• 文章类型: Journal Article
    目的:异位骨化(HO)是全髋关节置换术后常见的并发症。已经提出了各种预防性治疗,包括放疗(RT)。这篇综述总结了RT预防髋关节HO疗效的荟萃分析证据。
    方法:在PubMed上进行了文献检索。使用AMSTAR-2工具评估荟萃分析的质量。
    结果:纳入7项meta分析。一项荟萃分析报告,与对照组相比,RT后HO发生率显着降低。比较RT和非甾体抗炎药,一项和两项荟萃分析显示,RT在预防重度HO方面的疗效明显更高,在接受药物治疗的患者中效果更好,分别。关于RT设置,术后和术前RT均得到一项荟萃分析的支持.此外,两项荟萃分析显示,多级RT优于单级RT。荟萃分析的总体置信度是中等的,低,在一个人中非常低,三,和三个荟萃分析,分别。
    结论:RT是一种经证实的HO预防性干预措施。然而,定时的精确优化,剂量,分馏需要阐明。未来的研究应侧重于通过大规模数据收集和高级分析来开发预测模型,以完善个性化治疗策略并评估RT与药物的比较效果。
    OBJECTIVE: Heterotopic ossification (HO) is a common complication following total hip arthroplasty. Various prophylactic treatments have been proposed, including radiotherapy (RT). This review summarizes the evidence from meta-analyses on the efficacy of RT in preventing hip HO.
    METHODS: A literature search was conducted on PubMed. The quality of the meta-analyses was assessed using the AMSTAR-2 tool.
    RESULTS: Seven meta-analyses were included. One meta-analysis reported a significant reduction in HO occurrence after RT compared to the control group. Comparing RT and non-steroidal anti-inflammatory drugs, one and two meta-analyses showed significantly greater efficacy of RT in preventing severe HO and better outcomes in patients receiving drugs, respectively. Regarding RT settings, the postoperative and preoperative RT were each supported by one meta-analysis. Furthermore, two meta-analyses showed an advantage of multi-fractionated RT over single fraction RT. The overall confidence rate of the meta-analyses was moderate, low, and critically low in one, three, and three meta-analyses, respectively.
    CONCLUSIONS: RT is a confirmed prophylactic intervention for HO. However, the precise optimization of timing, dosage, and fractionation requires elucidation. Future research should focus on the development of predictive models through large-scale data collection and advanced analytics to refine individualized treatment strategies and assess RT comparative effectiveness with drugs.
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  • 文章类型: Journal Article
    背景:宫颈癌是女性第四常见的癌症,死亡率最高的是低收入和中等收入国家。宫颈癌的腹部顶叶转移是一种非常罕见的实体,发病率为0.1-1.3%,并代表一个不利的预后因素,生存率降至17%。这里,我们回顾了近几十年来腹部顶叶转移的病例,包括在诊断为IIB期宫颈癌(腺鳞癌)28个月后,在前引流管的疤痕部位出现4.5厘米的腹部顶叶转移的新病例,同时进行化疗和腔内近距离放射治疗以及随后的手术(B型根治性子宫切除术)。肿瘤在肿瘤范围内切除,组织病理学结果为腺鳞癌。该案例研究强调了早期发现和适当治疗宫颈癌患者转移的重要性。讨论探讨了壁转移的潜在途径以及不完整的外科手术对转移发展的影响。结论强调了宫颈癌患者与此类转移相关的不良预后,以及手术切除与全身治疗相关的潜在益处。
    BACKGROUND: Cervical cancer is the fourth most common cancer in women, the highest mortality being found in low- and middle-income countries. Abdominal parietal metastases in cervical cancer are a very rare entity, with an incidence of 0.1-1.3%, and represent an unfavorable prognostic factor with the survival rate falling to 17%. Here, we present a review of cases of abdominal parietal metastasis in recent decades, including a new case of a 4.5 cm abdominal parietal metastasis at the site of the scar of the former drain tube 28 months after diagnosis of stage IIB cervical cancer (adenosquamous carcinoma), treated by external radiotherapy with concurrent chemotherapy and intracavitary brachytherapy and subsequent surgery (type B radical hysterectomy). The tumor was resected within oncological limits with the histopathological result of adenosquamous carcinoma. The case study highlights the importance of early detection and appropriate treatment of metastases in patients with cervical cancer. The discussion explores the potential pathways for parietal metastasis and the impact of incomplete surgical procedures on the development of metastases. The conclusion emphasizes the poor prognosis associated with this type of metastasis in cervical cancer patients and the potential benefits of surgical resection associated with systemic therapy in improving survival rates.
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  • 文章类型: Systematic Review
    背景:根治性放疗(RT)是头颈部(H&N)癌症治疗的基石,但它通常会由于大脑结构的照射而导致疲劳,影响患者生活质量。
    目的:本研究旨在系统地研究脑结构中H&NRT后疲劳的剂量相关性。
    方法:系统评价包括研究了在不同时间间隔接受RT的H&N癌症患者的疲劳结果与大脑结构之间的相关性。PubMed,Scopus,和WOS数据库用于系统评价。按照PRISMA指南对纳入研究进行方法学质量评估。RT之后,分析了H&N癌症患者队列与脑结构和亚结构的剂量相关性,比如后颅窝,脑干,小脑,脑垂体,髓质,和基底神经节.
    结果:在检索中确定了13项符合纳入标准的研究。这些研究评估了疲劳与H&NRT后的RT剂量之间的相关性。RT剂量范围为40Gy至70Gy。大多数研究表明疲劳轨迹与剂量效应之间存在相关性,与增加剂量相关的更高水平的疲劳。此外,五项研究发现,急性和晚期疲劳与特定大脑结构的剂量有关,比如脑干,后颅窝,小脑,脑垂体,海马体,和基底神经节.
    结论:H&NRT患者的疲劳与特定大脑区域接受的辐射剂量有关,特别是在后窝,脑干,小脑,脑垂体,髓质,和基底神经节.这些区域的剂量减少可能有助于缓解疲劳。监测放疗后高危患者的疲劳可能是有益的,特别是对于那些经历晚期疲劳的人。
    BACKGROUND: Radical radiotherapy (RT) is the cornerstone of Head and Neck (H&N) cancer treatment, but it often leads to fatigue due to irradiation of brain structures, impacting patient quality of life.
    OBJECTIVE: This study aimed to systematically investigate the dose correlates of fatigue after H&N RT in brain structures.
    METHODS: The systematic review included studies that examined the correlation between fatigue outcomes in H&N cancer patients undergoing RT at different time intervals and brain structures. PubMed, Scopus, and WOS databases were used in the systematic review. A methodological quality assessment of the included studies was conducted following the PRISMA guidelines. After RT, the cohort of H&N cancer patients was analyzed for dose correlations with brain structures and substructures, such as the posterior fossa, brainstem, cerebellum, pituitary gland, medulla, and basal ganglia.
    RESULTS: Thirteen studies meeting the inclusion criteria were identified in the search. These studies evaluated the correlation between fatigue and RT dose following H&N RT. The RT dose ranged from 40 Gy to 70 Gy. Most of the studies indicated a correlation between the trajectory of fatigue and the dose effect, with higher levels of fatigue associated with increasing doses. Furthermore, five studies found that acute and late fatigue was associated with dose volume in specific brain structures, such as the brain stem, posterior fossa, cerebellum, pituitary gland, hippocampus, and basal ganglia.
    CONCLUSIONS: Fatigue in H&N RT patients is related to the radiation dose received in specific brain areas, particularly in the posterior fossa, brain stem, cerebellum, pituitary gland, medulla, and basal ganglia. Dose reduction in these areas may help alleviate fatigue. Monitoring fatigue in high-risk patients after radiation therapy could be beneficial, especially for those experiencing late fatigue.
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  • 文章类型: Journal Article
    泪囊的非霍奇金淋巴瘤(NHL)是一种罕见的,但在眼部恶性肿瘤范围内具有临床意义的实体。虽然原发性泪囊淋巴瘤并不常见,它提出了独特的诊断和治疗挑战,由于其解剖位置和潜在的攻击行为。尽管目前对NHL的理解和治疗取得了进展,目前缺乏专门针对泪囊受累的研究。因此,本综述旨在提供对流行病学的见解,临床表现,诊断方式,组织病理学特征,泪囊NHL的治疗策略及预后.通过对以往文献的系统分析,本综述强调了影响泪囊的NHL亚型的多样性,包括弥漫性大B细胞淋巴瘤,结外边缘区淋巴瘤,套细胞淋巴瘤和滤泡性淋巴瘤。此外,本综述讨论了先进的成像技术在准确分期和治疗计划中的作用,包括计算机断层扫描(CT),磁共振成像和正电子发射断层扫描-CT。本综述还讨论了不断发展的治疗方法,比如手术干预,化疗,放射治疗,免疫疗法,上述治疗和靶向治疗的组合。此外,本综述强调了多学科合作对泪囊NHL患者获得最佳结局的重要性.本综述旨在为进一步研究可能有助于指导个性化管理策略的新治疗方式和预后标志物提供基础。最终改善NHL患者的预后。
    Non-Hodgkin\'s lymphoma (NHL) of the lacrimal sac is a rare, yet clinically significant entity within the spectrum of ocular malignancies. While primary lacrimal sac lymphoma is uncommon, it poses unique diagnostic and therapeutic challenges due to its anatomical location and potential for aggressive behavior. Despite advancements being made in the current understanding and treatment of NHL, research that specifically addresses the involvement of the lacrimal sac is currently lacking. Thus, the present review aimed to provide insight into the epidemiology, clinical presentation, diagnostic modalities, histopathological features, treatment strategies and prognosis of lacrimal sac NHL. Through a methodical analysis of previous literature, the present review highlights the diverse spectrum of NHL subtypes that affect the lacrimal sac, including diffuse large B-cell lymphoma, extranodal marginal zone lymphoma, mantle cell lymphoma and follicular lymphoma. Moreover, the present review discusses the role of advanced imaging techniques in accurate staging and treatment planning, including computed tomography (CT), magnetic resonance imaging and positron emission tomography-CT. The present review also discusses evolving treatment approaches, such as surgical intervention, chemotherapy, radiotherapy, immunotherapy, combinations of the aforementioned treatments and targeted therapy. In addition, the present review highlights the significance of multidisciplinary collaboration in attaining optimal outcomes for individuals with lacrimal sac NHL. The present review aimed to provide a basis for \'further investigations into novel treatment modalities and prognostic markers that may aid in guiding personalized management strategies, ultimately improving outcomes for patients with NHL.
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  • 文章类型: Journal Article
    人工智能(AI)是一种尝试像人类一样思考并模仿人类行为的技术。它已被认为是放射治疗(RT)中许多依赖人类的步骤的替代方案,因为人类参与是RT的主要不确定性来源。这项工作的目的是对当前有关AI在RT中应用的文献进行系统的总结,并从临床观点上阐明其对RT实践的作用。
    对PubMed和GoogleScholar进行了系统的文献检索,以确定从成立到2022年在RT中涉及AI应用程序的原始文章。如果他们报告了原始数据并探索了AI在RT中的临床应用,则包括研究。
    选定的研究分为三个方面的RT:器官和病变分割,治疗计划和质量保证。对于每个方面,这篇综述讨论了这些人工智能工具如何参与RT协议。
    我们的研究表明,AI是RT复杂过程中依赖人类的步骤的潜在替代品。
    UNASSIGNED: Artificial intelligence (AI) is a technique which tries to think like humans and mimic human behaviors. It has been considered as an alternative in a lot of human-dependent steps in radiotherapy (RT), since the human participation is a principal uncertainty source in RT. The aim of this work is to provide a systematic summary of the current literature on AI application for RT, and to clarify its role for RT practice in terms of clinical views.
    UNASSIGNED: A systematic literature search of PubMed and Google Scholar was performed to identify original articles involving the AI applications in RT from the inception to 2022. Studies were included if they reported original data and explored the clinical applications of AI in RT.
    UNASSIGNED: The selected studies were categorized into three aspects of RT: organ and lesion segmentation, treatment planning and quality assurance. For each aspect, this review discussed how these AI tools could be involved in the RT protocol.
    UNASSIGNED: Our study revealed that AI was a potential alternative for the human-dependent steps in the complex process of RT.
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  • 文章类型: Journal Article
    我们的综述旨在阐明颈动脉狭窄的发生率,发展的风险,筛选,管理,和文献中记录的头颈癌放射治疗后的一级预防策略。头颈癌放射治疗后颈动脉狭窄的高患病率使监测和风险分层变得至关重要。除了一般的心血管危险因素,如吸烟,糖尿病,和血脂异常,头颈部放疗后颈动脉狭窄的危险因素包括总斑块评分,放射治疗的用途和剂量,放疗后的时间长度,年龄大于50。癌症亚型,即鼻咽癌,也可能与风险增加有关,尽管已经发现了相反的结果。有趣的是,然而,放疗剂量与卒中风险之间没有显著关系.放疗后颈动脉狭窄的手术治疗与放疗无关的狭窄相似,颈动脉内膜切除术被认为是金标准治疗,颈动脉支架置入术是可以接受的,侵入性较小的替代品。这些病人的医疗管理还没有得到很好的研究,但是抗血小板治疗,他汀类药物,和血压控制可能是有益的。筛查辐射引起的狭窄的主要方法是多普勒超声,测量内膜-中膜厚度的变化是疾病发展的主要标志。使用MeSH术语“颈动脉狭窄,头颈部肿瘤,“和”放射治疗。\"
    Our review aims to clarify the incidence of carotid artery stenosis, risks of development, screening, management, and primary prevention strategies documented in the literature after radiation therapy for head and neck cancers. The high prevalence of carotid stenosis after radiation therapy for head and neck cancers has made surveillance and risk stratification critical. In addition to general cardiovascular risk factors such as smoking, diabetes, and dyslipidemia, risk factors for carotid artery stenosis after head and neck radiation included total plaque score, radiotherapy use and dosage, length of time after radiotherapy, and age greater than 50. Cancer subtype, namely nasopharyngeal cancer, may be correlated with increased risk as well, though contrasting results have been found. Interestingly, however, no significant relationship has been found between radiotherapy dose and stroke risk. Surgical management of post-radiation carotid stenosis is similar to that of stenosis unrelated to radiation, with carotid endarterectomy considered to be the gold standard treatment and carotid artery stenting being an acceptable, less-invasive alternative. Medical management of these patients has not been well-studied, but antiplatelet therapy, statins, and blood pressure control may be beneficial. The mainstay of screening for radiation-induced stenosis has been Doppler ultrasound, with measurement of changes in the intima-media thickness being a primary marker of disease development. A literature review was carried out using the MeSH terms \"Carotid Artery Stenosis,\" \"Head and Neck Neoplasms,\" and \"Radiotherapy.\"
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  • 文章类型: Journal Article
    Graves眼病的眼眶放射治疗是非肿瘤放射治疗的一个例子。在1930年代首次引入,自20世纪80年代以来,这种治疗方法已被广泛使用,多项研究证明了其有效性和安全性:70%~80%的患者减少了软组织受累,30%~80%的患者改善了眼活动度.如今,它是糖皮质激素失败后中度至重度和活动性疾病管理中Graves眼眶病欧洲小组认可的二线治疗选择之一。在那种背景下,眼眶放疗应联合糖皮质激素。据我们所知,对于Graves眼病应如何计划和实施眼眶放疗,目前尚无切实可行的建议.最佳剂量未定义,但最常见的方案包括20Gy在10个部分的2Gy,尽管其他选择可能会产生更好的结果。最后,与使用横向相对视野的三维放射治疗相比,使用现代放射治疗技术,如强度调节放射治疗,可以更好地保护有风险的器官。
    Orbital radiotherapy for Graves\' ophthalmopathy is an example of non-oncological radiotherapy. First introduced in the 1930s, this treatment has become widely used since the 1980s with several studies showing proof of both effectiveness and safety: a decrease of soft tissue involvement in 70 to 80% of patients and an improvement of ocular mobility in 30 to 80% of patients. Nowadays, it\'s one of the second line treatment options recognized by the European Group on Graves\' orbitopathy in the management of a moderate to severe and active disease after failure of glucocorticoids. In that setting, orbital radiotherapy should be combined with glucocorticoids. To our knowledge, there are no practical recommendations on how orbital radiotherapy should be planned and conducted for Graves\' ophthalmopathy. Optimal dose is not defined however the most frequent regimen consists of 20Gy in ten fractions of 2Gy, though other options may yield better results. Lastly, the use of modern technique of radiotherapy such as intensity-modulated radiation therapy may allow a better sparing of organs at risk compared to three-dimensional radiotherapy using lateral opposing fields.
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  • 文章类型: Journal Article
    目的:本研究回顾并荟萃分析了基于影像组学的混合模型预测放射性肺炎(RP)的证据。这些模型对于改善胸部放疗计划和减轻RP至关重要,胸部放疗的常见并发症。我们检查并比较了这些研究中开发的RP预测模型与RP模型中采用的影像组学特征。
    方法:我们系统地搜索了谷歌学者,Embase,PubMed,和MEDLINE为截至2024年4月19日发表的研究。16项研究符合纳入标准。我们比较了这些研究中开发的RP预测模型和所用的影像组学特征。
    结果:Radiomics,作为单因素评估,受试者工作特征曲线下面积(AUROC)为0.73,准确度为0.69,灵敏度为0.64,特异性为0.74.Dosiomics实现了0.70的AUROC。临床和剂量学因素表现较低,AUROC为0.59和0.58。结合临床和放射组学因素产生0.78的AUROC,而结合剂量组学和放射组学因素产生0.81的AUROC。三重组合,包括临床,剂量测定,和影像组学因素,实现了0.81的AUROC。该研究确定了影像组学的关键特征,例如灰度共生矩阵(GLCM)和灰度大小区域矩阵(GLSZM),提高了RP模型的预测精度。
    结论:基于影像组学的混合模型在预测RP方面非常有效。这些模型,将传统的预测因子与放射学特征相结合,特别是GLCM和GLSZM,为识别RP风险较高的患者提供了一种临床可行的方法。这种方法提高了临床结果并改善了患者的生活质量。
    背景:本研究的方案已在PROSPERO(CRD42023426565)上注册。
    OBJECTIVE: This study reviewed and meta-analyzed evidence on radiomics-based hybrid models for predicting radiation pneumonitis (RP). These models are crucial for improving thoracic radiotherapy plans and mitigating RP, a common complication of thoracic radiotherapy. We examined and compared the RP prediction models developed in these studies with the radiomics features employed in RP models.
    METHODS: We systematically searched Google Scholar, Embase, PubMed, and MEDLINE for studies published up to April 19, 2024. Sixteen studies met the inclusion criteria. We compared the RP prediction models developed in these studies and the radiomics features employed.
    RESULTS: Radiomics, as a single-factor evaluation, achieved an area under the receiver operating characteristic curve (AUROC) of 0.73, accuracy of 0.69, sensitivity of 0.64, and specificity of 0.74. Dosiomics achieved an AUROC of 0.70. Clinical and dosimetric factors showed lower performance, with AUROCs of 0.59 and 0.58. Combining clinical and radiomic factors yielded an AUROC of 0.78, while combining dosiomic and radiomics factors produced an AUROC of 0.81. Triple combinations, including clinical, dosimetric, and radiomics factors, achieved an AUROC of 0.81. The study identifies key radiomics features, such as the Gray Level Co-occurrence Matrix (GLCM) and Gray Level Size Zone Matrix (GLSZM), which enhance the predictive accuracy of RP models.
    CONCLUSIONS: Radiomics-based hybrid models are highly effective in predicting RP. These models, combining traditional predictive factors with radiomic features, particularly GLCM and GLSZM, offer a clinically feasible approach for identifying patients at higher RP risk. This approach enhances clinical outcomes and improves patient quality of life.
    BACKGROUND: The protocol of this study was registered on PROSPERO (CRD42023426565).
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  • 文章类型: Journal Article
    癌症的有效治疗多年来一直是科学家研究的主题。目前的癌症治疗方法,如放射治疗,化疗和手术已被用于传统的联合治疗,但是他们有重大的挫折,比如非特异性,某些癌症类型对治疗无反应,肿瘤复发,等。流行病学数据显示,乳腺癌占印度女性癌症病例的14%。近年来,科学家们已经开始专注于使用天然化合物,如从各种来源获得的凝集素,以对抗传统疗法的副作用。像Sambucusnigra凝集素这样的凝集素,Maackiaamurensis凝集素,秋葵凝集素,HaliclonaCaerulea凝集素,硬核凝集素,等。,已被发现对乳腺癌患者具有诊断和治疗潜力。已发现凝集素对各种癌细胞活性具有抑制作用,例如新血管生成,导致细胞周期停滞在G1期,诱导细胞凋亡。在癌症诊断和治疗中使用凝集素的主要思想是它们与在细胞表面表达的糖基化蛋白结合的能力。本文就翻译后修饰在癌细胞中的作用进行综述。尤其是糖基化,以及凝集素在癌症诊断和治疗中的潜力。
    Efficient treatment of cancer has been a subject of research by scientists for many years. Current treatments for cancer, such as radiotherapy, chemotherapy and surgery have been used in traditional combination therapy, but they have major setbacks like non-specificity, non-responsiveness in certain cancer types towards treatment, tumor recurrence, etc. Epidemiological data has shown that breast cancer accounts for 14% of cancer cases occurring in Indian women. In recent years, scientists have started to focus on the use of natural compounds like lectins obtained from various sources to counter the side effects of traditional therapy. Lectins like Sambucus nigra Agglutinin, Maackia amurensis lectin, Okra lectins, Haliclona caerulea lectin, Sclerotium rolfsii lectin, etc., have been discovered to have both diagnostic and therapeutic potential for breast cancer patients. Lectins have been found to have inhibitory effects on various cancer cell activities such as neo-angiogenesis, causing cell cycle arrest at the G1 phase, and inducing apoptosis. The major idea behind the use of lectins in cancer diagnostics and therapeutics is their capability to bind to glycosylated proteins that are expressed on the cell surface. This review focuses on an exploration of the roles of post-translational modification in cancer cells, especially glycosylation, and the potential of lectins in cancer diagnosis and therapeutics.
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  • 文章类型: Journal Article
    放射治疗在癌症治疗中具有显著的通用性和有效性,从而在肿瘤学领域发挥着至关重要的作用。然而,仍然迫切需要对放射治疗的各个方面进行广泛的研究,包括目标选择,损伤修复及其与免疫治疗的结合。特别是,体外模型的发展,以复制体内肿瘤病变的反应是至关重要的。本研究对肿瘤类器官在放射治疗中的建立和应用进行了全面综述。旨在探索它们对癌症治疗的潜在影响。
    Radiotherapy exhibits significant versatility and efficacy in cancer treatment, thereby playing a crucial role in the field of oncology. However, there remains an urgent need for extensive research on various aspects of radiotherapy, including target selection, damage repair and its combination with immunotherapy. Particularly, the development of in vitro models to replicate in vivo tumor lesion responses is vital. The present study provides a thorough review of the establishment and application of tumor organoids in radiotherapy, aiming to explore their potential impact on cancer treatment.
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