Purpose Spinal stereotactic body radiation therapy (SBRT) has become the standard of care in management of patients with limited sites of metastatic disease, radio-resistant histologies, painful vertebral metastases with long life expectancy and cases of reirradiation. Our case-based guidelines aim to assist radiation oncologists in the appropriate utilization of SBRT for common, yet challenging, cases of spinal metastases. Materials and Methods Cases were selected to include scenarios of large volume sacral disease with nerve entrapment, medically inoperable disease abutting the thecal sac, and local failure after prior SBRT. Relevant literature was reviewed, and areas requiring further investigation were discussed to offer a framework for evidence-based clinical practice. Results Spinal SBRT can be effectively delivered in challenging cases following multidisciplinary discussion by utilizing a methodical approach to patient selection, appropriate dose selection, and adherence to evidence-based dose constraints. Conclusions The Radiosurgery Society's case-based practice review offers guidance to practicing physicians treating technically challenging SBRT candidate patients with spinal metastases.

PurposeIncreasing life expectancy and advances in cancer treatment will lead to more patients needing both radiation therapy (RT) and cardiac implantable electronic devices (CIEDs). CIEDs, including pacemakers and defibrillators, are essential for managing cardiac arrhythmias and heart failure. Telemetric monitoring of CIEDs checks battery status, lead function, settings, and diagnostic data, thereby identifying software deviations or damage. This study evaluates the German Society for Radiation Oncology (DEGRO)/German Society for Cardiology (DGK) guideline, assessing real-world complications and risk factors and analyzing pacemaker and implantable cardioverter-defibrillator (ICD) lead function for their predictive value concerning device malfunction.MethodsA total of 54 patients with pacemakers or ICDs who underwent radiation therapy were identified. Demographics, treatment courses, and device information from physical and digital records were extracted. DEGRO/DGK risk groups and pacemaker dependency at the start of RT were assessed. Delineation of the devices and lead insertion sites was performed in the treatment planning system. Dosimetric information from the treatment plans was then correlated with reports of standardized device checks.ResultsOver 80% of patients were treated with dual-chamber pacemakers or cardiac resynchronization therapy (CRT), and 16.7% had ICDs. One third of patients were pacemaker dependent. 59.3% of patients were in the low-risk category, 29.3% in the medium-risk, and 11.1% in the high-risk category. Thoracic irradiation resulted in the highest median dose to devices. Lead parameter deviations exceeding thresholds were found in 14.8% for the stimulation threshold and 13.5% for sensing. Device malfunctions occurred in 3.7% of cases, both involving electrical resets and neutron-producing radiation (beam energy 10 megaelectron volt (MV) or higher).ConclusionCollecting lead parameters in addition to secure malfunctions like electrical restarts and memory erasure revealed a significant proportion of treatment courses with temporary changes, though no correlation with individual treatment plans or adverse events was found. The focus on reducing neutron-producing radiation could be further supported.

Heat shock proteins belong to a highly conserved family of chaperone proteins, and in addition to their participation in the regulation of cellular proteostasis (folding of polypeptides and proteins, disaggregation of incorrectly folded peptides, and participation in autophagy processes), also play a significant immunomodulatory role in both innate and adaptive immunity. Changes in the HSP level, both downwards (e.g., in neurodegenerative diseases) and upwards (e.g., autoimmune, oncological diseases), underlie the pathogenesis of many somatic and oncological pathologies. In this review, we consider the main physiological mechanisms of HSP level regulation and also analyze pharmacological, genetically engineered methods of modulating the chaperone level, citing the advantages and disadvantages of a particular method of influence. In conclusion, modulation of the HSP level, according to numerous preclinical studies, can have a significant impact on the course of various pathological conditions, which, in turn, can be used to develop new therapeutic approaches, when the effect on the level of chaperones can be used as monotherapy or as an adjuvant method of action.

In a previous preclinical trial on human HNSCC xenografts, 18 genes were predictive for adding cetuximab to fractionated radiotherapy. Here, we apply the corresponding 18-gene classifier to two HNSCC patient cohorts treated with combined radiochemotherapy (without cetuximab). We show that the classifier is related to EGFR expression and stratifies patients for loco-regional control (LRC) in both cohorts.

Infratentorial brain metastases (BM), particularly those causing obstruction of the fourth ventricle, are associated with a significant risk of postoperative hydrocephalus. This complication remains poorly understood, especially regarding its predictors beyond mechanical obstruction. This study aims to identify clinical predictors of postoperative hydrocephalus in patients undergoing surgery for infratentorial BM. We performed a single-center retrospective analysis of 235 adult patients surgically treated for infratentorial BM between 2009 and 2025. Patients with leptomeningeal disease were excluded. Pre- and postoperative hydrocephalus were defined based on imaging and clinical criteria. Logistic regression and multivariate modeling were used to evaluate predictors, including clinical presentation, treatment history, and imaging features. Postoperative hydrocephalus occurred in 18.45

Large language models (LLMs) exhibit extensive medical knowledge but are prone to hallucinations and inaccurate citations, which pose a challenge to their clinical adoption and regulatory compliance. Current methods, such as Retrieval Augmented Generation, partially address these issues by grounding answers in source documents, but hallucinations and low fact-level explainability persist. In this work, we introduce a novel atomic fact-checking framework designed to enhance the reliability and explainability of LLMs used in medical long-form question answering. This method decomposes LLM-generated responses into discrete, verifiable units called atomic facts, each of which is independently verified against an authoritative knowledge base of medical guidelines. This approach enables targeted correction of errors and direct tracing to source literature, thereby improving the factual accuracy and explainability of medical Q A. Extensive evaluation using multi-reader assessments by medical experts and an automated open Q A benchmark demonstrated significant improvements in factual accuracy and explainability. Our framework achieved up to a 40

Characteristics of adult patients with high-grade gliomas.

Purpose:/Objectives: Older adults with WHO grade 4 glioma face distinct therapeutic challenges due to age-related comorbidities, treatment intolerance and tumor aggressiveness. This retrospective study evaluates the prognostic value of the Onco-Functional Outcome (OFO) classification, which integrates extent of resection and postoperative functional status, in the context of radiotherapy (RT) for patients with grade 4 glioma. Materials:/Methods: 139 patients aged ≥ 60 years treated between 2001 and 2021 were included. Patients were grouped into four OFO categories based on Karnofsky Performance Status, National Institutes of Health Stroke Scale, and resection extent. Survival outcomes were assessed using Kaplan-Meier and compared by log-rank test. Univariate and multivariable analyses were performed using Cox proportional hazards model. Results:Median OS decreased across OFO groups (OFO1-4: 22.6, 20.5, 12.6, and 11.2 months respectively, log-rank, p = 0.0026). PFS followed a similar pattern (12.2, 9.3, 6.7, and 5.7 months respectively; p = 0.0030). Among 119 patients with known MGMT status, methylation (n = 49) was associated with significantly prolonged OS (36.3 vs. 12.6 months, p < 0.00001) and PFS (14.1 vs 5.9 months, p < 0.00001). Survival advantage of NF-RT showed a a strong trend in both univariate (OS HR = 0.47, 95 % CI 0.28-0.82; p = 0.007) and multivariate models (OS HR = 0.57, 95 % CI 0.33-1.00, 0.051). In multivariable analysis, the OFO classification retained independent prognostic value, with OFO Group 4 associated with a significantly increased risk of both death (OS: HR = 2.91, p = 0.003) and disease progression (PFS: HR = 3.08, p = 0.0005) compared to OFO Group 1. Conclusions:OFO classification effectively stratifies survival in elderly grade 4 glioma patients. Its integration with MGMT methylation status and RT regimen refines risk assessment, supporting personalized treatment strategies in this vulnerable patient group.

Motility of Hsp70-positive cells in a GBM tumor sample detected using laser scanning confocal microscopy during observation for 1 h.

Motility of Hsp70-positive cells emerging from a piece of tumor during cultivation for three days.

Supplementary Figure S3. (Top) Hypoxia-M V2 is associated with decreased OS in the TCGApancancer cohort (p<0.002) (Bottom) Hypoxia-M V2 is an independent prognosticator of OS (HR=1.81, p<0.03) after adjusting for demographic and clinical factors.

Analysis of the mass-spectrometry data from isolated lipid rafts.

Supplementary Table S4. Correlations with CIBERSORT immune signature expressions in the TCGA-HNSCC cohort

Grade content and co-localization of biomarkers (Hsp70, Nestin, SOX2) on histological preparations of human GBM.