Frontiers in Oncology最新文献

Hepatocellular carcinoma (HCC) is one of the most common malignancies with high global mortality. Yttrium-90 selective internal radiation therapy (⁹⁰Y-SIRT) is a precision radio-interventional treatment whose efficacy and safety critically depend on accurate microsphere delivery and dose distribution. This review provides an overview of imaging techniques used in ⁹⁰Y-SIRT, emphasizing both single-modality and multimodal approaches. We summarize the clinical value of ultrasound, CT, MRI, angiography, and nuclear medicine, each providing anatomical, functional, or metabolic information. We further discuss multimodal imaging integration across the treatment workflow: pre-procedural fusion supports patient selection and dose planning; intraprocedural volumetric imaging guides catheter placement; and post-treatment functional imaging assesses microsphere distribution and therapeutic response. By consolidating current evidence, this review highlights the clinical utility of multimodal imaging and identifies areas for optimization in treatment planning, procedural guidance, and outcome assessment of ⁹⁰Y-SIRT. This synthesis serves as a practical reference for clinicians and researchers aiming to improve the precision and effectiveness of radioembolization for HCC.

Purpose/objective: Magnetic resonance-linear accelerator (MR-Linac) systems enable high-precision radiotherapy through real-time MR guidance and daily online adaptive treatment planning. While online adaptation offers substantial dosimetric advantages, it extends treatment session durations on an already resource-intensive platform. This study aimed to evaluate patient-reported outcome measures (PROMs) and long-term toxicity profiles associated with MR-guided radiotherapy, with a particular focus on the impact of online adaptive workflows.

Materials and methods: This subgroup analysis of an ongoing prospective observational study comprises patients treated with the MRIdian Linac at the Department of Radiation Oncology at Heidelberg University Hospital between January 2019 and May 2021. Online plan adaptation was implemented in February 2020. A custom-designed in-house questionnaire (PRO-Q) was employed to assess patient experience with MR-guided treatment. Toxicity was classified according to the Common Terminology Criteria for Adverse Events (CTCAE v. 5.0).

Results: A total of 231 patients were included, comprising 130 non-adaptive and 101 adaptive treatments across 286 target volumes. Baseline patient characteristics, prior systemic therapy, and median planning target volumes (36.4 mL vs. 35.3 mL) were comparable between groups. Adaptive treatment was associated with significantly prolonged session durations (median 71 minutes vs. 36 minutes; p<0.01). During adaptive treatment, patients reported significantly higher discomfort in domains related to treatment duration, immobility, and sensory perceptions (e.g., tingling) as per PRO-Q responses. No statistically significant differences in overall toxicity were observed. However, patients undergoing adaptive therapy exhibited a faster return to baseline status post-treatment (6-8 weeks vs. 6-12 months).

Conclusion: Online plan adaptation at the MR-Linac increased treatment times and was associated with less favorable short-term patient-reported outcomes, yet it was delivered safely without compromising toxicity or oncologic outcomes. These results support adaptive MR-guided radiotherapy as a feasible and technically promising approach, while highlighting the need for further studies with validated PROMs and cost-benefit analyses to define its clinical value.

Background: A 60-year-old male patient presented to a senological clinic with a left axillary tumor. The histomorphological characteristics were ambiguous, initially pointing to apocrine carcinoma of mammary origin. This suspicion led to a delay in establishing the correct diagnosis. Only after complete tumor excision and comprehensive work-up in a multidisciplinary dermato-oncological clinic could a definitive diagnosis of primary cutaneous apocrine carcinoma (PCAC) be reached, allowing for appropriate therapy to be commenced.

Case presentation: The patient had an unremarkable medical history and had presented for excisional biopsy of an axillary nodule. Following the cancer diagnosis, several diagnostic tests and histopathological evaluations were initially performed in a senological setting to assess the likelihood of (metastatic) mammary carcinoma. Workup included breast ultrasonography, CT and MRI imaging and bone scintigraphy. A previously unrecognized subcutaneous tumor mass was identified in the left axilla, located deep to the excised nodule. No further lesions, either mammary or otherwise, were detected. The patient was referred to a dermato-oncological clinic, and the subcutaneous mass, containing metastatic lymph nodes, was completely excised with clear margins. Following extensive histopathological analysis, imaging and deliberation in the interdisciplinary tumor board, mammary carcinoma and metastatic disease were ruled out and the diagnosis of primary cutaneous apocrine carcinoma was reached. Adjuvant locoregional radiotherapy could subsequently proceed.

Conclusion: This case underscores the importance of an interdisciplinary approach in diagnosing axillary neoplasms and illustrates the valuable role of a high-volume, multidisciplinary skin cancer center in optimizing patient management. Although patients may initially present to a senological clinic, maintaining a broad differential diagnosis is crucial, especially when treating tumors with overlapping or atypical features. This prevents misdiagnoses, ensuring timely and effective care, thereby improving patient outcomes.

Introduction: Lung adenocarcinoma (LUAD) is the leading cause of cancer-related mortality worldwide, but its therapeutic efficacy remains suboptimal. This study explores the functional role and underlying mechanism of BUB1 in LUAD.

Methods: In vitro, BUB1 knockdown (si-BUB1) in A549/H1299 cells was performed, and effects were assessed. The ferroptosis inhibitor Fer-1 was used. Mechanistically, the role of the STAT3/GPX4 axis was investigated through overexpression experiments. In vivo, xenograft models were used.

Results: Bioinformatics analysis highlighted a significant upregulation of BUB1 in LUAD tissues, with elevated expression levels correlated with reduced disease-free survival (DFS) and overall survival (OS). BUB1 knockdown markedly suppressed cell proliferation, migration, and invasion, while concurrently inducing ferroptosis. This was evidenced by typical mitochondrial morphological changes (shrinkage, increased membrane density, reduced cristae), altered ferroptosis-related markers (decreased FTH1/SLC7A11, increased COX2), elevated Fe²⁺/MDA levels and reduced GSH activity, which could be reversed by Fer-1. BUB1 silencing suppressed the expression and phosphorylation of STAT3, thereby downregulating the transcription of GPX4. Overexpression of STAT3 and GPX4 partially reversed the inhibitory effects of BUB1 knockdown on LUAD cell malignancy and abrogated the ferroptosis induced by BUB1 silencing. In vivo, xenograft models further validated that BUB1 silencing significantly reduces tumor volume, accompanied by modulation of ferroptosis-related genes in tumor tissues.

Discussion: Collectively, our findings identify BUB1 as a novel prognostic biomarker and therapeutic target for LUAD, revealing a new regulatory mechanism by which BUB1 promotes LUAD progression through the activation of the STAT3/GPX4 axis to suppress ferroptosis.

We report a 58-year-old woman with cervical squamous cell carcinoma who developed an early-onset left external iliac artery rupture followed by a sigmoid fistula after multimodal treatment. Notably, key baseline tumor parameters-including maximal tumor diameter and stromal invasion depth-were not documented preoperatively because PET-CT was not performed and the original MRI/CT datasets from the outside hospital were unavailable. This incomplete staging likely contributed to underestimation of disease extent and to selection of a non-guideline-concordant primary radical hysterectomy, although postoperative pathology ultimately confirmed FIGO 2018 stage IIIC2 disease with extensive nodal metastases. The patient subsequently received adjuvant pelvic external-beam radiotherapy and vaginal cuff high-dose-rate brachytherapy. One month after completing radiotherapy, she presented with acute hematochezia and hemorrhagic shock. Angiography revealed active extravasation from the left external iliac artery adjacent to a postoperative lymphocele, and a covered stent was deployed with temporary hemostasis. Despite intensive antimicrobial and supportive therapy, she later developed a sigmoid fistula, pelvic abscess, recurrent bleeding, and persistent sepsis, culminating in fatal deterioration. The arterial rupture was considered to be multifactorial, with potential contributions from extensive lymphadenectomy, lymphocele formation, infection, and radiation-related tissue fragility. This case underscores the critical importance of comprehensive preoperative assessment and guideline-based primary treatment selection in cervical cancer, as inappropriate initial management may predispose patients to severe lymphatic, infectious, and vascular complications. Early multidisciplinary surveillance and timely intervention may be essential to prevent catastrophic outcomes. In gynecologic oncology, the combination of early-onset iliac arterial rupture and subsequent sigmoid fistula shortly after postoperative radiotherapy remains exceedingly rare, and to our knowledge has not been previously reported in a patient with unrecognized FIGO IIIC2 disease at initial treatment.

Background: The majority of tumors in the upper urinary tract are classified as urothelial carcinomas, with only 15% exhibiting different levels of squamous differentiation, known as the squamous subtype. These tumors tend to be more aggressive and are associated with a worse prognosis compared to standard urothelial carcinomas.

Case presentation: A 60-year-old man was found to have cancer in his left ureter and subsequently underwent a robot-assisted laparoscopic procedure to partially remove the left ureter and perform a ureterovesical anastomosis. The postoperative analysis revealed high-grade urothelial carcinoma with marked squamous differentiation(40% squamous differentiation) and microsatellite stability (MSS). Three months after surgery, the abdominal incision recurred and abdominal mass resection was performed again. One month after abdominal surgery, imaging evaluation showed lymph node metastasis in the left lower wall of the bladder and retroperitoneum.Ultimately, the patient attained complete imaging remission following treatment with the GC chemotherapy regimen, along with tislelizumab immunotherapy and radiotherapy.

Conclusion: The GC chemotherapy protocol, along with tislelizumab immunotherapy and radiotherapy, shows remarkable effectiveness in treating metastatic ureteral urothelial carcinoma with significant squamous differentiation.

Peritumoral brain edema is an accompanying symptom of meningiomas, and its severity impacts patient symptoms and prognosis. Meningioma-related peritumoral brain edema can result in severe symptoms such as neurological disturbance and brain herniation. Traditionally, the main treatment options for peritumoral brain edema in the perioperative period have been osmotherapy and corticosteroids, but the side effects and limited effectiveness cannot be ignored. This review summarizes the known influencing factors and mechanisms that contribute to meningioma-related brain edema, discusses the limitations of existing edema treatments, and outlines future edema treatments. More research on meningioma-related peritumoral brain edema is needed to improve patient outcomes and enhance treatment efficacy.

Background: The optimal duration of oxaliplatin-based adjuvant chemotherapy for stage II-III colorectal cancer (CRC) remains uncertain. Although a 3-month regimen may reduce toxicity, particularly peripheral sensory neuropathy (PSN), its effect on long-term survival is unclear. This study systematically compared the efficacy and safety of 3 versus 6 months of oxaliplatin-based adjuvant chemotherapy in stage II-III CRC patients.

Methods: A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was conducted to identify randomized controlled trials (RCTs) comparing 3 months versus 6 months FOLFOX or CAPOX adjuvant chemotherapy in stage II-III CRC patients. Outcomes included disease-free survival (DFS), 3-year DFS rate, overall survival (OS), chemotherapy completion rate, and PSN. The certainty of evidence was evaluated using the GRADE approach, and trial sequential analysis (TSA) was performed to assess the robustness of the results.

Results: Six RCTs involving a total of 16,420 stage II-III CRC patients were included. In the overall patients, the 3-month regimen showed no significant difference in DFS compared with the 6-month regimen (HR = 1.05, 95% CI 0.98-1.13, P = 0.18). Within the FOLFOX subgroup, the risk of DFS events was increased in the 3-month regimen (HR = 1.21, 95% CI 1.11-1.33, P < 0.001), with a similar difference observed among stage III patients (HR = 1.23, 95% CI 1.06-1.43, P = 0.007). No significant differences were observed in OS or 3-year OS rate, and all subgroup analyses showed no statistically significant differences in 3-year DFS rates. The 3-month regimen demonstrated a significantly higher chemotherapy completion rate, and grade 3-4 PSN was significantly lower in the 3 months regimen.

Conclusion: Stage II patients may preferentially receive a 3-month treatment regimen, whereas stage III patients receiving FOLFOX should still consider a 6-month regimen.

Systematic review registration: https://inplasy.com/inplasy-2025-12-0022/, identifier INPLASY-2025-12-0022.

Background: There is little evidence on breast cancer (BC) diagnosed in women with a high genetic risk, before and after their inclusion in a long-term risk management program based on genetic risk assessment. We analyzed clinical outcomes in women enrolled in the Phare Grand Ouest (PGO) program.

Methods: The PGO includes carriers of the BRCA1 and BRCA2 pathogenic variants (PV) and women at high risk without BRCA PV, enrolled in eight cancer genetics units. The study population included all women with incident or prevalent BC, and 1:1 matching by age at first diagnosis was conducted. Multivariable generalized linear and logistic regression models were used to examine the associations between tumor size and cancer stage and the following covariates: age, tumor subtype, pathogenic variant status, prevalent/incident BC status, and healthcare accessibility indicators.

Results: Within the matched cohort, those with incident BC were significantly younger at inclusion, but were of comparable age at the time of first diagnosis. They had smaller tumors, and the odds of advanced-stage disease were approximately 30% lower than those observed in women with prevalent BC (OR = 0.29, p < 0.01). Younger age and a triple-negative phenotype were independently associated with larger tumor size. No significant effect was shown from healthcare accessibility indicators.

Conclusion: The PGO's coordinated, person-centered approach to high genetic risk management was likely associated with earlier-stage BC detection in women with the BRCA PV and women at high risk without BRCA PV. These findings both underscore the enhanced value of person-centered surveillance programs that integrate genetic risk assessment and long-term clinical follow-up, and pave the way for further research in this area.

Background: The third leading cause of death worldwide is colorectal cancer due to a lack of early detection biomarkers and therapeutic small molecules. Advances in systems biology offer a combination of multi-omics and Artificial intelligence to discover the potential biomarkers and targets.

Methods: We used a combination of in silico and in vitro methodologies to identify potential biomarkers and a putative mediator of Embelin in colon cancer treatment. The human colorectal cancer (gene expression profiling by array) datasets were analyzed by using Weighted Gene Co-expression Analysis (WGCNA), and predictive AI models were trained by three algorithms (LASSO, SVM-RFE, RF). All three algorithms predicted COL6A3 as a common hub gene. qRT-PCR was used to analyze the expression level of COL6A3 along with apoptosis markers in HCT116 cell lines (human colorectal cancer) by treating Embelin in a dose-dependent manner.

Results: Trained model predicted COL6A3 as a prominent hub gene across all three ML algorithms with high cross validation accuracy (AUC values: > ~0.90), showing the accuracy of predictions and feature selections of the trained model. Embelin treatment results in the upregulation of pro-apoptotic markers (BAX, CASPASE3) and the downregulation of anti-apoptotic genes (BCL2, PI3KCA). These findings suggest that COL6A3 is a candidate biomarker and a potential mediator of embelin activity.

Conclusion: This study underscores the integration of AI, multi-omics, and in vitro studies for the discovery of candidate biomarkers and mechanistic insights into pathway modulation by Embelin in colorectal cancer. The research successfully identified and validated the role of COL6A3 as a potential biomarker and putative target modulated by Embelin in colon cancer.