Asia-Pacific journal of clinical oncology最新文献

{"title":"Nanoliposomal Irinotecan With Fluorouracil and Folinic Acid in Older Versus Younger Patients With Unresectable Pancreatic Cancer: The Multicenter NAPOLEON-2 Study.","authors":"Atsuko Kakihara, Shigeyuki Takeshita, Mototsugu Shimokawa, Taiga Otsuka, Shiho Arima, Akio Ido, Taro Shibuki, Junichi Nakazawa, Keisuke Miwa, Futa Koga, Yujiro Ueda, Yoshihito Kubotsu, Hozumi Shimokawa, Azusa Komori, Kazuo Nishikawa, Satoshi Otsu, Ayumu Hosokawa, Tatsunori Sakai, Hisanobu Oda, Machiko Kawahira, Shuji Arita, Takuya Honda, Kengo Tsuneyoshi, Hiroki Taguchi, Yasunori Kawaguchi, Toshihiro Fujita, Takahiro Sakae, Tsuyoshi Shirakawa, Toshihiko Mizuta, Kenji Mitsugi","doi":"10.1111/ajco.70041","DOIUrl":"10.1111/ajco.70041","url":null,"abstract":"<p><strong>Aim: </strong>Nanoliposomal irinotecan plus fluorouracil and folinic acid (NFF) has been used as a standard treatment for unresectable pancreatic cancer refractory to gemcitabine-based therapies. However, reports on the efficacy of NFF in older patients with pancreatic cancer, especially in those aged > 75 years, are limited. We retrospectively compared the efficacy and safety of NFF in older and younger patients.</p><p><strong>Methods: </strong>We reviewed the clinical records of 161 consecutive patients with unresectable pancreatic cancer who were treated with NFF between June 2020 and May 2021. Patients ≥ 75 years old were classified as the older group. We compared the antitumor efficacy, safety, and survival of the older and younger groups. Geriatric nutritional risk index (GNRI) was used as a prognostic indicator in the older group.</p><p><strong>Results: </strong>Overall, 26 and 135 patients were enrolled in the older and younger groups, respectively. The pretreatment characteristics of the two groups were not significantly different. Median overall survival and progression-free survival were 10.9 and 5.0 months, respectively, in the older group, versus 7.6 (p = 0.15) and 3.1 months (p = 0.29), respectively, in the younger group. There were no clinical differences in the adverse events or the overall response rates between the two groups. The older group with GNRI < 86 tended to have a shorter overall survival.</p><p><strong>Conclusion: </strong>Older patients with pancreatic cancer may benefit from NFF to the same extent as younger patients without severe adverse events. GNRI needs further study as a predictor of NFF efficacy in older patients.</p>","PeriodicalId":8633,"journal":{"name":"Asia-Pacific journal of clinical oncology","volume":" ","pages":"447-456"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncology Rehabilitation in Australia: A National Survey Update.","authors":"Ally Lasscock, Nicholas F Taylor, Amy M Dennett","doi":"10.1111/ajco.70003","DOIUrl":"10.1111/ajco.70003","url":null,"abstract":"<p><strong>Introduction: </strong>Few exercise-based oncology rehabilitation programs were available across Australia in 2015. Clinical guidelines have since recommended that exercise be included in standard cancer care. This study aimed to (1) identify and describe exercise-based oncology rehabilitation programs in Australia, (2) determine whether there have been changes in the number or content of programs since 2015, and (3) describe factors associated with program implementation.</p><p><strong>Methods: </strong>A cross-sectional survey collected data from program coordinators of Australian oncology rehabilitation programs. Quantitative data were analysed descriptively and using independent t-tests and chi-squared tests. Qualitative data underwent content analysis.</p><p><strong>Results: </strong>The number of oncology rehabilitation programs in Australia increased from 31 programs in 2015 to 76 programs in 2024, equating to an 88% increase from 8 to 15 programs per 100,000 cancer survivors. Sixty-two completed surveys were returned (62/76, 82% response rate). Programs were typically for people with any cancer at any stage of treatment. The proportion of programs offering education decreased by 29% since 2015 [χ²(1) = 6.011, p = 0.014]. On average, programs ran three times per week (standard deviation [SD] 4) for 11 weeks (SD 10). There was increased use of exercise testing in 2024. Program implementation was supported by an increasing presentation of cancer survivors in general rehabilitation programs (30/62, 48%) and challenged by a lack of funding (27/62, 44%).</p><p><strong>Conclusion: </strong>Oncology rehabilitation programs in Australia have more than doubled in the past decade, but availability remains poor. Programs were mainly exercise-only, with an increased use of objective criteria for exercise dosage and progression.</p>","PeriodicalId":8633,"journal":{"name":"Asia-Pacific journal of clinical oncology","volume":" ","pages":"473-482"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overdiagnosis and Overtreatment of Thyroid Cancer, a Single City Experience in the Kurdistan Region/Iraq.","authors":"Ramadhan Tayeb Othman","doi":"10.1111/ajco.70054","DOIUrl":"10.1111/ajco.70054","url":null,"abstract":"<p><strong>Background and aims: </strong>The incidence of thyroid cancer (TC) has increased globally over the last three decades. Overdiagnosis appears to be the primary factor driving an increasing number of TC diagnoses. Most documented TC cases involve small, well-differentiated lesions. This study aimed to evaluate the changing trends in TC diagnoses and mortality over the last 10 years.</p><p><strong>Methods: </strong>This retrospective study included patients registered between January 2013 and December 2022. Data on the number of patients diagnosed over 10 years were presented, and data on the types of treatment used were analyzed. This study aimed to investigate possible overdiagnosis and the approach to treatment of TC.</p><p><strong>Results: </strong>The total number of registered cases was 342; the majority of cases were females (295, 86%), and only 47 cases were males (14%), with a female-to-male ratio of 6:1. The age-standardized rate (ASR) has increased over 10 years, from 47 cases to 621 per 1,000,000 people. Between 2013 and 2022, the ASR of TC increased from 58 to 1030 cases/1,000,000 and from 30 to 212 cases among women and men, respectively. Among the 184 patients with micropapillary TC, 173 (94%) underwent total thyroidectomy, whereas only 11 (6%) underwent lobectomy. In 2022, TC became the third most common cancer in this region, following breast and colorectal cancers in females. Of the 80 new cases diagnosed in 2022, only 47% had adjuvant radioactive iodine. The mortality rate over the 10-year period from 2013 to 2022 did not increase and remained relatively stable, with minor variations between 0 and 2 cases per year.</p><p><strong>Conclusions: </strong>This study demonstrated a significant increase in TC diagnosis, especially in early-stage disease, without a corresponding increase in the mortality rate. This finding suggests that the current incidence of TC may be an example of overdiagnosis and overtreatment.</p>","PeriodicalId":8633,"journal":{"name":"Asia-Pacific journal of clinical oncology","volume":" ","pages":"457-463"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145511543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracranial, Extragonadal Germ Cell Tumors: A Multicenter Australian Case Series.","authors":"Kar Ven Cavan Chow, Ciara Conduit, Sophie O'Haire, Anna Kuchel, Shirley Wong, Peter Grimison, Andrew Weickhardt, Ganes Pranavan, James Lynam, Patricia Bastick, Jeffrey Goh, Shomik Sengupta, Annabel Smith, Elizabeth Liow, David Campbell, Ming Wong, Kristina Zlatic, Peter Gibbs, Ben Tran, Chun Loo Gan","doi":"10.1111/ajco.70083","DOIUrl":"10.1111/ajco.70083","url":null,"abstract":"<p><strong>Aim: </strong>To describe the treatment pattern and outcomes for patients with extracranial, extragonadal germ cell tumors (EGCTs).</p><p><strong>Methods: </strong>We conducted a retrospective analysis of male patients with EGCT prospectively registered in the Australian GCT clinical registry (iTestis) since its inception in 2018. Demographics, clinicopathologic features, treatment characteristics, and outcomes were recorded. Data were analyzed using descriptive statistics and the Kaplan-Meier method estimates of overall survival (OS).</p><p><strong>Results: </strong>Of 1256 patients in the iTestis registry, 33 (3%) had EGCT including 18 (55%) with mediastinal, 14 (42%) with retroperitoneal, and 1 (3%) with a lung primary. The median age was 31 years (range: 24-38), ECOG performance status was 0-1 in 26 (79%), and 21 (64%) were non-seminoma. Chemotherapy was administered upfront in 27 (82%) patients, upfront surgery in four patients (12%), and treatment was unknown in two (6%) patients. The most common chemotherapy regimen was bleomycin/etoposide/cisplatin (BEP) (n = 20, 74%), followed by etoposide/ifosfamide/cisplatin (VIP) (n = 5, 19%) and EP (n = 2, 7%). Post-chemotherapy surgery was carried out in 16 (59%) patients, and 4 (15%) patients received second-line chemotherapy. At a median follow-up of 22.7 months (range: 0-126), no deaths were observed in individuals with retroperitoneal primary (n = 14), seminoma (n = 12), or International Germ Cell Cancer Collaborative Group (IGCCCG) good (n = 15) and intermediate risk (n = 3) disease. Three deaths occurred in patients with mediastinal non-seminoma. The estimated 24-month OS for mediastinal non-seminoma and IGCCCG poor risk disease was 71% (95% confidence interval [CI]: 27%-94%) and 79% (95% CI: 25%-95%), respectively.</p><p><strong>Conclusion: </strong>Incidence of EGCT in Australia is consistent with published literature. Treatment patterns reflect international practices. Primary mediastinal non-seminoma has the poorest outcomes. Primary retroperitoneal and primary mediastinal seminomas have excellent outcomes.</p>","PeriodicalId":8633,"journal":{"name":"Asia-Pacific journal of clinical oncology","volume":"22 3","pages":"404-410"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalized Cancer Vaccines in the Clinical Trial Pipeline.","authors":"Liudmila Iamukova, Elena Alferova","doi":"10.1111/ajco.70006","DOIUrl":"10.1111/ajco.70006","url":null,"abstract":"<p><strong>Aim: </strong>To present an overview of personalized cancer vaccines currently undergoing clinical development, aiming to enhance awareness and promote collaboration among academic, commercial researchers, and non-profit communities.</p><p><strong>Methods: </strong>A dataset of 78 clinical trials for personalized cancer vaccines was generated using ClinicalTrials.gov database as of November 25, 2024. We conducted an analysis of the studies based on sponsors, conditions, phases, types of vaccines, and global geographic distribution.</p><p><strong>Results: </strong>The majority of trials focused on peptide vaccines (40%) and dendritic cell vaccine (19%), targeting solid tumors, brain, pancreatic and breast cancers, among others. Phase 1 trials dominated the landscape, accounting for over 90% of studies, with significant activity in the United States (44%) and China (24%). Industry sponsors backed 22% of studies. Active trials represented 72% of the dataset, reflecting ongoing research efforts in this field. Enrollment sizes varied widely, ranging from small exploratory cohorts of fewer than 10 participants to larger-scale trials enrolling up to 700 patients. Completed clinical trials evaluating personalized neoantigen vaccines across various cancer types showed that vaccines were generally well-tolerated, elicited strong T-cell responses, and resulted in promising clinical outcomes such as tumor shrinkage or prolonged progression-free survival, particularly in melanoma, glioblastoma, and urothelial cancer, although no universal cure was demonstrated.</p><p><strong>Conclusions: </strong>There is a broad early-stage pipeline of personalized cancer vaccines currently being tested in clinical trials for various cancer types.</p>","PeriodicalId":8633,"journal":{"name":"Asia-Pacific journal of clinical oncology","volume":" ","pages":"362-368"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung V5 and Planning Target Volume/Lung Volume Ratio as Independent Risk Factors for ≥Grade 2 Radiation Pneumonitis after Moderately Hypofractionated Radiotherapy: A Retrospective Study.","authors":"YuanYou Yang, FengXia Luo, Chao Wang, Gang Ren","doi":"10.1111/ajco.70122","DOIUrl":"https://doi.org/10.1111/ajco.70122","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to identify dosimetric and clinical risk factors for ≥Grade 2 radiation pneumonitis (RP) in patients with primary lung cancer undergoing moderately hypofractionated radiotherapy (MHRT).</p><p><strong>Methods: </strong>We retrospectively analyzed 126 patients with primary lung cancer who received MHRT (total dose 35-56 Gy in 10-15 fractions) between December 2023 and December 2024. The primary endpoint was the occurrence of ≥Grade 2 RP, graded according to CTCAE v5.0. Logistic regression analysis was used to identify risk factors, and receiver operating characteristic (ROC) curves were generated to evaluate predictive performance. To account for the differential biological effects of various fractionation regimens, a biologically effective dose (BED) correction (using an α/β ratio of 3 Gy for lung tissue) was applied to key dosimetric parameters, including the lung volume receiving ≥5 Gy (V5).</p><p><strong>Results: </strong>With a median follow-up of 7.5 months, 45 patients (35.7%) developed ≥Grade 2 RP. Univariate analysis identified planning target volume/lung volume (PTV/LV) ratio, lung V5, lung V20, fraction dose, and chemotherapy history as significant factors (all p < 0.05). Multivariate analysis confirmed both lung V5 (odds ratio [OR] = 3.335, 95% confidence interval [CI]: 1.208-9.212; p = 0.020) and PTV/LV ratio (OR = 2.097, 95% CI: 1.027-8.607; p = 0.045) as independent risk factors. BED-corrected analysis confirmed BED-V5 as an independent risk factor (OR = 1.10, 95% CI: 1.03-1.18, p = 0.007). ROC analysis showed that lung V5 had significant predictive value (area under the curve [AUC] = 0.667, p = 0.002), while BED-V5 had an AUC of 0.698 (p < 0.001) with an optimal cutoff of 40.1%. PTV/LV ratio did not reach statistical significance (AUC = 0.584, p = 0.117). Model diagnostics indicated good calibration (Hosmer-Lemeshow p = 0.620) and no significant multicollinearity (variance inflation factors = 1.021).</p><p><strong>Conclusion: </strong>Lung V5 and PTV/LV ratio are independent risk factors for ≥Grade 2 RP in patients receiving MHRT for primary lung cancer. The significance of V5 persisted after BED correction. Lung V5 demonstrates significant predictive value. Optimizing treatment plans to maintain lung V5 < 34.75% and PTV/LV ratio < 4.25% may help reduce the risk of RP in this setting.</p>","PeriodicalId":8633,"journal":{"name":"Asia-Pacific journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating Evidence Standards: Stakeholder Perspectives on External Controls and Randomization in Cancer Trials.","authors":"Sarah E Heynemann, Wendy L Lipworth, Sue-Anne McLachlan, Jennifer Philip, Tom John, Ian H Kerridge","doi":"10.1111/ajco.70120","DOIUrl":"https://doi.org/10.1111/ajco.70120","url":null,"abstract":"<p><strong>Introduction: </strong>Randomized controlled trials (RCTs) have historically been considered the 'gold standard' for generating evidence about emerging cancer therapies. However, conducting conventional RCTs has become increasingly challenging due to the increasing subdivision of cancer into smaller subtypes, the cost of conducting large-scale trials, and various ethical concerns. The use of 'external controls' has received increased attention of late as a potential mechanism for generating evidence in circumstances when obtaining RCT-level evidence is deemed infeasible (or otherwise challenging). External controls encompass a variety of statistical techniques whereby data are sourced from 'real world' or other settings and form the basis of comparative analyses. However, there are concerns about the potential for bias and other challenges to the veracity of non-randomized data. Official guidance regarding the appropriate use of external controls also varies widely across jurisdictions and agencies.</p><p><strong>Methods: </strong>In this qualitative study, 52 semi-structured interviews were conducted with key stakeholders across the cancer clinical trials landscape to explore perspectives regarding external controls in oncology. This included various types of 'trial experts' (trialists, statisticians, ethicists, ethics review board members, industry, regulatory, and reimbursement body representatives).</p><p><strong>Results: </strong>Data arising from interviews converged on three main themes: (a) support for randomization and the methodological limitations of non-randomized controls, (b) consideration as to possible utility of external controls, and (c) the relationship of external controls to public decision-making.</p><p><strong>Conclusions: </strong>Findings of this study highlight the 'value laden' nature of apparently technical questions about evidence generation and the need for further studies to systematically recognize, articulate and balance values of trustworthiness, efficiency, and fairness.</p>","PeriodicalId":8633,"journal":{"name":"Asia-Pacific journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical-Pathologic Response Discordance After Neoadjuvant Therapy in Rectal Cancer and Its Prognostic Implications.","authors":"Aysun Arslantas Erken, Selvi Tabak Dincer","doi":"10.1111/ajco.70119","DOIUrl":"https://doi.org/10.1111/ajco.70119","url":null,"abstract":"<p><strong>Aims: </strong>The prognostic value of clinical complete/near-complete response (cCR/near-cCR) relative to pathologic complete/near-complete response (pCR/near-pCR) after neoadjuvant therapy for locally advanced rectal cancer (LARC) remains incompletely defined.</p><p><strong>Methods: </strong>We retrospectively analyzed 180 non-metastatic LARC patients treated with total neoadjuvant therapy (TNT) or standard neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision. Agreement between cCR/near-cCR and pCR/near-pCR was assessed using Cohen's κ, and associations with survival outcomes were evaluated using Kaplan-Meier and Cox models.</p><p><strong>Results: </strong>Preoperative cCR/near-cCR was observed in 89 patients (49.4%), whereas pCR/near-pCR occurred in 63 (35.0%), with moderate concordance (κ = 0.53, p < 0.001). Discordance between clinical and pathologic response classification was observed in 42 patients (23.3%). Compared with patients who achieved pCR/near-pCR, those without pCR/near-pCR had inferior 5-year distant metastasis-free survival (DMFS) (66.7% vs. 87.3%; hazard ratio [HR] 2.98, 95% confidence interval [CI] 1.44-6.09; p = 0.003) and locoregional recurrence-free survival (LRFS) (81.0% vs. 95.0%; HR 4.32, 95% CI 1.28-12.23; p = 0.02), while Overall survival (OS) did not differ significantly between groups (63.8% vs. 78.4%; HR 1.42, 95% CI 0.75-3.11; p = 0.06). cCR/near-cCR was associated with improved DMFS on univariable analysis; however, this association was attenuated after multivariable adjustment and did not remain independently significant. Prognostic separation by response was more pronounced in the TNT cohort. Among patients with pCR/near-pCR, baseline biopsy-derived lymphovascular invasion/perineural invasion was associated with numerically poorer outcomes, although these differences were not statistically significant.</p><p><strong>Conclusion: </strong>pCR/near-pCR provides more consistent prognostic discrimination than cCR/near-cCR, and clinically relevant discordance persists in routine practice. Integrating baseline tumor biology with response assessment may refine post-treatment risk stratification, particularly after TNT.</p><p><strong>Trial registration: </strong>Not applicable. This study is a retrospective observational study and does not require trial registration.</p>","PeriodicalId":8633,"journal":{"name":"Asia-Pacific journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Outcomes of Total Neoadjuvant Therapy Versus Standard Neoadjuvant Chemoradiotherapy in Stage II-III Locally Advanced Rectal Cancer: A Comparative Cohort Study.","authors":"Aysun Arslantas Erken, Selvi Tabak Dincer","doi":"10.1111/ajco.70118","DOIUrl":"https://doi.org/10.1111/ajco.70118","url":null,"abstract":"<p><strong>Aim: </strong>Total neoadjuvant therapy has been adopted to improve systemic disease control in locally advanced rectal cancer, yet long-term real-world outcomes, particularly in non-Western populations, remain incompletely defined. We compared total neoadjuvant therapy with neoadjuvant chemoradiotherapy and assessed the prognostic impact of posttreatment lymphovascular and perineural invasion.</p><p><strong>Methods: </strong>We retrospectively analyzed 171 patients with Stage II-III locally advanced rectal cancer treated between 2016 and 2023 with total neoadjuvant therapy (n = 76) or neoadjuvant chemoradiotherapy (n = 95) followed by total mesorectal excision. Overall survival was the primary endpoint; secondary endpoints included disease-free survival, local recurrence-free survival, distant metastasis-free survival, and treatment response.</p><p><strong>Results: </strong>At a median follow-up of 45 months, total neoadjuvant therapy was associated with numerically higher 5-year overall survival than neoadjuvant chemoradiotherapy (74.3% vs 60.0%; hazard ratio 0.58, 95% confidence interval 0.32-1.06; log rank p = 0.048). Disease-free survival, local recurrence-free survival, and distant metastasis-free survival numerically favored total neoadjuvant therapy but did not reach statistical significance. Pathologic complete response occurred in 39.5% versus 30.5% with total neoadjuvant therapy and neoadjuvant chemoradiotherapy, respectively (p = 0.221), and was associated with improved local recurrence-free survival and distant metastasis-free survival. The absence of lymphovascular and perineural invasion predicted favorable outcomes. Adjuvant chemotherapy was more frequently administered after neoadjuvant chemoradiotherapy.</p><p><strong>Conclusion: </strong>In this real-world cohort, total neoadjuvant therapy was associated with numerically higher overall survival than neoadjuvant chemoradiotherapy, whereas recurrence-based endpoints were comparable. Posttreatment lymphovascular invasion and perineural invasion provided clinically informative prognostic stratification beyond response assessment and may help inform postoperative risk assessment in the TNT era.</p>","PeriodicalId":8633,"journal":{"name":"Asia-Pacific journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myeloablative Busulfan, Fludarabine and Melphalan Conditioning for Allogeneic Hematopoietic Stem Cell Transplantation in Childhood Myeloid Malignancy.","authors":"Mayank Dhamija, Fiona Kerr, Hazel Gough, Johnathan Soggee, Laurence C Cheung, Rishi S Kotecha, Shanti Ramachandran","doi":"10.1111/ajco.70113","DOIUrl":"https://doi.org/10.1111/ajco.70113","url":null,"abstract":"<p><strong>Background: </strong>Allogeneic hematopoietic stem cell transplant (HSCT) is a proven curative therapy for children with high-risk myeloid malignancies. Disease relapse, transplant-related mortality and graft versus host disease (GvHD) are the main causes of treatment failure and death post-transplant. The optimum pretransplant conditioning regimen is yet to be defined. There is limited data regarding the use of busulfan, fludarabine and melphalan as a myeloablative conditioning regimen in children receiving HSCT for myeloid malignancies.</p><p><strong>Aim: </strong>To evaluate the outcome of pharmacokinetic-guided busulfan dosing, in addition to fludarabine and melphalan, as a myeloablative conditioning regimen in children with myeloid malignancies.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center study of all patients <18 years of age who received busulfan, fludarabine, and melphalan conditioning prior to HSCT for myeloid malignancies between January 2013 and June 2023.</p><p><strong>Results: </strong>Thirteen children were included in the study. Seven were heavily pretreated with two or more lines of therapy prior to HSCT. All thirteen had neutrophil engraftment and twelve had platelet engraftment. Mucositis was the only significant regimen-related toxicity, which completely resolved with standard management. Acute and chronic GVHD were seen in seven and two patients respectively, with favorable outcomes. One patient was salvaged following cytogenetic relapse, one died following morphological relapse, and one patient succumbed to infection. Eleven patients are currently alive without evidence of leukemia, myelodysplasia, or GvHD.</p><p><strong>Conclusion: </strong>Busulfan, fludarabine and melphalan conditioning was well tolerated and effective, representing a suitable treatment option for heavily pretreated children with high-risk myeloid malignancies prior to HSCT.</p>","PeriodicalId":8633,"journal":{"name":"Asia-Pacific journal of clinical oncology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}