Radiology and Oncology Feed

Irreversible electroporation ablation with bipolar electrodes: ultrasound findings of ablation zones

Thu, 16 Apr 2026 00:00:00 GMT

Background This study aimed to explore the ultrasound and contrast-enhanced ultrasound (CEUS) imaging characteristics and dimensions of ablation lesions after irreversible electroporation of the swine liver and to determine which imaging modality is more suitable for post-procedural follow-up by correlating imaging findings with histopathology. Materials and methods Irreversible electroporation procedures were conducted on three swine with single bipolar electrodes. All procedures were carried out after laparotomy. Twenty-four ablation zones were created under ultrasound guidance. Ultrasound and CEUS evaluations were performed immediately and 48 h after irreversible electroporation. Liver specimens were harvested 48 h after irreversible electroporation for histopathological analysis. Results The ablation area appeared as a hypoechoic, well-defined lesion on ultrasound and showed no enhancement on CEUS immediately after irreversible electroporation. At 48 h, the ablation zone appeared as an inhomogeneous hyperechoic area with a hyperechoic margin and blurred boundaries on ultrasound. CEUS clearly delineated the boundary of the ablation zone and demonstrated centripetal enhancement. The dimensions of the ablation area measured on CEUS 48 h after irreversible electroporation showed the highest correlation with the pathologic ablation zone size (length: r = 0.909, width: r = 0.942, p < 0.001), whereas ultrasound measurements showed the lowest correlation (length: r = 0.676, width: r = 0.842, p < 0.001). Conclusions Compared with conventional ultrasound, CEUS can accurately measure the dimension of the ablation area, especially 48 h after irreversible electroporation.

Correlation of quiescent-interval single-shot (QISS) magnetic resonance angiography (MRA), computed tomography angiography (CTA) and digital subtraction angiography (DSA) for peripheral arterial disease (PAD) assessment

Thu, 16 Apr 2026 00:00:00 GMT

Background Cross-sectional imaging methods such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are widely used for the assessment of peripheral arteries in patients with chronic limbthreatening ischemia (CLTI) or claudication. Given the limitations of CTA in evaluating heavily calcified vessels, we aimed to determine whether quiescent-interval single-shot (QISS) MRA provides better diagnostic agreement with digital subtraction angiography (DSA). Patients and methods In this retrospective study, 25 patients who underwent lower limb QISS MRA between April 2022 and April 2024 were included. Thirteen patients also underwent CTA, and 19 underwent DSA. Results The mean patient age was 67 ± 12 years (range: 32–86), and 20 were male. CLTI was present in 12 patients (48%), and medial arterial calcification was noted in 7 patients (28%). A total of 450 segments were evaluated by QISS MRA, 229 by CTA, and 149 by DSA. Agreement for ≥ 50% stenosis/occlusion was moderate for QISS MRA vs. CTA (κ = 0.41) and QISS MRA vs. DSA (κ = 0.49), and moderate for CTA vs. DSA (κ = 0.57). In below-the-knee arteries, QISS MRA showed substantial agreement with DSA (κ = 0.61) and high sensitivity (86.2%). Conclusions In this small, exploratory cohort QISS MRA showed promising performance for segment-based assessment of peripheral arterial disease (PAD), particularly in below-the-knee arteries in patients with medial arterial calcification, and outperformed CTA for the detection of ≥ 50% stenosis relative to DSA. Larger studies are needed to further establish its clinical utility.

Adjuvant nivolumab in resected oesophageal or gastroesophageal junction cancer following neoadjuvant chemoradiotherapy: Slovenian real-world data

Thu, 16 Apr 2026 00:00:00 GMT

Background Adjuvant nivolumab has become the new standard of care for patients with oesophageal and gastroesophageal junction cancer (OEC/GEJC) following neoadjuvant chemoradiotherapy (neoCRT) and surgical resection. In Slovenia, this treatment has been in use since January 2022. Here, we report the first Slovenian real-world experience with adjuvant nivolumab. Patients and methods We conducted a retrospective, observational cohort study of patients with OEC/GEJC who received adjuvant nivolumab after neoCRT and radical resection between January 2022 and December 2023. Data on patient characteristics, treatment completion, disease progression, and immune-related adverse events (irAEs) were collected from medical records and analysed via descriptive statistics. Results A total of 17 patients were included. The median follow-up was 34.6 months (range 11.2–55.7). The cohort included 14 (82%) males, with a mean age of 59 years. The Eastern Cooperative Oncology Group (ECOG) performance status was 0 for 15 (88%) patients and 1 for 2 (12%) patients. The tumor location was the esophagus in 9 (53%) patients and the gastroesophageal junction in 8 (47%) patients. At diagnosis, 13 (76%) patients were stage III (8th TNM classification). Histology revealed adenocarcinoma (AC) in 12 (71%) patients and squamous cell carcinoma (SCC) in 5 (29%) patients. Only 6 (35%) patients completed one year of adjuvant nivolumab. Treatment was discontinued in 5 (29%) patients due to disease progression and in 6 (35%) patients due to irAEs. Overall, 11 (65%) patients experienced irAEs of any grade. Grade 3 or 4 irAEs occurred in 4 (24%) patients: myocarditis G4 in 1 (6%) patient and colitis G3 in 3 (18%) patients. No irAE-related deaths were reported. The median disease-free survival (DFS) was 21.4 months (95% confidence interval [CI], 14.6–28.9). Conclusions Real-world data from Slovenia indicate that 65% of patients discontinued adjuvant nivolumab prematurely due to disease progression or irAEs. These findings highlight the need for careful patient selection and monitoring when using adjuvant immunotherapy in this population.

Clinical impact of trace elements as potential biomarkers for diagnosis and prediction of response to systemic treatment in gastrointestinal cancers

Thu, 16 Apr 2026 00:00:00 GMT

Background Gastrointestinal cancers are among the most common malignancies worldwide and, at advanced stages, remain incurable. Currently used biomarkers, such as tumour markers, have limited diagnostic value for early detection and relapse, highlighting the urgent need for more sensitive and specific markers. Trace elements are involved in numerous physiological and metabolic processes, and deregulation of their homeostasis is implicated in the carcinogenesis of various cancers, including gastrointestinal malignancies. Several basic and preclinical studies have identified the importance of trace elements in key biological processes. Recent clinical studies and retrospective analyses suggest that fluctuations in trace element levels may be associated with the development and progression of many cancers. Thus, quantitative and dynamic determination of serum trace element concentrations during treatment and follow-up represents a promising option for monitoring treatment efficacy and disease prognosis. Conclusions Trace elements may serve as potential prognostic and predictive biomarkers for diagnosis and response to systemic treatment.

Comparison of complications between laparoscopic and open abdominal approaches in morbidly obese patients with early-stage endometrial carcinoma

Thu, 16 Apr 2026 00:00:00 GMT

Background Endometrial carcinoma is the most common gynecological malignancy globally. Its rising incidence is closely linked to the increasing prevalence of morbid obesity (body mass index [BMI] > 40 kg/m2), which elevates the technical difficulty of surgery and the risk of perioperative complications. Identifying the optimal surgical approach is critical for this high-risk population. Patients and methods This retrospective study with prospectively collected data compared laparoscopic (LPSC) versus open abdominal (LAP) surgical approaches for low risk endometrioid carcinoma in morbidly obese patients. Data were collected over an eleven-year period (January 2013–December 2023) and included 73 patients (58 LPSC, 15 LAP) who met the inclusion criteria (BMI > 40 kg/m2, low-grade, early-stage endometrioid carcinoma). Outcomes measured included operative time, intraoperative blood loss, length of hospital stay, and intraoperative/postoperative complications, which were rigorously classified using the Clavien-Dindo system. Results Baseline patient characteristics were comparable between the two groups. The LPSC group demonstrated significantly superior perioperative outcomes. The average postoperative hospital stay was markedly shorter in the LPSC group (4.5 days) compared to the LAP group (12.7 days). Furthermore, LPSC was associated with lower rates of reoperation, transfusions, and postoperative anemia. Crucially, LPSC resulted in a statistically lower occurrence of severe postoperative complications (Clavien-Dindo Grade II and III). Conclusions he laparoscopic approach offers clear and significant perioperative advantages over open abdominal surgery for morbidly obese patients with low-risk endometrial carcinoma. Given the improved safety profile, LPSC or robotic-assisted surgery should be established as the preferred initial surgical approach in these technically challenging cases.

Predictive value of elastography (Shear-Wave and Elasticity Index) in differentiating benign from malignant breast lesions: a retrospective study in Peru

Thu, 16 Apr 2026 00:00:00 GMT

Background Evidence on the usefulness of quantitative elastography in the characterization of breast lesions remains limited in Latin America and scarce in Peru. This study aims to fill a relevant scientific gap by establishing specific cut-off points to optimize diagnostic interpretation and improve accuracy in differentiating benign from malignant lesions. Patients and methods An observational, retrospective, and analytical study was conducted in 189 patients who underwent breast elastography between October 2024 and September 2025. Clinical and radiological variables were analysed. Bivariate tests and multivariate binary logistic regression were applied to identify independent predictors of malignancy. The cut-off points were determined via receiver operating characteristic (ROC) curve analysis. Results Of the 85 lesions with histopathological confirmation, 54 (63.5%) were malignant, and 31 (36.5%) were benign. Malignant lesions presented significantly greater values of the elastography index (2.5 vs. 1.9; p = 0.001) and shear-wave elastography (SWE) (53 vs. 43 kPa; p < 0.001). According to the adjusted model, the Breast Imaging Reporting and Data System (BI-RADS) category remained the most relevant radiological predictor, suggesting that elastography values can be considered complementary for more accurate classification. The optimal SWE cut-off value of ≥ 47.5 kPa demonstrated acceptable diagnostic performance, with a sensitivity of 79.6% and specificity of 67.7%, indicating an adequate ability to distinguish between benign and malignant breast lesions. Conclusions This study represents one of the first examples of Peruvian evidence contributing scientific information on the application of quantitative elastography in the evaluation of breast lesions.

Radiotherapy for malignant spinal cord compression - prognostic factors for better functional outcome

Tue, 24 Mar 2026 00:00:00 GMT

Background Malignant spinal cord compression (MSCC) is one of the most devastating complications in cancer patients. This retrospective single-center analysis was aimed to identify prognostic factors for better functional outcome after radiotherapy for MSCC. Patients and methods Consecutive patients with MSCC treated with upfront radiotherapy between January 2017 and December 2022 were included in this analysis. Data on patient, tumor and treatment characteristics, functional status before and after treatment and diagnostic work-up were collected from the hospital digital database. The treatment was considered effective if performance status (PS) was maintained in PS 1-2 patients or PS improved in PS 3-4 patients. Results 295 patients were treated for MSCC. The most common primary tumor type was lung cancer (29.3%), followed by prostate (18%) and breast cancer (12%). The treatment was effective in 44.7% of patients. Patients who survived more than 1 month after radiotherapy were more likely to experience functional improvement than patients who died within the first month (60.5% vs. 16.5%, p < 0.001). In the multivariate analysis PS 1-2, myeloma/lymphoma, MRI at the time of MSCC and no motor deficits vs. paralysis were associated with better functional outcome. Conclusions The prognosis of patients with MSCC remains poor. Better stratification of patients to assess possible benefit of radiotherapy for MSCC is warranted.

Patient doses in image-guided radiotherapy: status in Europe for cone-beam CT imaging in the pelvic region

Tue, 24 Mar 2026 00:00:00 GMT

Background Organ absorbed doses in cone-beam CT (CBCT) imaging are often neglected in image-guided radiation therapy (IGRT). However, frequent imaging for patient positioning can result in significant and unrecorded additional radiation exposure. This study aims to evaluate organ doses from kV-CBCT and assess if they are optimized and how, in prostate and pelvic patient positioning protocols across Europe. Status of quality assurance in IGRT CBCT imaging is assessed in general. Materials and methods Data collected from a survey distributed across Europe on IGRT practices were compiled and analysed. A representative set of imaging protocols were simulated using Monte Carlo based ImpactMC software to assess mean absorbed doses in various organs in the International Commission on Radiological Protection (ICRP) standard phantom. Absorbed doses to red bone marrow were estimated with a three-parameter mass-energy absorption coefficient method. The simulations were validated against measurements with MOSFET detectors and radiochromic film. Results Simulated prostate absorbed doses ranged from 12 mGy to 34 mGy per imaged fraction for pelvic protocols, and 4 mGy to 26 mGy for prostate protocols. The selected length of the imaging region influenced doses to the femur and sacral red bone marrow. Overall, 74% of treatments involved positioning imaging at every fraction, indicating substantial cumulative doses from kV-CBCT imaging. Quality assurance was performed by 90% of responders, but good practice guides and national protocols do not exist. Conclusions The results of this study suggest that clear guidelines and standardized protocols for CBCT imaging in IGRT are lacking. There is significant potential to optimize the patient doses resulting from imaging. Given that most clinics already perform regular quality assurance for imaging equipment, including dosimetry and positioning accuracy verification, establishing diagnostic reference levels for CBCT imaging in IGRT could help promote further dose optimization.

Impaired booster-induced SARS-CoV-2 antibody responses in rituximab-treated B-cell lymphoma patients despite peripheral B-Cell Recovery

Tue, 24 Mar 2026 00:00:00 GMT

Background Rituximab-treated patients with B-cell lymphoma exhibit profound B-cell depletion and impaired vaccine-induced antibody responses. However, it remains uncertain whether recovery of peripheral B-cell counts after rituximab is sufficient to restore effective humoral immunity following booster vaccination. Patients and methods In this prospective, single-center observational study at the Institute of Oncology Ljubljana, adult B-cell lymphoma patients treated with or previously exposed to rituximab received the Comirnaty® mRNA COVID-19 vaccine. Antibody responses to the SARS-CoV-2 spike and nucleoprotein were measured at baseline, 14 days after the second dose, and at 3, 6, 9, and 12 months. A third dose was administered at 6 months. T-cell responses (IFN-γ release) were assessed in patients before and after the primary series and booster dose. Lymphocyte subsets were analysed pre-vaccination. Adverse events and nutritional status were monitored. Results Patients undergoing anti-CD20 therapy showed absent antibody responses. Longer intervals since rituximab correlated with peripheral B-cell repopulation. However, even after reaching normal B-cell counts, patients’ antibody responses after revaccination remained significantly lower than in controls. Conclusions Rituximab is associated with impaired vaccine-induced antibody responses. Despite recovery of peripheral B-cell counts, patients with B-cell lymphoma show reduced humoral responses compared with healthy individuals following booster COVID-19 vaccination.

Conversion therapy for advanced hepatocellular carcinoma following complete response to transarterial radioembolization combined with atezolizumab and bevacizumab

Tue, 24 Mar 2026 00:00:00 GMT

Background The current Barcelona Clinic Liver Cancer (BCLC) classification recommends systemic treatment with atezolizumab and bevacizumab as the first-line therapy for advanced hepatocellular carcinoma (HCC). Recent studies suggest that combining systemic immunotherapy with locoregional treatments, such as transarterial radioembolization (TARE), may enhance immune responses and improve overall treatment outcomes. This article presents a case series of three patients with advanced hepatocellular carcinoma who were treated with transarterial radioembolization followed by atezolizumab and bevacizumab achieving conversion to surgical resection. Patients and methods Between June 2020 and April 2024, three patients with advanced HCC were treated with TARE followed by atezolizumab and bevacizumab. The cohort included: Patient 1: A 59-year-old female, with noncirrhotic liver, with a 12 cm tumor and a 1.5 cm satellite lesion located in the liver, with hepatic vein and inferior vena cava (IVC) tumor thrombosis (Vv3 Japanese classification) and a small lung metastasis. Patient 2: A 63-year-old male with chronic hepatitis C (CHV), presenting with a 10 cm tumor and portal vein tumor thrombosis (Vp4 Japanese classification). Patient 3: A 50-year-old male, with non-cirrhotic liver, with a 17 cm tumor with portal vein and IVC tumor thrombosis (Vp3, Vv3 Japanese classification). Results The combined treatment approach enabled surgical resection in all three patients, each achieving a complete pathological response. Interestingly, follow-up dosimetric analysis showed that all tumors had received a subtherapeutic absorbed radiation doses. Conclusions In selected patients, combining transarterial radioembolization with systemic immunotherapy may enable conversion to surgical resection in advanced hepatocellular carcinoma, even with subthreshold tumor radiation doses, highlighting a potential synergistic and abscopal effect between locoregional and systemic therapies.

Bleomycin ElectroScleroTherapy (BEST): mechanistic parallels to electrochemotherapy, experimental models, and unresolved questions

Tue, 24 Mar 2026 00:00:00 GMT

Background Bleomycin electrosclerotherapy (BEST) is an emerging treatment option for vascular malformations (VMs), predominantly slow-flow venous malformations, with increasing use in other types of VMs. By combining application of bleomycin with electroporation, BEST enhances intracellular drug delivery and may improve treatment efficacy while allowing the use of lower drug doses. Although clinical evidence supporting its efficacy is growing, the biological mechanisms underlying these effects remain poorly understood. Key unresolved questions include endothelial responses to BEST, what are the dominant mechanisms of vascular injury and remodeling, and how hemodynamics and abnormal vessel architecture affect bleomycin distribution, pharmacokinetics, and effective dosing within the lesion. Although the clinical effects of BEST may be similar to the vascular disrupting effect of electrochemotherapy, it remains unclear whether these vascular mechanisms are in fact the same. Conclusions Understanding, how bleomycin is delivered, distributed, and retained within VM tissue, and how this interacts with endothelial susceptibility and electroporation efficiency, will be essential for defining optimal dosing strategies. Addressing these questions will require experimental approaches and physiologically relevant models capable of capturing the genetic, structural, and hemodynamic features of VMs. Such advances will be critical for elucidating the mechanisms of BEST and optimizing its clinical application.

Hyper-rapid progression in Salmonella-associated mycotic aortic aneurysms: a narrative review

Tue, 24 Mar 2026 00:00:00 GMT

Background Mycotic aortic aneurysms (MAAs), or infective native aortic aneurysms, are rare, life-threatening infections with a high risk of rupture. Non-typhoidal Salmonella (NTS) species show a tropism for the diseased aorta in elderly, atherosclerotic patients, causing explosive growth poorly captured by conventional surveillance. Management is complex when the visceral/paravisceral aorta is involved, making open surgical repair (OSR) risky and requiring tailored endovascular aortic repair (EVAR). This review synthesises evidence on Salmonella-associated MAAs and introduces hyper-rapid progression (HRP) as an early imaging biomarker. Conclusions Salmonella MAAs represent a high-velocity phenotype. We define HRP as progression from aortitis to saccular pseudoaneurysm (≥ 5 mm) within 7 days or rapid enlargement (≥ 5 mm or > 50%) within 72 hours despite antibiotics. HRP serves as a “red flag” for urgent mechanical stabilisation. While OSR is the gold standard, in anatomically complex or high-risk patients, complex EVAR with parallel grafts and an optimized radial sealing strategy (ORSS) offers a life-saving alternative. Prospective validation of HRP and its integration into imaging algorithms are needed to improve survival in this devastating condition.

Management of malignant bowel obstruction in patients with advanced cancer at the end of life

Wed, 04 Mar 2026 00:00:00 GMT

Background Malignant bowel obstruction in patients with advanced cancer at the end of life is common. Patients may have substantial symptoms (pain, nausea and vomiting) and experience aggressive care at the end of life. Due to the lack of robust evidence, the care algorithm of treatment for patients at the end of life is not standardized. Patient’s prognosis, clinical condition and patient’s preferences related to goals of care discussion must be considered when opting between comfort-focused care (conservative/pharmacological treatment), palliative (nonsurgical) procedures and palliative surgery. Patients and methods A focused literature search was conducted in PubMed/Medline to identify recommendations on the management of malignant bowel obstruction in patients with advanced cancer at the end of life. The search focused on symptom management using Medical Subject Headings (MeSH) terms related to intestinal obstruction in patients with advanced cancer at the end of life. Results Using the MeSH terms related search in PubMed/Medline, 9,532 articles were initially identified. After applying filters, 535 articles were selected for further review. Additional sources included reference lists and grey literature. In total, 83 references were used to support the management recommendations/suggestions in this article. Conclusions It is essential to engage patients and families in goals of care discussions to promote understanding of the palliative intent of different malignant bowel obstruction interventions. Research is needed to assist clinicians in decision making to provide patients at the end of life with appropriate care. Criteria for the selection of candidates for palliative surgery are needed to avoid significant complications and overly aggressive treatment at the end of life when the focus is maintaining and enhancing the quality of life of patients.

Interactions between hematological biomarkers of virus infection and immune cells in mediating distant metastasis in nasopharyngeal carcinoma: insights into prognosis and induction chemotherapy administration

Fri, 06 Feb 2026 00:00:00 GMT

Background Considering the increased metastatic risk in hepatitis B surface antigen (HBsAg)-positive patients with nasopharyngeal carcinoma (NPC), we aimed to investigate the interactions among HBsAg, tumor burden indicators, and immune function in the accurate stratification of prognosis and treatment for this specific cohort. Patients and methods We retrospectively analysed 1650 pathologically-confirmed patients with NPC from two centers and performed interaction and mediation analyses among HBsAg, plasma Epstein-Barr virus (EBV) DNA load, and absolute lymphocyte count (ALC), concerning distant metastasis. A 1:1 random matched-paired analysis was performed to evaluate survival according to risk and treatment stratification. Treatment-related adverse events were also compared. Results Overall, 17.3% (285/1650) of patients tested positive for HBsAg. Significant interactions occurred between HBsAg and low ALC (≤ 1.9×109/L) (HL), as well as between HBsAg and high plasma EBV DNA load (> 4000 copies/mL) (HE), both independently predicting poor distant metastasis-free survival (DMFS). The influence of T and N staging on tumor metastasis was mediated by HL (+) and HE (+), respectively. Among patients with stage III–IVa NPC, interaction associations presented with a worse 5-year DMFS and higher rates of severe neutropenia and leukopenia among those treated with additional induction chemotherapy (IC) than among those treated with radiochemotherapy alone. Conclusions Interactions exist between HBsAg positivity and high EBV/low ALC, mediating the effects of tumor staging and distant metastasis. The collective influence of viral infection, tumor burden, and reduced immune cells leads to worse DMFS in patients with HBsAg-positive NPC, requiring a tailored treatment beyond IC.

Histopathologic growth patterns as prognostic factor for survival in patients with colorectal liver metastases

Fri, 06 Feb 2026 00:00:00 GMT

Background Histopathologic growth patterns (HGPs) of colorectal liver metastases (CRLM) have emerged as potential prognostic biomarkers, though their clinical significance remains under investigation. The objective is to evaluate the prognostic value of HGPs on recurrence-free survival (RFS) and overall survival (OS) in patients undergoing liver resection for CRLM. Patients and methods This was a retrospective analysis of the OSLO-COMET randomized controlled trial, where 280 patients underwent laparoscopic or open parenchyma-sparing liver resection for CRLM between February 2012 and February 2016. Patients eligible for long-term analysis and with available histological material were included. HGPs were categorized as desmoplastic, pushing, replacement, or mixed, according to international consensus guidelines. Kaplan–Meier and Cox proportional hazards models were used to evaluate associations between HGPs and survival. Results A total of 239 patients were included. Desmoplastic HGP was present in 43.5% of patients and associated with significantly better outcomes. Median RFS was 31 months for desmoplastic versus 9, 10, and 11 months for replacement, pushing, and mixed groups, respectively (p = 0.002). Five-year OS was 62% for desmoplastic, 59% for replacement, 55% for mixed, and 39% for pushing HGP (p = 0.036). In multivariable analysis, HGP, lymph node status, and extrahepatic disease were independent predictors of RFS. Age, tumor size, ECOG score, and extrahepatic metastasis significantly impacted OS. Conclusions Replacement, pushing and mixed HGPs were associated with poor RFS, although replacement and mixed patterns showed better OS after treatment of recurrences. Desmoplastic HGP was independently associated with better RFS and OS following resection for CRLM.

Dual-channel ultrasonic images empowered deep learning: significantly improving prediction of occult central lymph node metastases in solitary papillary thyroid microcarcinoma

Fri, 06 Feb 2026 00:00:00 GMT

Background Central lymph node metastasis (CLNM) significantly elevates the risk of postoperative recurrence and contributes to ongoing debates regarding the necessity of prophylactic dissection in clinically node-negative papillary thyroid microcarcinoma (PTMC). Therefore, accurate preoperative prediction of occult CLNM is crucial for tailoring individualized treatment strategies. Patients and methods This retrospective study included 461 patients with PTMC from two hospitals who underwent preoperative ultrasound. A dual-channel deep learning (DL) model was developed by combining longitudinal and transverse ultrasound images. The model’s performance was compared with single-direction DL models and a clinical model using machine learning classifiers. Performance was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration curves. Results The dual-channel DL model outperformed the single-direction models, with AUC values of 0.765 in the training set and 0.726 in the external test set. The combined model, which integrated DL features and clinical indicators, achieved the highest AUC of 0.900 in the training set and 0.873 in the external test set, surpassing both the deep learning model using fused DL model (DL_F) and clinical models. Conclusions The dual-channel DL model demonstrated superior performance in predicting occult CLNM in PTMC patients. When combined with clinical features, it offers a robust tool for personalized risk stratification and treatment decision-making, providing a non-invasive method for predicting occult CLNM and supporting individualized treatment strategies.

Dosimetric comparison of organs at risk in ultra-hypofractionated versus hypofractionated postoperative radiotherapy for early breast cancer: single center clinical study

Fri, 06 Feb 2026 00:00:00 GMT

Background Growing evidence of safety and feasibility has prompted a shift toward ultra-hypofractionated (UHF) schedules in postoperative radiotherapy in early breast cancer. Patients and methods Eighty patients over 50 years of age with early breast cancer (T1-2 and N0-1) who underwent postoperative, 3D conformal, free-breathing whole breast radiotherapy were included. The prospective arm consisted of 40 patients treated with UHF (26 Gy/5 fractions/one week) from 2023-2024, whereas the control arm was retrospective and represented by data from 40 patients treated with hypofractionated radiotherapy (HF) (40.5–42.2Gy/15–16 fractions/3 weeks) between 2015 and 2020. Dosimetric parameters for organs at risk (OARs) (heart and ipsilateral lung) were derived from the dose-volume histograms. Statistical evaluation was done with paired sample t-test and Mann-Whitney U test. Results Dosimetric analysis revealed that patients treated with UHF schedule received significantly lower equivalent doses in 2 Gy fractions (EQD2Gy) to OARs compared with those treated with the HF schedule. The mean ipsilateral lung EQD2Gy dose was significantly lower in the UHF group (3.94 ± 2.1 Gy) than in the HF group (6.24 ± 2.4 Gy; p < 0.01). Among patients with left-sided breast cancer, the mean heart EQD2Gy dose was also significantly reduced in the UHF group (1.34 ± 0.5 Gy) compared with the HF group (3.02 ± 1.4 Gy; p < 0.01). Conclusions These findings indicate a consistent dosimetric advantage of the UHF schedule, particularly in reducing radiation exposure to the heart and ipsilateral lung. These results support the dosimetric safety and feasibility of UHF schedules in early breast cancer treatment.

Inequity in access to palliative care services worldwide and in Slovenia

Wed, 04 Feb 2026 00:00:00 GMT

Background Palliative care aims to enhance the quality of life of patients and their families facing progressive and incurable disease by addressing physical, psychological, social, and spiritual challenges. Despite being recognized as a human right, palliative care remains out of reach for most people worldwide, with only about 14% of those who need it receiving it. Global demand for palliative care is rising due to aging populations and the increasing burden of chronic diseases. While high-income countries focus on expanding access and inclusivity to this care, low-income countries face severe shortages in prevention, diagnostics and treatment of underlying diseases, which creates an urgent need for palliative care services. Cultural differences, a lack of trained professionals, limited opioid availability, and weak policy further deepen inequities. Conclusions Historically rooted in religious and charitable care, modern palliative care emerged with Dame Cicely Saunders’ hospice movement, evolving into a medical specialty. Access varies widely – Europe has high integration in some countries but significant disparities in service distribution and opioid use. Africa, Latin America, and parts of Asia still lack widespread provision. In Slovenia, palliative care development began in the 1980s and has recently expanded to include some specialized palliative care services across the country. Despite this progress, palliative care in Slovenia remains underdeveloped due to limited coverage, regional disparities, workforce shortages, insufficient formal education, and an old and ineffective national policy. Opioid availability is slightly below the European average, and its use is declining, which raises concerns about further unmet needs.

Imaging-based prognostic factors in patients undergoing thermal ablation for colorectal liver metastases. A retrospective study on the role of sarcopenia parameters and tumor burden score

Wed, 04 Feb 2026 00:00:00 GMT

Background To investigate imaging-based prognostic factors in patients who underwent thermal ablation for colorectal liver metastases (CRLM), with a focus on sarcopenia-related body composition parameters and L1-bone-density in comparison to tumor burden score (TBS). Patients and methods A retrospective analysis was conducted on patients who received thermal ablation for CRLM at our tertiary care center between 2009 and 2023. CT-derived body composition metrics included the psoas muscle volume index (PMVI), the psoas muscle index (PMI), and L1-bone-density. PMVI was automatically extracted using the open-source deep learning tool TotalSegmentator. Comparisons between 1-year survivors and non-survivors were performed using unpaired t-tests. Results A total of 88 patients were included, most had previously undergone hepatic resection (n = 72, 82%). Among sarcopenia-related imaging markers, PMVI showed a significant association with 1-year survival (p = 0.048), with higher PMVI values observed in survivors (mean 113.3 cm3/m3) compared to non-survivors (mean 101.3 cm3/m3). No significant differences were observed for L1-density (p = 0.925) or PMI (p = 0.137). Similarly, the TBS was not significantly associated with 1-year survival (p = 0.182). Conclusions In our cohort of patients treated with thermal ablation for CRLM, PMVI showed significant association with 1-year survival, which was not observed for conventional tumor burden score or other sarcopenia-related imaging parameters.

IgG Fc binding protein (FCGBP) inhibits the development of laryngeal squamous cell carcinoma and cisplatin resistance through the PIGR/JAK2/STAT3 pathway

Wed, 21 Jan 2026 00:00:00 GMT

Background Laryngeal squamous cell carcinoma (LSCC) is the second most common malignancy of the head and neck, and one of the major therapeutic challenges is resistance to cisplatin (CDDP). IgG Fc binding protein (FCGBP), known as a tumor suppressor in various cancers, has also been implicated in drug resistance. This study investigated the role of FCGBP in LSCC. Materials and methods The expression and prognostic relevance of FCGBP were initially analyzed using the Gene Expression Profiling Interactive Analysis 2 (GEPIA2) database. The in vivo effects of FCGBP were examined using a nude mouse xenograft model of LSCC, and its in vitro effects were assessed through half-maximal inhibitory concentration (IC50) analysis, colony formation assays, and flow cytometry. The underlying mechanism by which FCGBP modulates CDDP resistance was invstigated by silencing the polymeric immunoglobulin receptor (PIGR). Results FCGBP was significantly downregulated in head and neck squamous cell carcinoma (HNSCC) tissues and LSCC cell lines, and its reduced expression was associated with poor prognosis. It inhibited the viability and proliferation of LSCC cells by approximately 50% and reduced their resistance to CDDP, lowering the IC50 from 50 μM to approximately 30 μM. Mechanistically, FCGBP modulated the PIGR/JAK2/STAT3 signaling pathway, thereby exerting both anti-tumor and anti-CDDP resistance effects. In vivo, FCGBP overexpression significantly suppressed LSCC tumor growth, with tumor volume reduced by approximately 67%. Conclusions These findings suggest that the FCGBP/PIGR/JAK2/STAT3 axis regulates CDDP resistance in LSCC and that FCGBP may serve as a potential therapeutic target to improve cisplatin efficacy in treating LSCC.