Chinese clinical oncology最新文献

{"title":"The effects of radiation therapy on the brain: implications for management.","authors":"Bayle Smith-Salzberg, Kristin Hsieh, Daniel Cherry, Julie R Bloom, Catherine Yu, Anthony D Nehlsen, Lucas Resende Salgado, Kunal K Sindhu","doi":"10.21037/cco-24-125","DOIUrl":"10.21037/cco-24-125","url":null,"abstract":"<p><p>Radiation therapy (RT) plays a critical role in the management of intracranial malignancies, offering a potent and targeted approach to tumor control. The benefits of RT have been recognized for decades, and it is commonly employed in the management of both primary brain tumors and, especially, brain metastases. Through the induction of DNA damage and disruption of cellular integrity, RT promotes apoptosis and inhibits the proliferative capacity of cancer cells. Advances in imaging, dose planning, and delivery techniques have significantly enhanced the precision of RT, allowing for effective tumor eradication while minimizing harm to surrounding healthy tissue. As a result, RT improves local disease control and contributes to prolonged survival in patients with brain tumors. Nonetheless, intracranial RT may inadvertently damage surrounding healthy brain structures. The effects of RT can manifest as both acute and delayed toxicities, potentially compromising patient quality of life and long-term outcomes. For treating clinicians, a thorough understanding of these complications is necessary to design radiation treatment plans that properly balance the therapeutic efficacy of therapy with the risks of adverse treatment-related outcomes. In this review, we explore the distinct pathophysiological mechanisms, symptoms, and management strategies associated with acute, early delayed (one to six months), and late delayed radiation-induced brain toxicities. In particular, we discuss the risks of somnolence syndrome, peri-ictal pseudoprogression, radiation necrosis, vascular disorders, cognitive impairment, cranial neuropathies, endocrine dysfunction, the development of secondary malignancies, stroke-like migraine attacks after radiation therapy (SMART) syndrome, and acute late-onset encephalopathy after radiation therapy (ALERT) syndrome after brain RT.</p>","PeriodicalId":9945,"journal":{"name":"Chinese clinical oncology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causal relationship between infection and gastrointestinal cancers: a multivariable Mendelian randomization study.","authors":"Ruopeng Zhang, Yinghe Li, Yuqian Huang, Lei Liu, Shatong Li, Bowen Huang, Wanqi Chen","doi":"10.21037/cco-24-126","DOIUrl":"https://doi.org/10.21037/cco-24-126","url":null,"abstract":"<p><strong>Background: </strong>The association between infection and gastrointestinal cancers (GICs) were indicated by pervious studies, but the direct causal link between infection and GIC remains largely unknown. We performed multivariable mendelian randomization (MR) analyses in order to investigate the causal relationship between genetically predicted infection and the GIC risk.</p><p><strong>Methods: </strong>Instrumental variables (IVs) for several common pathogens including Helicobacter pylori (H. pylori), human papillomavirus (HPV) and herpesvirus were retrieved from different genome-wide association studies (GWAS), respectively. The summary-level statistics of GIC were obtained from the European heritage. The inverse-variance weighted MR was conducted as the main approach followed by multiple sensitivity analyses. Twenty datasets of seropositivity and antigen antibody levels against infectious pathogens were utilized as IVs. Four GWAS datasets of GIC were retrieved.</p><p><strong>Results: </strong>It is notable that no evidence demonstrated the causal relationship of H. pylori with gastric cancer (GC) in European ancestry. Several infectious agents were proposed as protective factors for GIC in European population. MR results showed that anti-Epstein-Barr virus (EBV) immunoglobulin G (IgG) seropositivity [odds ratio (OR) =0.32, 95% confidence interval (CI): 0.11-0.95] and EBV ZEBRA antibody levels (OR =0.74, 95% CI: 0.58-0.94) was negatively correlated with the risk of GC. Genetical predisposition of herpes simplex virus (HSV) infection showed a negative correlation with the risk of colon cancer. Similarly, increased levels of H. pylori GroEL antibody also exhibited as a protective factor for colorectal cancer (CRC; OR =0.80, 95% CI: 0.69-0.93).</p><p><strong>Conclusions: </strong>The results reflected differential patterns of geographically distribution and pathogenic role of infectious pathogens among diverse population. Human and infection pathogens co-evolution shape the risk of cancers.</p>","PeriodicalId":9945,"journal":{"name":"Chinese clinical oncology","volume":"14 3","pages":"31"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning algorithms in predicting survivability of patients with renal cell carcinoma after nephrectomy: a retrospective study.","authors":"Peipei Wang, Zhao Hou, Dingyang Lv, Fan Cui, Huiyu Zhou, Jie Wen, Weibing Shuang","doi":"10.21037/cco-24-137","DOIUrl":"https://doi.org/10.21037/cco-24-137","url":null,"abstract":"<p><strong>Background: </strong>Poor prognosis brings great physical suffering and financial burden to patients with renal cell carcinoma (RCC) after nephrectomy. This study aims to explore the application of machine learning for feature selection in predicting survivability and construct a well-performed prognostic model for identifying and managing the high-risk patients.</p><p><strong>Methods: </strong>We retrospectively analyzed 737 patients with RCC after nephrectomy. Important features were respectively selected by least absolute shrinkage and selection operator (LASSO) regression and random survival forest (RSF), and the LASSO-Cox model and RSF-Cox model were constructed in conjunction with Cox regression. And their predictive performance were evaluated and compared by the C-index, calibration curve, decision curve analysis (DCA), area under the curve (AUC) of the receiver operating characteristic (ROC), and Kaplan-Meier curve. Besides, a Cox model was constructed using all clinical variables and compared with the C-index and AUC of the two models described above to demonstrate the necessity of feature selection.</p><p><strong>Results: </strong>A total of 725 cases fitted this study ultimately, of which 48 died during the period of follow-up. The shared variables for the two models were tumor size, preoperative plasma fibrinogen content, N stage, and Fuhrman grade. In the training set, the C-index of the Cox, LASSO-Cox and RSF-Cox was 0.863, 0.893 and 0.874, and the 5-year AUC was 0.816, 0.880 and 0.837. And in the validation set, the C-index was 0.837, 0.856 and 0.821, and the 5-year AUC was 0.790, 0.855 and 0.852. The calibration and DCA curves suggested that the LASSO-Cox model outperformed the RSF-Cox model in survival prediction and net benefit. Significant survival differences were observed between the low and high-risk groups.</p><p><strong>Conclusions: </strong>The LASSO-Cox model we constructed has been simplified and obtained higher efficiency, which can help to inform early intervention and clinical decision-making.</p>","PeriodicalId":9945,"journal":{"name":"Chinese clinical oncology","volume":"14 3","pages":"30"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rechallenge of immune checkpoint inhibitor after local therapy for immune checkpoint inhibitor-resistant non-small cell lung cancer.","authors":"Satoshi Hirano, Tetsuo Fujita, Hidekazu Takahashi, Kento Noda, Naoki Yoshida, Kosei Matsuda, Hikaru Shojima, Kohei Shikano, Hiroyuki Amano, Makoto Nakamura, Masakatsu Onozawa, Hitoshi Araki, Takashi Aruga, Sukeyuki Nakamura","doi":"10.21037/cco-25-3","DOIUrl":"https://doi.org/10.21037/cco-25-3","url":null,"abstract":"<p><strong>Background: </strong>The introduction of immune checkpoint inhibitors (ICIs) has enabled long-term survival for non-small cell lung cancer (NSCLC) patients. However, the proportion of patients achieving this is still low compared to patients with melanoma. Many NSCLC patients experience early progression (primary resistance) following ICI treatment, or relapse after initial responses (acquired resistance). While chemotherapy regimens, typically involving cytotoxic agents, are commonly used after ICI resistance, little evidence has been accumulated regarding the efficacy of ICI rechallenge. The aim of this study was to evaluate the efficacy of ICI rechallenge in patients who experienced failure of primary treatment with ICI-containing regimens. Additionally, we assessed whether the administration of local therapy prior to rechallenge influenced the efficacy of ICI rechallenge.</p><p><strong>Methods: </strong>We retrospectively reviewed the records of advanced NSCLC patients for whom response was evaluated as progressive disease (PD) after receiving an ICI-containing regimen as first-line therapy and underwent rechallenge with an ICI in Funabashi Municipal Medical Center between January 2020 and March 2024. We analyzed progression-free survival (PFS) and overall survival (OS) based on whether local therapy (including beyond PD with local therapy) was performed. PFS was compared using the Kaplan-Meier method, with statistical significance set at P<0.05 using log-rank testing.</p><p><strong>Results: </strong>The study included 20 patients, with 10 patients in the local therapy group and 10 in the no-local therapy group. No significant differences in patient characteristics were apparent between groups, although the no-local therapy group tended to show a higher number of organs with residual metastases at the time of rechallenge. When ICI rechallenge was administered after local therapy, median PFS was significantly longer in the local therapy group (9.0 months) than in the no-local therapy group (1.6 months, P=0.02), particularly in cases where radiation therapy was applied to the primary lesion just before rechallenge. However, no significant difference in OS was evident between the local treatment group (21.4 months) and the no-local treatment group (18.8 months; P=0.12).</p><p><strong>Conclusions: </strong>Rechallenge with ICI following local therapy in NSCLC patients who developed resistance to ICIs may extend PFS, suggesting potential value as a therapeutic option.</p>","PeriodicalId":9945,"journal":{"name":"Chinese clinical oncology","volume":"14 3","pages":"29"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulsed reduced dose rate radiotherapy: a narrative review.","authors":"Ece Atak, Tugce Kutuk, Alonso La Rosa, Minesh P Mehta, Alonso N Gutierrez, Rupesh Kotecha","doi":"10.21037/cco-24-115","DOIUrl":"10.21037/cco-24-115","url":null,"abstract":"<p><strong>Background and objective: </strong>Pulsed reduced dose rate (PRDR) radiotherapy, also known as pulsed low dose rate (PLDR) radiotherapy, involves delivering radiation at significantly lower dose rates in a pulsed manner (0.1-0.2 Gy/minute for a 3-minute interval resulting in a time-averaged, effective dose rate of 0.0667 Gy/min). This approach enhances tumor sensitivity while minimizing normal tissue damage, presenting a promising strategy for recurrent tumor treatment. This comprehensive review aims to consolidate the biological rationale, clinical applications, and prospects of PRDR radiotherapy across several disease sites.</p><p><strong>Methods: </strong>We conducted a comprehensive literature search on the Medline database, ClinicalTrials.gov, and Google Scholar using various word combinations in the \"title\" field, including \"PRDR\", \"Pulsed reduced dose rate\", \"Pulsed low dose rate\", \"PLDR\" and various types of cancers. There were no limitations on the publication year. All obtained publications were reviewed, and their key references were cross-checked to ensure a balanced and high-quality review.</p><p><strong>Key content and findings: </strong>PRDR has multiple radiobiologic advantages, including reoxygenation, redistribution, and immune regulation. These factors collectively contribute to PRDR's efficacy and reduced toxicity. PRDR has shown feasibility across multiple treatment modalities, including both intensity-modulated radiotherapy (IMRT) and pencil beam scanning (PBS) proton therapy, demonstrating significant potential in treating a variety of recurrent tumors. Clinical evidence supports its efficacy in central nervous system (CNS) tumors (i.e., glioma, meningioma, ependymoma, and brain metastases), recurrent breast cancer, head and neck cancers, gastrointestinal cancers, and cervical cancers.</p><p><strong>Conclusions: </strong>PRDR radiotherapy shows promising efficacy and safety across various malignancies, especially in the re-irradiation setting. It is particularly effective for CNS tumors with manageable toxicity and shows potential in recurrent breast, head and neck, and gastrointestinal cancers. Treatment doses typically range from 40 to 66 Gy, depending on tumor type and clinical context. These findings position PRDR as a viable option for patients being considered for re-irradiation above traditional palliative doses. Large-scale clinical trials will likely further validate its efficacy and safety, along with studies aimed at understanding the underlying molecular mechanisms driving its unique therapeutic benefits. The role of PRDR is expected to expand, potentially offering new hope for patients with challenging cancer diagnoses.</p>","PeriodicalId":9945,"journal":{"name":"Chinese clinical oncology","volume":"14 3","pages":"33"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chemoresistance in cutaneous melanoma: contemporary and future aspects.","authors":"Sankalp Nigam, Elliot Enshaie, Jacob Smith, Vikrant Rai","doi":"10.21037/cco-25-9","DOIUrl":"https://doi.org/10.21037/cco-25-9","url":null,"abstract":"<p><p>Melanoma is one of the most common types of skin cancer and is the most lethal type of skin cancer presently. Despite the presence of various drugs for the treatment of melanomas, increasing resistance to the existing treatment is a major concern. Due to the involvement of complex mechanisms including genetic mutations, the presence of neoantigens, tumor microenvironment, and cellular plasticity, the tumor cell develops the ability to evade the effects of current therapies including targeted drugs and immunotherapy limiting the treatment efficacy. This leads to difficulties in achieving long-term control in patients with advanced melanoma. It is important to understand the molecular mechanisms underlying chemoresistance to overcome this resistance and develop potential therapeutic strategies. In this article, we will discuss the most common drugs used to fight skin cancer and their mechanisms of fighting cancer, followed by a discussion of intrinsic resistance and extrinsic resistance. We will address molecular mechanisms of chemoresistance including the alteration in apoptosis and lipid metabolism, the role of tumor microenvironments, genetic and epigenetic mutations, phenotypic switching of cells, and the presence of neoantigens. Next, the strategies to overcome drug resistance including blocking alternative pathways that cancer cells use to avoid treatment, using combination therapies that target multiple signaling pathways, and personalizing treatment regimens to account for a patient's genetic and immunologic characteristics have been discussed. Lastly, the need for advanced techniques including transcriptomic, metabolomics, and proteomics in identifying novel targets and therapies to treat hard-to-treat melanoma or skin cancers has been discussed.</p>","PeriodicalId":9945,"journal":{"name":"Chinese clinical oncology","volume":"14 3","pages":"34"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidental brain uptake of Gallium-68 DOTATATE positron emission tomography/computed tomography scan in patients with neuroendocrine tumors: a case report and literature review.","authors":"Albara Alshalkhaty, Ruaa Al-Ward, Abdullah Esmail, Maen Abdelrahim","doi":"10.21037/cco-25-18","DOIUrl":"10.21037/cco-25-18","url":null,"abstract":"<p><strong>Background: </strong>Neuroendocrine tumors (NETs) often express somatostatin receptors, which makes Gallium-68 DOTATATE positron emission tomography/computed tomography (68Ga-DOTATATE PET/CT) scan an important diagnostic tool. However, incidental brain uptakes on 68Ga-DOTATATE PET/CT scan pose a significant diagnostic challenge, where these uptakes can represent meningiomas or tumor metastasis.</p><p><strong>Case description: </strong>This case report presents two cases of patients with low-grade NETs that had incidental brain uptake on 68Ga-DOTATATE PET/CT. In the first case, a 48-year-old female with a history of bronchial carcinoid tumor and Cushing's syndrome had incidental uptake near the right skull, which magnetic resonance imaging (MRI) confirmed as a stable meningioma. In the second case, a 65-year-old female with a grade 1 gastric NET had incidental uptake in the right temporal and left occipital lobes; however, follow-up MRI was negative. Given the affinity of meningiomas for somatostatin analogues, such findings can complicate the interpretation of PET/CT results.</p><p><strong>Conclusions: </strong>Previous studies reported a prevalence of Incidental brain uptake on 68Ga-DOTATATE PET/CT scan between 1.6% to 11%. The prevalence of meningioma was between 1.6% to 9%. In minor cases, the uptake revealed other causes such as varix abnormalities and metastasis. MRI is considered essential for differentiating meningioma from tumor metastasis, although some cases of meningioma can be missed while showing on PET/CT. Incidental brain uptake on 68Ga-DOTATATE PET/CT scan, while usually suggestive of meningioma, requires follow-up with MRI to confirm the diagnosis and prevent unwarranted aggressive treatments. Awareness of the diagnostic challenges is crucial for the appropriate management of patients with NETs.</p>","PeriodicalId":9945,"journal":{"name":"Chinese clinical oncology","volume":"14 3","pages":"36"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the accuracy of EndoSCellTM system in margin assessment for breast-conserving surgery.","authors":"Jiajian Chen, Jun Mei, Bo Li, Fan Yang, Shuang Hao, Jing Liu, Baohua Yu, Fei Ren, Bo Ping, Jiong Wu","doi":"10.21037/cco-24-108","DOIUrl":"https://doi.org/10.21037/cco-24-108","url":null,"abstract":"<p><strong>Background: </strong>The rapid and accurate assessment of surgical margins in breast-conserving surgery (BCS) remains a pressing clinical challenge. This study aims to evaluate the effectiveness of the EndoSCellTM system, an innovative intraoperative cellular probing technology in assessing surgical margins during BCS and distinguishing between cancerous and normal breast tissue, to explore the feasibility of evaluating surgical margins during BCS.</p><p><strong>Methods: </strong>Patients diagnosed with primary breast cancer by core needle biopsy and received BCS were consecutively enrolled from August 2022 to March 2023. Tissue samples from the primary lesion, peritumoral tissue, and normal breast tissue were obtained from consecutive cases undergoing BCS. A junior surgeon and a senior surgeon employed the EndoSCellTM system during routine breast-conserving or oncoplastic breast-conserving surgeries. Three pathologists were included to assess the accuracy of surgical margin determinations using the EndoSCellTM system postoperatively. The paraffin-embedded pathology remains the gold standard for diagnosis.</p><p><strong>Results: </strong>A total of 53 breast cancer patients, including 43 (81.1%) cases of invasive carcinoma and 10 cases (18.9%) of ductal carcinoma in situ (DCIS) were enrolled in this study, with a total of 289 biopsy samples collected. Using the EndoSCellTM system, surgical oncologists achieved an area under the curve (AUC) of 0.909, demonstrating a sensitivity of 88.70% and a specificity of 93.01%. Pathologists, on the other hand, achieved a higher AUC of 0.937, with a sensitivity of 99.32% and a specificity of 88.11%. In the evaluation of diagnostic consistency using the EndoSCellTM system, the AUC for the comparison between pathologists and surgical oncologists was 0.880.</p><p><strong>Conclusions: </strong>The application of the EndoSCellTM system has proven effective in assessing the pathological state of tissues in real-time, offering a feasible method for evaluating surgical margins during BCS. This technology not only supports the decision-making process in surgery but also provides a foundation for further prospective clinical validation.</p>","PeriodicalId":9945,"journal":{"name":"Chinese clinical oncology","volume":"14 3","pages":"27"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of radiation therapy on the brain: implications for management.","authors":"Bayle Smith-Salzberg, Kristin Hsieh, Daniel Cherry, Julie R Bloom, Catherine Yu, Anthony D Nehlsen, Lucas Resende Salgado, Kunal K Sindhu","doi":"10.21037/cco-24-125","DOIUrl":"10.21037/cco-24-125","url":null,"abstract":"<p><p>Radiation therapy (RT) plays a critical role in the management of intracranial malignancies, offering a potent and targeted approach to tumor control. The benefits of RT have been recognized for decades, and it is commonly employed in the management of both primary brain tumors and, especially, brain metastases. Through the induction of DNA damage and disruption of cellular integrity, RT promotes apoptosis and inhibits the proliferative capacity of cancer cells. Advances in imaging, dose planning, and delivery techniques have significantly enhanced the precision of RT, allowing for effective tumor eradication while minimizing harm to surrounding healthy tissue. As a result, RT improves local disease control and contributes to prolonged survival in patients with brain tumors. Nonetheless, intracranial RT may inadvertently damage surrounding healthy brain structures. The effects of RT can manifest as both acute and delayed toxicities, potentially compromising patient quality of life and long-term outcomes. For treating clinicians, a thorough understanding of these complications is necessary to design radiation treatment plans that properly balance the therapeutic efficacy of therapy with the risks of adverse treatment-related outcomes. In this review, we explore the distinct pathophysiological mechanisms, symptoms, and management strategies associated with acute, early delayed (one to six months), and late delayed radiation-induced brain toxicities. In particular, we discuss the risks of somnolence syndrome, peri-ictal pseudoprogression, radiation necrosis, vascular disorders, cognitive impairment, cranial neuropathies, endocrine dysfunction, the development of secondary malignancies, stroke-like migraine attacks after radiation therapy (SMART) syndrome, and acute late-onset encephalopathy after radiation therapy (ALERT) syndrome after brain RT.</p>","PeriodicalId":9945,"journal":{"name":"Chinese clinical oncology","volume":"14 3","pages":"32"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful salvage therapy of ruxolitinib on interstitial pneumonia after long COVID or post-COVID-19 syndrome with follicular lymphoma: two case reports and literature review.","authors":"Tingting Zhu, Xin Li, Shuquan Gao, Rui Cui, Jia Wang, Qi Deng","doi":"10.21037/cco-24-106","DOIUrl":"10.21037/cco-24-106","url":null,"abstract":"<p><strong>Background: </strong>Immunocompromised patients with B lymphocyte deficiency and hypogammaglobulinemia after anti-CD19 chimeric antigen receptor (CAR) T cell therapy for relapsed/refractory follicular lymphoma (FL) are at high risk of severe coronavirus disease 2019 (COVID-19) infection.</p><p><strong>Case description: </strong>In our study, two patients with refractory FL had persistent COVID-19 infection after their anti-CD19 CAR T cell therapy. The patients were diagnosed with post-COVID-19 syndrome or COVID-19 with interstitial inflammation and persistent hypoxemia. The patients received molnupiravir and Paxlovid, along with methylprednisolone therapy when their interleukin (IL)-6 levels were high. No response was observed in interstitial inflammation, persistent hypoxemia, or persistent positive expression of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); however, the level of IL-6 decreased after these therapies. These two patients subsequently received low-dose ruxolitinib (5 mg, twice daily) as salvage therapy in combination with a gradually reduced dosage of methylprednisolone. After 1-2 months of ruxolitinib therapy, persistent hypoxemia was relieved, and interstitial inflammation was significantly absorbed. At the same time, the SARS-CoV-2 detection was found to be negative.</p><p><strong>Conclusions: </strong>Ruxolitinib might be a safe and effective alternative salvage therapy for patients with COVID-19 having interstitial inflammation and persistent hypoxemia without high cytokine levels and no response to corticosteroids.</p>","PeriodicalId":9945,"journal":{"name":"Chinese clinical oncology","volume":"14 3","pages":"35"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}