OncoReview

Immune checkpoint inhibitor-associated myocarditis: current insights into pathogenesis, diagnosis, and treatment

2026-06-16T15:50:00+02:00

Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy by enhancing T-cell-mediated antitumor immunity through blockade of cytotoxic T-lymphocyte-associated antigen 4 and programmed cell death protein 1 pathways. Despite their clinical efficacy across multiple solid tumors and select hematologic malignancies, ICIs can disrupt peripheral immune tolerance, triggering immune-related adverse events, among which myocarditis is rare but potentially fatal. Immune checkpoint inhibitor-associated myocarditis (ICI-M) typically emerges early after therapy initiation and is characterized by dense myocardial infiltration of activated T lymphocytes, particularly clonally expanded CD8+ cells. Mechanisms involve autoreactive responses against cardiac antigens, such as α-myosin heavy chain, and molecular mimicry with tumor or skeletal muscle proteins. Clinical presentations are highly heterogeneous, ranging from isolated biomarker elevation to fulminant myocarditis with cardiogenic shock, malignant arrhythmias, or conduction disturbances. Concomitant myositis or myasthenia gravis-like syndromes are common, reflecting shared antigenic targets. Diagnosis requires integrated evaluation using clinical assessment, cardiac biomarkers, electrocardiography, echocardiography, and cardiac magnetic resonance, with endomyocardial biopsy remaining definitive. Early recognition and prompt initiation of high-dose corticosteroids are critical to mitigate morbidity and mortality, while second-line immunosuppressive strategies are increasingly explored in refractory cases. Despite its low incidence, ICI-M carries substantial risk, underscoring the need for vigilance and multidisciplinary management.

Use of intraoperative radiotherapy as part of the combined treatment of borderline resectable locally advanced pancreatic cancer

2026-06-16T15:50:01+02:00

Cancer remains a disease with a poor prognosis, due to late diagnosis, the progression of the disease, and the need for radical treatment. The specific risks associated with marginal resection margins, where radical resection is performed, are challenging and often involve additional microscopic resection margins. The objective of the present study was to evaluate the efficacy of intraoperative radiotherapy (IORT ) as a component of multimodal cancer treatment. A 70-year-old patient with a tail tumor, classified as borderline resectable, received first-line chemotherapy according to the FOLFIRINOX regimen. This was followed by preoperative chemoradiotherapy, adjuvant therapy, and IORT . The treatment was well tolerated, with no postoperative complications related to IORT . A partial response to treatment was achieved, along with local control, thereby preventing disease progression and metastasis. The extant literature indicates that intraoperative radiotherapy may be a concomitant modality with multimodal therapy in patients with resectable cancer, particularly in cases of high-risk disease. This technique facilitates the irradiation of the tumor bed while concomitantly limiting exposure to critical risks. Whilst the benefits in terms of local control are recognized, the impact of IORT on overall survival remains unclear and requires further research.

Recurrence of an olfactory groove meningioma: clinical and radiological findings from a six-year follow-up

2026-06-16T15:50:01+02:00

Introduction and importance: Surgical resection of olfactory groove meningioma remains the cornerstone of treatment, with the goal of gross total resection (GTR) to minimize the risk of recurrence. This study details the presentation, surgical management, and long-term (six-year) follow-up of a 45-year-old female patient with large olfactory groove meningioma.

Case presentation: A 45-years female presented urinary and fecal incontinence, apathy, disinhibition, and progressive visual decline. Preoperative MRI revealed an extra-axial mass in the left frontal region measuring 4.5 × 5.7 × 5.7 cm, producing significant mass effect. The tumor was successfully resected via a bicoronal subfrontal approach, and histopathological analysis confirmed a WHO Grade I meningioma. Serial postoperative MRI and CT scans over a six-year follow-up period (2019– 2025) demonstrated marked initial tumor regression. However, a small residual lesion visible on the first postoperative scan showed gradual regrowth, culminating in a substantial recurrence by September 2025. At that time, the recurrent mass measured 5.2 × 3.4 × 4.55 cm and exhibited aggressive radiological features, including bone invasion and hyperostosis.

Clinical discussion: This case underscores the impact of residual tumor on long-term outcomes in olfactory groove meningioma’s. Although initial resection was a GTR that achieved substantial cytoreduction, the presence of postoperative residue led to delayed but progressive recurrence, including bone invasion, despite benign histology.

Conclusion: These findings highlight that recurrence risk is shaped not only by WHO grade but also by residual tumor burden and local anatomical behavior. Long-term and careful radiological follow- up is therefore essential when GTR cannot be achieved.