This retrospective cohort study compared the efficacy and tolerability of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) between octogenarians (aged ≥80 years) and non-octogenarians with advanced EGFR-mutated lung adenocarcinoma.

We retrospectively analyzed 151 patients with advanced lung adenocarcinoma harboring common EGFR exon 19 deletions or exon 21 L858R mutations who received first-line EGFR-TKI therapy. Patient characteristics, treatment outcomes, and adverse events were evaluated.

Progression-free survival (PFS) did not differ significantly between octogenarians and non-octogenarians. Overall survival (OS) was shorter in octogenarians, which may be partly explained by lower rates of subsequent therapy and age-related clinical factors. No significant differences in treatment-related toxicities were observed between the two groups.

This study provides clinically relevant real-world evidence supporting the feasibility of first-line EGFR-TKI therapy in octogenarians with EGFR-mutated lung adenocarcinoma. Chronological age alone should not preclude carefully selected very elderly patients from receiving EGFR-TKI treatment.

Esophageal cancer, specifically esophageal squamous cell carcinoma (ESCC), poses a significant health challenge characterized by a poor prognosis and high mortality rates. Surgical interventions, such as minimally invasive esophagectomy, are the primary treatment approach; however, the occurrence of postoperative complications, particularly pneumonia, presents substantial risks. Small airway disease (SAD) affecting the bronchioles' small airways is a frequently underestimated respiratory condition with potential implications for the postoperative outcomes of ESCC patients.

From January 2020 to December 2023, the McKeown procedure was exclusively utilized as the treatment modality for resectable esophageal squamous cell carcinoma patients in this retrospective study. Rigorous diagnostic criteria for small airway disease and postoperative pneumonia were employed, followed by detailed statistical analyses using logistic regression models with adjustments for confounding variables. Both multivariate and univariate logistic regression analyses were performed to identify the independent risk factors contributing to postoperative pneumonia incidence.

A total of 293 participants were included in the analysis. Baseline characteristic analysis revealed that individuals with small airway disease exhibited impaired small airway function, lower pre-albumin levels, a higher incidence of pulmonary infection, and longer hospital stays compared to those without SAD. Univariate logistic analysis identified SAD as a strong independent predictor for postoperative pneumonia, with individuals with SAD having a significantly higher risk compared to those without SAD. Multivariate logistic analysis further confirmed this association, demonstrating a robust relationship between SAD and postoperative pneumonia risk even after adjusting for confounding factors.

The preoperative identification of SAD is significantly associated with an increased risk of postoperative pneumonia in resectable ESCC patients, highlighting the importance of addressing small airway disease in perioperative management to enhance clinical outcomes. These findings underscore the significance of recognizing and managing SAD as a potential risk factor in strategies for preventing and managing postoperative pneumonia.

Paraneoplastic Sjögren-like syndrome is a rare extraglandular manifestation of occult malignancy that can closely mimic primary autoimmune disease, leading to delayed diagnosis of the underlying neoplasm. While most reported cases are associated with hematological malignancies, its occurrence in the context of solid tumors, particularly salivary gland carcinomas, is exceptionally rare and poorly characterized. We report a 43-year-old male presenting with progressive dyspnea, constitutional symptoms, and severe polyserositis, initially suggestive of primary Sjögren's syndrome (SS) based on objective sicca findings, including severely reduced lacrimal secretion on the Schirmer test and clinically observed asialia, in conjunction with positive anti-SSA antibodies. Imaging showed persistent pulmonary lesions and pleural effusions, while bronchoalveolar lavage revealed markedly elevated galactomannan levels, suggesting probable pulmonary aspergillosis. Despite immunosuppressive therapy, no clinical improvement was observed. Further evaluation, including surgical biopsy, demonstrated metastatic adenocarcinoma of probable salivary gland origin. The final diagnosis was stage IV parotid adenocarcinoma with pulmonary metastases and paraneoplastic Sjögren-like syndrome. The patient received one cycle of chemotherapy but subsequently deteriorated and died. Paraneoplastic Sjögren-like syndrome is exceptionally rare and characterized by heterogeneous clinical presentations, often lacking classic histopathological findings. Red flags such as rapid progression, systemic involvement, and poor response to standard therapy should prompt evaluation for occult malignancy. This case highlights the importance of recognizing atypical Sjögren-like presentations as a probable paraneoplastic phenomenon. Early identification of warning signs may facilitate timely diagnosis of underlying malignancy and impact clinical outcomes.

Upper tract urothelial carcinoma is a rare disease entity with complex diagnostic and treatment options. In the Swedish National Quality Register for Bladder and Urinary Tract Cancer (SNRUBC), prospective registration of tumour and treatment characteristics is performed with high coverage, where data including quality indicators are presented online (RODRET). Between 2023 and 2024 regional differences in the majority of quality indicators are observed in the SNRUBC, with target levels only met in a few regions. For some quality indicators, such as proportion of patients referred to multidisciplinary tumour board discussion or proportion receiving curative treatment and perioperative lymphadenectomy, an association with better performance and hospital volume above 10 patients per year was observed. A regional centralization of multidisciplinary tumour boards for these patients might decrease regional inequalities and improve quality metrics.

To analyse the clinicopathological features, diagnostic pitfalls, and unusual presentations of eyelid eccrine tumors. Methods: Retrospective case series of 25 histopathologically confirmed eyelid eccrine tumors surgically excised between 2016 and 2023. Clinical records, histopathology (H&E with selective PAS staining), and follow-up data were reviewed. Results: Eccrine hidrocystoma was the most common subtype (80%, n=20), followed by eccrine hidradenoma (16%, n=4) and eccrine spiradenoma (4%, n=1). Mean patient age was 43.8 years, with a 4:1 male predominance. Clinical misdiagnosis occurred in 84% of lesions, most commonly as sebaceous cysts (64%). cases demonstrated unusual features, including three giant hidrocystomas (>2 cm), one giant hidradenoma (3.0 cm) with ulceration and mechanical ptosis clinically suspicious for squamous cell carcinoma, and one spiradenoma with maggot infestation mimicking malignancy. All giant tumors required excision with reconstruction (e.g., staged Cutler-Beard procedure). No recurrences were observed during follow-up (mean 14 months; range 6-24 months). Conclusion: Eyelid eccrine tumors present a broad clinical spectrum, from small cysts to large masses mimicking malignancy. Giant lesions, though rare, cause diagnostic confusion and functional impairment. Histopathological examination remains the gold standard for definitive diagnosis, and heightened clinical awareness is essential to avoid misdiagnosis.

Children treated with ifosfamide seem to have an increased risk for developing chronic kidney disease (CKD) already within the first years following chemotherapy. However, studies investigating CKD prevalence in this specific phase are scarce. This study aimed to determine the prevalence, course, and determinants of CKD in ifosfamide-treated children within the first five years after chemotherapy.

This cohort study included children treated with ifosfamide at the Princess Máxima Center for pediatric oncology in the Netherlands between 2015 and 2021. Chronic kidney disease was defined as decreased eGFR (< 90 mL/min/1.73 m²) and/or proteinuria.

This cohort consisted of 292 patients, with a median follow-up duration of 30 months (IQR 7-46). The overall prevalence of CKD was 42.1% (123/292 patients), with 29 being at substantial risk of progression to kidney failure (eGFR < 60 mL/min/1.73 m²). In 21 patients, CKD was reversible. A cause-specific hazard model identified cumulative ifosfamide dose of 30-59.9 g/m² (HR_cs 1.95, 95% CI 1.22-3.12) or > 60 g/m² (HR_cs 4.09, 95% CI 2.08-8.02), increasing age at diagnosis (HR_cs 1.12, 95% CI 1.06-1.18), and ≥ 2 episodes of acute kidney injury (AKI) during treatment (HR_cs 3.81, 95% CI 2.24-6.46) as significant determinants.

With a prevalence of 42.1% within the first five years following ifosfamide administration, CKD is a common early complication, with varying severity; seven patients developed severe CKD (G4-G5). These findings highlight the importance of awareness and long-term kidney function surveillance, especially in patients with a history of AKI.

Breast cancer comprehensive therapies often cause body image changes, triggering stigma that impairs mental health and quality of life. Existing studies lack an integrated model to reveal the underlying mechanisms between these variables.

A cross-sectional survey was conducted among 292 breast cancer patients selected via convenience sampling from 5 hospitals in Guangdong Province between March 2021 and March 2022. The Distress Disclosure Index (DDI), Consumer Experiences of Shame Questionnaire (CESQ), Functional Assessment of Cancer Therapy-Breast (FACT-B), and Multidimensional Scale of Perceived Social Support (PSSS) scales were administered. Pearson correlation analysis explored variable relationships, structural equation modeling (SEM) constructed the chain mediating model, the Bootstrap method tested mediating effects, and subgroup associations with stigma were analyzed.

Breast cancer patients had self-disclosure and stigma scores of 38.17 ± 0.54 and 13.74 ± 0.42, respectively. Stigma was significantly negatively correlated with self-disclosure, social support, and quality of life (all p < 0.01). Self-disclosure was directly associated with lower stigma (β = -0.52, p < 0.001) and indirectly mediated by two pathways: the independent pathway through "better quality of life" (11.6% of total effect) and the chain pathway through "higher social support and better quality of life" (5.4% of total effect). Subgroup analysis indicated that patients with a bachelor's degree or above were more significantly associated with low stigma (OR = 0.42, 95% CI: 0.17-0.96), while introverted patients showed a stronger association with high stigma than extroverted ones (OR = 2.90, 95% CI: 1.57-5.56).

Breast cancer patients exhibit relatively low self-disclosure and moderate-to-low stigma. Higher self-disclosure is associated with lower stigma directly or indirectly via the chain mediation of social support and quality of life. Enhancing psychological counseling, social support, and quality of life, paired with targeted interventions for education and personality subgroups, facilitates physical and mental recovery and social reintegration.

Pancreatic cancer Volumetric Modulated Arc Therapy (VMAT) planning presents a significant dosimetric challenge due to the high-dose gradients required to spare adjacent, radiosensitive organs at risk (OARs) like the stomach and duodenum. This anatomical complexity has limited the scope of automated planning for this site. Broadly, while deep learning (DL) has been introduced to streamline treatment planning, most existing models only predict intermediate outputs, such as dose distributions or fluence maps, which still necessitate a subsequent, computationally expensive inverse optimization step on a treatment planning system.

To address these challenges, we aim to develop an optimization-free fully automated VMAT planning framework for pancreatic cancer. As a key component of this system, this study introduces a DL model designed to directly generate machine parameters from dose distributions and anatomical contours.

A total of 200 vmat plans for pancreatic cancer (prescription: 42 Gy in 15 fractions) were retrospectively collected. The dataset was randomly split into training (n = 170), validation (n = 10), and testing (n = 20) sets. The proposed Multi-modal, Attention & Transformer-Enhanced U-Net (MATE-UNet) utilizes beam's-eye-view (BEV) projections of the reference dose distribution and anatomical contours to directly predict machine-executable multi-leaf collimator (MLC) apertures and Monitor Units (MUs). The proposed model was benchmarked against baseline U-Nets (using contour-only, dose-only, and combined inputs) on the testing set. Model accuracy was assessed using the Dice Similarity Coefficient (DSC) for MLC and Mean Absolute Error (MAE) for MU, while plan quality was evaluated using clinical dose-volume histogram (DVH) metrics and Conformity Index (CI), Homogeneity Index (HI), and Gradient Index (GI).

MATE-UNet achieved a clinical acceptance rate of 100% (20/20), compared to 70% for the best-performing baseline model. In terms of prediction accuracy, the proposed model achieved a DSC of 0.9553 ± 0.0042 for MLC apertures and an MAE of 1.960 ± 0.396 for MU. Dosimetric evaluation demonstrated that, relative to the reference plans, MATE-UNet maintained comparable target coverage, CI (0.773), and HI (0.100), while achieving a significantly improved GI (3.732, p < 0.05). Furthermore, MATE-UNet significantly reduced the V_39Gy of the stomach and duodenum, as well as the global maximum dose, compared with the baseline models (p < 0.05).

This study demonstrates the feasibility of MATE-UNet for the direct prediction of VMAT machine parameters without iterative optimization. By leveraging multi-modal BEV inputs and a Transformer-enhanced architecture, the proposed framework represents a valuable step toward bridging the gap between dose distributions and clinically usable treatment plans. Although an additional normalization step is required to determine the absolute MUs, MATE-UNet has the potential to serve as a downstream component of a future fully automated anatomy-to-plan pipeline.

BACKGROUND Cancer is a leading cause of global mortality and morbidity, accounting for millions of deaths each year. This study aimed to assess quality of life (QoL), examine the demographic, clinical, and psychological factors associated with QoL, evaluate the prevalence of anxiety and depressive symptoms, and assess the associations between treatment modalities and QoL domains among patients with cancer receiving anticancer therapy in Lahore, Pakistan. MATERIAL AND METHODS A cross-sectional study included 385 cancer patients using a convenience sampling. Data were collected using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire, which assesses 4 QoL domains: physical well-being (PWB), social well-being (SWB), emotional well-being (EWB), and functional well-being (FWB). The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression levels. RESULTS The median overall FACT-G score was 68 (IQR: 24), with EWB scoring the highest median of 19 (IQR: 7) and PWB the lowest at 14 (IQR: 12). SWB and FWB had median scores of 16 (IQR: 4) and 18 (IQR: 9), respectively. HADS results indicated that 56.1% of participants had normal depression scores, while 23.4% had high depression. For anxiety, 60% were in the regular category, and 15.3% had clinical anxiety. Higher levels of anxiety and depression were associated with poorer QoL across all domains. Educational level and sex were significantly associated with QoL. CONCLUSIONS Overall, patients with cancer maintained a moderate QoL, with particularly low PWB scores, highlighting the physical burden of cancer treatment. These findings highlight the importance of routine psychological assessment and supportive care to address the physical, emotional, and social needs of cancer patients during treatment.

Endoscopic retrograde cholangiopancreatography (ERCP) with self-expandable metal stent (SEMS) placement is the standard treatment for malignant biliary obstruction; however, it may not be feasible in cases of duodenal invasion, altered anatomy, or failed cannulation. Although percutaneous transhepatic biliary drainage is a reliable alternative, it is associated with external catheter-related complications and impaired quality of life. Recently, a one-stage percutaneous SEMS placement procedure has been proposed to overcome these limitations.

We retrospectively reviewed five patients (four women and one man; median age, 68 years) with malignant biliary obstruction who underwent one-stage percutaneous SEMS placement between April 2016 and March 2025 at the Tokai University Hospital. The procedures were performed under ultrasonographic guidance using a 19-gauge EVS^™ needle, followed by guidewire exchange, tract dilation with an 8-Fr dilator, and deployment of an Epic^™ biliary SEMS. Technical and clinical success and procedure-related complications were evaluated.

Herein, the underlying diseases included pancreatic head carcinoma (n = 1), postoperative cholangiocarcinoma with lymph node recurrence (n = 2), postoperative gallbladder carcinoma with lymph node recurrence (n = 1), and postoperative gastric carcinoma with peritoneal dissemination (n = 1). ERCP failure was due to the following reasons: duodenal stenosis, choledochojejunostomy, subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) with cannulation failure, laparoscopic SSPPD not attempted due to inflammation, and Roux-en-Y reconstruction. Three and two patients presented with moderate and mild cholangitis, respectively, as per the Tokyo Guidelines 2018. Technical success was achieved in all patients. No procedure-related complications occurred.

One-stage percutaneous SEMS placement is a safe and effective option for treating malignant biliary obstruction in patients unsuitable for ERCP or endoscopic ultrasound-guided biliary drainage. With careful case selection, this approach enables rapid biliary decompression without external drainage and may improve the patient's quality of life.