Journal of cancer research and therapeutics最新文献

Background: The management of residual nodules after video-assisted thoracoscopic surgery (VATS) for multiple pulmonary nodules (MPNs) is challenging. Microwave ablation (MWA), which is highly repeatable and minimally invasive, has garnered widespread attention in the treatment of MPNs.

Methods: Ninety-one patients with MPNs who underwent VATS for resection of high-risk nodules followed by MWA for residual nodules were examined. Clinical efficacy and complications were assessed. The primary end points were MWA success rate and complete ablation rate. Secondary end points were local progression-free survival (LPFS), overall survival (OS), and complications.

Results: MWA was successfully completed in all patients. Mean tumor diameter, ablation time, and ablation output power were 0.81 cm, 3.4 minutes, and 39 W, respectively. LPFS was 100% at 3, 6, 12, and 24 months, respectively. OS was 100% at 12 and 24 months, respectively. No intraoperative or postoperative deaths occurred. Complications with MWA were infrequent. Pneumothorax was most common, occurring in 31 patients (34.07%); among these, seven (7.69%) required closed thoracic drainage. Pleural effusion occurred in six patients (6.59%), hydropneumothorax in five (5.49%), and pneumonia in three (3.30%). The pain level after MWA was moderate-to-severe in 29 patients (31.87%).

Conclusion: MWA is safe and feasible for treating residual nodules in patients with MPNs who have undergone VATS. The incidence of complications was low, and most complications were mild.

Abstract: Adenoid basal carcinoma of the uterine cervix is a rare epithelial neoplasm. Adenoid basal carcinoma constitutes less than 1% of all cervical adenocarcinomas and has a favorable prognosis. Adenoid basal carcinoma is assumed to arise from a multipotential basal or reserve cell layer in the cervical epithelium. We report a case of adenoid basal carcinoma of the uterine cervix with complaints of bleeding per vagina in a 40-year-old female. The carbohydrate antigen 125 level was elevated (100 U/ml), and the MRI abdomen and pelvis revealed increased signal intensity in the anterior lip of the cervix. The local examination revealed thickening of the anterior lip of the cervix and induration in the left fornix. The patient was diagnosed with carcinoma cervix stage IB2 (FIGO Stage). The patient was operated by a radical robotic hysterectomy. Microscopic examination revealed small basaloid tumor cell nests with peripheral cell palisading and microcyst formation. The tumor cells showed p63 immunoreactivity in basaloid tumor cells and were negative for CD117 and S-100P. This tumor should be differentiated from adenoid basal cell hyperplasia, which has a favorable outcome, and adenoid cystic carcinoma, with a dismal course.

Abstract: Cushing's syndromes (CSs) due to the thymic neuroendocrine tumors are rarely seen. Here, a case of ectopic CS originating from an atypical neuroendocrine tumor has been presented. A 49-year-old woman was hospitalized with symptoms of fatigue, chest pressure, dyspnea, muscle weakness, and resistant hypertension. There was marked hyperpigmentation in the whole-body surface suggestive of adrenocorticotropic hormone (ACTH) excess and there were physical features of CS. There was deep hypokalemia. Basal hormone profile, dexamethasone suppression tests, midnight cortisol, and 24-hour urine cortisol levels were suggestive of ectopic CS. The pituitary magnetic resonance imaging revealed a 5 mm cystic lesion and the patient refused inferior petrosal sinus sampling. Thorax computerized tomography showed an anterior mediastinal mass. A fluorodeoxyglucose-positron emission tomography showed the same mediastinal lesion (suvmax: 11.4), and no other tumor focus was detected. There was an aggressive cortisol excess causing acute respiratory distress syndrome, making it difficult to perform the surgery. We immediately started fluconazole and octreotide therapy and were successful in lowering the cortisol level. Then a complete resection of the tumor had been able to be surgically performed and tumor cells showed strong cytoplasmic immunopositivity with ACTH. A definitive diagnosis of "ACTH secreting atypical thymic carcinoid tumor" was rendered based on the histopathological and immunohistochemical features. There was only surrounding vessel invasion, and no lymphoid or other organ metastases were detected. As there were surrounding vessel invasions, a two-cycle regimen cisplatin-etoposide chemotherapy and radiotherapy were employed. After surgical and medical therapy, the cortisol and ACTH levels turned to normal. The patient is in biochemical and clinical remission and has no tumor recurrence yet. Ectopic ACTH-producing thymic carcinoids are rare but life-threatening tumors because of the underlying malignancy and severe hypercortisolemia. It is important to consider this disease and perform appropriate treatment at the right time. Today, surgery is the standard therapeutic modality if it is possible to perform, but there is not a clear and constant recommendation for nonsurgical therapeutic modalities. Further studies are needed for the optimal treatment strategies.

Objectives: Medullary thyroid carcinoma (MTC) accounts for only about 5% of total thyroid cancers. It usually presents as an advanced disease carrying a poor prognosis than well-differentiated thyroid cancers. While the treatment of choice is surgery, the role of adjuvant radiotherapy is still unclear. This retrospective study aims to understand the role of adjuvant radiotherapy in MTC and its effect on survival.

Materials and methods: We did a retrospective two study to estimate the effect of adjuvant external beam radiotherapy (EBRT) on survival outcomes in MTC. A total of 30 patients who were diagnosed with nonmetastatic MTC during the period 2015 to 2020 were included in the study. Fifteen patients underwent only total thyroidectomy with cervical lymph node dissection. Rest 15 patients received adjuvant EBRT following surgery. A median dose of 60 Gy in 30 fractions, 2 Gy per fraction, 5 days per week, was given by conventional radiotherapy technique. Survival outcomes were estimated using Kaplan-Meier method. A univariate analysis using log rank test was performed to estimate the association of various prognostic factors including age, sex, tumor size, nodal involvement, and surgical resection status on survival outcomes.

Results: Median age of presentation in our study is 47 years (inter quartile range: 36-55 years). Median follow-up time is 4 years. Male to female ratio is 2:3-70% of patients presented with T3 lesions and 77% with N1b disease. There was no significant difference in overall survival (OS) in patients who received adjuvant RT following surgery in comparison to patients who underwent only surgery (92.9% vs. 71.4% P value = 0.202). Similarly, there was no improvement in locoregional recurrence-free survival (LRFS) (100% vs. 85.7%, P value-0.157), Distant metastasis-free survival (DMFS) (64.3% vs. 71.4%, P value = 0.725), and Disease-free survival (DFS) (64.3% vs. 64.3%, P value = 0.91). Age, gender, nodal involvement, and surgical resection status (R0, R1, R2) did not have any effect on survival outcomes. DFS (100% vs. 63.6% P value = 0.008), LRFS (100% vs. 94.7% P value = 0.002), and DMFS (100% vs. 63.2% P value = 0.006) were significantly better in T2 lesions compared to advanced lesions.

Conclusion: Adjuvant EBRT failed to show any significant improvement in survival outcomes and locoregional control in MTC. Further prospective randomized clinical trials are needed to validate the role of EBRT in MTC. Clinicians should proceed with caution before advising adjuvant radiotherapy in MTC and make an informed decision after weighing the pros and cons of giving adjuvant EBRT.

Abstract: In recent years, advances in radiotherapy technology have led to the use of high-precision radiotherapy such as volumetric modulated arc therapy (VMAT). Total body irradiation using VMAT technique (VMAT-TBI) was performed for the first time in our hospital. A 56-year-old male patient diagnosed with B-cell acute lymphoblastic leukemia was performed TBI as pretreatment for haploidentical-related peripheral blood stem-cell transplantation. The prescribed dose was 4 Gy for planning target volume in two fractions. The treatment plan was divided into two plans: upper body and lower body with three and two isocenters, respectively. The overall treatment time with VMAT-TBI was approximately 55 min, and it was not significantly longer than that of moving couch techniques. VMAT-TBI is a less burdensome and more accurate treatment for patients, and it may be a useful treatment for TBI.

Background: It is essential in modern radiotherapy treatment practices to evaluate the quality assurance (QA) of the treatment plan prior to the exclusion of patient from treatment. The typical suitable tools used for patient pretreatment QA are phantoms representing the human anatomy. An anthropomorphic heterogeneous female pelvic (AHFP) phantom has been developed to represent the real female pelvic structure.

Purpose: The objective of the current study is to assess the findings of relative dosimetry carried out utilizing an electronic portal imaging device (EPID) on the AHFP phantom fabricated.

Methods: The planning target volume (PTV) was created on CT slices of an AHFP phantom to confirm the tool's ability to represent female pelvic anatomy and serve as a QA tool. In order to assess the dose received by healthy organs during radiotherapy, organs at risk such as the bladder and rectum were additionally drawn alongside the PTV. Rapid Arc and Intensity modulated radiation therapy (IMRT) were both used to create the treatment plan on treatment planning system, and the Anisotropic Analytical Algorithm Version 11.0.31 was used to calculate the dose.

Results: The results obtained for the average gamma value in RapidArc plans are 0.26, 0.27, and 0.28 (g ≤1) and IMRT plans are 0.39, 0.40, and 0.46 (g ≤1) for target 1, target 2, and target 3, respectively.

Conclusion: According to the findings of the current study, the AHFP phantom was used to explore the potential of relative dosimetry using EPID as a QA tool, which was found to be suitable.

Background: This study aimed to identify the efficacy of increasing the dose of stereotactic body radiotherapy (SBRT) for lung cancer.

Method and materials: Patients who received SBRT for primary lung cancer between 2002 and 2021 were evaluated retrospectively. The patients were categorized into the 48, 50, and 55 Gy groups according to the prescribed dose. Analyses were performed for all matched patients.

Result: A total of 323 patients underwent SBRT for lung lesions at doses of 48, 50, and 55 Gy in four fractions. The median follow-up period in the 55 Gy group (32.3 months; Interquartile range (IQR), 15.1-54.1 months, P = 0.01) was significantly shorter than in the 48 Gy (47.0 months; IQR, 16,2-107.7 months) and 50 Gy (78.9 months; IQR 47.2-104.2 months) groups. The 3-year local progression-free survival (LPFS) was 90% in the 55 Gy group (95% confidence interval (CI), 62.4%-94.0%), 75.7% in the 48 Gy group (62.1%-85.0%), and 79.1% in the 50 Gy group (62.2%-89.1%). LPFS in the 55 Gy group was significantly higher than that in the 48 Gy group (hazard ratio (HR), 0.40; 95% CI, 0.20-0.79; P = 0.025). There is no significant difference in the local control rate between the 55 Gy group and the 50 Gy group (HR 0.60, CI 0.27-1.39). After propensity score matching, the 3-year LPFS in the 55 Gy group was 88.3% (CI, 71.2-95.5%). LPFS in the 55 Gy group did not significantly differ from that of the 48 Gy group (HR, 0.47; CI, 0.17-1.35) and the 50 Gy group (HR, 0.83; CI, 0.28-2.51).

Conclusion: We conducted the analysis using propensity score matching. It was not apparent whether there was a significant difference in the effect of increasing the dose, owing to a lack of power caused by the small number of cases after propensity score matching. A prospective study is in progress, and the results are awaited.

Abstract: Trastuzumab emtansine (T-DM1) is an antibody-drug conjugate of trastuzumab and the cytotoxic agent emtansine (DM1), approved for use as an adjuvant treatment for patients with residual disease after neoadjuvant chemotherapy and antihuman epidermal growth factor receptor 2 (HER-2) therapy and in metastatic HER-2-positive breast cancer. Previous studies have shown that T-DM1 has a favorable safety profile, with few high-grade toxicities reported so far. We describe a patient who developed profound hyponatremia-which has not been reported previously-following treatment with adjuvant T-DM1 for HER-2+ breast cancer.

Objective: There is a lack of evidence to support a consensus on whether surgery or radiotherapy is optimal for elderly or very elderly patients with early-stage non-small cell lung cancer (NSCLC). We aimed to assess the impact of surgery or radiotherapy on survival in elderly (≥70 years) and very elderly (≥80 years) patients with early-stage NSCLC.

Methods: Patients aged ≥70 years diagnosed with early-stage NSCLC between January 1, 1975, and December 31, 2018, were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Overall survival (OS) and cancer-specific survival (CSS) were assessed based on surgery, radiotherapy, and no-treatment groups.

Results: Data for 15,224 NSCLC patients aged ≥70 years were collected, which consisted of 6949 (45.6%) patients who underwent surgery alone, 5014 (32.9%) who underwent radiotherapy alone, and 3261 (21.5%) who received no treatment. Surgery significantly improved patient survival compared with no treatment (MST: 74 months vs. 7 months, HR: 0.201, 95% CI: 0.186-0.217, P < 0.001), as did radiotherapy (MST: 28 months vs. 7 months, HR: 0.440; 95% CI: 0.413-0.469, P < 0.001). Surgery also resulted in improved survival compared with radiotherapy (74 months vs. 28 months, HR: 0.455; 95% CI: 0.430-0.482, P < 0.001). A similar conclusion was made from the analysis of CSS. A subgroup analysis further confirmed the survival benefits.

Conclusions: The results of this large-scale retrospective study indicate that both surgery and radiotherapy significantly enhance survival outcomes in patients aged ≥70 or ≥80 years with early-stage NSCLC. The survival benefits of surgery were particularly notable.

Introduction: Accumulating evidence suggests the significant involvement of GADD45G in the development of various cancers. This study investigates GADD45G's involvement and methylation status in endometrial cancer (EC), along with molecular mechanisms and potential therapies.

Methods: The expression of GADD45G in EC tissues and controls was evaluated using RNA-seq, quantitative real-time polymerase chain reaction (qRT-PCR), and western blotting (WB). Methylation-specific PCR (MSP) evaluated GADD45G's methylation status. Protein-protein interaction (PPI) prediction identified potential interactors of GADD45G, and co-immunoprecipitation (co-IP) confirmed GADD45G interact with Cyclin-dependent kinase 1 (CDK1) and cyclin B1 (CCNB1). Several cell behavior assays were conducted in both in vitro and in vivo settings to comprehensively understand the impact of GADD45G dysregulation in EC.

Results: Our findings revealed a significant decrease in the expression of GADD45G in endometrial cancer tissues and cells, which was attributed to its methylation status. Reduced GADD45G expression correlated with increased invasive behaviors in EC cells. Furthermore, GADD45G negatively regulated CDK1 and CCNB1, promoting invasive behaviors at transcript and protein levels.

Conclusion: This study demonstrated that the downregulation of GADD45G, mediated by methylation, facilitates the invasive behaviors of EC cells through interaction with the CDK1/CCNB1. These findings enhance understanding of the molecular mechanisms underlying endometrial cancer and suggest potential therapeutic strategies targeting GADD45G for treatment.