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The challenges of cascade genetic testing in hereditary cancer syndromes: A few ethical considerations. 遗传性癌症综合征的级联基因检测所面临的挑战:一些伦理方面的考虑。
IF 2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-11-13 DOI: 10.1177/03008916241297782
Linda Battistuzzi

Progress in the discovery and understanding of cancer susceptibility genes and ever-cheaper genomic technologies are generating precious opportunities to optimize the identification of individuals with a hereditary cancer predisposition.Any such effort will have a more significant impact if it prioritizes those most at risk of developing cancer. This premise is central to cascade genetic testing, in which healthcare professionals encourage cancer patients carrying a predisposing gene variant to discuss the implications of their test results with their at-risk relatives so that, ideally, all the at-risk individuals in that family have the option to seek genetic counseling and testing in turn. Among the relatives found to have the gene variant, those who have developed cancer can then access targeted treatment and follow-up, those who are asymptomatic can benefit from enhanced preventive measures, while those who test negative can avoid unnecessary, costly, and time-consuming screening.Despite its life-saving potential, cascade genetic testing in hereditary cancer syndromes is often reported to have disappointing uptake rates, particularly among historically disadvantaged and underrepresented communities, for reasons that include barriers in intrafamilial genetic risk communication and low health and genetic literacy.This paper will discuss the challenges of cascade genetic testing in hereditary cancer syndromes, addressing some of the ethical questions arising from its current model, from strategies aimed at improving its uptake, as well as from alternative approaches to identifying asymptomatic individuals who may carry a cancer- associated pathogenic variant.

在发现和了解癌症易感基因方面取得的进展以及日益廉价的基因组技术,为优化遗传性癌症易感人群的鉴定工作提供了宝贵的机会。这一前提是级联基因检测的核心。在级联基因检测中,医护人员鼓励携带易感基因变异的癌症患者与其高危亲属讨论检测结果的影响,以便在理想情况下,该家庭中的所有高危个体都能选择寻求基因咨询和检测。尽管遗传性癌症综合征的级联基因检测具有挽救生命的潜力,但据报道,其接受率往往令人失望,尤其是在历来处于不利地位和代表性不足的群体中,原因包括家庭内部遗传风险交流障碍以及健康和遗传知识水平低。本文将讨论在遗传性癌症综合征中进行级联基因检测所面临的挑战,探讨其现有模式、旨在提高其接受率的策略以及识别可能携带癌症相关致病变异的无症状个体的替代方法所产生的一些伦理问题。
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引用次数: 0
Effect of anti-inflammatory molecules from food on organoids derived from adenomatous polyps of FAP subjects. 食物中的抗炎分子对来自 FAP 患者腺瘤息肉的有机体的影响
IF 2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-10-27 DOI: 10.1177/03008916241291301
Oscar Illescas, Antonino Belfiore, Luca Varinelli, Davide Battistessa, Susanna Zanutto, Clorinda Brignola, Francesco Segrado, Irene Cafferati, Maria Teresa Ricci, Giovanna Sabella, Massimo Milione, Vito Ladisa, Stefano Signoroni, Marco Vitellaro, Patrizia Pasanisi, Manuela Gariboldi

Introduction: Individuals with Familial Adenomatous Polyposis (FAP) or APC-associated polyposis, an autosomal dominant inherited condition, develop multiple adenomatous polyps and have an increased colorectal cancer (CRC) risk. A change in diet can help reduce cancer risk, and several dietary components have an antitumor effect. We aimed to evaluate the potential of the anti-inflammatory and anticancer substances quercetin (QER), epigallocatechin gallate (EGG) and fisetin (FIS) in decreasing the risk of CRC by reducing the growth of polyps in an organoid model.

Methods: Patient-derived organoid (PDO) lines were generated from polyps obtained from patients with FAP undergoing prophylactic colectomy. PDOs were treated with QER, EGG, or FIS to determine their effect on cell growth. Changes in caspase 3/7 activity and expression of inflammation and apoptosis mediators were assessed by luminescent and colorimetric assays.

Results: Three PDO lines with different inactivating pathogenic variants in the APC gene were developed using a combinatorial approach. FIS was the most active of the three substances tested, presenting the lowest IC50 in all PDO lines (range: 42.6-9.2 uM). The IC50 was defined as the concentration required to halve the number of cells after 72 hours. All molecules tested induced apoptosis through activation of caspases 3/7.

Conclusions: QER, EGG, and FIS can be easily taken from foods or dietary supplements, show toxicity on PDOs derived from adenomatous polyps, while they are known to be harmless on normal cells. Diets enriched with these substances could be potential supplemental treatments to reduce the risk of CRC in individuals with FAP.

导言:家族性腺瘤性息肉病(FAP)或 APC 相关性息肉病是一种常染色体显性遗传病,患者会出现多发性腺瘤性息肉,并增加患结直肠癌(CRC)的风险。改变饮食习惯有助于降低患癌风险,而多种饮食成分具有抗肿瘤作用。我们的目的是评估抗炎和抗癌物质槲皮素(QER)、表没食子儿茶素没食子酸酯(EGG)和鱼腥草素(FIS)在类器官模型中通过减少息肉生长来降低 CRC 风险的潜力:患者衍生类器官(PDO)系由接受预防性结肠切除术的FAP患者的息肉生成。用 QER、EGG 或 FIS 处理 PDO,以确定它们对细胞生长的影响。通过发光和比色法评估了 caspase 3/7 活性的变化以及炎症和凋亡介质的表达:结果:采用组合方法培育出了 APC 基因中具有不同失活致病变体的三种 PDO 株系。在测试的三种物质中,FIS 的活性最高,在所有 PDO 品系中的 IC50 最低(范围:42.6-9.2 uM)。IC50 被定义为 72 小时后细胞数量减半所需的浓度。所有测试分子都通过激活 caspases 3/7 诱导细胞凋亡:结论:QER、EGG 和 FIS 很容易从食物或膳食补充剂中摄取,对来自腺瘤性息肉的 PDOs 有毒性,而对正常细胞无害。富含这些物质的膳食可作为潜在的辅助疗法,以降低 FAP 患者罹患 CRC 的风险。
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引用次数: 0
PALB2 analysis in the diagnostic process of breast cancer: An Italian monocentric experience. 乳腺癌诊断过程中的 PALB2 分析:意大利单中心经验
IF 2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-10-24 DOI: 10.1177/03008916241290738
Maria Grazia Tibiletti, Ileana Carnevali, Sofia Facchi, Laura Libera, Corrado Chiappa, Fausto Sessa, Stefano La Rosa, Francesca Rovera

Background: The clinical utility of germline BRCA1 and BRCA2 testing is well established in patients with family history suggestive for hereditary breast and ovarian cancer syndrome. Recently, germline PALB2 pathogenic variants were also associated with an increased risk of breast and other cancers and, in the Italian population, it has been described in few studies without a systematic germline analysis of BRCA1, BRCA2 and PALB2.

Objectives and methods: In this study, we described ASST Sette Laghi cancer genetic counselling services' experience in the analysis of 402 patients with suspected breast and ovarian cancer syndrome, by using BRCA1, BRCA2 and PALB2 germline genetic test.

Results: The frequency of PALB2 pathogenic variants was 1.2% compared to 3.5% and 3.2% for BRCA1 and BRCA2, respectively, whereas class 3 variants were detected in 0.3% and 0.5% of the BRCA1 and BRCA2 investigated patients, respectively. PALB2 pathogenic variants were identified in patients with a strong family history for breast cancer. Moreover, PALB2 variants were significantly associated with a younger age of breast cancer onset (mean age, 40.25 years) compared to wild-type patients (mean age 51.2 years, p-value = 0.0331). Similar to BRCA-associated breast cancer, the majority of PALB2 breast cancers were identified at an advanced clinical stage. Pedigree analysis revealed a family history of breast and ovarian cancer syndrome in all PALB2 pathogenic variants carriers (early breast cancer onset, bilateral breast cancer and ovarian cancer).

Conclusion: In conclusion, the germline analysis of BRCA1, BRCA2 and PALB2 should be included in breast cancer clinical practice as a not negligible number of PALB2 carriers could be identified and referred to specific surveillance protocols.

背景:对于有遗传性乳腺癌和卵巢癌综合征家族史的患者,种系 BRCA1 和 BRCA2 检测的临床实用性已得到公认。最近,种系 PALB2 致病变异也与乳腺癌和其他癌症风险的增加有关,在意大利人群中,很少有研究对其进行描述,也没有对 BRCA1、BRCA2 和 PALB2 进行系统的种系分析:在这项研究中,我们介绍了 ASST Sette Laghi 癌症遗传咨询服务机构通过 BRCA1、BRCA2 和 PALB2 种系遗传检测分析 402 名疑似乳腺癌和卵巢癌综合征患者的经验:PALB2致病变异的频率为1.2%,而BRCA1和BRCA2的频率分别为3.5%和3.2%,而在接受调查的BRCA1和BRCA2患者中,分别有0.3%和0.5%的患者检测到3类变异。在有严重乳腺癌家族史的患者中发现了PALB2致病变体。此外,与野生型患者(平均年龄 51.2 岁,P 值 = 0.0331)相比,PALB2 变体与乳腺癌发病年龄(平均年龄 40.25 岁)明显相关。与 BRCA 相关性乳腺癌类似,大多数 PALB2 乳腺癌都是在晚期临床阶段发现的。家系分析显示,所有PALB2致病变异携带者都有乳腺癌和卵巢癌综合征家族史(早期乳腺癌发病、双侧乳腺癌和卵巢癌):总之,BRCA1、BRCA2 和 PALB2 的种系分析应纳入乳腺癌临床实践中,因为有相当数量的 PALB2 基因变异携带者可以被识别出来,并转入特定的监测方案。
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引用次数: 0
Personalized treatment using predictive biomarkers in solid organ malignancies: A review. 在实体器官恶性肿瘤中使用预测性生物标记物进行个性化治疗:综述。
IF 2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-02 DOI: 10.1177/03008916241261484
Haoming Tang, Yi Xin Li, Jun Jie Lian, Hsin-Yueh Ng, Samuel Sherng Young Wang

In recent years, the influence of specific biomarkers in the diagnosis and prognosis of solid organ malignancies has been increasingly prominent. The relevance of the use of predictive biomarkers, which predict cancer response to specific forms of treatment provided, is playing a more significant role than ever before, as it affects diagnosis and initiation of treatment, monitoring for efficacy and side effects of treatment, and adjustment in treatment regimen in the long term. In the current review, we explored the use of predictive biomarkers in the treatment of solid organ malignancies, including common cancers such as colorectal cancer, breast cancer, lung cancer, prostate cancer, and cancers associated with high mortalities, such as pancreatic cancer, liver cancer, kidney cancer and cancers of the central nervous system. We additionally analyzed the goals and types of personalized treatment using predictive biomarkers, and the management of various types of solid organ malignancies using predictive biomarkers and their relative efficacies so far in the clinical settings.

近年来,特定生物标志物对实体器官恶性肿瘤诊断和预后的影响日益突出。预测性生物标志物可预测癌症对特定治疗方式的反应,它对诊断和治疗的启动、疗效和副作用的监测以及长期治疗方案的调整都具有重要作用。在本综述中,我们探讨了预测性生物标记物在实体器官恶性肿瘤治疗中的应用,包括结直肠癌、乳腺癌、肺癌、前列腺癌等常见癌症,以及胰腺癌、肝癌、肾癌和中枢神经系统癌症等死亡率较高的癌症。此外,我们还分析了使用预测性生物标记物进行个性化治疗的目标和类型,以及使用预测性生物标记物治疗各种类型的实体器官恶性肿瘤的情况及其迄今为止在临床上的相对疗效。
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引用次数: 0
Outcomes of chemotherapy/chemoradiation vs. R2 surgical debulking vs. palliative care in nonresectable locally recurrent rectal cancer. 化疗/放疗 vs. R2手术切除 vs. 姑息治疗对非切除性局部复发性直肠癌的疗效。
IF 2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-05-10 DOI: 10.1177/03008916241253130
Luca Sorrentino, Andrea Scardino, Luigi Battaglia, Raffaella Vigorito, Giovanna Sabella, Filippo Patti, Michele Prisciandaro, Elena Daveri, Alessandro Gronchi, Filiberto Belli, Marcello Guaglio

Locally recurrent rectal cancer is resected with clear margins in only 50% of cases, and these patients achieve a three-year survival rate of 50%. Outcomes and therapeutic strategies for nonresectable locally recurrent rectal cancer have been much less explored. The aim of the study was to assess the three-year progression-free survival and the three-year overall survival in locally recurrent rectal cancer patients treated by chemotherapy/chemoradiation only vs. chemotherapy/chemoradiation and R2 surgical debulking vs. palliative care. A total of 86 patients affected by nonresectable locally recurrent rectal cancer were included: three-year progression-free survival was 15.8% with chemotherapy/chemoradiation vs. 20.3% with R2 surgical debulking (Log-rank p=0.567), but both rates were higher than best palliative care (0.0%, Log-rank p=0.0004). Three-year overall survival rates were respectively 62.0%, 70.8% and 0.0% (Log-rank p<0.0001). Chemotherapy/chemoradiation (HR 0.33, p=0.028) and R2 surgical debulking with or without chemotherapy/chemoradiation (HR 0.23, p=0.005) were independent predictors of improved progression-free survival on multivariate analysis. In conclusion, both chemotherapy/chemoradiation alone and R2 surgery with or without chemotherapy/chemoradiation provide a survival benefit over palliative care in nonresectable locally recurrent rectal cancer. However, considering that pelvic debulking is burdened by a high rate of complications, and considering its negligible impact on progression-free survival and overall survival when associated to medical therapy, surgery should be avoided in this setting.

只有 50% 的局部复发直肠癌切除后边缘清晰,这些患者的三年生存率为 50%。对不可切除的局部复发直肠癌的治疗效果和治疗策略的探讨则少得多。该研究旨在评估仅接受化疗/放疗与化疗/放疗和R2手术切除与姑息治疗的局部复发性直肠癌患者的三年无进展生存期和三年总生存期。共纳入了86名不可切除的局部复发性直肠癌患者:化疗/放疗的三年无进展生存率为15.8%,R2手术切除术为20.3%(Log-rank p=0.567),但两者均高于最佳姑息治疗(0.0%,Log-rank p=0.0004)。三年总生存率分别为 62.0%、70.8% 和 0.0%(Log-rank p=0.567)。
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引用次数: 0
Secular trends in incidence and mortality of non-Hodgkin's lymphoma in China, 1990-2019, and predictions to 2030: Outlook for the future burden of disease. 1990-2019年中国非霍奇金淋巴瘤发病率和死亡率的长期趋势及对2030年的预测:未来疾病负担展望。
IF 2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-02 DOI: 10.1177/03008916241261166
Hongbo Su, Shuping Xie, Jun Lyu, Yan Liu, Yanbo Zhang

Background: The aim of this study was to analyze the trend of non-Hodgkin's lymphoma incidence and mortality in China from 1990 to 2019, along with assessing the effects of age, period, and cohort, as well as to predict future trends.

Material and methods: Using data from the Global Burden of Disease Study 2019 we calculated the estimated annual percentage changes in the incidence and mortality of non-Hodgkin's lymphoma. Age-period-cohort analysis was used to assess the independent effects of these elements. Incidence and mortality until 2030 were predicted using a Bayesian age-period-cohort approach.

Results: During 1990-2019, there was a significant increase in the age-standardized incidence and mortality rate in non-Hodgkin's lymphoma. Strong effects of birth cohort and period on non-Hodgkin's lymphoma incidence and mortality were observed. In terms of prediction, future non-Hodgkin's lymphoma incidence and mortality in China will continue to increase, while the mortality rate will decrease; for women, both the rates are projected to rise, but they will remain lower than men.

Conclusions: Currently, the non-Hodgkin's lymphoma burden is high in China, and it is expected to continue increasing in the future. Policymakers need to prioritize addressing the factors contributing to sex differences in disease burden, including variations in environmental exposures and lifestyles among men and women.

研究背景本研究旨在分析1990年至2019年中国非霍奇金淋巴瘤发病率和死亡率的变化趋势,同时评估年龄、时期和队列的影响,并预测未来趋势:利用2019年全球疾病负担研究的数据,我们计算了非霍奇金淋巴瘤发病率和死亡率的估计年度百分比变化。采用年龄-时期-队列分析法来评估这些因素的独立影响。结果显示,1990-2019 年间,非霍奇金淋巴瘤的发病率和死亡率出现了显著下降:结果:1990-2019年间,非霍奇金淋巴瘤的年龄标准化发病率和死亡率显著上升。出生队列和时期对非霍奇金淋巴瘤的发病率和死亡率有很强的影响。预测未来中国非霍奇金淋巴瘤发病率和死亡率将继续上升,而死亡率将下降;女性非霍奇金淋巴瘤发病率和死亡率均将上升,但仍将低于男性:结论:目前,中国的非霍奇金淋巴瘤发病率较高,预计未来还将继续上升。政策制定者需要优先解决导致疾病负担性别差异的因素,包括男女之间环境暴露和生活方式的差异。
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引用次数: 0
Immunogenicity of radiotherapy on bone metastases from prostate adenocarcinoma: What is the future for the combination with radiotherapy/immunotherapy? 放疗对前列腺腺癌骨转移的免疫原性:放疗/免疫疗法联合疗法的前景如何?
IF 2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-05-15 DOI: 10.1177/03008916241249366
Pierre Cornillon, Wafa Bouleftour, Thomas Reynaud, Gregoire Pigne, Denis Maillet, Salima Hamizi, Marie Beguinot

Bone metastatic prostate cancers (PCa) are resistant to usual immunotherapies such as checkpoint inhibitors. The main hypothesis related to this immunoresistance is the lack of antigens to stimulate anti-tumor immunity. External radiation is a potential inducer antigens presentation and thus to immunotherapy proprieties. The aim of this review is to describe the tumor microenvironment specificities, especially in bone metastasis and the immune modifications after radiation therapy on a metastatic castration-resistant PCa population. PCa microenvironment is immunosuppressive because of many tumor factors. The complex interplay between PCa cells and bone microenvironment leads to a 'vicious circle' promoting bone metastasis. Furthermore, the immune and bone systems, are connected through an osteoclastogenic cytokine: the Receptor Activator Nuclear Factor Kappa B ligand. Adapted doses of ionizing radiation play a dual role on the tumor. Indeed, radiotherapy leads to immunogenicity by inducing damage associated with molecular patterns. However, it also induces an immunosuppressive effect by increasing the number of immunosuppressive cells. Interestingly, the abscopal effect could be used to optimize immunotherapy potential, especially on bone metastasis. Radiotherapy and immunotherapy combination is a promising strategy, however further studies are necessary to determine the more efficient types of radiation and to control the abscopal effect.

骨转移性前列腺癌(PCa)对检查点抑制剂等常规免疫疗法具有抗药性。与这种免疫抵抗有关的主要假说是缺乏刺激抗肿瘤免疫的抗原。体外辐射是一种潜在的抗原诱导剂,因此也是一种免疫疗法。本综述旨在描述肿瘤微环境的特异性,尤其是骨转移和转移性阉割耐药 PCa 患者放疗后的免疫改变。由于多种肿瘤因素的影响,PCa 微环境具有免疫抑制作用。PCa 细胞与骨微环境之间复杂的相互作用导致了促进骨转移的 "恶性循环"。此外,免疫系统和骨系统还通过一种破骨细胞生成细胞因子--受体激活因子核因子 Kappa B 配体--联系在一起。适应剂量的电离辐射对肿瘤起着双重作用。事实上,放疗通过诱导与分子模式相关的损伤而导致免疫原性。不过,放疗也会通过增加免疫抑制细胞的数量来诱导免疫抑制效应。有趣的是,脱落效应可用于优化免疫疗法的潜力,尤其是在骨转移方面。放疗与免疫疗法的结合是一种很有前景的策略,但还需要进一步研究,以确定更有效的放射类型并控制脱落效应。
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引用次数: 0
Italian translation, cultural adaptation and pilot testing of Psychosocial Assessment Tool (PAT 3.1) in pediatric cancer. 小儿癌症社会心理评估工具(PAT 3.1)的意大利语翻译、文化调整和试点测试。
IF 2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-30 DOI: 10.1177/03008916241259933
Chiara Battaglini, Mario Giordano, Paola Quarello, Nicoletta Bertorello, Giulia Zucchetti, Franca Fagioli

Introduction: Experiences related to pediatric oncology diagnosis cause great imbalances within the family structure. Assessing the frailties and needs of families and children with cancer from a psychosocial perspective is an important step in providing appropriate pediatric psychology care.

Methods: The aim of this study was to develop an Italian translation of the last version of the Psychosocial Assessment Tool questionnaire (PAT 3.1) and to pilot-test it among pediatric oncological families. The guidelines for cross-cultural adaptation of health-related quality of life measures were followed. Specifically, two independent forward translations were produced, followed by a reconciliation step by a multidisciplinary expert committee and back-translation. Revision of the original text and all translations were performed by the expert committee leading to a final version, which was pilot-tested by cognitive debriefing on five families. Subsequently, the final Italian PAT 3.1 version was approved.

Results: The Italian version of the PAT 3.1 generated in the present study is a useful instrument to examine the psychosocial risk of the families with a child with cancer.

Conclusions: This instrument will be a valuable tool for future clinical trials and it will help clinicians to target specific pediatric psychology support intervention. The questionnaire will be further validated through a multicenter Italian study on psychosocial screening of pediatric oncology and pediatric general diseases.

简介与儿科肿瘤诊断相关的经历会导致家庭结构严重失衡。从社会心理角度评估患癌家庭和患癌儿童的弱点和需求,是提供适当儿科心理治疗的重要一步:本研究的目的是开发社会心理评估工具问卷(PAT 3.1)最新版本的意大利语译本,并在儿科肿瘤家庭中进行试点测试。研究遵循了健康相关生活质量测量的跨文化适应指南。具体来说,首先制作了两份独立的正向译文,然后由一个多学科专家委员会进行调和并进行回译。专家委员会对原文和所有译文进行修订,最终形成最终版本,并通过对五个家庭的认知汇报进行了试点测试。随后,意大利语 PAT 3.1 最终版本获得批准:结果:本研究中产生的意大利语版 PAT 3.1 是一种有用的工具,可用于检查癌症患儿家庭的社会心理风险:该工具将成为未来临床试验的重要工具,并将帮助临床医生有针对性地采取儿科心理支持干预措施。该问卷将通过意大利一项关于儿科肿瘤和儿科普通疾病社会心理筛查的多中心研究得到进一步验证。
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引用次数: 0
Efficacy and safety of induction chemotherapy in oral cavity cancer: An eight-year experience at a Portuguese reference center. 口腔癌诱导化疗的有效性和安全性:葡萄牙参考中心的八年经验。
IF 2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-06-02 DOI: 10.1177/03008916241257099
João Barbosa-Martins, Ana Rolo, Bárbara Lima, José Carlos Pereira, Cláudia Araújo, Jorge Guimarães, José Dinis, Cláudia Vieira

Background: Induction chemotherapy has been described as an option in locally advanced oral cavity squamous cell carcinoma when the surgical morbidity is expected to be high. This work aimed to evaluate the outcome and safety of induction chemotherapy in this setting.

Methods: We performed a retrospective and observational study including patients with oral cavity squamous cell carcinoma, treated with induction chemotherapy between January 2010 and December 2018. Outcomes included induction chemotherapy toxicity, treatment response, disease-free survival and overall survival.

Results: A total of 108 oral cavity squamous cell carcinoma patients were included. Ninety-six (88.9%) had stage IV disease, while 12 (11.1%) had stage III. Eighty-four patients (80.8%) achieved at least a partial response to induction chemotherapy at clinical evaluation, and 75 (72.1%) at radiological evaluation. Seventy-eight patients have been proposed for subsequent definitive treatments, with no differences obtained in prognosis, when comparing surgical to non-surgical approaches. In patients treated with definitive treatments, improved five-year disease-free survival was obtained if at least a clinical (56.3%; p=0.001) or radiological (52.9%; p=0.001) partial response was achieved after induction chemotherapy. Similarly, superior five-year overall survival was verified for those achieving at least clinical (51.1%; p<0.0001) or radiological (52.6%; p=0.001) partial response. Also, accomplishing a pathologic complete response (n=22.6%) significantly improved disease-free survival (p=0.039) and overall survival (p=0.005). Grade 3 and 4 toxicities were observed in 52 patients (41.8%).

Conclusion: Responses to induction chemotherapy predicted prognosis in our population, however important toxicities were observed. Further studies are necessary to identify induction chemotherapy response predictors and subgroups who may benefit from this approach.

背景:诱导化疗被认为是局部晚期口腔鳞状细胞癌的一种选择,因为预计手术发病率较高。这项研究旨在评估这种情况下诱导化疗的效果和安全性:我们进行了一项回顾性观察研究,研究对象包括2010年1月至2018年12月期间接受诱导化疗的口腔鳞癌患者。结果包括诱导化疗毒性、治疗反应、无病生存率和总生存率:共纳入108名口腔鳞癌患者。96例(88.9%)为IV期,12例(11.1%)为III期。84名患者(80.8%)在临床评估中至少对诱导化疗取得了部分反应,75名患者(72.1%)在放射评估中取得了部分反应。78名患者被建议接受后续的确定性治疗,手术和非手术治疗方法的预后没有差异。在接受确定性治疗的患者中,如果在诱导化疗后至少获得了临床部分反应(56.3%;p=0.001)或放射学部分反应(52.9%;p=0.001),则五年无病生存率会提高。同样,至少获得临床部分反应(51.1%;P=0.001)的患者的五年总生存率也更高:对诱导化疗的反应可预测本研究人群的预后,但也观察到了重要的毒性反应。有必要开展进一步研究,以确定诱导化疗反应预测因素和可能从这种方法中获益的亚组。
{"title":"Efficacy and safety of induction chemotherapy in oral cavity cancer: An eight-year experience at a Portuguese reference center.","authors":"João Barbosa-Martins, Ana Rolo, Bárbara Lima, José Carlos Pereira, Cláudia Araújo, Jorge Guimarães, José Dinis, Cláudia Vieira","doi":"10.1177/03008916241257099","DOIUrl":"10.1177/03008916241257099","url":null,"abstract":"<p><strong>Background: </strong>Induction chemotherapy has been described as an option in locally advanced oral cavity squamous cell carcinoma when the surgical morbidity is expected to be high. This work aimed to evaluate the outcome and safety of induction chemotherapy in this setting.</p><p><strong>Methods: </strong>We performed a retrospective and observational study including patients with oral cavity squamous cell carcinoma, treated with induction chemotherapy between January 2010 and December 2018. Outcomes included induction chemotherapy toxicity, treatment response, disease-free survival and overall survival.</p><p><strong>Results: </strong>A total of 108 oral cavity squamous cell carcinoma patients were included. Ninety-six (88.9%) had stage IV disease, while 12 (11.1%) had stage III. Eighty-four patients (80.8%) achieved at least a partial response to induction chemotherapy at clinical evaluation, and 75 (72.1%) at radiological evaluation. Seventy-eight patients have been proposed for subsequent definitive treatments, with no differences obtained in prognosis, when comparing surgical to non-surgical approaches. In patients treated with definitive treatments, improved five-year disease-free survival was obtained if at least a clinical (56.3%; p=0.001) or radiological (52.9%; p=0.001) partial response was achieved after induction chemotherapy. Similarly, superior five-year overall survival was verified for those achieving at least clinical (51.1%; p<0.0001) or radiological (52.6%; p=0.001) partial response. Also, accomplishing a pathologic complete response (n=22.6%) significantly improved disease-free survival (p=0.039) and overall survival (p=0.005). Grade 3 and 4 toxicities were observed in 52 patients (41.8%).</p><p><strong>Conclusion: </strong>Responses to induction chemotherapy predicted prognosis in our population, however important toxicities were observed. Further studies are necessary to identify induction chemotherapy response predictors and subgroups who may benefit from this approach.</p>","PeriodicalId":23349,"journal":{"name":"Tumori","volume":" ","pages":"340-347"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141199359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Quality assurance for cancer patient safety: Clinical assessment for precise angles in linac during radiation therapy. 癌症患者安全的质量保证:在放射治疗过程中对直列加速器的精确角度进行临床评估。
IF 2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-02 DOI: 10.1177/03008916241261450
Sana Salahuddin, Saeed Ahmad Buzdar, Khalid Iqbal, Muhammad Adeel Azam, Mamona Aslam, Saima Altaf, Ayesha Ikhlaq, Muhammad Usman Mustafa, Lidia Strigari

Purpose: Quality assurance for stereotactic body radiation treatment requires that isocentric verification be ensured during gantry rotation at various angles. This study examined statistical parameters on Winston-Lutz tests to distinguish the deviation of angles from isocenter during gantry rotation using machine learning.

Method: The Varian TrueBeam linac was aligned with the marked lines on the Ruby phantom. Eight images were captured while the gantry was rotating at a 45° shift. The statistical features were derived from IsoCheck EPID software. The decision tree model was applied to these Winston-Lutz tests to cluster data into two groups: precise and error angles.

Results: At 90° and 270° angles, the gantry exhibits isocentric stability compared to other angles. In these angles, the most statistical features were inside the range. Most variations were observed at 0° and 180° angles. In most tests, the angles 45°, 135°, 225°, and 315° showed reasonable performance and with less variation.

Conclusion: The comprehensive statistical analyses for gantry rotation of angles assists expert radiotherapists in determining the contribution of each feature that highly affects gantry movement at specific angles. Misalignment between radiation isocenter and imaging isocenter, tuning of the beam at each angle, or a slight change in the position of the Ruby phantom can further improve the inaccuracy that causes the most variations. Better precision can effectively increase patient safety and quality during cancer treatment.

目的:立体定向体放射治疗的质量保证要求在龙门架旋转过程中以不同角度确保等中心验证。本研究利用机器学习方法,对温斯顿-鲁兹测试的统计参数进行了研究,以区分龙门旋转过程中偏离等中心的角度:方法:将瓦里安 TrueBeam 直列加速器与 Ruby 模型上的标记线对齐。在龙门旋转 45° 时拍摄八张图像。统计特征来自 IsoCheck EPID 软件。决策树模型应用于这些温斯顿-鲁兹测试,将数据分为两组:精确角度和误差角度:与其他角度相比,在 90° 和 270° 角度,龙门架表现出等中心稳定性。在这些角度中,大多数统计特征都在范围之内。在 0° 和 180° 角上观察到的变化最多。在大多数测试中,45°、135°、225° 和 315°角表现合理,变化较小:对龙门架旋转角度的综合统计分析有助于放射治疗专家确定在特定角度下对龙门架移动影响较大的每个特征的作用。辐射等中心和成像等中心之间的不对齐、每个角度的光束调整或红宝石模型位置的轻微变化,都能进一步改善造成最大差异的不准确性。更高的精确度可以有效提高癌症治疗过程中的患者安全和质量。
{"title":"Quality assurance for cancer patient safety: Clinical assessment for precise angles in linac during radiation therapy.","authors":"Sana Salahuddin, Saeed Ahmad Buzdar, Khalid Iqbal, Muhammad Adeel Azam, Mamona Aslam, Saima Altaf, Ayesha Ikhlaq, Muhammad Usman Mustafa, Lidia Strigari","doi":"10.1177/03008916241261450","DOIUrl":"10.1177/03008916241261450","url":null,"abstract":"<p><strong>Purpose: </strong>Quality assurance for stereotactic body radiation treatment requires that isocentric verification be ensured during gantry rotation at various angles. This study examined statistical parameters on Winston-Lutz tests to distinguish the deviation of angles from isocenter during gantry rotation using machine learning.</p><p><strong>Method: </strong>The Varian TrueBeam linac was aligned with the marked lines on the Ruby phantom. Eight images were captured while the gantry was rotating at a 45° shift. The statistical features were derived from IsoCheck EPID software. The decision tree model was applied to these Winston-Lutz tests to cluster data into two groups: precise and error angles.</p><p><strong>Results: </strong>At 90° and 270° angles, the gantry exhibits isocentric stability compared to other angles. In these angles, the most statistical features were inside the range. Most variations were observed at 0° and 180° angles. In most tests, the angles 45°, 135°, 225°, and 315° showed reasonable performance and with less variation.</p><p><strong>Conclusion: </strong>The comprehensive statistical analyses for gantry rotation of angles assists expert radiotherapists in determining the contribution of each feature that highly affects gantry movement at specific angles. Misalignment between radiation isocenter and imaging isocenter, tuning of the beam at each angle, or a slight change in the position of the Ruby phantom can further improve the inaccuracy that causes the most variations. Better precision can effectively increase patient safety and quality during cancer treatment.</p>","PeriodicalId":23349,"journal":{"name":"Tumori","volume":" ","pages":"366-374"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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