Efficacy and safety of thoracic radiotherapy in extensive-stage small-cell lung cancer patients receiving first-line immunotherapy plus chemotherapy: a propensity score matched multicentre retrospective analysis.

BACKGROUND: Platinum-etoposide chemotherapy combined with immune checkpoint inhibitors (ICIs) has been recommended as the first-line standard treatment for extensive-stage small-cell lung cancer (ES-SCLC). However, the effect of thoracic radiotherapy (TRT) on these patients is still unknown. This study aimed to evaluate the efficacy and safety of TRT for ES-SCLC patients who responded to first-line ICIs and chemotherapy (CHT). METHODS: Patients who received 4 to 6 cycles of ICIs and CHT as first-line therapy at three hospitals between 2018 and 2022 were included in the analysis. All patients were divided into two groups based on whether they received TRT as first-line treatment, and propensity score matching (PSM) was performed to ensure that the characteristics of two groups were well-balanced. The primary endpoints were overall survival (OS) and progression-free survival (PFS), and the secondary endpoint was toxic effects. RESULTS: A total of 276 patients were included, and the median follow-up time was 22.3 (range, 4.0-53.73) months. After PSM, 197 patients were further analysed, and 99 of whom received TRT. The baseline characteristics were well-balanced between patients in the TRT and non-TRT groups. There were significant differences in PFS between the TRT and non-TRT groups, with the median PFS of 10.76 and 7.63 months, respectively (P = 0.014). Significantly improved OS was observed in the TRT group (21.67 vs. 16.6 months, P = 0.009). In addition, the use of TRT was an independent prognostic factor for PFS and OS of ES-SCLC patients receiving ICIs plus CHT. In terms of safety, no significant increase of any grades adverse event (AE) (P = 0.874) and G3-4 AE (P = 0.909) was observed for patients receiving TRT. Radiation esophagitis, gastrointestinal and hematologic toxicities were the most common AEs in TRT group, which were tolerable. And high-dose radiotherapy was associated with higher incidence of pneumonitis. CONCLUSION: Addition of TRT showed significant survival benefits and well tolerability in ES-SCLC patients receiving platinum-etoposide CHT and ICIs, which could be a feasible first-line treatment strategy for ES-SCLC patients.

Uncertainties in Pollution and Risk Assessments of Heavy Metals in Lake Sediments Using Regional Background Soils in China.

Background soils are frequently utilized as a surrogate to assess pollution levels and environmental risks of heavy metals in Chinese lakes. However, there remains a lack of understanding regarding the reliability and uncertainty of such assessments. Here, we determined heavy metals (As, Cd, Co, Cr, Cu, Hg, Ni, Pb, and Zn) in sediment cores from five rural lakes in North China to evaluate the reliability and uncertainty of the assessments using background soils by comparing them with assessments based on background sediments. Comparative studies reveal large uncertainties in the assessments using background soils. Among these metals, uncertainties for Hg and Cd are relatively large, whereas those for the other metals are minor. This discrepancy is due to the considerably higher natural variability of Hg and Cd in soils and sediments in comparison to the other metals. Generally, assessments utilizing background soils underestimate pollution levels and risks of Hg but overestimate those of Cd in these lakes. Despite limited human activities around the lakes, they still received a considerable influx of heavy metals via regional atmospheric transport. Assessments of the nine metals indicate moderate to considerable ecological risks in these lakes. The risks are contributed primarily (78-89%) by Hg and Cd. This study underscores the substantial uncertainties in assessing heavy metal pollution and risks using regional background soils and emphasizes the importance of controlling atmospheric emissions of Hg and Cd to mitigate pollution in rural and remote water bodies in China.

18F-FDG PET/CT radiomics predicts brain metastasis in I-IIIA resected Non-Small cell lung cancer.

OBJECTIVE: To establish 18F-FDG PET/CT radiomics model for predicting brain metastasis in non-small cell lung cancer (NSCLC) patients. METHODS: This research comprised 203 NSCLC patients who had received surgical therapy at two institutions. To identify independent predictive factors of brain metastasis, metabolic indicators, CT features, and clinical features were investigated. A prediction model was established by incorporating radiomics signature and clinicopathological risk variables. The suggested model's performance was assessed from the perspective of discrimination, calibration, and clinical application. RESULTS: The C-indices of the PET/CT radiomics model in the training, internal validation, and external validation cohorts were 0.911, 0.825 and 0.800, respectively. According to the multivariate analysis, neuron-specific enolase (NSE) and air bronchogram were independent risk factors for brain metastasis (BM). Furthermore, the combined model integrating radiomics and clinicopathological characteristics related to brain metastasis performed better in terms of prediction, with C-indices of 0.927, 0.861, and 0.860 in the training, internal validation, and external validation cohorts, respectively. The decision curve analysis (DCA) suggested that the PET/CT nomogram was clinically beneficial. CONCLUSIONS: A predictive algorithm based on PET/CT imaging information and clinicopathological features may accurately predict the probability of brain metastasis in NSCLC patients following surgery. This presented doctors with a unique technique for screening NSCLC patients at high risk of brain metastasis.

Safety and Efficacy of Concurrent or Sequential Radiotherapy Plus (PD-1) Inhibitors in Oligometastatic Esophageal Cancer.

Purpose: We assess real-world outcomes, including safety and efficacy, of concurrent or sequential treatment with radiotherapy plus programmed cell death protein 1 (PD-1) inhibitors in patients with oligometastatic esophageal cancer (OMEC). Methods: This cohort study retrospectively collected clinical data of patients with synchronous or metachronous OMEC. All patients underwent concurrent or sequential treatment with radiotherapy plus PD-1 inhibitors. Each patient had up to five measurable metastatic lesions and up to three organs involved. Study endpoints were progression-free survival (PFS), treatment-related toxicities, locoregional progression-free survival (LRPFS), objective response rate (ORR), and disease control rate (DCR). Description statistics and Kaplan-Meier models were used for statistical analysis. Results: A total of 86 patients were included, most of whom were diagnosed with squamous cell carcinoma histology (98%) and presented with synchronous OMEC (64%). The median follow-up period was 17 months (range: 6-32 months), the median PFS was 15.2 months (95% confidence interval: 12.1-18.2 months); and the 1- and 2-year PFS rates were 61.4% and 26.7%, respectively. The 1- and 2-year LRPFS were 91.3% and 57.3%, respectively. The ORR and DCR were 46.5% and 91.8%, respectively. Forty-two patients (48.8%) experienced grade 3 or higher treatment-related adverse events (TRAEs); a grade 5 treatment-related adverse event was observed in one patient (1.2%) who died of immune-related pneumonitis. Conclusion: Combining radiotherapy with PD-1 inhibitors is a safe and effective treatment option for patients with OMEC. No new safety concerns were identified in this study. However, due to the potential risk of cumulative toxicity, an individual risk-benefit assessment for each patient is required prior to treatment initiation.

Smiling enemies: Young children better recall mean individuals who smile.

Remembering whether a person is cooperative is essential in social interactions. It has been shown that adults have better memory of a person who showed an incongruence between emotional expression and expected behavior (e.g., smiling while stealing). To examine whether children would show similar emotional incongruity effects, we examined 70 children aged 5 or 6 years. They obtained coins that could be exchanged later for rewards (stickers) by answering quiz questions. Then, they participated in the coin collection game where individual persons with smiling or angry expressions appeared one at a time on a computer monitor. These same individuals then either gave coins to or took coins away from the children, leading to congruent (smiling giver and angry taker) and incongruent (smiling taker and angry giver) conditions. After the game, children needed to choose between two faces to indicate which one previously appeared in the game. Participants recognized faces better under the incongruent conditions. In particular, the smiling taker was recognized significantly better than the angry taker, whereas no difference was observed for the smiling and angry givers. Evidently, 5- and 6-year-olds better remember individuals whose facial expression or appearance is incongruent with their expected behavior.

Children draw more affiliative pictures following priming with third-party ostracism.

Humans have a strong need to belong. Thus, when signs of ostracism are detected, adults often feel motivated to affiliate with others in order to reestablish their social connections. This study investigated the importance of affiliation to young children following priming with ostracism. Four- and 5-year-old children were primed with either ostracism or control videos and their understanding of, and responses to, the videos were measured. Results showed that children were able to report that there was exclusion in the ostracism videos, and that they recognized that the ostracized individual felt sad. Most interestingly, when subsequently asked to draw a picture of themselves and their friend, children primed with ostracism depicted relationships that were significantly more affiliative. Children drew themselves and their friend standing significantly closer together and adults rated their drawings as more affiliative overall. These findings introduce drawing as a useful new method for measuring social motivations and processes following an experimental manipulation, and demonstrate that affiliation is particularly important to children following even a vicarious experience of social exclusion.