ABSTRACT Background To analyze survival outcomes and identify prognostic factors in patients with locoregionally recurrent nasopharyngeal carcinoma (NPC) receiving salvage treatment, and to evaluate the safety profile of re‐irradiation. Methods We retrospectively analyzed clinical data from 95 patients with recurrent NPC (rM0) who were diagnosed and received salvage treatment at the PLA General Hospital between January 2008 and October 2018. Patients were stratified into two treatment groups: the radiotherapy (RT) group (n = 72) and the non‐RT group (n = 23). Results With a median follow‐up of 37 months (4–100 months), the 3‐year overall survival (OS), progression‐free survival (PFS), and disease‐specific survival (DSS) rates were 58.7%, 46.2%, and 33.3%, respectively. The corresponding 5‐year OS, PFS, and DSS rates were 34.2%, 31.3%, and 11.1%, respectively. Significant differences in survival outcomes were observed between the RT and non‐RT groups: OS (43.4% vs. 0%, p < 0.001), PFS (36.2% vs. 0%, p < 0.001), and DSS (16.2% vs. 0%, p = 0.007). Of the tumor‐related deaths, 19 (31.1%) were attributed to massive hemorrhage and 18 (29.5%) to distant metastasis. The univariate and multivariate analyses identified re‐irradiation as an independent predictor of superior OS and PFS, and salvage surgery as a predictor of OS improvement. Conversely, advanced nodal disease (rN2‐3) independently predicted worse OS and PFS, while local and regional recurrence associated with poorer PFS. Conclusion Salvage re‐irradiation significantly improves survival outcomes in locoregionally recurrent NPC, whereas advanced nodal disease (rN2‐3) independently predicts poor prognosis. Massive hemorrhage and distant metastasis are the most common causes of death. Trial Registration Clinical Trial Register: ChiCTR2500098189

BACKGROUND:The aim of this study is to investigate the effects of hypobaric hypoxia (simulated altitude of 3600 m) on regional cerebral blood flow (CBF) and cognitive function, and to explore the regulatory role of transcutaneous vagus nerve stimulation (tVNS). METHODS:Forty-three healthy Han Chinese males (18-45 years) were enrolled at the Chinese PLA General Hospital (June 2024-December 2025). During 24-h hypobaric hypoxia exposure via a specialized hypobaric chamber, participants were randomly assigned to tVNS (n = 23) or non-tVNS (n = 20) groups. A non-exposure cohort (n = 18) was included to correct for cognitive learning effects. Arterial spin labeling quantified CBF in the anterior, middle, and posterior cerebral artery territories and hippocampus at baseline, exposure, and post-exposure; the Repeatable Battery for the Assessment of Neuropsychological Status assessed cognitive function at the same time points. RESULTS:Hypoxia-induced compensatory CBF increases across all examined regions in the control group (p < 0.05). In the tVNS group, CBF modulation was region-specific: frontotemporal CBF was higher at exposure than post-exposure and higher at post-exposure than baseline; occipital and hippocampal CBF were higher at exposure than at both other time points, with no difference between post-exposure and baseline. Only temporal lobe CBF was significantly higher in the tVNS group than the control group (76.22 ± 7.49 vs. 70.88 ± 8.93, p = 0.039). Hypoxia impaired visuospatial ability, language, and attention and delayed memory (all p < 0.05), but tVNS did not ameliorate these deficits. CONCLUSIONS:Simulated 3600 m hypobaric hypoxia induces compensatory regional CBF elevations. tVNS selectively increases temporal lobe perfusion but does not ameliorate cognitive impairment, warranting optimized studies to clarify its neuroprotective role.

BACKGROUND AND PURPOSE:Identifying isocitrate dehydrogenase (IDH) mutation and α-thalassemia/mental retardation syndrome X-linked (ATRX) mutation status is helpful for diagnosis and specific classification of diffuse gliomas, while currently, the detection of IDH and ATRX status mainly relies on invasive methods. In this study, we aimed to predict IDH and ATRX mutation status of diffuse gliomas utilizing clinically available MRI Visually Accessible Rembrandt Images (VASARI) features. MATERIALS AND METHODS:Five hundred ninety-two patients (352 IDH wild-type and 240 IDH-mutant patients) with pathologically proved diffuse gliomas from our institution were randomly divided into training set (n=414) and validation set (n=178) for IDH mutation prediction according to a ratio of 7 to 3. Patients with IDH mutant were further stratified into ATRX mutant (n=109) and ATRX wild-type (n=131) subgroups, with the cohort then divided into training set (n=168) and validation set (n=72) for ATRX mutation prediction. Two radiologists independently analyzed the patients' MR images based on the VASARI feature set. Multivariable logistic regression analysis was employed to develop the prediction models. Receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA) were utilized to validate the models and nomograms were developed to visualize the models. RESULTS:For IDH prediction, 6 VASARI features combined with age and relative ADC values contributed to the model, with the area under the curve (AUC) of 0.96 (0.94-0.98) in training set and 0.92 (0.88-0.97) in validation set. For ATRX prediction, 3 VASARI features combined with age and minimum ADC values contributed to the model, with the AUC of 0.76 (0.68-0.83) in training set and 0.71 (0.58-0.83) in validation set. The DCA and calibration plots further confirmed the clinical utility of the 2 nomograms for IDH and ATRX prediction. CONCLUSIONS:The integration of MRI VASARI features and clinical data demonstrates strong predictive capability for IDH mutation status and moderate predictive capability for ATRX status in diffuse gliomas.

Bladder paraganglioma is a rare neuroendocrine tumor, accounting for only 0.05% of all bladder tumors. This article reports the diagnosis and treatment of a 16-year-old male patient with acute hemorrhage secondary to a giant bladder paraganglioma(approximately 10 cm in maximum diameter). Preoperative imaging evaluation suggested locally advanced disease, and the patient subsequently received three cycles of neoadjuvant chemotherapy with temozolomide. He patient's blood tests revealed hemorrhagic shock. During the waiting period of surgery, hemostasis was successfully achieved through emergency transarterial embolization. Subsequently, the patient underwent emergency radical cystectomy combined with orthotopic ileal neobladder reconstruction under general anesthesia and recovered well after surgery. Postoperative pathological examination confirmed the diagnosis of bladder paraganglioma, with positive immunohistochemical staining for succinate dehydrogenase subunit B and a Ki-67 proliferation index of 3%. At the 6-week follow-up, the patient's blood pressure and endocrine parameters had returned to normal, with a satisfactory quality of life. This case demonstrates that a multidisciplinary team approach can effectively integrate expertise from various specialties to formulate comprehensive and systematic treatment plans, which is crucial for ensuring successful management of such complex cases.

Objective:To evaluate whether comprehensive salivary gland-sparing helical tomotherapy (HT) can reduce radiation-induced xerostomia without compromising locoregional control or survival in patients with nasopharyngeal carcinoma (NPC). Methods:A total of 266 patients with NPC treated with HT were prospectively analyzed. A comprehensive salivary gland-sparing planning strategy, including preservation of the parotid glands and other salivary structures whenever clinically feasible, was applied to minimize irradiation of salivary glands. Xerostomia was assessed using patient-reported outcome measures during follow-up. Acute and late toxicities were graded according to the RTOG/EORTC criteria. Overall survival (OS), cancer-specific survival (CSS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) were estimated using the Kaplan-Meier method. Results:With a median follow-up of 70.5 months, patients showed significant improvement in xerostomia symptoms. Late xerostomia was observed in 26 patients (9.8%) with Grade I-II, and only one patient (0.4%) developed Grade III xerostomia. The 1-, 3-, and 5-year overall survival (OS) rates were 95.9%, 86.8%, and 81.6%, respectively, while the corresponding cancer-specific survival (CSS) rates were 98.1%, 92.6%, and 90.2%. Locoregional control remained excellent, with a locoregional recurrence rate of 7.5% and a 5-year locoregional recurrence-free survival (LRRFS) of 92.1%. No grade 4 acute or late toxicity was observed. Multivariate Cox regression analysis demonstrated that age was significantly associated with survival outcomes (OS: p = 0.01; CSS: p = 0.01). Conclusions:Comprehensive salivary gland-sparing helical tomotherapy reduces radiation-induced xerostomia without compromising locoregional control or survival, supporting its oncologic safety in NPC radiotherapy. Clinical trial registration:https://www.chictr.org.cn/showproj.html?proj=17360, identifier ChiCTR-ONN-17010597.

To compare the radiomics features of pseudocontinuous arterial spin labeling (ASL) and dynamic susceptibility contrast (DSC) perfusion-weighted imaging in distinguishing radiation-induced brain injury (RIBI) from tumor recurrence (TR) in patients with diffuse gliomas. A total of 131 patients with pathologically confirmed adult-type diffuse gliomas, presenting with newly developed abnormal enhancing lesions after standard radiotherapy, were included for model development. Lesion segmentation was performed manually by two raters using ITK-SNAP and the segmentation consistency was assessed by intraclass correlation coefficient (ICC). A total of 1015 radiomics features were extracted from the segmented areas of T2WI, T1WI, contrast-enhanced T1WI (CE-T1WI), cerebral blood flow (CBF) maps from ASL, and relative cerebral blood flow (rCBF) maps from DSC, respectively. Feature selection was conducted via t-tests, and an elastic net regression (ENR) algorithm combined with recursive feature elimination (RFE) with cross-validation was used to identify the important features. Four machine learning classifiers were employed to establish radiomics models. Diagnostic performance was assessed using the area under the curve (AUC) in conventional (T2WI+T1WI + CE-T1WI), ASL-CBF, DSC-rCBF, conventional + ASL-CBF, and conventional + DSC-rCBF radiomics models, respectively. The optimal models were further validated in an independent validation set (n = 37). Six features from ASL-CBF, five from DSC-rCBF, one from T1WI, one from T2WI, and four from CE-T1WI were identified as the most significant features. The K-nearest neighbor (KNN) classifier was selected as the optimal classifier. In the training set, both ASL-CBF (AUC = 0.962) and DSC-rCBF (AUC = 0.946) radiomics models demonstrated satisfactory diagnostic performance, surpassing that of conventional MRI radiomics model (AUC = 0.844). The diagnostic accuracy was further improved when integrating DSC-rCBF features into conventional MRI models (AUC = 0.971). In the independent validation set, the ASL-CBF, conventional + ASL-CBF and conventional + DSC-rCBF models achieved satisfactory performance, with AUC of 0.955, 0.968 and 0.960. While the DSC-rCBF model alone showed an AUC of 0.887 and decreased specificity (58.3

The optimal strategy for laryngeal preservation in locally advanced hypopharyngeal carcinoma (LAHPC) remains undefined. This prospective observational study compared long-term outcomes between two primary treatment approaches: induction chemotherapy followed by concurrent chemoradiotherapy (IC-CCRT) and neoadjuvant chemotherapy followed by surgery and adjuvant (chemo)radiotherapy (NAC-Sur-RT). From December 2018 to December 2023, 199 patients with LAHPC were prospectively enrolled and treated with either IC-CCRT (n = 124) or NAC-Sur-RT (n = 75). The primary endpoints were survival with functional larynx (SFL), overall survival (OS), progression-free survival (PFS), locoregional failure-free survival (LRFFS), and distant metastasis-free survival (DMFS). Prognostic factors were identified using multivariable Cox regression. In the matched cohort (median follow-up 49 months), NAC-Sur-RT was associated with significantly superior 5-year OS (58.3

BackgroundSpatially Fractionated Radiotherapy (SFRT) is an innovative radiation oncology technique that strategically redistributes doses within a tumor volume to optimize tumor ablation while preserving normal tissue integrity. Despite substantial technological advancements and growing interdisciplinary interest, a systematic characterization of the global research environment remains absent. This study aims to provide a comprehensive bibliometric evaluation to map research trajectories and identify future priorities.MethodsA systematic search was performed across the Web of Science Core Collection (WoSCC) and PubMed databases, covering the period from January 1, 2005, to December 31, 2025. Following the standard PRISMA guidelines, 427 eligible publications (385 primary articles and 42 reviews) were selected from an initial pool of 1,221 records. Three analytical platforms—VOSviewer, CiteSpace, and Biblioshiny—were integrated to synthesize data on publication trends, institutional contributions, collaborative networks, and thematic evolution.ResultsThe SFRT landscape demonstrates a distinct three-phase evolutionary pattern, characterized by a substantial acceleration in publications and citations from 2020 to 2025. The United States maintains the highest cumulative research output, whereas France exhibits leading institutional productivity and significant citation impact. Foundational works in physical dosimetry and early preclinical models have established the disciplinary knowledge base. Thematic evolution identifies five core clusters, revealing a paradigm shift from early investigations into microbeam technology and cellular radiobiology toward recent advancements in proton minibeam therapy, computational precision, and clinical feasibility assessment.ConclusionSFRT is a maturing interdisciplinary field that increasingly integrates dose heterogeneity with complex radiobiological responses. To facilitate broader clinical implementation, future research must focus on identifying robust biological markers, refining delivery technologies, and establishing standardized protocols through large-scale prospective trials.

Introduction The optimal management of localized prostate cancer (PCa) in the “oldest-old” demographic presents a unique clinical challenge, requiring a careful balance between oncological control and the preservation of quality of life. This study aims to evaluate the safety, toxicity profile, and clinical outcomes of moderately hypofractionated helical tomotherapy (HT) in a cohort of patients aged 75 years and older with localized PCa. Materials and Methods In this retrospective cohort study, we analyzed 51 consecutive patients with a median age of 79 years treated between 2016 and 2022. All patients received 69 Gy in 25 fractions (2.76 Gy/fraction) via the HT platform. Risk stratification was performed using the D’Amico classification, revealing that the majority were high-risk (52.9%) or intermediate-risk (43.1%). Clinical outcomes included biochemical relapse-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS). Toxicity grading followed CTCAE v4.0 criteria, and Quality of Life (QoL) was evaluated through the International Prostate Symptom Score (IPSS) and a single-item index. Results At a median follow-up of 38 months, the 5-year BRFS, CSS, and OS rates were 83.3%, 80.1%, and 68.8%, respectively. Acute Grade 2 genitourinary and gastrointestinal toxicities occurred in 25.5% and 27.5% of the subjects. Late Grade 3 complications were rare (1 GU, 4 GI). Significant longitudinal improvements in IPSS and QoL were observed within 3 months post-treatment ( p < 0.001 ). Conclusion Moderately hypofractionated HT may be a safe and effective treatment for elderly PCa patients, suggesting potential for excellent oncological control and symptomatic relief.

Spatially fractionated radiotherapy (SFRT) offers a promising investigational strategy to address the dilemma of maximizing tumor ablation while sparing adjacent normal tissues through controlled intra-tumoral dose heterogeneity. This approach utilizes partial-volume high-dose exposure, hypothesized to leverage the regenerative capacity of normal tissues-as suggested by low toxicity rates observed in preliminary cohorts like the SBRT-PATHY pilot study. Furthermore, SFRT is thought to potentially contribute to tumor control through putative pathways including tumor necrosis factor-alpha/ceramide-mediated bystander cytotoxicity and immunogenic cell death-induced immune responses. While early clinical observations in bulky tumors (> 8 cm) indicate encouraging response rates with manageable toxicity, the transition from these mechanistic hypotheses and small-scale exploratory data to standardized clinical practice requires further validation through robust, randomized trials.

BACKGROUND:Optimal induction chemoimmunotherapy sequential concurrent chemoradiotherapy (cCRT) in locally advanced hypopharyngeal squamous cell carcinoma (HSCC) remains undefined. This study aimed to evaluate toripalimab plus chemotherapy sequential cCRT with nimotuzumab, followed by toripalimab maintenance in unresectable stage IVB HSCC. METHODS:In this single-arm, open-label, phase 2 study, untreated patients received two 21-day cycles of induction toripalimab 240 mg (d1) plus nab-paclitaxel 230 mg/m2 (d1) and cisplatin/nedaplatin 40 mg/m2 (d1-2) sequential cCRT (helical tomotherapy; nab-paclitaxel 230 mg/m2 (d1, 22, 43)) with nimotuzumab 200 mg weekly for 7 weeks. Subsequently, toripalimab maintenance was administered for eight cycles. Primary endpoint was progression-free survival (PFS). RESULTS:From March 16, 2022 to April 24, 2024, 31 patients completed induction chemoimmunotherapy. With a median follow-up of 31 months, median PFS and overall survival (OS) were not reached; 2-year PFS and OS rates were 67.7% and 86.4%. The 2-year larynx preservation rate was 93.3%. 30 (96.8%) patients achieved the best objective response, with 28 (90.3%) complete responses and 2 (6.5%) partial responses. The most common grade 3-4 treatment-related adverse events (TRAEs) were radiation-induced oropharyngeal mucositis and decreased appetite (each 46.9%). No grade 5 and fatal TRAEs occurred. No difficulties in speech and swallowing functions were reported in 96.8% of patients. There was no significant association between PFS and PD-L1 combined positive score, epidermal growth factor receptor expression, tumor-infiltrating T-lymphocytes, tumor mutational burden, or genetic alterations. High baseline peripheral CD3+ and CD8+CD28+ T-cell levels were associated with favorable PFS. Exploratory biomarker analyses identified that patients without disease progression after maintenance exhibited significantly higher levels of CD8+CD28⁻ T cells with a memory phenotype and lower B-cell levels. CONCLUSIONS:This exploratory study demonstrated preliminary efficacy and larynx preservation with manageable toxicity, possibly supporting further evaluation of induction toripalimab plus chemotherapy sequential cCRT with nimotuzumab, followed by toripalimab maintenance in stage IVB HSCC. Peripheral lymphocytes may warrant further investigation as candidate biomarkers in locally advanced disease. TRIAL REGISTRATION NUMBER:NCT05860335; ChiCTR2300074672.

Given no standard therapies, this single-arm, open-label, multicenter phase II study was conducted in unresectable locally advanced or recurrent/metastatic adenoid cystic carcinoma of the head and neck (LA or R/M ACCHN). Patients received chemotherapeutic nanomedicines (20 mg/m2 liposomal doxorubicin plus 120 mg/m2 nab-paclitaxel on days 1 and 8) for three 21-day cycles. Subsequently, patients eligible for radiotherapy received concurrent chemoradiotherapy (cCRT; helical tomotherapy or intensity-modulated radiotherapy and nab-paclitaxel), whereas those ineligible for radiotherapy continued 2-3 cycles of original chemotherapy. Between May 27, 2021, and November 13, 2024, 31 enrolled patients were evaluable for efficacy and safety. The primary endpoint objective response rate (ORR) was 90.3% (95% CI, 74.2-98.0%), with 15 (48.4%) complete responses and 13 (41.9%) partial responses, meeting the prespecified primary endpoint. The median duration of response was 18.5 (95% CI, 0-45.8) months. With a median follow-up of 15.7 months by data cutoff (June 25, 2025), the median progression-free survival (PFS) was 25.7 (95% CI, 6.5-44.8) months; the 1-year PFS was 77.1%. The median overall survival (OS) was not reached (NR), with a 1-year OS of 90.0%. Patients who received cCRT had a prolonged PFS (NR vs. 12.8 months) and OS (NR vs. 21.2 months) compared to those who did not. Grade 3 treatment-related adverse events (TRAEs) occurred in 8 (25.8%) patients. No ≥grade 4 TRAEs or treatment-related deaths occurred. This study demonstrated tumor responses among the highest reported to date, with a manageable safety profile in unresectable LA or R/M ACCHN. Chemotherapeutic nanomedicines, especially sequential cCRT for appropriate patients, may represent an effective and safe option.

BACKGROUND:Accurate preoperative glioma grading and molecular subtyping are important for treatment. The vascular microenvironment promotes tumor progression. A noninvasive screening tool capable of mapping tumor vascularity may assist in preoperative grading and subtyping of gliomas. PURPOSE:To evaluate 7T susceptibility-weighted imaging (SWI) for differentiating glioma isocitrate dehydrogenase (IDH) status and World Health Organization (WHO) grade based on vascular microenvironment features. STUDY TYPE:Retrospective. POPULATION:Among 218 patients with histologically confirmed gliomas, 152 (70%) were assigned to training and 66 (30%) to validation by stratified random sampling. The training/validation sets included 61/26 IDH-mutant, 91/40 IDH-wildtype, 57/25 Grade 1-2, and 95/41 Grade 3-4 gliomas. FIELD STRENGTH/SEQUENCE:7T; T1-weighted Magnetization prepared 2 rapid acquisition gradient echo (MP2RAGE) and SWI. ASSESSMENT:Two independent neuroradiologists delineated tumors on 7T SWI. Vascular topology, density, and intensity were extracted following Frangi filtering and 3D skeletonization. Following feature selection, logistic regression (LR), support vector machine (SVM), naive Bayes (NB), and random forest (RF) were developed to differentiate IDH mutant from IDH wildtype, and WHO Grade 1-2 from WHO Grade 3-4. STATISTICAL TESTS:Continuous and categorical variables were compared using Student's t-test/Mann-Whitney U test and chi-square test, respectively. Cohen's kappa statistic and intraclass correlation coefficient (ICC) were used to assess the interobserver agreement. Features were selected by t-test (or Mann-Whitney U test) and Spearman's rank correlation. Sensitivity, specificity, accuracy, F1-score, and area under the curve (AUC) were used to evaluate model performance. A p value < 0.05 was considered significant. RESULTS:Nine robust vascular features were retained. Imaging models achieved AUCs of 0.816-0.843 for IDH status and 0.834-0.874 for WHO grade in the internal validation set. Integrating clinical factors improved performance, with optimal AUCs of 0.888 and 0.889, respectively. DATA CONCLUSION:Integrating 7T SWI vascular features with machine learning may aid noninvasive differentiation of glioma molecular status and grade. EVIDENCE LEVEL:4. TECHNICAL EFFICACY:Stage 2.

This study compared deep inspiration breath-hold (DIBH) versus free-breathing (FB) techniques in postoperative radiotherapy for left-sided breast cancer. Dosimetric parameters for 94 patients were analyzed. DIBH significantly improved target conformity while reducing cardiac exposure, with mean heart dose decreasing by 2.631 Gy (EQD2). Significant dose reductions were also observed in bilateral lungs, esophagus, and spinal cord. A weak correlation was identified between left lung volume expansion and organ-at-risk dose reduction. Receiver operating characteristic analysis determined that a left lung volume increase of 807.1 cc predicted clinically meaningful cardiac protection. DIBH demonstrates effective organ sparing while only marginally compromising target coverage. Additionally, lung volume expansion could serve as a potential patient selection criterion.

Glymphatic system (GS) alterations has been increasingly associated with cognitive impairment in cerebral small vessel disease (CSVD). Comprehensive and quantifiable markers of GS function remain limited. GS was assessed using three non-invasive MRI-based metrics including analysis along perivascular space (ALPS) index, coupling between global blood-oxygen-level-dependent (gBOLD) signal and cerebrospinal fluid (CSF) movement, and choroid plexus volume (CPV). Correlations between GS metrics and CSVD markers were examined, along with their associations with cognition. A weighted glymphatic composite score (GCS) was subsequently derived based on relative cognitive contributions. We recruited 350 participants (65.53 ± 7.65 years), with 160 CSVDs and 190 healthy controls (HC). Compared with CSVD-normal cognition (CSVD-NCI), the CSVD-mild cognitive impairment (CSVD-MCI) group exhibited significantly lower ALPS indices and higher CPV (p < 0.001). CSVD markers including periventricular (β = -0.350; β = 0.404) and deep (β = -0.330; β = 0.324) white matter hyperintensities, microbleeds (β= -0.255; β = 0.191), lacunes (β = -0.194; β = 0.177), and perivascular spaces (β = -0.335; β = 0.390) were associated with ALPS index and CPV (p < 0.01).Linear analyses revealed a significant interaction between ALPS and CSVD on cognition (p < 0.05), which remained robust after further adjustment for vascular risk factors. Compared to CSVD-NCI, CSVD-MCI exhibited significantly lower GCS (p < 0.05). The GCS was significantly associated with MCI status after adjustment for clinical factors (OR = 0.31, p = 0.024). Combining multiple GS-related MRI markers into a composite index effectively reflects cognitive status in CSVD and may serve as a non-invasive biomarker for CSVD-MCI discrimination.

Parkinson's disease (PD) has been recognized for more than two centuries. Historically viewed as a clinicopathological entity, PD may have diverse genetic or environmental factors that initiate the disease through various, albeit partially overlapping, pathways. The disease manifests both motor and non-motor symptoms, which may occur individually or concurrently, with a tendency to gradually worsen and intensify as the disease progressed. Together, PD poses rapidly escalating healthcare challenges with profound global repercussions. Encouragingly, PD is treatable, particularly when the interventions are tailored through a personalized approach. In recent years, acupuncture, a cornerstone of traditional Chinese medicine, has garnered widespread acceptance as a therapeutic intervention for PD, demonstrating clinically meaningful effects across multiple domains-including motor symptoms (eg, tremor and bradykinesia), non-motor manifestations (eg, sleep disturbances and depression), and cognitive impairment-based on accumulating evidence from both mechanistic and clinical studies. Elucidating the therapeutic mechanisms and clinical efficacy of acupuncture in PD could substantially enhance treatment alternatives. While accumulating evidence supports its benefits, several critical research gaps persist including comparative effectiveness among acupuncture modalities (eg, manual versus electroacupuncture) in modifying disease progression; sustained neuroprotective effects versus transient symptomatic improvement; and development of standardized protocols tailored to distinct motor and non-motor symptom profiles. Methodical investigation of these aspects may yield more targeted, evidence-based interventions for PD management. This narrative review synthesizes evidence from PubMed, Web of Science, CNKI, VIP, Wanfang, and CBM, to examine the application of acupuncture in PD, subsequently summarized the available evidence supporting its utilization and outlined the mechanisms by which acupuncture may exert its therapeutic effects. These mechanisms include preventing the accumulation of α-synuclein in dopaminergic neurons, mitigating apoptosis and oxidative stress, modulating dopamine-related neuroinflammation, and regulating the circuits surrounding dopaminergic neurons in the ganglia. Our study provides the comprehensive integration of clinical and preclinical evidence, which offers a mechanistic explanation for acupuncture's therapeutic benefits while identifying optimal treatment protocols for clinical application. In summary, acupuncture shows significant potential as an effective treatment for PD.

BACKGROUND:No randomized trials confirm the efficacy of concurrent chemoradiotherapy (CCRT) in platinum-ineligible patients with locally advanced head and neck squamous cell carcinoma (LAHNSCC) post-induction chemotherapy (IC). OBJECTIVES:This study evaluates the efficacy of platinum-based versus taxane-based CCRT after IC in LAHNSCC patients, excluding nasopharyngeal carcinoma, to assess the viability of taxanes as a platinum alternative. MATERIALS AND METHODS:A retrospective analysis was conducted on 215 LAHNSCC patients treated with IC using nab-paclitaxel/docetaxel, cisplatin, and fluorouracil (AP/APF or TP/TPF). During CCRT, patients were divided into platinum and taxane groups. Survival rates, and safety profiles of nab-paclitaxel versus docetaxel were compared. All patients received Helical tomotherapy and Intensity-modulated radiotherapy at 60-70 Gy. RESULTS:No significant differences were observed in CR rates, 3-year progression-free survival (PFS) (75.2 vs. 84.8%), or overall survival (OS) (72.1 vs. 84.1%) between taxane and platinum groups. Within the taxane group, CR rates and 3-year PFS showed no significant difference. However, the nab-paclitaxel group demonstrated significantly improved 3-year OS (80.9 vs. 67.6%) and disease-specific survival (DSS) (94.09 vs. 70.72%) compared to the docetaxel group. CONCLUSIONS:Taxane-based CCRT after IC is as effective as platinum-based treatment with manageable toxicity. Nab-paclitaxel surpassed docetaxel in 3-year OS and DSS.

In primary central nervous system lymphoma (PCNSL), B-cell lymphoma-6 (BCL-6) is an unfavorable prognostic biomarker. We aim to non-invasively detect BCL-6 overexpression in PCNSL patients using multiparametric MRI and machine learning techniques. 65 patients (101 lesions) with primary central nervous system lymphoma (PCNSL) diagnosed from January 2013 to July 2023, and all patients were randomly divided into a training set and a validation set according to a ratio of 8 to 2. ADC map derived from DWI (b = 0/1000 s/mm2), fast spin echo T2WI, T2FLAIR, were collected at 3.0 T. A total of 2234 radiomics features from the tumor segmentation area were extracted and LASSO were used to select features. Logistic regression (LR), Naive bayes (NB), Support vector machine (SVM), K-nearest Neighbor, (KNN) and Multilayer Perceptron (MLP), were used for machine learning, and sensitivity, specificity, accuracy F1-score, and area under the curve (AUC) was used to evaluate the detection performance of five classifiers, 6 groups with combinations of different sequences were fitted to 5 classifiers, and optimal classifier was obtained. BCL-6 status could be identified to varying degrees with 30 models based on radiomics, and model performance could be improved by combining different sequences and classifiers. Support vector machine (SVM) combined with three sequence group had the largest AUC (0.95) in training set and satisfactory AUC (0.87) in validation set. Multiparametric MRI based machine learning is promising in detecting BCL-6 overexpression.

This article comprehensively reviews research progress in prostate cancer radiation therapy. It provides an overview of fundamental principles, encompassing the disease's epidemiology, pathological mechanisms, and radiation sensitivity, alongside technological advancements. The clinical application, technological progress, and efficacy evaluation of moderate hypofractionated radiation therapy and ultra hypofractionated radiation therapy are discussed. Diagnostic and monitoring techniques specific to radiation therapy are analyzed, alongside prevailing controversies and challenges. Finally, the review outlines future prospects, including novel radiotherapy techniques, multidisciplinary collaboration trends, and the evolving role of radiation within comprehensive treatment. The findings demonstrate continuous technological and clinical evolution in prostate cancer radiotherapy, yet emphasize the need for further exploration to optimize treatments and improve patient survival and quality of life.

Purpose To predict the genetic subtypes of adult-type diffuse gliomas with three-class MRI radiomics. Material and Methods Four hundred and eighty patients with pathologically proved diffuse gliomas from our institution were randomly divided into training set (n = 336) and internal validation set (n = 144) according to a ratio of 7 to 3, and 105 patients from the cancer imaging archive (TCIA) were utilized as an external validation set. All patients were classified into IDH wild-type (IDHwt), IDH-mutant with 1p19q-noncodeleted (IDHmut-intact) and IDH-mutant with 1p19q-codeleted (IDHmut-codel) subtypes, and all the patients underwent conventional MR imaging and diffusion weighted imaging (DWI) scans. Two regions of interest (ROI) segmentation schemes (tumor ROI and tumor with peritumoral edema ROI) and MRI sequences with and without apparent diffusion coefficient (ADC) maps were tested with 6 machine learning classifiers to filter the optimal models. Results Support vector machine (SVM) classifier combined with conventional MR sequences based on tumor ROI was proved to be the best diagnostic model, with the area under the curve (AUC) of 0.963, 0.964, and 0.929, and accuracy of 0.902, 0.929, and 0.890 for IDHwt, IDHmut-intact, and IDHmut-codel prediction, respectively, and overall accuracy (micro average accuracy) of 0.860. The model was validated in both internal and external validation sets. Conclusions Three-class MRI radiomics can be used preoperatively in predicting the molecular subtype of adult diffuse gliomas with satisfactory performance and show potential value for the diagnosis and risk stratification in glioma patients. This retrospective study received ethics approval with a waiver of informed consent.