Lung cancer remains the leading cause of cancer-related deaths worldwide.The treatment of non-small cell lung cancer(NSCLC),which accounts for a vast majority of lung cancers,has shifted to personalized,targeted thera...Lung cancer remains the leading cause of cancer-related deaths worldwide.The treatment of non-small cell lung cancer(NSCLC),which accounts for a vast majority of lung cancers,has shifted to personalized,targeted therapy following discoveries of several targetable oncogenic mutations.Targeting of specific mutations has improved outcomes in many patients.This success has led to several target-specific agents replacing chemotherapy as first-line treatment in certain mutated NSCLC.Several researchers have reported that there may be imaging biomarkers that may be predictive of the presence of these mutations.These features,when present,have the potential in triaging patients into the most appropriate diagnostic and treatment algorithms.Distinct imaging features and patterns of metastases that have been associated with NSCLC with various targetable oncogenic mutations are presented in this review.展开更多
Objective:The aim of our study was to investigate the value of CT/CT image fusion radiation treatment planning in non-small cell lung cancer(NSCLC) and the impact on V20 and radiation pneumonitis(RP).Methods:Patients ...Objective:The aim of our study was to investigate the value of CT/CT image fusion radiation treatment planning in non-small cell lung cancer(NSCLC) and the impact on V20 and radiation pneumonitis(RP).Methods:Patients who were pathologically or cytologically diagnosed of stage IIIA and IIIB NSCLC were treated with three-dimensional conformal radiation therapy(4000 cGy).Forty patients got at least 25% tumor reduction were randomly divided into two groups:group A of regular shrink field radiotherapy(20 cases) and group B of CT/CT image fused shrink field radiotherapy(20 cases).Dosage reached 6600 cGy.Clinical data,V20 and RP were observed within 3 months after radiotherapy.Statistical analysis was conducted for the NSCLC patients.Results:22.5%(9/40) patients got RP during follow-up.Group A accounted for 6 cases(30%),and group B had 3 cases(15%).There was no marked difference between the two groups(P = 0.256),univariate analysis revealed that the IV20 of A and B groups,and IV20 and CV20 of all patients were statistically related to the incidence of RP(P < 0.05).With Wilcoxon method assay,the ipsilateral lung V20 and contralateral lung V20 had statistical significance between the two groups(P < 0.05).Conclusion:The CT/CT image infusion treatment planning could increase the radical dosage with better tumor control probability but won't increase adverse reaction.展开更多
Objective To introduce an end-to-end automatic segmentation method for organs at risk(OARs)in chest computed tomography(CT)images based on dense connection deep learning and to provide an accurate auto-segmentation mo...Objective To introduce an end-to-end automatic segmentation method for organs at risk(OARs)in chest computed tomography(CT)images based on dense connection deep learning and to provide an accurate auto-segmentation model to reduce the workload on radiation oncologists.Methods CT images of 36 lung cancer cases were included in this study.Of these,27 cases were randomly selected as the training set,six cases as the validation set,and nine cases as the testing set.The left and right lungs,cord,and heart were auto-segmented,and the training time was set to approximately 5 h.The testing set was evaluated using geometric metrics including the Dice similarity coefficient(DSC),95%Hausdorff distance(HD95),and average surface distance(ASD).Thereafter,two sets of treatment plans were optimized based on manually contoured OARs and automatically contoured OARs,respectively.Dosimetric parameters including Dmax and Vx of the OARs were obtained and compared.Results The proposed model was superior to U-Net in terms of the DSC,HD95,and ASD,although there was no significant difference in the segmentation results yielded by both networks(P>0.05).Compared to manual segmentation,auto-segmentation significantly reduced the segmentation time by nearly 40.7%(P<0.05).Moreover,the differences in dose-volume parameters between the two sets of plans were not statistically significant(P>0.05).Conclusion The bilateral lung,cord,and heart could be accurately delineated using the DenseNet-based deep learning method.Thus,feature map reuse can be a novel approach to medical image auto-segmentation.展开更多
Lung cancer mortality has decreased over the past decade and can be partly attributed to advances in targeted therapy and immunotherapy.Immune checkpoint inhibitors(ICIs)have rapidly evolved from investigational drugs...Lung cancer mortality has decreased over the past decade and can be partly attributed to advances in targeted therapy and immunotherapy.Immune checkpoint inhibitors(ICIs)have rapidly evolved from investigational drugs to standard of care for the treatment ofmetastatic non-small cell lung cancer(NSCLC).In particular,antibodies that block inhibitory immune checkpoints,such as programmed cell death protein 1(PD-1)and programmed cell death 1 ligand 1(PD-L1),have revolutionized the treatment of advanced NSCLC,when administered alone or in combination with chemotherapy.Immunotherapy is associated with higher response rates,improved overall survival(OS),and increased tolerability compared with conventional cytotoxic chemotherapy.These benefits may increase the utility of immunotherapy and its combinational use with chemotherapy in the neoadjuvant treatment of patients with NSCLC.Early findings from various ongoing clinical trials suggest that neoadjuvant ICIs alone or combined with chemotherapy may significantly reduce systemic recurrence and improve long-term OS or cure rates in resectable NSCLC.Here we further summarize the safety and efficacy of various neoadjuvant treatment regimens including immunotherapy from ongoing clinical trials and elaborate the role of neoadjuvant immunotherapy in patients with resectable NSCLC.In addition,we discuss several unresolved challenges,including the evaluations to assess neoadjuvant immunotherapy response,the role of adjuvant treatment after neoadjuvant immunotherapy,the efficacy of treatment for oncogenic-addicted tumors,and predictive biomarkers.We also provide our perspective on ways to overcome current obstacles and establish neoadjuvant immunotherapy as a standard of care.展开更多
Photothermal therapy(PTT)has received a lot of attention as a promising strategy for eliminating tumors quickly.However,the unavoidable inflammatory response during the treatment might result in a high concentration o...Photothermal therapy(PTT)has received a lot of attention as a promising strategy for eliminating tumors quickly.However,the unavoidable inflammatory response during the treatment might result in a high concentration of M2-like tumor-associated macrophages(TAMs),increasing the risk of tumor recurrence and metastasis.To address this problem,gold-based nanocarriers(PGMP-small interfering RNA(siRNA)nanoparticles(NPs))containing STAT6siRNA,that inhibited M2-like TAM polarization,were designed and investigated for PTT and gene therapy of non-small cell lung cancer(NSCLC).In an NSCLC model,the nanocarriers demonstrated excellent siRNA delivery ability and a high gene transfection rate of up to 90%in macrophages,thus inhibiting the polarization of about 87%of M2-like TAMs and effectively suppressing the invasion and metastasis of NSCLC.Meanwhile,the unique gold nanosphere structure offered improved PTT and contrast-enhanced ultrasound imaging,thus contributing to the efficient elimination and real-time monitoring of the tumor tissues.These nanocarriers with combined gene and photothermal therapeutic capabilities improved the efficacy of single-modality treatment,and showed the potential to inhibit cancer cell recurrence and metastasis to ultimately cure NSCLC.展开更多
文摘Lung cancer remains the leading cause of cancer-related deaths worldwide.The treatment of non-small cell lung cancer(NSCLC),which accounts for a vast majority of lung cancers,has shifted to personalized,targeted therapy following discoveries of several targetable oncogenic mutations.Targeting of specific mutations has improved outcomes in many patients.This success has led to several target-specific agents replacing chemotherapy as first-line treatment in certain mutated NSCLC.Several researchers have reported that there may be imaging biomarkers that may be predictive of the presence of these mutations.These features,when present,have the potential in triaging patients into the most appropriate diagnostic and treatment algorithms.Distinct imaging features and patterns of metastases that have been associated with NSCLC with various targetable oncogenic mutations are presented in this review.
文摘Objective:The aim of our study was to investigate the value of CT/CT image fusion radiation treatment planning in non-small cell lung cancer(NSCLC) and the impact on V20 and radiation pneumonitis(RP).Methods:Patients who were pathologically or cytologically diagnosed of stage IIIA and IIIB NSCLC were treated with three-dimensional conformal radiation therapy(4000 cGy).Forty patients got at least 25% tumor reduction were randomly divided into two groups:group A of regular shrink field radiotherapy(20 cases) and group B of CT/CT image fused shrink field radiotherapy(20 cases).Dosage reached 6600 cGy.Clinical data,V20 and RP were observed within 3 months after radiotherapy.Statistical analysis was conducted for the NSCLC patients.Results:22.5%(9/40) patients got RP during follow-up.Group A accounted for 6 cases(30%),and group B had 3 cases(15%).There was no marked difference between the two groups(P = 0.256),univariate analysis revealed that the IV20 of A and B groups,and IV20 and CV20 of all patients were statistically related to the incidence of RP(P < 0.05).With Wilcoxon method assay,the ipsilateral lung V20 and contralateral lung V20 had statistical significance between the two groups(P < 0.05).Conclusion:The CT/CT image infusion treatment planning could increase the radical dosage with better tumor control probability but won't increase adverse reaction.
基金Supported by a grant from the Beijing Municipal Science and Technology Commission Foundation Programme(No.Z181100001718011).
文摘Objective To introduce an end-to-end automatic segmentation method for organs at risk(OARs)in chest computed tomography(CT)images based on dense connection deep learning and to provide an accurate auto-segmentation model to reduce the workload on radiation oncologists.Methods CT images of 36 lung cancer cases were included in this study.Of these,27 cases were randomly selected as the training set,six cases as the validation set,and nine cases as the testing set.The left and right lungs,cord,and heart were auto-segmented,and the training time was set to approximately 5 h.The testing set was evaluated using geometric metrics including the Dice similarity coefficient(DSC),95%Hausdorff distance(HD95),and average surface distance(ASD).Thereafter,two sets of treatment plans were optimized based on manually contoured OARs and automatically contoured OARs,respectively.Dosimetric parameters including Dmax and Vx of the OARs were obtained and compared.Results The proposed model was superior to U-Net in terms of the DSC,HD95,and ASD,although there was no significant difference in the segmentation results yielded by both networks(P>0.05).Compared to manual segmentation,auto-segmentation significantly reduced the segmentation time by nearly 40.7%(P<0.05).Moreover,the differences in dose-volume parameters between the two sets of plans were not statistically significant(P>0.05).Conclusion The bilateral lung,cord,and heart could be accurately delineated using the DenseNet-based deep learning method.Thus,feature map reuse can be a novel approach to medical image auto-segmentation.
基金supported by the High-Level Hospital Construction Project(grant No.Dfjh201801)the National Natural Science Foundation of China(grant No.81872510 and 81802266)+2 种基金the Guangdong Provincial People’s Hospital Young Talent Project(grant No.Gdpphytp201902)the Guangdong Provincial Key Laboratory of Lung Cancer Translational Medicine(grant No.2017b030314120)the Guangdong Basic and Applied Basic Research Foundation(grant No.2019b1515130002).
文摘Lung cancer mortality has decreased over the past decade and can be partly attributed to advances in targeted therapy and immunotherapy.Immune checkpoint inhibitors(ICIs)have rapidly evolved from investigational drugs to standard of care for the treatment ofmetastatic non-small cell lung cancer(NSCLC).In particular,antibodies that block inhibitory immune checkpoints,such as programmed cell death protein 1(PD-1)and programmed cell death 1 ligand 1(PD-L1),have revolutionized the treatment of advanced NSCLC,when administered alone or in combination with chemotherapy.Immunotherapy is associated with higher response rates,improved overall survival(OS),and increased tolerability compared with conventional cytotoxic chemotherapy.These benefits may increase the utility of immunotherapy and its combinational use with chemotherapy in the neoadjuvant treatment of patients with NSCLC.Early findings from various ongoing clinical trials suggest that neoadjuvant ICIs alone or combined with chemotherapy may significantly reduce systemic recurrence and improve long-term OS or cure rates in resectable NSCLC.Here we further summarize the safety and efficacy of various neoadjuvant treatment regimens including immunotherapy from ongoing clinical trials and elaborate the role of neoadjuvant immunotherapy in patients with resectable NSCLC.In addition,we discuss several unresolved challenges,including the evaluations to assess neoadjuvant immunotherapy response,the role of adjuvant treatment after neoadjuvant immunotherapy,the efficacy of treatment for oncogenic-addicted tumors,and predictive biomarkers.We also provide our perspective on ways to overcome current obstacles and establish neoadjuvant immunotherapy as a standard of care.
基金This work was supported by the Natural Science Foundation of China(Nos.81873898,81960316,81871411,32011530115,and 32025021)the Science&Technology Bureau of Ningbo City(Nos.2020Z094 and 2021Z072)+1 种基金the Excellent Member of Youth Innovation Promotion Association Foundation of CAS(No.Y2021079)the Ningbo 3315 Innovative Teams Program,China(No.2019A-14-C).
文摘Photothermal therapy(PTT)has received a lot of attention as a promising strategy for eliminating tumors quickly.However,the unavoidable inflammatory response during the treatment might result in a high concentration of M2-like tumor-associated macrophages(TAMs),increasing the risk of tumor recurrence and metastasis.To address this problem,gold-based nanocarriers(PGMP-small interfering RNA(siRNA)nanoparticles(NPs))containing STAT6siRNA,that inhibited M2-like TAM polarization,were designed and investigated for PTT and gene therapy of non-small cell lung cancer(NSCLC).In an NSCLC model,the nanocarriers demonstrated excellent siRNA delivery ability and a high gene transfection rate of up to 90%in macrophages,thus inhibiting the polarization of about 87%of M2-like TAMs and effectively suppressing the invasion and metastasis of NSCLC.Meanwhile,the unique gold nanosphere structure offered improved PTT and contrast-enhanced ultrasound imaging,thus contributing to the efficient elimination and real-time monitoring of the tumor tissues.These nanocarriers with combined gene and photothermal therapeutic capabilities improved the efficacy of single-modality treatment,and showed the potential to inhibit cancer cell recurrence and metastasis to ultimately cure NSCLC.
