BackgroundCancer-related fatigue (CRF) is one of the most common and distressing side effects of cancer and its treatment. Its clinical impact contributes to poorer health outcomes, reduced quality of life, and higher healthcare costs. Although several primary studies have been conducted in Ethiopia, no systematic review has yet synthesized their findings on CRF.MethodsA comprehensive systematic search was conducted across major databases, including HINARI, Science Direct, Embase, Thesis Bank, PubMed/MEDLINE, Google Scholar, and Research Gate. Following a rigorous screening based on predefined inclusion criteria, 7 studies were included. Data extraction and quantitative synthesis were performed using STATA software. Statistical heterogeneity was assessed with Cochran’s Q and the I2 statistic, while publication bias was assessed via Egger’s regression test.ResultsThis systematic review and meta-analysis included 7 studies comprising 2047 participants, with a pooled prevalence of 73.04% (95% CI: 69.00-77.08%). The prevalence was highest in the Hawassa region (77.40%) and among studies conducted before 2020 (73.34%). Cancer-related fatigue was significantly associated with late-stage disease presentation, anemia, depression, and anxiety.Conclusion and RecommendationsCancer-related fatigue is a significant public health issue in Ethiopia, with a high prevalence, especially in the Hawassa region. Late-stage cancer, anemia, depression, and anxiety were strong predictors of CRF. Routine screening for fatigue and psychological comorbidities should be integrated into oncology care to improve patient outcomes.

Abstract Background Brain metastases (BrM) among patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (mBC) are under-studied. We sought to understand the endocrine sensitivity of patients with HR+/HER2- BrM and determine associated risk of leptomeningeal metastatic disease (LMD). Methods We conducted a retrospective cohort study of 204 consecutive patients (≥18 years of age) with HR+/HER- mBC who were treated for BrM at the Sunnybrook Odette Cancer Centre between 2008-2018. We used descriptive statistics to summarize patient and treatment characteristics and Kaplan-Meier analyses for survival outcomes. The log-rank test was used to compare outcomes of patients with endocrine sensitive versus endocrine resistant disease. Results Among 204 patients with HR+/HER2- BrM, the median age at BrM diagnosis was 56 years (range, 48-64) and the median time between diagnosis of mBC to development of BrM was 15 months (interquartile range [IQR], 3-36). At the time of BrM development, 160 patients (78.4%) had endocrine resistant and 28 patients (13.7%) had endocrine sensitive disease; endocrine sensitivity of the remaining 16 patients (7.8%) was unknown. In total, 58 patients (28.4%) developed LMD with a median time from BrM to LMD of 10.8 months (IQR 3.1—14.8).Patients with endocrine sensitive disease at time of BrM diagnosis had a a longer brain-specific progression-free survival (7 months versus 5 months, p = 0.004) and overall survival (24 months versus 5 months, p = 0.002) compared to those with endocrine resistance. Conclusions Most patients with HR+/HER2- BrM have endocrine resistant disease, with an unexpectedly high likelihood of developing LMD.

Central nervous system tumors present significant diagnostic and therapeutic challenges, as WHO histomolecular prognostic criteria are not always optimal. Decision-making increasingly relies on multidisciplinary team meetings (MDTs), which require highly qualified specialists. We aimed to assess available human resources and propose a framework for subregional collaboration through a West African neuro-oncology MDT. A multicenter descriptive study was conducted via an online questionnaire from April 13 to June 15, 2025, involving 35 healthcare professionals from nine West African countries. Participants included 45.7% neurosurgeons, over 57% with <3 years' experience. Most managed <100 patients/year, and 90% performed <100 tumor excisions. Awake surgery and stereotactic biopsy were rare. Access to chemotherapy, pathology, immunohistochemistry, and molecular biology was reported by 83%, 80%, 51%, and 14% of respondents, respectively. Median turnaround time was about 3 weeks for histopathology and about 1 month for immunohistochemistry. Clinical trial access was available to 26%. Neurosurgeon density was <1 per million inhabitants, peaking in Senegal (1 per 700,000). Only 34% reported functional MDTs. Nearly all participants (95%) supported establishing a subregional network with regular online MDTs (monthly or bimonthly) and a specialized interuniversity degree. MDTs are essential in neuro-oncology, enabling individualized therapeutic planning. Given critical workforce shortages in West Africa, a subregional collaborative MDT network could optimize patient care, enhance resource sharing, and standardize management across the region.

Cell-based immunotherapies have emerged as promising strategies for brain tumors, offering the potential for targeted and durable antitumor responses. However, their efficacy has been limited by challenges unique to the central nervous system, including suboptimal delivery routes and an immunosuppressive tumor microenvironment that impairs cell function. Focused ultrasound (FUS) is a noninvasive technology that, when combined with intravenously administered microbubbles, can transiently and reversibly increase blood-brain barrier permeability. FUS has improved drug delivery to brain tumors in clinical trials and offers compelling opportunities to enhance trafficking, activation, and control of therapeutic cells. Despite this potential, critical questions remain regarding the timing and sequencing of FUS with cell therapies, the impact of FUS on the tumor and neuroimmune microenvironments, strategies to mitigate acute and delayed toxicities, and methods to tune potency to maximize tumor specificity while minimizing bystander tissue injury. To address these challenges, the Focused Ultrasound Foundation convened a multidisciplinary roundtable in March 2025. Experts in neuro-oncology, neuroimmunology, cell therapy, neurosurgery, and FUS participated. Discussions focused on cell delivery routes, pharmacokinetics and blood-brain barrier opening, tumor microenvironment and CNS inflammation, FUS-induced immune modulation, clinical trial design, and approaches to safety monitoring and cell control. In this review, we summarize the discussions and key messages from the roundtable, which may serve as a foundation for advancing FUS-enhanced cell therapy for brain tumors in a collaborative manner.

Adult IDH-mutant brainstem gliomas (BSGs) are rare and appear molecularly distinct from H3K27-altered diffuse midline gliomas. We aimed to provide a comprehensive characterization by integrating an institutional cohort with a pooled individual-patient analysis. Adults with IDH-mutant BSGs diagnosed at our institution were identified. A PRISMA-guided search of PubMed and Scopus captured additional cases. Individual-level demographic, radiographic, molecular, treatment, and outcome data were abstracted. Kaplan-Meier and log-rank testing evaluated survival associations with age, sex, WHO grade, surgery, chemoradiation, IDH variant, MGMT methylation, ATRX status, and location. Eighty-four patients were analyzed (n = 7 institutional, n = 77 literature-derived). Mean age was 37.8 years; 68.6% male. Most tumors involved the pons/medulla (90.4% astrocytomas; 68.7% WHO grade 2). Among evaluable cases, MGMT methylation was present in 47.5%, ATRX loss in 53.2%, and TP53 mutation in 84.3%. Non-canonical IDH variants accounted for 45.3% of cases. Median overall survival (OS) was 77.3 months. In multivariate analysis, non-canonical IDH variants independently predicted improved OS (HR = 0.37, P = .012), while surgical resection showed a strong clinical trend toward improved OS (HR = 0.48, P = .073). Chi-squared analysis confirmed no significant difference in high-grade tumor distribution between resection and biopsy groups (P = .52), suggesting the trend was not driven by selection bias. Adult IDH-mutant BSGs represent a clinically meaningful subgroup with outcomes more favorable than H3K27-altered gliomas but shorter than supratentorial IDH-mutant gliomas. Their recurrent molecular features, including frequent non-canonical IDH variants, warrant study in larger cohorts to clarify biological significance, refine prognostication, and inform the potential role of IDH-targeted therapies.

BackgroundBoron neutron capture therapy (BNCT) presents a targeted re-irradiation strategy for recurrent glioblastoma. However, its survival benefit remains unclear, as few studies have compared the addition of BNCT to bevacizumab (BEV) with BEV alone or other salvage approaches.MethodsWe retrospectively analyzed 171 adults with recurrent glioblastoma: 116 treated with BEV ± chemotherapy (control group) and 55 treated with BNCT plus BEV ± chemotherapy (BNCT group). To improve comparability, propensity score matching was performed using age, performance status, recurrent tumor volume, recurrence-to-salvage-treatment interval, the number of relapses, re-resection, and chemotherapy use. Survival outcomes were assessed using Kaplan-Meier estimates and Cox proportional hazards models.ResultsIn the matched cohort (n = 98), progression-free survival (PFS) was significantly longer in the BNCT group compared with the control group (median 5.34 vs 3.70 months, hazard ratio [HR]: 0.54, P = .026), whereas overall survival (OS) was comparable (HR: 0.86, P = .524). The objective response rate was significantly higher in the BNCT group compared with the control group (67.4% vs 47.0%; P = .041). Multivariable analysis showed that the absence of callosal involvement (odds ratio [OR]: 0.10, P = .033) and higher minimum absorbed dose (OR: 1.09; P = .028) were independently associated with better BNCT response.ConclusionsBoron neutron capture therapy plus BEV was associated with higher objective response rate and improved PFS compared with BEV alone in patients with recurrent glioblastoma, although no OS difference was demonstrated. These findings support BNCT as a salvage strategy but warrant prospective validation.

BackgroundGlioblastoma multiforme (GBM) is an aggressive brain tumor with abysmal prognosis because cancer cell growth in the tumor microenvironment (TME) is orchestrated by complex interplay between aerobic glycolysis (AG) and endothelial dysfunction (ED). AG acidifies extracellular pH (pHe) to promote tumor invasion and suppress immune response, whereas ED leads to leaky blood vessels which hampers perfusion and stimulates hypoxia. Since metabolism generates heat and perfusion removes heat, we hypothesized that temperature could reflect both metabolic and vascular reprogramming in the TME mediated by AG and ED.MethodsWe used multiple magnetic resonance methods and bioheat modeling to dissect temperature contributions from metabolic and vascular sources in rat gliomas.ResultsUpregulated AG in the TME results from enhanced glycolysis (∼4.2× higher) and reduced glucose oxidation (∼4.8× lower), which leads to more acidic pHe (6.9 ± 0.1 vs 7.3 ± 0.1). Since TME is hypoperfused (∼40% lower) and glycolysis is less exothermic compared to glucose oxidation, simulations predict a cooler TME as in vivo measurements clearly demonstrate (0.5-1.5 °C). Moreover, temperature and pHe are correlated both inside and outside the TME for untreated and treated rats (r > 0.6).ConclusionsSince TME is more glycolytic, acidic, hypoperfused, and cooler than neighboring milieu, thermal mapping can represent combined effects of AG and ED for early GBM detection and therapy optimization.

Combination chemotherapy of procarbazine, lomustine (CCNU), and vincristine (PCV), a standard treatment for oligodendroglioma, is associated with frequent adverse events. In Japan, only nimustine (ACNU), an analog of CCNU, is approved. This study aimed to evaluate the long-term outcomes of ACNU-based chemotherapy after maximal safe resection with deferred radiation therapy (RT) for oligodendrogliomas. This retrospective study included 50 patients diagnosed with IDH-mutant 1p/19q-codeleted oligodendroglioma of grades 2 (n = 27) or 3 (n = 23) between 2002 and 2022. Progression-free survival (PFS), overall survival (OS), and time to decline in performance status (deterioration-free survival [DFS]) were analyzed using the Kaplan-Meier method. Postoperative chemotherapy was administered to 94% of patients (procarbazine, ACNU, and vincristine [PAV], n = 24; ACNU, n = 22; temozolomide [TMZ], n = 1; excluded). Median follow-ups were 142.9 and 50.6 months for PAV and ACNU groups, respectively. Ten-year PFS rates were 54.2% and 30.0% for grades 2 and 3 tumors, respectively (P = .0870), and 10-year OS rates were 91.5% and 78.8% for grades 2 and 3, respectively (P = .5098), with comparable DFS (P = .6922). Comparing regimens, the 10-year OS rate was 82.3% for PAV, while all patients in the ACNU group remained alive. Five-year PFS were almost identical: 58.9% (PAV) versus 56.8% (ACNU), P = .9996. Treatment completion rates were 75% and 91% for PAV and ACNU, respectively. ACNU monotherapy has a similar efficacy to PAV and tolerability to TMZ, suggesting that it is the most favorable chemotherapeutic option currently available in Japan, considering its risk-benefit profile.

Abstract Background Patient-reported outcomes (PROs) are crucial for guiding patient care and maintaining quality of life This study assesses the feasibility of computer-based adaptations of the Patient-Reported Outcomes Measurement Information System (PROMIS) in a clinical setting and compares its outcomes with the EORTC-QLQ-C30 and EORTC-BN20 questionnaires. Validated, modular computer adaptive testing might reduce patient survey burden and provide physicians with more precise PROs. Methods Newly diagnosed glioblastoma (GBM) patients were prospectively enrolled prior to radiation to evaluate feasibility. PROMIS modules were selected to reflect EORTC-QLQ-C30 and EORTC-BN20 domains, including anxiety, depression, fatigue, physical function, sleep disturbance, social satisfaction, cognitive ability, and global health. Patients completed both EORTC and PROMIS questionnaires electronically, preceding descriptive analyses. Results Forty-three patients with 124 responses were analyzed. 31 patients completed surveys before or within 14 days of radiation, and 12 were outside the radiation window, yielding 60 completed surveys. Median completion times for the EORTC-QLQ-C30 and EORTC-BN20 were 4.77 (range: 2.05-18.6) and 2.63 (range: 1.17-24.83) min, respectively. For most PROMIS modules, completion times ranged from 0.6 to 1 min (range: 0.15-7.77), while global health took a median of 2.35 min (range: 1.02-21.12), The average time to completion was 8.65 min (range: 3.32-66.01). For most variables, PROMIS and EORTC-QLQ-C30 showed strong to moderate correlations. Conclusions PROMIS measures correlated well with EORTC instruments, making them a suitable tool for evaluating patients with GBM. Response times were generally short, but variability suggested that low computer literacy, limited internet access, and disease burden may affect involvement.

IntroductionOlder patients may be at particular risk of decline in neurocognitive function (NCF) following brain tumor resection, particularly when tumors are near-eloquent regions.MethodsWe identified 95 patients of advanced age (≥60 years) with newly diagnosed, left hemisphere, high-grade eloquent glioma who underwent a first-time awake craniotomy for tumor resection. All patients had comprehensive neuropsychological evaluations preoperatively and a subset of patients (N = 45) completed postoperative assessment.ResultsMedian age at surgery was 66 years (range, 60-81) and tumors were most commonly located in the temporal (56%) and frontal (27%) lobes. Preoperatively, most patients exhibited NCF impairment on at least 1 neuropsychological test, most frequently in verbal learning (66%) and memory (71%). Localization in temporal regions conveyed greater impairment to memory, and patients with frontal tumors exhibited poorer executive functioning. Following awake resection, neurocognitive decline was most frequent in verbal learning (41%) and memory (38%). Postoperative change in neurocognitive performance was not associated with more advanced age, comorbidities, frailty, or tumor volume or extent of resection.ConclusionsAdvanced age, frailty, and medical comorbidities were not significantly associated with poorer NCF outcome. Postoperative decline was greatest when patients present with high levels of baseline functioning and tumors involve the mesial temporal lobe. Importantly, rates of baseline impairment and postoperative decline in this older age sample were similar to other cohorts, including younger patients and lower grade tumors. Findings support the relative safety of awake craniotomy for resection of eloquent glioma in advanced age individuals.