Open Access

Simple Summary In Molecular Tumor Boards (MTBs), clinicians and researchers discuss the biology of tumor samples from individual patients to find suitable therapies. MTBs have therefore become key elements of precision oncology programs. Patients living in urban areas with specialized medical centers can easily access MTBs. Dedicated efforts are necessary to also grant equal access for patients from rural areas. To address this challenge, the four German cancer centers in Würzburg, Erlangen, Regensburg and Augsburg collectively measured the regional efficacy of their MTBs. By jointly analyzing the residences of all MTB patients, we uncovered regional differences in our mostly rural catchment area. Mapping and further understanding these local differences—especially the underrepresented white spots—will help resolving inequalities in patient access to precision oncology. Our study represents a hands-on approach to assessing the regional efficacy of a precision oncology program. Moreover, this approach is transferable to other regions and clinical applications. Abstract (1) Background: molecular tumor boards (MTBs) are crucial instruments for discussing and allocating targeted therapies to suitable cancer patients based on genetic findings. Currently, limited evidence is available regarding the regional impact and the outreach component of MTBs; (2) Methods: we analyzed MTB patient data from four neighboring Bavarian tertiary care oncology centers in Würzburg, Erlangen, Regensburg, and Augsburg, together constituting the WERA Alliance. Absolute patient numbers and regional distribution across the WERA-wide catchment area were weighted with local population densities; (3) Results: the highest MTB patient numbers were found close to the four cancer centers. However, peaks in absolute patient numbers were also detected in more distant and rural areas. Moreover, weighting absolute numbers with local population density allowed for identifying so-called white spots—regions within our catchment that were relatively underrepresented in WERA MTBs; (4) Conclusions: investigating patient data from four neighboring cancer centers, we comprehensively assessed the regional impact of our MTBs. The results confirmed the success of existing collaborative structures with our regional partners. Additionally, our results help identifying potential white spots in providing precision oncology and help establishing a joint WERA-wide outreach strategy.

Background Melanoma is the main cause of skin cancer-related death. Treatment with immune checkpoint inhibitors (CPI) has improved the prognosis in recent years. However, subtypes of melanoma differ in their response. Acral lentiginous melanoma (ALM) has a worse prognosis compared to cutaneous melanoma other than ALM (CM) and is therefore of particular relevance. Aims To evaluate the efficacy of CPI in first-line treatment of patients with advanced ALM compared CM. Methods Retrospective analysis of patients with metastatic ALM (n = 45) or CM (n = 328) who received first-line CPI therapy from the multicenter prospective skin cancer registry ADOREG. Study endpoints were best overall response (BOR), progression-free survival (PFS) and overall survival (OS). Results ALM patients had significantly higher rates of ulcerated tumors, loco regional metastases and fewer BRAF-mutated tumors compared to CM patients. Combined CPI was administered in 48.9 % ALM patients and 39.3 % of CM patients, while the remaining patients received PD-1 monotherapy. OS trended to be shorter in patients with ALM (18.1 vs. 43.8 months, p = 0.10) with no significant differences in PFS (7.0 vs. 11.5 months, p = 0.21). In patients with CM, median OS with combined CPI was not reached, whereas the median OS after PD-1 monotherapy was 37.8 months (p = 0.22). Conversely, in patients with ALM, OS with combined CPI was 17.8 months, compared to 26 months with PD-1 monotherapy (p = 0.15). There were no significant differences in BOR between patients with ALM or CM. Conclusion Analysis of this real-world cohort of patients with metastatic melanoma showed a trend towards poorer survival outcomes upon first-line treatment with CPI in ALM compared to cutaneous melanoma of other subtypes.

BACKGROUND AND OBJECTIVES: Intracranial infection in children is a rare but life-threatening condition that requires immediate neurosurgical care. The impact of the COVID-19 pandemic on incidence and outcome is unclear. METHODS: This study is a multicenter retrospective analysis of children who underwent neurosurgical treatment of intracranial infections (epidural abscess, subdural empyema, cerebral abscess, ventriculitis, and meningitis) between January 2014 and October 2024. Comparison of children with intracranial infections and neurosurgical intervention stratified by pre and postpandemic. RESULTS: The annual incidence of pediatric intracranial infections requiring neurosurgery increased significantly from 5.6 cases (95% CI: 4.0-7.5) prepandemic to 14.4 cases (95% CI: 11.2-18.0) postpandemic, with an incidence risk ratio (IRR) of 2.6 (95% CI: 1.8-3.8; P < .0001). Causative were the observed sinusitis-associated cases, with absolute numbers rising from 13 prepandemic to 31 postpandemic. The annual incidence increased from 1.81 cases (95% CI: 0.99-2.97) to 6.45 cases (95% CI: 4.44-9.00), yielding an IRR of 3.6 (95% CI: 1.9-7.1; P = .0001). For otitis-related cases, absolute counts surged from 6 to 19, accompanied by an incidence increase from 0.83 (95% CI: 0.33-1.69) to 3.95 (95% CI: 2.43-6.01), with an IRR of 4.7 (95% CI: 2.0-13.0; P = .0009). However, functional outcomes assessed by the pediatric modified Rankin Scale showed no statistically significant differences between pre- and postpandemic cohorts in the Wilcoxon-Mann-Whitney test, both at discharge (P = .388) and at 3-month follow-up (P = .927). CONCLUSION: Our study demonstrates a significant increase in the incidence of intracranial infections requiring neurosurgical treatment in children after the pandemic, with a 2.4-fold higher IRR compared with the prepandemic period. The postpandemic group had a significantly higher incidence of underlying complicated otitis and sinusitis.