Chronic myelogenous leukemia (CML) is a myeloproliferative neoplasm with an annual diagnosis rate of 93,000 individuals in the U.S. per year. Advances in therapy have reduced mortality. In this study, we aim to explore trends of CML-related mortality in the U.S. from the years 1999 to 2020 as they pertain to sex, race, year, state and census region.

CDC Wonder retrospectively identified patients with an age ≥ 45 with CML-related deaths. Data points analyzed included mortality related to sex, race, year, and census region. Statistical analysis for age adjusted mortality rate (AAMR) per 100,000 persons, annual percentage change (APC), and average annual percentage change (AAPC) were calculated via joinpoint regression.

Between 1999 and 2020, there were 32,484 CML-related deaths in the U.S. The AAMR declined across the entire study period. There was a pronounced decrease from 1999 to early 2006 (APC -8.50% for males and -8.30% for females, with the decline plateauing in the following years). Males exhibited higher AAMRs than females throughout the study period. White individuals appeared to have a higher AAMR than black and Hispanic individuals, while Asian individuals (as reported in national datasets) had the lowest rates. The Midwest has a higher AAMR followed by the West, the South, and the Northeast. Notably, from 2018 to 2020, a slight increase in AAMR was observed across all groups.

Disparities of CML related mortality were observed as they relate to sex, race, year, state and census region.

Uterine fibroids are the most common tumour of the female genital tract and represent a major cause of gynaecological morbidity. Management options have expanded in recent years, including minimally invasive surgical techniques and emerging medical and incisionless therapies. However, access to these treatments may vary geographically. This study aimed to explore current practice patterns, availability of interventions, and clinician perspectives on the future organisation of fibroid services in the United Kingdom.

A pilot survey of UK gynaecologists was conducted using an online questionnaire developed by a focus group of clinicians with expertise in fibroid management. The survey assessed availability of treatment modalities, imaging preferences, surgical practices, and opinions on service organisation. The questionnaire was disseminated through the British Society for gynaecological endoscopy newsletter and at the society's 2024 annual scientific meeting. Responses were analysed using descriptive statistics.

Fifty UK-based clinicians were included in the analysis. Established surgical interventions, including abdominal, laparoscopic, and hysteroscopic myomectomy, were widely available. However, access to newer technologies varied between regions. Radiofrequency ablation was available in five of nine regions represented, while high-intensity focused ultrasound was not available to any respondents. Most clinicians reported access to MRI for fibroid mapping, although specialist ultrasound availability was more variable. Minimally invasive myomectomy was performed by 60% of respondents. The majority supported referral to specialised centres when local expertise was unavailable. Most respondents favoured multidisciplinary discussion for complex cases and supported a more centralised model of fibroid care.

This survey highlights variation in access to fibroid treatments across the UK and identifies support among clinicians for more structured and centralised fibroid services. These findings support the need for further national evaluation and service development to improve equitable access to comprehensive fibroid care.

The influence of neoadjuvant immunochemotherapy (nICT) on intraoperative opioid consumption during esophagectomy for cancer is not well understood. IoC2 enables real-time antinociceptive depth monitoring. This study assesses nICT's effect on remifentanil requirements in elderly patients using IoC2.

This prospective observational cohort study will be conducted at Jiangsu Cancer Hospital. Sixty patients scheduled for esophagectomy will be enrolled. Patients will be divided into the nICT group (n = 30) or the treatment-naive group (n = 30). All patients will receive a standardized anesthetic protocol. The primary outcome is the mean intraoperative remifentanil infusion rate (μg/kg/min). Secondary outcomes include: total intraoperative dose of sufentanil; postoperative cumulative opioid consumption at PACU, 12, 24, 48, and 72 h; pain scores, PCIA attempts, and rescue analgesia use at PACU, 12, 24, 48, and 72 h post-surgery, and the incidence of moderate-to-severe pain (NRS ≥ 4) at these time points; as well as delirium, postoperative complications, chest tube removal time, and hospital length of stay.

This study aims to clarify the effect of neoadjuvant therapy on opioid requirements during esophageal cancer surgery. By employing precise IoC2 monitoring, we aim to establish a methodological basis for developing individualized, precise anesthesia-analgesia strategies and to provide prospective evidence for their clinical application.

The study protocol is registered with the Chinese Clinical Trial Registry under registration number ChiCTR2500105958, dated July 15, 2025.

This study aims to evaluate the clinical efficacy of an innovative robot-assisted totally intracorporeal antecolic modified ileal conduit procedure (robotic group) versus laparoscopic surgery (laparoscopic group) in bladder cancer patients, providing evidence for optimizing urinary diversion strategies and reducing associated complications.

From Jan 2023 to Oct 2025, 69 patients undergoing total cystectomy by one surgeon were enrolled; 23 received robotic surgery (KangDuo SR2000) and 46 laparoscopic. Baseline, perioperative, and postoperative data were collected. Primary endpoint: radiologically confirmed ureteroileal anastomotic stenosis; secondary: postoperative ileus, new upper urinary tract stones, 90‑day complications, and recovery indicators.

Baseline characteristics were similar between groups (all p > 0.05). The robotic group had significantly lower stenosis (0% vs 15.22%, p = 0.043), ileus (8.70% vs 28.26%, p = 0.043), and new stones (4.35% vs 21.74%, p = 0.046). Intraoperative blood loss was reduced (98.70±28.97 vs 155.00±65.76 mL, p < 0.001), but operative time was longer (249.7±19.7 vs 199.6±22.7 min, p < 0.001). No significant differences were found in time to bowel function recovery or 90‑day complication rate.

Robot‑assisted intracorporeal radical cystectomy with modified ileal conduit ensures perioperative safety, lowers long‑term complications and blood loss despite longer operative time, suggesting it is a promising alternative; however, prospective randomized controlled trials are needed to confirm these findings.

Support persons are essential in cancer care, particularly during surgical consultations that involve complex decision-making and emotional stress. However, the COVID-19 pandemic introduced visitor restrictions that limited in-person companion access, raising concerns about patient-centered care. This study examined patterns of companion presence during breast reconstruction consultations in 2020 and compared findings to a pre-COVID cohort to assess shifting predictors of support-seeking behavior.

A retrospective review was conducted of all breast reconstruction consultations (N = 59) at a regional plastic surgery center during the first year of the COVID-19 pandemic. Demographics, cancer status, travel distance, and companion presence were extracted from electronic medical records. Companion types and behaviors were qualitatively assessed from provider notes. Results were compared to a previously published pre-COVID cohort (N = 421). Statistical analyses included chi-squared tests and independent samples t-tests (α = 0.05).

Despite pandemic restrictions, 51% of patients brought a companion. Companion presence was significantly associated with having an active cancer diagnosis (71.9% vs. 25.9%, p = .004), while marital status and travel distance were not significant predictors. In contrast, pre-COVID data showed marital status and travel burden as significant predictors of accompaniment. Provider notes revealed companions frequently offered emotional support, clarified medical details, and assisted in decision-making.

Support persons remained integral to breast cancer care during COVID-19, particularly for patients facing active disease. These findings underscore the importance of flexible institutional policies that preserve the patient-companion relationship during emotionally charged consultations.

Early-onset colorectal cancer (EOCRC) is rising nationally, with South Dakota experiencing a reversal in historical trends. Traditionally, American Indian populations have had higher EOCRC rates attributed to healthcare access disparities and socioeconomic factors. Recent data now reveals that the White population exhibits higher EOCRC incidence in South Dakota.

We analyzed data from the South Dakota Cancer Registry (2007-2022) to calculate EOCRC incidence rates for American Indian and White populations. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were computed. Behavioral risk factors and insurance coverage were also reviewed.

The White population's EOCRC incidence rose to 9.6 per 100,000 in 2018-2022, surpassing the American Indian rate of 7.8 per 100,000 (IRR = 1.27, 95% CI: 1.10-1.45). From 2021 to 2022, insurance coverage improved for both American Indians (46.6% to 55.5%) and Whites (81.5% to 83.4%). However, lifestyle disparities persisted. In 2021, American Indians reported higher fruit but lower vegetable intake than Whites. In 2022, physical activity was lower among American Indians (63.3%) than Whites (77.8%). In 2022-2023, obesity prevalence was significantly higher among American Indians (50.2%) than Whites (34.7%). Binge and heavy drinking percentages were elevated among Whites (30.8% and 10.1%, respectively) compared to American Indians (20.0% and 5.4%). Commercial tobacco use was reported higher among American Indians (45.1%) when compared to Whites (27.0%).

This shift highlights the success of American Indian-focused interventions and underscores emerging challenges among the White population.

Glioblastoma remains the most aggressive primary malignant brain tumor in adults, with survival largely unchanged despite advances in molecular diagnostics and supportive care. Therapeutic failure reflects fundamental biological and anatomical barriers, including intratumoral heterogeneity, an immunosuppressive tumor microenvironment, and restricted drug delivery across the blood-brain barrier. In this Review, we summarize the current standard of care and critically examine emerging strategies aimed at overcoming these constraints, including locoregional delivery technologies, immunotherapy, biomarker-defined precision approaches, and adaptive clinical trial designs. We highlight key translational and clinical studies shaping the field and discuss principles for developing more effective, integrated therapeutic paradigms.

Nonimmune effector cell-associated neurotoxicity syndrome neurotoxicities (NINTs) are serious, atypical toxicities associated with ciltacabtagene autoleucel (cilta-cel), a US Food and Drug Administration chimeric antigen receptor T cell (CAR T cell) therapy approved for relapsed/refractory multiple myeloma (RRMM). Risk factors contributing to the development of NINTs are poorly understood. In a cohort of 109 patients with RRMM treated with cilta-cel, we identify predisposing risk factors and propose strategies to mitigate NINTs. We show that high-peak absolute lymphocyte count is a strong NINT predictor, which directly correlates with flow cytometry-based peripheral blood CAR T cell quantitation. The observed CAR lymphocytosis was polyclonal with a bias toward CD4⁺ CAR T cells rich in memory marker expression. We then identified CAR lymphocytosis-associated CD4⁺ CAR T cell populations, which exhibited increased inflammatory pathway gene expression. Last, we characterize NINT-associated CD4⁺ CAR T cell populations, which are potential therapeutic targets for future exploration.

Chronic non-cancer pain (CNCP) due to comorbid conditions presents a barrier to optimal pain management in patients with cancer. While opioid is widely used for the treatment and management of CNCP, it is also associated with misuse and addictions. Therefore, we determined the impact of CNCP on opioid prescribing patterns in patients with the three most common cancer types- breast, lung, and colorectal cancers.

A retrospective cohort study was conducted utilizing Surveillance Epidemiology and End Results (SEER)-Medicare (2006-2019) linked database. Patients, at least 66 years old with histologically confirmed incidental diagnoses of breast, lung, or colorectal cancer from 2007 to 2017, were included in the study. Patients with cancer in baseline period, in palliative care, or those who died in the follow-up period were excluded from the study. Patients with CNCP were identified in the baseline period. Patients without CNCP during the study period were included in the no-CNCP group. The follow-up period was one year after cancer diagnosis (index date) and the primary outcome was opioid prescribing patterns defined as: any opioid use, high-dose opioid use, total count of opioid prescriptions filled, and chronic opioid use. Inverse probability weighting (IPTW) method was used to balance the covariates (age at the cancer diagnosis time, sex, race, ethnicity, marital status, cancer type, cancer stage, metropolitan status, year of cancer diagnosis, chronic cancer-treatment-related pain, neoplasm pain, and cancer treatment modalities) between the CNCP and no-CNCP group. Logistic and Poisson regressions were used to compare opioid use and opioid prescription patterns among the two groups.

A majority of patients included in the study were breast cancer (CNCP = 38230, no-CNCP = 56157), lung cancer (CNCP = 17255, no-CNCP = 24602), colorectal cancer (CNCP = 16660, no-CNCP = 29037). Among cancer patients, the prevalence of CNCP was highest in those with lung cancer (41.2%) followed by breast cancer (40.1%) and colorectal cancer (36.4%). Descriptive analysis demonstrated patients with lung cancer had consistently higher rates across opioid prescribing patterns, followed by patients with colorectal and breast cancer. The result of logistic regression after weighting showed that the odds of any opioid use were higher among lung cancer patients with CNCP (OR 1.5; 95% CI 1.5-1.6; p < 0.01) compared to the no-CNCP group with lung cancer. Patients with breast cancer and CNCP had higher odds of chronic opioid use followed by lung cancer and colorectal cancer (OR 2.7; 95% CI 2.6-2.8; p < 0.01, OR 2.4, 95% CI 2.3-2.5; p < 0.01, and OR 2.4; 95% CI 2.3-2.5; p < 0.01) respectively compared to patients without CNCP but respective cancer.

CNCP adds an additional burden in opioid prescription in active cancer patients which necessitates a meticulous approach to opioids prescribing.

HyperArc is an effective technique for treating multiple small brain metastases using high-definition, precise radiation. However, the small size of individual lesions makes treatment vulnerable to inherent inaccuracies from beam-limiting devices such as multi-leaf collimators (MLCs), as well as patient setup errors. These uncertainties must be thoroughly evaluated prior to administering a single-fraction, high-dose HyperArc treatment to ensure optimal clinical outcomes.

To comprehensively evaluate the robustness of HyperArc VMAT plans for multiple brain metastases (MBT) against (i) high-definition MLC leaf positional errors and (ii) patient rotational and translational setup variations.

A retrospective analysis of 34 MBT plans from 30 patients with 123 lesions treated using HyperArc VMAT plans was performed. Prescription doses (21-24 Gy) targeted PTVs (GTV + 1 mm), with each plan addressing 2-7 brain metastases (< 2 cm). D_100% for GTV and V_12Gy for normal brain were re-evaluated under simulated (i) 20 MLC positional errors (0.2-1 mm) and (ii) 26 patient rotational (Yaw/Pitch/Roll by 1°) and 26 translational errors (SI/LR/AP by 1 mm). The impact of target distance to isocenter (DTI), target volume, and plan modulation factor on plan robustness was assessed. Replans with larger PTV margins, 1.5 and 2 mm, were investigated for a proper PTV margin for the worst-case scenarios.

Per our cohort, D_100% of GTV is highly sensitive to both MLC and patient errors. Their dosimetric effects follow linear regressions: 1 mm shift reduces GTV D_100% by 8%; 1 mm symmetric MLC openings increase GTV D_100% by > 22%, while 1 mm symmetric closings decrease it by > 25.8% per 1 mm; Patient rotation/translation impacts GTV D_100% by 0.04-1.28% per 1° or ∼7% per 1 mm. Normal brain V_12Gy is only sensitive to MLC errors, increasing slightly with shifts and significantly with symmetric openings (+5cc/1 mm), but decreasing with closings (-2.77cc/1 mm). DTI shows minimal correlation with MLC shifts but is affected by patient setup uncertainties. Large targets amplify dose sensitivity to symmetric MLC errors, whereas plan modulation factor shows no significant impact. A minimum 1 mm margin is required to absorb these uncertainties, with 2 mm margins recommended in the worst cases to ensure treatment accuracy.

Overall, the target dose and V_12Gy for HyperArc VMAT plans are more significantly affected by symmetric MLC opening and closing errors than by patient rotational setup errors. The pronounced effects of these errors highlight the importance of rigorous plan robustness verification, accounting for target size, margins, and DTI.