Peritumoral brain edema (PTBE) is a major contributor to neurological morbidity in patients with melanoma brain metastases (BM). While serum lactate dehydrogenase (LDH) is an established systemic biomarker in metastatic melanoma, its relationship with local radiological characteristics such as PTBE remains insufficiently understood. This study aimed to investigate the association between serum LDH levels and PTBE, as well as its relationship with clinical and tumor-related parameters.

We performed a retrospective analysis of 56 consecutive patients who underwent surgical resection for melanoma BM between 2012 and 2024. Preoperative MRI was used to assess the presence and volumetric extent of PTBE. Clinical, radiological, and laboratory parameters, including serum LDH levels, MIB-1 proliferation index, tumor volume and preoperative seizures were analyzed. Associations were evaluated using univariate analyses and Spearman rank correlation. Receiver operating characteristic (ROC) curve analyses were performed to assess the discriminative ability of the variables.

Preoperative PTBE was present in 71.4% of patients. Serum LDH levels were significantly higher in patients with PTBE (p < 0.001) and demonstrated a strong positive correlation with edema volume (r = 0.822, p < 0.001). In addition, LDH levels were significantly correlated with the MIB-1 proliferation index (r = 0.601, p < 0.001) and tumor volume (r = 0.584, p < 0.001) and were significantly elevated in patients presenting with preoperative seizures (p < 0.001). ROC analysis demonstrated that LDH had the highest discriminative performance (AUC 0.802, p < 0.001), with an optimal cut-off value of 179.4 U/L.

In this exploratory study, serum LDH was associated with both the presence and extent of PTBE and may serve as a surrogate of tumor-related biological activity. These hypothesis-generating findings warrant prospective validation before clinical implications can be drawn.

While intravesical Bacillus Calmette-Guérin Vaccine (BCG) instillation remains standard adjuvant therapy for high-grade non-muscle-invasive bladder cancer (NMIBC) post-resection, marked interpatient response heterogeneity complicates recurrence prediction. This study develops a contrast-enhanced computed tomography (CT) radiomics-based machine learning model to quantify tumor heterogeneity and noninvasively predict 5-year recurrence in high-grade NMIBC.

This retrospective study included 136 patients with histopathologically confirmed high-grade NMIBC from our institution and an external cohort of 51 patients from an independent testing center. All patients underwent transurethral resection of bladder tumor (TURBT) followed by BCG instillation therapy. The internal cohort was randomly partitioned into a training set (n = 95) and a validation set (n = 41) at a 7:3 ratio, with an independent external test set (n = 51) used for external validation. All patients received contrast-enhanced CT prior to treatment. Independent clinicopathological predictors were identified through univariate and multivariate logistic regression analyses. Radiomics features were selected using the Least Absolute Shrinkage and Selection Operator (LASSO) regression, and a radiomics score (Radscore) was constructed. Four machine learning models-Gradient Boosting Decision Tree (GBDT), Support Vector Machine (SVM), Extreme Gradient Boosting (XGBoost), and Random Forest (RF)-were developed. Model performance was comprehensively evaluated via the area under the receiver operating characteristic curve (AUC), accuracy, precision, F1 score, confusion matrix, calibration curve, and decision curve analysis (DCA). Additionally, the interpretability of the models was assessed using Shapley Additive Explanations (SHAP).

Multivariate logistic regression analysis identified tumor size (OR = 3.11, 95% CI: 1.16-8.34, p = 0.024), number of lesions (OR = 4.56, 95% CI: 1.52-13.70, p = 0.007), and tumor calcification (OR = 3.41, 95% CI: 1.15-10.15, p = 0.027) as independent clinical predictors of 5-year recurrence following BCG instillation. A total of 4,738 radiomic features were extracted from contrast-enhanced CT images, and the top 20 most discriminative features were selected via LASSO regression to construct the Radscore. Among the four machine learning models developed by combining clinical factors and Radscore, SVM demonstrated the superior performance, with an AUC of 0.816 (95% CI: 0.774-0.858), accuracy of 73.2%, precision of 74.3%, and F1 score of 0.734. This performance was significantly better than that of XGBoost (AUC = 0.727, 95% CI: 0.683-0.770; accuracy 65.9%, precision 65.4%, F1 score 0.655), RF (AUC = 0.717, 95% CI: 0.675-0.752; accuracy 68.3%, precision 67.9%, F1 score 0.677), and GBDT (AUC = 0.685, 95% CI: 0.633-0.740; accuracy 70.7%, precision 71.4%, F1 score 0.709). External validation using independent test sets confirmed these.

SHAP analysis revealed that the number of lesions and Radscore were the most influential predictors in the SVM model. Calibration curves and DCA demonstrated that the SVM model exhibited robust stability and provided substantial clinical benefit.

We developed an interpretable machine learning model derived from contrast-enhanced CT radiomics, integrating clinicopathological characteristics and quantitative radiomic features to accurately predict the 5-year recurrence risk in patients with high-grade NMIBC following BCG instillation.

Tumor treating fields (TTFields) are FDA-approved for supratentorial glioblastoma, but feasibility in infratentorial tumors remains poorly defined. This simulation study evaluated TTFields dose in brainstem gliomas using patient-specific modeling with scalp-only transducer arrays.

MRI and CT imaging from seven patients with brainstem gliomas were used for TTFields planning with MAXPOINT^® (Novocure, Switzerland). Clinical target volume (CTV) was defined as enhancing tumor on T1 post-contrast MRI (Gross tumor volume, GTV) plus a 3 mm peritumoral expansion. The platform optimized scalp-only array layouts, and finite element calculations generated maps of local minimum field intensity (LMiFI, V/cm) and local minimum power density (LMiPD, mW/cm³). Values were compared against a standard, unplanned layout using one-sided paired t-tests, with LMiFI ≥ 1.0 V/cm as a therapeutic reference.

MAXPOINT-optimized layouts achieved significantly higher LMiFI than the standard layout across all regions (all p ≤ 0.019). GTV median LMiFI was 1.1 vs. 1.0 V/cm (p = 0.019). CTV median LMiFI was 1.1 vs. 1.0 V/cm (p = 0.002). Brainstem median LMiFI was 1.3 vs. 1.1 V/cm (p = 0.002). Posterior fossa showed the largest difference: median LMiFI 1.5 vs. 1.2 V/cm (p < 0.001). All optimized LMiFI values met or exceeded the therapeutic reference. LMiPD was also significantly higher with MAXPOINT^® across all regions (all p ≤ 0.006).

This simulation study demonstrates that patient-specific modeling can achieve favorable TTFields intensities in brainstem gliomas using scalp-only arrays, supporting prospective clinical evaluation for infratentorial tumors.

To appraise financial toxicity (FT) among women receiving care for breast cancer during the COVID-19 pandemic and determine sociodemographic, clinical, psychosocial, and care-disruption factors linked to greater financial hardship.

Forty-eight survivors (mean age = 45.3 ± 10.9 years; 42% Black, 42% non-Hispanic White, 17% Hispanic/Latina) completed an online survey. FT was measured with the COST-FACIT. Additional instruments assessed perceived stress (PSS-10), coping (Brief-COPE), self-efficacy (CBI-B), social isolation (PROMIS-SF-4a), health-related quality of life (FACT-B), and pandemic-related delays or changes in cancer care. Pearson correlations explored bivariate associations; backward-selection regression identified predictors of FT.

Mean COST score was 21.77 ± 12.33 and 58.3% of survivors met the threshold for mild or moderate FT (< 26). Worse FT correlated with higher psychological distress (p = 0.001), greater social isolation (p = 0.005), and more care disruptions (p < 0.001). Financial security correlated with greater self-efficacy (p = 0.019) and higher health-related quality of life (p < 0.001). In multiple regression analysis (R² = 0.69), survivors reporting worse quality of life, lower income, and less education reported greater financial toxicity.

Breast cancer survivors experienced substantial FT while navigating care during the pandemic, with greater burden associated with psychological distress, social isolation, care disruptions, and lower socioeconomic status. FT was attenuated among those with higher health-related quality of life and self-efficacy. Integrating proactive financial navigation, psychosocial screening, and targeted support for socioeconomically vulnerable survivors into routine oncology care may mitigate financial hardship and improve overall well-being.

Malignant tumors remain a major global health challenge, highlighting the need for rapid and sensitive analytical tools for investigating cancer-associated oxidative stress. In this study, we developed a non-enzymatic electrochemical hydrogen peroxide (H₂O₂) sensor based on a reduced graphene oxide/platinum nanoparticle/ferrocene-tyramine/poly(o-phenylenediamine) (rGO/Pt NPs/Fc-Tyr/POPD) nanocomposite. H₂O₂, although not a tumor-specific biomarker, is an important reactive oxygen species associated with oxidative stress in cancer-related systems. The proposed sensing platform integrates the high conductivity of rGO, the electrocatalytic activity of Pt NPs, the TSA-derived Fc-Tyr deposition strategy, and the anti-interference properties of POPD. The sensor exhibited two wide linear detection ranges (5.0 µM-570 µM and 570 µM-10.5 mM), a low detection limit of 1.18 µM, and a rapid response time of less than 5 s. In addition, the sensor demonstrated satisfactory selectivity, reproducibility, and stability. Compared to previously reported rGO/Pt-based H₂O₂ sensors, the present platform introduces a TSA-derived Fc-Tyr deposition strategy to facilitate interfacial electron transfer and increase the density of redox-active species. The sensor was successfully applied to monitoring H₂O₂ changes in cultured cancer cells and ex vivo tumor tissue-derived samples under chemically stimulated oxidative conditions. These findings suggest that the proposed system may provide a useful tool for investigating oxidative-stress-associated biological processes and electrochemical H₂O₂ determination.

The distal femur is the most common site for bone sarcoma in children. Expandable prostheses may be used to overcome the resultant limb length discrepancy due to the sacrifice of the growth plate in children who undergo resection of primary bone tumors in the distal femur. Few studies analyzed the complications in children treated with expandable prostheses. Furthermore, to date, no studies evaluated the association between medial tibial plateau deformity and the use of constrained versus rotating hinges expandable prostheses in children who underwent primary bone resection of the distal femur. This study aimed to evaluate the complications and reconstruction survival rates associated with expandable prostheses for the distal femur in children with primary bone tumours, with a particular focus on the risk of tibial plateau deformity related to the use of constrained versus rotating hinge expandable prostheses.

We performed a retrospective single-centre study of 25 children who underwent distal femur reconstruction with expandable prostheses after resection of primary bone tumours between 2001 and 2024. Eleven children had rotating hinge expandable prosthesis, 14 children had constrained hinge expandable prosthesis, nine children had mechanical expandable prosthesis, and 16 children had magnetic expandable prosthesis. Eight out of 25 children had expandable prosthesis with uncemented femoral stem, and 17 out of 25 children had cemented femoral stem. All 25 children had expandable prosthesis with uncemented tibial smooth stem. The median age of children was nine years (range, 5-14 years). The median follow-up was 9.4 years (range, 1.1-16.5 years).

Twelve out of 25 children (48%) presented complications. The mean number of complications per child was 1.0 (range, 0-2). Aseptic loosening of the femoral stem was observed in four out of 25 children (16%). Periprosthetic fracture occurred in one out of 25 children (4%). Breakage of the hinge component of the prosthesis occurred in one out of 25 children (4%). Infection occurred in two out of 25 children (8%). None of the 14 children with constrained hinged prosthesis presented medial tibial plateau deformity. In contrast, seven out of 11 children (63%) who underwent reconstruction with rotating hinge expandable prostheses presented medial tibial plateau deformity. Overall, nine of the 25 children (36%) had to replace their temporary expandable prosthesis with a definitive standard prosthesis. Reconstruction survival was 79.3% at five years (95% confidence interval 53.7 to 91.7%) and 59.5% at ten years (95% confidence interval 28.3% to 80.1%).

Rotating hinge prosthesis showed a high risk of medial tibial plateau deformity compared to constrained hinged prosthesis. We may recommend the preferential use of constrained hinge expandable prosthesis in children who undergo primary bone tumour resection of the distal femur to reduce the risk of tibial deformity.

Pharmacodynamic analyses are increasingly important to early-phase oncology drug development, however these analyses use invasive methods to collect patient material. Yet, their role in guiding recommended phase II dose (RP2D) decisions remains unclear. Therefore, this review evaluates how pharmacodynamic analyses assisted the determination of the recommended phase II dose (RP2D) in first-in-human cancer trials of small-molecule agents.

First-in-human dose finding clinical trials of single-agent small-molecule anticancer therapies published between 2022 and 2025 that included pharmacodynamic assessments, were investigated. Clinical trials were evaluated for correlation of pharmacodynamic results at the analyzed doses and their influence in the RP2D decision-making process.

In total, 535 records were identified and 34 articles, reporting on 34 separate trials, were included. A correlation was found between the pharmacodynamic results and the analyzed dose levels in 92% (n = 31/34). However, only half of the clinical trials (n = 17/34) reported their pharmacodynamic results in the RP2D decision-making process, while 41% (n = 14/34) did not. In most of the clinical trials that did not use their pharmacodynamic results in the RP2D decision-making process, only one pharmacodynamic analysis was performed (n = 9/14, 64%) and they often determined their RP2D solely based on safety and/or tolerability (n = 7/14, 50%). Invasive procedures were often performed without clear utilization of pharmacodynamic data, raising ethical considerations.

These findings underscore the need for appropriate sample sizes planning and validated, fit-for-purpose pharmacodynamic assays to ensure meaningful use in dose selection, optimizing patient benefit and trial design.

Background: Symptomatic neuroma formation and chronic post-amputation pain remain major barriers to functional recovery following lower limb amputation. Active nerve management strategies, such as the Regenerative Peripheral Nerve Interface (RPNI), have emerged as promising techniques for preventing neuropathic pain by providing a biological target for transected nerves. Methods: A retrospective observational study was conducted including 24 adult patients who underwent transfemoral or transtibial amputation. Twelve patients received prophylactic RPNI at the time of amputation, while 12 underwent standard amputation without active nerve management. Incidence of symptomatic neuroma, Tinel's sign, pain intensity (VAS), pain interference (PROMIS Pain Interference 8a) and prosthetic use were evaluated over a 12-week follow-up period. Results: No cases of symptomatic neuroma were observed in the RPNI group (0%), compared to 66.7% in the control group (p < 0.001). At 12 weeks, mean VAS pain scores were significantly lower in the RPNI group (0.4 ± 0.8) compared to controls (5.8 ± 1.7; p < 0.0001). PROMIS Pain Interference scores at 3 months were markedly improved in the RPNI group (44.0 ± 4.5) versus the control group (66.0 ± 5.8; p < 0.001). A higher proportion of RPNI patients successfully used a prosthesis (66.7% vs. 41.7%), although this difference did not reach statistical significance. Conclusion: Prophylactic RPNI during lower limb amputation effectively prevents symptomatic neuroma formation and significantly reduces post-amputation pain, with favorable functional outcomes. These findings support routine active nerve management as a strategy to optimize rehabilitation and quality of life in amputee patients.

Introduction: Oral squamous cell carcinoma (OSCC) is one of the most common malignant neoplasms in the head and neck region. The standard therapeutic approach typically includes surgical intervention followed by adjuvant radiotherapy, which, although necessary, may significantly impair salivary gland function and disrupt redox homeostasis in the oral cavity. Aim: The aim of this study was to evaluate the effect of radiotherapy on the quantity and quality of saliva, assessed through salivary biomarkers FRAS, MDA, and SOD, in patients with oral squamous cell carcinoma who had undergone surgical treatment and subsequent head and neck radiotherapy. Materials and Methods: The study included 20 patients of both sexes, aged 41 to 76 years, who were surgically treated and subsequently underwent head and neck radiotherapy. Unstimulated saliva samples were collected at two time points: before and after completion of radiotherapy. Salivary flow rate was measured immediately after collection, and following sample processing, ferric reducing ability of saliva (FRAS), malondialdehyde (MDA) concentration, and superoxide dismutase (SOD) activity were determined spectrophotometrically. Results: The salivary flow rate was significantly reduced after radiotherapy compared to the pre-treatment values. The post-radiotherapy FRAS levels were significantly lower, whereas MDA levels were significantly higher. SOD activity was slightly higher before radiotherapy compared to the post-radiotherapy values. Conclusion: Our findings confirm that radiotherapy is associated with increased oxidative stress and reduced antioxidant capacity in saliva. Although antioxidants may potentially mitigate radiotherapy-induced complications, their clinical application requires caution due to the possibility of protecting the tumor cells, thereby potentially compromising the oncologic treatment outcomes.

Surgery is the most frequent treatment for breast cancer and requires postoperative follow-up to detect complications and monitor patient recovery. Postoperative telemonitoring has demonstrated benefits in improving rehabilitation and psychological well-being. However, patient expectations of and barriers to telehealth follow-up after oncologic breast surgery remain insufficiently explored.

A prospective survey was conducted among adult patients attending pre- or postoperative follow-up appointments for breast cancer in the Department of Breast and Reconstructive Surgery at the Civil Hospitals of Colmar between March and August 2025. The questionnaire comprised four sections: demographic data, treatments received, telemedicine accessibility and acceptability, and patient expectations of and barriers to telemonitoring.

A total of 124 questionnaires were analyzed. Results demonstrated high accessibility to digital tools among participants. Although patients recognized several advantages of telemonitoring, most expressed a strong preference for in-person follow-up visits. The most expected features included the ability to report postoperative complications and to monitor recovery and pain. The main barrier was the fear of reduced human contact. Retired status was associated with lower acceptance of postoperative telemonitoring.

These findings support the implementation of a hybrid follow-up model combining early postoperative telemonitoring with later in-person consultations, which could help reassure patients and shorten hospital stays while maintaining personalized care. The monocentric design may limit the external validity of the findings. Future studies should explore patients' perceptions following repeated use of telemonitoring tools and incorporate healthcare professionals' perspectives on their integration into clinical practice.