Hasan Al-Sattar

Bladder cancer remains a major global health challenge, characterized by diagnostic uncertainty, substantial treatment costs and high recurrence rates. Current diagnostic and treatment modalities, including cystoscopy, transurethral resection of bladder tumour and standard histopathology, have limitations, including the inability to detect flat lesions, frequent understaging and interobserver variability, highlighting a crucial need for improved approaches. Advances in artificial intelligence (AI), blue-light cystoscopy, narrow-band imaging, cytology and urinary markers show promise in enhancing early detection and diagnosis. Developments in multiparametric MRI, radiomics, genomics and AI-driven algorithms for histopathological analyses have demonstrated considerable improvements in staging and risk stratification of bladder tumours, enabling personalized therapy selection and prognostication. Despite these promising developments, challenges remain regarding standardization, external validation, cost-effectiveness and ethical considerations in clinical implementation. Future research should prioritize addressing these barriers through collaborative, multi-institutional studies and robust validation frameworks. Ultimately, adopting a comprehensive multimodal strategy, such as proposed, novel, multimodal decision-making frameworks in which these advances and technologies are integrated, promises to considerably advance precision oncology in bladder cancer, improving patient outcomes and reducing health care burdens.

Immunotherapy has shown inconsistent results in Epstein–Barr virus-associated gastric cancer (EBVaGC) despite being associated with an active tumour microenvironment. This calls for the identification of subtypes within the EBVaGC subtype, and subsequent treatments tailored for their properties. This review identified six different EBVaGC subtypes alongside potential therapeutic opportunities. EBVaGCs, which express immune checkpoints, high microsatellite instability or high tumour mutational burden, are shown to respond better to immune checkpoint inhibitors, each due to their own specific characteristics. Co-infection of EBV and Helicobacter pylori in gastric cancer (GC) can exacerbate their impact on inflammatory stress and has the potential to be treated by antiviral agents and antimicrobials. EBVaGCs are also more likely to express wild-type p53 than other GCs, which suggests potential for lytic-induction therapy, where the EBV genome is kicked out of latency and subsequently killed using antiviral nucleoside analogue prodrugs. Lastly, EBVaGC is more likely to express the PI3K and ARID1A mutations, which can potentially be treated using PI3K/mTOR dual inhibitors and Akt/PARP inhibitors. These six subtypes could aid the selection of more successful treatments for EBVaGC, thereby improving the current overall survival and prognosis of patients.

Stereotactic ablative radiotherapy (SABR) has revolutionized the management of patients with oligometastatic and selected primary cancers due to its ability to deliver highly conformal, high-dose radiation in few fractions with minimal toxicity. However, the biological heterogeneity among patients treated with SABR results in variable outcomes, emphasizing the need for predictive and prognostic biomarkers to guide patient selection and post-treatment management. This narrative review discusses the current landscape of biomarker development in the context of SABR across tumor types. Key classes include circulating tumor DNA (ctDNA), extracellular vesicles (EVs), radiomic features, and immunological markers. We highlight the role of each biomarker category in refining therapeutic approaches, their integration into ongoing clinical trials, and future directions for personalized SABR paradigms. Translating these promising biomarker strategies into clinical SABR workflows will require further standardisation, validation, and regulatory alignment.

Colorectal cancer (CRC) is a major cause of cancer mortality worldwide, with metastatic disease remaining the main driver of poor prognosis. In recent years, the concept of oligometastatic disease, where patients present with a limited number of metastases, has created an opportunity to use local therapies with curative intent. Stereotactic ablative radiotherapy (SABR) has become increasingly important in this setting, as it allows the delivery of high, ablative doses with excellent local control and generally low toxicity. Notably, randomised data such as SABR-COMET, alongside large prospective series including SABR-5, have demonstrated improvements in survival outcomes in the context of oligometastatic disease across mixed primary tumour types, with CRC patients making up a relatively small proportion in these trials. This has presented SABR as a practical treatment option for patients with oligometastatic CRC, although more CRC-specific phase III trials are needed. Other challenges include the radioresistance of CRC metastases, and treatment outcomes that vary depending on the anatomical site, tumour biology, and prior therapies. Technical issues such as motion management and organ-at-risk constraints also continue to limit dose escalation. Emerging strategies—including MR-guided radiotherapy, proton-based SABR, integration with systemic agents such as immunotherapy, and the use of biomarkers and artificial intelligence to refine patient selection—are beginning to address these limitations. This review summarises the current evidence and emerging advancements to highlight how SABR may evolve as part of an integrated approach to oligometastatic CRC.