Background/aim: The aim of our study was to compare the efficacy and the safety of the FLOT and the modified DCF (mDCF) regimens in patients with metastatic gastric (GC) and gastroesophageal junction (GEJ) adenocarcinoma as first-line treatment. Materials and methods: The medical records of 72 patients were retrospectively reviewed. Survivals and hematological adverse events of the patients were examined. Factors affecting survivals were analyzed in univariate analysis. A multivariate analysis was performed with the factors contributing to survivals in univariate analysis. Results: The median PFS (mPFS) was 10.1 months (95% CI, 6.8?13.4) in the FLOT arm (n = 33) and 7.4 months (95% CI, 9.1?21.6) in the mDCF arm (n = 39) (p = 0.041). The median OS (mOS) was 12.9 months (95% CI, 9.7?16.1) in the FLOT arm and 15.4 months (95% CI, 9.1?21.6) in the mDCF arm (p = 0.622). It was found that all grade neutropenia was 51.3% vs. 72.7% (p = 0.063), febrile neutropenia was 8.3% vs. 6.3% (p = 0.743), and thrombocytopenia was 48.7% vs. 51.5% (p = 0.813) in the FLOT and mDCF arms, respectively. Anemia was 59% in the FLOT arm and 100% in the mDCF arm (p < 0.001). Grade 3-4 anemia was 7.7% in the FLOT arm and 24.2% in the mDCF arm (p = 0.052). Conclusion: It was shown that the mPFS was significantly increased in the FLOT arm compared to the mDCF arm as the first-line treatment in patients with metastatic GC and GEJC. Hematological adverse events were more favorable in the FLOT arm than in the mDCF arm.

Background/Aim: Cholangiocarcinoma (CCA) is the second most frequently occurring primary malignant tumor of the liver, characterized by poor survival due to late diagnosis and limited treatment options. The albumin-bilirubin (ALBI) and platelet-ALBI (PALBI) scores, which reflect liver function and inflammation, have emerged as potential prognostic markers in hepatocellular carcinoma (HCC). Their prognostic significance in CCA, however, remains less established. Patients and Methods: A retrospective analysis was conducted on 184 patients diagnosed with CCA between 2007 and 2024. The study evaluated the relationship between tumor location, ALBI/PALBI grades, and overall survival (OS). Patients were categorized into three groups based on their ALBI and PALBI scores, and survival outcomes were analyzed. Results: Tumor location significantly impacted OS. The median OS (mOS) was 18 months for distal CCA, 13 months for perihilar CCA, and 7 months for intrahepatic CCA (p<0.001). When stratified by ALBI grade, mOS was 17 months for Grade 1, 8 months for Grade 2, and 2 months for Grade 3 (p=0.001). Similarly, for PALBI grade, mOS was 13 months for Grade A1, 11 months for Grade A2, and 8 months for Grade A3 (p=0.037). Among the variables included in the multivariate analysis, only the ALBI grade retained its significance as an independent prognostic factor for overall survival. Conclusion: ALBI and PALBI grades serve as effective prognostic indicators in CCA, with lower grades associated with enhanced survival rates. Notably, ALBI grade was found to be an independent predictor of OS, presenting a cost-efficient biomarker that may support clinical decision-making by providing crucial prognostic information insights.

Aims: Hypercalcemia is a malignancy-associated oncologic emergency, and evaluating short-term mortality in hospitalized patients is critical for predicting prognosis and guiding treatment. This study assessed 30-, 60-, and 90-day mortality rates in patients hospitalized for hypercalcemia and compared short-term survival according to the corrected calcium (dCa) level determined by receiver operating characteristic (ROC) analysis based on 90-day mortality. Methods: A total of 135 patients were included. ROC analysis was performed to identify the optimal dCa cutoff for predicting 90-day mortality. Patients were divided into low and high dCa groups, and survival was compared using the Kaplan–Meier method. A p-value

Paclitaxel is a widely used chemotherapeutic agent for the treatment of breast cancer. While peripheral neuropathy is a well-recognized dose-limiting toxicity of paclitaxel, cranial nerve involvement remains exceptionally rare. We report a case of unilateral facial nerve palsy in a breast cancer patient receiving standard-dose paclitaxel therapy, highlighting the diagnostic challenges in distinguishing drug-induced neurotoxicity from other aetiologies. A 43-year-old woman with metastatic breast cancer developed left facial nerve paralysis after 12 months of weekly paclitaxel treatment (80 mg/m²). Contrast-enhanced cranial Magnetic Resonance Imaging (MRI) demonstrated bilateral cranial nerve VII enhancement, creating diagnostic uncertainty between leptomeningeal metastasis, paclitaxel-induced neuritis, and idiopathic Bell's palsy. Paclitaxel was discontinued, and corticosteroid therapy was initiated. Clinical and radiological improvement at follow-up strongly supported a drug-related aetiology. This case illustrates the diagnostic complexity of facial nerve palsy in cancer patients receiving neurotoxic chemotherapy. The overlapping clinical and radiological features between drug-induced cranial neurotoxicity, leptomeningeal disease, and idiopathic causes present significant diagnostic challenges. Clinicians should maintain a high degree of suspicion for rare chemotherapy-related cranial neuropathies while pursuing comprehensive differential diagnosis, including infectious aetiologies and metastatic disease.

Aims: Malignancy-associated hypercalcemia (MAH) is a severe metabolic complication affecting 2-3% of cancer patients, with higher prevalence in multiple myeloma (20-30%), lung cancer (12-15%), and breast cancer (10-20%). Median survival following MAH diagnosis ranges from 25 to 68 days, highlighting its status as an oncological emergency. This retrospective study examines demographic characteristics, clinical findings, treatment responses, and survival outcomes in patients with malignant hypercalcemia, with particular emphasis on the influence of bone metastasis on the presentation, severity, and management of hypercalcemia.Methods: This retrospective cohort study included 124 cancer patients aged 18 years or older who were hospitalized for malignant hypercalcemia at a tertiary oncology training and research hospital between January 2018 and December 2023. Inclusion criteria were a corrected serum calcium level of at least 10.5 mg/dl and a diagnosis of active malignancy. Collected data encompassed demographic characteristics, primary cancer diagnosis, disease stage, presence of bone metastases, laboratory values, treatment modalities, treatment responses, and survival times. Statistical analyses were performed using SPSS 26.0. Survival was assessed using the Kaplan-Meier method, and inter-group comparisons were performed using the log-rank test. A p-value below 0.05 was considered statistically significant. Results: The median age of the cohort was 58 years (range: 21-90 years), with an equal gender distribution (50.0% female, 50.0% male). The median corrected calcium level at diagnosis was 12.77 mg/dl (range: 10.5-21.0 mg/dl). Bone metastases were identified in 66.9% of patients at the time of malignant hypercalcemia diagnosis, with primary tumor distribution as follows: breast cancer 33.9%, lung cancer 20.1%, and other cancers 46.0%. Treatment modalities comprised bisphosphonates (66.9%), hydration alone (23.4%), and denosumab (9.7%). The median time to normalization of hypercalcemia was 4.0 days (range: 1-16), varying by treatment: hydration-diuretic 3.0 days, bisphosphonates 4.0 days, and denosumab 3.0 days (p=0.032). After hypercalcemia diagnosis, the median survival was 2.0 months (range: 0-60), with a 75% mortality rate within 6 months. Prior bisphosphonate use correlated with improved survival in breast cancer patients (57.0 vs 22.0 months, p=0.002), but not in lung cancer patients (8.0 vs 8.0 months, p>0.05). At the end of follow-up, 91.9% of patients had died.Conclusion: Malignant hypercalcemia mostly affects patients with advanced cancer and a high rate of bone metastasis (66.9%). However, having bone involvement did not independently affect survival or the time it took for calcium levels to return to normal. The only factor that predicted poor survival after hypercalcemia was Eastern Cooperative Oncology Group (ECOG) performance status, which suggests that systemic factors are more important than the extent of bone disease in determining outcomes. The longer survival seen in breast cancer patients who had used bisphosphonates before should be viewed with caution, as this may be due to immortal time bias and confounding by indication. Overall, these results highlight the poor outlook for malignant hypercalcemia and stress the need for early detection and proper treatment.