Total neoadjuvant therapy (TNT) has emerged as a promising approach for managing locally advanced rectal cancer (LARC), aiming to enhance resectability, increase pathological complete response (pCR), improve treatment compliance, survival, and sphincter preservation. This study compares the clinical outcomes of TNT, with either induction or consolidation chemotherapy, to those of the standard chemoradiotherapy (CRT). In this retrospective multi-institutional study, patients with stage II-III LARC who underwent CRT or TNT from seven oncology centers between 2021 and 2024 were retrospectively analyzed. The TNT group was categorized into induction or consolidation groups based on the sequence of chemotherapy and radiotherapy. Clinical and pathological data and treatment outcomes, including pCR, event-free survival (EFS), and overall survival (OS), were analyzed. Among the 276 patients, 105 received CRT and 171 underwent TNT. The TNT group showed significantly higher pCR (21.8% vs. 2.9%, p < 0.001) and lower lymphatic (26.3% vs. 42.6%, p = 0.009), vascular (15.8% vs. 32.7%, p = 0.002), and perineural invasion rates (20.3% vs. 37.6%, p = 0.003). Furthermore, 16.9% of TNT patients opted for non-operative management (NOM), compared to 0.9% in the CRT group (p < 0.001). The median interval between the end of radiotherapy and surgery was longer in the TNT group (17.6 weeks vs. 8.8 weeks, p < 0.001). The 3-year EFS was 58.3% for CRT and 71.1% for TNT (p = 0.06). TNT is associated with higher pCR, lower lymphatic and vascular invasion rates, and higher rates of NOM compared to CRT. This supports the use of TNT as a viable treatment strategy for LARC, offering potential benefits in quality of life.

Background and Objectives: Abdominal compartment syndrome (ACS) is a severe clinical condition caused by intra-abdominal hypertension (IAH), often observed in surgical and trauma patients. However, ACS can also develop in non-surgical patients with massive ascites, leading to acute kidney injury (AKI) due to renal hypoperfusion. This study investigates the association between intra-abdominal pressure (IAP) changes, renal biomarkers, and mortality in patients with ACS-related AKI. Materials and Methods: A prospective cohort study was conducted on 24 hospitalized patients with ascites due to malignancy, cirrhosis, or heart failure. IAP was measured via the trans-vesical method on the first and seventh days of hospitalization. Serum and urinary biomarkers, including kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and interleukin-6 (IL-6), were assessed for their correlation with IAP changes. The primary outcome was in-hospital mortality, and the secondary outcomes included AKI progression and the effect of paracentesis on IAP reduction. Results: The overall in-hospital mortality rate was 50%. Patients who survived had significantly lower IAP on the seventh day compared to those who died (14.9 ± 3.5 mmHg vs. 20.2 ± 5.6 mmHg, p = 0.01). A 25% reduction in IAP was associated with improved kidney function and increased survival (p < 0.001). Urinary KIM-1 and serum NGAL levels showed a moderate correlation with IAP (r = 0.55, p = 0.02 and r = 0.61, p = 0.018, respectively), while IL-6 levels were significantly higher in non-survivors (p = 0.03). Paracentesis was associated with improved survival outcomes (p = 0.04). Conclusions: ACS is a critical but often overlooked cause of AKI in non-surgical patients with massive ascites. Lowering IAP significantly improves renal function and reduces mortality. Urinary KIM-1 and serum NGAL may serve as useful biomarkers for monitoring IAP changes. The early identification and management of IAH through timely interventions such as paracentesis and volume control strategies could improve patient outcomes.

Immune checkpoint inhibitors (ICIs) therapy has revolutionized cancer treatment. However, it is important to acknowledge that ICI therapy can lead to immune-related adverse events (irAEs), including myocarditis. While early-onset myocarditis is well-documented, late-onset cases are increasingly recognized. This case series presents four cases of late-onset ICI-associated myocarditis, emphasizing the need for long-term surveillance of this potentially fatal complication. Patients exhibited a range of cardiac symptoms, including chest pain, shortness of breath, and arrhythmias. The diagnosis was confirmed through cardiac magnetic resonance imaging (MRI) and elevated cardiac biomarkers. Treatment involved the immediate discontinuation of ICI therapy and the initiation of high-dose corticosteroids. In cases with an inadequate response, additional immunosuppressive agents were considered. This case series underscores the importance of prolonged monitoring for late-onset ICI-associated myocarditis. Further research is needed to establish optimal treatment strategies and long-term management approaches for this complex condition.

Background/Objectives: Extrapulmonary neuroendocrine carcinomas (EP-NECs) are rare, aggressive malignancies with no standardized treatment approach. Although platinum-based chemotherapy is considered the first-line therapy, overall survival (OS) and progression-free survival (PFS) remain limited. This study aims to evaluate the clinical and pathological characteristics of EP-NEC patients, their treatment responses, and survival outcomes. Methods: This retrospective observational study included 29 EP-NEC patients diagnosed and followed between 2015 and 2024. Clinical and demographic data, tumor localization, disease stage, administered treatments, and survival outcomes were analyzed. Kaplan–Meier survival analysis was used to assess OS and PFS, with subgroup comparisons performed via the log-rank test. Results: The most common primary tumor sites were the pancreas (21%), prostate (17%), and cervix (14%). At diagnosis, 55.2% of patients had metastatic disease. First-line platinum-based chemotherapy achieved an objective response rate of 82.1%, with a median PFS of 8.16 months and a median OS of 14.16 months. Surgical intervention significantly improved survival (p = 0.020), while a high Ki-67 proliferation index (>80%) was associated with worse PFS (p = 0.032). Other factors, including smoking status and liver-directed therapies, had no significant impact on survival. Conclusions: EP-NECs present with a poor prognosis despite platinum-based chemotherapy achieving high response rates. Surgical resection improves survival outcomes, whereas high Ki-67 expression is associated with a worse prognosis. These findings highlight the need for further research into novel therapeutic strategies for EP-NECs.

Background: Immune checkpoint inhibitors (ICIs) have become the standard first-line treatment for patients with metastatic non-small cell lung cancer (NSCLC) with high programmed death-ligand 1 (PD-L1) expression. However, the optimal selection between immunotherapy monotherapy and chemo-immunotherapy in patients with a PD-L1 tumor proportion score (TPS) ≥ 50% remains uncertain in routine clinical practice. Methods: We retrospectively reviewed patients with metastatic NSCLC and a PD-L1 TPS ≥ 50% who initiated first-line treatment with pembrolizumab monotherapy or pembrolizumab combined with platinum-based chemotherapy at the Istanbul Medipol University Department of Medical Oncology between July 2017 and December 2024. Survival outcomes, including progression-free survival (PFS) and overall survival (OS), were evaluated and compared according to PD-L1 expression levels and treatment strategy. Prognostic factors associated with survival outcomes were also explored. Results: A total of 65 patients were included, of whom 36 received pembrolizumab plus chemotherapy and 29 received pembrolizumab monotherapy. The estimated median PFS and OS for the entire cohort were 24.2 months (95% CI, 6.5–33.0) and 34.6 months (95% CI, 6.5–62.7), respectively. Patients with very high PD-L1 expression (TPS ≥ 90%) experienced significantly longer survival outcomes compared with those with a TPS of 50–89%, and a PD-L1 TPS ≥ 90% remained an independent prognostic factor for OS. When treatment strategies were compared across the entire cohort, no statistically significant differences in PFS or OS were observed between immunotherapy monotherapy and chemo-immunotherapy. Hypertension was identified as an independent negative prognostic factor for PFS. In patients with a PD-L1 TPS ≥ 90%, survival outcomes numerically favored pembrolizumab monotherapy, although this difference did not reach statistical significance. Conclusions: In this real-world cohort of patients with PD-L1 high metastatic NSCLC, PD-L1 expression, particularly very high TPS levels, was strongly associated with survival outcomes. While no survival differences were observed between treatment strategies in the overall population, pembrolizumab monotherapy may represent an appropriate first-line option in selected patients with a PD-L1 TPS ≥ 90%. Larger prospective studies are warranted to refine treatment selection in this setting.

Amaç: Çalışmamızda, torasik bölgeye radyoterapi (TRT)/ kemoradyoterapi (KRT) +/- immünoterapi (İO) alan hastalarda gelişen radyasyon pnömoniti sürecini ve etki eden faktörlerin ortaya konulması amaçlanmıştır. Yöntem: TRT alan hastaların verileri retrospektif olarak tarandı ve radyasyon pnömoniti gelişen 26 hastanın verileri analiz edildi. Bulgular: Hastaların ortanca yaşı 54.5 iken çoğu erkekti. Hastaların çoğunluğunda primer tanı akciğer kanseri idi. Ondört hasta (%53.8) eş zamalı KRT alırken, 13 hasta (%50) IO ile eş zamanlı RT almıştı. Toplamda ise 17 hasta (%65.4) tedavi sürecinde IO almıştı. Median RT dozu 44 Gy idi. Hastalarda RT ile pnömonit gelişene kadar geçen süre ortanca 5.8 ay iken IO başlangıcından pnömonitis gelişene kadar geçen süre ortanca 6.2 aydı. 20 hastada (%76.9) grad 2, 3 hastada (%11.5) grad 3 ve 3 hastada (%11.5) grad 1 pnömonitis görülmüştü. En sık görülen tomografi bulguları konsolidasyon ve septal kalınlaşma ve distorsiyon ile 5 hastada retikülonodüler görünüm ve 3 hastada buzlu cam görünümü şeklindeydi. Ortanca steroid kullanımı 1.95 ay idi . 14 hastada (%53.8) steroid dozu 1 mg/kg dozuna kadar çıkılmıştı. Ortanca 22.5 aylık takip süresinde, ortanca PFS 28.8 ay ve ortanca OS 54.1 aydı. Hiçbir hastada RT pnömonitine bağlı ölüm gözlenmedi. Grad 2-3 RT pnömoniti gelişimine etki eden faktörlerin analizi yapıldığında, her hangi bir predikte edici anlamlı faktör gösterilemedi. Sonuç: Çalışmamızda KRT+İO alan hastalarda RT pnömoniti İO almayanlara kıyasla daha fazla görülmedi. Fakat hasta sayısı az olduğu için daha fazla hasta sayıları ile geniş kapsamlı karşılaştırmalı çalışmalara ihtiyaç bulunmaktadır. RT pnömoniti zamanında akla getirilmediğinde ciddi mortal olabilen fakat erken farkedilerek, doğru tedavi edildiğinde yönetilebilir bir klinik antitedir.