Maastro Clinic

ObjectivesTo explore how former breast cancer patients (BCPs) experience the daily-life impact of radiotherapy (RT) side effects and to examine how these narratives can inform the selection of patient stories for the BRASA patient decision aid (BRASA-PtDA).MethodsSemi-structured interviews were conducted with fourteen former BCPs who completed adjuvant RT 6 months–5 years earlier. Thematic analysis identified locoregional, general, and overarching impacts on quality of life (QoL). Narrative excerpts were classified by type, purpose, and evaluative valence.ResultsParticipants described locoregional side effects (pain, reduced arm function, changes in breast appearance, skin irritation) and general effects (fatigue, concentration difficulties) affecting daily activities and self-perception. Three overarching themes—comparisons to the pre-treatment self, acceptance, and work—captured broader QoL impacts. All narratives were experiential or outcome-focused, mostly negative in valence. Thirteen balanced narratives were selected for potential inclusion in the BRASA-PtDA.ConclusionsNarratives from BCPs illustrate how RT side effects shape daily life and overall QoL. Structured narrative classification provided a transparent method for selecting stories for a decision aid. Future research should examine how different narrative types influence patient engagement and decision outcomes.InnovationTo our knowledge, this is the first qualitative study to examine how BCPs live with RT side effects, highlighting impacts on daily life that are under-communicated in current practice in the Netherlands and internationally. Findings provide rich insights for improving risk communication and shared decision making by moving beyond symptom-focused information to incorporate patients' lived experiences.

BackgroundPancreatic cancer treatment significantly impacts patients’ quality of life, making both safety and patient preference key considerations. Central venous access devices (CVADs) are indispensable for chemotherapy administration in pancreatic cancer, yet device selection varies widely. This study explored which CVADs oncology specialists use in pancreatic cancer care, focusing on the basis for their recommendations.Materials and methodsA nationwide expert survey was distributed among Dutch medical oncologists and nurse specialists involved in pancreatic cancer care via the Dutch Pancreatic Cancer Group, the Dutch Association for Medical Oncology, the Dutch association for nurses, and the study committee’s network.ResultsNinety-one clinicians responded. Most (88%) had access to both port-a-caths (PORTs) and peripherally inserted central catheters (PICCs), while 12% could only offer one device. Decision-making autonomy varied: 53% reported full autonomy, while others followed hospital-wide preferences (39%) or guidelines (9%). Even within these subgroups, preferred CVAD varied greatly. Although 60% listed patient preference among the top five influential factors, only 28% incorporated patients in that decision. Logistical constraints were key barriers influencing device choice.ConclusionSubstantial variability exists in CVAD selection, availability, and clinician autonomy in pancreatic cancer care. While evidence supports PORTs as the safer option, PICCs remain widely used in daily practice. This discrepancy appears driven by disease-specific and logistical factors, including poor prognosis and uncertainty regarding treatment tolerance. Addressing real-world barriers through improved access to PORTs, clearer guideline recommendations, and enhanced patient counseling may help align clinical practice with evidence and ensure high-quality care for patients receiving chemotherapy.

Hepatocellular carcinoma (HCC) ranks as the fourth leading cause of cancer-related mortality worldwide and poses a substantial challenge in the field of oncology. The majority of patients are diagnosed at advanced stages of the disease, where systemic therapies remain the primary treatment modality. These interventions, however, are frequently constrained by limited efficacy and considerable adverse effects, highlighting the pressing need for more precise and effective therapeutic strategies. Emerging evidence has identified cholesterol as a critical factor in HCC pathogenesis, influencing key processes such as tumor initiation, cellular proliferation, immune dysregulation, and metastatic progression. Moreover, disruptions in cholesterol metabolism have been increasingly implicated in resistance to systemic treatments. This review provides a concise overview of therapeutic approaches targeting cholesterol in HCC and examines the influence of cholesterol metabolism on the efficacy of systemic therapies, particularly those currently considered standard of care. Finally, we discuss existing challenges and propose future directions for integrating cholesterol-lowering strategies to enhance treatment outcomes in patients with HCC.

The novel hypoxia-activated prodrug CP-506 selectively targets the hypoxic, treatment-resistant tumor microenvironment. Given the alkylating effector metabolites of CP-506, we hypothesized that defects in interstrand crosslink (ICL) and double-strand break repair influence treatment efficacy. In vitro and in vivo isogenic cancer models proficient or deficient in the Fanconi anemia (FA), homologous recombination (HR), or non-homologous end joining (NHEJ) pathway were used to assess CP-506-induced cytotoxicity and DNA damage. Viability and clonogenic assays demonstrated enhanced sensitivity to CP-506 in FA- or HR-deficient cells compared to parental cells, which was confirmed by spheroid growth inhibition studies. In vivo, CP-506 caused greater enhancement ratios in FA- and HR-deficient xenografts versus parental controls (p < 0.0001) but not in NHEJ-deficient xenografts (p = 0.18). Mechanistically, CP-506 increased γH2AX expression (1.9- to 9.3-fold) in FA- and HR-deficient cells and xenografts, whereas NHEJ-deficient models showed a 0.5-fold reduction. Alkaline comet assays confirmed CP-506-induced ICLs and DNA strand breaks but did not explain the differential therapeutic responses among isogenic cancer cells. These data indicate that deficiencies within FA or HR, but not NHEJ or nucleotide excision repair (NER), determine CP-506 sensitivity, consistent with a synthetic-lethal interaction. Therefore, tumor hypoxia and DNA repair status are key biomarkers for stratifying patients in CP-506 clinical trials.

ObjectivesDeep learning neural network (DLNN)-based tools can automate body composition analysis for cancer cachexia research. We aimed to evaluate a DLNN tool trained on a European population of Chinese cancer patients.MethodsComputed tomography (CT) images at the 3rd lumbar vertebral (L3) level of Chinese gastric cancer patients were retrospectively collected. An externally validated DLNN tool (Mosamatic) was used to segment skeletal muscle, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). Manual segmentation was performed using SliceOmatic software (TomoVision, version 5.0). Geometric similarity between automated and manual segmentation, and the reliability was assessed.ResultsThe cohort comprised 203 patients with a median body mass index (BMI) of 22.2 kg/m2, and 604 CT images at L3 were collected. The median Dice Similarity Coefficient (IQR) of skeletal muscle, VAT and SAT were 0.973 (0.961-0.980), 0.980 (0.964-0.989), and 0.967 (0.945-0.977), respectively. The median Lin’s Concordance Correlation Coefficient for skeletal muscle area (0.983), VAT area (1.000), SAT area (0.998), skeletal muscle radiation attenuation (0.995), VAT radiation attenuation (0.994), and SAT radiation attenuation (0.997) demonstrated excellent reliability. Low BMI (<18.5 kg/m2) and ascites impaired the agreement between the 2 methods. The automated method showed high diagnostic concordance with manual segmentation for sarcopenia (κ = 0.843, P < .001) and myosteatosis (κ = 0.946, P < .001).ConclusionsThe Mosamatic tool displays excellent generalizability to analyse body compositions in Chinese gastric cancer patients and can facilitate cachexia research.Advances in knowledgeThe Mosamatic tool displayed excellent generalizability without recalibration to analyse body composition on the 3rd lumbar vertebral CT images in Chinese gastric cancer patients.