for studies directly comparing DBUC and IC following pelvic exenteration. Eligible studies reported perioperative or urological outcomes. Results: Four retrospective studies (164 patients; DBUC 88, IC 73) were included. Urinary leak was lower with DBUC (10.2% vs. 15.1%), with pooled analysis showing a higher risk in IC (RR 2.52, 95% CI 1.02–6.20, p = 0.04). Pyelonephritis (42.0% vs. 15.3%; RR 1.37, p = 0.24) and electrolyte derangements (20.6% vs. 15.6%; RR 1.21, p = 0.64) did not differ significantly. Rates of urinary and enteric fistulas were similar. Clavien–Dindo grade III (42.1% vs. 37.1%) and grade IV complications (17.1% vs. 24.2%) were also comparable between groups. Conclusion: DBUC is a feasible alternative to IC after pelvic exenteration, with reduced urinary leak rates and comparable morbidity. Its single-stoma approach may offer patient-centred advantages. Larger prospective studies incorporating long-term and quality-of-life outcomes are needed.

OBJECTIVES:Treatment response to definitive chemoradiation (dCRT) in patients with anal cancer varies significantly, with a subset experiencing persistent or progressive disease despite therapy. Radiomics extracts quantitative features from radiological images, with the potential to develop predictive tools to assess treatment response. We aim to develop and validate an MRI-based radiomics nomogram to predict response to dCRT in patients with anal cancer. METHODS:A single-institutional retrospective analysis of 45 patients with anal cancer treated with dCRT was performed. Radiomic features were extracted from pre-treatment T2-weighted MRI scans, and predictive models were constructed. Clinical and radiomic features were analysed to develop the nomogram. Internal validation with 1000 bootstrap samples was performed to calculate optimism-corrected performance measures. RESULTS:Overall, 30/45(66.7%) achieved a complete treatment response. Male gender was found to be an independent predictor of incomplete response to dCRT (OR 4.763,95% CI: 1.170-19.384,*P = .029). Two radiomic signatures emerged as strong predictors of treatment response to dCRT. The combined model outperformed the clinical and radiomic models. The combined model showed the highest predictive accuracy, achieving an apparent area under the receiver operating characteristic curve (AUC): 0.87 (0.75-0.99) and an optimism-corrected AUC: 0.85, mean absolute error: 0.029, positive predictive value (0.68) and negative predictive value (0.92), indicating excellent discriminative performance. It demonstrated a positive net benefit in decision analysis. The optimism-corrected calibration curves demonstrate that the radiomic and combined model provide well-calibrated predictions. CONCLUSION:This MRI-based radiomics nomogram offers a promising approach to predict response to dCRT in patients with anal cancer. ADVANCES IN KNOWLEDGE:This study is the first to integrate radiomics and clinical features into a validated predictive model for anal cancer.

e15696 Background: The incidence of early onset colorectal cancer (EOCRC; ≤50 years) is increasing globally, while the incidence of average onset colorectal cancer (AOCRC; colorectal cancer ≥ 50years) is stabilising and beginning to decline with increased screening uptake. In Ireland screening begins at 59 years. We analysed trends in incidence of colorectal cancer (CRC) in the Republic of Ireland over a twenty-eight year period. Methods: Epidemiological data pertaining to the incidence of CRC (ICD-10 C18-C20), was obtained from the National Cancer Registry of Ireland (NCRI) from January 1994 until December 2021. Additional information on age of diagnosis and tumour sidedness for the entire period was obtained, while data relating to stage and gender was available for the study period 1999 - 2018. Incidence rates were stratified by sex, age group (20-34, 35-49, and greater than 50 years), and tumour sidedness (right versus left side). Results: Between 1994 to 2021, there were 61,180 cases of colorectal cancer among adults ≥20 years in the Republic of Ireland. During that time, the incidence of EOCRC increased by 34%, while the incidence of AOCRC decreased by 12.2%. The age specific rate (ASPR) annual percentage change (APC) amongst those with EOCRC was 0.97 (CI 0.30 - 1.76) in females and 0.57 (CI 0.08 - 1.30) in males. The age specific rate (ASPR) APC in those with AOCRC was -0.60 (CI -1.03 - -0.15) in females and -0.70 in males (CI -1.18 - -0.16). There were significantly higher rates of stage III and stage IV disease at diagnosis in the EOCRC group compared to the AOCRC group. For instance, in the 20-34 age group, 64% of individuals in the EOCRC group presented with stage III or IV disease, compared to 49% in the AOCRC group. A higher percentage of left-sided colorectal cancers compared to right-sided ones was observed across all age groups across the entire study period. The proportion of males diagnosed was higher than females in all groups except in the 20-34 age group, where there was a higher percentage of females than males. The 5-year net survival rate increased for both sexes across all age groups during the study period. Conclusions: In line with global trends, the incidence of EOCRC across both sexes is increasing in Ireland, and such patients are diagnosed at a later stage than their AOCRC counterparts. Public health initiatives must focus on screening age and public and healthcare practitioner awareness of this concerning trend. In addition, undertaking large-scale epidemiological and genomic studies will be essential to improve understanding of this disease and inform new treatment strategies for this patient group with unique needs.

ABSTRACT Introduction Local recurrence and distant metastasis remain a concern in advanced rectal cancer, with up to 10% and 20%–30% of patients suffering local and distal progression, respectively. Radiomics refers to a novel technology that extracts and analyses quantitative imaging features from images, which can be subsequently used to develop and test clinical models predictive of outcomes. We aim to develop and test an MRI‐based radiomics nomogram predictive of disease recurrence in patients with T4 rectal cancer. Methods We conducted a multi‐institutional retrospective analysis of 55 patients with T4 rectal cancer treated with neoadjuvant chemoradiotherapy followed by exenterative surgery. Radiomic features were extracted from pre‐treatment T2‐weighted MRI scans and used to construct predictive models. The top‐performing radiomic signatures were identified, and internal validation with 1000 bootstrap samples was performed to calculate optimism‐corrected performance measures. Results Two radiomic signatures were identified as strong predictors of post‐operative disease recurrence. The best‐performing model achieved an optimism‐corrected AUC of 0.75, demonstrating good discriminative ability. Calibration plots showed a satisfactory fit of the predictions to the actual rates, and decision curve analyses confirmed the positive net benefit of the models. Conclusion The MRI‐based radiomics nomogram provides a promising tool for predicting disease recurrence in T4 rectal cancer patients post‐exenteration. This model could improve risk stratification and guide more personalized treatment strategies. Further studies with larger cohorts and external validation are needed to confirm these findings and enhance the model's generalizability.

METHODS:This prospective, multi-centre RCT was conducted in accordance with the CONSORT guidelines for prospective, parallel group randomised studies. Adult patients undergoing elective laparoscopic surgery at two teaching hospitals in Dublin, Ireland were recruited and assigned to one of three closure methods (sutures (SU), staples (ST) or tissue glue (TG)) with primary outcome being cosmesis and secondary outcomes being closure speed, wound complications, cost effectiveness and sustainability outcomes being assessed by a blinded outcomes assessor. RESULTS:A total of 147 patients were recruited and randomised with a total of 138 being examined in the final analysis (SU = 48, ST = 63, TG = 27). Patient demographics were similar across all groups for gender, mean age, body mass index and American Society of Anaesthesiologists grade (all p > 0.050). For cosmesis, SU had the lowest overall mean observer (p < 0.001) and patient (p = 0.005) scar scores. Furthermore, when evaluating the breakdown for Observer Scar Score (OSS), SU had the lowest vascularity (p = 0.001), pigmentation (p = 0.006), thickness (p < 0.001), relief (p = 0.003) and pliability (p < 0.001). For patient scar score (PSS), SU had the lowest irregularity (p = 0.035). SU was the most cost-effective (p < 0.001) and had the lowest total produced non-recyclable waste (p < 0.001). ST had the shortest closure time (p < 0.001). Overall, there was a no difference in wound complication rates (SU = 6.3 %, ST = 6.4 %, TG = 18.5 %; p = 0.130). CONCLUSION:In conclusion, SU was the most effective method for laparoscopic port site closure with regards to cosmesis, cost-efficiency and surgical sustainability. ST was the marginally quicker method of closure and demonstrated equipoise in terms of complication rate. We advocate for SU as the current 'gold standard' with reduced non-recyclable waste generated and a valuable training opportunity for junior trainees. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT03843866.

BackgroundRadiomics refers to the conversion of medical images into high-throughput, quantifiable data to analyze disease patterns, aid decision-making, and predict prognosis. Radiogenomics is an extension of radiomics and involves a combination of conventional radiomics techniques with molecular analysis in the form of genomic and transcriptomic data. In the field of bladder cancer, studies have investigated the development, implementation, and efficacy of radiomic and radiogenomic nomograms in predicting tumor grade, gene expression, and oncological outcomes, with variable results. We aimed to perform a systematic review of the current literature to investigate the development of a radiomics-based nomogram to predict oncological outcomes in bladder cancer.Materials and methodsThe Medline, EMBASE, and Web of Science databases were searched up to February 17, 2023. Gray literature was also searched to further identify other suitable publications. Quality assessment of the included studies was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 and Radiomics Quality Score.ResultsRadiogenomic nomograms generally had good performance in predicting the primary outcome across the included studies. The median area under the curve, sensitivity, and specificity across the included studies were 0.83 (0.63-0.973), 0.813, and 0.815, respectively, in the training set and 0.75 (0.702-0.838), 0.723, and 0.652, respectively, in the validation set.ConclusionsSeveral studies have demonstrated the predictive potential of radiomic and radiogenomic models in advanced pelvic oncology. Further large-scale studies in a prospective setting are required to further validate results and allow generalized use in modern medicine.