Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Journal of robotic surgery
A focused systematic review and meta-analysis of robot-assisted inguinal lymphadenectomy versus open inguinal lymph node dissection in penile cancer
This focused systematic review and meta-analysis evaluated robot-assisted inguinal lymphadenectomy (RAIL) versus open inguinal lymph node dissection (OILND) in penile cancer, aiming to provide robot-specific comparative estimates rather than a broad minimally invasive synthesis. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched through December 2025 for comparative studies. All meta-analyses were conducted using STATA 18, employing random-effects modeling. Binary outcomes were summarized using odds ratios (ORs), and continuous outcomes were presented as weighted mean differences (WMDs), with all estimates accompanied by 95% confidence intervals (CIs). Risk of bias in the included non-randomized comparative studies was assessed using the ROBINS-I tool. Four retrospective comparative studies involving 276 patients were included, and no randomized controlled trials were identified. A lower odds of total postoperative complications was observed with RAIL (OR = 0.52, 95% CI: 0.27, 0.97; P = 0.047), but this borderline finding should be interpreted cautiously given the small number of retrospective studies and potential residual confounding. Across individual studies, operative time generally tended to be longer with RAIL, whereas findings for estimated blood loss and drainage-related outcomes were inconsistent. Lymph node yield, skin-related complications, minor complications, and groins with positive nodes did not differ significantly between approaches. According to the GRADE assessment, the certainty of evidence was low for most pooled outcomes and very low for skin-related complications and lower-limb edema/lymphedema. RAIL may be associated with lower overall postoperative complications than open surgery, but the evidence remains low certainty and insufficient to establish a definitive morbidity-reduction benefit. In addition, several continuous perioperative variables showed extreme between-study heterogeneity and were not clinically interpretable as reliable pooled effects.
22 June 2026
Read appraisal →Biomedical physics & engineering express
RADIANT: A fully configurable radiotherapy dose prediction framework
Objective.Treatment planning is a multi-disciplinary effort that requires medical decision-making, specialized training, and access to specialized software. Recently, deep learning has arisen as a powerful method for predicting patient-specific dose distributions. This work presents the radiotherapy dose inference and analysis toolkit (RADIANT), an open-source, fully configurable framework for 3D radiotherapy dose prediction. Built upon the Medical Imaging Segmentation Toolkit, RADIANT supports diverse network architectures, loss functions, and training strategies.Approach.We demonstrate its capabilities on cervical and prostate treatment plans generated with the radiation planning assistant, and on head and neck cancer plans from the American Association of Physicists in Medicine OpenKBP challenge data. For cervical cancer, we trained and compared nnU-Net, FMG-Net, W-Net, ddU-Net, and Swin UNETR using clinical metrics such as dose score, homogeneity index, and percent errors inD95,D98, andD99. Benchmarking was also performed on the OpenKBP dataset using dose score and dose-volume histogram (DVH) score for comparison with top challenge submissions.Results.Our results indicate that RADIANT provides a scalable platform for the rapid development and benchmarking of dose prediction models for selected cancer sites (cervix, prostate, head and neck). For cervical cancer, the best configuration (nnU-Net architecture, mean absolute error loss, cosine learning rate scheduler) achieved a dose score of 1.31 and sub-1%errors inD95andD98on the training set, and a dose score of 1.20 on the test set. The same configuration performed best on prostate data with a dose score of 1.96 on a test set. On the head and neck OpenKBP data, RADIANT achieved a dose score of 2.702 and a DVH score of 1.495, competitive with top challenge results.Significance.This work provides an open-source, fully configurable framework for deep learning-based dose prediction. RADIANT facilitates reproducible experimentation across data preprocessing, model configuration, training, and evaluation for multiple cancer sites and anatomical structures.
30 May 2026
Read appraisal →Clinical cancer research : an official journal of the American Association for Cancer Research
Neoadjuvant Nivolumab with or without Ipilimumab for Cisplatin-Ineligible Patients with Muscle-Invasive Bladder Cancer
PURPOSE: Many patients with muscle-invasive bladder cancer (MIBC) are ineligible for cisplatin-based therapy. We conducted a phase II trial of neoadjuvant nivolumab ± ipilimumab for cisplatin-ineligible patients. PATIENTS AND METHODS: Patients with MIBC were enrolled in two consecutive cohorts: (i) nivolumab alone and (ii) ipilimumab/nivolumab. A third cohort with alternative dosing was planned. The primary endpoint was eligibility for cystectomy ≤60 days after last treatment. Correlative analyses were performed, with the PURE-01 trial used as an independent dataset. RESULTS: Fifteen patients enrolled onto each cohort. In cohorts 1 and 2, 12 of 15 and eight of 15 were eligible for cystectomy within 60 days, respectively. Due to cohort 2's failure to meet the primary endpoint, cohort 3 was not initiated. With nivolumab alone, four patients achieved <ypT2ypN0 (26%), with two pathologic complete responses (pCR; 13%). With ipilimumab/nivolumab, three achieved <ypT2ypN0 (20%), with one pCR (7%). One patient after nivolumab and two after ipilimumab/nivolumab had durable clinical complete responses (CR) without cystectomy. Twelve-month recurrence-free survival (RFS) was 79% with nivolumab [95% confidence interval (CI), 61-100] and 61% with ipilimumab/nivolumab (95% CI, 39-95). Sequencing analyses suggest that NCOR1 alterations may be associated with improved clinical outcomes. Gene expression profiling indicated a potential association between tumor-infiltrating immune cells and longer RFS (log-rank P = 0.18); this was also observed in PURE-01 (P = 0.022). CONCLUSIONS: Among cisplatin-ineligible patients with MIBC, nivolumab alone was well tolerated. Ipilimumab/nivolumab caused toxicity that delayed cystectomy. Cases of progression before cystectomy indicated insufficient efficacy of pure neoadjuvant immunotherapy for unselected patients. Despite low response rates, some patients experienced sustained clinical CR without cystectomy.
16 Apr 2026
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