Oncology最新文献

{"title":"Redefining Fitness in Chronic Lymphocytic Leukaemia: A Treatment-Specific Framework for the Targeted Therapy Era.","authors":"Yousef Al-Asa'd, Salem H Alshemmari, Nabeel Mohammad Qasem, Afaf Al Battah, Mohamed A Yassin","doi":"10.1159/ocl/aebag001","DOIUrl":"10.1159/ocl/aebag001","url":null,"abstract":"<p><strong>Background: </strong>Therapeutic advances in chronic lymphocytic leukaemia (CLL) have made treatment selection far more nuanced than in the chemoimmunotherapy era. Patients now have access to two principal therapeutic strategies: continuous therapy with Bruton's tyrosine kinase inhibitors (BTKis) or fixed-duration regimens combining venetoclax with CD20 monoclonal antibodies and/or BTKis. These strategies carry fundamentally different safety profiles, monitoring requirements, and logistical demands, necessitating a treatment-specific approach to fitness assessment.</p><p><strong>Summary: </strong>The objective of this article was to synthesise current evidence and propose a practical, treatment-specific fitness assessment framework for patients with CLL, enabling physicians to match patient characteristics to the most appropriate targeted therapy. This was a narrative review of the literature from PubMed, Scopus, and Embase. Landmark randomised controlled trials, contemporary expert opinion papers, and current guidelines from ESMO, ASCO, and ESC were reviewed. The two therapeutic paradigms impose distinct fitness demands. For continuous BTKi therapy, cardiovascular comorbidity is the dominant determinant, given the class-effect risk of atrial fibrillation and hypertension. For fixed-duration venetoclax-based regimens, the key determinants instead shift to renal function and tumour burden, which govern tumour lysis syndrome risk, and to the social support and hospital access required for intensive ramp-up monitoring. Building on this distinction, the landmark phase 3 CLL17 trial (N Engl J Med, 2026) demonstrated that fixed-duration venetoclax-obinutuzumab and venetoclax-ibrutinib are non-inferior to continuous ibrutinib, with superior rates of undetectable minimal residual disease and lower treatment discontinuation, particularly in older patients. Notably, frailty - better conceptualised as lower resilience - is dynamic rather than fixed and may improve during effective targeted therapy. Structured pre-treatment screening can be performed with validated instruments such as the G8, VES-13, GAH, and the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS); however, no single tool has yet been prospectively validated for outcome prediction specifically with BTKi or BCL-2 inhibitor therapy, and addressing this evidence gap is a priority for future research.</p><p><strong>Key messages: </strong>A treatment-specific, individualised fitness assessment - rather than an age-based or aggregate comorbidity score - is the appropriate framework for CLL in the targeted therapy era. Most patients, including those with lower resilience, are candidates for targeted therapy; the clinical imperative is to match each patient to the treatment best suited to their specific fitness profile.</p>","PeriodicalId":19497,"journal":{"name":"Oncology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain-Tropic Metastasis: Mechanistic Checkpoints Governing Cerebral Colonization.","authors":"Henry Freeman, Clayton Rawson, Denise Baloi, Michael Karsy, Mehrdad Pahlevani","doi":"10.1159/ocl/aebag007","DOIUrl":"10.1159/ocl/aebag007","url":null,"abstract":"<p><strong>Background: </strong>Brain metastasis is a major contributor to morbidity in advanced cancer, with substantial variability in incidence and biological behavior across primary tumor types and molecular subtypes. Increasing evidence suggests that cerebral organotropism is driven by coordinated interactions between tumor-intrinsic programs and the specialized brain microenvironment. This review aimed to synthesize contemporary mechanistic evidence underlying brain-tropic metastasis and identify biologically actionable bottlenecks involved in metastatic progression within the central nervous system.</p><p><strong>Summary: </strong>We conducted a mechanism-focused narrative review of recent neuro-oncology literature examining the biological processes that facilitate brain-specific metastatic dissemination. Four major mechanistic domains were evaluated: (1) extracellular vesicle and exosome-mediated conditioning of the brain vascular-immune niche; (2) cerebral microvascular arrest and endothelial adhesion under shear stress facilitating tumor transmigration; (3) brain-tumor barrier remodeling and endothelial-state heterogeneity influencing permeability and transport; and (4) perivascular metastatic progression shaped by astrocytic and microglial/myeloid microenvironments. The strongest mechanistic support for cerebral organotropism was identified in breast cancer, oncogene-driven non-small cell lung cancer, and melanoma. In contrast, the biological pathways underlying brain metastasis in renal cell carcinoma and colorectal cancer remain comparatively less defined.</p><p><strong>Key messages: </strong>Cerebral organotropism appears to emerge through iterative tumor subclone evolution coupled with dynamic host microenvironmental reprogramming. Coordinated vascular, immune, and glial interactions represent critical mechanistic checkpoints governing metastatic seeding and survival in the brain. Future advances in prediction and prevention will require subtype-resolved and spatially informed human validation studies, alongside mechanistically grounded therapeutic strategies targeting vascular docking, barrier remodeling, and glial-myeloid support pathways.</p>","PeriodicalId":19497,"journal":{"name":"Oncology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148830729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperthermic Intraperitoneal Chemotherapy Combined with Cytoreductive Surgery and Systemic Therapy Improves Prognosis in Colorectal Cancer with Peritoneal Metastases: An Updated Meta-Analysis.","authors":"Kangshuo Hu, Xuanhao Hu, Ting Jiang, Xuelian Dai, Yixuan Wu, Zhongxuan Xie, Qili Yu","doi":"10.1159/ocl/aebag002","DOIUrl":"10.1159/ocl/aebag002","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with colorectal cancer (CRC) and peritoneal metastases (PMs) have a poor prognosis. The efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial. This study aimed to evaluate the efficacy of HIPEC combined with cytoreductive surgery (CRS) and systemic therapy in these patients.</p><p><strong>Methods: </strong>PubMed, Web of Science, Embase, and the Cochrane Library were searched from their inception to March 2026. The primary outcomes were progression-free survival (PFS) and overall survival (OS). Treatment effects were quantified as pooled hazard ratios (HRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>This meta-analysis included 12 studies (2 randomized controlled trials), 9 cohort studies, and 1 case-control study), encompassing >2,700 patients. Pooled analysis showed that the addition of HIPEC significantly improved OS (HR = 0.60, 95% CI: [0.51, 0.70], p < 0.001, I2 = 18.2%), with a 40% reduction in mortality, and significant PFS benefit (HR = 0.51, 95% CI: [0.30, 0.87], p = 0.013, I2 = 76.3%), with a 49% reduction in the risk of progression or death. Subgroup analyses demonstrated consistent OS benefits across regions (Eastern: HR = 0.50, 95% CI: [0.32, 0.78]; Western: HR = 0.62, 95% CI: [0.52, 0.74]) and follow-up durations (<30 months: HR = 0.57, 95% CI: [0.51, 0.63]; ≥30 months: HR = 0.60, 95% CI: [0.42, 0.85]). No significant OS benefit was observed in either the peritoneal cancer index (PCI) <11 (HR = 0.71, p = 0.089) or PCI ≥ 11 (HR = 0.53, p = 0.063) subgroups. Regarding PFS, a significant benefit was observed only in patients with PCI < 11 (HR = 0.74, p = 0.043), whereas no significant difference was found in those with PCI ≥ 11 (HR = 0.45, p = 0.066).</p><p><strong>Conclusion: </strong>HIPEC combined with CRS and systemic therapy significantly improves prognosis in patients with CRC and PM.</p>","PeriodicalId":19497,"journal":{"name":"Oncology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of the Lymphocyte-to-Monocyte Ratio in Predicting Prognosis in Patients with Hepatocellular Carcinoma Receiving Atezolizumab Plus Bevacizumab.","authors":"Emi Tanaka, Toshifumi Tada, Atsushi Hiraoka, Masashi Hirooka, Kazuya Kariyama, Joji Tani, Masanori Atsukawa, Koichi Takaguchi, Ei Itobayashi, Takashi Nishimura, Kunihiko Tsuji, Toru Ishikawa, Kazuto Tajiri, Hironori Tanaka, Hidenori Toyoda, Chikara Ogawa, Takeshi Hatanaka, Satoru Kakizaki, Kazuhito Kawata, Atsushi Naganuma, Hisashi Kosaka, Hidekatsu Kuroda, Yutaka Yata, Hiroki Nishikawa, Michitaka Imai, Tomoko Aoki, Hironori Ochi, Hideyuki Tamai, Shohei Komatsu, Takanori Matsuura, Yoshihide Ueda, Tomomitsu Matono, Soo Ki Kim, Hideko Ohama, Fujimasa Tada, Shinichiro Nakamura, Yoshiko Nakamura, Osamu Yoshida, Kazuhiro Nouso, Asahiro Morishita, Norio Itokawa, Tomomi Okubo, Taeang Arai, Akemi Tsutsui, Takuya Nagano, Kazunari Tanaka, Yuichi Koshiyama, Yuki Kanayama, Hidenao Noritake, Hirayuki Enomoto, Kosuke Matsui, Masaki Kaibori, Jumpei Okamura, Takumi Fukumoto, Yoichi Hiasa, Masatoshi Kudo, Takashi Kumada","doi":"10.1159/000553349","DOIUrl":"https://doi.org/10.1159/000553349","url":null,"abstract":"<p><p>Aim The lymphocyte-to-monocyte ratio (LMR) has emerged as a potential immune-related biomarker; however, its prognostic significance in patients with unresectable hepatocellular carcinoma (HCC) treated with atezolizumab plus bevacizumab (Atezo/Bev) remains unclear. To investigate the prognostic significance of the LMR in patients with unresectable HCC treated with Atezo/Bev. Methods This multicentre study included 941 patients with unresectable HCC treated with Atezo/Bev therapy at 30 institutions in Japan. The optimal LMR cutoff value was determined using time-dependent receiver operating characteristic (ROC) analysis. Multivariate survival analyses were performed for progression-free survival (PFS) and overall survival (OS). The prognostic utility of the LMR was compared with that of the neutrophil-to-lymphocyte ratio (NLR) using integrated discrimination improvement and net reclassification improvement. Results Time-dependent ROC analysis identified an optimal LMR cutoff value of 3.6 based on median OS. The median PFS was 5.6 months in patients with an LMR < 3.6 and 8.9 months in those with an LMR ≥ 3.6 (P<0.01). The disease control rate was significantly higher in the high LMR group (P<0.01). Multivariate analysis identified the LMR as an independent factor associated with prolonged PFS (hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.90-0.98; P<0.01) and OS (HR, 0.90; 95% CI, 0.85-0.96; P<0.01). Compared with NLR, LMR demonstrated a significantly greater improvement in prognostic predictive performance for both PFS and OS (P<0.01). Conclusions The LMR is a simple and clinically useful prognostic biomarker for predicting both PFS and OS in patients with unresectable HCC treated with Atezo/Bev therapy.</p>","PeriodicalId":19497,"journal":{"name":"Oncology","volume":" ","pages":"1-26"},"PeriodicalIF":1.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical Guide for Managing Philadelphia-Negative Myeloproliferative Neoplasms in Patients with Organ Dysfunction.","authors":"Shams Abdulsalam, Rafal Al-Shibly, Rasha Kaddoura, Omar Mohammad Ismail, Mohamed A Yassin","doi":"10.1159/000553574","DOIUrl":"10.1159/000553574","url":null,"abstract":"<p><strong>Background: </strong>Classical Philadelphia-negative myeloproliferative neoplasms (MPNs), including polycythemia vera, essential thrombocythemia, and myelofibrosis, frequently occur in patients with renal, hepatic, cardiovascular, or hematologic comorbidities. These vulnerabilities complicate treatment selection, dose adjustment, and toxicity monitoring. However, patients with advanced kidney disease, dialysis dependence, decompensated cirrhosis, severe cytopenias, or overlapping organ impairment are often underrepresented in prospective trials.</p><p><strong>Summary: </strong>This narrative review presents a practical, organ-adapted framework for selecting MPN therapy in clinically complex patients. We define renal and hepatic impairment, compare commonly used cytoreductive and targeted therapies, including hydroxyurea, busulfan, anagrelide, ruxolitinib, fedratinib, momelotinib, pacritinib, ropeginterferon alfa-2b, and pegylated interferon alfa-2a, and discuss their use in dialysis, decompensated liver disease, cytopenic myelofibrosis, anemia-dominant myelofibrosis, and combined organ vulnerability. The proposed approach prioritizes label-based dose modification when available, cautious dose initiation when evidence is extrapolated, structured early monitoring, and multidisciplinary review for high-risk patients.</p><p><strong>Key messages: </strong>Management of Philadelphia-negative MPNs in organ dysfunction should be individualized according to disease phenotype, treatment goal, organ reserve, hematologic tolerance, frailty, and label-specific safety restrictions. In renal impairment, hydroxyurea and ruxolitinib may remain feasible in selected patients when dose-adjusted and monitored closely, whereas dialysis and severe renal impairment require conservative initiation and multidisciplinary review because direct evidence remains limited. In myelofibrosis, JAK inhibitor choice should be phenotype-adapted; ruxolitinib remains a common standard when blood counts and organ function permit, momelotinib is attractive in anemia-dominant disease, pacritinib is particularly relevant in severe thrombocytopenia, and fedratinib is useful in selected settings but requires thiamine-focused safety management. In hepatic dysfunction or overlapping organ vulnerability, therapy should prioritize safety, reversible contributors, conservative starting strategies, explicit stopping rules, and early reassessment.</p>","PeriodicalId":19497,"journal":{"name":"Oncology","volume":" ","pages":"1-15"},"PeriodicalIF":1.9,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13489602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fat Mass and Survival in Immunotherapy-Treated Metastatic Renal Cell Carcinoma Patients.","authors":"Tanguy Bouget, Marine Lottin, Abeer Najem, Sahir Javed, Marine Marrucho, Julien Elices-Diez, Pierre-Yves Cren, Marie-Cécile Le Deley, Nicolas Penel, Aurélien Carnot, Gautier Marcq, Alexandra Forestier","doi":"10.1159/000552741","DOIUrl":"10.1159/000552741","url":null,"abstract":"<p><strong>Introduction: </strong>Immune checkpoint inhibitors (ICIs) are widely prescribed as the first-line treatment for metastatic renal clear-cell carcinoma because of their overall survival (OS) benefits. However, ICIs are associated with unreliable efficacy and sometimes severe and unpredictable toxicities. There is a lack of biomarkers for efficacy or toxicity beyond the IMDC score. Body composition (fat and muscle mass) may also be a biomarker of interest. The aim of this retrospective study was to analyze the association between body composition, OS, and toxicities in patients with RCC treated with ICI as a first-line metastatic treatment.</p><p><strong>Methods: </strong>Body composition parameters - subcutaneous fat index (SFI), visceral fat index (VFI), total fat index (TFI), and skeletal muscle index (SMI) - were measured on computed tomography scans using semiautomated software.</p><p><strong>Results: </strong>In 71 patients, no significant association was found between TFI and OS (adjusted HR, 0.71 [0.35; 1.45]) or toxicities. The TFI was strongly correlated with BMI (r = 0.81), whereas the SFI and VFI were weakly correlated.</p><p><strong>Conclusion: </strong>Larger studies would be valuable to better define the thresholds of different parameters (SFI, VFI, TFI, and SMI) and their association with the efficacy and toxicity of ICI.</p>","PeriodicalId":19497,"journal":{"name":"Oncology","volume":" ","pages":"1-12"},"PeriodicalIF":1.9,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unique Stroma of Higher-Grade Pancreatic Intraepithelial Neoplasia: Fibroblastic Cluster Formation and CD36 Downregulation.","authors":"Yuuji Aoki, Yuki Fukumura, Jun Nakahodo, Yoshihiro Mezawa, Yifare Maimaitiaili, Mulading Maimaitituerxun, Takashi Yao","doi":"10.1159/000553573","DOIUrl":"10.1159/000553573","url":null,"abstract":"<p><strong>Introduction: </strong>Identifying pathological markers to differentiate between high- and low-grade pancreatic intraepithelial neoplasia (PanIN) remains an unmet clinical need. Recent studies suggest that the tumor microenvironment undergoes dynamic changes during PanIN progression. To establish objective pathological markers, this study investigated histological, immunohistochemical, and molecular alterations in PanIN-associated stroma across different grades.</p><p><strong>Methods: </strong>Fibroblastic cluster (FC) was defined and characterized using immunohistochemistry (IHC) for SMA, CD31, and CD34, and their frequency was assessed according to PanIN grade in 202 PanIN lesions and 58 normal ducts. To identify molecular differences among PanIN types, multiple gene expression analysis (MGEA) was performed for six normal ducts and for three PanIN1, three PanIN2, and six PanIN3 lesions. IHC and fluorescent dual IHC for CD31 and CD36 were performed to quantify CD36-positive stromal vessels. RNA scope for PPARγ and IHC for thrombospondin-1 (TSP-1) and forkhead box O1 (FOXO-1) were performed to explore the molecular basis of CD36 downregulation.</p><p><strong>Results: </strong>FCs were identified in 86.6% of PanIN3 stroma and were significantly more frequent than in lower-grade PanINs. MGEA revealed downregulation of CD36 in PanIN2-3 compared with PanIN1, and CD36-positive vessels were significantly fewer in higher-grade PanIN stroma. PPARγ signals were present in low-grade but absent in high-grade PanIN stroma. TSP-1 expression paralleled CD36 expression. These findings suggest that the possible relationship between the repression of CD36 in the stromal vasculature of high-grade PanIN and reduced PPARγ and TSP-1 signaling.</p><p><strong>Conclusions: </strong>Higher-grade PanINs harbor a unique stroma characterized by FC formation and an increased proportion of CD36-negative vessels.</p>","PeriodicalId":19497,"journal":{"name":"Oncology","volume":" ","pages":"1-12"},"PeriodicalIF":1.9,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13480974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148448570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Department Visits after Radiotherapy in Patients with Solid Malignancies: Analysis of Causality and Severity.","authors":"Sunmin Park, Sungwoo Moon, Jong-Hak Park, Jungsun Kim, Jungyoon Choi, Chai Hong Rim, Won Sup Yoon","doi":"10.1159/000553522","DOIUrl":"10.1159/000553522","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to characterize emergency department (ED) visits after radiotherapy (RT) and to assess the causality and severity of these visits.</p><p><strong>Methods: </strong>Patients who received RT for solid malignancies from 2016 to 2021 were retrospectively analyzed. The study period for ED visits was defined from the start of RT to 3 months after the completion of RT. Causes of ED visits were classified as (1) cancer treatment-related causes, (2) RT-related causes, (3) cancer-related causes, and (4) other medical conditions, and the degree of relevance for each cause was assessed as (1) certain, (2) probable, (3) possible, or (4) unlikely. Severity was graded using the Korean Triage and Acuity Scale (KTAS). Acuity at ED presentation was categorized by KTAS grade: grades 1-2 as high, grade 3 as moderate, and grades 4-5 as low. Predictors related to strong relevance (certain and probable) for each cause and to severe events were examined using binary logistic regression. A p value <0.05 indicated statistical significance.</p><p><strong>Results: </strong>A total of 177 patients presented to the ED, and 192 ED visits were evaluated. The thoracic site was the most frequent primary site, and 67.2% of cases were stage III/IV. KTAS 3, indicating urgency, was the most common, accounting for 64.1%. The degree of relevance to RT-related causes was positively correlated with KTAS grade (r = 0.253, p < 0.001). The proportions of ED visits with strong relevance for cancer treatment-related, RT-related, cancer-related, and other medical conditions were 62.5%, 41.1%, 16.1%, and 38.0%, respectively. Among causes with strong relevance, concurrent chemoradiotherapy (OR: 4.24, p < 0.001) and curative RT (OR: 3.23, p < 0.001) were significantly associated with cancer treatment-related and RT-related causes, respectively. Severe events were more frequently observed with thoracic primary tumors (OR: 3.01, p = 0.005), intervals >30 days after RT (OR: 2.60, p = 0.016), and age ≥65 years (OR: 2.37, p = 0.022).</p><p><strong>Conclusion: </strong>Patients with identified risk factors require close and continuous follow-up after RT to reduce severe ED presentations.</p>","PeriodicalId":19497,"journal":{"name":"Oncology","volume":" ","pages":"1-10"},"PeriodicalIF":1.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydroxyurea Bridging Before Frontline Tyrosine Kinase Inhibitor Therapy in Newly Diagnosed Chronic-Phase Chronic Myeloid Leukemia: A Critical Appraisal.","authors":"Mohammed Abdulgayoom, Awni Alshurafa, Abdulrahman F Al-Mashdali, Shehab F Mohamed, Mohamed A Yassin","doi":"10.1159/000553465","DOIUrl":"10.1159/000553465","url":null,"abstract":"<p><strong>Background: </strong>Hydroxyurea-based cytoreduction before tyrosine kinase inhibitor (TKI) initiation remains common in newly diagnosed chronic-phase chronic myeloid leukemia (CML), yet its contemporary value is uncertain.</p><p><strong>Summary: </strong>This critical narrative review examines the historical rationale, biologic basis, clinical evidence, and guideline positions relevant to hydroxyurea use before or immediately around frontline TKI therapy. Hydroxyurea can lower leukocyte and platelet counts rapidly and may provide short-term symptomatic relief while diagnostic confirmation is pending or when definitive treatment access is briefly delayed. However, contemporary evidence does not support routine pretreatment in clinically stable chronic-phase CML. Observational studies have shown no improvement in European LeukemiaNet response milestones, no acceleration of molecular response kinetics, and possible disadvantages including delayed TKI initiation, greater hematologic toxicity, and more treatment interruptions. Randomized studies evaluating early hydroxyurea together with imatinib likewise have not demonstrated meaningful molecular or hematologic benefit over TKI therapy alone. Current guidelines consistently position hydroxyurea as a selective, time-limited bridging option rather than a standard pretreatment strategy.</p><p><strong>Key messages: </strong>In modern practice, the priority should be rapid initiation of definitive BCR::ABL1-directed therapy once the diagnosis is confirmed and access is secured. Hydroxyurea retains a limited role in selected situations such as symptomatic proliferative burden, suspected leukostasis, clinically important thrombocytosis, or short unavoidable logistical delay to TKI initiation.</p>","PeriodicalId":19497,"journal":{"name":"Oncology","volume":" ","pages":"1-7"},"PeriodicalIF":1.9,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Outcomes in Acute Promyelocytic Leukemia: A 13-Year Cohort from Qatar.","authors":"Rola Ghasoub, Hesham Elsabah, Anas Hamad, Nabeel Mohammad Qasem, Hawraa Shwaylia, Feryal Ibrahim, Halima Elomri, Rajvir Singh, Shehab Fareed, Abdulrahman F Al-Mashdali, Anil Ellahie, Honar Cherif","doi":"10.1159/000553398","DOIUrl":"10.1159/000553398","url":null,"abstract":"<p><strong>Introduction: </strong>Acute promyelocytic leukemia (APL) is among the most curable acute leukemias, but real-world early mortality continues to undermine population-level cure. This study evaluated long-term outcomes and prognostic factors among adults with APL treated in a single tertiary center in Qatar.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of consecutive adult patients diagnosed with APL between 2012 and 2024. Baseline demographic, clinical, and laboratory data, treatment regimens, and response outcomes were extracted from electronic medical records. Patients were stratified according to Sanz risk criteria. Overall survival (OS) was estimated using the Kaplan-Meier method, and prognostic factors were assessed using log-rank tests and Cox proportional hazards regression.</p><p><strong>Results: </strong>A total of 87 patients were included (median age: 36 years; 47.1% high-risk groups by Sanz criteria). Early mortality within 30 days occurred in 26.4% (n = 23), predominantly due to intracranial hemorrhage (47.8% of early deaths). Among 71 patients who received treatment, the complete remission (CR) rate was 84.1%, with the highest CR observed in those treated with all-trans retinoic acid (ATRA)-arsenic trioxide (90.9%). Treatment-related complications occurred in 73.2% of patients, most commonly infections (66.2%) and differentiation syndrome (21.1%). Three-year OS was 93% in low-risk groups, 88% in intermediate-risk groups, and 56% in high-risk groups (log-rank p = 0.001). In multivariable analysis, ICU admission (hazard ratio [HR]: 5.42) and lack of treatment initiation (HR: 8.06) were independent predictors of mortality. Excluding patients presenting with intracranial hemorrhage, early mortality decreased to 14.7%, and 5-year OS improved to 87.6%.</p><p><strong>Conclusion: </strong>Despite the effectiveness of contemporary APL therapies, early mortality, primarily driven by hemorrhagic complications, remains a significant challenge. Strategies to improve outcomes should focus on rapid diagnosis, immediate initiation of empiric ATRA, and aggressive correction of coagulopathy. Integration of APL-specific emergency care pathways may represent a key opportunity to reduce preventable deaths.</p>","PeriodicalId":19497,"journal":{"name":"Oncology","volume":" ","pages":"1-13"},"PeriodicalIF":1.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}