Acta Oncologica
type: channel
description: Acta Oncologica publishes cancer research across the broad field of modern oncology. We welcome research contributions from all parts of the world, target an international audience and offer global reach with all content published open access. Our Nordic signatures commits us to high quality, interest in innovation and a focus on clinical impact. Join us as we continue to investigate, define, share and discuss new knowledge that advances our understanding of cancer and influences tomorrow’s oncology.
publisher: MJS Publishing
language: en-US
publication name: Acta Oncologica
issn: 1651-226X
items: An updated system for categorising and reporting unintended incidents in radiotherapy at a national level
items: Incidence and impact of pseudoprogression and mixed responses in metastatic renal cell carcinoma patients treated with ipilimumab/nivolumab: a retrospective analysis
items: Real-world outcomes of pembrolizumab in advanced anal cancer: a nationwide Danish anal Cancer Group report
items: Adenocarcinoma of the small intestine cohort: prospectively collecting real-world data to improve care and quality of life for patients with a rare cancer
items: Radiotherapy and diagnostic capacity in relation to the changing cancer burden in the Baltic States
items: The role of radiotherapy in patients with advanced melanoma failing targeted therapy
items: Feasibility of patient-reported outcomes collection in clinical routine at a radiotherapy department
items: Increasing survival disparity between children, adolescents, and young adults with osteosarcoma or Ewing sarcoma of bone from 1990 to 2024: a population-based cohort study
items: Prevalence of self-reported pain in patients 5 years after rectal cancer treatment: results from the prospective QoLiRECT cohort study
items: Risk factors for distant recurrence in patients with rectal cancer supporting selection for total neoadjuvant therapy
items: Temporal trends in diagnostic work-up, treatment, and mortality in locally advanced prostate cancer in 2016–2024: nationwide, population-based study in Sweden
items: Malpractice claims for pancreatic cancer in Norway: claim-rates, injury domains, claim outcomes and indemnity compensation
items: Targeted therapy in the treatment of lung cancer in Iceland 2010–2023
items: Association between short-term radiation-induced toxicity and oncological outcomes in high-risk prostate cancer: a retrospective single-centre cohort study
items: How does pulmonary function impact QoL in patients with locally advanced NSCLC treated with chemoradiotherapy and durvalumab?
items: Real-world management of patients with simultaneously diagnosed synchronous liver and lung metastatic colorectal cancer – a national cohort study
items: Characteristics, treatment and survival of patients with chondrosarcoma in five European countries: a DARWIN EU® cohort study
items: Prediction of dumping after oesophageal cancer surgery
items: Outcome of resectable distal cholangiocarcinoma in a single-centre Western patient cohort: comparison of the 7th and 8th edition of the UICC/AJCC TNM classification
items: Real-world outcome of neoadjuvant therapy with or without pembrolizumab for triple-negative breast cancer
items: Post-treatment infection prediction in CLL using domain adaptation of lymphoma electronic health records
items: Nordic Society of Paediatric Haematology and Oncology (NOPHO) Radiotherapy Working Group consensus guidelines on radiotherapy for paediatric low-grade gliomas
items: Antibiotic treatment indicates shorter survival in patients with immunotherapy for metastatic kidney cancer
items: Healthcare costs and resource use in advanced breast cancer at the end of life: a register study
items: The Association of right atrium and sinoatrial node irradiation with atrial fibrillation and radiation-induced heart disease in non-small cell lung cancer
items: Baseline results from the Norwegian radiology-led lung cancer screening pilot
items: The rise of 3D spheroids in radiobiology for assessing tumour radioresistance
items: Cost-effectiveness analysis of operative versus non-operative management of colorectal cancer metastases in the Finnish RAXO Study
items: Stakeholders’ experiences with a clinician-led access programme linking evidence generation and reimbursement for precision cancer treatments: the drug access protocol in the Netherlands
items: Characteristics, treatment, and outcome of recurrent gastro-oesophageal adeno­carcinoma after perioperative chemotherapy and radical resection
items: Procedures of data merging in precision cancer medicine: the PRIME-ROSE project
items: Tumour acquisition method and molecular profiling success in advanced cholangiocarcinoma
items: A 10-year-long ongoing complete response to vismodegib as first-line treatment in adult metastatic medulloblastoma
items: PIK3CA mutation testing and alpelisib use in metastatic breast cancer: a real-world data set
items: SPRINTR: Swedish PRecision medicine Initiative for Novel Treatments and Research-towards efficient recruitment to clinical trials for prostate cancer
items: Psychological distress and tumor cell β2-adrenergic receptor levels in patients with surgically resected non-small cell lung cancer
items: Multidisciplinary team meetings for lung cancer in the Nordic countries: results from a Nordic survey
items: Extent of prostate cancer cases not registered in The National Cancer Register of Sweden and consequences for estimates of prostate cancer incidence and mortality
items: FOCU.SE trial: a nationwide Swedish drug repurposing protocol and research framework
items: Differences in tumor mutational burden assessment: a national ring trial
items: Specialized healthcare diagnostic events within one year preceding colorectal cancer diagnosis
items: ‘Crossing borders’ in data standardisation: application of OMOP CDM in an international clinical trial network in precision cancer medicine
items: Realising precision oncology through shared real-world data infrastructure
items: https://medicaljournalssweden.se/actaoncologica/article/view/45174
items: Selecting patients with rectal cancer for total neoadjuvant therapy based on clinical lymph node status: do we dare?
items: Eribulin-induced resolution of high-risk basal cell carcinoma: implications for microtubule-targeting agents in BCC management: a case report
items: Comorbidity indices in observational studies on cancer risk
items: Improving confidence in MRI-based auto-segmentation via uncertainty assessment
items: FIN-EGFRprint: a Finnish real-world study on treatments and outcomes in advanced NSCLC with common EGFR mutations
items: Clinical outcomes of genomically guided trametinib monotherapy across cancer types: results from the IMPRESS-Norway trial
items: Feasibility of lung cancer screening in low-risk populations of the Nordic countries
items: Merging clinical research and standard healthcare – Nordic Precision Cancer Medicine Symposium 2025
items: Treatment of neuropathic pain in cancer survivors: a scoping review of pharmacological, exercise, and psychosocial interventions
items: Prevalence and risk factors for nausea and vomiting in breast cancer patients undergoing chemotherapy
items: The false-negative rate of sentinel lymph node biopsy and its related factors in early-stage cervical cancer: a systematic review and meta-analysis
items: A conceptual health economic modelling framework to assess the cost-effectiveness of molecular target–driven treatment regimens in oncology

An updated system for categorising and reporting unintended incidents in radiotherapy at a national level
type: item
description: Background and purpose: Radiotherapy is a complex, multistage process that involves collaboration across professional disciplines (radiographers working in pre-treatment preparation, physicians, physicists, radiation therapists during planning and treatment. While severe errors are uncommon, they can have profound consequences for patients. The Danish Society for Medical Physics supports a Special Interest Group dedicated to improving patient safety by analysing unintended events (UEs) and near misses in radiotherapy. Here we report on the work conducted with an updated system for categorising UEs in radiotherapy in Denmark. Material and methods: An updated reporting system based on the English Radiotherapy Pathway Coding (RPC) system has been taken into use in 2025. This system, including the use of a Danish system that ranks the UEs from the patients perspective, called Patient Centred Coding, is outlined and UEs reported in 2025 are summarised. Results: Radiotherapy is generally a safe treatment modality, a conclusion further supported by our results from 2025. In 2025 only 339 UEs were reported, 315 of these with low risk and 24 with medium risks. The lesson learned is that the main focus in order to prevent the most harmful UEs should be on the delineation and the planning process. Interpretation: Based on our experience from this work, we recommend the development of a national system for categorising and ranking UEs. We further recommend establishing a national working group that meets regularly and focuses on UEs at a national level.
creator: Kirsten L Jakobsen
creator: Annette R Jakobsen
creator: Karina L Gottlieb
creator: Martin Berg
creator: Harald Spejlborg
creator: Susan B N Biancardo
creator: Bob Smulders
creator: Heidi S. Rønde
rights: Copyright (c) 2026 Kirsten L Jakobsen, Annette R Jakobsen, Karina L Gottlieb, Martin Berg, Harald Spejlborg, Susan B N Biancardo, Bob Smulders, Heidi S. Rønde https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-05-11
publication date: 2026-05-11
volume: 65
starting page: 416
ending page: 421
doi: 10.2340/1651-226X.2026.45699

Incidence and impact of pseudoprogression and mixed responses in metastatic renal cell carcinoma patients treated with ipilimumab/nivolumab: a retrospective analysis
type: item
description: Introduction: Immune checkpoint inhibitors can elicit atypical responses such as pseudoprogression (psPD) and mixed responses (MR). We aimed to analyze the occurrence and prognostic impact of atypical responses in metastatic clear-cell renal cell carcinoma (m-ccRCC) patients treated with ipilimumab/nivolumab. Materials and methods: In this retrospective series of m-ccRCC patients treated with ipilimumab/nivolumab in first-line, we performed radiographic evaluation using Response Evaluation Criteria in Solid Tumors and iRECIST consensus guidelines and compared both methods. Results: We assessed 258 baseline target lesions in 100 eligible patients. MR occurred in 24% of patients. In 15 patients (62%), the MR evolved to confirmed progressive disease (cPD), while in nine patients (38%), the MR evolved toward a partial response (PR) and was thus a psPD. psPD occurred in 13% of patients: with increase of all lesions in four patients or with MR features in nine patients. psPD patients had the second best time-to-progression (TTP) and cancer-specific survival (CSS), slightly lower compared to TTP and CSS in patients with PR without a phase of psPD and better than TTP and CSS in patients with stable disease as best response. From all patients who presented with PD at first CT evaluation (n = 40), including 17 patients with unconfirmed progressive disease and 23 patients with MR, in 12 (30%) patients this was a psPD and led to a PR. Conclusions: Atypical responses such as psPD and MR occurred in 13 and 24% of m-ccRCC patients treated with ipilimumab/nivolumab. Patients with psPD had favorable outcomes, while MR in most cases evolved to progression.
creator: Aaron Caeyman
creator: Giulia Mammone
creator: Lisa Kinget
creator: Marcella Baldewijns
creator: Liesbeth De Wever
creator: Maarten Albersen
creator: Philip R Debruyne
creator: Octavie Demeulenaere
creator: Edward Scott McTaggart
creator: Saurabh Saraswat
creator: Charlien Berghen
creator: Gert De Meerleer
creator: Stefan Naulaerts
creator: Abhishek D Garg
creator: Benoit Beuselinck
rights: Copyright (c) 2026 Aaron Caeyman, Giulia Mammone, Lisa Kinget, Marcella Baldewijns, Liesbeth De Wever, Maarten Albersen, Philip R Debruyne, Octavie Demeulenaere, Edward Scott McTaggart, Saurabh Saraswat, Charlien Berghen, Gert De Meerleer, Stefan Naulaerts, Abhishek D Garg, Benoit Beuselinck https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-05-06
publication date: 2026-05-06
volume: 65
starting page: 379
ending page: 388
doi: 10.2340/ao.v65.45460

Real-world outcomes of pembrolizumab in advanced anal cancer: a nationwide Danish anal Cancer Group report
type: item
description: Background and purpose: Squamous cell carcinoma of the anal canal (SCCA) is a rare malignancy with limited treatment options for advanced or metastatic disease. Immune checkpoint inhibitors (ICIs) have shown durable responses in clinical trials, but evidence derives from small and highly selected populations. This study investigates the effectiveness and tolerability of pembrolizumab in an unselected real-world cohort. Patient/material and methods: This retrospective, multicenter cohort study evaluated the real-world efficacy, durability, and safety of pembrolizumab in Danish patients with advanced or metastatic SCCA treated between September 2018 and September 2023. A total of 37 patients, who received at least one dose of pembrolizumab for non-resectable, recurrent or metastatic disease, were included (89% ≥ 2nd line). Median age was 64 years, the majority were female (64.9%), and most tumours were human papillomavirus (HPV) (p16) positive (73.0%). Results: The objective response rate (ORR) was 13.5%, with two complete and three partial responses. The clinical benefit rate (CBR) was 48.6%, and two patients had durable responses exceeding 24 months. Median progression-free survival (PFS) and overall survival (OS) were 4.0 months 95% confidence interval (CI) (2.6–5.5) and 12.1 months 95% CI (7.6–15.2), respectively. Patients with good performance status and HPV-positive disease had significantly improved survival outcomes. Treatment was well tolerated, and no treatment-related deaths were reported. Interpretation: In this real-world cohort, pembrolizumab demonstrated durable responses in a subset of patients with advanced SCCA and an acceptable safety profile. Outcomes were comparable to clinical trial data, indicating modest activity. Findings support using pembrolizumab as a treatment option in selected patients, but further evidence is needed to refine its role.
creator: Karen-Lise Garm Spindler
creator: Christian Andreas Hvid
creator: Lars Ulrik Fokdal
creator: Karen Lycke Wind
creator: Anne Vittrup Jakobsen
creator: Rikke Løvendahl Eefsen
creator: Eva Serup-Hansen
rights: Copyright (c) 2026 Karen-Lise Garm Spindler, Christian Andreas Hvid, Lars Ulrik Fokdal, Karen Lycke Wind, Anne Vittrup Jakobsen, Rikke Løvendahl Eefsen, Eva Serup-Hansen https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-05-11
publication date: 2026-05-11
volume: 65
starting page: 394
ending page: 400
doi: 10.2340/1651-226X.2026.44690

Adenocarcinoma of the small intestine cohort: prospectively collecting real-world data to improve care and quality of life for patients with a rare cancer
type: item
description: Background and purpose: Small intestinal adenocarcinoma (SIA) is a rare cancer with a poor prognosis. Optimal treatment strategies are unclear as biological understanding of the disease is limited and randomized controlled trials are lacking. Current management is based on protocols for other gastrointestinal cancers. Therefore, the AdenoCarcinoma of the Small Intestine (ACSI) cohort was initiated, a subcohort of the nationwide Prospective Dutch ColoRectal Cancer cohort (PLCRC) study. The ACSI cohort aims to provide a large-scale, prospective SIA cohort, where clinical and molecular data will be combined to improve knowledge on tumor biology, treatment responsiveness, disease outcome and patient reported outcomes (PROs). Patient/material and methods: All adult SIA patients in the Netherlands are eligible for inclusion. Nationwide inclusion is facilitated by 68 hospitals. Clinical data are collected, as well as optional PROs, pathology- and blood samples. Results: Until June 2025, 143 patients have been enrolled. Data of the first 105 patients show a median age of 65 years (interquartile range 58–73) at diagnosis with a slight male predominance (60%). Most tumors are located in the duodenum (57%) and 27% of patients present with stage IV disease, with a majority having single-site metastases (64%). Primary tumor resection is performed in 80%, while systemic treatment is administered in 42%. Four patients did not receive any anti-tumor treatment (14%). Mismatch repair deficiency is detected in 28% of patients. Interpretation: The ACSI cohort enables structured national collection of clinical data, tumor samples and PROs of SIA patients. These data provide a valuable source for further research and improvement of care for this patient group.
creator: Pascale J.M. Schafrat
creator: Tim R. de Back
creator: Felice N. van Erning
creator: Frederieke H. van der Baan
creator: Geraldine R. Vink
creator: Miriam Koopman
creator: Ruben S.A. Goedegebuure
creator: Louis Vermeulen
creator: Ignace H.J.T. de Hingh
creator: Dirkje W. Sommeijer
rights: Copyright (c) 2026 Pascale J.M. Schafrat, Tim R. de Back, Felice N. van Erning, Frederieke H. van der Baan, Geraldine R. Vink, Miriam Koopman, Ruben S.A. Goedegebuure, Louis Vermeulen, Ignace H.J.T. de Hingh, Dirkje W. Sommeijer https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-04-28
publication date: 2026-04-28
volume: 65
starting page: 363
ending page: 369
doi: 10.2340/ao.v65.45471

Radiotherapy and diagnostic capacity in relation to the changing cancer burden in the Baltic States
type: item
description: Background and purpose: Cancer mortality rates in the Baltic States (Estonia, Latvia, and Lithuania) exceeds the European Union (EU) average, in part due to limited access to radiation therapy (RT). We updated RT capacity and utilization to inform regional planning. Patient/material and methods: We conducted a census of all 11 RT centres (2016–2023) via a standardized questionnaire, cross-validated with national registries and international databases. We compared technology availability, workforce, and utilization with EU countries in relation to the present cancer burden and projections to 2050. This multicentre observational study adhered to STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE) guidelines. Results: Only 35–42% of cancer patients received RT, below the 50% recommendation. Linear accelerator availability ranged from 3.8 to 5.1 per million inhabitants, figures that are almost half those seen in EU countries with higher Gross Domestic Product (GDP) per capita. While the use of intensity modulated RT, volumetric modulated arc therapy and stereotactic RT increased, staffing levels has remained static in recent years. Mortality-to-incidence ratio correlated negatively with GDP (r = –0.7) and RT capacity (r = –0.7). Interpretation: Despite technological progress in the Baltic States, major gaps persist in RT access and workforce levels. Baltic States still underperform compared to EU countries with higher GDP per capita in terms of equipment availability, workforce capacity, and overall cancer outcomes. Future-oriented strategic investments, based on regional collaboration and shared infrastructure are urgently needed, including the development of a regional particle therapy centre, to ensure equitable access to state-of-the art advanced cancer care across the Baltic States.
creator: Erika Korobeinikova
creator: Kristaps Paļskis
creator: Manjit Dosanjh
creator: Freddie Bray
creator: Eduard Gershkevitsh
creator: Inga Balode
creator: Alvis Bernans
creator: Gaļina Boka
creator: Laimonas Jaruševičius
creator: Zanda Liepa
creator: Māris Mežeckis
creator: Aista Plieskienė
creator: Maija Radziņa
creator: Romas Skomskis
creator: Giedrė Smailytė
creator: Sandra Stepiņa
creator: Jonas Venius
rights: Copyright (c) 2026 Erika Korobeinikova, Kristaps Paļskis, Manjit Dosanjh, Freddie Bray, Eduard Gershkevitsh, Inga Balode, Alvis Bernans, Gaļina Boka, Laimonas Jaruševičius, Zanda Liepa, Māris Mežeckis, Aista Plieskienė, Maija Radziņa, Romas Skomskis, Giedrė Smailytė, Sandra Stepiņa, Jonas Venius https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-04-27
publication date: 2026-04-27
volume: 65
starting page: 355
ending page: 362
doi: 10.2340/ao.v65.45442

The role of radiotherapy in patients with advanced melanoma failing targeted therapy
type: item
description: Background and purpose: Approximately 50% of patients with metastatic melanoma harbor mutations in the BRAF gene, making them eligible for targeted therapy (TT). However, treatment options become limited once resistance develops. The role of radiotherapy (RT) in this context remains uncertain, and concerns exist regarding toxicity when RT is delivered concurrently with TT. Patient/material and methods: This retrospective study included metastatic melanoma patients treated with RT after experiencing disease progressing on TT between 2015 and 2023. Patients were grouped by subsequent systemic therapy: RT-STOP (discontinued TT), RT-TT (continued TT), and RT-ICI (switched to immune checkpoint inhibitors (ICI)). Study endpoints were progression-free survival (PFS), overall survival (OS), efficacy, and toxicity. Results: Sixty-three patients were analyzed. Median PFS and OS were 1.9 and 3.1 months. The median OS in RT-STOP, RT-TT, and RT-ICI was 1.7, 4.7, and 3.0 months, while the 1-year OS rate was 4.9, 7.6, and 33.4%, respectively (p = 0.001). RT was well tolerated, with no grade ≥3 adverse events observed and 50.9% of patients derived a local benefit. Interpretation: In advanced melanoma patients with disease progression on TT, RT was safe and provided a local effect. Although survival outcomes remained suboptimal, continuation of TT beyond progression or transition to ICI following RT was associated with improved OS compared with discontinuation of TT. These results support the role of RT as a safe bridging modality, suggest benefit from treatment beyond progression with TT, and warrant confirmation in prospective trials.
creator: Ellen Heurlin
creator: Lina Grödeberg
creator: Hildur Helgadottir
rights: Copyright (c) 2026 Ellen Heurlin, Lina Grödeberg, Hildur Helgadottir https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-04-24
publication date: 2026-04-24
volume: 65
starting page: 344
ending page: 354
doi: 10.2340/ao.v65.45437

Feasibility of patient-reported outcomes collection in clinical routine at a radiotherapy department
type: item
description: Background and purpose: Routine collection of patient-reported outcome measures (PROMs) may provide valuable real-world data on quality of life (QoL) and treatment tolerability, complementing clinical outcomes. This study evaluated the feasibility of launching a semi-automated, department-wide PROM collection program at a large tertiary radiotherapy centre. Patients and methods: Patients ≥ 18 years referred for radiotherapy were invited to participate. Exclusion criteria were inability to provide informed consent, severe cognitive conditions, or language barriers. PROMs were collected using a web-based application (“Blå Appen”) at baseline, end-of-treatment, and follow-up intervals, using the EORTC QLQ-C30 questionnaire (Version 3). Results: During the study period (January 2022 to April 2025), 12,472 patients underwent treatment in the department. A total of 4,764 provided informed consent for study participation, where 3,699 (77.6%) remained after exclusion due to data loss or data inconsistency. Among these, 3,056 patients (82.6%) provided at least one usable PROM questionnaire at baseline. Participants were younger (median age 69 years vs. 71 years). Overall, global health status was relatively high at baseline and remained stable or slightly improved at one-year follow-up. To further investigate clinically significant changes in QoL over time, we evaluated the proportion of patients in each diagnostic category who experienced a change of > 10 points in selected QLQ-C30 scales between baseline and follow-up. Breast cancer patients had the highest rates of meaningful improvement and the lowest rates of major deterioration. In contrast, prostate cancer patients were more prone to significant declines in QoL scales over time. Interpretation: This prospective study demonstrates that department-wide collection of PROM is feasible. Using a digital platform, we achieved a high initial response rate and successfully engaged patients across a broad range of cancers. The …
creator: Ingrid Fagerström Kristensen
creator: Anton Linnér
creator: Martin Nilsson
creator: Viktor Rogowski
creator: Per Munck af Rosenschöld
creator: Mats Jerkeman
rights: Copyright (c) 2026 Ingrid Fagerström Kristensen, Anton Linnér, Martin P Nilsson, Viktor Rogowski, Per Munck af Rosenschöld, Mats Jerkeman https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-04-22
publication date: 2026-04-22
volume: 65
starting page: 326
ending page: 332
doi: 10.2340/ao.v65.45546

Increasing survival disparity between children, adolescents, and young adults with osteosarcoma or Ewing sarcoma of bone from 1990 to 2024: a population-based cohort study
type: item
description: Background and purpose: Bone sarcomas are important contributors to early-life cancer mortality and morbidity. Optimisation of treatment regimens has improved survival, but the survival disparity between children, adolescents and young adults has widened. Population-based studies are needed to understand and address these disparities. This is the first comprehensive study of early-life bone sarcomas in Denmark. Patient/material and methods: We combined population-wide data from national registers from 1990 to 2024 with clinical data from patient records. We calculated age-standardised incidence rates, 5-year relative survival rates stratified by several clinical factors, and Aalen-Johansen estimators for relapse/progression and death within 5 years. Results: A total of 578 patients under 40 years of age were diagnosed with either osteosarcoma (n = 336) or Ewing sarcoma of bone (n = 242) in Denmark between 1990 and 2024. Five-year relative survival improved for patients aged 0–24 years but stagnated for those aged 25–39 years. We observed age-dependent differences in the distribution of tumours and in relative survival across anatomical sites, tumour sizes, and treatment regimens. Metastatic disease or a tumour diameter of > 8 cm reduced relative survival by 19 to 45 percentage points. Interpretation: Survival disparities between children, adolescents, and young adults with bone sarcomas are likely multifactorial. Age-dependent differences in the distribution of tumours across anatomical sites and in tumour size appear to play a role. The incidence of and survival from relapse/progression also appear to favour younger patients. Including patients in international, joint paediatric-adult treatment protocols remains a high priority.
creator: Daniel Thor Halberg Dybdal
creator: Klaus Rostgaard
creator: Henrik Hjalgrim
creator: Ninna Aggerholm-Pedersen
creator: Niels Junker
creator: Thomas Baad-Hansen
creator: Pernille Wendtland Edslev
creator: Eva Kristine Ruud Kjær
creator: Akmal Safwat
creator: Michael Mørk Petersen
creator: Lisa Lyngsie Hjalgrim
rights: Copyright (c) 2026 Daniel Thor Halberg Dybdal, Klaus Rostgaard, Henrik Hjalgrim, Ninna Aggerholm-Pedersen, Niels Junker, Thomas Baad-Hansen, Pernille Wendtland Edslev, Eva Kristine Ruud Kjær, Akmal Safwat, Michael Mørk Petersen, Lisa Lyngsie Hjalgrim https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-04-22
publication date: 2026-04-22
volume: 65
starting page: 316
ending page: 325
doi: 10.2340/ao.v65.45405

Prevalence of self-reported pain in patients 5 years after rectal cancer treatment: results from the prospective QoLiRECT cohort study
type: item
description: Background and purpose: Pain as a long-term outcome following rectal cancer treatment has received limited attention in previous studies. This prospective cohort study examined pain prevalence up to 5 years post-surgery in patients treated with curative intent. Secondary aims included evaluating pain intensity and its interference with daily life, and comparing pain experiences with a reference population. In addition, potential risk factors for pain were explored. Patient/material and methods: The study is based on the multicenter prospective cohort study QoLiRECT including patients from 16 surgical departments in Denmark and Sweden (2012–2015). Questionnaires regarding Quality of Life were administered at diagnosis and at 1, 2 and 5 years after treatment. Information about self-assessed pain was primarily derived from the ‘Brief Pain Inventory – Short Form’. Comparisons were made with an age- and sex- matched reference population. Results: Five years post-treatment, 37% of rectal cancer survivors reported pain exceeding common types of pain, with an average pain level of 3.8 and interference score of 3.1 (range 0–10). Pain was mainly located to the lower extremities, back and pelvis. Surprisingly, pain prevalence was higher in the reference population (53%), a difference consistent at all time points. No significant difference was found between groups regarding average pain or interference. Higher pain levels were associated with female sex, severe baseline pain, and elevated Body Mass Index (BMI). Interpretation: Pain was more common in the reference population, while intensity and interference were similar between groups. This suggests that the experience of pain may differ after surviving cancer, and such differences might be considered when studying pain in cancer survivors.
creator: Tekla Kjellberg Nätterdal
creator: Rode Grönkvist
creator: Eva Haglind
creator: Jacob Rosenberg
creator: Elisabeth González
creator: Dan Asplund
creator: Sofie Walming
creator: Eva Angenete
rights: Copyright (c) 2026 Tekla Kjellberg Nätterdal, Rode Grönkvist, Eva Haglind, Jacob Rosenberg, Elisabeth González, Dan Asplund, Sofie Walming, Eva Angenete https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-04-22
publication date: 2026-04-22
volume: 65
starting page: 306
ending page: 315
doi: 10.2340/ao.v65.45198

Risk factors for distant recurrence in patients with rectal cancer supporting selection for total neoadjuvant therapy
type: item
description: Background and purpose: In locally advanced rectal cancer, distant recurrence remains a major challenge. Total neoadjuvant therapy (TNT) has been implemented to reduce this risk. Identification of risk factors for distant recurrence to support selection of TNT is crucial to avoid excessive treatment. This study aimed to identify magnetic resonance imaging (MRI) features predictive of distant recurrence in patients with rectal cancer. Material and methods: In this national retrospective cohort study, all patients were diagnosed with non-metastatic rectal cancer between 2016 and 2020 and received neoadjuvant radiotherapy followed by surgery. MRI features from the diagnostic report, including cT-stage, cN-stage, clinical extramural vascular invasion (cEMVI), distance to the mesorectal fascia (MRF), and tumor deposit, were registered. The primary endpoint was distant recurrence. Results: A total of 648 patients were included in the study. In multivariate analysis using multiple imputation, risk factors significantly associated with distant recurrence were cT3c/cT3d/cT4-stage (hazard ratio [HR]: 1.8), cEMVI positive tumors (HR: 2.05), and cT3-stage tumors with a distance to MRF of ≤ 2 mm (HR: 1.51) compared with patients with cT1/cT2/cT3/cT3a/cT3b-stage, cEMVI negative tumors, and cT3-stage tumors with a distance to MRF > 2 mm, respectively. The cN-stage was not significantly associated with distant recurrence. Due to 67% missing data on tumor deposit status, the results regarding this feature cannot be considered conclusive. Interpretation: In this study, cT-stage, cEMVI status, and distance to MRF are prognostic features for risk stratification for patients receiving neoadjuvant radiotherapy. These results may be used for selecting patients for future treatment strategies such as TNT.
creator: Anna Baech Slipsager
creator: Rana Bahij
creator: Heidi Søgaard Christensen
creator: Laura Vittrup Diness
creator: Birgitte Mayland Havelund
creator: Anne Ramlov
creator: Signe Korsgaard Skriver
creator: Joanna Eliza Szpejewska
creator: Olga Tcacenco
creator: Christian Thomsen
creator: Laurids Østergaard Poulsen
rights: Copyright (c) 2026 Anna Baech Slipsager, Rana Bahij, Heidi Søgaard Christensen, Laura Vittrup Diness, Birgitte Mayland Havelund, Anne Ramlov, Signe Korsgaard Skriver, Joanna Eliza Szpejewska, Olga Tcacenco, Christian Thomsen, Laurids Østergaard Poulsen https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-04-17
publication date: 2026-04-17
volume: 65
starting page: 289
ending page: 296
doi: 10.2340/ao.v65.45169

Temporal trends in diagnostic work-up, treatment, and mortality in locally advanced prostate cancer in 2016–2024: nationwide, population-based study in Sweden
type: item
description: Background and purpose: We aimed to describe temporal changes in diagnostic work-up, treatment, and prostate cancer (PCa) mortality in locally advanced PCa in 2016–2024 in Sweden. Patient/material and methods: Men registered in the National Prostate Cancer Register of Sweden in 2016–2024 with locally advanced PCa; clinical T stage 3–4, no distant metastases, and prostate-specific antigen < 100 ng/ml were included. We computed the proportion of use of prostate magnetic resonance imaging (MRI) before biopsy, radical prostatectomy, radical radiotherapy, androgen deprivation therapy, and abiraterone, and described the trend in PCa mortality across three calendar periods. Results: During the 9-year study period 7,484 men with locally advanced PCa were identified. Use of MRI before biopsy increased from 3% in 2016 to 73% in 2024. Concomitantly, radical treatment increased from 35% to 48%, entirely due to increased use of radiotherapy. Abiraterone was not used before 2022 but 31% received this treatment in 2024. The 3-year PCa mortality decreased from 8% (95% confidence interval [CI]: 7–9) in 2016–2018 to 6% (95% CI: 4–8) in 2022–2024. Interpretation: In this nationwide, population-based study of men with locally advanced PCa, the use of MRI before biopsy, radical radiotherapy, and treatment with abiraterone increased over time. These changes coincided with a modest decrease in 3-year PCa mortality.
creator: Armando Galdieri
creator: Hans Garmo
creator: Rolf Gedeborg
creator: Mats Ahlberg
creator: Andri Wilberg Orrason
creator: Eugenio Ventimiglia
creator: Pär Stattin
creator: Marcus Westerberg
rights: Copyright (c) 2026 Armando Galdieri, Hans Garmo , Rolf Gedeborg , Mats Ahlberg, Orrason Andri Wilberg, Eugenio Ventimiglia, Pär Stattin, Marcus Westerberg https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-04-15
publication date: 2026-04-15
volume: 65
starting page: 282
ending page: 288
doi: 10.2340/ao.v65.45593

Malpractice claims for pancreatic cancer in Norway: claim-rates, injury domains, claim outcomes and indemnity compensation
type: item
description: ABSTRACT Background and purpose: Pancreatic cancer is difficult to diagnose early and at a curative stage, yet little is known about errors in management. The aim of the study was to investigate malpractice claims in Norway. Patients and Methods: All malpractice claims filed to the Norwegian System of Patient Injury Compensation between 2015 and 2024 for pancreatic cancer were evaluated. Results: A total of 148 claims (median 15 [range 8–20] claims/year) were filed among 9548 patients with pancreatic cancer, for an average claim rate of 1.55% (1 claim per every 65 pancreatic cancers). Most claims were filed against hospital/specialists (n = 90), followed by general practitioners (n = 49) with nine claims towards private practice contractors (P < 0.001). A total of 33 claims (22.3%) were approved, of which 28 (85%) concerned delayed diagnosis. Radiology was involved in 18 of the 33 approvals. According to caretaker-level for the malpractice claim, approved claims were 23% for hospital-claims, with lowest approval-rate against general practitioners (12%), and highest against private contractors (66%). Median delay in diagnosis was estimated at 6 months. The outcome of the error was ‘death’ in 16 of 33. Prognostic loss was determined in five of 33 patients, while 12 patients had no prognostic loss despite an approved claim. Caretaker-level did not differ regarding death or prognostic loss in claims (P = 0.203). A total of 1.47 million EUR was paid in indemnity payments. Interpretation: The claim rate of 1.5% was stable, with about one in five claims approved. Diagnostic delay was the predominant cause, with several stakeholders involved across the healthcare system.
creator: Annbjørg H Søreide
creator: Karin H. Edland
creator: Andreas B. Alvestad
creator: Solveig Hodne
creator: Kjetil Søreide
rights: Copyright (c) 2026 Annbjørg H Søreide, Karin H. Edland, Andreas B. Alvestad, Solveig Hodne, Kjetil Søreide https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-04-13
publication date: 2026-04-13
volume: 65
starting page: 273
ending page: 281
doi: 10.2340/ao.v65.45500

Targeted therapy in the treatment of lung cancer in Iceland 2010–2023
type: item
description: Background and purpose: Lung cancer is the third most common malignancy in Iceland and remains the leading cause of cancer-related mortality. Lung cancer may harbor driver mutations affecting the function of Epidermal growth factor receptor (EGFR), Anaplastic lymphoma kinase (ALK), ROS proto-oncogene 1 (ROS1), B-raf proto-oncogene (BRAF), RET proto-oncogene (RET), MET proto-oncogene (MET), and NTRK, which can influence the selection of targeted therapies and treatment outcomes. In Iceland, EGFR testing was initiated in 2005, and in 2016, multigene targeted panel became standard for tumor testing. The objective was to determine the uptake of testing and frequency of targeted mutations in lung cancer nationwide, the utilization of targeted therapies, and duration of such treatments. Patients/material and methods: Data on lung cancer diagnoses and stage at diagnosis were obtained from the Icelandic Cancer Registry, and molecular testing results were retrieved from the Department of Pathology at Landspitali University Hospital. Treatment data and outcomes were obtained from a central prescription/death registry and chart reviews. Results: From 2010 to 2023, 2,528 patients were diagnosed with lung cancer, and 25% underwent ­molecular tumor testing, with 90% of stage IV adenocarcinomas tested in 2023. During comprehensive molecular testing in 2016–2023, targeted mutations were detected in 19.3% of tested patients: EGFR 9.9%, BRAF 2.3%, MET 2.7%, HER2 1.2%, ALK 2.7%, ROS1 0.6%, and RET 0.2%. Among patients found to have targeted mutations (2010–2023), 61.2% received targeted therapy; 33.8% remained on therapy for ≥ 12 months, and 13.5% for ≥ 24 months. Interpretation: The use of molecular testing has increased significantly in the last 20 years, and the ­adaptation of new targeted therapies has been rapid.
creator: Stefanía Ásta Tryggvadóttir
creator: Guðlaugur V. Stefánsson
creator: Helgi Birgisson
creator: Örvar Gunnarsson
creator: Tómas Guðbjartsson
creator: Hrönn Harðardóttir
creator: Bylgja Hilmarsdóttir
creator: Rósa B. Barkardóttir
creator: Sigurdis Haraldsdottir
rights: Copyright (c) 2026 Stefanía Ásta Tryggvadóttir, Guðlaugur V. Stefánsson, Helgi Birgisson, Örvar Gunnarsson, Tómas Guðbjartsson, Hrönn Harðardóttir, Bylgja Hilmarsdóttir, Rósa B. Barkardóttir, Sigurdis Haraldsdottir https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-04-09
publication date: 2026-04-09
volume: 65
starting page: 261
ending page: 267
doi: 10.2340/ao.v65.45118

Association between short-term radiation-induced toxicity and oncological outcomes in high-risk prostate cancer: a retrospective single-centre cohort study
type: item
description: Background and purpose: This retrospective cohort study aimed to explore the association between short-term genitourinary (GU) and gastrointestinal (GI) toxicity and oncological outcomes in high-risk prostate cancer patients treated with external beam radiotherapy (EBRT) alone or with high-dose-rate brachytherapy (HDR-BT). Patient/material and methods: High-risk prostate cancer patients treated at Örebro University Hospital (2008–2021) were divided into two cohorts based on treatment modality: EBRT-only (66 Gy/22 fractions), EBRT-BT (42 Gy/14 fractions + 14.5 Gy HDR-BT-boost). Maximum 6-month toxicity grade was categorised as: GU-low (grade 0–1), GU-high (grade ≥ 2), GI-low (grade 0) and GI-high (grade ≥ 1), respectively. Freedom from biochemical failure (FFBF), metastasis-free survival (MFS) and overall survival were compared between the low- and high- toxicity groups, using Kaplan–Meier and Cox proportional hazards regression. Prostate cancer-specific mortality was compared between the groups using the Aalen–Johansen method and Fine-Gray regression. Results: The EBRT-only cohort encompassed 114 and 162 patients for GU- and GI-analyses. The EBRT-BT cohort comprised 306 patients for GU- and 344 patients for GI-analyses. High GU-toxicity was associated with inferior FFBF (adjusted hazard ratio (aHR) = 2.57, 95% Confidence Interval [CI] = 1.32–5.00) and MFS (aHR = 2.22, 95% CI = 1.21–4.07) in the EBRT-only but not in the EBRT-BT cohort. No statistically significant associations were found between GI-toxicity and oncological outcomes. Interpretation: Early grade ≥ 2 GU-toxicity was linked to worse FFBR and MFS after EBRT alone, whereas no such association was seen after EBRT-BT. GI toxicity showed no prognostic impact. These exploratory findings warrant validation in larger studies addressing interactions between patient-, tumour- and treatment-related factors.
creator: Jenny Kahlmeter Brandell
creator: Antonis Valachis
creator: Henrik Ugge
creator: Daniel Smith
creator: Bengt Johansson
rights: Copyright (c) 2026 Jenny Kahlmeter Brandell, Antonis Valachis, Henrik Ugge, Daniel Robert Smith, Bengt Johansson https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-03-23
publication date: 2026-03-23
volume: 65
starting page: 241
ending page: 251
doi: 10.2340/1651-226X.2026.45030

How does pulmonary function impact QoL in patients with locally advanced NSCLC treated with chemoradiotherapy and durvalumab?
type: item
description: Background: Impaired pulmonary function is common among patients with lung cancer and may negatively affect health-related quality of life (HRQoL). The primary objective of the present sub-study of the DART-trial was to assess the overall quality of life changes during treatment and stratified by the presence of Chronic Obstructive Pulmonary Disease (COPD). Methods: The investigator-initiated DART trial (NCT04392505) included patients with unresectable stage III non-small cell lung cancer (NSCLC) treated with chemoradiotherapy followed by durvalumab. Baseline pulmonary function was measured by spirometry, and patients were stratified by FEV1/FVC <70% (COPD) or ≥70% (non-COPD). HRQoL was assessed regularly using the EORTC QLQ-C30 and QLQ-LC13 questionnaires at screening and during treatment. A difference in mean score of ≥10 was defined as clinically significant. Results: A total of 86 patients initiated durvalumab and completed at least one HRQoL assessment; pulmonary function data were available for 64 patients. For the overall cohort, quality of life scores remained stable throughout treatment. Patients with COPD consistently reported lower global health scores than those with preserved lung function. The global health score among patients with COPD was not significantly different at end of treatment compared to baseline, however significantly lower than patients without COPD. Symptom trajectories across QLQ-C30 scales were stable in both groups. Dyspnoea was more prevalent among patients with COPD. In the LC13 module, no clinically significant differences were observed except for dyspnoea, which was consistently higher among patients with COPD. Interpretation: The HRQoL remained stable during chemoradiotherapy and durvalumab treatment in stage III NSCLC patients. Impaired lung function was associated with modestly lower HRQoL, though larger studies are needed to confirm subgroup effects.
creator: Frigg Å. Sommervoll
creator: Henrik Horndalsveen
creator: Dag Einar Sommervoll
creator: Jussi Koivonen
creator: Tarje Onsøien Halvorsen
creator: Bjørn Henning Grønberg
creator: Marianne Aanerud
creator: Saulius Cicenas
creator: Nina Helbekkmo
creator: Jarkko Ahvonen
creator: Maria Silvoniemi
creator: Gina Barrera
creator: Maria M. Bjaanæs
creator: Vilde Haakensen
creator: Åsa Öjlert
creator: Kersti Oselin
creator: Åslaug Helland
creator: Tesfaye Madebo
rights: Copyright (c) 2026 Frigg Å. Sommervoll, Henrik Horndalsveen , Dag Einar Sommervoll, Jussi Koivonen, Tarje Onsøien Halvorsen, Bjørn Henning Grønberg, Marianne Aanerud, Saulius Cicenas, Nina Helbekkmo, Jarkko Ahvonen, Maria Silvoniemi, Gina Barrera, Maria M. Bjaanæs, Vilde Haakensen, Åsa Öjlert, Kersti Oselin, Åslaug Helland, Tesfaye Madebo https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-03-19
publication date: 2026-03-19
volume: 65
starting page: 232
ending page: 240
doi: 10.2340/1651-226X.2026.45040

Real-world management of patients with simultaneously diagnosed synchronous liver and lung metastatic colorectal cancer – a national cohort study
type: item
description: Background and purpose: Real-world data on management and outcomes of patients with simultaneously diagnosed synchronous colorectal liver and lung metastases are limited. This national study evaluated referral patterns, treatment strategies, and survival in a population-based cohort. Patient/material and methods: This retrospective cohort study used Swedish national registries to identify patients with synchronous liver and lung metastatic colorectal cancer (CRC), defined as metastases detected within 6 months of CRC diagnosis between 2008 and 2016. Medical record review provided additional information on diagnosis confirmation, multidisciplinary team (MDT) referral, metastatic burden, and treatment. Logistic regression identified factors associated with MDT referral and curative treatment, and Cox regression with a time-varying covariate assessed survival. Results: Among 2703 registry-identified patients, medical records were accessible for 855. After exclusion of extrahepatic, non-pulmonary metastases, 556 remained for analysis. A total of 189 patients (34%) were discussed at a liver MDT conference. Referred patients were younger, had lower metastatic burden, and better performance status than non-referred. Median survival was 24 months (95% CI [confidence interval] 21–28) for referred versus 10 months (95% CI 7–12) for non-referred patients. Curative local treatment of liver and/or lung metastases was performed in 101 patients (18%), and complete metastasectomy in 34 (6%), conferring superior survival compared with liver-only intervention (hazard ratio 0.34, 95% CI 0.18–0.61). The main reason for non-referral was presumed non-resectability. Interpretation: Referral to an MDT and subsequent local treatment were associated with improved survival, although this may partly reflect favorable patient and tumor characteristics influencing referral and treatment decisions. Patients with adequate physiological reserve should routinely be evaluated in an organ-specific MDT…
creator: Laia Faseh
creator: Petter Fruhling
creator: Helena Taflin
creator: Jenny Lundmark Rystedt
creator: Caroline Williamsson
creator: Oskar Hemmingsson
creator: Bergthor Björnsson
creator: Marco Gerling
creator: Ernesto Sparrelid
creator: Per Sandström
creator: Kristina Hasselgren
creator: Jennie Engstrand
rights: Copyright (c) 2026 Laia Faseh, Petter Fruhling, Helena Taflin, Jenny Lundmark Rystedt, Caroline Williamsson, Oskar Hemmingsson, Bergthor Björnsson, Marco Gerling, Ernesto Sparrelid, Per Sandström, Kristina Hasselgren, Jennie Engstrand https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-03-12
publication date: 2026-03-12
volume: 65
starting page: 201
ending page: 212
doi: 10.2340/1651-226X.2026.45045

Characteristics, treatment and survival of patients with chondrosarcoma in five European countries: a DARWIN EU® cohort study
type: item
description: Background and purpose: Chondrosarcoma is a rare bone malignancy with a poor response to systemic therapy in advanced stages. European-level epidemiological data remain scarce. This study aimed to characterise patient demographics, treatments and survival using real-world data to inform regulatory decisions about the feasibility and design of new trials for the systemic treatment of chondrosarcoma. Patient/material and methods: This cohort study, part of the DARWIN EU® initiative, analysed data from six healthcare databases in Finland, France, the Netherlands, Spain and the UK. Patients diagnosed with chondrosarcoma between 2010 and 2022 were identified. Standardised analyses were performed within a federated network using the Observational Medical Outcomes Partnership (OMOP) Common Data Model. Results: A total of 2,498 chondrosarcoma patient records were identified, covering at least 2,356 unique patients. Median age at diagnosis was 52–55 years, with a balanced sex distribution. Surgical treatment was the most common intervention, recorded in 15.2% to 88.9% of patients, depending on the database. Fewer than 5% received systemic anticancer therapy, and radiotherapy was reported in fewer than 7%. The 10-year overall survival (OS) ranged from 58% (95% confidence interval [CI]: 43–78) to 80% (95% CI: 78–82), with restricted mean survival between 7.4 and 8.7 years. In the Netherlands, patients with late-stage, metastatic or high-grade disease showed significantly poorer outcomes. Interpretation: This study demonstrates the feasibility of using real-world data across Europe to describe chondrosarcoma patients. Most had early-stage, low-grade disease amenable to surgery, with limited use of systemic therapies. Survival was generally favourable, except in advanced disease. Clinical trials remain difficult due to the rarity of advanced chondrosarcoma and the lack of standards.
creator: Anton Barchuk
creator: Cesar Barboza
creator: Julieta Politi
creator: Berta Raventós
creator: Peter Prinsen
creator: Jelle Evers
creator: Vincent KY Ho
creator: Michiel AJ van de Sande
creator: Eric Fey
creator: Kimmo Porkka
creator: Anna Hammais
creator: Tiina Wahlfors
creator: Tuomo Nieminen
creator: Toni Lehtonen
creator: Antonella Delmestri
creator: Guillaume Verdy
creator: Romain Griffier
creator: Airam de Burgos-González
creator: Ana Llorente-Garcia
creator: Cristina Justo-Astorgano
creator: Miguel-Angel Macia-Martinez
creator: Olli Tenhunen
creator: Anja Schiel
creator: Alexandra Pacurariu
creator: Ross Brennan
creator: Ross Williams
creator: Katia Verhamme
creator: Talita Duarte Salles
rights: Copyright (c) 2026 Anton Barchuk, Cesar Barboza, Julieta Politi, Berta Raventós, Peter Prinsen, Jelle Evers, Vincent KY Ho, Michiel AJ van de Sande, Eric Fey, Kimmo Porkka, Anna Hammais, Tiina Wahlfors, Tuomo Nieminen, Toni Lehtonen, Antonella Delmestri, Guillaume Verdy, Romain Griffier, Airam de Burgos-González, Ana Llorente-Garcia, Cristina Justo-Astorgano, Miguel-Angel Macia-Martinez, Olli Tenhunen, Anja Schiel, Alexandra Pacurariu, Ross Brennan, Ross Williams, Katia Verhamme, Talita Duarte Salles https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-03-10
publication date: 2026-03-10
volume: 65
starting page: 193
ending page: 200
doi: 10.2340/1651-226X.2026.45117

Prediction of dumping after oesophageal cancer surgery
type: item
description: Introduction: Dumping syndrome is a common consequence following oesophagectomy and may lead to reduced food intake, resulting in subsequent weight loss, and negatively impact health-related quality of life. This study aimed to develop a predictive model to facilitate preventive treatment planning by identifying individuals at an increased risk of developing dumping syndrome. Materials and methods: Data were obtained from a nationwide, population-based cohort of patients who underwent oesophagectomy for cancer between 2013 and 2020. Patient and clinical characteristics were retrieved from national health registries and medical records. Dumping symptoms were self-reported 1 year after surgery. Multivariable regression models provided odds ratios (OR) with 95% confidence intervals (CI). Model performance was evaluated using the area under the receiver operating characteristic curve (AUC). Results: Among the 384 individuals, 41 (11%) developed significant symptoms of dumping. The following variables that increased the probability of developing dumping were included in the final prediction model: younger age, female sex, higher preoperative body mass index, no neoadjuvant therapy, Charlson Comorbidity Index score > 0, open oesophagectomy, cervical anastomosis, and less severe postoperative complications (lower Clavien Dindo grade). For the prediction of early dumping symptoms, the AUC for the total cohort was 0.74 (95% CI: 0.64–0.83) and after cross-validation, 0.62 (95% CI: 0.53–0.72). For early and late symptoms, the AUC was 0.75 (95% CI: 0.67–0.83), and for the cross-validated model, 0.65 (95% CI: 0.56–0.74). Interpretation: This study offers insights into factors associated with dumping syndrome after oesophagectomy. The prediction model showed modest ability to distinguish between high and low-risk patients, and should therefore be interpreted as supportive rather than definitive. Its potential value lies in complementing clinical judgement, informing structured fo…
creator: Pernilla Lagergren
creator: Laima Kampa
creator: Kalle Mälberg
creator: William Jebril
creator: Johan Hardvik Åkerström
creator: Asif Johar
creator: Anna Schandl
rights: Copyright (c) 2026 Pernilla Lagergren, Laima Kampa, Kalle Mälberg, William Jebril, Johan Hardvik Åkerström, Asif Johar, Anna Schandl https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-03-05
publication date: 2026-03-05
volume: 65
starting page: 186
ending page: 192
doi: 10.2340/1651-226X.2026.45044

Outcome of resectable distal cholangiocarcinoma in a single-centre Western patient cohort: comparison of the 7th and 8th edition of the UICC/AJCC TNM classification
type: item
description: Background and purpose: Distal cholangiocarcinoma (CCA) is a rare malignancy with poor prognosis, even after surgical resection. Accurate staging is essential for guiding treatment and predicting outcomes. The 8th edition of the Union for International Cancer Control (UICC)/The American Joint Committee on Cancer (AJCC) TNM classification introduced depth of tumour invasion (DOI) as the criterion for T-staging (T1–T3) and a three-tiered lymph node (N) classification. This study evaluates patient stratification and prognostic accuracy of the 8th versus 7th edition in a single-centre Western cohort and discusses difficulties with measuring DOI. Patient/material and methods: Patients undergoing pancreatoduodenectomy for distal CCA at Oslo University Hospital (2015–2021) were retrospectively analysed. Tumours were restaged according to the 7th and 8th TNM editions. Survival was assessed using Kaplan–Meier estimates and log-rank tests to compare prognostic accuracy. Results: Seventy-one patients were included. Using the 7th edition, most cancers (94.4%, 67 patients) were categorised as T3. With the 8th edition, stage redistribution was notable: T2 included 45 patients (63.4%) and T3 included 22 (31.0%). Five-year survival was significantly better for T2 (31.8%) than T3 (10.5%) according to the 8th edition, demonstrating improved discrimination. The revised N classification provided better prognostic distinction, with median survival of 30 months for N1 (1–3 nodes) and 23 months for N2 (≥4 nodes). Interpretation: The 8th edition provides more accurate prognostic stratification of distal CCA compared to the 7th edition but requires meticulous, standardised pathology assessment to ensure accurate prognosis and appropriate post-surgical management.
creator: Maia Blomhoff Holm
creator: Sondre Busund
creator: Rahul Rihel
creator: Mushegh A. Sahakyan
creator: Ivar Prydz Gladhaug
creator: Caroline S. Verbeke
creator: Sheraz Yaqub
creator: Dyre Kleive
rights: Copyright (c) 2026 Maia Blomhoff Holm, Sondre Busund, Rahul Rihel, Mushegh A. Sahakyan, Ivar Prydz Gladhaug, Caroline S. Verbeke, Sheraz Yaqub, Dyre Kleive https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-19
publication date: 2026-02-19
volume: 65
starting page: 148
ending page: 155
doi: 10.2340/1651-226X.2026.44965

Real-world outcome of neoadjuvant therapy with or without pembrolizumab for triple-negative breast cancer
type: item
description: Background and purpose: Neoadjuvant therapy (NAT) has become standard therapy for early triple-negative breast cancer (TNBC). The aim of this study was to report real-world outcome of TNBC treated with NAT with or without pembrolizumab and to identify predictive factors for achieving pathologic complete response (pCR) in the pembrolizumab cohort. Patient/material and methods: The data of 75 consecutive TNBC patients treated with neoadjuvant chemotherapy and pembrolizumab at the Helsinki University Hospital Comprehensive Cancer Center were retrospectively collected. Treatment outcome and predictive factors for pCR were analyzed. Additionally, the outcome of nonmatched 102 consecutive TNBC patients treated without pembrolizumab during the preceding years is reported. Results: Forty-two patients (56.0%) achieved pCR to pembrolizumab-based NAT, while 47 patients (46.1%) without pembrolizumab had pCR. Lymph node metastasis (p = 0.011) and multifocality (p < 0.001) were inversely associated with pCR in the pembrolizumab cohort. Thirty-four patients (45.3%) had immune-related adverse events (irAEs), and 11 patients (14.7%) had grade 1–2 myocarditis in the pembrolizumab cohort. Due to adverse events (AEs), pembrolizumab was discontinued in 22 patients (29.3%) in the neoadjuvant setting, not started postoperatively in 21 patients (28%) and discontinued postoperatively in eight patients (10.7%). The number of preoperative pembrolizumab cycles was not associated with pCR. Interpretation: Despite higher incidence of myocarditis and interruption of the systemic therapy due to irAEs, higher pCR rates were seen with pembrolizumab. Even though the number of preoperative pembrolizumab cycles was not associated with pCR monitoring and limiting AEs is important.
creator: Meeri Maunu
creator: Juho Lähteenmaa
creator: Peeter Karihtala
creator: Suvi Tuohinen
creator: Joonas Laaksolilja
creator: Anders Ståhls
creator: Tuomo Meretoja
creator: Johanna Mattson
rights: Copyright (c) 2026 Johanna Mattson, Meeri Maunu, Juho Lähteenmaa, Peeter Karihtala, Suvi Tuohinen, Joonas Laaksolilja, Anders Ståhls, Tuomo Meretoja https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-19
publication date: 2026-02-19
volume: 65
starting page: 131
ending page: 140
doi: 10.2340/1651-226X.2026.44896

Post-treatment infection prediction in CLL using domain adaptation of lymphoma electronic health records
type: item
description: Background and purpose: Infections are the leading cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL) and occur during and after treatment. When deciding on the type of CLL treatment, the risk of infections is typically assessed based only on age and comorbidities; therefore, there is a need to develop a predictive model that incorporates information from multiple data sources. However, training an effective machine learning model requires a large sample size. Patient/material and methods: In this study, we developed a machine learning approach using domain adaptation (DA) to predict the risk of severe infection during treatment in patients with CLL. We implemented a DA strategy using lymphoma patient data and compared it with a domain-specific (DS) strategy across multiple models. Results: The DA strategy outperformed the DS strategy across all models, with an odds ratio of 4.43 for infection risk between high-risk and low-risk groups, compared with an odds ratio of 3.69 for the best DS model and 2.27 for the CLL-IPI alone. Explainability analysis identified predictive features for both the DA and DS models, including medication data and biochemistry tests. Specifically, C-reactive protein levels and non-therapeutic drugs were common features identified by both DA and DS models, while the DA models relied more heavily on alimentary tract drugs, solvents and diluting agents, and antibacterial medications. Interpretation: These findings highlight the value of integrating data from different diseases (lymphoma) to improve predictions in a target disease (CLL), and represent a step toward data-driven identification of CLL patients at high risk of infection during treatment.
creator: Mehdi Parviz
creator: Christian Brieghel
creator: Mikkel Werling
creator: Thomas Lacoppidan
creator: Emelie Rotbain
creator: Carsten U. Niemann
creator: Rudi Agius
rights: Copyright (c) 2026 Mehdi Parviz, Christian Brieghel, Mikkel Werling, Thomas Lacoppidan, Emelie Rotbain, Carsten U. Niemann, Rudi Agius https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-19
publication date: 2026-02-19
volume: 65
starting page: 109
ending page: 118
doi: 10.2340/1651-226X.2026.44569

Nordic Society of Paediatric Haematology and Oncology (NOPHO) Radiotherapy Working Group consensus guidelines on radiotherapy for paediatric low-grade gliomas
type: item
description: Background and purpose: Paediatric low-grade gliomas (pLGG) are the most common brain tumours in children. Radiotherapy, once the standard treatment for unresectable pLGG, is now used less frequently due to concerns about late side effects. The Nordic Society of Paediatric Haematology and Oncology (NOPHO) Radiotherapy Working Group aims to provide consensus guidelines on the use of radiotherapy for pLGG, addressing the current controversies and facilitating decision-making. Patient/material and methods: The guidelines were developed by clinical/radiation oncologists from the Nordic and Baltic countries and two international experts during a 2-day working group meeting. The meeting included presentations from the international experts and was preceded by a survey on radiotherapy practices and a non-systematic review of the literature on pLGG. Results: We present consensus-based recommendations for radiotherapy of pLGG. The guidelines discuss indications and timing of radiotherapy, age-related considerations, and the impact of genetic predisposition disorders such as neurofibromatosis type 1. Modern radiotherapy techniques, such as proton therapy, are highlighted for their potential to reduce long-term side effects. Interpretation: Radiotherapy remains the most effective treatment for unresectable pLGG, but its use must be carefully weighed against the risk of long-term side effects. The guidelines emphasise a personalised treatment approach, considering the evolving field of targeted therapies and the importance of multidisciplinary input in decision-making.
creator: Anna Embring
creator: Tanja Skyttä
creator: Jacob Engellau
creator: Irina Kerna
creator: Daiva Sendiuliene
creator: Malin Blomstrand
creator: Daniel J. Indelicato
creator: Beate Timmermann
creator: Yasmin Lassen-Ramshad
creator: Henriette Magelssen
rights: Copyright (c) 2026 Anna Embring, Tanja Skyttä, Jacob Engellau, Irina Kerna, Daiva Sendiuliene, Malin Blomstrand, Daniel J. Indelicato, Beate Timmermann, Yasmin Lassen-Ramshad, Henriette Magelssen https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-15
publication date: 2026-02-15
volume: 65
starting page: 101
ending page: 108
doi: 10.2340/1651-226X.2026.44815

Antibiotic treatment indicates shorter survival in patients with immunotherapy for metastatic kidney cancer
type: item
description: Background and purpose: Antibiotic treatment (ABT) has been associated with worse outcomes of cancer immunotherapy. However, this association might be confounded by other poor prognostic factors. We aimed to evaluate the use of ABT and outcomes of immune checkpoint inhibitors (ICI) in metastatic kidney cancer (mRCC). Patient/material and methods: We identified retrospectively 192 patients treated with ICI for mRCC between 2015 and 2021 at three academic hospitals in Finland. Information on patient characteristics, ABT, and immunotherapy was collected from electronic medical records. Cox regression and Kaplan-Meier methods were used for survival analyses. Results: A total of 61 (32%) patients had received early ABT (3 months before and 1 month after the first dose of ICI), of whom 31 (51%) had ABT > 7 days. Patients with early ABT had shorter median overall survival (mOS) than patients without early ABT (20.4 vs 27.9 months, p = 0.046). Patients with ABT > 7 days had shorter mOS than patients with ABT 0–7 days (17.2 vs 27.5 months, p = 0.015). After adjustment for International Metastatic Renal Cell Carcinoma Database Consortium risk groups, histological renal cell carcinoma subtype, baseline levels of C-reactive protein, and tumor burden, the risk of death was higher in patients with ABT > 7 days (hazard ratio 1.83 (95% confidence interval 1.06–3.17). No significant differences in progression-free survival times (PFS) were observed. Interpretation: Early ABT and prolonged ABT duration were associated with shorter OS, but not with PFS, in patients treated with ICI for mRCC. Prolonged ABT indicated poor prognosis regardless of other risk factors.
creator: Elisa Kankkunen
creator: Kaisa Sunela Sunela
creator: Timo Makkonen Makkonen
creator: Katriina Jalkanen Jalkanen
creator: Kalle Mattila
rights: Copyright (c) 2026 Elisa Kankkunen, Kaisa Sunela, Timo Makkonen, Katriina Jalkanen, Kalle E Mattila https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-10
publication date: 2026-02-10
volume: 65
starting page: 83
ending page: 89
doi: 10.2340/1651-226X.2026.44974

Healthcare costs and resource use in advanced breast cancer at the end of life: a register study
type: item
description: Background and purpose: Advanced breast cancer (ABC) involves substantial end-of-life (EOL) healthcare use and costs. Understanding cost drivers can inform care delivery and resource allocation. Patient/material and methods: We conducted a retrospective, population-based study of individuals (n = 1,437) who died with breast cancer in the Stockholm Region (2015–2023). Healthcare utilization and costs during the last 12 months of life were obtained from the Stockholm Regional Healthcare Data Repository (VAL) and estimated using the Region Stockholm cost model. Variables included age, sex, socioeconomic status (Mosaic), Charlson Comorbidity Index, Hospital Frailty Risk Score (HFRS), systemic therapy, and place of death. Descriptive statistics and generalized linear models assessed cost associations. Results: Total costs rose toward EOL, increasing 140% in the final 3 months versus the prior quarter. Hospitalizations and specialized palliative care drove costs, while outpatient visits declined. Younger age (18–69 years), high frailty (HFRS > 15), and systemic therapy were independently associated with higher costs. Hospital death was associated with lower expenditures than dying elsewhere (rate ratio [RR]: 0.84, 95% confidence interval [CI]: 0.78–0.91). The top 5% of cost users were mainly younger, frail patients receiving systemic therapy. Interpretation: ABC-related costs escalate in the final year of life, driven by hospitalizations, palliative care, and systemic therapies. Younger, frailer patients incur higher costs, while those dying in hospital settings are associated with lower costs. Early palliative integration and frailty-based risk stratification were associated with distinct patterns of healthcare utilization and costs toward the EOL.
creator: Giovanni Galvis Rojas
creator: Peter Strang
creator: Torbjörn Schultz
creator: Lars-Åke Levin
rights: Copyright (c) 2026 Giovanni Galvis Rojas, Peter Strang, Torbjörn Schultz , Lars-Åke Levin https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-06
publication date: 2026-02-06
volume: 65
starting page: 75
ending page: 82
doi: 10.2340/1651-226X.2026.44970

The Association of right atrium and sinoatrial node irradiation with atrial fibrillation and radiation-induced heart disease in non-small cell lung cancer
type: item
description: Background and purpose: Radiotherapy (RT) is a key treatment for locally advanced non-small cell lung cancer (NSCLC). Tumours near the heart may result in unintended cardiac radiation exposure, increasing the risk of cardiotoxicity, such as de novo atrial fibrillation (DNAF) and de novo heart diseases (DNHD) as ischemic heart disease, heart failure, arterial hypertension or sudden cardiac death. This study investigated associations between radiation dose to cardiac substructures and risk of DNAF and DNHD. Patient/material and methods: This retrospective cohort study included patients treated between January 1, 2010, and December 31, 2020 for NSCLC with definitive RT. The heart, right atrium (RA) and sinoatrial node (SAN) were delineated. Associations between dose-volume parameters and cardiac outcomes were analysed using multivariable models adjusted for relevant confounders. Kaplan-Meier curves estimated survival; p-values < 0.05 were significant. Results: Among 273 included patients, 9.5% had AF pre-RT and 12.8% developed DNAF. DNAF was significantly associated with SAN Dmax (hazard ratio [HR] = 1.01), RA Dmax (HR = 1.02), RA Dmean (HR = 1.03), mean heart dose (MHD) (HR = 1.04) and heart V40Gy (HR = 1.03). One-year probabilities of DNAF and DNHD were 9.3% and 11%, increasing to 12.2% and 13.2% at 2 years. DNHD was significantly associated with SAN Dmax (HR = 1.02), RA Dmax (HR = 1.02), RA Dmean (HR = 1.04), MHD (HR = 1.06), heart V25Gy (HR = 1.03) and V40Gy (HR = 1.03). Interpretation: The RA and SAN may be considered organs at risk in future RT planning. Minimising cardiac radiation is important to reduce DNAF and DNHD risk. Validation in an independent cohort is warranted.
creator: Christoffer Sander Graven-Nielsen
creator: Anna Jakobsen Kragh
creator: Rasmus Froberg Brøndum
creator: Marie Louise Milo
creator: Martin Skovmos Nielsen
creator: Asbjørn Ettrup-Christensen
creator: Kasper Lind Laursen
creator: Weronika Maria Szejniuk
rights: Copyright (c) 2026 Christoffer Sander Graven-Nielsen , Anna Jakobsen Kragh, Rasmus Froberg Brøndum, Marie Louise Milo, Martin Skovmos Nielsen, Asbjørn Ettrup-Christensen, Kasper Lind Laursen, Weronika Maria Szejniuk https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-06
publication date: 2026-02-06
volume: 65
starting page: 66
ending page: 74
doi: 10.2340/1651-226X.2026.43885

Baseline results from the Norwegian radiology-led lung cancer screening pilot
type: item
description: Background and purpose: Implementation of low-dose computed tomography (LDCT) screening for lung cancer is recommended. The Norwegian Lung Cancer Screening pilot (TIDL) has been conducted to explore recruitment strategy, detection rate and the value of a radiology-led screening program. This publication presents baseline results from the screened participants. Patient/material and methods: All 125,095 individuals aged 60–79 years in Akershus county, Norway were invited to participate. Ever-smokers completed a risk questionnaire based on the PLCOm2012NoRace model: those with ≥35 pack-years or a ≥2.6% 6-year lung cancer risk were eligible for inclusion. Of 2,499 eligible participants, 1,006 underwent baseline LDCT between August 2022 and May 2023, and up to two more rounds later. Nodules were categorized by Lung-RADS v2022. Follow-up and staging were managed by thoracic radiologists; High-suspicion cases were referred to pulmonologists. Results: At baseline, lung cancer was diagnosed in 23 participants (2.3%), whereof 19 (83%) in stage I and 2 (9%) in stage II. Most underwent curative treatment, primarily robot-assisted surgery. Only 2.9% of the screened individuals were referred for further diagnostic evaluation. The false positive rate was 0.6% after pulmonologist referral and 1.7% after radiological staging. A total of 13.8% required 3- or 6-month imaging follow-up. Complication rates from diagnostic procedures were low. Interpretation: LDCT screening using combined risk-based eligibility and a radiology-led model is feasible and effective in the Norwegian context. The high detection rate and low clinical burden support its potential for national implementation. These findings may guide the development of future lung cancer screening programs in the Nordic countries and beyond.
creator: Albin Mahovkic
creator: Kirill Neumann
creator: Trond-Eirik Strand
creator: Oluf Dimitri Røe
creator: Haseem Ashraf
rights: Copyright (c) 2026 Albin Mahovkic, Kirill Neumann, Trond-Eirik Strand, Oluf Dimitri Røe, Haseem Ashraf https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-03
publication date: 2026-02-03
volume: 65
starting page: 59
ending page: 65
doi: 10.2340/1651-226X.2026.44910

The rise of 3D spheroids in radiobiology for assessing tumour radioresistance
type: item
description: Background and purpose: Particle therapy (PT), including proton (PRT) and carbon ion radiotherapy (CIRT), offers physical and biological advantages over photon radiotherapy (XRT), particularly for radioresistant tumours such as glioblastoma and osteosarcoma. However, systematic preclinical comparisons using physiologically relevant models remain limited. Material and methods: T98G (glioblastoma), Saos-2 and U2-OS (osteosarcoma) cells were cultured as two-dimensional (2D) monolayers and three-dimensional (3D) spheroids and irradiated with XRT, PRT or CIRT at 2, 4 or 6 Gy. Clonogenic survival, metabolic activity (PrestoBlue), invasion and spheroid growth kinetics were quantified. Relative biological effectiveness (RBE) was derived from survival data, and spheroid sections were analysed histologically (H&E). Results: CIRT induced the strongest cytotoxic and anti-invasive effects across all models. In 2D cultures, the surviving fraction at 2 Gy decreased from 0.62 to 0.69 after XRT to 0.16–0.28 following CIRT (RBE = 2.1–2.4 vs. 1.1 for PRT; p < 0.0001). 3D spheroids exhibited overall higher radioresistance, yet CIRT markedly reduced growth and invasion, lowering normalised indices to 0.52 ± 0.12 (T98G) and 0.58 ± 0.09 (Saos-2) at 6 Gy, while photons often promoted invasion (> 1.2; p < 0.001). RBE values in 3D reached 3.6–4.0. H&E staining confirmed dose-dependent architectural disruption, with carbon ions inducing extensive necrosis and cellular degeneration. Interpretation: This study introduces a robust 3D preclinical platform for radiobiological assessment of particle therapy. CIRT consistently overcame intrinsic and microenvironment-mediated resistance, outperforming photons and protons in suppressing viability, invasion and spheroid integrity, thus reinforcing the translational relevance of 3D models and the therapeutic promise of carbon ion therapy for resistant malignancies.
creator: Alexandra Charalampopoulou
creator: Fabrizio De Luca
creator: Giuseppe Magro
creator: Niloufar Matoor
creator: Amelia Barcellini
creator: Giorgio Butella
creator: Giovanni Battista Ivaldi
creator: Sara Lillo
creator: Lorenzo Manti
creator: Alessio Mereghetti
creator: Paola Tabarelli De Fatis
creator: Maria Grazia Bottone
creator: Angelica Facoetti
rights: Copyright (c) 2026 Alexandra Charalampopoulou, Fabrizio De Luca, Giuseppe Magro, Niloufar Matoor, Amelia Barcellini, Giorgio Butella , Giovanni Battista Ivaldi , Sara Lillo, Lorenzo Manti, Alessio Mereghetti , Paola Tabarelli De Fatis , Maria Grazia Bottone , Angelica Facoetti https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-03
publication date: 2026-02-03
volume: 65
starting page: 46
ending page: 58
doi: 10.2340/1651-226X.2026.45079

Cost-effectiveness analysis of operative versus non-operative management of colorectal cancer metastases in the Finnish RAXO Study
type: item
description: Background and purpose: Cancer therapies place an increasing financial burden on societies. In metastatic colorectal cancer (mCRC), an optimised curative-intent treatment combines metastasectomy, local ablative therapy, and perioperative systemic anti-cancer therapy (SACT) under multidisciplinary team guidance. The resource-intensive operative treatment strategy results in better survival than a non-operative approach with SACT only. The cost-effectiveness of the strategy including operative treatment has not been investigated in the era of modern treatment options. Patient/material and methods: A Markov model was developed to estimate lifetime healthcare costs and quality-adjusted life-years (QALYs). Patients receiving operative treatment, including metastasectomy along with SACT, and those receiving non-operative treatment with SACT only, were identified from the prospective Finnish RAXO study that recruited 1,086 patients between 2012 and 2018. Cost-effectiveness analyses and sensitivity analyses were conducted from the healthcare payer’s perspective using 2023 cost levels. Results: The mean lifetime costs (158,309€) for patients with an operative treatment produced 6.57 life years and 5.91 QALYs according to the Markov model. The non-operative treatment group had costs of 77,182€, producing 1.99 life years and 1.74 QALYs. The incremental cost-effectiveness ratio (ICER) was 19,455€/QALY, with the caveat that more favourable characteristics were present in the operative group. In probabilistic sensitivity analyses with a willingness-to-pay threshold of 30,000€/QALY, the operative treatment group had an 81% probability of being cost-effective. The results were robust in adjusted sensitivity analyses, including propensity score matched subgroups. Interpretation: An operative treatment strategy is cost-effective at a commonly referenced acceptability threshold.
creator: Joel Kontiainen
creator: Kaisa Lehtomäki
creator: Timo Muhonen
creator: Jarmo Hahl
creator: Iiro Toppila
creator: Tuija Poussa
creator: Emerik Osterlund
creator: Eetu Heervä
creator: Hanna Stedt
creator: Raija Kallio
creator: Päivi Halonen
creator: Arno Nordin
creator: Aki Uutela
creator: Tapio Salminen
creator: Sonja Aho
creator: Maarit Bärlund
creator: Annika Ålgars
creator: Raija Ristamäki
creator: Annamarja Lamminmäki
creator: Bengt Glimelius
creator: Helena Isoniemi
creator: Pia Osterlund
rights: Copyright (c) 2026 Joel Kontiainen, Kaisa Lehtomäki, Timo Muhonen, Jarmo Hahl, Iiro Toppila, Tuija Poussa, Emerik Osterlund, Eetu Heervä, Hanna Stedt, Raija Kallio, Päivi Halonen, Arno Nordin, Aki Uutela, Tapio Salminen, Sonja Aho, Maarit Bärlund, Annika Ålgars, Raija Ristamäki, Annamarja Lamminmäki, Bengt Glimelius, Helena Isoniemi, Pia Osterlund https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-03
publication date: 2026-02-03
volume: 65
starting page: 36
ending page: 45
doi: 10.2340/1651-226X.2026.45005

Stakeholders’ experiences with a clinician-led access programme linking evidence generation and reimbursement for precision cancer treatments: the drug access protocol in the Netherlands
type: item
description: Background and purpose: In the current landscape of tumour-agnostic oncology drugs receiving European Medicines Agency (EMA) authorisation, Health Technology Assessment (HTA) bodies face challenges in assessing these innovative drugs. Due to these products’ non-randomised, single-arm nature, uncertainty exists regarding their real-world benefit. In the Netherlands, the Drug Access Protocol (DAP), a programme developed by oncologists, insurers and the healthcare public institute, aims to provide an innovative solution to address this uncertainty. This study aims to investigate the key characteristics, enablers and challenges of the programme by exploring stakeholders’ perceptions. Patient/material and methods: A qualitative, semi-structured interview study was conducted. A supporting interview guide was drafted using available literature and a flowchart figure to illustrate the process. Interviews were conducted with market authorisation holders (MAHs) who participated in the programme, the insurer, the DAP study management and the DAP’s governance committee. Recorded interviews were transcribed, pseudonymised and subsequently coded using NVivo software. Inductive thematic analysis was used to identify common themes, enablers and challenges for participating in the programme. Results: In total, eight organisations were interviewed. Although MAHs indicated several enablers (e.g. providing patient access, collecting real-world data), several challenges (e.g. the lack of transparency) lead to questions regarding the feasibility of the programme. Health insurers acknowledge these outcomes and expect products that obtain regular reimbursement to serve as an example. Interpretation: As the Drug Access Protocol may be a promising solution to mitigate uncertainties for healthcare decision-makers, implementation challenges can hamper its feasibility. Addressing these challenges could realise the potential of such programmes.
creator: Christine Leopold
creator: Atse H Huisman
creator: Kevin J. G. M. Vlaar
creator: Haiko J Bloemendal
creator: Sahar Barjesteh van Waalwijk van Doorn-Khosrovani
rights: Copyright (c) 2026 Christine Leopold, Atse H Huisman, Kevin J. G. M. Vlaar, Haiko J Bloemendal, Sahar Barjesteh van Waalwijk van Doorn-Khosrovani https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-01-14
publication date: 2026-01-14
volume: 65
starting page: 22
ending page: 31
doi: 10.2340/1651-226X.2026.45000

Characteristics, treatment, and outcome of recurrent gastro-oesophageal adeno­carcinoma after perioperative chemotherapy and radical resection
type: item
description: Background: Evidence of treatment of patients with relapse following multimodal treatment for oesophageal, gastro-oesophageal junctional and gastric adenocarcinoma is almost absent. Methods: In a nationwide consecutive cohort of 202 patients, radically resected after perioperative chemotherapy (CTx) and followed-up without scheduled imaging, we identified 89 patients with recurrence within 12 years. We registered prior clinico-pathological and treatment characteristics, alarming symptoms, work-up, recurrence patterns, treatment of recurrence, and outcome. Results: Median time to recurrence was 15.2 months, 91% of relapses occurred within 3 years. Frequent alarming symptoms were pain, weight loss and loss of appetite. Fifty-four percent recurred at multiple sites, 36% at a single anatomic site, and 10% were solitary. Recurrence was a 99% fatal event with a median overall survival (OS) of only 4.6 months. Older age, ypN3 at surgery, poor performance status, weight loss, non-solitary recurrence, no postoperative CTx, and no palliative CTx, were associated with short OS. Three patients had initial surgery, but all progressed; one additional patient was cured by salvage surgery after palliative CTx. Sixty percent (53 patients) were treated with CTx yielding a median progression-free survival and OS of 4.0 and 5.8 months, respectively; the overall response rate was 35%. Pleuroperitoneal metastases predicted poor prognosis. Non-platinum-based, first-line palliative CTx was used in 38%, mostly in patients with short treatment-free interval. Interpretation: In this national cohort, recurrence was a 99% fatal event and only 60% of patients received palliative CTx. Efficacy of palliative CTx at relapse after multi-modal treatment is poor and needs further investigations.
creator: Anders Christian Larsen
creator: Susy Shim
creator: Lene Bæksgaard
creator: Per Pfeiffer
creator: Marianne Nordsmark
creator: Jan Reiter Sørensen
creator: Rasmus Brøndum
creator: Anne Krejbjerg Motavaf
creator: Morten Ladekarl
rights: Copyright (c) 2026 Anders Christian Larsen, Susy Shim, Lene Bæksgaard, Per Pfeiffer, Marianne Nordsmark, Jan Reiter Sørensen, Rasmus Brøndum, Anne Krejbjerg Motavaf, Morten Ladekarl https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-01-11
publication date: 2026-01-11
volume: 65
starting page: 9
ending page: 18
doi: 10.2340/1651-226X.2026.44264

Procedures of data merging in precision cancer medicine: the PRIME-ROSE project
type: item
description: Background and purpose: As more interventional clinical trials in Precision Cancer Medicine (PCM) are introduced, molecular descriptions of tumours have led to multiple subtypes, even within common tumour types. Therefore, the main limitation of these trials is the small number of eligible patients to assess the clinical benefit. The PRIME-ROSE project addresses this limitation by pooling data from multiple European Drug Rediscovery Protocol (DRUP)-like clinical trials, such that slowly accruing cohorts are accelerated. To achieve this task, a well-documented commonly approved procedure for data merging needs to be established. Patient/material and methods: Data sharing is achievable when there is an organisation that includes people from different disciplines who can navigate institutional and country-specific information and governance requirements. Furthermore, alignment of all the study procedures are needed before data are shared. Next, the process of merging data requires harmonisation and standardisation. Implementation of the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) facilitates future data aggregation. Results: By aggregating data from European DRUP-like clinical trials, cohorts are completed that were unable to do so in stand-alone studies. Since initiation, the PRIME-ROSE project monitors over 300 cohorts across more than 20 treatments encompassing over 1,000 patients. At least 20 cohorts have progressed after interim analysis. Interpretation: Data sharing across European trials is feasible and enhances the advancements of PCM studies. The methodologies developed in the PRIME-ROSE project provide a foundation for future data integration efforts in PCM clinical trials, underscoring the viability of conducting robust trials in a global context.
creator: Henk van der Pol
creator: Tina Kringelbach
creator: Maria Martin Agudo
creator: Gabriel Bratseth Stav
creator: Gro Live Fagereng
creator: Marta Fiocco
creator: Ragnhild Sørum Falk
creator: Victoria Homer
creator: Soemeya Haj Mohammad
creator: Hans Timmer
creator: Loic Verlingue
creator: Åslaug Helland
creator: Kristoffer Rohrberg
creator: Ulrik Lassen
creator: Sarah Halford
creator: Katriina Jalkanen
creator: Tanja Juslin
creator: Matthew G Krebs
creator: Julio Oliveira
creator: Edita Baltruskeviciene
creator: Kristiina Ojamaa
creator: Kjetil Taskén
creator: Hans Gelderblom
rights: Copyright (c) 2026 Henk van der Pol, Tina Kringelbach, Maria Martin Agudo, Gabriel Bratseth Stav, Gro Live Fagereng, Marta Fiocco, Ragnhild Sørum Falk, Victoria Homer, Soemeya Haj Mohammad, Hans Timmer, Loic Verlingue, Åslaug Helland, Kristoffer Rohrberg, Ulrik Lassen, Sarah Halford, Katriina Jalkanen, Tanja Juslin, Matthew G Krebs, Julio Oliveira, Edita Baltruskeviciene, Kristiina Ojamaa, Kjetil Taskén, Hans Gelderblom https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-01-06
publication date: 2026-01-06
volume: 65
starting page: 1
ending page: 8
doi: 10.2340/1651-226X.2026.44889

Tumour acquisition method and molecular profiling success in advanced cholangiocarcinoma
type: item
creator: Eleni Vrana
creator: Alia Alothman
creator: Luke Taylor
creator: Joe Geraghty
creator: Javaid Iqbal
creator: Lucy Foster
creator: Alicia-Marie Conway
creator: Nadina Tinsley
creator: Melissa Frizziero
creator: Victoria Foy
creator: Richard A Hubner
creator: Mairéad G McNamara
rights: Copyright (c) 2026 Eleni Vrana, Alia Alothman, Luke Taylor, Joe Geraghty, Javaid Iqbal, Lucy Foster, Alicia-Marie Conway, Nadina Tinsley, Melissa Frizziero, Victoria Foy, Richard A Hubner, Mairéad G McNamara https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-05-07
publication date: 2026-05-07
volume: 65
starting page: 389
ending page: 393
doi: 10.2340/ao.v65.45466

A 10-year-long ongoing complete response to vismodegib as first-line treatment in adult metastatic medulloblastoma
type: item
creator: Suweydo Abdi
creator: Paula Poikonen-Saksela
creator: Päivi Halonen
creator: Olli Tynninen
creator: David A Reardon
creator: Micaela Hernberg
rights: Copyright (c) 2026 Suweydo Abdi, Paula Poikonen-Saksela, Päivi Halonen, Olli Tynninen, David A Reardon, Micaela Hernberg https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-05-11
publication date: 2026-05-11
volume: 65
starting page: 412
ending page: 415
doi: 10.2340/1651-226X.2026.45543

PIK3CA mutation testing and alpelisib use in metastatic breast cancer: a real-world data set
type: item
creator: Maja B Drakenberg Danese
creator: Christoffer P Vannas
creator: Henrik A Fagman
creator: Per O Karlsson
creator: Karolina F Larsson
rights: Copyright (c) 2026 Maja B Drakenberg Danese, Christoffer P Vannas, Henrik A Fagman, Per O Karlsson, Karolina F Larsson https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-05-11
publication date: 2026-05-11
volume: 65
starting page: 401
ending page: 405
doi: 10.2340/1651-226X.2026.45589

SPRINTR: Swedish PRecision medicine Initiative for Novel Treatments and Research-towards efficient recruitment to clinical trials for prostate cancer
type: item
creator: Karin Welén
creator: Andreas Josefsson
rights: Copyright (c) 2026 Karin Welén, Andreas Josefsson https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-05-04
publication date: 2026-05-04
volume: 65
starting page: 375
ending page: 378
doi: 10.2340/ao.v65.45126

Psychological distress and tumor cell β2-adrenergic receptor levels in patients with surgically resected non-small cell lung cancer
type: item
creator: Hronn Hardardottir
creator: Thor Aspelund
creator: Bryndis Valdimarsdottir
creator: Jurate Asmundsson
creator: Vigdis Petursdottir
creator: Katja Fall
creator: Erika Broström
creator: Heiddis Valdimarsdottir
creator: Fang Fang
creator: Magnus K. Magnusson
creator: Thorarinn Gudjonsson
creator: Tomas Gudbjartsson
creator: Erica K. Sloan
creator: Susan K. Lutgendorf
creator: Christer Jansson
creator: Unnur A. Valdimarsdottir
rights: Copyright (c) 2026 Hronn Hardardottir, Thor Aspelund, Bryndis Valdimarsdottir, Jurate Asmundsson, Vigdis Petursdottir, Katja Fall, Erika Broström, Heiddis Valdimarsdottir, Fang Fang, Magnus K. Magnusson, Thorarinn Gudjonsson, Tomas Gudbjartsson, Erica K. Sloan, Susan K. Lutgendorf, Christer Jansson, Unnur A. Valdimarsdottir https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-05-04
publication date: 2026-05-04
volume: 65
starting page: 370
ending page: 374
doi: 10.2340/ao.v65.45317

Multidisciplinary team meetings for lung cancer in the Nordic countries: results from a Nordic survey
type: item
creator: Anja Gouliaev
creator: Janna Berg
creator: Johan Isaksson
creator: Heidi Andersén
creator: Torben Riis Rasmussen
rights: Copyright (c) 2026 Anja Gouliaev, Janna Berg, Johan Isaksson, Heidi Andersén, Torben Riis Rasmussen https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-04-17
publication date: 2026-04-17
volume: 65
starting page: 301
ending page: 305
doi: 10.2340/ao.v65.45213

Extent of prostate cancer cases not registered in The National Cancer Register of Sweden and consequences for estimates of prostate cancer incidence and mortality
type: item
creator: Eugenio Ventimiglia
creator: Hans Garmo
creator: Rolf Gedeborg
creator: Mats Ahlberg
creator: Armando Galdieri
creator: Andri Wilberg Orrason
creator: Lars Holmberg
creator: Pär Stattin
creator: David Robinson
rights: Copyright (c) 2026 Eugenio Ventimiglia, Hans Garmo, Rolf Gedeborg, Mats Ahlberg, Armando Galdieri, Andri Wilberg Orrason, Lars Holmberg, Pär Stattin, David Robinson https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-04-17
publication date: 2026-04-17
volume: 65
starting page: 297
ending page: 300
doi: 10.2340/ao.v65.45596

FOCU.SE trial: a nationwide Swedish drug repurposing protocol and research framework
type: item
creator: Edvard Abel
creator: Päivi Östling
creator: Ebba Hallersjö Hult
creator: Katarzyna Kulbacka
creator: Haris Babacic
creator: Annika Baan
creator: Ana Carneiro
creator: Luigi De Petris
creator: Henrik Fagman
creator: Signe Friesland
creator: Oskar Frisell
creator: Mats Hellström
creator: Gabriel Lindahl
creator: Katarina Steen Carlsson
creator: David Tamborero
creator: Antonios Valachis
creator: Daniel Öhlund
creator: Janne Lehtiö
creator: Richard Rosenquist
creator: Anders Edsjö
rights: Copyright (c) 2026 Edvard Abel, Päivi Östling, Ebba Hallersjö Hult, Katarzyna Kulbacka, Haris Babacic, Annika Baan, Ana Carneiro, Luigi De Petris, Henrik Fagman, Signe Friesland, Oskar Frisell, Mats Hellström, Gabriel Lindahl, Katarina Steen Carlsson, David Tamborero, Antonios Valachis, Daniel Öhlund, Janne Lehtiö, Richard Rosenquist, Anders Edsjö https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-04-13
publication date: 2026-04-13
volume: 65
starting page: 268
ending page: 272
doi: 10.2340/ao.v65.45355

Differences in tumor mutational burden assessment: a national ring trial
type: item
creator: Christine Federspiel Secher
creator: Christina Westmose Yde
creator: Britt Elmedal Laursen
creator: Estrid Høgdall
creator: Henriette Sylvain Thomsen
creator: Tim Svenstrup Poulsen
creator: Mads Sønderkær
creator: Tina Kringelbach
creator: Mads Malik Aagaard Jørgensen
creator: Rikke Frydendahl Sick Olsen
creator: Anja Elaine Sørensen
creator: Christian Baudet
creator: Magnús Halldór Gíslason
creator: Michael Knudsen
creator: Ida Kappel Buhl
rights: Copyright (c) 2026 Christine Federspiel Secher, Christina Westmose Yde, Britt Elmedal Laursen, Estrid l Høgdall, Henriette Sylvain Thomsen, Tim Svenstrup Poulsen, Mads Sønderkær, Tina Kringelbach, Mads Malik Aagaard Jørgensen, Rikke Frydendahl Sick Olsen, Anja Elaine Sørensen, Christian Baudet, Magnús Halldór Gíslason, Michael Knudsen, Ida Kappel Buhl https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-03-04
publication date: 2026-03-04
volume: 65
starting page: 178
ending page: 180
doi: 10.2340/1651-226X.2026.45220

Specialized healthcare diagnostic events within one year preceding colorectal cancer diagnosis
type: item
creator: Elina Hermiö
creator: Salla E. Toikkanen
creator: Liisa H. Pylkkänen
creator: Jutta Järvelin
creator: Janne M. Pitkäniemi
creator: Nea K. Malila
creator: Karri J. Seppä
rights: Copyright (c) 2026 Elina Hermiö, Salla E. Toikkanen, Liisa H. Pylkkänen, Jutta Järvelin, Janne M. Pitkäniemi, Nea K. Malila, Karri J. Seppä https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-03-01
publication date: 2026-03-01
volume: 65
starting page: 173
ending page: 177
doi: 10.2340/1651-226X.2026.44788

‘Crossing borders’ in data standardisation: application of OMOP CDM in an international clinical trial network in precision cancer medicine
type: item
creator: Maria Martin Agudo
creator: Henk van der Pol
creator: Gabriel Bratseth Stav
creator: Tina Kringelbach
creator: Katarina Puco
creator: Åsmund Flobak
creator: Hans Gelderblom
creator: Kjetil Taskén
creator: Gro Live Fagereng
creator: Eivind Hovig
rights: Copyright (c) 2026 Maria Martin Agudo, Henk van der Pol, Gabriel Bratseth Stav, Tina Kringelbach , Katarina Puco, Åsmund Flobak, Hans Gelderblom, Kjetil Taskén, Gro Live Fagereng, Eivind Hovig https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-23
publication date: 2026-02-23
volume: 65
starting page: 159
ending page: 163
doi: 10.2340/1651-226X.2026.45120

Realising precision oncology through shared real-world data infrastructure
type: item
creator: Andreas Bjerrum
creator: Andreas Fanø
creator: Ulrik Lassen
rights: Copyright (c) 2026 Andreas Bjerrum, Andreas Fanø, Ulrik Lassen https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-22
publication date: 2026-02-22
volume: 65
starting page: 156
ending page: 158
doi: 10.2340/1651-226X.2026.45074

https://medicaljournalssweden.se/actaoncologica/article/view/45174
type: item
title: SWE-NEO: Swedish NEO-adjuvant trial comparing anti-PD-1 monotherapy to combined anti-CTLA-4/anti-PD-1 blockade in resectable stage III melanoma: study protocol for a phase III open-label multi-centre trial
creator: Hildur Helgadottir
creator: Ana Carneiro
creator: Francesca Portelli
creator: Konstantinos Papadakis
creator: Karl Björkström
creator: Muyi Yang
creator: Iva Johansson
creator: Ingela Skogvall Svensson
creator: Allan Jazrawi
creator: Amanda Hallgren
creator: Katja Harbst
creator: Rusana Bark
creator: Suzanne Egyhazi Brage
creator: Anders Berglund
creator: Karolin Isaksson
creator: Stina Wickström
creator: Jonas Nilsson
creator: Lars Ny
creator: Göran Jönsson
creator: Roger Olofsson Bagge
rights: Copyright (c) 2026 Hildur Helgadottir, Ana Carneiro, Francesca Portelli, Konstantinos Papadakis, Karl Björkström, Muyi Yang, Iva Johansson, Ingela Skogvall Svensson, Allan Jazrawi, Amanda Hallgren, Katja Harbst, Rusana Bark, Suzanne Egyhazi Brage, Anders Berglund, Karolin Isaksson, Stina Wickström, Jonas Nilsson, Lars Ny, Göran Jönsson, Roger Olofsson Bagge https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-19
publication date: 2026-02-19
volume: 65
starting page: 126
ending page: 130
doi: 10.2340/1651-226X.2026.45174

Selecting patients with rectal cancer for total neoadjuvant therapy based on clinical lymph node status: do we dare?
type: item
creator: Anna Baech Slipsager
creator: Michael Bødker Lauritzen
creator: Laura Katrine Buskov
creator: Laurids Østergaard Poulsen
rights: Copyright (c) 2026 Anna Baech Slipsager, Michael B. Lauritzen, Laura K. Buskov, Laurids Ø. Poulsen https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-15
publication date: 2026-02-15
volume: 65
starting page: 97
ending page: 100
doi: 10.2340/1651-226X.2026.45125

Eribulin-induced resolution of high-risk basal cell carcinoma: implications for microtubule-targeting agents in BCC management: a case report
type: item
creator: Jan Lapins
creator: Niki Radros
creator: Karina Schultz
creator: Ismini Vassilaki
creator: Christina Linder Stragliotto
creator: Hildur Helgadottir
rights: Copyright (c) 2026 Jan Lapins, Niki Radros, Karina Schultz, Ismini Vassilaki, Christina Linder Stragliotto, Hildur Helgadottir https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-03
publication date: 2026-02-03
volume: 65
starting page: 32
ending page: 35
doi: 10.2340/1651-226X.2026.44993

Comorbidity indices in observational studies on cancer risk
type: item
creator: Björn Zethelius
creator: Mats Talbäck
creator: Rickard Ljung
rights: Copyright (c) 2026 Björn Zethelius, Mats Talbäck, Rickard Ljung https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-01-11
publication date: 2026-01-11
volume: 65
starting page: 19
ending page: 21
doi: 10.2340/1651-226X.2026.45061

Improving confidence in MRI-based auto-segmentation via uncertainty assessment
type: item
description: Background and purpose: Accurate delineation of organs of interest (OOIs, also commonly referred to as organs at risk, OARs) is crucial for safe radiotherapy. While deep learning-based segmentation using convolutional neural networks has achieved high geometric accuracy, clinical translation is hindered by overconfident, uncalibrated predictions in anatomically ambiguous regions. Uncertainty quantification and model calibration are prerequisites for safe clinical workflows. This study compared the standard nnU-Netv2 against its residual-encoding variant (ResEncM), hypothesizing that ResEncM would demonstrate superior reliability and calibration while maintaining comparable geometric accuracy. Patient/material and methods: T1-weighted contrast-enhanced MRI scans from 70 brain cancer patients were used (55 training/validation, 15 testing). Ground-truth contours for brainstem, hippocampi, chiasm, optic nerves, optic tracts, and pituitary were delineated per Danish Neuro Oncology Group guidelines. Both architectures were trained using five-fold cross-validation with identical preprocessing. Epistemic uncertainty was quantified using mutual information, and Expected Calibration Error (ECE) was computed within a 10-mm isotropic margin around reference contours. Results: Both models achieved high geometric accuracy (brainstem dice similarity coefficient [DSC] > 0.93, hippocampi DSC > 0.81). No significant geometric differences were found for large structures. ResEncM showed significantly lower DSC for the pituitary (p = 0.003) and chiasm (p = 0.018). However, ResEncM demonstrated significantly lower epistemic uncertainty and ensemble variance across all structures (p < 0.05), and significantly reduced ECE for the optic chiasm, optic tracts, and pituitary. Interpretation: Integrating a deep residual encoder into the standard U-Net framework significantly improves reliability and calibration of automated brain OOI contours while maintaining strong geometric performance. The …
creator: Jesper Folsted Kallehauge
creator: jintao Ren
creator: Yasmin Lassen-Ramshad
rights: Copyright (c) 2026 Jesper Folsted Kallehauge, Jintao Ren, Yasmin Lassen-Ramshad https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-05-11
publication date: 2026-05-11
volume: 65
starting page: 406
ending page: 411
doi: 10.2340/1651-226X.2026.45685

FIN-EGFRprint: a Finnish real-world study on treatments and outcomes in advanced NSCLC with common EGFR mutations
type: item
description: Background and purpose: The treatment of advanced non-small cell lung cancer (aNSCLC) with common epidermal growth factor receptor (cEGFR) mutations has evolved substantially over the last 15 years, with the discovery of activating epidermal growth factor receptor (EGFR) mutations and introduction of first-, second- and third generation (gen) EGFR tyrosine kinase inhibitors (TKIs) as first-line therapy. This retrospective observational study aimed to evaluate whether the introduction of these treatments has led to improved ‘real-world’ outcomes over time by analysing time to next treatment (TTNT) and overall survival (OS). Patient/material and methods: Patients (n = 379) with EGFR exon 19 deletion (Del19) or exon 21 L858R (L858R) substitution and aNSCLC were identified from two Finnish university hospital data lakes between 2010 and 2023. TTNT and OS were analysed from first-line treatment initiation using Kaplan–Meier survival and multivariable Cox regression analyses. Patients were stratified into three cohorts based on date of diagnosis and which TKIs were available at that time (1st-gen: 2010–2016, 2nd-gen: 2017–2020 and 3rd-gen: 2020–2023). Results: The use of chemotherapy as first-line therapy declined from 32% (2010–2016) to 6% (2020–2023), while 80% of patients received 3rd-gen TKIs as first-line treatment in 2020–2023. Median TTNT improved over time (9.7 to 13.2 to 21.6), with a significant improvement in 2020–2023 versus 2010–2016 (HR: 0.46; 95% CI: 0.33–0.64; p < 0.001). Median OS also increased over time (19.1 to 23.9 to 29.3 months) and was significantly higher in 2020–2023 versus 2010–2016 (HR: 0.56; 95% CI: 0.39–0.82; p = 0.002). Interpretation: ‘Real-world’ treatment outcomes for aNSCLC with cEGFR mutations have improved over time likely due to the transition from 1st- to 3rd-gen TKIs. However, real-word survival with TKIs remains lower than clinical trials results emphasizing the unmet need.
creator: Aija Knuuttila
creator: Lalli O Nurmi
creator: Petri M Vänni
creator: Eija K Heikkilä
creator: Joanne Edwards
creator: Monica H Ekblom
creator: Irene Luccarini
creator: Maria Silvoniemi
rights: Copyright (c) 2026 Aija Knuuttila, Lalli O Nurmi, Petri M Vänni, Eija K Heikkilä, Joanne Edwards, Monica H Ekblom, Irene Luccarini, Maria Silvoniemi https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-19
publication date: 2026-02-19
volume: 65
starting page: 119
ending page: 125
doi: 10.2340/1651-226X.2026.44731

Clinical outcomes of genomically guided trametinib monotherapy across cancer types: results from the IMPRESS-Norway trial
type: item
description: Background and purpose: Molecular profiling guides cancer treatment, by identifying actionable genomic alterations. The IMPRESS-Norway trial (NCT04817956) is a nation-wide precision medicine trial evaluating the efficacy of approved cancer drugs on a novel indication in patients with advanced cancers harbouring potentially actionable alterations. Trametinib, a selective MEK1/2 inhibitor targeting the Mitogen-Activated Protein Kinase (MAPK) signalling pathway, is approved for BRAF V600 mutant melanoma but may also show activity in tumours with other alterations. This sub-study aimed to assess the efficacy of trametinib monotherapy across tumour types with alterations activating the MAPK signalling pathway. Patient/material and methods: In the IMPRESS-Norway trial patients are screened with the TruSight Oncology 500 panel or circulating tumour DNA profiling. Eligible patients are offered biomarker matched targeted therapies. In this subgroup analysis, we identified patients treated with trametinib monotherapy. Primary endpoints were disease control rate (DCR) after 16 weeks and safety. Secondary endpoints included progression-free survival (PFS) and overall survival (OS). Results: DCR after 16 weeks of treatment was 39% in 52 response evaluable patients, with four patients (8%) experiencing partial response, and 16 (31%) stable disease. Responses were seen in tumours harbouring BRAF fusions, GNA11, GNAQ, KRAS, NF1, and NRAS alterations, most frequently in low-grade serous ovarian cancer, central nervous system tumours, and uveal melanoma. Forty-eight percent of patients experienced treatment-related adverse events, including two treatment related deaths. Median PFS and OS were 4 and 9 months, respectively. Interpretation: Trametinib monotherapy achieved a 39% DCR in patients lacking standard options, supporting further studies to confirm efficacy and identify predictive biomarkers for treatment response.
creator: Kathinka Schmidt Slørdahl
creator: Katarina Puco
creator: Ragnhild Sørum Falk
creator: Ingrid Dyvik
creator: Sigmund Brabrand
creator: Pitt Niehusmann
creator: Eli Sihn Samdal Steinskog
creator: Egil S. Blix
creator: Åsmund Flobak
creator: Irja Alida Oppedal
creator: Sebastian Meltzer
creator: Cecilie Fredvik Torkildsen
creator: Hanne Blakstad
creator: Kristina Lindemann
creator: Sigbjørn Smeland
creator: Anita Amundsen
creator: Kjetil Taskén
creator: Åslaug Helland
rights: Copyright (c) 2026 Kathinka Schmidt Slørdahl, Katarina Puco, Ragnhild Sørum Falk, Ingrid Dyvik, Sigmund Brabrand, Pitt Niehusmann, Eli Sihn Samdal Steinskog, Egil S. Blix, Åsmund Flobak, Irja Alida Oppedal, Sebastian Meltzer, Cecilie Fredvik Torkildsen, Hanne Blakstad, Kristina Lindemann, Sigbjørn Smeland, Anita Amundsen, Kjetil Taskén , Åslaug Helland https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-10
publication date: 2026-02-10
volume: 65
starting page: 90
ending page: 96
doi: 10.2340/1651-226X.2026.45086

Feasibility of lung cancer screening in low-risk populations of the Nordic countries
type: item
creator: Mef Nilbert
creator: Gunnar Wagenius
creator: Simon Ekman
rights: Copyright (c) 2026 Mef Nilbert, Gunnar Wagenius, Simon Ekman https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-03-18
publication date: 2026-03-18
volume: 65
starting page: 228
ending page: 231
doi: 10.2340/1651-226X.2026.45489

Merging clinical research and standard healthcare – Nordic Precision Cancer Medicine Symposium 2025
type: item
creator: Elisa Bjørgo
creator: Nina Ånensen
creator: Gro Live Fagereng
creator: Hege G. Russnes
creator: Sigbjørn Smeland
creator: Kjetil Taskén
creator: Åslaug Helland
rights: Copyright (c) 2026 Elisa Bjørgo, Nina Ånensen, Gro Live Fagereng, Hege G. Russnes, Sigbjørn Smeland, Kjetil Taskén, Åslaug Helland https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-03-04
publication date: 2026-03-04
volume: 65
starting page: 181
ending page: 185
doi: 10.2340/1651-226X.2026.45168

Treatment of neuropathic pain in cancer survivors: a scoping review of pharmacological, exercise, and psychosocial interventions
type: item
description: Background and purpose: Neuropathic pain is a debilitating late effect among cancer survivors. This scoping review aims to provide an overview of pharmacological, psychological, and exercise interventions for neuropathic pain among cancer survivors and to identify further relevant research areas. Patient/material and methods: PubMed, PsychInfo, and EMBASE were systematically searched for studies published from January 2004 to January 2026 and abstract and full text screening was carried out. The target population was cancer survivors who had completed primary treatment and have no active disease. Neuropathic pain was defined as a) a mean pain intensity the last week/month of ≥ 3 at a numerical rating scale (0 = no pain, 10 = worst pain), and b) symptoms of neuropathy, or c) neuropathic pain diagnosed by an experienced neurologist. Results: Of the 956 systematic reviews/guidelines and 604 original studies identified, 11 pharmacological, two psychological and three studies on exercise were eligible. Most of the studies included patients with breast cancer. Duloxetine was effective in reducing neuropathic pain from painful chemotherapy-induced neuropathy and gabapentin + concomitant morphine compared to morphine alone reduced neuropathic pain in cancer survivors with neuropathic pain due to radiation therapy, and surgery. Mindfulness-based cognitive behavioral therapy showed no effect after correction for multiple comparisons. Exercise interventions were useful in both reducing neuropathic pain as well as neuropathic symptoms. Interpretation: This scoping review found evidence for pharmacological treatment of neuropathic pain in cancer survivors, could not make any conclusion on psychological treatment, and exercise interventions show promising effects. Further research on interdisciplinary treatment of neuropathic pain among cancer survivors is needed.
creator: Ellen Lund Schaldemose
creator: Bolette Skjødt Rafn
creator: Pernille Envold Bidstrup
creator: Agon Olloni
creator: Katrin Schättiger
creator: Peter Christensen
creator: Cæcilie Borregaard Myrhøj
creator: Maja Johannsen Lindberg
creator: Christoffer Johansen
creator: Sandra Jensen
creator: Ida Hovdenak
creator: Sasja Jul Håkonsen
creator: Lise Ventzel
rights: Copyright (c) 2026 Ellen Lund Schaldemose, Bolette Skjødt Rafn, Pernille Envold Bidstrup, Agon Olloni, Katrin Schättiger, Peter Christensen, Cæcilie Borregaard Myrhøj, Maja Johannsen Lindberg, Christoffer Johansen, Sandra Jensen, Ida Hovdenak, Sasja Jul Håkonsen, Lise Ventzel https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-04-24
publication date: 2026-04-24
volume: 65
starting page: 333
ending page: 343
doi: 10.2340/ao.v65.45347

Prevalence and risk factors for nausea and vomiting in breast cancer patients undergoing chemotherapy
type: item
description: Background and purpose: Chemotherapy-induced nausea and vomiting (CINV) is a common and severe adverse effect of breast cancer (BC) treatment that compromises treatment adherence and quality of life. This meta-analysis aims to assess the prevalence and risk factors of CINV in BC patients, thereby providing clinical insights for its prevention and improvement. Patient/material and methods: Relevant literature was identified through an extensive search of electronic databases from their inception up to July 10, 2025: PubMed, Web of Science, Embase, Cochrane, CNKI, Wanfang, and VIP databases on prevalence rates, odds ratios (OR), and corresponding 95% confidence intervals (CI) were extracted for analysis. Results: The screening process identified 12 eligible studies. The meta-analysis showed that the overall prevalence of CINV in BC patients was 48% (95% CI = 0.37–0.58). Univariate analysis identified the following risk factors: age ≤ 45 years (OR = 3.21, 95% CI = 1.44–7.17) and a history of motion sickness (OR = 4.85, 95% CI = 1.65–14.30). Multivariate analysis showed that age ≤ 45 years (OR = 2.36, 95% CI = 1.78–3.14), history of motion sickness (OR = 2.05, 95% CI = 1.42–2.98), and chemotherapy cycles ≥ 3 (OR = 2.27, 95% CI = 1.28–4.04) were risk factors. In contrast, anxiety (OR = 2.74, 95% CI = 0.66–11.29) and comorbidities (OR = 1.04, 95% CI = 0.72–1.49) were not significantly associated with CINV in BC patients. Interpretation: This meta-analysis shows that the prevalence of CINV in BC patients is high. It focused on the Asian population and indicated that younger age, history of motion sickness, and more chemotherapy cycles (≥ 3) were risk factors for CINV. Targeting these risk factors may help prevent CINV in BC patients.
creator: Yuhui Feng
creator: Liushan Wei
creator: Qinhong Zou
creator: Xiaoyong Lei
creator: Xiaoyan Yang
rights: Copyright (c) 2026 Yuhui Feng, Liushan Wei, Qinhong Zou, Xiaoyong Lei, Xiaoyan Yang https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-04-01
publication date: 2026-04-01
volume: 65
starting page: 252
ending page: 260
doi: 10.2340/1651-226X.2026.44933

The false-negative rate of sentinel lymph node biopsy and its related factors in early-stage cervical cancer: a systematic review and meta-analysis
type: item
description: Background and purpose: The objective of this systematic review and meta-analysis was to evaluate the false-negative rate (FNR) of sentinel lymph node biopsy (SLNB) performed in patients with early-stage cervical cancer (ECC), and to study the risk factors affecting FNR. Material and methods: We searched three databases (Embase, MEDLINE, and Cochrane Central Library) for articles published in the last decade from January 2014 to September 2024. Publications on patients with ECC who underwent SLNB, with information on the FNR of SLNB, were included. The QUADAS-2 tool was used to assess the risk of bias and the clinical applicability of the included studies. The FNR and associated factors were synthesized using random-effects meta-analysis and meta-regression. Results: A total of 49 eligible studies with a low to moderate risk of bias were included in the final analysis. The overall FNR was 10.9% (95 CI: 6.0–16.7). No significant differences in FNR were found for different reference standards or tumor diameters (< 2 cm vs. ≥ 2 cm). However, different tracers (e.g. methylene blue [MB], carbon nanoparticle [CNP], indocyanine green [ICG], and Technetium-99m [Tc-99m] combined with other tracers) appear to account for the different FNRs. In the meta-regression analysis, we found that the proportion of SLNs located in the obturator area was significantly negatively associated with FNR (coefficient = −0.88, p = 0.04). Interpretation: The overall FNR of SLNB for ECC was approximately 10.9%. Factors that tended to reduce the FNR included using a low-volume metastatic detection technique, having a tumor diameter of < 2 cm, employing specific tracer regimens, and identifying more than one lymph node in the obturator fossa. Registration: PROSPERO (CRD42024608411)
creator: Chao He
creator: Fei Li
creator: Min He
creator: Jia Li
rights: Copyright (c) 2026 Chao He, Fei Li, Min He, Jia Li https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-03-16
publication date: 2026-03-16
volume: 65
starting page: 213
ending page: 227
doi: 10.2340/1651-226X.2026.44984

A conceptual health economic modelling framework to assess the cost-effectiveness of molecular target–driven treatment regimens in oncology
type: item
description: Background and purpose: Molecularly targeted cancer therapies challenge conventional health economic evaluation frameworks that are structured around tumour-specific indications, comparators, and trial designs. Existing models often rely on pooled estimates from heterogeneous early-phase evidence or single-indication analyses, creating uncertainty for reimbursement decision-makers. We propose a conceptual modelling framework that aligns cost-effectiveness analyses with the biological rationale of precision oncology, evaluating therapies according to shared molecular alterations across tumour types. Patient/material and methods: We examined the methodological limitations of conventional partitioned survival models (PSMs) commonly applied in oncology and evaluated their suitability for tumour-agnostic indications. Based on the collected literature, we developed a dynamic, modular PSM framework that integrates multiple tumour sites expressing a common biomarker. The framework supports pooled and tumour-specific analysis of cost-effectiveness and enables progressive disaggregation of subgroups as additional evidence becomes available. Results: The proposed modelling approach facilitates transparent synthesis of heterogeneous evidence across tumour types using epidemiologically informed weighting, while preserving the ability to estimate tumour-specific cost-effectiveness where data permit. It addresses key challenges in tumour-agnostic evaluation, including variation in standard of care, treatment effects, and resource use across cancer sites. The modular design promotes internal consistency, reduces duplication of analytical effort, and enables iterative re-assessment of both overall and subgroup-specific cost-effectiveness. Interpretation: A dynamic, weighted multi-site modelling framework represents a coherent and adaptable extension of current health-technology assessment-practice for tumour-agnostic therapies. By structuring evidence around molecular targets, the f…
creator: Oskar Frisell
creator: Eline Aas
creator: Pia Sofie Henkel
creator: Gro Live Fagereng
creator: Kjetil Taskén
creator: Ebba Hallersjö Hult
creator: Peter Lindgren
creator: Katarina Steen Carlsson
rights: Copyright (c) 2026 Oskar Frisell, Eline Aas, Pia Sofie Henkel, Gro Live Fagereng, Kjetil Taskén, Ebba Hallersjö Hult, Peter Lindgren, Katarina Steen Carlsson https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2026-02-19
publication date: 2026-02-19
volume: 65
starting page: 141
ending page: 147
doi: 10.2340/1651-226X.2026.45088