Circulating cell-free DNA (cfDNA) has attracted increasing attention as a minimally invasive biomarker for assessing radiation-induced tissue injury. Radiation exposure can alter cfDNA concentration, fragmentation profiles, and methylation patterns. These changes may reflect cellular damage, tissue origin, and temporal responses to irradiation. During radiotherapy, however, cfDNA can arise from tumor cells, irradiated normal tissues, endothelial cells, immune cells, and hematopoietic cells. This mixed origin complicates the interpretation of radiation-related signals. Current evidence is derived mainly from preclinical studies and small, heterogeneous clinical cohorts. Sampling schedules, analytical workflows, and clinical thresholds also vary across studies. Recent advances in fragmentomics, tissue-specific methylation analysis, mitochondrial cfDNA, multi-omics integration, and artificial intelligence have expanded the information obtained from cfDNA. In particular, tissue-specific methylation and fragmentation features may help identify the cellular or organ origin of injury. Nevertheless, prospective multicenter validation and methodological standardization are required before routine clinical use. This review summarizes the mechanisms linking radiation injury to cfDNA release, current detection technologies, and evidence for organ-specific applications. It also discusses clinical confounders, translational barriers, and future directions for integrating cfDNA into precision radiation oncology.

PD-L1 expression is an established predictive biomarker for immune checkpoint inhibitor therapy in recurrent or metastatic head and neck squamous cell carcinoma (HNSCC), including oral squamous cell carcinoma (OSCC). However, the spatial heterogeneity of PD-L1 and additional biomarkers such as c-MET between primary tumors and lymph node metastases remains insufficiently characterized. Given the potential for compartment-specific biomarker differences between primary tumors and metastatic lesions, we investigated PD-L1 and c-MET expression patterns in matched primary tumors and lymph node metastases of OSCC patients.

In this retrospective cohort study, PD-L1 expression (Tumor Proportion Score [TPS], Combined Positive Score [CPS]) and c-MET expression (H-score, percentage-based scoring) were analyzed by immunohistochemistry in primary tumors from 59 OSCC patients. Matched primary tumor-lymph node metastasis pairs were available for 24 patients and served as the basis for the paired spatial heterogeneity analyses. Biomarker concordance between primary tumors and metastases as well as associations with clinicopathologic parameters were evaluated.

Both PD-L1 and c-MET were frequently expressed in primary tumors but showed significantly lower expression levels in matched lymph node metastases. Higher PD-L1 expression in primary tumors was associated with nodal metastasis in exploratory analyses, whereas c-MET expression showed no significant association with nodal status. No significant correlation between PD-L1 and c-MET expression was observed. Furthermore, discordance of PD-L1 CPS status between primary tumors and lymph node metastases resulted in different biomarker classifications in a substantial subset of matched cases. In exploratory analyses, biomarker expression and primary tumor-lymph node discordance were not significantly associated with recurrence, although the limited number of events precludes definitive conclusions.

Our findings demonstrate pronounced spatial heterogeneity of PD-L1 and c-MET expression in OSCC and reveal compartment-specific biomarker expression patterns between primary tumors and lymph node metastases. The observed discordance between tumor compartments warrants further investigation in larger prospective studies to determine its biological and potential clinical relevance for biomarker assessment in OSCC.

This study investigated the correlation between serum parathyroid hormone (PTH) levels and the risks of all-cause and cause-specific mortality, with specific focus on the association between serum PTH levels within the normal range and mortality risk. This prospective cohort study included 6633 non-hypoparathyroid participants (aged ≥ 20 years) from the National Health and Nutrition Examination Survey 2003-2006. We employed restricted cubic splines to depict the dose-response relationship between serum PTH and the risks of mortality. Multivariate Cox proportional hazards models were used to calculate the hazard ratios (HR) and 95% confidence intervals (95%CI). Among the 6633 participants, 1309 died during follow-up, including 437 cardiovascular deaths, 316 cancer-related deaths, and 556 non-cardiovascular-non-cancer deaths. Restricted cubic splines suggested that ideal outcomes were observed with serum PTH at the lower level of the normal range (18-41 pg/ml). Compared with participants in the low-normal PTH range (18-41 pg/ml), those in the high-normal range (42-74 pg/ml, accounting for 40.4% of the entire normal range) had 22% (HR:1.22,95%CI 1.02-1.46) and 66% (HR:1.66,95%CI 1.20-2.30) increased risks of all-cause and cardiovascular mortality. Similarly, participants in the high PTH range (> 74 pg/ml) had 34% (HR:1.34,95%CI 1.08-1.68), 59% (HR:1.59,95%CI 1.03-2.46) and 44% (HR:1.44,95%CI 1.02-2.04) increased risks of all-cause, cardiovascular and non-cardiovascular-non-cancer mortality. Among U.S. adults, high-normal and high PTH levels were both associated with higher risks of all-cause and cardiovascular mortality. Further studies are needed to evaluate the clinical implications of screening and management for this high-risk population, especially those with high-normal PTH levels, who account for a substantial proportion of the normal-range population but are usually receiving insufficient clinical attention.

For advanced cancer patients, unrelieved moderate-to-severe pain adversely affects quality of life and psychological well-being. While pain control is fundamental to palliative care, the benefits associated with a multimodal approach warrant investigation. This PSM-based retrospective study (2022-2025) evaluated the associations between comprehensive pain management and quality-of-life and mental health outcomes in advanced cancer. Participants received either comprehensive management (standard analgesics plus ≥1 adjunct modality: interventional oncology, thermotherapy, psychological counseling, or palliative support) or pharmacotherapy alone. One-to-one nearest-neighbor matching balanced demographics, disease status, and baseline pain severity. Primary endpoints (Numerical Rating Scale [NRS], Pain Management Index, European Organization for Research and Treatment of Cancer Quality of Life Core Scale, Hospital Anxiety and Depression Scale) were assessed at baseline and two weeks. Propensity matching yielded 60 balanced pairs from 150 patients (standardized mean differences < 0.1). At 2 weeks, multimodal therapy was associated with superior analgesia (NRS: 2.8 ± 1.1 vs 4.2 ± 1.3), higher response rates (58.3% vs 35.0%), and fewer undertreated cases (16.7% vs 41.7%) (all P < 0.05). Comprehensive care was associated with better functional capacity (68.5 ± 12.4 vs 55.3 ± 13.6), lower symptom burden (25.6 ± 8.9 vs 38.4 ± 11.2) (P < 0.001), and lower anxiety/depression scores (6.2 ± 2.8 vs 9.5 ± 3.1; 5.8 ± 2.5 vs 8.9 ± 3.0, P < 0.001). Opioid escalation was attenuated in the multimodal arm (47.26% vs 65.27%, P < 0.001), while adverse events were similar (P > 0.05). Regression identified comprehensive care as an independent correlate of better outcomes, and sensitivity analyses confirmed its robustness. In conclusion, comprehensive pain management was associated with superior pain control, better quality of life, and improved psychological outcomes in advanced cancer compared to standard analgesia, alongside reduced opioid escalation-a finding that may have clinical relevance for reducing opioid-related adverse events.

IntroductionLymphocele is a common complication following gynecologic cancer surgery. Given that lymphadenectomy for ovarian cancer differs from that for other gynecologic malignancies, it is essential to determine whether the risk factors for postoperative lymphocele are specific to this patient population.MethodA Delphi study was conducted to identify risk factors for postoperative lymphocele in ovarian cancer and to establish eligibility criteria for an institutional development cohort. Based on these findings, we retrospectively collected clinicopathological data from patients who underwent ovarian cancer staging surgery at our institution between 2019 and 2024. Postoperative lymphocele and baseline clinical variables were compared using chi-square tests and regression analyses. A nomogram for predicting lymphocele risk was developed using the least absolute shrinkage and selection operator (LASSO) method, and its performance was evaluated using calibration curves and decision curve analysis (DCA).ResultsFollowing three rounds of the Delphi survey, 13 risk factors met the criteria for expert consensus and boundary definition. Among 324 patients with ovarian cancer, multivariate analysis revealed that open surgery, a higher number of retrieved lymph nodes, and adjuvant therapy were independently associated with lymphocele. LASSO regression selected age, hypertension, diabetes, anemia, surgical approach, lymphadenectomy details (number and extent), lymph node metastasis, drainage, and adjuvant therapy as predictors for the nomogram. The model demonstrated good predictive performance (C-index: 0.784), which was confirmed by calibration and decision curve analyses.ConclusionBy incorporating the Delphi method into the development of our prediction model, we achieved a more comprehensive identification of risk factors for postoperative lymphocele in ovarian cancer than previously reported. We anticipate that this innovative model will facilitate broader adoption in future clinical practice and research.

Cancer equity is a global priority, particularly within Universal Health Coverage systems that are committed to reducing disparities in access and outcomes. However, practical barriers to addressing inequities persist, such as varying definitions and clinical measurements. This inconsistency leads to a reliance on data that does not accurately reflect existing inequities or progress towards equitable care. Commonly reported measures are often aggregate, population-level indicators, such as cancer incidence and mortality, which fall outside the scope of health services and clinicians to influence. A detailed protocol and search strategy were developed a priori, following the Joanna Briggs Institute Reviewer's Manual. Systematic searching was conducted via PudMed Central, CINAHL EBSCO and Cochrane, resulting in 53 studies meeting the selection criteria for analysis. Only eight (n = 8) studies offered definitions of equity, commonly emphasising accessible health services that support optimal health outcomes and the elimination of financial barriers. Seven (n = 7) main equity-related exposures or populations were associated with experiencing cancer inequities: ethnic minority or migrant populations, low socio-economic status, geographic location or remoteness, experiencing severe mental illness, low health literacy, high comorbidities, and those with a disability. A total of fifty-nine (n = 59) individual measures were utilised to demonstrate inequities. The absence of standardised, reproducible data undermines cancer equity efforts, as ad hoc reporting can misrepresent disparities or perpetuate the statistical invisibility of disadvantaged populations. This review aimed to summarise how equity has been defined and measured within UHC contexts, to inform the development of intentional and validated indicators for measuring and addressing cancer inequities.

Neoadjuvant chemotherapy (NAC) is widely utilized in female breast cancer to achieve disease downstaging, reduce distant dissemination, and assess chemosensitivity. However, the efficacy of NAC in male breast cancer (MBC) remains poorly understood. This study aimed to evaluate pathologic complete response (pCR) rates and overall survival (OS) outcomes following NAC in MBC patients, stratified by tumor subtype.

Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database for MBC patients who received NAC between 2000 and 2020. Patients were categorized by receptor status: hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-), HR+/HER2+, HR-/HER2+, and HR-/HER2-. The proportions of pCR (ypT0/Tis ypN0) were compared across subtypes. OS was estimated using the Kaplan-Meier method, and differences were analyzed using the log-rank test. Propensity score matching (PSM) was applied to reduce selection bias inherent to this retrospective observational study. Based on the baseline characteristics of breast cancer patients who received NAC, univariate Cox proportional hazards regression analysis was first performed to screen potential prognostic variables. Covariates with statistically significant differences in the univariate model were subsequently incorporated into the multivariate Cox regression model to identify independent risk factors associated with OS prognosis. Statistical analyses were performed using STATA 12.0 and SPSS Version 23.0.

A total of 260 MBC patients who received NAC were included in the analysis. No statistically significant difference in OS was observed between MBC and FBC patients receiving NAC (HR = 1.067; 95% CI: 0.929-1.226; p = 0.358). However, female patients had a better OS (HR = 0.930; 95% CI: 0.913-0.948; p < 0.001) after PSM. Five-year OS for MBC patients with pCR versus non-pCR was 92% vs. 77.3% (HR = 1.236; 95% CI: 0.787-1.942; p = 0.357). The results were further confirmed in the multivariate Cox regression model after PSM, in which pCR can be considered an independent prognostic factor. In addition, adjuvant chemotherapy demonstrated superior OS compared to NAC in MBC patients (HR = 3.223; 95% CI: 2.772-3.747; p < 0.001). The proportions of pCR by tumor subtype were as follows: (i) HR-/HER2+: 50.0% (n = 3), (ii) HR-/HER2-: 41.7% (n = 5), (iii) HR+/HER2+: 10.7% (n = 7), and (iv) HR+/HER2-: 5.5% (n = 9). OS was significantly worse with NAC compared to adjuvant chemotherapy in both HR+/HER2- (HR = 1.363; 95% CI: 1.129-1.646; p = 0.001) and HR+/HER2+ (HR = 1.951; 95% CI: 1.449-2.627; p < 0.001) subtypes. However, no statistically significant differences were observed in HR-/HER2+ (HR = 2.296; 95% CI: 0.807-6.538; p = 0.119) and HR-/HER2- (HR = 1.758; 95% CI: 0.847-3.649; p = 0.130).

This population-based study demonstrates that MBC patients receiving NAC achieved significantly lower pCR rates compared to female patients. The HR+/HER2- and HR+/HER2+ subtypes exhibited greater resistance to NAC. Furthermore, achieving pCR was not prognostic for improved survival in MBC. These findings suggest that NAC may not be necessary for all MBC cases. Future research should explore alternative treatment strategies tailored to the unique biological characteristics of MBC.

This case report aimed to describe the use of a patient-specific 3D printed model to support communication and informed consent in a pediatric patient diagnosed with Gorlin syndrome, a rare condition frequently associated with multiple odontogenic keratocysts.

A 9-year-old girl with Gorlin syndrome presented with swelling of the maxilla and mandible. Imaging revealed two large cystic lesions. Conventional explanations using radiographs and CBCT slices failed to ensure adequate parental understanding, partly due to language barriers. A digital workflow was developed using free segmentation software (3D Slicer) and a low-cost fused deposition modelling printer to produce life-size maxillary and mandibular models, with cysts highlighted in color. The models were presented during consultation, enabling the family to visualize the extent of the lesions and their proximity to critical structures. According to parental feedback, the model made the pathology and surgical rationale "much clearer" than prior explanations. Informed consent was successfully obtained, and the family adhered to follow-up and referral recommendations.

This case demonstrates that patient-specific 3D printed models can enhance comprehension, engagement, and trust in the care of children with complex conditions. Such models represent a feasible, low-cost adjunct to the informed consent process in dentistry.

This report describes the excisional biopsy of a lower lip mucocele using a dual-wavelength super-pulsed diode laser (810/980 nm). The procedure was performed under local anesthesia using a 400 μm fiber tip with peak power of 100 W, pulse frequency of 20 Hz, pulse width of 0.05 ms, and average power of 1.2 W. The super-pulsed emission enabled precise tissue incision, effective intraoperative hemostasis, and clear visualization of the surgical field. The excised specimen showed preserved morphology without carbonization, allowing histopathological confirmation of mucocele. After excision, photobiomodulation therapy was applied using a 7-mm adapter (0.3 W, 2 J, 7 s per point, 5.5 J/cm²) to promote postoperative analgesia and tissue repair. Healing was uneventful, with no postoperative pain, edema, or recurrence at 90 days. The dual-wavelength super-pulsed diode laser represents a minimally invasive approach for oral mucocele excision while preserving tissue integrity for histopathological analysis.

The modular four-cart design of the Hugo robotic-assisted surgery (RAS) system raises a practical concern: does it impose a greater operative workflow burden than established platforms? We characterized operative workflow across the Hugo RAS and da Vinci Multiport systems, incorporating a concurrent mature-adoption Multiport cohort as an institutional maturity reference.

This retrospective study analyzed 15 consecutive qualifying cases per cohort: Hugo RAS, initial da Vinci Multiport (de novo adoption), and recent da Vinci Multiport (mature adoption, concurrent with Hugo RAS). Primary endpoints were workflow time intervals across five phases derived from prospectively recorded timestamps. Secondary endpoints included 30-day complications, TME completeness, lymph node yield, and resection margin status.

Hugo RAS access phase (27 minutes; IQR, 20-55 minutes) was equivalent to both the initial (p > 0.999) and recent Multiport cohorts (p = 0.693). Nonsurgical time was equivalent between Hugo RAS and recent Multiport cohorts (45 vs. 40 minutes; p = 0.461), operated by the same team at identical institutional maturity. Workflow differences between Hugo RAS and initial Multiport were mirrored by equivalent differences between initial and recent Multiport cohorts-implicating institutional maturity rather than platform effects. TME completeness was 100% in all evaluable cases, and lymph node yield was equivalent across all cohorts (all pairwise p > 0.999).

The Hugo RAS four-cart architecture did not impose a greater workflow burden than the da Vinci Multiport system under equivalent institutional conditions. Remaining differences reflected case-mix heterogeneity and asymmetric adoption maturity, supporting continued multi-platform robotic colorectal program development.