T-cell lymphomas are a heterogeneous group of lymphoid neoplasms with a variable prognosis. They can be further divided into cutaneous T-cell lymphomas and peripheral T-cell lymphomas. Treatment options are relatively limited for patients with relapsed or refractory disease. Janus kinase (JAK) inhibitors have emerged as promising new drugs for these lymphomas, as increasing evidence supports the JAK and signal transducer and activator of transcription (STAT) pathway as a potential target. The objective of this review is to summarize the current evidence supporting the use of JAK inhibitors in the treatment of T-cell lymphomas and highlight areas for future research. Although many JAK inhibitors have been developed for the treatment of autoimmune conditions, only a subset of these have been tested in T-cell lymphomas and reported in the literature. These include abrocitinib, cerdulatinib, golidocitinib, ruxolitinib, tofacitinib, and upadacitinib. Other drugs are currently being tested in clinicals trials, including pacritinib and ivarmacitinib, but results are not yet available. Most of the published data are for ruxolitinib, which was found to have a clinical benefit rate of up to 53% in patients with PTCL with activating JAK and/or STAT mutations. Response durations are limited, which may be overcome through combination therapies in the future. JAK inhibitors are associated with multiple adverse effects, including cytopenias and infections, and long-term safety data are lacking for newer agents. Future studies will need to clarify long-term safety and efficacy through well-designed clinical trials involving larger groups of patients.

Background: MRI-based radiomics has shown promise in men with prostate cancer (PCa); however, successful clinical implementation is contingent upon on reproducible measurements. Purpose: We assessed the reproducibility of radiomics features extracted from bi-parametric prostate MRI (bpMRI) in prostate lesions and non-tumoral prostate tissue in men with PCa undergoing active surveillance (AS). Methods: This retrospective study included 47 men with biopsy-proven PCa undergoing AS (mean 68.9 ± 8.2 years, mean PSA density [PSAD] 0.08 ± 0.03 ng/mL/mL) who underwent two bpMRI approximately 12 months apart (range, 10-14 months; December 2018 to April 2020). The reproducibility of radiomics measurements was assessed using the same MRI platform (3T Skyra, Siemens Healthineers; inter-platform) (n = 37), different MRI vendors (Skyra, Siemens Healthineers; 3T Discovery MR750, GE Healthcare; inter-platform) (n = 10), and between observers (n = 10). Shape/1st-/2nd-order radiomics features were extracted from regions of interest on axial T2-weighted (T2-WI), diffusion-weighted imaging (DWI, b1600), and apparent diffusion coefficient (ADC) maps on prostate lesions, non-tumoral peripheral zones (PZs), and transition zones (TZs) using software. Reproducibility was evaluated by calculating the intraclass correlation coefficient (ICC) and coefficient of variation (CV). Associations of clinical variables and prostate volume were assessed. Results: PCa diagnoses included Gleason grade groups 1 (n = 46) and 2 (n = 1)]. Thirty-seven lesions (mean size 0.9 ± 0.4 cm) in 31 patients had PI-RADS v2.1 scores of 2 (n = 3)/3 (n = 12)/4 (n = 21)/5 (n = 1); 16 patients demonstrated diffuse PI-RADS 2 changes. Lesion radiomics features from T2-WI yielded a high proportion of good/moderate ICCs (intra-platform, 77.8%; inter-platform, 56.5%), whereas most DWI/ADC features yielded poor reproducibility. Similar results were observed for non-tumoral PZ/TZ. Intra-platform CVs were lowest for T2-WI lesion features (13.6%) and background PZ/TZ (<13.3%), while DWI/ADC exceeded 20%. Inter-platform CVs were lowest for lesions on T2-WI and were <18% for DWI/ADC; all background PZ/TZ CVs were < 16.4%. Inter-observer analyses showed good/moderate ICCs across all sequences and regions (57.4-92.6%). The distribution of ICC and CV values did not differ between intra- and inter-platform analyses (p > 0.05). Higher reproducibility (ICC > 0.5) was associated with larger prostate volume (intra-platform diagnostic odds ratio [DOR] = 2.58, 95% confidence interval [95%CI], 1.35-3.80, p = 0.01; inter-platform DOR = 3.48, 95%CI 1.79-5.17, p = 0.01) and older age (inter-platform DOR = 5.30, 95%CI 3.75-6.85, p < 0.01). Conclusions: Radiomics measurements from T2-WI demonstrated better intra-/inter-platform reproducibility than DWI/ADC for prostate lesions and non-tumoral tissue. Patient factors (larger prostate volumes and older age) influence radiomics stability. The optimization of diffusion-based radiomics features is needed to improve reproducibility given the essential role of DWI in prostate MRI.

Background/Objectives: Palliative radiotherapy (RT) to the breast or chest wall is an effective option for symptom relief in advanced or metastatic breast cancer. However, real-world data on clinical outcomes, prognostic factors, and optimal RT dose and timing in the modern systemic therapy era remain limited. This study aimed to evaluate the efficacy of palliative breast RT and explore the optimal integration of systemic therapy with RT. Methods: We retrospectively reviewed 38 patients treated with palliative RT between 2015 and 2024 at a regional tertiary center. The median gross tumor volume (GTV) dose was 50 Gy (range, 30-62.5 Gy), corresponding to a median biologically effective dose (BED) to the GTV (α/β = 4) of 78.9 Gy. Treatment response, symptom relief, toxicity, and survival outcomes were analyzed. Results: With a median follow-up of 9.5 months, median overall survival (OS) was 12.8 months. 1- and 2-year in-field local control (LC) rates were both 79.6%. In a parsimonious multivariate analysis, ≥3 prior lines of systemic therapy (HR 3.500, 95% CI 1.278-9.590, p = 0.015) was independently associated with worse OS, whereas use of SIB or GTV boost was associated with improved OS (HR 0.351, 95% CI 0.145-0.848, p = 0.020). Higher planning target volume (PTV)-BED (α/β = 4) correlated with improved LC (HR 0.909, 95% CI 0.839-0.985, p = 0.019). Symptom relief within 3 months occurred in 82%. Treatment-related toxicities were generally mild, with no grade ≥ 4 acute or grade ≥ 2 late toxicities observed. Conclusions: Palliative breast RT achieved durable local control and effective symptom palliation with acceptable toxicity. Dose-tailored RT and earlier integration within the disease course may optimize outcomes in selected patients.

Background: Hematologic malignancies pose a critical threat to global health, with their pathological progression intrinsically linked to metabolic dysregulation and nutrient imbalance. Malnutrition accelerates the trajectory of adverse outcomes while substantially diminishing the quality of survival. Although several nutritional assessment tools are currently used in clinical practice, a significant evidence gap persists regarding their validation in populations with hematologic neoplasms. This study systematically evaluates the prognostic performance of existing nutritional assessment instruments in this cohort. Based on these findings, we further explored the feasibility of a preliminary framework that reflects metabolic characteristics specific to this population. Methods: This prospective cohort study analyzed nutritional assessment data from 1067 patients with hematologic malignancies enrolled in the INSCOC registry. Eight assessment systems were examined: Patient-Generated Subjective Global Assessment (PG-SGA), Modified PGSGA (mPG-SGA), PGSGA Short Form (PG-SGA SF), Abbreviated PGSGA (abPG-SGA), Nutritional Risk Screening-2002 (NRS-2002), Global Leadership Initiative on Malnutrition criteria (GLIM), Scored-GLIM, and Karnofsky Performance Status Scale (KPS). Kaplan-Meier survival curves and multivariate Cox regression analyses were conducted to investigate the association between nutritional status and overall survival (OS) and to determine the prognostic weight of individual components within the nutritional assessment tools. Linear regression models were applied to examine the relationships between nutritional assessment tools, length of hospital stay (LOS), and EORTC QLQ-C30 scores. The predictive performance of the tools was evaluated using the area under the receiver operating characteristic curve (AUC) and the concordance index (C-index). Least absolute shrinkage and selection operator (LASSO) regression was applied to optimize the selection of inflammation-related biomarkers. Results: A total of 1067 participants were analyzed (mean [SD] age, 55.54 [17.4] years; 625 were male [58.6%]). Cox proportional hazards regression demonstrated statistically significant associations for all eight nutritional assessment tools (p ≤ 0.05). However, their prognostic discrimination was limited, as indicated by the AUC analysis. Specifically, the area under the curve (AUC) values for each tool were as follows: mPG-SGA, 0.561; NRS-2002, 0.557; PG-SGA, 0.550; KPS, 0.544; PG-SGA SF, 0.542; abPG-SGA, 0.528; Scored-GLIM, 0.489; and GLIM, 0.473. The concordance index validation further corroborated these findings. Prognostically significant components and inflammation-related biomarkers identified by Cox and LASSO regression were combined to explore a composite assessment approach, termed the Hematologic Marker-Patient Generated Subjective Global Assessment (HMPG-SGA), incorporating the albumin-globulin ratio (AGR). The HMPG-SGA was significantly associated with overall survival (p < 0.001), with an AUC of 0.616 and a C-index of 0.605. Conclusions: Multidimensional validation demonstrated limited prognostic discrimination of eight conventional nutritional assessment tools for overall survival in patients with hematologic malignancies. Based on existing assessment tools and integrated hematologic indicators, the HMPG-SGA was preliminarily explored as a prognostic assessment tool in hematologic malignancies.

Prescription monitoring programs (PMPs) are commonly used to monitor non-medical opioid use (NMOU); however, the effectiveness of PMPs for identifying cancer patients with risk factors is not well known.

This study assessed the frequency and predictors of concerning PMP findings among cancer patients in a palliative care clinic and examined the ability of PMPs, clinical review, and urine drug testing to identify NMOU behaviors. This was a retrospective analysis of consecutive cancer patients seen by palliative care at a safety-net hospital over four years. Demographic, clinical, and psychosocial risk factors for NMOU were extracted from the medical record. Concerning PMP findings were based on prescriber documentation. Logistic regression models identified predictors of documented PMP concerns.

Among 906 patients, 844 (93%) had PMP reviews at either consultation or a follow-up visit. Of these, 31/844 (4%) demonstrated documented PMP concern. Predictors of documented PMP irregularities included a history of illicit drug use (OR 6.30, 95% CI: 2.35-17.06), opioid use for non-malignant pain (OR 19.49, 95% CI: 6.24-60.90), and a family history of illicit drug use (OR 5.42, 95% CI: 0.96-25.04).

A total of 166 patients (20%) were identified as having NMOU behaviors based on clinical review; in contrast, PMP review identified only 31 (4%) patients with NMOU behaviors, and two (6%) were missed by clinical review. Documented PMP concern was low in cancer patients. Clinical review identified most patients with NMOU behaviors, with limited contribution from PMP review. Our findings suggest that PMP should not be used in isolation when assessing opioid-related risk in this population.

Philadelphia-Negative Myeloproliferative neoplasms (MPNs) are chronic clonal hematopoietic malignancies characterized by dysregulated myeloid proliferation, chronic inflammation, and an increased risk of thrombotic and hemorrhagic complications. In addition to disease-related morbidity, MPNs are associated with a substantial symptom burden that significantly impacts quality of life. Menopause is accompanied by hormonal changes that can produce symptoms overlapping with those of MPNs, complicating clinical assessment and management in affected women. This challenge is further compounded by the lack of disease-specific guidance on menopause management in women with MPNs and ongoing concerns regarding the thrombotic risk associated with hormone replacement therapy (HRT). This narrative review summarizes the current evidence on menopause in women with Philadelphia chromosome-negative MPNs, with particular focus on the safety and role of HRT, non-hormonal therapeutic alternatives, and supportive care strategies. We also propose a pragmatic clinical algorithm to support individualized menopause management in this high-risk population.

Neuroendocrine tumors (NETs) are rare neoplasms arising from the diffuse neuroendocrine system that can range from indolent to highly aggressive diseases. They usually clinically manifest when reaching a significant size or when hepatic metastases develop, leading to overproduction and impaired hepatic metabolism of vasoactive substances. The clinical course of NETs may be complicated by cardiac involvement, known as carcinoid heart disease (CHD), predominantly affecting the right side of the heart. CHD is characterized by specific echocardiographic features, including thickening, reduced excursion and retraction of valvular leaflets, resulting in valvular stenosis or regurgitation. Despite its clinical relevance, awareness of CHD as a complex hormonal sequela of NETs remains limited among cardiologists, and its echocardiographic findings are not universally recognized. This review aims to (a) provide cardiologists with the main principles for understanding CHD pathophysiology; (b) illustrate the main echocardiographic features of CHD, using a stepwise approach; and (c) refine a diagnostic algorithm for detecting cardiac involvement in NET populations and identifying patients at high risk of developing CHD.

Background/Objectives: Non-muscle invasive bladder cancer (NMIBC) is characterized by high recurrence rates, requiring frequent diagnostic and therapeutic interventions. This study evaluates the feasibility, safety, oncological outcomes, and economic impact of implementing an in-office laser bladder tumor fulguration protocol. Methods: A descriptive, longitudinal study was conducted between 2020 and 2025 on 65 patients with recurrent NMIBC. Procedures were performed in an outpatient setting under local anesthesia using a flexible cystoscope and a Holmium:YAG (Ho:YAG) laser. The primary endpoint was recurrence-free survival. Secondary endpoints included complication rates (Clavien-Dindo) and a cost-analysis comparison with conventional transurethral resection of the bladder (TURBT). Results: The mean age was 69.4 years, with 89.2% of patients classified as ASA ≥ 2. After a median follow-up of 20.3 months, the recurrence rate was 33.8%, with 0% progression. Most procedures (95.4%) had no complications; only 4.6% presented Clavien-Dindo grade 1 events. Adjuvant mitomycin C was administered in 93.8% of cases. The cost analysis demonstrated substantial economic advantages, with costs reduced by 89.7% versus the 24 h admission model and 82.1% versus the day-surgery model according to regional health-system tariffs. Conclusions: In-office laser fulguration is a safe, effective, and economically sustainable alternative to traditional TURBT for selected low-risk recurrences. It optimizes hospital resources, minimizes anesthetic risk in comorbid patients, and maintains favorable oncological control.

The integration of immunotherapy with neoadjuvant therapy for proficient mismatch repair (pMMR) locally advanced rectal cancer (LARC) is a promising strategy. However, the optimal treatment platform, a short-course radiotherapy (SCRT)-based regimen or a long-course chemoradiotherapy (LCRT)-based regimen, remains uncertain due to the absence of direct comparative trials. This network meta-analysis (NMA) aimed to compare the efficacy and safety of these two platforms, each with or without immune checkpoint inhibitors (ICIs).

We systematically searched PubMed/MEDLINE, Embase, and Cochrane Library from inception to September 20, 2025, for randomized controlled trials (RCTs) comparing neoadjuvant SCRT-based or LCRT-based regimens combined with ICIs versus the corresponding regimens without ICIs in LARC. A frequentist NMA was performed using random-effects models. The co-primary outcomes were the curative-intent response rate [a composite of pathological complete response (pCR) or clinical complete response followed by a Watch-and-Wait strategy (WW)] and the incidence of grade ≥ 3 treatment-related adverse events (TRAEs). The pCR rate was a key secondary endpoint. Treatments were ranked using surface under the cumulative ranking curve (SUCRA) probabilities.

Seven RCTs (1132 patients) evaluating four strategies (SCRT-based regimen alone, SCRT-based regimen with ICIs, LCRT-based regimen alone, and LCRT-based regimen with ICIs) were included. For the primary endpoint of curative-intent response, SCRT + ICIs had the highest probability of being the most effective treatment (SUCRA, 98.5%). SCRT + ICIs significantly outperformed SCRT alone (RR, 1.82; 95% CI, 1.27-2.60) and LCRT alone (RR, 2.23; 95% CI, 1.33-3.76). It also showed a numerical, but non-significant, advantage over LCRT + ICIs (RR, 1.63; 95% CI, 0.88-3.02). The addition of ICIs to LCRT resulted in a numerical increase in response (RR, 1.37; 95% CI, 0.98-1.90) compared to LCRT alone. Results for the pCR rate were consistent in treatment ranking. Regarding safety, the addition of ICIs to either platform was not associated with a significant increase in grade ≥ 3 TRAEs, and no significant difference was observed between the two combination strategies (SCRT + ICIs vs. LCRT + ICIs: RR, 0.87; 95% CI, 0.38-2.04).

This NMA suggests that the SCRT-based platform may be the preferred option to combine with immunotherapy in pMMR LARC. The results support direct comparison of these platforms in future phase III trials focused on long-term survival and organ preservation.

To evaluate whether arterial phase CT using the downslope injection method improves the detection of liver metastases from colorectal cancer (LMCC) compared with portal venous phase (PVP) imaging alone.

This retrospective study included 57 patients with 180 confirmed LMCC lesions who underwent CT using the downslope injection method. Early arterial phase (EAP, 25 s) and late arterial phase (LAP, 40 s) images were evaluated by three radiologists for lesion detection and enhancement patterns. Detection rates were compared using generalized estimating equations with PVP as reference.

Among 180 LMCC, 42 (23%) were hyperenhancing, 78 (43%) ring-enhancing, 50 (28%) hypoenhancing, and 10 (6%) not detectable on arterial phases. Small lesions (≤ 10 mm) showed the highest proportion of arterial hyperenhancement (42%). LAP images (162/180, 90%) significantly outperformed PVP alone (143/180, 79%; odds ratio 2.29; 95% confidence interval [CI] 1.05-4.98; p = 0.037). For hyperenhancing lesions, EAP (86%; p = 0.011) and LAP (81%; p = 0.024) demonstrated significantly higher sensitivity than PVP (52%). Interobserver agreement was moderate to good for detectability (κ = 0.64-0.77) and almost perfect for enhancement pattern classification (Cohen's κ = 0.87-0.95).

Adding arterial phase CT using the downslope injection method to PVP significantly improves the detection of LMCC, particularly small hyperenhancing lesions.

Question Can arterial phase CT with optimized contrast injection improve the detection of small colorectal liver metastases frequently missed on portal venous phase imaging? Findings Late arterial phase CT detected 90% of colorectal liver metastases and significantly outperformed portal venous phase alone (79%) using the downslope injection method. Clinical relevance Arterial phase CT improves the detection of small colorectal liver metastases, enabling more accurate preoperative staging. The downslope injection method optimizes arterial phase enhancement without increasing contrast dose.