Cancer journal最新文献

{"title":"FLASH Particle Radiotherapy.","authors":"Jufri Setianegara, Ioannis I Verginadis, Constantinos Koumenis, Boon-Keng Kevin Teo, Alexander Lin","doi":"10.1097/PPO.0000000000000816","DOIUrl":"10.1097/PPO.0000000000000816","url":null,"abstract":"<p><p>FLASH radiotherapy is an emerging treatment modality characterized by the ultrahigh dose rate delivery of radiation, which has demonstrated the potential to significantly reduce normal tissue toxicity while maintaining tumor control. In cancers traditionally managed with radiotherapy, this approach could improve the therapeutic ratio by mitigating severe side effects associated with current techniques. The integration of particle therapy-such as protons or heavier ions-with FLASH dose rates offers unique physical and biological advantages, including enhanced normal tissue sparing and the possibility of safe dose escalation. Clinical implementation will require a deeper understanding of the mechanistic biological underpinnings of the FLASH effect, alongside advancements in beam delivery systems capable of achieving FLASH dose rates, rigorous quality assurance protocols, and adaptive strategies to accommodate anatomic changes during treatment. Ultimately, widespread clinical adoption will depend on prospective trials comparing FLASH particle therapy with established modalities, with endpoints focused on toxicity, disease control, and patient-reported quality of life.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"32 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147509205","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":"Challenges and Errors in Genetic Testing: The Sixth Case Series.","authors":"Meagan Farmer, Claire McDonald, Darcy K Berry, Danielle Carr, Tanner F Coleman, Matthew J Goldstein, Rebecca Haskins, Jessica Kenney, Kerri Murphy, Rebecca Waggoner, Leah Zaretsky, Danielle Bonadies, Ellen Matloff","doi":"10.1097/PPO.0000000000000813","DOIUrl":"10.1097/PPO.0000000000000813","url":null,"abstract":"<p><strong>Purpose: </strong>This case series explores ongoing and emerging challenges in genetic testing, focusing on errors and complexities encountered as testing becomes routine across diverse clinical settings.</p><p><strong>Methods: </strong>Cases were solicited from clinicians in multiple specialties via professional networks and social media between 2021 and 2025. Deidentified documentation was reviewed when available, and 15 cases were selected for thematic analysis. Contributors reviewed and approved the representation of their cases.</p><p><strong>Results: </strong>Analysis revealed persistent gaps in communication, coordination, and interpretation of genetic test results. Themes included proactive intervention by genetics professionals, missed opportunities for counseling, evolving complexities in variant interpretation, system failures, delayed diagnoses, and risks of testing without a clear clinical indication. Cases reflected the expanding reach of genetic testing into oncology, primary care, and obstetrics and gynecology, as well as nononcologic contexts.</p><p><strong>Discussion: </strong>The cases highlight the importance of responsible integration of genetic testing into mainstream medical practice. Effective use of digital tools, structured workflows, and interprofessional collaboration is essential to support quality and efficiency. Shared responsibility among providers, laboratories, and technology partners is needed to ensure accurate interpretation and management. Genetic counselors play a central role in designing scalable, high-integrity systems and guiding teams through the complexities of genomic medicine.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"32 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147509885","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":"Errors in Germline Biomarker Testing: Significant Consequences and Missed Opportunities for Cancer Control in Patients and Their Families.","authors":"Suzanne M Mahon, Laura A McLaughlin, Usa Khemthong, Constance Owen","doi":"10.1097/PPO.0000000000000812","DOIUrl":"10.1097/PPO.0000000000000812","url":null,"abstract":"<p><strong>Purpose: </strong>Germline biomarker testing to assess inherited risk for developing malignancy has evolved quickly from testing for 1 or 2 genes from a few laboratories to ordering panels of 80 or more genes available from multiple laboratories. Many health professionals did not receive foundational information in training yet are expected to identify and manage care for individuals and families with germline risk. Errors in testing do occur and can have significant adverse consequences including missed opportunities for prevention and detection for the patient and family, unnecessary risk-reducing surgery, and even death. By better understanding these errors and underlying causes, as well as the potential negative consequences due to these errors, strategies can be developed to help prevent future harm to patients.</p><p><strong>Methods: </strong>Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting system a literature review was completed to identify case reports of errors in germline testing for hereditary cancer. Ovid MEDLINE, Scopus, and EBSCOHOST CINAHL, were searched from January 2009 through February 2025. Reference lists were reviewed to identify additional case reports. Each case report was abstracted to identify error(s), consequence(s), and potential error(s) prevented.</p><p><strong>Results: </strong>A total of 106 cases were identified from the search of the databases and 1 case using archival methods. Sixty-six (61%) cases described more than one error and 61 (44%) described more than one negative consequence. In 48 (45%) cases one or more additional errors were prevented when a genetics professional was consulted. The most common errors were misinterpretation of data, failure to take a full family history and review previous test results, not recognizing a syndrome, and selecting the wrong test or wrong laboratory for testing. Negative consequences included missed opportunities for prevention and detection for the patient and potentially other family members, one or more unnecessary risk-reducing surgeries in 10 patients, late detection of malignancy in 8 patients, and 7 patient deaths.</p><p><strong>Discussion: </strong>Although germline testing seems to be a simple laboratory test, many errors occur that have avoidable adverse consequences for both the patient and family. Errors may occur because of a lack of foundational knowledge in comprehensive risk assessment and on how to order the best test in a laboratory capable of detecting a pathogenic variant as well as how to interpret germline testing results. Increasing the number of genetics professionals, implementing new delivery models, and increasing educational efforts in nongenetics professionals could prevent and decrease errors.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"32 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147509899","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":"Economic Evaluation of Particle Therapy for Cancer Treatment: A Systematic Review.","authors":"Seyyed M M J Sarayi, Sara Nofal, Mehdi Hemmati, Samuel Garvin, Ethan N Maldonado, Alex Elliott, David P Farris, Maria A Lopez-Olivo, Iakovos Toumazis","doi":"10.1097/PPO.0000000000000815","DOIUrl":"10.1097/PPO.0000000000000815","url":null,"abstract":"<p><p>Particle therapy represents a cutting-edge modality in radiation oncology that offers potential advantages over conventional radiation therapy; however, its cost-effectiveness has not been established. We conducted a systematic search of several electronic databases to synthesize contemporary evidence on the cost-effectiveness of particle therapy. The methodological quality of the included studies was assessed, and reported outcomes on costs, health benefits, and incremental cost-effectiveness ratios (ICERs) were extracted. We identified 57 studies, which collectively reported 134 comparisons for particle therapies. In general, studies were of good quality, although better reporting of data sources and modeling assumptions is warranted. Included studies primarily evaluated the cost-effectiveness of proton therapy, used photon therapy as the comparator, utilized a Markov Cohort model, and used the payer's perspective. Findings were inconsistent, with the reported ICERs ranging from $55 to $1,066,266 per unit of benefit gained, with discrepancies across cancer sites and treatment modalities. Particle therapy is cost-effective for specific groups but may not be universally cost-effective. More research is warranted to identify subgroups for which particle therapy is cost-effective.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"32 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147509908","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":"Role of Immunotherapy and Targeted Agents to Treat Brain Metastases.","authors":"Nicole Hajdari, David M Peereboom","doi":"10.1097/PPO.0000000000000806","DOIUrl":"10.1097/PPO.0000000000000806","url":null,"abstract":"<p><p>Brain metastases are a common yet dismal complication of metastatic cancers, originating most commonly from nonsmall cell lung cancer, breast cancer, melanoma, and renal cell carcinoma. While the current standard of care for most patients involves radiation therapy, the associated side effects have caused clinicians and researchers to search for new treatments with hopefully fewer adverse effects. The growing field of immunotherapy, including immune checkpoint inhibitors, shows promising results in cancer patients with brain metastases and warrants further investigation.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"32 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028421","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":"Future Directions and Emerging Approaches in the Treatment of Brain Metastases.","authors":"Rifaquat Rahman, Minesh Mehta","doi":"10.1097/PPO.0000000000000807","DOIUrl":"10.1097/PPO.0000000000000807","url":null,"abstract":"<p><p>The management of brain metastases is increasingly complex and requires multidisciplinary input from a wide array of experts, including radiation oncology, medical oncology, neurosurgery, and palliative care. Novel radiation techniques, radiosensitization, combination approaches with systemic therapy and approaches to penetrate or bypass the blood-brain barrier represent some of the more promising strategies that have the potential to improve outcomes of brain metastases patients. A better understanding of the biology and development of brain metastases may allow for greater efforts towards prevention. Rigorous, well-designed clinical trials addressing specific challenges of the brain metastasis population will be necessary to evaluate these novel approaches.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"32 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028433","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":"The Role of Artificial Intelligence for the Radiotherapeutic Management of Brain Metastases.","authors":"Alexander Podgorsak, John Kang, Dandan Zheng, Michael Milano, Simon Lo, Sara Hardy","doi":"10.1097/PPO.0000000000000809","DOIUrl":"10.1097/PPO.0000000000000809","url":null,"abstract":"<p><p>As the radiotherapeutic management of brain metastases increasingly utilizes stereotactic radiosurgery (SRS) and repeated treatments, artificial intelligence (AI) applications are being investigated in treatment planning, prognostication, and evaluation of treatment effects versus tumor progression. The burden on radiation oncologists increases as more lesions are targeted with SRS. AI algorithms facilitate improved detection and segmentation of lesions, reduce interobserver variability, and save clinician time. Predictive analytics, based on large datasets, enable better prognostication and treatment strategies tailored to individual patients. There is also data for the differentiation between radiation necrosis and tumor progression, which is a difficult issue that comes up more and more in patient care. However, challenges remain regarding data standardization, model validation, and clinical integration. Continued research and interdisciplinary collaboration are essential to fully harness AI's potential in the radiotherapeutic management of brain metastases and improving patient outcomes in neuro-oncology.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"32 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028409","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":"Innovations in Whole Brain Radiation Therapy.","authors":"Praveen Pendyala, Adannia Ufondu, Vinai Gondi","doi":"10.1097/PPO.0000000000000810","DOIUrl":"10.1097/PPO.0000000000000810","url":null,"abstract":"<p><p>Whole brain radiation therapy (WBRT) continues to play a critical role in managing patients with extensive brain metastases, but neurocognitive decline remains a significant limitation. This review examines the clinical presentation and underlying pathophysiology of radiation-induced neurocognitive impairment, which affects the majority of patients within a year of treatment. The mechanisms are multifactorial and include vascular injury, chronic neuroinflammation, impaired hippocampal neurogenesis, and disruption of white matter connectivity within key neural networks. Established neuroprotective strategies, such as memantine and hippocampal-avoidance radiation techniques, as well as emerging approaches, including memory-avoidance and genu-sparing WBRT that target broader limbic structures, are discussed. In addition, we review methods to improve local control through simultaneous integrated boosts and streamline treatment workflows using autosegmentation and simulation-free planning. Balancing tumor control with neurocognitive preservation is increasingly important as patients with brain metastases live longer with modern systemic therapies.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"32 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028404","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":"Biology of Brain Metastases.","authors":"Ozum Atasoy, Eyub Y Akdemir, Rupesh Kotecha","doi":"10.1097/PPO.0000000000000802","DOIUrl":"10.1097/PPO.0000000000000802","url":null,"abstract":"<p><p>Brain metastases affect up to 40% of patients with cancer and represent a major clinical challenge. Despite advances in surgery, radiotherapy, and systemic therapies, outcomes remain modest, partly due to the blood-brain barrier and the limited penetration of systemic therapies. Brain metastasis formation involves a complex sequence of events, including hematogenous spread, blood-brain barrier transmigration, and adaptation to neural niches. Recent multi-omics studies have revealed that brain metastases undergo substantial genomic, epigenetic, and transcriptomic divergence from primary and extracranial tumors. These changes promote immune evasion, metabolic reprogramming, and resistance to therapy. Tumor-glia interactions and vascular co-option further sustain metastatic progression. As conventional molecular profiling often fails to capture central nervous system-specific alterations, site-specific biopsies and liquid biopsies are gaining importance. This review provides a comprehensive overview of the molecular and cellular mechanisms underlying brain metastases and outlines emerging avenues for targeted interventions.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"32 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028406","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":"Modern Surgical Approaches for Brain Metastases.","authors":"Alexander Becker, Alejandro Carrasquilla, Michael A Vogelbaum","doi":"10.1097/PPO.0000000000000803","DOIUrl":"10.1097/PPO.0000000000000803","url":null,"abstract":"<p><p>Surgical resection is an important treatment consideration for patients with brain metastases, as it offers rapid symptom relief and enhances local control. Although surgery remains a mainstay of treatment, there exists increasing nuance in the selection of appropriate patients for surgical intervention and the choice of surgical adjuncts. This chapter reviews the current indications for open resection, evaluates surgical technique, and highlights the role of more minimally invasive strategies and other intraoperative adjuncts. In addition, it summarizes current evidence for the use of laser interstitial thermal therapy (LITT), brachytherapy, and Ommaya reservoirs, all within the context of evolving radiotherapy/radiosurgery and medical oncology paradigms.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"32 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028466","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}