Prostate cancer represents a prevalent malignancy within the male genitourinary system. In recent years, its incidence in China has gradually increased, becoming a significant public health issue. While early detection correlates strongly with improved prognosis, the majority of newly diagnosed prostate cancer patients in China are already in intermediate or advanced stages, precluding curative-intent interventions and contributing to marked survival disparities. The progression of prostate cancer is lengthy, typically encompassing diagnosis, treatment, progression, metastasis, and death, accompanied by a decline in quality of life. Personalized treatment plans should be developed based on the disease stage and patient preferences. In non-metastatic prostate cancer, where the tumor is confined to the prostate, surgery and radiotherapy are the primary treatments, supplemented by neoadjuvant and adjuvant therapies to delay metastasis. For metastatic prostate cancer, systemic therapy is prioritized to prolong survival. In metastatic hormone-sensitive prostate cancer, controlling androgen levels is crucial, while treatment options for metastatic castration resistant prostate cancer are relatively limited, necessitating individualized and precise treatment. During prostate cancer management, prostate-specific antigen levels are closely linked to prognosis and require monitoring. Bone metastasis, the most common site in prostate cancer patients, often triggers skeletal-related events, demanding effective prevention and management. Treatment-related adverse reactions are also a clinical challenge, requiring balanced risk-benefit assessments and judicious drug selection to preserve quality of life. Rapid advancements in screening technologies, surgical innovations, drug development, and China-specific epidemiological factors further complicate decision-making in holistic prostate cancer management. To optimize the standardization of prostate cancer diagnosis and treatment in China, the Genitourinary Oncology Committee of Chinese Anti-cancer Association synthesized global guidelines, clinical evidence and clinical expertise, and addressed critical challenges in the whole-course management of prostate cancer to formulate a multidisciplinary consensus. The expert consensus on whole-course management of prostate cancer (2025 edition) establishes standardized protocols to guide clinical practice, improve treatment outcomes, and enhance patient quality of life.
Humans ; Male ; Prostatic Neoplasms/diagnosis* ; Consensus ; Prostate-Specific Antigen/blood* ; Quality of Life ; Prostatic Neoplasms, Castration-Resistant/pathology* ; China ; Bone Neoplasms/secondary* ; Androgen Antagonists/therapeutic use*

Lung cancer is the malignancy with the highest incidence and mortality burden globally, ranking first in both morbidity and mortality among all types of malignant tumors. Pathologically, lung cancer is classified into non-small cell lung cancer (NSCLC) and small cell lung cancer, with NSCLC accounting for approximately 85% of cases. Due to the often subtle or nonspecific clinical manifestations in early-stage disease, many patients are diagnosed at a locally advanced or metastatic stage, where treatment options are limited and prognosis remains poor. Therefore, molecular targeted therapy focusing on driver genes has become a key strategy to improve the survival outcomes of patients with advanced NSCLC. The epidermal growth factor receptor (EGFR) is one of the most common driver genes in NSCLC. While EGFR mutations occur in approximately 12% of advanced NSCLC patients globally, the incidence rises to 55.9% in Chinese patients. Among EGFR mutations, P-loop and αC-helix compressing (PACC) mutations account for about 12.5%. Currently, EGFR tyrosine kinase inhibitors (TKIs) have become the first-line standard treatment for advanced NSCLC patients with classical EGFR mutations, with efficacy well-established through clinical studies and real-world evidence. However, with rapid advancements in NSCLC precision medicine and deeper exploration of the EGFR mutation spectrum, EGFR PACC mutations have emerged as a key clinical focus. The structural characteristics of these mutations lead to significant variability in responses to EGFR TKIs, leaving therapeutic options still limited, while detection challenges persist due to the sensitivity constraints of current testing technologies, driving increasing demand for improved diagnostic and treatment approaches. The current clinical evidence primarily stems from retrospective analyses and small-scale exploratory studies, while prospective, large-scale, high-level evidence-based medical research specifically targeting this mutation subtype remains notably insufficient. This evidence gap has consequently led to the absence of standardized guidelines or expert consensus regarding optimal treatment strategies for advanced NSCLC with EGFR PACC mutations. As a clinical consensus specifically addressing EGFR PACC-mutant NSCLC, this document provides a comprehensive framework encompassing the clinical rationale for EGFR PACC mutation testing, therapeutic strategies for advanced-stage disease, management of treatment-related adverse events, and follow-up protocols. The consensus underscores the pivotal role of EGFR PACC mutation detection in precision medicine implementation while offering evidence-based recommendations to guide personalized therapeutic decision-making. By establishing clear clinical pathways encompassing molecular testing, therapeutic intervention, and long-term monitoring for EGFR PACC-mutant NSCLC, this consensus aims to meaningfully improve patient survival outcomes while serving as a robust, evidence-based foundation for developing personalized clinical management approaches.
Humans ; Carcinoma, Non-Small-Cell Lung/pathology* ; ErbB Receptors/antagonists & inhibitors* ; Mutation ; Lung Neoplasms/pathology* ; Protein Kinase Inhibitors/therapeutic use* ; Molecular Targeted Therapy ; Consensus

Mutations in the human epidermal growth factor receptor 2 (HER-2) gene are recognized as significant but relatively rare driver alterations in non-small cell lung cancer (NSCLC). These mutations predominantly manifest as gene mutation, amplification, and protein overexpression, with an estimated prevalence from 2.8% to 15.4% among NSCLC patients in China. Research indicates that HER-2 mutations, particularly exon 20 insertions (ex20ins), are strongly correlated with aggressive tumor biology, poor prognosis, and limited responsiveness to immunotherapy, thereby exhibiting characteristics of "cold tumors". Overexpression and amplification of HER-2 are also indicative of a heightened risk of chemotherapy resistance and unfavorable survival outcomes, suggesting a distinct molecular subtype with unique biological behaviors. In recent years, novel antibody-drug conjugates (ADCs), particularly trastuzumab deruxtecan (T-DXd), have demonstrated groundbreaking efficacy in HER-2-mutant advanced NSCLC patients. These ADCs have shown significant clinical benefits, including high objective response rates and progression-free survival advantages, making T-DXd the first targeted therapy approved for this patient population globally. Additionally, ADCs have exhibited therapeutic potential in patients with HER-2 overexpression, thus broadening the scope of their indications. To standardize the clinical diagnosis and treatment of HER-2 variant NSCLC, the Chinese Anti-cancer Association convened multidisciplinary experts from oncology, pulmonology, thoracic surgery, pathology, and molecular diagnostics to develop this consensus based on the latest evidences from both domestic and international studies, coupled with China's clinical practice experience. This consensus focuses on the molecular characteristics, clinical significance, diagnostic strategies, treatment options, and safety management of HER-2 alterations, addressing ten critical clinical questions in a systematic manner. It is recommended that HER-2 status be routinely tested at initial diagnosis, disease progression, or recurrence in NSCLC. Mutation detection should prioritize next-generation sequencing (NGS), while protein overexpression may be assessed using immunohistochemistry (IHC) standards for gastric cancer. Fluorescence in situ hybridization (FISH) is recommended for detecting HER-2 amplification. Regarding treatment, for HER-2-mutant patients, first-line therapy may involve chemotherapy with or without immune checkpoint inhibitors (ICIs), similar to treatment approaches for driver-gene negative populations. Upon failure of first-line treatment, trastuzumab deruxtecan, may be considered as alternative therapeutic options. For patients with HER-2 overexpression, ADCs should be considered after failure of standard systemic therapy. However, the management of HER-2 amplification remains insufficiently supported by evidence, necessitating a cautious, individualized approach. The consensus also includes detailed recommendations for screening and managing adverse effects associated with ADCs, such as interstitial lung disease (ILD), emphasizing the crucial role of safety management in ensuring treatment efficacy. The publication of this consensus aims to drive the standardization of molecular diagnosis and treatment pathways for HER-2 variant NSCLC, improve clinical outcomes and quality of life for patients, and facilitate the implementation of personalized precision treatment strategies.
Humans ; Carcinoma, Non-Small-Cell Lung/pathology* ; Lung Neoplasms/pathology* ; Receptor, ErbB-2/metabolism* ; Mutation ; Immunoconjugates/therapeutic use* ; Consensus ; Trastuzumab/therapeutic use* ; Camptothecin/analogs & derivatives*

Objective:To assess the application value of low-dose contrast agent combined with bolus tracking technique in radiotherapy localization for nasopharyngeal carcinoma (NPC).Methods:One hundred patients with NPC for radiotherapy localization were enrolled prospectively and randomly divided into observation ( n = 50) and control ( n = 50) group using random number table. All patients in the control group underwent routine computerized tomography (CT) for radiotherapy localization with an intravenous bolus of 80 ml iodinated contrast media. Images were obtained at a fixed delay of 50 s from the beginning of contrast injection. Patients in the observation group underwent CT scan using a bolus tracking technique with an intravenous bolus of 50-60 ml iodinated contrast media. By observing the time-CT value monitoring curve, the scanning was manually triggered when the peak fell. The score of image quality, enhanced CT value, iodine contrast dose, and dose calculation variance of planning target volume were compared between the two different dose groups. The differences of dose were compared using independent sample t-tests and the differences in graph scores were compared using Wilcoxon rank sum tests. Results:The dosage of iodine contrast agent in the observation group was 28.75% less than that in the control group, and the difference achieved statistical significance ( t=-42.11, P<0.001). The enhanced CT value of carotid artery and jugular vein in the control group increased 32.58% and 21.02% compared with patients in the observation group, respectively ( t=-8.11 and -4.82, P<0.001 for both). No statistically significant differences in the enhanced CT value were found for the gross tumor volume (GTV) of nasopharynx or sternocleidomastoid between the two groups ( P>0.05). The images in both groups can met the requirements of target volume delineation, and the difference of subjective score was not statistically significant ( Z=-1.36, P=0.175). There were no significant differences in the signal-to-noise ratio (SNR) or contrast-to-noise ratio (CNR) of nasopharynx between the two groups ( P>0.05). The results of subjective score and GTV target area showed high consistency between the two doctors with a κ value of 0.77. The differences in dose calculation variance of planning target volume between the two different dose groups was also not statistically significant ( P>0.05). Conclusions:In the radiotherapy localization for nasopharyngeal carcinoma, the application of low-dose contrast agent combined with bolus tracking technique could obtain good images for target delineation and effectively reduce the intake of iodine contrast agent and the risk of adverse reactions. Based on these results, low-dose contrast agent combined with bolus tracking technique has wide range of application.

Objective:To investigate the clinical efficacy and safety of anlotinib combined with radiotherapy as a third-line treatment regimen for extensive stage small-cell lung cancer (ES-SCLC) in a real-world background.Methods:Forty ES-SCLC patients enrolled in a single center of Affiliated Cancer Hospital of Xinjiang Medical University in China between November 2018 and July 2021 were treated with radiotherapy added on anlotinib as a third-line treatment regimen. Overall survival (OS), progression-free survival (PFS), safety, and quality of life were analyzed, and the survival status was statistically analyzed using Kaplan-Meier method.Results:Among the 40 patients, partial remission, stable disease, and progressive disease was confirmed in 7, 24 and 9 patients, respectively. The obtained objective remission rate (ORR) was 18%, the disease control rate (DCR) was 78%, and median PFS and median OS were 4.5 months and 9 months, respectively. The most common adverse reactions included fatigue (28%), bleeding (20%), anorexia (13%), and hand-foot syndrome (8%). Most of them were grade 1-2 in severity, 4 cases were documented as ≥grade 3, and no grade 5 toxicity was recorded.Conclusions:In the real world, radiotherapy added on anlotinib as a third-line regimen can prolong PFS and OS of the ES-SCLC patients, and the adverse reactions are generally tolerated. This combination treatment regimen is worthy of further investigation.

Objective:To investigate the overall recurrence rate and the pattern of treatment failure in thoracic esophageal cancer (TEC) patients after minimally invasive esophagectomy (MIE), and to evaluate the significance of adjuvant therapy after MIE.Methods:Clinical data of TEC patients who underwent MIE with or without neoadjuvant chemotherapy in the Fourth Hospital of Hebei Medical University between 2016 and 2018 were retrospectively analyzed. The pathology-based lymph node metastasis (LNM) rate, overall recurrence rate, and pattern of treatment failure following MIE were analyzed by SPSS 26.0 statistical software. Cox regression model was used to identify the high-risk factors for recurrent disease. Propensity score matching was performed to compare the survival of patients between the postoperative radiotherapy group and non-radiotherapy group.Results:A total of 443 eligible patients were enrolled in this study, and the pathology-based LNM rate in all groups was 42.0%. The overall recurrence rate was 34.8%. Regional lymphatic metastasis was the most frequent pattern of recurrence (24.2%), followed by distant metastasis (19.4%). Multivariate Cox regression analysis identified pT 3-4 stage and pN + stage as the independent risk factors for recurrence. At the same time, the total number of lymph nodes dissected ≥12 and the number of lymph nodes dissected ≥7 in the neck clavicle and upper mediastinum could reduce the risk of tumor recurrence. The 1-, 3-, and 5-year disease-free survival (DFS) rates in the postoperative radiotherapy group and non-radiotherapy group were 83.5%, 66.8%, 60.7%, and 79.2%, 61.6%, 57.2%, respectively ( χ2=0.13, P=0.715). The 1-, 3-, and 5-year overall survival (OS) rates in two groups were 92.0%, 72.0%, 67.5% and 84.0%, 68.0%, 55.4% , respectively ( χ2=0.43, P=0.513). Conclusions:Regional lymphatic and distant metastases are the main patterns of recurrence for TEC patients after MIE with or without neoadjuvant chemotherapy. pT 3-4 stage, pN + stage, insufficient total number of lymph node dissection and insufficient number of lymph nodes in neck supraclavicular and upper mediastinal dissection are high-risk factors for postoperative recurrence. The survival rate in the postoperative radiotherapy group tends to be higher than that in the non-radiotherapy group. Adjuvant therapy, including postoperative radiotherapy, may remain necessary.

Objective:To investigate the relationship between serum miR-501 and miR-195 levels and sensitivity to concurrent chemoradiotherapy in patients with locally advanced cervical cancer (LACC).Methods:Clinical data of 96 patients with LACC admitted to Nanyang Central Hospital from January 2020 to June 2022 were retrospectively analyzed and compared with those of 96 healthy subjects during physical examination in our hospital during the same period to compare the differences of serum miR-501 and miR-195 levels. Tumor status was reviewed at 6 months after concurrent chemoradiotherapy. Patients were divided into the sensitive and resistant groups according to the evaluation criteria of solid tumor efficacy. The relationship between serum miR-501 and miR-195 levels and the sensitivity to concurrent chemoradiotherapy in LACC patients was analyzed by univariate and multivariate analyses. The receiver operating characteristic (ROC) curve was also drawn to predict differential efficacy of concurrent chemoradiotherapy sensitivity in LACC patients. Multivariate analysis was conducted by binary logistic regression analysis. P<0.05 indicated statistically significant differences. Results:In LACC patients, serum miR-501 level was significantly higher, whereas serum miR-195 level was significantly lower than those in physical examination subjects (both P<0.05). Univariate analysis showed that serum miR-501 level at admission in the resistant group was significantly higher, whereas serum miR-195 level was significantly lower than those in the sensitive group (both P<0.05). Multivariate analysis showed that serum miR-501 and miR-195 levels were significantly correlated with the sensitivity to concurrent chemoradiotherapy in LACC patients. The area under the ROC curve (AUC) was 0.736 and 0.913, respectively. Conclusions:The higher the serum miR-501 level and the lower the serum miR-195 level before treatment, the higher the probability of resistance to concurrent chemoradiotherapy in LACC patients. Serum miR-501 and miR-195 levels of LACC patients before treatment have certain predictive value for the sensitivity to concurrent chemoradiotherapy.

Objective:To analyze the robustness of the dose of clinical target volume (CTV) and tolerance dose of normal tissues after applying in-room CT before carbon ion radiotherapy for prostate cancer.Methods:Thirty prostate cancer patients treated with carbon ion in Shanghai Proton and Heavy Ion Center from January 2020 to June 2021 were enrolled in this study. Five in-room CT images of each patient were selected randomly before treatment. Dose distributions were recalculated using the original plan on in-room CT images and dose volume histogram (DVH) parameters were obtained, including V 95% and V 90% of CTV and V 80% of rectum. The values were compared with the dosimetric parameters of the original plan. Statistical analysis was performed by paired or two independent samples t-tests. Results:The dose distribution was recalculated by applying in-room CT. The mean values of V 95% and V 90% of CTV and V 80% of rectum were 98.1%±1.2% ( P<0.001), 99.9%±0.2% ( P=0.001) and (5.8±1.6) ml ( P<0.001), respectively. The differences were statistically significant compared with those of the original plan. The frequency of V 95%≥95%, V 90%≥98% of CTV, and V 80%<10 ml of rectum was 148 (98.7%), 150 (100.0%) and 147 (98.0%), respectively. Conclusion:Based on in-room CT analysis and the patient management and positioning methods of our research center, the uncertainty of target dose and normal tissue dose in the entire process of prostate cancer carbon ion therapy is small, and the robustness is good.

Objective:To evaluate the accuracy of the optical surface imaging system (OSI) using stereotactic radiosurgery (SRS) algorithm in single-center non-coplanar treatment of multiple brain metastases.Methods:Data of phantom and 15 patients with multiple brain metastases who underwent single-center non-coplanar radiotherapy in West China Hospital of Sichuan University from February to April 2022 were retrospectively analyzed. kV/MV and OSI imaging were used for imaging of the patients and phantoms under the same non-coplanar couch angle, respectively. The accuracy of OSI imaging of the phantoms and patients was evaluated using kV/MV imaging as reference image. The difference between the OSI and kV/MV systems is defined as accuracy, and the percentage of the absolute difference ≤1.00 mm in the translational direction or ≤0.50° in the rotational direction is defined as the threshold pass rate. Origin software was used to draw radar maps and Bland-Altman plots for statistical analysis.Results:When OSI images were used for the phantom imaging, the average differences in six-dimensional directions of lateral, long, vertical, rotational, roll and pitch were 0.03 mm, -0.09 mm, -0.27 mm, 0.04°, 0.17° and -0.19°, respectively. The maximum values were -2.20 mm, -2.30 mm, -1.20 mm, 0.60°, -1.00°, and -1.00°, respectively. When OSI system was utilized for the imaging of 15 patients, the average differences in six-dimensional directions were 0.44 mm, 0.16 mm, -0.20 mm, -0.11°, 0.10°, and -0.12°, respectively. The maximum values were -1.80 mm, 2.00 mm, 0.90 mm, -0.90°, -0.70°, and 0.80°, respectively. The translational errors mainly occurred in the lateral and long directions. The qualified rates of the threshold values of the phantoms and patients were 77% and 75% in the lateral direction, 82% and 89% in the long direction, respectively. In addition, 57% and 56% of patients met the threshold conditions of ±1.00 mm and ±0.50° in the six-dimensional directions, respectively.Conclusions:The OSI system using new SRS algorithm cannot meet the high accuracy requirements of single-center non-coplanar radiotherapy for multiple brain metastasis, especially in the lateral and long directions. It is not recommended for non-coplanar image guidance.

Objective:To evaluate the feasibility of 3D reconstruction techniques based on multi-depth cameras for daily patient positioning in radiotherapy.Methods:Through region of interest (ROI) extraction, filtering, registration, splicing and other processes, multi-depth cameras (Intel RealSense D435i) were used to fuse point clouds in real-time manner to obtain the real optical 3D surface of patients. The reconstructed surface was matched with the external contour of the localization CT to complete the positioning. In this article, the feasibility of the system was validated by using multiple models. Clinical feasibility of 5 patients with head and neck radiotherapy, 10 cases of chest radiotherapy and 5 cases of pelvic radiotherapy was also validated. The data of each group were analyzed by paired t-test. Results:The system running time was 0.475 s, which met the requirement of real-time monitoring. The six-dimensional registration errors in the model experiment were (1.00±0.74) mm, (1.69±0.69) mm, (1.36±0.87) mm, 0.15°±0.14°, 0.25°±0.20°, 0.13°±0.13° in the x, y, z, rotational, pitch and roll directions, respectively. In the actual patient positioning, the mean positioning errors were (0.77±0.51) mm, (1.24±0.67) mm, (0.94±0.76) mm, 0.61°±0.41°, 0.69°±0.55°, and 0.52°±0.35° in the x, y, z, rotational, pitch and roll directions, respectively. The translational error was less than 2.8 mm, and the positioning error was the largest in the pelvic region. Conclusions:Real-time 3D reconstruction techniques based on multi-depth cameras is applicable for patient positioning during radiotherapy. The method is accurate in positioning and can detect the small movement of the patient's position, which meets the requirements of radiotherapy.