To characterize changes in the retinal pigment epithelium (RPE) in pediatric combined hamartoma of the retina and RPE (CHRRPE) using wide-field swept-source optical coherence tomography (SS-OCT) and to identify factors associated with RPE involvement.

We conducted a retrospective study of children with CHRRPE diagnosed between 2018 and 2023 at Zhongshan Ophthalmic Center and imaged with wide-field SS-OCT. RPE alterations were defined using OCT features and classified as RPE deformation without discontinuity or RPE disruption with secondary changes. Factors associated with RPE involvement were evaluated using multivariable logistic regression analyses.

Forty-one eyes from 38 children (21 boys; median age, 7 years) were included. OCT showed preretinal fibrosis in 21 of 41 eyes (51%), mini-folds in 38 of 41 eyes (93%), and maxi-folds in 32 of 41 (78%). RPE involvement was detected in 11 of 41 eyes (27%), including RPE-originated vertical striae (8/41 [20%]), outer retinal hyper-reflective pigment clumps (7/41 [17%]), RPE protrusion (6/41 [15%]), RPE rupture (5/41 [12%]), and choroidal neovascularization (5/41 [12%]). RPE alterations occurred in all peripheral lesions (3/3), 50% of peripapillary lesions (3/6), and 16% of macular lesions (5/32). Multivariable analysis indicated extramacular location (odds ratio, 11.29; 95% confidence interval, 1.45-87.81; P = 0.021) and preretinal fibrosis (odds ratio, 7.08; 95% confidence interval, 1.14-44.00; P = 0.036) were associated with RPE involvement.

In pediatric CHRRPE, RPE involvement was not uncommon and was associated with extramacular location and preretinal fibrosis. Wide-field SS-OCT may help to identify structural features in pediatric CHRRPE.

Characterizing swept-source optical coherence tomography patterns in children with combined hamartoma of the retina and retinal pigment epithelium links retinal pigment epithelium damage to inner retinal contraction and supports risk stratification and follow-up planning.

Cervical cancer prevention has undergone a major shift with the implementation of human papillomavirus (HPV)-based screening, which offers high sensitivity but limited specificity due to the detection of transient infections. This has created a need for triage methods capable of identifying infections associated with clinically meaningful disease. Primary HPV testing provides a high level of reassurance when negative; however, individuals with a positive result require additional evaluation using triage methods that effectively identify precancerous lesions while avoiding unnecessary colposcopy referrals. This review addresses the role of p16/Ki-67 dual-stain (DS) immunocytochemistry as a biomarker of transforming HPV infection, with a focus on HPV-based screening settings. We discuss its biological basis and diagnostic performance in comparison with cytology, with particular attention to the principles and practical aspects of DS interpretation in routine cytopathological practice. We also summarize current evidence, including data from national studies and routine clinical practice, demonstrating that DS can be effectively integrated into screening pathways and support more informed clinical decision-making. Its increasing use reflects the broader transition toward biologically informed cervical cancer prevention.

Breast cancer remains a major cause of cancer-related morbidity among women worldwide, with persistent disparities in diagnosis, treatment access, and outcomes across low- and middle-income settings. Institution-based real-world data are limited in Bangladesh. This study aimed to describe the clinicopathological characteristics, molecular subtype distribution, documented treatment patterns, and progression-related outcomes of breast cancer patients managed at a tertiary care center in Bangladesh.

This retrospective observational study was conducted at Bangladesh Specialized Hospital, Dhaka, Bangladesh. Hospital records of 1058 adult breast cancer patients were reviewed. Data on demographics, tumor characteristics, molecular subtype, documented treatment modalities, and follow-up were analyzed. Progression-free survival (PFS) was assessed using Kaplan-Meier methods and Cox proportional hazards regression.

Luminal A was the most common primary molecular subtype, accounting for 38.47% of cases, followed by TNBC at 23.53% and HER2-positive disease at 11.91%. Documented metastatic or recurrent disease during the available records was present in 34.59% of patients, while Stage III or IV disease at diagnosis accounted for 33.65% of the cohort. Chemotherapy was the most frequently documented treatment modality, recorded in 79.02% of patients, followed by endocrine therapy in 53.78%, breast surgery in 56.52%, HER2-directed therapy in 21.17%, and radiotherapy in 20.04%. Among luminal cases, endocrine therapy was documented in 86.61%, and among the HER2-positive analytical subgroup, HER2-directed therapy was documented in 85.96%. A total of 59 PFS events were recorded, comprising 58 progression events and one death. In multivariable Cox analysis, Luminal B, HER2-negative disease, adjusted hazard ratio 2.97, 95% CI 1.41 to 6.23, p = 0.004, and HER2-positive disease, adjusted hazard ratio 2.70, 95% CI 1.39 to 5.26, p = 0.003, were associated with poorer PFS relative to Luminal A.

In this institution-based cohort, molecular subtype remained an important determinant of progression-related outcome. Luminal A showed the most favorable progression-related profile, whereas Luminal B, HER2-negative, and HER2-positive disease had poorer PFS. The study also demonstrates active use of multimodality treatment and provides real-world evidence on breast cancer care patterns at a tertiary oncology center in Bangladesh.

Carcinoma of the temporal bone is a rare disease entity accounting for about 0.2% of malignancies in the head and neck. The objectives of the present study are to report outcomes after surgical resection with adjuvant radiotherapy for patients with advanced temporal bone carcinoma with facial paralysis at presentation. The current study was conducted as a retrospective chart review and included patients with biopsy-proven squamous cell carcinoma of the temporal bone with complete facial paralysis at presentation (T4 by definition). All included patients underwent temporal bone resection and facial nerve sacrifice just lateral to the geniculate ganglion with simultaneous free flap coverage from January 1997 to December 2022. There was one mortality in the study population (0.9%). One patient suffered a stroke during their perioperative course (0.9%); 3 patients had myocardial infarctions (2.9%); 2 patients developed cerebrospinal fluid leaks (1.9%); 3 patients developed encephaloceles perioperatively (2.9%). Nine patients had complaints of malocclusion (8.8%). There was one flap failure in the study group. Disease-free survival at 24 months was 81.3% and overall survival at 24 months was 74.5%. The results of the current study suggest that aggressive surgical resection with high facial nerve sacrifice, simultaneous free tissue transfer, and adjuvant radiotherapy of at least 65 Gy may provide a survival benefit over other options for management in this patient population. Level of Evidence: Level III.

Understanding the population-level natural history of human papillomavirus (HPV) infection and cervical precancer is essential for informing effective prevention strategies. Multistate models provide a principled framework for characterizing disease progression by modeling transitions among discrete health states. However, intensity-based multistate analyses typically require longitudinal data, which are often costly and logistically difficult to obtain, whereas cross-sectional data are more widely available, particularly in resource-limited settings. We develop a semi-Markov multistate model that captures HPV infection dynamics and cervical precancer progression, including recurrent transitions between HPV-infected and uninfected states. To enable estimation from cross-sectional data, we propose a two-step approach that combines local cross-sectional observations with external information on transferable transition intensities. First, biologically driven transition intensities are estimated from external data under a transferability assumption. Second, these estimates are incorporated into an approximate likelihood to infer population-specific transition intensities shaped by local epidemiological and behavioral factors. Simulation studies and applications to 2 populations demonstrate the performance of the proposed method and its practical utility.

Multiple first-line (1L) and subsequent systemic treatment options are now available for patients with locally advanced or metastatic urothelial carcinoma (la/mUC), making shared decision-making increasingly important. In addition to clinical trial data, clinicians need real-world data (RWD) that describes effectiveness, safety, and contemporary treatment sequences in clinical practice. One 1L treatment option for patients with la/mUC is platinum-based chemotherapy (PBC) followed by avelumab maintenance in patients without disease progression. This narrative review summarizes Japanese RWD from three complementary studies of avelumab 1L maintenance-post-marketing surveillance, JAVEMACS, and JAVEMACS-D. These studies show that avelumab maintenance has a predictable and acceptable safety profile in Japanese clinical practice and is being used in an older and more clinically heterogeneous population than that enrolled in JAVELIN Bladder 100. These RWD also describe frequent use of cisplatin-containing chemotherapy, individualized timing of transition to maintenance, and increasing use of enfortumab vedotin after avelumab. Of note, the interpretation of some of these findings requires caution because of immortal time bias, treatment selection bias, and patient attrition before maintenance initiation. Additionally, this sequential strategy applies to a selected population without progression after induction PBC and should be interpreted in the context of the current treatment landscape, which also includes intensified 1L combination treatment options such as enfortumab vedotin plus pembrolizumab and gemcitabine-cisplatin plus nivolumab. Overall, these Japanese RWD can complement randomized clinical trial data by informing discussion of treatment trajectories, feasibility, and trade-offs, thereby supporting more individualized and patient-centered treatment decisions in contemporary la/mUC clinical practice in Japan.

Conventional physical interventions, including static photothermal ablation, frequently fail to eradicate cancer stem cells (CSCs) and instead induce sublethal stress that promotes therapeutic resistance. To address this translational challenge, this review establishes a comprehensive framework utilizing engineered gold nanoplatforms to advance the treatment strategy from non-specific cytotoxicity toward mechanism-driven phenotypic reprogramming. We outline how stimuli-responsive surface functionalization helps resolve the size-permeability paradox to secure precise intracellular access. Upon internalization, these platforms suppress intrinsic defenses by intercepting morphogenic pathways, inducing mesenchymal-to-epithelial transitions, and disrupting the bioenergetic dependence of multidrug resistance. Following this phenotypic stabilization, gold nanostructures catalyze targeted cell death via ferroptotic redox disruption and dual-metabolic blockade, alongside the immunological remodeling of the tumor microenvironment. Ultimately, by integrating real-time metabolic feedback with macroscopic surveillance, this strategy highlights the potential of gold nanoplatforms as adaptive, responsive systems to achieve precision therapy and overcome CSC-driven relapse.

Large B-cell lymphoma (LBCL) is a common and aggressive non-Hodgkin lymphoma (NHL) characterized by abnormal proliferation of mature B lymphocytes, with a 10-year prevalence of up to 45 cases per 100,000 individuals in European populations and a continuing upward trend. Axicabtagene ciloleucel (Axi-cel) and Tisagenlecleucel (Tisa-cel) are the two most established chimeric antigen receptor T-cell (CAR-T) therapy products for LBCL, yet a systematic comparison of their efficacy and safety in European populations has been lacking. This systematic review and meta-analysis aims to address this gap by comprehensively evaluating differences in treatment efficacy and adverse events between Axi-cel and Tisa-cel in European patients with LBCL.

We searched PubMed, Cochrane Library, Scopus, and other databases for studies published between January 2020 and February 2026, ultimately including eight European cohort studies with a total of 2,178 patients. Efficacy and survival outcomes comprised 3-month overall response (OR), 3-month complete response (CR), 12-month progression-free survival (PFS), and 12-month overall survival (OS). Toxicity outcomes included 12-month non-relapse mortality (NRM), all-grade and grade ≥ 3 cytokine release syndrome (CRS), all-grade and grade ≥ 3 immune effector cell-associated neurotoxicity syndrome (ICANS), all-grade and grade ≥ 3 neutropenia, thrombocytopenia, and anemia, as well as tocilizumab use and ICU support. A random-effects model was used for pooled analysis, with sensitivity analyses performed for outcomes exhibiting substantial heterogeneity.

Regarding efficacy, Axi-cel was associated with significantly higher 3-month OR and 3-month CR rates compared with Tisa-cel, whereas 12-month PFS was lower in the Axi-cel group. In terms of toxicity, the incidences of all-grade CRS, all-grade ICANS, and grade ≥ 3 ICANS were significantly higher with Axi-cel, and tocilizumab use was more frequent. No statistically significant differences were observed for the remaining outcomes.

In European patients with LBCL, Axi-cel demonstrated superior short-term efficacy compared with Tisa-cel, but showed inferior performance on certain intermediate-term efficacy endpoints and was generally associated with greater toxicity and higher healthcare resource utilization. Clinical selection of a CAR-T regimen should be individualized, with careful consideration of efficacy, toxicity, and cost. Future high-quality studies with longer follow-up are needed to evaluate long-term outcomes and to validate the findings of this analysis.

Spatially fractionated radiation therapy (SFRT) offers a method to treat bulky, radioresistant tumors while sparing normal tissues. Modern volumetric modulated arc therapy (VMAT) delivery enables conformal lattice SFRT plans, but practical guidance for implementation across different linear accelerators is limited.

This study presents a structured clinical workflow for implementing lattice SFRT across Edge and Halcyon linacs, with emphasis on quality assurance (QA) and motion management.

A systematic workflow was developed using Eclipse TPS (Acuros v16) with 6 MV flattening filter-free (FFF) beams and applied to Edge and Halcyon linacs. The implementation progressed from 28 preliminary phantom and test plans to 12 representative clinical test plans across head and neck, pelvis, and extremity sites, and 6 lung plans evaluating respiratory motion effects with and without the SDX breath-hold system. Two prescription strategies were investigated: (a) a single-fraction lattice regimen delivering 18 Gy to vertices with valley doses < 6 Gy, and (b) a simultaneous integrated boost (SIB) approach delivering 66.7 Gy to vertices with 20 Gy in 5 fractions to the entire target. Dosimetric accuracy and deliverability were evaluated using Delta4, Electronic Portal Imaging Device (EPID), and film measurements.

VMAT-based lattice SFRT plans were successfully delivered on both linacs with consistent dosimetric performance. Point-based peak-to-valley dose ratios (PVDRs) ranged from 2.8 to 3.4 across the two platforms for both dose prescriptions. Delta4 and EPID gamma pass rates exceeded 90% (3%/1 mm), and film dosimetry agreed within ∼5% uncertainty. Comparable outcomes between Edge and Halcyon support cross-platform reproducibility. In the evaluated lung cases, motion on the order of 5 mm was associated with changes in organ-at-risk (OAR) doses, highlighting the need for motion management.

This structured framework demonstrates that lattice SFRT can be safely implemented across different linac platforms. While dosimetric outcomes are institution-dependent, the method provides practical guidance for clinical adoption.

Appendicular soft tissue lymphoma (ASTL) are rare and frequently misinterpreted as soft tissue sarcoma. This can put patients at risk. Existing studies evaluating MRI of ASTL are sparse, small scaled and report heterogenous results. The purpose of this study was therefore, to identify comprehensive MRI characteristics of ASTL.

We retrospectively analyzed demographic data, clinical presentation and MRI data of 26 patients presenting to our musculoskeletal tumor surgery center between 2011 and 2023 with histopathologically proven ASTL.

Identified MRI characteristics included a diameter larger than 5 cm (77%), hyperintense signal intensity in all T2-weighted, PD-weighted and short tau inversion recovery (STIR) sequences and iso- to slightly hyperintense signal intensity in T1-weighted sequences compared to skeletal muscle. Furthermore, irregular contrast enhancement of adjacent fasciae (60%) and predominant enhancement of peripheral tumor accompanied by slightly less intensive homogenous enhancement of the remaining tumor (55%) were observed. Additionally, regional lymphadenopathy (31%), subcutaneous stranding (58%), traversing vessels (88%) and the absence of encapsulation (100%) were discernable. Features seen in ASTL primarily involving muscle (n = 16), were involvement of multiple muscles (100%), tissue types (88%) and anatomical compartments (69%) as well as long segmental involvement (69%), growth along neurovascular bundles (56%) and partial or complete encasement of major vessels (81%). Intratumoral necrosis was identified in four cases (25%).

MRI provides the presented morphological indicators, that should raise suspicion of ASTL. Our findings suggest that necrosis may occasionally occur in pretreatment ASTL and its presence alone should not exclude lymphoma from the differential diagnosis.