Technology in Cancer Research & Treatment最新文献

IntroductionThe utility and application of endocervical curettage (ECC) during colposcopy remain controversial. This study optimized ECC application for primary human papillomavirus (HPV) screening in patients with high-risk (HR)-HPV.MethodsThis retrospective study included patients with HR-HPV, who underwent subsequent cervical biopsy and ECC from January 1, 2014, to December 31, 2020. Logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). The prediction model was presented as a nomogram and evaluated for discrimination and calibration.ResultsThe additional detection rate of cervical intraepithelial neoplasia 2 + lesions with ECC was 2.0% (77/3887) in patients with HR-HPV. In multivariate risk factor analysis, HPV 16 infection presented a high risk of positive ECC, followed by HPV 33, HPV 58, and HPV 31. Irrespective of the abnormal cytopathological results, positive ECC was significantly increased (all P < .001). Females with acetowhite changes on colposcopy, transformation zone (TZ) type II, TZ type III, colposcopic impression of high-grade squamous intraepithelial lesion, or cancer were at a high risk of positive ECC. The final prediction model included significant variables from risk factor analysis, and had excellent calibration and classification capabilities, with an area under the receiver operating curve of 0.902 (95% CI, 0.881-0.922). Additionally, calibration analysis suggested consistency.ConclusionAs the additional detection value of ECC is limited. A satisfactory prediction model was designed to optimize ECC application in patients with HR-HPV infection.

Low temperature plasma (LTP), as an emerging cancer treatment technology, has shown significant therapeutic potential due to its unique physical and chemical properties and biological effects. This article reviews the basic characteristics of LTP and its multiple mechanisms of application in tumor treatment. LTP can induce various cell death modes, including apoptosis, pyroptosis, and autophagy, through its unique chemical and physical properties. Additionally, studies have demonstrated that the combination of LTP with traditional chemotherapy drugs (such as cisplatin and paclitaxel) can enhance the anti-tumor efficacy of the drugs while reducing drug resistance. The combined application of LTP and nanomaterials also shows promising prospects. However, LTP still faces some challenges and limitations in medical applications. Future research needs to further explore the specific applications of LTP in different tumor types, optimize treatment plans, and develop more portable and efficient LTP devices to promote its application in clinical treatment.

IntroductionThe role of radiotherapy (RT) in de novo metastatic breast cancer (dnMBC) patients undergoing surgery remains controversial due to limited evidence. This study aimed to evaluate the impact of postoperative radiotherapy on survival outcomes in this population.Materials and methodsWe retrospectively analyzed 102 dnMBC patients who underwent surgery at a provincial cancer hospital. Patients were grouped based on whether they received postoperative RT. Baseline characteristics were compared using the chi-square test. Kaplan-Meier analysis and Cox proportional hazards models were used to assess the prognostic impact of postoperative radiotherapy on local recurrence-free survival (LRFS), progression-free survival (PFS), and overall survival (OS).ResultsKM survival analysis showed that postoperative RT significantly improved LRFS (HR = 0.3634, 95%CI 0.1552-0.8508, p = .0197) and PFS (HR = 0.4903, 95%CI 0.3061-0.7855, p = .003) but had no significant effect on OS (HR = 0.7337, 95%CI 0.3514-1.508, p = .5395). Multivariate analysis identified postoperative RT as an independent protective factor for LRFS (HR = 0.265, 95%CI 0.088-0.795, p = .018) and PFS (HR = 0.525, 95%CI 0.313-0.882, p = .015). Subgroup analysis showed that for LRFS, RT had no significant interaction with different subgroup classification variables (all interaction p > .05). However, RT had a significant interaction with N stage for PFS (p = .016), specifically in N1-3 patients (HR = 0.384, 95% CI 0.221-0.668).ConclusionRT may improve disease control in selected dnMBC patients undergoing surgery, particularly those with lymph node metastasis. However, these findings still require further validation in larger, multicenter cohorts.

IntroductionUterine sarcoma (US) is an extremely rare and aggressive gynecologic malignancy with a poor overall survival (OS). The efficient prognostic biomarker is currently lacking.MethodsUtilizing a Sweden microarray dataset from the Gene Expression Omnibus (GEO) (GSE119043, n = 50) and a clinical cohort (n = 31) retrospectively collected from Suining Central Hospital, we analyzed β-catenin expression profiles and corresponding clinicopathological characteristics. Immunohistochemistry (IHC) was used to assess β-catenin expression level. Survival analysis was used to assess the relationship between β-catenin expression and prognosis. Gene set enrichment analysis (GSEA) was performed to characterize the specific pathways involved in β-catenin expression.ResultsImmunohistochemistry indicated that β-catenin expression was significantly upregulated in US group compared to both the normal uterine smooth muscle (UNSM) and uterine leiomyoma (ULM) groups (P < .01). IHC also exhibited a significant difference in β-catenin expression levels in four pathological subtypes. Leiomyosarcoma (LMS) and high-grade endometrial stromal sarcoma (HG-ESS) suggested higher levels of β-catenin expression compared with adenosarcoma (AS) or low-grade endometrial stromal sarcoma (LG-ESS), but no statistically significant difference was found in box plot (P > .05). GSEA indicated that transcriptional dysregulation in cancer, Wnt, AMPK, MAPK, PI3K, p53, Ras, and TNF signaling pathway were positively enriched in β-catenin high-expression group. Though survival analysis showed that β-catenin expression level was not associated with survival, low-β-catenin expression group showed a longer median OS compared to high expression group (56.17 months VS 9.60 months) in Sweden microarray dataset. Similar results were also observed for progression-free survival (PFS) in clinical cohort (not reached VS 45.97 months in high-expression group). Tumor type, lymphadenectomy, family history of malignancy and tumor recurrence remained significant predictors of OS, while only tumor type, stage and tumor recurrence had prognostic significance for PFS. Age, tumor size, menopausal status, CA125, adjuvant chemotherapy, and adjuvant radiotherapy, were not associated with survival (P > .05).Conclusionβ-catenin was highly expressed in uterine sarcoma and may be promising as a novel potential biomarker for diagnosis and prognosis.

Stereotactic radiotherapy (SRT) has become integral to modern oncology, offering the ability to deliver ablative doses while minimizing damage to surrounding normal tissues. Recent advancements in imaging integration, treatment planning, and dose delivery have expanded their clinical applications across various tumor types. However, challenges such as toxicity in anatomically critical regions, optimal margin determination, and the lack of standardized protocols persist. This review explores key issues in contemporary practice and highlights emerging clinical evidence across lung, liver, prostate, brain, and oligometastatic diseases. Further refinement in patient selection and treatment strategies is essential to maximize therapeutic efficacy and ensure safe implementation in broader clinical settings.

Background: Current evidence from evidence-based medicine is limited regarding the efficacy and safety of immunotherapy in elderly patients aged 75 years and older with malignant solid tumors. PRaG therapy, which combines PD-1/PD-L1 inhibitors, radiotherapy, and granulocyte-macrophage colony-stimulating factor (GM-CSF), aims to treat patients with advanced, refractory tumors. Preliminary findings indicate that patients aged 75 years and older can benefit from this treatment and can tolerate it well. Objective: This study aims to evaluate the efficacy and safety of the PRaG regimen in elderly patients with advanced malignant solid tumors to provide evidence-based support for immunotherapy in this population. Methods and Analysis: This study involves a multicenter, prospective, single-arm phase II clinical trial designed to enroll 29 patients aged 75 years and older with either newly diagnosed or recurrent metastatic advanced solid tumors that are histologically confirmed. All of the eligible patients will have had to receive at least two cycles of PRaG therapy until disease progression or intolerable adverse effects occurred. The study protocol was approved on September 12, 2023, by the Ethics Committee of the Second Affiliated Hospital of Soochow University (JD-LK-2023-082-I01) and by the ethics committees of all of the participating centers (Trial Registration Number: NCT06112041).

IntroductionThoracic SMARCA4-deficient tumors, which are rare and aggressive malignancies found in the lung or thoracic cavity, present a challenge in treatment standardization. This challenge arises from their resistance to chemotherapy and the absence of targeted therapy options.MethodsThoracic SMARCA4-deficient tumors were identified retrospectively using pathology databases. The clinicopathological characteristics of these tumors are outlined, and the clinical outcomes of advanced patients treated with immune checkpoint inhibitors (ICIs) in combination with chemotherapy and chemotherapy alone are reviewed.ResultsThirty-nine patients had thoracic SMARCA4-deficient tumors, with a median age of 62 years. The cohort consisted of 92.3% males, and 89.7% had a history of smoking. Within this group, 94.9% had stage III/IV disease at diagnosis. SMARCA4-deficient non-small cell lung cancer (SMARCA4-DNSCLC) and SMARCA4-deficient undifferentiated tumors (SMARCA4-DUT) display distinct histological and immunohistochemical features. Thirty-five patients underwent systemic therapy, achieving an ORR of 51.4%, a DCR of 82.9%, and a median OS of 20.9 months. Patients were categorized into chemotherapy (28.6%) and ICIs plus chemotherapy (71.4%) groups. The ICIs plus chemotherapy group exhibited an ORR of 64.0% and a DCR of 96.0%, while the chemotherapy group had an ORR of 20.0% and 50.0%, respectively (P < .0001 for ORR and DCR). The median OS for ICIs plus chemotherapy and chemotherapy groups were 20.9 months and 6.5 months, and median PFS were 9.6 months and 3.5 months, respectively, all statistically significant (P < .05). Multivariate COX regression analysis indicated that treatment was an independent prognostic factor for OS.ConclusionThoracic SMARCA4-deficient tumors exhibit a lack of SMARCA4 expression, displaying high malignancy and aggressiveness while exhibiting poor response to standard chemotherapy. The combination of ICIs with chemotherapy could potentially serve as an effective treatment approach for thoracic SMARCA4-deficient tumors.

PurposeAutomating quality assurance (QA) for contours generated by automatic algorithms is critical in radiotherapy treatment planning. Manual QA is tedious, time-consuming, and prone to subjective experiences. Automatic segmentation reduces physician workload and improves consistency. However, an effective QA process for these automatic contours remains an unmet need in clinical practice.Materials and MethodsThe patient data used in this study was derived from the AAPM Thoracic Auto-Segmentation Challenge dataset, including left and right lungs, heart, esophagus, and spinal cord. Two groups of organ-at-risk (OAR) were generated. A ResNet-152 network was used as a feature extractor, and a one-class support vector machine (OC-SVM) was employed to classify contours as 'high' or 'low' quality. To evaluate the generalizability, we generated low-quality contours using translation and resizing techniques and assessed correlations between detection limits and metrics such as volume, Dice similarity coefficient (DSC), 95% Hausdorff distance (HD95), and mean surface distance (MSD).ResultsThe proposed OC-SVM model outperformed binary classifiers n metrics such as balanced accuracy and area under the receiver operating characteristic curve (AUC) . It demonstrated superior performance in detecting various types of contour errors while maintaining high interpretability. Strong correlations were observed between detection limits and contour metrics.ConclusionOur proposed model integrates an attention mechanism with a one-class classification framework to automate QA for OAR delineations. This approach effectively detects diverse types of contour errors with high accuracy, significantly reducing the burden on physicians during radiotherapy planning.

Early detection of skin cancer is crucial for effective treatment and improved patient outcomes. Recent advancements in oncologic imaging, particularly molecular imaging techniques, have revolutionized cancer diagnostics and treatment by enabling the visualization of tumors and cellular activities at the molecular level. These techniques facilitate the identification of early-stage cancers that might remain undetectable through traditional imaging methods. Innovative technologies such as reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) which visualize skin at near-histologic detail and skin fluorescent imaging (SFI), which targets αvβ3 integrin expression, are promising for non-invasive early detection of melanoma. By integrating in vivo molecular imaging with tumor biomarkers, clinicians can gain more precise insights into processes integral to cancer biology, leading to improved diagnosis, prognosis and the development of personalized treatment strategies. This review explores imaging modalities used in skin cancer diagnosis, highlighting their advantages and limitations, with an emphasis on molecular imaging, stressing its potential to improve early detection, personalize treatment and monitor therapeutic responses.

IntroductionAccurate beam modeling is essential for ensuring safe and effective proton therapy delivery. Before clinical implementation, pencil beam scanning systems require thorough validation to confirm that calculated dose distributions reliably reflect measured performance. This work outlines a practical approach to achieving comprehensive and efficient validation.MethodsThe beam model for a pencil beam scanning system was configured in the treatment planning system (TPS). Beam data including integrated depth dose, lateral profiles in air, and absolute outputs for various energies were measured and entered into the TPS following vendor recommendations. Validation tests were performed according to AAPM TG 185 and insights from other proton centers, adapted to our clinical requirements, time constraints, and regulations. The validation incorporated test cases from AAPM TG 350 draft report and included: 1) rectangular field dose distributions in water, 2) PDD measurements, 3) planar dose measurements using the DigiPhant detector with TG 350 test plans and clinical cases, and 4) end-to-end tests in animal tissue. TPS-calculated dose distributions, obtained using either the proton convolution superposition or Acuros Protons algorithms, were compared with corresponding measurements. A peer review from an institute with a similar proton treatment machine validated the machine output and our validation process.ResultsFor rectangular targets with various ranges and modulation widths in water based on TG 185, TG 350 test plans, and clinical plans, ionization chamber and MatriXX PT planar dose measurements agreed with TPS calculations (point dose difference < 3%, planar dose 3%/3 mm > 95%). Range differences for animal tissues were within 3%. Independent peer output measurements agreed with our results within 1%.ConclusionTPS-calculated range and dose were in good agreement with measurements across multiple validation tests. The beam model for both PCS and Acuros PT has been validated and used clinically. Incorporating practical considerations is essential for achieving comprehensive and efficient beam commissioning and validation.