General Hospital of Rhodes

Abstract Background Identifying pathogenic/likely pathogenic variants in high-risk cancer genes is key to cancer risk management.Prophylactic surgeries like RRM and RRSO are guideline-recommended options. This study aims to provide real-world evidence on their clinical implementation. Methods Between 2020 and 2025, 203 women referred for genetic testing at Genekor Medical S.A., were detected with P/LP variants in cancer susceptibility genes, for which risk-reducing surgical options are either recommended or considered for discussion. Referring clinicians were invited to complete a questionnaire to assess whether prophylactic surgical options had been discussed, if the patients had agreed to undergo such procedures, and whether the surgeries have already been performed or postponed. Results Among the individuals referred for genetic testing, 168(83%) were referred following a cancer diagnosis, while 35(17%) were unaffected individuals referred due to a family history. 153 individuals (76%) harbored BRCA1/2, 31(15%) harbored PALB2, PTEN, TP53 and 19 (9%) harbored BRIP1,RAD51C, RAD51D P/LP variants. RRSO was discussed with 78/153 (51%) of BRCA1/2 carriers and agreed in 60/78 (77%) cases. Addition of hysterectomy to RRSO was discussed in 16/78 (21%) of cases and agreed in 10/16 (63%). RRM was discussed with 113/203 (56%) of patients and agreed in 73/113(65%). In PALB2, PTEN, TP53 carriers, RRM was discussed in 21/31 (68%) cases, and accepted in 9/21 (43%), while in 5 cases both RRM/RRSO were discussed with 3 women agreeing. Finally, for 19 BRIP1,RAD51C, RAD51D carriers, in 9 cases the physician discussed RRSO as an option, with the examinees agreeing in 7 of them and in 5 cases RRM was discussed with agreement to proceed in 2 of them. In all cases, 22 individuals although agreed to proceed with RRM and/or RRSO, decided to postpone the procedure. Conclusions This study highlights the high awareness and acceptance of surgical management demonstrating the adherence to the recommendations. Age under 35 years and receiving therapy at the time of genetic testing were significant factors in lowering risk reduction RRSO and hysterectomy performance rates. Stage IV cancer was the main reason for not discussing surgical intervention. Citation Format: K. Papazisis, M. Paraskeva, S. Giassas, M. Skondra, R. Iosifidou, C. Tolis, G. Kesisis, E. Zairi, V. Venizelos, C. Markopoulos, I. Natsiopoulos, E. Bleka, I. Xanthakis, A. Ananiadis, D. Matheos, D. Stefanou, A. Adamidis, A. Meintani, G. Kapetsis, D. Bouzarelou, E. Papadopoulou, G. Nasioulas. High-risk cancer susceptibility genes mutation carriers’ compliance with surgical risk reduction for breast and ovarian cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-05-05.

Abstract Background Discrepancies in the assessment of ER, PR, and HER2 status by immunohistochemistry (IHC) and Oncotype DX (ODX) can substantially impact treatment decisions. Variations in assay results that alter tumour molecular subtype may lead to changes in recommended adjuvant therapy. We present a series of such cases and explore whether these findings reflect tumour heterogeneity or misclassification of ER expression. We show how reclassification influenced systemic treatment choices and eligibility for genetic testing, underscoring the practical implications of such discrepancies for the personalisation of breast cancer care. Methods Retrospective analysis was conducted of 682 patients who underwent ODX testing between 2020-2025 at Barts Health NHS Trusts hospitals. Data extracted from the ODX reports included the recurrence score and the qualitative and quantitative assessments of mRNA levels of ESR1, PGR, and ERBB2 receptor genes. These results were compared to ER, PR, and HER2 receptor protein status determined by standard IHC staining and scoring on the diagnostic biopsy specimens1. The standard ER IHC scoring categorises ER status as ER negative (score 0,2) ; ER low positive (score 3,4) and ER positive (score 5-8)1. All ER biopsy slides were reviewed blind by a breast pathologist (MW). Receptor IHC was repeated on the resection specimen tumour block used for ODX testing and the results compared to the ER IHC score on the diagnostic biopsy. Results were compared with 5 control cases in which the ODX as well as ER IHC on biopsy was positive. Results From a total of 682 ODX tests performed, 12 patients (1.7%; 12/682) demonstrated discordance, with a negative ESR1 gene expression score on ODX and ER IHC positive score (5-8). Upon repeat histological review, all 12 cases (100%) were confirmed to be either ER low-positive (75%; 9/12) or ER negative (25%; 3/12) on ER IHC on the resected tissue. On review of the ER IHC biopsy slides, in 7/12 cases (58.3%) the tumour displayed heterogeneous ER IHC staining on biopsy, with predominantly ER negative tumour being present on the resection block. 3/12 biopsies (25%) originally reported as ER positive on the basis of highest-staining hotspots were reclassified as overall ER low-positive on review. 2/3 (66.7%) of these cases also exhibited heterogeneity of ER IHC staining. 1/12 cases had multifocal breast cancer with one ER positive (score 8) and one ER low positive tumour (score 3) with the Oncotype test performed on the ER low positive tumour. 1/12 (8.3%) of cases was an external referral case and could not be reviewed. All 5 control cases with ODX/biopsy IHC positive were also positive by ER IHC on the resection block. All discordant tumours were grade 3 invasive ductal carcinomas presenting in women aged 30-77 years. 3 patients (25%) were BRCA1 mutation carriers. Regarding adjuvant chemotherapy, 4 patients (33.3%) were treated with ER+ regimens, while 7 patients (58.3%) received triple-negative regimens. Conclusions Discordance between IHC and ODX ER status is rare (1.7%). Most discrepancies were attributable to intratumoural heterogeneity of ER protein expression in biopsies with predominantly ER negative sub-clones in resection samples. Repeat IHC confirmed these resected cases as ER low-positive or negative, in concordance with ODX, confirming a higher-risk subgroup. Our findings as well as data from several breast receptor RT-PCR studies 2,3,4 also support the potential for subtype reclassification initially classified as ER low positive (score 3,4), with low or negative ODX ESR1 gene scores as similar in biological behaviour and chemotherapy response to ER negative tumours. This could help guide personalisation of adjuvant treatment strategies and prompt germline mutation testing. Citation Format: V. Angelis, A. Grobbelaar, A. Zamani, P. Hall, M. Phillips, P. Schmid, K. Hawkesford, M. Ullah, L. Begolli, L. Johnson, S. Ledwidge, M. Thorat, F. Irakleidis, K. Sidlauskas, D. Ryan, M. Warren. Caught in the Middle: Discrepancies Between Immunohistochemistry and Oncotype DX in Hormone Receptor Assessment Leading to Triple Negative Reclassification—Tumour Heterogeneity or Just Low ER Expression? [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-09-14.

Evidence from rheumatology supports a within-class treatment switch for JAK-inhibitors (JAKi), but data in ulcerative colitis (UC) remain limited. We aimed to assess the effectiveness and safety of initiating a second JAKi in patients with UC previously treated with another JAKi. We conducted a multicenter retrospective study, including patients with UC starting a second JAKi after prior JAKi exposure. The primary endpoint was Week 12 steroid-free clinical remission (SFCR-rectal bleeding subscore = 0, stool frequency subscore ≤ 1, and no steroids). We included 243 patients (median follow-up: 38 [21-57] weeks). At Weeks 12, 26, and 52, SFCR was achieved in 116/243 (48%), 120/243 (49%), and 69/243 (28%), respectively. Secondary loss of response to the first JAKi was associated with higher SFCR at Week 12 compared to primary failure (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.11-3.30, P = 0.02). Higher baseline disease activity (OR = 0.68, 95% CI = 0.68-0.55, P < 0.01) and steroid use (OR = 0.23, 95% CI = 0.13-0.42, P < 0.01) had lower odds of Week 12 SFCR. Endoscopic remission occurred in 22/243 (9%) (<Week 26) and 27/243 (11%) (26-78 weeks), and endoscopic improvement in 53/243 (22%) and 45/243 (19%), respectively. Sixty-seven (28%) patients discontinued the second JAKi, mostly due to primary (36/67) or secondary failure (22/67). Sixty-six adverse events (mostly acne and infections) occurred in 56 (23%) patients, without major thromboembolic or cardiovascular events. Treatment with a second JAKi is effective and safe in patients with UC already exposed to JAKi. Primary failure to a first JAKi and steroid use at initiation of the second JAKi might reduce the likelihood of success with the second JAKi.

In the article “Exploring the administrative burden faced by hematologists: a comprehensive study in Italy” (1), which appeared in Volume 11, Issue 1 of Global and Regional Health Technology Assessment, the affiliation 1 for authors Davide Petruzzelli and Silvia Della Torre was incorrect. The correct affiliation is: 1 “La Lampada di Aladino ETS”, Milan - Italy We apologize for any inconvenience caused to the readers by this error, which does not affect the overall results or conclusions of the study.

With the advent of agents targeting distinct inflammatory pathways, therapeutic sequencing after anti-tumor necrosis factor alpha (TNF-α) failure in ulcerative colitis (UC) represents a major challenge. We compared the real-world effectiveness and safety of vedolizumab, ustekinumab, and Janus kinase inhibitors (JAKis) in anti-TNF-α-exposed patients. In this retrospective, multicenter European study, adults with UC initiating second-line vedolizumab, ustekinumab, or a JAKi after anti-TNF-α were evaluated. Baseline confounding was addressed by applying energy balancing weights (EBWs). Effectiveness outcomes included probability of steroid-free clinical remission (SFCR) and biochemical SFCR at 12 months, analyzed using EBW-weighted Royston-Parmar survival models to derive adjusted time-averaged hazard ratios (aHRs). Adverse event (AE) rates were compared using EBW-weighted Poisson regression. A total of 596 patients were included (301 vedolizumab, 149 ustekinumab, 146 JAKi); 54.7% were male, with a mean age of 43.9 ± 15.5 years. Clinical activity, endoscopic scores, and biomarker levels were broadly comparable across treatment groups. Infliximab was the most common prior anti-TNF-α (74.8%), and secondary failure was the predominant discontinuation reason (47.3%). Compared with vedolizumab, both ustekinumab and JAKi showed significantly higher probability of SFCR (aHR, 1.54; 95% confidence interval [CI], 1.09-2.07; and aHR, 1.66; 95% CI, 1.07-2.53, respectively) and biochemical SFCR (aHR, 2.26; 95% CI, 1.48-3.28 and 3.37; 95% CI, 2.01-5.36, respectively) at 12 months, with no differences between them. JAKi recipients experienced an approximately 4-fold higher incidence of AEs, compared with both vedolizumab and ustekinumab, with no differences between ustekinumab and vedolizumab. Ustekinumab and JAKi were more effective than vedolizumab in inducing steroid-free and biochemical remission following anti-TNF-α failure. Safety concerns with JAKi warrant careful patient selection in clinical practice. gov, Number: NCT06691061.

Abstract Background Janus kinase inhibitors (JAKi) are a class of oral therapies indicated for moderate-to-severe ulcerative colitis (UC), with three agents approved and broadly comparable efficacy and safety. Although no clear evidence shows that differences in target affinity influence response, switching to a second JAKi is sometimes attempted after failure or intolerance to the first. The main objective is to assess the effectiveness (defined as treatment persistence) and safety of a second JAKi after failure of the first one Methods This retrospective analysis is part of a 12-month, multicentre, ambispective observational study. We included patients who initiated a second JAKi less than 24 months prior to enrolment, following a first-line JAKi course. Demographics, disease features, and clinical, biochemical, and endoscopic data at baseline and at weeks 8, 26, and 52 were recorded in a REDCap database. Data are presented as frequencies and percentages. Treatment persistence was estimated with Kaplan–Meier survival analysis, and rates are reported both as observed and with non-responder imputation (NRI). Safety events were collected throughout follow-up. Recruitment for both retrospective and prospective phases is ongoing and will end in April 2026; this abstract presents preliminary. Results Data from 69 UC patients are currently available: median age 40 years (IQR 27–52); 30 (43.5%) females. Mean disease duration was 10.8±7.9 years. Disease extent: proctitis 3 (4.3%), left-sided colitis 29 (42.0%), extensive colitis 37 (53.7%). Eight patients (11.6%) were smokers, and 11.6% had other cardiovascular risk factors. Most patients (40, 57.9%) had prior exposure to ≥ 3 biologics or small molecules. Tofacitinib was the most common first JAKi (48, 69.6%) prescribed; among those who switched from tofacitinib, 9 (24.3%) moved to filgotinib and 28 (75.7%) to upadacitinib. Reasons for discontinuing the first JAKi were secondary loss of response in 42 patients (62%), primary non-response in 24 (34%), and intolerance in 3 patients (4%). At baseline, the mean Partial Mayo score was 5.1±2.3, and 20 (29%) were on systemic steroids. At week 26, treatment persistence was 87.0% (47/54) as observed and 68.1% (47/69) with NRI; at week 52 it was 85.1% (40/47) as observed and 58.0% (40/69) with NRI. Six patients experienced adverse drug reactions, none leading to discontinuation Conclusion Our preliminary findings suggest that switching from a first to a subsequent JAKi is effective and safe, including for patients with prior exposure to multiple biologic therapies. Further retrospective and prospective analyses will provide more precise estimates

This paper investigates the application of micro:bit-based S2 robotic set within an extracurricular STEM club at an evening junior high school in Greece. The club aimed to engage students in activities that would foster their connection to the school community while simultaneously enhancing their education in Science, Technology, Engineering, and Mathematics. The members of the club, both adults and minors, used the micro:bit and the kit’s peripheral devices in small projects. At the end of the year, they created puzzles using the micro:bit for an environmental escape room. The methodology involved a qualitative case study, based on observations and student feedback collected throughout the school year. Findings indicate that this specific educational robotic set can be effectively utilized in an evening school setting to increase student motivation and collaboration, improve problem-solving abilities, and enhance the understanding of abstract concepts. Simultaneously, challenges emerged related to students’ limited available time, technological limitations of the set, and the persistent need for specialized teacher training.

Background/Objectives: Upper gastrointestinal Crohn's disease (UGI-CD) is inconsistently defined and often underrecognized, obscuring epidemiology, complicating diagnosis, and delaying tailored care. The absence of a unified, operational definition with segment-specific criteria hinders reproducibility and comparability across studies. Methods: We performed a narrative synthesis of adult and pediatric studies and major guidelines, examining definitions, prevalence, diagnosis, and management. Where possible, findings were mapped to upper GI segments (esophagus, stomach, duodenum, proximal small bowel). Results: Definitions of UGI-CD are heterogeneous. Prevalence varies widely and rises with systematic foregut assessment; isolated upper GI disease without ileocolonic involvement is rare. Diagnosis relies on esophagogastroduodenoscopy with biopsies, complemented by cross-sectional imaging and enteroscopy. Management should extend beyond standard ileocolonoscopy, with segment-tailored monitoring. Anti-TNF agents show the most consistent efficacy in esophagogastroduodenal disease, whereas benefits are attenuated in proximal small bowel involvement. For stricturing disease, endoscopic balloon dilation is suitable for short, non-penetrating strictures but often requires repetition; surgery is preferred for complex anatomy or failed dilation. A short summary of the article's main findings is provided. Conclusions: UGI-CD remains poorly standardized across definition, epidemiology, and management. We propose a pragmatic diagnostic and monitoring pathway and highlight priorities for research: segment-based reporting, inclusion of upper GI-only cohorts, and validation of treatment targets aligned with treat-to-target care-steps essential to improve early recognition and patient outcomes.

Simple SummaryCancer patients are more likely to develop shingles, a painful skin rash caused by the reactivation of the chickenpox virus. This risk increases because cancer and its treatments can weaken the immune system. A new vaccine, called the recombinant zoster vaccine, can effectively prevent shingles and its complications, but vaccination rates among cancer patients remain low. To address this problem, our oncology center introduced an in-house vaccination program that made the vaccine easily available to patients during their routine cancer care visits. This initiative greatly increased vaccination rates and was well accepted by patients. The results show that offering the vaccine directly within oncology services can remove practical barriers, improve patient protection, and serve as a model for other cancer centers aiming to enhance preventive care for their patients.Background: Herpes zoster (HZ) poses significant risks to immunocompromised individuals, particularly cancer patients receiving systemic therapies. The recombinant zoster vaccine (RZV, Shingrix®) provides strong and durable protection against HZ and its complications. Nevertheless, vaccination coverage remains low, mainly due to limited awareness among patients and healthcare providers and logistical barriers to vaccine access and delivery. Materials and Methods: We conducted a single-center quality improvement (QI) project to enhance RZV uptake among oncology outpatients receiving systemic therapy. Following the Plan–Do–Study–Act (PDSA) model, baseline HZ vaccination coverage was assessed, and an in-house vaccination campaign was implemented. Vaccination rates were monitored every two months over a 14-month period. Results: At baseline, only 5.4% (24/446) of patients had received RZV. After 14 months, 365 patients were evaluated for vaccination: 200 (55%) were vaccinated, 134 (37%) were ineligible, and 31 (8%) refused RZV. The overall vaccination rate increased from 5.4% to 44%. Reported adverse events were mild and primarily local reactions, confirming the vaccine’s favorable safety profile in this population. Conclusions: This real-world QI initiative demonstrates that an in-house vaccination strategy embedded within oncology services can substantially improve RZV coverage and patient engagement. The approach highlights the key role of oncology teams in leading preventive interventions for immunocompromised patients. By integrating vaccination into routine cancer care, institutions can overcome traditional organizational barriers and align with current ASCO and ESMO recommendations for comprehensive patient protection.

This article describes a clinical protocol utilizing soft tissue augmentation alone or in combination with guided bone regeneration (GBR), introducing simultaneous application of the one abutment one time concept for three-dimensional reconstruction of the deficient ridge. Soft and hard tissue quality and dimensions are fundamental elements for long lasting results in implant dentistry. Different techniques have been described for soft and hard tissue augmentation at time of implant placement presenting favorable results. However, multiple abutment disconnections during the prosthetic phase of treatment can compromise the results achieved during surgery. The purpose of this article is to present a surgical protocol that allows three-dimensional ridge reconstruction involving soft tissue augmentation alone, or in combination with hard tissue augmentation in one single step with the use of an one-time intermediate abutment as an anchorage device for the regenerative materials. Two clinical cases utilizing the proposed protocol are also presented, demonstrating favorable results. The application of the proposed protocol simplifies the surgical phase of treatment, protects the achieved result and enables a favorable outcome in decreased time. Utilising an intermediate abutment as an anchorage device at time of surgery can be proven an easy to apply and biologically favorable alternative way to other methods of soft tissue graft stabilization proposed in the past.