2025

Cure vs. toxicity: quantifying preferences for non-surgical management of rectal cancer using a prospective discrete choice experiment study (2025)

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Type of publication:

Conference abstract

Author(s):

Webb E.J.; Twiddy M.; Noutch S.; Adapala R.; Bach S.P.; Brown S.; Burnett C.; Burrage A.; Gilbert A.; Hawkins M.; Howard D.; Hudson E.; Jefford M.; Kochhar R.; Saunders M.; Seligmann J.; Smith A.; Teo M.; West N.; Sebag-Montefiore D.; *Gollins S.; Appelt A.L.

Citation:

Radiotherapy and Oncology. Conference: ESTRO 2025. Vienna Austria. 206(Supplement 1) (pp S1253-S1255), 2025. Date of Publication: 01 May 2025.

Abstract:

Purpose/Objective: Dose-escalation may increase the chance of successful non-surgical rectal cancer management, but requires an understanding of acceptable trade-offs between chance of cure and toxicity risks. This study is the first to measure patient preferences for non-surgical management (NOM) of rectal cancer using a discrete choice experiment (DCE). Material/Methods: A prospective, multicentre study conducted in seven UK radiotherapy centres. Patients consented to participation prior to initiation of radiotherapy-based NOM for rectal cancer (any stage), and completed the survey pre-treatment and 6 months post-treatment. The DCE was developed with qualitative patient input and had a Bayesian D-efficient design. Patients made repeated choices between hypothetical NOM treatments, described using six attributes: treatment length; chance of being cancer-free two years post-treatment; side effect risks during and two years posttreatment; support available. Participants indicated preferences for non-surgical vs. surgical treatment on a Likert scale. Baseline responses were analysed using mixed logit, quantifying trade-offs between attributes, using preference for chance of cure as the unit of measurement. Post-estimation, individual preferences conditional on choices were estimated. Changes in mean preferences pre/post-treatment were analysed using multinomial logit, with the delta method used to test for pre/post-treatment differences. Differences in preferences for surgical/nonsurgical management were assessed using Mann-Whitney U tests. Result(s): There were 96 participants recruited, and 51 completed follow-up. Participants had a mean baseline age of 68.4 and were 38.9% female. There were no significant differences between characteristics of people who did/did not complete follow-up. Figure 1 shows distributions of patients' baseline preferences. Patients on average required a 0.34 percentage point (pp) higher chance of cure to accept a 1pp higher chance of short-term side effects, compared to 0.78pp for a 1pp higher chance of long-term side effects, and 3.3pp higher chance of cure to accept support from usual GP rather than a dedicated nurse. The mean chance of cure patients would trade for shorter treatment lengths was not significantly different from 0 (p=.900). Preferences for treatment attributes did not change significantly pre/post-treatment (p-values between.374 and.759, Figure 2a). There was a significant shift in preferences towards non-surgical vs. surgical management post-treatment (p=.017, Figure 2b). Conclusion(s): Participants would accept extra toxicity in exchange for better chances of cure, suggesting most would accept treatment intensification, including dose-escalation. Participants were more concerned about long-term than shortterm side effects, highlighting the need for long-term follow-up of toxicity, and for clinical decision-making to take account of individual patients' preferences.

DOI: 10.1016/S0167-8140%2825%2901971-1

ARISTOTLE: Mature results of a phase 3 trial evaluating the addition of irinotecan to capecitabine chemoradiation in locally advanced rectal cancer (2025)

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Type of publication:

Conference abstract

Author(s):

Sebag-Montefiore D.; Samuel L.; *Gollins S.; Glynne-Jones R.; Harte R.; West N.; Quirke P.; Myint A.S.; Bach S.; Falk S.; Parsons P.; Dhadda A.; Misra V.; Brown G.; Harrison M.; White L.; Duggan M.; Begum R.; Chang E.; Musleh R.; Lopes A.; Adams R.

Citation:

Radiotherapy and Oncology. Conference: ESTRO 2025. Vienna Austria. 206(Supplement 1) (pp S1192-S1194), 2025. Date of Publication: 01 May 2025

Abstract:

Purpose/Objective: To determine if the addition of irinotecan to capecitabine chemoradiation (CRT) improves disease-free survival in MRI-defined locally advanced rectal cancer (LARC). Material/Methods: ARISTOTLE (ISRCTN:09351447) is a phase III, multi-centre, open-label trial that randomly assigned (1:1) patients with MRI-defined LARC threatening or involving resection margins without metastases to pre-operative radiotherapy:45Gy/25 fractions combined with either capecitabine 900mg/m2 (CRT) or 650 mg/m2 bd weekdays with Irinotecan iv once-weekly 60mg/m2 (IrCRT) weeks 1-4. The primary endpoint is disease-free survival (DFS). Result(s): 75 UK sites randomised 564 eligible patients from 10/2011 to 07/2018; 284 to CRT and 280 to IrCRT. 66% male; median age 61 years (range:24-83). Radiological staging in both arms was similar:mrT3(77%), mrT4(16%); mrCRM involved(49%);resection margin threatened <=1mm(38%). Median follow-up is 62.1 months.Compared with CRT, IrCRT patients were less likely to receive 45Gy RT: 208(75%) vs 251(89%), p < 0.001; or receive >=90% capecitabine dose:187(68%) in IrCRT vs 253(89%) CRT, p < 0.001. 205(74%) IrCRT patients received >=90% irinotecan dose. >=Gd 3 non-haematological adverse events included fatigue 17(6%) vs 8(3%) p=0.06; diarrhoea:14% vs 4% p<0.001; abdominal pain 5% vs <1% p=0.001 for IrCRT and CRT respectively. >=Gd 3 haematological adverse events included leucopaenia: 9% vs 2%, p<0.001; neutropaenia: 10% vs 1%,p<0.001; and febrile neutropaenia: 1% vs <1% for IrCRT and CRT respectively. 5 patients had a grade 5 adverse event (3 lrCRT,2 CRT). The median time from the end of RT to surgery was 10.6 weeks. 238(85%) and 243(86%) patients underwent surgery in the IrCRT and CRT arms. The R0 resection rate was 90% vs 89% p=0.75 for IrCRT and CRT respectively. The pCR rate was 20% for IrCRT vs 18% for CRT p = 0.52. The rate of any post-surgical complications was similar in both arms:94(39%) for IrCRT and 91(37%) for CRT p=0.65). There is no evidence of a difference in loco-regional failure free (HR 0.94 [0.46-1.90]p=0.86, distant metastasis free (HR 0.89 [0.63-1.25] p=0.51), disease free HR 0.87 [0.64-1.18] p=0.37) or overall survival (HR 0.91[0.63-1.30],p=0.59) when IrCRT is compared with CRT. Conclusion(s): For patients with MRI-defined high risk LARC, low rates of CRM involvement and 36 month loco-regional failure were observed.The addition of irinotecan to CRT was associated with decreased radiotherapy and chemotherapy compliance and a higher rate of adverse events.There is no evidence of a difference in the pCR rate,36 month locoregional recurrence free or disease-free survival.

DOI: 10.1016/S0167-8140%2825%2900901-6

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Mitral Valve-in-Ring Approach for High-Risk Pannus-Related Mitral Stenosis (2025)

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Type of publication:

Journal article

Author(s):

*Yera, Hassan O; Azam, Ziyad; *Azam, Najeeb M.

Citation:

Cureus. 17(10):e94204, 2025 Oct.

Abstract:

A male patient under follow-up for degenerative mitral regurgitation, treated with a Physio annuloplasty ring two decades earlier, developed progressive shortness of breath and fluid overload, corresponding to New York Heart Association (NYHA) class III/IV. A transoesophageal echocardiogram revealed significant mitral stenosis, with a mean gradient of 11.8 mmHg due to pannus formation around the annuloplasty ring. Surgical repair posed a mortality risk of 25%-35% because of the combined risks of redo surgery, reduced left ventricular systolic function and chronic kidney disease. A transcatheter mitral valve-in-ring (TMViR) procedure was the only feasible option. A 29 mm Sapien 3 valve (Edwards Lifesciences, Irvine, CA) was successfully implanted within the mitral ring. Four months following the procedure, the patient reported significant symptom relief and an improved quality of life (QOL), with a shift to NYHA class I/II. Follow-up echocardiography demonstrated a stable valve position, a mean gradient of 4 mmHg and mild mitral regurgitation. This case highlights TMViR as a viable option for high-risk patients with pannus-related mitral stenosis.

DOI: 10.7759/cureus.94204

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Missed on X-ray, Found on CT: A Retrospective Study on the Diagnostic Yield and Clinical Consequences of Occult Posterior Malleolus Fractures in Tibial Shaft Fractures (2025)

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Type of publication:

Journal article

Author(s):

Kanesan, Hariprasath; Choudhary, Zain; Singal, Sachin; *Kanesan, Mahesh; Hang-Kin Nam, Ronald; Radhamony, Niranj Ganeshan; Hamadto, Mohamed.

Citation:

Cureus. 17(10):e94260, 2025 Oct.

Abstract:

Background Posterior malleolus fractures (PMFs) are common in distal tibial shaft fractures yet are frequently occult on plain radiographs. Accurate preoperative characterization on CT may improve surgical planning and functional recovery. Methods We conducted a retrospective cohort study of consecutive adults (>=18 years) with mid- or distal tibial shaft fractures treated at a major trauma center (January 2022-December 2024). Demographics, imaging, fracture characteristics, management, and outcomes were abstracted. PMF detection was compared across radiography, CT, and intraoperative findings. Predictors of a posterior malleolus (PM) fragment being missed on radiography were evaluated with multivariable logistic regression. Among operatively treated cases, the effect of fixation strategy on postoperative full weight-bearing (FWB) was analyzed with a logistic model including fixation, PM status, and their interaction; pairwise, covariate-adjusted contrasts (emmeans with Tukey correction) compared strategies. An exploratory random forest provided permutation-importance rankings. Findings PMFs were present in 147/387 fractures (38.0%), more often in women (60.5%), closed injuries (76.9%), and distal fractures (98.0%). Radiography identified 116/147 PMFs (78.9%), and CT 120/147 (81.6%); 29/147 (19.7%) fragments were missed on radiographs but detected on CT or intraoperatively. Missed fragments were most frequent in undisplaced and intermediate-sized (33-50%) fragments; CT identified all posteromedial and >50% fragments. In adjusted analyses, fracture morphology was the principal correlate of radiographic omission: oblique patterns were less likely to be missed (adjusted odds ratio 0.18, 95% CI 0.04-0.60), whereas other demographic and injury variables were not significant. Among operatively managed fractures, intramedullary nailing was associated with the highest likelihood of achieving FWB and was statistically superior to plate and external fixation in pairwise, covariate-adjusted comparisons; the relative ranking of fixation methods did not differ by PM involvement. Neither PMF location (posteromedial, posterolateral, or undisplaced) nor fragment size independently predicted FWB, infection, or mal-/non-union. Conclusions Approximately two in five distal tibial shaft fractures harbour a PM fragment, and nearly one in five PMFs are occult on initial radiographs, particularly when undisplaced or of intermediate size. CT modestly increases detection and ensures complete characterisation of posteromedial and large fragments, supporting a low threshold for pre-operative CT in distal tibial fractures.

DOI: 10.7759/cureus.94260

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A Diagnostic Challenge: Sclerosed Hepatic Haemangioma Mimicking Malignancy (2025)

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Type of publication:

Journal article

Author(s):

*Lakhani, Umar A.

Citation:

Cureus. 17(10):e94449, 2025 Oct.

Abstract:

A 75-year-old lady presented to Accident and Emergency (A&E) with acute worsening shortness of breath and new palpitations. On assessment, she was found to have fast atrial fibrillation, signs of heart failure, and bilateral peripheral oedema. Investigations revealed pulmonary embolism and an incidental hepatic lesion on CT imaging, suspicious for malignancy. Multidisciplinary discussion led to liver biopsy, which confirmed a benign sclerosed haemangioma. The patient was managed conservatively for cardiac and thromboembolic complications. This case highlights the difficulty in differentiating sclerosed haemangiomas from malignant liver lesions on imaging alone and underscores the importance of biopsy and multidisciplinary decision-making in elderly patients with comorbidities. Learning points include diagnostic vigilance, safe management of anticoagulation, and avoidance of unnecessary surgery.

DOI: 10.7759/cureus.94449

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Long-Term Outcomes of Coronary Artery Aneurysms in Children With Kawasaki Disease: A Systematic Review (2025)

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Type of publication:

Systematic Review

Author(s):

Shafy, Shoaib Syed Mohammed; Salavarria, Karla Andrea Calderon; Saleh, Sara; *Cuino, Ingrid; Nadeem, Sadaf; Perez, Rebeca Cristina Romero; Shetty, Arushi; Adhikari, Kedar; Khatter, Tanya; Arasada, Chinmayee; Moussa, Naji; Mbaekwe, Eziamaka; Horsaengchai, Panchanit; Ali, Ramsha.

Citation:

Cureus. 17(10):e94418, 2025 Oct.

Abstract:

Kawasaki disease (KD) is a systemic inflammation of the blood vessels seen in children. It is the leading cause of acquired heart disease. Coronary artery aneurysm (CAA) is the most concerning complication, associated with long-term morbidity and mortality. This systematic review examined long-term outcomes of CAAs in KD, with emphasis on regression, complications, and the role of medical and surgical interventions. A total of 21 studies involving 10,922 patients were reviewed. The incidence of CAAs ranged from 3%-27%, mostly affecting infants under 6 months. Small and moderate aneurysms regressed in the majority of cases (>80%), whereas giant aneurysms were less likely to regress. Complications included thrombosis, myocardial infarction, major adverse cardiac events, and cardiac death. Early treatment with intravenous immunoglobulin (IVIG) enhanced the likelihood of regression. Aneurysms in the left anterior descending artery were less likely to regress, suggesting an anatomical influence. Coronary artery bypass grafting was the most common surgical intervention. Early and aggressive management with IVIG, with escalation to steroids or biologics when required, remains the preferred approach. Surgical intervention is sought for giant or persistent aneurysms. These findings emphasize the importance of timely diagnosis, risk stratification, and the establishment of standardized guidelines to optimize long-term care and surveillance of patients with KD.

DOI: 10.7759/cureus.94418

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IUGA Opinion Paper on Obstructed Defecation: Management of Clinical and Proctographic Rectoceles (2025)

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Type of publication:

Journal article

Author(s):

*Rachaneni, Suneetha; Dietz, Hans Peter; Latthe, Pallavi; Sirany, Annie; Spivak, Anna; Dua, Anupreet.

Citation:

International Urogynecology Journal.  2025 Nov 11.

Abstract:

INTRODUCTION AND HYPOTHESIS: Obstructed defecation syndrome (ODS) is a defecatory abnormality with a sensation of incomplete evacuation, the need to strain at stool, the need for digitation in the vagina, the anus, or the perineum. Anterior rectocele and rectal intussusception are the frequent pathologies behind ODS. The review focuses on the assessment and treatment of obstructed defecation in women with rectocele, recto-enterocele and rectal intussusception in the remit of a urogynecologist.

METHODS: A working subcommittee from the International Urogynecology Association (IUGA) Research and Development (R&D) Committee was formed with colorectal surgeons from the American Society of Colon & Rectal Surgeons (ASCRS). An initial document was drafted based on a literature review. The review focused on the treatment options of women with presenting with obstructed defecation and posterior compartment prolapse either on clinical examination or on imaging. After evaluation by the
entire IUGA R&D Committee revisions were made. The quality of the evidence was graded and used to form consensus recommendations.

RESULTS: Ultrasound and dynamic MRI are helpful imaging modalities in triaging patients. A defecating proctogram to evaluate the size of rectal intussusception and enterocele is the standard investigation. Conservative therapies are effective first-line management options. The transvaginal native tissue rectocele repair is a safe and effective first-line surgical treatment in women with obstructed defecation.

CONCLUSIONS: When evaluating patients with obstructive defecation, it is important to address anatomy as well as function. In the absence of a clinically significant rectocele or enterocele during vaginal examination, in women with obstructed defecation, referral to a gastroenterologist or colorectal surgeon for further evaluation and management is recommended.

DOI: 10.1007/s00192-025-06288-7

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CT guided percutaneous lung biopsy - self-audit (2025)

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Type of publication:

Audit

Author(s):

*Abayaratne, Chulangani

Citation:

Shrewsbury and Telford Hospital NHS Trust, 2025

Abstract:

CT-guided percutaneous lung biopsy is a widely practiced interventional radiology procedure for
obtaining tissue samples from pulmonary lesions. Regular self-audit of such procedures is good
clinical practice and is recommended to ensure high diagnostic adequacy and low complication
rates, in line with national benchmarks.

In the UK, the British Thoracic Society (BTS) and the Royal College of Radiologists (RCR)
recommend regular audits to evaluate local diagnostic yield and complication rates and compare
them with national standards.

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A survey of the current state of training in inflammatory disease (IBD) surgery in the United Kingdom (UK) (2025)

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Type of publication:

Conference abstract

Author(s):

Argyriou O.; *El-Sayed C.; Drami I.; Celentano V.; Reza L.

Citation:

Colorectal Disease. Conference: 20th Scientific and Annual Conference of the European Society of Coloproctology, ESCP 2025. Paris France. 27(Supplement 1) (no pagination), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Aim: Inflammatory Bowel Disease (IBD) surgery demands advanced technical skills due to the complexity and variability of procedures. High-quality training is essential, not only for the management of acute IBD-related emergencies but also for the development of a specialist IBD practice. This survey, developed by the Dukes' Club for UK colorectal surgery trainees and the IBD Subcommittee of the Association of Coloproctology of Great Britain and Ireland (ACPGBI), aims to evaluate the current state of IBD surgical training in the UK and to identify key areas and potential interventions for improvement. Method(s): An electronic survey was designed by members of the Dukes' Club executive committee and the ACPGBI IBD subcommittee, followed by dissemination via various professional networks, between September 2024 and April 2025.The survey investigated a number of key domains, including exposure to IBD procedures (routine/complex), participation in multidisciplinary team (MDT) meetings and joint surgical-gastroenterological clinics, career and fellowship intentions, as well as access to training resources. Result(s): The survey was completed by 103 participants (70% in training, 30% early years consultants).Senior trainees (ST6-ST8) represented 58.4% of the trainee participants.58.4% of trainees reported lack of exposure to IBD MDTs, with only 5.6% undertaking an active role in the MDT.Trainees reported minimal exposure to ileoanal pouch surgery and complex procedures such as strictureplasties and Kono-S anastomosis. In contrast, higher levels of exposure were noted for subtotal colectomies, ileo-caecal resections for Crohn's Disease, and IBD-related perianal fistula procedures. Conclusion(s): The survey demonstrated a lack of focus in IBD surgical training. Apart from high-quality educational activities that are delivered by the Dukes' Club and ACPGBI, a structured approach to ensure better exposure, through the training curriculum, is called for.

DOI: 10.1111/codi.70174

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Incidence and Survival Outcomes of Primary Parotid Follicular Lymphoma (PPFL): a Seer-Based Retrospective Analysis (2025)

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Type of publication:

Conference abstract

Author(s):

Backer G.; *Arunachalam J.

Citation:

HemaSphere. Conference: 30th Congress of theEuropean Hematology Association Annual Congress, EHA2025. Milan Italy. 9(Supplement 1) (pp 1214-1215), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Primary malignant lymphomas of the parotid glands are rare, estimated to account for just 0.6% to 5% of all tumors of the parotid gland. Primary Parotid Follicular Lymphoma (PPFL) is a rare subtype of non-Hodgkin lymphoma (NHL) originating in the parotid gland, often associated with autoimmune disorders such as Sjogren's syndrome. Due to its low incidence, comprehensive population-based studies are scarce, limiting our understanding of epidemiological factors associated with PPFL and how they impact survival outcomes. Aims Using a large, population-based cancer registry, we aimed to evaluate the incidence trends and survival patterns of PPFL for the past 20 years in the US. Methods We conducted a retrospective population-based study utilizing data between 2000-2021 from the SEER (Surveillance, Epidemiology, and End Results) database. SEER is a program of the National Cancer Institute that collects epidemiological and survival data from cancer registries across the United States. We identified and extracted data from patients diagnosed with PPFL using ICD codes specific for primary tumors of the parotid gland (C07.9) and for follicular lymphoma (ICD codes 9690, 9691, 9695, 9698). Demographic data collected included year of diagnosis, age, sex, race, and area of residence. Incidence rates (IR) were calculated per 100,000 population and were age adjusted to the US standard population using SEER*stat 8.4.4. Using GraphPad Prism software, Kaplan-Meier survival analysis was done to calculate overall survival (OS) and cancer specific survival (CSS). Log rank (Mantel-Cox) test was used to compare survival outcomes between different groups. Results 793 patients with primary parotid follicular lymphoma were identified. 52% were male. 56% were older than 65 years at the time of diagnosis. 79% of patients were white, 10% were Hispanic, and 5% were black. 18% of patients had metastatic disease at initial presentation. IR was 0.050 (SE 0.002, 95% CI 0.045-0.055) for the years 2000-2010 and 0.036 (SE 0.002, 95% CI 0.032-0.040) from 2011 to 2021. Incidence was 29.7% higher in males compared to females with p = 0.0001(IR 0.048 vs 0.037, respectively). IR was 0.049 amongst white patients (SE 0.002, 95% CI 0.046 – 0.054), 0.021 amongst black patients (SE 0.003, 95% CI 0.015 – 0.029), and 0.031 amongst hispanic patients (SE 0.004, 95% CI 0.024-0.038). Patients between the ages of 75-79 years had the highest IR of 0.241 (SE 0.024, 95% CI 0.197- 0.293). Median overall survival (mOS) was 174 months. 5-year and 10-year CSS was 90% and 84%, respectively. mOS was 180 months in patients who received chemotherapy. mOS was 106 months in adults older than 65 years, compared to those younger (p<0.0001). White patients had the poorest mOS of 161 months (p=0.0042). There was no statistically significant difference in survival outcome based on gender. mOS was 109 months in patients residing in non metropolitan counties compared to mOS of 187 months in patients residing in metropolitan counties (p=0.0005). Summary/Conclusion PPFL primarily affects older adults, with high incidences in males and white patients. Though CSS rates are generally favorable, overall survival was found to be worse in white patients, adults aged > 65, and people residing in non metropolitan counties. These differences highlight potential disparities in disease outcomes and suggest the need for future research into factors influencing survival and access to care for patients with PPFL.

DOI: 10.1002/hem3.70152

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