Pub Date : 2026-01-02DOI: 10.1016/j.lana.2025.101351
Theodore L. Wagener , Alice Hinton , Theodore M. Brasky , Yoo Jin Cho , Laura A. Beebe , Michael S. Businelle , Matthew J. Carpenter , Jonathan Hart , Katrina A. Vickerman
Background
E-cigarettes have emerged as a potentially more effective and satisfying alternative to nicotine replacement therapy (NRT) for smokers who struggle to quit. Although quitlines are effective platforms for tobacco cessation, they have not incorporated e-cigarettes due to regulatory concerns and limited clinical evidence. We evaluated whether quitline-delivered counseling combined with e-cigarettes was more effective than counseling with NRT among adults who recently failed to quit using standard quitline services.
Methods
We conducted a pragmatic, open-label, parallel-group randomised controlled trial with two U.S. state quitlines between October 2020 and January 2023. Adults [N = 350; 212 (61%) female & 248 (72%) white] who were still smoking after a recent quitline enrollment were randomised (1:1) to receive 8 weeks of either JUUL e-cigarettes or a combination of nicotine patch and lozenge, along with three counseling calls. The primary outcome was biochemically verified 7-day point prevalence smoking abstinence (7-day PPA) at 8 weeks. Analyses used an intent-to-treat approach; secondary outcomes included 12-week abstinence, prolonged abstinence, changes in smoking behavior, dependence, and adverse effects.
Findings
At 8 weeks, 7-day PPA did not differ significantly between e-cigarette and NRT groups [25 (14.3%) of 175 and 17 (9.7%) of 175, respectively; OR 1.56; 95% CI 0.80–3.04; p = 0.19]. Both groups showed similar reductions in cigarette use and dependence. Adherence to counseling and assigned products was high. Adverse events were generally mild; cough and breathing difficulties were more frequently reported in the e-cigarette group and NRT participants reported more dizziness, sleeplessness, and allergies.
Interpretation
Among quitline users with a recent failed quit attempt, e-cigarettes combined with quitline counseling were not more effective than combination NRT in increasing smoking abstinence after 8 weeks’ follow-up.
Funding
U.S. National Institute on Drug Abuse.
对于那些努力戒烟的人来说，de -香烟已经成为尼古丁替代疗法（NRT）潜在的更有效、更令人满意的替代品。虽然戒烟热线是戒烟的有效平台，但由于监管方面的考虑和有限的临床证据，它们并没有纳入电子烟。我们评估了在最近使用标准戒烟热线服务戒烟失败的成年人中，戒烟热线提供的咨询与电子烟结合是否比NRT更有效。方法：我们在2020年10月至2023年1月期间对美国两条州戒烟线进行了一项实用、开放标签、平行组随机对照试验。成人[N = 350；在最近的戒烟热线登记后，仍在吸烟的212名（61%）女性（248名（72%）白人）被随机分成（1:1）组，接受8周的JUUL电子烟或尼古丁贴片和锭剂的组合，同时还有3个咨询电话。主要终点是8周时经生化验证的7天点流行戒烟（7天PPA）。分析采用意向治疗法；次要结局包括12周戒烟、长期戒烟、吸烟行为的改变、依赖和不良反应。结果发现，在8周，7天的PPA在电子烟组和NRT组之间没有显著差异[175人中分别有25人（14.3%）和17人（9.7%）；或1.56;95% ci 0.80-3.04；P = 0.19]。两组人在吸烟和对香烟的依赖方面都有相似的减少。对咨询和指定产品的依从性很高。不良事件一般轻微；电子烟组更频繁地报告咳嗽和呼吸困难，NRT参与者报告更多的头晕、失眠和过敏。解释：在最近戒烟失败的戒烟热线使用者中，经过8周的随访，电子烟联合戒烟热线咨询在增加戒烟方面并不比联合NRT更有效。国家药物滥用研究所。
{"title":"E-cigarettes versus combination nicotine replacement therapy following a recent failed quit attempt: a pragmatic randomized trial through state tobacco quitlines","authors":"Theodore L. Wagener , Alice Hinton , Theodore M. Brasky , Yoo Jin Cho , Laura A. Beebe , Michael S. Businelle , Matthew J. Carpenter , Jonathan Hart , Katrina A. Vickerman","doi":"10.1016/j.lana.2025.101351","DOIUrl":"10.1016/j.lana.2025.101351","url":null,"abstract":"<div><h3>Background</h3><div>E-cigarettes have emerged as a potentially more effective and satisfying alternative to nicotine replacement therapy (NRT) for smokers who struggle to quit. Although quitlines are effective platforms for tobacco cessation, they have not incorporated e-cigarettes due to regulatory concerns and limited clinical evidence. We evaluated whether quitline-delivered counseling combined with e-cigarettes was more effective than counseling with NRT among adults who recently failed to quit using standard quitline services.</div></div><div><h3>Methods</h3><div>We conducted a pragmatic, open-label, parallel-group randomised controlled trial with two U.S. state quitlines between October 2020 and January 2023. Adults [N = 350; 212 (61%) female & 248 (72%) white] who were still smoking after a recent quitline enrollment were randomised (1:1) to receive 8 weeks of either JUUL e-cigarettes or a combination of nicotine patch and lozenge, along with three counseling calls. The primary outcome was biochemically verified 7-day point prevalence smoking abstinence (7-day PPA) at 8 weeks. Analyses used an intent-to-treat approach; secondary outcomes included 12-week abstinence, prolonged abstinence, changes in smoking behavior, dependence, and adverse effects.</div></div><div><h3>Findings</h3><div>At 8 weeks, 7-day PPA did not differ significantly between e-cigarette and NRT groups [25 (14.3%) of 175 and 17 (9.7%) of 175, respectively; OR 1.56; 95% CI 0.80–3.04; p = 0.19]. Both groups showed similar reductions in cigarette use and dependence. Adherence to counseling and assigned products was high. Adverse events were generally mild; cough and breathing difficulties were more frequently reported in the e-cigarette group and NRT participants reported more dizziness, sleeplessness, and allergies.</div></div><div><h3>Interpretation</h3><div>Among quitline users with a recent failed quit attempt, e-cigarettes combined with quitline counseling were not more effective than combination NRT in increasing smoking abstinence after 8 weeks’ follow-up.</div></div><div><h3>Funding</h3><div>U.S. <span>National Institute on Drug Abuse</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101351"},"PeriodicalIF":7.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.lana.2025.101359
George Dewey , Austin G. Meyer , Raul Garrido Garcia , Mauricio Santillana
Background
Influenza and respiratory syncytial virus (RSV) are major contributors to the burden of seasonal influenza-like illnesses (ILI) in the US. The prevention and treatment of ILI varies substantially across age groups and in cost and administration schedule. This study aimed to characterize the timing and ordering of RSV, influenza, and COVID-19 epidemics in the post-pandemic period to inform public health preparedness.
Methods
We implemented a series of independent regression models to infer the contribution of each of these diseases to seasonal ILI syndromic indicators. We further implemented anomaly-detection algorithms on data from the US Centers for Disease Control and Prevention National Syndromic Surveillance Program for the 2022–23, 2023–24, and 2024–25 ILI seasons to identify the timing of onsets and peaks of RSV, influenza, and COVID-19.
Findings
A total of 148 state-ILI seasons were analyzed. In 114 out of 148 (77.0%) of analyzed seasons, volume of RSV emergency department (ED) visits peaked before influenza ED visits. The median time difference between peaks of RSV and peaks of influenza was +3.0 weeks (95% percentile range: −7.0, +7.0 weeks; interquartile range: 5.0 weeks). The timing of RSV and influenza onsets were found to occur more synchronously in the 2023–2024 and 2024–2025 ILI seasons. The timing of COVID-19 outbreaks did not show a consistent seasonal pattern across the study period.
Interpretation
RSV epidemics frequently reach peak volume before influenza epidemics across the US. Healthcare professionals and public health authorities should anticipate increases in RSV cases and hospitalizations at the start of the annual ILI season and establish infrastructure and planning to handle incoming surges of both RSV and influenza appropriately.
Funding
CDC Center for Forecasting and Outbreak Analytics; National Institutes of Health.
{"title":"Uncovering the post-pandemic timing of influenza, RSV, and COVID-19 driving seasonal influenza-like illness in the United States: a retrospective ecological study","authors":"George Dewey , Austin G. Meyer , Raul Garrido Garcia , Mauricio Santillana","doi":"10.1016/j.lana.2025.101359","DOIUrl":"10.1016/j.lana.2025.101359","url":null,"abstract":"<div><h3>Background</h3><div>Influenza and respiratory syncytial virus (RSV) are major contributors to the burden of seasonal influenza-like illnesses (ILI) in the US. The prevention and treatment of ILI varies substantially across age groups and in cost and administration schedule. This study aimed to characterize the timing and ordering of RSV, influenza, and COVID-19 epidemics in the post-pandemic period to inform public health preparedness.</div></div><div><h3>Methods</h3><div>We implemented a series of independent regression models to infer the contribution of each of these diseases to seasonal ILI syndromic indicators. We further implemented anomaly-detection algorithms on data from the US Centers for Disease Control and Prevention National Syndromic Surveillance Program for the 2022–23, 2023–24, and 2024–25 ILI seasons to identify the timing of onsets and peaks of RSV, influenza, and COVID-19.</div></div><div><h3>Findings</h3><div>A total of 148 state-ILI seasons were analyzed. In 114 out of 148 (77.0%) of analyzed seasons, volume of RSV emergency department (ED) visits peaked before influenza ED visits. The median time difference between peaks of RSV and peaks of influenza was +3.0 weeks (95% percentile range: −7.0, +7.0 weeks; interquartile range: 5.0 weeks). The timing of RSV and influenza onsets were found to occur more synchronously in the 2023–2024 and 2024–2025 ILI seasons. The timing of COVID-19 outbreaks did not show a consistent seasonal pattern across the study period.</div></div><div><h3>Interpretation</h3><div>RSV epidemics frequently reach peak volume before influenza epidemics across the US. Healthcare professionals and public health authorities should anticipate increases in RSV cases and hospitalizations at the start of the annual ILI season and establish infrastructure and planning to handle incoming surges of both RSV and influenza appropriately.</div></div><div><h3>Funding</h3><div>CDC <span>Center for Forecasting and Outbreak Analytics</span>; <span>National Institutes of Health</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101359"},"PeriodicalIF":7.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.lana.2025.101364
The Lancet Regional Health – Americas
{"title":"A new era for RSV: the end in sight?","authors":"The Lancet Regional Health – Americas","doi":"10.1016/j.lana.2025.101364","DOIUrl":"10.1016/j.lana.2025.101364","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101364"},"PeriodicalIF":7.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-31DOI: 10.1016/j.lana.2025.101347
Abelardo Q.C. Araujo , Marcus Tulius T. Silva
Human T-lymphotropic virus type 1 (HTLV-1) has long been linked mainly to HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). However, four decades of research show that the virus causes a much broader range of neurological conditions. In Latin America and the Caribbean—regions with high prevalence but limited awareness, diagnostic capacity, and treatment—its burden is especially severe. Misdiagnosis or neglect often delays care, leading to increased disability and emotional distress. This Personal View highlights the expanding neurological spectrum of HTLV-1, which includes rare but well-documented encephalopathy, cognitive decline, peripheral neuropathy, inflammatory myopathy, cerebellar dysfunction, autonomic disorders, motor neuron disease-like syndromes, and seizures. These can happen independently or alongside HAM/TSP. The proposed concept of an “HTLV-1 neurological complex” better represents this multifaceted involvement. Recognising this diversity is essential for accurate diagnosis and better outcomes, particularly in endemic settings. A paradigm shift is needed—one that broadens the clinical focus beyond myelopathy to encompass the full neurological spectrum, thereby improving global care and management.
{"title":"Expanding the neurological spectrum of HTLV-1 beyond HAM/TSP: a contemporary perspective","authors":"Abelardo Q.C. Araujo , Marcus Tulius T. Silva","doi":"10.1016/j.lana.2025.101347","DOIUrl":"10.1016/j.lana.2025.101347","url":null,"abstract":"<div><div>Human T-lymphotropic virus type 1 (HTLV-1) has long been linked mainly to HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). However, four decades of research show that the virus causes a much broader range of neurological conditions. In Latin America and the Caribbean—regions with high prevalence but limited awareness, diagnostic capacity, and treatment—its burden is especially severe. Misdiagnosis or neglect often delays care, leading to increased disability and emotional distress. This Personal View highlights the expanding neurological spectrum of HTLV-1, which includes rare but well-documented encephalopathy, cognitive decline, peripheral neuropathy, inflammatory myopathy, cerebellar dysfunction, autonomic disorders, motor neuron disease-like syndromes, and seizures. These can happen independently or alongside HAM/TSP. The proposed concept of an “HTLV-1 neurological complex” better represents this multifaceted involvement. Recognising this diversity is essential for accurate diagnosis and better outcomes, particularly in endemic settings. A paradigm shift is needed—one that broadens the clinical focus beyond myelopathy to encompass the full neurological spectrum, thereby improving global care and management.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101347"},"PeriodicalIF":7.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-30DOI: 10.1016/j.lana.2025.101355
Garrett Keim , Paula Magee , Cody Gathers , Anireddy R. Reddy , Charlotte Z. Woods-Hill , Nadir Yehya
Background
Disparities in pediatric critical care outcomes are recognized, but national data describing Pediatric Acute Respiratory Distress Syndrome (PARDS) prevalence, mortality and temporal trends are limited. We described prevalence, and regional and racial/ethnic mortality disparities for algorithm-defined ARDS, a surrogate for PARDS in US children from 2016 to 2022.
Methods
We performed a retrospective cohort study using the 2016, 2019, and 2022 Kids' Inpatient Database (KID). Algorithm-defined ARDS was identified with an ICD-10 approach requiring acute respiratory failure from pulmonary, sepsis, or shock etiologies requiring invasive mechanical ventilation ≥24 h. The primary outcome was in-hospital mortality. Exposures were US region and Race/Ethnicity, modeled individually and jointly. Mixed-effect logistic regression models, adjusting for income quartile, APR-DRG severity of illness, hospital type, and complex chronic conditions, estimated adjusted mortalities and risk differences.
Findings
Algorithm-defined ARDS occurred in about 42,000 hospitalizations per year, with prevalence increasing from 0.68% (95% CI 0.67–0.69) in 2016 to 0.75% (0.74–0.75) in 2022. Overall mortality was 12.9% (12.5–13.3) in 2016, 12.5% (12.1–12.9) in 2019, and 13.7% (13.3–14.1) in 2022. In the joint model, relative to Northeastern White children (predicted 10.9%, 95% CI 9.72–12.1), risks were higher for Black children in the South (predicted 14.2%, ARD 3.27%, 1.74–4.79) and West (14.6%, ARD 3.69%, 1.39–6.00); Hispanic children in the West (12.6%, ARD 1.70%, 0.09–3.31), and children of Other race/ethnicity in the South (16.5%, ARD 5.57%, 3.14–7.99) and West (14.0%, ARD 3.11%, 0.96–5.25). Disparities did not meaningfully change from 2016 to 2019, while mortality increased from 2019 to 2022.
Interpretation
Algorithm-defined ARDS among hospitalized US children remains common and highly fatal. Persistent regional and racial/ethnic disparities highlight systemic drivers of inequity and the need for targeted interventions.
Funding
This work was supported by the National Heart, Lung, and Blood Institute, National Institutes of Health (Award K23HL177271, PI: Keim).
背景：儿童重症监护结果的差异是公认的，但描述儿童急性呼吸窘迫综合征（PARDS）患病率、死亡率和时间趋势的国家数据是有限的。我们描述了2016年至2022年美国儿童中算法定义的ARDS （PARDS的替代方法）的患病率、地区和种族/民族死亡率差异。方法采用2016年、2019年和2022年儿童住院患者数据库（KID）进行回顾性队列研究。通过ICD-10方法确定算法定义的ARDS，要求肺部、败血症或休克病因引起的急性呼吸衰竭需要有创机械通气≥24小时。主要结局是院内死亡率。暴露是美国地区和种族/民族，单独和联合建模。混合效应logistic回归模型，调整了收入四分位数、疾病的APR-DRG严重程度、医院类型和复杂慢性病，估计了调整后的死亡率和风险差异。算法定义的ARDS发生在每年约42,000例住院患者中，患病率从2016年的0.68% （95% CI 0.67-0.69）增加到2022年的0.75%（0.74-0.75）。2016年总死亡率为12.9%(12.5-13.3)，2019年为12.5%(12.1-12.9)，2022年为13.7%（13.3-14.1）。在联合模型中，相对于东北部白人儿童（预测10.9%,95% CI 9.72-12.1），南部黑人儿童（预测14.2%,ARD 3.27%, 1.74-4.79）和西部黑人儿童（14.6%,ARD 3.69%, 1.39-6.00）的风险更高；西部的西班牙裔儿童（12.6%,ARD 1.70%, 0.09-3.31），南部（16.5%,ARD 5.57%, 3.14-7.99）和西部（14.0%,ARD 3.11%, 0.96-5.25）的其他种族/族裔儿童。从2016年到2019年，差距没有显著变化，而死亡率从2019年到2022年有所上升。解释算法定义的急性呼吸窘迫综合征在美国住院儿童中仍然很常见且高度致命。持续存在的区域和种族/族裔差异突出了不平等的系统性驱动因素和有针对性干预措施的必要性。本研究得到了美国国立卫生研究院国家心肺血液研究所的支持（编号：K23HL177271， PI: Keim）。
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Pub Date : 2025-12-29DOI: 10.1016/j.lana.2025.101360
Thiago Cerqueira-Silva , Felipe Argolo , Gabriel Gonçalves da Costa , Felipe Nogueira Barbara , Pedro Hallal , Bruno Gualano
{"title":"Uncovering the biases: why the claimed mask–excess mortality link fails to hold","authors":"Thiago Cerqueira-Silva , Felipe Argolo , Gabriel Gonçalves da Costa , Felipe Nogueira Barbara , Pedro Hallal , Bruno Gualano","doi":"10.1016/j.lana.2025.101360","DOIUrl":"10.1016/j.lana.2025.101360","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101360"},"PeriodicalIF":7.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-29DOI: 10.1016/j.lana.2025.101352
Caineng Cao , Teeradon Treechairusame , Amir H. Safavi , Yingzhi Wu , Zhigang Zhang , Achraf Shamseddine , Yao Yu , Nadeem Riaz , Daphna Y. Gelblum , Sean M. McBride , Alan L. Ho , Winston Wong , Lara A. Dunn , Loren Scott Michel , Eric J. Sherman , Nancy Y. Lee
Background
Intensity-modulated proton therapy (IMPT) is associated with fewer acute toxicities compared with intensity-modulated radiotherapy (IMRT) in definitive treatment of nonmetastatic nasopharyngeal carcinoma (NPC). Longer term efficacy and safety data are warranted to appraise the comparative benefit of IMPT for this population. The aim of this study was to evaluate the long-term toxicity and survival outcomes of NPC treated with IMPT vs IMRT at a tertiary academic cancer center during 2016–2022.
Methods
Sixty-seven (42.1%) cases treated by IMPT, and 92 (57.9%) controls treated by IMRT were included.
Findings
The median follow-up time was 55.4 months (interquartile range [IQR], 32.1–73.8 months). The incidence of any grade 2+ acute toxicity was lower with IMPT than IMRT (86.6% vs 97.8%, p = 0.009). Based on the logistic regression analysis, radiotherapy modality (IMRT vs IMPT) was significantly associated with developing any grade 2+ acute toxicity (odds ratio, 0.177; 95% confidence interval 0.035–0.886; p = 0.035). The incidence of grade 2+ late toxicity was not significantly different (p > 0.05) following IMPT (40.3%) and IMRT (52.7%). There were no statistically significant differences following IMRT and IMPT in 5-year cumulative incidence of local or regional failures [16.4% (9.1–25.6) vs 14.1% (6.5–24.7)], progression free survival and overall survival.
Interpretation
Although there were no statistically significant differences in incidence of late toxicities or oncologic outcomes, IMPT was associated with lower incidence of acute toxicity in comparison with IMRT.
Funding
This research was funded in part through the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748.
背景：在非转移性鼻咽癌（NPC）的最终治疗中，与调强放疗（IMRT）相比，调强质子治疗（IMPT）的急性毒性更小。需要长期疗效和安全性数据来评估IMPT对这一人群的相对获益。本研究的目的是评估2016-2022年在三级学术癌症中心接受IMPT与IMRT治疗的鼻咽癌的长期毒性和生存结果。方法采用IMPT治疗67例（42.1%），对照组92例（57.9%）。中位随访时间为55.4个月（四分位数间距32.1-73.8个月）。IMPT组任何2+级急性毒性发生率均低于IMRT组（86.6% vs 97.8%, p = 0.009）。根据logistic回归分析，放疗方式（IMRT vs IMPT）与发生任何2+级急性毒性显著相关（优势比0.177；95%可信区间0.035 - 0.886;p = 0.035）。IMPT组（40.3%）和IMRT组（52.7%）2+级晚期毒性发生率无显著差异（p > 0.05）。IMRT和IMPT在5年累积局部或区域失败发生率[16.4% (9.1-25.6)vs 14.1%(6.5-24.7)]、无进展生存期和总生存期方面无统计学差异。尽管在晚期毒性发生率或肿瘤预后方面没有统计学上的显著差异，但与IMRT相比，IMPT的急性毒性发生率较低。本研究部分由美国国立卫生研究院/国家癌症研究所癌症中心支持基金P30 CA008748资助。
{"title":"Intensity-modulated proton therapy vs intensity-modulated radiotherapy in nasopharyngeal carcinoma: a case–control study","authors":"Caineng Cao , Teeradon Treechairusame , Amir H. Safavi , Yingzhi Wu , Zhigang Zhang , Achraf Shamseddine , Yao Yu , Nadeem Riaz , Daphna Y. Gelblum , Sean M. McBride , Alan L. Ho , Winston Wong , Lara A. Dunn , Loren Scott Michel , Eric J. Sherman , Nancy Y. Lee","doi":"10.1016/j.lana.2025.101352","DOIUrl":"10.1016/j.lana.2025.101352","url":null,"abstract":"<div><h3>Background</h3><div>Intensity-modulated proton therapy (IMPT) is associated with fewer acute toxicities compared with intensity-modulated radiotherapy (IMRT) in definitive treatment of nonmetastatic nasopharyngeal carcinoma (NPC). Longer term efficacy and safety data are warranted to appraise the comparative benefit of IMPT for this population. The aim of this study was to evaluate the long-term toxicity and survival outcomes of NPC treated with IMPT vs IMRT at a tertiary academic cancer center during 2016–2022.</div></div><div><h3>Methods</h3><div>Sixty-seven (42.1%) cases treated by IMPT, and 92 (57.9%) controls treated by IMRT were included.</div></div><div><h3>Findings</h3><div>The median follow-up time was 55.4 months (interquartile range [IQR], 32.1–73.8 months). The incidence of any grade 2+ acute toxicity was lower with IMPT than IMRT (86.6% vs 97.8%, p = 0.009). Based on the logistic regression analysis, radiotherapy modality (IMRT vs IMPT) was significantly associated with developing any grade 2+ acute toxicity (odds ratio, 0.177; 95% confidence interval 0.035–0.886; p = 0.035). The incidence of grade 2+ late toxicity was not significantly different (p > 0.05) following IMPT (40.3%) and IMRT (52.7%). There were no statistically significant differences following IMRT and IMPT in 5-year cumulative incidence of local or regional failures [16.4% (9.1–25.6) vs 14.1% (6.5–24.7)], progression free survival and overall survival.</div></div><div><h3>Interpretation</h3><div>Although there were no statistically significant differences in incidence of late toxicities or oncologic outcomes, IMPT was associated with lower incidence of acute toxicity in comparison with IMRT.</div></div><div><h3>Funding</h3><div>This research was funded in part through the <span>National Institutes of Health</span>/<span>National Cancer Institute Cancer Center</span> Support Grant <span><span>P30 CA008748</span></span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101352"},"PeriodicalIF":7.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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