Current Issue : October-December Volume : 2026 Issue Number : 4 Articles : 6 Articles
Tumor Treating Fields (TTFields) represent a novel, non-invasive therapeutic modality in oncology that employs low-intensity, intermediate-frequency alternating electric fields to disrupt mitotic processes and induce cancer cell death. This review integrates mechanistic, preclinical, and emerging clinical evidence supporting the integration of TTFields with immunotherapeutic strategies in pancreatic ductal adenocarcinoma (PDAC). Although immunotherapy has transformed the treatment landscape across multiple malignancies, its efficacy in PDAC remains limited due to the tumor’s dense stroma, immunosuppressive microenvironment, and low immunogenicity. Preclinical investigations suggest that TTFields may potentiate immune-based therapies by enhancing antigen presentation, modulating the tumor microenvironment (TME), and attenuating mechanisms of immune resistance. We highlight studies evaluating TTFields in combination with immune checkpoint inhibitors (ICI), adoptive cellular therapies, and cancer vaccines, emphasizing their potential synergistic effects in PDAC. Clinically, the phase II PANOVA-2 trial demonstrated feasibility and encouraging survival outcomes with TTFields in combination with gemcitabine and nab-paclitaxel, providing the rationale for the ongoing phase III PANOVA-3 trial and the phase II PANOVA-4 trial, which combines TTFields with chemotherapy and atezolizumab. Additional clinical experiences in glioblastoma (GBM) and non-small-cell lung cancer (NSCLC) further substantiate the broader applicability of TTFields as an immunomodulatory adjunct. Remaining challenges include optimizing treatment sequencing, identifying predictive biomarkers, and managing TTFields-associated toxicities. Collectively, current evidence positions TTFields as a promising strategy to augment immunotherapy in PDAC, warranting further translational and clinical investigation to establish its role in reshaping therapeutic paradigms....
Purpose: Pediatric central nervous system (CNS) tumors often recur despite multimodality therapy. Although re-irradiation (re- RT) has historically been limited by concerns for severe late toxicities, modern techniques have renewed interest in this approach. Proton therapy provides dosimetric advantages that may enable curative re-treatment with reduced normal tissue exposure. Methods: We retrospectively reviewed 54 pediatric patients who underwent proton re-RT for recurrent CNS tumors at our institution (2010–2024). Eligible patients had received prior CNS-directed RT at ≤ 20 years of age. Toxicities were graded per Common Terminology Criteria for Adverse Events (CTCAE) v5.0 as acute ( < 3 months) or late ( ≥ 3 months). Cumulative dosimetry was assessed by registering RT1 and RT2 plans and converting doses to EQD2 ( α/ β = 2 Gy). Overall survival (OS) and progression-free survival (PFS) were estimated using Kaplan–Meier methods. Results: Median age at re-RT was 11 years, with a median interval of 28.5 months between RT courses. The median prescribed re-RT dose was 54 Gy (range, 25–60), yielding a cumulative EQD2 of 102.6 Gy (range, 46.8–112.9). Median OS and PFS were 46.0 and 16.5 months, respectively. Among 16 ependymoma patients, all received full-dose proton re-RT (54–59.4 Gy), yielding a 1-year OS of 91.7% and PFS of 50.0%. Glioma patients had inferior outcomes (1-year OS 55.4%, PFS 41.6%) with a median re-RT EQD2 of 48.1 Gy. An RT interval of ≥ 12 months was associated with improved OS and PFS. Composite dosimetry in 21 patients showed a median cumulative brain D0.1cc of 109.0 Gy; only one patient developed Grade 3 radiation necrosis (RN). High-grade acute toxicity occurred in 13.0% of patients, all manageable with supportive care. Conclusion: Proton re-RT for pediatric CNS tumors is feasible and associated with encouraging survival and low rates of serious late toxicity....
Despite the adoption of neoadjuvant FLOT chemotherapy as standard treatment for locally advanced gastric and gastroesophageal junction cancer, many patients fail to achieve meaningful pathological response, limiting efficacy. The aim of this study was to evaluate the impact of pharmacogenetic markers on pathological response in Russian patients receiving neoadjuvant FLOT. Thirty patients with locally advanced gastric or gastroesophageal junction adenocarcinoma received neoadjuvant FLOT followed by surgery. Polymorphisms in CYP3A5 (rs776746), CYP2C8 (rs10509681, rs11572080, rs1058930), ERCC1 (rs11615), and GSTP1 (rs1695) were analyzed. Favorable pathological response (TRG0-2) was observed in 23.3% of patients, including 3.3% complete responses. Most patients (76.7%) had minimal or no regression (TRG3-5). Clinical variables were not associated with response. ERCC1 (rs11615) showed a significant association: patients with the Wt/Wt genotype had higher odds of achieving TRG0-2 (OR = 8.889; p = 0.033; 95% CI: 1.294–61.058). No associations were found for CYP3A5, CYP2C8, or GSTP1. Median PFS was 18.21 months in TRG3-5, while not reached in TRG0-2 (p = 0.108). No significant PFS differences by ERCC1 genotype were observed (p = 0.525). ERCC1 (rs11615) may serve as a potential pharmacogenetic marker of response to FLOT, supporting further research in personalized treatment strategies....
With the rapid growth of electronic health records, medical imaging, and highthroughput omics data, precision oncology faces increasing demands for crossmodal information integration and complex clinical decision support. In recent years, large language models (LLMs) and their multimodal extensions have opened new technological avenues for addressing these challenges and have shown considerable promise across a range of applications. This review provides a structured narrative overview of the current applications of these technologies across the precision oncology care continuum, encompassing key stages such as cancer screening, diagnosis, staging, treatment recommendation, and clinical documentation. However, single-model approaches still have clear limitations in constructing complex clinical reasoning pathways, ensuring the traceability and verifiability of decision processes, and integrating deeply with established clinical workflows. Against this backdrop, AI agents with autonomous planning and coordination capabilities, together with multi-agent systems (MAS), have emerged as an important new direction in precision oncology research. Building on this development, we further propose an analytical framework centered on task–architecture alignment, emphasizing that foundation models, single-agent systems, and multi-agent systems should be selected according to the complexity and risk profile of the clinical task. Such a framework may provide a useful basis for the design, evaluation, and clinical translation of AI systems in precision oncology....
Objective: Recent guidelines suggest sublobar resection as a viable option for peripheral lung cancer smaller than 2 cm. However, the presence of Spread through Air Spaces (STAS) is a well-known poor prognostic factor in early-stage lung cancer treated with sublobar resections. The aim of this study is to analyze the potential correlation between STAS and maximum standardized uptake volume (SUVmax) in this subset of patients to help define the optimal resection. Methods: A retrospective monocentric study was performed including patients diagnosed with stage IA lung cancer undergoing surgical resection. Patients were divided into two groups according to the presence/absence of STAS. As further investigation, we also separately analyzed the subgroup of patients with a peripheral nodule smaller than 2 cm. A p-value ≤ 0.05 was considered statistically significant. Results: The study cohort consists of 121 patients, 76 (62.8%) male, with a mean age of 74.2 ± 8.8 years. STAS was observed in 67 (55.4%) cases. The STASpositive group showed a higher SUVmax value compared to the STAS-negative one (mean 5.5 ± 4.4 vs. 3.9 ± 3.0; p-value 0.007) with an AUC of 0.65 and an optimum SUVmax cut-off value of 3.0. Moreover, patients with SUVmax ≥ 3 showed a 77% increase in risk of having STAS (RR = 1.77; 95%CI = 1.21–2.59, p-value 0.014). This association was confirmed also in the subgroup of patients with nodules ≤ 2 cm (mean SUVmax 5.3 ± 4.6 vs. 3.6 ± 2.7; p value = 0.014). Conclusions: In our study, an SUVmax ≥ 3 in preoperative 18-FDG-PET is associated with the presence of STAS in stage IA lung cancer and peripheral cancer smaller than 2 cm. These findings, integrated with other clinical and radiological data, may guide surgeons to optimize the surgical strategy....
Purpose: To investigate treatment variations and outcomes between older (≥ 70 years) and younger (< 70 years) patients with mucosal head and neck squamous cell carcinoma (mHNSCC) treated with radiotherapy. Methods: A multicenter retrospective review of patients diagnosed from 2010 to 2018 was conducted. Patient, tumor, and treatment data were collected, including overall survival (OS) and progression- free survival (PFS). Multivariable analyses examined factors influencing standard- of- care (SOC) treatment, OS, and PFS. Results: Of 1553 patients, 432 patients were ≥ 70 years. Older patients were significantly less likely to receive curative treatment, SOC, or concurrent systemic therapy. Age, marital status, ECOG status, stage, and subsite influenced SOC treatment. Three- year OS and PFS were lower in older patients. ECOG status, stage, subsite, and SOC treatment were significantly associated with OS and PFS. Older age and smoking status were significantly associated with lower OS but not PFS. Conclusions: Older patients should be offered SOC treatment where appropriate for maximal disease control and survival....
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