Comparative study between single modality radiotherapy and concurrent chemoradiation for selected patients with early-stage laryngeal cancer

Unfavorable T2 glottic squamous cell carcinoma with impaired vocal cord mobility and/or bulky disease has been a real treatment challenge with high local failure rates. The purpose of this study is to compare the oncological outcome of unfavorable T2 glottic carcinoma in patients treated with radical radiotherapy versus concurrent chemoradiation. This study is a prospective, open label, randomized trial, in which all patients with unfavorable T2 glottic cancer were treated with either single modality radiotherapy using hypofractionation protocol 65.25 Gy (arm A) or concurrent chemoradiation (arm B) between 2019 and 2023. The primary end points were local control and local progression free survival (PFS). Sixty-two patients were recruited in the study. Local control was significantly higher in concurrent chemoradiation (CCRT) group compared to radiotherapy (RT) group. The 3-year local progression free survival rates were significantly higher in CCRT arm (85.5%) compared to RT arm (57.8%) (P=0.015). Concurrent chemoradiation should be considered for selected patients with T2 glottic squamous cell carcinoma with impaired vocal cord mobility and/or bulky disease due to high rate of local failure with radiotherapy alone.

CT-guided high-dose-rate brachytherapy ablation of HCC patients with portal vein tumor thrombosis

BACKGROUND

We assessed the safety and efficacy of computed tomography (CT)-guided high-dose-rate (HDR) brachytherapy in treating hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT).

METHODS

From January 2010 to January 2022, 56 patients (median age 67.5 years) with HCC and PVTT underwent 64 procedures. PVTT was further classified according to the Japan liver cancer study group into VP1-VP4. Tumor response was evaluated by cross-sectional imaging 6 weeks after CT-guided HDR brachytherapy and every 3 months thereafter. Local tumor control (LTC), progression-free survival (PFS), and overall survival (OS) were assessed using Kaplan-Meier curves. The severity of procedure-related complications was classified according to the Society of Interventional Radiology guidelines.

RESULTS

Patients were available for imaging evaluation for a median follow-up of 14.0 months. The median diameter of the largest lesion was 56 mm. Estimated median PFS, LTC, and OS were 7.0 (95% CI 5.0-13.0), 14.0 (95% CI 7.0-21.0), and 20.0 (95% CI 13.0-26.0) months respectively. Actuarial 1-, 2-, and 3-year OS rates were 66%, 41%, and 27%, respectively. Subclassified for VP1, VP2, VP3, and VP4 estimated OS was 38.0 (95% CI 9.0-Not-a-number), 21.5 (95% CI 15.0-25.0), 15.0 (95% CI 7.0-33.0), and 13.0 (95% CI 6.0-34.0) months, respectively. Considering the 64 procedures, we recorded no complications for 49 (76.6%), mild-to-moderate complications for 12 (18.8%), and major complications for 3 (4.7%).

CONCLUSION

CT-guided HDR brachytherapy was safe and effective for locoregional treatment in patients with advanced HCC due to PVTT, achieving long-lasting local tumor control.

RELEVANCE STATEMENT

CT-guided HDR brachytherapy is an option to be considered for locoregional treatment of patients with advanced HCC due to PVTT.

KEY POINTS

Evaluation of CT-guided high-dose-rate (HDR) brachytherapy in treating HCC patients with portal vein tumor thrombosis (PVTT). Median OS was 20.0 months ranging between 13.0 and 38.0 months. CT-guided HDR brachytherapy seems to be a safe and effective treatment option in HCC patients with PVTT.

Low-dose Radiation Therapy (LDRT) in Managing Osteoarthritis: A Comprehensive Review

Osteoarthritis (OA) is the most common degenerative arthropathy, impacting the quality of life for millions worldwide. It typically presents with chronic pain, stiffness, and reduced mobility in the affected joints. Nonsurgical treatments like physiotherapy or pharmacotherapy may provide limited relief and may have adverse effects and complications. Recently, low-dose radiation therapy (LDRT) has emerged as a potential alternative for managing OA, utilizing its anti-inflammatory effects. LDRT's anti-inflammatory effects involve modulating immune responses, reducing pro-inflammatory cytokines, and inducing apoptosis in inflammatory cells. Clinical studies show varying degrees of symptom relief, with some patients experiencing pain reduction and improved joint mobility while others show minimal response. The variability in LDRT treatment designs, radiation dosages, and patient populations complicates standardized treatment protocols and raises concerns about potential carcinogenic risks. Despite these issues, LDRT shows promise as an alternative to other OA treatments, especially for patients who don't respond to other treatments. This review aims to provide updated information on the effectiveness, mechanisms, and safety of LDRT in treating OA. We reviewed the literature of studies on the safety and efficacy of LDRT on affected joints by OA, its biological effects, potential therapeutic and adverse effects, application and contraindications, clinical outcomes, and clinical evidence in subjects with OA.

Hepatocellular carcinoma: signaling pathways and therapeutic advances

Liver cancer represents a major global health concern, with projections indicating that the number of new cases could surpass 1 million annually by 2025. Hepatocellular carcinoma (HCC) constitutes around 90% of liver cancer cases and is primarily linked to factors incluidng aflatoxin, hepatitis B (HBV) and C (HCV), and metabolic disorders. There are no obvious symptoms in the early stage of HCC, which often leads to delays in diagnosis. Therefore, HCC patients usually present with tumors in advanced and incurable stages. Several signaling pathways are dis-regulated in HCC and cause uncontrolled cell propagation, metastasis, and recurrence of HCC. Beyond the frequently altered and therapeutically targeted receptor tyrosine kinase (RTK) pathways in HCC, pathways involved in cell differentiation, telomere regulation, epigenetic modification and stress response also provide therapeutic potential. Investigating the key signaling pathways and their inhibitors is pivotal for achieving therapeutic advancements in the management of HCC. At present, the primary therapeutic approaches for advanced HCC are tyrosine kinase inhibitors (TKI), immune checkpoint inhibitors (ICI), and combination regimens. New trials are investigating combination therapies involving ICIs and TKIs or anti-VEGF (endothelial growth factor) therapies, as well as combinations of two immunotherapy regimens. The outcomes of these trials are expected to revolutionize HCC management across all stages. Here, we provide here a comprehensive review of cellular signaling pathways, their therapeutic potential, evidence derived from late-stage clinical trials in HCC and discuss the concepts underlying earlier clinical trials, biomarker identification, and the development of more effective therapeutics for HCC.

Predicting complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer: The role of baseline volumetric 18F-FDG PET/CT parameters and inflammatory markers

OBJECTIVES

We evaluated the influence of baseline volumetric 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) parameters and inflammatory prognostic markers on complete response (CR) in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (nCRT).

MATERIALS AND METHODS

In total, 90 patients with LARC, including those with and without CR, were evaluated based on baseline volumetric PET/CT parameters, such as maximum standard uptake value, metabolic tumor volume (MTV), tumor lesion glycolysis, and inflammatory prognostic markers, including the lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio.

RESULTS

Of the 90 patients, 62 (68.9%) were male and 28 (31.1%) were female. The median age was 61 (31-81) years. A complete response was observed in 20 (22%) patients following nCRT. Of these, 5 demonstrated a clinical complete response, whereas 15 exhibited a complete response after surgery. A low pretreatment PLR, low MTV levels, and stage 2 disease were identified as significant predictors of complete response. The optimal cutoff values were 16.5 for MTV (sensitivity 80%, specificity 62%) and 121 for PLR (sensitivity 73%, specificity 65%).

CONCLUSION

Our findings suggest that stage 2 disease, low pretreatment MTV, and low PLR levels may be predictive of a CR to nCRT in patients with LARC.

Cancer therapy-related interstitial lung disease

ABSTRACT

With the increasing utilization of cancer therapy, the incidence of lung injury associated with these treatments continues to rise. The recognition of pulmonary toxicity related to cancer therapy has become increasingly critical, for which interstitial lung disease (ILD) is a common cause of mortality. Cancer therapy-related ILD (CT-ILD) can result from a variety of treatments including chemotherapy, targeted therapy, immune checkpoint inhibitors, antibody-drug conjugates, and radiotherapy. CT-ILD may progress rapidly and even be life-threatening; therefore, prompt diagnosis and timely treatment are crucial for effective management. This review aims to provide valuable information on the risk factors associated with CT-ILD; elucidate its underlying mechanisms; discuss its clinical features, imaging, and histological manifestations; and emphasize the clinical-related views of its diagnosis. In addition, this review provides an overview of grading, typing, and staging treatment strategies used for the management of CT-ILD.

Application of cellular microstructural diffusion MRI (cell size imaging) in rectal lesions: a preliminary study

Objectives

To explore the value of cellular microstructural mapping by IMPULSED (imaging microstructural parameters using limited spectrally edited diffusion) method in evaluating the histological type and prognostic factors of rectal lesions.

Materials and methods

Sixty-six patients with rectal lesions were enrolled in this study. All subjects underwent MRI scans including conventional diffusion weighted imaging (DWI) and the IMPULSED MRI scans of oscillating gradient spin-echo (OGSE) and pulse gradient spin-echo (PGSE) sequences. Parameters including mean cell diameter (dmean), intracellular fraction (vin), extracellular diffusivity (dex), cellularity, and apparent diffusion coefficient (ADC) values (ADCPGSE, ADC17Hz, ADC33Hz, and ADC of conventional DWI) were measured in different histopathologic types, grades, stages, and structure invasion statuses. The receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic power. The sensitivity, specificity, and the corresponding area under the curves (AUCs) were calculated.

Results

Our preliminary results illustrated that malignant lesion showed higher vin and cellularity ([0.2867 ± 0.0697] vs. [0.1856 ± 0.1011], [2.3508 ± 0.6055] vs. [1.2716 ± 0.4574], all P<0.05), lower dex and ADC values (ADCPGSE, ADC17Hz, and ADC of conventional DWI) compared to benign lesion ([2.1637 ± 0.3303 μm2/ms] vs. [2.5595 ± 0.5085 μm2/ms], [0.9238 (0.7959, 1.0741) ×10-3 mm2/s] vs. [1.3373 ± 0.3902×10-3 mm2/s], [1.3204 ± 0.2342×10-3 mm2/s] vs. [1.8029 ± 0.3119×10-3 mm2/s], [0.7400 (0.6750, 0.8375) ×10-3 mm2/s] vs. [1.0550 ± 1.1191×10-3 mm2/s], all P<0.05), while no significant difference was seen for dmean. Vin and cellularity of rectal common adenocarcinoma (AC) were significantly higher than those of rectal mucinous adenocarcinoma (MC) ([0.2994 ± 0.0626] vs. [0.2028 ± 0.0571], [2.4579 ± 0.5553] vs. [1.6412 ± 0.4347], all P<0.05), while dex and ADC values (ADCPGSE, ADC17Hz, ADC33Hz, and ADC of conventional DWI) were lower in AC ([2.1189 ± 0.3187 μm2/ms] vs. [2.4609 ± 0.2534 μm2/ms], [0.8996 ± 0.1583×10-3 mm2/s] vs. [1.2072 ± 0.2326×10-3 mm2/s], [1.2714 ± 0.1916×10-3 mm2/s] vs. [1.6451 ± 0.2420×10-3 mm2/s], [1.8963 (1.6481, 2.1138) ×10-3 mm2/s] vs. [2.3104 ± 0.3851×10-3 mm2/s], [0.7341 ± 0.8872×10-3 mm2/s] vs. [1.1410 ± 0.1840×10-3 mm2/s], all P<0.05). In AC group, the dmean had significant difference between negative and positive tumor budding (TB) ([13.2590 ± 1.3255 μm] vs. [14.3014 ± 1.1830 μm], P<0.05). No significant difference of dmean, vin, dex, cellularity or ADC values was observed in AC with different grade, T stage, N stage, perineural and lymphovascular invasion (all P>0.05). The ROC curves showed that the area under the curves (AUCs) of vin, dex, cellularity, and ADC values (ADCPGSE, ADC17Hz, and ADC of conventional DWI) for distinguishing malignant and benign lesion were 0.803, 0.757, 0.948, 0.807, 0.908 and 0.905, respectively. The AUCs of vin, dex, cellularity, and ADC values (ADCPGSE, ADC17Hz, ADC33Hz, and ADC of conventional DWI) in distinguishing AC from MC were 0.887, 0.802, 0.906, 0.896, 0.896, 0.781 and 0.991, respectively. The AUC of the dmean for evaluating TB status was 0.726. The AUC of ADC from conventional DWI for evaluating WHO grade was 0.739.

Conclusion

Cellular microstructural mapping by the IMPULSED method has great potential in preoperative evaluation of rectal lesions. It could be helpful in differentiating malignant and benign lesions, distinguishing AC from MC, and in predicting the TB status.

Th1 adjuvant ARNAX, in combination with radiation therapy, enhances tumor regression in mouse tumor-implant models

Radiation therapy (RT) rarely induces tumor regression at untreated metastatic sites, the so-called abscopal effect. A syngeneic tumor (EG7) transplanted into a Th1-dominant mouse strain (C57BL/6) regressed significantly on the treated side and less on the contralateral side after RT. Additional subcutaneous administration of ARNAX, a non-inflammatory adjuvant, further accelerated tumor regression on the untreated side. This suggests that ARNAX after RT significantly enhances the tumor regression effect on the irrelevant tumor. Based on this setting, we next observed similar tumor shrinkage after RT and ARNAX by transplanting syngeneic breast cancer tumors (4T1) into a Th2-dominant mouse strain (BALB/c). The results were as follows: 1. ARNAX enhanced RT-mediated tumor shrinkage comparable to polyI:C; 2. In the Th2 mouse strain, little tumor regression occurred on the untreated side compared to tumor regression on the treated side after RT alone; 3. RT+ARNAX treatment caused additive regression on the treated side and induced slight tumor regression on the untreated side; 4. PD-L1 antibody + RT combination therapy caused tumor regression and further induced additive regression with ARNAX; 5. The combination of RT and ARNAX reduced the number and volume of lung metastases compared to RT alone. However, tumor regression was not always accompanied by a significant prolongation of survival in the mice receiving our regimen and protocol (one 10Gy radiation and a single ARNAX treatment). In conclusion, RT therapy promoted abscopal tumor regression in both Th2 and Th1 models with the addition of the non-inflammatory adjuvant ARNAX.

Prooxidant state in anticancer drugs and prospect use of mitochondrial cofactors and anti-inflammatory agents in cancer prevention

An extensive body of literature has associated cancer with redox imbalance and inflammatory conditions. Thus, several studies and current clinical practice have relied on the use of anticancer drugs known to be associated with prooxidant state. On the other hand, a number of studies have reported on the effects of several antioxidants, anti-inflammatory agents and of mitochondrial cofactors (also termed mitochondrial nutrients, MNs) in counteracting or slowing carcinogenesis, or in controlling cancer growth. In the available literature, a body of evidence points on the roles of anti-inflammatory agents and of individual MNs against carcinogenesis or in controlling cancer cell proliferation, but only a few reports on the combined use of two or the effect of three MNs. These combinations are proposed as potentially successful tools to counteract carcinogenesis in prospective animal model studies or in adjuvant cancer treatment strategies. A "triad" of MNs are suggested to restore redox balance, mitigate side effects of prooxidative anticancer drugs, or aid in cancer prevention and/or adjuvant therapy. By elucidating their mechanistic underpinnings and appraising their clinical efficacy, we aim to contribute with a comprehensive understanding of these therapeutic modalities.

Sinonasal malignancy: ESMO-EURACAN Clinical Practice Guideline for diagnosis, treatment and follow-up

•The CPG provides key recommendations and algorithms for managing SMs, excluding mucosal melanoma and soft-tissue sarcomas. •The guideline covers diagnosis, staging, risk assessment, treatment and disease monitoring. •Technological advancements in treatment with RT are discussed with a special focus on particle therapy. •Surgical indications for open and transnasal endoscopic surgery are provided. •Neoadjuvant chemotherapy in high-grade, locally advanced SMs helps to select subjects for conservative treatments.

Validation, measurement uncertainty, and application of sesquiterpenoids and curcuminoids in turmeric (Curcuma longa L.) using HPLC-DAD and UHPLC-ESI-MS/MS

Liquid chromatography-diode array detection (HPLC-DAD) and ultra-high-performance liquid chromatography (UHPLC)-electrospray ionization tandem mass spectrometry (ESI-MS/MS) methods were investigated for the simultaneous determination of five bioactive compounds in the rhizome and tuberous root of Curcuma longa L. (turmeric). These belonging to the two chemical groups: three curcuminoids (curcumin, bisdemethoxycurcumin, and demethoxycurcumin) and two sesquiterpenoids (ar-turmerone and bisacurone). The established analytical method was validated based on AOAC guidelines for specificity, linearity, accuracy, and precision. Additionally, the system suitability test and measurement uncertainty were also estimated. The validated method was successfully applied to evaluate the quality of 25 commercial turmeric samples. This proposed method can be applied in practice for the quality control indicator of turmeric, such as its functionality and stability. Therefore, the development of this analytical method represents a significant advancement in the quality assessment of turmeric, offering a valuable tool for food industries reliant on this particular spice and ingredient.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10068-024-01677-y.

Hydrogen-Generating Magnesium Alloy Seed Strand Sensitizes Solid Tumors to Iodine-125 Brachytherapy

Radioactive iodine-125 (125I) seed implantation, a brachytherapy technique, effectively kills tumor cells via X-rays and gamma rays, serving as an alternative therapeutic option following the failure of frontline treatments for various solid tumors. However, tumor radioresistance limits its efficacy. Hydrogen gas has anticancer properties and can enhance the efficacy of immunotherapy. However, its role in radiotherapy sensitization has rarely been reported. Many current hydrogen delivery methods involve hydrogen-generating nanomaterials, such as magnesium-based nanomaterials. This study introduces an AZ31 magnesium alloy 125I seed strand (termed AMASS) with pH-dependent slow-release hydrogen characteristics and excellent mechanical properties. AMASS can be implanted into tumors via minimally invasive surgery, releasing hydrogen around the 125I seeds. In vitro experiments showed that hydrogen from AMASS degradation significantly inhibited tumor proliferation, increased apoptosis, disrupted redox homeostasis and mitochondrial membrane potential, reduced adenosine triphosphate levels, and induced DNA damage due to 125I radiation. In mouse xenograft and rabbit liver tumor models, hydrogen from AMASS showed superior therapeutic effects compared with 125I seeds alone, with no noticeable side effects. In addition, AMASS has a uniform radiation dose distribution and simple implantation. Therefore, hydrogen from AMASS enhanced 125I seed efficacy, supporting the further promotion and application of 125I seed implantation in cancer therapy.

Effects of the Curcuminoid and Non-Curcuminoid Compounds of Turmeric on the Gut Microbiome and Inflammation: Potential Use in the Treatment and Prevention of Disease

The gut microbiome is a complex system that directly interacts with and influences many systems in the body. This delicate balance of microbiota plays an important role in health and disease and is highly influenced by lifestyle factors and the surrounding environment. As further research emerges, understanding the full potential of the gut microbiome and the impact of using nutraceuticals to positively influence its function may open the door to greater therapeutic outcomes in the treatment and prevention of disease. Curcumin, a bioactive compound derived from the turmeric rhizome, has been studied in depth for its influence on human health as a potent anti-inflammatory and antioxidant properties. However, the therapeutic activity of curcumin is limited by its low oral bioavailability. While most available research has primarily focused on the curcuminoid compounds of turmeric, the non-curcuminoid compounds hold promise to offer therapeutic benefits while synergistically enhancing the bioavailability of curcumin and supporting the gut microbiome. This review summarizes current knowledge of the relationship between the gut and the various systems within the body, and how dysbiosis, or disruption in the gut microbial balance, leads to inflammation and increased risk of chronic disease. The review also summarizes recent research that focuses on the bioactivity of both the curcuminoid and non-curcuminoid compounds that comprise the whole turmeric root and their synergistic role in enhancing bioavailability to support a healthy gut microbiome and promising use in the treatment and prevention of disease.

Clinical Significance of the Peripheral Blood Neutrophil-to-Lymphocyte Ratio in Predicting Chemotherapy Outcomes for Small Cell Lung Cancer

Objective

This study aims to assess the clinical significance of the peripheral blood neutrophil-to-lymphocyte ratio (NLR) in predicting chemotherapy outcomes for patients with small cell lung cancer (SCLC).

Methods

A cohort of 44 patients diagnosed with SCLC between January 2021 to June 2022 at Fuyang People's Hospital was selected for analysis. All patients in this group received a first-line platinum-based doublet chemotherapy regimen. In parallel, a control group consisting of 44 healthy individuals undergoing routine physical examinations at the same hospital was also selected. Fasting venous blood samples were collected in the morning within one week before the initiation of chemotherapy, and a complete blood cell count was performed to calculate the NLR.

Results

The NLR in the plasma of patients with SCLC was significantly elevated compared to that of healthy individuals (P < 0.01). After two cycles of chemotherapy, there were no statistically significant differences in plasma NLR in SCLC patients compared to pre-chemotherapy levels (P > 0.05). However, in the subgroup of patients with a partial response (PR) to treatment, the NLR decreased to 2.625 (95% CI: 1.900, 3.625), down from a pre-chemotherapy level of 3.430 (2.688, 4.800) (Z = -3.127, P = 0.002). Conversely, in patients whose disease progressed (PD) following chemotherapy, the NLR increased to 3.880 (95% CI: 2.953, 5.223) from a pre-chemotherapy level of 2.060 (1.915, 2.968) (Z = -2.521, P = 0.012).

Conclusion

The dynamic variations in the peripheral blood NLR before and after chemotherapy in patients with SCLC are strongly associated with the efficacy of first-line chemotherapy regimens. These changes in NLR levels may serve as a crucial indicator for predicting the effectiveness of first-line chemotherapy in patients with SCLC.

Mebendazole Exerts Anticancer Activity in Ovarian Cancer Cell Lines via Novel Girdin-Mediated AKT/IKKα/β/NF-κB Signaling Axis

Mebendazole (MBZ), a benzimidazole anthelmintic and cytoskeleton-disrupting compound, exhibits antitumor properties; however, its action on ovarian cancer (OC) is not clearly understood. This study evaluates the effect of MBZ on OC cell lines OVCAR3 and OAW42, focusing on cell proliferation, migration, invasion, and cancer stemness. The underlying mechanisms, including cytoskeletal disruption, epithelial-mesenchymal transition (EMT), and signaling pathways, were explored. MBZ inhibited OVCAR3 and OAW42 cell proliferation in a dose- and time-dependent manner. Additionally, MBZ significantly impedes migration, spheroid invasion, colony formation, and stemness. In addition, it reduced actin polymerization and down-regulated CSC markers (e.g., CD24, CD44, EpCAM). Moreover, MBZ suppressed MMP-9 activity and inhibited the EMT marker as judged by decreased N-Cadherin and Vimentin and increased E-Cadherin. Furthermore, MBZ induced G2/M cell cycle arrest by modulating Cyclin B1, CDC25C, and WEE1. Also, it triggered apoptosis by disrupting mitochondrial membrane potential. Mechanistic studies revealed a significant downregulation of Girdin, an Akt modulator, along with reduced p-Akt, p-IKKα/β, and p-NF-κB, indicating MBZ's novel mechanism of action through the Girdin-mediated Akt/IKKα/β/NF-κB signaling axis. Thus, by targeting Girdin, MBZ presents a promising repurposed therapeutic strategy to inhibit cancer cell proliferation and metastasis in ovarian cancer.

CD73/adenosine dynamics in treatment-induced pneumonitis: balancing efficacy with risks of adverse events in combined radio-immunotherapies

Consolidation with PD-1/PD-L1-based immune checkpoint blockade after concurrent platinum-based chemo-radiotherapy has become the new standard of care for advanced stage III unresectable non-small cell lung cancer (NSCLC) patients. In order to further improve therapy outcomes, innovative combinatorial treatment strategies aim to target additional immunosuppressive barriers in the tumor microenvironment such as the CD73/adenosine pathway. CD73 and adenosine are known as crucial endogenous regulators of lung homeostasis and inflammation, but also contribute to an immunosuppressive tumor microenvironment. Furthermore, the CD73/adenosine pathway can also limit the immune-activating effects of cytotoxic therapies by degrading the pro-inflammatory danger molecule ATP, which is released into the tumor microenvironment and normal lung tissue upon therapy-induced cell damage. Thus, while targeting CD73 may enhance the efficacy of radio-immunotherapies in cancer treatment by mitigating tumor immune escape and improving immune-mediated tumor killing, it also raises concerns about increased immune-related adverse events (irAEs) in the normal tissue. In fact, combined radio-immunotherapies bear an increased risk of irAEs in the lungs, and additional pharmacologic inhibition of CD73 may further enhance the risk of overwhelming or overlapping pulmonary toxicity and thereby limit therapy outcome. This review explores how therapeutic interventions targeting CD73/adenosine dynamics could enhance radiation-induced immune activation in combined radio-immunotherapies, whilst potentially driving irAEs in the lung. We specifically investigate the interactions between radiotherapy and the CD73/adenosine pathway in radiation pneumonitis. Additionally, we compare the incidence of (radiation) pneumonitis reported in relevant trials to determine if there is an increased risk of irAEs in the clinical setting. By understanding these dynamics, we aim to inform future strategies for optimizing radio-immunotherapy regimens, ensuring effective cancer control while preserving pulmonary integrity and patient quality of life.

FASN inhibition shows the potential for enhancing radiotherapy outcomes by targeting glycolysis, AKT, and ERK pathways in breast cancer

PURPOSE

Breast cancer ranks as the most prevalent cancer in women, characterized by heightened fatty acid synthesis and glycolytic activity. Fatty acid synthase (FASN) is prominently expressed in breast cancer cells, regulating fatty acid synthesis, thereby enhancing tumor growth and migration, and leading to radioresistance. This study aims to investigate how FASN inhibition affects cell proliferation, migration, and radioresistance in breast cancer, as well as the mechanisms involved.

MATERIALS AND METHODS

We used lentiviruses carrying shFASN to create FASN-knockdown cell lines called MCF-7-shFASN and MDA-MB-231-shFASN. We conducted Western blot analysis to determine the expression levels of FASN and other proteins of interest. Furthermore, we evaluated cellular glucose uptake and migration using the 18F-FDG assay, wound healing, and transwell assays. We also employed the MTT assay to assess the short-term survival of the negative control and FASN-knockdown cells after irradiation.

RESULTS

FASN knockdown led to a decrease in the expressions of proteins related to fatty acid synthesis and glycolysis in both MCF-7-shFASN and MDA-MB-231-shFASN cells when compared to their counterparts. Moreover, reduced 18F-FDG uptake and lactate production were also detected after FASN knockdown. FASN knockdown inhibited cell proliferation and survival by downregulating the AKT, ERK, and AMPK pathways and promoted apoptosis by increasing the BAX/p-Bcl-2 ratio. In addition, FASN knockdown impaired cell migration while enhancing radiosensitivity.

CONCLUSIONS

FASN knockdown disrupts fatty acid synthesis and glycolysis, inhibits cell proliferation and induces apoptosis. The increased radiosensitivity after FASN inhibition suggests that it could potentially complement radiotherapy in treating breast cancer.

The accuracy of radiomics in diagnosing tumor deposits and perineural invasion in rectal cancer: a systematic review and meta-analysis

Background

Radiomics has emerged as a promising approach for diagnosing, treating, and evaluating the prognosis of various diseases in recent years. Some investigators have utilized radiomics to create preoperative diagnostic models for tumor deposits (TDs) and perineural invasion (PNI) in rectal cancer (RC). However, there is currently a lack of comprehensive, evidence-based support for the diagnostic performance of these models. Thus, the accuracy of radiomic models was assessed in diagnosing preoperative RC TDs and PNI in this study.

Methods

PubMed, EMBASE, Web of Science, and Cochrane Library were searched for relevant articles from their establishment up to December 11, 2023. The radiomics quality score (RQS) was used to evaluate the risk of bias in the methodological quality and research level of the included studies.

Results

This meta-analysis included 15 eligible studies, most of which employed logistic regression models (LRMs). For diagnosing TDs, the c-index, sensitivity, and specificity of models based on radiomic features (RFs) alone were 0.85 (95% CI: 0.79 - 0.90), 0.85 (95% CI: 0.75 - 0.91), and 0.82 (95% CI: 0.70 - 0.89); in the validation set, the c-index, sensitivity, and specificity of models based on both RFs and interpretable CFs were 0.87 (95% CI: 0.83 - 0.91), 0.91 (95% CI: 0.72 - 0.99), and 0.65 (95% CI: 0.53 - 0.76), respectively. For diagnosing PNI, the c-index, sensitivity, and specificity of models based on RFs alone were 0.80 (95% CI: 0.74 - 0.86), 0.64 (95% CI: 0.44 - 0.80), and 0.79 (95% CI: 0.68 - 0.87) in the validation set; in the validation set, the c-index, sensitivity, and specificity of models based on both RFs and interpretable CFs were 0.83 (95% CI: 0.77 - 0.89), 0.60 (95% CI: 0.48 - 0.71), and 0.90 (95% CI: 0.84 - 0.94), respectively.

Conclusions

Diagnostic models based on both RFs and CFs have proven effective in preoperatively diagnosing TDs and PNI in RC. This non-invasive method shows promise as a new approach.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=498660, identifier CRD42024498660.

Comparison of stereotactic body radiotherapy and transcatheter arterial chemoembolization for hepatocellular carcinoma: Systematic review and meta-analysis

Stereotactic body radiation therapy (SBRT) is an emerging treatment for hepatocellular carcinoma (HCC), which provides excellent local control (LC) and prolongs overall survival (OS). However, in current guidelines, transcatheter arterial chemoembolization (TACE) has been proposed as a key treatment option for patients with early- and intermediate-stage HCC, whereas SBRT is not. Therefore, we performed a systematic review and meta-analysis of randomized controlled trials and retrospective studies using the propensity score (PS) to compare the outcomes of SBRT and TACE for HCC in a balanced manner. We systematically searched the PubMed, Cochrane, EMBASE, and Web of Science databases to identify randomized controlled trials and studies comparing SBRT and TACE using PS analysis. The hazard ratios (HRs) for OS and LC were pooled. The heterogeneity between the data collected from these studies was also assessed. SBRT led to a comparable OS (HR: 0.83; 95 % confidence interval (CI): 0.52-1.34; p = 0.44) to TACE, and significantly improved LC (HR: 0.25; 95 % CI: 0.09-0.67; p = 0.006). Considerable heterogeneity was observed in the HR of OS and LC. Although there was no significant difference in the rate of grade 3 or higher toxicities between TACE and SBRT, or between studies, liver toxicity was identified as a common adverse event associated with both SBRT and TACE. Compared to TACE, SBRT showed a comparable OS and improved LC without serious toxicity. Therefore, SBRT should be considered an effective treatment option for various stages of HCC, depending on the tumor factors and pretreatment liver function.

Stereotactic Radiation Therapy in 3 Fractions for T1 Glottic Cancer

PURPOSE/OBJECTIVE(S)

To report the results of a phases 1 and 2 study on stereotactic body radiation therapy (SBRT) for early glottic cancer.

METHODS AND MATERIALS

This a prospective study at a single institution enrolling patients with T1 glottic cancer. The true vocal cords (TVCs) were divided into thirds and the third(s) containing disease prescribed 36 Gy in 3 fractions. The portions of the TVCs next to the involved one were planned to receive 30 Gy in 3 fxs. SBRT was delivered by a linear accelerator-based approach using multiple arcs. Toxicity was scored by Common Terminology Criteria for Adverse Events and late events were considered those occurring 3 months after SBRT. Voice quality was investigated by the Voice Handicap Index at regular intervals. The planned sample size was 75 patients.

RESULTS

Accrual was discontinued after 33 patients because of concerns for late toxicity. T stage was as follows: T1a: 23 patients (69.7%); T1b: 10 patients (30.3%). All patients received the planned treatment and the median follow-up time was 51.5 months (IQR, 47.9-61.0 months). At last follow-up, all patients were alive and without evidence of disease but 2 patients who died for intercurrent causes. The local control rate was 100% at 4 years. Six patients (18.2%) developed soft tissue necrosis (N = 4) or cartilage necrosis (N = 2) after a median time of 14.9 months from SBRT. Five out of 6 necrotic events were observed in patients who kept smoking and/or had a recent COVID infection. All 4 soft tissue events healed with conservative therapy. After an initial deterioration, the average Voice Handicap Index score significantly improved at 6 months over baseline.

CONCLUSIONS

SBRT to 36 Gy in 3 fractions is highly effective in controlling T1 TVC carcinoma, but necrosis, although mostly transient, is a concern. On the basis of the present results, a reduction in total dose and a more accurate patient selection are warranted.

Automated segmentation in planning-CT for breast cancer radiotherapy: A review of recent advances

Postoperative radiotherapy (RT) has been shown to effectively reduce disease recurrence and mortality in breast cancer (BC) treatment. A critical step in the planning workflow is the accurate delineation of clinical target volumes (CTV) and organs-at-risk (OAR). This literature review evaluates recent advancements in deep-learning (DL) and atlas-based auto-contouring techniques for CTVs and OARs in BC planning-CT images for RT. It examines their performance regarding geometrical and dosimetric accuracy, inter-observer variability, and time efficiency. Our findings indicate that both DL- and atlas-based methods generally show comparable performance across OARs and CTVs, with DL methods slightly outperforming in consistency and accuracy. Auto-segmentation of breast and most OARs achieved robust results in both segmentation quality and dosimetric planning. However, lymph node levels (LNLs) presented the greatest challenge in auto-segmentation with significant impact on dosimetric planning. The translation of these findings into clinical practice is limited by the geometric performance metrics and the lack of dose evaluation studies. Additionally, auto-contouring algorithms showed diverse structure sets, while training datasets varied in size, origin, patient positioning and imaging protocols, affecting model sensitivity. Guideline inconsistencies and varying definitions of ground truth led to substantial variability, suggesting a need for a reliable consensus training dataset. Finally, our review highlights the popularity of the U-Net architecture. In conclusion, while automated contouring has proven efficient for many OARs and the breast-CTV, further improvements are necessary in LNL delineation, dosimetric analysis, and consensus building.

Effectiveness of Chemoimmunotherapy in Small-cell Lung Cancer Patients With a Poor Performance Status or Higher Neutrophil/Lymphocyte Ratio

BACKGROUND/AIM

Chemoimmunotherapy has improved overall survival in patients with extensive small-cell lung cancer (SCLC). However, the backgrounds of patients enrolled in clinical trials tend to differ from those of patients treated in clinical practice, and the effectiveness of chemoimmunotherapy may be unclear in some populations, including patients with poor performance status. This study aimed to evaluate the effectiveness of chemoimmunotherapy for SCLC patients in clinical practice while focusing on several subgroups.

PATIENTS AND METHODS

We retrospectively analyzed the data of SCLC patients who received chemoimmunotherapy or chemotherapy. The association between chemoimmunotherapy and overall survival was evaluated by adjusting for patient backgrounds using the Cox proportional hazards model, followed by a subset analysis.

RESULTS

The chemoimmunotherapy and chemotherapy groups included 43 and 71 patients, respectively. The Cox proportional hazards model showed that chemoimmunotherapy was significantly associated with improved overall survival (hazard ratio=0.47, 95% confidential interval=0.26-0.83). Furthermore, subgroup analysis showed that overall survival was significantly improved in patients with good performance status, lower neutrophil/lymphocyte ratio, and no liver metastases. However, overall survival with chemoimmunotherapy was similar to that with chemotherapy and was less than 12 months in patients with a poor performance status or higher neutrophil/lymphocyte ratio.

CONCLUSION

Chemoimmunotherapy was significantly associated with improved overall survival in clinical practice. However, the effectiveness was equivocal in SCLC patients with a poor performance status or higher neutrophil/lymphocyte ratio.

Despicable role of epithelial-mesenchymal transition in breast cancer metastasis: Exhibiting de novo restorative regimens

Breast cancer (BC) is the most prevalent cancer in women globally. Anti-cancer advancements have enabled the killing of BC cells through various therapies; however, cancer relapse is still a major limitation and decreases patient survival and quality of life. Epithelial-to-mesenchymal transition (EMT) is responsible for tumor relapse in several cancers. This highly regulated event causes phenotypic, genetic, and epigenetic changes in the tumor microenvironment (TME). This review summarizes the recent advancements regarding EMT using de-differentiation and partial EMT theories. We extensively review the mechanistic pathways, TME components, and various anti-cancer adjuvant and neo-adjuvant therapies responsible for triggering EMT in BC tumors. Information regarding essential clinical studies and trials is also discussed. Furthermore, we also highlight the recent strategies targeting various EMT pathways. This review provides a holistic picture of BC biology, molecular pathways, and recent advances in therapeutic strategies.

Synthetic and Natural Radioprotective Agents: Recent Status and their Underlying Mechanism of Action

Various substances possessing radiation scavenging properties, known as radioprotectors, play a crucial role in shielding organisms from the harmful effects of ionizing radiation (IR) by preventing cellular damage caused by free radicals. Initially, synthetic radioprotectors were developed using thiol synthetic compounds. However, among these, only amifostine (WR-2721) underwent clinical testing as a radioprotector. Various composites with different chemical structures other than thiol compounds were also investigated. However, synthetic radioprotectors are known to be associated with severe side effects, which lead to an inclination towards natural substances. Plants and natural products have emerged as promising sources of radioprotectors, renowned for their non-toxic nature across a broad range of doses and their cost-effectiveness. Radioprotectors are employed in diverse pharmaceutical approaches to mitigate the toxicities induced by radiation. The present review encompasses a detailed account of various synthetic and naturally occurring compounds possessing radioprotective properties, and different investigations related to their radioprotective action, ranging from free radicals scavenging to gene therapy, have also been precisely covered. Numerous radioprotectors have different mechanisms of action, and have proven benefits of naturally occurring compounds over chemically synthesized ones.

The prognostic impact of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio on patients with small cell lung cancer receiving first-line platinum-based chemotherapy: a systematic review and meta-analysis

BACKGROUND

The prognostic significance of Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) in Small Cell Lung Cancer (SCLC) patients receiving platinum-based chemotherapy is debated.

METHODS

This study aims to elucidate their roles in survival outcomes. A systematic search across PubMed, Embase, Web of Science, and Cochrane Library identified relevant studies. The Newcastle-Ottawa Scale (NOS) evaluated study quality. Meta-analysis was conducted using random-effects and fixed-effects models, supplemented by sensitivity analysis.

RESULTS

A total of 11 studies with 3,634 SCLC patients were included. Patients with high NLR had significantly decreased overall survival (OS) (HR = 1.39, 95% CI: 1.18-1.59, P < 0.001) and progression-free survival (PFS) (HR = 1.52, 95%CI: 1.27-1.78, P < 0.001). The OS was not statistically different between high and low PLR groups (HR = 1.13, 95%CI: 0.84-1.43, P = 0.265). Subgroup analysis revealed that OS in high NLR group was significantly lower across different strata, and OS in the high PLR group was significantly lower among patients with limited-stage SCLC (LS-SCLC) and populations with a PLR cutoff value < 160.

CONCLUSIONS

High NLR is associated with poor OS and PFS in patients with SCLC receiving first-line platinum-based chemotherapy. PLR does not significantly impact OS, except in LS-SCLC patients and populations with a PLR cutoff value < 160. These findings require further validation from prospective studies.

Gliclazide protects ionizing radiation-induced intestinal injury in mice by inhibiting oxidative stress and caspase-3

Gliclazide (GLZ), an oral antihyperglycemic medication, has additional beneficial effects, such as anti-inflammatory and antioxidant properties, besides lowering blood glucose levels. In this study, the radio-protective effect of GLZ was evaluated against ionizing radiation (IR)-induced intestinal injury in mice. Eight groups of mice were randomized as follows: control, GLZ (5, 10, and 25 mg/kg), IR (6 Gy), and IR + GLZ (at 5, 10, and 25 mg/kg). GLZ was administered to the mice for eight consecutive days, after which they were exposed to X-rays at a single dose of 6 Gy. After irradiation, biochemical parameters, immunohistochemical, and histological examinations were conducted on the ileum of the mice. IR exposure increased the levels of malondialdehyde and protein carbonyl, while glutathione levels, as oxidative stress biomarkers, decreased. Apoptosis in ileum tissues was also assessed. Furthermore, histopathological changes were observed in the irradiated mice. GLZ treatment significantly mitigated these changes. The administration of GLZ resulted in a marked decrease in caspase-3 immunoreactivity in the ileum of irradiated mice. This preclinical study exhibited that GLZ has a radioprotective effect against intestinal injury by inhibiting oxidative stress and apoptosis.

Stereotactic ablative radiotherapy for pulmonary metastasis from sarcoma: a retrospective comparison with metastasectomy

Recent studies report excellent local control (LC) and favorable toxicities of stereotactic ablative radiotherapy (SABR) for pulmonary metastasis (PM) from sarcoma. This study compared the LC and survival of SABR and metastasectomy for sarcoma PM. We analyzed the LC rates of 54 PMs treated with SABR between 2008 and 2022. For survival analysis, we compared 14 patients who received SABR as first-line treatment with 61 patients who underwent metastatectomy. For SABR-treated PMs, a median total dose of 55 Gy (range, 48-60) was administered over 3-10 fractions. Median follow-up for LC in SABR-treated PMs was 19.2 months (range, 0.8-124.0), and the 2-year LC rate was 92.2%. No patients experienced toxicities of grade 3 or higher. The median age of the patients in the survival analysis was 73 years (range, 42-83) in the SABR group and 54 years (range, 19-78) in the metastasectomy group (p < 0.001). PMs in the "gray zone" were more common in the SABR group (35.7%) than in the metastasectomy group (8.2%) (p = 0.029). The median follow-up for survival analysis was 44.8 months (interquartile range, 21.5-66.4). The 3-year rates of LC and overall survival were 92.3% and 57.3% in the SABR group and 89.2% and 75.9% in the metastasectomy group (p = 0.807, 0.224), respectively. The out-of-field intrapulmonary failure-free survival and extrapulmonary systemic failure-free survival rates at 3 years were not significantly different (p = 0.673, 0.386). SABR for sarcoma PM demonstrated excellent LC with acceptable toxicity. Survival rates of SABR were comparable to those of metastasectomy.

Prognostic prediction models for postoperative patients with stage I to III colorectal cancer based on machine learning

BACKGROUND

Colorectal cancer (CRC) is characterized by high heterogeneity, aggressiveness, and high morbidity and mortality rates. With machine learning (ML) algorithms, patient, tumor, and treatment features can be used to develop and validate models for predicting survival. In addition, important variables can be screened and different applications can be provided that could serve as vital references when making clinical decisions and potentially improving patient outcomes in clinical settings.

AIM

To construct prognostic prediction models and screen important variables for patients with stage I to III CRC.

METHODS

More than 1000 postoperative CRC patients were grouped according to survival time (with cutoff values of 3 years and 5 years) and assigned to training and testing cohorts (7:3). For each 3-category survival time, predictions were made by 4 ML algorithms (all-variable and important variable-only datasets), each of which was validated via 5-fold cross-validation and bootstrap validation. Important variables were screened with multivariable regression methods. Model performance was evaluated and compared before and after variable screening with the area under the curve (AUC). SHapley Additive exPlanations (SHAP) further demonstrated the impact of important variables on model decision-making. Nomograms were constructed for practical model application.

RESULTS

Our ML models performed well; the model performance before and after important parameter identification was consistent, and variable screening was effective. The highest pre- and postscreening model AUCs 95% confidence intervals in the testing set were 0.87 (0.81-0.92) and 0.89 (0.84-0.93) for overall survival, 0.75 (0.69-0.82) and 0.73 (0.64-0.81) for disease-free survival, 0.95 (0.88-1.00) and 0.88 (0.75-0.97) for recurrence-free survival, and 0.76 (0.47-0.95) and 0.80 (0.53-0.94) for distant metastasis-free survival. Repeated cross-validation and bootstrap validation were performed in both the training and testing datasets. The SHAP values of the important variables were consistent with the clinicopathological characteristics of patients with tumors. The nomograms were created.

CONCLUSION

We constructed a comprehensive, high-accuracy, important variable-based ML architecture for predicting the 3-category survival times. This architecture could serve as a vital reference for managing CRC patients.

Lymph node metastasis following chemoradiotherapy in advanced rectal cancer: ypT2-focused analyses of total mesorectal excision specimens

BACKGROUND

Non-radical management is an option for good responders to neoadjuvant chemoradiotherapy in mid-to-low rectal cancer. This study aimed to analyze risk factors for lymph node metastasis in patients with ypT2 rectal cancer, exploring the possibility of non-radical management.

METHODS

We included patients with ypT2 rectal cancer who received neoadjuvant chemoradiotherapy followed by total mesorectal excision between January 2004 and December 2022. Clinicopathological parameters were evaluated to identify risk factors for lymph node metastasis.

RESULTS

Among the 198 patients, 158 (79.8%) had ypT2N0 and 40 (20.2%) had ypT2N+. In univariable analyses, the risk factors of lymph node metastasis were perineural invasion (48.0% vs. 16.3% without perineural invasion, P < 0.001), female sex (30.0% vs. 14.8% with male sex, P = 0.011), and clinically positive nodes after neoadjuvant chemoradiotherapy (32.6% vs. 16.4% with negative nodes, P = 0.017). These factors were confirmed as independent risk factors in multivariable analyses: perineural invasion (odds ratio [OR]: 4.50; 95% confidence interval [CI]: 1.79-11.29; P < 0.001), female sex (OR: 2.62; 95% CI: 1.24-5.52; P = 0.012) and clinical node involvement after neoadjuvant chemoradiotherapy (OR: 2.28; 95% CI: 1.03-5.05; P = 0.012). The rate of lymph node metastasis in patients with ypT2 rectal cancer without any of these three risk factors was 12.5%.

CONCLUSIONS

This study revealed a high probability of lymph node metastasis in patients with ypT2 rectal cancer, even in the absence of identifiable risk factors. We confirm that lymph node metastasis should be considered in ypT2 rectal cancer.

Synthesis and evaluation of anticancer activity of new 4,5,6,7-tetrabromo-1H-benzimidazole derivatives

An efficient method for the synthesis of new 4,5,6,7-tetrabromo-1H-benzimidazole derivatives has been developed. New ketones were obtained by N-alkylation of TBBi or 2-Me-TBBi with various phenacyl halides and then reduced to the corresponding alcohols. All compounds were obtained with satisfactory yields in the range of 40-91 %. The synthesized compounds appeared a weak CK2 and PIM-1 inhibitors but exhibit an interesting cytotoxic activity against cancer cell lines, i.e. MCF-7, PC-3, CCRF-CEM, K-562. 1-Phenyl-2-(4,5,6,7-tetrabromo-1H-benzimidazol-1-yl)ethanone 3aA exhibits the highest cytotoxic activity with IC50 value of 5.30 µM for MCF-7 and 6.80 µM for CCRF-CEM. Moreover, this compound shows the highest selectivity against both MCF-7 and CCRF-CEM with SI selectivity coefficients (against MRC-5 and Vero cells) equal 5.45 and 4.30 for MCF-7 and 4.25 and 3.35 for CCRF-CEM, respectively. Furthermore, it was shown that compound 3aA exhibits very good pro-apoptotic properties, through induction of the mitochondrial apoptotic pathway in CCRF-CEM cells. These results correlate with data showing the effect of 3aA on intracellular level of CK2α protein and CK2-mediated phosphorylation of Ser529 in NF-κBp65. Study of the effect of compound 3aA on mRNA levels of CK2α and CK2α' showed no significant differences in gene expression levels in control CCRF-CEM and cells treated with 3aA, indicating 3aA action at the protein level.

Exploring the Impact of Sarcopenia on Mortality in Breast Cancer Patients: A Comprehensive Systematic Review and Meta-Analysis

Background

This study assesses the frequency of sarcopenia in patients with breast cancer (BC) and its association with mortality rates.

Methods

An all-encompassing search across (PubMed, Scopus, Web of Science, and CINAHL) was done, to identify studies, published until August 2023, that report data on sarcopenia and mortality in BC patients. A meta-analysis was then done using a random-effects model.

Results

Out of 989 initially identified potential studies, 19 met inclusion criteria. Analysis of 15 studies showed a rate of sarcopenia of 38% (95% CI: 29-48%), with moderate heterogeneity (I 2 = 25.8%). Sarcopenia was linked to increased mortality risk in BC patients across 16 studies (HR: 1.77, CI: 1.35-2.32, p = <0.001) with both shorter and longer follow-up periods. Similarly, mortality risks were significantly higher in metastatic (HR: 1.52, CI: 1.14-2.03, p = 0.004) and non-metastatic (HR: 2.55, CI: 1.66-3.93, p < 0.001) BC patients with sarcopenia.

Conclusion

Our analysis demonstrates a substantial prevalence of sarcopenia in BC patients. Importantly, sarcopenia was significantly linked to an elevated risk of mortality in this population. Subgroup analyses, stratified by follow-up periods and disease stage, consistently reveal increased mortality risks associated with sarcopenia, underscoring its clinical relevance in both short- and long-term patient outcomes. Our findings further strengthen the need to recognize and address sarcopenia as a critical factor in BC management and prognosis.

Determination of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic immune-inflammation index in dogs with leptospirosis

Leptospirosis is a globally distributed zoonosis with multisystemic involvement in canine species, capable of causing a pulmonary hemorrhagic syndrome (LPHS) in the most severe cases. In humans, the neutrophil to lymphocyte ratio (NLR), platelets to lymphocytes (PLR) and systemic immune-inflammation index (SII) have been described as predictors of morbidity and mortality in various pathologies, but no such studies have been developed for canine leptospirosis. Hence, we aimed to assess the usefulness of NLR, PLR and SII in dogs affected with leptospirosis, focusing on those that died or survived after hospitalization, whether or not they developed LPHS. The leptospirosis group was composed by 36 dogs while the control group consisted of 32 healthy dogs. The NLR, associated with inflammation, demonstrated a threefold or greater increase in all leptospirosis groups compared to the control group (median 2.44 ± 1.66) (developing or not LPHS). Dogs that died (median 67.78 ± 158.67), developed LHPS (median 85.17 ± 143.77), or both developed LHPS and died (median 67.78 ± 155,14) had a lower PLR in comparison to the control group (median 101,82 ± 53,75) and the rest of groups, but no statistically significant differences were observed (p > 0.05). The SII was higher in leptospirosis-affected dogs that survived (median 1356,92 ± 2726,29) and statistically significant differences were observed in those who did not develop LPHS (median 1770,41 ± 2630,77; p < 0.05) compared to the control group (median 555,21 ± 313,26). Our data shows that NLR may be used as inflammation indicator, while more studies are needed for PLR and SII in canine leptospirosis.

Investigation of Uncovering Molecular Mechanisms of Alcohol-Induced Female Infertility-A Rational Approach

This study aimed to investigate the molecular mechanisms by which chronic alcohol consumption impacts female infertility, highlighting significant societal implications. By conducting a comprehensive literature review, we examined existing evidence on the association between long-term alcohol use and female reproductive health. Relevant studies were identified through systematic searches of electronic databases and key journals. We synthesized information on the molecular pathways affected by alcohol consumption, with particular emphasis on oxidative stress, inflammation, and hormonal disruptions. Additionally, we reviewed efforts to address alcohol-related health issues, including public health interventions, regulatory measures, and educational initiatives. Our study found strong evidence linking chronic alcohol consumption to increased mortality rates and a range of preventable diseases globally. Alcohol's effects extend beyond physiological consequences to psychological, social, and economic burdens. Chronic alcohol consumption disrupts hormonal balance and reproductive function, contributing to female infertility. Future research should focus on quantifying mortality risks associated with alcohol consumption, understanding gender-specific patterns in alcohol-related health outcomes, and elucidating the molecular mechanisms underlying female infertility. Addressing these gaps will inform strategies to mitigate the burden of alcohol-induced health issues and promote overall well-being. Collaborative efforts among diverse stakeholders are essential for advancing research agendas and translating findings into effective interventions.

Comprehensive review of post-treatment imaging in head and neck cancers: from expected to unexpected and beyond

Head and neck cancer management requires multidisciplinary approach in which radical surgery with or without flap reconstructions and neck dissection, along with radiotherapy (RT)/chemoradiotherapy (CRT) serve as the key components. Neoadjuvant chemotherapy and immunotherapy are used in selected cases based on the institutional preference. Knowledge of expected post-treatment changes on imaging is essential to differentiate it from recurrence. In addition, awareness of various post-treatment complications is imperative for their early detection on imaging. Distorted anatomy after treatment poses diagnostic challenge, hence, proper choice of imaging modality and appropriate timing of scan is pertinent for accurate post-treatment evaluation. In this article, we have comprehensively reviewed expected post-treatment appearances and complications on imaging. We have discussed imaging appearances of recurrences at the primary and lymphnodal sites and discussed documentation of findings using Neck Imaging Reporting and Data Systems (NI-RADS). We have also delved into the patterns of recurrence in human papillomavirus (HPV) positive HNSCC. Furthermore, we have provided flowcharts and discussed recommendations on the site-specific and treatment-related imaging modalities to be used along with their appropriate timing, for adequate evaluation of HNSCC after treatment. In addition, we have also touched upon the role of advanced imaging techniques for post-treatment HNSCC evaluation.

Analysis of linear accelerator-based fractionated stereotactic radiotherapy in brain metastases: efficacy, safety, and dose tolerances

Objective

To assess the efficacy and safety of linear accelerator-based fractionated stereotactic radiotherapy (LINAC-FSRT) in patients with brain metastases (BM).

Methods

We retrospectively analyzed 214 patients treated with LINAC-FSRT, categorized based on biologically effective dose (BED10, α/β = 10) into two groups (≤55 Gy, >55 Gy). Stratified analyses were conducted based on targeted therapy to compare survival outcomes. To examine brain tissue dose-tolerance volume, patients were divided into two groups: the standard Hypofractionated Treatment Effects in the Clinic (HyTEC) protocol group and an adjusted HyTEC protocol group where dose-volume restrictions exclude the planning target volume (PTV).

Results

Results as of December 2023 showed median intracranial progression-free survival (iPFS) at 12.4 months, with median overall survival (OS) not reached and a one-year local control (LC) rate of 68.7%. Mild to moderate toxicity affected 17.3% of patients, while severe toxicity occurred in 2.8%. Multivariate Cox analysis indicated that uncontrolled extracranial disease significantly reduced iPFS (HR = 2.692, 95%CI:1.880-3.853, P < 0.001) and OS (HR = 3.063, 95%CI:1.987-4.722, P < 0.001). BED10 >55 Gy (HR = 0.656, 95%CI:0.431-0.998, P = 0.049) improved OS, showing statistical significance (P = 0.037) without affecting iPFS or CNS toxicity (P = 0.127, P = 0.091). Stratified analysis highlighted nearly significant OS improvements with high-dose FSRT and targeted therapy (P = 0.054), while concurrent therapy markedly enhanced iPFS (P = 0.027). No significant differences were observed in intracranial local failure (ILF-which represents progression in previously treated areas during follow-up), one-year LC rates, iPFS, or OS between dose-volume groups. Adjusting HyTEC volume restrictions did not significantly increase CNS adverse reactions (P = 0.889).

Conclusions

LINAC-FSRT is safe and effective in BM. BED10>55 Gy notably enhances OS post-LINAC-FSRT and may benefit LC. High BED10 FSRT with targeted therapy likely boosts synergy, and concurrent targeted therapy significantly improves iPFS. Diminishing dose volume constraints at different fractions based on the HyTEC guidelines is feasible.

Current Management of Locally Recurrent Rectal Cancer

Locally recurrent rectal cancer (LRRC), which occurs in 6-12% of patients previously treated with surgery, with or without pre-operative chemoradiation therapy, represents a complex and heterogeneous disease profoundly affecting the patient's quality of life (QoL) and long-term survival. Its management usually requires a multidisciplinary approach, to evaluate the several aspects of a LRRC, such as resectability or the best approach to reduce symptoms. Surgical treatment is more complex and usually needs high-volume centers to obtain a higher rate of radical (R0) resections and to reduce the rate of postoperative complications. Multiple factors related to the patient, to the primary tumor, and to the surgery for the primary tumor contribute to the development of local recurrence. Accurate pre-treatment staging of the recurrence is essential, and several classification systems are currently used for this purpose. Achieving an R0 resection through radical surgery remains the most critical factor for a favorable oncologic outcome, although both chemotherapy and radiotherapy play a significant role in facilitating this goal. If a R0 resection of a LRRC is not feasible, palliative treatment is mandatory to reduce the LRRC-related symptoms, especially pain, minimizing the effect of the recurrence on the QoL of the patients. The aim of this manuscript is to provide a comprehensive narrative review of the literature regarding the management of LRRC.

In situ gel-forming oil solubilizing α-lipoic acid as a physical shielding alleviated chemotherapy-induced oral mucositis via inhibiting oxidative stress

Oral mucositis (OM) is a common and serious complication of cancer chemoradiotherapy. OM managements mainly focused on topical healthcare or analgesia, which offers limited wound healing. Herein, in situ gel-forming oil (LGF) have been developed as a physical shielding for OM treatment. LGF oil, composed of soybean phosphatidyl choline (40 %, w/w), glycerol dioleate (54 %, w/w), and alcohols (6 %, w/w), is a viscous oil-like liquid. The contact angle of LGF oil on porcine buccal mucosa were 30°, significantly smaller than that of water (60°), indicating its good wetting and spreading properties. Besides, the adhesion force and adhesion energy of LGF oil toward porcine buccal mucosa was as high as 3.9 ± 0.2 N and 60 ± 2 J/m2, respectively, indicating its good adhesive property. Moreover, the hydrophobic α-lipoic acid (LA) as a native antioxidative agent was highly solubilized in LGF oil, its solubility in which was above 100 mg/mL. Upon contacting with saliva, LA-loaded LGF oil (LA-LGF) could rapidly transform from oil into gel that adheres on oral mucosa. Moreover, LA was slowly released from the formed LA-LGF gel, which benefited alleviating oxidative stress caused by chemoradiotherapy. In vivo animal experiments showed that LA-LGF could effectively promote the repairing of oral mucosa wound of 5-fluorouracil induced OM rats. Besides, the mucosa edema was greatly improved and new granulation around wound was produced after LA-LGF treatment. Meanwhile, the production of proinflammatory cytokines such as IL-1β, TNF-α, 1L-6 was substantially inhibited by LA-LGF. Collectively, LGF oil as carrier of hydrophobic drug might be a promising strategy for oral mucositis.

Glucose chemical exchange saturation transfer MRI for predicting the histological grade of rectal cancer: a comparative study with amide proton transfer-weighted and diffusion-weighted imaging

BACKGROUND

To evaluate the utility of glucose chemical exchange saturation transfer (glucoCEST) MRI with non-contrast injection in predicting the histological grade of rectal cancer.

METHODS

This prospective analysis included 60 patients with preoperative rectal cancer who underwent pelvic glucoCEST, amide proton transfer-weighted imaging (APTWI), and diffusion-weighted imaging (DWI). In total, 21 low-grade and 39 high-grade cases were confirmed by postoperative pathology. The MTRasym (1.2 ppm), MTRasym (3.5 ppm), and apparent diffusion coefficient (ADC) values of lesions between the low-grade and high-grade groups were compared. The area under the receiver operating characteristic curve (AUC) was generated to evaluate the diagnostic performance of each technique. Logistic regression (LR) analysis was applied to determine independent predictors and for multi-parameter combined diagnosis.

RESULTS

Elevated MTRasym (1.2 ppm), MTRasym (3.5 ppm) values and lower ADC values were observed in the high-grade group compared with low-grade cases (all p < 0.01). The AUCs of MTRasym (1.2 ppm), MTRasym (3.5 ppm), and ADC for differentiating between low- and high-grade rectal cancer cases were 0.792, 0.839, and 0.855, respectively. The diagnostic performance of the combination of the three indexes was improved (AUC, 0.969; sensitivity, 95.24%; specificity, 87.18%). The good consistency and reliability of the combination of independent predictors were demonstrated by calibration curve analysis and DCA.

CONCLUSION

The glucoCEST MRI without contrast injection, APTWI, and DWI all facilitate the assessment of histological grade in rectal cancer, and the combination of the three can effectively discriminate between high- and low-grade rectal cancer, which is expected to be a promising imaging marker.

CRITICAL RELEVANCE STATEMENT

The glucose chemical exchange saturation transfer MRI method facilitates the assessment of histological grade in rectal cancer and offers additional information to improve the diagnostic performance of amide proton transfer-weighted imaging, and diffusion-weighted imaging.

KEY POINTS

Glucose chemical exchange saturation transfer imaging could differentiate histological grade. Amide proton transfer-weighted and diffusion-weighted were associated with histological grade. The combination of different parameters showed the best diagnostic performance.

Three-dimensional conformal radiation therapy with concurrent chemotherapy for stage III non-small cell lung cancer: protocol for a systematic review and meta-analysis

INTRODUCTION

Lung cancer continues to be a common form of cancer worldwide and a primary contributor to cancer-related fatalities. Non-small cell lung cancer (NSCLC) is the most prevalent form, making up 80% to 85% of newly identified malignant lung tumours, and remains a major concern for worldwide health. Surgical resection is the preferred treatment for localised NSCLC, but more than one-third of patients present with locally advanced, unresectable tumours. Concurrent radiation therapy and chemotherapy are believed to offer the potential for prolonged disease-free and overall survival to those patients. However, the results are inconsistent, and systematic meta-analysis is lacking to evaluate its treatment effect comprehensively. Therefore, we will conduct a meta-analysis to evaluate the efficacy and safety of 3D-CRT concurrent chemotherapy in unresectable stage III NSCLC to provide evidence-based medical support for clinical treatment.

METHODS AND ANALYSIS

This systematic review and meta-analysis will adhere to the guidelines outlined in the PRISMA statement. Based on the predetermined criteria for inclusion, we will conduct a comprehensive search for randomised controlled trials (RCTs) examining the efficacy and safety of three-dimensional conformal radiation therapy (3D-CRT) concurrent chemotherapy in unresectable stage III NSCLC. The search will be performed across multiple databases including PubMed, Embase, Cochrane, Scopus and Web of Science from inception to 1 November 2024 using terms including NSCLC, 3D-CRT concurrent chemotherapy, radiation therapy, RCT and controlled clinical trial. Furthermore, relevant literature citations will be gathered, and relevant journals will be manually searched. The primary outcomes in the study were overall survival; progression-free survival; 1-, 3- and 5-year survival rates; event-free survival; and median survival time. Secondary outcomes included treatment effectiveness, all adverse events (AEs), all treatment-related adverse events (TRAEs), AEs (grade ≥3) and TRAEs (grade ≥3). Two separate reviewers will be responsible for screening, extracting data and evaluating quality. Our reviewers will perform subgroup analysis, sensitivity analysis and publication bias analysis to evaluate the heterogeneity and robustness. Review Manager 5.4 will be used for the analysis and synthesis process. The risk of bias will be assessed using the Cochrane Risk of Bias tool (RoB 2), and the Grading of Recommendations Assessment, Development and Evaluation will be employed to evaluate the study's overall evidence quality.

ETHICS AND DISSEMINATION

This study is based on a secondary analysis of the literature, so ethical review approval is not required. The final report will be published in a peer-reviewed journal.

TRIAL REGISTRATION

The protocol of the systematic review has been registered on Open Science Framework, with a registration DOI https://doi.org/10.17605/OSF.IO/R7WCG.

Nanomaterials for the Diagnosis and Treatment of Triple-Negative Breast Cancer

In recent years, the diagnosis and treatment at the early stages significantly raise the survival rate of breast cancer patients. Moreover, antibody drugs pave the way toward precision target therapy. However, the treatment and survival of triple-negative breast cancer (TNBC) patients is still worrying, which needs further understanding and study. During the last several years, nanomaterials attracted extensive research interests in TNBC diagnosis and therapy. In this review, we summarize recent advances of nanomaterial-based strategies for diagnosing and treating TNBC. Specifically, treatments for TNBC utilizing nanomaterials are classified into monotherapy, combined therapy, and multimodal therapy based on the complexity of the treatment. Nanomaterials also offer the opportunity to integrating diagnosis with treatment, which are introduced and summarized in this review. By summarizing the design principles in detail, some insights into the challenges and opportunities are provided to inspire further research and clinical translation in this field. The scope of this review is to summarize the development of nanomaterials for diagnosis and treatment of TNBC, and to discuss future directions to improve the clinical outcome of TNBC patients.

Combination of ionizing radiation and 2-thio-6-azauridine induces cell death in radioresistant triple negative breast cancer cells by downregulating CD151 expression

BACKGROUND

Triple-negative breast cancer (TNBC) represents the most aggressive subtype of breast cancer and is frequently resistant to therapy, ultimately resulting in treatment failure. Clinical trials have demonstrated the potential of sensitizing radiation therapy (RT)-resistant TNBC through the combination of chemotherapy and RT. This study sought to explore the potential of CD151 as a therapy response marker in the co-treatment strategy involving ionizing radiation (IR) and the repurposed antiviral drug 2-Thio-6-azauridine (TAU) for sensitizing RT-resistant TNBC (TNBC/RR).

METHODS

The investigation encompassed a variety of assessments, including viability using MTT and LDH assays, cell proliferation through BrdU incorporation and clonogenic assays, cell cycle analysis via flow cytometry, cell migration using wound scratch and Boyden chamber invasion assays, DNA damage assessment through γH2AX analysis, apoptosis evaluation through acridine-orange and ethidium bromide double staining assays, as well as caspase 3 activity measurement using a colorimetric assay. CD151 expression was examined through ELISA, flow cytometry and RT-qPCR.

RESULTS

The results showed a significant reduction in TNBC/RR cell viability following co-treatment. Moreover, the co-treatment reduced cell migration, induced apoptosis, downregulated CD151 expression, and increased caspase 3 activity in TNBC/RR cells. Additionally, CD151 was predicted to serve as a therapy response marker for co-treatment with TAU and IR.

CONCLUSION

These findings suggest the potential of combination treatment with IR and TAU as a promising strategy to overcome RT resistance in TNBC. Furthermore, CD151 emerges as a valuable therapy response marker for chemoradiotherapy.

Comparison of 3D-printed multichannel non-co-planar vaginal applicators and single-channel vaginal applicators for brachytherapy with positive or close surgical margins in cervical cancer

OBJECTIVE

This study was conducted to compare the differences between 3D-printed multichannel non-co-planar vaginal applicators and single-channel vaginal applicators in cervical cancer patients with positive or close surgical margins.

METHODS

Between January 2015 and June 2023, 104 cervical cancer patients who underwent radical surgery with positive or close surgical margins were enrolled to receive concurrent intensity-modulated chemoradiotherapy combined with 3D-printed multichannel non-co-planar vaginal applicators (3D-printed group, 41 patients) or single-channel vaginal applicators (single-channel group, 63 patients) guided brachytherapy. The dosimetric parameters, 5-year local control (LC), progression-free survival (PFS), overall survival (OS) of two groups were retrospectively analyzed.

RESULTS

The high-risk clinical target volume (D90, D100) and high-dose volume fraction (V150) in 3D-printed group were significantly higher than those in single-channel group (p < 0.05), and the homogeneity index (HI) and conformal index (COIN) were equally better in 3D-printed group. In 3D-printed group, the D2cc, D1cc, and D0.1cc of the bladder and rectum were significantly lower than those of the single-channel group (p < 0.05). The 3D-printed group had significantly superior 5-year LC (70.0% vs. 51.3%, p = 0.041) and PFS (63.0% vs. 44.2%, p = 0.045), but OS were not significantly different between treatment groups (75.4% vs. 59.7%, p = 0.112). The incidence of radiation enteritis and cystitis was lower in the 3D-printed group than in the single-channel group, but no statistical difference was noted.

CONCLUSIONS

The 3D-printed multichannel non-co-planar vaginal insertion applicators show the advantage of target dose, improve the LC and PFS in patients with positive or close surgical margins after cervical cancer surgery. Thus, the popularization of this method and its application may be of value.

Pilot Feasibility and Safety Study of Hydrogen Gas Inhalation in Locally Advanced Head and Neck Cancer Patients

Purpose

Hydrogen (H2) gas inhalation might alleviate acute radiotherapy toxicities by scavenging free radicals produced by ionizing radiation and anti-inflammatory properties. This study aimed to investigate the feasibility and safety of H2 gas inhalation during concurrent chemoradiotherapy (CCRT) in patients with locally advanced head and neck cancer (LAHNC).

Patients and Methods

We designed a pilot prospective study combining CCRT with aerosol inhalation of H2 gas. Each patient was scheduled to receive daily intensity-modulated radiotherapy (IMRT) in 33 fractions on a weekday and six cycles of weekly chemotherapy. All patients inhaled H2 gas through a cannula or mask 1 hour per day, 1-2 hours before IMRT. The primary endpoint was the feasibility of H2 inhalation. Eighty percent of the patients who completed at least 20 applications of H2 gas inhalation were considered feasible. The secondary endpoints were safety profiles during H2 gas inhalation (vital signs and symptoms related to H2 gas inhalation) and acute toxicities during CCRT.

Results

We enrolled 10 patients with LAHNC between July 2023 and December 2023. All patients received 33 fractions of H2 gas inhalation on the same day as the IMRT. Vital signs during and at the end of H2 gas inhalation were stable in all patients. None of the 10 patients had hypertension or hypotension during any of the 33 inhalations. No adverse events related to H2 gas inhalation, such as cough, nasal bleeding, dizziness, headache, nausea, or vomiting, were reported. Grade 3 leukopenia was found in two patients (20%) during the 5th week of CCRT. Grade 2 radiation dermatitis and pharyngitis were found in three patients (30%).

Conclusion

H2 gas inhalation combined with CCRT is feasible and safe for patients with LAHNC.

Treatment of Colorectal Lung Metastases: Two Centers Retrospective Study

INTRODUCTION

Clear guidelines for colorectal lung metastasis (LM) treatment are not available. This study aimed to provide insight into the treatment strategies and efficacy of local and systemic therapy in patients with LM eligible for (potentially) curative treatment.

METHODS

This was a retrospective study of patients with ≤5 LM discussed in two tertiary referral centers. Patient and tumor characteristics were compared between treatment groups. Treatment strategies were compared between centers and survival data between treatment groups, local treatment modalities, and treating centers.

RESULTS

Ninety-two patients (median 2 LMs) were included. Seventy-one (77%) patients underwent local treatment (17 surgery, 13 ablation, 38 radiotherapy, 3 combination of local treatments) and 21 (23%) with systemic therapy alone. The latter group more frequently had extrapulmonary metastases (81.0% vs. 26.8%, p < 0.001) and synchronous presentation of LM (23.8% vs. 7.0%, p = 0.045). Choice of local versus systemic therapy and time to start treatment after diagnosis (median 109 days, IQR 44-240 vs. 88 days, IQR 53-168) were comparable between centers. Three-year survival rates did not differ between treatment groups, local treatment modalities, or treating centers.

CONCLUSION

Treatment strategies and oncological outcomes were rather similar between centers. Survival outcomes were not different between locally and systemically treated patients.

The prognostic value of skeletal muscle mass and density in breast cancer: a systematic review and meta-analysis

Aim: The effect of skeletal muscle mass and density on the long-term survival outcome of breast cancer patients is unclear.Materials & methods: Systematically searched all articles in PubMed, Web of science, Springerlink, EMBASE and Wiley databases that studied the association between skeletal muscle and survival outcomes of breast cancer by 25 September 2023. The hazard ratios and confidence intervals of the multiple factor analysis results controlling for confounding variables in the study were collected and analyzed using STATA 14.0 software.Results: This meta-analysis included a total of 13 studies, with a median age of 48.2 years. Meta results showed that the survival (hazard ratio [HR]: 0.98, 95% CI: 0.89-1.08) and recurrence (HR: 0.96, 95% CI: 0.92-1.00) outcomes of breast cancer patients with sarcopenia were not significantly affected compared with those without sarcopenia. No significant heterogeneity or publication bias was observed in the study.Conclusion: The conclusion that skeletal muscle is regarded as a useful factor that can guide and optimize the prognosis of breast cancer patients is uncertain, or the result is very weak. Considering the impact of research quality and confounding factors, prospective studies are needed in the future to further demonstrate.PROSPERO identifier: CRD42023463480 (www.crd.york.ac.uk/prospero).

A radiomics model for predicting perineural invasion in stage II-III colon cancer based on computer tomography

BACKGROUND

Colon cancer, a frequently encountered malignancy, exhibits a comparatively poor survival prognosis. Perineural invasion (PNI), highly correlated with tumor progression and metastasis, is a substantial effective predictor of stage II-III colon cancer. Nonetheless, the lack of effective and facile predictive methodologies for detecting PNI prior operation in colon cancer remains a persistent challenge.

METHOD

Pre-operative computer tomography (CT) images and clinical data of patients diagnosed with stage II-III colon cancer between January 2015 and December 2023 were obtained from two sub-districts of Sun Yat-sen Memorial Hospital (SYSUMH). The LASSO/RF/PCA filters were used to screen radiomics features and LR/SVM models were utilized to construct radiomics model. A comprehensive model, shown as nomogram finally, combining with radiomics score and significant clinical features were developed and validated by area under the curve (AUC) and decision curve analysis (DCA).

RESULT

The total cohort, comprising 426 individuals, was randomly divided into a development cohort and a validation cohort as a 7:3 ratio. Radiomics scores were extracted from LASSO-SVM models with AUC of 0.898/0.726 in the development and validation cohorts, respectively. Significant clinical features (CA199, CA125, T-stage, and N-stage) were used to establish combining model with radiomics scores. The combined model exhibited superior reliability compared to single radiomics model in AUC value (0.792 vs. 0.726, p = 0.003) in validation cohorts. The radiomics-clinical model demonstrated an AUC of 0.918/0.792, a sensitivity of 0.907/0.813 and a specificity of 0.804/0.716 in the development and validation cohorts, respectively.

CONCLUSION

The study developed and validated a predictive nomogram model combining radiomics scores and clinical features, and showed good performance in predicting PNI pre-operation in stage II-III colon cancer patients.

Prognostic value of nutrition and immune‑related biomarkers in patients with locally advanced rectal cancer treated with chemoradiotherapy

The ability of nutrition and immune-related biomarkers to predict outcomes in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant therapy followed by surgery remains controversial due to the lack of evidence regarding the accuracy and reliability of these biomarkers in predicting outcomes for such patients. Therefore, the present study aimed to investigate the prognostic potential of nutrition and immune-related biomarkers in patients with LARC who underwent chemoradiotherapy followed by curative surgery. The clinical data of patients with LARC treated with neoadjuvant therapy followed by surgery between January 2010 and December 2019 were analyzed. In total, 214 consecutive patients were enrolled into the present study, who were then categorized into low and high prognostic nutritional index (PNI) groups. The X-tile 3.6.1 program was used to calculate and then determine the optimal cut-off values for PNI. Disease-free survival (DFS) and overall survival (OS) were compared between the low and high PNI groups. Cox regression analysis demonstrated that low PNI and high post-chemoradiotherapy carcinoembryonic antigen levels were significantly associated with reduced disease-free survival and overall survival. Specifically, a low PNI was associated with inferior 5-year DFS (P=0.025) and OS (P=0.018). These findings suggest that amongst the nutritional and immune-related biomarkers, PNI is a significant predictive factor for disease recurrence and mortality in patients with LARC treated with neoadjuvant therapy followed by surgery.

Arginine-solubilized lipoic acid-induced β-sheets of silk fibroin-strengthened hydrogel for postoperative rehabilitation of breast cancer

Breast cancer is the most common cancer among women worldwide, and adjuvant radiotherapy (RT) following tumor removal is one of the most commonly used treatments for breast cancer. However, the high risk of tumor recurrence and inevitable radiation skin injury after RT remain fatal problems, seriously challenging the patient's postoperative rehabilitation. Herein, a multifunctional poly (lipoic acid)-based hydrogel is constructed through one-step heating the mixture of α-lipoic acid (LA)/arginine (Arg)/silk fibroin (SF), without introducing any non-natural molecules. The multiple synergistic interactions among LA, Arg, and SF not only enhance the solubilization of LA in aqueous systems but also stabilize poly(lipoic acid) through strong salt bridge hydrogen bonds and ionic hydrogen bonds. Intriguingly, the LA-based surfactant induced β-sheet transformation of SF can further modulate the bulk strength of the hydrogel. Regulating the content of LA in hydrogels not only allows efficient control of hydrogel bioactivity but also enables the evolution of hydrogels from injectable forms to adhesive patches. Based on the different biological activities and forms of hydrogels, they can be implanted internally or applied externally on the mice's skin, achieving simultaneous prevention of tumor recurrence post-surgery and assistance in treating radiation-induced skin damage after radiotherapy.

Antioxidative and immunity-enhancing effects of heat-killed probiotic Enterococcus faecium KU22001 without toxin or antibiotic resistance

This study evaluated the probiotic properties, safety profile, and antioxidative and immune system-enhancing effects of Enterococcus faecium strains isolated from human infant feces. E. faecium KU22001, E. faecium KU22002, and E. faecium KU22005 exhibited potential probiotic properties; however, to eliminate concerns about toxin production and antibiotic resistance, the E. faecium strains were heat-treated prior to experimental usage. E. faecium KU22001 showed the highest antioxidant activity and lowest reactive oxygen species production among the three strains. The immune system-enhancing effects of heat-killed E. faecium strains were evaluated using a nitric oxide assay. E. faecium KU22001 induced an increase in the mRNA expression of inducible nitric oxide synthase, cyclooxygenase-2, and proinflammatory cytokines, including tumor necrosis factor-α, interleukin-1β, and interleukin-6 in RAW 264.7 cells. Furthermore, E. faecium KU22001 activated the mitogen-activated protein kinase pathway, which was a key regulator of the immune system. These results demonstrate the potential use of E. faecium KU22001 as a multifunctional food material.

Analysis of Treatment Modalities for Advanced Stage Squamous Cell Carcinoma of the Maxillary Sinus: A National Cancer Database Study

Introduction  Stage cT4a and cT4b squamous cell carcinomas (SCCa) typically require multimodal treatment with adjuvant or neoadjuvant therapy. This study aims to evaluate the impact of different treatment modalities on survival outcomes in patients with stage cT4a-b SCCa exclusively of the maxillary sinus. Methods  A multivariate survival analysis was conducted, evaluating treatment modalities for patients diagnosed between 2004 and 2020 utilizing the National Cancer Database. Cox hazard regression was performed for variables. Results  The study identified a total of 1,788 patients with SCCa of the maxillary sinuses, of which 71.2% were cT4a. Increasing age, Charlson-Deyo score ≥ 1, and undifferentiated/anaplastic grade were associated with worse rates of survival. Multivariate analysis revealed that neoadjuvant treatment exhibited the lowest hazard ratio ([HR]: 0.574, 95% confidence interval [CI]: 0.370-0.892) across the entire cohort (cT4a-b). Neoadjuvant treatment plus surgery, adjuvant treatment plus surgery, and surgery alone demonstrated the highest adjusted 5-year survival for cT4a-b tumors. On the other hand, radiation alone exhibited the highest HR (1.939, 95% CI: 1.555-2.418) in multivariate analysis and the lowest adjusted 5-year survival. Conclusion  Multimodal treatment of advanced stage maxillary SCCa has a variable effect on outcomes by tumor stage. Our findings suggest that surgery plus neoadjuvant and surgery plus adjuvant treatment are associated with higher rates of survival. Increasing age, Charlson-Deyo score ≥ 1, and undifferentiated/anaplastic grade were associated with worse rates of survival. Further randomized controlled trials are required to quantify the therapeutic benefit of these treatments on survival and organ sparing in advanced stage disease.