Frontiers in Oncology最新文献

Epidermal growth factor receptor (EGFR) exon 19 deletion (Ex19del) is one of the most prevalent sensitizing mutations in non-small cell lung cancer (NSCLC), particularly in Asian populations. However, management after progression or suboptimal response is unclear. We describe two patients with advanced lung adenocarcinoma harboring EGFR Ex19del who received furmonertinib plus pemetrexed. Case 1 achieved partial response (PR) with substantial tumor shrinkage and a marked decline in carcinoembryonic antigen (CEA) after six cycles; disease remained stable over 19 months of follow-up. Case 2 had suboptimal benefit from first-line osimertinib but attained PR with resolution of pleural effusion after switching to the combination; subsequent computed tomography (CT) confirmed stable disease (SD). Both patients tolerated treatment without severe treatment-related adverse events. These observations suggest that furmonertinib plus pemetrexed may have antitumor activity and acceptable tolerability in EGFR Ex19del lung adenocarcinoma, and may inform personalized approaches following resistance to first-line therapy in EGFR-sensitizing NSCLC.

Human epidermal growth factor receptor 2 (HER2)-positive breast cancer is associated with an aggressive clinical course and a high incidence of central nervous system (CNS) metastases. Although trastuzumab emtansine (T-DM1) is a standard therapy for previously treated HER2-positive metastatic breast cancer, reports of exceptionally prolonged administration with long-term intracranial stability remain scarce. Here, we describe a patient with HER2-positive metastatic breast cancer with brain metastases who achieved long-term systemic and intracranial stability following CNS-directed local therapy and subsequent T-DM1 treatment. T-DM1 was administered from May 2019 to November 2025 (107 cycles; >6 years), and serial imaging every 3-4 months demonstrated continued disease stability without the development of new metastatic lesions. Long-term tolerability was acceptable, with only intermittent grade 1 hyperbilirubinemia without dose modification and preserved cardiac function on longitudinal monitoring. This case suggests that prolonged administration of T-DM1 may be feasible in carefully selected patients with durable clinical benefit and manageable toxicity, emphasizing the role of individualized treatment decisions, imaging surveillance, and long-term safety monitoring.

Introduction: Cutaneous melanoma (CM) is among the most aggressive human malignancies characterised by its strong propensity for metastasis. Recent advances in melanoma research have reframed the disease as a systemic condition driven by dynamic interactions between tumour cells, the tumour microenvironment and the immune system. Increasing evidence indicates that these interactions are largely mediated by extracellular vesicles (EVs), small lipid-bilayer-enclosed particles that facilitate intercellular communication. EVs can be isolated from all biofluids, making them attractive minimally invasive biomarkers for diagnosis, staging, monitoring response to treatment and predicting relapse. Despite growing interest, a comprehensive overview of global research trends in this area is lacking.

Methods: We performed a bibliometric systematic review of EVs-related CM research from 2005 to 2025 using Web of Science, Scopus, and EMBASE. Eligible studies focused on EVs characterisation, biomarker development, and functional roles in melanoma. Data were analysed using the Bibliometrix R-package to assess publication trends, citation metrics, author networks, institutional output and thematic evolution.

Results: An analysis of the 288 included studies revealed that publication activity peaked in 2020, representing a 4000% increase in annual output compared to 2005. Additionally, a marked surge in citation frequency was observed beginning in 2018. The United States and China led in output, although international collaboration was limited. Chongqing Medical University and the University of Pittsburgh were among the most productive institutions. The Journal of Extracellular Vesicles published the highest number of articles in this field. Keyword and co-citation analysis identified major research themes, including immune evasion, biomarker discovery, and therapy resistance.

Discussion: This first bibliometric analysis of EV research in CM reveals a rapidly expanding field with evolving research priorities. These findings offer a data-driven framework to guide future studies, promote collaboration, and inform strategic investment in EVs-based melanoma research.

Consolidative allogeneic hematopoietic stem cell transplantation (allo-HSCT) after chimeric antigen receptor (CAR) T-cell therapy is an emerging modality in hematologic malignancies. Knowledge regarding the optimal interval and pretreatment regimen between CAR T-cell therapy and allo-HSCT remains limited. Here, we report two cases of confirmed relapsed/refractory (R/R) T-cell acute lymphoblastic leukemia (T-ALL) treated with autologous anti-CD7 CAR T cells infusion bridging to allo-HSCT. Case 1 had a poor prognosis due to grade 3 cytokine release syndrome (CRS), infection, drug-related organ toxicity, hyperacute graft-versus-host disease (GVHD), and transplant-associated thrombotic microangiopathy (TA-TMA). In contrast, case 2 demonstrated a favorable course, marked by effective inflammation control, complete recovery following CAR T-cell therapy, and timely transplantation. These cases indicate that anti-CD7 CAR T-cell therapy represents a promising therapeutic strategy for R/R T-ALL. However, its integration with allo-HSCT constitutes a high-risk clinical approach that requires careful and individualized management.

Background: Radiation dose to cardiac conduction nodes may contribute to arrhythmia risks in breast cancer (BC) patients after radiotherapy, yet dosimetric evidence remains limited. This study aimed to evaluate doses to the sinoatrial (SAN) and atrioventricular nodes (AVN) in BC patients treated with intensity-modulated radiation therapy (IMRT) and to clinically validate a deep learning-based autosegmentation model for these structures.

Methods: A retrospective analysis was conducted on 87 BC patients who underwent IMRT. Doses to the whole heart, four cardiac chambers, the SAN, and the AVN were evaluated and correlated. For autosegmentation, a convolutional neural network (CNN) was trained on 60 patients, validated on seven, and tested on 20. Segmentation accuracy was assessed using the Dice similarity coefficient (DSC), and dosimetric consistency was compared between automated and manual contours.

Results: In right-sided BC patients, the SAN received the highest mean dose among cardiac substructures (5.43 Gray [Gy]) under a mean heart dose of 3.39 Gy. Both SAN and AVN doses showed strong correlations with right atrial (RA) dose (R ² for SAN: 0.63 in left- and right-sided cases; for AVN: 0.77 and 0.63, respectively). The autosegmentation model achieved DSCs of 0.83 for SAN and 0.75 for AVN, with no statistically significant dosimetric differences between autosegmented and manual contours.

Conclusions: The SAN receives substantial irradiation in right-sided BC patients during IMRT, and RA dose strongly correlates with conduction node doses, suggesting its potential as a clinical surrogate. The CNN-based autosegmentation method enables accurate and efficient delineation of the SAN and AVN, facilitating reliable dosimetric assessment in clinical practice.

Objective: To systematically retrieve, appraise and synthesize the best available evidence on sexual health management in patients undergoing intracavitary brachytherapy for cervical cancer, so as to provide an evidence-based foundation for developing individualized sexual-health care plans in clinical practice.

Methods: A comprehensive computer-based search of domestic and foreign databases, guideline repositories and professional association websites was conducted for all evidence on sexual health management in cervical-cancer patients receiving intracavitary brachytherapy. Document types included guidelines, evidence summaries, systematic reviews, expert consensus statements and clinical decision aids. The search timeframe spanned database inception to June 2025.

Results: Twelve publications were ultimately included: two clinical decision aids, one guideline, four systematic reviews, two evidence summaries, one expert consensus and two randomized controlled trials. Thirty-nine evidence statements were extracted and grouped under seven themes: target population and risk factors, screening and assessment, health education, non-pharmacologic interventions, pharmacologic and hormonal therapies, special treatments, and follow-up.

Conclusion: This study summarizes the best current evidence on sexual health management for cervical-cancer patients undergoing intracavitary brachytherapy and offers valuable guidance for improving patients' quality of life and sexual-health outcomes.

Systematic review registration: http://ebn.nursing.fudan.edu.cn/home, identifier ES20256976.

Background and objective: Accurate prostate cancer risk stratification benefits from the fusion of T2-weighted (T2WI) and Apparent Diffusion Coefficient (ADC) MRI. However, patient motion and imaging distortions frequently cause spatial misalignments between these sequences. While radiologists compensate for this via subjective cognitive fusion, the process introduces inter-reader variability and can be particularly challenging in equivocal cases. Conventional fusion models are even more vulnerable, as they require perfect image registration, making them brittle in real-world clinical scenarios. We aimed to develop and validate a deep learning framework that overcomes these limitations by robustly fusing unregistered mpMRI data.

Methods: We retrospectively analyzed a cohort of 300 consecutive men (mean age, 71.5 ± 7.6 years) who underwent pre-biopsy prostate mpMRI at our institution between January 2021 and May 2023. All included patients had pathologically confirmed prostate cancer, with high-risk prostate cancer, as defined by NCCN guidelines, present in 184 of 300 cases (61.3%). The dataset was partitioned chronologically into a development cohort (n=250) for 5-fold cross-validation and a temporal test cohort (n=50) for independent evaluation. We developed Cross-Modal Optimal Transport Fusion (CMOT-Fusion), a deep learning framework that learns to identify and match diagnostically relevant regions between misaligned T2WI and ADC images. This approach enables robust multimodal fusion without requiring an explicit image registration step.

Results: For discriminating NCCN high-risk versus low/intermediate-risk disease among pathologically confirmed prostate cancer cases, CMOT-Fusion achieved a mean Area Under the Curve (AUC) of 0.849 ± 0.034 in 5-fold cross-validation, outperforming single-modality baselines and conventional fusion methods. On an independent test set, the model's performance remained robust, with an ensemble AUC of 0.824 (95% CI: 0.694-0.930; ensemble probability computed as the mean of the five fold-specific model probabilities per patient). As a cohort-specific clinical reference based on routine radiology suspicion scoring, PI-RADS v2.1 achieved an AUC of 0.839 (95% CI: 0.726-0.930) on the same test cohort.

Conclusion: Our results demonstrate that learning a direct correspondence between unregistered mpMRI sequences significantly improves prostate cancer risk stratification. The proposed CMOT-Fusion framework offers a robust solution to the common clinical problem of inter-sequence misalignment, potentially enhancing diagnostic reliability and streamlining clinical workflows by removing the need for a separate image registration step. Given the single-center retrospective design and the small independent test cohort, these findings should be considered exploratory and warrant multi-center prospective validation.

Background: This study investigated the prognostic value of the preoperative red cell distribution width to lymphocyte ratio (RLR) for recurrence-free survival (RFS) and overall survival (OS) in patients with non-muscle-invasive bladder cancer (NMIBC) undergoing transurethral resection of bladder tumor (TURBT).

Methods: A retrospective analysis was performed on data from 239 patients who received TURBT. The optimal RLR cutoff was determined using time-dependent receiver operating characteristic (ROC) curve analysis. Survival outcomes were assessed using Kaplan-Meier curves and univariate/multivariate Cox regression. An RFS prognostic nomogram incorporating independent factors was developed and evaluated via the concordance index (C-index), calibration plots, time-dependent ROC, and decision curve analysis (DCA). Subgroup analyses assessed the consistency of the RLR-RFS association.Results: Elevated preoperative RLR was an independent prognostic factor for worse RFS and OS. Moreover, compared to the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR), RLR demonstrated relatively higher predictive performance for 1-year and 3-year RFS. The novel nomogram incorporating the RLR parameter demonstrated improved predictive accuracy and a trend toward greater net clinical benefit compared to the conventional model based solely on the EORTC recurrence risk classification. Subgroup analysis indicated a stronger relationship between high RLR and poor RFS in patients with pTaN0M0 compared to those with pT1N0M0.

Conclusion: Preoperative RLR represents a potential independent prognostic indicator for tumor recurrence in NMIBC patients following TURBT. The RLR-based nomogram may improve recurrence risk prediction in this population.

Introduction: Thymidine kinase 1 (TK1), a key enzyme in DNA biosynthesis, has been shown to correlate with breast cancer prognosis and treatment response in dynamic monitoring settings. However, the clinical relevance of baseline TK1 levels remains controversial due to inconsistent evidence across studies. To address this issue, we conducted the first systematic meta-analysis of available studies to investigate the potential association between baseline TK1 levels and prognostic outcomes in breast cancer patients.

Methods: A comprehensive computerized literature search was conducted across major Chinese and English databases to identify studies investigating the association between TK1 expression and breast cancer prognosis. Baseline TK1 expression levels and corresponding patient survival data were systematically extracted for meta-analysis.

Results: The meta-analysis evaluating the association between baseline TK1 expression levels and progression-free survival (PFS) in breast cancer included 2,887 patients from 11 studies. Significant heterogeneity was observed across the included studies (I ² = 87.9%, p = 0.099), which persisted even after subgroup analyses. Therefore, a random-effects model was employed, yielding a pooled hazard ratio (HR) of 1.63 (95% confidence interval [CI]: 1.28-2.10, p = 0.000, Z = 3.88). The meta-analysis evaluating the association between baseline TK1 expression levels and OS in breast cancer included 2,233 patients from six studies. Significant heterogeneity was initially observed (I ² = 72.3%, p = 0.003), which was resolved through subgroup stratification by treatment status (treatment-naive versus recurrent disease). In the treatment-naive subgroup, the HR was 1.30 (95% CI: 1.11-1.52, p = 0.001, Z = 3.26). For the recurrent disease subgroup, the HR was 2.10 (95% CI: 1.74-2.54, p = 0.000, Z = 7.64).

Conclusion: Breast cancer patients presenting with high baseline TK1 expression are associated with significantly worse prognostic outcomes. Collectively, these findings support the clinical potential of TK1 assessment for prognostic risk stratification and treatment guidance, which merits further verification in large-scale, multicenter clinical trials.

Introduction: Phyllodes tumor of the breast (PTB) is a rare fibroepithelial neoplasm, classified as benign, borderline, and malignant. They typically present as solitary, painless, firm masses with potential rapid enlargement, and 20% exceed 10 cm, often indicating malignancy. Local recurrence frequently occurs within two years postoperatively. While the survival benefit of adjuvant radiotherapy remains controversial, it significantly reduces recurrence rates. We report a 27×14 cm malignant PTB and evaluate optimal radiotherapy strategies and re-irradiation safety in recurrent cases.

Case report: A 55-year-old female presented with a rapidly enlarging left breast mass, initially detected seven years prior, measuring 50×40 cm on physical examination. The patient underwent complete surgical excision, with a postoperative pathological mass measuring 27×14 cm, followed by adjuvant radiotherapy (50 Gy/25 fractions). One month after radiation, a 15×15 cm axillary recurrence was resected (10×8 cm specimen). Two months later, a 10×8 cm infraclavicular recurrence was excised (6×5 cm specimen). Subsequently, six cycles of epirubicin-cyclophosphamide chemotherapy and re-irradiation (45-60 Gy/25 fractions) were administered. At present, there is no evidence of local recurrence.

Conclusions: This case highlights the potential role of adjuvant RT in reducing recurrence and the feasibility of carefully selected re-irradiation for recurrent MPTs. Prospective studies are needed to define optimal target volume of radiotherapy, dose fractionation, and the safety of re-irradiation.