Role of primary tumor volume and metastatic lymph node volume in response to curative effect of definitive radiotherapy for locally advanced head and neck cancer.

BACKGROUND: Studies have shown mixed results concerning the role of primary tumor volume (TV) and metastatic lymph node (NV) volume in response to the curative effect of definitive radiotherapy for locally advanced head and neck squamous cell carcinoma (LAHNSCC). OBJECTIVE: We aimed to evaluate the impact of TV and NV on the efficacy of radical radiotherapy in LAHNSCC patients, with the goal of guiding individualized therapy. PATIENTS AND METHODS: Patients with LAHNSCC who received radical radiation therapy and were reexamined within 6 months post-therapy from January 2012 to December 2021 were selected. The volumes of the primary tumors and metastatic lymph nodes were calculated by software and then were divided into a large TV group vs small TV group and a large NV group vs small NV group according to the relationship with the median. Additionally, patients who received concurrent chemoradiotherapy (CCRT) or not were divided into the CCRT group and the radiotherapy (RT) group. Patients with lymph node metastasis were divided into node concurrent chemotherapy (N-CCRT) group and a node metastatic chemotherapy (N-RT) group according to whether they received concurrent chemotherapy or not. The volume shrinkage rate (VSR), objective response rate (ORR), local control rate (LCR) and overall survival (OS) were recorded and analyzed. RESULTS: 96 patients were included in the primary tumor volume group, and 73 patients were included in the metastatic lymph node group. Receiver operating characteristic (ROC) curves were constructed for objective remission (OR) endpoints, and a volume threshold was defined for TV and NV patients. The threshold primary tumor volume was 32.45 cm3, and the threshold metastatic lymph node volume was 6.05 cm3.The primary TV shrinkage rates of the small TV and the large TV groups were basically the same, P = 0.801. Similarly, the ORR and LCR were not significantly different between the small TV group and the large TV group (PORR = 0.118, PLCR = 0.315). Additionally, the TV shrinkage rate did not significantly differ between the CCRT group and the RT group, P = 0.133. Additionally, there was no significant difference in ORR or LCR in CCRT group (PORR = 0.057, PLCR = 0.088). However, the metastatic lymph node volume shrinkage rate in the small NV group was significantly greater than that in the large NV group (P = 0.001). The ORR and LCR of the small NV subgroup were significantly greater than those of the large NV subgroup (PORR = 0.002, PLCR = 0.037). Moreover, compared with that of the N-RT group, the NV shrinkage rate of the N-CCRT group was 84.10 ± s3.11%, and the shrinkage rate was 70.76 ± s5.77% (P = 0.047). For the ORR and LCR, the N-CCRT group and N-RT group were significantly different (PORR = 0.030, PLCR = 0.037). The median OS of the whole group was 26 months. However, neither TV/NV nor concurrent chemotherapy seemed to influence OS. CONCLUSION: Primary tumor volume is not a prognostic factor for the response to curative effect radiotherapy in LAHNSCC patients. Nevertheless, metastatic lymph nodes are a prognostic factor for the response to curative effect radiotherapy in LAHNSCC patients. Patients with smaller lymph nodes have better local control.

Efficacy of PD-1 or PD-L1 Inhibitors and Central Nervous System Metastases in Advanced Cancer: A Meta-Analysis.

BACKGROUND: Little is known about the efficacy of programmed cell death protein-1 (PD-1) or programmed cell death-ligand 1 (PD-L1) inhibitors in patients with central nervous system (CNS) metastases. OBJECTIVE: This study aimed to assess the difference in efficacy of PD-1 or PD-L1 inhibitors in patients with and without CNS metastases. METHODS: From inception to March 2020, PubMed and Embase were searched for randomized controlled trials (RCTs) about PD-1 or PD-L1 inhibitors. Only trails with available hazard ratios (HRs) for overall survival (OS) of patients with and without CNS metastases simultaneously would be included. Overall survival hazard ratios and their 95% confidence interval (CI) were calculated, and the efficacy difference between these two groups was assessed in the meantime. RESULTS: A total of 4988 patients (559 patients with CNS metastases and 4429 patients without CNS metastases) from 8 RCTs were included. In patients with CNS metastases, the pooled HR was 0.76 (95%CI, 0.62 to 0.93), while in patients without CNS metastases, the pooled HR was 0.74 (95%CI, 0.68 to 0.79). There was no significant difference in efficacy between these two groups (χ2=0.06 P=0.80). CONCLUSION: With no significant heterogeneity observed between patients with or without CNS metastases, patients with CNS metastases should not be excluded in the PD-1 or PD-L1 blockade therapy. Future research should permit more patients with CNS metastases to engage in PD-1 or PDL1 blockade therapy and explore the safety of PD-1 or PD-L1 inhibitors in patients with CNS metastases.

Antioxidant protective effects of lactitol against endotoxemia in patients with chronic viral hepatitis.

Although antiviral drugs are widely used in the clinic, progression to liver cirrhosis and hepatocellular carcinoma cannot yet be entirely prevented. The aim of this study was to determine the effects of lactitol in chronic viral hepatitis patients with endotoxemia. Ninety-four patients with chronic viral hepatitis were separated into two groups based on plasma endotoxin levels: one group with endotoxemia (≥ 45 ng/l, n=60) and one group without endotoxemia (<45 ng/l, n=34). Sixty patients with gut-derived endotoxemia were randomly and evenly divided into a lactitol treatment group and a control group. Plasma endotoxin levels in patients with chronic viral hepatitis exhibited a negative correlation with superoxide dismutase (SOD) activity (P<0.001) and a positive correlation with levels of malondialdehyde (MDA) (P<0.001). The levels of SOD in the lactitol-treated group increased (P<0.01), while the levels of MDA decreased (P<0.01). Plasma endotoxin levels decreased (P<0.01) and the number of lactobacilli and bifidobacteria in the intestinal tract increased (P<0.01 for all). These results suggest that lactitol administration is capable of reducing injury caused by oxidants through regulating intestinal flora and decreasing gut-derived endotoxemia in patients with chronic viral hepatitis.