Risultati per: Carcinoma mammario in fase iniziale

New England Journal of Medicine, Ahead of Print.

Cutaneous squamous cell carcinoma (cSCC) is the second most common type of skin cancer and, according to recent data from Europe, has possibly overtaken melanoma as the leading cause of skin cancer–related death. Accurate data from the US remain elusive, limiting the ability to conduct large-scale analyses of cSCC. Much of the issue lies in assembling a complete clinical record for individual patients and in processing text from notes and pathology reports into a usable format. The ability of large language models to do these tasks holds great promise to capture more of the patient record in the near future and provide highly granular data. Even once there is better integration of these tools, new approaches to provide high-quality data are necessary as it is painfully evident that methods relying on International Classification of Disease codes alone are poor at identifying distinct skin cancers, let alone differentiating basal cell carcinoma from cSCC.

This Consensus Statement develops recommendations for reporting measures and types of statistical analyses to be used in retrospective observational studies of cutaneous squamous cell carcinoma.

In Reply We appreciate the comments made by Lee et al and Bayatfard et al on our recent article. We applied concurrent cisplatin in the conventional 30-mg/m2 dose weekly when we designed this trial. This dose was routinely used in the treatment of head and neck neoplasms, including nasopharyngeal carcinoma. A secondary analysis of a prospective trial revealed that a cumulative cisplatin dose of 200 mg/m2 is sufficient for patients with locoregionally advanced nasopharyngeal carcinoma who undergo concurrent chemoradiotherapy. Prospective evidence on the optimal concurrent cisplatin dose after induction chemotherapy is lacking. Results from a large-sample retrospective study showed that cumulative cisplatin doses between 100 mg/m2 and 200 mg/m2 achieved satisfactory outcomes. In our study, the median cumulative cisplatin dose during radiation therapy was 180 mg/m2. Therefore, we consider that for patients with locoregionally advanced nasopharyngeal carcinoma who receive induction chemotherapy, the doses of concurrent cisplatin do not influence therapeutic effects.

To the Editor We read the article by Dai et al with great interest. Omitting chemotherapy in patients receiving induction chemotherapy (IC) is a hot topic in nasopharyngeal carcinoma treatment, particularly in the intensity-modulated radiotherapy era. Yet, concurrent cisplatin is still recommended in advanced-stage disease, and the cumulative dose of concurrent cisplatin recommended is at least 200 mg/m2 in the latest American Society of Clinical Oncology/Chinese Society of Clinical Oncology guidelines. The authors in the current study gave 30-mg/m2 cisplatin per week and only 12.1% of patients had received 7 weeks of cisplatin, which makes a total 210 mg/m2. For patients receiving IC, at least a total 160-mg/m2 dose of cisplatin is recommended, which had been received by 85.8% of patients. Could the inadequate cumulative concurrent cisplatin dose be the reason why the IC in combination with radiotherapy (IC-RT) arm was noninferior to the IC with induction chemotherapy combined with chemoradiotherapy (IC-CCRT) arm? Therefore, we would kindly like the authors to separately analyze the results of patients receiving adequate doses of concurrent cisplatin.

To the Editor A recent randomized clinical trial reported that after induction chemotherapy (IC), patients with stages III to IVB (American Joint Committee on Cancer Staging Manual, 7th Edition) nasopharyngeal carcinoma (NPC) receiving radiation therapy alone had noninferior oncologic outcomes and fewer acute adverse events, compared with those receiving concurrent chemoradiotherapy (CCRT). We have several comments about this impactful study.

The Cancer and Leukemia Group B (CALGB140503; also known as ALLIANCE) is a phase 3 trial that demonstrated that peripheral (outer third of lung) non–small cell lung carcinoma (NSCLC) with tumor size 2 cm or smaller and lymph node (LN) negative for metastasis, sublobar resection (defined as wedge resection or segmentectomy) compared to lobectomy was not inferior in disease-free survival (DFS) and overall survival (OS). The Japan Clinical Oncology Group (JCOG0802; also known as West Japan Oncology Group WJOG4607L study) is also a phase 3 trial that revealed that peripheral NSCLC with tumor size 2 cm or smaller with consolidation to tumor ratio more than 0.5 and LN negative for metastasis, segmentectomy (wedge resection was not allowed) compared to lobectomy was not inferior in relapse-free survival (RFS) and OS. Both trials are practice changing and challenged the prior standard of care of lobectomy for peripheral tumors 3 cm and smaller and LN negative for metastasis as established by the Lung Cancer Study Group.

New England Journal of Medicine, Volume 391, Issue 8, Page 710-721, August 22/29, 2024.

This randomized clinical trial evaluates the efficacy and safety of transarterial chemoembolization (TACE) plus sorafenib vs TACE alone for patients with recurrent intermediate-stage hepatocellular carcinoma.

Deaths from the majority of cancers are falling globally, but the incidence and mortality from hepatocellular carcinoma (HCC) is increasing in the United Kingdom and in other Western countries. HCC is a highly fatal cancer, often diagnosed late, with an incidence to mortality ratio that approaches 1. Despite there being a number of treatment options, including those associated with good medium to long-term survival, 5-year survival from HCC in the UK remains below 20%. Sex, ethnicity and deprivation are important demographics for the incidence of, and/or survival from, HCC. These clinical practice guidelines will provide evidence-based advice for the assessment and management of patients with HCC. The clinical and scientific data underpinning the recommendations we make are summarised in detail. Much of the content will have broad relevance, but the treatment algorithms are based on therapies that are available in the UK and have regulatory approval for use in the National Health Service.

New England Journal of Medicine, Volume 391, Issue 2, Page 185-186, July 11, 2024.

Wang K, Yu H-M, Xiang Y-J, et al. Efficacy and safety of radiotherapy combined with atezolizumab plus bevacizumab in treating hepatocellular carcinoma with portal vein tumour thrombus: a study protocol. BMJ Open 2022;12:e064688. doi:10.1136/ bmjopen-2022-064688 This article has been corrected since it was published online. In the Method and Analysis section of the Abstract: The sentence currently reads: ‘Assuming an ORR of 47%, with a two-sided alpha error of 0.1, 90% power, and a 10% drop-out rate, the required number of evaluable patients is 42.’ It should be corrected to: ‘Assuming an ORR of 47%, with a one-sided alpha error of 0.1, 90% power, and a 10% drop-out rate, the required number of evaluable patients is 42.’ In the Statistical Methods section: The sentence currently reads: ‘Hence, assuming an ORR of 47% after discussion among investigators based on the experience, with a two-sided alpha error…

Introduction
Sebaceous gland carcinoma (SGC) of the eyelid is an aggressive tumour with the ability to metastasise and an increased morbidity. Controversies regarding the epidemiology of this malignant eyelid tumour is widespread in the scientific literature. Western reports repeatedly describes eyelid SGC as a rare occurring tumour in general, accounting for 1%–3% of all eyelid tumours, however studies from Asia have uncovered a higher frequency of eyelid SGC including 54% of all eyelid tumours in Japan, and 43%–56% in India. We wish to retrieve observational data of eyelid SGC prevalence in proportion to total eyelid tumours, from pathological studies published worldwide to resolve this controversy.

Methods and analysis
We will search Ovid Medline, EMBASE, Cochrane Central Register of Controlled Trials, Scopus and Google Scholar to identify published reports on eyelid SGC prevalence proportions, aiming to clarify the incidence of the tumour. We will include observational clinicopathological studies reporting prevalence with confirmed histopathology. No limitations on publication date or language will be applied. Data from the individual studies and study quality will be extracted by two individual reviewers. Study quality will be assessed using the JBI Critical Appraisal Instrument for Studies Reporting Prevalence Data. Raw proportions will be transformed and pooled using a random effects model for meta-analysis. And subgroup analysis according to geography will be performed. If data are deemed unsuitable for a meta-analysis, a narrative synthesis will be presented. We will judge the certainty of evidence and present whether this has an overall effect on the results. The results may shed light on a long-standing academic disparity of the scientific literature.

Ethics and dissemination
This systematic review does not require ethical approval. The results of this proposed review will be the subject to a publication in an international peer-reviewed journal within the ophthalmic or pathological specialty.

PROSPERO registration number
CRD42023487141.

Objectives
The study aimed to assess the feasibility, acceptability and safety of delivering a home-based telehealth exercise intervention to older patients with hepatocellular carcinoma (HCC).

Design
Non-randomised feasibility study.

Setting
Patients were recruited from UK outpatient liver cancer clinics.

Participants
Patients were aged ≥60 years with HCC, with post-treatment imaging reporting a complete response, partial response or stable disease.

Intervention and data collection
Patients were invited to attend synchronous online exercise sessions, twice weekly for 10 weeks. Physical function and patient-reported outcomes were assessed pre-intervention and post-intervention. Qualitative data were collected via semistructured interviews after intervention completion.

Primary outcome measures
Recruitment, retention, exercise adherence and safety.

Results
40 patients were invited to participate and 19 (mean age 74 years) provided consent (recruitment rate 48%). Patients completed 76% of planned exercise sessions and 79% returned to the clinic for follow-up. Hand grip strength (95% CI 1.0 to 5.6), Liver Frailty Index (95% CI –0.46 to –0.23) and time taken to perform five sit-to-stands (95% CI –3.2 to –1.2) improved from pre-intervention to post-intervention. Patients reported that concerns they had relating to their cancer had improved following the intervention (95% CI 0.30 to 5.85). No adverse events occurred during exercise sessions.
Qualitative data highlighted the importance of an instructor in real time to ensure that the sessions were achievable, tailored and well balanced, which helped to foster motivation and commitment within the group. Patients reported enjoying the exercise intervention, including the benefits of peer support and highlighted perceived benefits to both their physical and mental health. Patients felt that the online sessions overcame some of the barriers to exercise participation and preferred attending virtual sessions over face-to-face classes.

Conclusions
It is feasible, acceptable and safe to deliver supervised group exercise via videoconferencing to patients with HCC in their own homes. These findings will inform the design of a future, adequately powered randomised controlled trial to evaluate the efficacy of the intervention.

Trial registration number
ISRCTN14411809.

Primary liver cancer is the third-leading cause of cancer-related mortality globally, accounting for over 700 000 deaths each year.1 In the last decade, the contribution of diet has been unravelled as a significant driver of hepatic oncogenesis.2 Specifically, diets high in fat have been associated with increased risk for the development of metabolic dysfunction-associated steatohepatitis (MASLD) and hepatocellular carcinoma (HCC) in many epidemiological studies,3 4 and these findings have been recapitulated in various in vitro and in vivo models. Although the link between diet and tumourigenesis has been convincingly established, the underlying mechanisms remain poorly understood. In Gut, Bu et al hypothesised that exogenous metabolites from the diet might play a direct regulatory role in protein signalling and specifically in the activation of protein kinase B (AKT).5 The PI3K-AKT pathway is a well-characterised transducer of extracellular signals and promotes tumourigenesis…