Clinica Terapeutica最新文献

{"title":"Challenges Faced by Left-Handed Surgeons: A Cross-Sectional Study.","authors":"Akash Tomar, Adarsh Sugathan, Tejaswini Girish, Varun Girish, Poornajita Natarajan Dhanalakshmi, Arun Kumar Nayanatara","doi":"10.7417/CT.2026.2064","DOIUrl":"10.7417/CT.2026.2064","url":null,"abstract":"<p><strong>Purpose: </strong>Left-handed surgeons often adapt to right-handed instruments and environments designed for the majority. Indian data on their professional and ergonomic challenges are limited.</p><p><strong>Methods: </strong>A cross-sectional questionnaire survey was conducted among left-handed surgeons and trainees across Karnataka. The semi-structured tool included demographic details and questions on awareness, mentorship, training obstacles, and instrument access. Data were analysed using descriptive statistics and chi-square/Fisher's exact tests.</p><p><strong>Results: </strong>Seventy-seven respondents were included. Most (88.3%) were aware of laterality issues before choosing surgery; 85.7% encountered practical difficulties during surgical training , and 57.1% felt pressured to be ambidextrous. Only 10.4% had ever been provided left-hand instruments despite 81.8% awareness of such tools. Access to left-hand instruments and reported obstacles both differed significantly.</p><p><strong>Conclusions: </strong>Left-handed surgeons face considerable ergonomic and educational barriers with minimal institutional support. Structured mentorship and wider provision of left-hand instruments could enhance equity and training quality.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 4","pages":"729-733"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148320386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-Assisted versus Laparoscopic Radical Nephrectomy for High-Complexity Renal Tumors: A Multidisciplinary Systematic Review and Meta-Analysis.","authors":"Mohamed Elnemr, Md Hasan Sharif, Hayat Mahmoud Mahmoud, Mohamad Adel Abdalgaleel, Saher Elshazly, Thamer Mhanna, Taher Rezk, Khaled Asem Allam, Mohammad Albachaan, Osama M Ghoneimy, Gameel Aboelgheit, Sarah Abdelrahman Mohammed, Khalid Alaghbar, Ayman Abdelmonem Ahmed Kayed, Mennat Allah Oda","doi":"10.7417/CT.2026.2086","DOIUrl":"10.7417/CT.2026.2086","url":null,"abstract":"<p><strong>Background: </strong>Radical nephrectomy for high-complexity renal tumors, stage T2-T4, size ≥7 cm, and/or inferior vena cava (IVC) involvement, represents one of the most technically demanding procedures in urologic oncology. Robot-assisted radical nephrectomy (RARN) has expanded rapidly in adoption, yet its comparative benefit over laparoscopic radical nephrectomy (LRN) in the high-complexity subpopulation remains undefined. No systematic review has restricted analysis to T2-T4 disease or applied a multidisciplinary outcome framework spanning surgical, renal, infectious, and oncologic domains.</p><p><strong>Methods: </strong>Searches of PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, Scopus, and CINAHL retrieved comparative studies (randomized controlled trials, prospective and retrospective cohorts, case-control studies) reporting RARN versus LRN outcomes in adults with high-complexity renal tumors. Screening, data extraction, and risk-of-bias assessment were performed independently in duplicate. Pooling used DerSimonian-Laird random-effects meta-analysis. Heterogeneity was quantified using I² and 95% prediction intervals. Evidence certainty was graded with GRADE. A total of 22 studies encompassing 4,163 patients (RARN: 1,748; LRN: 2,415) met inclusion criteria.</p><p><strong>Results: </strong>RARN was associated with a significantly lower conversion rate to open surgery (odds ratio [OR] 0.38, 95% CI 0.21-0.68; I²=11%; moderate-certainty evidence), reduced estimated blood loss (mean difference [MD] -81.4 mL, 95% CI -112.3 to -50.5; I²=48%), lower transfusion rate (OR 0.54, 95% CI 0.35-0.84), and superior eGFR preservation (MD +3.2 mL/min/1.73 m², 95% CI 0.8-5.6). Operative time was longer in the RARN group (MD +22.7 min, 95% CI 9.3-36.1). No statistically significant differences emerged in overall complication rate, major complication rate, positive surgical margin rate, or recurrence-free survival; however, RARN was associated with a modestly shorter length of stay. Subgroup analysis demonstrated the greatest RARN advantage in IVC thrombus cases (Mayo level III-IV) and tumors ≥10 cm.</p><p><strong>Conclusions: </strong>Among adults undergoing radical nephrectomy for high-complexity renal tumors, RARN confers a meaningful reduction in conversion to open surgery, intraoperative blood loss, transfusion requirement, and acute renal functional loss compared with LRN, at the cost of modestly longer operative time. Evidence quality is moderate for the primary outcome and low-to-moderate for secondary endpoints, reflecting a predominantly observational evidence base. A dedicated randomized controlled trial in the T3-T4 and IVC thrombus subpopulation remains the priority for future research.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 4","pages":"916-926"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148320302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of dl-DECT for Postmortem Interval Estimation Through Changes in Yellow Bone Marrow: Preliminary Results.","authors":"Vincenzo Cianci, Marco Cavallaro, Simone Barbera, Cristina Mondello, Tommaso D'Angelo, Gianluca Tripodi, Annalisa Cracò, Antonino Germanà, Antonio Bottari, Giorgio Ascenti, Desirèe Speranza, Patrizia Gualniera, Alessio Asmundo, Michele Gaeta, Daniela Sapienza","doi":"10.7417/CT.2026.2061","DOIUrl":"10.7417/CT.2026.2061","url":null,"abstract":"<p><strong>Abstract: </strong>Being able to correctly estimate the post-mortem interval is one of the most challenging tasks in forensic pathology, as the most used methods are influenced by various factors that can reduce their reliability. Through this study, the authors propose an innovative method aimed to further narrowing the time interval within which to place the time of death. It is proposed an analysis of the yellow bone marrow using the dual-layer dual-energy computed tomog-raphy (dl-DECT) as a tool to potentially identify its alteration composition occurring post-mortem. In adults, in physiological conditions, DECT does not usually show fluid components within bone marrow. Therefore, the identi-fication of fluid-like components in the bone marrow of cadaveric femurs we observed could be attributable to post-mortem phenomena. The obtained results are still preliminary, therefore further studies are required. In the near future, further analyses will be performed by this research group, trying to identify a correlation between the variations of water in the yellow bone marrow and the time of death.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 4","pages":"705-710"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148320560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structural Brain Changes and Cognitive Impairments in Drivers with PTSD: Cross-Sectional Study.","authors":"Sergey Greybo, Andrey Sivkov, Natalya Chernus","doi":"10.7417/CT.2026.2062","DOIUrl":"10.7417/CT.2026.2062","url":null,"abstract":"<p><strong>Background/objectives: </strong>This cross-sectional study investigates how post-traumatic stress disorder (PTSD) affects memory functioning and brain structure in automobile drivers. Specifically, it examines associations between PTSD symptom severity, cognitive impairments, and structural brain alterations.</p><p><strong>Methods: </strong>The sample included 240 automobile drivers from Moscow, Russia, assessed between 2022 and 2023: 120 drivers diagnosed with PTSD and 120 trauma-exposed controls without PTSD. PTSD was evaluated using the Clinician-Administered PTSD Scale (CAPS-5). Cognitive functioning was assessed through standardized neuropsychological tests targeting short- and long-term memory, attention, and event segmentation. Psychological symptoms were measured using validated self-report instruments (BDI-II, BAI). Structural MRI and diffusion tensor imaging (DTI) were used to quantify regional brain volume and white matter integrity, focusing on the hippocampus and cingulate cortex.</p><p><strong>Results: </strong>Drivers with PTSD showed significantly lower performance in memory and attention tasks (p<0.05) and reported more difficulties with event segmentation (p=0.003). Structural MRI analyses revealed reduced volume in the hippocampus (p=0.018) and the isthmus of the cingulate cortex (p=0.034; p=0.039). DTI indicated decreased diffusion in cerebellar-hippocampal pathways (p=0.021). PTSD symptom severity was negatively correlated with short- and long-term memory scores (ρ=-0.45 and -0.38) and positively associated with event segmentation (ρ=0.61, p=0.009).</p><p><strong>Conclusion: </strong>The findings highlight the interplay between PTSD symptoms, structural brain alterations, and cognitive dysfunction in drivers. These results support the relevance of hippocampal and cingulate cortex abnormalities as potential biomarkers of trauma-related memory dysfunction and suggest that early screening of PTSD symptoms in drivers may help mitigate neurocognitive risks associated with traumatic stress.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 4","pages":"711-719"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148320277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Nomogram for Preoperative Prediction of Ovarian Cancer Risk: A Single-Center Study from Vietnam.","authors":"Nguyen Quoc Tuan, Nguyen Phuong Nam, Nguyen Hai Phuong, Dang Van Tot, Chu Quang Chien, Nguyen Phuong Tu","doi":"10.7417/CT.2026.2076","DOIUrl":"10.7417/CT.2026.2076","url":null,"abstract":"<p><strong>Objective: </strong>To develop and validate a nomogram for preoperative prediction of ovarian cancer risk using biochemical and hematological markers.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 250 patients who underwent surgery for ovarian masses at the National Hospital of Obstetrics and Gynecology (Hanoi, Vietnam). Variables included age, menopausal status, CA125, HE4, neutrophil count (NEU), lymphocyte count (LYM), and neutrophil-to-lymphocyte ratio (NLR). A nomogram was developed using multivariate logistic regression. Model performance was assessed via AUC, ROC analysis, and Decision Curve Analysis (DCA).</p><p><strong>Results: </strong>The final nomogram included CA125, HE4, NEU, LYM, and NLR. It demonstrated superior discrimination (AUC = 0.956) compared to CA125 (AUC = 0.815) or HE4 (AUC = 0.799) alone. DCA confirmed greater net clinical benefit across the 20%-60% threshold range.</p><p><strong>Conclusion: </strong>The proposed nomogram offers a reliable, accessible tool for malignancy risk stratification in women with ovarian tumors. Further validation is warranted.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 4","pages":"822-828"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148320410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic determinants of Pulmonary Hypertension in a Tertiary Care Hospital in Southern India.","authors":"Deepa Noronha, Prasanna Mithra P, Narasimha Pai D, Aishwariya L, Chaithra Nayak, Krishnananda Nayak","doi":"10.7417/CT.2026.2067","DOIUrl":"10.7417/CT.2026.2067","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hypertension (PH) is a progressive disorder with significant morbidity and mortality. Limited data exist on the demographics, echocardiographic profile, and quality of life of PH patients in the Indian population. The objective of this is to assess the demographics, clinical characteristics, echocardiographic parameters, and health-related quality of life (HRQoL) among patients with pulmonary hypertension across different WHO groups.</p><p><strong>Methods: </strong>This cross-sectional study included 114 patients diagnosed with pulmonary hypertension on echocardiographic criteria. This study aligns SDG 3 (Good Health and Well-being) by addressing non-communicable disease burden and highlighting sociodemographic disparities in pulmonary hypertension. Demographic and clinical data were recorded. Comprehensive echocardiographic assessment, including conventional measures and advanced indices such as RV tissue Doppler velocity and global longitudinal strain (GLS), was performed. HRQoL was evaluated using the EmPHasis-10 questionnaire. Intergroup comparisons were analyzed using one-way ANOVA.</p><p><strong>Results: </strong>The mean age was 57.1 ± 16 years, with a male predominance (64.9%). Group 2 PH (36%) was the most common etiology, followed by Group 1 PH (28.9%). Diabetes mellitus (68.4%) and hypertension (56.1%) were the most common comorbidities. RV function was impaired across all groups (mean TAPSE: 14.9 ± 4.42 mm; FAC: 34.2 ± 10.6%), with markedly reduced RV GLS (13.9 ± 5.2%). The RV tissue Doppler velocity differed significantly between the groups (p < 0.001). The mean EmPHasis-10 score was 42.2 ± 6.22, indicating substantial HRQoL impairment. Compared with the youngest group, patients in the oldest age group had greater than threefold greater odds of having severe disease (OR = 3.3, 95% CI: 1.0-10.6; p = 0.048).</p><p><strong>Conclusion: </strong>Pulmonary hypertension patients in this cohort presented with advanced functional limitations, high comorbidity burdens, and significant RV dysfunction. Older age is an independent predictor of severe disease. Advanced echocardiographic indices and HRQoL assessment provide valuable insights for early detection and comprehensive management.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 4","pages":"752-759"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148320305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prognostic Value of CRP/Albumin Ratio in Prediction of Limb Salvage in Patients with SFA Lesion According to TASC II Classification After Endovascular Treatment: A Pilot Study.","authors":"Osama Ahmed Mohamed, Wageh Fawzy Abdelmalek, Abdelrahmen Mohamed Ahmed, Ramez Monir Wahba, Mohamed Hatem Abdelazem","doi":"10.7417/CT.2026.2081","DOIUrl":"10.7417/CT.2026.2081","url":null,"abstract":"<p><strong>Background: </strong>Higher systemic inflammation may portend worse limb outcomes after endovascular therapy (EVT). We assessed whether the pre‑procedural C‑reactive protein/albumin ratio (CAR) predicts major amputation (limb loss) at 1 year after EVT for symptomatic superficial femoral artery (SFA) disease.</p><p><strong>Objective: </strong>To assess the applicability of CAR in prediction of limb salvage in patients with SFA lesion according to TASC II classification after endovascular treatment.</p><p><strong>Patients and methods: </strong>This Prospective observational single‑center cohort study of 40 patients at Ain Shams University Hospitals undergoing EVT for symptomatics SFA disease according to TASC II classification. Patients with active infection or non‑arterial causes of elevated CRP were excluded. The primary endpoint was major amputation at 12 months. CAR was calculated using harmonized units (CRP mg/L ÷ albumin g/L).</p><p><strong>Results: </strong>The CAR was identified as an independent predictor of limb salvage after one year, among 40 patients (mean age 61.4 ± 5.03 years; 75% male), major amputation occurred in 6 (15.0%). CAR discriminated 1‑year limb loss (AUC 0.912, p<0.001). The optimal cut‑off was CAR ≥2.11, yielding sensitivity 83.33%, specificity 73.53%. Dichotomized at this threshold, high CAR was associated with markedly higher odds of limb loss.</p><p><strong>Conclusion: </strong>Pre-procedural CAR is a valuable prognostic marker for predicting limb salvage in patients with superficial femoral artery lesions undergoing endovascular treatment. CAR ≥2.11 identifies a small, higher‑risk subgroup with substantially increased odds of limb loss while preserving a high negative predictive value.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 4","pages":"861-870"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148320317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional Status, Oxidative Stress and Endothelial Dysfunction in Elderly Adults with Essential Hypertension, Independent of Intestinal Parasitic Infection: A Case-Control Study.","authors":"Sabir Awad Mustafa Mohammedzein, Mohamed Elnemr, Nagah Abumohammed, Mohammad Abd Elhameed Alwaseef, Ayman Ahmed Gad, Naglaa M Shalaby, Eman Sobhy Ahmed Ewes, Samah Elboraee Shehta Hegab, Mohammed Hamed Sherif, Hend Mahmoud Taha, Yasmine Gamal Sabry, Eman M Fahmy, Hany Kamal Ahmed Mahrose, Mohammed B Alsharif, Medhat Ali Salah, Tayseer S Karoof, Adel M Abdou, ElSayed Abouzid Ibrahim Ibrahim, Ahmed Abdalla Almorsy, Ihab Anwar Orabi","doi":"10.7417/CT.2026.2044","DOIUrl":"10.7417/CT.2026.2044","url":null,"abstract":"<p><strong>Background: </strong>Hypertension in elderly adults is associated with oxidative stress, systemic inflammation, and micronutrient deficiencies, which may contribute to endothelial dysfunction. The impact of intestinal parasitic infections on these associations remains unclear.</p><p><strong>Objective: </strong>To investigate the relationships between micronutrient status, oxidative stress, and endothelial health in elderly patients with essential hypertension, independent of intestinal parasitic infection.</p><p><strong>Methods: </strong>In this case-control study, 100 participants (50 hypertensive, 50 normotensive controls) underwent assessment of vitamin D, zinc, C-reactive protein (CRP), oxidized LDL (Ox-LDL), and malondialdehyde (MDA). Stool samples were examined for intestinal parasites. Correlations among biomarkers and multivariate logistic regression were performed to identify independent predictors of hypertension.</p><p><strong>Results: </strong>Demographics and BMI were comparable between groups. No parasitic infections were detected. Hypertensive patients exhibited significantly lower vitamin D and zinc levels and higher CRP, Ox-LDL, and MDA compared with controls (all P < 0.01). Vitamin D and zinc were negatively correlated with CRP, Ox-LDL, and MDA, while CRP, Ox-LDL, and MDA were positively intercorrelated (all P < 0.001). Multivariate logistic regression identified MDA, CRP, Ox-LDL, low zinc, and low vitamin D as independent predictors of hypertension, with MDA being the strongest predictor (OR 3.49, 95% CI 1.80-6.75; P < 0.001).</p><p><strong>Conclusions: </strong>Essential hypertension in elderly adults is associated with micronutrient deficiencies, systemic inflammation, and oxidative stress, independent of intestinal parasitic infection. These factors may contribute to endothelial dysfunction and represent potential targets for prevention and therapeutic intervention.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"583-590"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dysphagia and Quality of Life: A Cross-Sectional study of patient and caregiver perspectives.","authors":"Angela Raimondo, Antonio Amitrano, Armando Bray","doi":"10.7417/CT.2026.2032","DOIUrl":"10.7417/CT.2026.2032","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to simultaneously explore the perception of dysphagia from both patient and caregiver perspectives, to assess its impact on quality of life and provide insights for the development of effective, individualized rehabilitation strategies.</p><p><strong>Materials and methods: </strong>A total of 160 participants were enrolled, including 80 patients with dysphagia of heterogeneous etiology and 80 caregivers. Patients completed the Italian Dysphagia Handicap Index (I-DHI), while caregivers filled out the Caregiver Mealtime and Dysphagia Questionnaire (CMDQ). Questionnaire data were compared with results from the Fiberoptic Endoscopic Evaluation of Swallowing (FEES), using the Penetration-Aspiration Scale (PAS).</p><p><strong>Results: </strong>Patients showed limited knowledge of dysphagia symptomatology (58.1%), adequate coping abilities (61.5%), and preserved emotional stability (62.9%). Caregivers demonstrated a clear understanding of the problem (61.5%) and high adherence to speech therapy recommendations (74.8%). Spearman's rank correlation revealed no significant associations between I-DHI and CMDQ scores, nor between Oropharyngeal Dysphagia Severity (ODS) and PAS (rs = 0.236). Cluster analysis indicated significant effects of diagnosis (p = 0.003) and educational level (p = 0.009) among patients, and of gender, caregiving role and educational level among caregivers (all p < 0.001).</p><p><strong>Conclusions: </strong>The findings underscore the importance of integrating patient and caregiver perspectives into clinical decision-making. Dysphagia significantly affects quality of life for both groups, supporting the need for multidimensional approaches combining self-report measures with clinical and instrumental assessments.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"483-489"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Outcomes of SIB-Based Concurrent Chemoradiation Therapy for Upper-Third Esophageal Cancer: A Single-Center Retrospective Study in Vietnam.","authors":"Trung Bach Tran, Van Xuan Vo, Xuan Huy Vu, Minh Nhat Nguyen, Cam Phuong Pham, Van Hieu Nguyen","doi":"10.7417/CT.2026.2031","DOIUrl":"10.7417/CT.2026.2031","url":null,"abstract":"<p><strong>Objectives: </strong>Upper-third esophageal cancer (EC) is a rare malignancy with limited high-quality evidence to guide treatment. Concurrent chemoradiotherapy (CCRT) remains the mainstay approach. This study aimed to evaluate the efficacy and safety of VMAT/IMRT-based CCRT with a simultaneous integrated boost (SIB) in patients with upper-third esophageal squamous cell carcinoma.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed 59 patients treated with definitive SIB-based CCRT at Vietnam National Cancer Hospital between April 2022 and April 2025. All patients received 59.4-61.6 Gy to the gross tumor and involved nodes using VMAT or IMRT. Outcomes included treatment response, failure patterns, survival rates, and toxicities. Progression-free survival (PFS) and prognostic factors were analyzed using Kaplan-Meier and Cox regression methods.</p><p><strong>Results: </strong>The complete response rate was 47.5%. One- and two-year PFS rates were 62.4% and 37.2%, respectively; OS rates were 85.0% and 73.1%. Local control at 1 and 2 years was 82.9% and 61.1%. Distant metastasis was the most common failure pattern (59.3%), followed by recurrence at the primary site (48.1%) and regional nodes (40.7%). Grade ≥3 toxicities were infrequent. Pretreatment BMI ≥18.5 kg/m² (p = 0.007) and complete response (p = 0.027) were independently associated with better PFS.</p><p><strong>Conclusions: </strong>This study provides the first real-world Vietnamese data on SIB-based CCRT for upper-third esophageal cancer, demonstrating feasibility, tolerability, and promising local control with shorter treatment duration. Distant metastasis remains a major challenge, highlighting the need for improved systemic strategies. Future research should focus on combining SIB with modern systemic therapies and refining boost volume definition using advanced imaging to enhance outcomes and support personalized treatment approaches.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"475-482"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}