Regional Cancer Center

A 41-year-old female presented to our service, referred by the oncology department for evaluation of multiple nodules in the right breast. Upon questioning, the patient reported that she had sought consultation for multiple dermal lesions present for approximately 20 years in the right areolar region. However, upon examination, the physician noted palpable breast nodules and requested imaging studies for better characterization. An excisional biopsy of one of the breast nodules was subsequently performed for histopathological analysis. Because the patient's primary concern was the longstanding dermal lesions, one of these was also excised and submitted for histopathological evaluation. The breast nodule was diagnosed as fibrocystic mastopathy, while the dermal lesion was identified as a keloid scar. Comprehensive multimodality breast imaging, including mammography, ultrasound, and contrast-enhanced MRI, is essential for accurate characterization of palpable nodules, particularly when clinical findings and patient-reported symptoms are discordant. Radiologic-pathologic correlation is especially critical in the presence of multiple lesions of differing tissue origins to ensure accurate diagnosis and appropriate management of both dermal and breast parenchymal conditions.

ObjectivesThis study aimed to identify clinical and socioeconomic factors associated with treatment selection and survival in patients diagnosed with synchronous metastatic renal cell carcinoma (mRCC).Patients and MethodsThe Renal Cell Cancer Database Sweden (RCCBaSe2.0), linking the National Swedish Kidney Cancer Register with other national quality registers, was used to identify all patients with synchronous mRCC diagnosed 1 January 2014–1 July 2019 (n = 951); thus, it was performed during the tyrosine kinase inhibitor era. Logistic and Cox regression were used to evaluate associations with treatment selection, overall survival (OS) and cancer‐specific survival (CSS).ResultsUpfront cytoreductive nephrectomy (uCN) was the primary treatment in 56% of patients and was associated with larger primaries and treatment at university hospitals. Immediate systemic treatment (IST) was chosen in 32% and associated with multidisciplinary team (MDT) discussions, cN1 disease, more metastatic sites and higher comorbidity index. Gender, income, education level or marital status were not associated with upfront treatment. Patients selected for uCN had longer OS and CSS compared with those allocated to IST. This association remained when adjusting for selection factors. Socioeconomic factors were not linked to survival. Limitations include the retrospective design and the lack of detailed data on the International mRCC Database Consortium risk factors.ConclusionTumour‐related factors had significant effects on the choice to perform uCN or not. Patients with more advanced disease, higher comorbidity index and those discussed at MDT were more likely to be offered immediate systemic treatment. Socioeconomic status did not affect treatment allocation or survival, indicating equal healthcare access for Swedish mRCC patients.

WHO melaporkan catatan historis lebih dari 14,6 juta kasus dengue dan lebih dari 12.000 kematian secara global. Sementara keterlibatan neurologis dalam dengue sebelumnya dianggap sebagai kejadian langka, keterlibatan SSP terjadi pada 0,5% hingga 21,2% infeksi virus dengue, mulai dari ensefalopati dan ensefalitis hingga meningitis yang jarang dilaporkan. Tantangan dalam diagnosis semakin diperparah oleh fakta bahwa meningitis dengue sering muncul sebagai penyakit oligosimtomatik. Studi ini menekankan nilai pemahaman, diagnosis, dan pengelolaan DBD yang rumit oleh meningitis pada bayi berusia 5 bulan dengan keluhan demam disertai kejang dalam 5 hari terakhir. Imunisasi dasarnya tampaknya masih tertinggal dimana imunisasi terakhir adalah pada usia 2 bulan. Pasien tampak sakit sedang dengan kesadaran kompos mentis. Tanda-tanda vital takikardia (nadi 168x/menit). Pemeriksaan leher menunjukkan leher kaku. Kami melakukan beberapa pemeriksaan, seperti laboratorium darah, tes serologi imunoglobulin dengue, fungsi ginjal, elektrolit, kalsium, CT scan kepala dengan kontras, tes Mantoux, dan rontgen dada. Pasien didiagnosis meningitis ec DBD. Pasien dirawat bersama dokter anak dan ahli saraf selama 8 hari dan diperbolehkan pulang karena kondisinya membaik.

Abstract The current rise in early-onset colorectal cancer (EOCRC) has been attributed to a Westernized lifestyle, but a definitive lifestyle factor or genetic etiology has yet to be discovered. Still, genetic studies do show that APC mutations are initiating events in both EOCRC and later-onset CRC (LOCRC). So, a key question is why do somatic APC mutations occur at a relatively young age in EOCRC patients? Hence, we surmise that something is retarding tissue renewal in colonic crypts so that somatic mutations are retained instead of being extruded during tissue turnover. Thus, we conjecture that EOCRC involves an essential nutrient required for tissue renewal. Accordingly, we investigated vitamin A (retinol, retinoic acid), which is an essential vitamin requiring adequate dietary intake. Indeed, vitamin A is essential for tissue homeostasis because germline mutations in retinoid receptors and vitamin A deficiency during pregnancy can lead to fetal malformations. Moreover, population-based studies report vitamin A deficiency in pre-school-aged children. Consequently, young-aged individuals might be prone to cancer-initiating effects of vitamin A deficient diets. Our Goal is to determine how aberrant retinoid receptor expression might promote EOCRC development through dysregulated retinoic acid signaling. Rationale: Our previous studies show that retinoic acid (RA) signaling pathway plays an essential role in regulating cell differentiation in the colon. Moreover, we reported that CRC cells harboring mutations in RA receptors (RAR, RXR) have drug resistance to all-trans RA (ATRA). So, mutation or aberrant expression of RA receptors could lead to incomplete differentiation and promote CRC initiation. Hypothesis: Aberrant RA receptor expression leads to dysregulated RA signaling that contributes to EOCRC development. Results: Our bioinformatics analyses show that retinoid receptors are often abnormally expressed and mutated in human CRCs. We found that up to 22% of CRCs have RA receptor mutations, but mutation status did not predict patient survival. However, we did find that frequency of retinoid receptor mutation was higher (>2X-fold) in EOCRC (age < 45) compared to LOCRC. Specifically, a high frequency of somatic mutations (2x-fold) occurred in receptors for vitamin A (STRA6) and retinoic acid (RARG, PPARG) in EOCRCs. We also found RARG hypermethylation occurs frequently in EOCRCs (p<0.05). Conclusions Since the rate of retinoid receptor alteration was increased in EOCRCs, aberrant RA signaling may be a predisposing factor for early CRC development and contribute to the etiology of EOCRCs. Based on this view, reduced retinoid signaling could lead to incomplete differentiation which provides a mechanism that may explain how delayed tissue renewal causes retention of acquired APC mutations in colonic epithelium: Thus, we put forth the idea that aberrant vitamin A (retinol) metabolism and APC mutation-induced activation of WNT signaling are co-factors in promoting EOCRC. Citation Format: Bruce Boman, Brian Osmond, Anh Nguyen, Chi Zhang. Colonic Tissue Renewal, Retinoic Acid Signaling, Early-onset CRC [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: The Rise in Early-Onset Cancers—Knowledge Gaps and Research Opportunities; 2025 Dec 10-13; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(23_Suppl):Abstract nr C004.

BackgroundFew studies have explored the impact that children—and grandchildren—have on treatment decisions in metastatic breast cancer (mBC). This study examined whether or not being a parent or grandparent influences treatment decisions.MethodsA qualitative sub-analysis was conducted with a purposive, diverse sample of 13 women with mBC in the Southeastern United States. Semi-structured interviews explored treatment decision-making, patient values, and patient-clinician communication. Transcribed interviews were analyzed using thematic analysis by three independent coders to identify recurrent themes.ResultsNearly half (n = 6, 46%) of participants were women of color, and 12 had children. Seven themes emerged as key factors in treatment decision-making, with five participants identifying children and grandchildren as critical. Other common factors included side effects (n = 7, 54%) and quality of life (n = 6, 46%). Among participants with children and grandchildren, body image emerged as a subtheme. For those prioritizing quality of life and managing side effects, children provided emotional support and assistance with daily activities.ConclusionsChildren and grandchildren significantly influenced treatment decisions, rivaling quality of life and side effects as critical factors. This influence varied by life stage, with younger mothers prioritizing treatment efficacy and older women valuing quality of life and emotional support. Our results demonstrate that continuous shared decision-making is crucial as treatment preferences evolve and are influenced by familial roles and disease progression.ImplicationsFuture tools should include an assessment that integrates family and children. This approach can better support survivors in aligning treatment with their values and familial priorities.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12885-025-14953-9.

Patient education is crucial for supporting individuals Living with or at risk of cancer. It empowers them with the knowledge necessary to navigate their diagnosis and treatment plan, improve health and digital health Literacy, and facilitate meaningful care engagement. There is a lack of current evidence on the most effective teaching strategies and methods for supporting individuals living with or at risk of developing cancer. As such, this systematic review aims to explore effective cancer patient education strategies and methods in terms of knowledge, physical and psychological well-being, satisfaction, experience, and self-efficacy. We searched MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, PsycINFO, CINAHL, Prospero, and Epistemonikos.org for Guidelines, systematic reviews, and meta-analyses published between January 2018 and June 2024, capturing the key concepts of teaching strategies or delivery methods for cancer patient education. Of the 3762 articles screened, 27 met the inclusion criteria. Study findings showed that one-on-one and group teaching strategies are effective in terms of improving psychological well-being, reducing anxiety, and enhancing cancer-related knowledge. The combination of these strategies in a multi-modality teaching strategy is effective in addressing diverse needs of learners and enhancing outcomes. Teaching materials and methods, including tailored written materials, verbal discussion, audio-visual materials, and technology-based tools (e.g., eLearning platforms), are effective strategies in different contexts, with certain aspects that should be carefully considered. By considering these various teaching strategies and the context in which they are most effective, learners can be better empowered to make informed decisions regarding their health and care.

Abstract Despite the approval of multiple CAR T-cell products, access to this therapy remains limited in many developing countries. We conducted a single-arm, open-label, non-randomized, parallel phase 1/2 clinical trial ( ClinicalTrials.gov identifier: NCT05333302 ) at two independent centers: the Vitebsk Regional Clinical Cancer Centre (VRCCC) and the Belarusian Research Center for Pediatric Oncology, Hematology, and Immunology (BRC POHI). The study enrolled patients with relapsed or refractory B-cell malignancies who received an in-house manufactured CD19 CAR T-cell product (BY19) following lymphodepletion with either fludarabine plus cyclophosphamide or cyclophosphamide plus fludarabine and decitabine. Seven patients at VRCCC and sixteen at BRC POHI received CD19 CAR T-cell therapy, comprising 17 patients with B-ALL, one with chronic lymphocytic leukemia (CLL), and five with non-Hodgkin lymphoma. The median age was 45 years (range: 38–56) at VRCCC and 13.5 years (range: 4–30) at BRC POHI. Cytokine release syndrome (CRS) occurred in 18 (67%) of the 27 infusions across both centers, predominantly mild cases. Immune effector cell-associated neurotoxicity syndrome (ICANS) was observed in 12 (44%) patients, with severe ICANS (grade ≥3) in 5 patients (18.5%). The overall response rate (ORR) was 80.0% (16/20), with a complete response (CR) rate of 75.0% (15/20) at the first assessment on day 28. The median progression-free survival (PFS) was 23 months, and the median overall survival (OS) was 55 months. At 12 months, PFS was 83.3% for non-Hodgkin lymphoma patients and 48.3% for B-ALL patients. Higher Cmax levels tended to correlate with better response rates; however, no clear advantage in PFS was observed. In conclusion, our in-house manufactured CD19 CAR T-cell product (BY19) demonstrates a safety and efficacy profile comparable to approved CD19 CAR T-cell therapies. This study underscores the translational potential of localized CAR T-cell manufacturing to expand global access to advanced immunotherapies, especially in middle-income countries. Additionally, incorporating decitabine into the lymphodepletion regimen shows promise in enhancing therapeutic efficacy and warrants further prospective investigation.

BackgroundTo compare doses deposited to the liver during right breast radiotherapy with static and dynamic radiotherapy techniques. The second aim was to introduce the liver load index (LLI), a novel index developed to estimate radiation exposure to the liver prior to treatment selection.Materials and methodsWe prepared radiotherapy treatment plans for ten patients with right breast cancer. Plans were created for conventional 3D conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT) with and without dose optimisation to liver, and hybrid 3D-CRT/volumetric modulated arc therapy (VMAT). Dosimetric evaluation was based on dose-volume histogram (DVH) parameters. The Wilcoxon test was used to assess differences between treatment plans. Spearman’s rank correlation was used to determine the correlation between the LLI and the radiation dose to the liver.ResultIMRT plans resulted in significantly higher Dmean (p = 0.0051), V5Gy (p = 0.0051), and V10Gy (p = 0.0051) liver values than 3D-CRT. Compared to non-optimised IMRT [liver not included as an organ at risk (OAR)], liver parameters: V5Gy, V10Gy, V20Gy (p = 0.0051) andV30Gy (p = 0.0152) were significantly lower when the IMRT plan was optimised (IMRTopt), with no increase in doses to other OAR. Compared to standard 3D-CRT, hybrid 3D-CRT/VMAT significantly reduced the V30Gy (p = 0.0209), V40Gy (p = 0.0077). The LLI was significantly correlated with liver Dmean for 3D-CRT (rS = 0.8909, p = 0.0005) and IMRT (rS = 0.8303, p = 0.0029), and also with liver D200 for 3D-CRT (rS = 0.8024, p = 0.0052) and IMRT (rS = 0.8545, p = 0.0016).ConclusionThe LLI provides an accurate estimation of liver exposure to radiation during right breast radiotherapy. This index, which is calculated prior to treatment planning, is highly accurate, as evidenced by the strong correlation between the LLI and the mean liver dose.

Colorectal cancer (CCR) is one of the leading causes of death worldwide. Early detection remains a highly effective strategy for curing this disease. In France, despite a free organised screening programme for people aged between 50 and 74, participation rates remain suboptimal. Socioeconomic position and health literacy levels exacerbate the situation, with the lowest screening rates observed in the most socially disadvantaged areas. This study assessed patients' and General Practitioners' (GP) views on the acceptability of an intervention to increase screening uptake using a simple brochure and video on the importance and process of CCR screening. We conducted a cross-sectional qualitative study using semi-structured interviews with patients (n = 24) and GPs (n = 22) who used or participated in the DECODE project intervention. The interviews were conducted by telephone or videoconference and analysed thematically using Nvivo software and dual independent coding. 95% of GPs expressed a clear preference for the video over the brochure. Patients had varied results with 50% preferring the video, as it demonstrated how to do the test, versus the brochure. The humorous and de-dramatising aspects of the video were the two key factors highlighted by interviewees. However, support from healthcare staff (GPs, nurses, etc.) is still essential, in supporting patients in prevention. This presents a challenge for GPs, who are frequently constrained by time limitations during consultations. Our findings emphasize the need to tailor promotional materials for both patients and healthcare professionals to improve CCR screening uptake, balancing digital efficiency with maintaining core human relationships in healthcare. Such intervention can be integrated into different workflows. The addition of video into national CRC screening programs might also help. Targeting CRC screening interventions at provider-patient interactions, ensuring they are tailored, accessible, and engaging, is key to reducing disparities.