Radiology and Oncology最新文献

Background: We aimed to comprehensively investigate the occurrence of thyroid nodules in a nationally representative population as well as in women of reproductive age from a geographic area with adequate iodine intake over the last two decades.

Patients and methods: This prospective cross-sectional study included 653 adult participants from three groups: a nationally representative gender-mixed group (205 participants) and women of reproductive age, including non-pregnant (306 participants) and pregnant (142 participants) women. For each participant, demographic data were collected, thyroid-stimulating hormone (TSH) levels were measured, thyroid volume was estimated, and the presence and size of thyroid nodules were recorded with high-resolution ultrasound. The ultrasound characteristics were analysed.

Results: Among the nationally representative participants, nodules were detected in 44.9%, with 39.0% larger than 5 mm and 13.7% larger than 0.5 mL. Among women of reproductive age, nodules were detected in 22.5%, with 14.1% larger than 5 mm and only 2.0% greater than 0.5 mL. The prevalence and size of nodules increased significantly with age in all groups, being significantly lower in non-pregnant women than in pregnant women, who were also older. In non-pregnant women of reproductive age, the number of nodules increased significantly after the age of 25, with the number of nodules larger than 5 mm increasing only after the age of 40.

Conclusions: Thyroid nodules are prevalent in the population, but are rarely clinically significant. Therefore, screening for thyroid nodules in asymptomatic individuals with normal thyroid findings on clinical examination should be avoided.

Background: Anlotinib has shown encouraging therapeutic effect on various solid tumors. This study assessed the efficacy and safety of anlotinib monotherapy in patients with recurrent or metastatic nasopharyngeal carcinoma (rmNPC).

Patients and methods: This study retrospectively included 30 patients with rmNPC, most following at least one previous line of systemic therapy. Patients underwent anlotinib monotherapy (12 or 10 mg/day). The primary endpoint was objective response rate (ORR). The secondary endpoints included progression-free survival (PFS), overall survival (OS), and toxicity.

Results: Thirteen patients (43.3%) had metastatic NPC, 10 (33.3%) had recurrent NPC, and 7 (23.3%) had both meta-static and recurrent NPC. Twenty-two patients (73.3%) were platinum-refractory, and 23 (76.7%) received at least three cycles of anlotinib therapy. The best overall response was partial response observed in four patients, stable disease in 18, and progressive disease in eight. The ORR was 13.3% (95% CI, 0.4-26.2%) and disease control rate was 73.3% (95% CI, 56.5-90.1%). The median OS and PFS were 11.5 months (95% CI, 7.5-15.5) and 5.7 months (95% CI, 4.7-6.7), respectively. The relatively common grade 3 or higher adverse events were hand-foot syndrome (13.3%) and oral mucositis (13.3%).

Conclusions: Anlotinib monotherapy demonstrated positive efficacy in patients with rmNPC. It was well tolerated by these patients and had acceptable toxicity.

Background: Diffuse large B-cell lymphoma (DLBCL) has variable prognosis, with only 50 to 60% of patients cured by standard first line treatment. Identifying patients unlikely to benefit from standard first line therapy is therefore crucial. Schmitz's study identified four molecular subtypes of DLBCL with differing prognoses: MCD, BN2, N1, and EZB, with BN2 and EZB showing more favorable outcomes. This study aimed to evaluate the effectiveness of the Archer FusionPlex Lymphoma Assay in identifying the newly defined genetic subtypes of DLBCL, while also exploring the association between immunohistochemical (IHC) and next-generation sequencing (NGS) methods for classifying the cell of origin (COO) and assessing their predictive value for patient survival.

Materials and methods: We classified 131 DLBCL patients using Hans algorithm into GCB (germinal center B-cell-like) and ABC (activated B-cell-like) subtypes, and with NGS applying Archer FusionPlex lymphoma assay into ABC, GCB, unclassified, and into Schmitz's novel genetic subtypes. A mutational analysis of just 7 genes (MYD88 ^L265P, CD79B, EZH2, NOTCH1, NOTCH2, BCL2, and BCL6) was used for genetic classification. Various statistical models were applied to assess survival differences between subtypes. Finally, STRATOS analysis was conducted to validate our preliminary statistical findings.

Results: 35.9% of patients were successfully classified into new genetic subtypes, with acceptable consistency between IHC and NGS method for COO determination. However, the new genetic subtype classification by NGS did not correlate with overall survival, nor did the COO classifications by IHC or NGS. The inclusion of these classifications also did not improve the predictive value of models compared to the basic model based on the International Prognostic Index (IPI) only.

Conclusions: The Archer FusionPlex Lymphoma assay showed a somewhat lower detection rate of novel genetic subtypes compared to reports based on exome sequencing, yet identified novel genetic subtypes in over one-third of patients. However, an in-depth STRATOS statistical analysis did not confirm its predictive value for DLBCL prognosis, likely due to factors like patient selection and sample size limitations.

Background: Anti-phase technology, a novel advancement in microwave antennas for percutaneous liver ablations, forms more spherical ablation zones. This study aimed to evaluate the efficacy and safety of microwave ablation (MWA) treatment for liver tumors using a microwave antenna equipped with anti-phase technology.

Patients and methods: The study included 92 patients (133 lesions) treated with MWA for hepatocellular carcinoma (HCC) or liver metastases. Of these, nine patients had HCC, and 83 had metastases (46 colorectal and 37 non-colorectal metastases). Retrospective analysis was conducted on patients' age, sex, pre- and post-procedural laboratory values (white blood cell count, neutrophil-to-lymphocyte ratio), tumor and ablation zone dimensions (preprocedure and post-procedure day 1 and months 1, 3, and 6), details of the single-shot MWA procedure (duration, power output), procedure-related complications, and local progression/recurrence during follow-up.

Results: The technical success rate of MWA was 100%. Ablations were performed at a median power output of 80 watts (range: 50-100), and the mean ablation duration was 5.2 ± 2.1 minutes. Follow-up imaging revealed an ablation zone diameter-to-tumor diameter ratio of 1.63 ± 0.3. Major complications occurred in three patients (3.2%) and included liver abscess (n = 1/92), hemorrhage (n = 1/92), and pleural effusion (n = 1/92). Minor complications were observed in 29 patients (31.5%). The median follow-up time of the patients was 33 (range 10-36) months. The median disease-free survival time was 25 months (95% confidence interval: 21-27). During the 24-month follow-up, local tumor progression occurred in 39 patients (42.4%). Tumor size was identified as an independent risk factor for local progression (p = 0.012).

Conclusions: This study represents the longest follow-up duration and the largest patient cohort for the MWA treatment of liver tumors using anti-phase technology. The results demonstrated high technical success and acceptable local control and complication rates.

Background: Chronic cancer pain, especially in advanced stages, remains a significant clinical challenge, often necessitating complex multimodal strategies. Although systemic opioids are standard therapy, many patients experience inadequate relief or adverse effects. Implantable intrathecal drug delivery systems (IDDS) have emerged as a promising alternative, enabling targeted analgesia with reduced opioid burden and improved quality of life. This narrative review summarizes current evidence on the clinical application, efficacy, safety, and cost-effectiveness of IDDS in cancer pain management. Literature sources include clinical trials, observational studies, health-economic evaluations, and international guidelines published between 2002 and 2023. A Slovenian case report is included, detailing the first national experience with IDDS implantation for refractory cancer pain. Clinical outcomes were assessed using the Visual Analogue Scale (VAS), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and the revised Edmonton Symptom Assessment System (r-ESAS).

Conclusions: Findings from the literature confirm that intrathecal pumps provide substantial and sustained pain relief, often with a significant reduction in systemic opioid doses and associated side effects. Compared to conventional pharmacotherapy, intrathecal delivery is associated with improved patient-reported outcomes, fewer hospitalizations, and lower long-term healthcare costs. In the Slovenian case, VAS scores decreased from > 8 to 3 shortly after implantation, with parallel improvements in quality-of-life indices. IDDS represent a clinically effective and economically sustainable option for selected patients with complex cancer pain, particularly when systemic therapy proves insufficient. Their integration into multidisciplinary palliative care pathways supports personalized, safe, and compassionate treatment approaches. By combining an evidence-based overview with real-world national experience, this review underscores the therapeutic value of intrathecal drug delivery and calls for broader clinical awareness and future research.

Background: Gene therapy has emerged as a transformative biomedical approach, offering new therapeutic possibilities from many so far uncurable diseases through the introduction of recombinant nucleic acids into target cells. Among non-viral delivery techniques, gene electrotransfer (GET) has become one of the frequently applied methods in clinical trials. It is based on the application of short, high-intensity electric pulses that transiently permeabilize cell membranes and enable the efficient transfer of plasmid DNA or other types of recombinant nucleic acids into various cell types. Beyond its role in gene delivery, GET can trigger complex cellular responses, as the introduced DNA interacts with intracellular DNA sensing pathways involved in innate immunity and inflammation. These responses can influence the therapeutic outcome - either by enhancing antitumour and vaccine-related immune activation or by reducing transfection efficiency when excessive inflammation or cell death occur. Our experimental findings in tumour, muscle, and skin models have shown that even non-coding plasmid DNA delivered by GET can induce local immune stimulation and tissue-specific inflammatory signaling, suggesting that the delivered DNA itself contributes to therapeutic efficacy.

Conclusions: The dual nature of cellular responses following plasmid DNA GET represents both an opportunity and a challenge. Controlled activation of innate immunity can be harnessed to amplify antitumour or vaccine efficacy, while excessive responses may hinder applications requiring cell survival and sustained expression. Understanding these mechanisms enables the rational optimization of GET parameters and plasmid vector design to fully exploit the adjuvant effect or reduce the off-target effect of DNA sensing after GET, based on the desired application.

Background: The presence of bone marrow involvement (BMI) in patients with diffuse large B-cell lymphoma (DLBCL) has a significant impact on treatment plans and prognosis, but clinical diagnosis is difficult. The purpose of this study was to evaluate the utility of PET/CT in the assessment of BMI and prognosis in newly diagnosed DLBCL.

Patients and methods: This retrospective study included 57 eligible DLBCL patients who underwent bone marrow biopsy (BMB) and PET/CT prior to any treatment initiation. Increased FDG uptake in the bone marrow on PET/CT scans was indicative of BMI positivity, with such instances not attributable to benign findings. If BMB yielded positive results, or if the marrow uptake resolved concurrently with other lymphoma lesions during PET/CT monitoring, the diagnosis of BMI was established. The evaluation of bone marrow status via PET/CT involved both visual analysis and a quantitative index, specifically the ratio of maximum standardized uptake values of bone marrow to liver (BLR). Factors associated with 2-year progression-free survival (PFS) was analyzed utilizing the Cox proportional hazards regression model.

Results: 34 patients were diagnosed with BMI. PET/CT demonstrated superior accuracy (93.0% vs. 75.4%) and sensitivity (94.1% vs. 58.8%) compared to BMB. During the follow-up period, 15 patients experienced disease progression. Survival analysis identified Eastern Cooperative Oncology Group performance status (ECOG PS), BLR, and PET/CT bone marrow status as the sole independent predictors of PFS (p = 0.010, 0.002, and 0.015, respectively).

Conclusions: PET/CT played an important role in evaluating BMI and predicting PFS in newly diagnosed DLBCL.

Background: Percutaneous nephrostomy displacement results in procedure failure, reducing quality of life in patients with hydronephrosis. Scarce data about factors influencing displacement led to evaluation of our data in order to give better insight into this topic.

Patients and methods: Patients admitted for percutaneous nephrostomy (PCN) exchange between March 3^rd and October 3^rd 2023 were included in our prospective observational study aiming to determine possible factors influencing PCN displacement. Catheter type, number of sutures and patients' age over 70 years were analyzed. Descriptive statistics and Pearson's chi-square test were used; value less than 0.05 was determined as statistically significant.

Results: We included 57 patients (35 males; mean age 71.4 years) in the study. Loop catheters with strings were implanted 58 times and without strings 17 times. Fixation was achieved by 55 single and by 20 double sutures. 17 PCN (22.7%) were displaced in designated period. The mean time from PCN implantation to exchange was 4.16 months. Neither catheter type, number of sutures or patients' age significantly influenced PCN displacement (chi-square 0.57, 0.34 and 0.61, respectively).

Conclusions: No significant difference in PCN displacement between two types of catheters and the number of fixing sutures was detected. Elderly patients had similar rates of PCN displacements as younger ones. The most important causes of PCN displacement remained probably patients' activity and a care for PCN during months after the implantation. Proper patients' education and care of the PCN are possibly the keys for long-term success.

Background: Periodontal disease (PD) is associated with more than 50 diseases and conditions, including colorectal cancer. The study aimed to investigate if periodontal treatment influences the blood levels of C-reactive protein (CRP) in colorectal cancer patients. In addition, the aim was to isolate periodontal pathogenic bacteria Fusobacterium nucleatum (FN) and Porphyromonas gingivalis (PG), which are most linked to colorectal cancer (CRC), from the mucosa of the cancer-affected intestine.

Patients and methods: To assess the effect of periodontal treatment on colorectal cancer, we measured the CRP levels in the blood during cancer therapy on the day of the initial examination by the oncological surgeon, two days following surgery, and at the first follow-up appointment. We compared the CRP levels between two groups: the group of subjects who underwent periodontal treatment and the patients who did not receive periodontal disease treatment. An attempt was made to isolate the periodontal pathogenic bacteria FN and PG from the mucosa of the cancerous tissue in the colon by using quantitative culture.

Results: We found no statistically significant difference between the groups in the initial CRP measurements before starting cancer treatment. There was no statistically significant difference between the groups in the CRP measurements taken 1st and 2nd day after surgery and at the follow-up appointment. We could not isolate periodontal pathogenic bacteria FN and PG from cancer-altered intestine mucosa using the quantitative culture method.

Conclusions: Our study did not find any correlation between periodontal treatment and CRC.

Background: Prostate cancer (PCa) is a common cancer in men in developed countries. PCa treatment depends on the disease's stage; focal therapy provides an intermediate approach, with lower toxicity compared to radical prostatectomy, and better tumor control than active surveillance. We report the first retrospective analysis of prostate cancer patients treated with ECT at our institution.

Patients and methods: A cohort of 144 men with prostate cancer who were ineligible for or refused standard therapies were included and treated with ECT. Routine follow-up included PSA tests and MRI scans, as well as toxicity and genitourinary function evaluation by means of standard questionnaires. Local response was evaluated with MRI at 3 months after treatment, following the RECIST criteria for solid tumors.

Results: The procedure was technically successful in all patients and was well tolerated, with mild and temporary adverse events. Urinary and erectile functions were mostly preserved. A complete response was observed in 75% of evaluated patients, a partial response in 18%, stable disease in 5%, and disease progression in 2%. Short-term response was associated with TNM stage (p < 0.05), Gleason score (p = 0.0066), and pre-ECT PSA levels (p = 0.0070). During follow-up, 18 patients (13%) experienced disease progression; 1-year PFS was 88% (95% CI: 80%-97%) and was found to be significantly associated with tumor stage and pre-treatment PSA levels.

Conclusions: ECT is a feasible, safe, and effective treatment for prostate cancer, with extremely low toxicity and side effects. Preliminary results suggest that it offers promising outcomes in terms of local disease control in early-stage tumors, but also in locally advanced cases where other treatments may not be viable.