Re-evaluating the role of pelvic radiation in the age of modern precision medicine and systemic therapy

The efficacy of pelvic radiation in the management of locally advanced stage rectal cancer has come under scrutiny in the context of modern precision medicine and systemic therapy as evidenced by recent clinical trials such as FOWARC(J Clin Oncol 2019;37:3223-3233),NCT04165772(N Engl J Med 2022;386:2363-2376),and PROSPECT(N Engl J Med 2023;389:322-334).In this review,we comprehensively assess these pivotal trials and offer additional insights into the evolving role of pelvic radiation in contemporary oncology.

Efficacy of surgical resection and ultra-reduced tension suture combined with superficial radiation in keloid treatment

BACKGROUND There are many available treatment options for keloid;however,single treatments are usually less effective.Therefore,more scientifically rational and effective com-bined treatment methods should be sought to solve the pain associated with keloids.AIM To explore the efficacy and safety of surgical resection and ultra-reduced tension suture combined with superficial radiation as keloid treatment.METHODS Fifteen keloid patients admitted to Qingdao Eighth People's Hospital from June 2020 to January 2022 were enrolled in this retrospective analysis.All patients underwent a comprehensive treatment approach comprising surgical resection,ultra-reduced tension suture incision,and superficial radiation therapy within 24 h postoperatively.The modified Vancouver Scar Scale(mVSS)and Patient and Observer Scar Assessment Scale(POSAS)were used to evaluate the treatment effect,whereas the efficacy,adverse effects,and recurrence rate were observed according to the 12-mo follow-up after treatment.RESULTS The mVSS and POSAS scores at 1 and 6 mo after combination treatment decreased compared to before treatment(P<0.001),and the overall response rate was 93.3%.Only one case recurred,yielding a 6.7%recurrence rate.The incidence of local chromour sedimentation rate in 1–3 mo after radiotherapy was 33.3%(5 patients),all subsiding after 6–9 mo,without complications,such as delayed wound healing or dermatitis.CONCLUSION Surgical resection,super subtraction sutures,and superficial radiotherapy are treatment methods with short courses,low recurrence rates,and good safety profiles.

Analysis of nutritional risk,skeletal muscle depletion,and lipid metabolism phenotype in acute radiation enteritis

BACKGROUND Radiation enteritis,which often occurs during radiation-induced acute intestinal symptoms(RIAIS),is the most common and important complication during radiotherapy for cervical cancer.RIAIS caused by abdominal and pelvic radiotherapy will affect nutrient intake,digestion,absorption,and metabolism,leading to malnutrition or poorer nutritional status.In patients with malignant tumors,malnutrition can adversely affect the curative effect and response of radiotherapy by reducing radiosensitivity,affecting the precision of radiotherapy placement and increasing the incidence of radiotherapy-related adverse reactions.AIM To analyze nutritional risk,skeletal muscle depletion,and lipid metabolism phenotype in acute radiation enteritis.METHODS Fifty patients with cervical cancer received external beam radiotherapy,and 15 patients received brachytherapy after external beam radiotherapy.Body weight,body composition parameters,nutritional risk screening(NRS)2002 score,and blood biochemical indices of patients with cervical cancer during periradiation were tested by a one-way repeated measures analysis of variance.Metabolomics analysis was used to identify characteristic lipid metabolism pathways.Clinical factors that affect linoleic acid changes were screened using the generalized evaluation equation.RESULTS Among the 50 patients,37 had RIAIS,including 34 patients with grade 1-2 RIAIS and 3 patients with grade 3 RIAIS.The NRS 2002 score of patients who underwent cervical cancer radiotherapy continued to increase during the periradiation period,and 42 patients who underwent cancer radiotherapy had nutritional deficits(NRS 2002 score≥3 points)at the end of radiotherapy.Correlation analyses revealed that body weight and body mass index changes were closely associated with body fat content(R2=0.64/0.51).The results of the univariate analysis showed that radiotherapy time,percentage reduction of serum albumin,and percentage reduction of serum prealbumin were the key factors affecting skeletal muscle exhaustion(P<0.05).Metabolomic analysis of fecal supernatants of cervical cancer patients during the periradiation period revealed the involvement of linoleic acid,cholic acid,arachidonic acid,and N-acetyl-L-benzene alanine in the metabolic pathway of linoleic acid.CONCLUSION Cervical cancer radiotherapy patients faced nutritional risks,decreased serum albumin synthesis,and increased risk of skeletal muscle exhaustion.Linoleic acid was a biomarker of high nutritional risk.

Study on pharmacodynamics and mechanism of nano-Kuiyangye in treating radiation esophagitis in rats

Objective:To explore the curative effect of nano-Kuiyangye on radiation esophagitis in Wistar rats,and to explore its possible mechanism.Methods:Wistar rats were irradiated locally with 30Gy rays to establish an animal model of radiation esophagitis in rats.After irradiation,nano-Kuiyangye,traditional Chinese medicine ulcer solution,Kangfuxin solution,nano-hydrotalcite matrix,and distilled water were used to intervene continuously for 7 d,during which the body weight and food intake of the rats were recorded.On day 7,blood was collected from the abdominal aorta under anesthesia,and the serum was obtained by centrifugation.The expression levels of pain-related factors prostaglandin-2(PGE-2),substance P(SP),and calcitonin gene-related peptide(CGRP)were detected by ELISA.Rats were sacrificed after blood collection,and full-length esophageal tissues were taken.Hematoxylin-eosin(HE)staining was performed to analyze the pathological changes of the rat esophagus,and Western Blotting was used to detect the expression of nuclear factor-κB(NF-κB)inflammatory protein.Results:Compared with the control group,the total food intake and body weight of the rats within 7 d after modeling were significantly decreased(P<0.05),and the expressions of pain-related factors PGE-2,SP,and CGRP were higher than those of the control group(P<0.05).,the esophageal pathological damage score increased(P<0.05),and the expression of NF-κB inflammatory protein increased(P<0.05);after treatment,the total food intake of the rats in the nano-Kuiyangye intervention group within 7 days after modeling was higher than that in other groups(P<0.05),the expressions of pain-related factors PGE-2,SP,and CGRP were lower than those in the model group(P<0.05),the esophageal pathological damage score was lower(P<0.05),and the expression of NF-κB inflammatory proteins was lower(P<0.05).Conclusion:Nano-Kuiyangye increases the food intake of rats with radiation esophagitis,reduces esophageal tissue damage,and reduces the concentration of serum pain factors;the anti-inflammatory effect of nano-Kuiyangye may be related to the reduction of NF-κB inflammatory factor levels.

Dosimetric Study of the Effect of Calypso-Compatible Couch Top for Spine Stereotactic Body Radiation Therapy

Purpose: To study the effect of the Qfix kVue Calypso-compatible couch top on the dosimetry of Spine Stereotactic Body Radiation Therapy (SBRT). Methods and Materials: The computed tomography (CT) data set for Qfix kVue Calypso-compatible couch top with rails were imported into the treatment planning system (TPS). Nine patients who underwent spine SBRT were selected for this study. The inclusion criteria included patients who were treated on a stereotactic linear accelerator with 5 fractions or less from 2016 to 2017 without the couch model. Seven patients were treated with static intensity-modulated radiation therapy (IMRT) fields and two patients were treated using volumetric modulated arc therapy (VMAT) technique. The dose was recalculated for 1) couch top and rails setup (CR) 2) couch-top no rails setup (CNR), and then compared to 3) no couch no-rails setup (NCNR). Dose to 100% of the target volume (D100%), Dose to cover 99% of the target volume (D99%), Dose to cover 95% of the target volume (D95%), Dose to cover 90% of the target volume (D90%), volume receiving 100% of the prescription dose (V100%), conformity index (CI), dose gradient index (DGI), and spinal cord threshold and maximum dose were compared to the plan with NCNR. Results: The average D100% was 77.89% ± 11.78%, 74.51% ± 12.24%, and 75.83 ± 12.67% for NCNR, CR, CNR (р = 0.84), respectively. The average D99% was 91.64% ± 9.57%, 89.93% ± 9.48%, and 91.15% ± 9.55% for NCNR, CR, CNR (р = 0.98), respectively. The average D95% was 99.14% ± 9.96%, 95.23% ± 9.76, and 96.78% ± 9.84% for NCNR, CR, CNR (р = 0.047), respectively. The average D90% was 101.3% ± 0.65%, 97.11% ± 2.48%, and 98.75% ± 2.12% for NCNR, CR, CNR (р = 0.0004), respectively. The maximum dose to the spinal cord was 1750.79 ± 41.84, 1672.90 ± 40.90, and 1709.91 ± 41.35 (cGy) for NCNR, CR, CNR (р = 0.97), respectively. In all cases, the spinal cord threshold dose was far below the tolerances and the differences were insignificant. Average CI was 1.18 ± 0.16, 0.53 ± 0.39, and 0.86 ± 0.24 for NCNR, CR, CNR (р = 0.0002), respectively. Conclusions: The study investigated the dosimetric impact of Qfix kVue Calypso-compatible couch top on the quality of the spinal SBRT treatment using static IMRT or VMAT techniques. IMRT plans showed more sensitivity to the couch being in the plan than the VMAT plans.

Artificial intelligence-driven radiomics study in cancer:the role of feature engineering and modeling

Modern medicine is reliant on various medical imaging technologies for non-invasively observing patients’anatomy.However,the interpretation of medical images can be highly subjective and dependent on the expertise of clinicians.Moreover,some potentially useful quantitative information in medical images,especially that which is not visible to the naked eye,is often ignored during clinical practice.In contrast,radiomics performs high-throughput feature extraction from medical images,which enables quantitative analysis of medical images and prediction of various clinical endpoints.Studies have reported that radiomics exhibits promising performance in diagnosis and predicting treatment responses and prognosis,demonstrating its potential to be a non-invasive auxiliary tool for personalized medicine.However,radiomics remains in a developmental phase as numerous technical challenges have yet to be solved,especially in feature engineering and statistical modeling.In this review,we introduce the current utility of radiomics by summarizing research on its application in the diagnosis,prognosis,and prediction of treatment responses in patients with cancer.We focus on machine learning approaches,for feature extraction and selection during feature engineering and for imbalanced datasets and multi-modality fusion during statistical modeling.Furthermore,we introduce the stability,reproducibility,and interpretability of features,and the generalizability and interpretability of models.Finally,we offer possible solutions to current challenges in radiomics research.

Prediction of pathological complete response and prognosis in locally advanced rectal cancer

BACKGROUND Colorectal cancer is currently the third most common malignant tumor and the second leading cause of cancer-related death worldwide.Neoadjuvant chemoradiotherapy(nCRT)is standard for locally advanced rectal cancer(LARC).Except for pathological examination after resection,it is not known exactly whether LARC patients have achieved pathological complete response(pCR)before surgery.To date,there are no clear clinical indicators that can predict the efficacy of nCRT and patient outcomes.AIM To investigate the indicators that can predict pCR and long-term outcomes following nCRT in patients with LARC.METHODS Clinical data of 128 LARC patients admitted to our hospital between September 2013 and November 2022 were retrospectively analyzed.Patients were categorized into pCR and non-pCR groups.Univariate analysis(using the χ^(2) test or Fisher’s exact test)and logistic multivariate regression analysis were used to study clinical predictors affecting pCR.The 5-year disease-free survival(DFS)and overall survival(OS)rates were calculated using Kaplan-Meier analysis,and differences in survival curves were assessed with the log-rank test.RESULTS Univariate analysis showed that pretreatment carcinoembryonic antigen(CEA)level,lymphocyte-monocyte ratio(LMR),time interval between neoadjuvant therapy completion and total mesorectal excision,and tumor size were correlated with pCR.Multivariate results showed that CEA≤5 ng/mL(P=0.039),LMR>2.73(P=0.023),and time interval>10 wk(P=0.039)were independent predictors for pCR.Survival analysis demonstrated that patients in the pCR group had significantly higher 5-year DFS rates(94.7%vs 59.7%,P=0.002)and 5-year OS rates(95.8%vs 80.1%,P=0.019)compared to the non-pCR group.Tumor deposits(TDs)were significantly correlated with shorter DFS(P=0.002)and OS(P<0.001).CONCLUSION Pretreatment CEA,LMR,and time interval contribute to predicting nCRT efficacy in LARC patients.Achieving pCR demonstrates longer DFS and OS.TDs correlate with poor prognosis.

Current landscape of preoperative neoadjuvant therapies for initial resectable colorectal cancer liver metastasis

Colorectal cancer liver metastasis(CRLM)presents a clinical challenge,and optimizing treatment strategies is crucial for improving patient outcomes.Surgical resection,a key element in achieving prolonged survival,is often linked to a heightened risk of recurrence.Acknowledging the potential benefits of preoperative neoadjuvant chemotherapy in managing resectable liver metastases,this approach has gained attention for its role in tumor downsizing,assessing biological behavior,and reducing the risk of postoperative recurrence.However,the use of neoadjuvant chemotherapy in initially resectable CRLM sparks ongoing debates.The balance between tumor reduction and the risk of hepatic injury,coupled with concerns about delaying surgery,necessitates a nuanced approach.This article explores recent research insights and draws upon the practical experiences at our center to address critical issues regarding considerations for initially resectable cases.Examining the criteria for patient selection and the judicious choice of neoadjuvant regimens are pivotal areas of discussion.Striking the right balance between maximizing treatment efficacy and minimizing adverse effects is imperative.The dynamic landscape of precision medicine is also reflected in the evolving role of gene testing,such as RAS/BRAF and PIK3CA,in tailoring neoadjuvant regimens.Furthermore,the review emphasizes the need for a multidisciplinary approach to navigate the comp-lexities of CRLM.Integrating technical expertise and biological insights is crucial in refining neoadjuvant strategies.The management of progression following neoadjuvant chemotherapy requires a tailored approach,acknowledging the diverse biological behaviors that may emerge.In conclusion,this review aims to provide a comprehensive perspective on the considerations,challenges,and advancements in the use of neoadjuvant chemotherapy for initially resectable CRLM.By combining evidencebased insights with practical experiences,we aspire to contribute to the ongoing discourse on refining treatment paradigms for improved outcomes in patients with CRLM.

Quantitative analysis of the morphing wing mechanism of raptors:IMMU-based motion capture system and its application on gestures of a Falco peregrinus

This paper presented a novel tinny motion capture system for measuring bird posture based on inertial and magnetic measurement units that are made up of micromachined gyroscopes, accelerometers, and magnetometers. Multiple quaternion-based extended Kalman filters were implemented to estimate the absolute orientations to achieve high accuracy.Under the guidance of ornithology experts, the extending/contracting motions and flapping cycles were recorded using the developed motion capture system, and the orientation of each bone was also analyzed. The captured flapping gesture of the Falco peregrinus is crucial to the motion database of raptors as well as the bionic design.

Transglutaminase 2 serves as a pathogenic hub gene of KRAS mutant colon cancer based on integrated analysis

BACKGROUND Colon cancer is acknowledged as one of the most common malignancies worldwide,ranking third in United States regarding incidence and mortality.Notably,approximately 40%of colon cancer cases harbor oncogenic KRAS mutations,resulting in the continuous activation of epidermal growth factor receptor signaling.AIM To investigate the key pathogenic genes in KRAS mutant colon cancer holds considerable importance.METHODS Weighted gene co-expression network analysis,in combination with additional bioinformatics analysis,were conducted to screen the key factors driving the progression of KRAS mutant colon cancer.Meanwhile,various in vitro experiments were also conducted to explore the biological function of transglutaminase 2(TGM2).RESULTS Integrated analysis demonstrated that TGM2 acted as an independent prognostic factor for progression-free survival.Immunohistochemical analysis on tissue microarrays revealed that TGM2 was associated with an elevated probability of perineural invasion in patients with KRAS mutant colon cancer.Additionally,biological roles of the key gene TGM2 was also assessed,suggesting that the downregulation of TGM2 attenuated the proliferation,invasion,and migration of the KRAS mutant colon cancer cell line.CONCLUSION This study underscores the potential significance of TGM2 in the progression of KRAS mutant colon cancer.This insight not only offers a theoretical foundation for therapeutic approaches but also highlights the need for additional clinical trials and fundamental research to support our preliminary findings.

Establishment of NaLuF_(4):15%Tb-based low dose X-PDT agent and its application on efficient antitumor therapy

X-ray excited photodynamic therapy(X-PDT)is the bravo answer of photodynamic therapy(PDT)for deep-seated tumors,as it employs X-ray as the irradiation source to overcome the limitation of light penetration depth.However,high X-ray irradiation dose caused organ lesions and side effects became the major barrier to X-PDT application.To address this issue,this work employed a classic-al co-precipitation reaction to synthesize NaLuF_(4):15%Tb^(3+)(NLF)with an average particle size of(23.48±0.91)nm,which was then coupled with the photosensitizer merocyanine 540(MC540)to form the X-PDT system NLF-MC540 with high production of singlet oxygen.The system could induce antitumor efficacy to about 24%in relative low dose X-ray irradiation range(0.1-0.3 Gy).In vivo,when NLF-MC540 irradiated by 0.1 Gy X-ray,the tumor inhibition percentage reached 89.5%±5.7%.The therapeutic mechanism of low dose X-PDT was found.A significant increase of neutrophils in serum was found on the third day after X-PDT.By immunohistochemical staining of tumor sections,the Ly6G^(+),CD8^(+),and CD11c^(+)cells infiltrated in the tumor microenvironment were studied.Utilizing the bilat-eral tumor model,the NLF-MC540 with 0.1 Gy X-ray irradiation could inhibit both the primary tumor and the distant tumor growth.De-tected by enzyme linked immunosorbent assay(ELISA),two cytokines IFN-γand TNF-αin serum were upregulated 7 and 6 times than negative control,respectively.Detected by enzyme linked immune spot assay(ELISPOT),the number of immune cells attributable to the IFN-γand TNF-αlevels in the group of low dose X-PDT were 14 and 6 times greater than that in the negative control group,respectively.Thus,it conclude that low dose X-PDT system could successfully upregulate the levels of immune cells,stimulate the secretion of cy-tokines(especially IFN-γand TNF-α),activate antitumor immunity,and finally inhibit colon tumor growth.

Management of lateral pelvic lymph nodes in rectal cancer:Is it time to reach an Agreement?

In this editorial,we proceed to comment on the article by Chua et al,addressing the management of metastatic lateral pelvic lymph nodes(mLLN)in stage II/III rectal cancer patients below the peritoneal reflection.The treatment of this nodal area sparks significant controversy due to the strategic differences followed by Eastern and Western physicians,albeit with a higher degree of convergence in recent years.The dissection of lateral pelvic lymph nodes without neoadjuvant therapy is a standard practice in Eastern countries.In contrast,in the West,preference leans towards opting for neoadjuvant therapy with chemoradiotherapy or radiotherapy,that would cover the treatment of this area without the need to add the dissection of these nodes to the total mesorectal excision.In the presence of high-risk nodal characteristics for mLLN related to radiological imaging and lack of response to neoadjuvant therapy,the risk of lateral local recurrence increases,suggesting the appropriate selection of strategies to reduce the risk of recurrence in each patient profile.Despite the heterogeneous and retrospective nature of studies addressing this area,an international consensus is necessary to approach this clinical scenario uniformly.

Plasmacytosis mimicking multiple myeloma in angioimmunoblastic T-cell lymphoma:A case report and review of literature

BACKGROUND Angioimmunoblastic T-cell lymphoma(AITL)is a common subtype of peripheral T-cell lymphoma.Approximately half of patients with AITL may concurrently present with hypergammaglobulinemia.Increased numbers of plasma cells in the bone marrow are commonly observed at diagnosis.These tumors mimic plasma cell myelomas,hindering a conundrum of clinical diagnoses and potentially delaying appropriate treatment.CASE SUMMARY A 78-year-old woman experienced poor appetite,weight loss of 5 kg,fatigue 2 months before presentation,and shortness of breath 2 d before presentation,but no fever or night sweats.Physical examination revealed splenomegaly and many palpable masses over the bilateral axillary regions,approximately>2 cm in size,with rubbery consistency and no tenderness.Blood tests revealed anemia and thrombocytopenia,lactate dehydrogenase level of 153 U/L,total protein level of 10.9 g/dL,albumin to globulin ratio of 0.2,and immunoglobulin G level more than the upper limit of 3000 mg/dL.The free kappa and lambda light chain concentrations were 451 and 614 mg/L,respectively.A pathological examination confirmed the diagnosis of AITL.The initial treatment was the cyclophosphamide,epirubicin,vincristine,and prednisolone regimen.Following this treatment,pleural effusion was controlled,and the patient was discharged in a stable condition and followed up in our outpatient department.CONCLUSION This report highlights the importance of differentiating reactive plasmacytosis from plasma cell myeloma in patients with hypergammaglobulinemia.A precise diagnosis of AITL requires a comprehensive evaluation,involving clinical,immunophenotypic,and histological findings conducted by a multidisciplinary team to ensure appropriate treatment.

Preoperative prediction of lymphovascular and perineural invasion in gastric cancer using spectral computed tomography imaging and machine learning

BACKGROUND Lymphovascular invasion(LVI)and perineural invasion(PNI)are important prognostic factors for gastric cancer(GC)that indicate an increased risk of metastasis and poor outcomes.Accurate preoperative prediction of LVI/PNI status could help clinicians identify high-risk patients and guide treatment deci-sions.However,prior models using conventional computed tomography(CT)images to predict LVI or PNI separately have had limited accuracy.Spectral CT provides quantitative enhancement parameters that may better capture tumor invasion.We hypothesized that a predictive model combining clinical and spectral CT parameters would accurately preoperatively predict LVI/PNI status in GC patients.AIM To develop and test a machine learning model that fuses spectral CT parameters and clinical indicators to predict LVI/PNI status accurately.METHODS This study used a retrospective dataset involving 257 GC patients(training cohort,n=172;validation cohort,n=85).First,several clinical indicators,including serum tumor markers,CT-TN stages and CT-detected extramural vein invasion(CT-EMVI),were extracted,as were quantitative spectral CT parameters from the delineated tumor regions.Next,a two-step feature selection approach using correlation-based methods and information gain ranking inside a 10-fold cross-validation loop was utilized to select informative clinical and spectral CT parameters.A logistic regression(LR)-based nomogram model was subsequently constructed to predict LVI/PNI status,and its performance was evaluated using the area under the receiver operating characteristic curve(AUC).RESULTS In both the training and validation cohorts,CT T3-4 stage,CT-N positive status,and CT-EMVI positive status are more prevalent in the LVI/PNI-positive group and these differences are statistically significant(P<0.05).LR analysis of the training group showed preoperative CT-T stage,CT-EMVI,single-energy CT values of 70 keV of venous phase(VP-70 keV),and the ratio of standardized iodine concentration of equilibrium phase(EP-NIC)were independent influencing factors.The AUCs of VP-70 keV and EP-NIC were 0.888 and 0.824,respectively,which were slightly greater than those of CT-T and CT-EMVI(AUC=0.793,0.762).The nomogram combining CT-T stage,CT-EMVI,VP-70 keV and EP-NIC yielded AUCs of 0.918(0.866-0.954)and 0.874(0.784-0.936)in the training and validation cohorts,which are significantly higher than using each of single independent factors(P<0.05).CONCLUSION The study found that using portal venous and EP spectral CT parameters allows effective preoperative detection of LVI/PNI in GC,with accuracy boosted by integrating clinical markers.

A retrospective analysis of mature T-and NK-cell lymphomas

Mature T-and natural killer(NK)-cell lymphomas are heterogeneous groups of malignant lymphoid neoplasms arising from T and NK cells. The incidence of mature T-and NK-cell lymphomas is 2.1 per 100,000 people, according to a US report~1.

Prognostic factors of breast cancer brain metastasis

In this editorial we comment on the article by Chen et al published in the recent issue of the World Journal of Clinical Oncology.Brain metastasis is one of the most serious complications of breast cancer and causes high morbidity and mortality.Brain metastases may involve the brain parenchyma and/or leptomeninges.Symptomatic brain metastases develop in 10%-16%of newly recognized cases each year,and this rate increases to 30%in autopsy series.Depending on the size of the metastatic foci,it may be accompanied by extensive vasogenic edema or may occur as small tumor foci.Since brain metastases are a significant cause of morbidity and mortality,early diagnosis can have significant effects on survival and quality of life.The risk of developing brain metastases emerges progressively due to various patient and tumor characteristics.Patient variability may be particularly important in the susceptibility and distribution of brain metastases because malignant blood must cross the brain barrier and move within the brain parenchyma.Some characteristics of the tumor,such as gene expression,may increase the risk of brain metastasis.Clinical growth,tumor stage,tumor grade,growth receptor positivity,HER2 positivity,molecular subtype(such as triple negative status,luminal/nonluminal feature)increase the risk of developing breast cancer metastasis.Factors related to survival due to breast cancer brain metastasis include both tumor/patient characteristics and treatment characteristics,such as patient age,lung metastasis,surgery for brain metastasis,and HER2 positivity.If cases with a high risk of developing brain metastasis can be identified with the help of clinical procedures and artificial intelligence,survival and quality of life can be increased with early diagnosis and treatment.At the same time,it is important to predict the formation of this group in order to develop new treatment methods in cases with low survival expectancy with brain metastases.

Clinical observation of extraction-site incisional hernia after laparoscopic colorectal surgery

BACKGROUND Laparoscopic colorectal cancer surgery increases the risk of incisional hernia(IH)at the tumor extraction site.AIM To investigate the incidence of IH at extraction sites following laparoscopic colo-rectal cancer surgery and identify the risk factors for IH incidence.METHODS This study retrospectively analyzed the data of 1614 patients who underwent la-paroscopic radical colorectal cancer surgery with tumor extraction through the abdominal wall at our center between January 2017 and December 2022.Diffe-rences in the incidence of postoperative IH at different extraction sites and the risk factors for IH incidence were investigated.RESULTS Among the 1614 patients who underwent laparoscopic radical colorectal cancer surgery,303(18.8%),923(57.2%),171(10.6%),and 217(13.4%)tumors were ex-tracted through supraumbilical midline,infraumbilical midline,umbilical,and off-midline incisions.Of these,52 patients developed IH in the abdominal wall,with an incidence of 3.2%.The incidence of postoperative IH was significantly higher in the off-midline incision group(8.8%)than in the middle incision groups[the supraumbilical midline(2.6%),infraumbilical midline(2.2%),and umbilical incision(2.9%)groups](χ^(2)=24.985;P<0.05).Univariate analysis showed that IH occurrence was associated with age,obesity,sex,chronic cough,incision infection,and combined diabetes,anemia,and hypopro-teinemia(P<0.05).Similarly,multivariate analysis showed that off-midline incision,age,sex(female),obesity,incision infection,combined chronic cough,and hypoproteinemia were independent risk factors for IH at the site of laparoscopic colorectal cancer surgery(P<0.05).CONCLUSION The incidence of postoperative IH differs between extraction sites for laparoscopic colorectal cancer surgery.The infraumbilical midline incision is associated with a lower hernia rate and is thus a suitable tumor extraction site.

Changes in acute and late toxicity and patient-reported health-related quality of life following radiotherapy in women with breast cancer:A 1-year longitudinal study

Objective:The objective of this study was to investigate the frequency of acute and late toxicities,as well as changes in the quality of life(QOL)for breast cancer patients following radiotherapy(RT).Materials and Methods:A total of 108 breast cancer women were recruited for this prospective study.Data were collected at various intervals;prior to,and 1,3,6 months,and 1 year after radiation therapy.The primary outcomes were toxicity radiation therapy oncology group/European Organization for Research and Treatment of Cancer(EORTC)criteria.Our secondary outcome was QOL,measured using EORTC QLQ-C30 and Edmonton Symptom Assessment Scale.We employed Friedman’s two-way analysis to evaluate the changes in QOL over the course of 1 year.Results:The early toxicities that are most commonly experienced include pharyngeal,skin,and mucous membrane toxicity.Late toxicities frequently involve skin and submucosal toxicity.To measure patient functionality,all functional subscale scores except for the patient’s emotional state increased over time compared to pre-RT.Symptoms of the patients,which were included in the QOL symptom scale,decreased during the follow-up period,except for fatigue;however,changes in pain,insomnia,and loss of appetite did not significantly change.We identified the analogous symptom profiles in Edmonton.Although patients’overall health scores declined in the 1st and 3rd months after radiotherapy(RT),they rebounded at 6 and 12 months.Conclusion:For breast cancer patients,RT did not adversely affect functional capacity or exacerbate symptoms,but persistent fatigue did increase during the observation period.Health-care professionals ought to devise strategies to assist patients with skin toxicity and fatigue.

Report of China's innovation increase and research growth in radiation oncology

Aims： To investigate the research status of radiation oncology in China through survey of literature in international radiation oncology journals and retrospectively compare the outputs of radiation oncology articles of the three major regions of China--Mainland （ML）, Taiwan （TW） and Hong Kong （HK）. Methods： Radiation oncology journals were selected from ＂oncology＂ and ＂radiology, nuclear ＆ medical image＂ category from Science Citation Index Expand （SCIE）. Articles from the ML, TW and HK were retrieved from MEDLINE. The number of total articles, clinical trials, case reports, impact factors （IF）, institutions and articles published in each journals were conducted for quantity and quality comparisons. Results： A total 818 articles from 13 radiation oncology journals were searched, of which 427 are from ML, 259 from TW, and 132 from HK. Ninety-seven clinical trials and 5 case reports are reported in China. Accumulated IF of articles from ML （1,417.11） was much higher than that of TW （1,003.093） and HK （544.711）, while the average IF of articles from ML is the lowest. Conclusions： The total number of articles from China especially ML increased significantly in the last decade. The number of articles published from the ML has exceeded those from TW and HK. However, the quality of articles from TW and HK is better than that from ML.

Assessment of Breast Cancer Prevention Practices among Women Attending Primary Health Care in Abha City, Aseer Region, Saudi Arabia

Cancer is a leading cause of death worldwide, with breast cancer being the most common (2.26 million new cases and 685,000 deaths). In Saudi Arabia, breast cancer ranked the first among females in 2014, accounting for 15.9% of all cancers reported among Saudi nationals and 28.7% of all cancers reported among females of all ages. Early detection of breast cancer could decrease the risks, have a better prognosis, and have better outcomes/more successful treatments. Prevalence of breast cancer reached more than 25% of all diagnosed cancer in the kingdom among women. Aim: This study aims to assess the knowledge and performance of women attending primary care centers about breast self-examination and mammogram screening for prevention and early detection of breast cancer in Abha city primary healthcare centers, Kingdom of Saudi Arabia. Research Method: cross sectional design was conducted by using questionnaire, which was distributed to primary care center nurses. The collected data was statistically analyzed using the Statistical Package for Social Sciences, version 25. Results: The study found that participants had poor awareness and knowledge about breast self-examination, risk factors for breast cancer, and trends and practices in early diagnosis of breast cancer. Conclusion and Recommendations: It recommends increasing awareness campaigns and providing educational programs to improve knowledge and practices.