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Background: Cancer-related cognitive impairment (CRCI) represents one of the most common and debilitating effects in patients surviving after cancer treatments. Neurocognitive deficits are important causes of disability and burden in cancer survivors. The true magnitude of CRCI is difficult to define due to significant heterogeneity of literature data. At present, there is no agreement on the gold standard for detection and grading of CRCI in clinical trials, and there is a lack of clear knowledge of its pathophysiology. Objectives: In this review, we aim to discuss some perspectives for future research to pursue in order to cover the gaps in knowledge in the CRCI field. Methods: We focused our literature research on the following relevant issues: neuroradiological correlates of CRCI; objective neuropsychological evaluation and subjective complaint assessment and their correlation with objective measures; timing of assessment; and possible treatments. Results: The correct methodology for evaluating cognitive deficits induced by anti-tumor treatments still requires a definition based on quality scientific evidence, and literature data are currently scarce. Conclusions: This review highlights the need for further research to understand the causes and consequences of cancer-related cognitive impairment using standardized and sensitive measures of cognitive functions and the long-term effects of chemotherapy on cognitive functions and to develop effective interventions.

Abstract. Background. To evaluate the effectiveness and safety of cabazitaxel in castration-resistant prostate cancer patients aged ≥80 years, we performed a retrospective study on a sample of patients from 11 Italian cancer centers. Materials and methods. Fifty-seven patients aged ≥80 years were treated with cabazitaxel after previous failure with docetaxel; 39 completed a comprehensive geriatric assessment questionnaire (34 fit and 5 vulnerable) and 8 patients (14%) had an Eastern Cooperative Oncology Group performance status (PS) ≥2, while most had a PS of 0–1 (86%). Cabazitaxel was administered at a dose of 25 mg/m2 in 30 (52%) patients and 20 mg/m2 or adapted schedules in 27 (48%) patients. These schedules were adopted mainly in patients ≥85 years (75%), with a PS ≥2 (87.5%), and those classified as vulnerable (100%). Results. The duration of treatment was 4.8 months and was comparable in all subgroups; disease control rate was reported in 36 patients (63%); prostate-specific antigen response was recorded in 18 patients (31.5%). Median overall survival was 13.1 months regardless of age (

Epstein-Barr virus (EBV) is a prevalent virus that can be detected in the vast majority of the population. Most people are asymptomatic and remain chronically infected throughout their lifetimes. However, in some populations, EBV has been linked to a variety of B-cell lymphoproliferative disorders (LPDs), such as Burkitt lymphoma, classic Hodgkin lymphoma, and other LPDs. T-cell LPDs have been linked to EBV in part of peripheral T-cell lymphomas, angioimmunoblastic T-cell lymphomas, extranodal nasal natural killer/T-cell lymphomas, and other uncommon histotypes. This article summarizes the current evidence for EBV-associated LPDs in the light of the upcoming World Health Organization classification and the 2022 ICC classification. Keywords: Epstein Barr Virus: EBV, Lymphoma; Lymphoproliferative Diseases.WHO Classification.

Background. The words “hope” and “cure” were used in a greater number of articles and sentences in narrative and editorial papers than in primary research. Despite concomitant improvements in cancer outcomes, the related reluctance to use these terms in more scientifically oriented original reports may reflect a bias worthy of future exploration. This study aims to survey a group of physicians and cancer patients regarding their perception and use of the word cure. Materials and Method. An anonymous online and print survey was conducted to explore Italian clinicians’ (the sample includes medical oncologists, radiotherapists, and oncological surgeons) and cancer patients’ approach to the perception and use of the word “cure” in cancer care. The participants received an email informing them of the study’s purpose and were invited to participate in the survey via a linked form. A portion, two-thirds, of questionnaires were also administered to patients in the traditional paper form. Results. The survey was completed by 224 clinicians (54 oncologists, 78 radiotherapists, and 92 cancer surgeons) and 249 patients. The results indicate a favourable attitude for patients in favour of a new language (“cured” vs. “complete remission”) of the disease experience. Conclusions. The use of the word cured is substantially accepted and equally shared by doctors and patients. Its use can facilitate the elimination of metaphoric implications and toxic cancer-related connotations registered in all cultures that discourage patients from viewing cancer as a disease with varied outcomes, including cure.

Background: Cancer-related cognitive impairment (CRCI) represents one of the most common and debilitating effects in patients surviving after cancer treatments. Neurocognitive deficits are important causes of disability and burden in cancer survivors. The true magnitude of CRCI is difficult to define due to significant heterogeneity of literature data. At present, there is no agreement on the gold standard for detection and grading of CRCI in clinical trials, and there is a lack of clear knowledge of its pathophysiology. Objectives: In this review, we aim to discuss some perspectives for future research to pursue in order to cover the gaps in knowledge in the CRCI field. Methods: We focused our literature research on the following relevant issues: neuroradiological correlates of CRCI; objective neuropsychological evaluation and subjective complaint assessment and their correlation with objective measures; timing of assessment; and possible treatments. Results: The correct methodology for evaluating cognitive deficits induced by anti-tumor treatments still requires a definition based on quality scientific evidence, and literature data are currently scarce. Conclusions: This review highlights the need for further research to understand the causes and consequences of cancer-related cognitive impairment using standardized and sensitive measures of cognitive functions and the long-term effects of chemotherapy on cognitive functions and to develop effective interventions. [ABSTRACT FROM AUTHOR]

During the Conference on Cancer Long-term Survivors, held in Siracusa (Italy) on September 16, 2022, Oncologists, General Practitioners, Epidemiologists, Hematologists, Pediatric Oncologists, Nurses, Industry Medical Affairs and Patients' Advocates came together to discuss the clinical implications of the condition beyond acute cancer. The debate was based both on the current literature on this topic, and on the opinion of all participants. Specifically, numerous issues were discussed in the round tables, but focused mainly on the following topics: - REASONS FOR SUCCESS IN IMPROVING SURVIVAL RATES - REHABILITATION - LONG-TERM SURVEILLANCE - PEDIATRIC AND YOUNG ADULT ISSUES - SOCIAL, FINANCIAL AND INSURANCE ISSUES This Opinion Paper aims to stimulate a suitable support to the growing population of people cancer disease free or with long-term or late effects. The development of new models can promote actions towards the elimination of obstacles and difficulties in cancer survivorship care.

Treatment of metastatic renal cell carcinoma (mRCC) has radically changed, switching from interferon alfa (IFN-α) and high-dose interleukin−2 (HD IL−2) to new targeted therapies directed against tumoral neoangiogenesis, the mammalian target of the rapamycin (mTOR) pathway and immune checkpoints. Of note, the inhibition of immune checkpoints restores antitumor immune response, therefore promoting immune-mediated elimination of neoplastic cells. The best example of this targeted treatment is represented by PD-1/PD-L1 inhibition that has become the standard of care in mRCC treatment and has improved mRCC patients’ prognoses after failure of other targeted therapies. In this manuscript, we review the main therapeutic protocols adopted for mRCC, based on the use of immune checkpoint inhibitors (ICIs) alone or combined with other drugs.

Luigino Dal Maso,1 Armando Santoro,2,3 Elisabetta Iannelli,4,5 Paolo De Paoli,6 Carla Minoia,7 Monica Pinto,8 Alexia Francesca Bertuzzi,3 Diego Serraino,1 Roberta De Angelis,9 Annalisa Trama,10 Riccardo Haupt,11 Gabriella Pravettoni,12,13 Maria Perrone,14 Francesco De Lorenzo,4,5 Paolo Tralongo15 On behalf of the Alliance Against Cancer (ACC) Survivorship Care and Nutritional Support Working Group1Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy; 2Department of Biomedical Sciences, Humanitas University, Milan, Italy; 3IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy; 4Italian Federation of Cancer Patients Organisations (FAVO), Rome, Italy; 5Italian Association of Cancer Patients (Aimac), Rome, Italy; 6Alleanza Contro il Cancro, Rome, Italy; 7SC Haematology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy; 8Rehabilitation Medicine Unit, Strategic Health Services Department, Istituto Nazionale Tumori-IRCCS Fondazione G. Pascale, Naples, Italy; 9Department of Oncology and Molecular Medicine, Italian National Institute of Health (ISS), Rome, Italy; 10Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy; 11DOPO Clinic, Department of Pediatric Haematology/Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy; 12Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; 13Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy; 14Psychology Unit, IRCCS Regina Elena Cancer Institute, Rome, Italy; 15Medical Oncology Unit, Umberto I Hospital, Department of Oncology, RAO, Siracusa, ItalyCorrespondence: Luigino Dal Maso, Epidemiologia Oncologica, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via Franco Gallini 2, Aviano (PN), 33081, Italy, Tel +39 0434 659354, Email epidemiology@cro.it Paolo Tralongo, Medical Oncology Unit, Umberto I Hospital, Department of Oncology, RAO, Via Giuseppe Testaferrata 1, Siracusa, 96100, Italy, Tel +39 0931 724 464, Email paolo.tralongo@asp.sr.itAbstract: A multidisciplinary panel of experts and cancer patients developed a position paper to highlight recent evidence on “cancer cure” (ie, the possibility of achieving the same life expectancy as the general population) and discuss the consequences of this concept on follow-up and rehabilitation strategies. The aim is to inform clinicians, patients, and health-care policy makers about strategies of survivorship care for cured cancer patients and consequences impacting patient lives, spurring public health authorities and research organizations to implement resources to the purpose. Two identifiable, measurable, and reproducible indicators of cancer cure are presented. Cure fraction (CF) is > 60% for breast and prostate cancer patients, > 50% for colorectal cancer patients, and > 70% for patients with melanoma, Hodgkin lymphoma, and cancers of corpus uteri, testis (> 90%), and thyroid. CF was > 65% for patients diagnosed at ages 15– 44 years and 30% for those aged 65– 74 years. Time-to-cure was consistently < 1 year for thyroid and testicular cancer patients and < 10 years for patients with colorectal and cervical cancers, melanoma, and Hodgkin lymphoma. The working group agrees that the evidence allows risk stratification of cancer patients and implementation of personalized care models for timely diagnosis, as well as treatment of possible cancer relapses or related long-term complications, and preventive measures aimed at maintaining health status of cured patients. These aspects should be integrated to produce an appropriate follow-up program and survivorship care plan(s), avoiding stigma and supporting return to work, to a reproductive life, and full rehabilitation. The “right to be forgotten” law, adopted to date only in a few European countries, may contribute to these efforts for cured patients.Keywords: cancer cure, survivorship, time-to-cure, personalized care models, right to be forgotten

Germ cell tumors arise in childhood but peak at around 30 years of age. They are the most common cancers in males under the age of 35. Over 95% arise in the testes while a minority originate in extragonadal sites such as the anterior mediastinum, or mainly in childhood the pineal gland or the sacrococcygeal area. These tumors show an extraordinary sensitivity to chemotherapy (and for seminoma, also to radiation) and cure rates are relatively high even in second or subsequent relapses. Very few data are present in the literature regarding patients diagnosed after 50 years and no specific trials have been conducted in this setting. Nearly all patients reported in the literature had testicular cancers, with occasional reports of extragonadal tumors. Despite the fact that > 50 years may be considered an “elderly” population, these patients are treated with the same cisplatin containing combinations as their younger counterparts with consequent higher toxicity. In this review we will present epidemiological and clinical data from this rare population of patients with testicular cancer.

Purpose AIOM guidelines aimed to provide evidence-based answers to practical questions concerning the effects of PA on the health demands of long-term cancer survivors. If regular PA should be recommended to these patients, the best proposal of PA, the recommendation of PA in lung cancer survivors and the safety of the prescription was investigated. Methods A systematic search was conduct on PUBMED and Cochrane database for meta- analyses, systemic reviews and primary studies (later updated 01/25/2019). The study selection criteria were population (long-term cancer survivors and non-metastatic off-therapy cancer survivors), PA intervention (aerobic exercise, resistance exercise and/or a combination of both, exercise of mild, moderate and vigorous intensity) and outcomes (overall mortality, cancer-speci c mortality, disease recovery, quality of life, “fatigue”, physical tness, reduction of treatment sequelae). The question on lung cancer survivors was studied with a dedicated research, updated on 01/23/2019 on MEDLINE/EMBASE/Central. Results In reviewing 32 report comprising large epidemiological trials, meta-analyses, systemic reviews, guidelines, randomized controlled trials with a total of several thousand study participants, we found that the PA brings important health bene ts for long-term cancer survivors. The Panel provides a strong recommendation to regular exercise at the same “dose” as the general population or adapted to comorbidities or cancer sequelae. Also recommends that all patients undergo a “multidimensional” assessment prior to PA prescription. The lack of speci c evidences in literature motivated the weak positive indication to PA in lung cancer survivors. Conclusions PA improves signi cantly the quality of life, depression, anxiety, “fatigue” and physical tness in long-term cancer survivors. And it is possible that it reduces the risk of overall, cancer-speci c mortality and disease recurrence. More research is needed to provide the best answers to cancer survivors' health questions: it is also hoped that clinicians, health-care professionals, people and authorities will increasingly pay attention to the needs of the long-term cancer population.

Health professionals involved in oncology care should make more efforts in developing a holistic attitude by placing the person and their needs at the center of their attention. Such an integrative approach has been the subject of in-depth studies and is currently active in Italy in a very limited number of oncology centers. On the other hand in the USA, the Society for Integrative Oncology actively collaborates with the American Society of Clinical Oncology and has developed Integrative Medicine guidelines of great scienti c strength. The program of the “Setting an Integrative Medicine Oncology Network” project aims to implement the use of integrative medicine at oncology centers in assisting people with cancer at all stages of their path in our territory. The most salient aspects of this holistic integrative medicine project in oncology are represented by nutrition, the psychological aspect, mindfulness, phytotherapy, the use of natural substances, Qi-gong, acupuncture, music therapy, physiotherapy methods (kinesis, lymphatic drainage, respiratory gymnastics, etc.), motor activity and adapted physical activity and other methods, but also by the promotion of clinical research.

Background: Thyroid metastases (TMs) are a rare entity, ranging between 0 and 24% in the autopsy series. In the assessment of the best management, the discrimination between a primary and a metastatic thyroid lesion is crucial. In this regard, fine needle aspiration cytology (FNAC) is likely to play a crucial role especially when ancillary techniques (i.e., immunocytochemistry (ICC) and molecular testing) are carried out. Methods: We searched for all the TMs diagnosed using FNAC and analyzed between 2014 and 2023. The cases were processed with liquid-based (LBC) and ICC and molecular testing performed on LBC-stored material. Results: We reported 2.2% (19 cases) of TMs out of 1022 malignancies. TMs included: 1 larynx carcinoma (LX-Ca), 1 melanoma, 2 breast carcinomas (B-Ca), 3 lung carcinomas (LG-Ca), 4 gastro-intestinal carcinomas (GI-Ca), and 8 clear cell renal carcinomas (CCRC). All patients had a previous cancer history, between 300 and 2 months from the primary cancers. The morphological features were supported by ICC, which were contributive in 100% of cases. All TMs cases were characterized by multiple thyroid nodules except the melanoma case. Four cases underwent total thyroidectomy (1 B, 1 LX, 1 melanoma, and 1 CCRC) whilst 15 TMs were treated with radio-chemotherapy. Conclusions: FNAC empowered the diagnostic workup of patients with TMs avoiding useless surgery. The low sensitivity of cytology might be reinforced by the application of ancillary techniques. We found a predominant rate of kidney metastatic carcinomas, followed by lung and breast. TMs are frequently multifocal and in a context of a systemic disease so a tailored therapy seems to be the best treatment.

Advances in scientific research and the launch of cancer prevention programs have changed the natural history of cancer. Especially, many types of cancer initially considered incurable has gradually transformed into a "chronic" disease. More recently, several epidemiological data have con rmed that some cancer patients can be considered "cured" after a certain period of time, a period that varies from tumour to tumour. Perhaps it has come the time to use this word when appropriate. Its use could have signi cant repercussions, not only from a psychological but also from a social point of view, with an extraordinary impact on the Quality of Life of each patient.

Undiagnosed interventricular anatomic variants are not usually associated with sudden death or other cardiac conditions. We present images of a sieve-like interventricular fruste septal anatomic variant that was associated with sudden death in an otherwise healthy 48-year-old man.

It is unequivocally recognized that thyroid nodules are frequently detected in the adult population and mostly characterized by benign lesions (up to 70% of them), with only 5%–15% malignant lesions. The evaluation of thyroid lesions with fine-needle aspiration cytology (FNAC) represents one of the first and most useful diagnostic tools in the definition of their nature. Despite the fact that the majority of thyroid lesions are correctly diagnosed as either benign (70%–75%) or malignant (5%–10%) entities, the remaining nodules (20%–25%) represent the “gray zone” of follicular lesions, which belong to indeterminate categories, according to the different classification systems. This indeterminate group of lesions includes both benign and malignant entities, which cannot be easily discriminate with morphology alone. In these last decades, the increasing role of molecular testings, feasibly performed on cytological material combined with the discoveries of specific genetic alterations in the field of thyroid pathology, has opened the pace to their more accurate and specific contribution on cytology. In fact, in 2015, in the revised management guidelines for patients with thyroid nodules and well-differentiated thyroid cancers (WDTCs), the American Thyroid Association (ATA) confirmed the performance of molecular testing in thyroid indeterminate cytology, and the same performance was addressed in recent update of the management of thyroid nodules in the second edition of the Bethesda system for reporting thyroid cytopathology (TBSRTC). In the current review, we discuss the role of molecular tests for the different thyroid diagnostic categories of the Bethesda system for reporting thyroid cytopathology, mostly focusing our attention on the follicular and indeterminate lesions.