Asian Pacific Journal of Cancer Care

Digital Nutrition in Cancer Care: A Co-Design Approach to Transform Chemotherapy Patient Outcomes

Hari Prakash G — 2025-12-15

Pharmacogenomic Profiling of DPYD Mutations and Genotype‑guided Dose Adjustment to Prevent Fluoropyrimidine Toxicity in Gastrointestinal Cancer Patients: A Real‑world Study from North India

Davinder Paul — 2025-12-15

Purpose: To quantify the prevalence of clinically actionable DPYD variants in North‑Indian gastrointestinal (GI) cancer patients and to evaluate whether Clinical Pharmacogenetics Implementation Consortium (CPIC)‑guided fluoropyrimidine dose attenuation mitigates early chemotherapy toxicity.

Methods: We retrospectively reviewed 66 adults treated between January 2021 and December 2024 who underwent prescriptive DPYD genotyping for *DPYD* *2A*, c.2846A>T, *9A* (c.85T>C) and *13*. Fluoropyrimidine doses were modified according to CPIC activity‑score algorithms (25–50 % reduction for scores 1.5–1.0; ≥ 50 % reduction or avoidance for ≤ 0.5). Variant frequency was the primary end‑point; grade ≥ 3 toxicity within two cycles served as the secondary end‑point. Multivariable logistic regression identified independent predictors of toxicity.

Results: Actionable variants were detected in 32/66 patients (48.5 %), dominated by *DPYD* *9A* (43.9 %). All carriers received genotype‑guided dose reduction. Overall grade ≥ 3 toxicity occurred in 13/66 patients (19.7 %): 17.6 % of wild‑type versus 21.9 % of variant carriers (P = 0.28). After adjustment, toxicity rates across gastrointestinal, hematological, and dermatological domains remained comparable. Diabetes mellitus emerged as the sole independent predictor of grade ≥ 3 toxicity (adjusted odds ratio 5.99, 95 % CI 1.19–30.3; P = 0.03).

Conclusion: Almost half of North‑Indian GI‑cancer patients harbor an actionable *DPYD* variant—chiefly *9A*. Implementing CPIC‑based dose reduction neutralized variant‑linked excess risk of early severe toxicity, underscoring the clinical utility of routine DPYD genotyping and personalized fluoropyrimidine dosing. Enhanced vigilance is warranted for diabetic patients, who remain at heightened toxicity risk despite pharmacogenomic tailoring.

Factorial Validity and Reliability of the Chemotherapy Dietary Adherence Scale: A Tool for Nutritional Assessment in Cancer Care

Hari Prakash G — 2025-12-15

Background: Nutritional adherence is vital in improving clinical outcomes for chemotherapy patients. The lack of validated tools to assess dietary adherence during chemotherapy prompted the development and psychometric validation of the Chemotherapy Dietary Adherence Scale (CDAS).

Objective: To develop, refine, and validate the CDAS, assessing its reliability and factorial structure through exploratory and confirmatory factor analyses.

Methods: This two-phase, cross-sectional study was conducted in the Department of Medical Oncology at a tertiary care cancer centre. Data were collected from 245 chemotherapy patients over a period of two months. Phase 1 involved exploratory factor analysis (EFA) on an initial scale, followed by refinement to address weak inter-item correlations. Phase 2 validated the revised scale using confirmatory factor analysis (CFA). Reliability was assessed using Cronbach’s alpha, and statistical analysis was conducted using SPSS version 26 and Python’s semopy library.

Results: The study population had a mean age of 58.13 years (SD, 9.85) and consisted predominantly of skilled workers (67.1%). The 7-item CDAS demonstrated excellent internal consistency (Cronbach’s alpha = 0.83), with subscales showing strong reliability: Nutritional Adherence (α = 0.79) and Dietary Adjustment (α = 0.81). EFA revealed a two-factor structure explaining 70.5% of the total variance. CFA confirmed this structure with exceptional model fit (χ² = 12.09, df = 13, p = 0.52; CFI = 1.00; GFI = 0.98; TLI = 1.00; RMSEA = 0.00). All items showed significant factor loadings (p < 0.001), with values ranging from 1.058 to 1.262. The moderate correlation between factors (r = 0.168, p < 0.001) indicated that they represented distinct but related dimensions of dietary adherence.

Conclusions: The CDAS demonstrated robust psychometric properties, with a clear two-factor structure that captures distinct aspects of dietary adherence among chemotherapy patients. The validated scale provides a reliable and valid tool for assessing nutritional adherence and dietary adaptations during chemotherapy, potentially enhancing clinical assessment and targeted nutritional interventions.

Serum IDO1 and Biochemical Markers Correlation in Iraqi Women with Breast Cancer

Hanaa Addai Ali — 2025-12-15

Background: Breast cancer (BC) is the leading cause of cancer-related mortality among women worldwide. The type of BC depends on the specific breast cells undergoing malignant transformation and can originate in different regions of the breast. Indoleamine 2,3-dioxygenase 1 (IDO1) is an enzyme that catabolizes tryptophan and is overexpressed in several metastatic tumors, suggesting its potential role in cancer progression. This study aimed to assess serum IDO1 levels across different stages and ages in Iraqi women with BC, evaluating its diagnostic and prognostic value. Additionally, the correlation between IDO1 and clinicopathological features, as well as lipid and liver enzyme profiles, was examined.

Materials and Methods: A case-control study was conducted on 90 newly diagnosed Iraqi women with BC and 90 age-matched healthy controls. Serum IDO1 concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Lipid profiles and liver enzyme activities (ALT, AST, ALP) were also evaluated. Statistical analyses were performed using SPSS software.

Results: Serum IDO1 levels were significantly elevated in BC patients compared to healthy controls (19.25 ± 7.36 vs. 2.16 ± 0.34 pg/mL; p < 0.001), with levels increasing progressively across advanced disease stages. Patients also exhibited elevated ALT, AST, ALP, triglycerides, total cholesterol, LDL-C, and VLDL-C, along with reduced HDL-C compared to controls. Serum IDO1 showed significant positive correlations with age, ALT, AST, ALP, TG, TC, and HDL-C, but not with BMI, LDL-C, or VLDL-C. Diagnostic performance analysis revealed a cut-off value of 12.65 ng/mL for IDO1, with 80.0% sensitivity, 81.1% specificity, and an AUC of 0.867 (95% CI: 0.814–0.919; p < 0.001).

Conclusion: Elevated serum IDO1 is a significant predictor of BC outcomes and may reflect its role in disease pathogenesis. IDO1 demonstrates strong potential as a diagnostic and prognostic biomarker, as well as a promising target for immunotherapeutic strategies in breast cancer management.

Histopathological Spectrum of Eyelid Tumors in Northeast India: A 6-Year Retrospective Study

Barnali Das — 2025-12-15

Background: Eyelid tumors present with a diverse histopathological spectrum, varying across geographic and ethnic groups. In Asia, sebaceous gland carcinoma (SGC) often rivals basal cell carcinoma (BCC) in incidence. This study evaluates the clinicopathological profile of eyelid tumors from Northeast India.

Objective: To analyse the histopathological distribution, demographic profile, and malignant versus benign ratio of surgically excised eyelid tumours over six years at a tertiary care centre.

Methods: A retrospective review was conducted on histopathologically diagnosed eyelid tumors excised between March 2008 and February 2014. Clinical and demographic data were retrieved. Routine H&E staining was performed, with immunohistochemistry as needed. Tumours were classified according to the WHO 5th edition classification.

Results: Of 132 excised eyelid lesions, 124 were neoplastic (81.5% benign, 18.5% malignant), and 8 were inflammatory chalazia. Benign tumors included epidermal cyst (23.8%), dermoid cyst (21.8%), haemangioma (14.9%), and squamous papilloma (11.9%). Among malignancies, basal cell carcinoma (BCC) predominated (39.1%), followed by squamous cell Carcinoma (SCC) (30.4%), Sebaceous gland carcinoma (SGC) (21.7%), and malignant melanoma (8.6%). Malignant tumors showed a female preponderance. Comparative analysis with regional and global studies demonstrated higher proportions of SGC and SCC in this cohort.

Conclusion: Benign lesions remain predominant in eyelid tumors. However, sebaceous carcinoma and squamous cell carcinoma constitute a significant malignant burden in this Northeast Indian population. Early biopsy and histopathological diagnosis are essential for timely intervention.

Epidemiological Profile of Breast Cancer Phenotypes in Rural Southern West Bengal, India

Arindam Chaudhury — 2025-12-15

Background: Breast cancer (BC) is now the most common cancer globally, exceeding lung cancer in 2020 with 2.3 million new cases. In 2016, India had an estimated 118,000 new cases, with a 39.1% increase in the age-standardized incidence rate between 1990 and 2016. This abstract highlights the growing global burden of BC, particularly focusing on the increasing incidence in rural India.

Methods: A retrospective, observational study was conducted at the Department of Radiation Oncology, All India Institute of Medical Sciences, Kalyani, focusing on rural areas in southern West Bengal between July 2022 and January 2025 in women with biopsy-proven breast cancer. The data of the patients pertaining to histopathology, hormone status, Grade of tumour, Ki-67 Index, and demography were collected, and phenotypical classification was derived.

Results: Among 456 breast cancer patients (159 premenopausal, 297 postmenopausal), 58.1% had locally advanced disease. Most presented with grade III tumours (51.8%) and high Ki-67 (67.9%). Infiltrating ductal carcinoma was predominant. Hormone receptor positivity was higher in premenopausal (64.77%) vs postmenopausal (52.52%) women; HER2 neu negative cases were more common in postmenopausal women (67.33%). Predominant phenotypic subgroups: premenopausal luminal B (40.9%), postmenopausal luminal A (34%).

Interpretation and Conclusion: The findings suggest the need for tailored therapeutic strategies, especially considering the distinct phenotypic subgroups identified. Overall, these insights contribute to a better understanding of breast cancer’s epidemiology and may inform future treatment approaches and research directions in this area.

The Application of Antioxidant in Skin Cancer Research: A Bibliometric Study

Luqman Alwi — 2025-12-15

Objective: Skin cancer is one of the most common malignancies globally. Considering the potential therapeutic benefits of antioxidants, this study aims to examine the trends and patterns in antioxidant application within skin cancer research over the past three decades.

Methods: A bibliometric analysis was conducted on 990 English-language articles published between 1990 and 2025, retrieved from the Scopus database. Data were processed using Bibliometrix (R-based) and VOSviewer to assess publication trends, research productivity, collaboration networks, keyword co-occurrence, and thematic evolution in antioxidant-related skin cancer research.

Result: The annual growth rate of publications reached 11.42%, with a sharp rise in output post-2010. The United States and China were the most productive countries, while European countries demonstrated strong international collaboration. Frequently recurring subjects included apoptosis, cancer, oxidative stress, and antioxidants. Co-occurrence analysis identified four major clusters: (1) cell biomolecular mechanisms, (2) drug metabolism, (3) malignancy agents, and (4) pharmacological innovation. Highly cited articles emphasized molecular mechanisms of antioxidants in tumor suppression. Thematic evolution showed a transition from mechanistic studies to translational and clinical research.

Conclusion: Antioxidant-related research in skin cancer is rapidly evolving, with increasing global contributions and thematic diversification. This study provides a comprehensive overview of current knowledge and identifies key research gaps, including the underexploration of areas such as DNA repair, tumorigenesis, and lesser-studied antioxidant compounds, as well as the limited translation of mechanistic findings into clinical applications.

Real World Safety, Survival Rate, and Effectiveness of Samarium-153 (153Sm) Administration in Metastatic Castration-Resistant Prostate Cancer (mCRPC) with Bone Metastases

Gilberto Chafrina — 2025-12-15

Background: Painful bone metastases are common in advanced prostate cancer. We report the clinical outcome after administration of Samarium-153 (153Sm), an emitter of beta-particles that concentrates in the areas of enhanced osteoblastic activity.

Methods: This analysis included patients with confirmed mCRPC with bone metastases scheduled to receive 153Sm. All patients received 1 dose of 153Sm. Primary endpoints are short- and long-term safety, including incidence of bone marrow suppression. Secondary endpoints included 5 years survival rate.

Results: Patients were enrolled from 2018 to 2019, and was followed up for 5 years. Out of 12 patients, 3 patients were lost to follow-up, and 9 patients were included. 9 patients (100%) had bone metastases only and received 153Sm injections. Most patients (88.9%) had high-volume osteoblastic lesions. The mean hot spot intensity decreased from 826,239.9 to 623,844.2 post-therapy (p = 0.036). Pain relief was significant, with the VAS score dropping from a median of 5 to 2 one day post-treatment (p = 0.003), and further improving to 1 thirty days later (p = 0.002). Drug-related treatment-emergent adverse events (TEAEs) occurred in 0% patients. At the 60-month follow-up, only 22.2% patients were found to be alive. The median time to death from samarium treatment end was recorded as 18 months.

Conclusions: In this single-center cohort, 153Sm-EDTMP provided clinically meaningful pain palliation with acceptable safety. Survival estimates are descriptive of the underlying disease trajectory and should not be interpreted as a treatment effect given the non-comparative design and small sample. Prospective, multicenter studies using standardized pain and quality-of-life endpoints are warranted.

Epidemiology and Survival Outcomes of Genitourinary Cancers: A Retrospective Cohort Study from Southern Saudi Arabia

Ahmed M. Badheeb — 2025-12-15

Background: Genitourinary (GU) cancers represent a significant health burden in Saudi Arabia, yet region-specific data from the southern Najran region are scarce. This study aims to characterize the epidemiology and survival outcomes of GU malignancies in this understudied population.

Patients and Methods: We conducted a retrospective single-center cohort study of 150 adults with histologically confirmed GU cancers (prostate [38.0%], bladder [28.7%], renal cell carcinoma [26.0%], testicular [7.3%]) treated at King Khaled Hospital, Najran, between 2014 and 2023. Demographic, clinical, and treatment data were analyzed. Overall survival (OS) was assessed using Kaplan-Meier methods. Multivariable Cox regression and propensity score matching were used to identify prognostic factors.

Results: The cohort was predominantly male (85.3%) with a mean age of 64.2 years. At diagnosis, 42.0% had localized disease, 18.0% had regional involvement, and 40.0% had metastatic disease. With a median follow-up of 42 months, 98 deaths were observed. The median OS for the entire cohort was 28.4 months (95% CI: 24.1–32.7). The 5-year OS rates varied significantly by subtype: prostate, 38.5%; bladder, 47.2%; renal cell carcinoma, 51.8%; and testicular cancer, 89.3%. Multivariable analysis identified metastatic disease (adjusted hazard ratio [aHR] = 3.85; 95% CI: 2.91–5.10) and increasing age (per decade, aHR = 1.42; 95% CI: 1.21–1.67) as independent predictors of mortality. Surgical treatment was associated with a significant survival benefit (aHR = 0.52; 95% CI: 0.40–0.68), a finding confirmed in a propensity-matched analysis.

Conclusions: This first comprehensive analysis from Najran reveals a high burden of advanced GU cancers and significant survival disparities. Metastatic disease and older age are key drivers of mortality, while surgical intervention is strongly associated with improved outcomes. These findings underscore an urgent need for enhanced early detection programs and optimized treatment access in this region.

Thyroglobulin and Antithyroglobulin Antibody Dynamics Following Radioactive Iodine Therapy in Post-Thyroidectomy Papillary Thyroid Carcinoma Patients

Cherlyna Cherlyna — 2025-12-15

Background: In some cases of papillary thyroid carcinoma (PTC), residual tissues are observed to persistently after total thyroidectomy has been performed. In an attempt to provide further treatment, radioactive iodine (RAI) therapy is administered to obtain remission. Serum thyroglobulin (Tg) and antithyroglobulin antibodies (TgAb) are widely used biomarkers to evaluate treatment response. This study aimed to evaluate the dynamic changes in serum Tg and TgAb levels following RAI therapy in post-thyroidectomy PTC patients, and to determine the predictive value of preablation biomarkers on postablation outcomes.

Methods: This observational analytic study employed a prospective cohort design. It was conducted with 51 patients with PTC who have undergone total thyroidectomy. Tg and TgAb levels were measured both pre- and one-month post-ablation. Associations were analyzed using univariate and multivariate methods.

Result: The mean preablation Tg level was 82.2 ± 196.1 ng/mL, decreasing slightly to 73.7 ± 198.9 ng/mL post-ablation. However, Tg levels increased in 29.5% of patients following RAI therapy. A significant correlation was observed between preablation and postablation Tg levels (P < 0.001). Importantly, 56.9% of patients had persistently positive TgAb before and after ablation, with no observed change in status. Moreover, TgAb positivity showed no significant association with postablation Tg levels (P = 0.55), suggesting its limited utility as a post-therapy prognostic indicator.

Conclusion: Preablation Tg level shows a significant correlation with postablation Tg outcomes, supporting their predictive value. However, RAI therapy showed limited effectiveness in reducing TgAb levels in certain patients, with preablation Tg being a predictor of postablation levels.

Interest of RT-PCR in the Diagnosis and Follow-Up of Patients with Chronic Myeloid Leukemia (A Study in Western Algeria)

Ouafia Liamani — 2025-12-15

Background: This prospective study evaluated the implementation of RT-PCR for the molecular monitoring of chronic myeloid leukemia (CML) patients at Sidi Bel Abbès University Hospital.

Methods: We analyzed 31 consecutive CML patients (mean age 50 years, range 31–72). All patients carried the b3a2 fusion transcript. The Sokal risk distribution was as follows: high (6.45%), intermediate (51.61%), and low (41.93%). Molecular response was assessed by the *BCR-ABL1/ABL1* ratio (IS%) at diagnosis and during treatment follow-up.

Results: The median BCR-ABL1/ABL1 ratio declined to 3.45% (IQR 0.66–19) at 3 months (n=12), 0.37% (IQR 0.00028–23) at 6 months (n=29), and 0.01% (IQR 0.00021–12) at 18 months (n=14). MMR rates were significantly higher in patients achieving a ratio of ≤10% at 3 months (83.3% vs. 19.0%, p<0.001) and ≤1% at 6 months (69.0% vs. 28.0%, p<0.001). Only one patient (3.2%, 95% CI 0–9.3) without an early molecular response achieved MMR by 18 months.

Conclusions: Our findings confirm the clinical utility of RT-PCR for CML monitoring and emphasize the prognostic importance of early molecular response, particularly at the 3- and 6-month timepoints, in Algerian patients.

In Vitro Cytotoxicity of Zingiber officinale -Mediated Gold Nanoparticles against Melanoma Cell Lines

Balaji MB — 2025-12-15

Aim: The present work investigates the cytotoxic activity of a candidate compound against A375 human melanoma cells. Cell viability was assessed using the MTT assay, while scanning electron microscopy (SEM) provided ultrastructural details and Fourier-transform infrared spectroscopy (FTIR) was applied to evaluate alterations in functional groups.

Materials and Methods: A375 cells were seeded in 96-well plates at 1 × 10⁴ cells/well, treated with serial dilutions of the compound for 48 h, and analyzed for viability through formazan formation. Cell morphology was preserved with ethanol-acetic acid fixation for SEM observation, and FTIR spectra were collected to examine compound-related molecular interactions.

Results: The treatment produced a dose-responsive reduction in viability, with an IC₅₀ value of 4.6 ± 0.3 µg/mL. At higher doses, SEM micrographs revealed morphological hallmarks consistent with apoptosis, including bleb formation and cellular shrinkage. FTIR signatures indicated shifts in protein and lipid regions, suggesting direct interaction with cellular macromolecules.

Conclusion: The compound displays significant in vitro cytotoxicity against A375 melanoma cells, with supporting evidence from morphological and spectral analyses. While the findings highlight potential bioactivity, they are preliminary and require confirmation through broader studies involving additional models and more specific mechanistic assays.

Quality of Life in Iranian Breast Cancer Patients Undergoing Chemotherapy: A Cross-Sectional Study from Qazvin

Mahfam Alijaniha — 2025-12-15

Background and Aims: Breast cancer is a leading health concern among Iranian women. This study evaluated the quality of life (QoL) in breast cancer patients undergoing chemotherapy at a specialized cancer center in Qazvin, Iran.

Materials and Methods: This cross-sectional study included 50 women aged ≥18 years with breast cancer receiving chemotherapy from the second cycle onward. Participants completed validated Persian versions of EORTC QLQ-C30 and QLQ-BR23 questionnaires. Cognitive function was assessed using a standardized cognitive assessment battery.

Results: Emotional functioning was the most severely affected QoL domain. Cognitive impairments were observed in working memory (25.3), reaction time (21.1), and organizational skills (22.1). Prevalent symptoms included insomnia (13.5), fatigue (12.4), and appetite loss (11.6). Significant negative correlations were found between psychological symptoms and overall QoL (p<0.05).

Conclusion: Chemotherapy significantly impacts multiple QoL dimensions in Iranian breast cancer patients. Integrated interventions addressing cognitive rehabilitation and psychological support are essential components of comprehensive cancer care.

TWIST1 Expression and Tumor Infiltrating Lymphocytes: Prognostic Value in Colorectal Adenocarcinoma

Siska Putri Wulandari Raharja — 2025-12-15

Background: Colorectal cancer remains a major health concern due to its high incidence and mortality. However, reports on the prognostic value for colorectal cancer were still limited. TWIST1 overexpression is associated with poor clinical prognosis in colorectal adenocarcinoma. Tumor-infiltrating lymphocytes (TILs) reflect the body’s immune response to cancer. This study aims to investigate these relationships between TWIST1 with histological grade, TILs grade, and depth of invasion in colorectal adenocarcinoma.

Methods: This cross-sectional study assessed TWIST1 expression in paraffin-embedded samples from an Indonesian population with colorectal adenocarcinoma. Immunohistochemical staining with a rabbit polyclonal TWIST1 antibody was performed. TWIST1 expression was evaluated under microscope. Statistical analysis was performed to determine association between TWIST1 with histological grade, TILs grade, and depth of invasion in colorectal adenocarcinoma.

Results: A total of 100 samples examined. Of 53 samples with low grade TILs, 39 (73.6%) showed strong TWIST1 expression. In intermediate grade TILs, 14 (50%) from 28 samples showed strong TWIST1 expression. In the high grade TILs, 8 (42.1%) from 19 samples showed strong TWIST1 expression. In low grade histological adenocarcinoma, 29 (47.5%) from 61 samples showed strong TWIST1 expression. In high grade adenocarcinoma, 32 (82.1%) from 39 samples showed strong TWIST1 expression. Statistical analysis using Chi square test shown a significant association between TWIST1 expression with both histological grade (p=0.001) and TILs grade (p=0.020), whereas no significant association was found with depth of invasion (p=0.976).

Conclusions: There is a significant positive correlation between TWIST1 expression with histological grade and TILs grade. Although, there is no significant correlation between TWIST1 expression with depth of invasion. Therefore, TWIST1 expression might be potential as a prognostic indicator in colorectal adenocarcinoma.

Weekly Procalcitonin Kinetics as an Early Biomarker of Treatment Response in Stage III Non-Small Cell Lung Cancer Undergoing Concurrent Chemoradiotherapy: A Multicenter Prospective Observational Study

Ahmed Sohaib — 2025-12-15

Background: Early identification of response during concurrent chemoradiotherapy (cCRT) for stage III non-small cell lung cancer (NSCLC) could critically inform clinical decision-making, particularly regarding surgical candidacy, modification or completion of therapy, and optimal integration with immunotherapies. This prospective study evaluates weekly serum procalcitonin (PCT) kinetics as a biomarker of treatment response in stage III NSCLC receiving cCRT, analyzing the potential to guide individualized care pathways.

Methods: In this multicenter prospective observational study, adults aged 18–65 years with stage III NSCLC eligible for upfront concurrent chemoradiotherapy (cCRT) were enrolled. Key exclusions were elevated baseline procalcitonin (PCT > 0.1 ng/mL), active infection at baseline or during cCRT, autoimmune disease, incomplete radiotherapy, or ECOG 3–4. Serum PCT was measured at baseline and weekly during radiotherapy. Tumor response was assessed 4–6 weeks post‑cCRT by RECIST v1.1. PCT trajectories were analyzed using mixed‑design repeated‑measures ANOVA (Time × Response), with non‑parametric alternatives as needed. Logistic regression evaluated baseline and early PCT changes as predictors of response, and ROC analysis determined AUC, sensitivity, specificity, and optimal cut‑offs. Analyses were performed in SPSS v20; p < 0.05 was considered significant.

Results: Of 79 screened, 73 were evaluable (5 CR, 24 PR, 27 SD, 17 PD). Responders (n=29) exhibited a consistent transient PCT peak at week 2 or 3, followed by a progressive decline. Non-responders (n=44) lacked this pattern, showing rather stable or irregular pattern of PCT levels. Repeated measures LMEM demonstrated a significant time × response effect (p<0.001). Logistic regression incorporating early PCT rise predicted response (AUC=0.84). Integration of PCT kinetics could support decisions to proceed to surgery or continue radiotherapy without interruption, obviating delays for radiologic confirmation.

Conclusions: This is the first prospective report of PCT kinetics as a biomarker of cCRT response in lung cancer. A characteristic early, transient PCT rise followed by decline is associated with treatment response. Dynamic PCT monitoring can enable real‑time, individualized decision‑making, including timing for surgical evaluation and potential for mid‑treatment immunotherapeutic intensification.

The Correlation of Radiogenomics and Green Tea Extract Polyphenols: Redefining Head and Neck Cancer Management

Manish Tenguria — 2025-12-15

Radiogenomics, an emerging paradigm that combines genomic and imaging information, is poised to advance precision oncology, particularly in head and neck cancer (HNC). This review explores the potential integration of radiogenomics with the polyphenol epigallocatechin-3-gallate (EGCG) from green tea, building on systematic and bibliometric analyses of an unprecedented amount of information (molecular and clinical milestones and advances) related to oncology and radiogenomics, spanning from 1997 to 2024. Including an antioxidant and anticancer compound, EGCG has shown promise in modifying the response to radiation and modifies certain biologic pathways. It is proposed that radiogenomic markers will be effective in modifying toxicity, potentially augmenting precision treatments in HNC, while simultaneously integrating the fields of genetics, imaging, and nutraceuticals into one new area for future research and clinical practice.

Triple Synchronous Primary Tumors of Stomach, Kidney and Ovary: A Rare Case Report

Thirunavukarasu Thivya — 2025-12-15

Synchronous multiple primary malignancies are rare clinical condition, and the occurrence of triple synchronous primary tumors are exceptionally uncommon. Among these, the simultaneous occurrence of primary gastric, renal, and ovarian tumor has seldom been reported in the literature. We present a case of a 70 year- female who presented with abdominal pain and endoscopic biopsy showed gastric adenocarcinoma. CECT abdomen and pelvis subsequently revealed an incidental right renal and ovarian tumor. The patient underwent curative surgical resection for all three tumors in a single operative session. Post-surgical histopathology confirmed Clear cell renal cell carcinoma and Ovarian mature cystic teratoma. There was no evidence of metastasis among the tumors. Elderly patient with gastric carcinoma have a higher risk of developing a synchronous tumor than younger people. This case highlights the importance of thorough diagnostic evaluation of multiple primary malignancies in an elderly patients with gastric cancer , as the differentiation between metastatsis and synchronous primaries significantly influences the planning of treatment. Early detection and multidisciplinary approach are essential for optimizing outcomes in such rare and complex presentations.

Fibre Proportion in Oral Nutritional Supplements on Diarrhea Management in Cancer Patients: A Case Study

May Kay Neoh — 2025-12-15

Background and purpose: Diarrhea is a common side effect in cancer patients, especially during chemotherapy or antibiotic treatment. Managing this symptom is important for patient comfort, hydration, and nutritional status. Fibre, an important component of many oral nutritional supplements (ONS) formulations, has been shown to influence bowel function, including diarrhea. This case study examines the role of fibre proportion in ONS for managing diarrhea in two cancer patients undergoing treatment.

Case presentation: Both patients initially experienced persistent diarrhea despite switching to fibre-based ONS. Upon transitioning to an ONS with an equal ratio of soluble to insoluble fibre, both patients showed improved stool consistency and bowel open frequencies with optimal energy and protein intake.

Discussion: The proportion of soluble to insoluble fibre in ONS may play a crucial role in managing diarrhea among cancer patients. While achieving adequate total fibre intake is important, healthcare providers may need to consider not just the quantity but also the quality and proportion of fibre in nutritional interventions. Soluble fibre-enriched ONS may offer benefits for reducing diarrhea, while high insoluble fibre content could aggravate the condition.

Conclusion: A careful consideration of the types and proportions of fibre may be necessary for optimal symptom management. A tailored approach that accounts for the patient’s specific needs is essential in optimizing nutritional care and improving quality of life.

A Case of Intracholecystic Papillary Neoplasm of Gall Bladder-A Rare Entity

Manish Sahni — 2025-12-15

Background: Intracholecystic Papillary Neoplasm is a rare epithelial neoplasm originating in the gallbladder mucosa. It usually presents as gallbladder mass and is associated with varying degree of dysplasia or invasiveness needing high index of suspicion for proper management.

Case Presentation: A 48-year-old female presented with complaints of vague upper abdominal pain for last 10 days.Ultrasound abdomen revealed polypoidal mass filling gall bladder lumen measuring 7x3.8 cm. MRCP revealed hypointense mass lesion within gallbladder lumen with its stalk at the hepatic surface of gall bladder. CT abdomen revealed heterogeneously enhancing gall bladder mass with no regional lymphadenopathy. Serum tumor markers of CEA, CA19.9 were normal. Patient underwent en bloc resection of 2 cm segment IVB liver along with gallbladder. Intraoperative frozen section specimen revealed exophytic polypoidal papillary lesion in distal body of gallbladder measuring 5x4x3 cm. Microscopic features revealed intracholecystic papillary neoplasia with low-grade dysplasia. Regional lymphadenectomy was not performed. Final diagnosis of Intracholecystic papillary neoplasm,gastric type was confirmed and patient was kept on close follow up.

Conclusion: Intracholecystic papillary neoplasm of gall bladder is a rare entity presenting as intraluminal growth which require proper histopathological diagnosis. Clinical features and imaging modalities are non-specific. They have variable morphological subtypes like papillary or tubular growth patterns and may have underlying varying degree of dysplasia or invasive foci making it pertinent to perform surgical resection.They are relatively indolent with better prognosis as compared to gallbladder carcinomas. Further studies are required to precisely diagnose it and manage the various subtypes appropriately.

Intraosseous Mucoepidermoid Carcinoma of the Mandible: A Case Report with Three-Year Follow-Up

Toktam Zamani — 2025-12-15

Background: Mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland tumor, but its intraosseous (central) presentation in the jaws is extremely rare and often mimics benign odontogenic lesions.

Case: We describe a 37-year-old woman with swelling and dull pain in the left mandible. Clinical and radiographic evaluation, including cone-beam computed tomography (CBCT), revealed a destructive multilocular radiolucent lesion with cortical perforation.

Treatment: An incisional biopsy confirmed the diagnosis of low-grade intraosseous MEC. The lesion was surgically excised, and mandibular reconstruction was performed using an autogenous fibular bone graft.

Outcome: At a three-year follow-up, the patient showed complete recovery with no evidence of recurrence. This case underscores the importance of timely diagnosis, appropriate surgical management, and long-term follow-up in intraosseous salivary gland malignancies.