AIM: To report our experience with the outcomes of open microsurgical management of third ventricular colloid cysts. MATERIAL and METHODS: This retrospective study presents the surgical outcomes of 33 patients who underwent open microsurgical resection-either through the interhemispheric transcallosal or transcortical transventricular approach-for third ventricular colloid cysts between 2010 and 2023. RESULTS: The mean follow-up period was 41.57 months. All patients were symptomatic, and severe, intractable headache was the most common presenting symptom. No perioperative mortality or postoperative infection occurred. During follow-up, five patients (15.15%) developed shunt-dependent hydrocephalus, and eight (24.24%) developed seizures. At the last follow-up, seven of the eight patients were seizure-free and no longer required antiepileptic medication. Thirty-two patients (96.96%) had no recurrence, and in one patient with a small residual lesion, no progression was observed. CONCLUSION: Open microsurgery, whether via the interhemispheric transcallosal or transcortical transventricular approach, is safe and offers a high likelihood of total resection with low recurrence. Shunt-dependent hydrocephalus and postoperative seizures remain the most common complications, underscoring the need for long-term surveillance, particularly for late-onset seizures even after complete removal. Although endoscopic surgery is now widely adopted, our findings demonstrate that open microsurgery continues to be a reliable and durable option with favorable recurrence and complication profiles.

AIM: To report our experience in implementing functional mapping-guided resection for eloquent diffuse low-grade gliomas (DLGGs) in a low- and middle-income country (LMIC) setting. There are logistical barriers to achieving onco-functional balance through glioma surgery in LMICs. MATERIAL and METHODS: The study is a retrospective chart review of adult patients who underwent surgical resection of their DLGGs that were located within supratentorial eloquent brain areas (within 15 mm). Functional mapping-guided surgery was performed using electrophysiological brain mapping techniques, namely intraoperative neuromonitoring (IONM) with or without awake craniotomy (AC). The primary outcome was the rate of postoperative neurological deficits. The secondary outcomes were the extent of resection, the rate of surgical complications, the Engel Outcome Scale score, and the progression-free survival (PFS) rate. RESULTS: Twenty-eight patients were included (43% males), with a mean age of 37.5 years. Their median preoperative Karnofsky Performance Scale score was 90. The predominant histopathology was astrocytoma (n = 20, 71%), and the primary site was perirolandic in 19 patients (68%). Seizures were the most common presenting symptom (71%). Resection was performed using either IONM alone (39%) or combined with AC (61%). Gross total resection was achieved in 20 patients. Six patients (21%) developed postoperative complications. Patients were followed up for a mean of 39.9 months. At discharge, 12 patients (43%) had experienced new or worsened neurological deficits, but nine of them later showed significant improvement. Sixteen patients achieved Engel class 1 seizure control, and the median PFS was 34 months. Two patients died during the study period. CONCLUSION: This study demonstrates that our institution's protocol for integrating functional mapping into the surgical management of DLGGs achieves a solid onco-functional balance.

AIM: To establish an effective predictive model to inform clinical practice for brainstem glioma, a rare and highly aggressive tumor of the central nervous system, given the lack of prior retrospective studies using the SEER database that have included both pediatric and adult patients. MATERIAL and METHODS: Cases of brainstem tumors diagnosed between 2000 and 2022 were identified from the SEER database. X-tile software and Maxstat were used to define the optimal tumor size cutoff value and risk subgroups for brainstem glioma. Independent prognostic factors were determined using univariate and multivariate Cox proportional hazards regression. These factors were used to construct two nomograms predicting 1-, 2-, and 3-year overall survival and cancer-specific survival for brainstem glioma. RESULTS: Age, tumor size, histological type, surgery, radiation, and chemotherapy were identified as independent prognostic factors for overall and cancer-specific survival. Notably, gross total resection was significantly associated with improved survival outcomes. CONCLUSION: This work enhances our understanding of the prognosis of brainstem glioma and corroborates the importance of surgical resection as a prognostic factor in its management. The validated nomograms offer a superior and personalized tool for risk stratification and prognostic estimation, which may be helpful for clinical decision making and patient counseling.

Hepatocellular carcinoma (HCC) remains a major public health issue across East Asia due to the high prevalence of hepatitis B viral infection in this area, and each country develops its own guideline according to clinical evidence and local health care resources. The latest guidelines from Taiwan, Hong Kong, China, Korea, and Japan were comprehensively reviewed. We highlight and compare the similarities and differences in epidemiology, surveillance, diagnosis, staging, and treatment strategies. Variations were observed in the issue of surveillance and early diagnosis by tumor marker integration, imaging modalities adoption, and individualized risk assessment tools, which reflect the local health resource availability and disease patterns. However, East Asian guidelines recommend broader criteria for curative treatment, such as liver resection and local ablation, which are beyond the criteria of Western guidelines. The introduction of immune checkpoint inhibitors and targeted therapy changes the treatment landscape for advanced HCC. The conversion strategies and drug-off criteria for patients who achieve tumor control have drawn great attention and discussion. The evolving treatment highlights the importance of the integration of global evidence-based practices and region-specific considerations to improve the treatment outcomes for HCC patients.

Non-Hodgkin lymphomas (NHLs) are associated malignancies with different morphological, genetic, immunophenotypic, and clinical characteristics. Research on genetic susceptibility to NHL is needed to identify at-risk groups and define important disease pathways. Interleukins (ILs) are cytokines that play important immunomodulatory roles. IL-6 stimulates IgG production, exerts antiviral effects, and has been linked to various diseases. Research on IL-6 mutations and NHL is important due to the role of IL-6 in immune regulation and cancer pathogenesis; however, direct causative links remain unclear. The purpose of this study was to investigate the association between the IL-6 genetic polymorphism at the rs1800796 locus and the risk of NHL in Egyptians using a case-control study. The study comprised 100 patients diagnosed with NHL and 100 age- and gender-matched healthy individuals. Risk factors for NHL were associated with lower hemoglobin and albumin levels, increased aspartate aminotransferase, and substantial outcomes in kidney function tests. The study found an absence of the CC genotype in NHL patients, whereas it was found in five healthy volunteers, suggesting a weak potential protective association. The GG genotype was found in more patients than healthy individuals (84 vs. 75); however, no significant association was found. The G allele was found to be more dominant in NHL patients than controls (184 vs. 170; P=0.02). These findings suggest that individuals carrying the G allele may be at twice the risk of developing NHL compared with those carrying the C allele (OR=2.02; 95% CI: 1.07-3.85). The study found no significant association between the IL-6 polymorphism and clinical presentation, tumor stage, or relapse status in NHL patients. These results support the use of the IL-6 variation in the diagnosis and genetic screening of NHL but not for therapeutic choices.

Direct-acting antivirals (DAAs) cure most chronic hepatitis C virus (HCV) infections, but their impact on liver functional reserve in patients with a history of hepatocellular carcinoma (HCC), particularly after non-curative HCC treatment, remains unclear. We evaluated antiviral efficacy and liver functional reserve after DAA therapy according to HCC history and timing of DAA initiation. In this retrospective single-center cohort, 716 patients initiated DAA therapy, and 690 with evaluable sustained virological response at 12 weeks after treatment (SVR12) were analysed. Patients were classified as no HCC, curative-treated HCC, or non-curative-treated HCC according to the most recent HCC treatment before DAA initiation. Liver functional reserve was assessed using the albumin-bilirubin (ALBI) score, modified ALBI grade, and Child-Pugh class. In the non-curative-treated HCC group, early (≤ 3 months) versus delayed (> 3 months) DAA initiation after the most recent HCC treatment was compared. Overall SVR12 was 96.1%, with similarly high rates across groups regardless of HCC history. The median ALBI score improved from -2.35 to -2.58 at SVR12 in the curative-treated HCC group (p < 0.001) but remained unchanged in the non-curative-treated HCC group (-2.36 to -2.38). Among 64 patients with a history of HCC, 43 (67.2%) developed recurrence; in these patients, the ALBI score improved from -2.31 at DAA initiation to -2.57 at recurrence (p < 0.001), and more than 90% remained Child-Pugh class A. Early and delayed DAA initiation showed similarly high SVR12 rates and comparable liver functional reserve. DAAs achieved high SVR12 rates and maintained liver functional reserve in patients with HCV, including those with a history of HCC after non-curative treatment.

Human papillomavirus (HPV) infection contributes to rising incidence of HPV-related oropharyngeal cancer (OPC). After the U.S. expanded HPV vaccination to adults aged 27-45 y in 2018, COVID-19 caused preventive visits and routine immunizations to plunge. We analyzed 2019 and 2022 NHIS data among adults aged 27-45 (2019 n = 8,745; 2022 n = 7,303). The primary outcome was ever HPV vaccination (≥1 dose), regardless of age at first vaccination. We estimated age-adjusted, survey-weighted coverage and used multivariable logistic regression to estimate adjusted odds of vaccination by sociodemographic characteristics; secondary 2022 analyses assessed initiation between ages 27 and 45. Ever HPV vaccine uptake increased from 15.1% in 2019 to 20.7% in 2022 (difference 5.6 percentage points; 95% CI, 4.03-7.07). In both years, lower odds were observed with increasing age, men, non-Hispanic Asian adults, individuals with lower educational attainment, and those without a usual place for care. By 2022, lower income-to-poverty ratios and lack of insurance were associated with reduced odds, whereas LGB+ and unmarried adults had higher odds, and adults in the Northeast had higher odds than those in the South. Only 1.43% (95% CI, 1.07-1.80) initiated vaccination between ages 27 and 45 in 2022. Initiation was more common among females, LGB+ and non-Hispanic Asian adults, and unmarried adults, and less common among those with lower education and no usual place for care. The increase in lifetime HPV vaccine coverage likely reflects childhood and adolescent vaccination rather than initiation at ages 27-45, which remained uncommon, and persistent inequities highlight missed opportunities for equitable OPC prevention.

This umbrella review aimed to systematically synthesize and critically appraise the available evidence from systematic reviews and meta-analyses evaluating the association between talc exposure and cancer risk in humans.

This umbrella review was conducted in accordance with the PRIOR guidelines and registered in PROSPERO. A comprehensive search of PubMed, Embase, Scopus, Web of Science, and Epistemonikos was performed up to October 2024 without language or date restrictions. Eligible studies were systematic reviews evaluating any type of talc exposure in humans. Study selection and data extraction were performed independently, and risk of bias was assessed using the AMSTAR-2 tool.

Nine systematic reviews were included, eight combining cohort and case-control studies and one restricted to cohort studies. Cosmetic talc exposure was the most frequently investigated, with most reviews focused on ovarian cancer. Moderate overlap of study populations (9.2%) was identified, primarily related to Boon et al. Based on AMSTAR-2, confidence in the evidence was moderate in one review and critically low in seven, with frequent methodological shortcomings such as lack of protocol registration and unclear study exclusions. For occupational exposure, elevated risks were observed for overall cancer (RR 1.21; 95% CI 1.03-1.42) and colorectal cancer (SIR 1.59; 95% CI 1.07-2.26), while no increased risk was found for other cancer types. Four of five systematic reviews evaluating cosmetic talc exposure and ovarian cancer reported a statistically significant association with increased ovarian cancer risk, whereas one review found no statistically significant association. However, confidence in the results of the reviews included was predominantly low or critically low, reflecting important methodological limitations, including concerns regarding risk-of-bias assessment and reporting. Overall, the evidence supporting an association between cosmetic talc exposure and ovarian cancer was of limited confidence.

There is limited evidence from systematic reviews regarding the association of exposure to cosmetic talc with an increased risk of developing ovarian cancer. Therefore, the results of the systematic reviews should be regarded as suggestive, rather than definitive, and further studies are required to demonstrate a causal relationship.

Cervical cancer remains one of the most common and preventable cancers among women in sub-Saharan Africa. Despite established curative treatments, most women present with locally advanced disease and many fail to complete therapy. Financial toxicity encompassing, direct medical costs, non-medical expenditures, income loss, and psychological distress, is an underrecognized but potentially important contributor to this treatment gap. This narrative review examines evidence on the magnitude, structural drivers, and consequences of financial toxicity in cervical cancer care across sub-Saharan Africa, and proposes system-level mitigation strategies. Targeted searches of PubMed, Embase, and Google Scholar (January 2013-April 2026), were supplemented by gray literature and reports from international health agencies. Thematic synthesis was conducted along the cervical cancer care continuum within a universal health coverage financial risk protection framework. The reviewed evidence suggests that financial toxicity is multi-dimensional, cumulative, and largely shaped by health-system organization. Quantitative studies report substantial out-of-pocket expenditure and catastrophic health spending, while qualitative studies consistently describe severe financial hardship, although definitions and measurement approaches vary across studies. Centralized radiotherapy services, requiring repeated long-distance travel over 5 to 6 weeks, appear to be an important structural contributor through transport, accommodation, and income-related costs. Available evidence further suggests that financial toxicity may contribute to delayed treatment initiation, missed radiotherapy sessions, incomplete chemoradiation, and treatment abandonment. This review also raises the hypothesis that, in radiotherapy-constrained settings, treatment pathway adaptation such as neoadjuvant chemotherapy followed by surgery may have financial as well as oncologic implications that warrant prospective evaluation. Direct evidence linking financial toxicity to survival outcomes remains limited. Reducing financial barriers will likely require health-system reforms, including decentralized service delivery where feasible, integration of financial navigation into oncology services, universal health coverage benefit packages covering the full cervical cancer care continuum, and treatment protocols that account for patients' financial burden.

BRAF V600E-mutant metastatic colorectal cancer (mCRC) is characterized by aggressive disease behavior and limited responsiveness to conventional systemic therapy. Although BRAF/EGFR-targeted therapies have improved clinical outcomes, durable complete remission remains uncommon, particularly in microsatellite-stable (MSS) disease. We report the case of a 26-year-old woman with MSS, BRAF V600E-mutant sigmoid colon adenocarcinoma and synchronous liver and omental metastases (cT4aN2M1c, stage IVC). Pretreatment biopsy demonstrated high programmed death-ligand 1 (PD-L1) expression (combined positive score = 20) and a high density of intratumoral CD8+ T cells (350 cells/mm2). Because the patient declined cytotoxic chemotherapy, first-line treatment consisted of tislelizumab combined with cetuximab and dabrafenib. After approximately 4 months of systemic therapy, radiological assessment showed a partial response, accompanied by normalization of serum marker levels, enabling conversion surgery. Histopathological examination confirmed a pathological complete response in the primary tumor and all resected metastatic lesions. A personalized tumor-informed circulating tumor DNA assay performed 3 months after surgery was negative. At the latest follow-up (35 months after treatment initiation), the patient remained free of clinical and radiological evidence of disease recurrence. This case highlights the possibility that selected patients with MSS, BRAF V600E-mutant mCRC may achieve durable remission with combined programmed cell death protein 1 blockade and dual-targeted therapy. The observed association between high intratumoral CD8+ T-cell infiltration, elevated PD-L1 expression, and favorable treatment response should be considered hypothesis-generating and requires validation in prospective biomarker-driven studies.