In the study of cancer evolution and therapeutic strategies, scientific evidence shows that a key dynamics lies in the tumour-environment interaction. In particular, oxygen concentration plays a central role in the determination of the phenotypic heterogeneity of cancer cell populations, whose qualitative and geometric characteristics are predominant factors in the occurrence of relapses and failure of eradication. We propose a mathematical model able to describe the eco-evolutionary spatial dynamics of tumour cells in their adaptation to hypoxic microenvironments. As a main novelty with respect to the existing literature, we combine a phenotypic indicator reflecting the experimentally-observed metabolic trade-off between the hypoxia-resistance ability and the proliferative potential with a 2d geometric domain, without the constraint of radial symmetry. The model is settled in the mathematical framework of phenotype-structured population dynamics and it is formulated in terms of systems of coupled non-linear integro-differential equations. The computational outcomes demonstrate that hypoxia-induced selection results in a geometric characterization of phenotypic-defined tumour niches that impact on tumour aggressiveness and invasive ability. Furthermore, results show how the knowledge of environmental characteristics provides a predictive advantage on tumour mass development in terms of size, shape, and composition.

Background and Objectives: Robotic-assisted surgery (RS) has progressively emerged as a promising technology in modern thoracolumbar spinal surgery, offering the potential to enhance accuracy and improve clinical outcomes. To date, the benefits of robot-assisted techniques in thoracolumbar spinal surgery remain controversial. The objective of this study was to assess the efficacy and safety of RS compared to fluoroscopy-assisted surgery (FS) in spinal fusion procedures. Materials and Methods: In accordance with the PRISMA guidelines, a systematic review and meta-analysis was conducted, using REVMAN V5.3 software. The review protocol was registered in the Prospective Register of Systematic Reviews (PROSPERO) website with the following registration number: CRD42024567193. Results: Eighteen studies were included in the meta-analysis with a total of 1566 patients examined. The results demonstrated a worse accuracy in FS in cases with major violations of the peduncular cortex (D–E grades, according to Gertzbein’s classification) [(odds ratio (OR) 0.47, 95%-CI 0.28 to 0.80, I² 0%]. In addition, a lower complication rate was shown in the RS group compared to the FS group, specifically regarding the need for surgical revision due to screw mispositioning (OR 0.28-CI 0.17 to 0.48, I² 98%). Conclusions: Advantages of robot-assisted techniques were demonstrated in terms of postoperative complications, revision surgery rates, and the accuracy of screw placement. While RS represents a valuable and promising technological advancement in thoracolumbar spinal surgery, future studies are needed to further explore its advantages in thoracolumbar spinal surgery and to identify which spinal surgical approach has greater advantages when using the robot.

Gliomas within the insular region represent one of the most challenging problems in neurosurgical oncology. There are two main surgical approaches to address the complex vascular network and functional areas around the insula: the transsylvian approach and the transcortical approach. In the literature, there is not a clear consensus on the best approach in terms of safety and efficacy. The purpose of this study is to evaluate the effectiveness of these approaches and to analyze prognostic factors on the natural history of insular gliomas. Patients with newly diagnosed high-grade insular gliomas who underwent surgery between January 2019 and June 2024 were analyzed. The series was analyzed according to the classification of Berger–Sanai and Yaşargil. The Karnofsky performance score (KPS), extent of resection (EOR), progression-free survival (PFS), and overall survival (OS) were considered the outcome measures. A total of 58 primary high-grade insular glioma patients were enrolled in this study. The IDH mutation was found in 13/58 (22.4%); specifically, 3/13 (23.1%) were grade 4, and 10/13 (76.9%) were grade 3. Furthermore, 40/58 patients (69%) underwent gross total resection (GTR), 15 patients (26%) subtotal resection, and 3 patients (5%) partial resection. Middle cerebral artery encasement negatively affected the OS. GTR, radiotherapy, KPS, and autonomous deambulation at a month after surgery positively affected the OS. The surgical approach used was transsylvian and transcortical in 11 and 47 cases, respectively. The comparison between the two different approaches did not display differences in terms of neurological deficits and OS (p > 0.05). The transcortical approach was related to the greater achievement of GTR (p = 0.031). According to the Berger–Sanai classification, the transcortical approach has higher EOR and postoperative KPS when the lesion is in zone III-IV (p = 0.029). Greater resection of insular gliomas can be achieved with an acceptable morbidity profile and is predictive of improved OS. Both the transsylvian and transcortical corridors to the insula are associated with low morbidity profiles. The transcortical approach with intraoperative mapping is more favorable for achieving greater EOR, particularly in gliomas within the inferior border of the Sylvian fissure.

The effectiveness of oncolytic virotherapy is significantly affected by several elements of the tumour microenvironment, which reduce the ability of the virus to infect cancer cells. In this work, we focus on the influence of hypoxia on this therapy and develop a novel continuous mathematical model that considers both the spatial and epigenetic heterogeneity of the tumour. We investigate how oxygen gradients within tumours affect the spatial distribution and replication of both the tumour and oncolytic viruses, focusing on regions of severe hypoxia versus normoxic areas. Additionally, we analyse the evolutionary dynamics of tumour cells under hypoxic conditions and their influence on susceptibility to viral infection. Our findings show that the reduced metabolic activity of hypoxic cells may significantly impact the virotherapy effectiveness; the knowledge of the tumour's oxygenation could, therefore, suggest the most suitable type of virus to optimise the outcome. The combination of numerical simulations and theoretical results for the model equilibrium values allows us to elucidate the complex interplay between viruses, tumour evolution and oxygen dynamics, ultimately contributing to developing more effective and personalised cancer treatments.

In the study of cancer evolution and therapeutic strategies, scientific evidence shows that a key dynamics lies in the tumor-environment interaction. In particular, oxygen concentration plays a central role in the determination of the phenotypic heterogeneity of cancer cell populations, whose qualitative and geometric characteristics are predominant factors in the occurrence of relapses and failure of eradication. We propose a mathematical model able to describe the eco-evolutionary spatial dynamics of tumour cells in their adaptation to hypoxic microenvironments. As a main novelty with respect to the existing literature, we combine a phenotypic indicator reflecting the experimentally-observed metabolic trade-off between the hypoxia-resistance ability and the proliferative potential with a 2d geometric domain, without the constraint of radial symmetry. The model is settled in the mathematical framework of phenotype-structured population dynamics and it is formulated in terms of systems of coupled non-linear integro-differential equations. The computational outcomes demonstrate that hypoxia-induced selection results in a geometric characterization of phenotypic-defined tumour niches that impact on tumour aggressiveness and invasive ability. Furthermore, results show how the knowledge of environmental characteristics provides a predictive advantage on tumour mass development in terms of size, shape, and composition.