Journal of cancer research and therapeutics最新文献

Background: The aim of total neoadjuvant therapy (TNT), which includes neoadjuvant radiation therapy followed by neo-adjuvant chemotherapy (NACT) and surgery, is to improve systemic control rates, while maintaining loco-regional control for locally advanced rectal cancers (LARC). We investigated this approach of TNT with short course radiotherapy (SCRT).

Methods: In this single-arm prospective interventional study, 25 LARC patients were enrolled and treated with SCRT of 25 Gray in five fractions over 1 week followed by NACT (oxaliplatin and capecitabine) for six cycles, followed by definitive surgery with total mesorectal excision (TME). The end point was to evaluate pathological complete response (pCR), acute toxicity (measured using Common Terminology Criteria for Adverse Events version 5.0), and loco-regional control (LRC).

Results: Male: Female ratio was 17:8 and median age was 47 years. The clinical stages were T2: T3: T4 and N0: N1: N2 in 3: 20: 2 and 5: 8: 12 patients, respectively. Twenty (80%) of the 25 patients that were recruited underwent the entire course of treatment. Two patients defaulted, one expired, and two achieved clinical complete response (cCR) and did not agree to surgery. The median follow-up period was 15.5 months (8.8 to 18.2 months). 1/25 patients (4%) experienced grade 3 gastrointestinal toxicity during SCRT. Seven (30%) out of twenty-three patients receiving NACT developed Grade 3 toxicity. Six (30%) out of 12 patients undergoing surgery achieved pCR. Two patients developed loco-regional relapse and crude LRC rate for the entire cohort of enrolled patient at 1-year was 86.95%.

Conclusion: The TNT approach with SCRT demonstrated favorable pathological complete response (pCR) rates, acceptable toxicity, and excellent short-term locoregional control.

Background: Various pre-operative blood inflammatory markers and ratios have been used to prognosticate different cancers. We investigated a few and correlated it with Disease-Free Survival (DFS) and Overall Survival (OS) in Gallbladder Cancer (GBC) patients.

Methods: Neutrophil to Lymphocyte ratio (NLR), Platelet to Lymphocyte ratio (PLR), Lymphocyte to Monocyte ratio (LMR), C-Reactive Protein (CRP), Lymphocyte to CRP ratio (LCR), modified Glasgow Prognostic Score (mGPS), CRP to Albumin ratio (CAR), and D dimer values were measured in 139 GBC patients (50 surgically resected and 89 not-operated).

Results: Significantly higher risk of mortality was observed in patients with the high NLR, PLR, CRP, CAR, mGPS, and D dimer with hazard ratio of 6.935 (4.048 to 11.881), 17.101 (7.652 to 38.218), 5.916 (3.167 to 11.049), 5.532 (3.157 to 9.695), 6.912 (4.249 to 11.245), and 1.810 (1.203 to 2.725), respectively, on Univariate analysis. High LMR and LCR had significantly lower risk of mortality with hazard ratio of 0.066 (0.026 to 0.166) and 0.183 (0.11 to 0.303), respectively. Upon multivariate analysis, only high NLR, PLR, and mGPS remained statistically significant with adjusted hazard ratio of 8.278 (2.046 to 33.492), 3.907 (1.236 to 12.356), and 3.350 (1.796 to 6.249), respectively.

Conclusions: High NLR, PLR, and mGPS were significantly and independently associated with higher risk of mortality.

Abstract: Artificial intelligence (AI) has transformed prostate brachytherapy by enhancing precision, efficiency, and personalization. This systematic review evaluates 70 peer-reviewed studies from PubMed, Embase, and Web of Science, focusing on the applications of AI in imaging, treatment planning, applicator reconstruction, and outcome prediction. Machine learning (ML) and deep learning (DL) techniques, including U-Net and deep reinforcement learning, demonstrate improvements in segmentation (84% sensitivity), dose optimization (20-30% time savings), and quality assurance (25% error reduction). Challenges include limited dataset diversity, generalizability, and clinical integration. This review highlights AI's potential to revolutionize prostate brachytherapy and identifies research gaps necessary for its clinical adoption.

Objective: This study examined the effect of hepatic arterial infusion chemotherapy (HAIC) plus programmed death 1 inhibitors (HAICPs) in patients with unresected colorectal cancer liver metastases (UCRLM) with and without KRAS mutations.

Materials and methods: We retrospectively collected data from patients with UCRLM, who received HAIC with HAICP or HAIC alone (oxaliplatin plus fluorouracil), including information on KRAS status (mutated, MUT; wild-type, WT) from a multicenter institutional database. Propensity score matching (PSM) was performed. The associations of KRAS status, treatment, and clinicopathological features with outcomes were determined. Confounding factors were adjusted using the Cox proportional hazard model.

Results: A total of 668 patients (414 KRAS-WT, 254 MUT) were followed for a median of 4.6 years post-HAIC. Fifty-five percent received HAICP. Before PSM, patients in the HAICP group exhibited a significantly higher CEA level (P = 0.014), more tumor nodules (P = 0.012), lower clinical risk score (P = 0.009), and fewer extrahepatic metastases (P = 0.017). After PSM analysis, 260 pairs of patients were established. The 5-year progression-free survival (PFS) for patients treated with HAICP versus HAIC was 36% and 31%, respectively (hazard ratio, 0.64; 95% CI, 0.48-0.85; P = 0.008). The 5-year overall survival (OS) for patients treated with HAICP versus HAIC was 72% and 64%, respectively (hazard ratio, 0.44; 95% CI, 0.32-0.63; P < 0.001). In KRAS-WT tumors, the 5-year survival was 79% and 61% for patients treated with HAICP versus HAIC (P < 0.001), respectively. In KRAS-MUT tumors, the 5-year survival was 68% and 52% for patients treated with HAICP versus HAIC (P < 0.001), respectively.

Conclusion: The combined application of HAICP is an effective regimen for treating patients with UCRLM. HAICP shows superior survival independent of KRAS mutation. In addition, HAICP ameliorates the poor survival observed among KRAS-MUT UCRLM cases.

Purpose: To evaluate the efficacy and safety of computed tomography (CT)-guided co-ablation in patients with hepatic metastases from malignant melanoma.

Methods: Clinical data of 79 patients with hepatic metastases from malignant melanoma who underwent co-ablation (integration of cryoablation and thermal ablation) and programmed death 1 (PD-1) treatment between October 2019 and January 2024 were retrospectively analyzed. The patients were divided into group A (n = 50), patients who received co-ablation, and group B (n = 29), patients who received PD-1 treatment. In group A, treatment efficacy and safety, changes in lymphocyte subsets, Th1/Th2 cell cytokines before and 3 weeks after treatment, and adverse events (AEs) during co-ablation were evaluated.

Results: Co-ablation exhibited favorable clinical efficacy in the treatment of hepatic metastases from malignant melanoma. The rates of complete remission (CR), partial remission (PR), progressive disease (PD), stable disease (SD), and disease control rate (DCR) were 56.0%, 24.0%, 8.0%, 12.0%, and 92.0%, respectively. In group B, the CR, PR, PD, SD, and DCR rates were 10.3%, 24.1%, 31.0%, 34.5%, and 68.9%, respectively. Three weeks after treatment, the levels of Th2-related cytokine interleukin-10, CD3-CD16 + CD56+, and CD8 + CD25 + significantly decreased compared with baseline, with group A demonstrating lower levels than group B. At the end of the follow-up, 16 patients (32%) in group A and 16 (55.2%) in group B had died. The median progression-free survival was 20.2 months in group A, which was significantly longer than the 7.93 months in group B (P = 0.005). The median overall survival in group A was 20.2 months, which was significantly longer than the 13.5 months in group B (P = 0.025). The intraoperative AEs during co-ablation included mild pain (4.0%), hepatic arterial bleeding (2.0%), minor subcapsular bleeding (4.0%), minor pneumothorax (4.0%), and vomiting (2.0%).

Conclusion: The CT-guided co-ablation system exhibited favorable clinical efficacy and was associated with a low incidence of AEs in the treatment of hepatic metastases from malignant melanoma, indicating its potential clinical value.

Introduction: In the past decade, the treatment methods for small-cell lung cancer (SCLC) have undergone advances and diversification. This study aimed to explore the treatment patterns of patients with SCLC and evaluate the efficacy of SCLC treatments in a real clinical setting.

Materials and methods: This retrospective study included patients with limited-stage (LS) and extensive-stage (ES) SCLC who received treatment at Qingdao Central Hospital (Qingdao, China) from August 1, 2016, to April 30, 2023. The progression-free survival (PFS) and overall survival (OS) were evaluated for all enrolled patients and participant subgroups via Kaplan-Meier survival analysis.

Results: A total of 83 and 117 patients with LS-SCLC and ES-SCLC, respectively, were enrolled. The median PFS and OS were 14.5 and 33.4 months for the LS-SCLC group and 9.8 and 20.1 months for the ES-SCLC group, respectively. First-line thoracic consolidative radiotherapy (TRT) and immune checkpoint inhibitors markedly prolonged the PFS in the ES-SCLC group (P = .023 and P = .045, respectively), whereas TRT alone significantly prolonged the OS (P = .036). PFS and OS were significantly prolonged in the LS-SCLC group in whom TRT was initiated during or before the second cycle of first-line chemotherapy (P = .031 and P = .041, respectively). Moreover, patients with at least three areas of lymph node metastasis had significantly poorer prognosis than those with fewer areas.

Conclusion: The patients in this study exhibited better prognosis than those in previous ones. TRT remains an important treatment that can improve the prognosis of patients with SCLC. However, new strategies are warranted for a more effective treatment.

Abstract: Radiotherapy is a conventional method that plays an important role in the comprehensive treatment of tumors. However, it has inevitable side effects that may affect prognosis. Therefore, increasing attention has been paid to radiotherapy-related side effects and prognosis after radiotherapy. With the development of artificial intelligence, high-throughput extraction of quantitative features and correlation analysis of medical images have rapidly developed to improve tumor diagnosis, staging, grading, and personalized treatment. In recent years, there has been growing interest in the use of machine learning models to predict the effects of radiotherapy based on three-dimensional dose distribution maps generated by optimizing radiotherapy plans, which contain dose features or dosiomics that reveal the dose-response relationship of organs and treatment. The use of machine learning modeling to describe the advantages and accuracy of dosiomics in predicting the toxicity and prognosis of radiotherapy has laid a foundation for personalized radiotherapy. This paper aimed to review the achievements of past dosiomics research, introduce the latest advancements in clinical radiotherapy, and discuss the value and future direction of dosiomics in personalized radiotherapy.

Background: This study evaluated the efficacy and safety of esketamine plus dexmedetomidine for sedation and analgesia during computed tomography (CT)-guided lung tumor percutaneous microwave ablation (MWA).

Methods: Patients undergoing CT-guided percutaneous MWA of lung tumors were randomly divided into two groups: esketamine plus dexmedetomidine (Group E) and sufentanil plus dexmedetomidine (Group S). The patients' general information, mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation, respiratory rate (RR), partial pressure of end-tidal carbon dioxide, bispectral index, and Ramsay sedation score were recorded before anesthesia administration (T0), after dexmedetomidine loading dose (T1), during percutaneous puncture (T2), during ablation (T3), at the end of surgery (T4), and during recovery of consciousness (T5). The postoperative Visual Analog Scale (VAS) scores, dexmedetomidine dosage, vasoactive drug usage, instances of sedation failure, and adverse events were also recorded.

Results: Group E showed higher MAP at T5 (P = 0.048) and HR at T3 (P = 0.044) compared to Group S. The RR was significantly higher in Group E than in Group S from T1 to T5 (P < 0.001). The incidence of respiratory depression, bradycardia, and postoperative nausea and vomiting in Group E was lower in Group E than in Group S. No significant differences in Ramsay sedation scores, postoperative VAS scores, dexmedetomidine dosage, vasoactive drug usage, number of sedation failure cases, or occurrence of adverse events were observed between the two groups.

Conclusion: Esketamine plus dexmedetomidine demonstrated potential advantages for lung tumor MWA compared to sufentanil plus dexmedetomidine.