Marina Campione

Background/Objectives: Mild cognitive impairment (MCI) is common in Parkinson’s disease (PD) and often precedes dementia. Non-invasive brain stimulation (NIBS) techniques such as transcranial random noise stimulation (tRNS) targeting dorsolateral prefrontal cortex (DLPFC) may offer additional benefits for cognitive and motor functions in PD-MCI patients. Methods: Using a randomized, double-blind, cross-over study, participants with PD-MCI completed two stimulation sessions (real vs. sham) 7 days apart. Cognitive and motor outcomes (MoCA, FAB, FAS, MDS-UPDRS motor) were assessed pre- and post-stimulation; stimulation was administered “online” during executive training. Scores before and after the sessions have been compared, as well as their variations between the two groups. Results: Ten subjects were in the study. Patients undergoing real tRNS showed improvements in global cognition and executive functioning compared to those undergoing sham stimulation, as demonstrated by significant increase in MoCA and FAB scores. In contrast, the motor examination showed no significant differences. Conclusions: This preliminary study showed that a single session of DLPFC-tRNS stimulation produced domain-specific cognitive benefits in PD-MCI patients. Studies with multiple stimulation sessions and larger samples are needed to confirm the effect of this non-pharmacological therapeutic option in PD-MCI.

Purpose/Objective(s): Peritoneal carcinosis can occur in several gastrointestinal or gynecological malignancies and its prognosis is usually poor. With the advent of more effective systemic agents, the overall survival of metastatic patients has been revolutionized and isolated peritoneal or abdominal wall metastases might benefit from local treatments; Stereotactic Body Radiotherapy (SBRT) might be considered in selected patients with oligometastatic presentation. Materials/Methods: Oligometastases were defined according to recent ESTRO/EORTC consensus. Inclusion criteria were as follows: ECOG PS ≤ 2, written informed consent, up to five lesions to be treated at the same time, patients treated with radiotherapy schedules applying minimum 6 Gy per fraction. The primary endpoint of the study was local control (LC); acute and late toxicity, distant progression-free survival (DPFS), time-to-next systemic treatment (TNST), polymetastatic-free survival (PMFS) and overall survival (OS) were secondary endpoints. Toxicity was assessed according to CTCAE criteria v5.0. Statistical associations between clinical variables and outcomes were assessed using Fisher’s exact test, and Kruskal–Wallis test, as appropriate. Survival outcomes were estimated using the Kaplan–Meier method and compared using the log-rank test. Results: Between April 2020 and September 2024 a total of 26 oligometastatic lesions located in the peritoneum or in the abdominal wall detected in 20 patients received SBRT with Helical Tomotherapy. All cases have been assessed by a multidisciplinary team. Only in three patients out of twenty did more than one lesion receive SBRT: two lesions in two patients, and five lesions in a single case of colorectal cancer with ongoing third-line systemic treatment. Median total dose was 30 Gy (27–35 Gy) in five fractions (3–5). The most frequent primary neoplasm was ovarian cancer in 14/20, endometrial in 2/20, while the remaining were colorectal, vaginal, pancreatic and non-small cell lung cancer. Four lesions were located in the abdominal wall, while the remaining twenty-two were located in the peritoneum. Concurrent systemic therapy was administered in 18/20 patients. With a median follow-up of 15 months (range, 6–59), our 1-year LC was 100%, while 1-year DPFS, PMFS, TNTS and OS rates were 54%, 69%, 61% and 83%, respectively. Abdominal wall location and treatment of a subsequent oligometastatic recurrence with a second course of SBRT were both significantly associated with improved OS (p = 0.03 and p = 0.04, respectively). No G ≥ 3 adverse events occurred. Conclusion: Our preliminary data support the use of SBRT in selected cases of oligometastatic disease located in the peritoneum or in the abdominal wall with excellent results in terms of tolerability and promising clinical outcomes.

Mediastinal oligometastases represent a clinical and technical challenge, due to the need to combine optimal treatment with the risk of severe toxicity. In this retrospective multicentre experience, we report the data of a cohort of patients treated with stereotactic body radiotherapy (SBRT) for oligometastatic mediastinal lymph-nodes. Inclusion criteria of the study were: written informed consent for the treatment, ECOG PS ≤ 2, diagnosis of oligometastatic mediastinal lymph-nodes up to 5 lesions being the mediastinum the only active site of disease, patients treated with radiotherapy schedules applying a minimum 6 Gy per fraction. Prior radiotherapy to the mediastinum was not considered as an exclusion criterion. A total of 63 lymph-node metastases in 49 patients with median age of 69.5 years (range 47–83 years) received SBRT between September 2020 and April 2024, for a median total dose of 30 Gy (range 21–50 Gy) in 5 fractions (range 3–5). With a median follow-up of 15 months, 1- and 2-year local control rates were 96.9% and 91.8%, while distant progression-free survival rates were 66.7% and 30.2%. Median time to new systemic therapy was 12 months, while 1- and 2-year polymetastatic-free survival (PMFS) and overall survival (OS) were respectively 78% and 64%, and 86.2% and 75.8%. At statistical analysis, patients who develop a further oligoprogression treated with a second course of SBRT have a longer time to new systemic treatment (p = 0.017), being genitourinary and gynecological malignancies related to improved PMFS and OS at univariate analysis. Only one late G3 adverse event was observed, consisting of dysphagia treated with intravenous steroids. In our series, SBRT for oligometastatic mediastinal lymph-nodes was safe with a single G3 late adverse event, with promising results in terms of local control and time to activation of a new systemic therapy.

Background: Computed tomography with bone scans (CT-B) has been widely used for staging metastatic hormone-sensitive prostate cancer (mHSPC), but whole-body magnetic resonance imaging (WB-MRI) is increasingly adopted. This study compares WB-MRI and CT-B in detecting metastatic sites, disease classification (CHAARTED and LATITUDE), and treatment outcomes in mHSPC. Methods: This retrospective study included patients with mHSPC diagnosed between February 2017 and August 2023 at 2 UK NHS hospitals. Patients underwent baseline staging with either WB-MRI or CT-B. Data on demographics, disease extent, and treatment were analysed. Patients were stratified using CHAARTED and LATITUDE criteria. Survival outcomes were assessed using Kaplan-Meier and Cox regression analyses. Results: Among 203 patients (120 WB-MRI, 83 CT-B), WB-MRI identified higher rates of bone-only disease (47% vs 22%, P < .001), high-volume (49% vs 22%, P < .001), high-risk (47% vs 18%, P < .001), and de novo metastatic disease (91% vs 65%, P < .001), but lower lymph node–only metastases (10% vs 26%, P = .003) and prior radical treatment (surgery: 2% vs 13%, P < .001; radiotherapy: 7% vs 25%, P < .001). CHAARTED (HR 4.922, 95% CI: 1.937-12.507, P < .0001) and LATITUDE (HR 4.807, 95% CI: 1.674-13.809, P = .003) classifications independently predicted overall survival, with significant volume/risk differences only observed in WB-MRI ( P < .001 and P = .001, respectively). Conclusions: Whole-body magnetic resonance imaging appears to enhance staging accuracy and risk stratification in mHSPC, potentially influencing treatment decisions. While limited by retrospective design, these findings suggest that WB-MRI may optimise management in mHSPC, warranting further prospective validation.