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Objective: Early diagnosis of primary and metastatic lung nodules is critical for effective therapeutic planning. Manual delineation of lung nodules is not time-efficient and is prone to human error as well as interobserver and intraobserver variability. This study aimed to address the unmet need for an open-source computer-aided detection (CAD) system for 3D segmentation of lung and metastatic lung nodules along with radiomic feature extraction., Methods: The proposed adaptive region-growing-based lung nodule segmentation (RGLNS) tool was developed in-house, requiring only manual input to select a seed point within the nodule on computed tomography (CT) images. A total of 230 CT scans from 100 patients with sarcomas were screened. Lung nodules were present in 200 CT scans, which were further analyzed. The accuracy of the lung and nodule segmentation was evaluated qualitatively using a 5-point Likert scale (uninterpretable: 1; poor: 2; fair: 3; good: 4; excellent: 5) and quantitatively using the Dice coefficient and Jaccard index., Results: A total of 200 CT scans comprising 12,000 CT slices were analyzed, among which 786 lung nodules were identified. Quantitative lung segmentation accuracies (n=2400 slices) yielded a Dice coefficient of 0.92±0.06 and a Jaccard index of 0.85±0.05. Qualitative scores (n=9600 slices) for lung boundary correction (4.56±1.18) and inclusion of pulmonary vessels (4.75±0.72) were rated as good to excellent. Quantitative nodule segmentation (n=142 nodules) accuracies were as follows: dice coefficient=0.92±0.03, 0.88±0.04, 0.86±0.03, 0.85±0.03, 084±0.04 and Jaccard index=0.84±0.03, 0.81±0.04, 0.78±0.04, 0.78±0.02, 0.76±0.04 for solitary (n=73), juxtapleural (n=32), juxtavascular (n=28), fissure-attached (n=6), and ground-glass (n=6) nodules, respectively. Qualitative scores (n=644 nodules) for nodule-boundary were good to excellent [solitary (n=342): 4.97±0.15; juxtapleural (n=155): 4.45±0.60; juxtavascular (n=127): 4.40±0.65; fissure-attached (n=9): 4.40±0.70; ground-glass (n=11): 4.25±0.75] and for exclusion of pulmonary vessels/pleura from nodules were good [juxtapleural (n=155): 4.10±0.66; juxtavascular (n=127): 4.08±0.64; fissure-attached (n=9): 4.30±0.67]., Conclusions: The proposed semiautomated CAD system, RGLNS, requiring minimal manual input, demonstrated robust, and promising segmentation results for the whole lung and various types of metastatic lung nodules., Competing Interests: The authors declare no conflict of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Ewing sarcoma of the head and neck (ES-HN) is a rare subsite of ES, where therapeutic outcomes need to be explored further., Methods: This retrospective study includes ES-HN patients registered at our center between 2003 and 2019. Demographic details and treatment outcomes were recorded from the hospital database. Prognostic factors for survival were identified by Cox regression., Results: Eighty-five patients were included. Metastatic disease was seen in nine patients (10.59%). Local therapy included radiotherapy alone (n = 38; 44.7%), surgery plus radiotherapy (n = 15; 17.6%), or surgery alone (n = 8; 9.4%). The median overall survival (OS) was 37.4 months. On multivariable analysis, osseous primary (HR 0.40; p = 0.009) and male sex (HR 0.43; p = 0.023) were associated with superior OS. Leucocytosis (HR 3.46; p = 0.001) was associated with inferior OS., Conclusions: ES-HN has favorable biology with metastases being rare at baseline. However, leucocytosis, extra-osseous disease, and female sex are poor prognostic factors. In resource-challenged settings, difficulties in administering local therapy may contribute to inferior outcomes., (© 2025 Wiley Periodicals LLC.)

Background: While teleconsultation has proven feasible for adult cancer patients, its utility in childhood cancer care in India is unknown. This study assesses caregiver satisfaction, feasibility, and the economic impact of teleconsultation for children with cancer., Procedure: This mixed methods study was conducted in the pediatric cancer outpatient service at a tertiary care cancer center in India. Routine care teleconsultations were performed via telephone or email. Caregivers who received teleconsultations during the study period or 6 months prior were interviewed by phone. Data collected included demographic details, teleconsultation usage patterns, caregiver satisfaction, reasons for satisfaction or dissatisfaction, and cost savings. Logistic regression identified baseline characteristics associated with satisfaction. In-depth interviews were conducted in a separate cohort till thematic saturation., Results: Caregivers of 465 children were included for telephonic and eight for in-depth interviews Among the respondents, 72.8% (n = 339) were satisfied with teleconsultation, and 85.4% (n = 397) of those planned to continue using it. Significant reasons for satisfaction were cost and time savings, while difficulty explaining issues caused dissatisfaction. Multivariable analysis showed parental education above high school [OR: 1.59, p = 0.035] increased satisfaction likelihood, while a residential distance of greater than 100 km from the hospital [OR: 0.62, p = 0.033] decreased it. Median cost savings per visit was $24.2 (range: $1-$846). Cost savings did not determine satisfaction magnitude. Frequently cited themes included cost and time savings and the need for literacy to benefit from teleconsultation., Conclusions: Teleconsultation is feasible and effective for routine childhood cancer care, even in resource-constrained settings., (© 2025 Wiley Periodicals LLC.)