Shikha Goyal

Background: [ ¹⁷⁷ Lu]Lu‐PSMA‐617 has been an approved treatment modality for metastatic castration‐resistant prostate cancer (mCRPC). Recent studies have shown PSMA upregulation following enzalutamide, which may enhance the outcomes with [ ¹⁷⁷ Lu]Lu‐PSMA‐617. This study aims to evaluate the efficacy and safety of short‐course enzalutamide priming with [ ¹⁷⁷ Lu]Lu‐PSMA‐617 in mCRPC patients. Methods: This investigator‐initiated, single‐arm phase 2 trial recruited men with mCRPC, having progressed on ≥one line of taxane and androgen‐receptor pathway inhibitors (ARPIs), and fit for [ ¹⁷⁷ Lu]Lu‐PSMA‐617. Enzalutamide (160 mg/day) was administered orally for 7 days before and after [ ¹⁷⁷ Lu]Lu‐PSMA‐617 (7.4 GBq/cycle, up to 6 cycles, at 6–8 week intervals). The primary end‐point was proportion of patients achieving ≥ 50% decline in prostate‐specific antigen (PSA50‐response rate, PSA50‐RR). A sample size of 20 patients was calculated using Simon's two‐stage design with at least 12/20 PSA50‐responses required for rejection of null hypothesis. Secondary end‐points included objective radiographic response rate (ORR), PSA progression‐free survival (PSA‐PFS), radiographic PFS (rPFS), overall survival (OS), and adverse events (AEs). Results: Between May 2023 and January 2025, 20 mCRPC patients (median age 67 years) were enrolled. The PSA50‐RR was 40% (8/20, 95% CI: 19–64), thus the null hypothesis was not rejected. The ORR was 25% (5/20, 95% CI: 10–49). Over a median follow‐up of 24 months, median PSA‐PFS, rPFS, and OS were 4.0 months (95% CI: 3.0–7.5), 4.0 months (95% CI: 4.0–7.5), and 12.6 months (95% CI: 6.2–17.0), respectively. Grade 3 AEs were observed in four patients (20%, 95% CI: 6–44). Conclusion: The addition of short‐course enzalutamide to [ ¹⁷⁷ Lu]Lu‐PSMA‐617 did not meaningfully improve treatment outcomes of taxane and ARPI‐exposed mCRPC patients in this trial. Trial Registration: Clinical Trials Registry‐India, CTRI/2023/05/053301. Registered 31 May 2023.

Purpose Sexual dysfunction is common after prostate radiotherapy, yet communication barriers remain unclear. This multinational study assessed radiation oncologists’ practices, attitudes, and sexual-health training. Materials and methods The International Geriatric Radiotherapy Group (IGRG) disseminated a 38-item cross-sectional survey to radiation oncologists across 17 countries. The instrument captured demographics, discussion frequencies, perceived barriers, referral patterns, and attitudes toward oncosexuality. Data was analyzed with descriptive statistics, chi-square tests, and multivariable logistic regression. An exploratory sensitivity analysis restricted to respondents reporting regular management of patients receiving radiotherapy with potential impact on sexual health (≥ 1 such patient per month) was performed. Results Among 117 radiation oncologists, 87% (102/117) reported some clinical exposure to patients receiving radiotherapy with potential impact on sexual health, and 57% (67/117) reported regular exposure (≥ 1 patient per month). 48% reported that patients rarely initiated discussions, and 8% never addressed the topic. Main barriers were time (39%), competing oncologic priorities (35%), and embarrassment (26%); 60% felt discomfort with older patients. Multivariable analysis revealed a “training paradox”: clinicians with formal sexual-health training (56%) had significantly lower odds of initiating discussions at the first visit (OR 0.37, 95% CI 0.15–0.94, p = 0.037) and higher odds of embarrassment with older patients (OR 5.72, 95% CI 2.09–15.65, p = 0.001), independent of age, gender, experience, and practice setting. Conclusion These findings suggest that awareness-focused sexual-health training alone may be insufficient; behaviourally anchored communication training and formal referral pathways are needed.

Thymic epithelial tumors (TETs) are rare malignancies with diverse histologic subtypes and complex clinical behavior, necessitating a multidisciplinary approach to care. We conducted a retrospective analysis of 52 patients with TETs treated at a tertiary cancer center, including 41 with thymoma and 11 with thymic carcinoma. The median age was 50 years for thymoma and 56 years for thymic carcinoma. Paraneoplastic syndromes, particularly myasthenia gravis, were more frequent in thymoma (46.3%) than in thymic carcinoma (9.1%). Most patients presented with advanced-stage disease (stage IIIA or higher accounted for 75.7% of thymoma cases and 72.8% of thymic carcinoma cases). Neoadjuvant chemotherapy was administered to 26.8% of thymoma cases and 27.3% of thymic carcinoma cases. Surgical resection was performed in 90.2% of thymoma and 63.6% of thymic carcinoma patients, with complete resection (R0) achieved in 83.8% and 71.4%, respectively. Post-operative radiotherapy (RT) was widely utilized, delivered via volumetric-modulated arc therapy or tomotherapy. Four patients with stage IVA thymoma received hyperthermic intrathoracic chemotherapy after cytoreductive surgery. At a median follow-up of 6 years, the 5-year overall survival for thymoma and thymic carcinoma was 70.0% and 30.7%, respectively, while the 5-year progression-free survival for thymoma and thymic carcinoma was 85.1% and 26%, respectively. Relapse occurred in 17.1% of thymoma and 63.6% of thymic carcinoma patients. Despite the predominance of advanced-stage disease and large tumor burden at presentation, an aggressive, multimodal treatment approach—including high rates of R0 resection, advanced RT techniques (e.g., volumetric modulated arc therapy, tomotherapy), multiline systemic therapy, and selective hyperthermic intrathoracic chemotherapy—demonstrates potential to improve treatment outcomes. Recurrence is the strongest predictor of mortality in both thymoma and thymic carcinoma.

Purpose: Patients with metastatic castration-resistant prostate cancer (mCRPC) often undergo multiple treatments, making accurate response assessment vital. The conventional imaging-based PCWG3 criteria, incorporating the RECIST-1.1, have been the gold standard so far. Although ⁶⁸ Ga-PSMA-11-PET/CT has shown an incremental role in staging of prostate cancer, its utility in response evaluation lacks prospective validation. Here, we prospectively evaluate different ⁶⁸ Ga-PSMA-11-PET/CT–based response evaluation criteria, including RECIP-1.0, PPP, and aPERCIST, and compare these with the PCWG3 criteria. Methods: mCRPC patients, initiating treatment with taxanes, androgen-receptor pathway inhibitors (ARPIs), or ¹⁷⁷ Lu-PSMA-617, underwent ⁶⁸ Ga-PSMA-11-PET/CT and conventional imaging (CECT and bone scintigraphy) at baseline, and every 12 weeks after treatment. Results: Thirty-four mCRPC patients were included (median age: 68.5 y, median PSA: 61.9 ng/mL). Nonprogression rates at 12 weeks according to PCWG3, aPERCIST, PPP, and RECIP-1.0 were 23.5%, 8.8%, 17.6%, and 23.5%, respectively. The highest inter-reader agreement was observed with RECIP-1.0 (κ=0.84). The median OS was 16.5 months with nonprogression according to PCWG3 being associated with significantly better OS ( P =0.02), and no significant associations were observed with the rest of the criteria. In surrogacy analysis of rPFS for OS in the overall cohort, the highest C-index was observed for PCWG3-rPFS (C=0.72), followed by RECIP-rPFS (C=0.71). In subgroup analyses, RECIP-rPFS had the highest C-index for non-ARPI patients (C=0.76), and PCWG3-rPFS for the ARPI patients (C=0.75). Conclusions: PCWG3 remains the most effective response criterion overall and for ARPI-treated patients, while RECIP-1.0 showed better prognostic value for non-ARPI patients. Larger studies are needed to validate these findings.

Septic or aseptic loosening may cause bone loss around artificial prosthesis leading to prosthesis failure. This occurrence due to metastatic infiltration of bone or surrounding soft tissues is rare but has been occasionally reported. We report a case of an elderly lady presenting with swelling and pain at the site of previous hemiarthroplasty performed for traumatic injury. On evaluation, she was found to have a lytic femur lesion with a large soft-tissue component around the prosthetic joint. Biopsy suggested a metastatic carcinoma of renal origin, but screening of kidneys did not reveal any primary lesion. She had additional skeletal metastatic lesions but no other primary site was detected either. She was given palliative radiotherapy and systemic therapy (sunitinib) based on the histologic diagnosis of renal cell origin but did not tolerate it. Thereafter, she is continuing on zoledronate every 4 weeks and best supportive management since 4 months from diagnosis.

Patients with autosomal dominant polycystic kidney disease (ADPKD), especially those with renal failure, carry a higher risk of developing renal cell carcinoma (RCC) compared to the general population. Genetic mutations associated with ADPKD are known but a direct link associated with RCC is still controversial. We discuss the clinical course of two such patients. The first patient was diagnosed with ADPKD at the age of 10 years with an unreported tubulocystic RCC focus on his renal biopsy that was picked up on review 16 years later when he presented with vertebral metastases determined to have originated from the RCC. He was doing well on multikinase inhibitors till 4 years of diagnosis with metastatic disease when he succumbed to progressive disease after 3 lines of systemic therapy. The second patient was diagnosed with ADPKD in middle age and papillary RCC 3 years later. Within 3 months of cancer diagnosis, there was progression to metastatic disease and rapid decline despite systemic therapies. We surmise that the diagnosis of RCC may be missed in ADPKD till the advanced stages. Patients with ADPKD should be monitored regularly with imaging and biopsy if needed. Histology may be varied but once diagnosed, systemic therapies may help disease control.

Purpose: We undertook a prospective planning study to describe the delineation of ileal conduit (IC) loop on radiotherapy planning computed tomography (RTP CT) scan as an organ at risk (OAR) and its sparing using volumetric modulated arc therapy (VMAT) during adjuvant irradiation of bladder malignancies. Materials and Methods: Fifteen patients with bladder malignancy needing adjuvant radiotherapy postoperatively and having normal renal function underwent delayed phase RTP CT from June 2020 to March 2021, with certain modifications (Foley’s catheter through stoma, additional delayed scans). We identified the course of ureters, external stoma, IC, and uretero-ileal (right and left) anastomotic sites. VMAT plans were generated. Results: A step-by-step description is given. Genitourinary OARs include kidneys, ureters, uretero-ileal anastomoses, and IC. The contrast on delayed scan opacifies ureters and IC. IC can be seen three-dimensionally as a structure with two fixed ends (blind proximal end anterior to the right sacroiliac joint and the open distal end over the right anterior abdominal wall in parasagittal location) and a 15–20 cm hanging intraabdominal loop that lies adjacent to the right iliac vessels. For prescription doses (PD) of 50.4 gray and 54 gray, respectively, VMAT plan achieved IC dose maximum to less than PD and V₅₀ lower than 10 cc. Stoma sparing traditionally used as a surrogate for IC sparing is insufficient due to the variable intraabdominal location of IC loop. Conclusions: Delineation of IC as an OAR is feasible with slight modifications in the RTP protocols. VMAT (or other forms of intensity modulated radiation therapy) can help IC sparing and should be considered when it lies in close proximity to target volumes and the risk of additional morbidity is considerable.

Solitary fibrous tumors (SFTs) are mesenchymal neoplasms with variable clinical behavior depending on age, tumor site, and size, and pathologic factors such as mitoses and necrosis. Imaging features on computed tomography (CT) or magnetic resonance imaging (MRI) are not specific, and the diagnosis relies on histopathology with immunohistochemistry. SFTs arising from seminal vesicles is rare and reported in only eight earlier cases. We discuss the clinical, histopathologic and positron emission tomography (PET) imaging characteristics of a 54-year-old patient with SFT of the seminal vesicle. The patient was treated with robot-assisted seminal vesiculotomy and is doing well on follow-up at two years.