Current Issue : April-June Volume : 2025 Issue Number : 2 Articles : 5 Articles
Photodynamic therapy (PDT) has emerged as a promising therapeutic approach owing to its non-invasive nature and minimal toxicity. PDT involves the administration of a photosensitizing agent (PS), which, upon light activation, induces a photodynamic reaction (PDR), leading to targeted cell destruction. However, developing resistance to PDT poses a significant challenge to its effectiveness. Various factors, including properties and administration of PSs, mediate this resistance. Despite the widespread use of substances like 5-aminolevulinic acid (5-ALA) and protoporphyrin, their efficacy is limited due to restricted tumor penetration and a lack of tumor targeting. To address these limitations, nano-delivery techniques and newer PSs like Aza-BODIPY and its derivatives, which offer enhanced tissue penetration, are being explored. In this paper, we provide an overview of resistance mechanisms in PDT and discuss novel methods, substances, and technologies to overcome resistance to improve clinical outcomes in tumor treatment....
Background: Immunotherapy is the cornerstone of treatment for many cancers. The effectiveness of immunotherapy in hospitalized patients is unknown due to the exclusion of this fragile population from clinical trials. This study evaluates the efficacy of immunotherapy in fragile hospitalized patients. Method: We conducted a single-center retrospective study involving 49 patients who started an immunotherapy (IO) during a hospitalization or within 3 months after a hospitalization at the Centre Hospitalier de l’Université de Sherbrooke (CHUS). Efficacy analysis included objective response rate (ORR), overall survival (OS), and progression-free survival (PFS). Results: Immunotherapy resulted in 30.6% of all grades combined and 18.4% of grade three to four immune-related adverse events (irAE). Efficacy outcomes were inferior in the fragile cohort of patients with ORR of 38.9%, PFS of 2.8 months (95% CI [2.17–3.35]), and OS of 3.2 months (95% CI [1.60–4.84]). Performance status of ECOG three to four compared to ECOG zero predicts poor OS (HR 5.666 [1.207–26.594]; p = 0.028) and PFS (HR 4.136 [0.867–19.733]; p = 0.075). Fitness to receive four to six cycles (HR 0.335 [0.152–0.0.738]; p < 0.007) or more predicts greater OS compared to one to three cycles of immunotherapy. Low levels of serum albumin (HR 0.917 [0.852–0.987]; p = 0.021) and elevated levels of serum LDH (HR 2.224 [1.469–3.367]; p < 0.001) are associated with a reduced OS. Conclusion: The effectiveness of immunotherapy in fragile hospitalized patients is compromised, although they exhibit significant irAE. Excellent performance status, fitness to receive many IO treatments, and normal levels of serum LDH and albumin may be useful in selecting patients who will benefit from immunotherapy....
Background: Cutaneous oncology encompasses a broad range of skin malignancies, including melanoma, cutaneous squamous cell carcinoma (SCC), and basal cell carcinoma (BCC), all of which pose significant global health challenges. The World Health Organization (WHO) estimates that melanoma incidence has increased by approximately 50% over the past three decades. While SCC and BCC are generally less aggressive than melanoma, they contribute significantly to the overall burden of skin cancer due to their high prevalence. Traditional treatment modalities for these malignancies, such as surgery, radiation, and chemotherapy, have shown limitations in achieving durable responses and minimizing systemic toxicity. As a result, there is an increasing need for more effective and less toxic treatment options. Immunotherapeutic strategies have emerged as a promising avenue in oncology, with the potential to revolutionize treatment approaches for cutaneous malignancies. Objectives: This literature review aims to undertake an in-depth examination of immunotherapeutic strategies for melanoma, SCC, and BCC. Specifically, the review focuses on the role of immune checkpoint inhibitors, adoptive cell therapies, and emerging immunotherapies, assessing their impact on treatment outcomes, survival rates, and patient quality of life. Methods: A literature search was conducted using databases such as PubMed, Google Scholar, and Scopus. The search terms included “cutaneous oncology”, “immunotherapy”, “immune checkpoint inhibitors”, “adoptive cell therapy”, “melanoma”, “cutaneous squamous cell carcinoma”, and “basal cell carcinoma”. Peer-reviewed articles published in the last 10 years that reported clinical outcomes from immunotherapy-based treatments for cutaneous malignancies were included. The studies were reviewed and analyzed based on their reported clinical outcomes, including survival rates, adverse events, and quality of life metrics. Results: Our review identified significant advancements in immunotherapeutic strategies for cutaneous oncology. Immune checkpoint inhibitors, such as pembrolizumab and nivolumab, demonstrated improved overall survival rates, particularly in melanoma patients. In addition, adoptive cell therapies, including tumor-infiltrating lymphocyte (TIL) therapies, showed promise in managing both cutaneous SCC and BCC, with reported reductions in tumor burden and durable responses. Emerging immunotherapies, such as cancer vaccines and oncolytic viruses, are in early clinical trials but exhibit potential in enhancing antitumor immunity and expanding treatment options. Conclusions: Immunotherapeutic strategies represent a critical advancement in the management of cutaneous malignancies, offering improved outcomes compared to traditional therapies. Immune checkpoint inhibitors and adoptive cell therapies are already reshaping clinical practice, while emerging immunotherapies provide exciting avenues for future research. These therapies not only enhance survival rates but also reduce systemic toxicities, representing a transformative approach to treating skin cancer. Further research and clinical trials are needed to refine these strategies and expand their applicability to a broader patient population....
Background: At present, there is a paucity of data in the literature pertaining to the impact of radiotherapy (RT) on the success of tracheal intubation in patients with nasopharyngeal cancer (NPC). The aim of this study is to investigate the frequency of difficult tracheal intubation in patients with NPC following RT. Methods: Patients with NPC who underwent RT followed by surgery between 2012 and April 2024 at the University Hospital Heidelberg were retrospectively analyzed. Results: Twenty-three patients, predominantly males (73.9%) with a mean age of 52.9 years, were enrolled. Overall, 65.2% of the patients had an American Society of Anesthesiologists (ASA) class of III. The mean total laryngeal dose was 53.5 Gy for the main and boost plan, and the maximum total laryngeal dose was 66.61 Gy. Direct laryngoscopy was performed in 69.6% of cases, followed by 26.1% videolaryngoscopy, and 4.2% required fiberoptic intubation. In total, 47.8% of the patients had a Cormack/Lehane grade of I, followed by 43.5% with grade II and 8.7% with grade III. Overall, 87% of patients were successfully intubated on the first attempt. Conclusions: It has been demonstrated by previous studies that RT has the potential to enhance complications and difficulties encountered during airway management. While the results must be interpreted with caution, our study provides no evidence of severe impairment in advanced airway management in patients with nasopharyngeal cancer who have undergone radiotherapy....
Introduction: This article compares surgical and survival outcomes of robot-assisted and open radical cystectomy with cutaneous ureterostomy for the treatment of frail bladder cancer patients with limited life expectancy. Methods: The institutional database was searched for cystectomy cases with cutaneous ureterostomy, from 1 June 2016 to 31 August 2022. The study population was split into two groups, according to the surgical approach. The baseline characteristics and surgical outcomes were compared. Logistic regression analyses identified predictors of major bleeding events (hemoglobin loss ≥ 3.5 g/dL or blood transfusion) and re-operation within 30 days from surgery. The Kaplan–Meier method estimated the impact of the robotic approach on overall survival and Cox regression analysis assessed its predictors. Results: A total of 145 patients were included: 30% (n = 43) underwent robotic cystectomy. Patients’ characteristics and tumor stages distribution were comparable in the two groups but those receiving a minimally invasive treatment showed significantly reduced times to flatus, bowel and hospital discharge (all p < 0.001). Although operation times were longer in this cohort, major bleeding events (60% vs. 89%) and postoperative severe complications (0 vs. 8%) (both p < 0.001) were less frequent compared to the open approach. A logistic regression showed that robotic surgery independently predicted major bleeding events (OR: 0.26; 95%CI 0.09–0.72; p = 0.02) but not the need for re-intervention. A Kaplan–Meier analysis showed that robotic cystectomy was associated with a significant advantage in terms of overall survival (LogRank = 0.03), and this result was confirmed by Cox regression analysis (HR: 0.39; 95%CI 0.14–0.94; p = 0.04). Conclusions: Robotic cystectomy with cutaneous ureterostomy may represent a viable option to treat frail bladder cancer patients, as the minimally invasive approach reduces the risk of bleeding and serious complications and provides a prompt restoration of bowel function and a shorter hospital stay compared to open surgery....
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