Adding simultaneous integrated boost to whole brain radiation therapy improved intracranial tumour control and minimize radiation-induced brain injury risk for the treatment of brain metastases.

BACKGROUND: Brain metastases (BMs) are the most frequent intracranial tumours associated with poor clinical outcomes. Radiotherapy is essential in the treatment of these tumours, although the optimal radiation strategy remains controversial. The present study aimed to assess whether whole brain radiation therapy with a simultaneous integrated boost (WBRT + SIB) provides any therapeutic benefit over WBRT alone. METHODS: We included and retrospectively analysed 82 patients who received WBRT + SIB and 83 who received WBRT alone between January 2012 and June 2021. Intracranial progression-free survival (PFS), local tumour control (LTC), overall survival (OS), and toxicity were compared between the groups. RESULTS: Compared to WBRT alone, WBRT + SIB improved intracranial LTC and PFS, especially in the lung cancer subgroup. Patients with high graded prognostic assessment score or well-controlled extracranial disease receiving WBRT + SIB had improved intracranial PFS and LTC. Moreover, WBRT + SIB also improved the long-term intracranial tumour control of small cell lung cancer patients. When evaluating toxicity, we found that WBRT + SIB might slightly increase the risk of radiation-induced brain injury, and that the risk increased with increasing dosage. However, low-dose WBRT + SIB had a tolerable radiation-induced brain injury risk, which was lower than that in the high-dose group, while it was comparable to that in the WBRT group. CONCLUSIONS: WBRT + SIB can be an efficient therapeutic option for patients with BMs, and is associated with improved intracranial LTC and PFS. Furthermore, low-dose WBRT + SIB (biologically effective dose [BED] ≤ 56 Gy) was recommended, based on the acceptable risk of radiation-induced brain injury and satisfactory tumour control. TRIAL REGISTRATION: Retrospectively registered.

Effects of PEG in patients with esophageal squamous cell carcinoma during concurrent chemoradiotherapy: a prospective study.

BACKGROUND AND AIMS: This prospective study aimed to compare the changes in nutritional status and adverse events among patients with esophageal squamous cell carcinoma who received enteral nutrition through oral intake, PEG, and an enteral nasogastric tube (NGT) during concurrent chemoradiotherapy (CCRT). METHODS: Of 141 included patients, 38, 74, and 29 patients were fed through oral intake, PEG, and NGTs, respectively. The clinical characteristics and baseline nutritional status of the 3 groups were recorded and analyzed. The Patient-Generated Subjective Global Assessment score, skeletal muscle index, and quality of life were evaluated before and after CCRT; the incidence of adverse events during feeding using PEG and NGTs was also recorded. The correlations among the different nutritional pathways and the CCRT-related adverse events (eg, radiation esophagitis and myelosuppression) were assessed. RESULTS: At baseline, the oral intake group had a significantly better nutritional status and lower disease stage than those in the PEG and NGT groups. However, during CCRT, the oral intake group exhibited the most significant decreases in weight and skeletal muscle index. The synchronous chemotherapy completion rate was the highest in the PEG group. Multivariate analysis showed that the planning tumor volume and oral intake and NGT feeding pathways were associated with radiation esophagitis of at least grade 2. CONCLUSIONS: We found that PEG effectively maintained the body weight and skeletal muscle index of patients with esophageal cancer during CCRT. PEG also improved the synchronous chemotherapy completion rate and reduced the occurrence of at least grade 2 radiation esophagitis. (Clinical trial registration number: NCT04199832.).

Immunotherapy with or without radiotherapy for metastatic or recurrent esophageal squamous cell carcinoma: A real-world study.

Background and purpose: To evaluate the efficiency and safety of immunotherapy combined with or without radiotherapy (RT) for metastatic or recurrent esophageal squamous cell carcinoma (ESCC). Methods: We retrospectively reviewed data of 127 patients with metastatic or recurrent ESCC, who received immunotherapy with or without RT at Tianjin Medical University Cancer Institute between 2017 and 2021. Results: The median follow-up time was 15.7 months (95 % confidence interval (CI): 12.42-18.99). The median PFS of the RT and NRT groups was 5.45 months (95 % CI: 2.89-8.28) and 4.60 months (95 % CI: 3.75-7.06), respectively (P = 0.660). The median OS was 11.9 (95 % CI: 8.61-19.2) and 10.3 (95 % CI: 7.56-15.8) months, respectively (P = 0.890). The median PFS of locoregional recurrence patients in the RT and NRT groups was 11.27 months (95 % CI: 2.45-20.09) and 4.17 months (95 % CI: 2.64-5.71), respectively (P = 0.081). The median OS of locoregional recurrent patients in the RT and NRT groups was 19.48 months (95 % CI: 8.37-30.60) and 7.69 months (95 % CI: 3.45-11.93), respectively (P = 0.026). 64 % of patients in the RT group and 30 % of patients in the NRT group experienced an improvement in dysphagia (P = 0.033). No significant increase in treatment-related toxicity was observed in the RT group compared with the NRT group, except for some hematological complications. Conclusions: Locoregional recurrent patients gained survival benefits from immunotherapy combined with RT. The combination of immunotherapy and RT was safe in metastatic/recurrent ESCC patients. RT for the esophagus leads to the improvement of dysphagia compared to immunotherapy alone.

Solar-excited graphene quantum dots for bacterial inactivation via generation of reactive oxygen species.

Nanoscale photocatalysts have attracted abundant research attention in the solar-activated disinfection. In this work, we find that solar irradiation significantly improves the antimicrobial activity of graphene quantum dots (GQDs), accompanied by severe oxidative stress and membrane damage. By using electron spin resonance (ESR) technique, we confirm that different reactive oxygen species (ROS), including singlet oxygen (1O2), hydroxyl radical (•OH), and superoxide anion (O2•-) were generated by GQDs upon irradiation with simulated sunlight. Additionally, these generated ROS will further facilitate lipid peroxidation of cell membrane and suppress bacterial antioxidant systems, enhancing the phototoxicity of GQDs. These findings will bring major advancements of GQDs in applications of solar-driven bacterial disinfection.

WUS and PIN1-related genes undergo dynamic expressional change during organ regeneration in response to wounding in Zoysia japonica.

Zoysia japonica is a grass specie used for golf courses and stadium lawns because of its eminent organ regeneration ability after cutting. However, the molecular mechanisms of the organ regeneration remain elusive. In plants, the shoot apical meristem (SAM) plays a critical role in organ regeneration process. Studies on shoot apical meristem (SAM) in Arabidopsis revealed PIN-FORMED 1 (PIN1) and WUSCHEL (WUS) as crucial components regulating the maintenance and proliferation of SAM via modulating the phytohormones auxin (IAA) and cytokinin (CTK), respectively. In this study, transcriptome analysis of the early wounding stage of Z. japonica cultivar "Zenith" was performed, and global expression pattern of genes related to the PIN1 and WUS network was analyzed. According to the Gene Ontology (GO) database classification, genes related to cell proliferation were identified in differentially expressed unigenes (DEGs) with dramatic changes. Meanwhile, there were 18 IAA and CTK-related GO terms. The Kyoto Encyclopedia of Genes and Genomes (KEGG) database classification showed that "plant hormone signal transduction" was gradually become the most abundant enrichment pathways within 6 h. Twenty-four Z. japonica genes with homology to Arabidopsis genes that are involved in PIN1 and WUS network were examined for expression. Among them, 21 genes showed dynamic changes whereas three genes did not. Those results suggesting that the key genes involved in the regeneration exhibited difference in both plants. Finally, we proposed a simple molecular mechanism of the Z. japonica organ regeneration regulated by PIN1 and WUS after wounding.