Background: Complex pathophysiology and high incidence of myelodysplastic syndromes (MDS) limits treatment options. Azacitidine (AZA) is the standard first-line (1L) treatment for high-risk MDS in Japan. This study evaluated treatment patterns and overall survival (OS) of patients with MDS in a real-world setting in Japan.

Materials and methods: This non-interventional, retrospective study examined patients with MDS aged ≥ 18 years between April 2008 and September 2018. The primary outcome was the proportion of patients who received MDS-related treatment regimens as 1L in main cohort. Secondary outcomes included treatment patterns from 1L to third-line (3L) in main cohort and OS in 1L-AZA cohort (patients from main cohort who had AZA as 1L receiving 7-day or 5-day AZA dosing schedule).

Results: Of 6,204 eligible patients, 1,068 comprised 1L-AZA cohort. Most patients received supportive therapies (53.2%) as 1L treatment, followed by antineoplastic agents (39.5%), with 31% receiving AZA. Approximately, 47% of patients switched to second-line (2L) treatment, while 25.3% advanced to 3L treatment. Patients in 1L-AZA cohort receiving 5-day AZA was associated with longer OS compared to 7-day AZA (median OS: 38.4 vs. 20.4 months; p < 0.001).

Conclusion: The majority of Japanese patients with MDS received supportive therapies as 1L followed by AZA. Five-day AZA treatment significantly improved OS compared with 7-day AZA.

Background: The treatment of muscle-invasive bladder cancer with chemoradiation allows preservation of the native bladder. Despite similar outcomes to cystectomy in retrospective multi-centre analyses, in practice, chemoradiation may not be discussed with suitable patients. To assess the proportion of patients suitable for both cystectomy and chemoradiation, with a documented discussion of both treatment options. The secondary aim was to assess the outcomes of metastatic disease and overall survival in chemoradiation compared to cystectomy.

Materials and methods: In this retrospective cohort study, 64 patients with metastatic muscle-invasive bladder cancer (MIBC) treated at Austin Health, Australia from January 2016 to December 2023 were identified using radiation oncology and urology databases. Patients were categorized as suitable for both treatment modalities, surgery alone, or chemoradiation alone.

Results: Totally, 22 (61%) out of 36 patients suitable for both treatment options underwent a cystectomy, of which 36% (8/22) discussed chemoradiation and 9% (2/22) were referred to a radiation oncologist. A total of 14 (39%) patients suitable for both modalities underwent chemoradiation, of which 100% had a discussion about a cystectomy. The cumulative incidence of metastatic disease at 2-year follow-up in patients undergoing surgery was 18.5% compared to 13.7% for chemoradiation. There was no statistically significant difference in overall survival between patients undergoing chemoradiation and cystectomy (HR=0.26; 95% CI: 0.04−1.94, p = 0.191).

Conclusion: A minority of patients undergoing cystectomy who were potentially suitable for chemoradiation had a documented discussion about bladder preservation treatment and only 9% saw a radiation oncologist. Given equivalent oncological outcomes, discussion of chemoradiation is supported for well-selected patients to make a fully informed decision about their treatment.

Background: Breast cancer (BC) incidence is increasing worldwide, including in Kuwait, which established a national BC screening program in 2014. This study examines overall BC screening uptake in Kuwait and its variation by socio-demographic characteristics. Material and methods: We conducted a cross-sectional study using 2014−2019 BC screening records from the Kuwait National Mammography Screening Program (KNMSP) and population data of the target female population (age 40−69). Ever-screened uptakes were calculated separately for Kuwaitis and non-Kuwaitis. The six regions were grouped into high and low population density, indirectly reflecting accessibility to screening centers. A complete-case approach was used for the analyses by socio-demographics characteristics. Screening and population counts were modeled using a generalized linear model with a negative binomial distribution, stratified by population density. Results: The BC ever-screened uptake remained very low, at 1.6% and 0.05% among Kuwaiti and non-Kuwaiti women, respectively. The complete-case analysis (using 88% of records) did not reveal strong variations by socio-demographic characteristics. Uptake was highest (3.4%) among Kuwaitis living in high-density regions, aged 40−49, ever married and with the highest education. In the same regions, this uptake decreased to 0.4% in Kuwaiti women aged 60−69, single and with the lowest education. Uptakes were even lower in low-density regions or non-Kuwaitis. Including mammogram tests performed outside the KNMSP had little impact on the overall findings.Discussion: Although socio-demographic and geographic factors were associated with differences in BC screening uptake, the proportion of screened women remained overall too low to have any public health impact at population level. This suggests that barriers extend beyond socio-demographic factors and may involve program awareness and accessibility.Conclusion: Major changes are needed in the KNMSP to reduce the burden of BC in Kuwait. Targeted interventions addressing awareness, accessibility, and cultural barriers are necessary to improve early detection and reduce BC mortality.

Background: Pancreatic schwannomas (PS) are extraordinarily rare, benign neoplasms arising from the neural sheath of Schwann cells. Due to frequent degenerative changes such as cyst formation and calcification, they often mimic other pancreatic pathologies, making preoperative diagnosis difficult.

Case Presentation: We report the case of a 64-year-old female presenting with chronic abdominal pain. Cross-sectional imaging revealed a large, peripherally enhancing cystic lesion with internal septations and calcification in the pancreatic head. Following Endoscopic Ultrasound (EUS), the patient developed secondary infection of the cyst with Klebsiella oxytoca, leading to a clinical and radiological mimicry of an infected pseudocyst. Percutaneous drainage was initially performed, followed by surgical enucleation. Histopathological analysis and S-100 protein positivity confirmed the diagnosis of a benign pancreatic schwannoma.

Conclusion: This case highlights the diagnostic complexity of cystic pancreatic schwannomas, particularly when complicated by iatrogenic infection. Accurate differentiation from mucinous cystic neoplasms and pseudocysts is critical, as it allows for organ-sparing surgery (enucleation) rather than radical resection.

Background: Managing coronavirus disease 2019 (COVID-19) in immunocompromised patients remains challenging, especially in haematological settings where B-cell-depleting therapies impair humoral immune responses. Evidence on optimal management strategies in this population continues to evolve.

Case Presentation: An unvaccinated patient with follicular lymphoma receiving rituximab maintenance therapy developed COVID-19 and was treated initially with remdesivir. The patient’s condition failed to improve and progressively worsened, necessitating intubation. As a rescue intervention, casirivimab/imdevimab was administered. This treatment was followed by viral clearance and significant clinical recovery.

Conclusion: The observed response suggests that monoclonal antibody therapy may provide meaningful therapeutic benefit in severe COVID-19 cases among immunocompromised patients, highlighting the need for tailored management strategies in this high-risk population.

Background: Anterior mediastinal yolk sac tumours (YSTs) are uncommon in children but represent a significant oncological emergency because of the compressive effects of these tumours on vital airway structures.

Case Presentation: We present a 2-year-old boy who presented with respiratory distress that was progressively worsening. Imaging showed a bulky anterior mediastinal mass compressing the trachea. The child required urgent intubation as well as paediatric intensive care. A biopsy confirmed yolk sac tumour. Once he was clinically stabilised, he began treatment with platinum-based BEP chemotherapy (bleomycin, etoposide, cisplatin) with an early good clinical and biochemical response. He was then discharged well and continues regular outpatient follow-up in oncology.

Conclusion: This case underscores the need for timely airway intervention, early histopathologic confirmation, and multidisciplinary oncologic management in children with mediastinal germ cell tumours. Furthermore, this case illustrates the importance of psychosocial support related to the psychosocial experience of an acute critical illness to the family.

Background: Neoadjuvant chemotherapy and radiotherapy are critical for improving local tumor control and survival in breast cancer treatment. However, both modalities may cause interstitial lung injury, which can affect subsequent therapy and prognosis.

Case presentation: We report a breast cancer patient who developed drug-induced interstitial pneumonia after neoadjuvant chemotherapy with doxorubicin plus cyclophosphamide followed by paclitaxel (AC-T). Respiratory symptoms and chest computed tomography (CT) findings were consistent with interstitial pneumonia. After glucocorticoid treatment, the pulmonary condition improved, allowing successful radical mastectomy. Postoperatively, the patient continued docetaxel chemotherapy followed by radiotherapy. After radiotherapy, interstitial pneumonia recurred, and chest computed tomography findings suggested radiation-induced interstitial pneumonia.

Conclusion: This case underscores the importance of recognizing and promptly managing treatment-related interstitial pneumonia during multimodal breast cancer therapy. Early intervention is essential to reduce toxicity, ensure treatment completion, and improve patient outcomes.