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Soft tissue sarcomas (STS) represent a heterogeneous group of malignancies that are all distinguished by mesodermal differentiation, with unique clinical and pathologic characteristics. Only 1% of adult malignancies are STS, which makes them comparatively uncommon. This low incidence is further complicated by their variable presentation, behavior, and long-term outcomes. There are more than 100 distinct histologic subtypes of soft tissue tumors, the majority of which are STS, according to the fifth edition of the WHO Classification of Tumors of Soft Tissue and Bone (1). The rarity and heterogeneity of these tumors, together with the difficult management paradigm, necessitate a multidisciplinary approach involving a skilled group of radiologists, pathologists, radiation and medical oncologists, and orthopedic oncologists.

Breast cancer is one of the most common malignancies, with a 10-year survival rate for early non-metastatic stages of over 80%. However, recurrence or relapse may occur decades after completing therapy, and cancer survivors have also a risk of secondary neoplasia especially due to radiation therapy. This case highlights the challenges of an accurate diagnosis and appropriate treatment in patients with second primary cancer and uncommon metastasis.

Preoperative parathyroid evaluation through nuclear medicine and intraoperative hormone monitoring has significantly increased the success of the surgical intervention. Material and method: Our study is descriptive, the database is retrospective but it is maintained prospectively. The preoperative protocol included single photon emission computed tomography (SPECT) with the use of technetium-99 sestamibi tracer. We preferred this approach as it allowed 3-D localization of the adenomas. PTH values were obtained from blood drawn from the ipsilateral jugular vein at the regular intervals of 5, 10 and 15 minutes post excision. Results: We had 6 cases with false negative which led to the necessary dissection of the contralateral neck. Two had previous surgery and 4 had tumors in other locations which were observed after the surgical intervention through methodical investigations. We encountered 3 patients with false positive results. 2 had intrathyroidal adenomas and 1 was diagnosed with thyroid papillary carcinoma. Causes of a misinterpretation are related to thyroid disease in association with hyperparathyroidism, a history of parathyroid surgery or multiple locations of hyperproductive parathyroid glands.

Background and Objectives: Ovarian cancer, including tubal and peritoneal cancer, is the third most common gynecological cancer and the leading cause of death from gynecological malignancies in developed countries. This study explores the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in determining the optimal duration of neoadjuvant chemotherapy (NACT) for advanced ovarian cancer. It also investigates the correlation between NLR dynamics and the KELIM score, a chemosensitivity marker, to enhance individualized therapeutic strategies. Materials and Methods: A total of 79 patients underwent NACT followed by interval debulking surgery (IDS) or palliative care. The data collected included demographic information, tumor characteristics, treatment modalities, and laboratory parameters. The baseline NLR (NLR-T0) and post-therapeutic NLR (NLR-T1) were calculated, and their variation (NLR∆) was analyzed. The KELIM score was determined using CA-125 values. Results: Patients with a high baseline NLR (≥2.5) had significantly worse progression-free survival (PFS) and overall survival (OS) compared to those with a low NLR (Conclusions: The NLR is a valuable prognostic marker for assessing treatment response and guiding NACT duration in advanced ovarian cancer.

Background: Metastatic renal cell carcinoma (mRCC) is an aggressive cancer characterised by an increased recurrence rate and an inadequate response to treatment. This study aimed to investigate the importance of the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker for long-term survival in patients with mRCC. Methods: We retrospectively analysed data from 74 patients with mRCC treated at our medical centre with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs). We evaluated the predictive value of NLR for overall survival (OS) in these patients. Results: The median OS was 5.1 months in the higher NLR group (≥3) and 13.3 months in the lower NLR group (p < 0.0001). There was no significant difference in the OS between the TKI and ICI therapies in the low NLR group (12.9 vs. 13.6 months, p = 0.411) or in the high NLR group (4.7 vs. 5.5 months, p = 0.32). Both univariate and multivariate analyses revealed that a higher NLR was an independent prognostic factor of long-term survival in patients with mRCC treated with first-line therapy. Conclusions: This retrospective study showed that adding NLR to other Memorial Sloan Kettering Cancer Center (MSKCC) and International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) variables might improve the prognostic and predictive power of these models.

Immune-checkpoint inhibitors (ICIs) are the most effective treatments nowadays. Nivolumab was the second ICI used for treating solid tumors with amazing results. Patients treated with Nivolumab may react differently to this treatment. Some people tolerate this treatment very well without experiencing any adverse reactions, whilst some may have mild symptoms and a part of them can present severe reactions. In our research, we sought to identify the answers to four questions: 1. what type of cancer has more severe hypersensitivity reactions to Nivolumab, 2. what is the time frame for developing these severe reactions to Nivolumab, 3. whether it is best to continue or stop the treatment after a severe hypersensitivity reaction to Nivolumab and 4. what severe hypersensitivity reactions are the most frequent reported along Nivolumab treatment. This review also highlights another problem with regard to the usage of concomitant and prior medications or other methods of treatment (e.g., radiation therapy), which can also lead to severe reactions. Treatment with Nivolumab is very well tolerated, but patients should also be warned of the possibility of severe hypersensitivity reactions for which they should urgently see a doctor for a personalized evaluation. There are some options for individuals with severe hypersensitivity reactions, for eg. switching the medication or applying a desensitization protocol.

Gastrointestinal metastases from cutaneous melanoma are rare and usually asymptomatic, with most patients not being clinically diagnosed throughout their lifetime. We report a case of how melanoma may metastasize insidiously in the small bowel. Unexplained iron deficiency anemia was assumed to be the result of underlying gastrointestinal bleeding. Therefore, the diagnosis of jejunal metastasis from cutaneous melanoma was suggested based on imaging findings and made through the histopathological examination. According to the international guidelines, the patient underwent the complete excision of the primary tumor and therapeutic lymph node dissection. Furthermore, an adjuvant treatment was required to reduce the risk of recurrence. Both immunotherapy and surgical therapy have been shown to be effective, providing long-term survival in this case.

Paraneoplastic syndromes of the nervous system are rare disorders, strongly linked with lung cancer. This report aims to explore the challenges in the diagnosis and treatment of a patient with early-stage small cell lung cancer and neurological manifestations as initial clinical symptoms.

Personalized treatment in oncology is the most innovative method of care. The best method to establish personalized treatment is by genetic characterization of the malignant cell. Theoretically, the more detailed the characterization, the more effective the choice of treatment becomes. Currently, there are fast and relatively low-cost options that allow such genetic characterization. However, test results sometimes do not detect targetable alterations and, even if they do detect, the use of the treatment-alteration combination does not always generate a satisfactory oncological response. The present paper aims to answer two questions. First, how targetable can the most common gene alterations in colorectal cancer be. Second, whether it makes sense to use broad molecular testing as a standard in all metastatic patients.

Although the standard treatment for ovarian carcinoma with peritoneal metastases is systemic chemotherapy alone or systemic chemotherapy with debulking surgery, a new technique gains more ground: a combination of hipertermic intraperitoneal chemotherapy (HIPEC) and optimal cytoreduction surgery. The proof is mounting regarding the benefits of HIPEC for patients with metastatic ovarian carcinoma but it still lacks a standard protocol of use. It has increased costs, and incomplete data regarding its safety. Due to these reasons, it is still considered an alternative treatment. Our study aimed to evaluate the published literature regarding this technique from the point of view of safety and efficacy when compared with the standard of care treatment.

Introduction: Cancer related- pain causes a negative psychosocial and physical impact on patients’ lives. The purpose of this review was to investigate the current strategies for cancer pain treatment. Material and Methods: We conducted a PubMed search of the literature published from 2018 to 2020, and details were extracted from the articles with adequate study quality. Discussion: Of 63 titles, 19 studies were selected and used in review. Conclusions: This review article focuses on the novel treatments available for cancer pain management.

Multigene assays were developed to guide treatment in early-stage breast cancer and to evaluate the benefit of adjuvant chemotherapy. Patients with invasive breast carcinoma, either T1 or T2, N0 or N1 (one to three positive lymph nodes), with no invaded surgical margins (R0), positive for hormone receptors and negative for Her2 receptor derive benefit from these tests. The Food and Drug Administration (FDA) validated the use of the following tests: OncotypeDX (a 21 gene test), Mammaprint (70 ARN messenger genes), Predictor Analysis of Microarray 50-PAM50 (50 genes) also known as Prosigna and Endopredict (12 genes). These gene expression signatures have been increasingly used to evaluate the prognosis (such as Endopredict- that can predict outcomes more accurately than ki67 values in early-stage breast cancer) or the benefi t of adjuvant chemotherapy (such as Oncotype DX). For the moment only two assays, the 70-gene signature (MammaPrint) and the 21-gene Recurrence Score (RS) assay (Oncotype DX), are supported by prospective randomized phase 3 trials. However, all multigene assays are important tools in the identification of low-risk, breast cancer patients, for whom chemotherapy could be avoided.

Background: Lung cancer (LC) is the first and most lethal cancer in the world; identifying new methods to treat it, such as immune checkpoint inhibitors (ICIs), is needed. ICIs treatment is very effective, but it comes bundled with a series of immune-related adverse events (irAEs). Restricted mean survival time (RMST) is an alternative tool for assessing the patients’ survival when the proportional hazard assumption (PH) fails. Methods: We included in this analytical cross-sectional observational survey patients with metastatic non-small-cell lung cancer (NSCLC), treated for at least 6 months with ICIs in the first- and second-line settings. Using RMST, we estimated the overall survival (OS) of patients by dividing them into two groups. A multivariate Cox regression analysis was performed to determine the impact of the prognostic factors on OS. Results: Seventy-nine patients were included (68.4% men, mean age 63.8), and 34/79 (43%) presented irAEs. The OS RMST of the entire group was 30.91 months, with a survival median of 22 months. Thirty-two out of seventy-nine (40.5%) died before we ended our study. The OS RMST and death percentage favored the patients who presented irAEs (long-rank test, p = 0.036). The OS RMST of patients with irAEs was 35.7 months, with a number of deaths of 12/34 (35.29%), while the OS RMST of the patients without irAEs was 17 months, with a number of deaths of 20/45 (44.44%). The OS RMST by the line of treatment favored the first line of treatment. In this group, the presence of irAEs significantly impacted the survival of these patients (p = 0.0083). Moreover, patients that experienced low-grade irAEs had a better OS RMST. This result has to be cautiously regarded because of the small number of patients stratified according to the grades of irAEs. The prognostic factors for the survival were: the presence of irAEs, Eastern Cooperative Oncology Group (ECOG) performance status and the number of organs affected by metastasis. The risk of dying was 2.13 times higher for patients without irAEs than for the patients who presented irAEs, (CI) 95% of 1.03 to 4.39. Moreover, by increasing the ECOG performance status by one point, the risk of death increased by 2.28 times, with a CI 95% of 1.46 to 3.58, while the involvement of more metastatic organs was associated with a 1.60 times increase in the death risk, with a CI 95% of 1.09 to 2.36. Age and the type of tumor were not predictive for this analysis. Conclusions: The RMST is a new tool that helps researchers to better address the survival in studies with ICIs treatment where the PH fails, and the long-rank test is less efficient due to the existence of the long-term responses and delayed treatment effects. Patients with irAEs have a better prognosis than those without irAEs in the first-line settings. The ECOG performance status and the number of organs affected by metastasis must be considered when selecting patients for ICIs treatment.

Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors and endocrine therapy are the gold standards for systemic therapy for patients with hormone-positive (HR+)/human epidermal growth factor receptor-2-negative (HER2-) metastatic breast cancer. Following progression, no prospective randomized data exist to help guide second-line treatment. Moreover, there is a scarcity of data on rechallenge treatment strategies with another CDK4/6 inhibitor after prior limiting toxicity. We report a real-world experience of rechallenging with abemaciclib after the prior reaction of grade 4 liver toxicity to ribociclib, with high transaminases values of more than 27 times the upper limit of normal (ULN) and unexpected grade 3 neutropenia and diarrhea after a few months of abemaciclib. After two years of treatment, the patient had stable oncological disease, with normal complete blood count, hepatic enzymes, and a very good performance status. We believe that our clinical case, along with others gathered from all around the world, will help with the consolidation of an unmet clinical need to readjust the treatment after experiencing toxicity to CDK4/6 inhibitors.

The latest and newest discoveries for advanced and metastatic hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2-) breast cancer are the three cyclin-dependent kinases 4 and 6 inhibitors (CDK4/6i) in association with endocrine therapy (ET). However, even if this treatment revolutionized the world and continued to be the first-line treatment choice for these patients, it also has its limitations, caused by de novo or acquired drug resistance which leads to inevitable progression after some time. Thus, an understanding of the overview of the targeted therapy which represents the gold therapy for this subtype of cancer is essential. The full potential of CDK4/6i is yet to be known, with many trials ongoing to expand their utility to other breast cancer subtypes, such as early breast cancer, and even to other cancers. Our research establishes the important idea that resistance to combined therapy (CDK4/6i + ET) can be due to resistance to endocrine therapy, to treatment with CDK4/6i, or to both. Individuals’ responses to treatment are based mostly on genetic features and molecular markers, as well as the tumor’s hallmarks; therefore, a future perspective is represented by personalized treatment based on the development of new biomarkers, and strategies to overcome drug resistance to combinations of ET and CDK4/6 inhibitors. The aim of our study was to centralize the mechanisms of resistance, and we believe that our work will have utility for everyone in the medical field who wants to deepen their knowledge about ET + CDK4/6 inhibitors resistance.

Multiple primary malignancies have an increasing incidence in the general population due to better diagnostic tools and the increased life expectancy. However, synchronous lesions are still rare and have a rate which varies between 0,17 and 0,69%. Second primary tumours usually develop after some time from the first cancer diagnosis. Although there is an arsenal of therapeutical options – the order and priority of the therapeutic choices are debatable and need to be tailored to every patient. The present paper illustrates the case of a 40 years old woman who presented to the emergency department with diffuse abdominal pain, nausea and bloating. The patient had done a fine needle biopsy of a suspicious lump in her right breast one week before the presentation and had no other relevant medical history. The CT scan revealed intraperitoneal free liquid with a paracolic mass at the rectosigmoid junction. The surgical team decided to perform an exploratory laparoscopy. At exploration, the mass was intensely adherent to the uterus and fixed to the pelvis. Conversion to laparotomy and extemporaneous exam of the mass were undertaken, which revealed adenocarcinoma. En-bloc rectosigmoidian resection with hysterectomy and bilateral adnexectomy. The histopathology report staged the tumour as pT4N2M0 adenocarcinoma. Breast biopsy pathology report revealed no special type (NST) carcinoma, with luminal B breast cancer on immunohistochemistry. Clinical staging of the breast was cT1N0. After discussion of the case in the multidisciplinary team, it was decided for Madden mastectomy with axillary lymphadenectomy. Breast reconstruction with retropectoral expander was done in the same operating procedure. Post-mastectomy pathology report revealed pT1N0 and no metastases were present at standard imaging. The immunohistochemical profile of the resected breast tumour proved to be Luminal A. Adjuvant therapy consisted in chemoradiation for the rectum. The breast neoplasia was treated with tamoxifen as adjuvant therapy. Synchronous primary neoplasia exists and even if they have a low incidence once identified their treatment requires particular treatment for each case. A multidisciplinary approach is essential.

There is ongoing debate regarding the role of neck dissection in differentiated thyroid cancer, about its usefulness in elective settings, and the increased costs regarding morbidity and operative time. This retrospective study aimed to determine the rate of metastases in cervical lymph nodes, to examine the morbidity of this surgery, and to assess whether a pattern of distribution of tumor cells concerning neck lymphatic compartments exists. The most frequent type of cancer to metastasize was papillary cancer, the majority of patients were young with a median of 30 years, predominantly females. Differentiated thyroid cancer frequently metastasizes to the central and lateral compartments of the neck. The morbidity is minimal in a high-volume center. Radical neck dissection is safe and feasible in selected patients with confirmed invaded or enlarged lymph nodes due to differentiated thyroid cancer, and postoperative complications are minimal if the anatomy is correctly identified and the cases strictly selected.

Introduction. The latest histological classification of lung adenocarcinoma includes lepidic, acinar, papillary, micropapillary, and solid as subtypes. Testing these subtypes for their prognostic and predictive value is an ongoing scientific challenge. The present research article aims to describe the influence this classification has on patient survival. Materials and Methods. Thirty-three patients were included in the trial. The most important enrollment criterion was the clear specification of the adenocarcinoma subtype in the pathology report. Patients were stratified into three groups which included the adenocarcinoma pathological subtypes as follows: lepidic (LEP), acinar and papillary (ACN/PAP), and micropapillary/solid (MIP/SOL). The primary endpoint was progression-free survival. Other endpoints included overall survival. Results. The lepidic subtype of ADC had superior PFS and OS, regardless of stage. Papillary and acinar subtype showed an intermediate prognosis, whereas micropapillary and solid subtypes were the most aggressive. Conclusions. The experience of this single center confirmed data in the literature. Further studies are needed to demonstrate all the possible implications of this pathology classification.

Basal Cell Carcinoma is the most common human malignant neoplasm. Vulvar basal cell carcinoma is rare, accounting for less than 5% of all vulvar neoplasms. Vulvar basal cell carcinomas are usually diagnosed late because they are often asymptomatic and tend to grow at slow rates. They are usually diagnosed late because they are often asymptomatic. However, these tumours may appear in areas which are normally covered with ultraviolet light. We present the case of a 60 years old woman diagnosed with invasive breast cancer for which she underwent surgery followed by chemotherapy and radiotherapy. The patient presented to our department with an ulcerated vulvar lesion. On inspection, the tumour measured 3/2 cm and was located on the left labium majus. The biopsy confirmed the diagnosis of vulvar basal cell carcinoma and a wide local excision was performed with no relapse at one year. In conclusion, early detection of BCC’s is critical to allow complete surgical cure so any abnormality on the vulva should be biopsied. A wide safety margin of 1cm should be achieved when resecting the tumour and the physician should keep in mind that the BCC’s of the vulva has a high recurrence rate. Previous chemotherapy is not associated with this type of non-melanoma skin cancer.

Objective. The purpose of this paper is to review the current concepts in the literature regarding the beneficial effects of adjuvant surgery after concurrent radio-chemotherapy for locally advanced cervical cancer. Method. Research of the literature was performed using PubMed databases in order to find articles relevant to the central topic. The PICOS criteria were used to filter the results. The paper was then structured according to the PRISMA guideline. Results. 50 individual papers were analyzed and sorted according to their relevance for the topic. 18 were classified as relevant. There was little agreement as to how beneficial adjuvant hysterectomy is in locally advanced cervical cancer after chemoradiotherapy. Some articles concluded that patients with a total clinical response after initial treatment might have superior progression-free survival and overall survival after surgery. 2 articles underlined the importance of accurate restaging after primary treatment. The lack of benefit for surgery in patients with bulky disease or persistent adenopathies was agreed upon in all cases. Conclusions. The decision for adjuvant hysterectomy with or without lymphadenectomy is a controversial one and has to be personalized and taken in a multidisciplinary team.

Microsatellite instability (MSI) is a feature of colorectal tumors that develops as a result of inactivation of the DNA mismatch repair system. It is found in about 15% of all colorectal cancers and is an important prognostic molecular marker when assessing patients with colorectal cancer. It can influence prognosis and treatment decisions in both the advanced and early stages. Although in early stages this marker suggests a favorable prognosis and presents an important argument against adjuvant treatment in stage II disease, in metastatic stages it no longer associated with such an optimistic outcome. The present trial is a prospective, single-center study which included 122 colorectal cancer patients who were tested for MSI using immunohistochemistry. The trial included patients with stage II to IV colorectal cancer, treated in the Prof. Dr. Agrippa Ionescu Emergency Hospital, Bucharest, Romania. Follow-up data were collected during a 24-month period. The study attempted to determine whether differences exist in overall survival for MSI (microsatellite instability) vs. MSS (microsatellite stable) colorectal cancer and to ascertain whether sex of the patient influences prognosis in MSI patients, irrespective of stage or treatment. Results demonstrated no significant differences in survival for MSI vs MSS colorectal patients, and patients’ gender proved not to influence the outcome in MSI patients.

Background. This study evaluated the difference between boys and girls in terms of nutritional status, lifestyle, and dietary habits during school life. Materials and Methods. A descriptive and observational study was conducted in 2016, in which 251 children, aged 7-17, from 3 elementary schools and a high school inBucharest,Romania, were evaluated. A questionnaire was used to assess food behavior, eating, and lifestyle habits. Results. Boys had a significantly higher waist circumference (71.18±9) than girls (67.46±9.91) (p=0.004). Thus 27% of boys were overweight or obese compared with only 22% of the girls. Differences were also seen between the two groups in terms of main meals and snacks and following a rhythm of meals: a statistically significant percentage of girls (36.3%) skip breakfast, while most boys (63.8%) take a food package to school. A total of 23.8% of the boys and 24% of the girls state that they eat while sitting in front of the computer or TV. Conclusions. We found that boys are more overweight or obese than girls. Obesity in the pediatric population of Romania could be explained by the country’s emergence from communism 25 years ago, pattern typical of all Eastern European countries and which currently involve an overexposure of people to fast food, fizzy drinks and sweets, as well as to a high consumption of salt and food additives. Unbalanced and highly caloric food had been preferable to healthy food in the last period. Leisure time is rather spent in front of the TV, tablet, detrimental to rational physical exercise, recreational sports or hiking. The family environment is very important and all our actions should be focused on continuous education about the risks of unhealthy food and a sedentary lifestyle.

Literature suggests that high body mass index can be correlated with better response to immune checkpoint inhibitors. On the other hand, sarcopenia seems to be a negative predictive marker. The present analysis is a retrospective, multicenter trial that included patients with metastatic melanoma, non-small cell lung cancer (NSCLC), and renal cell carcinoma treated with nivolumab between 2018 and 2020. Patients were stratified by creatinine levels both at treatment initiation and at first follow-up (at three months) and by BMI for the same intervals, as recorded in the patients’ charts. Creatinine was considered a surrogate marker for sarcopenia. IBM SPSS version 20 was used for statistical analysis. A total of 57 (n = 57) patients were included in the trial. Overall response rate (ORR) for the entire population was 38.59% (p = 0.02). Patients with BMI lower than 25 had an ORR of 28.5% (p = 0.003), whereas patients with BMI higher than 25 had an ORR of 42.3% (p = 0.002). Patients who gained weight during treatment had a lower probability of having progressive disease (OR = 0.4 [95% CI; 0.4–1.2]), as did patients with creatinine higher than 0.9 (OR = 0.39 [95% CI: 0.13–1.14]). No superiority was found in progression-free survival (PFS) when patients were dichotomized for BMI = 25 or BMI = 18.5. Mean PFS in the BMI under 18.5 group was 10.2 months [95% CI: 5.8–23.1], versus 11.2 for BMI over 18.5 [95% CI: 5.3–25.3], p < 0.03. Mean PFS for the BMI under 25 was 11.2 months [95% CI: 7.2–20.1], vs. 13.3 months [95% CI: 6.4–22] for the BMI over 25, p < 0.001. There were also differences in PFS in the patients with baseline creatinine over 0.9 when compared with under 0.9 values. Mean PFS in the first group was 19.78 months [95% CI: 16.23–22.9] vs. 16.1 [95% CI: 12.2–20.3], p < 0.001. Patients treated with nivolumab who have weight gain during treatment have a better PFS than the ones who do not. Creatinine levels of over 0.9 at treatment initiation also have positive predictive value.