PURPOSE:Urinary incontinence is the most common adverse outcome following radical prostatectomy (RP) for prostate cancer, and pelvic floor muscle training (PFMT) is among the most effective interventions. However, implementation of PFMT after RP in China remains limited. This study aimed to explore the barriers and facilitators influencing the implementation of evidence-based PFMT in this context. METHODS:This qualitative study recruited 35 stakeholders comprising physical therapists, medical staff, and post-prostatectomy patients from a tertiary hospital in China during the period from December 2022 to March 2023. Participants were selected through purposive and convenience sampling. Semi-structured interviews were conducted using a guide based on the Consolidated Framework for Implementation Research (CFIR), refined through expert consultation and pre-interviews. Data were collected through audio-recorded, in-person interviews and analyzed using directed content analysis. NVivo software facilitated coding, and COREQ guidelines were followed. Triangulation and independent double coding ensured rigor and reliability. RESULTS:Barriers in the innovation domain included evidence skepticism, implementation challenges, lack of standardization, and resource constraints; facilitators included strong support for PFMT and ease of implementation. In the outer setting, barriers included attitudinal resistance, resource inadequacy, coordination gaps, and financial constraints, while patient engagement served as a facilitator. Inner setting barriers included post-discharge support gaps, equipment limitations, and knowledge gaps; reform motivation was a facilitator. At the individual level, awareness gaps were a key barrier, while expert facilitation was beneficial. In the implementation process domain, follow-up challenges were noted, alongside adaptive implementation and data-informed decision-making as facilitators. CONCLUSIONS:Targeted strategies and improved resource allocation are needed to support PFMT implementation and enhance recovery and quality of life in Chinese prostate cancer patients.

BackgroundPrimary cutaneous adenoid cystic carcinoma (PCACC) is an extremely rare malignancy, typically presenting as a slow-growing, painless cutaneous mass with a relatively favorable prognosis compared to adenoid cystic carcinomas (ACC) of salivary gland origin. Metastatic PCACC is uncommon, with stage IV disease accounting for approximately 4% of reported cases. Due to its rarity, clinical understanding of the disease course and optimal management strategies remains limited.Case presentationWe report the case of a 57-year-old male who presented with a painful ulcerated mass on the left ankle. Magnetic resonance imaging (MRI) revealed a subcutaneous lesion, and histopathological examination following surgical excision confirmed the diagnosis of ACC. Immunohistochemistry was consistent with ACC, and a PET-CT scan excluded regional or distant disease, supporting the diagnosis of PCACC. The patient subsequently underwent adjuvant radiotherapy. However, within eight months, follow-up imaging revealed pulmonary and osseous metastases. A biopsy confirmed metastatic ACC consistent with the primary lesion. The patient was treated sequentially with three lines of systemic therapy, including chemotherapy, immunotherapy, and targeted therapy, along with palliative radiotherapy. Despite temporary disease stabilization, the malignancy progressed rapidly, with new pulmonary, intracranial, and extensive skeletal metastases. The patient eventually discontinued treatment and was lost to follow-up.ConclusionThis case highlights an unusually aggressive clinical course of PCACC with rapid progression to widespread metastatic disease shortly after definitive local treatment. Given the rarity of metastatic PCACC, this report contributes valuable insight into its natural history, diagnostic approach, and therapeutic challenges. It underscores the need for heightened clinical awareness and further research into effective systemic treatment strategies for advanced PCACC.

Anterior mediastinal soft tissue chondroma is an exceedingly rare benign tumor that poses a diagnostic challenge due to its overlapping imaging features with more common mediastinal masses. Accurate diagnosis is crucial to ensure appropriate surgical management and avoid overtreatment of benign lesions. In the present case, a 36-year-old asymptomatic woman presented with a calcified anterior mediastinal mass incidentally detected on a routine chest computed tomography. Imaging showed a well-circumscribed, lobulated mass with punctate calcifications, suggestive of a benign etiology. The mass was resected and histopathological evaluation confirmed a diagnosis of soft tissue chondroma. Complete surgical resection was performed via median sternotomy without complications. The patient had an uneventful recovery and remained disease-free at the 6-month follow-up. This case emphasizes the need to consider anterior mediastinal soft tissue chondromas in the differential diagnosis of calcified mediastinal masses.

OBJECTIVES:This research aimed to develop a radiomics-clinical nomogram based on enhanced thin-section CT radiomics and clinical features for the purpose of predicting the presence or absence of metastasis in lymph nodes among patients with resectable esophageal squamous cell carcinoma (ESCC).METHODS:This study examined the data of 256 patients with ESCC, including 140 cases with lymph node metastasis. Clinical information was gathered for each case, and radiomics features were derived from thin-section contrast-enhanced CT with the help of a 3D slicer. To validate risk factors that are independent of the clinical and radiomics models, least absolute shrinkage and selection operator logistic regression analysis was used. A nomogram pattern was constructed based on the radiomics features and clinical characteristics. The receiver operating characteristic curve and Brier Score were used to evaluate the model's discriminatory ability, the calibration plot to evaluate the model's calibration, and the decision curve analysis to evaluate the model's clinical utility. The confusion matrix was used to evaluate the applicability of the model. To evaluate the efficacy of the model, 1000 rounds of 5-fold cross-validation were conducted.RESULTS:The clinical model identified esophageal wall thickness and clinical T (cT) stage as independent risk factors, whereas the radiomics pattern was built based on 4 radiomics features chosen at random. Area under the curve (AUC) values of 0.684 and 0.701 are observed for the radiomics approach and clinical model, respectively. The AUC of nomogram combining radiomics and clinical features was 0.711. The calibration plot showed good agreement between the incidence of lymph node metastasis predicted by the nomogram and the actual probability of occurrence. The nomogram model displayed acceptable levels of performance. After 1000 rounds of 5-fold cross-validation, the AUC and Brier score had median values of 0.702 (IQR: 0.65, 7.49) and 0.21 (IQR: 0.20, 0.23), respectively. High-risk patients (risk point >110) were found to have an increased risk of lymph node metastasis [odds ratio (OR) = 5.15, 95% CI, 2.95-8.99] based on the risk categorization.CONCLUSION:A successful preoperative prediction performance for metastasis to the lymph nodes among patients with ESCC was demonstrated by the nomogram that incorporated CT radiomics, wall thickness, and cT stage.ADVANCES IN KNOWLEDGE:This study demonstrates a novel radiomics-clinical nomogram for lymph node metastasis prediction in ESCC, which helps physicians determine lymph node status preoperatively.

Background Nuclear protein in testis (NUT) cancers, also known as midline cancers, tends to occur in organs near the midline, such as the nasal sinuses and mediastinum. NUT carcinoma is very rare and has a poor prognosis.Case description We report the case of a 44-year-old female patient with sinonasal NUT carcinoma who presented with a soft tissue mass in the left frontal sinus, ethmoid sinus, and left nasal cavity on computed tomography; the tumor was poorly demarcated from the left rectus medialis. After discussion with a multidisciplinary team with expertise on head and neck tumors, the patient was considered inoperable, and definitive concurrent chemoradiotherapy (CCRT) was recommended. The patient underwent CCRT followed by three cycles of consolidation chemotherapy with albumin-bound paclitaxel and nedaplatin. Subsequently, the patient underwent 16 cycles of consolidation therapy with the programmed death-1 (PD-1) inhibitor tislelizumab. The immune-related adverse events included grade 2 hypothyroidism. After CCRT, consolidation chemotherapy, and consolidation immunotherapy, the patient achieved a favorable outcome. The patient survived for 31 months, and there were no signs of recurrence or metastasis during follow-up.Conclusion At present, there is no clear consensus on the consolidation treatment plan after CCRT for sinonasal NUT cancer. We used consolidation immunotherapy for the first time and achieved good efficacy, providing an innovative and promising treatment plan for refractory sinonasal NUT cancer.

AbstractBackgroundThe spleen plays an important role in systemic antitumor immune response, but whether spleen imaging features have predictive effect for prognosis and immune status was unknown. The aim of this study was to investigate computed tomography (CT)‐based spleen radiomics to predict the prognosis of patients with esophageal squamous cell carcinoma (ESCC) underwent definitive radiotherapy (dRT) and to try to find its association with systemic immunity.MethodsThis retrospective study included 201 ESCC patients who received dRT. Patients were randomly divided into training (n = 142) and validation (n = 59) groups. The pre‐ and delta‐radiomic features were extracted from enhanced CT images. LASSO‐Cox regression was used to select the radiomics signatures most associated with progression‐free survival (PFS) and overall survival (OS). Independent prognostic factors were identified by univariate and multivariate Cox analyses. The ROC curve and C‐index were used to evaluate the predictive performance. Finally, the correlation between spleen radiomics and immune‐related hematological parameters was analyzed by spearman correlation analysis.ResultsIndependent prognostic factors involved TNM stage, treatment regimen, tumor location, pre‐ or delta‐Rad‐score. The AUC of the delta‐radiomics combined model was better than other models in the training and validation groups in predicting PFS (0.829 and 0.875, respectively) and OS (0.857 and 0.835, respectively). Furthermore, some spleen delta‐radiomic features are significantly correlated with delta‐ALC (absolute lymphocyte count) and delta‐NLR (neutrophil‐to‐lymphocyte ratio).ConclusionsSpleen radiomics is expected to be a useful noninvasive tool for predicting the prognosis and evaluating systemic immune status for ESCC patients underwent dRT.

The radiomics of tumors can indirectly reflect the state of tumor proteins and even genes. The radiomics extract imaging features through high-throughput and conduct correlation analysis to play a role in predicting tumor stage, pathological differentiation, therapeutic efficacy, and prognosis. In this review paper, relevant literature about the research progress of radiomics in the prediction of esophageal cancer stage, lymphovascular invasion, pathological differentiation, short-term curative effect, and long-term prognosis is summarized.

BackgroundEsophageal squamous cell carcinoma is the predominant subtype of esophageal cancer in China and so differs from presentations in Western countries. Common metastatic locations of esophageal cancer include the liver, lung, bone, and brain. In contrast, metastases in subcutaneous soft tissue are exceedingly rare. Case presentationWe present the experience of a 57-year-old man with a complaint of hand and leg dysfunction on the right side. He had a past medical history of esophageal squamous cell carcinoma. Further imaging workup revealed a solitary brain metastasis, thickening of the esophageal wall, swollen lymph nodes in the mediastinum, and right adrenal gland metastasis. Gamma knife radiosurgery of the brain metastasis and intensity-modulated radiotherapy of the esophagus and lymph nodes were administered. After 1.5 months, he was admitted to our hospital again, and nodules were identified in the anterior abdominal wall and left posterior chest wall. Ultrasound, CT, and radical excision of the abdominal wall mass were undertaken and revealed metastatic squamous cell carcinoma with neuroendocrine differentiation. We administered immunotherapy followed by targeted therapy. A PET/CT scan was performed to identify other organ metastases; the scan revealed multiple areas of fluorodeoxyglucose uptake and foci in the esophagus, lung, liver, bone, and right adrenal gland; and in various lymph nodes. In addition, an intensely hypermetabolic lesion was localized in the left posterior thorax. ConclusionThis case highlights the diagnosis and treatment of uncommon metastases of esophageal squamous cell carcinoma. We hope that our clinical experience provides insights into these uncommon metastases.

Radiotherapy is a pivotal method in cancer treatment harbouring immunomodulatory effects. Radiotherapy combined with immunotherapy has been proven to yield promising preliminary results in certain types of tumors. Most studies have concentrated on the dose fractionation of radiotherapy and timing of radiotherapy and immunotherapy. With the development of related studies, attention has been gradually paid to the influence of target volume upon circulating lymphocytes and tumor microenvironment. The interaction between target volume and immunotherapy has been valued. For tumors not suitable for hypofractionated radiotherapy, such as advanced esophageal cancer, conventional fractionated radiotherapy has been adopted. The volume and planning of target volume play a pivotal role in radiotherapy combined with immunotherapy. This article illustrates the feasibility of radiotherapy combined with immunotherapy, theory and conception of optimizing target volume.

Background Clinical T4 stage (cT4) esophageal tumors are difficult to be surgically resected, and definitive radiotherapy (RT) or chemoradiotherapy (dCRT) remains the main treatment. The study aims to analyze the association between the status of lymph node (LN) metastasis and survival outcomes in the cT4 stage esophageal squamous cell carcinoma (ESCC) patients that underwent treatment with dCRT or RT. Methods This retrospective study analyzed the clinical data of 555 ESCC patients treated with dCRT or RT at the Shandong Cancer Hospital and the Liaocheng People’s Hospital from 2010 to 2017. Kaplan–Meier and Cox regression analyses was performed to determine the relationship between LN metastasis and survival outcomes of cT4 and non-cT4 ESCC patients. The chi-square test was used to evaluate the differences in the local and distal recurrence patterns in the ESCC patients belonging to various clinical T stages. Results The 3-year survival rates for patients with non-cT4 ESCC and cT4 ESCC were 47.9% and 30.8%, respectively. The overall survival (OS) and progression-free survival (PFS) rates were strongly associated with the status of LN metastasis in the entire cohort (all P < 0.001) and the non-cT4 group (all P < 0.001) but not in the cT4 group. The local recurrence rates were 60.7% for the cT4 ESCC patients and 45.1% for the non-cT4 ESCC patients (P < 0.001). Multivariate analysis showed that clinical N stage (P = 0.002), LN size (P = 0.007), and abdominal LN involvement (P = 0.011) were independent predictors of favorable OS in the non-cT4 group. However, clinical N stage (P = 0.824), LN size (P = 0.383), and abdominal LN involvement (P = 0.337) did not show any significant correlation with OS in the cT4 ESCC patients. Conclusions Our data demonstrated that the status of LN metastasis did not correlate with OS in the cT4 ESCC patients that received dCRT or RT. Furthermore, the prevalence of local recurrence was higher in the cT4 ESCC patients.

Purpose: Lymphocytes are central players in systemic anti-tumor immune responses. In this study, we aimed to identify the relationship between absolute lymphocyte count (ALC) nadir during definitive radiotherapy (RT) and survival outcomes in patients with esophageal squamous cell carcinoma (ESCC), as well as evaluate the effect of RT parameters on ALC during RT.Materials and methods: We retrospectively reviewed 189 patients with stage I-IVA ESCC, who were treated with definitive RT at a single institution between 2012 and 2015. ALC values were assessed before, weekly during RT, and 1 month after the end of RT. Kaplan–Meier and Cox regression analyses were used to evaluate the relationship between ALC nadir during RT and patient outcomes. Predictors of low ALC nadir were assessed using univariate and multivariate logistic regression analyses.Results: The median ALC before treatment was 1.73 × 103 cells/μL. Fifty-eight (58.2) percent of the patients exhibited low ALC nadir (≤ 0.38 × 103 cells/μL) during RT. A low ALC nadir during RT was significantly associated with poor OS, PFS, and LRFS. The planning target volume (PTV) was larger in patients with low ALC nadir compared with patients with high ALC nadir (418.5 vs. 347.7 cm3, P = 0.023). Multivariate logistic regression analysis revealed that tumor stage III-IVA (P = 0.002), low ALC before treatment (P = 0.028), large Log10(PTV) (P = 0.01), high heart V10 (P = 0.003), and high heart V20 (P = 0.028) were associated with low ALC nadir during RT.Conclusions: In ESCC patients who received definitive RT, a low ALC nadir during RT was associated with large PTVs, and it was an independent prognostic factor of outcomes.

BACKGROUND:Nasopharyngeal carcinoma is an endemic head and neck cancer in Southern China. The common metastases organs involve bone, lung, and liver. Metastases in the dura and at multiple locations in the brain after a diagnosis of nasopharyngeal carcinoma are extremely rare.CASE PRESENTATION:We present a case of a 66-year-old man who initially complained of nasal congestion, epistaxis, and hearing impairment. The biopsy of the nasopharynx lesion showed basaloid squamous cell carcinoma. Eight months after conventional therapy, the patient was admitted to our hospital again with the complaint of a headache. A PET/CT scan was performed, revealing multiple metastases. A biopsy of subcutaneous soft tissue from the right upper arm was consistent with the previous biopsy. Palliative chemotherapy was administered. Thereafter, the patient had sudden dysfunction of the right side of the body. MRI demonstrated dural and multiple brain metastases. The therapeutic regimen then consisted of whole-brain radiotherapy, anti-angiogenesis therapy, and immunotherapy.CONCLUSIONS:This case highlights the diagnosis and treatment of uncommon metastases of nasopharyngeal carcinoma. Clinicians should remain vigilant for metastases during the treatment and follow-up periods.

Abstract Purpose Few studies have reported the impact of the clinical response of patients with Esophageal Carcinoma to chemoradiotherapy (CRT). Our study examines the association between clinical response and pretreatment variables, survival, patterns of failure, and benefit of consolidation chemotherapy in subjects with esophageal squamous cell carcinoma (ESCC) patients receiving CRT. Methods Data from ESCC patients treated at Shandong Cancer Hospital between January 2013 and December 2016 were analyzed retrospectively. By definition, we considered a poor response as progressive disease (PD) and stable disease (SD), while complete response (CR) and partial response (PR) were considered as a good response. Multivariate analyses were carried out using Cox proportional hazards models and patient survival was assessed using the Kaplan‐Meier and log‐rank test. Results After CRT, 136 (48.9%) patients responded well (good response) and 152 (51.1%) patients responded poorly (poor response). Overall survival (OS) and progression‐free survival (PFS) differed significantly between patients responded well and those responded poorly. Patients with an early‐stage or the upper location of the tumor were more likely to achieve a good response. Patients showing poor responses tended to experience local failure. The 3‐year OS and PFS rates of patients showing poor response were 38.9% and 25.5%, respectively, for the CRT with consolidation chemotherapy (CRT + C) group, and 22.7% and 16.7%, respectively, for the CRT group. However, patients with a good response did not benefit from the consolidation chemotherapy. Primary tumor location, T category, N category, and clinical response to chemoradiotherapy were independent factors predicting OS and PFS in ESCC. Conclusion Clinical response to CRT substantially improves patient survival and is associated with failure patterns in ESCC. Consolidated chemotherapy may benefit patients with a poor response.

Background: The present study aimed to determine the prognostic value of the size of metastatic lymph node (LN) in non-surgical patients with esophageal squamous cell carcinoma (ESCC). Methods: Three hundred seventy-six ESCC patients treated with definitive (chemo-) radiotherapy from January 2013 to March 2016 were reviewed. We analyzed potential associations of metastatic nodal size with responses, patterns of failure, and survival. Log-rank testing and Cox proportional hazards regression models were used to assess the impact of the clinical factors on survival. Results: The 3-years over survival (OS) rates following a median follow-up of 28.2 months were 53.2, 46.2, 35.5, and 22.7% for the N0 group, the >0.5 to ≤1 cm group, the >1 to ≤2 cm group, and the >2 cm group, respectively. The progression-free survival (PFS) rates for 2 years were 50.9, 44.2, 26.6, and 23.4% for the N0 group, the >0.5 to ≤1 cm group, the >1 to ≤2 cm group, and the >2 cm group, respectively. The objective response rates (ORR) for the 280 patients with metastatic LNs were 43.1% for the LN >0.5 to ≤1 cm group, 46.9% for the LN >1 to ≤2 cm group, and 25.5% for the LN ≥2 cm group. The LN >2 cm group had the worst ORR of the three groups with LNs. Gross tumor volume (GTV) failure was the most common failure pattern, followed by distant failure and out of GTV LN failure, with incidences of 47.9% (180 of 376), 42% (158 of 376), and 13.8% (52 of 376), respectively. Nodal size correlated statistically with GTV failure and distant failure but not with out-of-GTV nodal failure. After adjusting for age, sex, T category, Primary tumor location, and CRT, the size of metastatic LNs was an independent prognostic factor for OS and PFS in multivariate analyses. Conclusions: Nodal size is one of prognostic factors for non-surgical patients with ESCC and correlated statistically with GTV failure and distant failure.

局部晚期直肠癌的标准治疗方式为术前放疗联合手术治疗,术前放疗包括长程放疗与短程放疗两种方式.两种方式各有利弊,本文就相关文献及指南进行综述,以为直肠癌术前放疗方式的选择提供依据.

Purpose Among Chinese breast cancer survivors, treatment decision-making is different than that in western countries. Among Chinese women, family often plays an important role during the treatment period, and Chinese-specific cultural factors have negative influences on their psychological conditions. The aim of the present study was to explore the treatment decision making, family influences, and cultural influences of Chinese breast cancer survivors. Methods This study used an expressive writing method to explore the experiences of breast cancer survivors who were diagnosed with stage 0 to III cancer. Participants were instructed to write 30 min per week over a period of 3 weeks. All writings were analyzed using a qualitative method. Results Three themes were identified: treatment decision making, family influences, and cultural influences. Treatment decision-making included the subthemes of preference for mastectomy, passive involvement, and active involvement. Family influences included the subthemes of financial burden, family expectations, and family support. Cultural influences included the subthemes of fatalism, barriers to expressing emotions, and stigma related to cancer. Conclusions Information on breast cancer treatment and survivorship should be provided to patients through multiple methods to improve their knowledge of breast cancer. Family support should be maintained to ensure patients' confidence and courage during the treatment period. Necessary and appropriate psychological interventions that consider cultural influences should be administered.

Objective To evaluate the 5 years results in nasopharyngeal carcinoma(NPC)patients treated by intensity modulated radiotherapy (IMRT).Methods From January,2008 to December,2008,a total of 5 6 cases in-patients on primary NPC with stages III and IVa were treated with radical radiotherapy at our cancer center.All of which had no evidence of distant metastasis before and during the treatment.In-tensity-modulated radiotherapy with simultaneous integrated boost was used to observe the long-term effects and its influencing factors.Results The follow up rate was 94.6%,The 5-year overall survival rate,distant metastasis-free survival rate,disease specific survival rate were 68.0%,67.3% and 72.1%. Multivariate analysis showed that N stage and Bilateral cervical lymph node metastasis were the independ-ent prognostic factors for the distant metastasis-free survival.Conclusion NPC treated with IMRT could get good long-term survival.Distant metastasis was the main cause of treatment failure.N stage and Bilat-eral cervical lymph node metastasis were prognostic factors for the distant metastasis-free survival.

Objective To investigate the relationship between EGFR,Rab5a,Rab21 protein expression and clinical features and the short-term efficacy in cervical squamous cell carcinoma.Methods Immunohisto-chemistry method was used to detect EGFR,Rab5a,Rab21 protein expression levels in 60 cases of CSCC. Chi-Square,Spearman rank correlation,Logistic regression analysis method were used.Results The pro-tein expression rates of EGFR,Rab5a,Rab21 were 70.0%,73.3%,55.0%,EGFR,Rab5a,Rab21 protein expression were correlated with lymph node metastasis and tumor differentiation (P <0.05);EG-FR protein expression was correlated with clinical stage (P =0.005);Rab21 protein expression was corre-lated with the diameter of tumor (P =0.044);Spearman rank correlation analysis showed that EGFR was positively correlated with Rab5a (r =0.428,P =0.001)and EGFR was negatively correlated with Rab21 expression (r =-0.300,P =0.020).EGFR,Rab5a and Rab21 protein expression were not the independ-ent factors of the short-term efficacy in CSCC (P >0.05);EGFR,Rab5a and Rab21 protein expression had no significant effect on objective efficiency (P >0.05).Conclusion EGFR protein expression may be the reference index of progression of CSCC;Rab5a may play a positive role in the regulation of EGFR-me-diated signal transduction pathway while Rab21 may play a negative role.