Pediatric nasopharyngeal carcinoma has a better chance of survival, although most patients present with advanced disease stage and undifferentiated pathology. Radiation-related toxicity is a major concern for younger individuals. Induction chemotherapy followed by concurrent chemoradiotherapy with tailored radiation doses has become an acceptable treatment for pediatric cases. This quasi-experimental study was conducted at the National Institute of Cancer Research and Hospital in Bangladesh from July 2016 to June 2022. The enrolled children received 3 cycles of induction chemotherapy, followed by concurrent chemoradiotherapy. Patients with a complete or partial response to IC received 61.2 to 66 Gy to the nasopharynx and neck. Among the studied children (n=50), males (33) were predominant with a male-to-female ratio of 1.94:1. The age range was 8.00 to 17 years, with a mean±SD of 13.15±267. Most of the patients (64%, 32 cases) were younger than 15 years. Advanced-stage disease was observed in 82% of patients, and most cases (96%) had poor to undifferentiated histology. The 4-year OS and EFS rates for the studied children were 80% (95% CI, 70.4%-86.2%) and 76% (95% CI, 65.2%-83.3%), respectively, over a median follow-up of 48 months. Mucositis (74%) and xerostomia (50%) were the most common acute and late adverse effects, respectively. Induction chemotherapy followed by concurrent chemoradiotherapy, but with a reduced-dose RT strategy, provided better survival outcomes with acceptable adverse effects in resource-limited settings.

To identify independent determinants influencing therapeutic outcomes of initial radioactive iodine (^{1 3 1}I) therapy in differentiated thyroid carcinoma (DTC) and establish an interpretable predictive framework for clinical decision-making.

A retrospective cohort of 950 treatment-naïve DTC patients undergoing primary ^{1 3 1}I therapy was randomly allocated into training (n = 664) and testing (n = 286) cohorts. Multivariable logistic regression (LR) analysis identified response-associated variables, followed by the development of seven machine learning (ML) architectures including decision trees (DT), LR, random forests (RF), support vector machines (SVM), adaptive boosting (AdaBoost), eXtreme gradient boosting (XGBoost), and light gradient boosting machine (LightGBM). Model performance was systematically evaluated through ROC curves (AUC), calibration plots, and decision curve analysis (DCA), complemented by SHapley Additive exPlanationgs (SHAP) interpretability framework for optimal model explanation.

Multivariable analysis demonstrated age, ^{1 3 1}I therapeutic interval (TI), tumor multiplicity, maximum tumor diameter (MTD), lymph node metastasis (LNM) topography, stimulated thyroglobulin (sTg), thyroglobulin antibody (TgAb) levels, administered activity (AA), and post-therapy whole-body scan (Rx-WBS) findings as independent predictors of non-excellent response (N-ER).The LightGBM architecture achieved superior predictive accuracy (AUC = 0.896) in the testing cohort, outperforming conventional LR (AUC = 0.842).SHAP interpretation identified sTg (mean absolute SHAP value = 1.285), TgAb (mean absolute SHAP value = 0.642), and LNM topography (mean absolute SHAP value = 0.308) as principal predictive determinants. DCA confirmed that the model had a net benefit higher than the "full treatment" and "no treatment" strategies at multiple threshold probabilities, indicating its certain application value in clinical decision-making.

The developed LightGBM framework precisely predicts primary ^{1 3 1}I therapeutic efficacy in DTC patients, with SHAP-driven elucidation of clinical risk factor contributions enabling personalized therapeutic paradigms.Future integration of multicenter prospective data and molecular biomarkers is required to enhance model generalizability.

The aim of this study is to perform an experimental evaluation of an imaging-based intraoperative electron beam radiotherapy (IOERT) and in vivo dose verification workflow for pancreatic cancer on a porcine cadaver.

The Imaging Ring m (ImR) mobile cone-beam computed tomography (CBCT) scanner (medPhoton GmbH, Salzburg), the Radiance (GMV, Tres Cantos, Madrid, Spain) treatment planning system (TPS) and the Mobetron (IntraOp Medical Inc, Sunnyvale, CA, USA) mobile linear accelerator (LINAC) were used. Cylindrical thermoluminescent dosimeters (TLD-100) were employed for in situ dose measurements. ImR calibration data were acquired and imported into Radiance for CT table commissioning. The porcine cadaver was immobilized using standard radiotherapy (RT) equipment and scanned preoperatively with a SOMATOM Go.Open Pro CT scanner (Siemens Healthineers AG, Forchheim, Germany) to obtain a reference abdominal CT image. Subsequently, a surgical procedure was performed to expose the pancreas, and a dedicated TLD-based dosimetry system was secured on its surface. The 5 cm diameter/30°-bevel IOERT plastic applicator was positioned over the dosimeters and intraoperative CBCT images were acquired. Treatment was delivered using a 9 MeV electron beam, prescribing 10 Gy to the distal 90% isodose depth. The intraoperative CBCT images were imported into Radiance, where the applicator was positioned based on imaging, relevant anatomy was contoured and three-dimensional (3D) dose distributions were calculated using a Monte Carlo (MC) algorithm and compared to the TLD measurements.

ImR CBCT calibration scans yielded CBCT numbers consistent with reference data. Image quality was sufficient for clear visualization of the applicator and TLD-based dosimetry systems without significant artifacts; however, soft-tissue contrast was limited for clear determination of pancreatic tissue and important neighboring vessels. Due to observed tissue extension within the applicator, dose calculations were adjusted to begin inside the applicator volume. In situ TLD dose measurements agreed with MC-calculated doses within 3%.

The developed image-guided pancreatic IOERT workflow was successfully simulated under near-clinical conditions using a porcine cadaver model. Agreement between in situ TLD measurements and MC dose calculations was within the accepted tolerance of ±5%, supporting further clinical implementation.

Metastatic pancreatic ductal adenocarcinoma (mPDAC) is a highly aggressive malignancy. Prior studies suggest that the initial site of metastasis may impact prognosis. This study investigates whether overall survival in mPDAC patients differs between patients first presenting with lung metastases versus those presenting with liver metastases.

This retrospective analysis utilized the multi-institutional TriNetX database, identifying patients with histologically diagnosed PDAC who initially presented with either liver or lung metastases. Demographic, histologic, and outcome data were collected and analyzed. Patients were matched 1:1 using a nearest neighbor propensity score (PS) algorithm, and Kaplan-Meier survival analyses were performed. Cox regression was also used to further validate the results of the PS matching.

A total of 6256 patients were identified, including 5390 patients presenting with liver and 866 patients presenting with lung metastases at diagnosis. The mean age was 66.6 ± 10.5, the male-to-female ratio was 54%:46%, the mean carbohydrate-antigen (CA) 19-9 level was 1309 ± 2078 ng/mL, the mean carcinoembryonic-antigen (CEA) level was 117 ± 1044 U/mL. Propensity score matching yielded 848 matched pairs. Median survival from time of metastatic diagnosis was significantly longer for patients with lung metastases compared to liver (377 vs. 195 days, p < 0.0001). Cox regression identified several factors associated with increased risk of death: older age, obesity, malnutrition, and elevated CEA or CA 19-9. Additionally, initial lung metastases were associated with decreased risk of death (HR = 0.61, p < 0.0001).

Initial presentation with lung metastases appears to be associated with improved survival outcomes as compared to initial presentation with liver metastases in patients with mPDAC.

Laryngeal transplantation offers the potential for patients to regain vocal function, yet standardised voice rehabilitation protocols are lacking. We share the experience of our team in the regular follow-up of voice function evaluation and address this gap by establishing a multidisciplinary pathway for functional recovery.

Four male transplant recipients (3 laryngeal cancers, 1 hypopharyngeal cancer) underwent protocolized assessments at 1/3/6/8 months post-op: subjective assessment (GRBAS scale) and objective evaluation (multiparametric acoustic analysis and electronic laryngoscopy). Personalized rehabilitation was delivered weekly by a licensed speech therapist. Protocol evolution occurred: Patients 1-2 received conventional training; Patients 3-4 received intensive neuromuscular reinnervation strategies.

The voice of the four patients showed a gradual decrease in the degree of hoarseness, a gradual alleviation of breathiness, and a gradual decrease in asthenia score, with the overall condition improving. The MPT was about 1.8 s at 1 month after surgery which kept increasing in all patients. The 3rd patient, who performed the best among the 4 patients, had an MPT of more than 10 s at 8 months after surgery. Laryngeal mucosa sensory function was gradually established in patients starting 3 months after operation, and compensatory vibration of ventricular band appeared at 8 months after operation with the assistance of voice training.

This study anchored to neuromuscular reinnervation milestones demonstrates that standardised evaluations coupled with individualized training progressively restore vocal function. Our protocolized framework guides evidence-based rehabilitation for institutions pursuing laryngeal transplantation WHAT THIS PAPER ADDS: What is already known on this subject Laryngeal transplantation surgically restores laryngeal anatomy but faces functional recovery challenges due to delayed neuromuscular reinnervation. Existing literature focuses predominantly on immunosuppression and graft viability, with sparse evidence guiding postoperative voice rehabilitation. Standardised protocols for phonatory recovery-routine in other neurogenic voice disorders (e.g., vocal fold paralysis)-are absent. Fewer than 20 human cases have been reported globally, and only two publications detail voice outcomes. Consequently, rehabilitation strategies remain ad hoc, lacking consensus on intervention timing, exercise biomarkers, or psychological support frameworks. What this study adds to existing knowledge This study establishes the first protocolized voice rehabilitation framework for laryngeal transplantation, anchored to neuromuscular milestones: Pharyngeal reflex recovery (3 months) signalling sensory reinnervation; Ventricular band compensation (8 months) indicating motor adaptation. We demonstrate that early, structured rehabilitation (initiated at 1 month) enables significant voice restoration (MPT: 1.8 s → >10 s). Critically, we identify modular design principles accommodating clinical interruptions (e.g., ICU admissions) without compromising core outcomes. We anticipate these findings will guide evidence-based rehabilitation for institutions pursuing laryngeal transplantation and inform standardised pathways for complex laryngologic rehabilitation. What are the potential or actual clinical implications of this work? Rehabilitation Standardization: Provides evidence-based timelines (1/3/6/8-month assessments) and neuromuscular biomarkers to guide intervention intensity. Broad Applicability: The protocol shows cross-utility for bilateral vocal fold paralysis and post-traumatic neurogenic dysphonia, leveraging shared reinnervation mechanisms. Contingency Management: Modular training design maintains efficacy despite clinical interruptions (e.g., 40% cohort ICU/oncology transfers). Technology Integration: Validates objective metrics (MPT, mucosal wave symmetry) as targets for future AI-assisted biofeedback tools. Clinicians should prioritise early sensorimotor retraining (<3 months) while monitoring compensatory strategies (ventricular vibration) as functional proxies.

Over 14,000 UK women undergo mastectomy annually, 70% of whom do not undergo breast reconstruction. These women are often left with suboptimal scars.

This study aimed to explore the attitudes of women towards their mastectomy scars, particular the aesthetic outcomes, and to raise awareness of the importance of achieving aesthetic flat closure.

Semi-structured interviews with women who had undergone mastectomy without reconstruction were recruited from a single UK teaching hospital. Thematic analysis was performed using the Framework Approach.

Twenty women aged 47-91 years old were interviewed in 2024. Themes identified: satisfaction with scar cosmesis, physical impacts of scars, attitude towards flat mastectomy scars, body image and confidence, pre-operative counselling and scar revision surgery. There was widespread patient dissatisfaction with mastectomy scar cosmesis, although attitudes and emotional responses varied. Women viewed their scars as a necessity. Physical symptoms included discomfort from dog ears chafing on bra straps, or scar tightness restricting arm or shoulder mobility. Most women were interested in scar revision surgery, with some requesting more information, or referrals. Those who had scar revision surgery or chose contralateral symmetrising mastectomy displayed more positive attitudes.

This study found considerable patient dissatisfaction with mastectomy scar cosmesis and demonstrated the profound impacts of poor cosmetic outcomes, highlighting the importance of optimising aesthetic outcomes and the need for scar revision surgery to help women achieve aesthetic flat closure. These findings demonstrate the importance of careful pre-operative planning and good surgical technique with more time allocated to manage expectations.

The WHO classification includes squamous cell carcinoma (SCC) and neuroendocrine carcinoma as two histotypes of HPV-associated oropharyngeal carcinoma (HPV + OPC). Among SCC, the recognized subtypes include non-keratinizing, keratinizing, papillary, adenosquamous, ciliated adenosquamous, lymphoepithelial, spindle cell, and basaloid subtypes.

This retrospective study included 379 consecutive cases of HPV+ OPC resected between 2017 and 2024.

The morphologies included SCC (83.4%), adenosquamous carcinoma (n=11, 2.9%, including 6 with cilia), combined neuroendocrine carcinoma and SCC (n=3, 0.8%), adenocarcinoma (n=1, 0.3%), and undifferentiated carcinoma (n=1, 0.3%). Among SCC subtypes, the most common was non-keratinizing (n=316), followed by papillary (n=22), lymphoepithelial (n=9), basaloid (matrix-producing, n=9), keratinizing (n=6), and spindle cell (sarcomatoid, n=1). Tumors could display various histologic features, such as papillary architecture (29.2%), lymphoepithelial regions (10.3%), and basaloid (matrix-producing) areas (7.1%). On univariate survival analysis, adverse histologic features included any percentage of glandular differentiation, a basaloid component, extranodal extension (ENE), and low stromal tumor infiltrating lymphocytes (sTIL). Basaloid areas and extranodal extension were independent adverse prognostic factors identified on multivariate survival analysis.

Herein, we report two histotypes of HPV+ OPC not yet recognized by the WHO classification, being adenocarcinoma and undifferentiated carcinoma. Additionally, multiple adverse histologic features were identified, including basaloid components and ENE as independent prognostic factors. Therefore, recognizing and reporting such features in the pathology report of HPV+ OPC, even when present in minor proportions, is important for risk stratification and clinical management.

Not applicable.

This study aimed to explore the predictive roles of intolerance of uncertainty and attitudes toward cancer in determining the level of spiritual well-being among patients with cancer.

The study population consisted of all patients diagnosed with cancer admitted to the oncology outpatient clinics of two different public hospitals or receiving inpatient treatment between March 1, 2024, and January 30, 2025. The sample consisted of 400 patients who met the inclusion criteria. In this study, three standardized instruments were used to assess the main study variables: the Three-Factor Spiritual Well-Being Scale (TFSWS), the Questionnaire for the Measurement of Attitudes Toward Cancer-Patient Version (QMATC-PV), and the Intolerance of Uncertainty Scale (IUS-12). Multiple linear regression analysis was used to analyze the data.

The mean scores of spiritual well-being, attitudes toward cancer, and intolerance of uncertainty were 118.63 ± 16.49, 2.06 ± 0.50, and 36.45 ± 9.80, respectively. There was a significant negative relationship between the impossibility of recovery and discrimination and spiritual well-being. There was a significant negative relationship between inhibitory anxiety and spiritual well-being. Furthermore, alcohol use and hormone therapy were significant variables for predicting spiritual well-being.

The results of this study revealed that in addition to alcohol use and hormone therapy, the impossibility of recovery, discrimination, and inhibitory anxiety significantly affect spiritual well-being in cancer patients. These findings highlight the importance of addressing patients' emotional and existential concerns as part of holistic cancer care. Interventions aimed at reducing uncertainty and improving attitudes toward cancer may enhance patients' spiritual well-being and overall quality of life.

Multiple myeloma (MM), a hematologic malignancy, is linked to significant neuropsychiatric comorbidities that negatively impact patient quality of life, treatment adherence, and survival outcomes.

This review aims to explore the potential mechanisms underlying the association between MM and neuropsychiatric manifestations.

This was a narrative review with searches in PubMed/Medline, Google Scholar, and EBSCOhost using keywords related to MM and psychiatric illness. Studies published in English, including preclinical, clinical, observational, case-control, prospective cohort studies, as well as reviews and meta-analyses, were considered.

Up to 43% of people with MM also suffer from psychiatric comorbidities, and psychiatric illness was shown to be associated with increased mortality rates, reduced quality of life, and higher healthcare costs in MM patients. Our review found that neuropsychiatric manifestations in MM patients are suggested to stem from various factors, including treatment-related effects from steroids and novel BCMA-directed therapies, cancer-induced pro-inflammatory cytokines coupled with systemic inflammation and stress response, direct central nervous system involvement by MM, and psychiatric symptoms resulting from MM complications, including electrolyte imbalances, anemia, infection, and chronic pain.

The association between MM and neuropsychiatric manifestations is likely multifactorial. This review underscores the critical need for integrated mental health support within MM management and calls for further research into possible causes such as pathophysiological inflammation, paraneoplastic phenomena related to monoclonal proteins, and prolonged exposure to steroid therapy. Routine neuropsychiatric screening and assessment are imperative for timely identification and intervention to improve overall prognosis in MM patients.