Trojan-horse inspired nanoblaster: X-ray triggered spot attack on radio-resistant cancer through radiodynamic therapy.

Radiotherapy as a mainstay of in-depth cervical cancer (CC) treatment suffers from its radioresistance. Radiodynamic therapy (RDT) effectively reverses radio-resistance by generating reactive oxygen species (ROS) with deep tissue penetration. However, the photosensitizers stimulated by X-ray have high toxicity and energy attenuation. Therefore, X-ray responsive diselenide-bridged mesoporous silica nanoparticles (DMSNs) are designed, loading X-ray-activated photosensitizer acridine orange (AO) for spot blasting RDT like Trojan-horse against radio-resistance cervical cancer (R-CC). DMSNs can encapsulate a large amount of AO, in the tumor microenvironment (TME), which has a high concentration of hydrogen peroxide, X-ray radiation triggers the cleavage of diselenide bonds, leading to the degradation of DMSNs and the consequent release of AO directly at the tumor site. On the one hand, it solves the problems of rapid drug clearance, adverse distribution, and side effects caused by simple AO treatment. On the other hand, it fully utilizes the advantages of highly penetrating X-ray responsive RDT to enhance radiotherapy sensitivity. This approach results in ROS-induced mitochondria damage, inhibition of DNA damage repair, cell cycle arrest and promotion of cancer cell apoptosis in R-CC. The X-ray responsive DMSNs@AO hold considerable potential in overcoming obstacles for advanced RDT in the treatment of R-CC.

Exploring the Evolving Landscape of Stereotactic Body Radiation Therapy in Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) carries significant morbidity and mortality. Management of the HCC requires a multidisciplinary approach. Surgical resection and liver transplantation are the gold standard options for the appropriate settings. Stereotactic body radiation therapy (SBRT) has emerged as a promising treatment modality in managing HCC; its use is more studied and well-established in advanced HCC (aHCC). Current clinical guidelines universally endorse SBRT as a viable alternative to radiofrequency ablation (RFA), transarterial chemoembolisation (TACE), and transarterial radioembolisation (TARE), a recommendation substantiated by literature demonstrating comparable efficacy among these modalities. In early-stage HCC, SBRT primarily manages unresectable tumours unsuitable for ablative procedures such as microwave ablation and RFA. SBRT has been incorporated as a modality to downstage tumours or as a bridge to transplant. In the case of intermediate or advanced HCC, SBRT offers excellent results either as a single modality or adjunct to other locoregional modalities such as TACE/TARE. Recent data from late-stage HCC patients illustrate the effectiveness of SBRT in achieving local tumour control while minimising damage to surrounding healthy liver tissue. It has promising local control of approximately 80-90% in managing HCC. Additional prospective data comparing the efficacy of SBRT with the first-line recommended therapies such as RFA, TACE, and surgery are essential. The standard of care for patients with advanced/metastatic disease is systemic therapy (immunotherapy/tyrosine kinase inhibitors). SBRT, in combination with immune-checkpoint inhibitors, has an immune-modulatory effect that results in a synergistic effect. Recent findings indicate that the combination of immunotherapy and SBRT in HCC is well-tolerated and exhibits synergistic effects. Further exploration of diverse immunotherapy and radiotherapy strategies is essential to identify the appropriate time for combination treatments and to optimise dose and fraction regimens. Prospective, randomised studies are imperative to establish SBRT as the primary treatment for HCC.

Estimation of the absorbed dose in simultaneous digital breast tomosynthesis and mechanical imaging.

Purpose: Use of mechanical imaging (MI) as complementary to digital mammography (DM), or in simultaneous digital breast tomosynthesis (DBT) and MI - DBTMI, has demonstrated the potential to increase the specificity of breast cancer screening and reduce unnecessary biopsies compared with DM. The aim of this study is to investigate the increase in the radiation dose due to the presence of an MI sensor during simultaneous image acquisition when automatic exposure control is used. Approach: A radiation dose study was conducted on clinically available breast imaging systems with and without an MI sensor present. Our estimations were based on three approaches. In the first approach, exposure values were compared in paired clinical DBT and DBTMI acquisitions in 97 women. In the second approach polymethyl methacrylate (PMMA) phantoms of various thicknesses were used, and the average glandular dose (AGD) values were compared. Finally, a rectangular PMMA phantom with a 45 mm thickness was used, and the AGD values were estimated based on air kerma measurements with an electronic dosemeter. Results: The relative increase in exposure estimated from digital imaging and communications in medicine headers when using an MI sensor in clinical DBTMI was 11.9 % ± 10.4 . For the phantom measurements of various thicknesses of PMMA, the relative increases in the AGD for DM and DBT measurements were, on average, 10.7 % ± 3.1 and 11.4 % ± 3.0 , respectively. The relative increase in the AGD using the electronic dosemeter was 11.2 % ± < 0.001 in DM and 12.2 % ± < 0.001 in DBT. The average difference in dose between the methods was 11.5 % ± 3.3 . Conclusions: Our measurements suggest that the use of simultaneous breast radiography and MI increases the AGD by an average of 11.5 % ± 3.3 . The increase in dose is within the acceptable values for mammography screening recommended by European guidelines.

Cone-Beam Computed Tomography (CBCT)-Guided Adaptive Boost Radiotherapy for a Patient With Locally Advanced Cervical Cancer Ineligible for Brachytherapy.

Brachytherapy is a critical component of locally advanced cervical cancer treatment, and patients ineligible for brachytherapy historically have poor outcomes. Delivery of boost with stereotactic body radiation therapy (SBRT) has been studied, though toxicity is a concern. Recent case reports have explored adaptive radiation boost, which can adjust plans for inter-fraction motion using magnetic resonance guidance. Herein, we report the first patient with locally advanced cervical cancer ineligible for brachytherapy who was treated with a cone-beam computed tomography (CBCT)-guided adaptive boost following completion of chemoradiation. A 71-year-old female with locally advanced cervical cancer was treated with chemoradiation and was deemed ineligible for a brachytherapy boost due to tumor size, geometry, and a fistula with a tumor in the bladder. She was prescribed a boost to the primary tumor of 25 Gy in five fractions using CBCT-guided adaptive radiation following the completion of chemoradiation. A simulation was performed using a non-contrast CT fused with a mid-chemoradiation magnetic resonance imaging (MRI) scan to create an initial plan. For each treatment fraction, kilovoltage CBCTs were acquired, contours of organs at risk (OARs) were adjusted to reflect anatomy-of-the-day, and an adapted plan was generated. The initial and adapted plans were compared using dose-volume histogram objectives, and the adapted plan was used if it resolved OAR constraint violations or improved target coverage. The use of the initial treatment plan would have resulted in constraint violations for the rectum, sigmoid, and bladder in all fractions. The adapted plans achieved hard constraints in all fractions for all four critical OARs. The mean total treatment time across all five fractions was 58 minutes. This case demonstrates the feasibility of a CBCT-guided adaptive boost approach and the dosimetric benefits of plan adaptation in this setting. Though larger-scale and longer-term data are needed, CBCT-guided adaptive radiation may present a feasible alternative modality to deliver boost doses for brachytherapy-ineligible patients.

Degenerative Atypia in Clival Chordoma: Two Case Reports.

In this study, we report surgical management combined with radiotherapy in two patients with typical chordoma. Different types of radiation have varied effects on chordomas when they are radiated. Classical cases display cellular atypia and fibrosis following irradiation, while necrosis and fibrosclerosis are observed after carbon ion therapy, implying that it is possible to control the tumor more effectively using carbon ion therapy with minimal side effects.

Radiation effects in head and neck and role of hyperbaric oxygen therapy: An adjunct to management.

Background: Radiotherapy is considered an essential treatment modality in cancers, especially head and neck cancers. Radiotherapy can be given as a definitive, supportive, or adjuvant therapy for various cancers. Radiation damage is an avoidable complication in many patients, after or during radiotherapy. It may be either dose-related, duration-related, or frequency-related. The effects of radiation damage are mainly caused by ischemic necrosis, and once settled it is difficult to manage due to the low vascularity of the affected area. Aim: To find out the effectiveness of hyperbaric oxygen therapy (HBOT) in the management of radiation damage in the head and neck region. Materials and Methods: Retrospective data of patients attending the HBOT clinic for postradiotherapy changes were recorded in an Excel sheet and analyzed in this study. Statistical analysis was done. Result: Our study showed that HBOT is effective in postradiation trismus, xerostomia, discharge, foul smell, discharging sinus, etc., However, it was not found to be significant in the closure of fistula with exposed bone. Conclusion: HBOT is an effective adjunct modality for the management of postradiation changes in the head and neck region.

New Insight into Nucleotide Changes on Irradiated Bactrocera dorsalis (Hendel), A Pest of Horticultural Importance.

Bactrocera dorsalis (Hendel) is a major quarantine pest species infesting most of the tropical fruits. Its infestation had significantly reduced and disrupted the export market trade, thus, very crucial to be controlled during the preharvest and postharvest. One of the most sustainable control methods is by using the radiation technique to reduce the pest population, thus curbing the spread of this pest to new geographical areas. The objective of this study was to measure the nucleotide changes in B. dorsalis (larval, pupal and adult stages) which had been irradiated with 50 to 400 Gray, using Gamma Cell Biobeam GM8000 irradiator with Cesium-137 source at the Malaysian Nuclear Agency, Selangor, Malaysia. Data from the treated samples (with and without morphological changes) were analysed using cytochrome oxidase subunit I (COI). The alignment of 59 sequences resulted in 0.92% variables with only four characters that were parsimony informative, and six sites (30, 60, 234, 282, 483 and 589) which had nucleotide changes, but had not been translated to another protein. Low polymorphism was presented on the sample groups, with only four haplotypes, but with high diversity value (Hd) = 0.5885. The phylogeny trees formed soft polytomy in both trees [neighbour joining (NJ) and maximum parsimony (MP)] presenting a mixture of individuals but did not show any significant difference between treatments. This finding concluded that low mutation had occurred on the treated B. dorsalis and this information is very valuable in getting new insight on the survival of B. dorsalis in the horticulture industry.

[Borderlines and malignant phyllodes tumors of the breast: From the anatomopathological challenge to the standard of care]. / Tumeurs phyllodes borderlines et malignes du sein : du défi anatomopathologique à l'élaboration d'un standard de prise en charge.

Phyllodes tumors, borderline (BPT) and malignant (MPT), represent a rare group of fibroepithelial breast tumors. Due to their rarity, their treatment remains poorly codified. The precise incidence of these tumors remains unknown. TPMs represent half of breast sarcomas and 1 % of breast tumors. Their treatment at the localized stage is based on surgery, that can be conservative surgery or a mastectomy. The impact of oncoplastic techniques and immediate breast reconstruction is not documented. The excision margins of the BPT and MPT must be free, a wider margin can provide a benefit in local recurrence but in also overall survival in the case of TPM. The optimal width of the excision margin is not known. In the event of positive margins, a second surgery could make up the result of an insufficient first surgery. Chemotherapy does not seem to provide any benefit on recurrence-free survival, but the available data are particularly weak. The data on adjuvant radiotherapy are more important. This allows better local control in the event of breast-conserving surgery. The benefit of post-mastectomy radiotherapy is less documented but can be considered in cases of poor prognostic factors. The management of TPM at the metastatic stage is based on the use of chemotherapy (anthracyclines, Ifosfamide) and local treatment of metastases in cases of oligometastatic disease. Due to the rarity of these tumors, it is essential that their management be discussed within a network of qualified professionals (NETSARC+).

Craniofacial Imaging of Pediatric Patients by Ultrashort Echo-Time Bone-Selective MRI in Comparison to CT.

RATIONALE AND OBJECTIVES: The emergence of low-dose protocols for CT imaging has mitigated pediatric radiation exposure, yet ionizing radiation remains a concern for children with complex craniofacial conditions requiring repeated radiologic monitoring. In this work, the clinical feasibility of an ultrashort echo time (UTE) MRI sequence was investigated in pediatric patients. MATERIALS AND METHODS: Twelve pediatric patients (6 female, age range 8 to 18 years) with various imaging conditions were scanned at 3T using a dual-radiofrequency, dual-echo UTE MRI sequence. Bright-bone images were generated using a weighted least-squares conjugate gradient method to enhance bone specificity. The overlap of the binary skull masks was quantified using the Dice similarity coefficient (DSC) and the 95th percentile Hausdorff distance (HD95) to evaluate the similarity between MRI and CT. To assess the anatomic accuracy of 3D skull reconstructions, six craniometric distances were recorded and the agreement between MRI- and CT-derived measurements was evaluated using Lin's concordance correlation coefficient (ρc). RESULTS: The bright-bone images from UTE MRI demonstrated high bone-contrast, suppression of soft tissue, and separation from air at the sinuses. The DSC and HD95 between MRI and CT had medians of 0.81 ± 0.10 and 1.87 ± 0.32 mm, respectively. There was good agreement between MRI and CT for all craniometric distances (ρc ranging from 0.90 to 0.99) with a mean absolute difference in measurements of < 2 mm. CONCLUSION: The clinical feasibility of the UTE MRI sequence for craniofacial imaging was demonstrated in a cohort of pediatric patients, showing good agreement with CT in resolving thin bone structures and craniometry.

DARES: A Phase II Trial of Durvalumab and Ablative Radiation in Extensive-Stage Small Cell Lung Cancer.

BACKGROUND: Immunotherapy in combination with chemotherapy is first-line treatment for patients with extensive-stage small-cell lung cancer (ES-SCLC). Growing evidence suggests that radiation, specifically stereotactic body radiation therapy (SBRT), may enhance the immunogenic response as well as cytoreduce tumor burden. The primary objective of the study is to determine the progression free survival for patients with newly diagnosed ES-SCLC treated with combination multisite SBRT and chemo-immunotherapy (carboplatin, etoposide, and durvalumab). METHODS: This is a multicenter, single arm, phase 2 study. Patients with treatment-naïve, ES-SCLC will be eligible for this study. Patients will receive durvalumab 1500mg IV q3w, carboplatin AUC 5 to 6 mg/mL q3w, and etoposide 80 to 100 mg/m2 on days 1 to 3 q3w for four cycles, followed by durvalumab 1500mg IV q4w until disease progression or unacceptable toxicity. Ablative radiation will be delivered 1 to 4 extracranial sites in 3 or 5 fractions, determined by location, during cycle 2. The primary endpoint is progression-free survival, measured from day 1 of chemoimmunotherapy. Secondary endpoints include grade ≥3 toxicity by CTCAE v5.0 within three months of RT, overall survival, response rate, time to second line systemic therapy, and time to new distant progression. CONCLUSIONS: Now that immunotherapy is an established part of ES-SCLC management, it is important to further optimize its use and effect. This study will investigate the progression-free survival of combined SBRT and chemo-immunotherapy in patients with ES-SCLC. In addition, the data from this study may further inform the immunogenic role of SBRT with chemo-immunotherapy, as well as identify clinical, biological, or radiomic prognostic features.

Diagnostic reference levels in interventional neuroradiology procedures - a systematic review.

INTRODUCTION: The establishment of diagnostic reference levels (DRLs) is challenge for interventional neuroradiology (INR) due to the complexity and variability of its procedures. OBJECTIVE: The main objective of this systematic review is to analyse and compare DRLs in fluoroscopy-guided procedures in INR. METHODS: An observational study reporting DRLs in INR procedures, specifically cerebral arteriography, cerebral aneurysm embolisation, cerebral thrombectomy, embolisation of arteriovenous malformations (AVM), arteriovenous fistulas (AVF), retinoblastoma embolisation, and spinal cord arteriography. Comprehensive literature searches for relevant studies published between 2017 and 2023 were conducted using the Scopus, PubMed, and Web of Science databases. RESULTS: A total of 303 articles were identified through an extensive literature search, with 159 removed due to duplication. The title and abstract of 144 studies were assessed and excluded if they did not meet the inclusion criteria. Thirty-one out of the 144 articles were selected for a thorough full-text screening. Twenty-one articles were included in the review after the complete text screening. CONCLUSION: The different conditions of patients undergoing INR procedures pose a barrier to the standardization of DRLs; nevertheless, they are extremely important for monitoring and optimising radiological practices.

Development and performance evaluation of medical radiation-reducing creams using eco-friendly radiation-shielding composites.

To ensure the safety of medical personnel in healthcare organizations, radiation-shielding materials like protective clothing are used to protect against low-dose radiation, such as scattered rays. The extremities, particularly the hands, are the most exposed to radiation. New materials that can be directly coated onto the skin would be more cost-effective, efficient, and convenient than gloves. We developed protective creams using eco-friendly shielding materials, including barium sulfate, bismuth oxide, and ytterbium oxide, to avoid harmful effects of heavy metals like lead, and tested their skin-protective effects. Particularly, the radiation-shielding effect of ytterbium oxide was compared with that of the other materials. As shielding material dispersion and layer thickness greatly affect the efficacy of radiation-shielding creams, we assessed dispersion in terms of the weight percentage (wt%). The effective radiation energy was reduced by 20% with a 1.0-mm increase in cream thickness. Ytterbium oxide had a higher radiation-shielding rate than the other two materials. A 28% difference in protective effect was observed with varying wt%, and the 45 wt% cream at 63.4 keV radiation achieved a 61.3% reduction rate. Higher content led to a more stable incident energy-reducing effect. In conclusion, ytterbium oxide shows potential as a radiation-shielding material for creams.

Machine learning models for daily net radiation prediction across different climatic zones of China.

Net radiation (Rn), a critical component in land surface energy cycling, is calculated as the difference between net shortwave radiation and longwave radiation at the Earth's surface and holds significant importance in crop models for precision agriculture management. In this study, we examined the performance of four machine learning models, including extreme learning machine (ELM), hybrid artificial neural networks with genetic algorithm models (GANN), generalized regression neural networks (GRNN), and random forests (RF), in estimating daily Rn at four representative sites across different climatic zones of China. The input variables included common meteorological factors such as minimum and maximum temperature, relative humidity, sunshine duration, and shortwave solar radiation. Model performance was assessed and compared using statistical parameters such as the correlation coefficient (R2), root mean square errors (RMSE), mean absolute errors (MAE), and Nash-Sutcliffe coefficient (NS). The results indicated that all models slightly underestimated actual Rn, with linear regression slopes ranging from 0.810 to 0.870 across different zones. The estimated Rn was found to be comparable to observed values in terms of data distribution characteristics. Among the models, the ELM and GANN demonstrated higher consistency with observed values, exhibiting R2 values ranging from 0.838 to 0.963 and 0.836 to 0.963, respectively, across varying climatic zones. These values surpassed those of the RF (0.809-0.959) and GRNN (0.812-0.949) models. Additionally, the ELM and GANN models showed smaller simulation errors in terms of RMSE, MAE, and NS across the four climatic zones compared to the RF and GRNN models. Overall, the ELM and GANN models outperformed the RF and GRNN models. Notably, the ELM model's faster computational speed makes it a strong recommendation for Rn estimates across different climatic zones of China.

Radiation therapy in mycosis fungoides.

Radiation therapy (RT) is administered with varying intentions, sometimes even several times in the same or in different body areas, to over 50% of patients with neoplastic conditions. Numerous techniques are available to patients in the clinical evolution of mycosis fungoides (MF), and there are several indications for radiation therapy (RT). RT as a skin-directed therapy is very widely used in these patients, either alone or in conjunction with other therapies. The application of RT, a tried-and-true therapy that improves MF patients' quality of life and treatment, can be encouraged by a multidisciplinary approach and an understanding of current methods and action mechanisms.

Comparison of doses received from non-contrast enhanced brain CT examinations between two CT scanners.

Objectives: Medical devices based on X-ray imaging, such as computed tomography, are considered notable sources of artificial radiation. The aim of this study was to compare the computed tomography dose volume index, the dose length product, and the effective dose of the brain non-contrast enhanced examination on two CT scanners to determine the current state in terms of radiation doses, compare doses to the reference values, and possibly optimize the examination. Materials and methods: Data from January 2020 to the second half of 2021 were retrospectively obtained by accessing dose reports from the Picture Archiving and Communication System (PACS). Data were collected and analyzed in Microsoft Excel. The effective dose was estimated using the dose-length product parameter and the normalized conversion factor for a given anatomical region. For statistical analysis, a two-sample t-test was used. Results: The first data set consists of 200 patients (100 and 100 for older and newer CT scanners) regardless of the scan technique; the average CTDIvol and DLP for the older CT scanner were 57.61 ± 2.89 mGy and 993.28 ± 146.18 mGy cm, and for the newer CT scanner, 43.66 ± 11.15 mGy and 828.14 ± 130.06 mGy cm. The second data set consists of 100 patients (50 for the older CT scanner and 50 for the newer CT scanner) for a sequential scan; the average CTDIvol and DLP for the older CT scanner were 58.63 ± 3.33 mGy and 949.42 ± 80.87 mGy.cm, and for the newer CT, 57.25 ± 3.4 mGy and 942.13 ± 73.05 mGy cm. The third data set consists of 40 patients (20 and 20 for older and newer CT scanners) for the helical scan - the average CTDIvol and DLP for the older CT scanner were 54.6 ± 0 mGy and 1252.2 ± 52.11 mGy.cm, and for the newer CT, 37.18 ± 2.52 mGy and 859.66 ± 72.04 mGy cm. The difference between the older and newer CT scanners in terms of dose reduction was approximately 30 % in favor of the newer scanner for noncontrast enhanced brain examinations performed using the helical scan technique. Conclusion: A non-contrast enhanced brain examination scanned with newer CT equipment was associated with a lower radiation burden on the patient.

Salvage lung resection after immunotherapy is feasible and safe.

Objectives: Patients with non-small cell lung cancer treated with immunotherapy and modern chemoradiation regimens show improved progression-free and overall survival. However, patients with limited oligo-progression represent a potential population in which local therapy such as surgery may have a potential role as salvage treatment. The objectives of our study were to evaluate the feasibility and safety of salvage lung resection after immunotherapy in patients with non-small cell lung cancer. Methods: The National Cancer Database was queried for patients diagnosed and treated for non-small cell lung cancer stage I to IV, from 2013 to 2020. Patients who underwent surgery as salvage after immunotherapy were defined as undergoing surgery >5 months from the initiation of immunotherapy. As a sensitivity analysis, patients who underwent surgery as salvage after chemoradiation were also analyzed in a similar fashion. Surgical outcomes such as type of surgery, complete resection (R0) rates, and complete pathologic response rates were determined for feasibility. Length of stay, 30-day readmission rates, and 30-day mortality rates were determined and overall survivals were estimated with Kaplan-Meier analysis to evaluate for safety. Results: Of the 934,093 patients diagnosed with non-small cell lung cancer stage I to IV from 2013 to 2020, 164 patients received immunotherapy and after 5 months underwent surgery. Lobectomy was the most commonly performed operation (74%) and pneumonectomy was required in 9% (n = 15). R0 resection was achieved in 89% (n = 146) and of these patients, 23% (n = 37) had complete pathologic response. Median length of stay was 4 days, 30-day readmission was 5%, and 30-day mortality was 0.6%. In our sensitivity analysis of chemoradiation patients (n = 445), the above data were similar to previously reported cohort studies of patients undergoing chemoradiation and subsequently salvage surgery. Conclusions: Lung resection after immunotherapy appears to be a feasible salvage treatment option, with lobectomy being most common and with high R0 resection rates. Low patient morbidity and mortality rates also suggest the safety of this approach. Salvage surgery may be considered in patients who have oligo-progression after immunotherapy within the context of a comprehensive multidisciplinary treatment plan.

Secondary Cancer in Prostate Cancer Patients Treated With Advanced External Beam Radiation Therapy.

Purpose: Previous studies have shown that external beam radiation therapy is associated with an increased risk of second primary cancer (SPC) among prostate cancer (PCa) patients, but the relative risks associated with newer and advanced radiation modalities such as proton beam therapy (PBT) and stereotactic body radiation therapy (SBRT) are unclear. This study aimed to assess the relative probability of SPC among patients treated with these newer modalities compared to intensity-modulated radiation therapy (IMRT). Patients and Methods: Using the National Cancer Database (NCDB), N0M0 PCa cases diagnosed between 2004 and 2018 were identified. Second primary cancer probabilities were compared among those treated with curative-intent PBT, SBRT, and IMRT. Multivariable logistic regression and inverse probability of treatment weighting were used to generate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results: In total, 133 898 patients were included, with a median age of 69 years and median follow-up of 6.4 years. As their first course of treatment, 3420 (2.6%) received PBT, 121 211 (90.5%) received IMRT, and 9267 (6.9%) received SBRT. Compared with IMRT, PBT and SBRT were associated with lower SPC risk (aORs and 95% CIs, PBT: 0.49 [0.40-0.60], SBRT: 0.57 (0.51-0.63), P < .001). Inverse probability of treatment weighting analyses corroborated these results. Conclusion: In this large national cohort, PBT and SBRT performed similarly and were associated with reduced SPC risk compared to IMRT when used as the first course of treatment.

Development and validation of a prognostic nomogram in patients aged ≥65 years with stage I-II non-small cell lung cancer treated with stereotactic body radiotherapy.

INTRODUCTION: This study aims to discern the efficacy and toxicity of stereotactic body radiotherapy (SBRT) in older adults with stage I-II non-small cell lung cancer (NSCLC) and establish a prognostic nomogram for these patients. MATERIALS AND METHODS: One hundred forty-two patients (aged ≥65 years) with clinically-confirmed stage I-II NSCLC treated with SBRT from 2009 to 2020 were enrolled in the study. Primary end points included overall survival (OS), progression free survival (PFS), cumulative incidences of local failure (LF), regional failure (RF), distant failure (DF), and toxicity. A nomogram for OS was developed and validated internally using one thousand bootstrap resamplings. RESULTS: The median times to LF, RF, and DF were 22.1 months, 26.9 months and 24.1 months, respectively. The 1-, 3-, and 5-year PFS rates from the start of SBRT were 79.4 %, 53.1 %, and 38.9 %, respectively. Performance status, pre-SBRT platelet to lymphocyte ratio (PLR), and planning tumor volume (PTV) were predictive of PFS. The 1-, 3-, and 5-year OS rates from the start of SBRT were 90.8 %, 67.9 % and 47.6 %, respectively. In multivariate analysis, good performance status, a low level of pre-SBRT PLR, and small tumor size were associated with better prognosis, all of which were included in the nomogram. The model showed optimal discrimination, with a C-index of 0.651 and good calibration. The most common adverse reactions were grade 1-2, such as anemia, cough, and fatigue. DISCUSSION: SBRT is a reasonable treatment modality for early-stage NSCLC in older adults. It achieved good survival outcomes and low toxicity. The proposed nomogram may be able to estimate individual outcomes for these patients.

Photoprotective sulfated mannogalactan from heterotrophic Bacillus velezensis blocks UV-A mediated matrix metalloproteinase expression and nuclear DNA damage in human dermal fibroblast.

Prolonged exposure of human dermal fibroblasts (HDF) to ultraviolet (UV) radiation triggers the production of reactive oxygen species by upregulating the expression of matrix metalloproteinases (MMPs), causing type-I collagen degradation and photoaging. A sulfated (1 â†’ 3)/(1 â†’ 4) mannogalactan exopolysaccharide (BVP-2) characterized as [→3)-α-Galp-{(1 â†’ 4)-α-6-O-SO3-Manp}-(1 â†’ 3)-α-6-O-SO3-Galp-(1→] was isolated from seaweed-associated heterotrophic bacterium Bacillus velezensis MTCC13097. Whole genome analysis of B. velezensis MTCC13097 (Accession number JAKYLL000000000) revealed saccharine biosynthetic gene clusters for exopolysaccharide production. BVP-2 administered cells showed noteworthy reduction in mitochondrial superoxide (∼85 %, p < 0.05) and ROS production (62 %) than those exhibited by UV-A irradiated HDF cells. Oxidative imbalance in HDF cells (after UV-A exposure) was recovered with BVP-2 treatment by significantly downregulating nitric oxide (NO) production (98.6 µM/mL, 1.9-fold) and DNA damage (⁓67 %) in comparison with UV-A induced cells (191.8 µM/mL and 98.7 %, respectively). UV-irradiated HDF cells showed a ∼30-50 % downregulation in the expression of MMPs (1, 2, and 9) following treatment with BVP-2. Considerable amount of sulfation (18 %) along with (1 â†’ 3)/(1 â†’ 4) glycosidic linkages in BVP-2 could be pivotal factors for down-regulation of the intracellular MMP-1, which was further supported by molecular docking and structure-activity studies. The (1 â†’ 3)/(1 â†’ 4)-linked bacterial exopolysaccharide (BVP-2) might be used as prospective natural lead to attenuate and mitigate UV-A-induced photoaging.