Sociedade Brasileira de Oncologia Clínica

To systematically review and analyze the effects of photobiomodulation on oral mucositis, xerostomia, salivary flow rates, oral pain, and quality of life in patients with head and neck cancer. A systematic search of six databases was conducted up to April 2025. Eligible randomized controlled trials (RCTs) examined the effects of photobiomodulation on the specified outcomes in patients with head and neck cancer. Pooled estimates (risk ratio [RR] and standardized mean difference [SMD]) were calculated using a three-level mixed-effects meta-analysis. Thirty-three articles describing 30 RCTs (n = 1748) were included. Photobiomodulation significantly reduced the risk of severe oral mucositis (RR 0.46, 95% CI: 0.29-0.71, P < 0.001) and severe oral pain (RR 0.35, 95% CI: 0.23-0.53, P < 0.001) compared with controls. Significant improvements were also observed for salivary flow rate (SMD 0.75, 95% CI: 0.03-1.46, P = 0.044). No significant effects were observed on xerostomia (SMD -0.07, 95% CI: -0.47-0.33, P = 0.646) and quality of life (SMD 1.06, 95% CI: -0.03-2.14, P = 0.060). The benefits were consistent across different photobiomodulation protocols for oral mucositis and quality of life. Photobiomodulation appears to be a promising supportive care intervention, reducing the risk of severe mucositis and oral pain, while potentially improving salivary flow rates and preserving quality of life in patients with head and neck cancer. However, the certainty of the evidence ranged from very low to low and most included studies presented a high risk of bias; therefore, these findings should be interpreted with caution.

The purpose of this article is to present the Brazilian Physical Activity (PA) During Cancer Treatment Guidelines(PA) during cancer treatment, and discuss the adaptations made to align the recommendations with the Brazilian context and its distinctive peculiarities. The development of Brazilian Guidelines for recommending PA during cancer treatment consisted of identifying international guidelines and positions and adapting their recommendations and statements for the Brazilian context. For this, an expert working group including scientists, exercise specialists, and oncologists revised the international guidelines, selected outcomes, and created recommendations based on PA safety and efficacy on the selected adverse effects of cancer treatment and the regional context. After review of 14 PA oncology guidelines, two were selected. Drawing from the selected guidelines, the working group formulated the recommendations considering the scientific evidence extracted from the documents and the Brazilian contextualization. Although the guidelines were based on international recommendations, the expert working group introduced adaptations to better reflect the Brazilian context. These adaptations included translating the content into Portuguese and simplifying the language to improve accessibility for healthcare professionals. Safety information and contraindications were added, and recommendations were adjusted not only in terms of intensity, mode, and frequency but also to promote accessibility, motivation, and long-term adherence. Additionally, the guidelines took into consideration professional regulations, access to qualified staff, the structure of the health system, and regional sociocultural and economic disparities, particularly in underserved and rural areas. There is a clear need for context-specific exercise oncology research and policies that reflect the low and middle-income countries’ social, economic, and cultural characteristics. This Brazilian guideline represents a first and essential step toward aligning Brazil with the international agenda for establishing PA standards in oncology.

Abstract Introduction Vestibular migraine is a major cause of recurrent vertigo, yet its mechanisms and diagnostic markers remain limited. Abnormal vestibular–cervical integration and convergence insufficiency, reflected by impaired near point convergence (NPC),suggest multisensory dysfunction. This study tested whether cervical proprioceptive perturbation provokes vertigo and nystagmus in vestibular migraine and evaluated NPC as a predictor of these responses. Methods Fifty-one vestibular migraine patients and 12 controls underwent interictal vestibular testing. Peripheral function was assessed with vHIT. Participants received randomized 100-Hz cervical (proprioceptive) and mastoid (vestibular) vibration without visual fixation, with eye movements recorded via video Frenzel goggles and NPC measured using standard methods. Analyses included McNemar’s, Wilcoxon signed-rank, Mann–Whitney U, correlations, and multivariable logistic regression. Results Neck vibration provoked vertigo in all vestibular migraine patients and none of the controls, producing nystagmus in 76.5%. Horizontal, ipsiversive nystagmus predominated, while less frequent vertical responses showed higher velocities. Mastoid vibration elicited no nystagmus. NPC was the only independent predictor of nystagmus and correlated with slow-phase velocity and bilateral responses. Age correlated with drift velocity, whereas vestibulo-ocular reflex gain showed no association. Discussion Neck vibration elicits vertigo and nystagmus in vestibular migraine, providing the first objective physiological marker. NPC predicts and correlates with nystagmus severity, highlighting its value as a surrogate of multisensory dysfunction. Together, these findings implicate abnormal cervical–vestibular integration and position NPC and neck-vibration testing as practical tools for diagnosis and phenotyping. Key points Vestibular migraine affects ∼3% of population yet remains highly controversial. Objective measures reveal reproducible vertigo and nystagmus in vestibular migraine. Impaired convergence strongly predicts vibration-induced nystagmus in VM patients. Findings support sensory mismatch model linking cervical proprioception to vertigo.

Abstract Background: Neoadjuvant chemotherapy (NAC) may alter tumor biology, leading to immunohistochemical (IHC) subtype conversions between diagnosis and residual disease. The prognostic impact of such changes remains unclear. This systematic review and meta-analysis evaluated the effect of NAC-induced IHC subtype conversion on overall survival (OS) and disease-free survival (DFS) in patients with residual disease (non-pCR). Methods: This study was registered in PROSPERO (CRD42024558811). PubMed, EMBASE, and Cochrane Library were searched through 2025 for studies reporting IHC subtype conversions after NAC and associated survival outcomes in non-pCR patients. Eligible studies included randomized trials and observational cohorts of adult women with primary breast cancer. Two reviewers independently selected studies and extracted data. Risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane tool. Pooled risk ratios (RRs) were calculated using random-effects models. Heterogeneity was quantified with I2, and publication bias was assessed by Egger’s test. Results: Twenty-five retrospective studies (n=5,263 non-pCR patients) were included. Mean patient age ranged from 46-54 years, and tumors were predominantly T2-T3. IHC subtype conversion occurred in 20% [95% CI: 0.17-0.24], with high heterogeneity (I2=89.8%). Common conversions included luminal-to-TNBC (35%), luminal-to-HER2+ (25%), HER2+-to-luminal (20%), and TNBC-to-luminal (20%).Patients without subtype conversion had significantly better OS (RR=1.13 [95% CI: 1.01-1.26], p=0.03; I2=62%). Luminal tumors showed the greatest OS benefit without conversion (RR=1.19 [1.01-1.41], p=0.04), while HER2+ (RR=1.11 [0.95-1.31], p=0.19) and TNBC (RR=0.98 [0.84-1.16], p=0.85) showed no significant OS impact. DFS was not significantly affected by conversion overall (RR=0.95 [0.80-1.14], p=0.58; I2=79%). Sensitivity analysis confirmed OS findings. Egger’s test revealed no publication bias for OS (p=0.33) but suggested bias for luminal DFS (p=0.044). Conclusion: IHC subtype conversion after NAC occurs in 1 in 5 patients with residual disease and is associated with worse OS—particularly in luminal breast cancer. Routine post-NAC IHC reassessment should be considered to improve prognostication and guide adjuvant treatment. Prospective studies with standardized reporting are needed to validate these findings and refine treatment algorithms. Citation Format: M. Antonini, A. Mattar, F. P. Cavalcante, F. Zerwes, E. C. Millen, F. P. Brenelli, L. A. Frasson, L. X. Félix, J. C. Vieira, R. C. Campos, M. Teixeira, M. Figueiredo, M. Madeira, H. C. Lima, G. Facina, R. Arakelian, A. D. Lima, L. R. Soares, R. J. Freitas, G. N. Garcia, F. Bagnoli, G. T. Tosello, L. H. Gebrim. Immunohistochemical Subtype Conversion After Neoadjuvant Chemotherapy and Its Impact on Breast Cancer Survival: A Systematic Review and Meta-analysis [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 PD2-01.

Primary anterior cruciate ligament (ACL) repair has reemerged as an alternative in selected cases thanks to advances in arthroscopic techniques and the development of modern fixation devices. The present paper describes the arthroscopic ACL repair technique with femoral fixation using an adjustable EndoButton (Smith & Nephew) combined with dynamic reinforcement using a high-strength suture. This technique is primarily indicated for acute proximal ruptures (Sherman et al. types I and II), which present a good ligament remnant and healing potential. The procedure aims to preserve the original anatomy and proprioception, reduce the morbidity associated with graft harvesting, and maintain future reconstruction options. The technique involves suturing the ligament stump, using adjustable femoral fixation, and applying internal bracing to provide additional biomechanical stability. The proposed postoperative protocol, based on the rationale of stability, prioritizes early mobilization, progressive weight-bearing, and structured rehabilitation. This approach represents a promising alternative for carefully-selected patients, especially young athletes and skeletally-immature subjects, provided the indications and limitations of the technique are respected. Long-term studies are needed to consolidate the clinical efficacy of this technique.

54 Background: There are limited data on the impact of TNT on complete response (CR) rates for LARC treated in community settings. Methods: A retrospective cohort study was conducted at two health centers, from January 2019 to August 2023. All consecutive patients with LARC staged cT3-cT4 and/or lymph node- positive (AJCC 8th Edition) who received at least one application of neoadjuvant therapy (NAT)—radiotherapy and/or chemotherapy—were included. The primary outcome was the overall CR rate, stratified by NAT: TNT versus Non-TNT. CR was defined as cases achieving pathological complete response (ypCR) or sustained complete clinical response (cCR) after 12 months for patients undergoing a watchful waiting protocol. Secondary endpoints were ypCR rates and clinical/ hematological toxicities (CTCAE version 5.0) stratified by NAT. Results: Overall, 137 patients were included, with 60 (43.8%) receiving TNT and 77 (56.2%) receiving Non- TNT. The median age was 58.9 years [standard deviation (SD): ±11.2] for the TNT group and 59.0 years (SD: ±11.0) for the Non-TNT group. Initial staging for the TNT and Non-TNT groups was as follows: cT3 (61.6% and 67.5%), cT4 (18.3% and 16.8%), and positive lymph nodes (68.3% and 66.2%), respectively. The median distance from the anal verge was 5.5 cm [Interquartile range (IQR): 5–9.5] for TNT and 6.0 cm (IQR: 5–10) for Non-TNT. The overall CR rates for the TNT and Non-TNT groups were 28.3% (17/60) and 11.6% (9/77), respectively [Odds ratio (OR) = 2.98; 95% CI: 1.24–7.17]. The ypCR rates were 20.0% (12/60) for TNT and 7.8% (6/77) for Non- TNT (OR = 2.96; 95% CI: 1.07–8.14). Grade ≥3 clinical toxicities during NAT occurred in 5.0% (3/60) of the TNT group and 6.4% (5/77) of the Non-TNT group (OR = 0.76; 95% CI: 0.19–3.01). Grade ≥3 hematological toxicities during NAT occurred in 3.3% (2/60) of the TNT group and 5.2% (4/77) of the Non-TNT group (OR = 0.62; 95% CI: 0.11–3.49). Conclusions: The data suggest a higher CR rate in the TNT group compared to the Non-TNT group among patients with LARC treated in community settings.

Managing G2 endometrioid endometrial adenocarcinoma without progesterone receptor (PR) expression presents significant challenges, particularly when considering fertility preservation. Grade 2 tumors fall into an area of uncertainty within fertility-sparing strategies, making treatment decisions complex and requiring careful individualization. This case report describes a 41-year-old patient who, despite PR and PE negativity, responded to conservative management with hysteroscopic resection, a levonorgestrel-releasing intrauterine device, metformin, and later megestrol, achieving complete histological remission in 15 months. The difficulty in managing G2 tumors lies in their variable behavior, necessitating a multidisciplinary approach, strict monitoring, and adaptability based on treatment response. This case underscores that, although fertility preservation in PR-negative G2 tumors remains challenging, it is feasible in highly selected cases. The evolving literature suggests that alternative strategies, such as immune modulation and aromatase inhibitors, may further expand options. Individualized management remains crucial, balancing oncological safety with reproductive goals through continuous reassessment and engagement with emerging therapeutic evidence.

This study aims to assess the rate of histopathologic diagnostic discordances between the local reviewer in each country of the Sarcoma European and Latin-American Network (SELNET) consortium and expert soft tissue and bone pathologists present in the SELNET network and to evaluate the causes of discrepancies. Histologic diagnosis at the local center of each country from the SELNET consortium and its relative agreement with the revised diagnosis of expert pathologists from the SELNET pathologist network were evaluated in 347 cases of bone or soft tissue tumors over 3 years. Diagnostic concordance was observed in 296 cases (85.3% with a Cohen's κ = 0.84, P < .001), whereas in the remaining 51 cases (14.7%), diagnostic discordance was observed. In 19 of 51 cases, the discordance was considered major because it was related to a significant change in clinical management. Minor histologic discordances were observed in the remaining 32 cases. The most frequent reason for diagnostic discordances was incorrect morphologic interpretation and/or the unavailability of key diagnostic immunohistochemical markers (41.2%), or the unavailability of molecular testing to confirm morphologic and immunohistochemical data (21.6%). Incorrect interpretations of morphologic features alone occurred in 37.2% of cases. A diagnostic agreement of 85.3% was obtained between the original diagnosis in each country of the SELNET consortium and the expert pathologist of the network. Morphologic assessment of tumors, the use of newer immunohistochemical markers, and molecular analysis on a limited number of cases were found to be useful in correcting discrepancies.

Background & objectives Genetic instability is frequent in tumour cells and might occur due to an imbalance of homologous recombination (HR). HR is a crucial mechanism of DNA double-strand break (DSB) repair that depends on the formation and resolution of Holliday junctions for genomic stability maintenance. The SMC6 complex with SMC5 is involved in DSB repair. We sought to investigate the association between SMC6 expression, genomic instability, and prognosis of breast cancer. Methods This was an observational retrospective cohort study. We assessed SMC6 expression and copy number variation (CNV) data measured by qRT-PCR and whole-genome comparative genomic hybridization in 33 women with breast cancer who are non-carriers of BRCA1/BRCA2 mutations. According to nuclear staining, the SMC6 protein expression was evaluated on a tissue microarrayer containing 481 samples classified as SMC6low (negative/weak) or SMC6high (moderate/strong). Results SMC6low tumours tend to show higher CNV. SMC6high group presented poorer disease-free survival than the SMC6low group (P=0.050), mainly for the luminal subtype (P=0.005). SMC6low/ERpos were protective biomarkers for recurrence. Interpretation & Conclusions There is a possible association between SMC6 expression and relapse of breast cancer, also suggesting that SMC6 abnormal expression may indicate tumour genetic instability in breast cancer.