Cancers最新文献

{"title":"The Osteosarcoma Tumor Microenvironment: Supportive of Tumor Progression, Hostile to Immunity, but Therapeutically Targetable.","authors":"Lidia Tarone, Irene Fiore Merighi, Elisa Tirtei, Davide Giacobino, Emanuela Maria Morello, Federica Cavallo, Federica Riccardo","doi":"10.3390/cancers18193239","DOIUrl":"10.3390/cancers18193239","url":null,"abstract":"<p><p>Osteosarcoma (OSA) remains the most common primary malignant bone tumor of children and young adults, with limited survival improvements in patients with relapsed or metastatic disease despite multimodal chemotherapeutic treatment. Beyond the intrinsic heterogeneity and malignancy of tumor cells, OSA progression and therapeutic resistance are strongly influenced by the specialized bone tumor microenvironment (TME). Interactions among tumor, immune and stromal cells generate a complex ecosystem characterized by immune suppression, hypoxia and metabolic adaptation, representing a major challenge for effective (immune) therapeutic approaches. In this review, we discuss how the OSA microenvironment shapes tumor evolution and therapeutic response, with particular emphasis on the mechanisms that limit effective immune-mediated tumor control. We further examine the rationale for combining tumor-directed and microenvironment-directed immunotherapies. Within this context, B7-H3/CD276 represents a relevant example of a multifunctional molecule at the interface between tumor biology and immune regulation. B7-H3 is associated with aggressive tumor features and therapy resistance, while its immunoregulatory activities contribute to the establishment of an immune-restrictive TME. Consequently, B7-H3-targeted therapies may exert complementary mechanisms of action, either by directly eliminating B7-H3-expressing tumor cells or by modulating the TME to overcome immunosuppressive barriers. This dual activity provides rationale for combination strategies integrating B7-H3-targeting with antigen-directed immunotherapies, including those targeting the novel OSA-associated antigen, chondroitin sulfate proteoglycan 4, where effective antitumor immunity may require simultaneous modulation of the local immune context. We then discuss how advanced preclinical models, comparative oncology, and emerging biomarker-guided approaches may accelerate the clinical translation of more effective immunotherapeutic strategies for OSA.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping Integrative Decision-Making Frameworks in Advanced Cancer Care: A Scoping Review of Diagnostic, Supportive-Care, and Therapeutic Integration.","authors":"Kazuyuki Murase, Yusuke Sugama, Yohei Arihara, Kohichi Takada, Kunihiko Ishitani","doi":"10.3390/cancers18193245","DOIUrl":"10.3390/cancers18193245","url":null,"abstract":"<p><strong>Background/objectives: </strong>Decision-making in advanced cancer care is intertwined with diagnostic profiling, prognostic communication, supportive care, and anticancer treatment selection. An author-developed D-S-T × B/C/E conceptual mapping scaffold-three decision/action domains (Diagnosis, Supportive care, Therapy) and three evaluative dimensions (Biological, Clinical, Existential)-was used to organise the literature, to identify coverage gaps and recurring framework categories, and, as a secondary conceptual synthesis objective, to derive a candidate integrative framework.</p><p><strong>Methods: </strong>The review was conducted according to the Joanna Briggs Institute (JBI) methodology for scoping reviews, pre-registered on OSF, and reported per PRISMA-ScR. PubMed was searched on 21 June 2026, and the final evidence set was derived solely from this search. Eligible records concerning adults with advanced cancer were dual-screened and charted using a structured form.</p><p><strong>Results: </strong>Eighty-two records (2010-2026) were included. Under the strict D-S-T × B/C/E matrix, Supportive care showed the highest joint coverage, particularly S × C (59/82, 72.0%), whereas D × B and D × E were the least represented cells (13/82 each, 15.9%). Eight recurring framework categories were inductively derived from the charted framework descriptors, led by early integrated palliative care (30/82) and prognosis-informed shared decision-making (27/82). Twenty-two records met an emergence-candidate screen defined at the synthesis stage, of which three received the maximum cross-axis coupling score of 6/6 from both reviewers.</p><p><strong>Conclusions: </strong>The advanced-cancer decision-framework literature clusters around a small number of architectures with uneven D-S-T × B/C/E coverage. Diagnosis-centred frameworks coupled with biological or existential dimensions were relatively under-represented within our mapping and represent priority targets for future primary research; the proposed Adaptive framework provides one structure in which this research could be conducted.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncovering the Role of Small and Intermediate-Length Non-Coding RNAs in Glioma Pathogenesis and Prognosis.","authors":"Jasmine Machhi, Priya Kumthekar, Stella Hartmann","doi":"10.3390/cancers18193232","DOIUrl":"10.3390/cancers18193232","url":null,"abstract":"<p><p>Gliomas are the most prevalent and aggressive primary tumors of the central nervous system (CNS), with glioblastoma demonstrating particularly poor survival rates despite multimodal treatment approaches. The extensive molecular heterogeneity and resistance to conventional therapies highlight the urgent need for novel biomarkers and therapeutic targets. Non-coding RNAs (ncRNAs), transcripts that do not encode proteins, have emerged as crucial regulators of gene expression and cellular homeostasis in both normal and malignant contexts. Their dysregulation contributes to key oncogenic processes, including uncontrolled proliferation, apoptosis, evasion, invasion, and therapeutic resistance. Small and intermediate-sized are strong candidates for biomarkers due to their high abundance and relative stability. Previous reviews on ncRNAs highlight the numerous roles of microRNAs, long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs) in gliomas. Here, we focus specifically on small and intermediate-length non-coding RNAs, including transfer RNAs (tRNAs) and tRNA-derived fragments (tRFs or tsRNAs), small nucleolar RNAs (snoRNAs), vault RNAs (vRNAs or vtRNAs), small nuclear RNAs (snRNAs) and mitochondrial tRNAs (mt-tRNAs). Recent studies suggest that these various non-coding RNAs participate in diverse aspects of glioma biology, including regulation of gene expression and modulation of metabolic and immune pathways, and correlate with tumor grade and molecular subtype. In this review, we summarize current evidence regarding the expression profiles and functional roles of small and intermediate-length non-coding RNAs in glioma tumorigenesis, progression, and therapeutic response. The differential expression of many of these ncRNAs in gliomas implies their involvement in both tumor-suppressive and oncogenic processes. A deeper understanding of these molecules may provide valuable insights into glioma biology and reveal novel biomarkers for diagnosis, prognosis, and treatment.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning on Histopathological Images Enables Accurate Diagnosis of Common B-Cell and Hodgkin Lymphoma.","authors":"Peisen Zhang, Changjiang Yan, Meilin Sun, Shaojie Ding, Lingmei Li, Wenfeng Cao, Lu Cao","doi":"10.3390/cancers18193237","DOIUrl":"10.3390/cancers18193237","url":null,"abstract":"<p><p>Accurate subtyping of lymphomas is critical for guiding treatment decisions and predicting patient outcomes, yet it remains challenging due to overlapping morphological features. This study aimed to develop and validate a deep learning-based diagnostic system, designated BH-LymphDS, to accurately differentiate the three most prevalent lymphoma subtypes: Diffuse Large B-cell Lymphoma (DLBCL), Follicular Lymphoma (FL), and Hodgkin Lymphoma (HL). The system integrates a Swin Transformer backbone with a clustering-constrained attention multiple instance learning (CLAM) algorithm and a k-nearest neighbors (KNN) classifier, supporting weakly supervised learning directly from whole-slide images without manual region-level annotation. A total of 1910 whole-slide images (WSIs) from diagnostic biopsies were utilized for model development-the largest cohort to date in this field. The performance of nine distinct deep learning architectures was systematically compared. Model efficacy was rigorously evaluated through five-fold cross-validation and further validated on independent external datasets from TCIA and TCGA. Additionally, a comparative analysis was conducted against the diagnostic performance of three experienced hematopathologists. In the internal testing cohort, BH-LymphDS achieved a micro-average AUC of 0.955 and an accuracy of 92.5%. During cross-validation, the system attained a superior micro-average F1-score (0.871) compared to the average of the three hematopathologists (0.851). The Swin Transformer emerged as the optimal backbone, and gradient-weighted class activation mapping (GradCAM) confirmed that the model's decisions were based on legitimate morphological features such as nuclear atypia and cellular growth patterns. Our findings demonstrate that an advanced AI system can satisfy the rigorous requirements for accurate lymphoma subclassification on histopathological slides. The BH-LymphDS shows strong potential as a reliable auxiliary diagnostic tool to enhance clinical workflow efficiency and diagnostic consistency.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Physical and Mind-Body Exercise on Anxiety Among Patients with Breast Cancer: A Systematic Review and Meta-Analysis of Controlled Trials.","authors":"Mesut Süleymanoğulları, Cemre Didem Eyipınar, Zarife Pancar, Valentina Stefanica, Nicola Luigi Bragazzi, Halil İbrahim Ceylan","doi":"10.3390/cancers18193244","DOIUrl":"10.3390/cancers18193244","url":null,"abstract":"<p><p><b>Background and Objectives:</b> Anxiety is highly prevalent among breast cancer patients and significantly impairs quality of life. Although both conventional physical exercise (PE) and mind-body interventions (MBE) are used in supportive care, their relative efficacy remains unclear. This systematic review and meta-analysis compared the effects of PE and MBE on anxiety in breast cancer patients. <b>Materials and Methods:</b> PubMed, Web of Science, Embase, PsycINFO, and CINAHL were systematically searched through April 2026 for controlled trials comparing structured PE or MBE with control conditions. Effect sizes were pooled as standardized mean differences (SMDs; Hedges' g) using a random-effects model with restricted maximum likelihood estimation and modified Hartung-Knapp inference. Subgroup analyses and univariable meta-regressions explored potential moderators. <b>Results:</b> Twenty-four reports (<i>N</i> = 2197) represented 25 independent trials; 22 estimates from 21 reports entered the meta-analysis, and three reports were synthesized narratively. Interventions significantly reduced anxiety on average (SMD = -0.58, 95% CI [-1.01, -0.15], <i>p</i> = 0.011), with substantial heterogeneity (I² = 85.0%) and a 95% prediction interval of -2.38 to 1.22. Both PE (SMD = -0.67) and MBE (SMD = -0.46) favored intervention numerically, although both subgroup confidence intervals included no effect, with no significant difference between modalities (<i>p</i> = 0.697). A larger, yet non-significant, effect was observed during active treatment (SMD = -0.84, 95% CI [-1.68, 0.01]) compared with survivorship (SMD = -0.34, 95% CI [-0.62, -0.07]); the between-phase comparison was inconclusive (<i>p</i> = 0.291). The comparison across diagnostic stages was also inconclusive (<i>p</i> = 0.366). None of the seven continuous moderators met the multiplicity-adjusted significance threshold. <b>Conclusions:</b> Current findings suggest an average reduction in anxiety following physical and mind-body interventions in breast cancer patients. However, no statistically significant differences were observed between intervention modalities or treatment stages. Very low certainty, substantial heterogeneity and indirect subgroup comparisons limit confidence in the size and consistency of benefit. Overall, individualized interventions may have a role in oncology care, but these findings do not establish superiority, equivalence or differential efficacy between modalities or treatment phases.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reclassifying No Specific Molecular Profile Endometrial Cancer: A Narrative Review of Molecular Heterogeneity, Prognostic Refinement, and Clinical Management.","authors":"Yujing You, Yan Zhang","doi":"10.3390/cancers18193223","DOIUrl":"10.3390/cancers18193223","url":null,"abstract":"<p><p>Molecular classification has transformed the management of endometrial cancer (EC), yet the no specific molecular profile (NSMP) subtype remains a major challenge for precision oncology due to its substantial biological and clinical heterogeneity. This narrative review summarizes evidence on the molecular features, candidate prognostic biomarkers, procedural implications, and treatment data relevant to NSMP EC and proposes a conceptual framework for further study. Emerging evidence indicates that NSMP represents a heterogeneous disease spectrum rather than a uniform entity. Histological grade and estrogen receptor (ER) expression provide important prognostic refinement, while molecular alterations, including <i>CTNNB1</i> mutations, <i>ARID1A</i> abnormalities, and L1CAM overexpression, may further discriminate risk. Current trials and guidelines increasingly support biomarker-driven treatment strategies, although prospective validation is needed. In conclusion, NSMP EC requires further refinement beyond conventional risk classification. We propose an evidence-informed three-layer conceptual framework integrating molecular classification (<i>POLE</i>, MMR, and p53 status), clinicopathological factors (grade and ER expression), and emerging biomarkers, including <i>ARID1A</i> and L1CAM. This framework is intended to organize current evidence and generate hypotheses for future validation, which may facilitate individualized prognostic assessment of NSMP EC.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choosing Between Anti-TROP2 ADCs in Advanced Breast Cancer Without Head-to-Head Evidence: A Practical Evidence-Informed Decision Framework Endorsed by the Polish Society of Clinical Oncology.","authors":"Piotr J Wysocki, Katarzyna Pogoda, Ewa Wysocka, Barbara Radecka, Maciej Krzakowski","doi":"10.3390/cancers18193227","DOIUrl":"10.3390/cancers18193227","url":null,"abstract":"<p><strong>Background/objectives: </strong>Antibody-drug conjugates (ADCs) targeting trophoblast cell-surface antigen 2 (TROP2), including sacituzumab govitecan (SG) and datopotamab deruxtecan (Dato-DXd), have expanded treatment options for patients with advanced breast cancer. Although both agents target TROP2, they differ in molecular design, clinical evidence, toxicity profiles, and monitoring requirements. Without head-to-head trials, their relative clinical positioning remains uncertain. This review aimed to critically assess the available evidence and develop a practical framework to support individualized treatment selection between SG and Dato-DXd.</p><p><strong>Methods: </strong>This narrative critical review used a structured literature search of PubMed/MEDLINE and targeted searches of major oncology guidelines, regulatory documents, pivotal-trial publications, conference reports when full publications were unavailable, and relevant retrospective or translational studies. The evidence cutoff was 29 September 2026. Direct randomized-trial evidence, indirect clinical inference, and expert/practical considerations were explicitly distinguished.</p><p><strong>Results: </strong>SG and Dato-DXd have both demonstrated clinically meaningful activity in advanced breast cancer, but their evidence base, toxicity patterns, and practical requirements differ. Cross-trial differences in populations, treatment lines, comparator composition, follow-up, subsequent therapy, response assessment, and safety reporting preclude valid numerical comparisons of efficacy or toxicity between the two agents. SG is characterized predominantly by hematologic and gastrointestinal toxicity, whereas Dato-DXd is associated with stomatitis, ocular toxicity, and interstitial lung disease/pneumonitis. These distinctions, together with patient-specific comorbidities, prior toxicities, prior ADC exposure, logistical considerations, and local healthcare resources, may inform individualized treatment selection when both agents are clinically appropriate.</p><p><strong>Conclusions: </strong>In the absence of direct comparative trials, treatment selection between SG and Dato-DXd should not rely on cross-trial efficacy or safety comparisons. The proposed framework separates regulatory and guideline eligibility from drug-specific safety evidence, indirect clinical inference, patient preferences, and healthcare system considerations. It is intended as evidence-informed clinical guidance rather than a validated comparative treatment selection rule and requires prospective evaluation.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Clinical Outcomes and Healthcare Utilization in Older Adults with Acute Myeloid Leukemia: Insights from a Single-Center Retrospective Cohort.","authors":"Tina Y Zhang, Alex Y Ge, Shyam A Patel, Poorva Bindal, Jan Cerny, Andrew Gillis-Smith, Muthalagu Ramanathan, Sakiko Suzuki, Laurie Pearson","doi":"10.3390/cancers18193230","DOIUrl":"10.3390/cancers18193230","url":null,"abstract":"<p><strong>Background: </strong>Acute myeloid leukemia (AML) predominantly affects older adults; however, patients 75 years of age and older are often not candidates for curative-intent treatments. Data on their treatment patterns, survival outcomes, and healthcare utilization are limited, and we evaluated these outcomes among patients 75 years of age and older with AML.</p><p><strong>Methods: </strong>We retrospectively analyzed 97 patients aged 75 years and older managed at our academic safety-net hospital between 2016 and 2025.</p><p><strong>Results: </strong>Median overall survival (mOS) was 95 days for all patients. Receipt of any AML-directed therapy was associated with longer mOS compared with no leukemia-directed treatment (144 days, 95% CI: 98-184 vs. 17 days, 95% CI: 7-50; <i>p</i> < 0.001). Among patients with 2024 ELN adverse-risk/<i>TP53</i>-mutated disease, mOS was 88 days (95% CI: 34-NE) with AML-directed therapy and 44 days (CI: 36-NE) without treatment (<i>p</i> = 0.2). Forty-four percent of patients were enrolled in a hospice at their time of death, and an additional 40% were managed with comfort measures as inpatients. Median duration of hospice or comfort care was 2 days (IQR: 1-5), with no difference based on whether patients received any AML-directed treatment. Fifty-one percent of patients died in the hospital.</p><p><strong>Conclusions: </strong>Our findings highlight real-world challenges for older adults with AML, including the need for more effective treatments for patients with <i>TP53</i>-mutated AML. AML-directed treatment was associated with longer survival without a decrease in the time spent in hospice care, and the risk of in-hospital mortality remains elevated for this population.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intratumoral Immunotherapy-The Future of Treating Merkel Cell Carcinoma?","authors":"Nayonika Pande, Justin C Moser, Sanjay Chandrasekaran, Andrew S Brohl, Rajan P Kulkarni, Vincent T Ma","doi":"10.3390/cancers18193226","DOIUrl":"10.3390/cancers18193226","url":null,"abstract":"<p><p>Merkel cell carcinoma (MCC) represents a rare but highly aggressive neuroendocrine skin cancer with limited systemic therapy options for patients who fail or are ineligible for immune checkpoint inhibitors (ICIs). Intratumoral (IT) immunotherapy has emerged as a promising strategy, leveraging the accessibility of tumor lesions and their inherent capacity to trigger immune responses, known as abscopal effects. This review synthesizes the current evidence on IT approaches in MCC, including Toll-like receptor agonists, cytokines, and oncolytic viruses, and highlights their distinct mechanisms of action, while emphasizing the critical need for standardized radiographic response assessment of injected and non-injected lesions. Inconsistent documentation of abscopal responses has hindered quantification of IT therapy's systemic potential, particularly in a disease where one-third of patients present with metastases and distant relapse is common. We outline MCC-specific rationale for routine lesion-level tracking, and recommendations for IT trial designs and objectives. Rigorous assessments of abscopal data will clarify IT's role as both rescue therapy and an ICI partner, potentially transforming outcomes in this refractory MCC.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthopaedic Management of Bone Metastases from Lung Cancer.","authors":"Júlio Martins Lopes, Vânia Oliveira, Pedro Cardoso, Manuel Magalhães, Paula Fidalgo, António Araújo","doi":"10.3390/cancers18193228","DOIUrl":"10.3390/cancers18193228","url":null,"abstract":"<p><strong>Background/objectives: </strong>Bone metastases from lung cancer can cause pain, pathological fracture, spinal instability, metastatic spinal cord compression and loss of independence. Lung cancer-specific evidence for orthopaedically relevant local management remains fragmented. This review assessed outcomes across spinal, appendicular and pelvic skeletal disease, while explicitly examining the anatomical distribution and limitations of the evidence.</p><p><strong>Methods: </strong>PubMed, Web of Science, Europe PMC and Scopus were searched for original studies published from January 2015 to December 2025. Eligible studies evaluated orthopaedic, surgical, minimally invasive or percutaneous skeletal interventions, including radiotherapy when combined with or directly compared with an orthopaedically relevant local strategy. Two reviewers independently screened studies, extracted data and completed the full Joanna Briggs Institute checklist applicable to each design. Findings were synthesised narratively, with evidence certainty assessed using GRADE.</p><p><strong>Results: </strong>Thirty-three studies comprising 3585 participants with lung cancer were included; 26 were retrospective observational studies. Thirty studies predominantly evaluated axial disease, mainly spinal metastases, whereas only six included appendicular lesions; these categories were not mutually exclusive. Local interventions were associated with pain relief, maintenance or recovery of ambulation, neurological improvement and local symptom control in selected patients. Comparative survival findings were inconsistent and vulnerable to selection bias and confounding by indication; no causal survival benefit of surgery was established. Complication patterns differed by intervention type. Overall certainty was low to very low and was weakest for appendicular and pelvic disease.</p><p><strong>Conclusions: </strong>Orthopaedic management can be clinically important for preserving function and controlling mechanical or neurological complications, but the evidence is substantially stronger for spinal than for extraspinal disease. Treatment should remain multidisciplinary and individualised. The proposed decision frameworks are conceptual and guideline-informed rather than validated treatment algorithms.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}