Stereotactic body radiotherapy for early glottic cancers: Is this "The Way"?

In the past decades, several options have been designed in order to preserve vocal function in patients with early glottic cancer, such as transoral laser microsurgery, new surgical strategies such as partial laryngectomy and radiation therapy (RT). With the development of new radiation techniques enabling a more accurate delivery of radiation dose, and the possibility to deliver high dose per fraction while sparing adjacent organs-at-risks (OARs), stereotactic body radiotherapy (SBRT) is being increasingly tested in this disease setting. We aimed to shed light on this appealing strategy, as well as to underline both optimal target population and specific technical considerations.

Factors Associated With Early Discontinuation of Radiation Therapy: An Analysis of the National Cancer Database

Purpose

Radiation therapy (RT) often involves multiple visits over weeks and may be discontinued before planned treatment completion. This analysis aims to identify clinical and socioeconomic factors that could serve as predictors of RT discontinuation.

Methods and Materials

Using National Cancer Database data from 2018 to 2019, we identified 749,135 cases treated with RT, chemoradiation (CRT), surgery with RT, or surgery with CRT that had information on radiation discontinuation. All patients were treated with curative intent. The variables assessed include age (18-<50, 50-<70, and ≥70), sex (male and female), race (White, Black, and Other), insurance status (private, Medicare/government, and Medicaid/uninsured), income level (<$46,277, $46,277-$57,856, $57,856-$74,062, and ≥$74,062), facility type (community, comprehensive community, academic/research, and integrated cancer network), Charlson-Deyo Comorbidity Score (0, 1, and ≥2), treatment type (RT, CRT, surgery with RT, and surgery with CRT), and primary tumor site. Reasons for RT discontinuation were evaluated. Univariable and multivariable logistic regression modeling was used to calculate the adjusted odds of RT discontinuation by clinical and socioeconomic factors.

Results

Of the 749,135 patients, RT was discontinued in 25,072 (3.3%) patients. The primary tumor sites include breast (36.6%), thorax (18.1%), genitourinary tract (13.2%), head and neck (11.4%), gastrointestinal system (10.9%), gynecologic system (6.0%), central nervous system (3.9%), musculoskeletal system (1.3%), and skin (0.7%). On multivariable analysis, older age, female sex, nonprivate insurance, lower income, treatment at community program facilities, multiple comorbidities, and CRT were independently associated with RT discontinuation. The reasons for RT discontinuation were patient decision (35.5%), contraindication because of patient risk factors (20.0%), toxicity (19.7%), patient expiration (13.8%), and family decision (3.0%).

Conclusions

This National Cancer Database analysis showed RT discontinuation rates correlated with clinical factors, including older age, multiple comorbidities, and CRT, and socioeconomic factors, including nonprivate insurance and lower household income.

Diagnosis and treatment of radiation induced pneumonitis in patients with lung cancer: An ESTRO clinical practice guideline

The incidence of radiation pneumonitis (RP) has decreased significantly compared to historical series, mainly due to improved radiotherapy techniques and patient selection. Nevertheless, some patients still develop RP. This guideline provides user-friendly flowcharts to address common clinical practice questions regarding RP. We summarize the current state of the art regarding the mechanisms, risk factors, diagnosis and treatment of RP. Dosimetric constraints to minimize the incidence of RP, as well as risk factors for developing RP, such as idiopathic pulmonary fibrosis (IPF) were identified. The combination of radiotherapy and medication as a risk factor for the development of RP was reviewed. RP remains a diagnosis of exclusion, but an algorithm for reaching the diagnosis has been proposed. Finally, practical approaches to the treatment of RP are outlined.

Clinical impact of radiotherapy quality assurance results in contemporary cancer trials: a systematic review and meta-analysis

BACKGROUND

Radiotherapy quality assurance (RTQA) is a critical aspect of randomized controlled trials (RCTs) and is associated with validity and reproducibility of the study findings. We conducted a systematic review and meta-analysis to assess the impact of RTQA results in contemporary RCTs on patient outcomes.

METHODS

We searched MEDLINE and CENTRAL from January 2010, to April 2024, for papers that report on the impact of RTQA on patient outcomes in contemporary RCTs. We conducted random-effects meta-analyses to examine the association of radiotherapy protocol deviations with overall survival (OS), progression free survival (PFS), and locoregional recurrence (LR).

RESULTS

Of 2,723 citations, 16 publications reporting on 13 RCTs were included across various disease sites. Of 7,170 total randomized patients across 1,076 institutions in over 25 countries, 5,560 patients had radiotherapy quality data and were included in RTQA analyses. Most included RCTs (7/12; 58 %) conducted exclusively retrospective RTQA after treatment completion. Our meta-analyses found that protocol deviations may be associated with worse OS [HR = 1.65 (95 % CI: 1.23-2.22; p < 0.001)] and PFS [HR = 1.79 (95 % CI: 1.00-3.21; p = 0.03)]. No significant association was demonstrated between protocol deviations and LR [HR = 2.09 (95 % CI: 0.85-5.15; p = 0.108)].

CONCLUSIONS

Quality of radiotherapy continues to have an important, measurable impact on patient outcomes in oncology RCTs, and rigorous, real-time RTQA procedures may diminish these effects by standardizing RT. Future trials should provide patient outcome data in relation to RTQA and continue to report on the effect of protocol deviations in the context of modern RT techniques.

Superior Regional Control and Laryngeal Function Preservation With Radiotherapy Versus Partial Laryngectomy: A Propensity Score-Matched Analysis of 562 Early Glottic Cancer Patients

OBJECTIVES

We aimed to compare the outcomes of patients with T1-T2N0M0 glottic squamous cell carcinoma who underwent either partial laryngectomy (PL) or radiotherapy (RT).

METHODS

A retrospective analysis of 562 patients treated with RT (n = 151) or PL (n = 411) was conducted. The Kaplan-Meier method was used to estimate outcomes. The risk factors were identified using univariate and multivariate Cox regression analyses. Propensity score matching (PSM) was used to adjust for baseline variations.

RESULTS

Post-PSM, the 5-year overall survival (89.4% vs. 88.4%, p = 0.879), 5-year cancer-specific survival (91.9% vs. 90.1%, p = 0.554), and 5-year local relapse-free survival (87.2% vs. 89.3%, p = 0.487) rates did not differ significantly between the two groups. However, the 5-year regional relapse-free survival rate was significantly higher in the RT group than that in the PL group (99.3% vs. 93.3%, p = 0.009). Recurrence was most likely to occur in the lymph nodes at levels II and III. Supraglottic engagement has emerged as an independent prognostic factor for regional relapse in T2 stage diagnosed PL. The RT group demonstrated significantly superior speech function (mean: 6.065) compared to the PL group (mean: 10.650, p < 0.0001).

CONCLUSIONS

RT yielded survival rates, local control, and laryngeal preservation comparable to PL. RT is associated with a higher regional control rate in T2 patients. Supraglottic involvement is an independent risk factor for regional relapse in patients with T2 disease after PL. The RT group exhibited extremely low complication rates and significantly improved speech function.

Outcomes After Palliative Radiation Therapy in Patients With Symptomatic Locoregionally Advanced Breast Cancer

PURPOSE

Symptomatic locoregionally advanced breast cancer (SLABC) can cause troublesome pain or wound complications that negatively impact quality of life. Although palliative radiation therapy (RT) can minimize tumor-related symptoms, how best to tailor RT to achieve the most meaningful and durable response is not well defined.

METHODS AND MATERIALS

This is a single institution, multi-site retrospective review of patients with SLABC treated between 2016 and 2023 with palliative RT to symptomatic disease in the breast, chest wall, and/or regional lymph node basins. Overall survival (OS), locoregional control (LC), clinical and radiographic treatment response, overall pain scores, and treatment-related toxicities were analyzed.

RESULTS

A total of 164 patients with a median age of 57 years were analyzed with a median follow-up time of 4.97 months. In total, 86% had distant metastases. The most common presenting symptom was pain (87%), followed by ulcerating or fungating lesion (76%) and discharge (45%). The median cumulative biologically effective dose to the gross tumor volume (BEDGTV) was 69 Gy. The 1-year OS and LC rates were 37% and 63%, respectively. Eighty-one percent experienced improvement in symptoms within 3 months after RT, the odds of which increased per Gy BEDGTV (odds ratio, 1.029; P = .003). Acute toxicities were associated with number of fractions and BEDGTV (both P < .001), but not with concurrent systemic therapy or reirradiation (both P > .05). Trends in pain scores showed a significant change in pain trajectory that was sustained during the first year after RT. OS and LC were not different among patients who received 1 versus 2 to 10 versus >10 fractions, and between ≤70 and >70 Gy BEDGTV.

CONCLUSIONS

In this large series of patients with SLABC, palliative RT was effective at relieving locoregional symptoms with acceptable toxicity, with the likelihood of symptom improvement associated with radiation dose. Survival of these patients remains poor, highlighting the importance of palliative care strategies that minimize overall symptom burden while maximizing quality of life.

Geometric and dosimetric evaluation of a commercial AI auto-contouring tool on multiple anatomical sites in CT scans

Current radiotherapy practices rely on manual contouring of CT scans, which is time-consuming, prone to variability, and requires highly trained experts. There is a need for more efficient and consistent contouring methods. This study evaluated the performance of the Varian Ethos AI auto-contouring tool to assess its potential integration into clinical workflows. This retrospective study included 223 patients with treatment sites in the pelvis, abdomen, thorax, and head and neck regions. The Ethos AI tool generated auto-contours on each patients' pre-treatment planning CT, and 45 unique structures were included across the study cohort. Multiple measures of geometric similarity were computed, including surface Dice Similarity Coefficient (sDSC) and mean distance to agreement (MDA). Dosimetric concordance was evaluated by comparing mean dose and maximum 2 cm3 dose (D2 cc) between manual and AI contours. Ethos AI demonstrated high geometric accuracy for well-defined structures like the bladder, lungs, and femoral heads. Smaller structures and those with less defined boundaries, such as optic nerves and duodenum, showed lower agreement. Over 70% of auto-contours demonstrated a sDSC > 0.8, and 74% had MDA < 2.5 mm. Geometric accuracy generally correlated with dosimetric concordance, however differences in contour definitions did result in some structures exhibiting dose deviations. The Ethos AI auto-contouring tool offers promising accuracy and reliability for many anatomical structures, supporting its use in planning workflows. Auto-contouring errors, although rare, highlight the importance of ongoing QA and expert manual oversight.

Interactions between radiotherapy resistance mechanisms and the tumor microenvironment

BACKGROUND

Resistance to radiotherapy (RT) presents a significant clinical challenge in management of cancer. Recent evidence points to specific mechanisms of resistance within the tumor microenvironment (TME), which we aim to discuss, with the aim of overcoming the clinical challenge.

METHODS

We performed the narrative review using PubMed and Web of Science databases to identify studies that reported the regulative network and treatments of RT resistance from TME perspectives.

RESULTS

RT significantly changes the immune TME of cancers, which is closely appearing to play a key role in RT resistance (RTR) by modulating immune cell infiltration and function. Various phenotypes are involved in the development of RTR, such as autophagy, senescence, oxidative stress, cell polarization, ceramide metabolism, and angiogenesis in the TME. Key genes and pathways are also implicated in RTR, including immune and inflammatory cytokines, TGF-β, P53, the NF-κB pathway, the cGAS/STING pathway, the ERK and AKT pathway, and the STAT pathway. Based on the mechanism of RTR in the TME, many proposed routes to overcome RTR, several specifically target the TME including targeting fibroblast activation protein, exosomes management, nanomedicine, and immunotherapy. Many challenges in RT resistance still need to be further explored with emerging investigative methods, such as artificial intelligence, genetic technologies, and bioengineering.

CONCLUSIONS

The complex interactions between RT and TME significantly affect the efficiency of RT. Novel approaches to overcome this clinical difficulty are promising, which needs future work to further explore and identify better treatment strategies.

Alpha lipoic acid modulates metabolic reprogramming in breast cancer stem cells enriched 3D spheroids by targeting phosphoinositide 3-kinase: In silico and in vitro insights

Breast cancer stem cells (BCSCs) are a unique subpopulation of tumor cells driving tumor resistance, progression, metastasis, and recurrence. Reprogrammed cellular metabolism and key signaling pathways, including Wnt/β-catenin, TGF-β, STAT3, and PI3K/AKT/mTOR pathway play a vital role in maintaining BCSCs. Importantly, PI3K/Akt/mTOR pathway regulates metabolism, survival, growth, and invasion, with PIK3CA, encoding the PI3K catalytic subunit p110α, the most frequently mutated gene in breast cancer. This study investigates the effects of alpha-lipoic acid (LA) on the metabolic profile of BCSCs, focusing on its interaction with PI3K signaling. LA was found to bind PI3K, disrupting cancer-associated metabolic pathways and significantly inhibiting BCSC metabolism. Metabolomic analysis of MCF-7 and MDA-MB-231-derived breast cancer spheroids showed LA-induced metabolic shifts. In MCF-7 spheroids, LA induced upaccumulation of 15 metabolites and downaccumulation of 5, while in MDA-MB-231 spheroids, it induced upaccumulation of 3 and downaccumulation of 16. LA also enhanced the sensitivity of breast cancer spheroids to doxorubicin (Dox), demonstrating a synergistic effect. Mechanistically, LA modulates the PI3K/Akt/mTOR pathway, impairing cell survival and proliferation. These findings highlight the potential of LA as a therapeutic agent for reprogramming cancer metabolism and enhancing chemotherapy efficacy. These results provide a strong rationale for incorporating LA into combination therapy strategies for breast cancer treatment.

Circulating Markers of Systemic Inflammation, Measured After Completion of Neoadjuvant Therapy, Associated With Response in Locally Advanced Rectal Cancer

BACKGROUND

The extent of neoadjuvant therapy response, before surgery, is an important prognosticator in locally advanced rectal cancer. A spectrum of response exists, with a dearth of reliable measurements. The host response to treatment remains unexplored. Within operable colorectal cancer, circulating markers of elevated systemic inflammation are associated with poor survival. Studies have suggested that elevated pre-neoadjuvant inflammatory markers, including the modified Glasgow prognostic score and the neutrophil:lymphocyte ratio, are associated with a poorer response.

OBJECTIVE

This study aimed to comprehensively evaluate hematological markers of inflammation before and after neoadjuvant therapy.

DESIGN

Longitudinal cohort study.

SETTINGS

Single health board from a prospectively maintained regional cancer database.

PATIENTS

Consecutive patients with locally advanced rectal cancer who underwent curative-intent neoadjuvant therapy between June 2016 and July 2021.

MAIN OUTCOME MEASURES

Elevated markers of the systemic inflammatory response before and after neoadjuvant therapy.

RESULTS

A total of 278 patients (67.3% men, median age 65 years) were identified. A complete response (clinical or pathological complete response) was achieved in 27.34%, and good tumor regression was achieved in 37.05% (tumor regression grading 0-1). No pre-neoadjuvant marker was found to be associated with response or regression. Multivariate analysis of post-neoadjuvant variables revealed an elevated modified Glasgow prognostic score (OR 2.8; 95% CI, 1.22-6.41; p = 0.015), and an elevated CEA (OR 4.09; 95% CI, 1.6-10.44; p = 0.003) was found to be independently associated with incomplete response. An elevated post-neoadjuvant modified Glasgow prognostic score (OR 2.14; 95% CI, 1.08-4.23; p = 0.029) was also independently associated with poor tumor regression on multivariate analysis.

LIMITATIONS

Retrospective design and slight variation in the timing of post-neoadjuvant blood tests were limitations.

CONCLUSIONS

We report that post-neoadjuvant modified Glasgow prognostic score is associated with poorer response and regression, potentially indicating that radiation resistance is associated with the development of a protumor inflammatory environment. Further work is required to define the local intratumoral processes associated with response and their interrelationship with systemic parameters. Ultimately, there may be a rationale for testing anti-inflammatory strategies in combination with radiotherapy as an option for optimizing treatment response. See Video Abstract .

LOS MARCADORES CIRCULANTES DE INFLAMACIN SISTMICA, MEDIDOS DESPUS DE COMPLETAR LA TERAPIA NEOADYUVANTE, SE ASOCIAN CON LA RESPUESTA EN EL CNCER RECTAL LOCALMENTE AVANZADO

ANTECEDENTES:El grado de respuesta a la terapia neoadyuvante, antes de la cirugía, es un pronosticador importante en el cáncer rectal localmente avanzado. Existe un espectro de respuestas, con una escasez de medidas confiables. La respuesta del huésped al tratamiento permanece inexplorada. Dentro del cáncer colorrectal operable, los marcadores circulantes de inflamación sistémica elevada se asocian con una supervivencia deficiente. Los estudios han sugerido que los marcadores inflamatorios pre-neoadyuvantes elevados, incluidos; el puntaje pronóstico de Glasgow modificado y la proporción neutrófilos::linfocitos, se asocian con una respuesta peor.OBJETIVO:Este estudio tuvo como objetivo evaluar de manera integral los marcadores hematológicos de inflamación antes y después de la terapia neoadyuvante.DISEÑO:Estudio de cohorte longitudinal.ESCENARIO:Junta de salud única de una base de datos de cáncer regional mantenida prospectivamente.PACIENTES:Pacientes consecutivos con cáncer rectal localmente avanzado que se sometieron a terapia neoadyuvante con intención curativa entre; Junio de 2016-julio de 2021.PRINCIPALES MEDIDAS DE RESULTADOS:Marcadores elevados de la respuesta inflamatoria sistémica antes y después de la terapia neoadyuvante.RESULTADOS:278 pacientes. 67,3 % varones, mediana de edad 65. El 27,34 % logró una "respuesta completa" (respuesta completa clínica o patológica). El 37,05 % logró una "buena regresión tumoral" (clasificación de regresión tumoral de 0 a 1). Ningún marcador pre-neoadyuvante se asoció con la respuesta o la regresión. El análisis multivariado de las variables pos-neoadyuvantes reveló un puntaje pronóstico de Glasgow modificado elevado (OR 2,8; IC del 95 % 1,22-6,41; p = 0,015) y un antígeno carcinoembrionario elevado (OR 4,09; IC del 95 % 1,6-10,44; p = 0,003) asociados de forma independiente con una respuesta incompleta. Un puntaje pronóstico de Glasgow modificado post-neoadyuvante elevado (OR 2,14, IC del 95 % 1,08-4,23, p = 0,029) también se asoció de forma independiente con una regresión tumoral deficiente en el análisis multivariable.LIMITACIONES:Diseño retrospectivo. Ligera variación en el momento de los análisis de sangre pos-neoadyuvante.CONCLUSIONES:Informamos que el puntaje pronóstico de Glasgow modificado pos-neoadyuvante se asoció con una respuesta y regresión más deficientes, lo que podría indicar que la resistencia a la radiación está asociada con el desarrollo de un entorno inflamatorio protumoral. Se requieren más estudios para definir los procesos intratumorales locales asociados con la respuesta y su interrelación con los parámetros sistémicos. En última instancia, puede haber una justificación para probar estrategias antiinflamatorias en combinación con radioterapia como una opción para optimizar la respuesta al tratamiento. (Traducción-Dr. Aurian Garcia Gonzalez ).

Association between the immune-inflammation index and the severity and clinical outcomes of patients with inflammatory bowel disease: a systematic review and meta-analysis

BACKGROUND

Existing studies have explored the association between immune-inflammatory indices and inflammatory bowel disease (IBD), but there is a lack of comprehensive evidence. This meta-analysis and systematic review seeks to synthesize the data of available clinical research and offer the latest and comprehensive evidence-based conclusions regarding whether these immune-inflammatory indices can effectively predict the severity, activity, and prognosis of IBD.

METHODS

Seven databases were comprehensively retrieved from their establishment to March 23, 2025. The combined results were described through standardized mean differences (SMD) or odds ratios (OR) with 95% confidence intervals (CI). Review Manager 5.4 and STATA 15.0 were leveraged for data analysis.

RESULTS

Our analysis included 35 studies involving 5,870 patients. The aggregated data revealed that the neutrophil-to-lymphocyte ratio (NLR) (OR = 1.18, 95% CI:1.04 to 1.34; P = 0.001) (SMD = 1.01, 95%CI = 0.73 to 1.29, P < 0.001), platelet-to-lymphocyte ratio (PLR) (SMD = 0.60, 95%CI = 0.46 to 0.74, P < 0.001), neutrophil-to-platelet ratio (NPR) (OR = 1.20, 95% CI:1.08 to 1.32, P < 0.001), and C-reactive protein to albumin ratio (CRP/ALB) (OR = 1.50, 95% CI:1.38 to 1.65, P < 0.001) were potentially linked to disease activity in IBD patients. PLR (SMD = 1.08, 95%CI = 0.60 to 1.55, P < 0.001) showed potential associations with disease severity in IBD patients. Additionally, NLR (SMD = 0.43, 95%CI = 0.15 to 0.70, P = 0.002) and eosinophil-to-lymphocyte ratio (ELR) (SMD = 0.63, 95%CI = 0.26 to 1.00, P < 0.001) had potential associations with endoscopic response in IBD patients. Moreover, NLR was potentially associated with disease relapse(OR = 1.35, 95% CI:1.09 to 1.68; P = 0.006) and steroid responsiveness (SMD = 0.50, 95%CI = 0.15 to 0.85, P = 0.005).

CONCLUSION

NLR, PLR, NPR, and CRP/ALB are potential predictors of disease activity in IBD patients. PLR shows the potential to predict disease severity, while NLR and ELR are potential indicators of endoscopic response. Furthermore, NLR is also a potential predictor of relapse and steroid responsiveness. Currently, there is insufficient evidence to support an association between NLR and the severity of IBD, whereas lymphocyte-to-monocyte ratio (LMR) appears to be associated with both the severity and activity of IBD and PLR and eosinophil*neutrophil-to-lymphocytes ratio (ENLR) are associated with endoscopic response in IBD.

PROSPERO REGISTRATION

CRD 42024609659.

Evaluating the theranostic potential of ferumoxytol when combined with radiotherapy in a mammary dual tumor mouse model

BACKGROUND

The radiation-induced abscopal effect (RIAE) is a desirable phenomenon involving radiation-induced activation of the immune system and regression of metastatic disease after local radiotherapy. However, the majority of patients undergoing radiotherapy do not experience abscopal responses. One potential barrier to the RIAE is tumor-associated macrophages (TAMs), which can be recruited to the tumor after radiotherapy and have an immunosuppressive effect on the tumor microenvironment (TME).

PURPOSE

We aim to evaluate the dual capabilities of the FDA-approved iron nanoparticle ferumoxytol for (1) enhancing the RIAE and (2) measuring TAMs by magnetic resonance imaging (MRI). We hypothesized that (1) the immunomodulating effect of ferumoxytol could enhance the RIAE by repolarizing the M2 TAMs to M1 TAMs, and (2) the TAMs could be non-invasively imaged by ferumoxytol-MRI.

METHODS

Twenty-eight BALB/c mice were subcutaneously implanted with 4T1 primary orthotopic tumor (mammary fat pad) and flank tumor (abscopal tumor). At 14 days post-implantation, mice were separated into four groups: control (Ctrl), radiotherapy (RT) only (8-Gy×3), ferumoxytol only (FMX; 40 mg/kg) and combined (Comb) group (a single dose of 40 mg/kg FMX 24 h prior to 8-Gy×3) (n = 7 mice per group; 56 tumors). At 23- and 24-day post-implantation the pre- and post-FMX injection MRI was performed for mice in FMX and Comb group. The percent change in transverse relaxation time (%T2*) from pre to post ferumoxytol injection was calculated from MR images for both tumors and lymph nodes (LNs). At 25 days post-implantation, both tumors were harvested, and the TAMs were analyzed by flow cytometry.

RESULTS

At 25 days post-implantation, the primary tumor volume in the RT and Comb groups was significantly lower than the Ctrl and FMX groups (p < 0.05). No significant size difference of abscopal tumors was observed among all groups. In addition, there was no significant difference in lung metastasis nodules. A significant decrease in %T2* values of tumors and LNs in the FMX and Comb group 24 h post-ferumoxytol injection was observed, suggesting ferumoxytol uptake in TAMs. The flow cytometry result showed that the CD80+ CD206- M1 macrophage population was similar among all tumors and groups. The CD80- CD206+ M2 macrophage population was also similar in all tumors and groups, with the exception of the FMX group, where the M2 tumor macrophage levels were significantly higher when compared to the Ctrl group (p < 0.05). Tumors in the FMX group had a significant negative Pearson correlation between tumor %T2* change and M1 tumor macrophage levels (r = -0.76, p < 0.05) but this correlation was not significant in any other treatment group.

CONCLUSIONS

Radiotherapy combined with ferumoxytol led to significant growth delays of irradiated tumors, but no abscopal effects were observed in non-irradiated tumors. Additionally, our hypothesis that the immunomodulating effect of ferumoxytol could enhance the RIAE by repolarizing the M2 TAMs to M1 was not supported by our findings. However, our second hypothesis that the TAMs could be non-invasively imaged by ferumoxytol-MRI was supported by our findings. This includes observation of a significant negative correlation between M1 TAMs and %T2* change in tumors in the ferumoxytol treatment group.

mtDNA/RNA boosts radiation-induced abscopal effect via M1 macrophage polarization-promoted IFN-β-dependent inflammatory response

The radiation-induced abscopal effect (RIAE) can suppress distal metastatic lesions and elicit a systemic anti-tumor response; however, the underlying mechanisms remain to be fully elucidated. Current research has shown that autophagy promotes the production of IFN-β by regulating mitochondrial DNA (mtDNA), thereby contributing to the modulation of RIAE. Nevertheless, the downstream pathways through which IFN-β influences RIAE require further investigation. In this study, we observed accumulation of an abundance of mtDNA in the cytosol of mammary tumor cells following RT, along with the presence of mitochondrial RNA (mtRNA). These molecules activated the cGAS-STING and RIG-I-MAVS signaling pathways, respectively, thereby synergistically promoting the production of IFN-β and secretion into the extracellular matrix. Subsequently, IFN-β facilitated the polarization of macrophages in distant non-irradiated tumor microenvironment towards the M1 phenotype through activating STAT1. Furthermore, our findings indicate that high linear energy transfer (LET) carbon ions are significantly more effective in inducing the production of IFN-β and promoting macrophage polarization compared to low-LET X-rays. Thus, our findings provide insights into the intricate mechanisms by which mtDNA/RNA and IFN-β mediate RIAE, suggesting that IFN-β could be a promising target for provoking RT immunogenicity in patients with breast cancer and high-LET radiation might effectively elicit RIAE.

Multidisciplinary Team Intervention: Catalysts for Changing Prognosis in Advanced Breast Cancer

PURPOSE

Multidisciplinary team (MDT) discussions are standard in cancer care; however, their effect on advanced breast cancer (ABC) prognosis is not well-documented. This study examined the impact of MDT intervention on ABC patient survival.

METHODS

A retrospective analysis of ABC patients diagnosed 2018 to 2021 was conducted by dividing them into MDT and non-MDT groups. Kaplan-Meier analysis was used to compare progression-free survival (PFS) and overall survival (OS) between the groups. Prognostic factors were evaluated using multivariate Cox regression analysis with subgroup analysis and 1:1 propensity score matching (PSM) to control for confounders.

RESULTS

Total 707 patients were included, with 72.8% (515/707) underwent MDT intervention. After a median follow-up of 43.73 months (interquartile range, 34.87-55.67 months), MDT intervention improved the median PFS (12.00 vs. 8.00 months; hazard ratio [HR], 0.75 [95% confidence interval {CI}, 0.63-0.89]; p = 0.001) and median OS (55.67 vs. 40.07 months; HR, 0.77 [95% CI, 0.61-0.97]; p = 0.030). Multivariate Cox analysis showed MDT as an independent factor for disease progression control (HR, 0.82 [95% CI, 0.68-0.98]; p = 0.041), but not for OS (HR, 0.88 [95% CI, 0.69-1.12]; p = 0.286). Subgroup analysis indicated that MDT benefited patients aged ≤ 39 years, those with disease status (de novo metastatic breast cancer), post-menopausal status, T4 stage, N3 stage, G3, visceral metastasis, > one organ metastasis and first-line systemic treatment, regardless of PFS or OS. After PSM, 172 matched patients were in the cohort. MDT still significantly controlled disease progression (12.00 vs. 8.00; HR, 0.74 [95% CI, 0.59-0.93]; p = 0.009) but did not significantly impact the OS (49.00 vs. 39.00; HR, 0.80 [95% CI, 0.59-1.08]; p = 0.121).

CONCLUSION

MDT effectively controlled the disease progression and improved OS in specific patient subgroups.

Factors affecting survival prognosis of patients with rectal cancer after neoadjuvant chemoradiotherapy

Objective

To identify potential factors influencing the survival prognosis of locally advanced rectal cancer patients receiving neoadjuvant chemoradiotherapy.

Methods

A retrospective study was conducted to collect data from January 2009 to December 2020 on 270 patients with locally advanced rectal cancer who were admitted to the Fourth Hospital of Hebei Medical University. The clinical data of patients before and after neoadjuvant chemoradiotherapy and postoperative treatment were compiled. The endpoints of the study were disease-free survival and overall survival of the patients. The univariate and multivariable regression analysis were used to identify factors that influence the patients' survival prognosis.

Results

Univariate analysis showed that factors associated with good prognosis in neoadjuvant chemotherapy patients included age <65 years, CEA value ≤5ng/mL, lymphocyte count >1.5×109/L, normal albumin level, NLR ≤2.64, SII ≤683.16, PNI >49.23, tumor distance from the anal margin >5cm, tumor length ≤5cm, tumor invasion of the bowel wall ratio ≤50%, lower T stage and N stage, good tumor regression response, absence of KRAS gene mutation, and mismatch repair protein deficiency. And multivariate analysis showed that age (HR=0.385, P=0.007), NLR (HR=0.294, P=0.011), cT stage (HR=0.287, P<0.001), and tumor regression grade (HR=0.273, P<0.001) were significant factors influencing DFS in patients receiving neoadjuvant chemoradiotherapy. For OS, age (HR=0.497, P=0.035), cT stage (HR=0.387, P=0.001), and tumor regression grade (HR=0.307, P<0.001) were significant factors influencing OS in patients receiving neoadjuvant chemoradiotherapy.

Conclusion

Age, cT stage, NLR, and tumor regression grade are significant factors influencing DFS and OS in patients with locally advanced rectal cancer. Younger age, lower cT stage, lower NLR value, and lower tumor regression grade are associated with better survival prognosis.

Cardiac imaging for the detection of ischemia: current status and future perspectives

INTRODUCTION

Coronary artery disease is the main cause of mortality worldwide mandating early detection, appropriate treatment, and follow-up. Noninvasive cardiac imaging techniques allow detection of obstructive coronary heart disease by direct visualization of the arteries or myocardial blood flow reduction. These techniques have made remarkable progress since their introduction, achieving high diagnostic precision. This review aims at evaluating these noninvasive cardiac imaging techniques, rendering a thorough overview of diagnostic decision-making for detection of ischemia.

AREAS COVERED

We discuss the latest advances in the field such as computed tomography angiography, single-photon emission tomography, positron emission tomography, and cardiac magnetic resonance; their main advantages and disadvantages, their most appropriate use and prospects. For the review, we analyzed the literature from 2009 to 2024 on noninvasive cardiac imaging in the diagnosis of coronary artery disease. The review included the 78 publications considered most relevant, including landmark trials, review articles and guidelines.

EXPERT OPINION

The progress in cardiac imaging is anticipated to overcome various limitations such as high costs, radiation exposure, artifacts, and differences in interpretation among observers. It is expected to lead to more automated scanning processes, and with the assistance of artificial intelligence-driven post-processing software, higher accuracy and reproducibility may be attained.

Naples Prognostic Score (NPS) as a Novel Prognostic Score for Stage III Breast Cancer Patients: A Real-World Retrospective Study

Objective

This study aims to explore whether Naples prognostic score (NPS) serves as a novel and original prognostic tool for predicting long-term survival in stage III breast cancer patients undergoing operation.

Methods

This retrospective study included 306 cases of stage III breast cancer patients hospitalized in our hospital from January 2014 to December 2018. In this study, NPS was based on five objective markers: (1) serum albumin level; (2) total cholesterol; (3) neutrophil to lymphocyte ratio; (4) lymphocyte to monocyte ratio. Survival curves of DFS and OS differences were visualized by Kaplan-Meier method and Log rank test. The variables with p < 0.05 in univariate analysis were performed in the multivariate Cox proportional hazard model analysis, and the p-values < 0.05 was considered the underlying independent variables. Nomogram was constructed by the multivariate Cox proportional hazard model analysis.

Results

Significant variations for DFS and OS categorized according to prognostic risk for the different NPS (DFS: χ2=24.926, P < 0.0001; OS: χ2=31.207, P < 0.0001). According to multivariable Cox analysis, NPS was an independent prognostic factor of DFS [Group 0 had significantly better prognosis than group 1 (HR = 2.733, 95% CI: 1.446-5.166, P = 0.002) and group 2 (HR = 4.990, 95% CI: 2.555-9.746), P < 0.001)] and OS [Group 0 had significantly better prognosis than group 1 (HR = 2.437, 95% CI: 1.288-4.610, P = 0.006) and group 2 (HR = 5.707, 95% CI: 2.900-11.231), P < 0.001)], respectively. Nomogram prognostic model exhibited excellent predictive performance on DFS [C-index: 0.692 (95% CI: 0.584-0.782)] and OS [C-index: 0.711 (95% CI: 0.606-0.797)] for stage III breast cancer.

Conclusion

NPS serves as a predictive tool for assessing the prognosis of stage III breast cancer after surgery. Nomogram prognostic model based on NPS show good prediction ability.

Predictive Value of Nutritional Status for Symptomatic Radiation Pneumonitis in Patients with Thoracic Cancer Undergoing Radiotherapy

The association between nutritional status and the risk of radiation pneumonitis (RP) in patients with thoracic cancer undergoing radiotherapy remains unclear and warrants further investigation. General clinical data between January 2021 and June 2024 were retrospectively analyzed. RP was diagnosed and graded according to the Common Terminology Criteria for Adverse Events (version 5), with symptomatic RP defined as grade ≥2. Predictive factors for RP were identified using least absolute shrinkage and selection operator and multivariate logistic regression analyses, followed by the development of a nomogram. The predictive performance of the nomogram was evaluated using the area under the curve (AUC) of receiver operating characteristic, calibration curve, and decision curve analysis. Controlling Nutritional Status (CONUT) scores and V5 were identified as independent predictors of symptomatic RP and incorporated into the predictive model. The nomogram demonstrated excellent predictive capability (AUC: 0.851; 95% confidence interval: 0.801-0.902), with good accuracy and clinical application utility. Nutritional status is associated with the development of symptomatic RP. The pre-radiotherapy CONUT score can serve as a predictor of symptomatic RP, and its incorporation into the CONUT-V5 model achieves better discriminative capacity. Improving nutritional status may be a simple way to prevent the development of symptomatic RP.

The crosstalk between non-coding RNAs and oxidative stress in cancer progression

As living standards elevate, cancers are appearing in growing numbers among younger individuals globally and these risks escalate with advancing years. One of the reasons is that instability in the cancer genome reduces the effectiveness of conventional drug treatments and chemotherapy, compared with more targeted therapies. Previous research has discovered non-coding RNAs' crucial role in shaping genetic networks involved in cancer cell growth and invasion through their influence on messenger RNA production or protein binding. Additionally, the interaction between non-coding RNAs and oxidative stress, a crucial process in cancer advancement, cannot be overlooked. Essentially, oxidative stress results from the negative effects of radicals within the body and ties directly to cancer gene expression and signaling. Therefore, this review focuses on the mechanism between non-coding RNAs and oxidative stress in cancer progression, which is conducive to finding new cancer treatment strategies.

Mechanisms of radioresistance and radiosensitization strategies for Triple Negative Breast Cancer

Breast cancer is one of the most common malignant tumors in women. Triple-negative breast cancer (TNBC) is a molecular subtype of breast cancer that is characterized by a high risk of recurrence and poor prognosis. With the increasingly prominent role of radiotherapy in TNBC treatment, patient resistance to radiotherapy is an attractive area of clinical research. Gene expression changes induced by multiple mechanisms can affect the radiosensitivity of TNBC cells to radiotherapy through a variety of ways, and the enhancement of radioresistance is an important factor in the malignant progression of TNBC. The above pathways mainly include DNA damage repair, programmed cell death, cancer stem cells (CSC), antioxidant function, tumor microenvironment, and epithelial-mesenchymal transition (EMT) pathway. Tumor cells can reduce the damage of radiotherapy to themselves through the above ways, resulting in radioresistance. Therefore, in this review, we aim to summarize the strategies for immunotherapy combined with radiotherapy, targeted therapy combined with radiotherapy, and epigenetic therapy combined with radiotherapy to identify the best treatment for TNBC and improve the cure and survival rates of patients with TNBC. This review will provide important guidance and inspiration for the clinical practice of radiotherapy for TNBC, which will help deepen our understanding of this field and promote its development.

Synergistic inhibition of proliferation and induction of apoptosis in oral tongue squamous cell carcinoma by mebendazole and paclitaxel via PI3K/AKT pathway mitigation

Serve as one of common cancer in the mouth, oral tongue squamous cell carcinoma (OTSCC) is a serious problem affecting human oral health. The aim of this study was to evaluate the effects of mebendazole (MBZ) alone and combined with paclitaxel on the proliferation and occurrence of OTSCC and its molecular mechanism. Cell viability, apoptosis, cell cycle distribution, and the expression of PI3K, p-PI3K, AKT, and p-AKT were evaluated by Cell Counting Kit-8 (CCK-8), flow cytometry, and Western blot, respectively. Immunofluorescence was used to assess changes in microtubule morphology of CAL-27 and UM-SCC-1 cells with α-tubulin antibody labeling. The CCK-8 assay revealed a dose-dependent inhibitory effect of both MBZ and paclitaxel on CAL-27 and UM-SCC-1 cells. The apoptosis assay showed significantly elevated levels of apoptosis-specific markers, cleaved caspase-3, and cleaved PARP, in the combined treatment group compared to the control and single-agent groups. The combination of MBZ and paclitaxel showed enhanced inhibition of key PI3K/AKT pathway proteins' phosphorylation and reduced expression of Cyclin B and PCNA compared to the control. The α-tubulin staining area was notably reduced in the combined treatment group relative to the other groups. Both MBZ and paclitaxel treatments inhibited of cell proliferation and microtubule formation by reducing the PI3K/AKT pathway in CAL-27 and UM-SCC-1 cells, with the combination demonstrating synergistic effects. Our study suggests MBZ and paclitaxel as potential agents for the treatment of OTSCC.

Transcontinental Differences in Management of Pulmonary Metastatic Disease: Europe

Several international registries, including 4 from Europe-Italy, Spain, the Netherlands, and the European Society of Thoracic Surgeons-are dedicated to addressing deficiencies in pulmonary metastasectomy research. The randomized PulMiCC and SABR-COMET trials provide contradictory outcomes and new randomized trials have been initiated. Europe's metastasectomy approach transitioned from open thoracotomy to video-assisted thoracoscopic surgery, with 72% of surgeons favoring minimally invasive methods by 2023. European Society for Medical Oncology guidelines recommend surgery for completely resectable lesions and propose ablative approaches as supplementary or alternative treatments for inoperable cases due to frailty or unfavorable anatomy.

Sortilin-Mediated Rapid, Precise and Sustained Degradation of Membrane Proteins via mRNA-Encoded Lysosome-Targeting Chimera

Recent advances in lysosome-targeting degradation technologies have introduced strategies to regulate therapeutic membrane proteins (MPs), potentially transforming treatment paradigms. However, challenges persist, including limited degradation precision due to the broad distribution of lysosome-targeting receptors (LTRs), as well as the high cost and complexity of recombinant protein production or chemical synthesis. Herein, it identifies sortilin as a promising LTR, highly expressed in malignancies but minimally present in healthy tissues outside the nervous system. Using AlphaFold-Multimer, it screened for a specific non-endogenous protein binder to sortilin and developed a modular, mRNA-encoded lysosomal targeting chimera (MedTAC) strategy, enabling rapid design and precise degradation of oncogenic MPs. In a breast cancer-bearing mouse model, a single low dose of MedTACPTK7 (0.5 mg kg-1) reduced protein tyrosine kinase-7 (PTK7) levels by up to 80% within 24 h, with sustained degradation of 44% at 72 h, demonstrating excellent pharmacokinetics. MedTACPTK7 significantly extended survival to over 50 days without systemic toxicity, compared to 20-30 days in controls. This MedTAC strategy establishes sortilin as a selective and efficient shuttle for targeted protein degradation, offering a scalable, rapidly producible platform for biochemical research and precise therapeutic applications.

Molecular Hydrogen in the Treatment of Respiratory Diseases

Molecular hydrogen is gaining increasing attention as an antioxidant, anti-inflammatory, and antiapoptotic agent. Once considered an inert gas, it reveals current therapeutic potential among others in inflammatory diseases, cancer, and sports medicine, among others. The present review aims to provide a consistent summary of the findings of the last twenty years on the use of molecular hydrogen in major respiratory diseases, including allergies, asthma, COPD, pulmonary fibrosis, lung injury of various origins, as well as cancer and infections of the respiratory tract. In addition, the basic mechanisms through which molecular hydrogen exercises its biological activity on the respiratory system are described.

Role and mechanism of molecular hydrogen in the treatment of Parkinson's diseases

Parkinson's disease (PD) is a complex neurodegenerative disorder characterized by a pathology that includes the aggregation of alpha-synuclein (α-syn), oxidative stress, and neuroinflammation. While existing treatments can alleviate motor symptoms, they have limited efficacy in slowing disease progression and improving non-motor symptoms. In recent years, molecular hydrogen has been recognized for its potential neuroprotective effects, attributed to its selective antioxidant and anti-inflammatory properties. While preclinical studies demonstrate promising results, clinical trials conducted thus far have yielded mixed outcomes, with some trials reporting limited or no therapeutic benefit. This review systematically analyzes the mechanisms of action of molecular hydrogen in PD and related neurodegenerative disorders, emphasizing its antioxidant, anti-inflammatory, and anti-apoptotic properties. By evaluating evidence from both preclinical and clinical studies, this paper explores the potential of molecular hydrogen to attenuate oxidative stress, modulate inflammatory responses, and inhibit apoptosis in neuronal cells, while also identifying key gaps in current research. As a novel neuroprotective agent, molecular hydrogen holds potential in PD and other neurodegenerative diseases, but further well-designed clinical trials are needed to validate its efficacy. Future studies should focus on elucidating the mechanisms through which hydrogen exerts its neuroprotective effects, particularly concerning α-syn aggregation and its clearance pathways, as well as Nrf2-mediated immunomodulation. Furthermore, large-scale, multicenter clinical trials are necessary to establish efficacy benchmarks and personalized delivery protocols.

Stereotactic body radiation therapy and thermal ablation for treatment of patients with pulmonary metastases: a systematic literature review and meta-analysis

OBJECTIVE

To compare local tumor progression (LTP) and overall survival (OS) after image-guided thermal ablation (IGTA; microwave/radiofrequency ablation) versus stereotactic body radiation therapy (SBRT) in patients with pulmonary metastases.

METHODS

A systematic literature review was performed to capture studies that used IGTA or SBRT for patients with pulmonary metastases and studies that reported one, two, and threeyear LTP/OS were included. Patients with pulmonary metastases, and a subgroup with metastases from colorectal or renal cell carcinoma, or sarcoma (termed subgroup) which are considered more radioresistant, were analyzed. Single-arm pooled analyses, univariable, and multivariable random-effects meta-regressions were conducted to compare LTP and OS between IGTA and SBRT treated patients.

RESULTS

Analyses included 3,264 IGTA and 5,486 SBRT patients. IGTA patients with pulmonary metastases had higher LTP than SBRT patients at one year, 13% and 9% respectively. At two years, the LTP for IGTA patients was 14% compared to 16% for SBRT patients. Three-year LTP remained lower for IGTA patients compared to SBRT patients (14% and 22% respectively). In the subgroup, SBRT patients had higher LTP than IGTA patients across all timepoints. OS was similar across analyses/subgroups in the single-arm pooled analyses. The multivariable analyses showed that SBRT was associated with significantly lower OS at one year; however nonsignificant differences were observed at years two and three.

CONCLUSIONS

In patients with pulmonary metastases, IGTA had lower LTP than SBRT at later timepoints. In patients with colorectal, renal cell carcinoma, or sarcoma pulmonary metastases, LTP was similar to overall LTP for IGTA, while it was higher for SBRT.

Patterns of Initial Lymph Node Involvement and Recurrence in Patients With Maxillary Sinus Squamous Cell Carcinoma

BACKGROUND

Determining whether to treat the elective cervical lymph node (LN) area remains a dilemma in maxillary sinus squamous cell carcinoma (SCC). This study analyzed the patterns of initial LN involvement and recurrence to guide treatment strategies.

METHODS

We retrospectively reviewed 119 patients with maxillary sinus SCC treated between 2005 and 2023. Patients received definitive concurrent chemoradiotherapy, neoadjuvant therapy followed by local treatment, or upfront surgery with or without adjuvant radiotherapy.

RESULTS

Among 119 patients, 28 (23.5%) had clinical LN involvement at diagnosis, primarily at ipsilateral neck levels I and II. Regional failure occurred in 18 (19.8%) cN0 and 9 (32.1%) cN+ patients, with ipsilateral level II being the most common site. Contralateral failures were frequent in cN+ patients. Distant metastases occurred in 17 patients (14.3%), predominantly in the lungs.

CONCLUSION

Understanding LN involvement and recurrence patterns can refine radiation field design and follow-up strategies in maxillary sinus SCC.

Efficacy and safety of image-guided hypofractionated radiotherapy for hepatocellular carcinoma with portal vein tumor thrombosis: a retrospective, multicenter study

BACKGROUND

External beam radiation therapy (RT) has shown promising effects for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) in recent studies. However, there is still a lack of consensus on the optimal RT scheme for PVTT treatment. We evaluated the efficacy and safety of image-guided 10-fraction hypofractionated RT in these patients.

METHODS

Between January 2016 and March 2022, a total of 95 HCC patients with PVTT received 10-fraction hypofractionated image-guided radiation therapy (IGRT) at two institutes, and 69 patients were analyzed. Follow-up imaging was performed at three-month intervals after the completion of RT. The extent of PVTT was described according to the Liver Cancer Study Group of Japan classification: Vp1 = segmental portal vein branch, Vp2 = right/left anterior/posterior portal vein, Vp3 = right/left portal vein, and Vp4 = main portal vein. Response evaluation was performed using Response Evaluation Criteria in Solid Tumors, version 1.1. Freedom from local progression (FFLP), progression-free survival (PFS), and overall survival (OS) were calculated from the start date of RT.

RESULTS

The median prescribed dose of 50 Gy (range: 40-50 Gy; biologically effective dose [BED]: 56-75Gy10) was delivered in 10 fractions. In this cohort, 4.3% of patients had Vp1, 20.3% had Vp2, 37.7% had Vp3, and 37.7% had Vp4. Median Planning target volume was 105.3 cc (interquartile range [IQR], 74.1-179.4 cc). Fifty-two (75.4%) patients received 50 Gy. With a median follow-up of 10.2 months (IQR, 6-21 months), the median OS was 20.3 months, and 1-year FFLP, PFS, and OS rates were 88.7%, 26.9%, and 62.2%, respectively. At 3 months follow-up, 13.0% had a complete response, 36.2% had a partial response, 46.4% had a stable disease and 4.4% had a progressive disease. In the multivariate analysis, alpha-fetoprotein level ≥ 600 IU/ml (hazard ratio [HR] 2.06, p = 0.03), Child-Pugh Class B or C (HR 2.30, p = 0.02), and stage IVA or IVB (4.05, p = 0.02) were significantly related to OS. During the follow-up period, there were 2 (2.9%) cases of grade ≥ 3 toxicity: grade 3 liver enzyme elevation (n = 1), and acute cholangitis (n = 1).

CONCLUSIONS

Hypofractionated RT demonstrated promising local PVTT control and OS rates with acceptable toxicity. These data suggest that 10-fraction image-guided hypofractionated RT (BED: 56-75 Gy10) is a feasible treatment option for PVTT in HCC patients.

Clinical features and prognostic nomogram development for cancer-specific death in patients with dual primary lung cancer: a population-based study from SEER database

OBJECTIVE

This study aimed to develop a concise and valid clinical prediction model to assess the survival prognostic risk of cancer-specific death in patients with dual primary lung cancer (DPLC).

DATA SOURCE

Surveillance, epidemiology, and end results (SEER) database.

DESIGN

A retrospective population-based study.

METHODS

Data of DPLC patients from the database from 1992 to 2020 were collected. The number of DPLC patients was determined based on the first primary LC (FPLC) and second primary LC (SPLC), and patients were randomly assigned to a training set and a testing set in a 7:3 ratio. The primary endpoint was cancer-specific survival (CSS). Kaplan-Meier survival analysis was performed to construct survival curves. Cox analysis and bilateral stepwise regression were used to analyze prognostic factors for cancer-specific death in patients and establish the nomogram. The discriminative ability of the nomogram was assayed by C-index and calibration curves, decision-making ability was assessed by decision curve analysis (DCA), and nomogram performance was measured by receiver operating characteristic (ROC) curves.

RESULTS

This study included 997 DPLC patients, divided into a training set (n = 698) and a testing set (n = 299) in a 7:3 ratio. Age, gender, histological type, surgery, chemotherapy, T stage, N stage, and tumor size were identified as risk factors affecting CSS in DPLC patients (P < 0.05) and were utilized to establish a nomogram. The C-index of the nomogram in the training set was 0.671, and the AUC values of ROC curves for 1-year, 3-year, and 5-year survival rates were 0.84, 0.78, and 0.74, respectively. The C-index of the testing set was 0.644, and the AUC values were 0.72, 0.74, and 0.75, respectively. Calibration curves for both sets were close to the diagonal line, indicating good predictive ability of the nomogram. DCA curves demonstrated the good decision-making ability of the nomogram.

CONCLUSION

This study revealed the clinical features of DPLC patients and developed an effective nomogram for predicting CSS, which can assist clinicians in making accurate and personalized clinical decisions regarding patient treatment.

A narrative literature review about alpha-lipoic acid role in dry eye and ocular surface disease

Ocular surface diseases (OSD) include various conditions that affect the eye's surface, causing discomfort and pain. One such condition, dry eye disease (DED), is a multifactorial disorder that significantly impacts patients' quality of life, with prevalence rates ranging from 5% to 50% and higher incidence in women. DED involves tear film instability, inflammation and neurosensory abnormalities, making its management challenging due to diverse underlying mechanisms. Conventional treatments typically focus on symptom relief, but new approaches targeting the disease's pathogenesis are emerging. Alpha-lipoic acid (ALA) is gaining attention for its potential in treating OSD and DED. ALA acts as a potent antioxidant, neutralizing reactive oxygen species. It protects cell membranes by interacting with vitamin C and glutathione, potentially recycling vitamin E. Its antioxidative properties are particularly relevant in meibomian gland dysfunction, a condition implicated in DED. By scavenging free radicals and modulating redox status in the meibomian glands, ALA can reduce oxidative damage, preserve glandular function and decrease inflammation. In diabetic patients with DED, ALA administration has been found to improve tear film parameters, reduce corneal defects, enhance antioxidant status and potentially prevent diabetic retinopathy and keratopathy. Its therapeutic effects on neurosensory abnormalities, especially in diabetic polyneuropathy and other neuropathies, are primarily due to its antioxidant, anti-inflammatory and metal-chelating properties. In summary, ALA holds promise as a therapeutic agent for DED and OSD and could be a promising treatment option for diabetic retinopathy and keratopathy, although further research is needed to confirm its efficacy.

Regulation of cellular senescence in tumor progression and therapeutic targeting: mechanisms and pathways

Cellular senescence, a stable state of cell cycle arrest induced by various stressors or genomic damage, is recognized as a hallmark of cancer. It exerts a context-dependent dual role in cancer initiation and progression, functioning as a tumor suppressor and promoter. The complexity of senescence in cancer arises from its mechanistic diversity, potential reversibility, and heterogeneity. A key mediator of these effects is the senescence-associated secretory phenotype (SASP), a repertoire of bioactive molecules that influence tumor microenvironment (TME) remodeling, modulate cancer cell behavior, and contribute to therapeutic resistance. Given its intricate role in cancer biology, senescence presents both challenges and opportunities for therapeutic intervention. Strategies targeting senescence pathways, including senescence-inducing therapies and senolytic approaches, offer promising avenues for cancer treatment. This review provides a comprehensive analysis of the regulatory mechanisms governing cellular senescence in tumors. We also discuss emerging strategies to modulate senescence, highlighting novel therapeutic opportunities. A deeper understanding of these processes is essential for developing precision therapies and improving clinical outcomes.

Evaluation of the protective effect of Compound Kushen Injection against radiation‑induced lung injury in mice

Radiation‑induced lung injury (RILI) is a prevalent complication following thoracic radiation, and currently there is a lack of effective intervention options. The present study investigated the potential of Compound Kushen Injection (CKI), a botanical drug, to mitigate inflammatory responses in mice with RILI, along with its underlying mechanisms of action. C3H mice underwent total lung irradiation (TLI) and intraperitoneal injection of CKI (2, 4 or 8 ml/kg) once daily for 8 weeks. Pre‑radiation treatment with 4 or 8 ml/kg CKI starting 2 weeks before TLI or concurrent treatment of 8 ml/kg CKI with TLI led to a significantly longer overall survival compared with the TLI vehicle‑treated group. Micro‑computed tomography evaluations showed that concurrent treatment with 8 ml/kg CKI was associated with a significantly lower incidence of RILI. Histological evaluations revealed that concurrent CKI (4 and 8 ml/kg) treatment significantly reduced grades of lung inflammation. Following radiation at 72 h, TLI plus vehicle‑treated mice had significantly elevated serum IL6, IL17A, and transforming growth factor β (TGF‑β) levels compared with non‑irradiated normal mice. Conversely, mice that received TLI plus CKI displayed lower cytokine levels than those in the TLI plus vehicle‑treated mice. Immunohistochemistry staining showed a reduction of TGF‑β positive cells in the lung tissues of TLI mice after CKI treatment. The concurrent TLI CKI‑treated mice had a significantly reduced cyclooxygenase 2 (COX‑2) activity and COX‑2 metabolites compared with TLI vehicle‑treated mice. These data highlight that CKI substantially reduced radiation‑induced lung inflammation, mitigated RILI incidence, and prolonged overall survival.

Complementary and Alternative Medicine Use in the Last Year of Life: The COMPASS Cancer Cohort Study

CONTEXT

There has been growing interest in the role of complementary and alternative medicine (CAM) as part of end-of-life care.

OBJECTIVES

This study prospectively examined the prevalence, predictors and outcomes of ingestible CAM use among cancer patients in their last year of life in Singapore.

METHODS

This study (N = 427) utilized data across 12 months (four time points) prior to patient death. Utilizing mixed effects logistic regressions, we examined sociodemographic, clinical (symptom burden) and treatment-related factors associated with CAM use. Subsequently, the association between patient quality of life (i.e., physical, social, emotional, functional well-being) and CAM use were examined.

RESULTS

Half of the patients (50%) reported using CAM at least once in the last year of life while 36% of patients reported using CAM in the last 3 months of life. Among CAM users, 67% reported using western herbal supplements while 56% reported using traditional Chinese medicine. Further, 27-28% of patients used CAM consistently (i.e., for six months or more). Most patients (73%) reported using CAM as a complementary treatment. Patients who were ethnically Chinese (OR: 5.59, 95% CI: 2.29-13.69), reported less financial difficulties (OR: 0.82, 95% CI: 0.69-0.98), and believed in other curative treatments for cancer (OR: 2.39, 95% CI: 1.00-5.70) were more likely to use CAM. Controlling for time, CAM use (β: 0.60, CI: 0.01-1.19) was associated with higher social well-being.

CONCLUSIONS

A significant proportion of terminal cancer patients reported using CAM as a complementary treatment in the last year of life.

Hypofractionated Radiation Therapy in the Definitive Management of Head and Neck Cancer

The use of hypofractionated radiation therapy has increased among many cancers, although its use in head and neck cancers remains limited due to concerns regarding acute and late toxicities. Recent retrospective and prospective studies demonstrate the preliminary safety and efficacy of hypofractionation in the definitive, postoperative, and preoperative settings for head and neck treatment. This article seeks to comprehensively review the rationale and data for novel fractionation schemes in this disease site. We also provide practical clinical and dosimetric insights based on our institutional experiences with hypofractionation in head and neck cancers.

Benzimidazole scaffold as a potent anticancer agent with different mechanisms of action (2016-2023)

Benzimidazole scaffolds have potent anticancer activity due to their structure similarity to nucleoside. In addition, benzimidazoles could function as hydrogen donors or acceptors and bind to different drug targets that participate in cancer progression. The literature had many anticancer agents containing benzimidazole cores that gained much interest. Provoked by our endless interest in benzimidazoles as anticancer agents, we summarized the successful trials of the benzimidazole scaffolds in this concern. Moreover, we discuss the substantial opportunities in cancer treatment using benzimidazole-based drugs that may direct medicinal chemists for a compelling future design of more active chemotherapeutic agents with potential clinical applications. The uniqueness of this work lies in the highlighted benzimidazole scaffold hybridization with different molecules and benzimidazole-metal complexes, detailed mechanisms of action, and the IC50 of the developed compounds determined by different laboratories after 2015.

Locally advanced maxillary sinus cancer fed from the internal carotid artery

OBJECTIVE

Superselective intra-arterial infusion of cisplatin and concomitant radiation therapy (RADPLAT) is one of the effective treatments for advanced maxillary sinus cancer, and prospective trials have been conducted. However, treatment of cases with intraorbital infiltration or skull base infiltration that are fed from the internal carotid artery (ICA) may be problematic. In this study, we investigated the frequency, treatment, and prognosis of locally advanced maxillary sinus cancer fed from the ICA.

METHOD

This study included patients with locally advanced maxillary sinus cancer (clinical T4a or T4b) who underwent RADPLAT only via external carotid artery from January 2008 to January 2024.

RESULT

Nineteen of 44 cases were fed from the ICA (43.2%). Three-year overall survival (OS), three-year progression-free survival (PFS), and three-year local control rate (LCR) of all cases were 69.8%, 47.5%, and 61.8%, respectively. The three-year OS, PFS and LCR were equivalent between cases with or without feeding from the ICA.

CONCLUSION

This study revealed the frequency and prognosis of locally advanced maxillary sinus cancer fed from the ICA. The prognosis was equivalent between cases with or without feeding from the ICA; therefore, it would be considered important to determine the tumor volume for each feeding blood vessel and assess the areas of dual perfusion.

Mechanotransduction and Skeletal Muscle Atrophy: The Interplay Between Focal Adhesions and Oxidative Stress

Mechanical unloading leads to profound musculoskeletal degeneration, muscle wasting, and weakness. Understanding the specific signaling pathways involved is essential for uncovering effective interventions. This review provides new perspectives on mechanotransduction pathways, focusing on the critical roles of focal adhesions (FAs) and oxidative stress in skeletal muscle atrophy under mechanical unloading. As pivotal mechanosensors, FAs integrate mechanical and biochemical signals to sustain muscle structural integrity. When disrupted, these complexes impair force transmission, activating proteolytic pathways (e.g., ubiquitin-proteasome system) that accelerate atrophy. Oxidative stress, driven by mitochondrial dysfunction and NADPH oxidase-2 (NOX2) hyperactivation, exacerbates muscle degeneration through excessive reactive oxygen species (ROS) production, impaired repair mechanisms, and dysregulated redox signaling. The interplay between FA dysfunction and oxidative stress underscores the complexity of muscle atrophy pathogenesis: FA destabilization heightens oxidative damage, while ROS overproduction further disrupts FA integrity, creating a self-amplifying vicious cycle. Therapeutic strategies, such as NOX2 inhibitors, mitochondrial-targeted antioxidants, and FAK-activating compounds, promise to mitigate muscle atrophy by preserving mechanotransduction signaling and restoring redox balance. By elucidating these pathways, this review advances the understanding of muscle degeneration during unloading and identifies promising synergistic therapeutic targets, emphasizing the need for combinatorial approaches to disrupt the FA-ROS feedback loop.

Tumor Microenvironment Dynamics of Triple-Negative Breast Cancer Under Radiation Therapy

Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer characterized by the absence of estrogen receptors (ER), progesterone receptors (PR), and HER2 expression. While TNBC is relatively less common, accounting for only 10-15% of initial breast cancer diagnosis, due to its aggressive nature, it carries a worse prognosis in comparison to its hormone receptor-positive counterparts. Despite significant advancements in the screening, diagnosis, and treatment of breast cancer, TNBC remains an important public health burden. Following treatment with chemotherapy, surgery, and radiation, over 40% of TNBC patients experience relapse within 3 years and achieve the least benefit from post-mastectomy radiation. The tumor microenvironment environment (TME) is pivotal in TNBC initiation, progression, immune evasion, treatment resistance, and tumor prognosis. TME is a complex network that consists of immune cells, non-immune cells, and soluble factors located in the region adjacent to the tumor that modulates the therapeutic response differentially between hormone receptor-positive breast cancer and TNBC. While the mechanisms underlying the radiation resistance of TNBC remain unclear, the immunosuppressive TME of TNBC has been implicated in chemotherapeutic resistance. Radiation therapy (RT) is known to alter the TME; however, immune changes elicited by radiation are poorly characterized to date, and whether these immune changes contribute to radiation resistance remains unknown. This review delves into the distinct characteristics of the TNBC TME, explores how RT influences TME dynamics, and examines mechanisms underlying tumor radiosensitization, radioresistance, and immune responses.

What is the impact of perineural invasion on the prognosis of cervical cancer: a systematic review and meta-analysis

BACKGROUND

Perineural Invasion (PNI) is a marker of a highly invasive tumor with poor prognosis, but the real influence on the prognosis of cervical cancer is still debated. We aimed to systematically investigate the prognostic impact of PNI in cervical cancer.

METHODS

We searched PubMed, Embase, Cochrane databases, and ClinicalTrials.gov from inception to 20 April 2024. Cohort, case-control, and randomized controlled studies reporting the PNI status and survival outcomes of women with cervical cancer were included. Two reviewers extracted data independently and appraised study quality following the PRISMA guideline. The quality of the studies was assessed with Newcastle-Ottawa Scale. Random effect model was used if the heterogeneity was significant (P ≤ 0.1, I2 ≥ 50%).

RESULTS

We included seven retrospective cohort studies (1561 women) in the analysis. PNI was remarkably associated with a worse survival (risk ratio [95% CI]: 2.79 [1.67- 4.66], I2 = 78% for 5-year overall survival (OS); 2.16 [1.30-3.59], I2 = 84% for 5-year disease-free survival (DFS)). After multivariate cox regression adjustment, the hazard ratio [95% CI] of PNI was 3.25 [1.09, 9.74] (I2 = 85%) for OS, and 2.50 [0.66, 9.46] (I2 = 89%) for DFS. PNI showed positive correlation with higher stage, larger tumor size, lymph node metastasis, deep stromal invasion, lymphovascular invasion, resection margin involvement, and parametrial invasion (P < 0.05). Besides, PNI was associated with higher possibility of adjuvant therapy (risk difference [95% CI]: 0.28 [0.04-0.52], I2 = 92%), especially for chemoradiation (0.25 [-0.02-0.53], I2 = 76%). Subgroup analysis showed patients with PNI had poorer prognosis than those without PNI in patients with LNM or large tumor size (P < 0.05).

CONCLUSIONS

PNI demonstrated a significant association with reduced overall survival in cervical cancer patients and emerged as a potential independent prognostic indicator, which provided a foundation for future investigations to evaluate the clinical utility of PNI status in guiding therapeutic strategies.

TRAIL REGISTRATION

The protocol for this study was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) under identifying number CRD42022315970.

UBC4: A Repurposed Drug Regimen for Adjunctive Use During Bladder Cancer Treatment

After it has metastasized, bladder cancer, the malignant transformation of the bladder urothelium, continues to be a common cause of death after maximal use of all currently available standard treatments. To address this problem in 2025, the drug repurposing movement within oncology aims to identify medicines in common general medical care use that have data indicating that they can interfere or inhibit a growth driving element that has been identified in bladder cancer. This paper now outlines extensive preclinical data showing that four drugs from general medical practice meet these criteria-the melatonergic drug ramelteon, the antidepressant fluoxetine, the antibiotic dapsone, and the analgesic drug celecoxib. This is the UBC4 regimen, meant as a possible adjunct added to standard treatments of metastatic bladder cancer. Three factors justify a clinical pilot trial of UBC4: (1) the UBC4 drugs are usually well tolerated and carry a low risk of harm, (2) the commonly fatal outcome of bladder cancer once it has widely metastasized, plus (3) the strong preclinical database showing UBC growth inhibition by each of the individual UBC4 drugs as outlined in this paper.

Prognostic Significance of Peripheral Blood Parameters as Predictor of Neoadjuvant Chemotherapy Response in Breast Cancer

The standard treatment for breast cancer typically includes surgery, often followed by systemic therapy and individualized treatment regimens. However, there is growing interest in identifying pre-therapeutic biomarkers that can predict tumor response to neoadjuvant chemotherapy (NACT). This study systematically evaluated various analytical parameters, including age, TNM stage, histological type, molecular subtype, and several biomarker ratios, such as the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammatory index (SII), and prognostic nutritional index (PNI). We aimed to assess the predictive value of these parameters regarding the tumor's response rate to NACT. The analysis revealed a statistically significant association between the pathological complete response-pCR (absence of any detectable cancer cells in the tissue following neoadjuvant chemotherapy (NACT))-rate and NLR in the subgroup with values between 1 and 3 (p = 0.001). The optimal cut-off for PLR was determined to be 120.45, with 80.55% of patients achieving pCR showing PLR values below this threshold (p = 0.000). Similarly, the LMR cut-off was found to be 12.34, with 77.77% of patients with pCR having LMR values below this threshold (p = 0.002). Additionally, lower pre-therapeutic values of NLR (p < 0.001), PLR (p = 0.002), SII (p = 0.001), and LMR (p = 0.001) were significantly correlated with pCR compared to the non-pCR subgroup (p < 0.005). These findings highlight the predictive potential of these biomarkers for achieving pCR following NACT. Our study supports the hypothesis that pre-therapeutic values of NLR, PLR, SII, and LMR can serve as predictive biomarkers for pCR in breast cancer patients undergoing NACT. However, the PNI did not demonstrate predictive potential in relation to pCR. These biomarkers may provide valuable insights into patient prognosis and guide personalized treatment strategies.

Chronic inflammation in a radium dial painter cohort: elevated neutrophil to lymphocyte ratio and radiation-induced hearing loss

The radium dial painters (RDPs) are a well-described group of predominantly young women who incidentally ingested226Ra and228Ra as they painted luminescent watch dials in the first part of the twentieth century. In 1974 pathologist Dr William D. Sharpe published complete clinical and autopsy results for 42 former RDPs evaluated in the New Jersey Radium Research Project. This was an important paper due to the completeness of the observations. Surprisingly, in this study, clinicians noted a 35.5% incidence of hearing loss, both conductive and mixed etiologies. Since the 1974 publication, there has developed a considerable literature on radiation-induced hearing loss in patients undergoing radiotherapy for head and neck cancers. It is expected that hearing loss would also be associated with systemic inflammation. Recently, the neutrophil to lymphocyte ratio (NLR) has been shown in many cancer and non-cancer studies to be a nonspecific marker of inflammation. In prior collaborative efforts with the United States Transuranium and Uranium Registries and with the NCRP Million Person Study, it has been possible to evaluate NLR from medical records of a cohort of 166 former RDPs previously evaluated at Argonne National Laboratory. In addition, NLR was available in historic medical records of the sarcoma and nasopharyngeal cancer patients described in Rowland's summary of the Argonne studies. Using elevation of the NLR as a non-specific marker of inflammation, chronic inflammation has been observed in all cohorts with significant dose. The RDP cohort has had a unique exposure to radium, but the incidence of radiation-induced hearing loss here is uncertain. Due to cosmic radiation dose to astronauts in space flight, there is a significant interest in high LET radiation dose to the brain, including the auditory system. This paper should be considered as hypothesis generating-that high LET radiation dose to the brain and auditory system may induce hearing loss.

Anticancer effects of alpha-lipoic acid, a potent organosulfur compound by modulating matrix metalloproteinases and apoptotic markers in osteosarcoma MG-63 cells

Osteosarcoma (OS), an extremely aggressive form of bone tumor primarily affects young adults. Despite significant advancements in clinical trials, the ability of cancer cells to metastasize and resist apoptosis remains a major challenge. To address these issues, novel therapeutic interventions with high specificity for these processes are essential. Alpha-lipoic acid (ALA), an organosulfur compound derived from octanoic acid, possesses a range of pharmacological properties. This study hypothesizes that ALA would inhibit metastasis and induce cell apoptosis in OS. To evaluate the potential of ALA, its effects on the migration, metastasis, and cell cycle of MG-63 OS cells were assessed, along with its ability to trigger apoptosis. To these aims, MG-63 cells were exposed to varying concentrations of ALA, and cell viability was measured using the alamarBlue assay. The impact of ALA on cell cycle progression, apoptosis, migration, and metastasis was analyzed through flow cytometry, scratch assay, and gelatin zymography. After validating the expression of MMP2, MMP9, VEGF, VEGFR, BAX, BCL-2, and P53 by the GEO database, the expression levels of these genes were examined through quantitative PCR (qPCR). Eventually, molecular docking was employed to simulate the interactions between ALA and matrix metalloproteinase (MMPs). The results demonstrated that ALA significantly inhibited cell migration, induced cell cycle arrest, and promoted apoptosis by upregulating P53 and BAX expression while downregulating BCL-2 levels. Furthermore, ALA was found to suppress the activity and expression of MMP2 and MMP9 and reduce the expression of angiogenesis markers. Notably, ALA interacted directly with the active site of MMP2 and MMP9. These findings suggest that ALA has the potential to be a promising agent with anti-cancer effects on MG-63 cells, warranting further preclinical investigations.

Hydrogen as an innovative nootropic in health and disease

Molecular hydrogen (H2, dihydrogen) is an antioxidant and signaling molecule with potent antioxidative, antiapoptotic, and anti-inflammatory properties. Despite the growing interest in H2 as a potential therapeutic agent, the evidence regarding its potential as a nootropic remains limited. Only a handful of studies on the human population have evaluated its effects, although there are suggestive indications of its efficacy. The present paper overviews H2's potential as a novel agent for improving cognitive functions in health and disease contexts, highlighting its mechanisms of action and areas for further investigation. Current evidence suggests that H2 improves executive function, alertness and memory in several clinical trials, from healthy young and elderly individuals to individuals with altered circadian rhythms, neurodegenerative disorders, and cancer. Further investigations are needed to confirm the potential positive effects of dihydrogen as a nootropic agent in both health and disease.

A Sustained H2/Fluorouracil-Releasing Suppository for High-efficacy and Low-Toxicity Hydrogenochemotherapy of Colon Cancer

To attenuate the intestinal toxicity of chemotherapeutic drugs from rectal suppositories and enhance their chemotherapeutic outcome is greatly significant, but maintains a challenge. In this work, a new strategy of local synergistic hydrogenochemotherapy is proposed to attenuate side effects and enhance therapeutic efficacy based on the anti-cancer selectivity and normal cells-protecting effect of H2, and construct a novel anti-cancer formulation of rectal suppository (5-FU/CSN@FAG) by fatty acid glycerides (FAG) encapsulating 5-fluorouracil (5-FU, a first-line drug for colorectal cancer treatment) and cerium silicide nanoparticles (CSN) with a sustained hydrolytic H2 release behavior which is synchronous with 5-FU release. The 3-week treatment with the suppository once a day can not only completely eradicate colon tumors without tumor recurrence after suppository administration withdrawal, but also efficiently protect the intestinal tract from chemotherapeutic damage. Mechanistically, H2 generated by CSN reduces the toxicity of 5-FU to normal cells in the intestinal tract by scavenging over-expressed reactive oxygen species and correcting energy metabolism, and also assists 5-FU to promote the apoptosis of colon tumor cells by inhibiting their respiration through a CO signaling pathway. High biosafety and therapeutic validity endow the developed suppository with a high potential for clinical translation.

Prognostic Significance of Desmoplastic Reaction After Neoadjuvant Chemoradiotherapy in Advanced Rectal Cancer

BACKGROUND

Desmoplastic reaction is recognized as a prognostic factor in colorectal cancer. However, its significance in locally advanced rectal cancer after neoadjuvant chemoradiotherapy remains underexplored.

OBJECTIVE

To assess the prognostic value of desmoplastic reaction in specimens from patients with advanced rectal cancer after chemoradiotherapy.

DESIGN

This was a retrospective study.

SETTINGS

This study was conducted at a single comprehensive cancer center.

PATIENTS

The study included 255 patients with advanced rectal cancer who underwent fluoropyrimidine-based chemoradiotherapy followed by total mesorectal excision from 2005 to 2014. Desmoplastic reaction was classified into mature, intermediate, and immature categories based on histological analysis.

MAIN OUTCOME MEASURES

The primary outcomes were recurrence-free survival and overall survival.

RESULTS

Desmoplastic reaction was classified as mature (69.0%), intermediate (5.5%), or immature (25.5%). The mature group had a higher percentage of good responders (34.1%) compared with the intermediate (0%) and immature (4.6%) groups ( p < 0.0001). The mature group correlated with better outcomes, with a higher 5-year recurrence-free survival (85.4%) and overall survival (93.0%) as compared with intermediate (45.1% and 76.2%, respectively) and immature (65.8% and 88.8%, respectively) groups. In the multivariable analysis, intermediate/immature desmoplastic reaction was significantly associated with poorer recurrence-free survival ( p = 0.03). Among poor responders, intermediate/immature desmoplastic reaction was associated with poorer recurrence-free survival ( p = 0.03). Adjuvant chemotherapy did not significantly improve the 5-year recurrence-free survival rate for the mature group (adjuvant chemotherapy vs no chemotherapy, 86.4% vs 84.8%; p = 0.64), with worse trends observed in the intermediate/immature combined group (55.9% vs 69.4%, respectively, p = 0.27).

LIMITATIONS

The limitations include the subjective nature of the desmoplastic reaction assessment and the retrospective design of the study.

CONCLUSIONS

Desmoplastic reaction in surgical specimens after chemoradiotherapy is associated with responses to chemoradiotherapy and serves as a significant prognostic factor in advanced rectal cancer, particularly for those responding poorly to chemoradiotherapy. See Video Abstract .

IMPORTANCIA PRONSTICA DE LA REACCIN DESMOPLSICA TRAS LA QUIMIORRADIOTERAPIA NEOADYUVANTE EN EL CNCER RECTAL AVANZADO

ANTECEDENTES:La reacción desmoplásica se reconoce como un factor pronóstico en el cáncer colorrectal. Sin embargo, su importancia en el cáncer rectal localmente avanzado después de la quimiorradioterapia neoadyuvante sigue sin explorarse.OBJETIVO:Evaluar el valor pronóstico de la reacción desmoplásica en muestras de pacientes con cáncer rectal avanzado después de la quimiorradioterapia.DISEÑO:Este es un estudio retrospectivo.ESCENARIO:Este estudio se llevó a cabo en un solo centro oncológico integral.PACIENTES:El estudio incluyó a 255 pacientes con cáncer rectal avanzado que se sometieron a quimiorradioterapia basada en fluoropirimidina seguida de una escisión mesorrectal total entre 2005 y 2014. La reacción desmoplásica se clasificó en categorías madura, intermedia e inmadura según el análisis histológico.RESULTADOS PRINCIPALES:Los resultados primarios fueron la supervivencia sin recurrencia y la supervivencia general. RESULTADOS: La reacción desmoplásica se clasificó como madura (69,0%), intermedia (5,5%) o inmadura (25,5%). El grupo maduro tuvo un mayor porcentaje de buenos respondedores (34,1%) en comparación con los grupos intermedio (0%) e inmaduro (4,6%) (p < 0,0001). El grupo maduro se correlacionó con mejores resultados, con una mayor supervivencia libre de recurrencia a 5 años (85,4%) y supervivencia general (93,0%) en comparación con los grupos intermedio (45,1% y 76,2%, respectivamente) e inmaduro (65,8% y 88,8%, respectivamente). En el análisis multivariable, la reacción desmoplásica intermedia/inmadura se asoció significativamente con una peor supervivencia libre de recurrencia ( p = 0,03). Entre los malos respondedores, la reacción desmoplásica intermedia/inmadura se asoció con una peor supervivencia libre de recurrencia (p = 0,03). La quimioterapia adyuvante no mejoró significativamente la tasa de supervivencia sin recurrencia a 5 años para el grupo maduro (quimioterapia adyuvante vs. ninguna quimioterapia, 86,4% vs. 84,8%; p = 0,64), observándose tendencias peores en el grupo combinado intermedio/inmaduro (55,9% vs. 69,4%, respectivamente, p = 0,27).LIMITACIONES:Las limitaciones incluyen la naturaleza subjetiva de la evaluación de la reacción desmoplásica y el diseño retrospectivo del estudio.CONCLUSIONES:La reacción desmoplásica en muestras quirúrgicas después de la quimiorradioterapia se asocia con respuestas a la quimiorradioterapia y sirve como un factor pronóstico significativo en el cáncer rectal avanzado, particularmente para aquellos que responden mal a la quimiorradioterapia. (Traducción-Yesenia Rojas-Khalil ).

Exploring the role and application of mitochondria in radiation therapy

Mitochondria are pivotal in cellular energy metabolism, the oxidative stress response and apoptosis. Recent research has focused on harnessing their functions to enhance the efficacy of radiation therapy (RT). This review focuses on the critical functions and applications of mitochondria in radiation therapy, including the targeting of mitochondrial metabolism and the modulation of mitochondria-mediated cell death and immune responses. While these strategies have demonstrated considerable potential in preclinical studies to improve radiotherapy outcomes, challenges remain, such as optimizing drug delivery systems, ensuring safety and overcoming resistance to therapy.

Potential Benefits of Adding Alendronate, Celecoxib, Itraconazole, Ramelteon, and Simvastatin to Endometrial Cancer Treatment: The EC5 Regimen

Metastatic endometrial cancer continues to be a common cause of death as of 2024, even after maximal use of all currently available standard treatments. To address this problem of metastatic cancer generally in 2025, the drug repurposing movement within oncology identifies medicines in common general medical use that have clinical or preclinical experimental data indicating that they interfere with or inhibit a specific growth driving element identified in a given cancer. The drug repurposing movement within oncology also uses data from large scale in vitro screens of thousands of drugs, looking for simple empirical growth inhibition in a given cancer type. This paper outlines the data showing that five drugs from general medical practice meet these evidence criteria for inhibition of endometrial cancer growth, the EC5 regimen. The EC5 regimen uses the osteoporosis treatment drug, alendronate; the analgesic drug, celecoxib; the antifungal drug, itraconazole; the sleep aid, ramelteon; and the cholesterol lowering drug, simvastatin. Side effects seen with these drugs are usually minimal and easily tolerated by patients.

Molecular hydrogen inhibits neuroinflammation and ameliorates depressive-like behaviors and short-term cognitive impairment in senescence-accelerated mouse prone 8 mice

BACKGROUND AND AIMS

Neuroinflammation, a low-grade chronic inflammation of the central nervous system, is linked to age-related neuropsychiatric disorders such as senile depression and Alzheimer's disease. Recent studies have explored controlling neuroinflammation as a novel treatment strategy. Molecular hydrogen shows anti-inflammatory effects. However, its impacts on neuroinflammation and age-related neuropsychiatric disorders remain unelucidated. We investigated molecular hydrogen's effects on microglial activation, neuroinflammation, depressive-like behavior, and short-term cognitive decline in senescence-accelerated mouse-prone 8 (SAMP8) mice.

METHODS

Six-week-old SAMP8 or senescence-accelerated mouse-resistant 1 (SAMR1) mice received hydrogen-rich jelly (HRJ) or placebo jelly (PJ) from six weeks of age for 26-28 weeks. Depressive-like behavior was assessed using tail suspension and forced swimming tests, while cognitive function was evaluated using the Y-maze and object recognition tests. Brain tissues were used for immunohistochemical studies or to measure pro-inflammatory cytokine levels via enzyme-linked immunosorbent assay (ELISA).

RESULTS

HRJ intake reduced immobility time in both tail suspension and forced swimming tests and enhanced visual cognitive and spatial working memory in SAMP8 mice. Additionally, HRJ intake suppressed the 8-hydroxy-2'-deoxyguanosine (8-OHdG), Iba1, and cleaved caspase 3 expression levels in the medial prefrontal cortex and hippocampal dentate gyrus. Furthermore, HRJ intake significantly lowered IL-6 levels in brain tissues of SAMP8 mice.

CONCLUSIONS

These findings suggest that molecular hydrogen treatment may regulate neuroinflammation induced by activated microglia and improve depressive-like behavior and short-term cognitive impairment in SAMP8 mice.

Low-Burden Oligometastatic Disease of the Lung Treated with Robotic Stereotactic Ablative Radiotherapy: A Retrospective Study

Background/Objectives: The lung is the most common site of metastases, regardless of the cancer subtype. Treating oligometastatic disease with surgery or stereotactic ablative radiotherapy (SABR) may improve patient survival. Methods: We retrospectively analyzed 41 patients with limited (one or two lesions, max dimension <3 cm) lung-only metastatic disease that were treated with the CK M6 robotic radiosurgery system in our Department, in terms of treatment efficacy and toxicity. Results: Acute and late toxicity was negligible (4 out of 41 patients developed grade 2 or 3 lung fibrosis). Six months post-SABR, complete response was achieved in 18 out of 41 patients (43.9%), while the rest of the cases exhibited major responses. A biological effective dose (BEDα/β=10) in the range of 100 Gy appears to be equally effective with higher doses. Within a median follow-up of 34 months, only three patients (7.3%) progressed locally, while three patients progressed to distal sites. Two-year local progression-free survival (LPFS) rates were 92.6% (95% CI 78.5-97%). Conclusions: SABR for low-burden lung oligometastases is an effective treatment modality that yields high local control and survival rates. Toxicity is negligible, regardless of the performance status of patients. Early referral of such patients to radiation oncology departments may be critical for patient survival and quality of life.