2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T9f7,Cancer survivors have increased cardiovascular disease (CVD) risk partly due to the toxic effects of cancer therapy. Clonal hematopoiesis of indeterminate potential (CHIP), an age-associated blood disorder caused by somatic variants in blood stem cells, is more prevalent among individuals receiving cancer therapy and increases CVD risk independent of traditional risk factors. It is unknown whether CHIP amplifies therapy-related cardiovascular toxic effects in patients with cancer. To assess the association between CHIP and CVD risk, accounting for competing risks, among patients with primary solid tumors who received chemotherapy, radiotherapy, or immunotherapy. A cohort study was conducted using BioVU, Vanderbilt University Medical Center's biorepository linking electronic health records to whole-genome sequencing data from 250 038 participants from 2006 to 2025. In this cohort, participants had a primary solid tumor diagnosis, received chemotherapy, radiotherapy, and/or immunotherapy, and did not have hematologic malignant disease before treatment. Data were analyzed from June 2025 to November 2025. CHIP variants detected via whole-genome sequencing, chemotherapy, radiotherapy, and immunotherapy. Time to first cardiovascular event, defined as heart failure, ischemic CVD, or arrhythmia following cancer treatment. Among 8004 eligible participants (median [IQR] age, 61.9 [52.2-69.9] years; 4385 female individuals [54.8%]) with a primary solid tumor diagnosis, 7438 had no heart failure, 7392 no ischemic CVD, and 6002 no arrhythmia before cancer therapy. Overall, 549 (6.9%) had CHIP. In the propensity score-matched cohort, participants with CHIP had a significantly higher 10-year cumulative incidence of heart failure (20.3%; 95% CI, 16.0%-24.4% vs 14.5%; 95% CI, 13.5%-15.6%; P = .001) and ischemic CVD (25.3%; 95% CI, 20.5%-30.0% vs 18.5%; 95% CI, 17.3%-20.0%; P < .001) compared with those without CHIP. In adjusted Fine-Gray models, CHIP was associated with increased risk of heart failure (subdistribution hazard ratio [sHR], 1.26; 95% CI, 1.02-1.56; P = .03). In an exploratory 24-month landmark analysis, there was a statistically significant interaction between CHIP and intensive chemotherapy (≥7 cycles) on heart failure risk (sHR, 1.02; 95% CI, 1.00-1.04; P = .03). In this cohort study, CHIP was associated with increased CVD risk in patients with solid tumors receiving cancer therapy. This finding suggests incorporating CHIP status may improve cardio-oncology treatment of cancer survivors.31:T105a, Importance Cancer survivors have increased cardiovascular disease (CVD) risk partly due to the toxic effects of cancer therapy. Clonal hematopoiesis of indeterminate potential (CHIP), an age-associated blood disorder caused by somatic variants in blood stem cells, is more prevalent among individuals receiving cancer therapy and increases CVD risk independent of traditional risk factors. It is unknown whether CHIP amplifies therapy-related cardiovascular toxic effects in patients with cancer. Objective To assess the association between CHIP and CVD risk, accounting for competing risks, among patients with primary solid tumors who received chemotherapy, radiotherapy, or immunotherapy. Design, Setting, and Participants A cohort study was conducted using BioVU, Vanderbilt University Medical Center’s biorepository linking electronic health records to whole-genome sequencing data from 250 038 participants from 2006 to 2025. In this cohort, participants had a primary solid tumor diagnosis, received chemotherapy, radiotherapy, and/or immunotherapy, and did not have hematologic malignant disease before treatment. Data were analyzed from June 2025 to November 2025. Exposures CHIP variants detected via whole-genome sequencing, chemotherapy, radiotherapy, and immunotherapy. Main Outcomes and Measures Time to first cardiovascular event, defined as heart failure, ischemic CVD, or arrhythmia following cancer treatment. Results Among 8004 eligible participants (median [IQR] age, 61.9 [52.2-69.9] years; 4385 female individuals [54.8%]) with a primary solid tumor diagnosis, 7438 had no heart failure, 7392 no ischemic CVD, and 6002 no arrhythmia before cancer therapy. Overall, 549 (6.9%) had CHIP. In the propensity score–matched cohort, participants with CHIP had a significantly higher 10-year cumulative incidence of heart failure (20.3%; 95% CI, 16.0%-24.4% vs 14.5%; 95% CI, 13.5%-15.6%; P = .001) and ischemic CVD (25.3%; 95% CI, 20.5%-30.0% vs 18.5%; 95% CI, 17.3%-20.0%; P &lt; .001) compared with those without CHIP. In adjusted Fine-Gray models, CHIP was associated with increased risk of heart failure (subdistribution hazard ratio [sHR], 1.26; 95% CI, 1.02-1.56; P = .03). In an exploratory 24-month landmark analysis, there was a statistically significant interaction between CHIP and intensive chemotherapy (≥7 cycles) on heart failure risk (sHR, 1.02; 95% CI, 1.00-1.04; P = .03). Conclusions and Relevance In this cohort study, CHIP was associated with increased CVD risk in patients with solid tumors receiving cancer therapy. This finding suggests incorporating CHIP status may improve cardio-oncology treatment of cancer survivors. 32:T63a,Historically, systemic therapy for hormone-sensitive prostate cancer (HSPC) was predicated on androgen-deprivation therapy (ADT) alone. However, in the past decade, substantial improvements have been made by intensifying treatment based on a better understanding of the broad underlying biology of these cancers. The addition of androgen receptor pathway inhibitors (ARPIs), docetaxel and/or radiotherapy to ADT is of proven benefit in certain patient subgroups, whereas AKT inhibitors, radioligand therapies and poly ADP-ribose polymerase (PARP) inhibitors are being evaluated in patients with metastatic HSPC. The clinical states of HSPC are determined by a history of localized prostate cancer versus presentation with de novo metastatic disease, as well as the extent of disease on conventional computed tomography imaging and whole-body bone scintigraphy. However, modern nuclear imaging modalities such as prostate-specific membrane antigen PET can visualize metastases below the limit of detection of computed tomography and whole-body bone scintigraphy; this earlier and more precise detection of metastases has identified new subgroups of patients for which certain treatment approaches, such as adding docetaxel to ADT plus an ARPI, might or might not apply. In this Review, we discuss the personalized management of both non-metastatic and metastatic HSPC, including how to select patients for docetaxel, choice of ARPI and use of radiotherapy to primary and metastatic disease sites. We also discuss emerging novel therapies and important principles of toxicity mitigation for HSPC.33:T628,L.M.B. is a member of the ANZUP Scientific Advisory Committee (unpaid). L.E. reports research grant support (to institution) from Clarity Pharma and Novartis and consulting fees for lectures or advisory boards from Advancell, Astellas, AstraZeneca, Clarity Pharma, Janssen, Novartis and Telix in the past 5 years. C.J.S. declares roles as principal investigator of the CHAARTED trial, study co-chair of the ENZAMET trial and is a member of the ANZUP Scientific Advisory Committee (unpaid); research funding (to institution) from Astellas, Bayer, Janssen, Pfizer and Sanofi; compensated advisory roles for Astellas, Bayer, Genentech/Roche, Hengrui, Janssen, Lilly, Novartis, Pfizer, PointBiopharma and Sanofi; and stock ownership in Leuchemix. C.J.S also holds patents for parthenolide as an anticancer agent, co-authored with H. Nakshatri (WO0145699A1, owned by Indiana University); for use of the drug combination of abiraterone and cabozantinib to treat prostate cancer, co-authors with P. Kantoff (WO 2014/165770 A1 owned by Exelixis); for compositions and methods for screening and diagnosis of prostate cancer with KDM5D biomarker, co-authored with P. Kantoff, G.-S. Mary Lee and K. Komura (WO2017/117486 A1, owned by Dana-Farber Cancer Institute); for compositions and methods for screening and identifying clinically aggressive prostate cancer with SNPs and ZFP36, co-authored with C. Huttenhower, T. Gerke, L. Mucci, G.-S. Mary Lee and D. Bornigen (WO2017127696A, owned by Harvard University and Dana-Farber Cancer Institute). M.A.C. declares no competing interests.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Radiotherapy: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Radiotherapy (modality). Clinician-written summaries and actionable practice insights. 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The RVS group (n=42) achieved 2-year DFS of 90% (95% CI, 77%–96%) with 100% laryngeal preservation in laryngeal/hypopharyngeal cancers, while the SVS group (n=5) had 2-year DFS of only 20% (95% CI, 0.8%–58%). Grade 3 AEs occurred in 16% (NAICT-related) and 15% (surgery-related); no grade 4–5 AEs were recorded.","limitations":"- Single-arm phase II design with no randomized comparator limits causal inference.\n- Small SVS subgroup (n=5) makes outcomes in poor responders highly uncertain.\n- Restricted to HPV-negative LA-HNSCC, limiting generalizability to HPV-positive disease.","practice_takeaway":"For HPV-negative LA-HNSCC patients who achieve ≥50% tumor regression after neoadjuvant immunochemotherapy, response-adapted reduced-volume surgery appears feasible and yields high laryngeal preservation rates with manageable toxicity. These results should be considered hypothesis-generating; phase III validation is needed before adopting this de-escalation approach."}},{"doi":"10.1016/s2213-2600(26)00221-3","pmid":"42702210","title":"Early-stage non-small-cell lung cancer: emerging treatments and evolving challenges","journal_title":"The Lancet Respiratory Medicine","journal_issn":"2213-2600","published_at":"2026-09-06T00:00:00.000Z","url":"https://doi.org/10.1016/s2213-2600(26)00221-3","source_score":34,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-12T06:20:02.585Z","updated_at":"2026-09-12T06:20:02.585Z","tags":[{"paper_doi":"10.1016/s2213-2600(26)00221-3","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00221-3","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00221-3","tag_type":"condition","value":"Non-Small-Cell Lung Cancer","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00221-3","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00221-3","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00221-3","tag_type":"modality","value":"Immunotherapy","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00221-3","tag_type":"modality","value":"Platinum-Based Chemotherapy","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00221-3","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00221-3","tag_type":"modality","value":"Targeted Therapy","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00221-3","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00221-3","tag_type":"warning","value":"Long-term survival data for newer perioperative regimens may still be immature as of the publication date.","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00221-3","tag_type":"warning","value":"No specific drugs or brand names were named in the abstract; immunotherapy and targeted therapy tags reflect the treatment classes discussed without agent-level specificity.","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00221-3","tag_type":"warning","value":"This is a Series/review paper — no original data or sample size; level of evidence reflects the review design, not the underlying trials. Individual cited RCTs may carry higher evidence levels.","value_numeric":null}],"summaries":{"what_studied":"This Series paper reviews the evolving treatment landscape for early-stage resectable non-small-cell lung cancer (NSCLC), covering neoadjuvant and perioperative immunotherapy, targeted therapies, and radiotherapy, with a focus on evidence from randomised trials.","key_result":"Perioperative immunotherapy and targeted therapies have established a new standard of care for resectable early-stage NSCLC, moving beyond the modest survival gains of surgery plus platinum-based chemotherapy alone; however, key uncertainties remain around optimal sequencing, treatment duration, patient selection, and escalation or de-intensification strategies.","limitations":"This is a narrative review/Series paper, not a primary trial — no original patient-level data are presented. Conclusions depend on the quality and completeness of the cited randomised trials. Specific subgroup analyses and long-term survival data for newer regimens may still be maturing.","practice_takeaway":"Clinicians treating resectable early-stage NSCLC should consider perioperative immunotherapy or targeted therapy as the new standard, while remaining attentive to ongoing uncertainties around sequencing, biomarker-driven patient selection, and whether to escalate or de-intensify treatment in specific populations."}},{"doi":"10.1016/j.chest.2026.08.021","pmid":"42668063","title":"The impact of national health systems on lung cancer mortality","journal_title":"CHEST","journal_issn":"0012-3692","published_at":"2026-08-29T00:00:00.000Z","url":"https://doi.org/10.1016/j.chest.2026.08.021","source_score":3,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-01T06:21:08.641Z","updated_at":"2026-09-01T06:21:08.641Z","tags":[{"paper_doi":"10.1016/j.chest.2026.08.021","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.08.021","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.08.021","tag_type":"condition","value":"Lung Cancer","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.08.021","tag_type":"condition","value":"Tracheal Cancer","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.08.021","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.08.021","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.08.021","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.08.021","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.08.021","tag_type":"study_design","value":"Ecological Study","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.08.021","tag_type":"warning","value":"Impact flag 'practice_changing' applied cautiously — findings are health-system-level and relevant to policy makers rather than individual clinical practice.","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.08.021","tag_type":"warning","value":"No sample size (number of countries included) is reported in the abstract; the sample_size tag was omitted.","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.08.021","tag_type":"warning","value":"The positive association found for physician density is counterintuitive and may reflect confounding; the abstract does not provide further mechanistic explanation.","value_numeric":null}],"summaries":{"what_studied":"This cross-national study used global health system data from WHO, World Bank, DIRAC, UNDP, and IARC to identify health system factors independently associated with lower mortality-to-incidence (M:I) ratios for cancers of the trachea, bronchus, and lung.","key_result":"In a multivariable model, health spending, nurse/midwife density, universal health coverage index, and radiotherapy center density were each independently associated with lower lung cancer M:I ratio; physician density showed a small positive (adverse) adjusted association.","limitations":"Ecological study design limits causal inference — associations reflect country-level averages, not individual patients. Key confounders such as smoking prevalence, stage at diagnosis, and histologic subtype distribution across countries are not accounted for. Data quality varies substantially across WHO and World Bank sources, especially in low- and middle-income countries.","practice_takeaway":"Health system planners should prioritize investments in nursing workforce, radiotherapy infrastructure, and universal health coverage to reduce lung cancer mortality — these factors showed independent benefit beyond physician density alone."}},{"doi":"10.1093/ced/llag377","pmid":"42663292","title":"Extramammary Paget Disease: A Review","journal_title":"Clinical and Experimental Dermatology","journal_issn":"0307-6938","published_at":"2026-08-28T00:00:00.000Z","url":"https://doi.org/10.1093/ced/llag377","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-04T06:22:16.881Z","updated_at":"2026-09-04T06:22:16.881Z","tags":[{"paper_doi":"10.1093/ced/llag377","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"category","value":"Dermatology","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"condition","value":"Extramammary Paget Disease","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"modality","value":"Surgery","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"modality","value":"Systemic Therapy","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"modality","value":"Topical Therapy","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"warning","value":"5-year survival figure is anchored to a single diagnosis cohort year (2013); more recent outcomes may differ.","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"warning","value":"Incidence and survival data are derived exclusively from England (2013–2020) and may not reflect global epidemiology.","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"warning","value":"No specific sample size (patient N) is provided in the abstract for the England dataset; sample_size tag was omitted.","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"warning","value":"Sex distribution of affected patients is not reported in the abstract; sex tag was omitted.","value_numeric":null}],"summaries":{"what_studied":"This review covers extramammary Paget disease (EMPD) — a rare adenocarcinoma of apocrine gland-rich skin — including its history, classification, epidemiology, aetiology, pathogenesis, diagnosis, malignancy screening, and management strategies.","key_result":"England data (2013–2020) show a crude incidence of 0.17 per 100,000 person-years; 5-year net survival was 90.9% for cases diagnosed in 2013, comparable to melanoma (89.6%), prostate (85.8%), and breast cancer (85.9%). Recurrence rates reach up to 50% across treatment modalities.","limitations":"Epidemiological data are drawn from England only, limiting global generalizability. Survival figures reflect a single diagnosis year (2013), which may not represent current outcomes. As a narrative review, it does not perform systematic evidence synthesis or meta-analysis.","practice_takeaway":"Screen all EMPD patients for underlying visceral malignancy, as risk varies by anatomical site. Counsel patients on the high recurrence rate (up to 50%) regardless of treatment chosen, and maintain close long-term surveillance."}},{"doi":"10.1001/jamasurg.2026.3716","pmid":"42647021","title":"Neoadjuvant Chemotherapy With or Without Radiotherapy in Resected Pancreatic Ductal Adenocarcinoma","journal_title":"JAMA Surgery","journal_issn":"2168-6254","published_at":"2026-08-26T00:00:00.000Z","url":"https://doi.org/10.1001/jamasurg.2026.3716","source_score":11,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-01T06:21:00.987Z","updated_at":"2026-09-01T06:21:00.987Z","tags":[{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"condition","value":"Pancreatic Ductal Adenocarcinoma","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"generic","value":"fluorouracil","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"generic","value":"gemcitabine","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"generic","value":"irinotecan","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"generic","value":"leucovorin","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"generic","value":"nab-paclitaxel","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"generic","value":"oxaliplatin","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"modality","value":"Chemotherapy","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"sample_size","value":"n=800","value_numeric":800},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"warning","value":"Patients who did not proceed to surgery after neoadjuvant treatment were excluded, which may introduce survivorship bias favoring both groups.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"warning","value":"Propensity score matching was applied retrospectively; unmeasured confounders (e.g., performance status, radiation technique/dose heterogeneity) may persist.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3716","tag_type":"warning","value":"The study is limited to two referral centers; results may not generalize to community or lower-volume settings.","value_numeric":null}],"summaries":{"what_studied":"This retrospective propensity score-matched cohort study evaluated whether adding preoperative radiotherapy to neoadjuvant chemotherapy (FOLFIRINOX or gemcitabine/nab-paclitaxel) improved oncologic outcomes in 800 patients undergoing curative-intent resection for pancreatic ductal adenocarcinoma at 2 high-volume centers (2015–2023), with a median follow-up of 44 months.","key_result":"Adding radiotherapy improved pathologic markers (R0 resection: 85.0% vs 52.2%; node-negative disease: 61.5% vs 33.6%; pCR: 6.6% vs 4.4%), but did not improve event-free survival (HR 1.10; 95% CI 0.88–1.37; P=.38), overall survival (HR 1.02; 95% CI 0.79–1.32; P=.84), or locoregional recurrence rates (subdistribution HR 0.90; 95% CI 0.53–1.54; P=.71). Distant recurrence was the dominant first failure in both groups (~50%).","limitations":"- Retrospective design with inherent selection bias, despite propensity matching.\n- Two-center study limits generalizability; radiotherapy techniques and doses may vary.\n- Patients who progressed on chemotherapy and never reached surgery were excluded, potentially enriching for favorable biology in both groups.","practice_takeaway":"Adding radiotherapy to neoadjuvant chemotherapy before pancreatic resection improves pathologic response but does not translate into survival benefit — systemic control remains the priority. Routine use of preoperative radiotherapy in resectable or borderline-resectable pancreatic cancer should not be adopted outside of clinical trials."}},{"doi":"10.1016/s1470-2045(26)00251-2","pmid":"42633755","title":"STAR-TREC and TESAR trials: strengthening the evidence for organ preservation in rectal cancer","journal_title":"The Lancet Oncology","journal_issn":"1470-2045","published_at":"2026-08-23T00:00:00.000Z","url":"https://doi.org/10.1016/s1470-2045(26)00251-2","source_score":53,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-30T06:19:54.493Z","updated_at":"2026-08-30T06:19:54.493Z","tags":[{"paper_doi":"10.1016/s1470-2045(26)00251-2","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00251-2","tag_type":"category","value":"Oncology","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00251-2","tag_type":"condition","value":"Rectal Cancer","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00251-2","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00251-2","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00251-2","tag_type":"modality","value":"Chemoradiotherapy","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00251-2","tag_type":"modality","value":"Organ Preservation / Non-Operative Management","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00251-2","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00251-2","tag_type":"study_design","value":"Clinical Trial (Randomized)","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00251-2","tag_type":"warning","value":"No sample size could be determined from the available metadata.","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00251-2","tag_type":"warning","value":"Only the paper's title, DOI, journal, and publication date were provided — no abstract or full text was available. Summaries, tags, and results are inferred from the title and known context of the STAR-TREC and TESAR trials. Specific numerical outcomes, sample sizes, and detailed findings could not be extracted and should be verified against the full publication.","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00251-2","tag_type":"warning","value":"Study design tag is based on the known trial nature of STAR-TREC and TESAR; confirmation from full text is recommended.","value_numeric":null}],"summaries":{"what_studied":"This paper reports on the STAR-TREC and TESAR trials, which investigate organ preservation (non-operative management) as an alternative to total mesorectal excision (TME) surgery in rectal cancer patients who achieve a clinical complete or near-complete response to (chemo)radiotherapy.","limitations":"The full text of the paper was not available for extraction of specific numerical results, response rates, or detailed outcome data; key findings and limitations cannot be confirmed from the provided metadata alone.","practice_takeaway":"Clinicians managing rectal cancer should follow the STAR-TREC and TESAR trial results closely, as they are designed to provide high-level evidence for or against organ preservation strategies as standard-of-care alternatives to TME."}},{"doi":"10.1200/jco-25-01846","pmid":"42585601","title":"Prognostic and Predictive Effect of Age in Molecularly Defined Lower-Grade Gliomas","journal_title":"Journal of Clinical Oncology","journal_issn":"0732-183X","published_at":"2026-08-12T00:00:00.000Z","url":"https://doi.org/10.1200/jco-25-01846","source_score":25,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-19T06:28:58.408Z","updated_at":"2026-08-19T06:28:58.408Z","tags":[{"paper_doi":"10.1200/jco-25-01846","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1200/jco-25-01846","tag_type":"category","value":"Oncology","value_numeric":null},{"paper_doi":"10.1200/jco-25-01846","tag_type":"condition","value":"Astrocytoma","value_numeric":null},{"paper_doi":"10.1200/jco-25-01846","tag_type":"condition","value":"Lower-Grade Glioma","value_numeric":null},{"paper_doi":"10.1200/jco-25-01846","tag_type":"condition","value":"Oligodendroglioma","value_numeric":null},{"paper_doi":"10.1200/jco-25-01846","tag_type":"generic","value":"temozolomide","value_numeric":null},{"paper_doi":"10.1200/jco-25-01846","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1200/jco-25-01846","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1200/jco-25-01846","tag_type":"modality","value":"Chemoradiotherapy","value_numeric":null},{"paper_doi":"10.1200/jco-25-01846","tag_type":"modality","value":"IDH Mutation Testing","value_numeric":null},{"paper_doi":"10.1200/jco-25-01846","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1200/jco-25-01846","tag_type":"sample_size","value":"n=2911","value_numeric":2911},{"paper_doi":"10.1200/jco-25-01846","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1200/jco-25-01846","tag_type":"study_design","value":"Pooled Analysis of Prospective Cohorts and Retrospective Validation","value_numeric":null},{"paper_doi":"10.1200/jco-25-01846","tag_type":"warning","value":"Temozolomide is inferred as the chemotherapy component of chemoradiotherapy based on standard of care; the paper does not explicitly name the chemotherapy agent in the abstract.","value_numeric":null},{"paper_doi":"10.1200/jco-25-01846","tag_type":"warning","value":"The paper is published ahead of today's date in the source metadata (August 12, 2026) but is consistent with the current date of August 19, 2026 — no anomaly.","value_numeric":null},{"paper_doi":"10.1200/jco-25-01846","tag_type":"warning","value":"The study design is a pooled analysis of heterogeneous prospective trials plus a separate retrospective cohort — it is not a single randomized controlled trial, which limits causal inference for treatment comparisons.","value_numeric":null},{"paper_doi":"10.1200/jco-25-01846","tag_type":"warning","value":"Total sample size of 2,911 reflects combined PROGRES (n=1,619) and REGRES (n=1,292) cohorts; these were analyzed separately and not merged into a single pooled dataset for all analyses.","value_numeric":null}],"summaries":{"what_studied":"This study examined whether age ≥40 years remains a relevant prognostic and predictive factor in molecularly defined lower-grade gliomas (grade 2–3 oligodendroglioma or astrocytoma), using individual patient-level data from 11 prospective trials/registries (PROGRES, n=1,619) validated in a retrospective cohort (REGRES, n=1,292).","key_result":"Age ≥40 was prognostic only in IDH-wildtype glioma (5-year PFS: 6% vs 24% for younger patients; HR 1.74 [95% CI, 1.21–2.50]), largely explained by a higher burden of aggressive molecular features (TERT mutation 65% vs 28%, EGFR amplification 41% vs 15%, +7/−10 alteration 57% vs 25%). In IDH-mutant glioma, age had no prognostic effect (5-year PFS: 60% vs 59%; HR 0.89 [95% CI, 0.76–1.05]), and was not predictive of benefit from chemoradiotherapy over radiotherapy alone.","limitations":"The PROGRES cohort draws from heterogeneous prospective trials and registries, which may introduce selection bias; retrospective molecular profiling of older trial specimens could be incomplete. The pooled clinical trial analysis for treatment prediction included only four trials, limiting statistical power for subgroup interactions.","practice_takeaway":"Age alone should no longer drive the decision to add or withhold adjuvant chemoradiotherapy in lower-grade glioma — IDH status and co-occurring molecular markers should guide that choice instead. Clinicians should advocate for updated practice guidelines that prioritize molecular profiling over age cutoffs."}},{"doi":"10.1016/j.breast.2026.104902","pmid":"42612559","title":"Beyond safety: rethinking concomitant radiotherapy and trastuzumab deruxtecan in metastatic breast cancer — from feasibility to precision practice","journal_title":"The Breast","journal_issn":"0960-9776","published_at":"2026-08-12T00:00:00.000Z","url":"https://doi.org/10.1016/j.breast.2026.104902","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-22T06:53:24.722Z","updated_at":"2026-08-22T06:53:24.722Z","tags":[{"paper_doi":"10.1016/j.breast.2026.104902","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104902","tag_type":"brand","value":"Enhertu","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104902","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104902","tag_type":"condition","value":"HER2-Low Breast Cancer","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104902","tag_type":"condition","value":"Metastatic Breast Cancer","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104902","tag_type":"generic","value":"trastuzumab deruxtecan","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104902","tag_type":"generic","value":"trastuzumab emtansine","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104902","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104902","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104902","tag_type":"modality","value":"Antibody-Drug Conjugate","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104902","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104902","tag_type":"study_design","value":"Expert Opinion / Viewpoint","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104902","tag_type":"warning","value":"HER2-low metastatic breast cancer is discussed as a subgroup of interest but no outcome data specific to this population are presented.","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104902","tag_type":"warning","value":"No sample size is applicable — the 'largest real-world evidence' cited belongs to the Visani et al. study being critiqued, not this paper.","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104902","tag_type":"warning","value":"Study design classification as 'Expert Opinion / Viewpoint' is inferred from abstract language; the journal section label is not explicitly stated.","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104902","tag_type":"warning","value":"This is a viewpoint/commentary with no original patient data; findings are opinion-based and reference a single real-world study (Visani et al.) not reproduced here.","value_numeric":null}],"summaries":{"what_studied":"This viewpoint critiques and extends real-world evidence on the safety of concomitant trastuzumab deruxtecan (T-DXd) and radiotherapy (RT) in metastatic breast cancer, arguing for stratified decision-making beyond binary safety assessments across RT intent, site, fractionation, and tumor biology.","key_result":"The authors contend that 'concomitant' is not a sufficient biological concept; radiosensitization risk varies by RT site, fractionation, and payload (distinguishing T-DM1 vs. T-DXd radionecrosis profiles), and three high-priority gaps remain: thoracic irradiation safety, HER2-low metastatic breast cancer, and cardiac vulnerability during combined therapy.","limitations":"This is an expert viewpoint/commentary — no original patient data, no comparator arm, and no quantitative outcomes are reported. Conclusions are largely opinion-based and derive from critique of a single referenced real-world study.","practice_takeaway":"Do not treat all concomitant T-DXd + RT combinations as equivalent; stratify decisions by anatomical site, fractionation schedule, and HER2 status. Treat thoracic irradiation and cardiac exposure during combined therapy as priority areas requiring extra caution until prospective data are available."}},{"doi":"10.1016/j.euo.2026.07.004","pmid":"42493283","title":"The Price of Cure: Rethinking Success in High-risk Prostate Cancer","journal_title":"European Urology Oncology","journal_issn":"2588-9311","published_at":"2026-07-23T00:00:00.000Z","url":"https://doi.org/10.1016/j.euo.2026.07.004","source_score":9,"is_retracted":false,"is_open_access":null,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":false},"created_at":"2026-07-31T13:36:56.638Z","updated_at":"2026-08-01T13:21:49.661Z","tags":[{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"condition","value":"Prostate Cancer","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"generic","value":"cabazitaxel","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"modality","value":"Chemotherapy","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"study_design","value":"Editorial","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"warning","value":"Impact flag 'practice_changing' reflects the editorial's explicit argument for reframing success criteria in high-risk prostate cancer trials, not a primary study finding.","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"warning","value":"Only the paper title, DOI, journal, and publication date were provided — no abstract, methods, results, or conclusions are available. All summary fields have been set to null as there is no source content to extract from. Full text is required to generate structured summaries, tags, or evidence-based takeaways.","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"warning","value":"The 90% 9-year cancer-specific survival figure is attributed to the PEACE-2 trial (Fizazi et al., J Clin Oncol 2026); this is a referenced claim, not independently verified here.","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"warning","value":"The editorial references a 65-year-old with ~18 years EU life expectancy as an illustrative example, not a study population.","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"warning","value":"This is a publisher page preview only — full editorial text was not available; summary is based solely on the abstract excerpt, reference list, and visible publisher page content.","value_numeric":null}],"summaries":{"what_studied":"This editorial commentary reflects on shifting treatment goals in very high-risk localized prostate cancer, arguing that traditional endpoints (cancer-specific survival, metastasis-free survival) no longer fully capture patient burden when 9-year cancer-specific survival now approaches 90% with contemporary multimodal therapy.","key_result":"In very high-risk localized prostate cancer treated with contemporary multimodal therapy, 9-year cancer-specific survival approaches 90% (referencing PEACE-2 trial data); the editorial argues that for a 65-year-old with ~18 years of remaining life expectancy, non-cancer mortality (cardiovascular, metabolic, age-related) increasingly dominates, shifting the central clinical question toward quality of life and treatment burden.","limitations":"This is an editorial/opinion piece with no original data; claims are based on referenced trial results and population-level life expectancy estimates, not a systematic review or primary analysis.","practice_takeaway":"When counseling patients with high-risk prostate cancer, consider that treatment intensification may offer diminishing survival returns relative to its burden on quality of life — endpoints like patient-reported outcomes and quality-adjusted survival deserve greater weight alongside cancer-specific endpoints."}},{"doi":"10.1136/bjo-2026-329476","pmid":"42463304","title":"Global retinoblastoma service availability in 2024 and equity trends since 2017","journal_title":"British Journal of Ophthalmology","journal_issn":"0007-1161","published_at":"2026-07-16T00:00:00.000Z","url":"https://doi.org/10.1136/bjo-2026-329476","source_score":5,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-25T13:57:56.677Z","updated_at":"2026-07-25T13:57:56.677Z","tags":[{"paper_doi":"10.1136/bjo-2026-329476","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1136/bjo-2026-329476","tag_type":"category","value":"Ophthalmology","value_numeric":null},{"paper_doi":"10.1136/bjo-2026-329476","tag_type":"condition","value":"Retinoblastoma","value_numeric":null},{"paper_doi":"10.1136/bjo-2026-329476","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1136/bjo-2026-329476","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1136/bjo-2026-329476","tag_type":"modality","value":"Cryotherapy","value_numeric":null},{"paper_doi":"10.1136/bjo-2026-329476","tag_type":"modality","value":"Intra-Arterial Chemotherapy","value_numeric":null},{"paper_doi":"10.1136/bjo-2026-329476","tag_type":"modality","value":"Intravenous Chemotherapy","value_numeric":null},{"paper_doi":"10.1136/bjo-2026-329476","tag_type":"modality","value":"Intravitreal Chemotherapy","value_numeric":null},{"paper_doi":"10.1136/bjo-2026-329476","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1136/bjo-2026-329476","tag_type":"sample_size","value":"n=438","value_numeric":438},{"paper_doi":"10.1136/bjo-2026-329476","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1136/bjo-2026-329476","tag_type":"study_design","value":"Cross-Sectional Study with Longitudinal Comparison","value_numeric":null},{"paper_doi":"10.1136/bjo-2026-329476","tag_type":"warning","value":"49 countries had no identified Rb centre and were excluded; findings likely underestimate the true global equity gap.","value_numeric":null},{"paper_doi":"10.1136/bjo-2026-329476","tag_type":"warning","value":"Level of evidence assigned as 3 (cross-sectional/survey); the longitudinal comparison is observational and based on centre self-report, limiting causal inference about inequality trends.","value_numeric":null},{"paper_doi":"10.1136/bjo-2026-329476","tag_type":"warning","value":"The study reports country-level binary service availability, which does not capture within-country access disparities or actual patient utilization.","value_numeric":null}],"summaries":{"what_studied":"Global availability of retinoblastoma (Rb) diagnostic and treatment services in 2024, with longitudinal comparison to 2017, across 438 centres in 145 countries; income-related distribution assessed using concentration indices.","key_result":"By 2024, pathology was available in 143/145 countries (98.6%), MRI in 128 (88.3%), and genetic testing in only 74 (51.0%); intra-arterial chemotherapy reached just 69 countries (47.6%). Availability improved across all modalities since 2017, but advanced diagnostics and eye-preserving treatments remain concentrated in higher-income settings.","limitations":"49 countries had no identified Rb centre and were excluded from longitudinal analysis; self-reported centre data may overestimate true service access within countries; longitudinal cohort limited to 246 centres in 124 countries that participated in both years.","practice_takeaway":"Clinicians and health system planners in low- and middle-income countries should prioritize access to intravitreal chemotherapy and genetic testing — the modalities with the largest gains since 2017 but still the widest equity gaps. Advocacy and capacity-building efforts should target the ~50% of countries lacking intra-arterial chemotherapy and genetic testing."}},{"doi":"10.1016/j.eururo.2026.05.008","pmid":"42251000","title":"A Multidisciplinary Approach to Prevention and Treatment of Late Genitourinary Adverse Events After Radiotherapy for Prostate Cancer","journal_title":"European Urology","journal_issn":"0302-2838","published_at":"2026-06-06T00:00:00.000Z","url":"https://doi.org/10.1016/j.eururo.2026.05.008","source_score":24,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-11T13:42:31.437Z","updated_at":"2026-06-11T13:42:31.437Z","tags":[{"paper_doi":"10.1016/j.eururo.2026.05.008","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.05.008","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.05.008","tag_type":"condition","value":"Genitourinary Toxicity","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.05.008","tag_type":"condition","value":"Prostate Cancer","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.05.008","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.05.008","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.05.008","tag_type":"warning","value":"It is unclear whether this is a review, guideline, or original research article; study design tag has been omitted accordingly.","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.05.008","tag_type":"warning","value":"Study design, sample size, level of evidence, and specific findings cannot be determined from the title and metadata alone. All corresponding fields have been omitted.","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.05.008","tag_type":"warning","value":"The paper was published on June 6, 2026, just days before today's date — the full text was not provided, so summaries, key results, limitations, and practice takeaways could not be extracted from actual content. Only metadata was available.","value_numeric":null}],"summaries":{"what_studied":"This paper evaluates a multidisciplinary approach to the prevention and treatment of late genitourinary (GU) adverse events following radiotherapy for prostate cancer, addressing the clinical management of radiation-induced GU toxicity."}},{"doi":"10.1111/ajd.70146","pmid":"42226723","title":"A Case of Lentigo Maligna Presenting as Repigmentation of Hair in a Scalp That Previously Underwent Radiotherapy for Tinea Capitis","journal_title":"Australasian Journal of Dermatology","journal_issn":"0004-8380","published_at":"2026-06-02T00:00:00.000Z","url":"https://doi.org/10.1111/ajd.70146","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-09T13:50:26.875Z","updated_at":"2026-06-09T13:50:26.875Z","tags":[{"paper_doi":"10.1111/ajd.70146","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1111/ajd.70146","tag_type":"category","value":"Dermatology","value_numeric":null},{"paper_doi":"10.1111/ajd.70146","tag_type":"condition","value":"Lentigo Maligna","value_numeric":null},{"paper_doi":"10.1111/ajd.70146","tag_type":"condition","value":"Melanoma","value_numeric":null},{"paper_doi":"10.1111/ajd.70146","tag_type":"condition","value":"Tinea Capitis","value_numeric":null},{"paper_doi":"10.1111/ajd.70146","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1111/ajd.70146","tag_type":"level_of_evidence","value":"6","value_numeric":null},{"paper_doi":"10.1111/ajd.70146","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1111/ajd.70146","tag_type":"modality","value":"Surgical Excision","value_numeric":null},{"paper_doi":"10.1111/ajd.70146","tag_type":"sample_size","value":"n=1","value_numeric":1},{"paper_doi":"10.1111/ajd.70146","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1111/ajd.70146","tag_type":"study_design","value":"Case Report","value_numeric":null},{"paper_doi":"10.1111/ajd.70146","tag_type":"warning","value":"Initial biopsy underestimated the lesion as in situ disease; invasive component was only found on full excision histology — highlighting sampling limitations in lentigo maligna diagnosis.","value_numeric":null},{"paper_doi":"10.1111/ajd.70146","tag_type":"warning","value":"This is a single case report; the proposed link between childhood scalp radiotherapy for tinea capitis and later melanoma development is speculative and not established by this evidence alone.","value_numeric":null}],"summaries":{"what_studied":"A case report of a 78-year-old male who developed lentigo maligna presenting as focal hair repigmentation on the scalp vertex, in an area with prior childhood radiotherapy for tinea capitis.","key_result":"Initial biopsy showed lentigo maligna in situ; full surgical excision with split-thickness skin graft revealed an invasive melanoma component on complete histological examination.","limitations":"Single case report limits generalizability; causal link between childhood scalp radiotherapy and melanoma development cannot be confirmed from one case alone.","practice_takeaway":"New focal hair repigmentation on the scalp — especially in older patients with prior radiation history — should prompt urgent biopsy to rule out lentigo maligna. Childhood scalp radiotherapy may be an underrecognized risk factor for melanoma development decades later."}},{"doi":"10.1158/0008-5472.can-25-3728","pmid":"41949452","title":"DHODH-Mediated Suppression of Ferroptosis Supports Radioresistance and Represents a Therapeutic Vulnerability in Lung Cancer","journal_title":"Cancer Research","journal_issn":"0008-5472","published_at":"2026-05-11T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13179828/","source_score":28,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-10T14:24:23.868Z","updated_at":"2026-06-10T14:24:23.868Z","tags":[{"paper_doi":"10.1158/0008-5472.can-25-3728","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1158/0008-5472.can-25-3728","tag_type":"category","value":"Oncology","value_numeric":null},{"paper_doi":"10.1158/0008-5472.can-25-3728","tag_type":"condition","value":"Lung Cancer","value_numeric":null},{"paper_doi":"10.1158/0008-5472.can-25-3728","tag_type":"condition","value":"Radioresistance","value_numeric":null},{"paper_doi":"10.1158/0008-5472.can-25-3728","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1158/0008-5472.can-25-3728","tag_type":"level_of_evidence","value":"6","value_numeric":null},{"paper_doi":"10.1158/0008-5472.can-25-3728","tag_type":"modality","value":"Anti-PD-1 Immunotherapy","value_numeric":null},{"paper_doi":"10.1158/0008-5472.can-25-3728","tag_type":"modality","value":"DHODH Inhibitor","value_numeric":null},{"paper_doi":"10.1158/0008-5472.can-25-3728","tag_type":"modality","value":"Ferroptosis Modulation","value_numeric":null},{"paper_doi":"10.1158/0008-5472.can-25-3728","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1158/0008-5472.can-25-3728","tag_type":"study_design","value":"Preclinical Study","value_numeric":null},{"paper_doi":"10.1158/0008-5472.can-25-3728","tag_type":"warning","value":"No clinical or human outcome data are presented — all results are preclinical; the 'practice_changing' flag reflects mechanistic novelty and trial rationale, not clinical evidence. The impact flag was applied cautiously given strong translational implications.","value_numeric":null},{"paper_doi":"10.1158/0008-5472.can-25-3728","tag_type":"warning","value":"Sample size is not reported in the abstract; no N is available for tagging.","value_numeric":null},{"paper_doi":"10.1158/0008-5472.can-25-3728","tag_type":"warning","value":"Study design is classified as 'Preclinical Study' based on the abstract's exclusive reference to preclinical models; no in vivo human data are described.","value_numeric":null}],"summaries":{"what_studied":"This study investigated the role of dihydroorotate dehydrogenase (DHODH) in radioresistance in lung cancer, using metabolomic and functional analyses to examine how DHODH activity regulates ferroptosis and DNA repair in irradiated and acquired radioresistant states.","key_result":"DHODH was upregulated by radiation via CREB-dependent transcription and suppressed ferroptosis through ubiquinol (a mitochondrial lipid antioxidant) while also supporting DNA repair via de novo pyrimidine synthesis. DHODH inhibition alone had limited effect, but combining it with IFN-γ (directly or via anti-PD-1) synergistically enhanced RT-induced ferroptosis and overcame radioresistance in preclinical models.","limitations":"Findings are from preclinical models only — no clinical or patient outcome data are presented. The generalizability beyond lung cancer to other solid tumors is speculative at this stage. The precise threshold of IFN-γ/anti-PD-1 activity needed in human tumors is not defined.","practice_takeaway":"DHODH inhibitors are not yet ready for routine clinical use in this setting, but these findings support exploring DHODH inhibitor + anti-PD-1 + radiotherapy combinations in lung cancer clinical trials. Clinicians should watch for trials targeting this metabolic-ferroptosis-immune axis in radioresistant solid tumors."}},{"doi":"10.1200/jco-25-01958","pmid":"42085620","title":"Metastatic Trajectories in Non–Small Cell Lung Cancer Guide Local and Systemic Therapies","journal_title":"Journal of Clinical Oncology","journal_issn":"0732-183X","published_at":"2026-05-05T00:00:00.000Z","url":"https://doi.org/10.1200/jco-25-01958","source_score":41,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-12T13:24:35.205Z","updated_at":"2026-06-12T13:24:35.205Z","tags":[{"paper_doi":"10.1200/jco-25-01958","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1200/jco-25-01958","tag_type":"category","value":"Oncology","value_numeric":null},{"paper_doi":"10.1200/jco-25-01958","tag_type":"condition","value":"Metastatic Non-Small Cell Lung Cancer","value_numeric":null},{"paper_doi":"10.1200/jco-25-01958","tag_type":"condition","value":"Non-Small Cell Lung Cancer","value_numeric":null},{"paper_doi":"10.1200/jco-25-01958","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1200/jco-25-01958","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1200/jco-25-01958","tag_type":"modality","value":"Image-Guided Ablation","value_numeric":null},{"paper_doi":"10.1200/jco-25-01958","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1200/jco-25-01958","tag_type":"modality","value":"Surgical Resection","value_numeric":null},{"paper_doi":"10.1200/jco-25-01958","tag_type":"modality","value":"Systemic Therapy","value_numeric":null},{"paper_doi":"10.1200/jco-25-01958","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1200/jco-25-01958","tag_type":"warning","value":"Age group tagged as 'adult' by inference from NSCLC context; paper does not explicitly restrict to adults.","value_numeric":null},{"paper_doi":"10.1200/jco-25-01958","tag_type":"warning","value":"No sample size is applicable; the paper is a narrative review.","value_numeric":null},{"paper_doi":"10.1200/jco-25-01958","tag_type":"warning","value":"The 'practice_changing' flag is aspirational—the framework requires prospective validation before direct clinical adoption.","value_numeric":null},{"paper_doi":"10.1200/jco-25-01958","tag_type":"warning","value":"This is a conceptual/opinion framework paper with no primary patient data; the 'practice_changing' impact flag reflects the novelty of the proposed framework, not validated clinical outcomes.","value_numeric":null}],"summaries":{"limitations":"This is a narrative/conceptual review without prospective clinical validation; no patient cohort or outcome data are presented; proposed standardized reporting parameters and biomarker tools require external validation across studies.","what_studied":"This paper introduces 'metastatic trajectories'—a framework characterizing spatiotemporal dynamics of response and progression across individual lesions in metastatic NSCLC—to guide adaptive local (radiotherapy, surgery, ablation) and systemic therapies beyond existing single-state oligometastatic classifications.","key_result":"No clinical trial data are reported; the paper proposes a conceptual framework covering dimensions such as response magnitude, resistance mechanisms, organotropism, and progression pace, along with standardized reporting parameters and biomarker strategies (ctDNA, radiomics, integrative genomics/imaging) for trajectory tracking.","practice_takeaway":"Consider evaluating lesion-level response patterns—not just overall disease state—when selecting patients for local therapies like SBRT or ablation in metastatic NSCLC. Emerging tools such as ctDNA and radiomic signatures may soon help predict which lesions will progress and guide treatment timing."}},{"doi":"10.1016/j.eururo.2026.03.024","pmid":"42049596","title":"Metastasis-directed Therapy With or Without Pembrolizumab for Oligometastatic Clear Cell Renal Cell Carcinoma: Pooled Analysis of Two Prospective Single-arm Phase 2 Trials","journal_title":"European Urology","journal_issn":"0302-2838","published_at":"2026-04-27T00:00:00.000Z","url":"https://doi.org/10.1016/j.eururo.2026.03.024","source_score":22,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-04T13:26:25.107Z","updated_at":"2026-07-04T13:26:25.107Z","tags":[{"paper_doi":"10.1016/j.eururo.2026.03.024","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.024","tag_type":"brand","value":"Keytruda","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.024","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.024","tag_type":"condition","value":"Clear Cell Renal Cell Carcinoma","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.024","tag_type":"condition","value":"Oligometastatic Renal Cell Carcinoma","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.024","tag_type":"generic","value":"pembrolizumab","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.024","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.024","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.024","tag_type":"modality","value":"Immune Checkpoint Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.024","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.024","tag_type":"sample_size","value":"n=150","value_numeric":150},{"paper_doi":"10.1016/j.eururo.2026.03.024","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.024","tag_type":"study_design","value":"Pooled Analysis of Prospective Single-Arm Phase 2 Trials","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.024","tag_type":"warning","value":"Study design is labeled as a pooled cohort analysis of two single-arm trials, not a head-to-head randomized comparison—level of evidence is accordingly limited.","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.024","tag_type":"warning","value":"The primary PFS result did not reach statistical significance (p=0.058); conclusions about superiority of MDT+ICI should be interpreted cautiously.","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.024","tag_type":"warning","value":"The two pooled trials had notable baseline imbalances: the MDT+ICI group had a higher median number of metastases (3 vs 1) and was younger (62 vs 66), which could confound PFS comparisons despite exploratory interaction analyses.","value_numeric":null}],"summaries":{"limitations":"Non-randomized pooled design with baseline imbalances (MDT+ICI group had more metastases and was younger); small MDT+ICI cohort (n=30) limits power; single-arm nature of each contributing trial precludes definitive causal conclusions.","what_studied":"This pooled analysis of two prospective single-arm phase 2 trials compared radiotherapy-based metastasis-directed therapy (MDT) plus pembrolizumab (ICI) vs. MDT alone in 150 patients with oligometastatic clear cell renal cell carcinoma (ccRCC), with a primary endpoint of RECIST-defined PFS and secondary analysis of peripheral immune populations over a median follow-up of 34 months.","key_result":"MDT+ICI showed a trend toward longer PFS vs. MDT alone (HR 0.57; 95% CI 0.32–1.02; p = 0.058), falling just short of statistical significance; the benefit was more pronounced in patients with prior systemic therapy. MDT+ICI also induced greater systemic activation of CD8+ T cells (ICOS+) and reductions in less functional CD8+ subsets.","practice_takeaway":"Adding maintenance pembrolizumab to MDT may improve outcomes in oligometastatic ccRCC—particularly in patients who have had prior systemic therapy—but evidence remains preliminary until the ongoing randomized ASTROs trial (NCT06004336) reports results. Clinicians should consider enrollment in that trial rather than adopting this combination as standard practice."}},{"doi":"10.1016/j.jtho.2026.103643","pmid":"41934464","title":"Definitive Radiotherapy to the Primary Tumor in Stage IV NSCLC: A Consensus Statement From the International Association for the Study of Lung Cancer Advanced Radiation Technology Subcommittee","journal_title":"Journal of Thoracic Oncology","journal_issn":"1556-0864","published_at":"2026-04-04T00:00:00.000Z","url":"https://doi.org/10.1016/j.jtho.2026.103643","source_score":33,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-07T22:50:00.740Z","updated_at":"2026-05-07T22:50:00.740Z","tags":[{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"condition","value":"EGFR-Mutant NSCLC","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"condition","value":"Metastatic NSCLC","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"condition","value":"Non-Small Cell Lung Cancer","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"condition","value":"Oligometastatic NSCLC","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"modality","value":"EGFR Tyrosine Kinase Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"modality","value":"Stereotactic Body Radiotherapy","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"study_design","value":"Consensus Statement / Systematic Review","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"warning","value":"Level of evidence set to 5 (expert consensus/systematic review without meta-analysis) given the methodology described.","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"warning","value":"No sample size tag was applied — this is a consensus/review document, not a single primary study with a defined patient cohort.","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"warning","value":"The consensus is based on a narrative synthesis of randomized trials rather than a formal meta-analysis; no statistical pooling was performed, which limits the strength of the evidence grading.","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"warning","value":"The 'practice_changing' impact flag applies specifically to the EGFR-mutant oligometastatic subgroup; evidence in non-AGA populations is explicitly described as insufficient for definitive recommendations.","value_numeric":null}],"summaries":{"what_studied":"This IASLC consensus statement evaluates the role, timing, dosing, target volumes, and safety of definitive-dose radiotherapy (RT) to the primary lung tumor in stage IV NSCLC — covering both actionable genomic alteration (AGA, e.g., EGFR-mutant) and non-AGA metastatic populations — based on randomized studies published 2010–2025.","key_result":"In EGFR-mutant oligometastatic NSCLC, randomized phase III evidence supports early consolidative RT to the primary tumor as a life-prolonging approach. In non-AGA populations, direct randomized evidence isolating primary-tumor irradiation remains limited; dose escalation of thoracic RT may improve locoregional control over lower-dose regimens, but no definitive recommendations can yet be made.","limitations":"- Direct randomized evidence isolating the impact of primary-tumor RT in non-AGA populations is sparse.\n- Optimal target volumes (including whether to exclude involved lymph nodes) are unresolved and unstudied in large randomized trials.\n- Optimal RT sequencing, fractionation, and integration with modern systemic agents remain undefined.","practice_takeaway":"For EGFR-mutant oligometastatic NSCLC, consider early consolidative RT to the primary tumor after induction systemic therapy, as phase III data suggest a survival benefit. For non-AGA metastatic NSCLC, definitive RT to the primary tumor should not yet be standard practice outside of prospective trials — carefully monitor for additive toxicity when combining RT with systemic agents."}},{"doi":"10.1182/blood.2025032050","pmid":"41824381","title":"Radiotherapy for indolent primary cutaneous B-cell lymphoma: an international multicenter ILROG analysis","journal_title":"Blood","journal_issn":"0006-4971","published_at":"2026-03-13T00:00:00.000Z","url":"https://doi.org/10.1182/blood.2025032050","source_score":10,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-22T13:24:15.812Z","updated_at":"2026-06-22T13:24:15.812Z","tags":[{"paper_doi":"10.1182/blood.2025032050","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1182/blood.2025032050","tag_type":"category","value":"Hematology","value_numeric":null},{"paper_doi":"10.1182/blood.2025032050","tag_type":"condition","value":"Indolent Primary Cutaneous B-Cell Lymphoma","value_numeric":null},{"paper_doi":"10.1182/blood.2025032050","tag_type":"condition","value":"Primary Cutaneous Follicle Center Lymphoma","value_numeric":null},{"paper_doi":"10.1182/blood.2025032050","tag_type":"condition","value":"Primary Cutaneous Marginal Zone Lymphoma","value_numeric":null},{"paper_doi":"10.1182/blood.2025032050","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1182/blood.2025032050","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1182/blood.2025032050","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1182/blood.2025032050","tag_type":"sample_size","value":"n=535","value_numeric":535},{"paper_doi":"10.1182/blood.2025032050","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1182/blood.2025032050","tag_type":"study_design","value":"Retrospective Multicenter Cohort Study","value_numeric":null},{"paper_doi":"10.1182/blood.2025032050","tag_type":"warning","value":"Overall survival benefit of higher doses was not demonstrated, but the study may be underpowered for survival endpoints given the indolent nature of the disease and likely long follow-up required.","value_numeric":null},{"paper_doi":"10.1182/blood.2025032050","tag_type":"warning","value":"The dose threshold used to define 'low dose' (≤4 Gy) may not align with all institutional or guideline definitions; clinicians should interpret dose-group comparisons with this in mind.","value_numeric":null},{"paper_doi":"10.1182/blood.2025032050","tag_type":"warning","value":"The study is retrospective and spans nearly 30 years (1995–2023); treatment heterogeneity across eras and institutions may affect dose-comparison reliability.","value_numeric":null}],"summaries":{"what_studied":"This retrospective international multicenter study (22 institutions, ILROG) evaluated radiotherapy outcomes in 535 patients with limited-stage (T1/T2) primary cutaneous marginal zone or follicle center lymphoma treated between 1995 and 2023, comparing low-dose (≤4 Gy) vs. conventional-dose (>4 Gy, median 24 Gy in 2 Gy fractions) radiotherapy.","key_result":"Overall complete response rate was 91% at a median of 3.6 months post-radiotherapy. Low-dose ≤4 Gy achieved similar response rates (P=.077 and P=.056 for CR and OR, respectively) but inferior 5-year local control (73% ±12% vs. 96% ±2%; P<.001) compared to >4 Gy. Higher doses did not confer an overall survival benefit. Toxicities >grade 2 were rare but more frequent in the >4 Gy group.","limitations":"- Retrospective design with inherent selection bias across 22 international institutions over nearly three decades.\n- No randomization between dose groups, limiting causal inference on dose-response relationships.\n- Long accrual period (1995–2023) means treatment practices and staging may have varied considerably over time.","practice_takeaway":"Conventional-dose radiotherapy (>4 Gy, typically ~24 Gy) provides superior long-term local control for indolent cutaneous B-cell lymphoma and should be the standard when durable control is the goal. Low-dose ≤4 Gy is a reasonable option for patients where minimizing toxicity is prioritized, with the understanding that local relapse rates are higher."}},{"doi":"10.1001/jamaoncol.2025.5785","pmid":"41505144","title":"Clonal Hematopoiesis and Cardiovascular Disease Risk After Cancer Therapy in Patients With Solid Tumors","journal_title":"JAMA Oncology","journal_issn":"2374-2437","published_at":"2026-01-08T00:00:00.000Z","url":"https://doi.org/10.1001/jamaoncol.2025.5785","source_score":78,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-01-11","doi":"10.1001/jamaoncol.2025.5785","days":"7","issn":"2374-2437","rank":"4","field":"Clinical Medicine","score":"78","category":"Oncology","categories":["Oncology"],"_categories":["Oncology"]},"pubmed":{"doi":"10.1001/jamaoncol.2025.5785","title":"Clonal Hematopoiesis and Cardiovascular Disease Risk After Cancer Therapy in Patients With Solid Tumors.","journal":"JAMA oncology","methods":"","results":"Among 8004 eligible participants (median [IQR] age, 61.9 [52.2-69.9] years; 4385 female individuals [54.8%]) with a primary solid tumor diagnosis, 7438 had no heart failure, 7392 no ischemic CVD, and 6002 no arrhythmia before cancer therapy. Overall, 549 (6.9%) had CHIP. In the propensity score-matched cohort, participants with CHIP had a significantly higher 10-year cumulative incidence of heart failure (20.3%; 95% CI, 16.0%-24.4% vs 14.5%; 95% CI, 13.5%-15.6%; P = .001) and ischemic CVD (25.3%; 95% CI, 20.5%-30.0% vs 18.5%; 95% CI, 17.3%-20.0%; P < .001) compared with those without CHIP. In adjusted Fine-Gray models, CHIP was associated with increased risk of heart failure (subdistribution hazard ratio [sHR], 1.26; 95% CI, 1.02-1.56; P = .03). In an exploratory 24-month landmark analysis, there was a statistically significant interaction between CHIP and intensive chemotherapy (≥7 cycles) on heart failure risk (sHR, 1.02; 95% CI, 1.00-1.04; P = .03).","abstract":"$30","keywords":[],"pubmed_id":"41505144","conclusions":"","publication_date":"2026-01-08T00:00:00"},"crossref":{"DOI":"10.1001/jamaoncol.2025.5785","URL":"https://doi.org/10.1001/jamaoncol.2025.5785","ISSN":["2374-2437"],"link":[{"URL":"https://jamanetwork.com/journals/jamaoncology/articlepdf/2843268/jamaoncology_shyr_2026_oi_250080_1766168135.11316.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Clonal Hematopoiesis and Cardiovascular Disease Risk After Cancer Therapy in Patients With Solid Tumors"],"author":[{"given":"Derek","family":"Shyr","sequence":"first","affiliation":[{"name":"Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham"},{"name":"Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}]},{"given":"Yash","family":"Pershad","sequence":"additional","affiliation":[{"name":"Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}]},{"given":"Kun","family":"Zhao","sequence":"additional","affiliation":[{"name":"Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}]},{"given":"Ashwin","family":"Kishtagari","sequence":"additional","affiliation":[{"name":"Division of Hematology Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}]},{"given":"Robert W.","family":"Corty","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}]},{"given":"Eric","family":"Shinohara","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee"}]},{"given":"Ben Ho","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Hematology Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}]},{"given":"J. Brett","family":"Heimlich","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}]},{"given":"Leo","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee"}]},{"given":"Alexander G.","family":"Bick","sequence":"additional","affiliation":[{"name":"Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, 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propensity score–matched analyses showed higher 10-year cumulative incidence with CHIP vs no CHIP for heart failure (20.3% vs 14.5%; P=.001) and ischemic CVD (25.3% vs 18.5%; P<.001). Adjusted Fine–Gray models found increased heart failure risk with CHIP (sHR 1.26; 95% CI, 1.02–1.56; P=.03), and an exploratory 24‑month landmark showed a CHIP×intensive chemotherapy (≥7 cycles) interaction (sHR 1.02; 95% CI, 1.00–1.04; P=.03).","limitations":"Single-center biobank cohort using EHR-linked genomic data limits generalizability. Results are observational despite propensity matching, and the chemotherapy interaction arose from an exploratory landmark analysis.","practice_takeaway":"In adults with solid tumors receiving cancer therapy, CHIP marks higher 10-year risk of heart failure and ischemic CVD. 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Lancet Oncol. 25, 1188–1201 (2024).","article-title":null,"journal-title":"Lancet Oncol.","doi-asserted-by":"publisher"}],"short-title":[],"update-policy":"https://doi.org/10.1007/springer_crossmark_policy","alternative-id":["1100"],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"original-title":[],"container-title":["Nature Reviews Clinical Oncology"],"reference-count":141,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2025,11,27]]},"references-count":141,"short-container-title":["Nat Rev Clin Oncol"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1038/s41571-025-01100-3","is_oa":false,"title":"Personalized intensification of treatment for hormone-sensitive prostate cancer","updated":"2025-11-28T03:10:16+00:00","published_date":"2025-11-27","best_oa_location":null}},"created_at":"2025-12-08T12:24:58.509Z","updated_at":"2025-12-08T12:24:58.509Z","tags":[{"paper_doi":"10.1038/s41571-025-01100-3","tag_type":"category","value":"Oncology","value_numeric":null},{"paper_doi":"10.1038/s41571-025-01100-3","tag_type":"condition","value":"Hormone-Sensitive Prostate Cancer","value_numeric":null},{"paper_doi":"10.1038/s41571-025-01100-3","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1038/s41571-025-01100-3","tag_type":"modality","value":"AKT Inhibitor","value_numeric":null},{"paper_doi":"10.1038/s41571-025-01100-3","tag_type":"modality","value":"Androgen Receptor Pathway Inhibitor","value_numeric":null},{"paper_doi":"10.1038/s41571-025-01100-3","tag_type":"modality","value":"PARP Inhibitor","value_numeric":null},{"paper_doi":"10.1038/s41571-025-01100-3","tag_type":"modality","value":"Radioligand Therapy","value_numeric":null},{"paper_doi":"10.1038/s41571-025-01100-3","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1038/s41571-025-01100-3","tag_type":"modality","value":"Taxane Chemotherapy","value_numeric":null},{"paper_doi":"10.1038/s41571-025-01100-3","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1038/s41571-025-01100-3","tag_type":"warning","value":"Design classification inferred as a narrative review; not specified as systematic.","value_numeric":null},{"paper_doi":"10.1038/s41571-025-01100-3","tag_type":"warning","value":"Narrative review without quantitative outcomes; the abstract provides no effect sizes or event counts.","value_numeric":null},{"paper_doi":"10.1038/s41571-025-01100-3","tag_type":"warning","value":"PSMA PET–defined subgroups are mentioned but not detailed in the abstract.","value_numeric":null}],"summaries":{"what_studied":"Review of how to personalize intensification for hormone‑sensitive prostate cancer, covering selection for ARPIs, docetaxel, and radiotherapy with ADT, the impact of PSMA PET staging, and the status of emerging options (AKT inhibitors, radioligand therapies, PARP inhibitors).","practice_takeaway":"Use disease history and extent on conventional imaging to select patients for ARPIs, docetaxel, and radiotherapy with ADT; consider PSMA PET to refine staging, as it can reveal subgroups where adding docetaxel to ADT plus an ARPI may or may not be appropriate."}}],"initialOffset":23,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Radiotherapy"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Radiotherapy"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Radiotherapy"}}}]]

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