In the context of quality assurance, the objectives were to describe the surgical treatment and postoperative morbidity (particularly renal insufficiency). A retrospective, multicentre study of patients who underwent cytoreductive surgery (CRS) with cisplatin-based HITOC was performed. The study was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation (GZ: RI 2905/3-1)). Patients (n = 350) with malignant pleural mesothelioma (n = 261; 75%) and thymic tumours with pleural spread (n = 58; 17%) or pleural metastases (n = 31; 9%) were analyzed. CRS was accomplished by pleurectomy/decortication (P/D: n = 77; 22%), extended P/D (eP/D: n = 263; 75%) or extrapleural pneumonectomy (EPP: n = 10; 3%). Patients received cisplatin alone (n = 212; 61%) or cisplatin plus doxorubicin (n = 138; 39%). Low-dose cisplatin (≤125 mg/m² BSA) was given in 67% of patients (n = 234), and high-dose cisplatin (>125 mg/m² BSA) was given in 33% of patients (n = 116). Postoperative renal insufficiency appeared in 12% of the patients (n = 41), and 1.4% (n = 5) required temporary dialysis. Surgical revision was necessary in 51 patients (15%). In-hospital mortality was 3.7% (n = 13). Patients receiving high-dose cisplatin were 2.7 times more likely to suffer from renal insufficiency than patients receiving low-dose cisplatin (p = 0.006). The risk for postoperative renal failure is dependent on the intrathoracic cisplatin dosage but was within an acceptable range.

Lymphodepletion, reconstitution and active-specific tumor cell vaccination (LRAST) enhances the induction of tumor-specific T cells in a murine melanoma model. Myeloid-derived suppressor cells (MDSC) may counteract the induction of tumor-reactive T cells and their therapeutic efficacy. Thus, the aim of the study was to evaluate a possible benefit of MDSC depletion using anti-Gr-1 antibodies (Ab) in combination with LRAST. Female C57BL/6 mice with 3 days established subcutaneous (s.c.) D5 melanoma were lymphodepleted with cyclophosphamide and reconstituted with naive splenocytes. Vaccination was performed with irradiated syngeneic mGM-CSF-secreting D5G6 melanoma cells. MDSC depletion was performed using anti-Gr-1 Ab (clone RB6-8C5). Induction of tumor-specific T cells derived from tumor vaccine draining lymph nodes (TVDLN) was evaluated by the amount of tumor-specific interferon (IFN)-γ release. LRAST combined with anti-Gr-1 mAb administration enhanced the induction of tumor-specific T cells in TVDLN capable of releasing IFN-γ in a tumor-specific manner. Additional anti-Gr-1 mAb administration in LRAST-treated mice delayed growth of D5 melanomas by two weeks. Furthermore, we elucidate the impact of anti-Gr-1-depleting antibodies on the memory T cell compartment. Our data indicate that standard of care treatment regimens against cancer can be improved by implementing agents, e.g., depleting antibodies, which target and eliminate MDSC.

Background: Large language models (LLMs) such as ChatGPT (OpenAI) are increasingly discussed as potential tools for patient education in health care. In radiation oncology, where patients are often confronted with complex medical terminology and complex treatment plans, LLMs may support patient understanding and promote more active participation in care. However, the readability, accuracy, completeness, and overall acceptance of LLM-generated medical content remain underexplored. Objective: This study aims to evaluate the potential of ChatGPT-4 as a supplementary tool for patient education in the context of lung cancer radiotherapy by assessing the readability, content quality, and perceived usefulness of artificial intelligence–generated responses from both clinician and patient perspectives. Methods: A total of 8 frequently asked questions about radiotherapy for lung cancer were developed based on clinical experience from a team of clinicians specialized in lung cancer treatment at a university hospital. The questions were submitted individually to ChatGPT-4o (version as of July 2024) using the prompt: “I am a lung cancer patient looking for answers to the following questions.” Responses were evaluated using three approaches: (1) a readability analysis applying the Modified Flesch Reading Ease (FRE) formula for German and the 4th Vienna Formula (WSTF); (2) a multicenter expert evaluation by 6 multidisciplinary clinicians (radiation oncologists, medical oncologists, and thoracic surgeons) specialized in lung cancer treatment using a 5-point Likert scale to assess relevance, correctness, and completeness; and (3) a patient evaluation during the first follow-up appointment after radiotherapy, assessing comprehensibility, accuracy, relevance, trustworthiness, and willingness to use ChatGPT for future medical questions. Results: Readability analysis classified most responses as “very difficult to read” (university level) or “difficult to read” (upper secondary school), likely due to the use of medical language and long sentence structures. Clinician assessments yielded high scores for relevance (mean 4.5, SD 0.52) and correctness (mean 4.3, SD 0.65), but completeness received slightly lower ratings (mean 3.9, SD 0.59). A total of 30 patients rated the responses positively for clarity (mean 4.4, SD 0.61) and relevance (mean 4.3, SD 0.64), but lower for trustworthiness (mean 3.8, SD 0.68) and usability (mean 3.7, SD 0.73). No harmful misinformation was identified in the responses. Conclusions: ChatGPT-4 shows promise as a supplementary tool for patient education in radiation oncology. While patients and clinicians appreciated the clarity and relevance of the information, limitations in completeness, trust, and readability highlight the need for clinician oversight and further optimization of LLM-generated content. Future developments should focus on improving accessibility, integrating real-time readability adaptation, and establishing standardized evaluation frameworks to ensure safe and effective clinical use.

Cytoreductive surgery (CRS) combined with hyperthermic intrathoracic chemoperfusion (HITOC) is a promising treatment strategy for pleural mesothelioma (PM). The aim of this study was to evaluate the impacts of this multimodal approach in combination with systemic treatment on disease-free survival (DFS) and overall survival (OS). In this retrospective multicenter study, clinical data from patients after CRS and HITOC for PM at four high-volume thoracic surgery departments in Germany were analyzed. A total of 260 patients with MPM (220 epithelioid, 40 non-epithelioid) underwent CRS and HITOC as part of a multimodal treatment approach. HITOC was administered with cisplatin alone (58.5%) or cisplatin and doxorubicin (41.5%). In addition, 52.1% of patients received neoadjuvant and/or adjuvant chemotherapy. The median follow-up was 48 months (IQR = 38 to 58 months). In-hospital mortality was 3.5%. Both the resection status (macroscopic complete vs. incomplete resection) and histologic subtype (epithelioid vs. non-epithelioid) had significant impacts on DFS and OS. In addition, adjuvant chemotherapy (neoadjuvant/adjuvant) significantly increased DFS (p = 0.003). CRS and HITOC within a multimodal treatment approach had positive impacts on the survival of patients with epithelioid PM after macroscopic complete resection. The addition of chemotherapy significantly prolonged the time to tumor recurrence or progression.

Local ablative therapies (LAT) are increasingly used in patients with metastatic soft tissue sarcoma (STS), yet evidence-based standards are lacking. This study aimed to assess the impact of LAT on survival of metastatic STS patients and to identify prognostic factors. In this retrospective multicenter study, 246 STS patients with metastatic disease who underwent LAT on tumor board recommendation between 2017 and 2021 were analyzed. A mixed effects model was applied to evaluate multiple survival events per patient. Median overall survival (OS) after first metastasis was 5.4 years with 1-, 2- and 5-year survival rates of 93.7, 81.7, and 53.1 %, respectively. A treatment-free interval ≥12 months and treatment of liver metastases were positively correlated with progression-free survival (PFS) after LAT (HR = 0.61, p = 0.00032 and HR = 0.52, p = 0.0081, respectively). A treatment-free interval ≥12 months and treatment of metastatic lesions in a single organ site other than lung and liver were positive prognostic factors for OS after first LAT (HR = 0.50, p = 0.028 and HR = 0.40, p = 0.026, respectively) while rare histotypes and LAT other than surgery and radiotherapy were negatively associated with OS after first LAT (HR = 2.56, p = 0.020 and HR = 3.87, p = 0.025). Additional systemic therapy was independently associated with a PFS benefit in patients ≤60 years with ≥4 metastatic lesions (for max. diameter of treated lesions ≤2 cm: HR = 0.32, p = 0.02 and >2 cm: HR = 0.20, p = 0.0011, respectively). This multicenter study conducted at six German university hospitals underlines the value of LAT in metastatic STS. The exceptionally high survival rates are likely to be associated with patient selection and treatment in specialized sarcoma centers.

Background: Lung cancer metastasis results from local invasion, loss of adhesion, migration, and distant implantation. Some small tumors metastasize diffusely other tumors progress to local bulky disease without metastasis. Here we compare these biologically divergent courses of progression and present an analysis of clinical features related to early diffuse metastasis vs. bulky disease. Methods: We retrospectively collected data from pathologically confirmed not-metastatic “bulky” (cT3-T4cN0cM0) or “diffusely metastatic” (cT1-T2cN1-3cM1) patients with lung cancer treated at our center from 2013 to 2023. Clinical data including sex, age, histology, ECOG-PS, tumor stage, smoking status, presence, and site of metastases, LDH, CRP, NLR ratio were collected. Results: A total of 375 patents with “bulky” (n = 95) or diffusely metastatic lung cancer (n = 280) were included in the analysis. In the univariate analysis, the diffusely metastatic population was younger (p = 0.001), had a higher proportion of never smokers (p = 0.02), histologically adenocarcinoma (p < 0.0001), TTF1 positive (p < 0.00001) and elevated baseline LDH in serum (LDH > 250U/l, p < 0.0001) compared to “bulky” population. Patients with diffuse metastatic disease presented worse OS (HR = 2.34, p = 0.0001) and PFS (HR = 6.89, p < 0.0001) compared to patients with bulky disease. Conclusions: Younger age, never smokers, TTF1 positivity, poorly differentiated tumors, adenocarcinoma histology were independently associated with risk of distant metastasis.