International Research Journal of Oncology

Stereotactic Body Radiotherapy for Oligometastatic Cancer: Evidence, Patient Selection, and Clinical Decision-Making

S. Divya — 2026-05-29

Background: Oligometastatic disease represents an intermediate biological state between localized cancer and widely disseminated metastases. Increasing evidence suggests that aggressive local treatment directed at limited metastatic deposits may improve disease control in selected patients. Stereotactic body radiotherapy (SBRT), which delivers highly conformal ablative radiation doses over a small number of fractions, has emerged as a key modality for metastasis-directed therapy. However, important questions remain regarding optimal patient selection, integration with systemic therapy, and the strength of existing clinical evidence.

Methods: A narrative review of the current literature was performed focusing on prospective trials, randomized studies, and major clinical series evaluating SBRT in oligometastatic disease. Particular emphasis was placed on landmark trials including SABR-COMET, ORIOLE, STOMP, and studies evaluating local consolidative therapy in oligometastatic non-small cell lung cancer. Evidence relating to site-specific outcomes, treatment planning considerations, and emerging systemic therapy combinations was also examined.

Results: Prospective clinical trials have demonstrated encouraging outcomes with SBRT in carefully selected patients with limited metastatic disease. Randomized phase II studies such as SABR-COMET have reported improvements in overall survival and progression-free survival when ablative radiotherapy is delivered to all metastatic sites. In oligometastatic prostate cancer, metastasis-directed therapy has been shown to delay disease progression and postpone initiation of systemic treatment. Similar benefits have been observed in selected patients with oligometastatic non-small cell lung cancer receiving local consolidative therapy after systemic treatment. Nevertheless, the available evidence remains heterogeneous, and most trials are limited by small sample sizes and varying definitions of oligometastatic disease.

Conclusions: SBRT represents an important component of the evolving management of oligometastatic cancer. While early clinical trials support its use in carefully selected patients, optimal patient selection, treatment sequencing, and integration with modern systemic therapies remain active areas of investigation. Ongoing randomized trials and translational research are expected to further clarify the role of SBRT within multimodality treatment strategies for metastatic cancer.

An Overview on Oral Cancer: Global and Myanmar Perspectives

Myo Khin — 2026-06-04

Oral cancer remains a critical global health challenge, with rising trends, particularly in South and Southeast Asia. In Myanmar, the disease represents a significant public health crisis, consistently ranking among the top ten causes of morbidity and mortality. Epidemiological data shows that oral cancer is the 3^rd leading malignancy in males and 8^th in females. Epidemiological studies identified betel quid chewing, tobacco use, and alcohol consumption as the primary risk factors driving high mortality rates, particularly among men. In Myanmar, the habit of betel quid chewing daily had been reported among 51.4% of adult males and 39% of females. The quid—typically a mixture of areca nut (a Group 1 carcinogen), tobacco, and slaked lime—causes chronic mucosal damage and fibrosis. Because many users keep the quid in their cheek for extended periods, the buccal mucosa is the most frequent subsite for malignancy, accounting for 62% of cases. Squamous cell carcinomas constitute the majority of these malignancies, which are typically aggressive and associated with poor prognosis. Although the oral cavity is easily accessible for screening, most cases in Myanmar are diagnosed at advanced stages due to limited public awareness and late-stage hospital presentations. This is particularly tragic as early detection can increase survival rates from approximately 20% to over 80%. To address this, research in Myanmar has validated modified oral brush biopsy techniques as cost-effective screening tools with reasonable sensitivity (80%) for detecting early epithelial dysplasia. In conclusion, while oral cancer is largely preventable in Myanmar, improving survival rates requires a significant shift in public health education and early detection infrastructure. A multifaceted public health approach focusing on primary prevention to stop habit initiation among adolescents and secondary prevention through regular visual screenings for high-risk adults. Without addressing the social acceptance of betel quid and improving early diagnostic infrastructure, oral cancer will remain a leading preventable cause of death.

Cervical Cancer Control in Cameroon: Examining Health System Constraints and Missed Opportunities for Prevention Through a Systematic Review

Ambroise Ntama — 2026-06-01

Cervical cancer remains one of the most preventable yet still highly lethal malignancies among women in low- and middle-income countries, particularly in sub-Saharan Africa. In Cameroon, despite the availability of effective preventive tools such as human papillomavirus vaccination, screening for precancerous lesions, and curative treatment for early disease, many women continue to present with advanced cervical cancer. This systematic review aimed to synthesize available evidence on the epidemiology, risk factors, clinical presentation, prevention gaps, treatment barriers, and health system constraints affecting cervical cancer control in Cameroon. A structured literature search was conducted in PubMed/MEDLINE, Scopus, African Journals Online, and Google Scholar for publications issued between January 2010 and March 2025. Eligible studies included peer-reviewed articles reporting epidemiological, clinical, virological, therapeutic, or health system data related to cervical cancer in Cameroon, with contextual evidence from comparable sub-Saharan African settings when national data were limited. Thirty-five studies were included in the qualitative synthesis. The evidence showed that cervical cancer in Cameroon is commonly diagnosed among women aged 45–55 years, with most patients presenting at FIGO stage III or IV. Squamous cell carcinoma was the predominant histological subtype, and persistent infection with high-risk HPV, particularly types 16 and 18, remained the principal etiological factor. Major barriers to effective control included low screening coverage, insufficient HPV vaccination uptake, limited public awareness, delayed diagnosis, inadequate pathology and radiotherapy capacity, concentration of oncology services in major urban centers, and high out-of-pocket costs. These constraints contribute to treatment delay, interruption, abandonment, and poor survival outcomes. Strengthening HPV vaccination, implementing organized screening, decentralizing diagnostic and oncology services, improving referral pathways, and reducing financial barriers are essential to reduce preventable cervical cancer mortality in Cameroon.

Diagnostic Accuracy of Radiomics and Deep Learning for Differentiating Pseudoprogression from True Tumour Recurrence in Glioblastoma: A Systematic Review and Meta-analysis

Isabela Sacco Camara — 2026-06-04

Background: Glioblastoma is an aggressive primary brain tumour with poor survival outcomes, where distinguishing true tumour recurrence from treatment-related pseudoprogression on post-therapy MRI remains a major clinical challenge.

Aims: The primary objective of this study was to evaluate and synthesise the diagnostic accuracy of artificial intelligence models, specifically Radiomics and Deep Learning, in differentiating pseudoprogression from true tumour recurrence in glioblastoma patients following standard treatment.

Study Design: Systematic review and meta-analysis of diagnostic test accuracy.

Methodology: Following PRISMA 2020 guidelines, we identified 10 original studies involving a total cohort of 1,102 subjects (552 in the experimental recurrence group and 550 in the pseudoprogression control group). Technical performance was assessed across three outcomes: global accuracy (Area Under the Curve), clinical performance (Sensitivity and Specificity), and diagnostic efficiency (Diagnostic Odds Ratio). Quantitative synthesis was performed using a random-effects model based on the DerSimonian-Laird method to account for clinical and technical heterogeneity.

Results: The analysis of global accuracy demonstrated absolute diagnostic stability with a pooled Area Under the Curve (AUC) of 0.86 (95% Confidence Interval: 0.82 to 0.90) and null heterogeneity (I-squared = 0.0%, P = 1.0000). While clinical performance showed significant dispersion (I-squared = 98.0%, P < .0001), diagnostic efficiency was highly significant, yielding a pooled standardised mean difference of 8.18 (95% Confidence Interval: 6.03 to 10.32; P < .0001). Deep Learning models, particularly those incorporating multimodal pre- and postoperative imaging, exhibited superior specificity (up to 94%) compared to traditional radiomics.

Conclusion: Artificial intelligence models provide robust and consistent diagnostic performance in differentiating glioblastoma recurrence from pseudoprogression. The high Diagnostic Odds Ratio supports the integration of these computational tools into clinical workflows to assist in treatment decisions and mitigate unnecessary surgical interventions.

Pleural Ewing’s Sarcoma in Young Women: A Report of Two Cases with Review of the Literature

Mehdi Alem — 2026-06-04

Background: Ewing's sarcoma (ES) arising from the pleura is an exceedingly rare entity, accounting for fewer than 2% of all ES cases. Its rarity and non-specific clinical presentation frequently result in diagnostic delays and therapeutic challenges.

Presentation of Cases: We report two young Moroccan female patients with histologically confirmed pleural ES managed at our institution. The first, a 25-year-old woman, presented with a large locally advanced left pleural ES and received six cycles of VIDE (vincristine, ifosfamide, doxorubicin, etoposide) neoadjuvant chemotherapy, achieving an initial response followed by metastatic progression requiring second-line gemcitabine-docetaxel. The second, an 18-year-old woman, presented with a locally advanced right latero-thoracic soft-tissue ES with pleural involvement and was treated with three cycles of VDC-IE (vincristine, doxorubicin, cyclophosphamide alternating with ifosfamide and etoposide), achieving a 73% partial response; surgical resection was declined and she was referred for consolidative radiotherapy.

Discussion: Pleural ES is an aggressive malignancy requiring multidisciplinary management. Immunohistochemical confirmation (CD99 positivity) and cytogenetic analysis are essential for diagnosis. Multimodal treatment including chemotherapy, surgery, and radiotherapy remains the cornerstone of management.

Conclusion: Our cases highlight the rarity of this tumor, the importance of early diagnosis, and the significant therapeutic challenges posed by locally advanced disease in resource-limited settings.

Malignant Vulvar Glomus Tumor Mimicking a Small Round Cell Sarcoma: A Diagnostic and Therapeutic Challenges

Mehdi Alem — 2026-06-05

Background: Malignant glomus tumors are rare neoplasms, and vulvar involvement is exceptionally uncommon, creating significant diagnostic challenges.

Aims: This case study reports an exceptional case of malignant glomus tumor of the vulva presenting with small round cell morphology, and to discuss the diagnostic and therapeutic challenges of this rare entity.

Presentation of Case: A 57-year-old postmenopausal woman presented with a progressively enlarging mass of the right mons pubis extending to the upper right labia majora. Initial histopathology on the excision specimen suggested a poorly differentiated granulosa cell tumour. Following local recurrence, a re-biopsy was performed and an extended immunohistochemical panel was applied: CD99 positivity, diffuse vimentin positivity, focal pan-cytokeratin expression, and low desmin expression were identified, while calretinin, inhibin, synaptophysin, chromogranin, CD56, and CD45 were negative. Molecular studies excluded EWSR1 and SS18 gene rearrangements and FOXL2 mutation. After expert multidisciplinary pathological review integrating morphology, immunoprofile, and molecular exclusion of differential diagnoses, the diagnosis of malignant glomus tumour was established. The patient received six cycles of doxorubicin and ifosfamide-based chemotherapy (MAI protocol, every 21 days), achieving marked radiologic regression including resolution of pulmonary micronodules. Surgical resection of the tumour bed showed no residual viable tumour.

Discussion: Malignant glomus tumors are rare mesenchymal neoplasms representing fewer than 1% of soft tissue sarcomas. Vulvar localization is exceptionally uncommon and may pose significant diagnostic challenges, particularly when histology demonstrates small round cell morphology mimicking other high-grade sarcomas. Accurate diagnosis relies on integrated histopathological, immunohistochemical, and molecular evaluation.

Conclusion: This case underscores the diagnostic complexity of extra-digital glomus tumors and highlights the importance of molecular testing and multidisciplinary management in rare vulvar mesenchymal neoplasms. Sarcoma-based chemotherapy may provide meaningful response in selected cases.