Brain metastasis (BM) is a common and severe complication of advanced cancer, and early, accurate diagnosis is critical to improving patient outcomes. This study comprehensively analyzes the characteristics of various imaging techniques for detecting BM. Conventional magnetic resonance imaging (MRI) remains the primary diagnostic method due to its high soft-tissue resolution, while advanced MRI techniques have improved the detection of small lesions. Computed tomography (CT) is valuable for rapid emergency assessment but is limited by lower soft-tissue resolution and radiation exposure. PET imaging offers unique advantages in functional imaging and treatment response differentiation, though constrained by signal-to-noise ratio limitations. Multimodal fusion techniques (e.g., PET/CT, PET/MRI) integrate anatomical and functional information to enhance diagnostic sensitivity and specificity. Furthermore, radiomics and AI extract high-dimensional features and construct predictive models, enabling precise identification and personalized treatment. This article reviews the progress and clinical applications of these imaging techniques.

PurposeBreast cancer is the most common malignancy among women worldwide. A notable subset of patients presents with de-novo stage IV breast cancer at initial diagnosis, meaning metastatic lesions are already present. These patients typically receive primary systemic therapy aimed at palliative care, with locoregional treatment remaining controversial. Although numerous retrospective studies have suggested that resection of the primary tumor may improve survival, prospective randomized trials have not demonstrated a clear benefit, and routine surgical intervention is not generally advocated. This paper aims to review and discuss the research progress regarding locoregional surgical treatment for de-novo stage IV breast cancer.MethodologyRecent retrospective and prospective studies on locoregional surgery for de-novo stage IV breast cancer were searched, with a focus on prospective randomized controlled trials (RCTs). The collected evidence was reviewed to evaluate the role of local surgery in this patient population.ResultsMost retrospective studies and meta-analyses report that primary breast surgery is associated with improved prognosis when stage IV disease is first diagnosed. However, significant selection bias exists in these data. Women who undergo surgery tend to be younger, have smaller primary tumors, fewer comorbidities, and lower metastatic burden—particularly fewer visceral metastases. They are also more likely to receive higher-quality overall care. These factors suggest that surgeons preferentially select patients with a better expected prognosis for surgery. In contrast, prospective randomized trials have consistently failed to demonstrate that locoregional surgery provides additional survival benefits beyond systemic therapy alone. Consequently, routine locoregional surgical treatment is not recommended for most patients with de-novo stage IV breast cancer. Nevertheless, a notable exception exists for patients with bone-only metastases.ConclusionAlthough retrospective analyses support a survival advantage from locoregional surgery in de-novo stage IV breast cancer, prospective RCTs have not confirmed a benefit for the general patient population. However, locoregional surgery does appear to offer survival benefits for patients with bone-only metastases. Further prospective clinical trial data are certainly needed to better define the value of locoregional surgery in de-novo stage IV breast cancer.

To compare the efficacy and safety of neoadjuvant chemoradiotherapy (NCRT) versus chemoimmunotherapy (NCIT) in resectable locally advanced esophageal squamous cell carcinoma (LA-ESCC). Patients with LA-ESCC who underwent NCIT or NCRT were retrospectively enrolled between November 2017 and April 2024. Propensity score matching (PSM) was applied to balance the baseline characteristics. Treatment response, survival outcomes, and safety were compared between groups. 501 patients were enrolled, with 204 in the NCRT group and 297 in the NCIT group. After PSM, 148 matched pairs were analyzed. The NCRT group had a superior objective response rate (ORR) (68.2

BACKGROUND:Thoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a newly defined type of epithelial tumor in the 2021 World Health Organization (WHO) fifth edition classification of thoracic tumors, with a low incidence. Currently, its treatment and prognosis remain unclear. Pathologically, it can be distinguished from SMARCA4-deficient non-small cell lung cancer (SMARCA4-dNSCLC) based on histological morphology and immunohistochemistry, yet whether there are differences in their clinical features, sensitivity to radiotherapy, and prognosis remains unknown. This study aimed to analyze the clinical characteristics of patients with SMARCA4-UT and SMARCA4-dNSCLC and to identify prognostic factors. METHODS:A retrospective analysis was performed on pathologically confirmed SMARCA4-UT and SMARCA4-dNSCLC patients with complete follow-up data who were admitted to Shandong First Medical University Affiliated Tumor Hospital from June 2022 to February 2025. The differences in clinicopathological characteristics and imaging findings between the two groups were statistically analyzed, and the impacts of surgery, radiotherapy, immunotherapy, and clinicopathological factors on the prognosis of patients in both groups were assessed. RESULTS:A total of 27 SMARCA4-UT patients and 40 SMARCA4-dNSCLC patients were enrolled. Both groups showed similar biological characteristics in terms of gender, age, smoking history, tumor size, symptoms, stage, presence of pleural metastasis, neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII). However, there were differences in the predilection sites: SMARCA4-UT occurred more frequently in the mediastinal pleura (22.22%) and right lower lobe (25.93%), while SMARCA4-dNSCLC occurred more frequently in the right upper lobe (25.00%) and left upper lobe (22.50%) (P<0.05). Furthermore, SMARCA4-UT more often presented with local invasion into adjacent structures and more extensive lymph node metastasis (proportion with metastasis in ≥5 lymph node stations: 55.56% vs 27.50%). Both types showed high sensitivity to radiotherapy, with a 6-month local control rate (LCR) of 84.62% vs 83.33% after radiotherapy; the objective response rate (ORR) of immunotherapy was 91.67% vs 68.18% (P>0.05). Regarding survival, the two groups did not show significant differences in progression-free survival (PFS) or overall survival (OS). Cox multivariate regression analysis indicated that surgery could improve the prognosis of both types, while a high NLR (≥3.57) was a predictor of poor prognosis. CONCLUSIONS:SMARCA4-UT and SMARCA4-dNSCLC share similar clinical characteristics and survival outcomes, with minor differences in local invasion, mediastinal lymph node metastasis, and primary tumor location. Surgery improved survival in both groups. Although both tumor types exhibited high sensitivity to radiotherapy, this did not translate into a significant survival benefit for the patients. Pretreatment NLR is a potential prognostic indicator.

Background: Radiotherapy is a major modality for esophageal cancer (ESCA) treatment, yet radioresistance severely hampers its therapeutic efficacy. Ubiquitin-specific peptidase 14 (USP14) is a novel deubiquitinase and can mediate cancer cells’ response to irradiation, although the underlying mechanism remains unclear, including in ESCA. Methods: To evaluate the expression of USP14 in ESCA tissues or cells, we used RNA-Seq, immunoblotting, co-immunoprecipitation (Co-IP), ubiquitination, quantitative real-time polymerase chain reaction (qRT-PCR), and immunofluorescence assays in this investigation. Additionally, we used CCK8, cloning, and migration tests to examine the proliferation and migration of ESCA cells. We also used transplantation tumor mouse model to investigate the course of the cancer cell growth. Finally, we looked into the biological processes linked to USP14 using gene set enrichment analysis (GSEA), which was later verified. Results: We observed a significant upregulation of USP14 in human ESCA tissues and cell lines, especially in those with radioresistance. Moreover, USP14 knockdown significantly restrained the proliferation and inhibited the radiation tolerance of ESCC cells. Here, we identified a potential inhibitor of USP14, Degrasyn (DGS), and investigated its regulatory effects on ESCA radioresistance and progression. We found that DGS had marked antiproliferative effects in radiosensitive ESCA cell lines. Notably, a low dose of DGS significantly enhanced the sensitivity of radioresistant ESCA cells to irradiation, as shown by the significantly reduced cell proliferation, migration, and invasion. Furthermore, the combination of DGS and X-ray irradiation strongly induced DNA damage in radioresistant ESCA cell lines by increasing the phosphorylation levels of H2AX (γ-H2AX) and checkpoint kinase 1/ataxia-telangiectasia-mutated-and-Rad3-related kinase (CHK1/ATR) signaling. Animal experiments confirmed the effective role of the DGS and X-ray combined treatment in reducing tumor growth and irradiation tolerance of ESCA in vivo with undetectable toxicity. Importantly, the promotive and malignant biological behaviors of ESCA cells suppressed by the DGS/X-ray combination treatment were almost eliminated by USP14 overexpression, along with the abolished DNA damage process. Mechanistically, we found that USP14 could interact with Yes-associated protein 1 (YAP1) and induce its deubiquitination in radioresistant ESCA cells. Interestingly, we discovered that DGS/X-ray co-therapy significantly reduced the stability of YAP1 and induced its ubiquitination in radioresistant ESCA cells. More importantly, the proliferation, epithelial-mesenchymal tansition (EMT) process, and DNA damage regulated by DGS/X-ray and USP14 knockdown were significantly eliminated when YAP1 was overexpressed in radioresistant ESCA cells. Conclusions: These data revealed the potential role of DGS/X-ray co-therapy in controlling ESCA resistance to radiotherapy by inhibiting the USP14/YAP1 axis, providing a candidate strategy for ESCA treatment.

Objective:Although preoperative prediction of axillary lymph nodes status has been achieved using radiomics and combined models, there is a dearth of research on internal mammary lymph node (IMN) metastasis status prediction. We developed a predictive model by combining clinicopathological factors with preoperative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) radiomics to accurately predict IMN metastasis in breast cancer. Methods:Patients who had no evidence of IMN metastasis on preoperative images but underwent internal mammary sentinel lymph node biopsy (IM-SLNB) were included in this study. Preoperative DCE-MRI and clinicopathological data of 124 patients with breast cancer were obtained, to developed Clinical, radiomics, and clinical-radiomics models, separately. Decision curve analysis (DCA) was employed to assess the models' clinical applicability. Results:The resulting area under the curves (AUCs) were 0.913, 0.831, 0.964 for the clinical model, the radiomics model, and the clinical-radiomics model, respectively. The Delong test revealed significant differences in the receiver operating characteristic (ROC) curves only between the clinical and clinical-radiomics models (all P<0.05). DCA substantiated the clinical-radiomics model's optimal predictive efficiency, enhanced discriminatory ability, and maximum benefit. The AUC (95% confidence interval: 0.935-0.993) of the clinical-radiomics model is 0.964. Repeated k-fold cross validation showed that average accuracy and Standard deviation of clinical-radiomics model are 90.23% and 8.45%, respectively. And the calibration slope of clinical-radiomics model is 1.08(p=0.071). Conclusions:Although the clinical model was effective in predicting IMN status, the addition of DCE-MRI radiomics significantly improved the predictive value of the clinical-radiomics model, which showed excellent discrimination, calibration, and stability. This suggests that the clinic-radiomics model has potential for preoperative assessment of IMN metastasis risk in breast cancer patients, but external validation is needed to confirm its clinical utility. IMN irradiation is recommended for early patients with high IMN metastasis risk, and overtreatment should be avoided for patients with low metastasis risk.

PURPOSE:This study evaluates the dosimetric benefits of TaiChi, a novel radiotherapy platform combining 6MV linac-based volumetric-modulated arc therapy (VMAT) and γ-ray stereotactic radiotherapy, for locally advanced cervical carcinoma (LACC) with pelvic lymph node metastases. METHODS:Twelve LACC cases were retrospectively analyzed, comparing TaiChi plans with conventional treatment plans. The prescribed doses were standardized at 50 Gy for the planning target volume (PTV) and 12.5 Gy for the PTVLn-a boost volume delivering focal dose escalation to metastatic lymph nodes.Conventional treatment plans were developed using the Varian Eclipse 13.5 treatment planning system (TPS) with VMAT techniques. In contrast, TaiChi plans were generated using the RTPRO TPS (OUR United Corp., China), leveraging the platform's unique dual-modality capabilities: a 6MV linac-based VMAT plan was optimized for PTV coverage, while gamma knife was utilized for PTVLn dose escalation. A comprehensive dosimetric comparison was conducted to evaluate the system's ability to simultaneously achieve PTVLn dose escalation and organs-at-risk (OARs) sparing. RESULTS:TaiChi achieved comparable PTVLn conformity (CI: 0.86 ± 0.06 vs. 0.87 ± 0.02, p = 0.299) but superior dose gradient (GI: 2.03 ± 0.27 vs. 2.21 ± 0.32, p < 0.001). Significant PTVLn dose escalation was observed with TaiChi: mean dose (68.58 ± 0.52 Gy vs. 63.55 ± 1.01 Gy, p < 0.001), D98 (61.81 ± 0.55 Gy vs. 57.09 ± 1.70 Gy, p < 0.001), and D2 (75.02 ± 1.61 Gy vs. 65.36 ± 2.74 Gy, p < 0.001). PTV D2 was moderately higher with TaiChi (64.11 ± 4.01 Gy vs. 62.17 ± 2.68 Gy, p = 0.04). OAR sparing improved significantly: bladder, rectum, and small intestine V45Gy decreased by 3.7 %, 5.1 %, and 3.9 %, respectively. CONCLUSION:TaiChi's synergistic X-ray/γ-ray approach enables safe dose escalation to metastatic nodes while reducing OAR exposure, potentially enhancing tumor control and toxicity outcomes for node-positive cervical carcinoma.

Alterations in the biophysical properties of subcellular compartments, particularly in dynamic structures, are fundamental to various cellular processes. However, methods for probing fast nanoscale changes in live cells remain limited. Single-molecule displacement mapping (SMdM) measures the diffusion coefficients of freely diffusing molecules using paired laser pulses, but its implementation is constrained by camera limitations and depends on specific hardware for precise timing control. To address this, we introduce galvo-accelerated single-molecule displacement mapping (G-SMdM), which overcomes the limitations of SMdM and achieves multi-fold performance enhancement. By utilizing a fast-scanning galvo mirror to spatially multiplex stroboscopic measurements, G-SMdM provides a generalized optical strategy for measuring rapid single-molecule displacements, significantly increasing acquisition efficiency while decoupling SMdM from specialized hardware constraints. Through simulation and experimental validation, we demonstrate improved accuracy and precision in diffusivity measurements using G-SMdM. In live-cell imaging, G-SMdM enabled high-fidelity mapping of fast-diffusing molecules with nanoscale resolution. Biological application of G-SMdM is demonstrated by revealing stress-induced alterations in endoplasmic reticulum membrane and lumen dynamics. Thus, G-SMdM provides a versatile, camera-independent, and modular platform for investigating nanoscale dynamics under physiological and pathological conditions. (c) 2025 Optica Publishing Group under the terms of the Optica Open Access Publishing Agreement

Objectives In this meta-analysis, we conducted a comparative analysis of the safety and efficacy of hypofractionated and conventional fractionated radiotherapy in individuals who had undergone surgery for breast cancer. Methods This study involved a systematic and independent review of relevant research articles published in reputable databases such as PubMed, Embase, Cochrane Library, and Web of Science. Two investigators conducted the review, which included studies published up to January 3, 2023. The quality of the eligible studies was evaluated and data were extracted using Review Manager software 5.4 (RevMan 5.4) to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results The analysis comprised 35 studies and encompassed a collective sample of 18,246 individuals diagnosed with breast cancer. We did not find a statistically significant disparity in efficacy between conventional fractionated (CF) radiotherapy and hypofractionated (HF) radiotherapy regarding local recurrence (LR; OR = 0.91, 95% CI: 0.76–1.09, P = 0.30), disease-free survival (DFS; OR = 1.20, 95% CI: 1.01–1.42, P = 0.03), and overall survival (OS; OR = 1.08, 95% CI: 0.93–1.26, P = 0.28). Concerning safety, there was no significant difference between the HF and CF regimens in terms of breast pain, breast atrophy, lymphedema, pneumonia, pulmonary fibrosis, telangiectasia, and cardiotoxicity. However, the HF regimen resulted in lower skin toxicity (OR = 0.43, 95% CI: 0.33—0.55, P < 0.01) and improved patient fatigue outcomes (OR = 0.73, 95% CI: 0.60 – 0.88, P < 0.01). Conclusions Although there is no substantial difference in LR, DFS, OS, or many other side effects between the HF and CF regimens, the HF regimen reduces skin toxicity and relieves patient fatigue. If these two issues need to be addressed in clinical situations, the HF regimen may be a superior alternative to conventional radiotherapy in postoperative breast cancer patients.

BACKGROUND:This study investigated the differences in target volumes between preoperative magnetic resonance imaging (MRIpre) and postoperative MRI (MRIpost) for breast radiotherapy after breast-conserving surgery (BCS) using deformable image registration (DIR). METHODS AND MATERIALS:Seventeen eligible patients who underwent whole-breast irradiation in the prone position after BCS were enrolled. On MRIpre, the gross tumor volume (GTV) was delineated as GTVpre, which was then expanded by 10 mm to represent the preoperative lumpectomy cavity (LC), denoted as LCpre. The LC was expanded to the clinical target volume (CTV) and planning target volume (PTV) on the MRIpre and MRIpost, denoted as CTVpre, CTVpost, PTVpre, and PTVpost, respectively. The MIM software system was used to register the MRIpre and MRIpost using DIR. Differences were evaluated regarding target volume, distance between the centers of mass (dCOM), conformity index (CI), and degree of inclusion (DI). The relationship between CILC /CIPTV and the clinical factors was also assessed. RESULTS:Significant differences were observed in LC and PTV volumes between MRIpre and MRIpost (p < 0.0001). LCpre was 0.85 cm3 larger than LCpost, while PTVpre was 29.38 cm3 smaller than PTVpost. The dCOM between LCpre and LCpost was 1.371 cm, while that between PTVpre and PTVpost reduced to 1.348 cm. There were statistically significant increases in CI and DI for LCpost-LCpre and PTVpost-PTVpre (CI = 0.221, 0.470; DI = 0.472, 0.635). No obvious linear correlations (p > 0.05) were found between CI and GTV, primary tumor volume-to-breast volume ratio, distance from the primary tumor to the nipple and chest wall, and body mass index. CONCLUSIONS:Despite using DIR technology, the spatial correspondence of target volumes between MRIpre and MRIpost was suboptimal. Therefore, relying solely on preoperative diagnostic MRI with DIR for postoperative LC delineation is not recommended.

Background and Purpose:This study aimed to investigate inter-/intra-observer delineation variability in GTVs of primary esophageal carcinomas (ECs) based on planning CT with reference to different combinations of diagnostic multimodal images from endoscopy/EUS, esophagography and FDG-PET/CT.Materials and Methods:Fifty patients with pathologically proven thoracic EC who underwent diagnostic multimodal images before concurrent chemoradiotherapy were enrolled. Five radiation oncologist independently delineated the GTVs based on planning CT only (GTVC), CT combined with endoscopy/EUS (GTVCE), CT combined with endoscopy/EUS and esophagography (X-ray) (GTVCEX), and CT combined with endoscopy/EUS, esophagography, and FDG-PET/CT (GTVCEXP). The intra-/inter-observer variability in the volume, longitudinal length, generalized CI (CIgen), and position of the GTVs were assessed.Results:The intra-/inter-observer variability in the volume and longitudinal length of the GTVs showed no significant differences (p>0.05). The mean intra-observer CIgen values for all observers was 0.73 ± 0.15. The mean inter-observer CIgen values for the four multimodal image combinations was 0.67 ± 0.11. The inter-observer CIgen for the four combined images was the largest, showing significant differences with those for the other three combinations. The intra-observer CIgen among different observers and inter-observer CIgen among different combinations of multimodal images showed significant differences (p<0.001). The intra-observer CIgen for the senior radiotherapists was larger than that for the junior radiotherapists (p<0.001).Conclusion:For radiation oncologists with advanced medical imaging training and clinical experience, using diagnostic multimodal images from endoscopy/EUS, esophagography, and FDG-PET/CT could reduce the intra-/inter-observer variability and increase the accuracy of target delineation in primary esophageal carcinomas.

Background and Purpose The low rate of internal mammary node (IMN) recurrence was attributed to systemic therapy and internal mammary chain (IMC) coverage by the tangential fields of irradiation. This study aimed to evaluate the incidental irradiation dose to the IMC in breast cancer patients after surgery and to estimate the clinical predictive parameters affecting the magnitude of the IMC. Materials and Methods A total of 138 patients treated with postmastectomy radiotherapy and 210 patients undergoing radiotherapy after breast-conserving surgery (BCS) in our hospital were retrospectively analyzed. The mean dose (Dmean) to the IMC and the first to third intercostal spaces of IMC levels (ICS1–3) were evaluated. We evaluated the IMC coverage according to the type of surgery and whether the ipsilateral supraclavicular fossa (SCF) was included in the irradiation field. Results The incidental radiation dose to the IMC was 29.69 Gy, and the dose delivered to the IMC, ICS1, and ICS2 showed a greater coverage in the modified radical mastectomy (MRM) group when compared with the BCS group (32.85 vs. 27.1 Gy, 26.6 vs. 12.5 Gy, 34.63 vs. 30.42 Gy). The dose delivered to ICS3 showed no difference between the MRM and BCS groups (37.41 vs. 36.24 Gy). Furthermore, 131 patients (37.64%) received radiotherapy to the chest wall and ipsilateral SCF. In the univariate analysis, both surgery type and SCF irradiation were parameters affecting the Dmean of incidental radiation to the IMC ( r = −0.179, P = 0.001; r = −0.175, P = 0.001). In the multivariate analysis, surgery type was the only correlative factor that affected incidental radiation dose to the IMC ( r = –3.534, P = 0.000). Conclusion The real influencing factor of incidental dose to the IMC was the surgery form rather than the accession of SCF irradiation.

Internal mammary lymph node (IMLN) metastasis forms part of the clinical node classification for primary breast cancer, which influences the treatment strategy. However, because of the IMLNs' complicated anatomical structures and relationships with adjacent structures, IMLN biopsy or resection is associated with a limited improvement in prognosis and a high complication rate. The positivity rate also varies broadly according to imaging modality, and there is a low rate of agreement between the imaging and pathological diagnoses, which creates imprecision in the preoperative staging. The IMLN positivity rate also varies remarkably, and there are no clear, accurate, and non-invasive modalities for diagnosing the pre-mastectomy IMLN status. Nevertheless, medical imaging modalities continue to evolve, with functional imaging and image-guided thoracoscopic biopsy of sentinel IMLNs being well established. Thus, personalized decision-making and treatment selection should be based on the modality-specific differences in the diagnosis of IMLN metastasis/recurrence and the patient's specific risk factors.

目的 评估乳腺癌术后放疗患者内乳淋巴引流区(IMC)非计划性照射剂量,明确乳腺癌手术方式对IMC非计划性受照剂量的影响.方法 回顾性分析2012-01-12-2017-01-26山东省肿瘤防治研究院210例保留乳房术(BCS)后及138例改良根治术(MRM)后接受乳腺(胸壁)±锁骨上淋巴引流区(SCF)放疗的患者,其中131例行患侧乳腺(胸壁)+SCF照射,217例仅行患侧乳腺(胸壁)照射,所有患者原治疗计划中均未接受IMC照射.依据肿瘤放射治疗协作组(RTOG)标准勾画患侧IMC,依据手术方式不同分为BCS及MRM组,比较2组患者间IMC非计划性受照剂量、第1～3肋间IMC受照剂量的差异性.结果 IMC非计划性受照剂量中位数为29.69 Gy,MRM组患者IMC及第1、2肋间IMC非计划性受照剂量高于BCS组(32.85 vs 27.10 Gy,Z=-3.327,P=0.001;26.60 vs 12.50 Gy,Z=-6.922,P<0.001;34.63 vs 30.42 Gy,Z=-2.777,P=0.005),而第3肋间2组差异无统计学意义(37.41 vs 36.24 Gy,Z=-1.103,P=0.270).131例接受侧乳腺(胸壁)+SCF放疗患者IMC(32.87 vs 27.19 Gy)、第1(26.8 vs 13.09 Gy)和2(34.65 vs 30.46 Gy)肋间内乳区非计划性受照剂量高于单纯患侧乳腺(胸壁)放疗组.二分类logistic回归分析结果显示,手术方式及是否行SCF照射均与IMC非计划性受照剂量有关联(OR=1.034,95％CI:1.015～1.054,P=0.001;OR=1.034,95％CI:1.014～1.054,P=0.001).结论 手术方式和SCF照射野的加入均会影响IMC非计划性受照剂量.相较于MRM患者,BCS患者IMC非计划性受照剂量更低,尤其是第1肋间.

Objective:To investigate the effectiveness of abdominal compression in tumor motion and the target volume, and analyze the suitable margins of planning target volume (PTV) for patients treated with lung-SBRT based on 4DCT.Methods:Patients diagnosed with peripheral pulmonary tumor were enrolled. The patients were divided into the whole group, upper-middle-lobe group (group A) and the lower-lobe group (group B). Each patient underwent 3DCT, 4DCT with abdominal compression (4DCT com) and 4DCT with free breath (4DCT free) scans. The GTVs were delineated and IGTVs on these images. PTV MIP 5 mm, PTV MIP 4 mm, PTV MIP 3 mm were constructed with a 5, 4, 3 mm margin in left-right (LR), anterior-posterior (AP) directions and cranial-caudal (CC) directions. Results:The median motion vector with compression reduced by 30.92% in whole group, increased by 3.42% in group A and reduced by 18.80% in group B, respectively. And there were no significant differences of TMA LR, TMA AP, TMA CC and motion vector by the Wilcoxon test ( P>0.05). The median sizes of IGTV MIP com , IGTV MIP free and IGTV10 com, IGTV10 free were 4.01, 5.36 cm 3and 6.59, 7.65 cm 3, with statistically significant difference ( Z=-3.45, -3.14, P<0.01). The median ratio of DI of IGTV CBCT com in PTV MIP 5 mm, PTV MIP 4 mm and PTV MIP 3 mm≥95% was 100%, 100% and 83.33%, respectively. Conclusions:The patients′ respiratory pattern changed with abdominal compression and abdominal compression is useful in reducing the size of IGTV MIP and IGTV10, which could reduce the target volume and protect the normal tissue. Adding a 4 mm margin to IGTV MIP com based on 4DCT account for respiration in SBRT is a tendency for precise radiotherapy.

目的 探讨同步加量调强放疗(SIB-IMRT)联合多西他赛顺铂(DP)治疗颈段和胸中上段食管癌疗效,并评估其可行性.方法 选择2009-05-01-2012-07-31山东省肿瘤医院行放化疗治疗的食管癌患者23例,其中肿瘤位于颈段3例,胸上段13例,胸中段7例;肿瘤长度2.5～10 cm,中位长度5.5 cm.放疗采用SIB-IMRT(PTV-G 60.2 Gy/28次;PTV-C 50.4 Gy/28次),放疗同时联合DP方案化疗,共完成2个周期.生存分期采用Kaplan-meier曲线描述,并行Log-rank检验.影响生存单因素分析采用Cox回归.结果 23例患者均坚持至同步放化疗结束.Ⅲ/Ⅳ度骨髓抑制发生率34.8％(8/23),Ⅲ/Ⅳ度急性放射性食管炎发生率30.4％(7/23).1年内3例出现食管瘘.近期疗效评估:完全缓解(CR)7例(30.4％),部分缓解(PR)9例(39.1％),疾病稳定(SD)5例(21.7％),疾病进展(PD)2例(8.7％),近期疾病控制率91.3％(21/23).中位生存时间30个月,1、2、3和5年总生存率(OS)分别为78％、57％、35％和25％.根据近期疗效的不同进一步对比OS,CR患者具有更好的生存情况(χ2=11.641,P=0.009).多因素分析显示,病变位置(HR=0.367,95％CI为0.157～0.859,P=0.021)及近期疗效(HR=3.401,95％CI为1.797～6.436,P<0.001)与生存相关,胸段食管癌预后好于颈段食管癌,近期疗效好的患者OS更高.结论 SIB-IMRT联合DP方案化疗治疗颈段和胸中上段食管鳞癌,近期疗效CR患者具有更好的生存情况.急性毒副作用主要表现为血液学毒性和放射性食管炎,但食管瘘发生率较高,因此具体的分割模式和病例的选择需进一步探讨.

[This corrects the article DOI: 10.3389/fonc.2021.650764.].

Introduction The aim of this study was to investigate the role of local radiotherapy in the management of epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancers (NSCLCs) treated with EGFR tyrosine kinase inhibitors (TKIs). Materials and Methods Patients with stage IV EGFR-mutant NSCLC treated with radiotherapy concomitant to EGFR TKIs from May 2010 to December 2017 were retrospectively identified. Overall survival (OS) was the primary endpoints of the study. Results A total of 205 patients were enrolled in the study. One hundred eleven patients received one-time single-site radiotherapy (SSR), and 94 patients received multiple-site radiotherapy (MSR). Patients who received MSR had longer OS (median OS, 40.0 months; 95% confidence interval [CI], 29.6 to 50.4) than those who received SSR (median OS, 28.9 months; 95% CI, 24.3 to 33.5; P=0.031). Thoracic radiotherapy was associated with prolonged median OS (41.7 months, 95% CI, 29.0 to 54.4 vs 27.1 months, 95% CI 22.7 to 31.5; log-rank P<0.001). Multivariate analysis confirmed that thoracic radiotherapy was independently associated with improved OS (adjusted hazard ratio [HR], 0.514; 95% CI 32.3% to 81.8%; P=0.005). Conclusion MSR improves survival outcomes in patients with advanced-stage, EGFR-mutant, lung adenocarcinoma, with thoracic radiotherapy having the most significant effect on prognosis.

Abstract Background This study aimed to investigate the effect of abdominal compression on tumour motion and target volume and to determine suitable planning target volume (PTV) margins for patients treated with lung stereotactic body radiotherapy (SBRT) based on four-dimensional computed tomography (4DCT). Methods Twenty-three patients diagnosed to have a peripheral pulmonary tumour were selected and divided into an all lesions group (group A), an upper middle lobe lesions group (group B), and a lower lobe lesions group (group C). Two 4DCT scans were performed in each patient, one with and one without abdominal compression. Cone beam computed tomography (CBCT) was performed before starting treatment. The gross target volumes (GTVs) were delineated and internal gross target volumes (IGTVs) were defined. IGTVs were generated using two methods: (1) the maximum intensity projections (MIPs) based on the 4DCT were reconstructed to form a single volume and defined as the IGTVMIP and (2) GTVs from all 10 phases were combined to form a single volume and defined as the IGTV10. A 5-mm, 4-mm, and 3-mm margin was added in all directions on the IGTVMIP and the volume was constructed as PTVMIP5mm, PTVMIP4mm, and PTVMIP3mm. Results There was no significant difference in the amplitude of tumour motion in the left–right, anterior–posterior, or superior-inferior direction according to whether or not abdominal compression was applied (group A, p = 0.43, 0.27, and 0.29, respectively; group B, p = 0.46, 0.15, and 0.45; group C, p = 0.79, 0.86, and 0.37; Wilcoxon test). However, the median IGTVMIP without abdominal compression was 33.67% higher than that with compression (p = 0.00), and the median IGTV10 without compression was 16.08% higher than that with compression (p = 0.00). The median proportion of the degree of inclusion of the IGTVCBCT in PTVMIP5mm, PTVMIP4mm, and PTVMIP3mm ≥ 95% was 100%, 100%, and 83.33%, respectively. Conclusions Abdominal compression was useful for reducing the size of the IGTVMIP and IGTV10 and for decreasing the PTV margins based on 4DCT. In IGTVMIP with abdominal compression, adding a 4-mm margin to account for respiration is feasible in SBRT based on 4DCT.

BackgroundClinically, many esophageal cancer patients who planned for radiation therapy have already undergone diagnostic Positron-emission tomography/computed tomography (PET/CT) imaging, but it remains unclear whether these imaging results can be used to delineate the gross target volume (GTV) of the primary tumor for thoracic esophageal cancer (EC).MethodsSeventy-two patients diagnosed with thoracic EC had undergone prior PET/CT for diagnosis and three-dimensional CT (3DCT) for simulation. The GTV3D was contoured on the 3DCT image without referencing the PET/CT image. The GTVPET-ref was contoured on the 3DCT image referencing the PET/CT image. The GTVPET-reg was contoured on the deformed registration image derived from 3DCT and PET/CT. Differences in the position, volume, length, conformity index (CI), and degree of inclusion (DI) among the target volumes were determined.ResultsThe centroid distance in the three directions between two different GTVs showed no significant difference (P > 0.05). No significant difference was found among the groups in the tumor volume (P > 0.05). The median DI values of the GTVPET-reg and GTVPET-ref in the GTV3D were 0.82 and 0.86, respectively (P = 0.006). The median CI values of the GTV3D in the GTVPET-reg and GTVPET-ref were 0.68 and 0.72, respectively (P = 0.006).ConclusionsPET/CT can be used to optimize the definition of the target volume in EC. However, no significant difference was found between the GTVs delineated based on visual referencing or deformable registration whether using the volume or position. So, in the absence of planning PET–CT images, it is also feasible to delineate the GTV of primary thoracic EC with reference to the diagnostic PET–CT image.