Gynecologic oncology surgery is delivered by clinicians with diverse specialty backgrounds and varied training pathways. The Q-GOAL (Quality in Gynecologic Oncology Advancement for Learning) study aimed to explore the heterogeneity of these training experiences, identify common training structures and surgical exposure profiles, evaluate self-reported surgical confidence, and compare these findings across income levels.

An open, cross-sectional, web-based survey was conducted between July and September 2025 using convenience and snowball sampling. The survey was distributed globally to trainees and consultants in obstetrics and gynecology, general surgery, gynecologic oncology, and surgical oncology. Descriptive statistics and exploratory unsupervised multi-variate analyses were performed.

A total of 1,035 clinicians participated (92% completion rate), of whom 64% were from low- and middle-income countries. Most respondents had an obstetrics and gynecology background, with general surgeons contributing a greater proportion in low- and middle-income countries than in high-income countries (23% vs 5.5%). Training pathways included dedicated sub-specialty programs, rotation-based training, and a small proportion reporting no formal training. Rotation-based training was associated with a less structured training environment in the latent class analysis. Multiple correspondence analysis identified distinct low-, intermediate-, and high-volume training profiles. Increased surgical exposure was associated with higher self-reported confidence, and income status remained an independent predictor of surgical confidence.

The study demonstrated the diversity of the workforce delivering gynecologic oncology surgery globally. These findings highlight the need for internationally harmonized training standards and a minimum level of surgical exposure, while recognizing the differences among health care systems worldwide.

To assess gynecologic oncology professionals' perspectives on biomarker testing and molecularly informed treatment for endometrial cancer across Latin America and to identify barriers to precision care adoption.

This was a secondary analysis of a multi-national, cross-sectional, web-based International Gynecologic Cancer Society survey of 679 oncology professionals from Argentina, Brazil, Colombia, and Mexico that was administered in Spanish and Portuguese using the Research Electronic Data Capture platform from March to August 2025. Endometrial cancer-specific items were completed by 506 respondents (74.5%), who formed the denominator for the results reported below; the items covered biomarker testing, interpretation and application of molecular results, access to systemic therapies, treatment delays, and institutional barriers.

Biomarker testing was reportedly ordered by 54.7% to 84.7% of respondents across the four main country groups; in-house next-generation sequencing and POLE testing were limited (17.2% and 18.0% of respondents, respectively), with many centers relying on external laboratories, including somatic next-generation sequencing send-out rates of 49.3% in Argentina and 62.9% in Colombia. A gap between biomarker availability and clinical application was evident: only 28.0% to 58.2% across countries would add immunotherapy for advanced mismatch repair-deficient/microsatellite instability-high disease, and 29.3% to 54.9% would add human epidermal growth factor receptor 2-directed therapy for human epidermal growth factor receptor 2-positive advanced disease. Access to immunotherapy and lenvatinib was generally lower and more heterogeneous than access to standard treatments; time to initiation of primary treatment was most commonly 28 days to 3 months, but longer delays (>3 months) were reported in a substantial proportion of cases, particularly in Mexico (21.3%).

Among gynecologic oncology professionals surveyed in Latin America, the central challenge in endometrial cancer care is not only access to biomarkers but also integration of molecular classification into therapeutic decision-making. Closing this gap requires improved access to key tests (POLE and next-generation sequencing-based assays), practical education in result interpretation, and more consistent access to targeted therapies.

Cervical cancer elimination is considered an achievable global health objective, yet progress toward the World Health Organization 90-70-90 targets remains highly uneven across countries and regions. Despite the effectiveness of human papillomavirus vaccination and human papillomavirus-based screening, implementation continues to be shaped by substantial variation in health-system readiness, program maturity, governance capacity, and service delivery infrastructure. This analysis proposes a pragmatic health-system archetype framework to support context-sensitive implementation of cervical cancer prevention strategies. The framework was informed by a multi-regional expert convening and an iterative synthesis of global evidence, World Health Organization guidance, and implementation experience. Three broad archetypes are described (evolving, transitional, and consolidated health systems), each reflecting distinct structural constraints and implementation capacities. In evolving systems, the primary challenge is establishing functional delivery platforms capable of supporting simplified, high-impact screening approaches. In transitional systems, the priority is consolidating program architecture during the shift from cytology-based to human papillomavirus-based screening. In consolidated systems, the focus shifts toward optimization, equity, and long-term sustainability of elimination gains. Across all archetypes, progress depends less on the availability of effective technologies than on their integration within health systems able to ensure continuity, accountability, and population reach. This framework is not intended as a country classification tool but as an analytical lens to support policy and program design. By aligning implementation pathways with system readiness, it offers a pragmatic approach to translate global targets into feasible, system-adapted action and accelerate equitable progress toward cervical cancer elimination.

To synthesise evidence on diagnostic colonoscopy completion and time-to-colonoscopy after abnormal stool-based colorectal cancer screening tests and to examine the implementation strategies and health-system configurations used to support follow-up.

Systematic review with narrative synthesis, reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement and the Synthesis Without Meta-analysis reporting guideline.

We searched MEDLINE via PubMed, Embase via Ovid and Scopus for articles published from 1 January 2010 to 28 October 2025. Reference lists of included studies were also screened.

Randomised and non-randomised trials, observational studies, mixed-methods studies and eligible programme evaluations involving adults with an abnormal faecal immunochemical test, guaiac faecal occult blood test or multitarget stool DNA-faecal immunochemical test were included. Eligible studies reported diagnostic colonoscopy completion, time to colonoscopy or implementation-related outcomes.

Study characteristics, implementation strategies, colonoscopy completion, time-to-colonoscopy and sociodemographic differences were extracted using a piloted form. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomised trials, the Risk of Bias in Non-randomised Studies of Interventions or the Joanna Briggs Institute tools, according to study design. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Because of differences in settings, study designs and outcome definitions, findings were synthesised narratively. Reported follow-up intervals were grouped into approximately ≤3, ≤6 and ≤12 months.

Twenty-five studies were included, predominantly from high-income settings. Colonoscopy completion within 6-12 months commonly ranged from approximately 30% to 55% in federally qualified health centres and safety-net settings to 70%-80% or higher in organised and integrated programmes. Time to colonoscopy ranged from approximately 42 to 184 days. Higher completion and shorter delays were more commonly reported in programmes combining real-time tracking, clearly assigned responsibility, proactive outreach or navigation and coordinated colonoscopy scheduling. Of the 25 studies, 1 was judged to have low overall risk of bias, 19 moderate risk and 5 serious risk. Certainty of evidence was low for colonoscopy completion at approximately 6 and 12 months and very low for approximately 3-month completion and time to colonoscopy.

Higher-performing post-abnormal-test pathways commonly incorporated registry-based tracking, clear ownership of abnormal results, proactive outreach or navigation and coordinated access to colonoscopy. However, confidence in the comparative performance of specific implementation bundles is limited by heterogeneous and predominantly observational evidence. Health systems serving under-resourced populations may require targeted investment in tracking, navigation and integrated scheduling to improve timely and equitable follow-up.

PROSPERO CRD42024579672.

To characterise the epidemiology, asbestos-exposure patterns, spatial distribution and survival of malignant mesothelioma in Apulia, Italy.

Population-based retrospective registry study.

Apulian Regional Mesothelioma Registry, a regional operating centre of the Italian National Mesothelioma Registry.

All 2281 malignant mesothelioma cases recorded between 1993 and 2025.

None.

Primary outcomes were case distribution, population-adjusted incidence, asbestos-exposure category and overall survival. Secondary outcomes included temporal trends, municipal patterns, proximity of environmentally exposed cases to the former Fibronit plant in Bari and factors independently associated with mortality.

Overall, 1689 cases (74.0%) occurred in men; mean age at diagnosis was 67.8 years and 2018 cases (88.5%) were pleural. Occupational exposure accounted for 49.8% of cases, environmental exposure for 8.9% and familial exposure for 2.4%. Taranto had the highest municipal annual incidence (7.43 per 100 000), followed by Bari (4.59). Among 112 environmentally exposed Bari cases with reconstructed residential distance, 89.3% lived within 1 km of the former Fibronit plant. Kaplan-Meier median survival was 1.0-year and 5-year survival was 10.1%. Survival improved across diagnostic periods (p<0.001). Older age, male sex and pleural site independently predicted higher mortality.

Mesothelioma in Apulia reflects persistent occupational and environmental consequences of historical asbestos use. Geographical hotspots and poor survival support continued registry surveillance, remediation of contaminated sites and targeted health monitoring of formerly exposed workers and communities.

The adoption of minimally invasive surgery (MIS) for endometrial cancer has progressed. This study aimed to evaluate the perioperative outcomes and early implementation of MIS in patients with preoperative International Federation of Gynecology and Obstetrics (FIGO) Stage IA endometrial cancer in a regional healthcare setting.

This retrospective multicenter cohort study included consecutive patients who underwent surgery for presumed FIGO Stage IA endometrial cancer at three tertiary and cancer-specialized institutions in Gunma Prefecture, Japan, between 2018 and 2021. Patients were categorized into the MIS and open surgery groups according to the surgical approach. Perioperative outcomes, including operative time, estimated blood loss, hospital stay, blood transfusion, perioperative complications, and laboratory parameters, were compared between the groups.

This study included 365 patients, of whom 182 underwent MIS and 183 underwent open surgery. The proportion of MIS increased during the study period. Compared with open surgery, MIS was associated with significantly lower estimated blood loss (52 vs. 220 mL, p < 0.001) and a shorter postoperative hospital stay (5 vs. 9 days, p < 0.001), although operative time was longer (256 vs. 215 min, p < 0.001). Postoperative complication rates were comparable, and severe complications were rare. Postoperative Day 1 C-reactive protein and creatine kinase levels were significantly lower in the MIS group.

MIS for preoperative FIGO Stage IA endometrial cancer was introduced across major institutions in a regional healthcare system. MIS was associated with favorable perioperative outcomes without increased complications, supporting the feasibility and perioperative safety of regional implementation of MIS.

Modern oncology drug development is increasingly focused on identifying the optimal biological dose (OBD) rather than just the maximum tolerated dose (MTD). Early-phase oncology trials have conventionally relied on short-term endpoints, such as overall response rate (ORR), to evaluate efficacy. However, there is a growing perception that incorporating longer-term endpoints, such as progression-free survival (PFS), into early-phase dose-finding trials can provide more informative guidance for dose optimization. This study proposes a new design, BOIN12-PFS, to identify the optimal dose based on PFS, short-term efficacy, and toxicity. As an extension of the BOIN12 design, BOIN12-PFS is expected to be comparatively straightforward to implement in clinical oncology dose-finding trials. Simulation studies demonstrate that the BOIN12-PFS design offers advantages over existing designs in terms of the probability of selecting the OBD, the average number of patients allocated to the OBD, reducing overdosing, and requiring a smaller total sample size across various realistic settings.

Approximately 12%-40% of patients with esophageal cancer develop local residual or recurrent lesions after chemoradiotherapy (CRT) or radiotherapy (RT). Photodynamic therapy (PDT) is a minimally invasive, organ-preserving alternative; however, therapeutic response is not guaranteed. We developed an artificial intelligence (AI) model to predict PDT efficacy.

We retrospectively analyzed 177 patients who underwent PDT after CRT/RT at the National Cancer Center Hospital East between August 2006 and December 2024. Clinical data and pre-PDT endoscopic images obtained within 1 month were collected. Local image features extracted via oriented FAST and rotated BRIEF were integrated with clinical information to build a multimodal support vector machine for binary classification. Model performance was evaluated on an independent test set and compared with that of three endoscopists.

The AI model was trained on 145 cases, achieving an accuracy, recall, precision, and F1 score, and area under the receiver operating characteristic curve of 0.813, 0.833, 0.833, 0.833, and 0.897, respectively in the test cohort of 32 cases. The AI model showed numerically higher accuracy, recall, precision, and F1 score than the endoscopists (0.531, 0.636, 0.389, and 0.483, respectively).

A multimodal AI model integrating clinical data and endoscopic images can accurately predict PDT efficacy after CRT or RT. This approach may help optimize treatment strategies and individualize patient management.

Everolimus 10 mg daily is the standard dose for advanced neuroendocrine tumors (NETs), but adverse events frequently necessitate dose reduction. As a result, oncologists often adopt a dose-escalation strategy starting at 5 mg and increasing the dose as tolerated. In this multicenter study, we evaluated the effect of reduced dose (RD) and standard dose (SD) everolimus on survival, progression, and toxicity in patients with advanced NETs. We conducted a multicenter retrospective cohort study of patients with advanced NETs treated with everolimus at Mayo Clinic and University Hospitals (Cleveland, OH). Patients were grouped by starting dose (5 mg vs. 10 mg). Primary endpoints were overall survival (OS), real-world progression-free survival (rwPFS), and adverse events. Multivariable Cox models, inverse probability of treatment weighting (IPTW), and time-varying dose sensitivity analysis were used to account for confounding and dose crossover. Among 170 patients (48 started on 5 mg; 122 on 10 mg), the 5 mg cohort was older, had worse ECOG PS, and was more heavily pretreated. Median OS was 43.7 months (5 mg) versus 81.5 months (10 mg; log-rank p = .02). However, after multivariable adjustment (N = 124 G1-G2 patients; 51 events), the association was no longer statistically significant (adjusted HR, 0.59; 95% CI, 0.31-1.12; p = .11). Median rwPFS was 7.0 versus 12.4 months (log-rank p = .05); the adjusted rwPFS difference was not statistically significant (HR, 0.95; 95% CI, 0.56-1.61; p = .84). Nearly half (46.7%) of 10 mg starters required dose reduction. Any-grade toxicity was more common with 10 mg (89% vs. 75%; p = .05). The apparent survival advantage of standard-dose everolimus was substantially attenuated after adjustment. These findings do not establish dose equivalence and should be interpreted in the context of limited statistical power. Given its more favorable observed tolerability profile, RD everolimus warrants prospective evaluation as a starting strategy for patients at increased risk of treatment-related toxicity who may not tolerate SD.

Pain therapy has obtained a high importance in clinical practice in the meantime and has become indispensable, in particular, with regard to a sufficient perioperative/-interventional case management but also related to a certain approach, specific (problematic) diagnoses, syndromes and special symptomatologies.

To provide a prompt and standardized access to a competently developed compact "Standard Operating Procedure" (SOP) on interdisciplinary pain therapy in tumor patients with a broad profile of (possible) diagnoses at a subspecialized medical center based on i) experiences from long-term clinical practice and ii) current references from the scientific medical literature (not to substitute completely earlier publications and text books).

Narrative short overview on the "SOP - Pain Therapy in tumor diseases/patients" (provided as QR code at the end).

In case of tumor-associated pain, opioids represent the primarily considered group of drugs for an efficient medication. Medication with opioids is limited by hepatic and renal insufficiency, type of opioid (e.g., Tapentadol's effect is not sufficient), further contraindications (e.g., MST in chronic obstructive pulmonary disease [COPD]) and mode of possible drug administration (patients cannot swallow or in lack of consciousness). In patients with tumor-associated pain, it needs to be asked for anxiety.

A couple of years ago, the interdisciplinary working group at the University Hospital of Magdeburg (Germany) created and established SOP's for postoperative pain therapy in general and abdominal surgery followed by vasculary surgery/medicine in 2024.

Tumor-associated pain belongs to the type of pain (in addition to birth pang and postoperative pain), which can be approached best. This represents a call to action. It comprises consequent, adequate drug administration with sufficient dosage according to the WHO scheme (WHO I actually not necessary), psychotropics and drug-free procedures.