Haldule, Saloni

Colorectal cancer (CRC) is responsible for a high cancer burden and a high number of deaths all over the world, although effective screening can make it preventable to a significant extent. Stool-based tests, such as the fecal immunochemical test (FIT) and multitarget stool DNA (mt-sDNA) testing, are gaining considerable popularity as non-invasive procedures that can be a replacement for colonoscopies for people at an average risk for colon cancer. Despite evidence from several randomized controlled trials supporting the use of these tests for colorectal cancer screening, their external validity in a real-world setting is influenced by many factors such as adherence, timely follow-up post testing, the healthcare cost burden, accessibility and the capacity of the health system. In this article, we have performed an extensive narrative literature review of research published between 2020 and 2025 comparing FIT and the mt-sDNA test with reference to diagnostic accuracy, cost-effectiveness, adherence and outcomes of implementation. We discuss the issues of sensitivity and specificity, look at post-test requirements for colonoscopy and check if there is any discrimination in healthcare. These findings suggest that FIT and mt-sDNA tests should not be considered competing technologies but rather complementary screening methods, with their overall effectiveness contingent upon appropriate patient selection and widespread system-level implementation. It is crucial to combine strategic test selection with a robust follow-up infrastructure to ensure that the entire population benefits from the CRC prevention program.

e24087 Background: Radiotherapy-induced nausea and vomiting (RINV) negatively impacts adherence and quality of life. Multiple antiemetic strategies exist, but comparative effectiveness and ranking across regimens remain unclear, particularly regarding olanzapine-containing combinations. Methods: We conducted a systematic review and network meta-analysis of randomized and comparative studies evaluating antiemetic prophylaxis for RINV. Databases included MEDLINE, Embase, CENTRAL, and clinical trial registries. Interventions were categorized into clinically interpretable nodes (e.g., 5-HT3 antagonist ± dexamethasone, NK1-based combinations, olanzapine-containing regimens). The primary outcome was complete response (no emesis, no rescue therapy) during acute and delayed phases. Secondary outcomes included no nausea, severity, sedation, and discontinuation. Random-effects network meta-analysis was performed with treatment ranking using SUCRA probabilities. Results: Twenty-two studies encompassing 3,145 patients were included. Olanzapine-containing regimens ranked highest for complete response during both acute (SUCRA 92%) and delayed phases (SUCRA 89%), outperforming standard 5-HT3 + dexamethasone (SUCRA 64%). NK1-based triple therapy showed intermediate efficacy (SUCRA 78%). Olanzapine regimens had modest increases in sedation (RR 1.14, 95% CI 1.01–1.29) but no significant differences in discontinuation rates. Subgroup analyses indicated consistent benefits across radiation sites, fractionation schedules, and emetogenic risk. Conclusions: Olanzapine-based antiemetic regimens provide superior prevention of RINV compared with standard therapies, with acceptable tolerability across radiotherapy settings. Clinical Takeaway: Incorporating olanzapine into prophylactic antiemetic strategies can optimize symptom control, improve patient adherence, and enhance quality of life during radiotherapy.

e22007 Background: Long-term neurocognitive impairment is a major source of disability in survivors of pediatric CNS tumors. Proton radiotherapy may reduce dose to developing brain structures, potentially preserving cognition compared with conventional photon therapy. Methods: We performed a systematic review and meta-analysis of MEDLINE, Embase, PsycINFO, and CENTRAL. Eligible studies included pediatric CNS tumor patients treated with proton or photon radiotherapy reporting neurocognitive outcomes (full-scale IQ, attention, processing speed, executive function) over time. Standardized mean differences (SMD) were pooled using random-effects models, and slope analyses assessed longitudinal IQ change. Subgroups included age at radiotherapy, craniospinal vs focal fields, tumor type, chemotherapy exposure, and follow-up duration. Certainty of evidence was graded using GRADE. Results: Eleven studies encompassing 624 patients were included. Proton therapy was associated with significantly less decline in full-scale IQ compared with photon therapy (SMD 0.43, 95% CI 0.21–0.65, p < 0.001). Domain-specific analyses showed preservation of attention (SMD 0.36, 95% CI 0.10–0.61) and processing speed (SMD 0.41, 95% CI 0.18–0.64). Longitudinal slope analysis indicated an average IQ decline of 0.7 points/year after proton therapy versus 2.4 points/year after photon therapy. Benefits were greatest in younger children (<8 years) and those receiving craniospinal irradiation. Attrition and missing data were similar across groups. Conclusions: Proton radiotherapy in pediatric CNS tumors is associated with clinically meaningful preservation of neurocognitive function compared with photon therapy, particularly in younger patients and those receiving extensive fields. Clinical Takeaway: When available, proton therapy should be considered for children at high risk of cognitive decline to optimize long-term functional outcomes.

e19116 Background: PET/CT is the primary end-of-treatment (EOT) evaluation for diffuse large B-cell lymphoma (DLBCL); yet, false positives and insufficient prognostic clarity continue to be significant problems. Circulating tumor DNA (ctDNA)-based minimum residual disease (MRD) provides a tumor-informed, noninvasive way to assess recurrence risk. Methods: We used the MEDLINE, Embase, CENTRAL, and Web of Science databases to perform a systematic review and meta-analysis in accordance with PRISMA 2020 guidelines. DLBCL cohorts with end-of-treatment ctDNA-MRD status and survival outcomes were considered eligible research. The key outcome measures were progression-free survival (PFS) and overall survival (OS). Random-effects models calculated hazard ratios (HRs) and measured heterogeneity using I². Results: Eleven trials with 1,247 participants were included. Individuals with ctDNA-MRD had significantly worse progression-free survival (PFS) (pooled HR 5.48, 95% CI 3.96-7.58; I² = 42%) and overall survival (OS) (pooled HR 4.21, 95% CI 2.71-6.54; I² = 36%) compared to those without MRD. In MRD-positive patients, the 24-month recurrence rate was 68% compared to 14% in MRD-negative patients (absolute difference 54%, p < 0.001), with ctDNA indicating return 4.2 months before clinical advancement. In studies reporting combined PET/CT, ctDNA-MRD showed superior predictive performance, with a higher positive predictive value (79% vs 41%) and negative predictive value (92% vs 78%) compared to PET positivity. Conclusions: End-of-treatment ctDNA-MRD is a strong predictor of DLBCL recurrence and survival, outperforming PET/CT for risk classification. Integrating ctDNA-MRD into post-therapy assessments may allow for early intervention and reduce the number of unnecessary biopsies. Clinical Takeaway: ctDNA-MRD at EOT identifies high-risk DLBCL patients missed by imaging and supports precision-guided post-remission management.

e19092 Background: Advances in immunochemotherapy and cellular treatment have improved outcomes for diffuse large B-cell lymphoma (DLBCL), but the population-level effect and equity of benefit are unclear. Understanding mortality trends and inequality is critical to developing targeted medicines. Methods: We used ICD-10 codes to assess DLBCL mortality from the CDC WONDER Multiple Causes of Death data (1999-2023). The age-adjusted mortality rates (AAMR) per 100,000 were calculated using the 2000 US standard population. Trends were assessed using Joinpoint regression to calculate annual percent change (APC) and average annual percent change (AAPC). Mortality was broken out by gender, race/ethnicity, age group, US Census area, and urban-rural categorization. Results: From 1999 to 2023, the national AAMR for DLBCL decreased from 3.8 to 2.5 per 100,000 (AAPC -2.1%) (p < 0.001). Non-Hispanic White patients saw the greatest decline (AAPC -2.5%), followed by non-Hispanic Black patients (AAPC -1.2%), resulting in increasing racial inequalities (rate ratio Black:White 1.35 in 2023 vs. 1.18 in 1999). Urban areas had much larger mortality decreases than rural areas (AAPC −2.3% versus −1.1%). Regional disparities were clear, with rates typically higher in the Southeast and Midwest. Inflection points were identified in 2006 and 2012, coinciding with widespread use of rituximab-based therapy and better availability of second-line medications. Conclusions: Although DLBCL mortality has decreased throughout the US over the last two decades, progress has been patchy, with significant racial and regional differences. Clinical Takeaway: Targeted interventions addressing access to therapy and early detection in high-risk populations are needed to close persistent DLBCL outcome gaps.

e19090 Background: PET/CT remains crucial for end-of-treatment (EOT) evaluation in large B-cell lymphoma (LBCL), but low specificity results in unnecessary biopsies and patient discomfort. Circulating tumor DNA (ctDNA)-based minimum residual illness (MRD) may aid in the identification of actual residual sickness. Methods: We conducted a systematic review and meta-analysis of diagnostic accuracy using MEDLINE, Embase, CENTRAL, and Scopus. Eligible studies compared EOT ctDNA-MRD to PET/CT with verified recurrence or long-term remission. The outcomes were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The study's quality was rated using the QUADAS-2 scale. A bivariate random-effects model combined sensitivity and specificity, yielding hierarchical summary receiver operating characteristic (HSROC) curves. Results: Nine studies with a total of 932 participants were included. ctDNA-MRD showed higher specificity (92%, 95% CI 88-95%) and PPV (81%, 95% CI 73-88%) than PET/CT (specificity 68%, 95% CI 60-75%; PPV 46%, 95% CI 38-55%), while maintaining similar sensitivity. The negative predictive value for ctDNA was higher (91%, 95% CI 86-95%) than for PET (79%, 95% CI 72-85%). Combined PET+ctDNA techniques had the highest diagnostic odds ratio and fewer false positives. The results were similar across Deauville criteria and testing systems. Conclusions: ctDNA-MRD has higher specificity and predictive value than PET/CT at EOT in LBCL and significantly improves risk categorization whether used alone or in conjunction with imaging. Clinical Takeaway: Incorporating ctDNA-MRD into EOT assessment can reduce unnecessary biopsies and enable more accurate, confidence-based post-treatment decision-making.

Abstract Objectives The lack of uniform terminology and abbreviations for anti-synthetase syndrome has led to significant challenges in research and clinical practice. This study aimed to establish an international consensus on a standardized nomenclature and abbreviation among a diverse group of global myositis experts and patient representatives. Methods This qualitative project was approved by the International Myositis Assessment and Clinical Studies Group (IMACS). Based on the outcomes of a literature review and preliminary survey, list of terms for nomenclature and abbreviations was finalized. Subsequently, two rounds of the Delphi survey were conducted among myositis experts and patient participants to ascertain current practices and preferences. Using Nominal Group Technique (NGT), the project steering committee developed a consensus nomenclature and abbreviation. Results A total of 241 and 132 myositis experts from six continents, 35 countries and 9 specialities participated in round 1 and round 2 of the Delphi survey, respectively. The results indicated a preference for the terms anti-synthetase syndrome, antisynthetase syndrome and anti-tRNA synthetase syndrome. The abbreviations ASS, ASyS and ASSD were most used, though ASS received notable disapproval. The steering committee, including twenty-five myositis experts and three patient representatives from diverse backgrounds and geographical locations, reached a consensus on ‘anti-synthetase syndrome’ as the preferred nomenclature and ASyS as the preferred abbreviation, with 100% and 93.1% votes, respectively. Conclusion The terms anti-synthetase syndrome and ASyS should be adopted as the standard nomenclature and abbreviation in both research and clinical practice. This standardization is expected to increase consistency within the literature.