Radiotherapy(RT)is considered a standard cancer treatment that directly kills tumor cells and promotes a systemic immune response.However,RT may also lead to tumor hypoxia,which further inhibits the antigen-presenting...Radiotherapy(RT)is considered a standard cancer treatment that directly kills tumor cells and promotes a systemic immune response.However,RT may also lead to tumor hypoxia,which further inhibits the antigen-presenting function of dendritic cells(DCs)and thereby weakens the systemic anti-tumor immune response induced by radiotherapy.In this study,the oxygen-loaded in situ gels carrying bacterial outer membrane(MOGel)were synthesized.As the gels slowly degraded,oxygen was gradually released to alleviate tumor hypoxia.The released bacterial outer membrane(OM)continuously activated DCs,enhancing their antigenpresenting capability.The results demonstrated that MOGel combined with RT induced the strongest tumor cell apoptosis in vitro and achieved a 80%tumor suppression rate in a colon cancer orthotopic model.Importantly,MOGel+RT induced an enhanced abscopal effect,and hypoxia and enhanced DCs activation contributed to the systemic immune response.Thus,OM-based oxygen gels may offer a novel strategy for enhancing the systemic immune response to RT.展开更多
Objectives:The PACIFIC trial established the benefit of durvalumab following chemo-radiotherapy for stage III non-small cell lung cancer(NSCLC).However,the concurrent use of radiotherapy(RT)and durvalumab(PACIFIC-2 tr...Objectives:The PACIFIC trial established the benefit of durvalumab following chemo-radiotherapy for stage III non-small cell lung cancer(NSCLC).However,the concurrent use of radiotherapy(RT)and durvalumab(PACIFIC-2 trial)showed no additional advantage.The PD-RAD study was set up to understand the immunological effects of RT on the tumor microenvironment(TME)to aid in optimizing sequencing of combination therapies.Methods:The PD-RAD trial(ClinicalTrials.gov identifier:NCT03258788)aimed to enroll thirty NSCLC patients receiving radical-intent RT.Tumor biopsies and blood samples were collected pre-RT and at week 2 during RT and analyzed using multiplex immunohistochemistry(mIHC)and high-dimensional mass cytometry(CyTOF),respectively.Results:Paired biopsies were collected from only three patients(Pts 1,3&4)and blood from four patients(Pts 1-4)before the study was closed early during the COVID-19 pandemic.Programmed Death-Ligand 1(PD-L1)expression in the TME was raised in Patient 1,who responded well to treatment,and unaltered in two patients with progressive disease.CyTOF analysis revealed elevated circulating classical monocytes,highest in the patient with a good response.Conclusions:This study underscores the challenges of integrating advanced immune monitoring during RT delivery and did not meet its primary endpoint.The hypothesis-generating findings highlight PD-L1+macrophages in the TME and classical monocytes in the blood as potential immune biomarkers of RT response,but larger studies are needed to validate these observations and characterize the immune changes following curative-intent RT in patients with NSCLC.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
OBJECTIVE： Precision radiotherapy plays an important role in the management of brain tumors. This study aimed to identify global research trends in precision radiotherapy for brain tumors using a bibliometric analysi...OBJECTIVE： Precision radiotherapy plays an important role in the management of brain tumors. This study aimed to identify global research trends in precision radiotherapy for brain tumors using a bibliometric analysis of the Web of Science. DATA RETRIEVAL： We performed a bibliometric analysis of data retrievals for precision radiotherapy for brain tumors containing the key words cerebral tumor, brain tumor, intensity-modulated radiotherapy, stereotactic body radiation therapy, stereotactic ablative radiotherapy, imaging-guided radiotherapy, dose-guided radiotherapy, stereotactic brachytherapy, and stereotactic radiotherapy using the Web of Science. SELECTION CRITERIA： Inclusion criteria： （a） peer-reviewed articles on precision radiotherapy for brain tumors which were published and indexed in the Web of Science; （b） type of articles： original research articles and reviews; （c） year of publication： 2002-2011. Exclusion criteria： （a） articles that required manual searching or telephone access; （b） Corrected papers or book chapters. MAIN OUTCOME MEASURES： （1） Annual publication output; （2） distribution according to country; （3） distribution according to institution; （4） top cited publications; （5） distribution according to journals; and （6） comparison of study results on precision radiotherapy for brain tumors. RESULTS： The stereotactic radiotherapy, intensity-modulated radiotherapy, and imaging-guided radiotherapy are three major methods of precision radiotherapy for brain tumors. There were 260 research articles addressing precision radiotherapy for brain tumors found within the Web of Science. The USA published the most papers on precision radiotherapy for brain tumors, followed by Germany and France. European Synchrotron Radiation Facility, German Cancer Research Center and Heidelberg University were the most prolific research institutes for publications on precision radiotherapy for brain tumors. Among the top 13 research institutes publishing in this field, seven are in the USA, three are in Germany, two are in France, and there is one institute in India. Research interests including urology and nephrology, clinical neurology, as well as rehabilitation are involved in precision radiotherapy for brain tumors studies. CONCLUSION： Precision radiotherapy for brain tumors remains a highly active area of research and development.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
Objective:Radiotherapy(RT)is the definitive treatment for stageⅡnasopharyngeal carcinoma(NPC),which is classified as stagesⅠA andⅠB in the latest ninth edition of American Joint Committee on Cancer(AJCC)/Union for ...Objective:Radiotherapy(RT)is the definitive treatment for stageⅡnasopharyngeal carcinoma(NPC),which is classified as stagesⅠA andⅠB in the latest ninth edition of American Joint Committee on Cancer(AJCC)/Union for International Cancer Control(UICC).A crucial question is whether concurrent chemo-radiotherapy(CCRT)could derive additional benefits to this recent“down-staging”subgroup of NPC patients.This study aimed to interrogate clinical and radiomic features for predicting 5-year progression-free survival(PFS)of stageⅡNPC treated with RT alone or CCRT.Methods:Imaging and clinical data of 166 stageⅡNPC(eighth edition AJCC/UICC)patients were collected.Data were allocated into training,internal testing,and external testing sets.For each case,851 radiomic features were extracted and 10 clinical features were collected.Radiomic and clinical features most associated with the 5-year PFS were selected separately.A combined model was developed using multivariate logistic regression by integrating selected features and treatment option to predict 5-year PFS.Model performances were evaluated by area under the receiver operating curve(AUC),prediction accuracy,and decision curve analysis.Survival analyses including Kaplan-Meier analysis and Cox regression model were performed for further analysis.Results:Thirteen radiomic features,three clinical features,and treatment option were considered for model development.The combined model showed higher prognostic performance than using either.For the merged testing set(internal and external testing sets),AUC is 0.76(combined)vs.0.56-0.80(clinical or radiomic alone)and accuracy is 0.75(combined)vs.0.62-0.73(clinical or radiomic alone).Kaplan-Meier analysis using the combined model showed significant discrimination in PFS of the predicted low-risk and high-risk groups in the training and internal testing cohorts(P<0.05).Conclusions:Integrating with clinical and radiomic features could provide prognostic information on 5-year PFS under either treatment regimen,guiding individualized decisions of chemotherapy based on the predicted treatment outcome.展开更多
BACKGROUND The standard treatment of locally advanced rectal cancers(LARC)consists on neoadjuvant chemoradiotherapy followed by total mesorectal excision.Different data in literature showed a benefit on tumor downstag...BACKGROUND The standard treatment of locally advanced rectal cancers(LARC)consists on neoadjuvant chemoradiotherapy followed by total mesorectal excision.Different data in literature showed a benefit on tumor downstaging and pathological complete response(pCR)rate using radiotherapy dose escalation,however there is shortage of studies regarding dose escalation using the innovative techniques for LARC(T3-4 or N1-2).AIM To analyze the role of neoadjuvant radiotherapy dose escalation for LARC using innovative radiotherapy techniques.METHODS In December 2020,we conducted a comprehensive literature search of the following electronic databases:PubMed,Web of Science,Scopus and Cochrane library.The limit period of research included articles published from January 2009 to December 2020.Screening by title and abstract was carried out to identify only studies using radiation doses equivalent dose 2 Gy fraction(EQD2)≥54 Gy and Volumetric Modulated Arc Therapy(VMAT),intensity-modulated radiotherapy or image-guided radiotherapy(IGRT)techniques.The authors’searches generated a total of 2287 results and,according to PRISMA Group(2009)screening process,21 publications fulfil selection criteria and were included for the review.RESULTS The main radiotherapy technique used consisted in VMAT and IGRT modality.The mainly dose prescription was 55 Gy to high risk volume and 45 Gy as prophylactic volume in 25 fractions given with simultaneous integrated boosts technique(42.85%).The mean pCR was 28.2%with no correlation between dose prescribed and response rates(P value≥0.5).The R0 margins and sphincter preservation rates were 98.88%and 76.03%,respectively.After a mean follow-up of 35 months local control was 92.29%.G3 or higher toxicity was 11.06%with no correlation between dose prescription and toxicities.Patients receiving EQD2 dose>58.9 Gy and BED>70.7 Gy had higher surgical complications rates compared to other group(P value=0.047).CONCLUSION Dose escalation neoadjuvant radiotherapy using innovative techniques is safe for LARC achieving higher rates of pCR.EQD2 doses>58.9 Gy is associated with higher rate of surgical complications.展开更多
Background:Stereotactic body radiotherapy(SBRT)in pancreatic cancer allows high delivery of radiation doses on tumors without affecting surrounding tissue.This review aimed at the SBRT application in the treatment of ...Background:Stereotactic body radiotherapy(SBRT)in pancreatic cancer allows high delivery of radiation doses on tumors without affecting surrounding tissue.This review aimed at the SBRT application in the treatment of pancreatic cancer.Data sources:We retrieved articles published in MEDLINE/PubMed from January 2017 to December 2022.Keywords used in the search included:“pancreatic adenocarcinoma”OR“pancreatic cancer”AND“stereotactic ablative radiotherapy(SABR)”OR“stereotactic body radiotherapy(SBRT)”OR“chemoradiotherapy(CRT)”.English language articles with information on technical characteristics,doses and fractionation,indications,recurrence patterns,local control and toxicities of SBRT in pancreatic tumors were included.All articles were assessed for validity and relevant content.Results:Optimal doses and fractionation have not yet been defined.However,SBRT could be the standard treatment in patients with pancreatic adenocarcinoma in addition to CRT.Furthermore,the combination of SBRT with chemotherapy may have additive or synergic effect on pancreatic adenocarcinoma.Conclusions:SBRT is an effective modality for patients with pancreatic cancer,supported by clinical practice guidelines as it has demonstrated good tolerance and good disease control.SBRT opens a possibility of improving outcomes for these patients,both in neoadjuvant treatment and with radical intent.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
Objective:Hepatocellular carcinoma(HCC)is the most common pathological subtype of primary liver cancer and is associated with high incidence and mortality.External beam radiation therapy(EBRT)is a widely used local tr...Objective:Hepatocellular carcinoma(HCC)is the most common pathological subtype of primary liver cancer and is associated with high incidence and mortality.External beam radiation therapy(EBRT)is a widely used local treatment modality for HCC across different disease stages.In the era of precision radiotherapy,standardized safety evaluation indicators for HCC radiotherapy remain lacking.Normal liver tissue surrounding the tumor may lose hepatic function after high-dose irradiation.In this study,remnant functional liver volume(RFLV)was defined as the volume of liver tissue that retains normal function after irradiation,and the residual remnant functional liver volume after x Gy irradiation(rRFLV_(x))was defined as the absolute liver volume receiving less than a given dose threshold(x Gy),and plans to explore the performance of rRFLV_(x) as a radiotherapy safety dose indicator based on real-world data,as well as to explore the safety and efficacy of EBRT in HCC.Methods:A total of 113 HCC patients who received stereotactic body radiotherapy(a SBRT group,n=35)or intensity-modulated radiation therapy(a IMRT group,n=78)for liver lesions at the Third Xiangya Hospital of Central South University between 2015 and 2023 were prospectively collected and selected.The occurrence of radiation-induced liver diseases(RILDs)was recorded.Dosimetric parameters potentially associated with RILDs were analyzed using binary logistic regression with Hosmer-Lemeshow test,mainly including mean liver dose(MLD),remnant liver volume(RLV),standard liver volume(SLV),and rRFLV_(x).Radiotherapy-related hepatitis virus reactivation and other radiotherapy-related toxicities were also observed.Progression-free survival(PFS)and overall survival(OS)were used to evaluate the efficacy of EBRT in HCC.Results:Among the 113 HCC patients,12 were diagnosed with RILDs,including 11 in the IMRT group and only 1 in the SBRT group.Binary logistic regression with Hosmer-Lemeshow test results suggested that rRFLV_(25),rRFLV_(20),rRFLV_(15),rRFLV_(25)/SLV,rRFLV_(20)/SLV,and rRFLV_(15)/SLV were significantly associated with the occurrence of RILDs in HCC patients in the IMRT group(all P<0.05),while MLD and RLV were not associated with the occurrence of RILDs(P=0.88).One patient without regular anti-hepatitis viral treatment was diagnosed with radiotherapy-related HBV clinical reactivation,and one patient was diagnosed with immunotherapy-related HBV clinical reactivation.The median PFS was 5.6 months in the IMRT group and 16.4 months in the SBRT group,and the best local control rates were 98.6%and 100.0%,respectively.The median OS was 12.2 months in the IMRT group and 33.5 months in the SBRT group.The 6-month,1-year,and 2-year OS rates in the IMRT group were 77.1%,52.6%,and 18.6%,respectively.The 1-year,2-year,3-year,4-year,and 5-year OS rates in the SBRT group were 86.1%,61.7%,39.2%,25.7%,and 18.3%,respectively.Conclusion:EBRT is safe and effective for HCC patients at different stages.Compared with MLD and RLV,rRFLV_(x) and rRFLV_(x)/SLV may be more reliable for evaluating the occurrence of RILDs after IMRT treatment.For patients with hepatitis background,concurrent antiviral therapy during radiotherapy is relatively safe,but serum viral load should be closely monitored.Further research is needed to explore the efficacy and safety of radiotherapy combined with targeted and immunotherapy.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 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
Treatment delays during radiotherapy for head and neck cancer(HNC)are a well-established factor negatively affecting clinical outcomes,with similar trends observed in other cancers.In this first part of a two-part rev...Treatment delays during radiotherapy for head and neck cancer(HNC)are a well-established factor negatively affecting clinical outcomes,with similar trends observed in other cancers.In this first part of a two-part review,we assessed the impact of overall treatment time(OTT)prolongation on locoregional control(LRC)and survival(SV)in cervical cancer(CC),prostate cancer(PC),and anal cancer(AC),while updating evidence for HNC.A comprehensive literature search was performed in evidence-based databases,including MEDLINE,identifying studies evaluating the relationship between OTT prolongation and outcomes.Particular attention was paid to the strength of evidence,distinguishing univariate analysis from multivariate analysis(MV-An).For CC,37 articles were identified,with 88.8%reporting a detrimental impact on LRC and/or SV,mostly supported by MV-An.In AC,15 studies were found,with 33.3%showing negative impacts,although with weaker evidence.For PC,12 articles were reviewed,with 66.6%demonstrating detrimental effects mainly on LRC or biochemical control,and occasional associations with cancer-specific SV.Recent studies in HNC reinforced prior findings.When available,radiobiological parameters and practical recommendations are provided.In conclusion,strong evidence confirms that prolonged OTT worsens outcomes in HNC and CC,with less consistent but relevant effects in PC and AC.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
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 Definitive chemoradiotherapy is the standard treatment for unresectable,locally advanced esophageal cancer.However,radiotherapy(RT)often affects the immune system of patients.One of the possible mechanisms ...BACKGROUND Definitive chemoradiotherapy is the standard treatment for unresectable,locally advanced esophageal cancer.However,radiotherapy(RT)often affects the immune system of patients.One of the possible mechanisms of lymphopenia after RT is that a large number of circulating lymphocytes in the systemic and pulmonary circulation will be killed by more sessions of low-dose radiation.The impact of dose-volume parameters of organs at risk(OARs)on absolute lymphocyte count(ALC)and the relationship between the extent of lymphocyte count reduction and survival prognosis in patients with middle and lower thoracic esophageal squamous cell carcinoma(ESCC)both remain difficult to determine.AIM To determine the relationship between RT parameters,lymphocyte count and survival prognosis of esophageal cancer patients.METHODS The clinical data of 112 patients with stage I-III ESCC who received definitive RT were analyzed retrospectively.The ALC values before RT,weekly during RT,and within 1 month after RT were determined.Logistic regression was used to evaluate the correlation between the parameters of radiation OARs and the lowest point of the ALC.Kaplan-Meier and Cox regression analyses were used to evaluate the relationship between the lowest point of the ALC and patient survival during RT.RESULTS The median value of the ALC before treatment was 1.57×10^(9)cells/L,and 32 patients(28.6%)showed grade 4 ALC reduction during RT.The reduction in G4 ALC during RT was significantly associated with poor overall survival(OS)and progression-free survival.Multivariate analysis showed that stage III tumors(P=0.003),high heart V_(10)(P=0.046),high lung V_(5)(P=0.048),and high lung V_(20)(P=0.031)were associated with G4 ALC reduction during RT.CONCLUSION The reduction in G4 ALC is related to OS.Joint evaluation of the tumor stage and dose volume parameters has predictive value for G4 ALC reduction and OS.展开更多
BACKGROUND Nasopharyngeal carcinoma(NPC),exhibiting high incidence in southern China,is linked to genetic and environmental factors.Vitamin D metabolism,involving transport[group-specific component(GC)protein]and acti...BACKGROUND Nasopharyngeal carcinoma(NPC),exhibiting high incidence in southern China,is linked to genetic and environmental factors.Vitamin D metabolism,involving transport[group-specific component(GC)protein]and activation[25-hydroxylase(CYP2R1)enzyme],may influence NPC susceptibility and radiotherapy response.Polymorphisms in GC and CYP2R1 genes affect protein function and serum 25-hydroxyvitamin D[25(OH)D]levels,and are implicated in other cancers.However,their role in NPC-particularly in high-risk Han Chinese populations-and interaction with vitamin D status remains unclear.This case control study(360 NPC patients,550 controls)investigates these relationships to inform prevention and personalized therapy.AIM To investigate the association between vitamin D binding protein(GC)and CYP2R1 gene polymorphisms with susceptibility to NPC and radiotherapy response.METHODS A case control study design was adopted,and 360 patients with NPC and 550 healthy controls were included.TaqMan method was used to perform genotyping on GC gene loci rs4588,rs7041,and CYP2R1 gene loci rs10741657,rs12794714.Serum 25(OH)D levels were detected,and the relationship between gene polymorphisms and NPC risk and radiotherapy response was analyzed.RESULTS The GC gene rs4588 TT genotype was significantly associated with the risk of NPC in both the codominant model[odds ratio(OR)=1.68,95%CI:1.15-2.45,P=0.007]and the recessive model(OR=1.56,95%CI:1.02-2.38,P=0.039).The association between the rs4588 TT genotype and the risk of NPC was more significant in the male subgroup(OR=1.87,95%CI:1.11-3.15,P=0.019)and the squamous cell carcinoma subgroup(OR=1.89,95%CI:1.19-3.00,P=0.007).The serum 25(OH)D level of the rs7041 AA genotype carriers was significantly lower than that of the CC genotype(P<0.001).The CYP2R1 gene rs10741657 AA genotype was associated with higher serum 25(OH)D levels(P=0.003).The rs12794714 AA genotype was associated with radiotherapy resistance(OR=1.76,95%CI:1.18-2.63,P=0.005).Stratified analysis showed that the association between rs4588 and rs12794714 was significant only in the subgroup with higher 25(OH)D levels.CONCLUSION GC and CYP2R1 genes polymorphisms are associated with NPC susceptibility and radiotherapy response,and this association may be affected by serum 25(OH)D levels.This study provides a new idea for the prevention and individualized treatment in NPC.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
BACKGROUND Colorectal cancer is one of the malignant tumors with a high incidence and mortality rate globally,and the occurrence of liver metastasis significantly affects patient survival prognosis.In recent years,the...BACKGROUND Colorectal cancer is one of the malignant tumors with a high incidence and mortality rate globally,and the occurrence of liver metastasis significantly affects patient survival prognosis.In recent years,the application of immune checkpoint inhibitors(ICIs)in cancer treatment has made important progress,especially showing good therapeutic effects in patients with high microsatellite instability or mismatch repair deficiency.However,for the majority of patients with microsatellite stable(MSS)or proficient mismatch repair(pMMR)colorectal cancer,the efficacy of ICIs is limited,prompting researchers to explore combination therapy strategies to improve efficacy.Targeted drugs such as tyrosine kinase inhibitors(TKIs)and radiotherapy are believed to work synergistically with ICIs by modifying the tumor microenvironment and enhancing antigen presentation.AIM To investigate the efficacy and safety of the combination therapy of radiotherapy,ICIs,and TKIs in patients with MSS or pMMR colorectal cancer liver metastasis(CCLM),in order to provide new clinical treatment references.METHODS A retrospective analysis was conducted on the clinical data of 43 MSS or pMMR CCLM patients treated at our hospital from September 2021 to July 2024.Based on the treatment interventions received,the patients were divided into a control group(n=21,receiving ICIs and TKIs combination therapy)and an observation group(n=22,receiving radiotherapy,ICIs,and TKIs triple therapy).The therapeutic effects,serum tumor markers(carcinoembryonic antigen and RESULTS The disease control rate in the observation group(63.64%)was significantly higher than that of the control group(23.81%)(P<0.05)).Both groups showed a decrease in carcinoembryonic antigen and carbohydrate antigen 199 levels post-treatment,with the observation group demonstrating a more significant change(P<0.05).The median progression-free survival and median overall survival in the control group were 5.1 months and 7.6 months,respectively,while the observation group had a median progression-free survival and overall survival of 4.3 months and 6.9 months,respectively.The control group had longer survival times than the observation group,but the differences were not statistically significant(P>0.05).The incidence of adverse reactions,including nausea and vomiting,gastrointestinal reactions,skin reactions,bone marrow suppression,liver and kidney function impairment,neurotoxicity,leukopenia,neutropenia,and thrombocytopenia,showed no significant differences between the two groups(P>0.05).CONCLUSION Compared to the ICIs and TKIs combination therapy,the radiotherapy,ICIs,and TKIs triple therapy can further improve the disease control rate and serum tumor marker levels in MSS or pMMR CCLM patients without increasing the risk of related adverse reactions,making it a treatment regimen worthy of further validation.展开更多
基金supported by the National Key R&D Program of China(2022YFC3401600)the National Natural Science Foun-dation of China(32530061 and 32171372)+1 种基金the Science and Technology Projects of Xizang Autonomous Region,China(XZ202202YD0029C)the Fundamental Research Funds for the Central Universities(KG202511)。
文摘Radiotherapy(RT)is considered a standard cancer treatment that directly kills tumor cells and promotes a systemic immune response.However,RT may also lead to tumor hypoxia,which further inhibits the antigen-presenting function of dendritic cells(DCs)and thereby weakens the systemic anti-tumor immune response induced by radiotherapy.In this study,the oxygen-loaded in situ gels carrying bacterial outer membrane(MOGel)were synthesized.As the gels slowly degraded,oxygen was gradually released to alleviate tumor hypoxia.The released bacterial outer membrane(OM)continuously activated DCs,enhancing their antigenpresenting capability.The results demonstrated that MOGel combined with RT induced the strongest tumor cell apoptosis in vitro and achieved a 80%tumor suppression rate in a colon cancer orthotopic model.Importantly,MOGel+RT induced an enhanced abscopal effect,and hypoxia and enhanced DCs activation contributed to the systemic immune response.Thus,OM-based oxygen gels may offer a novel strategy for enhancing the systemic immune response to RT.
基金the National Institute for Health and Care Research(NHR)Manchester Biomedical Research Centre(BRC)(NIHR203308,NIHR-BRC-1215-20007)Astra-Zeneca(ESR-14-10711)+2 种基金CRUK RadNet(C19941/A27801)TMI and CFF are the recipient of an NIHR Senior Investigator Award(NIHR205054 and NIHR205061)CTH is supported by the NIHR University College London Hospitals NHS Foundation Trust BRC,the City of London CRUK RadNet and the CRUK Lung Cancer Centre of Excellence.
文摘Objectives:The PACIFIC trial established the benefit of durvalumab following chemo-radiotherapy for stage III non-small cell lung cancer(NSCLC).However,the concurrent use of radiotherapy(RT)and durvalumab(PACIFIC-2 trial)showed no additional advantage.The PD-RAD study was set up to understand the immunological effects of RT on the tumor microenvironment(TME)to aid in optimizing sequencing of combination therapies.Methods:The PD-RAD trial(ClinicalTrials.gov identifier:NCT03258788)aimed to enroll thirty NSCLC patients receiving radical-intent RT.Tumor biopsies and blood samples were collected pre-RT and at week 2 during RT and analyzed using multiplex immunohistochemistry(mIHC)and high-dimensional mass cytometry(CyTOF),respectively.Results:Paired biopsies were collected from only three patients(Pts 1,3&4)and blood from four patients(Pts 1-4)before the study was closed early during the COVID-19 pandemic.Programmed Death-Ligand 1(PD-L1)expression in the TME was raised in Patient 1,who responded well to treatment,and unaltered in two patients with progressive disease.CyTOF analysis revealed elevated circulating classical monocytes,highest in the patient with a good response.Conclusions:This study underscores the challenges of integrating advanced immune monitoring during RT delivery and did not meet its primary endpoint.The hypothesis-generating findings highlight PD-L1+macrophages in the TME and classical monocytes in the blood as potential immune biomarkers of RT response,but larger studies are needed to validate these observations and characterize the immune changes following curative-intent RT in patients with NSCLC.
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.
文摘OBJECTIVE： Precision radiotherapy plays an important role in the management of brain tumors. This study aimed to identify global research trends in precision radiotherapy for brain tumors using a bibliometric analysis of the Web of Science. DATA RETRIEVAL： We performed a bibliometric analysis of data retrievals for precision radiotherapy for brain tumors containing the key words cerebral tumor, brain tumor, intensity-modulated radiotherapy, stereotactic body radiation therapy, stereotactic ablative radiotherapy, imaging-guided radiotherapy, dose-guided radiotherapy, stereotactic brachytherapy, and stereotactic radiotherapy using the Web of Science. SELECTION CRITERIA： Inclusion criteria： （a） peer-reviewed articles on precision radiotherapy for brain tumors which were published and indexed in the Web of Science; （b） type of articles： original research articles and reviews; （c） year of publication： 2002-2011. Exclusion criteria： （a） articles that required manual searching or telephone access; （b） Corrected papers or book chapters. MAIN OUTCOME MEASURES： （1） Annual publication output; （2） distribution according to country; （3） distribution according to institution; （4） top cited publications; （5） distribution according to journals; and （6） comparison of study results on precision radiotherapy for brain tumors. RESULTS： The stereotactic radiotherapy, intensity-modulated radiotherapy, and imaging-guided radiotherapy are three major methods of precision radiotherapy for brain tumors. There were 260 research articles addressing precision radiotherapy for brain tumors found within the Web of Science. The USA published the most papers on precision radiotherapy for brain tumors, followed by Germany and France. European Synchrotron Radiation Facility, German Cancer Research Center and Heidelberg University were the most prolific research institutes for publications on precision radiotherapy for brain tumors. Among the top 13 research institutes publishing in this field, seven are in the USA, three are in Germany, two are in France, and there is one institute in India. Research interests including urology and nephrology, clinical neurology, as well as rehabilitation are involved in precision radiotherapy for brain tumors studies. CONCLUSION： Precision radiotherapy for brain tumors remains a highly active area of research and development.
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Objective:Radiotherapy(RT)is the definitive treatment for stageⅡnasopharyngeal carcinoma(NPC),which is classified as stagesⅠA andⅠB in the latest ninth edition of American Joint Committee on Cancer(AJCC)/Union for International Cancer Control(UICC).A crucial question is whether concurrent chemo-radiotherapy(CCRT)could derive additional benefits to this recent“down-staging”subgroup of NPC patients.This study aimed to interrogate clinical and radiomic features for predicting 5-year progression-free survival(PFS)of stageⅡNPC treated with RT alone or CCRT.Methods:Imaging and clinical data of 166 stageⅡNPC(eighth edition AJCC/UICC)patients were collected.Data were allocated into training,internal testing,and external testing sets.For each case,851 radiomic features were extracted and 10 clinical features were collected.Radiomic and clinical features most associated with the 5-year PFS were selected separately.A combined model was developed using multivariate logistic regression by integrating selected features and treatment option to predict 5-year PFS.Model performances were evaluated by area under the receiver operating curve(AUC),prediction accuracy,and decision curve analysis.Survival analyses including Kaplan-Meier analysis and Cox regression model were performed for further analysis.Results:Thirteen radiomic features,three clinical features,and treatment option were considered for model development.The combined model showed higher prognostic performance than using either.For the merged testing set(internal and external testing sets),AUC is 0.76(combined)vs.0.56-0.80(clinical or radiomic alone)and accuracy is 0.75(combined)vs.0.62-0.73(clinical or radiomic alone).Kaplan-Meier analysis using the combined model showed significant discrimination in PFS of the predicted low-risk and high-risk groups in the training and internal testing cohorts(P<0.05).Conclusions:Integrating with clinical and radiomic features could provide prognostic information on 5-year PFS under either treatment regimen,guiding individualized decisions of chemotherapy based on the predicted treatment outcome.
文摘BACKGROUND The standard treatment of locally advanced rectal cancers(LARC)consists on neoadjuvant chemoradiotherapy followed by total mesorectal excision.Different data in literature showed a benefit on tumor downstaging and pathological complete response(pCR)rate using radiotherapy dose escalation,however there is shortage of studies regarding dose escalation using the innovative techniques for LARC(T3-4 or N1-2).AIM To analyze the role of neoadjuvant radiotherapy dose escalation for LARC using innovative radiotherapy techniques.METHODS In December 2020,we conducted a comprehensive literature search of the following electronic databases:PubMed,Web of Science,Scopus and Cochrane library.The limit period of research included articles published from January 2009 to December 2020.Screening by title and abstract was carried out to identify only studies using radiation doses equivalent dose 2 Gy fraction(EQD2)≥54 Gy and Volumetric Modulated Arc Therapy(VMAT),intensity-modulated radiotherapy or image-guided radiotherapy(IGRT)techniques.The authors’searches generated a total of 2287 results and,according to PRISMA Group(2009)screening process,21 publications fulfil selection criteria and were included for the review.RESULTS The main radiotherapy technique used consisted in VMAT and IGRT modality.The mainly dose prescription was 55 Gy to high risk volume and 45 Gy as prophylactic volume in 25 fractions given with simultaneous integrated boosts technique(42.85%).The mean pCR was 28.2%with no correlation between dose prescribed and response rates(P value≥0.5).The R0 margins and sphincter preservation rates were 98.88%and 76.03%,respectively.After a mean follow-up of 35 months local control was 92.29%.G3 or higher toxicity was 11.06%with no correlation between dose prescription and toxicities.Patients receiving EQD2 dose>58.9 Gy and BED>70.7 Gy had higher surgical complications rates compared to other group(P value=0.047).CONCLUSION Dose escalation neoadjuvant radiotherapy using innovative techniques is safe for LARC achieving higher rates of pCR.EQD2 doses>58.9 Gy is associated with higher rate of surgical complications.
文摘Background:Stereotactic body radiotherapy(SBRT)in pancreatic cancer allows high delivery of radiation doses on tumors without affecting surrounding tissue.This review aimed at the SBRT application in the treatment of pancreatic cancer.Data sources:We retrieved articles published in MEDLINE/PubMed from January 2017 to December 2022.Keywords used in the search included:“pancreatic adenocarcinoma”OR“pancreatic cancer”AND“stereotactic ablative radiotherapy(SABR)”OR“stereotactic body radiotherapy(SBRT)”OR“chemoradiotherapy(CRT)”.English language articles with information on technical characteristics,doses and fractionation,indications,recurrence patterns,local control and toxicities of SBRT in pancreatic tumors were included.All articles were assessed for validity and relevant content.Results:Optimal doses and fractionation have not yet been defined.However,SBRT could be the standard treatment in patients with pancreatic adenocarcinoma in addition to CRT.Furthermore,the combination of SBRT with chemotherapy may have additive or synergic effect on pancreatic adenocarcinoma.Conclusions:SBRT is an effective modality for patients with pancreatic cancer,supported by clinical practice guidelines as it has demonstrated good tolerance and good disease control.SBRT opens a possibility of improving outcomes for these patients,both in neoadjuvant treatment and with radical intent.
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 National Natural Science Foundation(81872473)the Chen Xiaoping Foundation for the Development of Science and Technology of Hubei Province(CXPJJH12000001-2020216)the Wu Jieping Medical Foundation(320.6750.19094-30),China。
文摘Objective:Hepatocellular carcinoma(HCC)is the most common pathological subtype of primary liver cancer and is associated with high incidence and mortality.External beam radiation therapy(EBRT)is a widely used local treatment modality for HCC across different disease stages.In the era of precision radiotherapy,standardized safety evaluation indicators for HCC radiotherapy remain lacking.Normal liver tissue surrounding the tumor may lose hepatic function after high-dose irradiation.In this study,remnant functional liver volume(RFLV)was defined as the volume of liver tissue that retains normal function after irradiation,and the residual remnant functional liver volume after x Gy irradiation(rRFLV_(x))was defined as the absolute liver volume receiving less than a given dose threshold(x Gy),and plans to explore the performance of rRFLV_(x) as a radiotherapy safety dose indicator based on real-world data,as well as to explore the safety and efficacy of EBRT in HCC.Methods:A total of 113 HCC patients who received stereotactic body radiotherapy(a SBRT group,n=35)or intensity-modulated radiation therapy(a IMRT group,n=78)for liver lesions at the Third Xiangya Hospital of Central South University between 2015 and 2023 were prospectively collected and selected.The occurrence of radiation-induced liver diseases(RILDs)was recorded.Dosimetric parameters potentially associated with RILDs were analyzed using binary logistic regression with Hosmer-Lemeshow test,mainly including mean liver dose(MLD),remnant liver volume(RLV),standard liver volume(SLV),and rRFLV_(x).Radiotherapy-related hepatitis virus reactivation and other radiotherapy-related toxicities were also observed.Progression-free survival(PFS)and overall survival(OS)were used to evaluate the efficacy of EBRT in HCC.Results:Among the 113 HCC patients,12 were diagnosed with RILDs,including 11 in the IMRT group and only 1 in the SBRT group.Binary logistic regression with Hosmer-Lemeshow test results suggested that rRFLV_(25),rRFLV_(20),rRFLV_(15),rRFLV_(25)/SLV,rRFLV_(20)/SLV,and rRFLV_(15)/SLV were significantly associated with the occurrence of RILDs in HCC patients in the IMRT group(all P<0.05),while MLD and RLV were not associated with the occurrence of RILDs(P=0.88).One patient without regular anti-hepatitis viral treatment was diagnosed with radiotherapy-related HBV clinical reactivation,and one patient was diagnosed with immunotherapy-related HBV clinical reactivation.The median PFS was 5.6 months in the IMRT group and 16.4 months in the SBRT group,and the best local control rates were 98.6%and 100.0%,respectively.The median OS was 12.2 months in the IMRT group and 33.5 months in the SBRT group.The 6-month,1-year,and 2-year OS rates in the IMRT group were 77.1%,52.6%,and 18.6%,respectively.The 1-year,2-year,3-year,4-year,and 5-year OS rates in the SBRT group were 86.1%,61.7%,39.2%,25.7%,and 18.3%,respectively.Conclusion:EBRT is safe and effective for HCC patients at different stages.Compared with MLD and RLV,rRFLV_(x) and rRFLV_(x)/SLV may be more reliable for evaluating the occurrence of RILDs after IMRT treatment.For patients with hepatitis background,concurrent antiviral therapy during radiotherapy is relatively safe,but serum viral load should be closely monitored.Further research is needed to explore the efficacy and safety of radiotherapy combined with targeted and immunotherapy.
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.
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Treatment delays during radiotherapy for head and neck cancer(HNC)are a well-established factor negatively affecting clinical outcomes,with similar trends observed in other cancers.In this first part of a two-part review,we assessed the impact of overall treatment time(OTT)prolongation on locoregional control(LRC)and survival(SV)in cervical cancer(CC),prostate cancer(PC),and anal cancer(AC),while updating evidence for HNC.A comprehensive literature search was performed in evidence-based databases,including MEDLINE,identifying studies evaluating the relationship between OTT prolongation and outcomes.Particular attention was paid to the strength of evidence,distinguishing univariate analysis from multivariate analysis(MV-An).For CC,37 articles were identified,with 88.8%reporting a detrimental impact on LRC and/or SV,mostly supported by MV-An.In AC,15 studies were found,with 33.3%showing negative impacts,although with weaker evidence.For PC,12 articles were reviewed,with 66.6%demonstrating detrimental effects mainly on LRC or biochemical control,and occasional associations with cancer-specific SV.Recent studies in HNC reinforced prior findings.When available,radiobiological parameters and practical recommendations are provided.In conclusion,strong evidence confirms that prolonged OTT worsens outcomes in HNC and CC,with less consistent but relevant effects in PC and AC.
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.
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.
文摘BACKGROUND Definitive chemoradiotherapy is the standard treatment for unresectable,locally advanced esophageal cancer.However,radiotherapy(RT)often affects the immune system of patients.One of the possible mechanisms of lymphopenia after RT is that a large number of circulating lymphocytes in the systemic and pulmonary circulation will be killed by more sessions of low-dose radiation.The impact of dose-volume parameters of organs at risk(OARs)on absolute lymphocyte count(ALC)and the relationship between the extent of lymphocyte count reduction and survival prognosis in patients with middle and lower thoracic esophageal squamous cell carcinoma(ESCC)both remain difficult to determine.AIM To determine the relationship between RT parameters,lymphocyte count and survival prognosis of esophageal cancer patients.METHODS The clinical data of 112 patients with stage I-III ESCC who received definitive RT were analyzed retrospectively.The ALC values before RT,weekly during RT,and within 1 month after RT were determined.Logistic regression was used to evaluate the correlation between the parameters of radiation OARs and the lowest point of the ALC.Kaplan-Meier and Cox regression analyses were used to evaluate the relationship between the lowest point of the ALC and patient survival during RT.RESULTS The median value of the ALC before treatment was 1.57×10^(9)cells/L,and 32 patients(28.6%)showed grade 4 ALC reduction during RT.The reduction in G4 ALC during RT was significantly associated with poor overall survival(OS)and progression-free survival.Multivariate analysis showed that stage III tumors(P=0.003),high heart V_(10)(P=0.046),high lung V_(5)(P=0.048),and high lung V_(20)(P=0.031)were associated with G4 ALC reduction during RT.CONCLUSION The reduction in G4 ALC is related to OS.Joint evaluation of the tumor stage and dose volume parameters has predictive value for G4 ALC reduction and OS.
文摘BACKGROUND Nasopharyngeal carcinoma(NPC),exhibiting high incidence in southern China,is linked to genetic and environmental factors.Vitamin D metabolism,involving transport[group-specific component(GC)protein]and activation[25-hydroxylase(CYP2R1)enzyme],may influence NPC susceptibility and radiotherapy response.Polymorphisms in GC and CYP2R1 genes affect protein function and serum 25-hydroxyvitamin D[25(OH)D]levels,and are implicated in other cancers.However,their role in NPC-particularly in high-risk Han Chinese populations-and interaction with vitamin D status remains unclear.This case control study(360 NPC patients,550 controls)investigates these relationships to inform prevention and personalized therapy.AIM To investigate the association between vitamin D binding protein(GC)and CYP2R1 gene polymorphisms with susceptibility to NPC and radiotherapy response.METHODS A case control study design was adopted,and 360 patients with NPC and 550 healthy controls were included.TaqMan method was used to perform genotyping on GC gene loci rs4588,rs7041,and CYP2R1 gene loci rs10741657,rs12794714.Serum 25(OH)D levels were detected,and the relationship between gene polymorphisms and NPC risk and radiotherapy response was analyzed.RESULTS The GC gene rs4588 TT genotype was significantly associated with the risk of NPC in both the codominant model[odds ratio(OR)=1.68,95%CI:1.15-2.45,P=0.007]and the recessive model(OR=1.56,95%CI:1.02-2.38,P=0.039).The association between the rs4588 TT genotype and the risk of NPC was more significant in the male subgroup(OR=1.87,95%CI:1.11-3.15,P=0.019)and the squamous cell carcinoma subgroup(OR=1.89,95%CI:1.19-3.00,P=0.007).The serum 25(OH)D level of the rs7041 AA genotype carriers was significantly lower than that of the CC genotype(P<0.001).The CYP2R1 gene rs10741657 AA genotype was associated with higher serum 25(OH)D levels(P=0.003).The rs12794714 AA genotype was associated with radiotherapy resistance(OR=1.76,95%CI:1.18-2.63,P=0.005).Stratified analysis showed that the association between rs4588 and rs12794714 was significant only in the subgroup with higher 25(OH)D levels.CONCLUSION GC and CYP2R1 genes polymorphisms are associated with NPC susceptibility and radiotherapy response,and this association may be affected by serum 25(OH)D levels.This study provides a new idea for the prevention and individualized treatment in NPC.
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.
文摘BACKGROUND Colorectal cancer is one of the malignant tumors with a high incidence and mortality rate globally,and the occurrence of liver metastasis significantly affects patient survival prognosis.In recent years,the application of immune checkpoint inhibitors(ICIs)in cancer treatment has made important progress,especially showing good therapeutic effects in patients with high microsatellite instability or mismatch repair deficiency.However,for the majority of patients with microsatellite stable(MSS)or proficient mismatch repair(pMMR)colorectal cancer,the efficacy of ICIs is limited,prompting researchers to explore combination therapy strategies to improve efficacy.Targeted drugs such as tyrosine kinase inhibitors(TKIs)and radiotherapy are believed to work synergistically with ICIs by modifying the tumor microenvironment and enhancing antigen presentation.AIM To investigate the efficacy and safety of the combination therapy of radiotherapy,ICIs,and TKIs in patients with MSS or pMMR colorectal cancer liver metastasis(CCLM),in order to provide new clinical treatment references.METHODS A retrospective analysis was conducted on the clinical data of 43 MSS or pMMR CCLM patients treated at our hospital from September 2021 to July 2024.Based on the treatment interventions received,the patients were divided into a control group(n=21,receiving ICIs and TKIs combination therapy)and an observation group(n=22,receiving radiotherapy,ICIs,and TKIs triple therapy).The therapeutic effects,serum tumor markers(carcinoembryonic antigen and RESULTS The disease control rate in the observation group(63.64%)was significantly higher than that of the control group(23.81%)(P<0.05)).Both groups showed a decrease in carcinoembryonic antigen and carbohydrate antigen 199 levels post-treatment,with the observation group demonstrating a more significant change(P<0.05).The median progression-free survival and median overall survival in the control group were 5.1 months and 7.6 months,respectively,while the observation group had a median progression-free survival and overall survival of 4.3 months and 6.9 months,respectively.The control group had longer survival times than the observation group,but the differences were not statistically significant(P>0.05).The incidence of adverse reactions,including nausea and vomiting,gastrointestinal reactions,skin reactions,bone marrow suppression,liver and kidney function impairment,neurotoxicity,leukopenia,neutropenia,and thrombocytopenia,showed no significant differences between the two groups(P>0.05).CONCLUSION Compared to the ICIs and TKIs combination therapy,the radiotherapy,ICIs,and TKIs triple therapy can further improve the disease control rate and serum tumor marker levels in MSS or pMMR CCLM patients without increasing the risk of related adverse reactions,making it a treatment regimen worthy of further validation.
