Prolactinomas in the transition age present unique challenges; treatment strategies and long-term outcomes in this population remain incompletely characterised. This is a multicentre, retrospective study of 110 consecutive patients (33 males) with prolactinomas, aged 15-25 years, across five Italian referral centres (2010-2025). Clinical, hormonal, radiological, and treatment-related parameters were assessed at diagnosis and at follow-up. At diagnosis, the median age was 20 years; median prolactin 177 ng/mL [49-6646]; 55% of patients had micro-tumours. Male patients presented with larger tumours, higher prolactin levels, and greater invasiveness (p < .001 for all comparisons). Cabergoline was first-line therapy in 95%, achieving prolactin normalisation in 75% and significant tumour shrinkage (≥50% volume and/or diameter reduction) in 66% of patients. Partial resistance (biochemical and/or radiological) occurred in 40% of patients. Treatment discontinuation occurred in 48% of cases; 61% of patients discontinuing cabergoline after prolonged normalisation experienced recurrence, which was predicted by younger age at diagnosis (OR 0.67/year, p = .040) and shorter treatment duration (OR 0.95/month, p = .050), the latter showed 93% sensitivity for recurrence at 45.5 months. Adverse events occurred in 12%, leading to treatment discontinuation in 6%. Surgery was required in 17%, achieving long-term remission in 31%, while 21% of surgical cases required radiotherapy. At last follow-up (median 72 months), 73% remained on cabergoline while 25% achieved complete radiological resolution. Transition-age prolactinomas demonstrate high cabergoline resistance rates and frequent recurrence after discontinuation. Treatment duration ≥45.5 months before withdrawal may reduce recurrence risk. Surgical remission is achievable, especially in non-invasive tumours, although multimodal therapy is often required for disease control.

This work of fiction is part of a case study series developed by the medical physics leadership academy (MPLA). It is designed to generate discussion of the managerial and leadership challenges medical physicists can face. Through discussion and quantitative analysis, the case aims to teach learners basic finance concepts and build their ability to gather and analyze financial information for capital budgeting decisions. In this case, medical physicist Dr. Angel Allende is a junior physicist who started a new position at a cancer center with two linear accelerators. A recent upgrade outfitted one linear accelerator with state-of-the-art capabilities for image-guided stereotactic radiation therapy. Dr. Allende is tasked by the chief medical physicist to establish a new stereotactic quality assurance (QA) program at the cancer center. The physics team needs to prepare a business case for obtaining the necessary QA software and equipment. Unfortunately, Dr. Allende anticipates complications due to the existing budget appearing too low. Despite having never done capital budgeting before, Dr. Allende doesn't want to turn down this unique opportunity. This case study falls under the scope of and is supported by the MPLA, a committee in the American Association of Physicists in Medicine (AAPM).

Resistance to therapy is a frequent occurrence in patients with epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer (NSCLC) who are treated with EGFR-tyrosine kinase inhibitors (EGFR-TKIs). However, spatial information on how the tumor microenvironment (TME) changes within the same patient from baseline to resistance to first- and then third-generation EGFR-TKIs is scarce. Here, we used rare consecutive re-biopsy samples to build an exploratory, longitudinal, and spatially resolved atlas, aiming to describe within-patient TME remodeling patterns as a resource for hypothesis generation.

A patient-matched cohort with serial samples obtained at baseline (T0), after first-generation EGFR-TKI resistance (T1), and after third-generation EGFR- TKI resistance (T2) was established. Using GeoMx Digital Spatial Profiling (DSP), tumor-enriched and stroma-enriched areas of interest (AOIs) were segmented, and paired RNA and protein profiles were quantified. We tracked temporal changes in compartment-specific heterogeneity and immune remodeling and explored associations between early remodeling and subsequent T790M acquisition.

We analyzed the data from 15 samples of 6 patients. Tumor- and stroma-enriched compartments were not only transcriptionally but also protein-wise consistently distinct. Spatial heterogeneity was relatively stable from T0 to T1 but increased from T1 to T2, with changes in the stroma-enriched compartments accounting for most of the increase. Early remodeling featured loss of T cell activation programs, reduced neutrophil signatures, increased myeloid remodeling, and impairment of antigen presentation. Longitudinal analyses suggested a biphasic immune trajectory, with early myeloid remodeling and late stromal checkpoint reprogramming. Early spatial remodeling patterns showed potential differences between samples that later acquired T790M and those that did not.

This study provides preliminary evidence for dynamic TME changes during sequential EGFR-TKI therapy in EGFR-mutant NSCLC. It suggests a late, stroma-associated expansion of spatial heterogeneity and stage-dependent immune remodeling. Additionally, it offers an initial spatial atlas and generates testable, time-aware hypotheses for future validation.

Although endoscopic resection is reported to be safe for early-stage esophagogastric cancer, uncertainty remains regarding oncological efficacy, particularly for submucosal lesions. The aim of this study was to assess the frequency of lymph node metastasis (LNM) and survival in patients operated for chemo- and radiotherapy-naïve pT1 esophagogastric cancer. Patients who underwent surgical resection for esophageal or gastric pT1 adenocarcinoma or squamous cell carcinoma without neoadjuvant oncologic treatment were included. Data were retrospectively extracted from registries in Denmark (2013-2021), Norway (2007-2024), Sweden (2012-2022), and Finland (2000-2016). The primary outcome was the frequency of LNM in resected specimens from patients operated for pT1 esophagogastric cancer. Secondary outcomes included: 5-year overall survival, number of lymph nodes harvested, and risk factors associated with LNM and mortality. 1647 patients with pT1 tumors were identified, of whom 949 (58%) did not receive neoadjuvant treatment; 413 (43%) had esophagectomy and 536 (56%) gastrectomy. 145 (15%) patients had LNM identified in the resected specimens for esophagectomies, the LNM rate was 3% for pT1a and 20% for pT1b, and for gastrectomies, 7% for pT1a and 21% for pT1b. The median follow-up was 62 months (interquartile range: 33-102) and 5-year overall survival was 81% for patients with pT1a tumors and 65% for those with pT1b tumors. Among patients with pT1b, the overall survival was 69% without LNM and 51% with LNM. Depth of tumor invasion was associated with risk of LNM. A high proportion of patients had LNM after resection for chemo- and radiotherapy-naïve pT1 esophagogastric cancer.

Lymphadenectomy is critical for accurate staging and prognostication of advanced gastric cancer. Indocyanine green (ICG) fluorescence imaging may optimize lymph node dissection but its applicability in Western patients is unclear. The aim of this study was to evaluate whether intraoperative ICG fluorescence is associated with change in surgical conduct (CSC) and stage migration during gastrectomy.

This was a prospective, multicentre observational study (iGreenGO) conducted at 15 Italian referral centres. Patients with cT2-4a N0-3 M0 gastric adenocarcinoma undergoing minimally invasive distal or total gastrectomy with D2 lymphadenectomy were eligible. Endoscopic peritumoral ICG injection (2 ml at a concentration of 0.125 mg/ml) was performed within 20 h before surgery. The primary outcome was CSC, defined as additional tissue dissection prompted by residual fluorescence after standard white-light D2 lymphadenectomy.

A total of 316 patients (median age of 71.2 years; 185 male) were included between January 2022 and December 2024. The median number of dissected lymph nodes was 38 (interquartile range 29-47). CSC occurred in 61 patients (19.3%). Additional lymph nodes were retrieved in 47 of 61 patients (77.0%), with metastatic involvement in 10 of 47 patients (21.3%). Stage migration occurred in 3 of 316 patients (0.9%). ICG fluorescence showed a high false-positive rate for nodal metastases.

Although ICG frequently led to additional dissection of nodal stations after standard white-light D2 lymphadenectomy, it rarely resulted in stage migration. Use of ICG fluorescence to optimize lymph node dissection likely does not have a clinically relevant benefit in Western patients with gastric cancer.

Background: Ripretinib, a switch-control kinase inhibitor approved for advanced gastrointestinal stromal tumor (GIST), inhibits primary and secondary KIT and PDGFRA mutations. Real-world data from Western and Middle Eastern populations remain limited. We report outcomes from a molecularly characterized Israeli multicenter cohort. Methods: We conducted a multicenter retrospective cohort study across seven university-affiliated medical centers in Israel. Patients with advanced GIST receiving Ripretinib at any treatment line were eligible. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method, and response was assessed according to modified RECIST v1.1. Results: Sixteen patients were identified (median age, 67.5 years; 75.0% received Ripretinib in the fourth-line setting). KIT exon 11 mutations were present in 62.5% of patients, including five with secondary resistance mutations involving exon 13 or exons 17/18. Median PFS was 7.0 months (95% CI, 2.0-13.0) and median OS was 14.7 months (95% CI, 4.4-NR). Individual outcomes varied substantially, with PFS ranging from 2.0 to 60.2 months and OS from 2.2 to 60.2 months. Three patients achieved complete responses, with PFS of 20.0, 33.6, and 60.2 months. ORR was 56.3% (CR, n = 3; PR, n = 6) and DCR was 81.3%. No dose reductions or treatment discontinuations due to adverse events were documented; however, adverse events were recorded in only 4 of 16 patients. Conclusions: Ripretinib demonstrated clinical activity in this small, heavily pre-treated cohort. The relatively high ORR and wide variability in outcomes should be interpreted cautiously given the small sample size, retrospective design, and absence of central radiological review. Durable responses were observed in some patients with KIT exon 11 and secondary exon 17/18 mutations, but this exploratory observation does not establish a predictive molecular subgroup. Larger prospective studies with systematic molecular, radiological, and safety assessment are warranted.

The Breast Cancer Index (BCI) is an established genomic assay that provides individualized risks of overall and late distant recurrence and predicts the likelihood of extended endocrine therapy (EET) benefit in patients with early-stage, hormone receptor-positive (HR+) breast cancer. Previous findings from the first 1000 patients in the prospective BCI Registry showed that physicians changed their EET recommendation in more than 40% of patients.

To investigate the use of the BCI in the full registry cohort and how physicians integrate prognostic and predictive results in real care settings.

The BCI Registry study is a US multicenter evaluation of long-term clinical outcome, decision impact, and medication adherence among patients enrolled from April 2021 to January 2024. Participants included women diagnosed with early-stage, HR+ breast cancer. Physician and patient questionnaires about recommendations or preferences for EET and confidence or comfort with these decisions were collected. For this cohort study, data were analyzed from January 2025 to March 2026.

Patients received BCI testing and endocrine therapy. The BCI prognostic model calculated a risk score to classify patients as having low or high risk of late distant recurrence, while the BCI predictive component used the BCI HOXB13/IL17BR (H/I) ratio to classify patients as having low or high likelihood of EET benefit.

Change in physicians' and patients' recommendations or preferences for EET, and their confidence or comfort with these decisions. Pre-BCI and post-BCI results were analyzed using the McNemar test. Fisher exact test was used to determine the association between BCI categories and clinical variables.

The final analysis included 2900 women with completed physician and patient questionnaires (mean [SD] age, 65.2 [10.3] years). Among these patients, 2570 (88.6%) were postmenopausal, 2245 (77.4%) were N0, and 2501 (86.2%) were HER2-negative. After BCI testing, 1209 physicians (41.7%) changed their EET recommendation (P < .001), and 1479 patients (51.0%) changed their preference for EET (P < .001). Among 1100 patients classified as BCI (H/I)-High, EET recommendations increased from 671 pre-BCI (61.0%) to 1014 post-BCI (92.2%). Among 1800 patients classified as BCI (H/I)-Low, the number of physicians not recommending EET increased from 856 (47.6%) to 1576 (87.6%). Physician confidence in their recommendation increased for 1269 patients (43.8%; P < .001), and 1260 patients (43.4%) were more comfortable with the EET decision (P < .001).

This cohort study of patients from the BCI Registry highlights the important treatment guidance provided by the BCI to reduce EET undertreatment or overtreatment and further substantiates its clinical utility to individualize patient care.

The war in Ukraine, beginning in February 2022, disrupted continuous medical care for Ukrainian childhood and adolescent cancer patients (UCC), many of whom were relocated to pediatric cancer centers worldwide, including Switzerland. In this Brief Report, we describe their health-related quality of life (HRQoL) after arrival. In a multicenter, cross-sectional survey across five Swiss pediatric oncology centers, we included patients ≤18 years at diagnosis who arrived after 24 February 2022 and were undergoing active treatment. HRQoL was assessed by the PedsQL™ 4.0 Generic Core Scales (self- and parent-reports). Fourteen of 23 eligible families (61%) participated. HRQoL declined with age, particularly in physical functioning, while psychosocial functioning remained relatively stable but lower among adolescents; parent scores closely matched self-reports. Scores were referenced against a published cohort of healthy Ukrainian children and previously reported pediatric cancer populations. Given the small sample and lack of a matched control group, the findings cannot separate the effects of displacement, cancer, and treatment and are hypothesis-generating. They suggest a potential role for age-tailored supportive care in displaced children with cancer and call for larger, controlled studies.

Nutrition is an essential component of colorectal cancer (CRC) care, influencing treatment tolerance, functional status, and quality of life, yet it remains inconsistently integrated into practice. This study examined experiences with nutrition management and gaps in nutrition care among patients with CRC, caregivers, and healthcare professionals across Canada through a multi-center, cross-sectional survey conducted from July 2025 to February 2026. A total of 243 participants completed the survey, including 121 patients, 45 caregivers, and 77 healthcare professionals. Among patients, 51.2% reported that nutritional status was discussed or assessed during treatment, while 24.0% reported it was never discussed. More than half of patients (55.4%) said they did not receive adequate information regarding weight loss during treatment. Caregivers described substantial nutrition impact symptoms and identified a need for clearer guidance, emotional support, and improved access to dietitians. Healthcare professionals rated nutrition care as highly important yet reported barriers to effective delivery, including limited staffing, lack of standardized screening, and reactive care processes. Across groups, respondents emphasized the importance of timely, personalized, and culturally relevant nutrition care. Overall, nutrition remains insufficiently embedded in CRC care, highlighting the need for routine screening, standardized referral pathways, earlier intervention, and integrated patient-centered nutrition care models to improve CRC care.

Enfortumab vedotin plus pembrolizumab (EVP) is the standard first-line treatment for locally advanced or metastatic urothelial carcinoma (la/mUC); however, real-world toxicity patterns, timing of onset, and prognostic significance of treatment-related adverse events (AEs) remain incompletely characterized.

We conducted a retrospective, multicenter analysis of 60 la/mUC patients treated with first-line EVP in Alberta, Canada (September 2024-January 2026). Treatment related toxicities, time to AE onset, dose modifications, and treatment discontinuation were assessed. Progression-free survival (PFS) and overall survival (OS) were analyzed.

The median age was 69 years, 82% of patients were male, and 80% had metastatic disease at treatment initiation. Histology was pure urothelial in 82% and mixed in 18%. Median follow-up was 10.3 months, and the median number of EV and pembrolizumab cycles was seven and eight, respectively. Rash (63%), fatigue (57%), and peripheral neuropathy (47%) were the most common adverse events, with median onset at 17, 29, and 90 days, respectively. Dose reductions occurred in 62%, dose delays in 43%, and treatment discontinuation in 38%. An initial enfortumab vedotin dose of 1.25 mg/kg was associated with improved PFS (HR 0.30, 95% CI 0.13-0.68; p = 0.004) and OS (HR 0.32, 95% CI 0.10-0.97; p = 0.044) compared with 1.0 mg/kg. Neuropathy was associated with improved PFS (HR 0.32, 95% CI 0.14-0.73; p = 0.007) and OS (HR 0.24, 95% CI 0.07-0.87; p = 0.029), while rash was associated with improved OS (HR 0.31, 95% CI 0.11-0.91; p = 0.032).

EVP was associated with frequent treatment-related adverse events requiring dose modifications, and the development of rash and peripheral neuropathy was associated with favorable survival outcomes.