Caregivers of children with hematologic malignancies experience prolonged treatment demands, uncertainty, and substantial psychosocial burden. This study explored how caregivers navigate everyday caregiving responsibilities, decision-making, and emotional endurance under conditions of uncertainty and constrained choice.

A qualitative study informed by a descriptive phenomenological orientation was conducted with 15 primary caregivers recruited from a pediatric hematology unit in China using purposive sampling. Data were collected through semi-structured interviews and supplemented by non-participant observation. Data were analyzed using reflexive thematic analysis. An existential-oriented interpretive lens was introduced during later stages of analysis to deepen understanding of agency, responsibility, and meaning within caregiving experiences.

Caregivers described caregiving as an ongoing process of negotiating treatment demands, family responsibilities, financial pressures, and emotional strain under conditions of limited control. Everyday life became reorganized around the child's illness, with caregivers adopting present-oriented routines focused on symptom monitoring, treatment continuity, and maintaining immediate stability. Emotional endurance was sustained through regulation of distress, selective focus on incremental improvement, and maintenance of everyday relational continuity. Caregivers' experiences were also shaped by sociocultural expectations surrounding parental responsibility, emotional restraint, and family obligation.

Caregiving in pediatric hematologic oncology involves continuous adaptation within conditions of uncertainty rather than discrete coping responses to stress. Psychosocial support may therefore benefit from approaches that help caregivers sustain everyday functioning, navigate ongoing decision-making, and maintain emotional continuity while living with unresolved uncertainty.

Sexual dysfunction is a recognised adverse outcome after rectal cancer treatments, yet reporting is predominantly male-focused, with female sexual dysfunction less consistently assessed or reported. This systematic review aimed to assess sexual health domains studied, examine sex-based reporting disparities, and identify limitations in the current evidence.

A systematic review and narrative synthesis were conducted in accordance with PRISMA and registered with PROSPERO (CRD420251178502). PubMed/MEDLINE, EMBASE, Scopus, CINAHL Plus, PsycINFO, and Cochrane Library were searched from March 1995 to March 2025, with an updated search to March 2026. Eligible studies included adults treated for rectal cancer in whom sexual function outcomes were assessed using International Index of Erectile Function (IIEF) and/or Female Sexual Function Index (FSFI), with additional related patient-reported outcome measures (PROMs) accepted where relevant. Risk of bias was assessed using RoB 2 and MINORS.

Twenty-five studies involving 4,071 patients were included. Participants were predominantly male (65.8%), while women comprised 34.2%. PROM reporting was inconsistent; only eight studies reported both total and domain-level results. Sexual outcomes were most consistently reported for men, particularly erectile and ejaculatory function, whereas female outcomes were often reduced to overall scores. Five studies restricted sexual outcome assessment and analysis to men. Only six reported response rates, and missing PROM data handling was not described. Key contextual variables, including sexual activity, sexual orientation, sexual practices, and menopausal status, were rarely captured.

Sexual function outcomes after rectal cancer treatment are inconsistently reported, with low certainty. Female sexual dysfunction remains under-represented. Standardised, inclusive sex-specific reporting and development of a core outcome set are needed.

Anthracycline plus taxane (ATAX) regimens are associated with improved survival in HER2-negative breast cancer (HBC) compared to taxane-based (TAX) regimens. However, anthracyclines are known for their cardiotoxicity, which could increase the risk of neurocognitive deficits, raising concerns about neurocognitive safety, particularly in older adults. Limited evidence exists comparing neurocognitive outcomes between these two regimens.

To compare the incidence of Alzheimer's disease and related dementias (ADRD) between ATAX and TAX regimens in neoadjuvant (Trial #1) and adjuvant (Trial #2) settings among older women with early-stage HBC.

Using SEER-Medicare data (2010-2021), we identified women aged ≥ 66 years with newly diagnosed HBC and no prior neurocognitive conditions between 2011 and 2021. Patients were longitudinally tracked, and their eligibility for each regimen was evaluated. We applied the clone-censor-weight method and used weighted pooled logistic regression to estimate the 10-year risks of ADRD, Alzheimer's disease (AD), and vascular dementia (VD).

We identified 14 079 and 9321 eligible individuals in Trial #1 and Trial #2, respectively. For ADRD outcome, the 10-year risk difference (RD) was -6.91% (95% CI: -15.60% to 0.91%) for HR+/HER2- cohort and -2.14% (95% CI: -9.57% to 5.46%) for TNBC cohort in Trial #1. The 10-year RD was -1.42% (95% CI: -9.33% to 6.98%) for HR+/HER2- cohort and -2.91% (95% CI: -9.54% to 7.86%) for TNBC cohort in Trial #2.

Our findings suggest that ATAX regimens were not associated with increased risks of ADRD, AD, and VD compared to TAX regimens in older women with HBC. However, the risks of AD and VD should be interpreted with caution due to sparse events. These findings may support the continued use of ATAX regimens in this population, while also informing more personalized, risk-adapted treatment strategies.

TG-43 formalism dose calculation for brachytherapy with the homogeneous water-based assumption is widely used, which can lead to dose inaccuracy in treatment planning.

Extremity malignancies are also treated with high-dose-rate (HDR) ¹⁹²Ir interstitial brachytherapy, a treatment site that has not been specifically investigated in prior comparative dosimetric studies, and the proximity of source dwell positions to bone and air introduces significant heterogeneity. BrachyPlanCheck, an in-house brachytherapy second dose verification program for Monte Carlo (MC) simulations, incorporates these heterogeneities and is used for a comparative dosimetric study on extremity malignancies.

BrachyPlanCheck was commissioned and validated in both a homogeneous water phantom and a heterogeneous breast phantom. The clinical evaluation included 8 patient-specific lower limb brachytherapy plans, comparing TG-43 and MC calculation using BrachyPlanCheck. Dosimetric differences were evaluated using dose comparisons, gamma index analysis, and dose-volume histogram (DVH) metrics for clinical target volume (CTV) and organ-at-risk (OAR), including bone and skin.

In commissioning Level 1, MC simulations using BrachyPlanCheck demonstrated point dose agreement within ± 0.9%. Gamma passing rates exceeded 99.9% with criteria 1 mm/1% in commissioning Level 2. In clinical evaluation, TG-43 calculation overestimated CTV V150 by up to 10.50% and CTV D90 by up to 7.25%. OAR doses were generally higher with TG-43, with mean differences of 1.09% for bone D1cc (p =  0.109), 1.38% for bone D0.1cc (p =  0.078), 7.30% for skin D2cc (p =  0.008), and 5.68% for skin D0.1cc (p =  0.008).

Validated by phantom and patient study, BrachyPlanCheck demonstrated robust performance for independent secondary dose verification. TG-43 calculation overestimated dose to CTV and OAR in extremity malignancy cases compared with BrachyPlanCheck.

Breast cancer (BC) remains the most diagnosed cancer among women worldwide and its growing survivorship population faces numerous long-term physical and psychological challenges. Cancer support groups emerge as promising interventions to promote comprehensive management of the disease and survivorship needs, emotional well-being and social connection. Accordingly, this study aimed to analyse the acceptability and perceived impact of the Mind Support Group (MSG), a professionally led support group intervention designed for women with BC.

A qualitative methodological approach was used to collect and analyse data.

Participants' feedback data were collected through a guided feedback discussion during the MSG final session and analysed using content and thematic analysis.

The sample comprised 22 women diagnosed with BC (stages I-III). Findings showed high acceptability, with participants expressing satisfaction with several aspects of the intervention: interpersonal processes, content, group composition and perceived outcomes. Suggestions for improvement focused exclusively on the intervention dose (e.g., earlier access) and format (e.g., in-person delivery). Mechanisms of change and perceived outcomes also emerged from participants' feedback. Through social (e.g., shared information and experience), behavioural (e.g., self-disclosure) and psychological (e.g., emotional tension release) mechanisms, the MSG appeared to facilitate shifts toward more adaptive coping strategies, personal growth, a reduction in perceived isolation and alienation, and improved communication and self-management skills.

These findings suggest that the MSG may serve as a valuable complement to medical treatment or, at minimum, inform the design of more comprehensive cancer care interventions integrating psychosocial support across the illness trajectory.

NCT05642897; NCT06212414.

Accurate delineation of target volumes and organs-at-risk (OARs) is a critical yet labor-intensive component of rectal cancer radiotherapy. While deep learning (DL)-based automatic contouring systems are increasingly used to address inter-observer variability and improve efficiency, artificial intelligence models require rigorous quality assurance and updates to reflect current technology. However, high-level evidence regarding the longitudinal real-world impact of implementing and iteratively updating these systems in clinical workflows is currently lacking.

This study aimed to evaluate the real-world clinical impact of implementing and updating a DL-based automatic contouring system in rectal cancer radiotherapy to generate high-quality evidence of iterative updates.

This longitudinal retrospective analysis included 150 patients divided into three cohorts: pre-implementation (n1 = 50), post-implementation (n2 = 50), and post-update (n3 = 50). Geometric similarities between unedited-automatic and final treatment contours were compared across cohorts. Failure rates were systematically analyzed. Six oncologists contoured 21 additional cases through manual, first-generation (Auto1), and second-generation (Auto2) system-assisted methods to evaluate contouring time, inter-observer consistency, and accuracy. Additionally, a 5-point Likert scale was used by two blinded senior oncologists to assess the clinical acceptability of the generated contours.

The mean Dice similarity coefficient (DSC) values of clinical target volume (CTV) before and after implementing the automatic contouring system were 0.87 ± 0.04 and 0.88 ± 0.04 (P = 0.067), while those of OARs were 0.80 ± 0.06 and 0.88 ± 0.05 (P < 0.001), respectively. Following the system update, they improved from 0.88 ± 0.04 to 0.93 ± 0.04 for CTV (P < 0.001) and from 0.88 ± 0.05 to 0.95 ± 0.02 for OARs (P < 0.001). The system update achieved an approximately 80.6% reduction in the mean failure rate. Auto2-assisted method decreased the total time by approximately 58.8% compared with the manual method, and 21.9% compared with the Auto1-assisted method. This method also demonstrated optimal inter-observer consistency (0.95 ± 0.03) and accuracy (0.94 ± 0.03) for CTV. In the blinded clinical evaluation, 99.2% (125/126) of the oncologist-revised final contours received a Likert score of ≥ 4, and Auto2-generated unedited contours showed significantly higher clinical acceptability than Auto1 (4.02 ± 0.25 vs. 3.26 ± 0.49, P < 0.001) CONCLUSIONS: Implementing an automatic contouring system provided crucial guidance for clinical practice. Its iterative update significantly reduced workload and inter-observer variation while enhancing contouring efficiency and quality.

Frameless thermoplastic masks are standard for intracranial stereotactic radiosurgery (SRS), with the Encompass (CQ Medical) widely used on the Varian HyperArc platform. A candidate mask must minimize beam attenuation, permit accurate dose calculation, and enable reproducible setup, yet these are rarely assessed together. Comprehensive comparative data for the proposed Environ (MacroMedics) mask are limited.

To compare the Environ and Encompass masks across three domains: beam attenuation, dose-calculation accuracy under different algorithm and mask-contouring conditions, and interfraction setup reproducibility.

Attenuation was measured with an ionization chamber in a head phantom (TrueBeam, 6 FFF) at seven static gantry angles and a 0°-180° arc, with an estimated measurement uncertainty budget. Planning accuracy was assessed using HyperArc plans on phantom CT for 1-15 mm PTV margins (single-target) and 3/5/7 mm (multi-metastasis), calculated in Eclipse with AAA and Acuros XB (AXB), each with and without the mask in the body contour. Setup reproducibility was analyzed retrospectively from CBCT six-degree-of-freedom corrections (Encompass: 67 fractions/21 patients; Environ: 72 fractions/24 patients). Because repeated fractions are not independent, positioning data were analyzed at the patient level (Mann-Whitney U, Levene's test), by within-patient reproducibility, and with a confirmatory mixed-effects model.

The Encompass attenuated 1.13% ± 0.59% more than the Environ for static beams (p = 0.002); the arc difference (0.06%) was within uncertainty (∼0.4%, k = 1). The Encompass required mask contouring with AXB for acceptable agreement (2.38% without), whereas the Environ achieved sub-1% AXB agreement without contouring (0.24%). The Environ showed a smaller mean vertical correction (mixed-effects p = 0.016) and reduced within-patient variability in vertical (0.31 vs. 1.25 mm, p < 0.001) and pitch (0.50 vs. 0.99°, p = 0.009); other axes were comparable.

The Environ performed comparably or favorably across all three domains, supporting it as a clinically acceptable SRS alternative. It achieved acceptable AXB agreement without mask contouring under the conditions tested, though this depends on institution-specific settings and should be verified locally. The setup-reproducibility advantages, most robust vertically, are hypothesis-generating given the retrospective design and absence of intrafraction data.

Total skin electron therapy (TSET) is a standard treatment for cutaneous T-cell lymphoma. Due to the complex patient positioning and irregular body contours, robust in-vivo dosimetry (IVD) is essential to verify dose uniformity. While thermoluminescent dosimeters (TLDs) are traditional standard, their utility is hindered by labor-intensive, manual processing.

This study evaluates the clinical implementation of a Gafchromic™ EBT4 film-based IVD system integrated with a bespoke, open-source analysis platform for automated batch-processing. To address the inherent orientation dependence and loss of film orientation frequently encountered when preparing small-format IVD films with a manual paper cutter, we developed an orthogonal dual-scan protocol. By averaging pixel values from two perpendicular scans for both calibration and clinical measurement, this protocol effectively mitigates orientation-dependent uncertainties and ensures dosimetric robustness.

The film-based IVD system was clinically assessed in five TSET treatments and compared to six treatments utilizing TLD-based IVD. Dosimetric accuracy was evaluated by comparing normalized fractional doses to the prescription. Statistical analysis was performed using the Mann-Whitney U test with the Benjamini-Hochberg procedure to control the false discovery rate across 20 anatomical sites. Workflow efficiency was quantified by the total time required for data readout and analysis per patient.

The EBT4 film-based IVD demonstrated dosimetric accuracy comparable to the TLDs, with mean fractional doses of 102.7% ± 9.6% and 100.4% ± 9.7%, respectively (p = 0.25). Clinical implementation of the film-based approach significantly enhanced efficiency, reducing the total processing time from approximately 50 min to 15 min per treatment.

The proposed EBT4 film-based IVD system, supported by open-source software and an orthogonal dual-scan protocol, offers a robust, cost-effective, and time-efficient alternative to traditional TLDs. This approach streamlines the clinical workflow without compromising dosimetric accuracy, making it a viable solution for TSET and broader radiotherapy IVD applications.

Brain metastasis remains one of the most devastating complications of lung cancer, contributing to poor prognosis and limited therapeutic efficacy. Increasing evidence suggests that the development and progression of lung cancer brain metastasis are shaped by dynamic and reciprocal interactions among tumor cells, neural components, and immune elements within the brain microenvironment. Neurotrophic factors, neurotransmitters, and glial cells participate in blood-brain barrier remodeling, immune modulation, and metabolic adaptation, while tumor cells exploit these neuro-immune interactions to facilitate colonization, survival, and therapeutic resistance. In this review, we organize current knowledge within a stage-specific and spatiotemporal framework encompassing early blood-brain barrier disruption and colonization, intermediate microenvironmental remodeling with immunosuppression formation, and late-stage stabilization characterized by sustained neuro-tumor interaction. Importantly, rather than summarizing neural or immune pathways in isolation, we integrate adaptive immune dynamics, glial reprogramming, and neurotransmitter-dependent signaling into a unified neuro-immune-tumor network model and explicitly prioritize context-dependent hub molecules according to graded levels of supporting evidence. Within this staged framework, we delineate regulatory axes that may define context-dependent therapeutic windows. Rather than providing an exhaustive catalog of mechanisms, we emphasize pathways with emerging translational relevance, including BDNF-TrkB signaling, adrenergic pathways, and glial reprogramming. This integrative perspective aims to clarify the organizational principles of neuro-immune-tumor networks in lung cancer brain metastasis and to inform future studies exploring combinatorial neural and immune modulation strategies, biomarker development, and rational clinical trial design, while acknowledging that direct LCBM validation remains limited for some pathways.

Gastrointestinal (GI) cancers encompass malignant conditions of the GI tract and accessory digestive organs, including the esophagus, gastric cancer (GC), biliary system, hepatocellular carcinoma (HCC), pancreatic cancer (PC), and colorectal cancer (CRC). Globally, CRC ranks as the third most commonly diagnosed cancer, with gastric, hepatic, and esophageal cancers following in fifth, sixth, and seventh places, respectively. PC contributes notably to cancer mortality, ranking 12th in incidence and 7th in mortality. Despite major advances in diagnosis and treatment, GI cancers remain among the most aggressive malignancies and continue to drive substantial global morbidity and mortality. In 2020, GI cancers accounted for more than 4.8 million new cases and 3.4 million deaths. Although early-stage GI tumors can be surgically resected with curative intent, the overall 5-year relapse rate remains high. Neoadjuvant or adjuvant chemotherapy and radiotherapy provide only modest long-term survival improvements when applicable. In recent decades, prognosis for advanced GI cancers has improved due to tailored therapies that combine cytotoxic and targeted agents and integrate systemic treatments with more effective surgical and locoregional approaches. Nevertheless, GI malignancies remain a leading cause of cancer death, underscoring the need for novel therapeutic options. A central molecular driver is the PI3K/AKT/mTOR signaling axis, which governs chemotherapy resistance, metastasis, survival, metabolism, and growth, and modulates the tumor microenvironment via angiogenesis and inflammatory infiltration. Dysregulation of this axis is common across GI cancers, guiding exploration of pathway-targeted therapies, alone or in combination. Although several agents show promise, toxicities such as neuropsychiatric effects, diarrhea, hepatotoxicity, and hyperglycemia limit clinical utility. Therefore, refined personalization and combination strategies targeting PI3K/AKT/mTOR are critical to improving efficacy and reducing resistance in GI malignancies.