This randomized clinical trial evaluates whether the addition of radiotherapy to adjuvant S-1 plus oxaliplatin chemotherapy increases disease-free survival among patients undergoing D2 gastrectomy for T4 or node-positive gastric cancer. QuestionIs adjuvant chemoradiotherapy more effective than chemotherapy alone in patients with gastric cancer and T4 or node-positive disease following D2 gastrectomy (ie, gastrectomy with D2 lymphadenectomy)?FindingsIn this randomized clinical trial involving 620 patients, adding radiotherapy to adjuvant S-1 plus oxaliplatin (SOX) chemotherapy after D2 gastrectomy did not significantly improve disease-free survival or overall survival compared with SOX alone.MeaningThese findings suggest that routine intensification with postoperative radiotherapy added to adjuvant SOX may not be warranted after D2 R0 resection for T4 or node-positive gastric cancer. ImportanceDespite advances in D2 gastrectomy (ie, gastrectomy with D2 lymphadenectomy) and adjuvant chemotherapy, the value of adding postoperative radiotherapy (RT) to adjuvant chemotherapy after D2 gastrectomy remains a topic of ongoing debate.ObjectiveTo assess whether the addition of RT to the S-1 plus oxaliplatin (SOX) chemotherapy regimen increases disease-free survival (DFS) in patients with T4 or node-positive gastric cancer after D2 gastrectomy.Design, Setting, and ParticipantsThis open-label, phase 3 randomized clinical trial was conducted between December 1, 2012, and August 30, 2022, at 5 large tertiary hospitals in China. Eligible patients were aged 18 to 70 years with gastric adenocarcinoma who underwent R0 resection with D2 lymphadenectomy, had pathologic stage T4 or node-positive disease, and had no evidence of metastasis (M0). Intention-to-treat statistical analyses were conducted from January 14 to March 31, 2025.InterventionsParticipants were assigned 1:1 to receive concurrent chemoradiotherapy (SOX RT) or chemotherapy alone (SOX). The SOX RT group received 1 cycle of induction SOX, followed by RT (50.4 Gy in 28 fractions) with concurrent S-1 (50 mg twice daily), and then 3 cycles of SOX. The SOX group received 6 cycles of SOX (S-1 30-40 mg/m2 twice daily on days 1-14; oxaliplatin 130 mg/m2 on day 1, every 3 weeks).Main Outcomes and MeasuresThe primary end point was 3-year DFS. Secondary end points included overall survival (OS) and adverse events.ResultsA total of 620 patients were randomly assigned to the SOX group (n = 311) or SOX RT group (n = 309). Patients had a median (IQR) age of 55 (47-62) years and included 401 males (64.7%). Overall, 274 patients (44.2%) had T4 disease, and 590 (95.2%) had node-positive disease. In the primary analysis for the prespecified 3-year DFS end point, there was no evidence of a between-group difference in DFS (SOX RT vs SOX: HR, 0.98; 95% CI, 0.73-1.33). Similarly, there was no evidence of a between-group difference in OS (HR, 0.86; 95% CI, 0.60-1.23). The Kaplan-Meier-estimated 3-year DFS rates were 70.5% in the SOX RT group and 69.3% in the SOX group (log-rank P = .93), and the corresponding 3-year OS rates were 80.8% and 78.4%, respectively (log-rank P = .41). At 5 years, the DFS rates were 60.0% and 57.3% (log-rank P = .76) and the corresponding OS rates were 73.7% and 71.4% (log-rank P = .55) in the SOX RT and SOX groups, respectively. Treatment-related adverse events were similar between groups.Conclusions and RelevanceIn this randomized clinical trial of patients with T4 or node-positive gastric cancer who underwent D2 gastrectomy, SOX RT did not significantly improve DFS or OS. Accordingly, among patients with D2-resected gastric cancer, the findings do not support routine addition of adjuvant chemoradiotherapy to chemotherapy.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR-TRC-12002919

Background:Adjuvant therapy with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) is effective and safe for patients with completely resected non-small cell lung cancer (NSCLC) with EGFR mutations, but certain issues remain unresolved. This retrospective study aimed to investigate the optimal adjuvant treatment regimen and duration of EGFR-TKI treatment, evaluate the efficacy of different generations of EGFR-TKIs, and identify prognostic factors for patients with stage N2 EGFR-mutant NSCLC. Methods:From July 31, 2010, to July 31, 2022, clinicopathological data were collected from 190 patients with N2 EGFR-mutant NSCLC who underwent complete surgical resections. Patients received either postoperative adjuvant EGFR-TKI monotherapy or adjuvant combination therapy with EGFR-TKI (chemotherapy, radiotherapy, or radiochemotherapy prior to EGFR-TKI therapy). Overall survival (OS) and disease-free survival (DFS) were assessed. Results:The median follow-up of the 190 patients was 49 months, with a 4-year DFS rate being 41.3% and the 4-year OS rate being 80.2%. Among these patients, 127 (66.8%) received EGFR-TKI monotherapy, while 63 (33.2%) received combination therapy. Pathological tumor-node-metastasis (pTNM) stage (stage IIIA vs. stage IIIB; P=0.01) and generation of EGFR-TKI (third vs. first; P<0.001) were significantly associated with DFS benefit, but not with OS. The number of positive mediastinal lymph nodes (<3 vs. ≥3) correlated with both DFS (P=0.02) and OS (P=0.04) benefit. EGFR mutation status (exon 19 deletion vs. exon 21 L858R point mutation) was significantly associated with DFS (P=0.03) and OS (P=0.01). However, EGFR-TKI monotherapy and combination therapy demonstrated no significant differences in terms of DFS (P=0.73) or OS (P=0.13). Longer duration of EGFR-TKI treatment (>3 vs. ≤3 years) was associated with better DFS (P<0.001) and OS (P<0.001). Moreover, pTNM stage, generation of EGFR-TKI, and duration of EGFR-TKI treatment were identified as independent prognostic factors for DFS (all P<0.05), while duration of EGFR-TKI treatment was also an independent prognostic factor for OS (P<0.001). Conclusions:Our study found that EGFR-TKI monotherapy and combination therapy demonstrated no significant differences in terms of DFS or OS in patients with completely resected stage N2 EGFR-mutant NSCLC. Adjuvant treatment with third-generation EGFR-TKIs and prolonged treatment duration may offer enhanced survival benefits.

Importance:Despite advances in D2 gastrectomy (ie, gastrectomy with D2 lymphadenectomy) and adjuvant chemotherapy, the value of adding postoperative radiotherapy (RT) to adjuvant chemotherapy after D2 gastrectomy remains a topic of ongoing debate. Objective:To assess whether the addition of RT to the S-1 plus oxaliplatin (SOX) chemotherapy regimen increases disease-free survival (DFS) in patients with T4 or node-positive gastric cancer after D2 gastrectomy. Design, Setting, and Participants:This open-label, phase 3 randomized clinical trial was conducted between December 1, 2012, and August 30, 2022, at 5 large tertiary hospitals in China. Eligible patients were aged 18 to 70 years with gastric adenocarcinoma who underwent R0 resection with D2 lymphadenectomy, had pathologic stage T4 or node-positive disease, and had no evidence of metastasis (M0). Intention-to-treat statistical analyses were conducted from January 14 to March 31, 2025. Interventions:Participants were assigned 1:1 to receive concurrent chemoradiotherapy (SOX RT) or chemotherapy alone (SOX). The SOX RT group received 1 cycle of induction SOX, followed by RT (50.4 Gy in 28 fractions) with concurrent S-1 (50 mg twice daily), and then 3 cycles of SOX. The SOX group received 6 cycles of SOX (S-1 30-40 mg/m2 twice daily on days 1-14; oxaliplatin 130 mg/m2 on day 1, every 3 weeks). Main Outcomes and Measures:The primary end point was 3-year DFS. Secondary end points included overall survival (OS) and adverse events. Results:A total of 620 patients were randomly assigned to the SOX group (n = 311) or SOX RT group (n = 309). Patients had a median (IQR) age of 55 (47-62) years and included 401 males (64.7%). Overall, 274 patients (44.2%) had T4 disease, and 590 (95.2%) had node-positive disease. In the primary analysis for the prespecified 3-year DFS end point, there was no evidence of a between-group difference in DFS (SOX RT vs SOX: HR, 0.98; 95% CI, 0.73-1.33). Similarly, there was no evidence of a between-group difference in OS (HR, 0.86; 95% CI, 0.60-1.23). The Kaplan-Meier-estimated 3-year DFS rates were 70.5% in the SOX RT group and 69.3% in the SOX group (log-rank P = .93), and the corresponding 3-year OS rates were 80.8% and 78.4%, respectively (log-rank P = .41). At 5 years, the DFS rates were 60.0% and 57.3% (log-rank P = .76) and the corresponding OS rates were 73.7% and 71.4% (log-rank P = .55) in the SOX RT and SOX groups, respectively. Treatment-related adverse events were similar between groups. Conclusions and Relevance:In this randomized clinical trial of patients with T4 or node-positive gastric cancer who underwent D2 gastrectomy, SOX RT did not significantly improve DFS or OS. Accordingly, among patients with D2-resected gastric cancer, the findings do not support routine addition of adjuvant chemoradiotherapy to chemotherapy. Trial Registration:Chinese Clinical Trial Registry Identifier: ChiCTR-TRC-12002919.

OBJECTIVE:This study aims to evaluate the predictive utility of multi-slice spiral computed tomography (MSCT) in assessing the response to neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC). METHODS:The clinical data of patients with MIBC who received treatment at our institution between January 2022 and January 2024 were retrospectively analysed. The patients were assigned to an observation group or a control group according to whether pathological downstaging was achieved following NAC with a gemcitabine and cisplatin regimen. A multivariate logistic regression analysis was conducted to develop a clinical prediction model, and a receiver operating characteristic (ROC) curve was generated to assess its diagnostic performance. For the evaluation of the model's stability, all patients were randomly assigned to either a training set or a validation set in a 7:3 ratio. RESULTS:A total of 86 patients were included in the study, among whom 46 achieved pathological downstaging with a downstaging rate of 53.49%. Multivariate logistic regression analysis identified blood flow (BF; odds ratio (OR), 95% confidence interval (CI): 0.63 (0.48-0.81)) and blood volume (BV; OR, 95% CI: 0.04 (0.00-0.46)) measured by MSCT as independent predictors of NAC efficacy (p < 0.05). In the training set, the area under the ROC curve (AUC) was 0.94 (95% CI: 0.89-0.99), with a specificity of 0.86 and a sensitivity of 0.87. In the validation set, the AUC was 0.98 (95% CI: 0.93-1.00), with a specificity of 0.84 and a sensitivity of 0.88. The Hosmer-Lemeshow goodness-of-fit test indicated good calibration, with p-values of 0.504 and 0.915 in the training and validation sets, respectively. The calibration curve demonstrated strong concordance with the ideal 45° reference line, indicating close alignment between predicted and observed probabilities. Decision curve analysis further confirmed the clinical utility of the nomogram, showing a favourable net benefit across a wide range of threshold probabilities. CONCLUSIONS:Pre-chemotherapy BF and BV parameters measured by MSCT were identified as significant predictors of NAC efficacy in patients with MIBC. The predictive model constructed using these parameters demonstrated strong performance in forecasting pathological downstaging following NAC.

Introduction:Esophageal cancer (ESCA) is a highly aggressive malignancy with poor prognosis. Small nuclear ribonucleoprotein polypeptide B2 (SNRPB2) is a core component of the spliceosome involved in pre-mRNA splicing. However, its role in tumor development and progression remains largely unclear. This study aimed to evaluate the clinical relevance and prognostic value of SNRPB2 in ESCA. Methods:SNRPB2 mRNA expression and genetic alterations were analyzed using GEPIA2 and cBioPortal. Protein expression was assessed by immunohistochemistry in paraffin-embedded esophageal squamous cell carcinoma (ESCC) tissues. Functional assays in ESCC cell lines were conducted to determine the biological role of SNRPB2. Immune-related and functional analyses were performed using TIMER, TISIDB, TISCH, Gene Ontology (GO), and Gene Set Enrichment Analysis (GSEA). Cycloheximide (CHX) chase assays were used to assess protein stability. Results:SNRPB2 mRNA was upregulated in ESCA and associated with tumor progression and poor prognosis. Immunohistochemistry confirmed high SNRPB2 protein expression in ESCC, correlating with vessel carcinoma embolus, lymph node metastasis, clinical stage, and tumor grade. SNRPB2 knockdown significantly inhibited ESCC cell proliferation, migration, and invasion in vitro and in vivo. GSEA indicated that SNRPB2 suppresses the Rb/E2F pathway. Mechanistically, SNRPB2 stabilized E2F4 protein by preventing its proteasomal degradation, and E2F4 overexpression reversed the tumor-suppressive effects of SNRPB2 silencing. Immune analyses showed that SNRPB2 expression correlated with increased infiltration of activated CD8+ T cells, γδ T cells, dendritic cells, and monocytes, as well as immune-related genes including PDCD1, CD274, CTLA4, HLA-DRA, and B2M. These findings suggest a dual role for SNRPB2 in promoting tumor progression and modulating the immune microenvironment in ESCA. Conclusion:SNRPB2 promotes ESCC progression by stabilizing E2F4 and regulating cell cycle genes. It is also associated with immune infiltration and gene expression in ESCA. SNRPB2 may serve as a prognostic biomarker and potential therapeutic target in esophageal cancer.

BackgroundWhile there are established international consensuses on the delineation of pelvic lymph node regions (LNRs), significant inter- and intra-observer variabilities persist. Contouring these clinical target volumes for irradiation in pelvic malignancies is both time-consuming and labor-intensive.PurposeThe purpose of this study was to develop a deep learning model of pelvic LNRs delineation for patients with pelvic cancers.MethodsPlanning computed tomography (CT) studies of 160 patients with pelvic primary malignancies (including rectal, prostate, and cervical cancer) were retrospectively collected and divided into training set (n = 120) and testing set (n = 40). Six pelvic LNRs, including abdominal presacral, pelvic presacral, internal iliac nodes, external iliac nodes, obturator nodes, and inguinal nodes were delineated by two radiation oncologists as ground truth (Gt) contours. The cascaded multi-heads U-net (CMU-net) was constructed based on the Gt contours from training cohort, which was subsequently verified in the testing cohort. The automatic delineation of six LNRs (Auto) was evaluated using dice similarity coefficient (DSC), average surface distance (ASD), 95th percentile Hausdorff distance (HD95), and a 7-point scale score.ResultsIn the testing set, the DSC of six pelvic LNRs by CMU-net model varied from 0.851 to 0.942, ASD from 0.381 to 1.037 mm, and HD95 from 2.025 to 3.697 mm. No significant differences were founded in these three parameters between postoperative and preoperative cases. 95.9% and 96.2% of auto delineations by CMU-net model got a score of 1-3 by two expert radiation oncologists, respectively, meaning only minor edits needed.ConclusionsThe CMU-net was successfully developed for automated delineation of pelvic LNRs for pelvic malignancies radiotherapy with improved contouring efficiency and highly consistent, which might justify its implementation in radiotherapy work flow.

Background:Nasopharyngeal carcinoma (NPC) originates in the nasopharyngeal mucosa, the lateral wall of the nasopharynx. A significant challenge in NPC management is skull-base bone invasion (SBBI), which affects prognosis and treatment planning. Magnetic resonance imaging (MRI) is the primary diagnostic tool for SBBI in NPC patients; however, the detection of SBBI can be challenging due to skull-base complexity and overlapping MRI signals. 18fluorine-sodium fluoride (18F-NaF) positron emission tomography/computed tomography (PET/CT) is an emerging imaging technique that has shown promise in detecting osseous lesions. This cohort study aimed to assess the supplementary diagnostic value of 18F-NaF PET/CT in detecting SBBI in NPC patients compared to that of MRI alone. Methods:Imaging data were retrospectively collected from 18F-NaF PET/CT and head-and-neck MRI examinations conducted within a 7-day period. The sensitivity, specificity, and accuracy of 18F-NaF PET/CT, MRI, and the combination of both modalities in detecting SBBI were individually assessed. Both lesion- and patient-based analyses were employed for the comparison. Cochran's Q test was used to compare the accuracy of these methods, while the Bonferroni-corrected McNemar test was used for the pairwise comparisons. The data analysis was performed using the R software package, and a significance level of P<0.05 was considered statistically significant. Results:A total of 164 patients were enrolled in the study. Using 18F-NaF PET/CT, MRI, and the combined modality of 18F-NaF PET/CT with MRI, 97, 84, and 94 cases of SBBI were diagnosed, respectively. At the patient level, the diagnostic efficacy (sensitivity, specificity, and accuracy) was as follows: 18F-NaF PET/CT had 100% sensitivity, 93.1% specificity, and 97.0% accuracy; MRI had 90.2% sensitivity, 98.6% specificity, and 93.9% accuracy; and the combination of 18F-NaF PET/CT and MRI had 100% sensitivity, 97.2% specificity, and 98.8% accuracy. The accuracy rate of 18F-NaF PET/CT combined with MRI were significantly higher than that of MRI alone (P=0.034). A total of 284, 243, and 276 SBBI lesions were diagnosed using 18F-NaF PET/CT, MRI, and 18F-NaF PET/CT combined with MRI, respectively. The diagnostic efficacy (sensitivity, specificity, and accuracy) at the lesion level was as follows: 18F-NaF PET/CT had 99.6% sensitivity, 75.9% specificity, and 95.4% accuracy; MRI had 88.2% sensitivity, 93.1% specificity, and 89.1% accuracy; and the combination of 18F-NaF PET/CT with MRI had 100% sensitivity, 91.4% specificity, and 98.5% accuracy. The combination of 18F-NaF PET/CT with MRI significantly improved the accuracy rate compared to that of MRI alone, and the difference was statistically significant (P<0.001). Conclusions:The combined use of 18F-NaF PET/CT and MRI significantly enhanced the diagnosis of SBBI in NPC patients, and the combined method had improved diagnostic sensitivity and accuracy than MRI alone.

Abstract Background The elderly population is increasing year by year. Aging has become an important risk factor for cardiac dysfunction and heart failure. Previous studies have found that bromodomain adjacent to zinc finger 2B (Baz2b) is closely associated with neurodegeneration, but its role in aging-related heart failure remains unclear. Purpose We aim to explore the mechanism of Baz2b in aging-induced heart failure and doxorubicin-induced heart failure. We also investigate whether Baz2b and its downstream mechanism can serve as targets for clinical intervention. Methods We injected doxorubicin intraperitoneally in Baz2b knockout and cardiac-specific Baz2b knockdown mice to produce in vivo models. The effects of Baz2b and its downstream regulators were further explored via RNA-sequence, chromatin immunoprecipitation-sequence (ChIP-seq) and assay for transposase-accessible chromatin-sequence (ATAC-seq). Besides, we elucidated the function of Baz2b in alpha-myosin heavy chain-induced myocarditis. Results we found that Baz2b expression was upregulated in both aged and doxorubicin-induced mice heart. Baz2b knockout resulted in cardiac function recovery accompanied by a decline in apoptosis in aged mice and doxorubicin-induced mice. In contrast to control mice, cardiac-specific Baz2b knockdown alleviated doxorubicin-induced cardiac dysfunction and apoptosis. Mechanistically, Baz2b was closely associated with inflammatory responses in heart. It regulates Stat1, an important inflammatory downstream regulator via H3k4me3. Furthermore, the overexpression of Stat1 was able to abolish the protective role of Baz2b in doxorubicin-induced cardiotoxicity. Besides, cardiac-specific Baz2b knockdown could alleviated myocarditis, in line with the fact that Baz2b was linked to inflammation. Conclusion Taken together, this study provides new insights that Baz2b plays an important role in aging-related heart dysfunction. Since epigenetic readers were previously unrecognized, these findings may shed on novel clinical therapeutic choice for patients with chemotherapy-induced cardiotoxicity.The schematic diagram of Baz2b in heart

Purpose: To explore the optimal combination of monochromatic images derived from dual -energy CT (DECT) in calculating the stopping power ratio (SPR) of human tissues. Methods: Monochromatic CT numbers ranging from 40 keV to 140 keV (in intervals of 10 keV) for 34 standard human tissues were theoretically computed based on the NIST database. These values were then paired, resulting in 55 different dual -energy combinations for calculating the stopping power ratio (SPR). The combinations adhered to the rule of a lower energy (Elow) paired with a higher X-ray energy (Ehigh). Subsequently, each energy combination was utilized to predict the SPR of human tissues, and the accuracy of each pairing was assessed. Additionally, an analysis of the impact of uncertainty in the attenuation coefficient was conducted. Results: When Elowis <= 70 keV, an optimal energy combination emerges. These optimal energy combinations within the 40 keV, 50 keV, 60 keV, and 70 keV groups are 40-100 keV, 50-90 keV, 60-80 keV, and 70-80 keV, respectively, with corresponding mean absolute errors (MAE) of SPR at 0.12%, 0.11%, 0.12%, and 0.15%, respectively. The impact of attenuation coefficient uncertainty on these findings is minimal; even with a 1-2% uncertainty, the maximum change in MAE for SPR error is only 0.04%. Conclusions: Dual -energy CT utilizing energy pairs within the low energy range (40-70 keV) exhibits greater advantages in predicting the stopping power ratio of human tissues. In our investigation, the four energy combinations-40-100 keV, 50-90 keV, 60-80 keV, and 70-80 keV-demonstrated the highest accuracy in predicting SPR.

Background: Immune checkpoint inhibitors (ICIs) have shown high efficacy in lung cancer. Adding ICIs to chemoradiation might increase the treatment efficacy, while the application of ICIs or chemoradiation alone can induce treatment-related pneumonitis, so whether combination therapy would increase the risk of pneumonitis needs careful evaluation. This study aimed to retrospectively analyze the incidence of pneumonitis in patients who underwent chemoradiation combined with ICIs compared with chemoradiation alone and explore the risk factors of pneumonitis in combination therapy. Methods: This was a retrospective cohort study. Patients who received conventional thoracic radiation with a minimum total dose of 50 Gy for lung cancer between January 2020 and December 2021 at West China Hospital were retrospectively reviewed and followed up for at least 6 months after radiation. Patients were divided into two groups according to whether chemoradiation was administered with or without ICIs. Pneumonitis was evaluated by chest computed tomography (CT) at least every 2 months in outpatient department. The clinical characteristics, including sex, age, smoking history, pathological diagnosis, baseline pulmonary disease [including chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD)], treatment strategy, location of primary tumor and radiological dosimetric parameters were recorded. Chi-squared tests or Fisher's exact tests were performed to analyze the difference between the combination group and control group for categorical variables and Mann-Whitney U test for continuous variables. Univariate and multivariate analyses were performed by logistic regression. Results: A total of 152 patients who received chemoradiation were enrolled. The median age was 59 years. A total of 115 (75.7%) patients were non-small cell lung cancer (NSCLC), 22 (14.5%) were small cell lung cancer (SCLC), and 15 (9.9%) were other pathological types. Among them, 58 received chemoradiation combined with ICIs and 94 received chemoradiation alone. The rate of grade >= 2 pneumonitis was significantly higher in the combination therapy group (39.7% vs. 22.3%, P=0.028) and was associated with the use of ICIs [odds ratio (OR): 2.641, 95% confidence interval (CI): 1.244-5.608, P=0.011] and percent volume of the lung receiving >= 30 Gy (V30) (OR: 1.728, 95% CI: 1.214-2.460, P=0.002). The history of chronic lung disease was the independent risk factor (OR: 6.359, 95% CI: 1.953-20.705, P=0.002) of grade >= 3 pneumonitis. In the combination group, univariate and multivariate analyses revealed that V5, V20, V30, and mean lung dose (MLD) were not associated with pneumonitis, whereas the history of chronic lung disease was an independent risk factor of grade >= 3 pneumonitis (OR: 8.351, 95% CI: 1.469-47.484, P=0.017). Conclusions: The incidence of pneumonitis of ICIs combined with chemoradiation was higher than chemoradiation alone, but manageable. The combination therapy should be applied with caution especially in patients with history of chronic lung disease.

Background: Gamma knife surgery (GKS) for brain metastases (BMs) adjacent to the pyramidal tract (PT) is still a challenge to conduct. PT visualization and biologically effective dose (BED) calculation on a voxel-by-voxel basis may provide data to establish clinically safe values. We aimed to assess the relationship of parameters extracted from the BED-volume histogram with outcomes of PT after GKS-treating target (adjacent BM of lung adenocarcinoma).Methods: We formed BED-volume histograms for 672 BMs in a retrospective cohort, using 3-dimensional (3D) coordinate values of PT, target, and each iso-centre to calculate the 3D BED distribution in a 200 x 200 x 200 matrix. PT conservation failure (PTCF) was judged clinically and radiologically and classified as lesion progression and radionecrosis. Cox proportional hazards models were used to analyse 3D BED parameters. Internal validation of models was performed by bootstrapping.Results: There were 116 (17.3 %) subjects with PTCF in the cohort, of which 74 (11.0 %) and 42 (6.3 %) were caused by lesion progression and radionecrosis, respectively. Multivariate analysis showed that DLesion_min BED and DLesion_90% BED significantly predicted lesion progression (P <.001). DPT_Max BED and VPT_ BED40 significantly predicted radionecrosis (P <.001). The model predicting PTCF showed fair discrimination and calibration of DLesion_min BED + DLesion_90% BED and DPT_Max BED + VPT_ BED40.Conclusions: The conservation of PT in GKS for BMs of lung adenocarcinoma depends on the combination of PT-tolerated BED and target effective control BED. Therefore, a BED-volume histogram with a 3D BED algorithm is proposed to assess plan quality.CO 2022 Elsevier B.V. All rights reserved. Radiotherapy and Oncology xxx (2023) xxx-xxx

Spatial dose response for NSCLC assessed using FDG-PET/CT feedback demonstrated high treatment resistant patterns, which had a large intra-tumoral variation. In addition, the medium correlations of DRM vs SUV and DRM vs SUV imply that all these factors could be used to guide adaptive modification of NSCLC treatment.

Thymoma combined with pure red cell aplasia (PRCA) and acquired amegakaryocytic thrombocytopenia (AAMT) has been rarely reported, often occurring in the initial stage of treatment and after chemotherapy or thymectomy, while PRCA and AAMT occurring after radiotherapy for thymoma has not been reported. The present study describes the case of a 42-year-old female patient with thymoma complicated by radiation-induced PRCA and AAMT after a rapid response to radiotherapy, who was in complete remission without recurrence after adjustment of initial symptomatic therapy to cyclosporine combined with prednisone. After 1 month, the patient underwent complete resection of mediastinal tumor. Next-generation sequencing revealed that the DNA damage repair pathway-related gene MSH3 was mutated, with p.A57P in abundance of 9.21%. To the best of our knowledge, the present study is the first to report that PRCA and AAMT secondary to thymoma after radiotherapy may be associated with increased sensitivity to radiotherapy caused by a mutation in the MSH3 gene.

Objective. Respiratory motion tracking techniques can provide optimal treatment accuracy for thoracoabdominal radiotherapy and robotic surgery. However, conventional imaging-based respiratory motion tracking techniques are time-lagged owing to the system latency of medical linear accelerators and surgical robots. This study aims to investigate the precursor time of respiratory-related neural signals and analyze the potential of neural signals-based respiratory motion tracking. Approach. The neural signals and respiratory motion from eighteen healthy volunteers were acquired simultaneously using a 256-channel scalp electroencephalography (EEG) system. The neural signals were preprocessed using the MNE python package to extract respiratory-related EEG neural signals. Cross-correlation analysis was performed to assess the precursor time and cross-correlation coefficient between respiratory-related EEG neural signals and respiratory motion. Main results. Respiratory-related neural signals that precede the emergence of respiratory motion are detectable via non-invasive EEG. On average, the precursor time of respiratory-related EEG neural signals was 0.68 s. The representative cross-correlation coefficients between EEG neural signals and respiratory motion of the eighteen healthy subjects varied from 0.22 to 0.87. Significance. Our findings suggest that neural signals have the potential to compensate for the system latency of medical linear accelerators and surgical robots. This indicates that neural signals-based respiratory motion tracking is a potential promising solution to respiratory motion and could be useful in thoracoabdominal radiotherapy and robotic surgery.

Replacement of CRT-D battery 2021 3 rd catheter ablation failed 2021 Received stereotactic body radiotherapy After 6-week blanking period Significant improvement of VT After 6-month post-ablation period No recurrences of VT and complications VT, ventricular tachycardia; CRT-D, cardiac resynchronization therapy-defibrillator.

The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)variant B.1.1.529,also named Omicron,is becoming the main circulating strain in many countries worldwide and brings new challenges to preventing COVID-19[1-5].The latest data show that the Omicron variant contains more than 50 mutations.Among them,there are 32 mutations in the spike protein[6],which is the key component that determines the infectivity and antigenicity of the virus.Furthermore,15 mutations are located in the receptor-binding domain(RBD),which is key for viral-cell interactions mediated by angiotensin-converting enzyme 2(ACE-2)[7,8].

The purpose of the study was to evaluate the accuracy of monochromatic energy (MonoE) computed tomography (CT) images reconstructed by spectral CT in predicting the stopping power ratio (SPRw) of materials in the presence of metal. The CIRS062 phantom was scanned three times using spectral CT. In the first scan, a solid water insert was placed at the center of the phantom (CTno metal). In the second scan, the solid water insert was replaced with a titanium alloy femoral head (CTmetal). The metal artifact reduction (MAR) algorithm was used in the last scan (CTmetal+MAR). The MonoE-CT images of 40 keV and 80 keV were reconstructed. Finally, the single-energy CT method (SECT) and the dual-energy CT method (DECT) were used to calculate the SPRw. The mean absolute error (MAE) of the SPRw of the inner layer inserts calculated by the SECT method were 3.19%, 13.88% and 2.71%, corresponding to CTno metal CTmetal and CTmetal+MAR, respectively. For the outer layer inserts, the MAE of SPRw were 3.43%, 5.42% and 2.99%, respectively. Using the DECT method, the MAE of the SPRw of the inner layer inserts was 1.30%, 3.69% and 1.46% and the MAE of the outer layer inserts-was 1.34%, 1.36% and 1.05%. The studies shows that, compared with the SECT method, the accuracy of the DECT method in predicting the SPRw of a material is more robust to the presence of metal. Using the MAR algorithm when performing CT scans can further improve the accuracy of predicting the SPR of materials in the presence of metal.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/bync/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Journal of Radiation Research, Vol. 64, No. 1, 2023, p. 202 https://doi.org/10.1093/jrr/rrac085 Advance Access Publication: 10 November 2022