Michele Fiore

Augmented reality (AR) represents an emerging technology that is increasingly being integrated into surgical navigation across various medical disciplines, including orthopedic surgery. This preclinical study investigated the application of AR in orthopedic oncology and performed a comparative assessment of two head-mounted displays (HMDs): Microsoft HoloLens 2 and Magic Leap 2. The study evaluated the feasibility of AR-assisted tracing of planned osteotomies for bone tumor resections in orthopedic surgery. The objective was to evaluate the visualization capabilities, spatial guidance performance, and user interaction provided by the two AR platforms under controlled preclinical conditions. Accuracy of AR-guided tracing of planned osteotomies was quantified using custom cutting guides incorporating grooves of 1 mm, 2 mm, and 3 mm to measure deviations from the planned osteotomy lines. Both AR HMDs were tested under identical experimental conditions, and their performance and accuracy were comparatively analyzed. Magic Leap 2 demonstrated a trend toward greater accuracy in AR-guided tracing of osteotomies, achieving 82%, 95%, and 100% accuracy within 1 mm, 2 mm, and 3 mm thresholds of the planned osteotomy lines, respectively. In comparison, the HoloLens 2 achieved 65%, 85%, and 95% accuracy within the same respective thresholds. Ergonomic assessment also suggested favorable user comfort and handling characteristics for Magic Leap 2. Further studies involving larger cohorts and comparisons with established navigation techniques are required to confirm the potential advantages of HMD-based AR guidance for bone tumor resections and other orthopedic procedures.

Background/Objectives: Early progression (EP) occurs in a subset of patients with locally advanced pancreatic cancer (LAPC), limiting the clinical benefit of treatment, and it remains difficult to predict. Methods: We developed a multiparametric predictive model integrating baseline ¹⁸F-FDG PET/CT radiomic features with clinical and biological data. A total of 242 radiomic features were extracted from each imaging modality (CT and PET), including first-order, gray-level co-occurrence matrix (GLCM), and local binary pattern (LBP-TOP) features, and combined with PET-derived metrics and clinical variables. Model development included cross-validation procedures and rigorous feature selection, followed by the training of a two-level decision tree classifier. Results: The model achieved an accuracy of 80.7% and an area under the curve (AUC) of 0.83. Integrated analysis of CT and PET texture enabled the identification of patients at high risk of EP prior to treatment initiation. Conclusions: PET/CT-based radiomic biomarkers, combined with clinical data, can non-invasively capture tumor heterogeneity and improve risk stratification in LAPC, supporting more personalized therapeutic decision-making.

Background: Stereotactic body radiotherapy (SBRT) has gained increasing interest in the treatment of locally advanced pancreatic cancer (LAPC), although its effectiveness has not been defined in randomized trials. This systematic review and meta-analysis aimed to compare clinical outcomes and treatment-related toxicity between SBRT and CFRT in LAPC. Methods: This analysis was performed in accordance with PRISMA guidelines (PROSPERO: CRD420251128943). MEDLINE and Scopus were searched for comparative studies published between January 2015 and July 2025. Five retrospective studies comprising 768 patients fulfilled the eligibility criteria. Pooled hazard ratios (HRs) were calculated for overall survival (OS) and progression-free survival (PFS), while risk ratios (RRs) were estimated for severe (grade ≥ 3) acute toxicity using random-effects models. Study quality was evaluated using the ROBINS-I tool. Results: No significant OS or PFS differences were observed between SBRT and CFRT. SBRT was associated with a lower incidence of severe acute toxicity. The overall risk of bias across studies was moderate. Conclusions: SBRT appears to achieve survival outcomes comparable to CFRT with a favorable acute toxicity profile in patients with LAPC. Nevertheless, the current evidence is limited by retrospective designs and heterogeneity, highlighting the need for prospective randomized trials to define the role of SBRT in this setting.

Backgrounds and aim: Protective effects of natural compounds have been suggested in the prevention and treatment of radiation-induced mucositis or bacterial infections. In this study, the protective effects of proanthocyanidin-rich grape seed extract (GSE) on bacterial Lipopolysaccharide (LPS) and radiation-induced epithelial barrier damage and Reactive Oxygen Species (ROS) production were investigated in an in vitro model. Methods: Human intestinal epithelial cells Caco-2, previously treated with LPS, GSE, or LPS + GSE, were irradiated with 10 Gy divided into five daily treatments. Epithelial barrier integrity and ROS production were measured before and after each treatment. Results: Irradiation, at different doses, significantly increased intestinal permeability and ROS production; pretreatment with GSE was able to significantly prevent the increased intestinal permeability (4.63 ± 0.76 vs. 15.04 ± 1.5; p < 0.05) and ROS production (12.9 ± 1.08 vs. 1048 ± 0.5; p < 0.0001) induced by irradiation treatment. When the cells were pretreated with LPS, the same results were observed: GSE cotreatment was responsible for preventing permeability alterations (5.36 ± 0.16 vs. 49.26 ± 0.82; p < 0.05) and ROS production (349 ± 1 vs. 7897.67 ± 1.53; p < 0.0001) induced by LPS exposure when added to the irradiation treatment. Conclusions: The results of the present investigation demonstrated, in an in vitro model, that GSE prevents the damage to intestinal permeability and the production of ROS that are induced by LPS and ionizing radiation, suggesting a potential protective effect of this extract on the intestinal mucosa during irradiation treatment.

Background: CDK4/6 inhibitor plus ET is a standard treatment for advanced HR+ BC. This study evaluates the efficacy and safety of CDK4/6 inhibitors with concurrent RT (SBRT and non-SBRT) in terms of pain, analgesic therapy changes, toxicities, and net clinical benefit (NCB). Methods: BC patients with bone metastases treated with RT and CDK4/6 inhibitor in the prospective observational COMBART study were analyzed. Pain was measured with the NRS. The NCB was defined by pain reduction (NRS), toxicity, and treatment changes. Adverse events (AEs) were graded per CTCAE v5.0. Statistical tests included chi-square and t-test. Results: Forty patients were treated with CDK4/6 inhibitor (palbociclib 30.8%, ribociclib 51.3%, abemaciclib 17.9%) and RT (131 lesions; 100 SBRT, 31 non-SBRT). The mean NRS score dropped from 3.52 (pre-treatment) to 1.31 (post-treatment) (p < 0.001), with better outcomes for patients treated with moderate hypofractionation (58.6% vs. 39.9% pain relief, p = 0.016). Pain relief was independent of the type of CDK4/6 inhibitor used (p = NS). Analgesic reduction was most common with palbociclib (35.4%, p = 0.001). Eight toxicities (grade 1–2) were reported. The NCB was 0.6 overall, higher with non-SBRT (0.74 vs. 0.52). Conclusions: RT plus CDK4/6 inhibitor, especially with moderate hypofractionation, significantly reduced pain with manageable toxicity. Analgesic therapy can often continue without stopping CDK4/6 inhibitor.