Patients with breast cancer planned for neoadjuvant chemotherapy (NAC) represent a diverse population including high-risk early breast cancer (EBC) and locally advanced breast cancer (LABC). Staging investigations are routinely performed, but the clinical utility is unclear.

Using a provincial cancer registry, we identified breast cancer patients referred for NAC between 2020 and 2022. Patients with staging investigations were stratified into EBC (anatomic clinical stage I-II) and LABC (stage III). Rates of metastatic (M1) disease and associated factors were assessed.

Among 529 EBC patients, 515 (97.4%) underwent staging. The M1 disease rate was 5.4%. The M1 rate for cT1-2N0 was 1.1%, and for cT1-2N1 it was 7.9%. In multivariable analysis, cT1N1 (OR 5.31; 95% CI 1.05-27.0; p = 0.044) and cT2N1 (OR 4.59; 95% CI 1.02-20.67; p = 0.047) were associated with M1 disease in EBC. All 320 LABC patients underwent staging. The M1 disease rate was 22.8%, significantly higher than in EBC (p < 0.001). A higher cT/N stage correlated with M1 disease in LABC, although most subgroups demonstrated rates of ≥10%.

These findings support a risk-adapted approach to pre-treatment staging in patients planned for NAC, omitting staging in asymptomatic cT1-2N0 disease, considering it for node-positive EBC, and performing it routinely in LABC.

Cardiopulmonary resuscitation (CPR) is one of the most consequential decisions in clinical medicine-a pivotal moment between life and death where science, ethics, and humanity intersect. Although advances in systems of care, technology, and training have refined technique and logistics, outcomes do not consistently result in meaningful, neurologically intact survival. In oncology-where disease trajectories are heterogeneous, treatment burdens substantial, and organ reserve often limited-these tensions are especially pronounced. Methods and approaches: This manuscript examines resuscitation as a medical, ethical, and human process, with explicit focus on patients with cancer. We review contemporary strategies for early recognition of deterioration (MEWS, NEWS, MET activation), team preparedness through Immediate Life Support (ILS), and structured decision-making at the boundaries of resuscitation. We also address communication with patients and families, the legal framework of Do-Not-Resuscitate (DNR) orders, and the distinctions among treatment forgoing, palliative sedation, and euthanasia, emphasising oncology-specific considerations such as metastatic burden, treatment intent (curative vs. palliative), performance status, and organ reserve.

The overall effectiveness of resuscitation remains modest (approximately 5-20% survival), highlighting the importance of prevention and early intervention. In cancer care, the limits of resuscitation are both clinical and ethical, requiring proportionality between the likely benefit and the risks of prolonging suffering, careful attention to prognosis and expected neurological outcomes, and rigorous alignment with goals of care. Early and ongoing involvement of palliative services, along with robust long-term care pathways, provides humane, value-concordant alternatives for patients with advanced disease. Psychotherapists and chaplains play integral roles in supporting families and clinical staff. Structured post-event debriefing and system-level safeguards are essential to mitigate burnout and moral distress within oncology teams. Initiating or discontinuing resuscitation in oncology requires expertise, empathy, and moral clarity. Dignity-preserving care depends on aligning interventions with patient values and realistic clinical endpoints. Acceptance of the natural course of dying represents an important component of responsible and patient-centred medical care.

Given ongoing uncertainty about the benefits and harms of prostate-specific antigen (PSA) screening, this systematic review updates the evidence to inform guideline recommendations for adults aged ≥ 18 years in primary care. We searched multiple bibliographic databases from inception to 30 May 2022, with an update on 24 July 2024, for randomized controlled trials (RCTs) and comparative observational studies evaluating PSA-based screening with or without adjunctive technologies such as magnetic resonance imaging (MRI). Studies were selected in duplicate, with data extraction and quality assessment verified by a second reviewer; risk of bias and evidence certainty were assessed using study design-specific tools and GRADE. Four RCTs and one cohort study (17 articles) were included: ERSPC, PLCO and CAP compared PSA screening with no screening, while STHLM3-MRI evaluated a risk-based test combined with MRI targeted biopsy. Meta-analysis showed 0.96 fewer prostate cancer deaths per 1000 individuals invited to screen, corresponding to a 12% relative reduction over 9.5-22 years (RR 0.88, 95% CI 0.81-0.95). One trial estimated 2.3% to 10.3% overdiagnosis over 10-14 years. Overall certainty of evidence was low or very low. PSA screening may offer a small mortality benefit, but uncertainty and variable harms limit confidence, underscoring the need for high-quality evidence, particularly for MRI and risk-based screening strategies.

Head and neck squamous cell carcinoma (HNSCC) continues to pose a major global health challenge, with over 600,000 new cases diagnosed annually and persistently poor survival outcomes despite advances in surgery, radiotherapy, and immunotherapy. Growing evidence implicates metabolic reprogramming, including enhanced glycolysis, glutaminolysis, lipid synthesis, and one-carbon/redox flux as a central driver of HNC initiation, progression, and therapy resistance. In contrast, metabolic crosstalk within the hypoxic, acidic tumor microenvironment (TME) further shapes immune evasion and stromal support. Recent innovations in mass spectrometry platforms (LC-MS, GC-MS, NMR) have attracted attention in clinical therapeutics, and spatial metabolomics imaging techniques now enable high-resolution in situ mapping of metabolites, revealing intratumoral heterogeneity and offering new insights into tumor-immune-stromal interactions and potential biomarkers for precision oncology. In this review, we integrate critical methodological considerations from sample collection and data-analysis workflows to analytical pitfalls with a balanced, pathway-focused analysis of HNSCC dysmetabolism, examine tumor immune stromal metabolic interactions, and highlight translational opportunities through emerging biomarkers, targeted inhibitors, and cutting-edge approaches such as single-cell and AI-driven metabolomics to chart a roadmap toward precision oncology for HNSCC.

Most patients with advanced/metastatic hormone receptor-positive, HER2-negative breast cancer receive first-line therapy with cycline-dependent kinase 4/6 inhibitors plus endocrine therapy. Almost universally, these patients eventually progress due to the emergence of resistant cancer clones. Targeting the PIK3CA/AKT1/PTEN pathway is a way of overcoming resistance. Recently, the oral, selective AKT kinase inhibitor capivasertib has been approved for the treatment of estrogen receptor-positive/human HER2-growth factor receptor-2 advanced BC with alterations in PIK3CA/AKT1/PTEN, in combination with fulvestrant after progression on endocrine therapy. We performed a narrative review to recapitulate the available evidence about capivasertib in the management of advanced hormone receptor-positive, HER2-negative breast cancer, focusing on studies that address preclinical rationale, pharmacology, and clinically relevant problems.

An increasing number of reports showed patients with bulky tumors after lattice radiation therapy (LRT) treatment achieved good local control. However, in these reports, LRT was previously used primarily for palliation. We reported a case that LRT plays a synergistic role in the radical treatment of locally advanced bulky cervical cancer (LABCC) combined with INTERLACE study protocol.

The patient was a 54-year-old female with LABCC and treated with LRT combined with the INTERLACE study protocol. She received three fractions of 3 Gy each to the gross tumor volume (GTV) and three fractions of 9 Gy each to the lattice therapy volume (LTV), on an emergent basis, using volumetric modulated arc therapy (VMAT). Subsequently, according to the INTERLACE study protocol, chemotherapy and radiotherapy were carried out and the standard follow-up examinations were conducted. Adverse events (AEs) were assessed according to the Common Terminology Criteria for AEs (CTCAE) version 5.0.

The patient initially received LRT, which reduced the tumor burden and controlled bleeding. After this was combined with the INTERLACE study protocol, the complete clinical response (cCR) was achieved and they maintained this status for 13 months after the completion of concurrent chemoradiotherapy (CCRT), with only manageable grade IV hematological toxicity observed after the completion of CCRT. During this period, only manageable grade IV hematological toxicity (platelet count 16 × 10⁹/L, white blood cell count 0.33 × 10⁹/L) was observed.

In this case, LRT combined with INTERLACE study protocol appears to be a safe and effective for the treatment of LABCC which improved the patient's quality of life without uncontrolled treatment-related toxicity.

Glioblastoma multiforme (GBM) is one of the most aggressive and treatment-resistant forms of brain cancer, posing challenges to modern oncology. Current treatments, including surgery, radiation, and chemotherapy (e.g., Temozolomide or TMZ), often fail due to the inevitable development of drug resistance. TMZ resistance remains a major therapeutic challenge for the reasons that it is the first-line treatment. Recent studies indicate a rising GBM tumour burden and a trend towards earlier age of onset. It highlights the urgent need for evidence-based policymaking and intensified research to address this most difficult-to-treat malignancy in clinical settings. Ferroptosis, a newly recognized type of controlled cell death induced by iron-dependent lipid peroxidation, has emerged as a potential approach to overcome apoptosis resistance and restore drug sensitivity in GBM. This mechanism is modulated by key molecules that can be specifically targeted to either enhance oxidative stress or inhibit antioxidant defences, ultimately leading to tumour cell death. This review conducts a meta-analysis of preclinical evidence to better understand the potential of activating ferroptosis as a key target for developing nanoparticles to resensitize TMZ-resistant GBM cells. Current evidence indicates that combining ferroptosis induction with strategically engineered nanocarrier systems can serve as a novel and effective therapeutic approach to overcome TMZ resistance and advance precision-based GBM treatment.

Primary malignant brain tumors (PBT) impose substantial burdens on patients and caregivers. Caregivers are essential in the delivery of outpatient care for patients with PBT but experience high levels of fatigue, distress, and health decline. Although exercise is known to improve outcomes in cancer patients, interventions tailored specifically to the PBT patient-caregiver dyad remain limited. Dyadic intervention, as well as exercise oncology, are emerging areas of active research in neuro-oncology. This scoping review incorporates both principles to evaluate the existing literature on exercise interventions on primary brain tumor patient-caregiver dyads.

We conducted a comprehensive search of MEDLINE (PubMed), Embase, CINAHL (EBSCO), Rehabilitation & Sports Medicine (EBSCO), and Cochrane Central (Ovid) in December 2025 for studies involving exercise interventions that included adult PBT patients and caregivers.

Of the 1126 records screened, eight studies were included: four yoga-based interventions (three feasibility trials and one ongoing multicenter RCT), one pilot ski-based intervention, and three aerobic and resistance training-based interventions (two qualitative and one ongoing trial). The interventions were safe and feasible, with high adherence and retention. The preliminary reported benefits included improvements in fatigue, sleep, quality of life, and caregiver distress for the dyads. Videoconference delivery was effective, particularly during the COVID-19 pandemic. The eight included studies comprised 5-67 dyads, with four being single-arm feasibility studies.

Current literature on dyadic exercise intervention in neuro-oncology consists primarily of small-scale feasibility and pilot studies. Initial findings have demonstrated that such interventions are safe. However, preliminary efficacy remains limited due to the risk of bias and lack of statistical power. Larger randomized clinical trials with objective endpoints are needed to define efficacy and guide evidence-based protocols.

Urachal carcinoma is a rare and aggressive malignancy for which standardized management remains limited, particularly in patients with locally advanced and node-positive disease. We report the case of a 34-year-old woman with urachal adenocarcinoma involving the bladder dome and radiographically suspicious pelvic lymph nodes who underwent robot-assisted partial cystectomy with urachal resection and extended bilateral pelvic lymph node dissection. Because there was no clinical, radiologic, or intraoperative evidence of umbilical involvement, the umbilicus was preserved after preoperative counseling and intraoperative confirmation of a negative proximal margin. Final pathology demonstrated a 4.5 cm enteric-type urachal adenocarcinoma, pT3a pN2 (2/17), with lymphovascular invasion, perineural invasion, and negative surgical margins. Immunohistochemistry and DNA- and RNA-based next-generation sequencing showed microsatellite stability, mismatch-repair proficiency, low tumor mutational burden, and no actionable genomic alteration. Given the absence of an established adjuvant standard, the multidisciplinary tumor board selected adjuvant FOLFOX as a non-standard postoperative strategy based on the overall clinicopathologic context. The patient remained continent, experienced no postoperative complications or treatment-limiting toxicity, and showed normalization of carcinoembryonic antigen and carbohydrate antigen 19-9 levels. This case provides a carefully contextualized example of transparent surgical reasoning and restrained multidisciplinary management in a rare malignancy with limited prospective evidence.

Treatment-associated regression of tumors outside the irradiated field has occasionally been reported, but the underlying mechanisms remain unclear, particularly in the context of central nervous system (CNS)-directed therapy. Glioblastoma (GBM) is commonly treated with radiotherapy and temozolomide, both of which may influence tumor biology and the systemic environment. We report a patient with synchronous primary GBM and early-stage lung adenocarcinoma who underwent craniotomy followed by intensity-modulated radiotherapy with concurrent temozolomide for GBM. During GBM-directed chemoradiotherapy, the untreated pulmonary lesion demonstrated progressive regression without any lung-specific therapy, temporally coinciding with CNS-targeted treatment. Although comprehensive immunophenotyping was not feasible, longitudinal changes in the proportion of peripheral blood lymphocytes were observed during therapy. These findings represent a clinical observation characterized by a temporal association between CNS-directed treatment and regression of a distant, non-irradiated tumor. However, the underlying mechanism remains uncertain, and a contribution from systemic temozolomide exposure cannot be excluded. While treatment-related systemic effects may be considered, no specific causal mechanism can be established based on this single case. This case highlights an unusual clinical observation that may warrant further investigation. Further studies are needed to clarify the relationship between CNS-directed therapies and systemic tumor behavior.