Zemin Xiao

This study examined geographic patterns, temporal trends, and determinants of tracheal, bronchus, and lung (TBL) cancer burden in Asia (1990-2023), evaluated disparities in health outcomes, and developed projections for targeted prevention initiatives. Data were obtained from the Global Burden of Disease Study 2023. We estimated age-standardized rates (ASPR, ASIR, ASMR, ASDR). Joinpoint regression assessed temporal trends; age-period-cohort and Das Gupta analyses identified underlying mechanisms and drivers. Data envelopment analysis (DEA) evaluated efficiency relative to the Human Development Index (HDI). Health inequalities were measured with the slope index of inequality (SII) and concentration index (CI). Bayesian age-period-cohort (BAPC) modeling projected trends to 2038. Asian populations experienced 2.05 million prevalent cases, 1.40 million incident cases, 1.26 million fatalities, and 29.45 million DALYs in 2023. East Asia had the highest burden. From 1990 to 2023, ASPR increased, while ASMR and ASDR declined. Males and older adults carried disproportionately higher burdens. Decomposition analysis revealed that epidemiological changes and population growth were the major contributors. Inequality worsened, with SII rising from 275.8 to 311.6 and CI consistently negative, indicating concentration in low-HDI regions. Projections suggested further increases in ASPR (+28.7%) and ASIR (+21.6%) by 2038. The TBL cancer burden in Asia is rising, with marked regional, gender, age disparities and deteriorating health equity. East Asia is most affected. Targeted strategies, including enhanced early screening in high-burden areas and improved healthcare accessibility in low-HDI regions, are essential to reduce the disease burden and promote equity.

Background: Anaplastic lymphoma kinase (ALK) fusion mutations exhibit exceptional sensitivity to tyrosine kinase inhibitors (TKIs) in patients with advanced non-small cell lung cancer (NSCLC). Ensartinib, a second-generation ALK-TKI, represents a promising therapeutic option for ALK mutation-associated NSCLC; however, its clinical application in perioperative therapy remains to be elucidated.Case description: We report the case of a 45-year-old female diagnosed with stage IIIA (cT2N2M0, AJCC eighth edition) adenocarcinoma of the right lung harboring an EML4-ALK fusion (E6:A20) and a TP53 mutation. Following 3-month neoadjuvant therapy with ensartinib, surgical conversion from R(un) to R0 resection was achieved, accompanied by histopathological assessment and confirmation of a major pathological response (MPR) (<10% viable tumor cells) and negative postoperative molecular residual disease (MRD) surveillance. Despite effective neoadjuvant targeted therapy and the absence of significant adverse events, the patient experienced drug-refractory grade 3 cutaneous toxicity (CTCAE v5.0) 4 weeks after surgery and was subsequently found to have a T12 vertebral metastasis on 3-month surveillance imaging. After multidisciplinary evaluation and considering the patient’s refusal to undergo local therapies, treatment was switched to lorlatinib. The patient subsequently experienced complete resolution of skin toxicity, sustained disease control, and a significantly improved quality of life.Conclusion: This case report describes a patient with an MPR subsequent to neoadjuvant ensartinib, who nonetheless developed early postoperative progression. Our case cautions that although MPR and MRD negativity can strongly predict lower recurrence risk, these markers may not universally guarantee long-term remission in every individual. The case underscores the need for continued vigilance and individualized surveillance strategies even once favorable pathological responses are achieved. Additionally, the perioperative evolution of skin toxicity highlights the importance of continuous adverse event monitoring and management.

This study evaluates the dosimetric benefits of off-line adaptive radiotherapy (ART) planning during radiotherapy for locally advanced cervical cancer. Forty-four patients in our hospital were included. The patients were monitored by cone-beam CT (CBCT), and the secondary CT scanning was performed timely. The ART2 planning was performed based on tumor regression and compared with the initial radiotherapy planning (ART1). The mean time of the secondary CT scanning was the thirteen fractions, and the mean gross tumor volume (GTV) decreased by 23.3%. The ART2 compared with the ART1 planning, significantly reduced the mean dose of PGTV (defined as the GTV with 5 mm expansion all directions)-D_2%, V₁₁₀, and PTV-V₁₁₀ by 1.9 Gy, 9.2%, and 3.4%, whereas there was no significant difference in tumor target D_98%, D_50%, and V₁₀₀ between the two groups. The HI of PGTV and planning target volume (PTV) was significantly lower in the ART2 planning. For the comparison of OARs dosimetric parameters, the ART2 planning was significantly decreased the mean dose of rectum-D_mean (2 Gy), D_1cc (0.6 Gy), V₃₀ (7.3%) and V₄₀ (5.9%), bladder-D_1cc (1.1 Gy), left femoral head-D_mean (1.2 Gy), V₄₀ (1.3%) and right femoral head-D_mean (1.3 Gy), but significantly increased the small intestinal-V₃₀ (2.5%). Other OARs dosimetric parameters were similar between two plannings. The Off-line ART planning can adapt for the changes in the target volume, and further decrease the target volume hotspot area/dose and OARs irradiation dose in locally advanced cervical cancer patients. And the clinical benefit of ART still needs to be verified in clinical trials.

To evaluate the feasibility of multi-parameters combined simplified intensity-modulated radiation therapy (sIMRT) planning in thoracic tumors and provide guidance for clinical practice. A total of 34 patients with thoracic tumors who underwent radiotherapy during 2019 to 2020 in our hospital were retrospectively analyzed. The same experienced medical physicist designed the sIMRT planning. The sIMRT planning limited the maximum number of segments per beam-field, the minimum segment area, and the minimum number of segment monitor units (MU), remaining consistent with the conventional intensity-modulated radiation therapy (IMRT). Comparative analysis of the difference in the irradiation dose to the tumor target area, and organs at risk, and delivery validate between 2 groups. The sIMRT slightly increased the tumor target area irradiation dose, but the homogeneity index was similar when compared with IMRT (P > .05). The sIMRT planning significantly reduced the low dose-volume area of the lungs (left lung, V ₅: 2.5%; right lung, V ₅: 3.1%; V ₁₀: 1.8%; lungs, V ₅: 3.2%; V ₁₀: 1.5%, P < .05) and significantly increased the high dose-volume area of the lungs, heart, and esophagus, while meeting the clinical dose-restriction requirements. Moreover, the planning delivery validation showed that significantly reduced the treatment time (6.5 ± 1.9 minutes vs 8.8 ± 2.0 minutes, P < .0001) and total MU (386.3 ± 109.4 MU vs 406.3 ± 107.9 MU, P < .05). This simplified sIMRT method can meet the requirements of thoracic tumors radiotherapy planning, and has higher time effectiveness. In the future, it needs to be further explored in clinical practice.

Adaptive radiotherapy (ART) provides greater benefits than intensity-modulated radiotherapy (IMRT) regarding dosimetric outcomes in patients with cervical cancer. To investigate the clinical benefits of ART, we have collected data from 115 cervical cancer patients who underwent radical radiotherapy at our institution. Fifty-nine patients received a single course of IMRT. Fifty-six patients underwent offline ART, defined as the reduction of the gross tumor volume (GTV) by at least 30% after 30 Gy of radiotherapy, followed by a modified treatment plan for the second-stage. After treatment, 53 patients of ART group achieved a partial response (PR) or completement response (CR), resulting in an objective response rate (ORR) of 94.6% for the ART group, compared to 93.2% for the IMRT group. Patients in both groups exhibited no significant differences in acute toxicities. However, the incidence of chronic constipation was significantly higher in the IMRT group compared to the ART group (p = 0.021). With a median follow-up time of 27 months, the ART group experienced a higher mortality (10/56) than the IMRT group (6/59). However, the difference between the two groups was not statistically significant. In summary, ART may be advantageous in reducing the incidence of chronic constipation among patients with locally advanced cervical cancer, and both clinical prognosis and near-term survival are satisfactory.

Background: Extensive-stage small-cell lung cancer (ES-SCLC) has a dismal prognosis owing to its high aggressiveness, rapid drug resistance, and early metastasis. ES-SCLC responds well to first-line chemotherapy, and chemotherapy coupled with immunotherapy can further improve overall survival. However, the long-term survival of patients remains unsatisfactory because of its high recurrence rate and the poor efficacy of second-line treatment. Although local radiotherapy is an important component of the overall treatment for ES-SCLC, its value in the age of immunotherapy remains controversial.Case description: A 54-year-old male with ES-SCLC achieved a complete response (CR), as determined using enhanced computed tomography (CT) after four cycles of immunochemotherapy (serplulimab, carboplatin, and etoposide). Whole-body positron emission tomography-CT was performed during maintenance treatment with serplulimab, which showed primary lung, liver, and bone metastatic lesions with CR. However, several mediastinal lymph nodes exhibited glucose metabolism uptake, and new lesions appeared on the head. The patient underwent palliative radiotherapy of the head and consolidative thoracic radiotherapy of the chest and continued maintenance treatment with serplulimab. Subsequent magnetic resonance imaging of the head suggested good control of metastatic lesions (CR). The patient received first-line immunotherapy for approximately 20 months.Conclusions: This report presents a patient with ES-SCLC who underwent local radiotherapy in addition to serplulimab as maintenance therapy. Although the programmed death-ligand 1 (PD-L1) expression level was negative and a PD-1 inhibitor instead of a PD-L1 inhibitor was used, the patient did not experience significant pneumonia during treatment, and the efficacy of the current treatment was evident. This treatment model warrants further clinical investigation.

SMARCA4-deficient undifferentiated tumor (SMARCA4-dUT) is a devastating subtype of thoracic tumor with SMARCA4 inactivation and is characterized by rapid progression, poor prognosis, and high risk of postoperative recurrence. However, effective treatments for SMARCA4-dUT are lacking. Herein, we describe a patient with SMARCA4-dUT who exhibited an impressive response to the anti-programmed cell death protein-1 (PD-1) antibody (tislelizumab) in combination with conventional chemotherapy (etoposide and cisplatin). To the best of our knowledge, this is the first case of SMARCA4-dUT treated with chemotherapy, comprising etoposide and cisplatin, combined with anti-PD-1 inhibitors. Immunotherapy combined with etoposide and cisplatin may be a promising strategy to treat SMARCA4-dUT.

Importance: Radiotherapy plays an important role in the treatment of esophageal cancer. Proton therapy has unique physical properties and higher relative biological effectiveness. However, whether proton therapy has greater benefit than photon therapy is still unclear.Objective: To evaluate whether proton was associated with better efficacy and safety outcomes, including dosimetric, prognosis, and toxic effects outcomes, compared with photon therapy and to evaluate the efficacy and safety of proton therapy singly.Data Sources: A systematic search of PubMed, Embase, the Cochrane Library, Web of Science, SinoMed, and China National Knowledge Infrastructure databases was conducted for articles published through November 25, 2021, and updated to March 25, 2023.Study Selection: For the comparison of proton and photon therapy, studies including dosimetric, prognosis, and associated toxic effects outcomes were included. The separate evaluation of proton therapy evaluated the same metrics.Data Extraction and Synthesis: Data on study design, individual characteristics, and outcomes were extracted. If I² was greater than 50%, the random-effects model was selected. This meta-analysis is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.Main Outcomes and Measures: The main outcomes were organs at risk (OARs) dosimetric outcomes, prognosis (overall survival [OS], progression-free survival [PFS], and objective response rate [ORR]), and radiation-related toxic effects.Results: A total of 45 studies were included in the meta-analysis. For dosimetric analysis, proton therapy was associated with significantly reduced OARs dose. Meta-analysis showed that photon therapy was associated with poor OS (hazard ratio [HR], 1.31; 95% CI, 1.07-1.61; I² = 11%), but no difference in PFS was observed. Subgroup analysis showed worse OS (HR, 1.42; 95% CI, 1.14-1.78; I² = 34%) and PFS (HR, 1.48; 95% CI, 1.06-2.08; I² = 7%) in the radical therapy group with photon therapy. The pathological complete response rate was similar between groups. Proton therapy was associated with significantly decreased grade 2 or higher radiation pneumonitis and pericardial effusion, and grade 4 or higher lymphocytopenia. Single-rate analysis of proton therapy found 89% OS and 65% PFS at 1 year, 71% OS and 56% PFS at 2 years, 63% OS and 48% PFS at 3 years, and 56% OS and 42% PFS at 5 years. The incidence of grade 2 or higher radiation esophagitis was 50%, grade 2 or higher radiation pneumonitis was 2%, grade 2 or higher pleural effusion was 4%, grade 2 or higher pericardial effusion was 3%, grade 3 or higher radiation esophagitis was 8%, and grade 4 or higher lymphocytopenia was 17%.Conclusions and Relevance: In this meta-analysis, proton therapy was associated with reduced OARs doses and toxic effects and improved prognosis compared with photon therapy for esophageal cancer, but caution is warranted. In the future, these findings should be further validated in randomized clinical trials.