Frontiers in Oncology最新文献

This article reports a case of ovarian cancer presenting with chest tightness as the initial symptom, accompanied by markedly elevated pleural fluid amylase. A middle-aged female patient sought medical attention for "chest tightness and wheezing" as her primary complaints. Imaging revealed a massive pleural effusion with significantly elevated serum and pleural fluid amylase levels. Pleural fluid cytology staining and ovarian tissue pathology confirmed the diagnosis of high-grade serous carcinoma of the ovary. Subsequently, she underwent open abdominal cytoreductive surgery for ovarian cancer under general anesthesia, which included total hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Adjuvant chemotherapy with paclitaxel and carboplatin was administered two weeks after surgery. Amylase levels returned to normal after four weeks. This case suggests that in female patients with unexplained abnormally elevated serum and body fluid amylase levels, clinicians should remain vigilant for the possibility of ovarian cancer. Amylase may serve as an auxiliary diagnostic clue, and its combination with pathological and imaging examinations can facilitate early differentiation. Clinical practice should emphasize the diagnostic value of atypical symptoms and laboratory indicators.

Burkitt lymphoma (BL) with TP53 mutations is characterized by strong chemoresistance and poor prognosis, posing significant challenges in clinical treatment. Chimeric antigen receptor T-cell (CAR-T) therapy has shown promise in refractory/relapsed (r/r) BL, but its efficacy in TP53-mutated cases remains to be further validated. This case report describes a 16-year-old male adolescent diagnosed with TP53-mutated BL, whose initial presentation with recurrent abdominal pain led to a misdiagnosis of high-grade B-cell lymphoma. The disease was refractory to two cycles of chemotherapy (DA-EPOCH-R and AZA + R-CDOP) and even progression after third-line R-CODOX-M therapy. Following reevaluation confirming BL, the patient received CD19-directed CAR-T cell therapy (Axicabtagene Ciloleucel infusion, Axi-cel) and achieved complete metabolic response (CMR). Baseline lactate dehydrogenase (LDH) was markedly elevated at 1,343 U/L. As of the latest follow-up in March 2025, the patient remains in remission at 30 months after CAR-T infusion with full functional recovery, including resumption of normal academic life. This case, among the youngest reported uses of commercial Axi-cel for BL, highlights the diagnostic complexity in adolescent lymphoma and demonstrates that CD19 CAR-T therapy can overcome TP53-associated chemoresistance in adolescent BL. It also suggests that integrating molecular profiling and immunotherapy may provide new strategies for managing high-risk, treatment-refractory cases in the adolescent and young adult population.

Purpose: Postmastectomy radiotherapy (PMRT) requires a balance between optimal target coverage and organ-at-risk (OAR) sparing. Thermoplastic masks and different bolus thicknesses are frequently applied in clinical practice, yet their combined dosimetric effects and dependence on chest wall thickness remain insufficiently defined.

Methods and materials: Seventeen breast cancer patients treated with PMRT were retrospectively analyzed. For each patient, six intensity-modulated radiotherapy (IMRT) plans were generated, combining the presence or absence of a thermoplastic mask with bolus thicknesses of 0, 3, and 5 mm. Dosimetric parameters of the skin, planning target volume (PTV), OARs, and treatment efficiency (monitor units, MU) were compared across plans. Subgroup analyses were performed according to chest wall thickness (<4.1 cm, 4.1-5.0 cm, >5.0 cm). Correlations between chest wall thickness and dosimetric indices were evaluated using Spearman's rank analysis.

Results: Application of bolus improved dose homogeneity and PTV coverage, reduced lung dose and MU, but increased skin dose. The thermoplastic mask alone raised skin dose, functioning as an unintended compensator. In patients without masks, bolus effects on skin and OARs were more pronounced, suggesting greater sensitivity to compensation thickness. Chest wall thickness demonstrated negative correlations with skin dose, lung exposure, and MU. Patients with thin chest walls (<4.1 cm) derived the greatest benefit from bolus application, whereas patients with thick chest walls (>5.0 cm) showed minimal dosimetric improvement.

Conclusions: Both thermoplastic masks and bolus significantly affect PMRT dosimetry. Bolus provides improved PTV coverage and lung sparing at the cost of higher skin dose, while thermoplastic masks act as unintended compensators. Chest wall thickness strongly influences these effects, supporting individualized selection of bolus and mask use, particularly for patients with thinner chest walls.

Ferritinophagy, a selective autophagic process mediated by NCOA4, plays a central role in cellular iron homeostasis by mobilizing iron from ferritin to sustain mitochondrial metabolism and redox balance. In cancer, ferritinophagy's effects vary with context: it can support metabolic fitness in some settings while promoting ferroptotic vulnerability in others. In acute myeloid leukemia (AML), evidence suggests that leukemic stem cells rely more heavily on iron-driven mitochondrial metabolism, making ferritinophagy a potential therapeutic target. This review summarizes current knowledge of NCOA4 regulation and ferritinophagy, discusses their relevance in hematologic malignancies, and highlights therapeutic opportunities and unresolved questions in AML.

Background: The treatment of osteosarcoma, a highly aggressive primary malignant bone tumour, has long faced limitations due to chemotherapy resistance, tumour het-erogeneity, and an immunosuppressive microenvironment.

Methods: This review synthesizes recent multi-omics and clinical trial data to analyse synergistic oncogenic mechanisms in osteosarcoma-including driver mutations (TP53/RB1), epigenetic re-programming (m⁶A/ncRNA networks), and dysregulated pathways (PI3K/AKT, Wnt/β-catenin)-and evaluates derived therapeutic strategies.

Results: Targeted therapies demonstrate potential to improve prognosis in clinical trials; immunotherapies significantly enhance response rates by remodelling the cold tumour microenvironment; advanced technologies like nanotechnology and 3D-printed scaffolds over-come limitations of conventional treatments and enable integrated diagnosis and therapy. However, tumour evolutionary heterogeneity, off-target toxicity of targeted therapies, and translational gaps between animal models and clinical efficacy remain major challenges.

Conclusions: Future directions require integrating AI-driven imaging omics, spatiotemporal multi-omics, and mechanically adaptive biomaterials to establish a precision management system. This will advance osteosarcoma therapy from survival prolongation toward functional cure-defined as complete tumour eradication with physiological reconstruction of bone structure/function (e.g., restoring load-bearing/joint mobility), while preventing treatment-related disability, ultimately achieving oncologic cure with preserved quality of life.

Primary thyroid pleomorphic rhabdomyosarcoma (PRMS) is an extremely rare and aggressive neoplasm, with only five cases reported in the literature to date. We present the sixth reported case of primary thyroid PRMS and the first case demonstrating distal metastases to the lungs and left adrenal gland in a 71-year-old female. The patient underwent total thyroidectomy with lymphadenectomy, with histopathological evaluation confirming PRMS and demonstrating a highly aggressive biological behavior. The immunophenotypic profile showed strong immunopositivity for skeletal muscle markers, including desmin and vimentin. Further computerized tomography imaging identified a metastasized lesion in the left adrenal gland and a diffuse lung nodular dissemination. The patient received a personalized treatment plan which combined both systemic chemotherapy and radiotherapy. After four cycles of chemotherapy, the patient achieved partial regression of metastatic lesions. The highly aggressive nature of PRMS emphasizes the importance of having individualized and multidisciplinary treatment approaches to such rare cases.

Background: Richter's transformation (RT) is an aggressive progression of chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL), most commonly to diffuse large B-cell lymphoma (DLBCL). Therapeutic options are limited, and outcomes are poor, particularly in relapsed or refractory cases. Bruton's tyrosine kinase (BTK) inhibitors have transformed the treatment landscape of CLL, but their role in RT is less well defined.

Methods: We conducted a systematic review in accordance with PRISMA guidelines to evaluate the efficacy and safety of BTK inhibitor-based therapies in patients with RT. PubMed, EMBASE, and ClinicalTrials.gov were searched through January 1, 2025. Clinical trials reporting outcomes such as overall response rate (ORR), progression-free survival (PFS), overall survival (OS), and adverse events (AEs) in RT patients treated with BTK inhibitors were included.

Results: Seven studies (six clinical trials and one case series) comprising 220 patients were included. Monotherapy with pirtobrutinib and acalabrutinib showed ORRs of 50% and 40%, respectively. Combination regimens such as zanubrutinib plus tislelizumab and ibrutinib plus nivolumab demonstrated ORRs ranging from 41.6% to 65%, with improved outcomes in treatment-naïve patients. Safety profiles were generally manageable, though grade ≥3 AEs, particularly cytopenias and infections, were common. Risk of bias was moderate to serious across studies due to non-randomized designs and small sample sizes.

Conclusion: BTK inhibitor-based therapies show promising efficacy in patients with RT, particularly in combination with immunotherapeutic agents. While monotherapy may offer a tolerable option for frail patients, combination regimens may improve outcomes in select populations. Larger, randomized controlled trials are needed to better define the role of BTK inhibition in this high-risk disease.

Objective: Cervical cancer faces significant pathological diagnosis challenges including pathologist shortages, subjective interpretation, and inconsistent detection rates. This systematic review evaluates AI technology's application status, development level, and key challenges in cervical cancer pathological diagnosis.

Methods: A systematic literature review across three databases (PubMed/MEDLINE, Scopus, Web of Science) covering January 2015 to August 2025. Search terms included "artificial intelligence," "cervical cancer," "pathological diagnosis," "histopathology," "machine learning," and "deep learning." Studies involving AI applications in cervical cancer pathological diagnosis were included, encompassing histopathological, immunohistochemical, and molecular pathological diagnoses. Animal studies, cytological screening, and genomic analyses unrelated to pathological diagnosis were excluded.

Results: From 1,847 identified articles, 56 studies were included. AI technology demonstrated substantial potential in histopathological image analysis, diagnostic support systems, and accuracy validation. Deep learning architectures, particularly convolutional neural networks, achieved 92-98% diagnostic accuracy while reducing processing time from 8-15 minutes to 1-3 minutes per case. However, significant implementation challenges persist including standardization issues, limited clinical validation, and substantial infrastructure costs.

Conclusion: AI technology shows broad application prospects in cervical cancer pathological diagnosis, potentially alleviating pathologist shortages and improving diagnostic standardization. The technology particularly suits cervical cancer prevention in resource-limited regions, supporting global elimination goals, though standardization and validation challenges require addressing before widespread clinical implementation.