Background and Objectives: The treatment of advanced and metastatic lung cancer is multimodal, and it is coordinated by a multidisciplinary team. Anxiety and depression occur frequently in patients with lung cancer, creating considerable discomfort in therapeutic management. At the same time, these psychoemotional symptoms affect the patients’ quality of life. Objective: This research seeks to identify correlations both between anxiety and depression and the patients’ performance statuses, as well as between anxiety and depression and the type of treatment: radiotherapy, chemotherapy, tyrosine kinase inhibitors (TKI), immunotherapy and palliative care. Materials and Methods: The study evaluated 105 patients with lung cancer from two oncologic centers. Patients were assessed for anxiety and depression using the questionnaire Hospital Anxiety and Depression Scale (HADS). The HADS is a self-report rating scale of 14 items. It measures anxiety and depression, and has two subscales. There are seven items for each subscale. There are 4-point Likert scale ranging from 0 to 3. For each subscale, the score is the sum of the seven items, ranging from 0 to 21. Results: The most powerful correlation with statistical significance was observed between the IT type of treatment (immunotherapy) and the normal level of anxiety, PC = 0.82 (p < 0.001) as well as the normal level of depression. Palliative treatment was correlated with anxiety and depression, both borderline and abnormal. For ECOG 3–4 performance status and abnormal anxiety, respectively, abnormal depression was significantly associated. Also, continuous hospitalization was associated with abnormal anxiety and depression. Conclusions: Early assessments of anxiety and depression are necessary in patients with advanced and metastatic lung cancer, with unfavorable performance status, who have been admitted to continuous hospitalization, and who require palliative care.

Gynecologic melanomas are uncommon and malignant mucosal melanomas with vaginal origin are extremely rare, treatment strategies are limited and extrapolated from those of cutaneous melanoma. A better understanding of the vulvovaginal melanoma’s biology and its risk factors is needed. Therapeutic strategies include surgery, systemic therapy and radiotherapy. For vulvovaginal melanoma, surgery is selected as the primary treatment. Immunotherapy and target treatment have recently enhanced the systemic therapy for cutaneous melanoma (CM). Immunotherapy and new target agents demonstrated a better survival of melanoma and might be considered as treatment of vulvovaginal melanoma. Radiotherapy is included in the therapeutic arsenal for mucosal melanoma and may be performed on selected patients who may receive concurrent checkpoints and inhibition neoadjuvant radiotherapy with the purpose of reducing morbidity and mortality.

Background and Objectives: The management of patients with multiple primary malignancies (MPMs) is performed by a multidisciplinary team whose purpose is to individualize the treatment plan and to determine the strategies that will improve the patient’s care. The most commonly encountered malignancies are prostate cancer, colorectal cancer, lung, and bladder cancer. Prostate cancer may be synchronous or metachronous with other cancer sites. The risk factors for MPMs are viral infections, genetic factors, environmental factors, and oncological treatments (chemotherapy and radiotherapy). Materials and Methods: In this retrospective cohort study, we analyzed 26 patients with either synchronous or metachronous prostate cancer with another cancer site, registered at “Sf. Apostol Andrei” County Emergency Hospital in Galati, Romania, over a 15-year time interval (2010–2025).This paper presents the clinical and therapeutic characteristics and the staging of synchronous/metachronous cancer sites. The stage of the disease was analyzed along with the time interval between the first cancer site and the second or the third cancer site occurrence; the undergone treatment was a multimodal one. Results: This paper discusses the analyzed cases and presents the articles published in the specialty literature regarding the stage of synchronous or metachronous prostate cancer with one or more cancer sites. The most common sites are presented, along with the importance of follow-up and a complex therapeutic management depending on the stage of primary tumors. Conclusions: This series represents a cohort study regarding synchronous/metachronous prostate cancer with other cancer sites (26 cases over a 15-year time period). This case series adds more experience to the already existing experience in the literature, providing guidelines to clinicians in order to make the right decisions regarding the treatment of this disease.

Introduction. Anxiety and depression have an increased prevalence in cancer patients, especially in those in an advanced stage of the disease. These disorders have a major impact on the social life, existential concerns and quality of life of cancer patients. Materials and Methods. A number of 114 consecutive patients were included in the study (in a period of 2 weeks) who were screened for anxiety, depression and for other common symptoms, using Hospital Anxiety and Depression Scale (HADS) and Edmonton Symptom Assessment System (ESAS). Results. Regarding the age—the abnormal level of anxiety and depression: the percentage of patients over 65 years was higher than the percentage of patients under 64 years, both in terms of anxiety and depression. Regarding the Performance status ECOG—abnormal level of anxiety and depression: the percentage of patients with ECOG = 3–4 is higher than that of patients with ECOG = 0–2. Results. The increased prevalence of anxiety and depression requires psychological counseling and treatment. It is important for these symptoms to be identified as soon as possible, in order to provide a good quality of life. Conclusions. The model we propose is for the HADS to be a screening tool on admission to a palliative care ward, for certain categories of patients.

Background: Brain radiation necrosis is a side effect of radiotherapy that can occur months, or even years, after the end of treatment. From an anatomical–pathological perspective, it is characterized by avascular damage, demyelination, and necrosis. Methods: We present a case of a patient with breast cancer cT2N1M0 and multiple brain metastases occurring at 2 years after diagnosis, who was treated with whole-brain radiotherapy (WBRT) and Stereotactic Radiotherapy (SRT) for tumor progression. Dynamic imaging revealed right parietal post-therapeutic changes in aggravation, requiring differential diagnosis between tumor progression (TP) and brain radionecrosis (BRN). Results: Brain radionecrosis and tumor progression are difficult to differentiate due to their similar radiological and clinical characteristics. MRI perfusion plays an important role in differentiating the two entities. Conclusions: Differentiating radiation necrosis from a recurrent tumor is crucial for appropriate treatment. Medical management includes corticosteroids as first-line treatment, after which bevacizumab is administered as secondary therapy.

Background and Objectives: Standard treatment in metastatic breast cancer with positive estrogen receptors and negative HER2neu is represented by CDK4 inhibitors combined with aromatase inhibitors or fulvestrant. Palliative radiotherapy is indicated for symptoms or local–regional control. Multiple preclinical data suggest a potential synergistic effect when CDK4/6 inhibitors and radiotherapy are administered concurrently. We are trying to address some questions and/or to establish correlations within a subgroup of patients with unusual toxicities, the safety of combined treatments, the correlation with radiotherapy techniques and fractionation schemas. Also, we are aware that some organs at risk of a rapid turnover are more vulnerable to the occurrence of acute toxicities. Materials and Methods: This retrospective study includes 20 patients with metastatic breast cancer, treated with CDK4 inhibitors and radiotherapy on 29 disease sites; we followed the compliance and toxicities of combined treatments. Results: Regarding the recorded hematological toxicities, grade 1 associated with CDK4 inhibitors, occurring anterior radiotherapy was recorded; grade 2, leucopenia during radiotherapy presented in three cases without radiotherapy interrupting and leucopenia with neutropenia grade 3 presented in one case after pleural secondary lesion’s irradiation. Non-hematological grade 3 toxicities occurred in two cases: one case with grade 3 enteritis, at 2 weeks from bone metastases irradiation—iliac bone (in field toxicity) and one case with radiodermitis during radiotherapy on the breast and lymph node level, in the second week of external radiotherapy (RTE). Conclusions: In all analyzed cases, we obtained control of irradiated lesions. Secondary toxicities occurred only in irradiated areas. A close monitoring of patients during combined treatment must be considered and we are confident that in the future it will be possible to identify the subgroup of patients with a high risk of unusual toxicities occurring; additionally, we hope that using more conforming radiotherapy techniques minimizes the organ being at risk from radiation doses.