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.
Medical physics in the Nordic countries: collaboration and future challenges – report from the Nordic Association for Clinical Physics 2026 Symposium
Copyright (c) 2026 Emelie Adolfsson, Jan Seppälä https://creativecommons.org/licenses/by/4.0
Feasibility of lung cancer screening in low-risk populations of the Nordic countries
Copyright (c) 2026 Mef Nilbert, Gunnar Wagenius, Simon Ekman https://creativecommons.org/licenses/by/4.0
Merging clinical research and standard healthcare – Nordic Precision Cancer Medicine Symposium 2025
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
Estimated number of children affected by paternal cancer diagnosis and death in Finland during 1970–2022: a population-based registry study
Background and purpose: Parental cancer effects millions of children worldwide. We estimated the number of children influenced by paternal cancer and paternal orphans, and examined changes in their numbers and annual rates over time, with a focus on time trends and the influence of cancer type. Patients and methods: Male cancer patients aged ≥15 years, diagnosed since 1953, were identified from the Finnish Cancer Registry. Cancer deaths and information on live births were obtained from Statistics Finland. Annual number of new children and prevalent children whose father was diagnosed with cancer and the annual number of new orphans and prevalent orphans due to paternal cancer death for 1970–2022 were estimated indirectly by combining cancer incidence and mortality data with population-level fertility rates. Results: The estimated age-standardized rate of new children with paternal cancer increased from 96/100,000 children in 1970–1974 to 163/100,000 in 2017–2021. The annual rate of new paternal orphans decreased from 56/100,000 in 1970–1974 to 35/100,000 in 2017–2021. The rate of new children increased 1.1% per year while the rate of new orphans decreased 1.1% in 1970–2021. Interpretation: Although the number of paternal orphans is decreasing due to improved cancer survival, the number of children influenced by paternal cancer is rising reflecting the increasing cancer incidence and resulting in more children vulnerable to the harmful effects of paternal cancer.
Copyright (c) 2026 Anniina Kyrönlahti, Eetu Mäkinen, Karri Seppä, Tea Lallukka, Janne Pitkäniemi https://creativecommons.org/licenses/by/4.0
Changing burden of cancers related to human papillomavirus in Estonia: a population-based registry study
Background and purpose: Human papillomavirus (HPV) causes multiple cancers. Understanding HPV-related cancer burden may help implement effective strategies for cancer prevention. The aim was to examine incidence and survival trends of eight HPV-related cancer sites in Estonia and estimate the number of cases attributable to HPV. Patient/material and methods: The Estonian Cancer Registry provided data on all cases of eight HPV-related cancer sites diagnosed in Estonia during 1995–2022. Age-standardized incidence trends were analyzed using joinpoint regression, estimating annual percentage change (APC). The number of HPV-attributable cases was estimated using internationally derived site-specific attributable fractions, as tumor HPV status was not available. Five-year relative survival ratios were calculated from national life tables. Results: In all, 11,266 cases of HPV-related cancer sites were diagnosed, of which 6,263 were estimated to be attributable to HPV; over 40% occurred before age 55. In women, estimated average annual number of HPV-attributable cases nearly quadrupled for oropharyngeal cancer (OPC) and tripled for anal cancer. A significant increase in OPC and anal cancer incidence was observed among women (APC 10.0 and 3.8, respectively). Cervical cancer incidence declined after 2012 (APC –5.6). Survival improved for OPC in men (from 13 to 44%) and vaginal cancer in women (from 45 to 73%). Interpretation: HPV-related cancer patterns in Estonia are shifting from cervical to non-cervical cancers. Increasing oropharyngeal and anal cancer incidence highlights the need for prevention strategies beyond cervical screening alone. Strengthening HPV vaccination uptake and sustaining organized cervical screening are critical for reducing future cancer burden.
Copyright (c) 2026 Sandra Kase, Mari-Liis Zimmermann, Margit Mägi, Aleksei Baburin, Keiu Paapsi, Reeli Hallik, Piret Veerus, Jana Jaal, Kaire Innos https://creativecommons.org/licenses/by/4.0
The effect of progressive resistance training on lean soft tissue mass in head and neck cancer patients during concomitant chemoradiotherapy: the DAHANCA 31 randomized controlled trial
Background and purpose: Head and neck cancer patients undergoing concurrent chemoradiation treatment (CCRT) lose a significant amount of lean soft tissue mass (LSTM) reducing muscle strength and performance. Progressive resistance training (PRT) may mitigate this loss and improve muscle strength and performance. The purpose was to investigate the effects of PRT initiated at CCRT onset on LSTM, muscle strength, and functional performance compared with usual care. Patients/material and methods: Patients were randomized to 12 weeks of PRT (36 sessions) or usual care with no exercise (control group [CON]). At baseline, after 6 and 12 weeks, 6 and 12 months, Dual-Energy Absorptiometry evaluated total body mass (BM), LSTM, and fat mass (FM); 1 repetition maximum (1RM) chest press and leg press test assessed maximal muscle strength and functional performance (30 seconds chair-rise; 30 seconds arm curls; stair climb) was evaluated. Dietary intake was registered as were Quality of Life questionnaires European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ) C30 and QLQ H&N-35. A sample size of 72 patients (36 per group) was determined a priori with LSTM as the primary endpoint. Results: Fifty patients were included (required sample size was not met), 25 in each group. From baseline to 12 weeks, patients in the PRT group lost 8.6 ± 1.0 kg BM (10%), 3.4 ± 0.6 kg LSTM (6%), and 5.2 ± 0.8 kg FM (21%). This was not significantly different from the CON group losing 7.4 ± 1.0 kg BM (9%), 3.4 ± 0.6 kg LSTM (6%), and 4.0 ± 0.8 FM (17%). Likewise, 1RM decreased equally in both groups. Chair rise and arm curl performance improved significantly more in PRT compared with in CON (p < 0.05). Interpretation: In this study PRT initiated at CCRT onset did not attenuate loss of LSTM or muscle strength. However, PRT did result in significantly increased functional performance.
Copyright (c) 2026 Camilla K. Lonkvist, Simon Lønbro, Anders Vinther, Bo Zerahn, Eva Rosenbom, Mads Vansted Svart, Morten Lyng Høgild, Hanne Primdahl, Julie Gehl https://creativecommons.org/licenses/by/4.0
Dose calculation errors for volumetric modulated arc therapy plans of various complexity
Background and purpose: Volumetric modulated arc therapy (VMAT) plans often involve small and irregular beam apertures (i.e. high complexity), which can pose challenges for accurate dose calculations. The aim of this study was to investigate plausible dose calculation errors for VMAT plans of various complexity. Patient/material and methods: Twenty patient cases, each with three VMAT plans of different complexities (i.e. 60 plans in total), were included. All plans were calculated using six different dose calculation methods. It was assumed that greater differences between calculations reflect increased difficulty in accurately estimating dose. Basic performances of the six calculation methods were evaluated based on static fields. Three-dimensional distributions of voxel-wise two standard deviations (2SDs) in percent of local voxel dose were visually evaluated. 2SD volume histograms were analyzed as well as the mean (2SDMean) and maximum 2SD within 2 cm3 (2SD2cc) for different regions of interest. Results: Higher 2SD values were generally found outside the planning target volume (PTV) compared to inside, particularly in low dose and buildup regions. Average (per treatment site) 2SDMean/2SD2cc values were 0.9–1.2%/1.8–5.1% in the PTV and 1.8–3.1/8.4–18.7% for the region 1 cm outside the PTV. For organs of interest, 2SDMean/2SD2cc values were larger than the equivalent values in the PTV, with highest values up to 5/15% observed for the prostate cases. Interpretation: Variations between dose calculation methods were larger in organs of interest than in the PTVs. Differences in 2SD distributions between the patient cases were generally larger than differences between the complexity levels.
Copyright (c) 2026 Emmanouil Terzidis, Fredrik Nordström, Magnus Gustafsson, Anna Karlsson, Julia Götstedt, Anna Bäck https://creativecommons.org/licenses/by/4.0
Overall survival following palliative immune checkpoint inhibitor treatment according to ECOG performance status: a large registry-based study
Background and purpose: Palliative immune checkpoint inhibitor (pICI) treatment has improved overall survival (OS) in many solid tumours during the last decades. However, the survival benefits are based on fit patients included in the clinical trials, all with Eastern Cooperative Oncology Group Performance status (ECOG PS) 0–1. Data on survival in PS 2–3 patients are limited. This study aimed to compare OS according to ECOG PS at the initiation of pICI in real world data. Patient/material and methods: ICI has been recorded in the Swedish National Cancer Drug Registries since 2010. Palliative ICI treatment in the Southeastern region, Sweden, from 2010 until April 2025 were included. Survival probability and median overall survival (mOS) were calculated. Results: A total of 1956 patients had received at least one pICI treatment, for lung cancer (n = 854), melanoma (n = 443), renal carcinoma (n = 218) and urothelial carcinoma (n = 127). PS 2 or higher was reported in 28.9% and 80.6% received ICI only (no chemotherapy). mOS was in PS 0–1 patients 23.4 months, in PS 2 patients 9.6 months and in PS 3 patients 3.8 months. Death within 90 days occurred in 45.7% of PS 3 patients. Interpretation: Less fit patients are commonly treated with pICI, and PS seems an important predictive factor for palliative ICI regardless of cancer subtype. In our data, mOS is particularly short in PS 3 patients, suggesting to refrain from treatment. mOS is shorter in PS 2 patients than in PS 0–1, warranting individual considerations in treatment decisions. Better tools to guide treatment decisions for PS 2 patients are desirable.
Copyright (c) 2026 Per Nodbrant, Eva Ulff, Magnus Lagerlund, Sander Ellegård, Olle Eriksson, Freddi Lewin, Kristina Engvall https://creativecommons.org/licenses/by/4.0
Cardiotoxicity, survival, and dexrazoxane use in patients with soft tissue sarcoma: a Danish population‑based cohort study
Background and purpose: Anthracycline-associated cardiotoxicity is a challenge that dexrazoxane may reduce. The aim of this study was to report the overall survival (OS), incidence of cardiotoxicity and dexrazoxane use in a Danish population-based cohort of patients with soft tissue sarcoma (STS) treated with doxorubicin, olaratumab and dexrazoxane. Patients/material and methods: We performed a retrospective study of adults (≥18 years) with locally advanced or metastatic STS treated with doxorubicin, olaratumab and dexrazoxane between 2015 and 2019 at Herlev University Hospital (Herlev) and Aarhus University Hospital (Aarhus). Dexrazoxane was administered from cycle 1 at Herlev and from cycle 4 at Aarhus. OS was measured from doxorubicin initiation to death. Cardiotoxicity was defined as a >10 percentage‑point decline in left ventricular ejection fraction to <50% compared with baseline. Results: In total, 106 patients were included: 71 patients (67%) from Herlev and 35 (33%) from Aarhus. Mean age was 59 years, 59% were female. Median OS was 18 months (95% confidence interval [CI]: 11.0–20.7) and median cumulative doxorubicin dose was 320.7 mg/m² (range: 37.5–605.4). Dexrazoxane was administered to 68 patients (96%) at Herlev and 18 (51%) at Aarhus. Seven patients (7%) developed cardiotoxicity (Herlev n = 4; Aarhus n = 3). Median OS was 19.6 months at Herlev and 14.8 months at Aarhus (p = 0.24). Neutropenic fever occurred in 27 patients (38%) at Herlev and six patients (17%) at Aarhus (p = 0.88). Interpretation: Doxorubicin with olaratumab and dexrazoxane resulted in a low incidence of cardiotoxicity and OS was consistent with previously reported.
Copyright (c) 2026 Joanna Vitfell-Rasmussen, Ninna Aggerholm-Pedersen, Christina Brun Knudsen, Kasper Madsen , Lars Fiksen , Niels Junker , Michael Mørk Petersen , Thomas Kümler , Anders Krarup-Hansen , Bodil Elisabeth Engelmann https://creativecommons.org/licenses/by/4.0
Patients’ preferences for follow-up after endometrial cancer surgery
Background and purpose: To compare follow-up preferences and health-related quality of life between newly operated endometrial cancer patients and those already enrolled in a traditional hospital-based follow-up program, and to explore whether preferences differ depending on follow-up experience. Patient/material and methods: In this prospective cross-sectional study, patients who underwent primary surgery for endometrial cancer in northern Sweden were included. Group 1 consisted of newly operated patients recruited before entering follow-up, and Group 2 included patients already participating in the standard hospital-based follow-up program. Participants completed questionnaires on sociodemographic characteristics, follow-up preferences, and quality of life (EORTC QLQ-C30). Clinical data were obtained from medical records. The primary outcome was follow-up preference; secondary outcomes included quality of life and associations with clinical and demographic variables. Results: Of the 121 invited patients, 92 (76%) responded, and 90 were included in the analysis (48 in Group 1; 42 in Group 2). The groups were comparable in baseline characteristics. Newly operated patients demonstrated more diverse follow-up preferences, with 51.1% preferring physician-led hospital visits compared to 82.9% in Group 2 (p = 0.035). Global quality of life did not differ significantly (p = 0.165), although Group 1 reported lower functional scores, particularly in role and emotional functioning. Appetite loss was the only symptom that differed significantly between groups. Interpretation: Newly operated patients are more open to alternative follow-up models despite similar overall quality of life. Integrating patient preferences into follow-up care may enhance personalization and sustainability.
Copyright (c) 2026 Linn Renman, Lotta Andréen, Sahruh Turkmen https://creativecommons.org/licenses/by/4.0
The impact of pazopanib and extremity radiotherapy on transaminase elevations in soft tissue sarcoma
Background and purpose: Unexpected high rates of grade ≥ 3 transaminase elevations were observed in patients receiving pazopanib and extremity radiotherapy. Although alanine transaminase (ALT) and aspartate transaminase (AST) primarily originate from the liver, both are also present in muscle tissue. In extremity soft tissue sarcomas (STS), where large muscle volumes are within the radiation field, radiation-induced muscle damage may contribute to these elevations. This study evaluated the impact of extremity radiotherapy, pazopanib, and their combination on the incidence and degree of ALT/AST elevations in STS patients. Patients and methods: A prospective cohort treated with extremity radiotherapy alone was combined with a retrospective cohort treated with pazopanib alone or in combination. Patient characteristics, treatment details, and laboratory values (liver enzymes and muscle injury biomarkers) were collected. Descriptive analyses and logistic regression were conducted to evaluate the association with grade ≥ 3 ALT/AST elevations. Results: Among 154 patients (10 radiotherapy, 108 pazopanib, 36 radiotherapy plus pazopanib), none of the radiotherapy-only patients experienced grade ≥ 3 elevations. Post-irradiation ALT/AST, creatine kinase and myoglobin elevations were minimal. Grade ≥ 3 elevations occurred in 6% of patients receiving pazopanib and 36% of those receiving both radiotherapy and pazopanib. All elevations typically resolved after pazopanib discontinuation. Grade ≥ 3 elevations were significantly associated with pazopanib, and modestly associated with pazopanib trough levels (odds ratio [OR]: 1.43 per 10 mg/L, 95% confidence interval [CI]: 1.12–1.90), but not with radiotherapy. Interpretation: Adding pazopanib to radiotherapy in localised extremity sarcoma significantly increases the rate of AST/ALT elevations. Extremity radiotherapy alone does not induce clinically relevant transaminase elevations. Grade ≥ 3 elevations were associated with pazopanib treatment. The mechanism underlying the substantially higher incidence of transaminase elevations with combined pazopanib and radiotherapy, compared with pazopanib alone, remains unknown.
Copyright (c) 2026 Bauke H. G. van Riet, Shermarke Hassan, Thomas R. de Wijkerslooth, Tom T. P. Seijkens, Alwin D. R. Huitema, Neeltje Steeghs, Rick L. Haas https://creativecommons.org/licenses/by/4.0
Pathological characteristics and prognosis of very young patients with early breast cancer: a comparative analysis with older patients
Background and purpose: It has generally been established that younger breast cancer patients exhibit unfavorable biology and poorer prognosis. However, previous studies have not consistently demonstrated differences between younger and older patients. The objective of this study, therefore, was to compare pathological characteristics and prognosis in young patients (age ≤ 40 years) with early breast cancer with those of older patients (age ≥ 55 years). Patients/material and methods: Individuals diagnosed with early breast cancer (age ≤ 40 years) and those ≥ 55 years of age, who were treated at two hospitals between June 2003 and December 2019, were identified. Oncological outcomes, including recurrence-free survival (RFS), distant RFS (DRFS), and locoregional RFS (LRRFS), were compared between two groups. Kaplan–Meier survival curves and the Cox proportional hazards model were used to evaluate. Results: Data from 288 young (≤ 40 years) and 830 older (≥ 55 years) patients were included. Pathologically, younger patients exhibited a higher prevalence of high-grade tumors. There was no significant difference in RFS and DRFS between the younger and older patient groups (RFS: hazard ratio 1.11 [95% confidence intervals (CI) 0.74–1.66]; P = 0.613; DRFS: hazard ratio 1.03 [95% CI 0.65–1.62]; P = 0.897). However, LRRFS was unfavorable in younger patients (hazard ratio, 2.15; 95% CI, 1.03–4.49; P = 0.043). Subgroup analysis revealed a significant difference in LRRFS among hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer patients (hazard ratio 4.04 [95% CI 1.17–13.97]; P = 0.027); however, no significant difference was observed in other subtypes. Interpretation: Younger patients with breast cancer exhibited a higher frequency of high-grade tumors, although no differences were observed in RFS and DRFS. However, locoregional recurrence was more common among younger patients, especially HR-positive/HER2-negative breast cancer.
Copyright (c) 2026 Youri Park, Yeonjoo Kwon, Jung Ho Park, Sanghwa Kim, Young Ah Lim, Hee-Joon Kang, Doyil Kim, Janghee Lee https://creativecommons.org/licenses/by/4.0
First-in-human quantitative [¹⁵O]H₂O PET imaging of tumour blood flow at rest and during exercise in lymphoma patients
Background and purpose: Although exercise is recommended for cancer patients, its acute effects on tumour blood flow (TBF) have not been quantified in humans. As TBF may influence tumour progression and treatment efficacy, we assessed its circulatory responses in malignant lymphoma during exercise using dynamic PET imaging. Patient/material and methods: Eight patients with Hodgkin or non-Hodgkin lymphoma underwent thoracic [¹⁵O]H₂O positron emission tomography/computed tomography (PET/CT) at rest and during 10 min of supine cycling (Borg RPE 11–16). TBF and its heterogeneity, tumour blood volume (TBV), mean transit time (MTT), and vascular resistance were quantified in eight index and three secondary tumours. Results: Baseline TBF in index tumours was high (mean 57.6 mL/dL/min; range 30.3–105.0). During exercise, TBF (mean 48.1 ± 16.1 mL/dL/min), its heterogeneity and MTT did not change significantly. However, TBV decreased (p = 0.038), and vascular resistance tended to increase (p = 0.055). TBF change correlated positively with age (r = 0.73, p = 0.04) and negatively with tumour volume (r = –0.67, p = 0.02), but not with heart rate or power output. Secondary tumours showed similar exercise responses, with lower absolute TBF (p = 0.02). Interpretation: This study demonstrates the feasibility of using [¹⁵O]H₂O PET/CT to quantify TBF in lymphoma patients in real time during acute exercise. Baseline TBF is remarkably high in lymphoma tumours, and responses to acute exercise are variable, tending to decline in younger patients and larger tumours, while vascular resistance tended to increase.
Copyright (c) 2026 Milla Perros, Tiia Koivula, Salla Lempiäinen, Tuula Tolvanen, Anna Kirjavainen, Laura Nummijärvi, Carl-Johan Sundberg, Helene Rundqvist, Heikki Minn, Kari Kalliokoski, H.A, https://creativecommons.org/licenses/by/4.0
Evaluation of 3D-CRT vs. VMAT for radiotherapy of whole breast with simultaneous integrated boost
Background and purpose: This study evaluates volumetric modulated arc therapy (VMAT) as a potential alternative to three-dimensional conformal radiotherapy (3D-CRT) for whole-breast radiotherapy (RT) with simultaneous-integrated boost (SIB). Patient/material and methods: Ten left-sided breast cancer patients previously treated in our institution (whole breast with SIB) were selected. Clinical plans were generated using tangential field-in-field 3D-CRT technique. VMAT plans were retrospectively created. Dosimetric evaluation was performed according to our clinical guidelines. A robustness evaluation of the 3D-CRT and VMAT plans against simulated anatomical and setup uncertainties was also performed. Differences between techniques were analysed using a two-sided Wilcoxon signed-rank test with a significance level of 0.05. Results: Both the 3D-CRT and VMAT plans fulfilled the clinical requirements for target volumes and organs at risk. VMAT plans showed a median increase in heart mean dose of 10.8%, compared to 3D-CRT (p < 0.05). Heart maximum dose was reduced by up to 56.7% with VMAT (p < 0.05), offering a clinically meaningful advantage. For the ipsilateral lung, no significant difference in mean dose was observed, V16Gy was significantly lower and V4Gy was significantly increased with VMAT. VMAT plans improved dose conformity to the boost planning target volume, (p < 0.05). Median monitor units (MU) values of 371 MU (359–466 MU) vs 927 MU (752–1018 MU) were obtained with 3D-CRT and VMAT. VMAT remained robust to simulated uncertainties for whole-breast but showed greater sensitivity in the boost volume. Interpretation: VMAT was a feasible alternative to 3D-CRT for whole-breast RT with SIB, improving boost dose-conformity and reducing maximum heart dose. However, VMAT requires careful dosimetric evaluation and robustness assessment.
Copyright (c) 2026 Gracinda Johansson, Rafat Kojoj, Sewa Surdashi, Martin Olin, Emil Fredén, Pelin Sen, Eija Dahl, Camilla Wendt https://creativecommons.org/licenses/by/4.0
Detection of disease recurrence in real-world patients with completely resected stage III cutaneous melanoma
Background and purpose: Optimal postoperative follow-up for high-risk cutaneous melanomas (CM) is unclear. We aimed to evaluate disease recurrences in patients with stage III CM before modern adjuvant therapies. Patient/material and methods: Three hundred and fifty patients with a median follow-up of 8.9 years at Helsinki University Hospital Comprehensive Cancer Center after complete resection of stage IIIA–D CM between 2008 and 2017 were identified. Information on baseline characteristics, recurrence patterns and survival were collected from electronic medical records. Results: One hundred and ninety patients (54.3%) developed disease recurrence with 258 recurrence events documented. Local recurrence occurred in 14.5, 27.0, 32.3 and 44.4% and distant metastases in 21.7, 40.5, 52.4 and 83.3% of patients with stage IIIA, IIIB, IIID and IIID, respectively. Median recurrence-free survival was not reached and 7.4 years in stage IIIA and IIIB compared to 2.9 and 0.9 years in IIIC and IIID. Routine computed tomography (CT) imaging revealed 51% of all recurrences and 64% of distant meta­stases. 13.2% of distant recurrences involved skin and soft tissues, 31.4 lungs, 34.0 other visceral organs and 21.5% brain. First recurrences occurred mostly during the first 2 years of follow-up (59.5–100% in stage IIIB–D) except for stage IIIA (45.0%). Most of recurrences detected by patients (58.0%), physical exams or ultrasound (76.1%) and routine CT (61.2%) occurred during the first 2 years. Interpretation: High rate of recurrences and distant metastases supports routine physical exams and CT particularly during the first years of postoperative follow-up, especially in stage IIIB–D CM.
Copyright (c) 2026 Tiina Peuranheimo, Anni Hellman, Siru Mäkelä, Kalle E Mattila, Micaela Hernberg https://creativecommons.org/licenses/by/4.0
Diagnostic pathways for lung cancer patients in Denmark: General practice events, first referral and stage at diagnosis
Background and purpose: This study examined lung cancer patients’ diagnostic pathways, focusing on first healthcare contact, general practice events, referral choice, and stage at diagnosis. Patients and methods: General practices in three Danish regions participated in a retrospective survey of medical records for patients diagnosed with lung cancer between March 2019 and February 2021. General practitioners completed a questionnaire on initial contact, symptom presentation, diagnostic events and first referral. Socioeconomic data and tumor stage were retrieved from national registers. Associations between symptom presentation and diagnostic events were analysed. Results: Among 1069 patients, 72% had initial contact in general practice, 22% at a hospital and 5% with out-of-hours care. Of patients starting in general practice (n = 766), 36% presented specific cancer symptoms, 48% non-specific symptoms, 9% both and 7% were asymptomatic. Diagnostic events included hesitation to seek care (10%), declining investigation or non-adherence (4%) and initial management for another disease (33%). Men were more likely to decline investigation or fail to follow-up (odds ratio [OR] 4.32; 95% confidence interval 1.75–10.65). Non-specific symptoms increased the odds of referral for another condition (OR 1.48) or another cancer type (OR 2.99). Most patients were first referred to imaging (48%), whereas 16% entered a cancer care pathway and 18% were acutely hospitalised. Advanced stage was common (80%) and more likely among acutely hospitalised patients (OR 2.68). Interpretation: Most lung cancer patients present first in general practice. Non-specific symptoms are frequent and pose challenges for timely diagnosis.
Copyright (c) 2026 Dorte Ejg Jarbøl, Peter Haastrup, Sanne Rasmussen, Gitte Bruun Lauridsen, Kirubakaran Balasubramaniam, Linda Juel Ahrenfeldt, Jesper Lykkegaard, Lisa Maria Sele Sætre https://creativecommons.org/licenses/by/4.0
Oncological outcome and immune-checkpoint-blockade-induced toxicities in patients with cervical cancer – a Norwegian real-world cohort
Background and purpose: The introduction of immune checkpoint inhibitors (ICIs) into the treatment of patients with metastatic or recurrent cervical cancer has been shown to significantly prolong survival. In this study, we examined the clinical outcomes and tolerability of treatment with ICIs in patients with metastatic or recurrent cervical cancer in a real-world setting in Norway. Patient/material and methods: This retrospective cohort study included patients treated with an ICI in combination with chemotherapy or as single agent at Oslo University Hospital between 2016 and 2024. The primary oncological endpoint was progression-free survival (PFS). Secondary endpoints include overall survival (OS) as well as tolerability. Results: We included 57 patients with a median age of 53 years and a median follow-up of 15.2 months. Thirty-five patients were treated with an ICI in combination with chemotherapy (cohort 1), and or an ICI alone (n = 22) (cohort 2). Forty-six patients (81%) were treated for recurrent disease. In cohort 1, the median PFS was 12.4 months (95% CI: 9.0–15.7), and the median OS was 27.5 months (95% CI: 18.0–37.1). In cohort 2, the median PFS was 3.7 months (95% CI: 2.4–5.0), and the median OS was 9.3 months (95% CI: 4.3–14.4). Nine patients (16%) discontinued treatment due to toxicity. Interpretation: Our real-world data on the use of ICIs alone or in combination showed antitumour efficacy comparable to that reported in clinical studies in patients with advanced or recurrent cervical cancer. Our discontinuation rate highlights that toxicity management and mitigation are paramount when novel drugs are introduced in clinical algorithms.
Copyright (c) 2026 Katharina Bischof , Keira Matallah Fredriksen, Margrethe Bjørnstad, Mari Bunkholt Elstrand, Brynhildur Eyjolfsdottir, Alda Birgisdottir, Elisabeth Lillo, Guro Aune, Kristina Lindemann https://creativecommons.org/licenses/by/4.0
Validation of absolute dose calculation of a single 125I-seed for ophthalmic brachytherapy within distance range 1–15 mm using a diode detector
Background and purpose: Intraocular tumors can be treated with brachytherapy. Dosimetry of ophthalmic applicators is challenging due to short distance ranges and steep dose gradients. Measurements are sensitive to the structure of the dosimeter, and correction methods specific to 125I-source are needed for validation measurements of dose distribution. Material and methods: We measured dose profiles of I25.S16 seed using diode detector in a water phantom at 2 and 5 mm above surface of acrylic (PMMA) and gold backing. Volume averaging effect was corrected by the ratio of dose calculated with AAPM TG-43 formalism at the center point and the dose average within the detector element area. The angular sensitivity was measured at a constant radius around the seed. The effect of gold backing was evaluated from measurements with and without gold slab behind the seed. Measurements were normalized to calculated value at the distance of 10 mm from the seed using the air-kerma rate measured with a calibrated well chamber. Results: 1D/3D gamma comparison pass rates 97% with criteria 0.3 mm/3% and 60% with 0.5 mm/5% were reached for a seed attached to PMMA and gold, respectively, in the range ± 10 mm. Interpretation: TG-43 calculated single seed distributions in PMMA were equivalent to measurements corrected for angular sensitivity and detector area. Gold-to-water ratio corrected calculations were not similarly comparable, and simple one-dimensional correction method is not accurate enough laterally. Diode dosimetry with these correction methods can be used for quality assurance and validation of clinical dose calculation of ophthalmic applicators.
Copyright (c) 2026 Anna Rintala, Vappu Reijonen, Assi Valve, Mikko Tenhunen https://creativecommons.org/licenses/by/4.0
Long-term lifestyle effects of prehabilitation in colorectal cancer
Background and purpose: Prehabilitation—a multimodal intervention aimed at optimizing patients’ physical, nutritional and psychological status prior to surgery—has been shown to improve postoperative outcomes. However, the long-term impact of such programs on lifestyle remains poorly understood. Aim is to evaluate long-term lifestyle changes following a 4-week prehabilitation program prior to elective colorectal cancer (CRC) surgery and to compare patient-reported outcomes over a 24-month postoperative period between prehabilitation and control groups. Patient/material and methods: This single-center cross-sectional study combined a prehabilitation specific questionnaire with longitudinal data from the Prospective Dutch Colorectal Cancer (PLCRC) cohort. Questionnaires were distributed to CRC patients who underwent prehabilitation between 2021 and 2023. Longitudinal data—including validated measures of physical activity and quality of life—were compared between prehabilitation and control groups at 6, 12, and 24 months post-surgery. Results: A total of 137 prehabilitation questionnaires were completed. Over half of the patients reported sustained lifestyle changes, including increased physical activity, healthier dietary habits and smoking cessation. However, longitudinal analyses of the PLCRC cohort (n=140) showed no significant differences in physical activity or quality of life between the prehabilitation and control groups. Interpretation: Patients reported perceived meaningful, sustained, long-term lifestyle improvements following prehabilitation. The positive patient perspective may help support the broader implementation of prehabilitation in CRC care and highlights its potential to facilitate long-term lifestyle changes. However, these improvements were not reflected in the PLCRC data, likely due to high variability and the limited sample size of the dataset.
Copyright (c) 2026 Lisa D Geomini, Barend J Spanninga, Margot HM Heijmans, Gerrit D Slooter https://creativecommons.org/licenses/by/4.0
Prospective evaluation and clinical outcomes of adaptive radiotherapy for locally advanced non-small cell lung cancer (LA-NSCLC)
Background and purpose: Locoregional tumor control is strongly associated with survival for non-small cell lung cancer, emphasizing the importance of precise radiotherapy delivery. This study aims to evaluate a traffic light adaptation protocol regarding target coverage, protocol performance and patient outcomes. Material and methods: From 2019 to 2022, we prospectively enrolled inoperable non-small cell lung cancer patients. We acquired daily cone-beam computed tomography and traffic light registrations, classifying anatomical changes and need of action. Using repeated computed tomography (rCT) in week 1 and 3 for dosimetric evaluation, we recalculated clinical target volume (CTV) D98% and V95% with and without adaptation, and compared traffic light registrations with the actual dose distribution. Protocol performance was evaluated by the sensitivity and specificity in detecting CTV V95% < 98%. Results: Among 45 patients with complete registrations, baseline shift and tumor shrinkage were most common changes, leading to corrections from bone to tumor match in 37.8% and replanning in 13.3% of patients. Among 38 patients with at least one rCT, 15.8% would have received insufficient CTV coverage without adaptation. Protocol sensitivity, specificity and balanced accuracy were 83.3, 88.6, and 85.7%, respectively. For 38 stage II–III patients, median overall survival was 43.5 months (95% confidence interval [CI]: 32.9–54.1), median time to locoregional failure 27.4 months (95% CI: 0–61.8) and median estimated time to distant failure 30.7 months (CI not estimated due to censoring). Interpretation: The protocol identified relevant changes, improving target coverage without increasing organ at risk doses. With appropriate training, protocol performance was good, and clinical outcomes were consistent with international results.
Copyright (c) 2026 Ingvild Helø Carlsen, Vilde Ragnvaldsen Dyvik, Tuva Borgund Johannessen, Kristine Fjellanger, Inger Marie Sandvik, John-Vidar Hjørnevik, Turid Husevåg Sulen, Tone Nybø, Johanna Austrheim Hundvin, Sara Margareta Cecilia Pilskog, Øystein Fløtten, Vilde Drageset Haakensen, Liv Bolstad Hysing https://creativecommons.org/licenses/by/4.0
Dose-de-escalated focal radiotherapy for primary cutaneous T-cell lymphoma: a lesion-based retrospective cohort study
Background and purpose: Radiotherapy (RT) is effective for cutaneous T-cell lymphoma (CTCL), but the optimal focal dose remains debated. We evaluated lesion response, local control, toxicity and patient satisfaction after 2 × 4 Gy compared with higher-dose regimens. Patient/material and methods: This single-centre retrospective study included CTCL patients treated with RT between 1990 and 2019 at a German university hospital. Lesions receiving 2 × 4 Gy (low-dose) were compared with lesions treated with higher doses (median 34 Gy). Endpoints were complete response (CR), overall response (OR), 1- and 5-year local control rate (LCR; Kaplan–Meier/log-rank), in-field relapse and toxicity (common terminology criteria for adverse events/ Radiation Therapy Oncology Group (RTOG)-European Organisation for Research and Treatment of Cancer). Patient satisfaction Freiburg Index of Patient Satisfaction (FIPS) was assessed in a subsample. Results: Thirty-two patients with 227 lesions were analysed (195 low-dose; 32 higher-dose). CR was achieved in 88.2% vs 90.6% and OR in 94.4% vs 100%, respectively (low- vs higher-dose). LCR was inferior after low-dose RT, with 1- and 5-year LCR estimates of 82 and 67% versus 100 and 96% after higher-dose RT (log-rank p = 0.013). In-field relapse occurred in 20.1% (37/184) vs 3.6% (1/28) of lesions with follow-up (Fisher p = 0.034). No toxicity > grade 2 was observed, and did not differ between groups (p = 0.695 and p = 0.657). In 11 FIPS questionnaires, satisfaction was high (mean score 1.27; median 1). Interpretation: Low-dose 2 × 4 Gy yields excellent initial response with minimal toxicity, but inferior local control compared with higher-dose focal RT. Findings support intent-based dosing: 2 × 4 Gy for symptom-driven treatment with re-irradiation as a pragmatic option, and higher-dose RT when durable local control is the primary objective.
Copyright (c) 2026 Philipp Linde, Kathrin Wagner, Johannes Rosenbrock, Michael Oertel, Simone Ferdinandus, Jiaqi Fan, Emmanouil Fokas, Christian Baues https://creativecommons.org/licenses/by/4.0
Survival and relapse of Danish patients with thymic epithelial tumors
Background and purpose: This study aims to evaluate survival, relapse, comorbidities, and prognostic factors in patients with thymic epithelial tumours (TETs) to improve risk stratification for TET-related mortality and relapse and support evidence-based follow-up and treatment strategies. Patient/material and methods: The cohort consists of consecutive Danish patients diagnosed with thymoma, thymic carcinoma (TC), or thymic neuroendocrine tumor (NET) between January 1st, 2015 and December 31st, 2020, with follow-up data available. Data were collected from online medical records including disease characteristics, survival outcomes, comorbidities, and relapse. Statistical analyses were performed in R 4.3.2 and the prognostic value baseline traits were analyzed using Cox Proportional Hazards models. Results: Our cohort comprised 282 patients with a mean diagnostic age of 65 years and the following histological distribution: thymoma (85%), TC (13.6%), and NET (1.4%). During the 72-month mean follow-up, 65 deaths occurred yielding overall survival (OS) of 81% in patients with thymoma and 47% in patients with TC. TET-related deaths predominated in TC, yielding a cancer-specific survival) of 53% compared with 96% in thymoma. Reduced OS was associated with increasing age (p < 0.001) and advanced Tumor, Node, Metastasis-stage (III p < 0.05; IV p < 0.001). Disease progression was verified in 13/201 (6%) of thymoma patients with R0 or R1 resection. Interpretation: We report a high OS of Danish TET patients compared to existing population-based studies. The occurrence of TET-related mortality and disease progression in patients with thymoma and TC, highlights the need for long-term follow-up and therefore risk stratification in TET management.
Copyright (c) 2026 Tine Østergaard, Caroline Van Alstine Bjerke, Eric Santoni-Rugiu, Thomas Hartvig Lindkær Jensen, Katharina Anne Perell, René Horsleben Petersen, Peter Meidahl Petersen https://creativecommons.org/licenses/by/4.0
Treatment and progression of patients in Sweden with metastatic castration-sensitive prostate cancer
Background and purpose: The metastatic castration-sensitive prostate cancer (mCSPC) treatment landscape in Sweden has evolved in recent years. The purpose of this study is to provide contemporary registry data on outcomes and treatment patterns in a nationwide cohort of Swedish patients with de novo mCSPC. Patient/material and methods: This retrospective cohort study included patients in Sweden with a clinical diagnosis of de novo mCSPC registered between January 1, 2017 and December 31, 2023. The primary outcome was time from de novo mCSPC diagnosis to mCRPC or death (2017–2023). Secondary outcomes included overall survival (OS), comorbidities, co-medication use, and treatment sequencing. OS, time to progression or death, and treatment sequencing for the 2017–2020 and 2021–2023 time periods were also analyzed. Results: A total of 2421 patients with de novo mCSPC were included in the primary analysis (mean age: 72.8 years). The median time to progression or death was 22.7 months (95% CI: 21.2–24.1), and the median OS was 49.8 months (95% CI: 47.0–52.6). Median time to progression or death increased from 19.9 months (95% CI: 18.6–21.2) in 2017–2020 to 30.0 months (95% CI: 26.6–33.3) in 2021–2023, while the proportion of patients receiving initial doublet or triplet therapy rose from 42.5 to 68.8%. No differences in OS were observed between different time periods. Interpretation: In Sweden (2017–2023), increased time to progression or death was observed in patients with de novo mCSPC.
Copyright (c) 2026 Johan Styrke, Åsa Jellvert, Marie Hjälm Eriksson, Fredrik Sandin, Elin Axén, Sam Jabbar, Kamilla Juhl Norgaard https://creativecommons.org/licenses/by/4.0
KaSARi: a national framework for standardized, automated, and predictive radiotherapy in Finland
Background and purpose: National radiotherapy (RT) data infrastructures are emerging to support treatment quality assurance and outcome research. However, prospective nationwide integration of full DICOM-RT data with toxicity and patient-reported outcome measures (PROMs) remains uncommon. KaSARi (Key advances in Standardizing, Automating, and predicting Risks in RT) was established to create national research infrastructure for prospective RT data collection and integration in Finland. Materials and methods: KaSARi is a prospective, consent-based multicenter cohort infrastructure involving Finnish university and central hospitals. All adult patients receiving RT are eligible. DICOM-RT datasets from treatment planning and oncology information systems are linked to clinician-graded toxicity, PROMs and relevant clinical variables. The infrastructure builds on previously validated multi-institutional DICOM workflows and follows FAIR (Findable, Accessible, Interoperable, Reusable) data principles. Predefined work packages support data harmonization, scalable data processing and enable downstream applications such as AI-based segmentation, dose prediction, and outcome modeling. Results: Patient recruitment started in May 2025. By February 2026, 221 patients had been enrolled at the coordinating center, initially including breast cancer patients and subsequently expanding to all RT indications. Recruitment at a second center began in November 2025, with 37 patients enrolled. The infrastructure is projected to include approximately 29,000 patients over 15 years. Integration of dosimetric, clinical and PROM data is progressing through a phased national implementation as additional centers join the network. Interpretation: KaSARi represents a national infrastructure prospectively integrating full DICOM-RT datasets with clinician-graded toxicity and PROMs across all RT indications within a unified research protocol. The study provides a foundation for nationwide outcome modeling, harmonization of RT practices and development and validation of data-driven AI-based methods.
Copyright (c) 2026 Jan Seppälä, Maria Tengström, Henri Korkalainen, Tuomas Virén, Juuso TJ Honkanen, Juha Nikkinen, Kaisa Lehtiö, Annika Ålgars, Jani Keyriläinen, Sami Suilamo, Heidi Nurmi, Tanja Skyttä, Eeva Boman , Tero Vatanen, Liisa Sailas , Ulla-Mari Arkko, Kristiina Vuolukka, Tuomas Koivumäki, Tiina Metsäharju, Timo Voivalin , Janne Heikkilä https://creativecommons.org/licenses/by/4.0
Exploring the somatic mutational landscape of ovarian cancer in Estonia
Background and purpose: This retrospective study provides Estonia’s first nationwide overview of pathogenic and likely pathogenic variants in ovarian cancer (OC) using routine tumor molecular profiling. The aim was to characterize the mutational landscape, identify clinically actionable alterations, and evaluate the integration of germline testing. Patient/material and methods: A total of 339 OC tumor samples underwent next‑generation sequencing-based profiling. Clinical characteristics, histological subtype, and prior germline testing were recorded. Variants were classified according to clinical‑actionability levels, and homologous recombination deficiency (HRD) was assessed in high‑grade serous OC cases. Results: The mean age at diagnosis was 62.4 ± 12.5 years, and high‑grade serous OC accounted for 82.0% of cases. Clinically actionable alterations (OncoKB Level 1&2) were detected in 37.5% of patients, most frequently involving BRCA1, BRCA2, KRAS, and BRAF. Additional therapeutic targets were identified across diverse biomarkers. HRD was present in 53.2% of tested high‑grade serous tumors. Germline testing had been performed in 41.9% of patients, revealing pathogenic or likely pathogenic variants in 22.5%, predominantly in BRCA1 and BRCA2. Interpretation: This study outlines the mutational spectrum of OC in Estonia and demonstrates a substantial prevalence of actionable alterations and HRD. The findings highlight the value of comprehensive tumor profiling to support precision‑medicine approaches and improve individualized patient management in Estonia.
Copyright (c) 2026 Mikk Tooming, Kadri Rekker, Kadri Toome, Laura Roht, Piret Laidre, Olga Fjodorova, Ustina Šamarina, Sander Pajusalu, Mihkel Ilisson, Pilleriin Peets, Tõnu Jõgi, Karin Klaup, Kristiina Ojamaa, Eva-Maria Niine-Roolaht, Piret Kaarde, Elen Vettus, Jüri Piirsoo, Helen Vahar, Katrin Õunap, Tiina Kahre https://creativecommons.org/licenses/by/4.0
An updated system for categorising and reporting unintended incidents in radiotherapy at a national level
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.
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
Real-world outcomes of pembrolizumab in advanced anal cancer: a nationwide Danish anal Cancer Group report
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.
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
Incidence and impact of pseudoprogression and mixed responses in metastatic renal cell carcinoma patients treated with ipilimumab/nivolumab: a retrospective analysis
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.
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
Adenocarcinoma of the small intestine cohort: prospectively collecting real-world data to improve care and quality of life for patients with a rare cancer
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.
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
Radiotherapy and diagnostic capacity in relation to the changing cancer burden in the Baltic States
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.
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
The role of radiotherapy in patients with advanced melanoma failing targeted therapy
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.
Copyright (c) 2026 Ellen Heurlin, Lina Grödeberg, Hildur Helgadottir https://creativecommons.org/licenses/by/4.0
Feasibility of patient-reported outcomes collection in clinical routine at a radiotherapy department
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 routine PROM collection provided valuable insights into patients’ quality of life and symptom burden during and after treatment.
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
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
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.
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
Prevalence of self-reported pain in patients 5 years after rectal cancer treatment: results from the prospective QoLiRECT cohort study
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.
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
Risk factors for distant recurrence in patients with rectal cancer supporting selection for total neoadjuvant therapy
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.
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
Temporal trends in diagnostic work-up, treatment, and mortality in locally advanced prostate cancer in 2016–2024: nationwide, population-based study in Sweden
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.
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
Malpractice claims for pancreatic cancer in Norway: claim-rates, injury domains, claim outcomes and indemnity compensation
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.
Copyright (c) 2026 Annbjørg H Søreide, Karin H. Edland, Andreas B. Alvestad, Solveig Hodne, Kjetil Søreide https://creativecommons.org/licenses/by/4.0
Targeted therapy in the treatment of lung cancer in Iceland 2010–2023
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.
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
Association between short-term radiation-induced toxicity and oncological outcomes in high-risk prostate cancer: a retrospective single-centre cohort study
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.
Copyright (c) 2026 Jenny Kahlmeter Brandell, Antonis Valachis, Henrik Ugge, Daniel Robert Smith, Bengt Johansson https://creativecommons.org/licenses/by/4.0
How does pulmonary function impact QoL in patients with locally advanced NSCLC treated with chemoradiotherapy and durvalumab?
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.
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
Real-world management of patients with simultaneously diagnosed synchronous liver and lung metastatic colorectal cancer – a national cohort study
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 for potential curative treatment.
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
Characteristics, treatment and survival of patients with chondrosarcoma in five European countries: a DARWIN EU® cohort study
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.
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
Prediction of dumping after oesophageal cancer surgery
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 follow-up and guiding future research.
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
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
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.
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
Real-world outcome of neoadjuvant therapy with or without pembrolizumab for triple-negative breast cancer
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.
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
Post-treatment infection prediction in CLL using domain adaptation of lymphoma electronic health records
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.
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
Nordic Society of Paediatric Haematology and Oncology (NOPHO) Radiotherapy Working Group consensus guidelines on radiotherapy for paediatric low-grade gliomas
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.
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
Antibiotic treatment indicates shorter survival in patients with immunotherapy for metastatic kidney cancer
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.
Copyright (c) 2026 Elisa Kankkunen, Kaisa Sunela, Timo Makkonen, Katriina Jalkanen, Kalle E Mattila https://creativecommons.org/licenses/by/4.0
Healthcare costs and resource use in advanced breast cancer at the end of life: a register study
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.
Copyright (c) 2026 Giovanni Galvis Rojas, Peter Strang, Torbjörn Schultz , Lars-Åke Levin https://creativecommons.org/licenses/by/4.0
The Association of right atrium and sinoatrial node irradiation with atrial fibrillation and radiation-induced heart disease in non-small cell lung cancer
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.
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
Baseline results from the Norwegian radiology-led lung cancer screening pilot
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.
Copyright (c) 2026 Albin Mahovkic, Kirill Neumann, Trond-Eirik Strand, Oluf Dimitri Røe, Haseem Ashraf https://creativecommons.org/licenses/by/4.0
The rise of 3D spheroids in radiobiology for assessing tumour radioresistance
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.
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
Cost-effectiveness analysis of operative versus non-operative management of colorectal cancer metastases in the Finnish RAXO Study
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.
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
Stakeholders’ experiences with a clinician-led access programme linking evidence generation and reimbursement for precision cancer treatments: the drug access protocol in the Netherlands
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.
Sahar Barjesteh van Waalwijk van Doorn-Khosrovani
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
Characteristics, treatment, and outcome of recurrent gastro-oesophageal adeno­carcinoma after perioperative chemotherapy and radical resection
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.
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
Procedures of data merging in precision cancer medicine: the PRIME-ROSE project
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.
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
Preliminary feasibility of pre-treatment F-18-PSMA-1007 PET/CT in dose prediction for Lu-177-PSMA-I&T therapy
Copyright (c) 2026 Suvi Kokkonen, Vappu Reijonen, Eero Hippeläinen, Veera Ahtiainen, Jukka Schildt, Outi Sipilä, Sauli Savolainen, Mikko Tenhunen https://creativecommons.org/licenses/by/4.0
Declining melanoma incidence among younger adults in Sweden: insights from histopathological subtypes and the role of immigration
Copyright (c) 2026 Yodit Girmay, Rasmus Mikiver, Jan Lapins, Karolin Isaksson, Hildur Helgadottir https://creativecommons.org/licenses/by/4.0
Recent survival trends in the most fatal cancers in the Nordic countries: gains in some but not in all
Copyright (c) 2026 Kari Hemminki, Zitricky Frantisek, Asta Försti, Akseli Hemminki https://creativecommons.org/licenses/by/4.0
Starshot field configuration in the linac isocentre size determination: a comparison of film and electronic portal imaging device measurements
Copyright (c) 2026 Ari-Pekka Honkanen, Antti Kulmala https://creativecommons.org/licenses/by/4.0
Perspectives on artificial intelligence-generated chronic disease risk predictions in early breast cancer: an international survey among radiation oncologists
Copyright (c) 2026 Frederik Voigt Carstensen, Belinda Bøgh Irankunda, Eva Batista, Desiree van den Bongard, Tanja Spanic, Sofie A.M. Gernaat, Helena Verkooijen, Maja Vestmø Maraldo https://creativecommons.org/licenses/by/4.0
A 10-year-long ongoing complete response to vismodegib as first-line treatment in adult metastatic medulloblastoma
Copyright (c) 2026 Suweydo Abdi, Paula Poikonen-Saksela, Päivi Halonen, Olli Tynninen, David A Reardon, Micaela Hernberg https://creativecommons.org/licenses/by/4.0
PIK3CA mutation testing and alpelisib use in metastatic breast cancer: a real-world data set
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
Tumour acquisition method and molecular profiling success in advanced cholangiocarcinoma
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
SPRINTR: Swedish PRecision medicine Initiative for Novel Treatments and Research-towards efficient recruitment to clinical trials for prostate cancer
Copyright (c) 2026 Karin Welén, Andreas Josefsson https://creativecommons.org/licenses/by/4.0
Psychological distress and tumor cell β2-adrenergic receptor levels in patients with surgically resected non-small cell lung cancer
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
Multidisciplinary team meetings for lung cancer in the Nordic countries: results from a Nordic survey
Copyright (c) 2026 Anja Gouliaev, Janna Berg, Johan Isaksson, Heidi Andersén, Torben Riis Rasmussen https://creativecommons.org/licenses/by/4.0
Extent of prostate cancer cases not registered in The National Cancer Register of Sweden and consequences for estimates of prostate cancer incidence and mortality
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
FOCU.SE trial: a nationwide Swedish drug repurposing protocol and research framework
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
Differences in tumor mutational burden assessment: a national ring trial
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
Specialized healthcare diagnostic events within one year preceding colorectal cancer diagnosis
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
‘Crossing borders’ in data standardisation: application of OMOP CDM in an international clinical trial network in precision cancer medicine
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
Realising precision oncology through shared real-world data infrastructure
Copyright (c) 2026 Andreas Bjerrum, Andreas Fanø, Ulrik Lassen https://creativecommons.org/licenses/by/4.0
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
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
Selecting patients with rectal cancer for total neoadjuvant therapy based on clinical lymph node status: do we dare?
Copyright (c) 2026 Anna Baech Slipsager, Michael B. Lauritzen, Laura K. Buskov, Laurids Ø. Poulsen https://creativecommons.org/licenses/by/4.0
Eribulin-induced resolution of high-risk basal cell carcinoma: implications for microtubule-targeting agents in BCC management: a case report
Copyright (c) 2026 Jan Lapins, Niki Radros, Karina Schultz, Ismini Vassilaki, Christina Linder Stragliotto, Hildur Helgadottir https://creativecommons.org/licenses/by/4.0
Comorbidity indices in observational studies on cancer risk
Copyright (c) 2026 Björn Zethelius, Mats Talbäck, Rickard Ljung https://creativecommons.org/licenses/by/4.0
Improving confidence in MRI-based auto-segmentation via uncertainty assessment
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 ResEncM architecture provides a more trustworthy tool for clinical radiotherapy by reliably flagging high-uncertainty voxels, supporting confidence-aware clinical workflows.
Copyright (c) 2026 Jesper Folsted Kallehauge, Jintao Ren, Yasmin Lassen-Ramshad https://creativecommons.org/licenses/by/4.0
FIN-EGFRprint: a Finnish real-world study on treatments and outcomes in advanced NSCLC with common EGFR mutations
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.
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
Clinical outcomes of genomically guided trametinib monotherapy across cancer types: results from the IMPRESS-Norway trial
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.
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
Change in skeletal muscle mass during systemic cancer treatment: a systematic review and meta-analysis
Background and purpose: Loss of skeletal muscle mass (SMM) is common during systemic cancer treatment, but the magnitude and variability across cancer and treatment types remain uncertain. We aimed to describe changes in SMM during systemic cancer treatment supported by pooled quantitative estimates. Patients/material and methods: We systematically searched PubMed, Embase, and Web of Science until April 2025 for longitudinal studies reporting SMM during chemotherapy and/or immunotherapy (± targeted therapy) in patients with cancer (PROSPERO CRD42022308388). Standardized mean changes (SMC) were pooled in random-effects meta-analyses using the restricted maximum-likelihood estimator with Hartung–Knapp adjustment. Heterogeneity was assessed using I². Risk of bias was assessed with the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Seventy-eight studies (n = 10,502; 52% male; median age 64 years [interquartile range, IQR: 34–77]) were included. Meta-analysis across cancers showed an association between systemic cancer treatment and decline in SMM (59 studies; n = 6,373; SMC = −0.24, 95% confidence interval [CI]: −0.29 to −0.20; I² = 92%), corresponding to −5% over a median interval of 90 (IQR: 71–129) days among studies (62%) reporting assessment intervals. Declines were most pronounced during chemotherapy (± targeted therapy). Interpretation: Declines in SMM are frequently observed during systemic cancer treatment, particularly during chemotherapy (± targeted therapy), although effect sizes were generally small per Cohen’s thresholds. However, substantial heterogeneity limits interpretation of a single pooled estimate. Prospective studies with standardized methods are needed to clarify trajectories, mechanisms and clinical implications of SMM loss.
Copyright (c) 2026 Lukas Svendsen, Sandra Jensen, Stine Hansen, Victor Sørensen, Christoffer Johansen, Charlotte Suetta, Helle Pappot, Casper Simonsen, Lars Hermann Tang, Susanne Oksbjerg Dalton, Gunn Ammitzbøll, Bolette Skjødt Rafn https://creativecommons.org/licenses/by/4.0
The impact of exercise interventions before, during, and following neoadjuvant therapies for locally advanced rectal cancer: a critical review
Background and purpose: Neoadjuvant chemoradiotherapy (NACRT) and radiotherapy (NART) are standard treatments for locally advanced rectal cancer (LARC). However, their associated toxicities negatively affect patients’ quality of life (QoL), prompting growing interest in exercise as a supportive intervention. This critical narrative review synthesised evidence on exercise interventions delivered before, during, or after NACRT/NART, with a focus on feasibility, safety, functional, psychosocial, and emerging oncological outcomes. Materials and methods: A systematic literature search was conducted across MEDLINE, CINAHL Ultimate, and SPORTDiscus (2010–2025). Prospective studies evaluating exercise-based interventions in patients with LARC receiving NACRT or NART were included. Studies were selected using the Participants, Exposure, and Outcome framework, and methodological quality was appraised using Critical Appraisal Skills Programme checklists. Data were synthesised narratively in accordance with PRISMA reporting standards. Results: Sixteen studies met the inclusion criteria. Interventions varied in type, intensity, supervision, and timing. Of these, nine studies (n = 226) were analysed quantitatively. Feasibility outcomes varied widely across studies: Eligibility (27.1–100%), recruitment (27.5–90.0%), attendance (74.0–96.0%), attrition (0–100%). No serious adverse events were reported. Consistent improvements were observed cardiorespiratory fitness, strength, fatigue, QoL. Limited evidence suggested a potential association between post-NACRT exercise and tumour regression; however, some of these findings were not powered for oncological endpoints. Interpretation: Exercise is a feasible and safe adjunct to treatment in LARC. Further research should explore oncological outcomes and improve representation across demographics.
Copyright (c) 2026 John Saxton, Chizitara Amadi, Victoria Brown, Mohan Hingorani, Rajarshi Roy https://creativecommons.org/licenses/by/4.0
Treatment of neuropathic pain in cancer survivors: a scoping review of pharmacological, exercise, and psychosocial interventions
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.
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
Prevalence and risk factors for nausea and vomiting in breast cancer patients undergoing chemotherapy
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.
Copyright (c) 2026 Yuhui Feng, Liushan Wei, Qinhong Zou, Xiaoyong Lei, Xiaoyan Yang https://creativecommons.org/licenses/by/4.0
The false-negative rate of sentinel lymph node biopsy and its related factors in early-stage cervical cancer: a systematic review and meta-analysis
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)
Copyright (c) 2026 Chao He, Fei Li, Min He, Jia Li https://creativecommons.org/licenses/by/4.0
A conceptual health economic modelling framework to assess the cost-effectiveness of molecular target–driven treatment regimens in oncology
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 framework can improve transparency and robustness of cost-effectiveness estimates, thereby supporting more equitable and efficient reimbursement decisions in the context of precision oncology.
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