Acta Oncologica最新文献

{"title":"Exploring the somatic mutational landscape of ovarian cancer in Estonia.","authors":"Mikk Tooming, Kadri Rekker, Kadri Toome, Laura Roht, Piret Laidre, Olga Fjodorova, Ustina Šamarina, Sander Pajusalu, Mihkel Ilisson, Pilleriin Peets, Tõnu Jõgi, Karin Klaup, Kristiina Ojamaa, Eva-Maria Niine-Roolaht, Piret Kaarde, Elen Vettus, Jüri Piirsoo, Helen Vahar, Katrin Õunap, Tiina Kahre","doi":"10.2340/1651-226X.2026.45612","DOIUrl":"10.2340/1651-226X.2026.45612","url":null,"abstract":"<p><strong>Background and purpose: </strong>This retrospective study provides Estonia's first nationwide overview of pathogenic and likely pathogenic variants in ovarian cancer (OC) using routine tumor molecular profiling. The aim was to characterize the mutational landscape, identify clinically actionable alterations, and evaluate the integration of germline testing. Patient/material and methods: A total of 339 OC tumor samples underwent next‑generation sequencing-based profiling. Clinical characteristics, histological subtype, and prior germline testing were recorded. Variants were classified according to clinical‑actionability levels, and homologous recombination deficiency (HRD) was assessed in high‑grade serous OC cases.</p><p><strong>Results: </strong>The mean age at diagnosis was 62.4 ± 12.5 years, and high‑grade serous OC accounted for 82.0% of cases. Clinically actionable alterations (OncoKB Level 1&2) were detected in 37.5% of patients, most frequently involving BRCA1, BRCA2, KRAS, and BRAF. Additional therapeutic targets were identified across diverse biomarkers. HRD was present in 53.2% of tested high‑grade serous tumors. Germline testing had been performed in 41.9% of patients, revealing pathogenic or likely pathogenic variants in 22.5%, predominantly in BRCA1 and BRCA2.</p><p><strong>Interpretation: </strong>This study outlines the mutational spectrum of OC in Estonia and demonstrates a substantial prevalence of actionable alterations and HRD. The findings highlight the value of comprehensive tumor profiling to support precision‑medicine approaches and improve individualized patient management in Estonia.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"422-429"},"PeriodicalIF":2.7,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13192237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147962003","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":"KaSARi: a national framework for standardized, automated, and predictive radiotherapy in Finland.","authors":"Jan Seppälä, Maria Tengström, Henri Korkalainen, Tuomas Virén, Juuso Tj Honkanen, Juha Nikkinen, Kaisa Lehtiö, Annika Ålgars, Jani Keyriläinen, Sami Suilamo, Heidi Nurmi, Tanja Skyttä, Eeva Boman, Tero Vatanen, Liisa Sailas, Ulla-Mari Arkko, Kristiina Vuolukka, Tuomas Koivumäki, Tiina Metsäharju, Timo Voivalin, Janne Heikkilä","doi":"10.2340/1651-226X.2026.45682","DOIUrl":"10.2340/1651-226X.2026.45682","url":null,"abstract":"<p><strong>Background and purpose: </strong>National radiotherapy (RT) data infrastructures are emerging to support treatment quality assurance and outcome research. However, prospective nationwide integration of full DICOM-RT data with toxicity and patient-reported outcome measures (PROMs) remains uncommon. KaSARi (Key advances in Standardizing, Automating, and predicting Risks in RT) was established to create national research infrastructure for prospective RT data collection and integration in Finland.</p><p><strong>Materials and methods: </strong>KaSARi is a prospective, consent-based multicenter cohort infrastructure involving Finnish university and central hospitals. All adult patients receiving RT are eligible. DICOM-RT datasets from treatment planning and oncology information systems are linked to clinician-graded toxicity, PROMs and relevant clinical variables. The infrastructure builds on previously validated multi-institutional DICOM workflows and follows FAIR (Findable, Accessible, Interoperable, Reusable) data principles. Predefined work packages support data harmonization, scalable data processing and enable downstream applications such as AI-based segmentation, dose prediction, and outcome modeling.</p><p><strong>Results: </strong>Patient recruitment started in May 2025. By February 2026, 221 patients had been enrolled at the coordinating center, initially including breast cancer patients and subsequently expanding to all RT indications. Recruitment at a second center began in November 2025, with 37 patients enrolled. The infrastructure is projected to include approximately 29,000 patients over 15 years. Integration of dosimetric, clinical and PROM data is progressing through a phased national implementation as additional centers join the network.</p><p><strong>Interpretation: </strong>KaSARi represents a national infrastructure prospectively integrating full DICOM-RT datasets with clinician-graded toxicity and PROMs across all RT indications within a unified research protocol. The study provides a foundation for nationwide outcome modeling, harmonization of RT practices and development and validation of data-driven AI-based methods.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"430-436"},"PeriodicalIF":2.7,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13191729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147962115","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":"PIK3CA mutation testing and alpelisib use in metastatic breast cancer: a real-world data set.","authors":"Maja B Drakenberg Danese, Christoffer P Vannas, Henrik A Fagman, Per O Karlsson, Karolina F Larsson","doi":"10.2340/1651-226X.2026.45589","DOIUrl":"10.2340/1651-226X.2026.45589","url":null,"abstract":"","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"401-405"},"PeriodicalIF":2.7,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13170083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147866318","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":"A 10-year-long ongoing complete response to vismodegib as first-line treatment in adult metastatic medulloblastoma.","authors":"Suweydo Abdi, Paula Poikonen-Saksela, Päivi Halonen, Olli Tynninen, David A Reardon, Micaela Hernberg","doi":"10.2340/1651-226X.2026.45543","DOIUrl":"10.2340/1651-226X.2026.45543","url":null,"abstract":"","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"412-415"},"PeriodicalIF":2.7,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13170084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147866265","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":"An updated system for categorising and reporting unintended incidents in radiotherapy at a national level.","authors":"Kirsten L Jakobsen, Annette R Jakobsen, Karina L Gottlieb, Martin Berg, Harald Spejlborg, Susan B N Biancardo, Bob Smulders, Heidi S Rønde","doi":"10.2340/1651-226X.2026.45699","DOIUrl":"10.2340/1651-226X.2026.45699","url":null,"abstract":"<p><strong>Background and purpose: </strong>Radiotherapy is a complex, multistage process that involves collaboration across professional disciplines (radiographers working in pre-treatment preparation, physicians, physicists, radiation therapists during planning and treatment. While severe errors are uncommon, they can have profound consequences for patients. The Danish Society for Medical Physics supports a Special Interest Group dedicated to improving patient safety by analysing unintended events (UEs) and near misses in radiotherapy. Here we report on the work conducted with an updated system for categorising UEs in radiotherapy in Denmark.</p><p><strong>Material and methods: </strong>An updated reporting system based on the English Radiotherapy Pathway Coding (RPC) system has been taken into use in 2025. This system, including the use of a Danish system that ranks the UEs from the patients perspective, called Patient Centred Coding, is outlined and UEs reported in 2025 are summarised.</p><p><strong>Results: </strong>Radiotherapy is generally a safe treatment modality, a conclusion further supported by our results from 2025. In 2025 only 339 UEs were reported, 315 of these with low risk and 24 with medium risks. The lesson learned is that the main focus in order to prevent the most harmful UEs should be on the delineation and the planning process.</p><p><strong>Interpretation: </strong>Based on our experience from this work, we recommend the development of a national system for categorising and ranking UEs. We further recommend establishing a national working group that meets regularly and focuses on UEs at a national level.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"416-421"},"PeriodicalIF":2.7,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147866291","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":"Improving confidence in MRI-based auto-segmentation via uncertainty assessment.","authors":"Jesper Folsted Kallehauge, Jintao Ren, Yasmin Lassen-Ramshad","doi":"10.2340/1651-226X.2026.45685","DOIUrl":"10.2340/1651-226X.2026.45685","url":null,"abstract":"<p><strong>Background and purpose: </strong>Accurate delineation of organs of interest (OOIs, also commonly referred to as organs at risk, OARs) is crucial for safe radiotherapy. While deep learning-based segmentation using convolutional neural networks has achieved high geometric accuracy, clinical translation is hindered by overconfident, uncalibrated predictions in anatomically ambiguous regions. Uncertainty quantification and model calibration are prerequisites for safe clinical workflows. This study compared the standard nnU-Netv2 against its residual-encoding variant (ResEncM), hypothesizing that ResEncM would demonstrate superior reliability and calibration while maintaining comparable geometric accuracy. Patient/material and methods: T1-weighted contrast-enhanced MRI scans from 70 brain cancer patients were used (55 training/validation, 15 testing). Ground-truth contours for brainstem, hippocampi, chiasm, optic nerves, optic tracts, and pituitary were delineated per Danish Neuro Oncology Group guidelines. Both architectures were trained using five-fold cross-validation with identical preprocessing. Epistemic uncertainty was quantified using mutual information, and Expected Calibration Error (ECE) was computed within a 10-mm isotropic margin around reference contours.</p><p><strong>Results: </strong>Both models achieved high geometric accuracy (brainstem dice similarity coefficient [DSC] > 0.93, hippocampi DSC > 0.81). No significant geometric differences were found for large structures. ResEncM showed significantly lower DSC for the pituitary (p = 0.003) and chiasm (p = 0.018). However, ResEncM demonstrated significantly lower epistemic uncertainty and ensemble variance across all structures (p < 0.05), and significantly reduced ECE for the optic chiasm, optic tracts, and pituitary.</p><p><strong>Interpretation: </strong>Integrating a deep residual encoder into the standard U-Net framework significantly improves reliability and calibration of automated brain OOI contours while maintaining strong geometric performance. The ResEncM architecture provides a more trustworthy tool for clinical radiotherapy by reliably flagging high-uncertainty voxels, supporting confidence-aware clinical workflows.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"406-411"},"PeriodicalIF":2.7,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13173403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147866245","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 of pembrolizumab in advanced anal cancer: a nationwide Danish anal Cancer Group report.","authors":"Karen-Lise Garm Spindler, Christian Andreas Hvid, Lars Ulrik Fokdal, Karen Lycke Wind, Anne Vittrup Jakobsen, Rikke Løvendahl Eefsen, Eva Serup-Hansen","doi":"10.2340/1651-226X.2026.44690","DOIUrl":"10.2340/1651-226X.2026.44690","url":null,"abstract":"<p><strong>Background and purpose: </strong>Squamous cell carcinoma of the anal canal (SCCA) is a rare malignancy with limited treatment options for advanced or metastatic disease. Immune checkpoint inhibitors (ICIs) have shown durable responses in clinical trials, but evidence derives from small and highly selected populations. This study investigates the effectiveness and tolerability of pembrolizumab in an unselected real-world cohort. Patient/material and methods: This retrospective, multicenter cohort study evaluated the real-world efficacy, durability, and safety of pembrolizumab in Danish patients with advanced or metastatic SCCA treated between September 2018 and September 2023. A total of 37 patients, who received at least one dose of pembrolizumab for non-resectable, recurrent or metastatic disease, were included (89% ≥ 2nd line). Median age was 64 years, the majority were female (64.9%), and most tumours were human papillomavirus (HPV) (p16) positive (73.0%).</p><p><strong>Results: </strong>The objective response rate (ORR) was 13.5%, with two complete and three partial responses. The clinical benefit rate (CBR) was 48.6%, and two patients had durable responses exceeding 24 months. Median progression-free survival (PFS) and overall survival (OS) were 4.0 months 95% confidence interval (CI) (2.6-5.5) and 12.1 months 95% CI (7.6-15.2), respectively. Patients with good performance status and HPV-positive disease had significantly improved survival outcomes. Treatment was well tolerated, and no treatment-related deaths were reported.</p><p><strong>Interpretation: </strong>In this real-world cohort, pembrolizumab demonstrated durable responses in a subset of patients with advanced SCCA and an acceptable safety profile. Outcomes were comparable to clinical trial data, indicating modest activity. Findings support using pembrolizumab as a treatment option in selected patients, but further evidence is needed to refine its role.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"394-400"},"PeriodicalIF":2.7,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13173333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147866285","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":"Tumour acquisition method and molecular profiling success in advanced cholangiocarcinoma.","authors":"Eleni Vrana, Alia Alothman, Luke Taylor, Joe Geraghty, Javaid Iqbal, Lucy Foster, Alicia-Marie Conway, Nadina Tinsley, Melissa Frizziero, Victoria Foy, Richard A Hubner, Mairéad G McNamara","doi":"10.2340/ao.v65.45466","DOIUrl":"10.2340/ao.v65.45466","url":null,"abstract":"","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"389-393"},"PeriodicalIF":2.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13162784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832149","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":"Incidence and impact of pseudoprogression and mixed responses in metastatic renal cell carcinoma patients treated with ipilimumab/nivolumab: a retrospective analysis.","authors":"Aaron Caeyman, Giulia Mammone, Lisa Kinget, Marcella Baldewijns, Liesbeth De Wever, Maarten Albersen, Philip R Debruyne, Octavie Demeulenaere, Edward Scott McTaggart, Saurabh Saraswat, Charlien Berghen, Gert De Meerleer, Stefan Naulaerts, Abhishek D Garg, Benoit Beuselinck","doi":"10.2340/ao.v65.45460","DOIUrl":"10.2340/ao.v65.45460","url":null,"abstract":"<p><strong>Introduction: </strong>Immune checkpoint inhibitors can elicit atypical responses such as pseudoprogression (psPD) and mixed responses (MR). We aimed to analyze the occurrence and prognostic impact of atypical responses in metastatic clear-cell renal cell carcinoma (m-ccRCC) patients treated with ipilimumab/nivolumab.</p><p><strong>Materials and methods: </strong>In this retrospective series of m-ccRCC patients treated with ipilimumab/nivolumab in first-line, we performed radiographic evaluation using Response Evaluation Criteria in Solid Tumors and iRECIST consensus guidelines and compared both methods.</p><p><strong>Results: </strong>We assessed 258 baseline target lesions in 100 eligible patients. MR occurred in 24% of patients. In 15 patients (62%), the MR evolved to confirmed progressive disease (cPD), while in nine patients (38%), the MR evolved toward a partial response (PR) and was thus a psPD. psPD occurred in 13% of patients: with increase of all lesions in four patients or with MR features in nine patients. psPD patients had the second best time-to-progression (TTP) and cancer-specific survival (CSS), slightly lower compared to TTP and CSS in patients with PR without a phase of psPD and better than TTP and CSS in patients with stable disease as best response. From all patients who presented with PD at first CT evaluation (n = 40), including 17 patients with unconfirmed progressive disease and 23 patients with MR, in 12 (30%) patients this was a psPD and led to a PR.</p><p><strong>Conclusions: </strong>Atypical responses such as psPD and MR occurred in 13 and 24% of m-ccRCC patients treated with ipilimumab/nivolumab. Patients with psPD had favorable outcomes, while MR in most cases evolved to progression.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"379-388"},"PeriodicalIF":2.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13158843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832222","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":"SPRINTR: Swedish PRecision medicine Initiative for Novel Treatments and Research-towards efficient recruitment to clinical trials for prostate cancer.","authors":"Karin Welén, Andreas Josefsson","doi":"10.2340/ao.v65.45126","DOIUrl":"10.2340/ao.v65.45126","url":null,"abstract":"","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"65 ","pages":"375-378"},"PeriodicalIF":2.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809517","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}