Purpose: To investigate the dosimetric characteristics of a low energy photon intra-operative radiotherapy (IORT) system and explore its potential limitation in clinical application. Methods: A special water phantom, ...Purpose: To investigate the dosimetric characteristics of a low energy photon intra-operative radiotherapy (IORT) system and explore its potential limitation in clinical application. Methods: A special water phantom, a parallel-plate ionization chamber and an electrometer were used to measure the depth dose rate, isotropy of dose distribution in X/Y plane, dosimetry reproducibility of bare probe and spherical applicators of different size which were used in comparison with the system data. Results: The difference in depth dose rate between the measurement and system data for bare probe is -2.16% ± 1.36%, the range of the relative deviation for isotropy in the X/Y plane is between -1.9% and 2.1%. The difference in depth dose rate, transfer coefficient, isotropy in X/Y plane between the measurement and system data for the whole set of spherical applicators is -10.0% - 2.3%, -8.9% - 4.2% and -1.6% - 2.6%, respectively. Higher surface dose rate and steeper gradient depth dose are observed in smaller spherical applicators. The depth dose rate and isotropy for bare probe and spherical applicators have been shown good reproducibility. The uncertainty of measurement is associated with the positioning accuracy, energy response, noise current and correction function f’(R). Conclusions: Thorough commissioning of the low energy photon IORT system helps us better understand the dosimetry characteristics, verify the system data, obtain adequate data for clinical application and routine quality assurance. The steep gradient depth dose and limited treatment range may restrain its potential in clinical application.展开更多
Objective Intra-operative coagulopathy has a close relationship with blood loss and the prognosis of patients. Rapid-thrombelastography （r-TEG） is a comprehensive assessment of coagulation abnormalities and also an...Objective Intra-operative coagulopathy has a close relationship with blood loss and the prognosis of patients. Rapid-thrombelastography （r-TEG） is a comprehensive assessment of coagulation abnormalities and also an effective way for constructing blood transfusion. This study attempts to investigate the correlation of r-TEG indices with intra-operative hemorrhage. Methods Patients who underwent transphenoidal hypophysectomy and craniotomy from January 15 to April 30, 2013 in Peking Union Medical College hospital were recruited. All patients had pre- and post-operative r-TEG and conventional coagulation tests （CCTs）. Patients’ information and intra-operative blood loss as a percentage of estimated blood volume were recorded. Spearman’s correlation analyses were used for discovering the relationship between indices in r-TEG or CCTs and the intra-operative blood loss. The significant correlated index of r-TEG was further investigated using linear regression analysis. Results A total of 181 patients participated in this study. Intra-operative change of α-angle, which reflects the fibrinogen level and function, was the only r-TEG index that correlated with blood loss significantly （P=0.013, r= ？0.184）, thus challenging the current empirical cognition of the effects of intra-operative hemorrhage on coagulation. As intra-operative blood loss increased, α-angle decreased, and every 1% loss of estimated blood volume （EBV） led to 0.60 degree decrease of α-angle. As for CCT results, changes of fibrinogen and platelet count were also significantly correlated with blood loss （P=0.015 and P=0.001, respectively）.Conclusions Peri-operative change of α-angle, as an index of r-TEG, exhibited a significant negative correlation with intra-operative blood loss. The impact of hemorrhage on fibrinogen, instead of clotting factors, should be scrutinized.展开更多
BACKGROUND: Living donor liver transplantation(LDLT)has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to ...BACKGROUND: Living donor liver transplantation(LDLT)has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to evaluate the effect of intraoperative cholangiography(IOC) and parenchymal resection on liver function of donors in LDLT, and to assess the role of IOC in influencing the biliary complications and improving the overall outcome.METHODS: Data from 40 patients who had donated their right lobes for LDLT were analyzed. Total bilirubin(TB), alanine aminotransferase(ALT), aspartate aminotransferase(AST),alkaline phosphatase(ALP) and γ-glutamyl transpeptidase(GGT)at different time points were compared, and the follow-up data and the biliary complications were also analyzed.RESULTS: The ALT and AST values were significantly increased after IOC(P<0.001) and parenchymal resection(P<0.001).However, the median values of TB, ALP and GGT were not significantly influenced by IOC(P>0.05) or parenchymal resection(P>0.05). The biochemical changes caused by IOC or parenchymal resection were not correlated with the degree of post-operative liver injury or the recovery of liver function. The liver functions of the donors after operation were stable, and none of the donors suffered from biliary stenosis or leakage during the follow-up.CONCLUSIONS: IOC and parenchymal resection may induce a transient increase in liver enzymes of donors in LDLT, but do not affect the recovery of liver function after operation. Moreover,the routine IOC is helpful to clarify the division line of the hepatic duct, thus reducing the biliary complication rate.展开更多
Injury to the Recurrent Laryngeal Nerve (RLN) is a worrisome complication of a thyroidectomy. Intra-operative nerve monitoring (IONM) of the RLN has gained prevalence as an aid to prevent injury. We reviewed our serie...Injury to the Recurrent Laryngeal Nerve (RLN) is a worrisome complication of a thyroidectomy. Intra-operative nerve monitoring (IONM) of the RLN has gained prevalence as an aid to prevent injury. We reviewed our series and other studies in literature for insight. A chart review was carried out to identify all patients who underwent a thyroidectomy between 2005 and 2010. IONM was implemented by the Otolaryngology service in 2007. All identified patients were separated into three groups: 1) Otolaryngology service with IONM, 2) Otolaryngology service without IONM, and 3) General Surgery service without IONM. Several factors were noted, including age, sex, thyroid disease, extent of thyroidectomy, and RLN injury along with recovery. 230 patients underwent thyroidectomy from 2005-2010. 60 patients were isolated in the IONM-Otolaryngology group with 3 patients suffering injury. 109 patients underwent a thyroidectomy by the Otolaryngology service without IONM with 8 patients suffering nerve damage. In the third group, 61 patients underwent a thyroidectomy by General Surgery without IONM with 4 patients suffering damage. Of the thyroid pathology, 10 patients had Multinodular Goiter while 4 had Papillary Cancer and 1 had a Follicular Adenoma. The most severe complication of a thyroidectomy is RLN injury. In order to further decrease the risk of RLN injury, IONM has been employed. From our review and other studies, there does not appear to be a significant difference in rates of RLN injury with or without use of nerve monitoring. An interesting note is the increased prevalence of nerve injuries in Multinodular Goiter—a finding that merits further study to evaluate the role of IONM.展开更多
Recent advancements in radiotherapy for esophageal cancer have significantly improved treatment outcomes and patient quality of life.Traditional radiotherapy techniques have been enhanced by the integration of advance...Recent advancements in radiotherapy for esophageal cancer have significantly improved treatment outcomes and patient quality of life.Traditional radiotherapy techniques have been enhanced by the integration of advanced imaging and precision targeting technologies,such as intensity-modulated radiotherapy and proton therapy,which allow for more accurate tumor targeting while minimizing damage to surrounding healthy tissues.Additionally,combining radiotherapy with immunotherapy has shown promising results,leveraging the body’s im-mune response to enhance the effectiveness of cancer treatment.Studies have also highlighted the benefits of neoadjuvant chemoradiation followed by surgical resection,which has been associated with improved overall survival rates com-pared to radiotherapy alone.These innovations are paving the way for more effe-ctive and personalized treatment strategies,offering new hope for patients with esophageal cancer.展开更多
The present study assessed the efficacy and safety of thoracic radiotherapy(TRT)following first-line chemotherapy or chemoimmunotherapy in patients with extensive-stage small cell lung cancer(ES-SCLC),focusing on the ...The present study assessed the efficacy and safety of thoracic radiotherapy(TRT)following first-line chemotherapy or chemoimmunotherapy in patients with extensive-stage small cell lung cancer(ES-SCLC),focusing on the influence of different TRT timing strategies(consolidative vs.salvage)on survival rates.We retrospectively analyzed a total of 54 patients with ES-SCLC treated between January 2019 and July 2022.Patients receiving consolidative TRT(cTRT)within three months after completion of first-line treatment were compared with those receiving salvage TRT(sTRT)after disease progression.The primary endpoints were overall survival(OS),progression-free survival(PFS),locoregional-free survival(LRFS),and distant metastasis-free survival(DMFS);the secondary endpoint included safety.The cTRT group(n=41)showed significantly longer median OS(26.6 vs.14.8 months,P=0.048),PFS(12.9 vs.3.5 months,P<0.0001),and DMFS(10.7 vs.3.4 months,P=0.0044)than the sTRT group(n=13).Multivariate analysis revealed that cTRT was an independent,favorable prognostic factor.No significant differences in OS or LRFS were observed between high-dose(≥50 Gy)and low-dose(<50 Gy)TRT.Hematologic and respiratory toxicities were the most frequently reported adverse events,with acceptable tolerability.In conclusion,cTRT after chemoimmunotherapy significantly improves survival outcomes for ES-SCLC patients,and low-dose TRT may be a suitable option.展开更多
This editorial explores the potential integration of non-Western medicine into radiotherapy for cervical cancer.While radiotherapy remains a radical treatment for cervical cancer,its associated toxicity and decline in...This editorial explores the potential integration of non-Western medicine into radiotherapy for cervical cancer.While radiotherapy remains a radical treatment for cervical cancer,its associated toxicity and decline in quality of life can significantly impact patients’lives.Currently,most treatments are supportive,with no specific treatment options available in Western medicine.Non-Western medicine,often less toxic and easier to administer,has shown promising results when used alongside radiotherapy for cervical cancer.Despite these potential benefits,challenges such as limited evidence and restricted application areas persist.While non-Western medicines may offer potential improvements in chemoradiotherapy outcomes for cervical cancer,further research is necessary to substantiate these benefits.展开更多
BACKGROUND Bone is a major site of metastasis in nasopharyngeal carcinoma(NPC).Recently,nuclear factor kappa-beta ligand(RANKL)inhibitors have garnered attention for their ability to inhibit osteoclast formation and b...BACKGROUND Bone is a major site of metastasis in nasopharyngeal carcinoma(NPC).Recently,nuclear factor kappa-beta ligand(RANKL)inhibitors have garnered attention for their ability to inhibit osteoclast formation and bone resorption,as well as their potential to modulate immune functions and thereby enhance the efficacy of programmed cell death protein 1(PD-1)inhibitor therapy.CASE SUMMARY We present a case of a patient with NPC who developed sternal stalk metastasis and multiple bone metastases with soft tissue invasion following radical chemoradiotherapy and targeted therapy.Prior to chemotherapy,the patient experienced severe bone marrow suppression and opted out of further chemotherapy sessions.However,the patient received combination therapy,including RANKL inhibitors(denosumab)alongside PD-1,radiotherapy,and granulocyte-macrophage colonystimulating factor(PRaG)therapy(NCT05435768),and achieved 16 months of progression-free survival and more than 35 months of overall survival,without encountering any grade 2 or higher treatment-related adverse events.CONCLUSION Denosumab combined with PRaG therapy could be a new therapeutic approach for the second-line treatment in patients with bone metastases.展开更多
Background: Early research describing the concept of intensity-modulated conformal radiotherapy (IMRT) was based on 7 to 9 beams to reach an adequate level of modulation. Nevertheless, its implementation demands signi...Background: Early research describing the concept of intensity-modulated conformal radiotherapy (IMRT) was based on 7 to 9 beams to reach an adequate level of modulation. Nevertheless, its implementation demands significant resources. Our objective was to compare the compliance and homogeneity of target dose distribution between simplified IMRT and 3D-CRT in patients with cervical cancer and to assess the clinical value of simplified IMRT. Materials and Methods: From 2016 to 2017, 17 patients with stage IIB - IIIC cervical cancer were treated with external beam radiotherapy using simplified IMRT (12 cases) or 3DCRT (05 cases) and brachytherapy. Prior to radiotherapy, CT scans were conducted to delineate the target volume. The clinical target volume (CTV) included the uterus, primary tumor, supravaginal portion of the cervix, paracervical tissue, common iliac, internal and external iliac lymph nodes, obturator, and pre sacral lymph nodes, and the surrounding tissues. If the lower vagina was involved, the target volume included the whole vagina. The planning target volume (PTV) included the CTV with 1 cm anteriorly and 0.5 cm in all other directions. The PTV received 95% of 45 Gy (1.8 Gy/25 fraction). Dose-volume histogram, conformity index, homogeneity index, and treatment time per fraction were compared. Results: The 3D-CRT plan was more homogeneous than the simplified IMRT plan, while the simplified IMRT plan was more conformal. The volume of small bowels that received high-dose radiation significantly increased with simplified IMRT compared to 3D-CRT. Treatment time per fraction was 6 and 13 minutes for 3D-CRT and simplified IMRT, respectively. Conclusion: The simplified IMRT treatment plan is technically and dosimetrically acceptable and an alternative to the classic 3D-CRT plan for cervical cancer. It provides better dose distribution than 3D-CRT. However, the 3D-CRT treatment plan significantly reduced the overall treatment time per fraction.展开更多
A recent study by Zhang et al developed a neural network-based predictive model for estimating doses to the uninvolved liver during stereotactic body radiation therapy(SBRT)in liver cancer.The study reported a signifi...A recent study by Zhang et al developed a neural network-based predictive model for estimating doses to the uninvolved liver during stereotactic body radiation therapy(SBRT)in liver cancer.The study reported a significant advancement in personalized radiotherapy by improving accuracy and reducing treatment-related toxicity.The model demonstrated strong predictive performance with R-values above 0.8,indicating its potential to improve treatment consistency.However,concerns arise from the small sample size and exclusion criteria,which may limit generalizability.Future studies should incorporate larger,more diverse patient cohorts,explore potential confounding factors such as tumor characteristics and delivery technique variability,and address the long-term effects of SBRT.展开更多
BACKGROUND Older patients are more likely to have a poor performance status and comor-bidities.There is a reluctance to extensively investigate and treat older patients.As elderly individuals and patients with neoplas...BACKGROUND Older patients are more likely to have a poor performance status and comor-bidities.There is a reluctance to extensively investigate and treat older patients.As elderly individuals and patients with neoplasms each increase in number,palliative treatment of older patients is expected to grow as an issue.AIM To investigated the role of palliative radiotherapy in older patients and patients who were expected to demonstrate a therapeutic effect.METHODS From February 2019 to February 2022,33 patients aged≥80 years underwent palliative radiotherapy.The prognosis in palliative care study predictor(PiPS),palliative prognostic index(PPI),and delirium-palliative prognostic score(D-PaP)models were used for prognosis prediction.D-PaP scores calculated according to the doctor's prediction of clinical prediction of survival(CPS)were excluded and then analyzed for comparison.Radiation was prescribed at a dose of 2.5-7 Gy per fraction,up to a median of 39 Gy10(range,28-75 Gy10).RESULTS The median follow-up was 2.4 months(range,0.2-27.5 months),and 28 patients(84.8%)showed subjective symptom improvements following treatment.The 2-and 6-month survival rates of all patients were 91.5%and 91.5%,respectively.According to regression analysis,the performance status index,symptom type,and radiation dose all showed no significant correlation with the treatment re-sponse.When survival was expected for>55 days in the PiPS model,the 2-month survival rate was 94.4%.For patients with PPI and D-PaP-CPS values of 0-3.9 points,the 2-month survival rates were 90.0%and 100%,respectively.For patients with a score of≥4 points,the 2-month survival rates were 37.5%and 0%,res-pectively.Core Tip:This is a retrospective study to investigate the role of palliative radiotherapy in older patients and patients who were expected to demonstrate a great therapeutic effect.The prognosis in palliative care study predictor,palliative prognostic index,and delirium-palliative prognostic score models were used for prognosis prediction.Most of patients showed subjective symptom improvements following treatment.The prognosis prediction model showed good correlation with survival.In order to increase the therapeutic effectiveness in palliative radiotherapy,it is necessary to assess a patient's exact prognosis and select appropriate patients accordingly.INTRODUCTION The incidence of cancer is high among individuals 60-69 years old and is 11 times greater among those≥65-years-old compared to those<65-years-old.For this reason,about half of all cancer cases are diagnosed in individuals aged≥70 years,and older patients account for a large portion of the total population regarding the prevalence of cancer[1].Cancer is one of the most significant diseases in older patients.About 60%of all cancer-related deaths occur in older patients aged 70 years[1,2].Moreover,cancer accounts for about one-third of the causes of death in the elderly population[1,2].When choosing a cancer treatment,both the characteristics of the cancer and the overall health status of the patient,such as their general condition and any underlying diseases,should be considered[2].Older patients have a shorter life expectancy than younger patients;moreover,they typically have many accompanying underlying diseases and have a poorer general condition.For this reason,older patients are often rejected from receiving active testing and treatment services.Therefore,even if other factors,such as the underlying disease,are the same in young and old patients,older patients typically receive less treatment due to the simple fact that they are older[3].Palliative treatment is a treatment approach that improves the pain and symptoms of a patient and their quality of life.Although palliative treatment is applicable regardless of patient age and the type and severity of their disease,most patients requiring palliative treatment are cancer patients.Palliative radiotherapy is relatively effective for cancer patients and tends to be a well-tolerated treatment.Although some studies have reported the usefulness of palliative radiotherapy in elderly patients,a large number of patients and caregivers are not receiving treatment due to fears of treatment,the risks of side effects,and doubts about treatment effectiveness[1].Since actual age is not always associated with physical ability,the determination of treatment based solely on age can be an obstacle preventing appropriate treatment opportunities.The importance of palliative care is increasing due to the recent growth of the elderly population,as well as,the increase in cancer incidence,and the changes in traditional views or perceptions,such as a growing acceptance of the pursuit of a dignified death[4].Therefore,in this study,we investigated the role of palliative radiotherapy in older patients and in patients who are expected to show a great therapeutic effect.展开更多
Background:The role of systemic tumor immune environment(STIE)is unclear in hepatocellular carcinoma(HCC).This study aimed to exam the cells in the STIE,their changes after transarterial chemoembolisation(TACE),stereo...Background:The role of systemic tumor immune environment(STIE)is unclear in hepatocellular carcinoma(HCC).This study aimed to exam the cells in the STIE,their changes after transarterial chemoembolisation(TACE),stereotactic body radiotherapy(SBRT),and immunotherapy(IO)and explore their significance in the treatment response of patients with unresectable HCC.Methods:This is a prospective biomarker study of patients with unresectable HCC.The treatment was sequential TACE,SBRT(27.5-40 Gy/5 fractions),and IO.The treatment response was assessed according to modified Re-sponse Evaluation Criteria in Solid Tumors(mRECIST)by magnetic resonance imaging(MRI)after 6 months of treatment.Longitudinal data of STIE cells was extracted from laboratory results of complete blood cell counts,in-cluding leukocytes,lymphocytes,neutrophils,monocytes,eosinophils,basophils,and platelets.Peripheral blood samples were collected at baseline and after TACE,SBRT,and IO for T-lymphocyte subtyping by flow cytometry.Generalized estimation equation was employed for longitudinal analyses.Results:A total of 35 patients with unresectable HCC were enrolled:23 patients in the exploratory cohort and 12 in the validation cohort.STIE circulating cells,especially lymphocytes,were heterogenous at baseline and changed differentially after TACE,SBRT,and IO in both cohorts.SBRT caused the greatest reduction of 0.7×10^(9)/L(95%CI:0.3×10^(9)/L-1.0×10^(9)/L,P<0.001)in lymphocytes;less reduction was associated with significantly better treatment response.The analysis of T-lymphocyte lineage revealed that the baseline levels of CD4+T cells(P=0.010),type 1 T helper(Th1)cells(P=0.007),and Th1/Th17 ratios(P=0.001)were significantly higher in responders,while regulatory T(Treg)cells(P=0.002),Th17 cells(P=0.047),and Th2/Th1 ratios(P=0.028)were significantly higher in non-responders.After treatment with TACE,SBRT and IO,T-lymphocyte lineage also changed differentially.More reductions were observed in CD25^(+)CD8^(+)T cells and CD127^(+)CD8^(+)T cells after SBRT in non-responders,while increases in natural killer T(NKT)cells after SBRT(10.4%vs.3.4%,P=0.001)and increases in the lymphocyte counts were noted during IO in responders.Conclusions:STIE cells are significant for treatment response,can be reshaped differentially after TACE,SBRT,and IO.The most significant changes of T-lymphocyte lineage are SBRT associated modulations in CD25^(+)CD8^(+)T cells,CD127^(+)CD8^(+)T cells,and NKT cells,which also have significant effects on the ultimate treatment response after TACE-SBRT-IO(ClinicalTrails.gov identifier:GCOG0001/NCT05061342).展开更多
Objectives:Triphenylphosphine(TPP)and Doxorubicin(DOX)were conjugated to obtain Triphenylphosphine-Doxorubicin(TPP-DOX),which was applied in tumor cells for enhancement of DOX in mitochondria targeting.The study focus...Objectives:Triphenylphosphine(TPP)and Doxorubicin(DOX)were conjugated to obtain Triphenylphosphine-Doxorubicin(TPP-DOX),which was applied in tumor cells for enhancement of DOX in mitochondria targeting.The study focused on investigating the anti-tumor effect of TPP-DOX in combination with radiotherapy throughout in vitro and in vivo studies.Methods:TPP-DOX was synthesized using the carbodiimide method.In vitro experiments were conducted with 4T1 cells(mouse breast cancer cell line)to assess apoptosis induction,mitochondrial targeting,reactive oxygen species(ROS)production,and mitochondrial membrane potential.The research evaluates the effects of TPP-DOX,DOX,and their combinations with radiotherapy.A nude mouse tumor heterograft model was established to investigate the synergistic effect of TPP-DOX and radiotherapy.Results:TPP-DOX was successfully synthesized and scrupulously verified.In vitro experiments showed that compared to DOX,TPP-DOX exhibited enhanced tumor cytotoxicity,improved cellular uptake in 4T1 cells,and increased apoptosis induction.Combined with radiotherapy,TPP-DOX promoted mitochondrial ROS production,reduced mitochondrial membrane potential,and amplified its anti-tumor effect.In vivo experiment confirmed that TPP-DOX combined with radiotherapy exhibited superior anti-tumor activity,promoted tumor tissue apoptosis,inhibited tumor angiogenesis,and showed a favorable in vivo safety profile.Conclusion:The study confirmed that when combined with radiotherapy,TPP-DOX promoted tumor cell apoptosis,and effectively enhanced the anti-tumor effect.In sensitive cells,TPP-DOX demonstrates comparable efficacy to DOX when combined with radiotherapy.TPP-DOX holds significant potential for a broader spectrum of applications and emerges as a valuable candidate for clinical application.These findings provide a promising and efficient therapeutic strategy for tumor treatment with improved efficacy and safety.展开更多
BACKGROUND Currently,there is limited research examining the relationship between anxiety,depression,coping styles,and illness uncertainty in patients with cervical cancer(CC)undergoing radiotherapy.Addressing this ga...BACKGROUND Currently,there is limited research examining the relationship between anxiety,depression,coping styles,and illness uncertainty in patients with cervical cancer(CC)undergoing radiotherapy.Addressing this gap could provide valuable insights and more reliable evidence for clinical practice targeting this patient population.AIM To analyze the anxiety,depression,and coping styles of patients with CC undergoing radiotherapy and explore their correlations with illness uncertainty.METHODS A total of 200 patients with CC undergoing radiotherapy at The First Affiliated Hospital of Soochow University between June 2018 and June 2022 were enrolled.Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale(HADS),comprising subscales for anxiety(HADS-A)and depression(HADS-D).Coping styles were evaluated using the Jalowiec Coping Scale(JCS-60),comprising dimensions such as confrontive,evasive,optimistic,fatalistic,emotive,palliative,supportive,and self-reliant.Illness uncertainty was measured using the Mishel Uncertainty in Illness Scale(MUIS),encompassing ambiguity,complexity,information deficit,and unpredictability.Correlations among anxiety,depression,coping styles,and illness uncertainty were analyzed.RESULTS During radiotherapy,the mean scores were 7.12±3.39 for HADS-A,6.68±3.49 for HADS-D,1.52±0.23 for JCS-60,and 93.40±7.44 for MUIS.Anxiety(HADS-A≥8)was present in 39.5%of patients,depression(HADS-D≥8)in 41.0%,and both in 14.0%.Anxiety was significantly positively correlated with ambiguity,unpredictability,and total MUIS score(P<0.05).Depression was significantly positively correlated with ambiguity,information deficit,unpredictability,and total MUIS score(P<0.05).Most patients adopted an optimistic coping style,whereas the emotive style was least utilized.Evasive,fatalistic,and emotive coping styles were significantly positively correlated with illness uncertainty,whereas the self-reliant style was significantly negatively correlated with unpredictability(P<0.05).CONCLUSION Anxiety,depression,and coping styles in patients with CC undergoing radiotherapy correlate significantly with their level of illness uncertainty.Medical staff should address patients’psychological status and coping strategies by providing targeted information to reduce negative emotions,foster adaptive coping styles,and decrease illness uncertainty.展开更多
BACKGROUND Gastrointestinal tumors are among the most common and deadly cancers globally,with radiotherapy and bevacizumab being key treatment strategies.Radiotherapy uses high-energy radiation to target DNA,reducing ...BACKGROUND Gastrointestinal tumors are among the most common and deadly cancers globally,with radiotherapy and bevacizumab being key treatment strategies.Radiotherapy uses high-energy radiation to target DNA,reducing tumor size and alleviating symptoms.Bevacizumab,a targeted therapy,inhibits angiogenesis and tumor growth,particularly in advanced gastrointestinal cancers.However,both treatments can cause adverse gastrointestinal effects,such as intestinal mucosal damage and perforation.While research on the risk of intestinal perforation has grown,the underlying mechanisms remain underexplored.This study aims to compare the incidence of intestinal perforation and survival rates in patients treated with radiotherapy combined with bevacizumab vs bevacizumab alone.AIM To investigate the effect of radiotherapy on the risk of intestinal perforation in patients with colon cancer treated with bevacizumab.METHODS A total of 70 patients diagnosed with gastrointestinal malignancies admitted to our hospital from January 2023 to December 2024 were selected as research subjects.According to different treatment methods,70 patients were divided into the bevacizumab only group(receiving bevacizumab treatment)and the bevacizumab+radiotherapy group(receiving radiotherapy combined with bevacizumab treatment),with 35 cases in each group.The two groups were compared in terms of clinical efficacy,incidence of intestinal perforation,serum tumor marker levels,overall survival and progression-free survival,levels of angiogenic factors,and adverse reactions.RESULTS Compared with the group treated with bevacizumab alone,the group treated with bevacizumab plus radiotherapy showed significant improvements in effective rate,overall survival,and progression-free survival(P<0.05);the probability of intestinal perforation in the bevacizumab+radiotherapy group was 13.33%,while the probability of intestinal perforation in the bevacizumab group was 0.There was a statistically significant difference in the incidence of intestinal perforation between the two groups(P=0.039).Following treatment,the levels of carbohydrate antigen(CA)125,CA199,and CA153 in patients were significantly reduced(P<0.05).CONCLUSION Radiation therapy may increase the risk of intestinal perforation in colon cancer patients receiving bevacizumab treatment.In clinical applications,the risks of combined use of radiotherapy and bevacizumab should be fully considered and personalized treatment plans should be formulated.展开更多
Objective:Although the role of circular RNAs(circRNAs)in tumor progression and immune regulation is well-known,the specific circ RNA molecules that mediate immune responses after radiotherapy(RT)and the underlying mec...Objective:Although the role of circular RNAs(circRNAs)in tumor progression and immune regulation is well-known,the specific circ RNA molecules that mediate immune responses after radiotherapy(RT)and the underlying mechanisms have not been identified.Methods:Cytometry with time-of-flight(CyTOF)was used to analyze blood samples from patients with liver cancer exhibiting abscopal effects(AEs)after stereotactic body radiotherapy(SBRT)to quantify the number of dendritic cells(DCs)and CD8+T cells and interferon-beta(IFN-β)level.circTMEM56 and IFN-βlevels were measured in 76 patients with liver cancer using q PCR and ELISA.Immunohistochemistry validated circTMEM56 and CD141 staining in tissues.The interaction between circTMEM56,miR-136-5p,and STING,as well as the impact on anti-tumor immunity,was verified using circTMEM56-specific probes,dual-luciferase activity assays,proteomics analysis,and western blot analysis.Results:The role of circTMEM56 in enhancing anti-tumor immunity and response to RT in hepatocellular carcinoma(HCC)was determined.Higher circTMEM56 levels were linked to an improved RT response and better clinical outcomes in patients with HCC.circTMEM56 enhanced cGAS-STING signaling,increased the number of tumor-infiltrating CD8+T cells,and elevated the serum IFN-βlevels.Moreover,circTMEM56 administration significantly boosted the response to RT in tumors with low circTMEM56 expression.Conclusions:High circTMEM56 expression in HCC modulates the distant effects of HCC RT by activating the cGAS-STING pathway to reshape the tumor microenvironment.This study provides a new approach to improve RT efficacy for HCC.展开更多
BACKGROUND Radiation resistance limits radiotherapy efficacy in esophageal squamous cell carcinoma(ESCC).The tumor microenvironment,particularly adipocytes,plays a role in promoting cancer progression.Extracellular ve...BACKGROUND Radiation resistance limits radiotherapy efficacy in esophageal squamous cell carcinoma(ESCC).The tumor microenvironment,particularly adipocytes,plays a role in promoting cancer progression.Extracellular vesicles and microRNAs(miRNAs)regulate gene expression and hold prognostic potential for esophageal carcinoma.Elucidating radioresistance mechanisms and identifying radiosensitization targets can help enhance radiotherapy efficacy for esophageal cancer.AIM To investigate the potential role of miRNAs derived from adipocyte exosomes as prognostic markers for radiotherapy efficacy in ESCC.METHODS Free adipocytes were isolated from human thoracic adipose tissue.A co-culture model of adipocytes and ESCC cells was established to observe colony formation and cell survival post-irradiation.ESCC cell apoptosis was assessed by flow cytometry.Western Blot and immunofluorescence assays were performed to evaluate DNA damage in ESCC cells post-irradiation.Adipocyte-derived exosomes were isolated by ultracentrifugation and identified by electron microscopy.A similar set of experiments was performed on ESCC cells to analyze cell survival,apoptosis,and DNA damage post-radiation exposure.Exosomes from adipose tissue and serum exosomes from ESCC patients pre-and post-radiotherapy were subjected to high-throughput miRNA-sequencing and validated using real-time quantitative polymerase chain reaction.The correlation between potential target miRNAs and the short-term prognosis of radiotherapy in ESCC was evaluated by receiver operating characteristic curve analysis.RESULTS Co-culturing adipocytes with ESCC cells enhanced radioresistance,as evidenced by increased colony formation.Adipocyte co-culture reduced ESCC cell apoptosis and DNA damage post-radiation.Adipocyte-derived exosomes similarly conferred radioresistance in ESCC cells,decreasing apoptosis and DNA damage post-irradiation.Highthroughput miRNA-sequencing identified miR-660-5p in serum and adipose tissue exosomes.Patients with high expression of serum exosome miR-660-5p showed poor prognosis after radiotherapy.CONCLUSION Adipocyte-derived exosomal miR-660-5p is a potential biomarker for evaluating radiotherapy efficacy in ESCC.展开更多
Real-time,noninvasive programmed death-ligand 1(PD-L1)testing using molecular imaging has enhanced our understanding of the immune environments of neoplasms and has served as a guide for immunotherapy.However,the util...Real-time,noninvasive programmed death-ligand 1(PD-L1)testing using molecular imaging has enhanced our understanding of the immune environments of neoplasms and has served as a guide for immunotherapy.However,the utilization of radiotracers in the imaging of human brain tumors using positron emission tomography/computed tomography(PET/CT)remains limited.This investigation involved the synthesis of[18F]AlF-NOTA-PCP2,which is a novel peptide-based radiolabeled tracer that targets PD-L1,and evaluated its imaging capabilities in orthotopic glioblastoma(GBM)models.Using this tracer,we could noninvasively monitor radiation-induced PD-L1 changes in GBM.[18F]AlF-NOTA-PCP2 exhibited high radiochemical purity(>95%)and stability up to 4 h after synthesis.It demonstrated specific,high-affinity binding to PD-L1 in vitro and in vivo,with a dissociation constant of 0.24 nM.PET/CT imaging,integrated with contrast-enhanced magnetic resonance imaging,revealed significant accumulation of[18F]AlF-NOTA-PCP2 in orthotopic tumors,correlating with blood-brain barrier disruption.After radiotherapy(15 Gy),[18F]AlF-NOTA-PCP2 uptake in tumors increased from 9.51%±0.73%to 12.04%±1.43%,indicating enhanced PD-L1 expression consistent with immunohistochemistry findings.Fractionated radiation(5 Gy×3)further amplified PD-L1 upregulation(13.9%±1.54%ID/cc)compared with a single dose(11.48%±1.05%ID/cc).Taken together,[18F]AlF-NOTA-PCP2 may be a valuable tool for noninvasively monitoring PD-L1 expression in brain tumors after radiotherapy.展开更多
BACKGROUND Esophageal cancer is a common malignancy with high mortality.Radiotherapy is an important treatment.Sarcopenia affects patients'physical function and prog-nosis.However,the relationship between sarcopen...BACKGROUND Esophageal cancer is a common malignancy with high mortality.Radiotherapy is an important treatment.Sarcopenia affects patients'physical function and prog-nosis.However,the relationship between sarcopenia diagnosed by Chun-Hou Chen method for sarcopenia measurement and index(C3SMI)criteria and eso-phageal cancer prognosis after radiotherapy is unclear.AIM To explore the correlation between sarcopenia(SA)diagnosed based on C3SMI criteria and the prognosis of patients with esophageal cancer following radiothe-rapy.METHODS A retrospective analysis was conducted on the general clinical data of 131 eso-phageal cancer patients who received radiotherapy in the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University from March 2021 to July 2024.Based on the presence of SA,the patients were assigned into two groups-the SA group and the non-SA group.Logistic regression analysis was used for investi-gating the risk factors influencing SA in esophageal cancer patients.Additionally,the patients were followed up,with their prognosis recorded.As per their prognostic outcomes,the patients were allocated into a good prognosis group and a poor prognosis group.The data of the two groups were compared.Using logistic regression analysis,the risk factors that may influence the prognosis of these patients were analyzed.SPSS 26.0 statistical software was introduced for analyzing the study data.Comparisons were made between groups using t-tests or χ_(2) tests based on the data type.RESULTS As revealed through logistic regression analysis,age[odds ratio(OR)=2.898,P=0.038],body mass index(OR=5.983,P=0.006),prealbumin(OR=6.253,P=0.003),and Karnofsky performance status score(OR=3.854,P=0.010)were independent risk factors impacting SA for esophageal cancer patients(P<0.05).Logistic regression analysis also found that age(OR=3.823,P=0.030),differentiation degree(OR=4.802,P=0.028),American Joint Committee on Cancer clinical staging(OR=3.732,P=0.013),alpha-fetoprotein level(OR=3.508,P=0.018),thrombospondin-1 level(OR=5.749,P=0.006),carcinoembryonic antigen level(OR=3.873,P=0.030),and SA(OR=3.593,P=0.017)were independent risk factors that may influence esophageal cancer patients'prognosis(P<0.05).CONCLUSION The presence of SA has a significant relation to the poor prognosis of esophageal cancer patients,which highlights the importance of assessing and intervening in SA in clinical management so as to improve patient prognosis.展开更多
Hepatocellular carcinoma(HCC)is one of the most common malignant tumors globally and is the most prevalent type of primary liver cancer,posing a heavy burden on global health.Surgical resection and liver transplantati...Hepatocellular carcinoma(HCC)is one of the most common malignant tumors globally and is the most prevalent type of primary liver cancer,posing a heavy burden on global health.Surgical resection and liver transplantation are the gold standard for the radical treatment of HCC.However,due to the heterogeneity and high invasiveness of HCC,the rates of local and distant recurrence are extremely high,with over 70%of patients experiencing recurrence within 5 years after treatment,significantly impacting the long-term quality of life.Therefore,researchers are exploring other treatment methods to reduce tumor recurrence and improve patient survival.To date,extensive research has concentrated on new alternative therapies,including radiotherapy(e.g.,selective internal radiotherapy),targeted drug therapy(e.g.,sorafenib and lenvatinib),and immunotherapy(e.g.,immune checkpoint inhibitors),which have played an integral role in the comprehensive treatment of HCC.This review mainly focuses on the cutting-edge advancements in these treatment methods for HCC and their potential role in reducing HCC recurrence.展开更多
文摘Purpose: To investigate the dosimetric characteristics of a low energy photon intra-operative radiotherapy (IORT) system and explore its potential limitation in clinical application. Methods: A special water phantom, a parallel-plate ionization chamber and an electrometer were used to measure the depth dose rate, isotropy of dose distribution in X/Y plane, dosimetry reproducibility of bare probe and spherical applicators of different size which were used in comparison with the system data. Results: The difference in depth dose rate between the measurement and system data for bare probe is -2.16% ± 1.36%, the range of the relative deviation for isotropy in the X/Y plane is between -1.9% and 2.1%. The difference in depth dose rate, transfer coefficient, isotropy in X/Y plane between the measurement and system data for the whole set of spherical applicators is -10.0% - 2.3%, -8.9% - 4.2% and -1.6% - 2.6%, respectively. Higher surface dose rate and steeper gradient depth dose are observed in smaller spherical applicators. The depth dose rate and isotropy for bare probe and spherical applicators have been shown good reproducibility. The uncertainty of measurement is associated with the positioning accuracy, energy response, noise current and correction function f’(R). Conclusions: Thorough commissioning of the low energy photon IORT system helps us better understand the dosimetry characteristics, verify the system data, obtain adequate data for clinical application and routine quality assurance. The steep gradient depth dose and limited treatment range may restrain its potential in clinical application.
文摘Objective Intra-operative coagulopathy has a close relationship with blood loss and the prognosis of patients. Rapid-thrombelastography （r-TEG） is a comprehensive assessment of coagulation abnormalities and also an effective way for constructing blood transfusion. This study attempts to investigate the correlation of r-TEG indices with intra-operative hemorrhage. Methods Patients who underwent transphenoidal hypophysectomy and craniotomy from January 15 to April 30, 2013 in Peking Union Medical College hospital were recruited. All patients had pre- and post-operative r-TEG and conventional coagulation tests （CCTs）. Patients’ information and intra-operative blood loss as a percentage of estimated blood volume were recorded. Spearman’s correlation analyses were used for discovering the relationship between indices in r-TEG or CCTs and the intra-operative blood loss. The significant correlated index of r-TEG was further investigated using linear regression analysis. Results A total of 181 patients participated in this study. Intra-operative change of α-angle, which reflects the fibrinogen level and function, was the only r-TEG index that correlated with blood loss significantly （P=0.013, r= ？0.184）, thus challenging the current empirical cognition of the effects of intra-operative hemorrhage on coagulation. As intra-operative blood loss increased, α-angle decreased, and every 1% loss of estimated blood volume （EBV） led to 0.60 degree decrease of α-angle. As for CCT results, changes of fibrinogen and platelet count were also significantly correlated with blood loss （P=0.015 and P=0.001, respectively）.Conclusions Peri-operative change of α-angle, as an index of r-TEG, exhibited a significant negative correlation with intra-operative blood loss. The impact of hemorrhage on fibrinogen, instead of clotting factors, should be scrutinized.
基金supported by grants from the Foundation for Innovative Research Groups of the National Natural Science Foundation of China(81121002)Zhejiang Provincial Program for the Cultivation of High-Level Innovative Health Talents(2012-236)+1 种基金Zhejiang Provincial Education Department Project(Y201018972)Zhejiang Provincial Natural Science Foundation of China(LQ12H03002)
文摘BACKGROUND: Living donor liver transplantation(LDLT)has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to evaluate the effect of intraoperative cholangiography(IOC) and parenchymal resection on liver function of donors in LDLT, and to assess the role of IOC in influencing the biliary complications and improving the overall outcome.METHODS: Data from 40 patients who had donated their right lobes for LDLT were analyzed. Total bilirubin(TB), alanine aminotransferase(ALT), aspartate aminotransferase(AST),alkaline phosphatase(ALP) and γ-glutamyl transpeptidase(GGT)at different time points were compared, and the follow-up data and the biliary complications were also analyzed.RESULTS: The ALT and AST values were significantly increased after IOC(P<0.001) and parenchymal resection(P<0.001).However, the median values of TB, ALP and GGT were not significantly influenced by IOC(P>0.05) or parenchymal resection(P>0.05). The biochemical changes caused by IOC or parenchymal resection were not correlated with the degree of post-operative liver injury or the recovery of liver function. The liver functions of the donors after operation were stable, and none of the donors suffered from biliary stenosis or leakage during the follow-up.CONCLUSIONS: IOC and parenchymal resection may induce a transient increase in liver enzymes of donors in LDLT, but do not affect the recovery of liver function after operation. Moreover,the routine IOC is helpful to clarify the division line of the hepatic duct, thus reducing the biliary complication rate.
文摘Injury to the Recurrent Laryngeal Nerve (RLN) is a worrisome complication of a thyroidectomy. Intra-operative nerve monitoring (IONM) of the RLN has gained prevalence as an aid to prevent injury. We reviewed our series and other studies in literature for insight. A chart review was carried out to identify all patients who underwent a thyroidectomy between 2005 and 2010. IONM was implemented by the Otolaryngology service in 2007. All identified patients were separated into three groups: 1) Otolaryngology service with IONM, 2) Otolaryngology service without IONM, and 3) General Surgery service without IONM. Several factors were noted, including age, sex, thyroid disease, extent of thyroidectomy, and RLN injury along with recovery. 230 patients underwent thyroidectomy from 2005-2010. 60 patients were isolated in the IONM-Otolaryngology group with 3 patients suffering injury. 109 patients underwent a thyroidectomy by the Otolaryngology service without IONM with 8 patients suffering nerve damage. In the third group, 61 patients underwent a thyroidectomy by General Surgery without IONM with 4 patients suffering damage. Of the thyroid pathology, 10 patients had Multinodular Goiter while 4 had Papillary Cancer and 1 had a Follicular Adenoma. The most severe complication of a thyroidectomy is RLN injury. In order to further decrease the risk of RLN injury, IONM has been employed. From our review and other studies, there does not appear to be a significant difference in rates of RLN injury with or without use of nerve monitoring. An interesting note is the increased prevalence of nerve injuries in Multinodular Goiter—a finding that merits further study to evaluate the role of IONM.
文摘Recent advancements in radiotherapy for esophageal cancer have significantly improved treatment outcomes and patient quality of life.Traditional radiotherapy techniques have been enhanced by the integration of advanced imaging and precision targeting technologies,such as intensity-modulated radiotherapy and proton therapy,which allow for more accurate tumor targeting while minimizing damage to surrounding healthy tissues.Additionally,combining radiotherapy with immunotherapy has shown promising results,leveraging the body’s im-mune response to enhance the effectiveness of cancer treatment.Studies have also highlighted the benefits of neoadjuvant chemoradiation followed by surgical resection,which has been associated with improved overall survival rates com-pared to radiotherapy alone.These innovations are paving the way for more effe-ctive and personalized treatment strategies,offering new hope for patients with esophageal cancer.
基金supported by the Young Talents Program of Jiangsu Cancer Hospital(Grant No.QL201802)the Science and Technology Development Fund of Jiangsu Cancer Hospital(Grant No.ZL202105).
文摘The present study assessed the efficacy and safety of thoracic radiotherapy(TRT)following first-line chemotherapy or chemoimmunotherapy in patients with extensive-stage small cell lung cancer(ES-SCLC),focusing on the influence of different TRT timing strategies(consolidative vs.salvage)on survival rates.We retrospectively analyzed a total of 54 patients with ES-SCLC treated between January 2019 and July 2022.Patients receiving consolidative TRT(cTRT)within three months after completion of first-line treatment were compared with those receiving salvage TRT(sTRT)after disease progression.The primary endpoints were overall survival(OS),progression-free survival(PFS),locoregional-free survival(LRFS),and distant metastasis-free survival(DMFS);the secondary endpoint included safety.The cTRT group(n=41)showed significantly longer median OS(26.6 vs.14.8 months,P=0.048),PFS(12.9 vs.3.5 months,P<0.0001),and DMFS(10.7 vs.3.4 months,P=0.0044)than the sTRT group(n=13).Multivariate analysis revealed that cTRT was an independent,favorable prognostic factor.No significant differences in OS or LRFS were observed between high-dose(≥50 Gy)and low-dose(<50 Gy)TRT.Hematologic and respiratory toxicities were the most frequently reported adverse events,with acceptable tolerability.In conclusion,cTRT after chemoimmunotherapy significantly improves survival outcomes for ES-SCLC patients,and low-dose TRT may be a suitable option.
文摘This editorial explores the potential integration of non-Western medicine into radiotherapy for cervical cancer.While radiotherapy remains a radical treatment for cervical cancer,its associated toxicity and decline in quality of life can significantly impact patients’lives.Currently,most treatments are supportive,with no specific treatment options available in Western medicine.Non-Western medicine,often less toxic and easier to administer,has shown promising results when used alongside radiotherapy for cervical cancer.Despite these potential benefits,challenges such as limited evidence and restricted application areas persist.While non-Western medicines may offer potential improvements in chemoradiotherapy outcomes for cervical cancer,further research is necessary to substantiate these benefits.
基金Supported by The Suzhou Medical Center,No.Szlcyxzx202103The National Natural Science Foundation of China,No.82171828+15 种基金The Key R and D Plan of Jiangsu Province(Development of Social),No.BE2021652The Subject Construction Support Project of The Second Affiliated Hospital of Soochow University,No.XKTJHRC20210011The Wu Jieping Medical Foundation,No.320.6750.2021-01-12The Special Project of"Technological Innovation"Project of CNNC Medical Industry Co.Ltd,No.ZHYLTD2021001The Suzhou Science and Education Health Project,No.KJXW2021018Foundation of Chinese Society of Clinical Oncology,No.Y-pierrefabre202102-0113 and No.Y-XD202002/zb-0015The Beijing Bethune Charitable Foundation,No.STLKY0016The Research Projects of China Baoyuan Investment Co.Ltd,No.270004The Suzhou Gusu Health Talent Program,No.GSWS2022028The Open Project of State Key Laboratory of Radiation Medicine and Protection of Soochow University,No.GZN1202302The New Medical Technology Project of the Second Affiliated Hospital of Soochow University,No.23zl001The Multi-center Clinical Research Project for Major Diseases in Suzhou,No.DZXYJ202304The Postgraduate Research and Practice Innovation Program of Jiangsu Province,No.SJCX24_1814The Gusu Health Talent Research Fund,No.GSWS2022053The National Natural Science Foundation of China,No.82102824The Scientific Research Program for Young Talents of China National Nuclear Corporation。
文摘BACKGROUND Bone is a major site of metastasis in nasopharyngeal carcinoma(NPC).Recently,nuclear factor kappa-beta ligand(RANKL)inhibitors have garnered attention for their ability to inhibit osteoclast formation and bone resorption,as well as their potential to modulate immune functions and thereby enhance the efficacy of programmed cell death protein 1(PD-1)inhibitor therapy.CASE SUMMARY We present a case of a patient with NPC who developed sternal stalk metastasis and multiple bone metastases with soft tissue invasion following radical chemoradiotherapy and targeted therapy.Prior to chemotherapy,the patient experienced severe bone marrow suppression and opted out of further chemotherapy sessions.However,the patient received combination therapy,including RANKL inhibitors(denosumab)alongside PD-1,radiotherapy,and granulocyte-macrophage colonystimulating factor(PRaG)therapy(NCT05435768),and achieved 16 months of progression-free survival and more than 35 months of overall survival,without encountering any grade 2 or higher treatment-related adverse events.CONCLUSION Denosumab combined with PRaG therapy could be a new therapeutic approach for the second-line treatment in patients with bone metastases.
文摘Background: Early research describing the concept of intensity-modulated conformal radiotherapy (IMRT) was based on 7 to 9 beams to reach an adequate level of modulation. Nevertheless, its implementation demands significant resources. Our objective was to compare the compliance and homogeneity of target dose distribution between simplified IMRT and 3D-CRT in patients with cervical cancer and to assess the clinical value of simplified IMRT. Materials and Methods: From 2016 to 2017, 17 patients with stage IIB - IIIC cervical cancer were treated with external beam radiotherapy using simplified IMRT (12 cases) or 3DCRT (05 cases) and brachytherapy. Prior to radiotherapy, CT scans were conducted to delineate the target volume. The clinical target volume (CTV) included the uterus, primary tumor, supravaginal portion of the cervix, paracervical tissue, common iliac, internal and external iliac lymph nodes, obturator, and pre sacral lymph nodes, and the surrounding tissues. If the lower vagina was involved, the target volume included the whole vagina. The planning target volume (PTV) included the CTV with 1 cm anteriorly and 0.5 cm in all other directions. The PTV received 95% of 45 Gy (1.8 Gy/25 fraction). Dose-volume histogram, conformity index, homogeneity index, and treatment time per fraction were compared. Results: The 3D-CRT plan was more homogeneous than the simplified IMRT plan, while the simplified IMRT plan was more conformal. The volume of small bowels that received high-dose radiation significantly increased with simplified IMRT compared to 3D-CRT. Treatment time per fraction was 6 and 13 minutes for 3D-CRT and simplified IMRT, respectively. Conclusion: The simplified IMRT treatment plan is technically and dosimetrically acceptable and an alternative to the classic 3D-CRT plan for cervical cancer. It provides better dose distribution than 3D-CRT. However, the 3D-CRT treatment plan significantly reduced the overall treatment time per fraction.
文摘A recent study by Zhang et al developed a neural network-based predictive model for estimating doses to the uninvolved liver during stereotactic body radiation therapy(SBRT)in liver cancer.The study reported a significant advancement in personalized radiotherapy by improving accuracy and reducing treatment-related toxicity.The model demonstrated strong predictive performance with R-values above 0.8,indicating its potential to improve treatment consistency.However,concerns arise from the small sample size and exclusion criteria,which may limit generalizability.Future studies should incorporate larger,more diverse patient cohorts,explore potential confounding factors such as tumor characteristics and delivery technique variability,and address the long-term effects of SBRT.
文摘BACKGROUND Older patients are more likely to have a poor performance status and comor-bidities.There is a reluctance to extensively investigate and treat older patients.As elderly individuals and patients with neoplasms each increase in number,palliative treatment of older patients is expected to grow as an issue.AIM To investigated the role of palliative radiotherapy in older patients and patients who were expected to demonstrate a therapeutic effect.METHODS From February 2019 to February 2022,33 patients aged≥80 years underwent palliative radiotherapy.The prognosis in palliative care study predictor(PiPS),palliative prognostic index(PPI),and delirium-palliative prognostic score(D-PaP)models were used for prognosis prediction.D-PaP scores calculated according to the doctor's prediction of clinical prediction of survival(CPS)were excluded and then analyzed for comparison.Radiation was prescribed at a dose of 2.5-7 Gy per fraction,up to a median of 39 Gy10(range,28-75 Gy10).RESULTS The median follow-up was 2.4 months(range,0.2-27.5 months),and 28 patients(84.8%)showed subjective symptom improvements following treatment.The 2-and 6-month survival rates of all patients were 91.5%and 91.5%,respectively.According to regression analysis,the performance status index,symptom type,and radiation dose all showed no significant correlation with the treatment re-sponse.When survival was expected for>55 days in the PiPS model,the 2-month survival rate was 94.4%.For patients with PPI and D-PaP-CPS values of 0-3.9 points,the 2-month survival rates were 90.0%and 100%,respectively.For patients with a score of≥4 points,the 2-month survival rates were 37.5%and 0%,res-pectively.Core Tip:This is a retrospective study to investigate the role of palliative radiotherapy in older patients and patients who were expected to demonstrate a great therapeutic effect.The prognosis in palliative care study predictor,palliative prognostic index,and delirium-palliative prognostic score models were used for prognosis prediction.Most of patients showed subjective symptom improvements following treatment.The prognosis prediction model showed good correlation with survival.In order to increase the therapeutic effectiveness in palliative radiotherapy,it is necessary to assess a patient's exact prognosis and select appropriate patients accordingly.INTRODUCTION The incidence of cancer is high among individuals 60-69 years old and is 11 times greater among those≥65-years-old compared to those<65-years-old.For this reason,about half of all cancer cases are diagnosed in individuals aged≥70 years,and older patients account for a large portion of the total population regarding the prevalence of cancer[1].Cancer is one of the most significant diseases in older patients.About 60%of all cancer-related deaths occur in older patients aged 70 years[1,2].Moreover,cancer accounts for about one-third of the causes of death in the elderly population[1,2].When choosing a cancer treatment,both the characteristics of the cancer and the overall health status of the patient,such as their general condition and any underlying diseases,should be considered[2].Older patients have a shorter life expectancy than younger patients;moreover,they typically have many accompanying underlying diseases and have a poorer general condition.For this reason,older patients are often rejected from receiving active testing and treatment services.Therefore,even if other factors,such as the underlying disease,are the same in young and old patients,older patients typically receive less treatment due to the simple fact that they are older[3].Palliative treatment is a treatment approach that improves the pain and symptoms of a patient and their quality of life.Although palliative treatment is applicable regardless of patient age and the type and severity of their disease,most patients requiring palliative treatment are cancer patients.Palliative radiotherapy is relatively effective for cancer patients and tends to be a well-tolerated treatment.Although some studies have reported the usefulness of palliative radiotherapy in elderly patients,a large number of patients and caregivers are not receiving treatment due to fears of treatment,the risks of side effects,and doubts about treatment effectiveness[1].Since actual age is not always associated with physical ability,the determination of treatment based solely on age can be an obstacle preventing appropriate treatment opportunities.The importance of palliative care is increasing due to the recent growth of the elderly population,as well as,the increase in cancer incidence,and the changes in traditional views or perceptions,such as a growing acceptance of the pursuit of a dignified death[4].Therefore,in this study,we investigated the role of palliative radiotherapy in older patients and in patients who are expected to show a great therapeutic effect.
基金supported by the Shenzhen Science and Technology Program(grant number:KQTD20180411185028798).
文摘Background:The role of systemic tumor immune environment(STIE)is unclear in hepatocellular carcinoma(HCC).This study aimed to exam the cells in the STIE,their changes after transarterial chemoembolisation(TACE),stereotactic body radiotherapy(SBRT),and immunotherapy(IO)and explore their significance in the treatment response of patients with unresectable HCC.Methods:This is a prospective biomarker study of patients with unresectable HCC.The treatment was sequential TACE,SBRT(27.5-40 Gy/5 fractions),and IO.The treatment response was assessed according to modified Re-sponse Evaluation Criteria in Solid Tumors(mRECIST)by magnetic resonance imaging(MRI)after 6 months of treatment.Longitudinal data of STIE cells was extracted from laboratory results of complete blood cell counts,in-cluding leukocytes,lymphocytes,neutrophils,monocytes,eosinophils,basophils,and platelets.Peripheral blood samples were collected at baseline and after TACE,SBRT,and IO for T-lymphocyte subtyping by flow cytometry.Generalized estimation equation was employed for longitudinal analyses.Results:A total of 35 patients with unresectable HCC were enrolled:23 patients in the exploratory cohort and 12 in the validation cohort.STIE circulating cells,especially lymphocytes,were heterogenous at baseline and changed differentially after TACE,SBRT,and IO in both cohorts.SBRT caused the greatest reduction of 0.7×10^(9)/L(95%CI:0.3×10^(9)/L-1.0×10^(9)/L,P<0.001)in lymphocytes;less reduction was associated with significantly better treatment response.The analysis of T-lymphocyte lineage revealed that the baseline levels of CD4+T cells(P=0.010),type 1 T helper(Th1)cells(P=0.007),and Th1/Th17 ratios(P=0.001)were significantly higher in responders,while regulatory T(Treg)cells(P=0.002),Th17 cells(P=0.047),and Th2/Th1 ratios(P=0.028)were significantly higher in non-responders.After treatment with TACE,SBRT and IO,T-lymphocyte lineage also changed differentially.More reductions were observed in CD25^(+)CD8^(+)T cells and CD127^(+)CD8^(+)T cells after SBRT in non-responders,while increases in natural killer T(NKT)cells after SBRT(10.4%vs.3.4%,P=0.001)and increases in the lymphocyte counts were noted during IO in responders.Conclusions:STIE cells are significant for treatment response,can be reshaped differentially after TACE,SBRT,and IO.The most significant changes of T-lymphocyte lineage are SBRT associated modulations in CD25^(+)CD8^(+)T cells,CD127^(+)CD8^(+)T cells,and NKT cells,which also have significant effects on the ultimate treatment response after TACE-SBRT-IO(ClinicalTrails.gov identifier:GCOG0001/NCT05061342).
基金supported by the Zhejiang Provincial Natural Science Foundation of China(LY24H300001)the Medical and Health Research Project of Zhejiang Province(KY202302130009)National Health Service Research Project(WKZX2024CX501205).
文摘Objectives:Triphenylphosphine(TPP)and Doxorubicin(DOX)were conjugated to obtain Triphenylphosphine-Doxorubicin(TPP-DOX),which was applied in tumor cells for enhancement of DOX in mitochondria targeting.The study focused on investigating the anti-tumor effect of TPP-DOX in combination with radiotherapy throughout in vitro and in vivo studies.Methods:TPP-DOX was synthesized using the carbodiimide method.In vitro experiments were conducted with 4T1 cells(mouse breast cancer cell line)to assess apoptosis induction,mitochondrial targeting,reactive oxygen species(ROS)production,and mitochondrial membrane potential.The research evaluates the effects of TPP-DOX,DOX,and their combinations with radiotherapy.A nude mouse tumor heterograft model was established to investigate the synergistic effect of TPP-DOX and radiotherapy.Results:TPP-DOX was successfully synthesized and scrupulously verified.In vitro experiments showed that compared to DOX,TPP-DOX exhibited enhanced tumor cytotoxicity,improved cellular uptake in 4T1 cells,and increased apoptosis induction.Combined with radiotherapy,TPP-DOX promoted mitochondrial ROS production,reduced mitochondrial membrane potential,and amplified its anti-tumor effect.In vivo experiment confirmed that TPP-DOX combined with radiotherapy exhibited superior anti-tumor activity,promoted tumor tissue apoptosis,inhibited tumor angiogenesis,and showed a favorable in vivo safety profile.Conclusion:The study confirmed that when combined with radiotherapy,TPP-DOX promoted tumor cell apoptosis,and effectively enhanced the anti-tumor effect.In sensitive cells,TPP-DOX demonstrates comparable efficacy to DOX when combined with radiotherapy.TPP-DOX holds significant potential for a broader spectrum of applications and emerges as a valuable candidate for clinical application.These findings provide a promising and efficient therapeutic strategy for tumor treatment with improved efficacy and safety.
基金Supported by National Natural Science Foundation of China,No.81602792The Natural Science Foundation of the Jiangsu Higher Education Institutions of China,No.23KJB310023+5 种基金Jiangsu Provincial Medical Key Discipline,No.ZDXK202235The Maternal and Child Health Research Project of Jiangsu Province,No.F202210The Project of State Key Laboratory of Radiation Medicine and Protection,Soochow University,No.GZK1202101Suzhou Science and Technology Development Plan Project,No.KJXW2020008BOXI Natural Science Cultivation Foundation of China of The First Affiliated Hospital of Soochow University,No.BXQN202107Clinical Diagnosis and Treatment Technology Innovation Project Youth Characteristic Technology Project of The First Affiliated Hospital of Soochow University,No.2100201.
文摘BACKGROUND Currently,there is limited research examining the relationship between anxiety,depression,coping styles,and illness uncertainty in patients with cervical cancer(CC)undergoing radiotherapy.Addressing this gap could provide valuable insights and more reliable evidence for clinical practice targeting this patient population.AIM To analyze the anxiety,depression,and coping styles of patients with CC undergoing radiotherapy and explore their correlations with illness uncertainty.METHODS A total of 200 patients with CC undergoing radiotherapy at The First Affiliated Hospital of Soochow University between June 2018 and June 2022 were enrolled.Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale(HADS),comprising subscales for anxiety(HADS-A)and depression(HADS-D).Coping styles were evaluated using the Jalowiec Coping Scale(JCS-60),comprising dimensions such as confrontive,evasive,optimistic,fatalistic,emotive,palliative,supportive,and self-reliant.Illness uncertainty was measured using the Mishel Uncertainty in Illness Scale(MUIS),encompassing ambiguity,complexity,information deficit,and unpredictability.Correlations among anxiety,depression,coping styles,and illness uncertainty were analyzed.RESULTS During radiotherapy,the mean scores were 7.12±3.39 for HADS-A,6.68±3.49 for HADS-D,1.52±0.23 for JCS-60,and 93.40±7.44 for MUIS.Anxiety(HADS-A≥8)was present in 39.5%of patients,depression(HADS-D≥8)in 41.0%,and both in 14.0%.Anxiety was significantly positively correlated with ambiguity,unpredictability,and total MUIS score(P<0.05).Depression was significantly positively correlated with ambiguity,information deficit,unpredictability,and total MUIS score(P<0.05).Most patients adopted an optimistic coping style,whereas the emotive style was least utilized.Evasive,fatalistic,and emotive coping styles were significantly positively correlated with illness uncertainty,whereas the self-reliant style was significantly negatively correlated with unpredictability(P<0.05).CONCLUSION Anxiety,depression,and coping styles in patients with CC undergoing radiotherapy correlate significantly with their level of illness uncertainty.Medical staff should address patients’psychological status and coping strategies by providing targeted information to reduce negative emotions,foster adaptive coping styles,and decrease illness uncertainty.
文摘BACKGROUND Gastrointestinal tumors are among the most common and deadly cancers globally,with radiotherapy and bevacizumab being key treatment strategies.Radiotherapy uses high-energy radiation to target DNA,reducing tumor size and alleviating symptoms.Bevacizumab,a targeted therapy,inhibits angiogenesis and tumor growth,particularly in advanced gastrointestinal cancers.However,both treatments can cause adverse gastrointestinal effects,such as intestinal mucosal damage and perforation.While research on the risk of intestinal perforation has grown,the underlying mechanisms remain underexplored.This study aims to compare the incidence of intestinal perforation and survival rates in patients treated with radiotherapy combined with bevacizumab vs bevacizumab alone.AIM To investigate the effect of radiotherapy on the risk of intestinal perforation in patients with colon cancer treated with bevacizumab.METHODS A total of 70 patients diagnosed with gastrointestinal malignancies admitted to our hospital from January 2023 to December 2024 were selected as research subjects.According to different treatment methods,70 patients were divided into the bevacizumab only group(receiving bevacizumab treatment)and the bevacizumab+radiotherapy group(receiving radiotherapy combined with bevacizumab treatment),with 35 cases in each group.The two groups were compared in terms of clinical efficacy,incidence of intestinal perforation,serum tumor marker levels,overall survival and progression-free survival,levels of angiogenic factors,and adverse reactions.RESULTS Compared with the group treated with bevacizumab alone,the group treated with bevacizumab plus radiotherapy showed significant improvements in effective rate,overall survival,and progression-free survival(P<0.05);the probability of intestinal perforation in the bevacizumab+radiotherapy group was 13.33%,while the probability of intestinal perforation in the bevacizumab group was 0.There was a statistically significant difference in the incidence of intestinal perforation between the two groups(P=0.039).Following treatment,the levels of carbohydrate antigen(CA)125,CA199,and CA153 in patients were significantly reduced(P<0.05).CONCLUSION Radiation therapy may increase the risk of intestinal perforation in colon cancer patients receiving bevacizumab treatment.In clinical applications,the risks of combined use of radiotherapy and bevacizumab should be fully considered and personalized treatment plans should be formulated.
基金funded by the National Key Research and Development Program of China(Grant No.2023YFC3402700)Shanghai Municipal Natural Science Foundation(Grant No.22ZR1411200)+2 种基金China Postdoctoral Science FundGeneral Fund(Grant No.2022M720779)Research Fund of Zhongshan Hospital Affiliated to Shanghai Fudan University for Young Scientists(Grant No.2023ZSQN26)National Natural Science Foundation of China(Grant Nos.82403999 and 82073479)。
文摘Objective:Although the role of circular RNAs(circRNAs)in tumor progression and immune regulation is well-known,the specific circ RNA molecules that mediate immune responses after radiotherapy(RT)and the underlying mechanisms have not been identified.Methods:Cytometry with time-of-flight(CyTOF)was used to analyze blood samples from patients with liver cancer exhibiting abscopal effects(AEs)after stereotactic body radiotherapy(SBRT)to quantify the number of dendritic cells(DCs)and CD8+T cells and interferon-beta(IFN-β)level.circTMEM56 and IFN-βlevels were measured in 76 patients with liver cancer using q PCR and ELISA.Immunohistochemistry validated circTMEM56 and CD141 staining in tissues.The interaction between circTMEM56,miR-136-5p,and STING,as well as the impact on anti-tumor immunity,was verified using circTMEM56-specific probes,dual-luciferase activity assays,proteomics analysis,and western blot analysis.Results:The role of circTMEM56 in enhancing anti-tumor immunity and response to RT in hepatocellular carcinoma(HCC)was determined.Higher circTMEM56 levels were linked to an improved RT response and better clinical outcomes in patients with HCC.circTMEM56 enhanced cGAS-STING signaling,increased the number of tumor-infiltrating CD8+T cells,and elevated the serum IFN-βlevels.Moreover,circTMEM56 administration significantly boosted the response to RT in tumors with low circTMEM56 expression.Conclusions:High circTMEM56 expression in HCC modulates the distant effects of HCC RT by activating the cGAS-STING pathway to reshape the tumor microenvironment.This study provides a new approach to improve RT efficacy for HCC.
基金Supported by the National Natural Science Foundation of China,No.81602792 and No.12205215and Science and Technology Program of Nantong,No.JC12022103.
文摘BACKGROUND Radiation resistance limits radiotherapy efficacy in esophageal squamous cell carcinoma(ESCC).The tumor microenvironment,particularly adipocytes,plays a role in promoting cancer progression.Extracellular vesicles and microRNAs(miRNAs)regulate gene expression and hold prognostic potential for esophageal carcinoma.Elucidating radioresistance mechanisms and identifying radiosensitization targets can help enhance radiotherapy efficacy for esophageal cancer.AIM To investigate the potential role of miRNAs derived from adipocyte exosomes as prognostic markers for radiotherapy efficacy in ESCC.METHODS Free adipocytes were isolated from human thoracic adipose tissue.A co-culture model of adipocytes and ESCC cells was established to observe colony formation and cell survival post-irradiation.ESCC cell apoptosis was assessed by flow cytometry.Western Blot and immunofluorescence assays were performed to evaluate DNA damage in ESCC cells post-irradiation.Adipocyte-derived exosomes were isolated by ultracentrifugation and identified by electron microscopy.A similar set of experiments was performed on ESCC cells to analyze cell survival,apoptosis,and DNA damage post-radiation exposure.Exosomes from adipose tissue and serum exosomes from ESCC patients pre-and post-radiotherapy were subjected to high-throughput miRNA-sequencing and validated using real-time quantitative polymerase chain reaction.The correlation between potential target miRNAs and the short-term prognosis of radiotherapy in ESCC was evaluated by receiver operating characteristic curve analysis.RESULTS Co-culturing adipocytes with ESCC cells enhanced radioresistance,as evidenced by increased colony formation.Adipocyte co-culture reduced ESCC cell apoptosis and DNA damage post-radiation.Adipocyte-derived exosomes similarly conferred radioresistance in ESCC cells,decreasing apoptosis and DNA damage post-irradiation.Highthroughput miRNA-sequencing identified miR-660-5p in serum and adipose tissue exosomes.Patients with high expression of serum exosome miR-660-5p showed poor prognosis after radiotherapy.CONCLUSION Adipocyte-derived exosomal miR-660-5p is a potential biomarker for evaluating radiotherapy efficacy in ESCC.
基金support from the National Natural Science Foundation of China(Grant Nos.:82272751 and 82202958)the Natural Science Foundation of Shandong,China(Grant No.:ZR2021LSW002)+6 种基金the Science and Technology Program of Jinan,China(Grant Nos.:202225019 and 202225013)to Man Huthe Shandong Postdoctoral Innovation Program,China(Grant No.:SDCX-ZG-202302011)Beijing Science and Technology Innovation Medical Development Foundation,China(Grant No.:KC2023-JX-0288-BQ26)to Yong Wangthe Natural Science Foundation of China(Grant No.:NSFC82303676)the Natural Science Foundation of Shandong(Grant No.:ZR2023QH208)the China Postdoctoral Science Foundation(Grant No.:2023M732125)the Taishan Scholar Project Special Fund(Grant No.:tsqn202312368)to Kewen He.
文摘Real-time,noninvasive programmed death-ligand 1(PD-L1)testing using molecular imaging has enhanced our understanding of the immune environments of neoplasms and has served as a guide for immunotherapy.However,the utilization of radiotracers in the imaging of human brain tumors using positron emission tomography/computed tomography(PET/CT)remains limited.This investigation involved the synthesis of[18F]AlF-NOTA-PCP2,which is a novel peptide-based radiolabeled tracer that targets PD-L1,and evaluated its imaging capabilities in orthotopic glioblastoma(GBM)models.Using this tracer,we could noninvasively monitor radiation-induced PD-L1 changes in GBM.[18F]AlF-NOTA-PCP2 exhibited high radiochemical purity(>95%)and stability up to 4 h after synthesis.It demonstrated specific,high-affinity binding to PD-L1 in vitro and in vivo,with a dissociation constant of 0.24 nM.PET/CT imaging,integrated with contrast-enhanced magnetic resonance imaging,revealed significant accumulation of[18F]AlF-NOTA-PCP2 in orthotopic tumors,correlating with blood-brain barrier disruption.After radiotherapy(15 Gy),[18F]AlF-NOTA-PCP2 uptake in tumors increased from 9.51%±0.73%to 12.04%±1.43%,indicating enhanced PD-L1 expression consistent with immunohistochemistry findings.Fractionated radiation(5 Gy×3)further amplified PD-L1 upregulation(13.9%±1.54%ID/cc)compared with a single dose(11.48%±1.05%ID/cc).Taken together,[18F]AlF-NOTA-PCP2 may be a valuable tool for noninvasively monitoring PD-L1 expression in brain tumors after radiotherapy.
文摘BACKGROUND Esophageal cancer is a common malignancy with high mortality.Radiotherapy is an important treatment.Sarcopenia affects patients'physical function and prog-nosis.However,the relationship between sarcopenia diagnosed by Chun-Hou Chen method for sarcopenia measurement and index(C3SMI)criteria and eso-phageal cancer prognosis after radiotherapy is unclear.AIM To explore the correlation between sarcopenia(SA)diagnosed based on C3SMI criteria and the prognosis of patients with esophageal cancer following radiothe-rapy.METHODS A retrospective analysis was conducted on the general clinical data of 131 eso-phageal cancer patients who received radiotherapy in the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University from March 2021 to July 2024.Based on the presence of SA,the patients were assigned into two groups-the SA group and the non-SA group.Logistic regression analysis was used for investi-gating the risk factors influencing SA in esophageal cancer patients.Additionally,the patients were followed up,with their prognosis recorded.As per their prognostic outcomes,the patients were allocated into a good prognosis group and a poor prognosis group.The data of the two groups were compared.Using logistic regression analysis,the risk factors that may influence the prognosis of these patients were analyzed.SPSS 26.0 statistical software was introduced for analyzing the study data.Comparisons were made between groups using t-tests or χ_(2) tests based on the data type.RESULTS As revealed through logistic regression analysis,age[odds ratio(OR)=2.898,P=0.038],body mass index(OR=5.983,P=0.006),prealbumin(OR=6.253,P=0.003),and Karnofsky performance status score(OR=3.854,P=0.010)were independent risk factors impacting SA for esophageal cancer patients(P<0.05).Logistic regression analysis also found that age(OR=3.823,P=0.030),differentiation degree(OR=4.802,P=0.028),American Joint Committee on Cancer clinical staging(OR=3.732,P=0.013),alpha-fetoprotein level(OR=3.508,P=0.018),thrombospondin-1 level(OR=5.749,P=0.006),carcinoembryonic antigen level(OR=3.873,P=0.030),and SA(OR=3.593,P=0.017)were independent risk factors that may influence esophageal cancer patients'prognosis(P<0.05).CONCLUSION The presence of SA has a significant relation to the poor prognosis of esophageal cancer patients,which highlights the importance of assessing and intervening in SA in clinical management so as to improve patient prognosis.
基金Supported by the National Natural Science Foundation of China,No.82270634Third Affiliated Hospital of Naval Medical University,No.tf2024yzyy01.
文摘Hepatocellular carcinoma(HCC)is one of the most common malignant tumors globally and is the most prevalent type of primary liver cancer,posing a heavy burden on global health.Surgical resection and liver transplantation are the gold standard for the radical treatment of HCC.However,due to the heterogeneity and high invasiveness of HCC,the rates of local and distant recurrence are extremely high,with over 70%of patients experiencing recurrence within 5 years after treatment,significantly impacting the long-term quality of life.Therefore,researchers are exploring other treatment methods to reduce tumor recurrence and improve patient survival.To date,extensive research has concentrated on new alternative therapies,including radiotherapy(e.g.,selective internal radiotherapy),targeted drug therapy(e.g.,sorafenib and lenvatinib),and immunotherapy(e.g.,immune checkpoint inhibitors),which have played an integral role in the comprehensive treatment of HCC.This review mainly focuses on the cutting-edge advancements in these treatment methods for HCC and their potential role in reducing HCC recurrence.
