The present review will highlight recent advances in the clinical application of oncolytic viral therapy. Until recently, oncolytic viral researchers saw the immune system as an enemy that would clear the virus from the bloodstream. However, researchers now understand that sustained responses are seen in those patients with more robust antitumor immune responses. Much of the current focus in oncolytic viral research is trained on manipulation of the immune system to affect cancer cell killing in the tumor microenvironment and to facilitate durable systemic antitumor immunity. Many investigators have demonstrated synergistic effects of checkpoint inhibition and other immune therapies with viral administration. At the same time, insertion of various markers enables noninvasive deep tissue imaging. Finally, following regulatory approval in the United States and Europe, unbridled clinical use of T-VEC for patients with metastatic melanoma is also generating large volumes of patient data that will help elucidate strengths and weaknesses of oncolytic viral therapy. Perhaps the most telling sign of the field's future is a seismic shift in clinical trials with more investigators combining virus and immunotherapies. This article reviews the current state of therapeutic oncolytic viruses in clinical use, and explores future directions of the field.

Introduction. A patent urachus is a rare congenital or acquired pathology, which can lead to complications later in life. We describe a case of urachal cystitis as the etiology of small bowel obstruction in an adult without prior intra-abdominal surgery.Case Report. A 64-year-old male presented to the acute care surgery team with a 5-day history of right lower quadrant abdominal pain, distention, nausea, and vomiting. He had a two-month history of urinary retention and his past medical history was significant for benign prostate hyperplasia. On exam, he had evidence of small bowel obstruction. Computed tomography revealed high-grade small bowel obstruction secondary to presumed ruptured appendicitis. In the operating room, an infected urachal cyst was identified with adhesions to the proximal ileum. After lysis of adhesions and resection of the cyst, the patient was subsequently discharged without further issues.Conclusion. Although rare, urachal pathology should be considered in the differential diagnosis when evaluating a patient with small bowel obstruction without prior intraabdominal surgery, hernia, or malignancy.

Background: Pertuzumab has improved pathologic complete response rates when compared with other chemotherapeutics in the treatment of HER‐2 positive breast cancer patients.Aims: We sought to determine if axillary lymph node dissections (ALNDs) yielding at least the national standard of 10 lymph nodes is lower in patients who received neoadjuvant pertuzumab.Methods and Results: A retrospective database identified patients who underwent ALND for breast cancer. We compared the axillary lymph node retrieval rates in those who received or did not receive neoadjuvant pertuzumab. Of 139 breast cancer patients who underwent ALND, fewer than 10 axillary lymph nodes were found in 41.7% of patients who received neoadjuvant pertuzumab (P < 0.01) and 18.6% of patients who received neoadjuvant therapy without pertuzumab (P = 0.01).Conclusion: Neoadjuvant chemotherapy was associated with a significantly lower rate of “adequate” ALNDs as defined by current guidelines. The patient subset that received neoadjuvant pertuzumab was more likely to have fewer than 10 axillary lymph nodes retrieved.

Uterine adenosarcoma has poor prognosis and management of this disease is controversial. We describe a case of sarcomatosis secondary to recurrent uterine adenosarcoma who underwent cytoreductive surgery (CS) and hyperthermic intraoperative peritoneal chemotherapy (HIPEC). A 52 year-old female presented with perimenopausal menometrorrhagia. She underwent laparoscopic hysterectomy and bilateral salpingo-oopherectomy with pathology showing uterine adenosarcoma. She developed a pelvic recurrence 2 years later. A pelvic exenteration was then performed and within 8 months, she recurred. CS/HIPEC with Cisplatin was performed. Six weeks post-operatively, the patient was found to have recurrence again. This case describes the use of CS/HIPEC as a treatment modality for uterine adenosarcoma with sarcomatosis. Despite CS and HIPEC, the patient developed an aggressive recurrence within six weeks of her surgery date. We recommend a multidisciplinary approach to this disease with the recognition that CS/HIPEC may offer little benefit as a salvage therapy based on this case.