Technology in Cancer Research & Treatment最新文献

IntroductionChemoradiotherapy (CRT) is important to the esophageal cancer (EC) management. However, the predictive value of lymphocyte-related parameters, such as lymphocyte count (L), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR), is not yet fully understood. Moreover, chemotherapy agents like fluorouracil and cisplatin may have an impact on lymphocyte dynamics. This meta-analysis aims to evaluate the prognostic value of these parameters in EC patients undergoing concurrent CRT (eg, radiotherapy combined with fluorouracil and cisplatin), particularly in the context of specific chemotherapy regimens.MethodsElectronic databases were comprehensively searched up to September 2023 for research that assesses the prognostic role of lymphocyte-related indicators in EC patients undergoing CRT. Combined Hazard Ratios (HR) were estimated with a random-effects model, supplemented by meta-regression and subgroup analyses for enhanced insights.ResultsOf the 41 studies selected for qualitative evaluation, 22 were eligible for meta-analysis. These results revealed that increased pre-NLR (HR = 1.87, 95% CI = 1.55-2.26), lower pre-LMR (HR = 1.94, 95% CI = 1.36-2.77), lower dur-L (HR = 1.56, 95% CI = 1.28-1.90), and higher post-NLR (HR = 1.95, 95% CI = 1.08-3.51) predicted poorer overall survival (OS). Lower pre-LMR (HR = 1.73, 95% CI = 1.14-2.65) and lower dur-L (HR = 1.39, 95% CI = 1.14-1.69) were significant predictors of worse progression-free survival (PFS). The predominant chemotherapy regimen analyzed was fluorouracil combined with cisplatin, which significantly influenced lymphocyte counts and ratios during treatment.ConclusionsOur meta-analysis indicates that pre-treatment NLR, pre-treatment LMR, during-treatment L, and post-treatment NLR are valuable prognostic biomarkers for EC undergoing CRT, particularly in those treated with fluorouracil and cisplatin. Further investigations are warranted to explore their prognostic implications and therapeutic potential.

IntroductionThe prognosis of patients with uveal melanoma is related to several factors, including local or extraocular extension of the disease. Up to 50% of the patients with initial diagnosis of uveal melanoma develop metastases within few years and the liver represents the main site of metastatic spread. Patients with metastatic disease have a generally poor prognosis and few treatment options are available. In the last decades, the role of interventional radiology has expanded the range of treatment options and different minimally invasive liver-directed therapies were developed for liver metastases from uveal melanoma. The purpose of our systematic review was to analyze and review techniques, outcomes and safety of targeted-liver minimally invasive therapies in patients with metastatic uveal melanoma.MethodsAccording to PRISMA criteria, an extensive literature research (including more than 1600 articles) was finalized to collect the main articles on minimally invasive therapies. Based on the inclusion and exclusion criteria, 26 studies were selected for inclusion in the present systematic review (20/26 articles were retrospective studies, 6/26 articles were prospective studies). We collected data on 955 patients underwent the following procedures: radioembolization, transcatheter arterial chemoembolization, transarterial immunoembolization, percutaneous hepatic perfusion and thermal therapies.ResultsAmong procedures analyzed, the median overall survival was 16 months, the median progression-free survival was 8.2 months, while the median overall response rate was 39%. Post-procedure haematologic and gastrointestinal adverse events were predominant after percutaneous hepatic procedures.ConclusionTo date, different minimally invasive therapies are available for the treatment of metastatic uveal melanoma. Studies on percutaneous liver-directed therapies have demonstrated improvement in outcomes, prolonging overall survival and progression-free survival, and with an acceptable safety profile.

IntroductionPeripherally inserted central catheter (PICC)-related bloodstream infections (BSIs) are severe complications in breast cancer patients undergoing chemotherapy. This study evaluated the diagnostic potential of calcitonin gene-related peptide (CGRP), programmed cell death protein-1 (PD-1), and its ligand (PD-L1) as biomarkers for PICC-related BSIs.MethodsA total of 384 breast cancer patients with PICC placement were retrospectively identified from medical records, of these, 78 developed BSIs and 306 did not. Serum levels of CGRP, PD-1, and PD-L1 were measured using enzyme-linked immunosorbent assay (ELISA) and quantitative polymerase chain reaction (qPCR), respectively, to evaluate their potential as diagnostic biomarkers for BSIs. Blood cultures were performed to confirm infections and identify pathogens.ResultsThe BSIs group showed significantly lower CGRP and PD-L1 levels, and higher PD-1 expression and PD-1/PD-L1 ratios compared to the non-BSIs group (all P < 0.001). Receiver operating characteristic (ROC) curve analysis showed area under the curve (AUC) values of 0.84 for CGRP, 0.77 for PD-1, 0.70 for PD-L1, and 0.86 for the PD-1/PD-L1 ratio. Combined detection achieved an AUC of 0.96, with 88% sensitivity and 92% specificity. Gram-negative bacteria (59.8%) were the predominant pathogens, with Escherichia coli (29.3%) being the most common.ConclusionCGRP alone showed strong diagnostic utility, but combining CGRP, PD-1, and PD-L1 markedly enhanced accuracy. ELISA and qPCR detection of these markers provides results within hours, enabling earlier diagnosis than conventional blood cultures.

Radiotherapy is a multi-step process that includes planning, contouring, simulation, patient assessment, quality control, and treatment. Each step must be completed before moving on to the next. Numerous factors, including patient characteristics, disease type, management, radiotherapy personnel, equipment, treatment modality, and total/fractional doses, affect the overall duration of radiotherapy. Time is one of life's most valuable resources and should be well managed and utilized. In radiotherapy, eliminating factors that unnecessarily prolong the treatment period significantly benefits the institution, patient, and staff. This review article examines the variables that affect overall treatment time in current external beam radiotherapy routines and offers suggestions for reducing treatment time.

This narrative review explores the potential role of electrochemotherapy (ECT) in treating anorectal tumors, focusing on its effectiveness, feasibility, and associated toxicities. ECT, which combines chemotherapy with the application of an electric field to enhance drug uptake by tumor cells, has shown promise as a local treatment, particularly in cases where conventional therapies such as radiotherapy have been exhausted or are unsuitable. The review, conducted according to SANRA guidelines, included 18 studies, on ECT in anorectal tumors, ranging from preclinical trials in dogs to case reports and clinical studies in humans. The findings indicate that ECT can achieve high tumor overall response rates (70-100%) with minimal side effects, offering benefits such as tumor reduction and preserved organ function. These results highlight the potential of ECT to provide not only tumor reduction but also the preservation of vital organ function with a relatively low toxicity profile. However, further comparative research is necessary to substantiate its role as a standard therapeutic option. Moreover, the evidence is limited by significant heterogeneity across studies, small sample sizes, and a lack of comparative research with other local treatments like radiotherapy and cryosurgery. Consequently, while ECT appears to be a promising option, particularly for palliative care or in a neoadjuvant setting, it cannot yet be recommended as a standard treatment. Future research should focus on larger, more robust studies with standardized outcomes and explore the potential synergy between ECT and other therapies to establish its place in the treatment of anorectal tumors.

IntroductionThis study aims to evaluate diagnosis, treatment and clinical outcomes for patients with cervical cancer in pregnancy (CCIP) and their fetuses over a 10-year period, providing clinical evidence for the management of CCIP.MethodsClinical data of 28 patients diagnosed with CCIP at our center between January 1st, 2013 and June 30th, 2023 were retrospectively analyzed, focusing on gestational age at diagnosis, treatment, and maternal-fetal outcomes.ResultsA total of 28 patients with CCIP were identified, accounting for 0.42% (28/6678) of patients with cervical cancer during the study period. The majority of patients (86%, 24/28) had squamous cell carcinoma diagnosed by colposcopic biopsy, and 21 patients presented with recurrent vaginal bleeding. Cervical cancer was diagnosed during pregnancy in 19 cases and in the postpartum period in 9 cases. The mean tumor diameter was 5.4 (2-12) cm. Among 19 patients diagnosed during pregnancy, 13 patients chose pregnancy preservation, resulting in an average delay of treatment by 16.4 (0-33) weeks without observed disease progression. Fetuses were delivered via cesarean section at an average gestational age of 36.3 weeks; eight of these patients received neoadjuvant chemotherapy. At a median follow-up duration of 40.1 (12-103) months, 25 patients survived. Disease-free survival was observed in 20 patients, whereas two patients experienced local progression, and six developed distant metastases.ConclusionClinical outcomes for patients with CCIP appear comparable to those observed in non-pregnant patients in the general population. Pregnant patients presenting with abnormal vaginal bleeding should undergo prompt cervical cancer screening to enable early diagnosis and tailored management strategies. For patients with a strong desire to maintain their pregnancy, careful consideration should be given to postponing delivery until fetal maturity, thereby minimizing maternal and fetal complications and improving maternal and fetal outcomes.

IntroductionStratifying the risk of recurrence for surgically treated papillary renal cell carcinoma (pRCC) could be challenging. Prognostic models are crucial for patient counselling and individualized surveillance. The GRANT score is one of the models suggested by guidelines to predict prognosis of surgically treated pRCC. This study aims to externally validate the GRANT score using a three-risk group stratification in a large cohort of pRCC patients.Materials and MethodsThe present analysis utilized retrospective data from pRCC patients who underwent radical or partial nephrectomy. The GRANT score parameters included tumor grade, age, pathological T-stage, and N-stage. Patients were stratified into three risk groups (0-1 vs 2 vs 3-4 risk factors). Cancer-specific survival (CSS) was assessed using the Kaplan-Meier method, and differences between groups were evaluated using the log-rank test. Harrell's c-index was used to measure model accuracy, and restricted mean survival time (RMST) was calculated for up to 120 months.ResultsA total of 1942 patients were included. The median follow-up was 64.6 months. At 60 months, CSS was 93.2% (95%CI 91.7%-94.6%) for group 1, 60.8% (95%CI 54.0%-78.6%) for group 2, and 26% (95%CI 15.7%-42.9%) for group 3, with significant differences between each group (p < 0.001). The median CSS was not reached for group 1 (95%CI NR-NR), 86.0 months in group 2 (95%CI 65-NR), and 22.8 months in group 3 (95%CI 16.4-48.0). The c-index for CSS was 0.732. The RMST at 120 months was 113.3 months for group 1, 75.9 months for group 2, and 56.6 months for group 3, with a statistically significant difference (p < 0.001).ConclusionThe GRANT score effectively stratified surgically treated pRCC patients into three risk groups, demonstrating good prognostic accuracy. This validation supports the GRANT score's utility as a reliable and easy-to-use prognostic tool.

PurposeThis study assessed dosimetric effects of setup errors on boost target volume (PTVboost) coverage using simultaneous integrated boost (SIB) in early-stage left-sided breast cancer.Methods35 patients who received whole-breast radiotherapy (40.0 Gy/15 Fr) combined with a SIB to the tumor bed (48.0 Gy/15 Fr) were retrospectively analyzed. Translational-rotational coupled errors (1.0°rotation paired with 1.0 mm translation, 2.0° with 2.0 mm, 3.0° with 3.0 mm) were simulated about all axes. The D95 (dose to 95% of the PTVboost) and V95 (volume covered by 95% of the prescribed dose) were assessed through multivariate analysis to explore the relationship between PTVboost coverage and various anatomy factors, including the volume of the PTVboost (V_boost), the distance from the PTVboost centroid to the isocentre (D_iso), the mean depth from the anterior edge of PTVboost to the body surface (S_Depth), and setup errors.ResultsUnder a combination of 1.0° rotation and 1.0 mm setup errors, the D95 values and V95 coverage of the PTVboost were ≥95% in all cases. However, when the error combination increased to 2.0°:2.0 mm, there was a significant decrease in coverage, with approximately 80% of the target areas exhibiting D95 and V95 values <95%. When the setup errors further increased to 3.0°:3.0 mm, D95 and V95 values were <95% in all cases. Multivariate analysis indicated that V_boost, D_iso, and S_Depth were significant predictors of target coverage.ConclusionPTVboost dose coverage risk were synergistically influenced by increasing D_iso, reduced V_boost, and shorter S_Depth. The multivariate model may stratify coverage risk categories using tumor anatomy and setup error magnitudes.

PurposeIn our institute, stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) were performed by Cyberknife-S7 (CK-S7) which provided the selection of different collimators. This study aimed to compare critical plan qualities including conformality, high-dose area, dose fallout, and treatment efficiency between InCise™ multileaf collimator (MLC) based and Iris™ variable aperture collimators (Iris) based treatment plans.MethodsTwenty-five patients with intracranial tumors treated with CK-S7 were retrospectively analyzed. The Precision 3.3.0.0 with VOLO™ optimizer and GPU-accelerated Monte Carlo dose calculation algorithm was used for treatment planning. The new conformality index (nCI), homogeneity index (HI), high-dose ratio (HDR) and distribution inside plan target volume (PTV), dose gradient distance (DGD) outside PTV, organs at risk (OARs) sparing, and treatment efficiency were compared between MLC based and Iris based plans.ResultsMLC plan achieved higher nCI, higher HDRs from 135% prescription dose (PD) to 110%PD and trended to form more centralized and gathered high-dose distribution inside PTV, while no statistical difference was found in HI. Iris possessed better dose-engraving ability around the target boundary especially when it close to OARs with strict dose constraints. MLC plan showed shorter DGD from 90%PD to 20%PD. MLC plan achieved less MUs (-67.14%), less nodes (-41.5%), less beams (-74.06%) and shorter treatment time (-51.64%). There were positive correlations between the effective radius of PTV (rPTV) and DGD from 90%PD to 10%PD both in MLC and Iris plans.ConclusionsMLC plan achieved comparable conformality, higher HDRs, more gathered high-dose distribution, faster dose fallout and more efficient treatment which proved it an excellent SRS/SRT choice for intracranial tumors treated with CK-S7. MLC might take an important advantage for the uncompliant and painful patients. However, Iris showed a better dose-engraving ability, it might be taken into consideration especially when the tumor was close to OARs with strict dose constraints.

IntroductionThis study aims to investigate and fairly compare the oncological therapeutic efficacy of red photodynamic therapy (Red-PDT) and near-infrared photodynamic therapy (NIR-PDT), to support the selection of suitable photosensitizers (PSs) for optimal PDT.MethodsTwo different representative PSs, trastuzumab-HiLyte Fluor™ 647 conjugate (Tra-HLF647) and trastuzumab-Indocyanine Green conjugate (Tra-ICG), activated by two laser systems at 635 nm and 808 nm, respectively, were used. To ensure a fair comparison, we used the same A4 cell line/tumor model expressing the same target, human epidermal growth factor receptor 2 (HER-2), and employed the same delivery approach. To comprehensively evaluate and compare the potential effects of Tra-HLF647-mediated Red-PDT and Tra-ICG-mediated NIR-PDT, we conducted cell viability imaging assays, intracellular reactive oxygen species (ROS) generation measurements, longitudinal monitoring of tumor volume changes, histological and immunohistochemical (IHC) analyses of tumor sections, and measurements of tumor necrotic depth.ResultsBoth PDTs exerted similar rapid cell death in cell viability imaging assays. There was no significant difference in ROS generation between cells subjected to Red-PDT and NIR-PDT. Both PDTs caused a statistically significant tumor growth delay compared to the control groups; however, no significant difference was detected between the Red-PDT and NIR-PDT groups. The H&E-stained sections of tumors that received Red-PDT and NIR-PDT showed a similar pattern of necrosis-associated features. No conspicuous tissue damage was observed in the control groups. The depth of necrosis, estimated via the coincided accumulation of a fluorescent necrosis marker (AF546-pHLIP) and utilized as an indirect index to approximate laser light penetration, was also nearly identical between tumors treated with Red-PDT and NIR-PDT.ConclusionsTarget-specific Red-PDT and NIR-PDT, using their respective PSs, demonstrated equivalent therapeutic efficacy in tumor models. These findings suggest that wavelength differences between Red-PS and NIR-PS may not critically impact treatment outcomes, offering flexibility in fluorophore selection for future PS conjugate design.