Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype with a high risk of early central nervous system dissemination and poor outcomes after brain metastasis (BM). This systematic review summarizes current evidence on incidence, treatment strategies, outcomes, guidelines, and ongoing trials in TNBC-associated BM.

The review followed PRISMA guidance and was registered in the Open Science Framework (OSF.IO/6TDRF). MEDLINE, Scopus, Web of Science, DOAJ, and ClinicalTrials.gov were searched through January 17, 2026. Eligible records comprised randomized trials, prospective, retrospective, and ambispective cohorts, registry analyses, case series, guideline or consensus documents, and registered clinical trials reporting TNBC-specific CNS data. Data were extracted independently and synthesized descriptively because clinical and methodological heterogeneity precluded quantitative meta-analysis.

Forty-three records met the inclusion criteria: 27 clinical studies (25 addressing parenchymal brain metastases and two addressing leptomeningeal metastases), seven guideline or consensus documents, and nine ongoing clinical trials. Across clinical studies, 67,290 patients were included; 2,555 patients had TNBC and developed CNS involvement. SRS achieved 1-year local control rates of 90-99% in selected patients with limited intracranial disease, but distant intracranial relapse remained frequent. Whole-brain radiotherapy was commonly used for extensive disease and was associated with poorer survival in observational cohorts. Among systemic options, sacituzumab govitecan had the most consistently reported TNBC-specific intracranial signal, although current evidence did not establish comparative superiority.

TNBC-associated BM remains linked to substantial morbidity, mortality, and limited prospective evidence. SRS is preferred for appropriately selected patients with limited disease. Sacituzumab govitecan has the most consistently reported TNBC-specific CNS activity, but no systemic agent has established superiority in prospective TNBC-specific CNS trials.

Not applicable.

Pancreatic cancer represents a malignant tumor of the digestive system with an inferior clinical prognosis, primarily attributable to the challenges in early diagnosis that preclude surgery-based treatment for most patients. Furthermore, the high postoperative recurrence rate significantly limits long-term survival in surgical candidates. Among patients experiencing recurrence after pancreatic cancer resection, local recurrence emerges as one of the most prevalent patterns. Early detection remains equally critical for recurrent cases, as selected patients undergoing potentially curative therapy for localized recurrence demonstrate that they can still extend post-recurrence survival. This comprehensive review synthesizes current evidence regarding the pathogenesis, risk determinants, diagnostic approaches, therapeutic interventions, and preventive measures for local recurrence following pancreatic cancer surgery. Emphasis is placed on analyzing the potential etiopathogenetic mechanisms and risk determinants for postoperative local recurrence, including tumor biology characteristics, tumor microenvironment interactions, and clinicopathological influences, providing foundations for preventive strategies. Emerging diagnostic modalities, particularly advanced imaging, and histopathological techniques, enhance early detection of locoregional recurrence. The review further examines evolving treatment paradigms encompassing precision radiotherapy, targeted systemic therapies, and innovative immunotherapeutic approaches for recurrent disease management. By integrating multidisciplinary perspectives, this work aims to inform optimized preventive approaches, surveillance and diagnostic protocols, and advance personalized management strategies for postoperative local recurrence in patients with pancreatic cancer.

Colorectal cancer (CRC) involves metabolic reprogramming alongside genetic alteration. ATP-citrate lyase (ACLY), the rate-limiting enzyme of de novo lipogenesis, is a validated target of microRNA-22 (miR-22) in tumor tissue. We asked whether both are dysregulated in the circulation of patients with CRC and whether they carry diagnostic value.

Serum ACLY (ELISA) and circulating miR-22 (RT-qPCR, normalized to U6) were measured in 32 patients with histopathologically confirmed CRC and 31 healthy controls; metabolic activity was assessed by PET/CT SUVmax. Analyses used SPSS and REST 2009. miR-22 was downregulated in patients (relative expression 0.175; p < 0.001) and serum ACLY was elevated (p = 0.009). Across the whole cohort the two markers were inversely correlated (ρ = -0.362; p = 0.004), but not within the patient group (ρ = -0.128; p = 0.485) or within controls (ρ = -0.180; p = 0.333), indicating that it reflects their opposite direction of change between groups. Serum ACLY was higher in patients with radiologically active tumor involvement on PET/CT (p = 0.047). The ACLY/miR-22 ratio separated patients from controls with an AUC of 0.984 (p < 0.001), exceeding serum ACLY alone (AUC = 0.691).

In this single-center, proof-of-concept study, circulating miR-22 and serum ACLY were dysregulated in opposite directions in colorectal cancer, and their ratio discriminated patients from controls (AUC > 0.98). These estimates were obtained in a single-center discovery cohort without an independent validation set and require external validation before any diagnostic use. The data do not demonstrate a direct regulatory interaction between the two markers in the circulation, and require validation in larger, prospective cohorts.

Urolithin A (UA) is a gut microbiota-derived metabolite formed from dietary ellagitannins and ellagic acid. It has drawn sustained interest because it can influence mitochondrial quality control, but the evidence does not support a simple anti-aging or anticancer label. In this review, UA is examined across microbial metabolism, urolithin metabotypes, pharmacokinetic exposure, mitophagy biology, aging-related phenotypes, and cancer. The emphasis is placed on what has been shown, what remains model-dependent, and where translational claims are still premature. Preclinical work links UA to PINK1/Parkin-, TFEB-, AMPK-, sirtuin-, and Nrf2-associated pathways, with reported improvements in mitochondrial turnover and inflammatory signaling. Human data are narrower: most trials have been short and have focused on safety, muscle performance, mitochondrial signatures, and circulating biomarkers. Evidence for cancer prevention or cancer therapy still comes mainly from cell and animal studies. Because mitophagy can limit early mitochondrial damage but may also help established tumors survive hypoxia, nutrient restriction, dormancy, and therapy-induced stress, UA is better regarded as a microbiome-dependent mitochondrial modulator whose effects depend on biological setting. The next step is to define direct molecular targets, test native and conjugated UA at human-relevant exposure ranges, account for UM-A, UM-B, and UM-0 metabotypes, and evaluate cancer-specific endpoints before making therapeutic claims.

Genetic testing in ovarian carcinoma (OC) patients is very important for patients and their relatives. The Tumor-First workflow uses a tumor DNA test to stratify germline testing for hereditary cancer predisposition as well as treatment options with PARP inhibitors. This workflow is adopted and successfully implemented nationwide. Here, we evaluated recent tumor DNA testing rates in the Netherlands to identify untested OC patient groups and optimize tumor DNA testing rates. OC patients diagnosed in 2023 or 2024 were selected from the Netherlands Cancer Registry. We analyzed patient characteristics associated with the likelihood of tumor DNA testing using multivariable logistic regression. Tumor-First testing was performed for 1765 out of the 2221 (79%) OC patients. Patients diagnosed with advanced stage OC were more likely to receive tumor DNA testing (OR = 2.5, p < 0.001) than those with low-stage disease. Compared with patients who underwent surgery as primary treatment, those who received chemotherapy or no primary treatment were less likely to be tested (OR = 0.21 and OR = 0.07, respectively, p < 0.001). Patients who died within 100 days were less likely to receive testing (OR = 0.57, p = 0.003). Patients without resection after diagnosis on biopsy/cytology had the lowest Tumor-First testing rates (58% vs. 87-95%, χ2 p < 0.001). Tumor-First testing rates are high. However, OC patients that do not undergo a resection are less likely to undergo testing. With these data strategies to identify hereditary cancer predisposition in patients and their relatives can be further improved.

Online cancer forums are often assumed to promote misinformation and unsupported treatment claims, including some non-evidence-based complementary and alternative medicine (CAM) approaches. This study examined the relationship between online cancer forum use, attitudes toward complementary and alternative medicine (CAM), and the use of non-evidence-based therapies, with a specific focus on CAM approaches prevalent in German-speaking countries.

A cross-sectional anonymous online survey was conducted in June-July 2025 among adult users of the largest German cancer forum, assessing forum use, CAM-related attitudes (defined according to the German S3 guideline checklist, version 1.2), eHealth literacy, psychological distress, and sociodemographic and disease-related variables. Forum use was dichotomized by median split, and data were analyzed using non-parametric tests and multivariable regression models.

Among 458 participants, high versus low forum use differed by sociodemographic and disease-related factors but was not associated with eHealth literacy or psychological distress. Among CAM users (44.3%, n = 203), CAM use intensity was moderate (median = 2, IQR 1-3) and showed no association with forum use, eHealth literacy, psychological distress, or sociodemographic variables; no independent predictors were identified. CAM-related forum discussions were rated as significantly less trustworthy than discussions on conventional cancer treatments (t(383) = 16.88, p < 0.001), independent of eHealth literacy, psychological distress, or participant role.

The use of CAM approaches, including both evidence-based supportive interventions and non-evidence-based methods, was not associated with forum exposure, eHealth literacy, or psychological distress. Forum users demonstrated differentiated trust patterns, with consistently lower perceived credibility attributed to CAM-related discussions compared with discussions on conventional cancer treatments.

For cancer survivors, online cancer forums appear to function primarily as contextual support resources rather than drivers of non-evidence-based treatment decisions. Clinicians should therefore address forum use openly and early, focusing on guidance and shared decision-making instead of discouragement.

A lateral flow analysis (LFA) strip for detecting dual miRNAs (miR155 and miR21) was constructed based on the "AND" logic gate and DNA self-assembly. The ternary synergistic strategy of "logic gating-signal amplification-visual output" enables highly sensitive and visual detection of miR21 and miR155 for breast cancer diagnosis. Only if both miR21 and miR155 are present can the trigger DNA (TDNA) in the sensor specifically dissociate and activate the "AND" logic gate (output signal = "1"); in the absence of either miRNA, the system remains in an inactive state (output signal = "0"). TDNA initiates catalytic hairpin assembly (CHA), and the product of the CHA reaction cascaded triggers the hybridization chain reaction (HCR) to achieve dual signal amplification. Gold nanoparticles (AuNPs) were used to label DNA for the construction of the LFA strip, allowing naked-eye observation of the detection results of miR21 and miR155. Detection results showed that the signal intensity of the test line (T line) had a positive correlation with the concentration of miRNAs (with a miR155:miR21 ratio of 1:1). Within the concentration range of 0.1-10 nM, the average grayscale value of the T line exhibited a good correlation with the logarithm of miRNA concentration (correlation coefficient r = 0.9983), and the limit of detection (LOD) was 30.98 pM. This LFA strip has been preliminarily validated to the detection of human serum samples, and the results indicated that the levels of miR155 and miR21 in the serum of breast cancer patients were significantly higher than those in normal individuals. Free from the limitation of large-scale instruments, this strip holds great commercialization potential.

Breast cancer (BC) is the leading cause of cancer in women worldwide with rising incidence in low- and middle-income countries (LMIC). We examined trends in reproductive and lifestyle factors for breast cancer across birth cohorts of Nigerian women.

We conducted a cross-sectional analysis of 2,309 female control participants (mean age, 42.5 ± 13.0 years) recruited between 1998 and 2017 as part of the Nigerian Breast Cancer Study (NBCS), an ongoing case-control study. Birth cohort was modeled as an ordinal predictor to evaluate temporal trends. Reproductive and lifestyle factors were analyzed across six birth cohorts (< 1940, 1940-1949, 1950-1959, 1960-1969, 1970-1979, and ≥ 1980). Analyses of reproductive variables were repeated among women aged ≥ 40 years, and hormonal contraceptive use was additionally evaluated among women aged ≥ 30 years.

Among all women, mean age at menarche declined from 16.0 years among women born before 1940 to 15.1 years among those born in or after 1980 (P for trend = 0.001), whereas age at thelarche remained stable across birth cohorts. Among women aged ≥ 40 years, mean parity declined from 6.1 to 4.1 live births, and cumulative lifetime breastfeeding duration decreased from 114 to 75 months (both P for trend < 0.001). Mean breastfeeding duration per live birth showed only a modest decline. Among women aged ≥ 30 years, the prevalence of ever hormonal contraceptive use increased from 7.2% to 55.8% across birth cohorts (P for trend < 0.001). Among all women, alcohol consumption remained low throughout (≤ 9% in every birth cohort).

Modest generational changes were observed in several reproductive and lifestyle factors traditionally associated with breast cancer risk among Nigerian women. These findings describe temporal changes in breast cancer risk factor profiles across successive birth cohorts. Future studies should examine environmental and other contextual exposures that may contribute to the evolving epidemiology of breast cancer in Nigeria and other low- and middle-income countries.

Postoperative meningitis remains an important complication following pediatric posterior fossa tumor (PPFT) surgery and is associated with increased morbidity, prolonged hospitalization, and delays in adjuvant therapy. However, data regarding its incidence and perioperative risk factors in children remain limited.

To determine the incidence, risk factors, microbiological profile, and cerebrospinal fluid (CSF) characteristics of postoperative meningitis in PPFTs.

A retrospective analysis of 116 PPFT cases was performed. Patients with postoperative meningitis were compared with those without meningitis to identify potential risk factors. Meningitis cases were further classified into culture-positive and culture-negative groups, and CSF biochemical and cytological parameters were analyzed. Statistical analysis was performed with significance set at p < 0.05.

Among 116 patients (age = 9 ± 4 years; male:female::2.2:1), postoperative meningitis occurred in 19 (16.4%). Emergency surgery was significantly associated with meningitis (11/19, 57.9% vs 27/97, 27.8%; p = 0.011). Wound complications were more frequent in meningitis patients (52.6% vs 29.9%, p = 0.055). Age, tumor location, raised intracranial pressure, preoperative external ventricular drainage, shunt placement, postoperative CSF leak, intraventricular hemorrhage (IVH), and leukocyte count were not significantly associated. Among meningitis cases, 6 were culture-positive and 13 culture-negative. Bacterial meningitis showed higher median CSF cell counts (415 vs 12.5 cells/mm³, p = 0.082) and protein levels (139.3 vs 71.05 mg/dL, p = 0.190). IVH was more frequent in bacterial meningitis (33.3% vs 0%, p = 0.028). The most common isolates were Klebsiella species and methicillin-resistant Staphylococcus aureus (MRSA).

Postoperative meningitis occurred in one-sixth of pediatric PFT cases. Emergency surgery independently increased risk, while culture-positive cases showed intraventricular hemorrhage and higher CSF inflammatory indices. The microbial profile highlights the increasing prevalence of multidrug-resistant organisms.

Background With the advent of immune checkpoint inhibitor-based combination therapy, treatment sequencing for advanced hepatocellular carcinoma (HCC) has become increasingly complex. The Barcelona Clinic Liver Cancer (BCLC) 2026 recommendations emphasize individualized decision-making. Purpose To compare clinical outcomes of hepatic arterial infusion chemotherapy (HAIC) and tyrosine kinase inhibitors (TKIs) in patients with advanced HCC after atezolizumab-bevacizumab (AB) failure, within the BCLC 2026 treatment paradigm. Materials and Methods This multicenter retrospective study included patients who received AB and subsequently received either HAIC or a TKI between March 2022 and August 2025. HAIC used a cisplatin-fluorouracil regimen, and TKIs were given at standard doses. Tumor response and progression-free survival (PFS) were assessed using contrast-enhanced multiphase CT or liver MRI according to routine clinical practice. Imaging was reviewed by radiologists blinded to treatment allocation. Inverse probability of treatment weighting (IPTW) was applied for age, sex, Eastern Cooperative Oncology Group performance status, Child-Pugh class, portal vein tumor thrombosis, and tumor burden based on the up-to-seven criteria. Results This study included 90 patients (mean age, 62 years ± 10.9 [SD]; 73 men; HAIC group, n = 51; TKI group, n = 39). Baseline tumor burden was higher in the HAIC group than in the TKI group (percentage of patients with tumors beyond the up-to-seven criteria: 88% [45 of 51] vs 64% [25 of 39]; P = .01). In unweighted analyses, median overall survival (OS) was similar between the HAIC and TKI groups (10.4 vs 6.4 months; P = .62), whereas PFS favored HAIC over TKIs (median, 5.3 vs 3.6 months; P = .008). Objective response rate and disease control rate were higher with HAIC than with TKIs (objective response rate: 35% [18 of 51] vs 5% [two of 39], P = .002; disease control rate: 67% [34 of 51] vs 26% [10 of 39], P < .001). After IPTW, HAIC remained associated with longer PFS than TKIs (median, 7.1 vs 3.4 months; P < .001), and OS remained similar between groups (median, 10.5 vs 6.3 months; P = .32). Conclusion In patients with advanced HCC, after AB failure, second-line HAIC yielded higher response rates and longer PFS than TKIs. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Deyirmendjian and Tang in this issue.