Five PubMed papers for August 18–25: conversion surgery for HCC, stroke head position, and IV iron before cardiac surgery

Five papers entered PubMed during the August 18, 09:00 to August 25, 09:00 (UTC-05:00) window. The ranking combines journal impact tier with an early OpenAlex cited-by snapshot retrieved on August 25. OpenAlex returned one cited-by work each for TALENTOP, HeadSOAR, and GETUG AFU 18, and zero cited-by works for ITACS and STArT at retrieval time. Because these papers are only days old, randomized design, sample size, endpoint strength, and clinical or research utility break the remaining ties. The citation counts are an early signal, not a stable leaderboard.

The five papers answer five different triage questions: whether conversion surgery after systemic response improves failure-free time in advanced hepatocellular carcinoma, whether head position after thrombectomy changes recovery, whether dose-escalated prostate radiotherapy still matters on long-term androgen deprivation therapy, whether preoperative intravenous iron moves patient-centered recovery after cardiac surgery, and whether intravenous arginine shortens sickle cell crisis resolution in children and young adults.

Journal and design. TALENTOP was an open-label, multicenter phase 3 trial at 24 hospitals in China. Treatment-naive patients with hepatocellular carcinoma, macrovascular invasion, and no extrahepatic metastasis received induction with three cycles of atezolizumab plus bevacizumab and one cycle of atezolizumab alone. Patients with partial response or stable disease by RECIST 1.1 who were judged resectable were randomized 1:1 to liver resection plus up to 12 months of postoperative atezolizumab–bevacizumab, or to maintenance atezolizumab–bevacizumab without surgery. The primary endpoint was time to treatment failure, defined as local recurrence or progression, new extrahepatic spread, or death. 6

Primary result. Of 489 patients who entered induction, 201 were randomized (101 surgery, 100 maintenance). At a median follow-up of 18.4 months, median time to treatment failure was 20.4 versus 11.8 months with surgery versus maintenance: HR 0.60 (95% CI 0.39-0.91; P=0.015). Grade 3 or 4 treatment-related adverse events occurred in 39% versus 21% of patients. Two treatment-related deaths occurred in the surgery group. 6

Why it matters. The trial supplies randomized evidence that conversion surgery can extend failure-free time after a systemic response in advanced hepatocellular carcinoma with vascular invasion, a setting where resection has often been debated case by case. The result applies only to patients who completed induction, had controlled disease, and were considered surgically feasible. The trial was open label, enrolled only in China, and is still ongoing, so later survival analyses and external validation will decide how far the strategy travels.

People and funding. First author Hui-Chuan Sun is affiliated with Zhongshan Hospital, Fudan University, Shanghai. The abstract lists funding from Shanghai Roche Pharmaceuticals and the Ministry of Science and Technology of China. ClinicalTrials.gov lists Jia Fan of Fudan University as sponsor-investigator. 6

Read the original paper on PubMed.

Journal and design. HeadSOAR was a multicenter, prospective, open-label, blinded-endpoint randomized trial at 67 comprehensive stroke centers in China. It enrolled 1,368 adults with acute ischemic stroke from anterior-circulation large-vessel occlusion who achieved successful endovascular reperfusion (expanded TICI ≥2b). Participants were assigned 1:1 to keep the head elevated at 30-40° or flat at 0-10° for 72 hours after thrombectomy. The primary outcome was the 90-day modified Rankin scale distribution. 7

Primary result. Median age was 68 years, and median baseline NIHSS was 15. The median 90-day modified Rankin score was 3 in both groups (IQR 1-5). The adjusted generalized odds ratio for a better disability outcome with head elevation was 1.12 (95% CI 0.97-1.29; P=0.14). Ninety-day all-cause mortality was 18.3% versus 20.3% (adjusted RR 0.86, 95% CI 0.69-1.07; P=0.18). 7

Why it matters. After successful reperfusion, routine 72-hour head elevation left 90-day disability scores essentially unchanged versus flat positioning. The confidence interval still leaves room for a modest effect, so head elevation can remain available for airway, aspiration, comfort, or nursing reasons. What the trial weakens is the case for treating head angle as a major recovery lever once the vessel is open. The trial was open label for the intervention itself and enrolled only in China.

People and funding. First author Zhengzhou Yuan is affiliated with the Affiliated Hospital of Southwest Medical University in Luzhou. Competing-interest disclosures list support from the National Natural Science Foundation of China, the Sichuan Provincial Health Commission, and Southwest Medical University. 7

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Journal and design. GETUG AFU 18 was a multicenter, open-label phase 3 trial at 25 centers in France. It enrolled 505 men with high-risk prostate cancer, defined as PSA ≥20 ng/mL, Gleason score ≥8, or clinical stage T3-T4. Participants were randomized to prostate-targeted external-beam radiotherapy at 80 Gy in 2 Gy fractions or 70 Gy in 2 Gy fractions, both with long-term androgen deprivation therapy. The primary endpoint was 5-year progression-free survival; 10-year progression-free survival was reported post hoc because few events had accrued by year 5. 8

Primary result. At a median follow-up of 9.5 years, 5-year progression-free survival was 91.4% versus 88.1%, and 10-year progression-free survival was 83.6% versus 72.2% with 80 Gy versus 70 Gy: stratified HR 0.56 (95% CI 0.40-0.78; P<0.0001). Acute grade 3 or worse adverse events occurred in 24% versus 25%. Late grade 3 or worse toxicities occurred in 8% versus 7%. There were no treatment-related deaths. 8

Why it matters. In high-risk disease treated with long-term androgen deprivation, a 10 Gy dose increase improved long-horizon progression-free survival without a clear late grade 3 toxicity penalty in this report. Cancer-specific and overall survival still need more events before the dose choice can be treated as settled. The trial used older fractionated external-beam techniques rather than contemporary stereotactic or highly hypofractionated regimens, so the absolute numbers should be read against current planning standards.

People and funding. First author Christophe Hennequin is affiliated with Hôpital Saint-Louis, AP-HP, and Université Paris-Cité. The abstract lists funding from the French National Cancer Institute and AstraZeneca. ClinicalTrials.gov lists UNICANCER as sponsor. 8

Read the original paper on PubMed.

Journal and design. ITACS was an international, multicentre, double-blind, placebo-controlled randomized trial at 33 hospitals in 10 countries. It enrolled 955 adults with anemia scheduled for elective cardiac surgery. Participants received 1,000 mg intravenous iron or placebo between 1 and 26 weeks before surgery. The primary outcome was days alive and at home up to 90 days after surgery. 9

Primary result. Among 921 participants assessed for the primary outcome, median days alive and at home were 81.1 versus 80.0 with iron versus placebo (adjusted median difference 1.0 day, 95.4% CI 0.0-2.1; P=0.041). In-hospital red-cell transfusion occurred in 61.1% versus 68.2% (RR 0.90, 95% CI 0.82-0.99; P=0.027). Major complications and hospital length of stay did not differ. 9

Why it matters. The trial supports preoperative intravenous iron as a blood-management tool in anemic patients facing elective cardiac surgery: fewer transfusions and a small gain in days at home. The home-days difference sits at the edge of the confidence interval, so the patient-centered benefit is modest rather than transformative. Timing ranged from 1 to 26 weeks before surgery, so programs still need local logistics for who can be treated early enough.

People and funding. First author Paul S. Myles is affiliated with Alfred Hospital and Monash University in Melbourne. Competing-interest disclosures list support from the Australian National Health and Medical Research Council and the Australian and New Zealand College of Anaesthetists. ClinicalTrials.gov lists Bayside Health as lead sponsor, with collaborators including NHMRC Australia and Monash University. 9

Read the original paper on PubMed.

Journal and design. STArT was a phase 3, double-blind randomized trial at 10 U.S. children's hospitals. It enrolled patients aged 3 to 21 years who presented to the emergency department with sickle cell disease acute pain episodes requiring parenteral opioids. Participants received intravenous arginine (200 mg/kg loading, then 100 mg/kg every 8 hours until discharge) or saline placebo. The primary outcome was time to crisis resolution, defined as hours from first study-drug dose to the last intravenous opioid dose. 10

Primary result. Of 274 randomized participants, 271 received study drug. Mean age was 14.3 years; 92% were Black. The trial was stopped early for futility. Median time to crisis resolution was 60.8 versus 65.8 hours with arginine versus placebo (absolute difference 7.2 hours, 95% CI -21.6 to 35.9). Parenteral opioid use, pain scores, patient-reported outcomes, and safety events did not differ. 10

Why it matters. Earlier single-center phase 2 signals failed to replicate in this multicenter phase 3 test. For acute vaso-occlusive pain in children and young adults, STArT leaves intravenous arginine without evidence as a crisis-shortening therapy. Other arginine formulations, chronic dosing, and adult-only populations outside the enrolled age range remain untested by this trial.

People and funding. First author Claudia R. Morris is affiliated with Emory University School of Medicine and Children's Healthcare of Atlanta. ClinicalTrials.gov lists Claudia R. Morris as sponsor-investigator, with the National Heart, Lung, and Blood Institute as a collaborator. PubMed did not list a separate grant field on the indexed record. 11

Read the original paper on PubMed.

Hepatology and surgical oncology teams should start with TALENTOP: the conversion-surgery signal is clear on time to treatment failure, while overall survival and external generalizability remain open. Stroke units can read HeadSOAR as a null positioning trial that still leaves room for bedside exceptions. Radiation oncology should open GETUG AFU 18 for the long-horizon progression-free survival gain with 80 Gy and watch for later survival updates. Cardiac anesthesia and blood-management programs get a practical affirmative from ITACS, with a small home-days effect and a clearer transfusion reduction. Pediatric hematology can treat STArT's futility stop as the current answer on acute arginine for crisis duration.