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Role of radiotherapy to the primary lesion in metastatic non-small cell lung cancer patients after first-line systemic therapy — a prospective randomized phase II study
Full text linkIntroduction. Radiation therapy for oligometastatic non-small cell lung cancer (NSCLC) showed overall survival (OS) benefit in phase II clinical trials, with stereotactic body radiation therapy (SBRT) being the main modality for distant metastases. This study aimed to assess the benefit of consolidative irradiation of the primary lesion in patients with partial response or stationary disease after first-line therapy, regardless of their metastatic burden.
Material and methods. Stage IV NSCLC patients without progressive disease after initial systemic therapy were randomly assigned to arm 1 (consolidative primary radiotherapy 45Gy/15 fractions followed by standard treatment) or arm 2 (standard treatment). The primary endpoint was progression-free survival (PFS), and the secondary endpoints were OS and toxicity.
Results. Between September 2020 and January 2023, 75 patients were randomized: 37 to the radiotherapy arm and 38 to the control arm. The median follow-up was 13.50 months (4.50–35.93). Median PFS was 15.37 months in the radiotherapy group versus 10.93 months in the control group (univariate HR = 1.99; 95% CI 1.16–3.41; p = 0.012). Median OS was 18.30 months versus 13.73 months, respectively (HR = 1.84; 95% CI 0.98–3.46; p = 0.057). Except for one patient in the radiotherapy group who experienced grade 3 dysphagia, no grade 3 or higher toxicities were noted.
Conclusions. Primary consolidative radiotherapy in metastatic NSCLC after standard systemic treatment added a benefit for patients who had stationary disease or showed partial response to standard systemic treatment
Improving outcomes in oral mucositis — emerging role of polaprezinc
Full text linkOne of the most common and debilitating complications of cancer treatment is oral mucositis (OM), characterized by erythema and ulcerations of the oral mucosa. It mainly affects head and neck cancer patients receiving radiotherapy and patients treated with high-dose chemotherapy for hematopoietic stem cell transplants. It is associated with excruciating pain, inability to eat or drink, and decreased quality of life. While numerous strategies for managing OM have been explored, few have shown sufficient effectiveness to establish clear treatment guidelines. In recent years, an increasing number of studies have investigated polaprezinc (PZ), an insoluble zinc complex of L-carnosine, as a new promising treatment in OM. We reviewed nine publications, including three randomized controlled trials, published between 2010 and 2023, focusing on polaprezinc’s potential benefits in managing OM. To the best of our knowledge, this is the first comprehensive summary of research on PZ in its various forms and its efficacy in OM management. Despite the limited number of studies available, most of the research reviewed supported polaprezinc’s potential to reduce the incidence and/or severity of oral mucositis. Additionally, its role in addressing other complications, such as pain relief, xerostomia, and taste disturbances, has also been reported as promising. However, further evaluation through high-quality, multi-institutional randomized studies on a larger scale, preferably conducted outside of Japan, is needed to confirm polaprezinc’s efficacy in preventing and managing OM
Analysis of the effects of site-specific toxicity on survival in immunotherapy
No full textIntroduction. Immune-checkpoint inhibitors (ICIs) have significantly altered the treatment for patients with various cancer types and have led to improved survival among patients with advanced or metastatic cancer. In recent years the potential link between immunotherapy efficacy and immune adverse effects became a topic of clinical investigation.
Material and methods. This single-center, observational study investigates the relationship between immune- -related adverse events (irAEs) and survival outcomes in 151 patients treated with ICIs .Data on patient demographics, cancer type, treatment regimen, irAEs, overall survival (OS), and progression-free survival (PFS) were collected from electronic medical records. Statistical analyses were performed using the multivariable Cox proportional hazard model (p < 0.05).
Results. IrAEs were observed in 38% of patients, with the most common being thyroid dysfunction (11.9%) and dermal toxicity (6.6%). The results close to the accepted significant threshold were reached by fatigue toxicity, which may indicate a potential area of interest for further research. Organ toxicity did not show a strong positive correlation between overall irAE, OS and PFS.
Conclusions. Absence of a clear influence of organ toxicity on OS does not diminish the necessity of toxicity supervision and management in clinical practice. However organ toxicity did not show any correlation with decreased overall survival, it is significant to pay attention to patients’ quality of life and the influence of those toxicities on daily functioning
Cardiac tumor as first presentation of melanoma
No full textMelanoma metastases most commonly involve the skin, lungs, central nervous system, and liver. In 1.8% of all patients with melanoma, cardiac metastases are diagnosed. Melanomas with an unknown primary origin account for about 3% of cases and should be treated as cutaneous melanomas. A 66-year-old woman presented at a primary physician office with chest pain and reduced physical capacity lasting four months. Echocardiography showed a 55 mm tumor in the left ventricle. Initial pathology examination of the resected tumor suggested synovial sarcoma. A PET-CT two weeks post-surgery confirmed a 20 mm residual lesion in the heart muscle without distant metastases, but the patient was not eligible for reoperation. Histopathology in the reference center ruled out the initial diagnosis and identified a malignant peripheral nerve sheath tumor (MPNST) and melanoma as likely diagnoses. Ultimately, a BRAF-negative melanoma of unknown primary was confirmed. Pembrolizumab treatment at 200 mg every three weeks was initiated with complete remission (CR) of the cardiac lesion after three cycles. This remission persisted over 27 cycles. Treatment pauses were needed due to grade 2 toxicities affecting the skin, liver, pancreas, and lungs. After 27 cycles, the patient started drug holidays, with the last cycle of pembrolizumab administered 40 months ago (as of January 2025). Given the diagnostic challenges in suspected sarcoma cases, patients should be referred to specialized centers after biopsy. Multidisciplinary teams should guide treatment decisions, supported by comprehensive examination and next-generation sequencing (NGS) testing where indicated
The impact of isolation related to the COVID-19 pandemic on the thickness of melanoma diagnosed before, during, and after the pandemic
No full textThe evolution of concomitant mitral regurgitation in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: a prospective multi-center China-DVD2 cohort study
No full textBackground: Severe aortic stenosis (AS) often coexists with mitral regurgitation (MR). This study evaluated the significant evolution of MR in patients undergoing transcatheter aortic valve replacement (TAVR) for AS.
Methods: This multi-center China Degenerative Valve Disease II Cohort (China-DVD2) Study enrolled patients undergoing TAVR for AS from January 2020 to October 2023. MR severity was assessed at baseline and 12 months post-TAVR. Composite endpoints included all-cause death, heart failure rehospitalization, myocardial infarction, and angina.
Results: Among 424 enrolled patients, 130 (31%) had significant MR at baseline. At 12 months, MR improved in 56 (70%) of 80 patients with follow-up, and greater improvement in left ventricular ejection fraction (LVEF) was associated with MR improvement [odds ratios (OR): 0.97, 95% confidence interval (CI): 0.95–1.00, p = 0.04)]. Patients with MR improvement showed significant New York Heart Association (NYHA) functional class improvement at 12-month follow-up. No survival benefit disparity was observed between patients with and without significant baseline MR, but a trend toward lower composite endpoint rate (12.5% vs. 20.8%, log-rank p = 0.49) was observed in patients with MR improvement. Older age [hazard ratios (HR): 1.12, 95% CI: 1.01–1.24, p = 0.04)] and higher systolic pulmonary arterial pressure (SPAP) (HR: 1.05, 95% CI: 1.00–1.09, p = 0.04) were linked to worse outcomes.
Conclusions: Most patients with significant MR experienced improvement of NYHA class and MR post TAVR. Baseline significant MR was not linked to worse outcomes, but MR improvement showeda trend toward better prognosis. Older age and higher SPAP predicted worse outcomes
Acute and late toxicities following postoperative intensity-modulated radiotherapy simultaneously integrated boost (IMRT-SIB) in oral cavity cancer — a retrospective analysis
No full textIntroduction. Head and neck squamous cell carcinoma (SCCHN) is a major health concern in Asia, accounting for 57.5% of global cases. In India, SCCHN represents 30% of all cancers, largely due to widespread tobacco use. Tobacco contains over 5,000 chemicals, including carcinogens such as polycyclic aromatic hydrocarbons (PAHs) and nitrosamines. Surgery remains the mainstay for oral cavity tumors, with adjuvant radiotherapy, with or without chemotherapy, advised for patients with high-risk features. Radiation therapy can cause acute and late toxicities including mucositis, skin changes, xerostomia, weight loss, odynophagia, and dysphagia. Higher radiation doses increase toxicity risk in critical structures like the floor of the mouth and salivary glands. Intensity-modulated radiotherapy (IMRT) enables sparing of organs at risk, reducing toxicities while maintaining tumor control.
Material and methods. This IRB-approved retrospective study (2023–2024) enrolled 59 postoperative SCCHN patients. Twenty received adjuvant radiotherapy alone. All underwent IMRT with simultaneous integrated boost (IMRT-SIB), delivering 60–66 Gy (2–2.2 Gy/fraction) to high-risk planning target volume (HR-PTV) and 54 Gy (1.8 Gy/fraction) to low-risk PTV (LR-PTV) over 30 fractions in 6–6.5 weeks. Toxicities were assessed using CTCAE v5.0.
Results. All patients received IMRT-SIB; 62.7% had concurrent chemotherapy. Grade 1–2 skin reactions occurred in > 90%, and grade 2 mucositis in 40.8%, with no grade ≥ 3 toxicities. At six months, xerostomia was seen in 49.3% (mostly grade 1), dysphagia in 27.2%, and hoarseness in 23.8%, all improving over time. Median radiotherapy duration was 45 days; most completed treatment on schedule. Late toxicities were mild and manageable.
Conclusions. Toxicities following radiotherapy in SCCHN are multifactorial. Although dysphagia may persist beyond a year, IMRT facilitates parotid sparing, reducing long-term xerostomia and improving quality of life
Right ventricular myocardial infarction in a patient on permanent left ventricular assist device therapy: 6-year follow-up
No full textDiagnosis and treatment of pleural mesothelioma. State of the art 2024
Full text linkPleural mesothelioma is a cancer with a low incidence and poor prognosis. Treatment of pleural mesothelioma includes surgery, radiotherapy and systemic treatment — chemotherapy and immunotherapy. Tri-modal therapy, consisting of surgery, chemotherapy and radiotherapy, remains the standard for radical management. The stage of the tumour at the time of diagnosis usually precludes surgical treatment. Recent years have seen significant advances in the treatment of all cancers. The introduction of dual immunotherapy into everyday practice resulted in a breakthrough in the treatment of pleural mesothelioma. Last year, the combination of nivolumab and ipilimumab is also available in Poland for patients with pleural mesothelioma, irrespective of the histological type. This article reviews reports on pleural mesothelioma therapy based on guidelines from global oncology organisations and results of clinical trials conducted over the past several years
Risk of glioma malignant progression after biopsy-induced oncotaxis — a systematic review
No full textIntroduction. Glioma biopsy remains the cornerstone of diagnosis and treatment planning. However, increasing evidence suggests that biopsy-induced tissue disruption and inflammatory responses may accelerate tumor progression and malignant transformation.
Objectives. To systematically review clinical and preclinical evidence regarding the biological mechanisms and risks of glioma malignant transformation after biopsy.
Material and methods. A systematic search was conducted in PubMed, Embase, Web of Science, and Cochrane Library (2000–2024). Eligible studies included clinical reports, experimental models, and mechanistic studies investigating glioma progression, invasion, or malignant transformation following biopsy or surgical trauma. Data extraction was performed independently by two reviewers. Risk of bias was assessed using ROBINS-I for non-randomized clinical studies and SYRCLE’s tool for animal studies.
Results. Of 732 records identified, 24 studies met eligibility criteria. Mechanistic studies demonstrated that biopsy-induced trauma initiates epithelial-mesenchymal transition (EMT), upregulates matrix metalloproteinases (MMP-2, MMP-9), and activates hypoxia-inducible pathways, thereby enhancing glioma cell motility and invasion. The CXCL12/CXCR4 axis and TRP channels (TRPV1, TRPV4, TRPM7) were consistently implicated in post-biopsy oncotaxis. Clinical evidence indicated that neutrophil infiltration and inflammatory cytokines promote glioblastoma progression after biopsy, and case reports described rapid transformation of low-grade gliomas to glioblastoma. Nonetheless, study heterogeneity and lack of prospective controlled designs limited the strength of causal inference.
Conclusions. Biopsy-induced inflammatory and molecular responses may contribute to glioma aggressiveness and malignant progression. Minimizing tissue disruption during biopsy and developing adjunctive anti-inflammatory strategies should be prioritized in future research