2026

A meta-analysis on vitamin D deficiency in patients with sickle cell disease (2026)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Alawad M.

Citation:

British Journal of Haematology. Conference: 66th Annual Scientific Meeting of the British Society for Haematology. Liverpool United Kingdom. 208(Supplement 1) (pp S90), 2026. Date of Publication: 01 Apr 2026.

Abstract:

Vitamin D Deficiency (VDD) is reported to be more frequent with serious clinical outcomes in patients with Sickle Cell Disease (SCD). There is a wide disparity in data in the existing literature regarding the prevalence and risk of VDD in patients with SCD. These data require further summary and analyses for better accuracy. This review aimed to assess the association between VDD and SCD, and was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline/PubMed, World Health Organization Virtual Health Library, ScienceDirect, and Google Scholar were used for the systematic search. A random effects model was used to estimate the pooled prevalence, Risk Ratio (RR), and Standardized Mean Difference (SMD) estimates with the corresponding 95% Confidence Interval (CI) using OpenMeta Analyst software version 10.10 (Tufts Medical Center, Boston, MA, USA). Twenty-five studies fulfilled the eligibility criteria. The prevalence of VDD among patients with SCD was 63.8% (95% CI 52.5-75.1). The risk of VDD among patients with SCD was more than two times that of the general population (RR = 2.129; 95% CI 1.024-4.423; p < 0.001). Serum vitamin D levels were significantly lower in SCD patients than in their controls (SMD = -1.883: 95% CI -3.006 to -0.760; p < 0.001). This review provides a comprehensive view of the association between vitamin D status and SCD.

DOI: 10.1111/bjh.70471

576eP Observational study in UK patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer receiving abemaciclib (2026)

Posted on by

Type of publication:

Conference abstract

Author(s):

Koliou P.; O'Brien C.S.; Levitt N.; Twelves C.J.; *Pettit L.; Nathan M.; Khan S.; Luttropp K.A.; Pastrello D.; Jarvis R.S.; Oikonomidou O.

Citation:

ESMO Open. Conference: ESMO Open Science for Optimal Cancer Care. Berlin Germany. 11(Supplement 4) (no pagination), 2026. Article Number: 107596. Date of Publication: 01 May 2026.

Abstract:

Background: This subgroup analysis of UK patients from a prior multi-national chart review described characteristics and outcomes of those with HR+/HER2- advanced/metastatic breast cancer (ABC) receiving the cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) abemaciclib with an aromatase inhibitor (AI) or fulvestrant as initial endocrine-based therapy (ET), or who had received prior ET.
Method(s): The analysed patient population received abemaciclib 150 mg twice daily plus AI or fulvestrant per licensed indication. Effectiveness outcomes included real-world progression-free survival (rwPFS) and time to chemotherapy (rwTTC), assessed using Kaplan-Meier by treatment line.
Result(s): Median age of the 101 patients was 62 (interquartile range 55-72) years, 78 (77.2%) were post-menopausal. At abemaciclib start, 88.1% had stage IV disease; 5.0% stage III; and 6.9% unknown. The ET partner was fulvestrant in 68.3% and AI in 31.7%. Fifty patients received abemaciclib as first-line (1L) and 34 as second-line (2L) treatment; third-line cases (n=17) are not reported. Median rwPFS was 30.0 and 17.7 months for patients in 1L or 2L, respectively (Table). Of those who received abemaciclib in 1L and 2L, 13 (26.0%) and 15 (44.1%) patients, respectively, required chemotherapy in a subsequent line; rwTTC for 2L was 23.1 months. At 24 months, 27.0% of 1L and 57.0% of 2L patients had started chemotherapy. Based on time-to-discontinuation data (n=101), 54 patients discontinued abemaciclib due to: disease progression (n=16), toxicity (n=27), physician choice (n=6), or unknown/other (n=5). [Formula presented]
Conclusion(s): In these UK patients with HR+/HER2- ABC, abemaciclib with ET showed meaningful real-world clinical benefits that were consistent with findings from clinical trials. The outcomes reinforce that adding abemaciclib to ET can prolong rwTTC and delay disease progression, supporting ongoing clinical utility in UK patients with HR+/HER2- ABC. Editorial acknowledgement: Medical writing support was provided by Laura Wesley, and Sarah Birch (Rx Communications Ltd, Mold, UK), and funded by Eli Lilly. Legal entity responsible for the study: Eli Lilly and Company.

DOI: 10.1016/j.esmoop.2026.107596

Link to full-text [open access - no password required]

What should be discussed when considering an induction of labour? A UK-wide, multi-centre Delphi study to develop a core information set for induction of labour (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Bunni, Eve; Kingdon, Carol; Bradley, Vicky; Hunt, Alexandra; Mahdi, Amy; Axcell, Thomas; Jagadish, Ria; Fox, Sophie; O'Dair, Millie; Simms, Charlotte; Munn, Yee Tan; Bonnett, Laura; Greenfield, Benjamin; Cunningham, Caroline; Holt, Siobhan; Burden, Christy; Ficquet, Joanna; Otero-Romero, Elena; *Parry-Smith, William; Black, Mairead; Merriel, Abi.

Citation:

BMJ Open. 16(5):e118024, 2026 May 27.

Abstract:

OBJECTIVE: To develop a core information set for induction of labour. Rates of induction of labour for childbirth are rising in many high-income countries. In England, a third of women have their labours induced. National guidelines recommend women receive information to make informed decisions about induction.

DESIGN: Two-stage consensus study using modified Delphi.

SETTING: UK.

PARTICIPANTS: Pregnant people, parents and professionals.

OUTCOMES: Stage 1: A long list of information points was identified through a systematic review of reviews, reviewing patient leaflets, qualitative interviews and a stakeholder survey, with ongoing patient, public and professional involvement. Stage 2: Think-aloud interviews were undertaken to refine the Delphi survey before a two-round modified Delphi process where participants voted on the importance of the information items. Pre-specified criteria were used to select items taken forward to a consensus meeting.

RESULTS: 199 information points were identified through systematic review (110), patient information leaflets (162), qualitative interviews (58) and a survey (93). 46 unique information items entered the first Delphi round after four think-aloud interviews, 2 items were added following round 2. 368 people (310 parents/58 professionals) participated in round 1 and 177 people (154 parents/23 professionals) in round 2. 44 items met inclusion criteria; one item excluded, and three items were carried forward for consensus meeting discussion where 12 overarching information points were agreed on.

CONCLUSIONS: This study has established a consensus-based core information set for induction of labour from a sample of the birthing population and staff providing their care. The resultant set has been populated with evidence in line with national guidelines. It can be used by women and clinicians as a standardised starting point from which to personalise discussions about birth.

TRIAL REGISTRATION NUMBER: COMET Initiative registration 2600: Developing a core information set for induction of labour.

DOI: 10.1136/bmjopen-2026-118024

Link to full-text [open access - no password required]

What do student and educator perspectives reveal about assisted dying in the UK medical curriculum? A narrative review (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Smith, Benjamin; Roberts, Megan; *Talha, Saarah.

Citation:

Annals of Palliative Medicine. 15(2):24, 2026 Mar.

Abstract:

OBJECTIVE: Assisted dying is a highly complex and evolving ethical area in the United Kingdom (UK) healthcare, with ongoing legislative developments creating urgency. UK medical students, potentially the first generation to navigate its legalisation, face an inconsistent curriculum. This review examined the inclusion and quality of assisted dying education in UK undergraduate medical schools, analysing curricular extent and alignment with General Medical Council (GMC) end-of-life care expectations.

METHODS: A narrative literature review was conducted. Searches of PubMed and Scopus (2004-2025) focused on assisted dying, palliative care, and UK medical undergraduate education. Six publications were included and analysed thematically regarding student attitudes, ethical education, and curricular gaps.

KEY CONTENT AND FINDINGS: Teaching on assisted dying is fragmented, inconsistent, and often superficial, typically confined to isolated workshops. Active-learning modules improve ethical reasoning, but general progression often conveys only current legal frameworks. Student attitudes are diverse, influenced by religious background and clinical exposure. A major finding is the scarcity of robust UK-specific research on implementation. This deficiency risks future doctors being unprepared to professionally and ethically navigate the evolving legal landscape.

CONCLUSIONS: The UK medical education system lacks a standardised, integrated approach to teaching assisted dying. The curriculum is insufficiently robust, and evidence for implementation is scarce. Medical schools must be proactive to potential legislative change. A standardised framework incorporating case discussions, dedicated ethics/law sessions, and communication skills training is essential to prepare the future workforce for this challenging issue.

DOI: 10.21037/apm-2025-1-138

Link to full-text [open access - no password required]

Tjalma Syndrome: A Rare Autoimmune Cause of Multisystem Serositis (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Kodamanchile, Aaditya; Ekhelikar, Sowmya; AbiMusaAsa'ari, Ahmad Kamal Azri; Aboushehata, Moustafa; *Ahmad, Nawaid.

Citation:

Cureus. 18(3):e105188, 2026 Mar.

Abstract:

Tjalma syndrome is a rare manifestation of systemic lupus erythematosus (SLE) characterized by pleural effusion, ascites, and elevated cancer antigen 125 (CA-125) levels in the absence of ovarian malignancy. We report the case of a woman in her 50s who presented with recurrent pleuritic chest pain, dyspnea, peripheral edema, ascites, and constitutional symptoms. Initial investigations were inconclusive, resulting in repeated admissions and multidisciplinary referrals. Subsequent immunological testing confirmed SLE. Given the constellation of serositis and elevated CA-125, a diagnosis of Tjalma syndrome was established. Treatment with immunosuppressants such as corticosteroids, hydroxychloroquine, and azathioprine resulted in symptomatic improvement. However, the disease course was complicated by constrictive pericarditis requiring pericardiectomy and later inflammatory arthritis requiring escalation of immunosuppression. This case highlights the importance of considering autoimmune etiologies in patients with unexplained multisystem effusions and elevated tumor markers, thereby avoiding misdiagnosis and unnecessary oncological interventions.

DOI: 10.1177/17562848261446551

Link to full-text [open access - no password required]

The UK vedolizumab real-life experience study in inflammatory bowel disease (VEST): patient characteristics, drug persistence and patient-centred outcomes (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Bodger, Keith; Booker, Cheryl; Taylor, Frederick; Ahmad, Tariq; Bloom, Stuart; *Butterworth, Jeffrey; Kok, Klaartje; Lobo, Alan; Irving, Peter; Cummings, J R Fraser.

Citation:

Therapeutic Advances in Gastroenterology. 19:17562848261446551, 2026.

Abstract:

Background: VEST was a multi-centre study of real-world use of vedolizumab in inflammatory bowel disease (IBD) in routine practice in the United Kingdom.

Objectives: To describe real-world indications, effectiveness, patient-reported outcomes and safety.

Design: Prospective observational cohort study at 22 centres.

Methods: Patients receiving vedolizumab as part of standard care were included. Data were collected at infusion visits for activity indices (Harvey-Bradshaw Index (HBI) or partial Mayo Score (PMS)), physician global assessment (PGA), patient-reported quality-of-life and treatment perception (IBD-Control Questionnaire) and adverse events. Clinical response (Wk14) was defined as a reduction in HBI 3 or PMS 2, clinical remission as HBI 4 or PMS 1 and analysed using non-responder imputation. One-year persistence was defined as continuing on vedolizumab after an infusion at 48 weeks. Biomarker and endoscopic data were not available.

Results: 364 patients, mean age: 48 years; 132 (36%) with Crohn's disease (CD), 224 (62%) with UC and 8 (2%) with IBD-U; 174 (48%) male; 142 (39%) receiving steroids at baseline (Wk0); 141 (39%) bio-naive. At baseline, 279 (77%) had "active" disease. One-year persistence: 58% overall (54% for active disease). Among persistent cases (n = 212), median (IQR) IBD-Control-8 scores improved from 6 (3-10) at baseline to 14 (10-16) at post-induction (Wk14) and 1 year (p < 0.001 vs baseline). Corresponding scores for IBD-Control-VAS were: 50 (30-70), 80 (65-90) and 85 (70-95), respectively (p < 0.001 vs baseline). Each domain of IBD-Control-8 showed improvement. Baseline and post-induction health status (activity index, PGA or IBD-Control) were associated with 1-year persistence, but no significant associations were observed for disease type, duration, bio-naive status or baseline steroids. Of those with active disease at Wk0, clinical remission rates were 29%, 30% and 38% for CD, UC and IBD-U, respectively, and steroid-free remission rates were 26%, 27% and 38%. Similar remission rates were observed at 1 year. Possible adverse events leading to treatment cessation were rare (3%).

Conclusion: In routine clinical practice in the UK, vedolizumab demonstrated high levels of persistence. Similar rates of clinical response, remission and 1-year persistence were seen in UC and CD patients, and in bio-experienced versus naive cases. Persistent cases experienced significant and sustained improvements in quality of life and treatment perception. Persistence does not imply anti-inflammatory efficacy, as biomarker data were not available.

DOI: 10.1177/17562848261446551

Link to full-text [open access - no password required]

Rotating Hinge Knee Versus Constrained Condylar Knee Revision: A Single Centre, Retrospective Comparative Study (2026)

Posted on by

Type of publication:

Journal article

Author(s):

*Bishi, Habeeb; Afzal, Irrum; Wang, Chao; Stammers, John; Madanipour, Suroosh; Radha, Sarkhell; Field, Richard; Mitchell, Philip; Alazzawi, Sulaiman.

Citation:

Cureus. 18(7):e112443, 2026 Jul.

Abstract:

Introduction In revision total knee arthroplasty, rotating hinge implants (RHK) have been presumed to result in higher complication rates and lower survivorship when compared to constrained condylar implants (CCK). This study aimed to compare patient-reported outcome measures (PROMs), complication rates and survivorship of RHK and CCK used in revision arthroplasty at a single, high-volume elective orthopaedic centre with a previously validated bespoke database. Methods Patients (n=108) who underwent revision knee arthroplasty with either CCK or RHK and matched our inclusion criteria were identified. EuroQol Five Dimensions (EQ5D), EuroQol Five Dimensions (EQ5D)-Health State and Oxford Knee Scores were collected pre-operatively and at one year post-operatively. Complication data was collected at six weeks, six months and one year post-operatively. National Joint Registry (NJR) data were interrogated, in addition to our orthopaedic database, to investigate implant survival with a maximum follow-up of 12 years. Results There was no statistical significant difference between RHK and CCK in implant survival at two to 12 years of follow up. In addition, we observed no statistical significant difference in the PROMs scores and complication rates of the two implants. Conclusion This study shows that both the RHK and CCK remain viable options in revision arthroplasty; the implant survival and complication rates were comparable. We recommend future research through prospective randomised control trials with long-term follow up to further investigate the use of CCK and RHK implants in revision knee arthroplasty.

DOI: 10.7759/cureus.112443

Link to full-text [open access - no password required]

Refining prognosis in advanced renal cell carcinoma: international real-world validation of the Meet-URO score in first-line immunotherapy combinations (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Rebuzzi, Sara Elena; Ghose, Aruni; Rudman, Sarah; Venugopal, Balaji; Young, Kate; Frazer, Ricky Dylan; Ayodele, Olubukola; Stares, Mark; O'Carrigan, Brent; Ali, Waqas; McGrane, John; Jain, Ankit; Fiala, Ondrej; Chauhan, Vishwani; Michael, Agnieszka; Zarkar, Anjali; Kapur, Gaurav; Charnley, Natalie; Afshar, Mehran; Vengalil, Salil; Forde, Caroline; Brown, Janet; Urun, Yuksel; Bianchini, Diletta; Bahl, Amit; *Srihari, Narayanan; Di Costanzo, Fabrizio; Smalley, Benjamin; Parkes, Joanne; Crabb, Simon; Vasudev, Naveen; Poprach, Alexandr; Brown, Nicholas; James, Lijo; Haywood, Sophia; Tapia, Jose; Vijay, Anupama; Parry, Jane; Cheung, Michael; Mahajan, Ishika; Moon, Niall O; Abrol, Ritika; Tkadlecova, Michaela; Soe, Yamin Shwe Yee; Zargham, Anum; Smith, Michelle; Ashley, Sophie; Hardy, Orla; Patel, Grisma; Tun, Kyaw Kyaw; Johnston, Emma; Sarwer, Abdullah; Bolek, Hatice; Shrestha, Roshani; Challapalli, Amarnath; *Meegan, James; Anpalakhan, Shobana; Buono, Francesco; Kolarikova, Eva; Leung, David Ka-Wai; Murianni, Veronica; Catalano, Fabio; Bimbatti, Davide; Buti, Sebastiano; Signori, Alessio; Fornarini, Giuseppe; Rescigno, Pasquale; Teoh, Jeremy Yuen Chun; Banna, Giuseppe Luigi.

Citation:

Oncologist. 31(7), 2026 Jun 06.

Abstract:

BACKGROUND: Effective risk stratification is essential for guiding treatment decisions in patients with metastatic renal cell carcinoma (mRCC). The Meet-URO score is a novel prognostic model that integrates the International Metastatic RCC Database Consortium (IMDC) criteria with neutrophil-to-lymphocyte ratio (NLR) and the presence of bone metastases. Developed in the immunotherapy era, it has demonstrated superior prognostic accuracy compared to the IMDC score across various clinical settings and treatment strategies. Its validation in the context of first-line immune-based combinations has been awaited.

METHODS: External validation of Meet-URO was performed using a large retrospective real-world cohort of mRCC patients treated with first-line immune-based combinations. Secondary analyses included a comparison with the IMDC score for predicting overall survival (OS) and progression-free survival (PFS). Additionally, restricted mean survival time (RMST) was assessed.

RESULTS: A total of 1,418 patients were included in the analysis: 54% received ICI-ICI regimen (nivolumab plus ipilimumab), while 46% received the ICI-TKI combination. At baseline, 52.5% of patients had an NLR >= 3.2, and 32% had bone metastases. After a median follow-up of 26.8 months, the median OS and median PFS were 34.7 and 11.3 months, respectively. Meet-URO demonstrated effective prognostic stratification, identifying patient groups with markedly different outcomes (median OS 11.5-51.4 months; 3-year OS 26-66%; RMST 20.0-42.8 months). Compared to IMDC, Meet-URO showed a significantly better OS (c-index 0.675 vs 0.643; DELTAc = 0.032, P < .001) and PFS (c-index 0.60 vs 0.58; P < .001) prediction performance.

CONCLUSIONS: Meet-URO demonstrated robust prognostic accuracy. Its integration into routine clinical practice and use as a stratification factor in clinical trials may support more personalized treatment strategies and enhance clinical trial design.

DOI: 10.1093/oncolo/oyag203

Link to full-text [open access - no password required]

Real-world experience of transoesophageal echocardiography for detection of clinically significant persistent foramen ovale (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Wilmshurst, Peter; *Pearson, Matthew; Walsh, Kevin; Morrison, W Lindsay.

Citation:

Diving & Hyperbaric Medicine. 56(2):148-153, 2026 Jun 30.

Abstract:

Introduction: Transoesophageal echocardiography (TOE) is claimed to be the investigation of choice for detecting a persistent foramen ovale (PFO) with almost 100% diagnostic accuracy. If true, TOE would detect all large/clinically significant PFOs.
Methods: Retrospective analysis to determine the sensitivity of TOE for detection of clinically significant PFOs. Patients were from a consecutive series of 150 patients who had transcatheter closure of a PFO following events attributed to paradoxical embolism (decompression sickness or stroke). In each patient, transthoracic echocardiogram with bubble contrast showed a clinically significant atrial right-to-left shunt. The data reported are from the sub-group of the 150 patients with a clinically significant PFO who also had a TOE performed in other hospitals.
Results: Twenty seven of 150 consecutive patients had a total of 31 TOEs performed at 22 United Kingdom regional cardiac centres. TOE failed to detect a PFO in 17 of the 27 patients. Four patients had a TOE on two separate occasions and in each case both of the TOEs failed to show a PFO. TOE gave a false negative test in 21 of 31 investigations (sensitivity 32%). The mean PFO diameter was 9.4 mm (median 9 mm, range 5-16 mm) in the 21 patients in whom balloon sizing was performed and 9.8 mm (median 10 mm, range 5-16 mm) in the 13 patients in whom balloon sizing was performed and a TOE failed to show a PFO.
Conclusions: These finding demonstrate that the precision of TOE for detecting a PFO in real world clinical practice is considerably lower than generally believed.Introduction: Liver transplantation has re-emerged as a potential therapeutic option for patients with unresectable colorectal liver metastases after failure of standard treatments. This systematic review and meta-analysis evaluated survival outcomes, recurrence patterns, and prognostic factors associated with this approach. Materials and Methods: A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO. Electronic databases were searched for studies published between November 2015 and November 2025, that assessed liver transplantation in the context of unresectable colorectal liver metastases. Random-effect meta-analyses were conducted to estimate the pooled overall survival, disease-free survival and recurrence rates. Heterogeneity was assessed using I2 statistics.
Results: Twenty-three studies involving patients with unresectable liver-only colorectal metastases were included. Pooled overall survival after liver transplantation was 96.6% at 1 year (95% CI 93.9-99.4; I2 = 44.3%), 73.4% at 3 years (95% CI 62.9-83.9; I2 = 95.4%), and 49.4% at 5 years (95% CI 35.4-63.3; I2 = 90.5%). Ten-year overall survival was approximately 27%. The pooled recurrence rate was 63.5% (95% CI 52.5-76.8), and the type of recurrence was mainly extrahepatic, most commonly pulmonary. Disease-free survival was 64.1% (95% CI 47.5-80.7) with substantial heterogeneity (I2 = 95.6%). Biological risk factors, including carcinoembryonic antigen levels, metabolic tumor volume, and composite risk scores, consistently influenced survival outcomes.
Conclusions: In highly selected patients with unresectable colorectal liver metastases, liver transplantation is associated with favorable long-term survival despite frequent recurrence. Outcomes appear to be primarily driven by tumor biology rather than tumor burden, supporting the cautious use within specialized centers under structured selection protocols.

DOI: 10.28920/dhm56.2.148-153

Liver Transplantation as a Salvage Therapy Option in Colorectal Liver Metastases: Feasibility, Oncologic Outcomes, and Survival After Failure of Conventional Therapy-A Systematic Review and Meta-Analysis (2026)

Posted on by

Type of publication:

Systematic review

Author(s):

Soomro, Faiza Hashim; Kazmi, Tehreem Fatima; *Ansar, Mehwish; Gulnaz, Nadia; Arshad, Rabia; Aiste, Gulla.

Citation:

Cancers. 18(8), 2026 Apr 15.

Abstract:

Introduction: Liver transplantation has re-emerged as a potential therapeutic option for patients with unresectable colorectal liver metastases after failure of standard treatments. This systematic review and meta-analysis evaluated survival outcomes, recurrence patterns, and prognostic factors associated with this approach. Materials and Methods: A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO. Electronic databases were searched for studies published between November 2015 and November 2025, that assessed liver transplantation in the context of unresectable colorectal liver metastases. Random-effect meta-analyses were conducted to estimate the pooled overall survival, disease-free survival and recurrence rates. Heterogeneity was assessed using I2 statistics.
Results: Twenty-three studies involving patients with unresectable liver-only colorectal metastases were included. Pooled overall survival after liver transplantation was 96.6% at 1 year (95% CI 93.9-99.4; I2 = 44.3%), 73.4% at 3 years (95% CI 62.9-83.9; I2 = 95.4%), and 49.4% at 5 years (95% CI 35.4-63.3; I2 = 90.5%). Ten-year overall survival was approximately 27%. The pooled recurrence rate was 63.5% (95% CI 52.5-76.8), and the type of recurrence was mainly extrahepatic, most commonly pulmonary. Disease-free survival was 64.1% (95% CI 47.5-80.7) with substantial heterogeneity (I2 = 95.6%). Biological risk factors, including carcinoembryonic antigen levels, metabolic tumor volume, and composite risk scores, consistently influenced survival outcomes.
Conclusions: In highly selected patients with unresectable colorectal liver metastases, liver transplantation is associated with favorable long-term survival despite frequent recurrence. Outcomes appear to be primarily driven by tumor biology rather than tumor burden, supporting the cautious use within specialized centers under structured selection protocols.

DOI: 10.3390/cancers18081254

Link to full-text [open access - no password required]