Advanced sarcomas have limited treatment options. Gemcitabine and docetaxel (GD) regimen showed efficacy in soft tissue sarcomas (STSs) in phase II studies but failed in first-line phase III trial. Adding cisplatin to GD showed efficacy in other types of cancer. mTOR pathway has been shown to play a role in resistance to these drugs. Inflammatory biomarkers have been identified as potential prognostic indicators in various malignancies, but their role in patients with advanced sarcomas is not clear.

We retrospectively enrolled 77 patients with advanced or metastatic sarcomas (STSs, n = 71; bone sarcomas, n = 6) receiving a novel combination with gemcitabine-gemcitabine/docetaxel/cisplatin plus everolimus (G-GDC + E). Primary endpoints included overall survival (OS) and progression-free survival (PFS). Inflammatory biomarkers were calculated, and their prognostic influence was evaluated.

The median OS and PFS were 16.8 months (95% CI, 13.6-23.9) and 5.4 months (95% CI, 4.3-8.3), respectively. Undifferentiated pleomorphic sarcoma/myxofibrosarcoma (UPS/MFS) demonstrated superior PFS compared to round cell sarcoma/translocation-related sarcoma (7.8 vs. 3.6 months, p = 0.009) and bone sarcoma (7.8 vs. 2.3 months, p < 0.001). Eastern Cooperative Oncology Group Performance Status ≥ 2, unfavorable histology (round cell sarcoma/translocation-related sarcoma and bone sarcoma), lower albumin level, and lymphocyte-to-monocyte ratio < 2.7 were independent predictors of OS. Grade 3-4 toxicities included neutropenia (68.8%), thrombocytopenia (59.7%), anemia (49.4%), diarrhea (18.2%), and skin toxicities (28.6%).

G-GDC + E demonstrates histology-specific efficacy in advanced/metastatic sarcomas, with substantial hematologic toxicity (Grade 3-4 thrombocytopenia 59.7%, neutropenia 68.8%) and notable non-hematologic events (Grade 3-4 diarrhea 18.2%, skin reactions 28.6%), all controllable with close monitoring, dose modifications and supportive care. Inflammatory biomarkers provide independent prognostic values.

Parents with cancer face unique psychosocial challenges as they navigate treatment while caring for dependent children, yet parenthood status is rarely captured in oncology workflows. This initiative evaluated the feasibility and outcomes of a new electronic health record (EHR)-based workflow to systematically identify parents with cancer and then connect them to family-focused assessment and supportive care.

A two-phase quality improvement initiative was conducted at an NCI-designated comprehensive cancer center. Phase 1 included process mapping, analysis of tumor registry and distress screening data, and development of an EHR screening item assessing parenting status. Phase 2 implemented the item ("Patient is a parent/caregiver with child/ren < 22 years of age?") into oncology workflows, linking identified parents to a new supportive care program, Family Circle, which includes psychosocial assessment, navigation, and family-centered support. Training for oncology clinicians included in-service education. Analyses examined prevalence estimates and associations between parenting, distress, anxiety, and depression and reports of quality improvement metrics.

Among N = 2,172 screened patients, 20.6% identified as parents; the age-adjusted prevalence of parenting with children under 21 was 16.9%, consistent with national estimates. Parents reported significantly higher distress (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.11-1.64, p = 0.003) and anxiety (OR = 1.28, 95% CI = 1.06-1.52, p = 0.009) than matched non-parents. Parents with younger children exhibited greater anxiety than those with older children (F = 4.32, df = 2, 393, p = .01). During implementation, N = 431 parents were identified in 6 months (79.4% through the EHR item).

Embedding parenting status screening into the EHR is feasible, accurate, and critical for linking parents with cancer to supportive care. Wider implementation of such workflows may enhance psychosocial oncology practice and improve cancer parenting outcomes.

Although immune checkpoint inhibitors (ICIs) have long half-lives, preclinical and retrospective clinical studies across multiple tumor types suggest that the time-of-day of ICI infusion may influence therapeutic efficacy by aligning initial drug exposure with circadian peaks in T-cell responsiveness. The immunological basis of this phenomenon and its clinical relevance in hepatocellular carcinoma (HCC) remains unknown.

We followed patients with advanced HCC receiving ICI therapy at Johns Hopkins from 2021 to 2025, classifying them into a morning (first treatment before 12:00 hours) or afternoon (first treatment after 12:00 hours) group. We assessed clinical outcomes and compared immunological responses from baseline to early-on-treatment by profiling peripheral blood mononuclear cells using cytometry by time-of-flight and plasma cytokines using a 39-plex Luminex assay.

Our cohort included 84 patients, 39 of whom received their first infusion in the morning. There were no statistically significant differences in baseline demographic or clinical characteristics between patients initiating therapy in the morning versus afternoon. The morning group had superior progression-free survival (multivariable HR 0.50, 95% CI 0.30 to 0.84, p<0.01) and higher odds of treatment response (multivariable OR 3.26, 95% CI 1.08 to 10.90, p<0.05), with no significant increase in immune-related adverse events. The timing of subsequent infusions after the first dose had no impact on outcomes. Immunological responses diverged after the initial dose, with morning-treated patients showing reduced interleukin (IL)-6 levels (p<0.01) and greater expansion of cytotoxic central memory CD8+ T cells (p=0.01) as well as cytotoxic effector and effector memory CD8+ T cells (p=0.06).

Morning first-dose infusion of ICIs in HCC was associated with improved clinical outcomes and distinct immune responses, including reduced IL-6 signaling and expansion of cytotoxic central memory CD8+ T cells. These findings suggest that the timing of the initial infusion can imprint an immunological program that shapes subsequent antitumor immunity, providing a mechanistic rationale for strategically scheduling ICI administration.

Long-term cancer survivors may suffer from significant bio-psycho-social burden even years after treatment. Yet, a structured approach to detect and address bio-psycho-social burden of long-term cancer survivors in primary care is missing in Germany, although family physicians are the primary medical contact for most patients. In this paper, we describe the DELPHIN study aiming to develop and test a structured care model for long-term cancer survivors. The DELPHIN study and intervention will facilitate networking of regional medical and non-medical services. This protocol describes the intervention as well as the pilot study.

The DELPHIN study comprises a developmental and a feasibility phase. In the developmental phase, we will assess (1) the current care needs of long-term cancer survivors (n=1000) using a cross-sectional questionnaire survey; (2) in an additional cross-sectional questionnaire survey, we will address medical and non-medical care providers to assess current care practice for this patient group (n≥250); (3) a qualitative interview study with both long-term cancer survivors (n=12) and family physicians (n=10) will assess patients' needs and barriers for effective care. Results will then be triangulated to inform development of the DELPHIN intervention. The intervention shall include the following elements: the DELPHIN mobile app for patients with a digital screening tool, a digital treatment plan, a survivorship passport and information on regional medical and non-medical providers. Additionally, a DELPHIN website and a DELPHIN eLearning tool for family physicians will be developed. The subsequent feasibility study will follow 100 long-term cancer survivors using the DELPHIN app for 4 months, with two assessments (t⁰=baseline; t¹=4 months follow-up) regarding the usability of the app and their health-related quality of life. The eLearning tool will be tested by 50 family physicians using three measurement points to evaluate learning success (t^a=before; t^b=directly after eLearning; t^c=after 4 weeks).

The DELPHIN study seeks to address cancer survivors' unmet bio-psycho-social needs through implementing a digital mobile application. Positive results in the feasibility study will provide the basis for a future effectiveness study and integration into routine care.

The study was reviewed by the Ethics Committee of the University of Bonn, Germany (No: 2024-409 BO) which did not object to the study.

DRKS00035726.

Androgen deprivation therapy (ADT) improves survival in advanced prostate cancer but may lead to debilitating side effects, including sarcopenic obesity and a 10-45% increased risk of other comorbidities. Guidelines recommend exercise and nutrition interventions during ADT, but access to these services is often limited, and referral pathways are unclear. This study aims to evaluate the feasibility and preliminary efficacy of an online, home-based, multi-faceted, exercise, nutrition and education programme (ProHealth) for men with prostate cancer treated with ADT. ProHealth was co-designed with consumers and healthcare professionals to include (i) education on prostate cancer and treatment-related side effects and (ii) multimedia behaviour change resources to support individualised nutrition and exercise behaviour change.

This 12-week randomised controlled trial (target n=50) will include men treated with ADT for >3 months or who have completed ADT in the last 24 months, are overweight or obese and are not under the care of a dietitian or exercise professional. Participants will be randomised (1:1) to the ProHealth intervention or usual care. The intervention group will receive four consultations with an Accredited Practising Dietitian to promote a high protein and energy reduced diet, and five consultations with an Accredited Exercise Physiologist to follow a home-based progressive resistance training and aerobic exercise programme. The primary outcomes are feasibility (recruitment rate, retention, data completeness, reach, safety, consultation attendance and adherence, and usage of the ProHealth web platform), acceptability and satisfaction of the ProHealth intervention. Exploratory secondary outcomes will be assessed at baseline and 12 weeks and include changes in body weight and composition (total and appendicular fat-free mass, fat mass), quality of life (Functional Assessment of Cancer Therapy (FACT)-General, FACT-Prostate, FACT-Fatigue), physical function (30-second sit-to-stand), dietary intake (3-day food diary) and physical activity (7-day accelerometer). Linear regression models will estimate differences between the intervention and usual care group. Qualitative interviews on participant satisfaction will be transcribed verbatim for thematic analysis.

This study is approved by Deakin University Human Research Ethics Committee (DUHREC2024-038) and registered on Australian and New Zealand Clinical Trials Registry (ACTRN12624000874516). Findings will be disseminated through peer-reviewed journals, scientific meetings and other public forums.

ACTRN12624000874516.

Canine meningioma is the most common intradural extramedullary and primary spinal cord tumor. Previous studies suggest that postoperative radiation therapy can be effective for spinal meningiomas. Information on radiation-induced complications and prognosis remains limited. This case series evaluated treatment outcomes of surgical and radiation therapy in dogs with spinal meningiomas. Ten dogs were included. All underwent surgery, and histopathological examination confirmed meningioma. Among the four cases where surgical margins were assessed, three had incomplete resections. Postoperative radiation therapy was administered as an adjuvant treatment in nine dogs. One dog that did not receive postoperative radiation underwent radiation upon recurrence, observed at 99 days postsurgery. The radiation protocol consisted of fractionated irradiation (32-55 Gy/12-21 fractions) delivered five times per week. During the observation period, nine of 10 dogs died, with a median survival time of 568 days (range: 165-1823 days). Local recurrence occurred in six dogs at 95, 99, 153, 367, 433, and 1086 days postoperatively, confirmed by magnetic resonance imaging. Among 10 dogs receiving radiation, one experienced worsening limb paralysis on day 1679, suspected as a radiation-induced complication. No clinically evident acute or late radiation-induced side effects were noted in the medical records of the remaining cases.

IntroductionPostoperative active raster-scanning intensity modulated proton beam therapy (IMPT) for gynecological cancers requires precise target coverage, yet interfractional motion of the vaginal cuff and adjacent pelvic organs may compromise dosimetric robustness. This study retrospectively assessed interfractional organ movement and evaluated the clinical need for rectal balloon (RB) use to ensure adequate target coverage.Methods23 patients, 17/6 with/without RB, received postoperative IMPT between 2017 and 2020 at Heidelberg Ion-beam Therapy Center (HIT). Positioning verification computed tomography (pv-CT) and treatment planning CT (tp-CT) images were retrieved and rectum, bladder and the vaginal cuff (VC) were contoured. The clinical target volume (CTV) and planning target volume (PTV) were mapped from tp-CT to the pv-CT images and forward dose calculation was performed. To assess the volume of the VC not covered by the CTV or PTV, the region of interest (ROI), VC outside of CTV (VC-CTV) and outside of PTV (VC-PTV) were created. Volume differences (Δ) to the tp-CT images and dose parameters for each ROI were evaluated.Results139 pv-CTs were analysed. The use of RB significantly reduced VC displacements, resulting in fewer pv-CTs with the VC located outside the CTV (40% vs. 91%, p = 0.0252) and PTV (28% vs. 68%, p = 0.0362). CTV/PTV coverage and ROI doses remained stable across all fractions and there was no significant difference between groups. The applied PTV margins ensured robust dose coverage despite interfractional anatomical variations.ConclusionRB application effectively reduced interfractional VC motion and there was no significant Δ in target coverage or ROI doses. Using tp-CT images with full and empty bladder for definition of the CTV and standardized PTV margins contributed to stable dosimetry outcomes, confirming the robustness of the used IMPT treatment protocol. However, the use of RB may be beneficial, especially in patients with known gastrointestinal comorbidities or trapped air in the rectum.

As a prevalent side effect, chemotherapy-induced nausea and vomiting (CINV) imposes a burden on the daily lives of patients with breast cancer. Multiple clinical trials have suggested the validity of acupuncture in alleviating CINV; however, the optimal acupuncture modality remains unclear.

This protocol describes a systematic review and network meta-analysis to investigate the efficacy and safety of distinct acupuncture interventions for treating CINV in patients with breast cancer.

Eight databases (PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, VIP Database, Wanfang Database, and the Chinese Biomedical Literature Database) will be searched for eligible studies from their respective inception to July 31, 2025. The language of published studies is limited to English and Chinese. Primary outcomes are CINV intensity and clinical effectiveness rates. Secondary outcomes include recurrence rates, safety outcomes, and quality of life. Risk of bias will be assessed using the Cochrane risk of bias tool. Pairwise meta-analysis will be conducted in Stata using random-effects models with Hartung-Knapp-Sidik-Jonkman CIs. Network meta-analysis will be conducted using Bayesian Markov chain Monte Carlo methods in R software. Convergence will be assessed using Gelman-Rubin statistics and trace plots. Heterogeneity will be summarized using τ2 and τ, along with prediction intervals, when applicable. Consistency between direct and indirect evidence will be evaluated using the node-splitting method and design-by-treatment interaction test. Small-study effects will be assessed via comparison-adjusted funnel plots and the Egger test in Stata. Where feasible, subgroup analyses and meta-regression analyses will be performed. The certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation framework.

A preliminary scoping search was completed in August 2025, and this protocol was finalized in October 2025. The comprehensive literature search and study selection are expected to be completed by June 2026, followed by data extraction by August 2026. Data synthesis and final manuscript preparation are scheduled to be completed by December 2026.

This analysis will expand the range of evidence-based acupuncture options available to clinicians for treating CINV in patients with breast cancer.

Oral medications are commonly used in the treatment of breast cancer (BC), despite high rates of nonadherence. As adherence is fundamental for optimal treatment, finding ways to effectively improve it is important. Artificial intelligence (AI) is being widely applied to health care.

This review aims to offer an overview of the contribution of AI to medication nonadherence among patients with BC, suggesting future research directions, and highlighting existing gaps.

Four databases (PubMed, Embase, Scopus, and Web of Science) were searched. Studies were eligible if they used AI to predict, monitor, or support medication adherence in patients with BC, were published in English, and had full text available. Reviews, conference abstracts, editorials, and studies with mixed samples were excluded. This review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered in PROSPERO (International Prospective Register of Systematic Reviews) database (CRD42024587020). The risk of bias was evaluated using the PROBAST (Prediction Model Risk of Bias Assessment Tool) and the Downs and Black's methodological quality scale.

Ten studies were included in this review. Most of them (k=9) focused on developing machine learning models to predict medication nonadherence. These studies used a range of techniques, including logistic regression, artificial neural networks, and random forests. Model performance varied widely, with area under the receiver operating characteristic curve values ranging from 0.61 to 1.00. Predictors of nonadherence were clustered into 4 groups: clinical, disease, and treatment-related factors (eg, side effects and comorbidities); behavioral factors (eg, prior nonadherence); psychosocial factors (eg, quality of life and self-efficacy); and sociodemographic factors (eg, age and income). The only intervention study identified evaluated an AI-based chatbot and reported promising results, showing a 20% increase in adherence among participants who engaged with its reminder feature. All included studies were at high risk of bias, mainly due to the absence of model calibration or insufficient reporting, and their findings should therefore be interpreted with caution. A further limitation was the lack of attention to implementation: predictive accuracy alone is insufficient, and future work must also address actionability, safety, and cost-effectiveness to enable real clinical use. Progress in this area will require coordinated efforts among researchers, developers, clinicians, and policymakers to support the responsible development and implementation of these tools into routine care.

To our knowledge, this is the first systematic review of AI applications specifically targeting medication adherence in BC. It focuses on both predictive and interventional studies, mapping current AI applications within this specific clinical context. The findings highlight gaps in the implementation phase and emphasize the need for future research integrating a coordinated, multidisciplinary approach involving researchers, AI specialists, policymakers, and health care teams.

Research suggests that multi-modal prehabilitation can improve quality of life and clinical outcomes. There is, however, limited evidence on the effect of prehabilitation on hospital resource use.

This is a non-randomised observational cohort evaluation. The intervention group were patients receiving multi-modal prehabilitation (Active Together) before surgery for colorectal, lung or upper gastrointestinal cancer between January 2022 and March 2024. Patients who declined to participate in Active Together and historical patient data (2017-2021) were used as comparator groups. Outcome measures were length of hospital stay, length of critical care stay, total number of days spent in hospital as a readmission within 90 days following surgery, and one-year survival rate.

Three hundred and five patients completed prehabilitation, 96 patients declined to join the service, and 869 patients were included in the historical dataset. Active Together colorectal patients spent less time in critical care than historical colorectal patients (0.9 vs 1.2 days, p = 0.011). Whereas Active Together lung patients spent longer in critical care than historical lung patients (2.5 vs 1.7 days, p < 0.001). One-year survival rate was greater in Active Together patients compared to the declined group (95% vs 85%, p = 0.013) but did not differ significantly from the historical group (95% vs 92%, p = 0.140). The probability of prehabilitation being more cost-effective than not receiving prehabilitation was 58%, 60%, and 59% for colorectal, lung and upper gastrointestinal patients, respectively.

The impact of prehabilitation on healthcare resource use was mixed with promising evidence of a positive effect of prehabilitation and rehabilitation on overall survival. There were notable differences between tumour groups in these outcomes which warrants further investigation. Future research is needed to build on these findings by including a larger sample size, a wider range of tumour groups, and a longer follow up period.