Objective:To compare the preliminary efficacy and adverse events of chemoradiotherapy (CRT) with or without immunotherapy in bladder preservation therapy for localized muscle-invasive bladder cancer (MIBC) confined to the pelvis.Methods:Clinical data of 60 patients with MIBC who received CRT with or without immunotherapy for bladder preservation at the Cancer Hospital, Chinese Academy of Medical Sciences from January 2016 to June 2024 were retrospectively analyzed. Patients were divided into CRT plus immunotherapy group and CRT-alone group. Survival outcomes, bladder function preservation, recurrence and metastasis, as well as early and late radiation toxicities were evaluated. The Mann-Whitney U test was used for between-group comparisons. Overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were estimated by the Kaplan-Meier method, and survival rates were compared by the log-rank test. Results:In the CRT plus immunotherapy group ( n=23), the median follow-up was 20 months. The median OS and median PFS were not reached. The 2-year OS, PFS, LRFS, and DMFS rates were 95.7%, 70.7%, 70.7%, and 92.9%, respectively, and 22 patients (96%) preserved normal bladder function. Patients with programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥1 had significantly higher 1-year PFS rate than those with CPS <1 (100% vs. 66.7%, P=0.004). In the CRT-alone group ( n=37), the median follow-up was 37 months, with median OS and PFS of 68 and 19 months, respectively. The 2-year OS, PFS, LRFS, and DMFS rates were 92.0%, 41.1%, 60.9% and 81.5%, respectively, and 33 patients (89%) preserved normal bladder function. Compared with the CRT-alone group, the CRT plus immunotherapy group showed a significant improvement in PFS ( χ2=4.38, P=0.036), while no significant differences were observed in OS, LRFS, or DMFS (all P>0.05). The incidence of acute hematologic toxicity in the CRT plus immunotherapy group and CRT-alone group were 52% (12/23), 27% (10/37) respectively, and late genitourinary toxicity was 22% (5/23), 8% (3/37), respectively, with no significant differences in overall acute or late toxicities (all P>0.05). Conclusions:For localized MIBC, bladder preservation with CRT combined with immunotherapy significantly improves PFS compared with CRT alone, while maintaining comparable safety. The PD-L1 status may serve as a favorable predictor for immunotherapy efficacy.

Objective:To evaluate the incidence and risk factors of pneumonia in patients with thoracic cancer treated with immunotherapy combined with radiotherapy (RT).Methods:The clinic data of 265 patients with thoracic cancer who received RT and at least 2 cycles of immunotherapy at Renmin Hospital of Wuhan University between January 2020 and January 2024 were retrospectively analyzed. Patients were divided into 2 groups according to treatment sequence: 100 patients with sequential immunotherapy after RT, 165 patients with RT after immunotherapy, including sequential RT after immunotherapy (119 cases) and concurrent RT with immunotherapy (46 cases). The occurrence and grading of treatment-related pneumonia were determined by clinical symptoms, signs, and chest CT findings. The relationship between interval time window of different treatment methods and pneumonia was analyzed by Pearson correlation analysis. χ2 test was used for univariate analysis of risk factors, and logistic regression for multivariate analysis. Results:In the sequential immunotherapy after RT group, the incidence of pneumonia was 12.0% (12/100), with grade ≥2 pneumonia in 4.0% (4/100). The interval time between RT and immunotherapy, has a strong negative correlation with pneumonia incidence and grade ≥2 pneumonia incidence ( r=-0.88, -0.79; both P<0.001). When immunotherapy was initiated ≥7 weeks after RT, the incidence of pneumonia significantly decreased to 5% ( P=0.020), with no grade ≥2 cases. In the immunotherapy followed by sequential / concurrent RT cohort, the incidence of pneumonia was significantly higher in the concurrent subgroup compared with the sequential subgroup [65% (30/46) vs. 44.5% (53/119), P=0.027], and the comparison of the incidence of grade ≥2 pneumonia was the same [33% (15/46) vs. 14.3% (17/119), P=0.014]. The interval time window of RT after immunotherapy was strongly negatively correlated with the incidence of pneumonia and grade ≥2 pneumonia ( r=-0.77, -0.83; both P<0.001). When RT was initiated ≥4 weeks after immunotherapy, the incidence of pneumonia significantly decreased ( P<0.001). Pneumonia incidence differed significantly across RT target sites (intrapulmonary vs. extrapulmonary), total dose (<60 Gy vs. ≥ 60 Gy), and fractionation regimen (conventional vs. hypofractionation) ( P < 0.001, = 0.008, = 0.031), but was not associated with age, gender, smoking history, type of immune checkpoint inhibitor (anti-programmed death-1 vs. anti-programmed death ligand-1), or the number of prior immunotherapy cycles (all P > 0.05). Multivariate analysis identified RT within the lung and interval time of RT after immunotherapy ≤ 4 weeks as independent risk factors for the incidence of pneumonia (both P < 0.001). Conclusions:The interval window between RT and immunotherapy is a critical determinant of pneumonia incidence. Delaying immunotherapy for more than 7 weeks after RT, or delaying RT for more than 4 weeks after immunotherapy, can significantly reduce the risk of radiation-related pneumonia.

Objective:To evaluate the acute toxicities and related influencing factors of vertebral-body-sparing proton craniospinal irradiation (VBSpCSI) using pencil beam scanning (PBS) technology in pediatric patients, and to assess spinal growth and survival outcomes.Methods:A retrospective analysis was conducted on 70 pediatric patients treated with PBS-based VBSpCSI at Hebei Yizhou Cancer Hospital between January 2020 and December 2022, and continued to follow up until November 2023. Acute toxicities were assessed, and linear regression analysis combined with receiver operating characteristic curve were employed to investigate the dose-effect relationship between vertebral dose and toxicities. Spinal growth after radiotherapy was evaluated by measuring the Cobb angle on follow-up MRI. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method.Results:The median age of patients at the time of irradiation was 6 years (range, 2-16 years). Two patients (3%) developed grade ≥3 gastrointestinal toxicities, while 7 patients (10%) experienced grade 1 radiation-induced esophagitis. The nadirs of white blood cell count (WBC), absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) during treatment were significantly negatively correlated with vertebral V 5 Gy ( P=0.009, 0.006, 0.001) and vertebral V 20 Gy ( P=0.007, 0.011, <0.001). When vertebral V 5 Gy<86.5% and vertebral V 20 Gy<73.2%, the incidence of grade ≥3 myelosuppression was significantly reduced ( P<0.001, =0.001). Additionally, younger patient age (in months) and concurrent chemotherapy were also significantly associated with increased acute hematologic toxicity. Among 43 patients with MRI follow-up, no scoliosis, kyphosis, or chronic lumbosacral pain was observed. The 3-year OS and PFS rates were 95.7% and 86.4%, respectively. Conclusions:PBS-based VBSpCSI in pediatric patients demonstrates manageable acute toxicities, with a clear dose-effect relationship between vertebral V 5 Gy , V 20 Gy and hematologic toxicities, and the incidence of non-hematological toxicities remains low. No adverse effects on spinal growth or survival outcomes were observed in the short term.

Due to advances in treatment methods, the survival rate and quality of life of cancer patients have been improved. Radiation-induced vascular injury (RIVI) is a common adverse reaction following radiotherapy, mainly manifested as capillary injury and atherosclerosis in the irradiated area. Radiotherapy induces RIVI in the cerebral vessels, carotid arteries, coronary arteries, and large arteries through mechanisms such as endothelial cell injury and senescence, oxidative stress and inflammatory responses, angiogenesis, and vascular remodeling. In this review research progress in the pathological features, pathophysiological mechanisms, clinical manifestations, prevention and treatment strategies of RIVI was summarized, aiming to provide insights for future research on RIVI.

Radiation-induced rectal injury (RRI) refers to inflammatory intestinal complications of patients with pelvic cavity, abdominal cavity and retroperitoneal tumor during or after radiotherapy, presenting symptoms such as diarrhea, abdominal pain, anal distension, bloody stool, etc. In severe cases, rectovaginal fistula, intestinal obstruction, canceration can occur, adversely affecting the quality of life of patients. The clinical factors of RRI involve total radiotherapy dose, tumor volume, radiotherapy mode and patient-related risk factors. The diagnosis mainly depends on imaging examinations (such as CT, MRI and ultrasound), endoscopy and laboratory examination. The mechanism of RRI is related to intestinal epithelial cell destruction, stem cell injury, microvascular changes and microbial flora imbalance. At present, there is no gold standard for RRI treatment, and the main measures include surgical treatment, internal medicine treatment, hyperbaric oxygen therapy and fecal microbiota transplantation, etc. In this article, the latest progress in the pathogenesis, diagnosis and treatment of RRI was reviewed.

Radiation-induced esophageal injury (RIEI) is a frequent complication following radiotherapy for thoracic and head-neck malignancies, which may lead to severe sequelae including esophageal stricture and perforation, adversely affecting patients' quality of life and therapeutic outcomes. With advancements in radiotherapy techniques — particularly the adoption of unconventional fractionation regimens, concurrent chemoradiotherapy, and combined molecular targeted / immunotherapy — the incidence of RIEI has been increasing. In this review, recent advances in understanding the pathogenesis, clinical manifestations, risk factors, and management strategies for RIEI were comprehensively summarized. Current therapeutic approaches have evolved beyond conventional anti-inflammatory and nutritional support to include novel interventions such as targeted therapy, free radical scavengers, and microbiota modulation, etc. Future research should prioritize the development of optimized, individualized prevention and treatment protocols to mitigate RIEI risk and improve patient prognosis.

The global incidence of head and neck cancer (HNC) is rising, with over 60% of patients presenting at a locally advanced stage. Radiotherapy remains a cornerstone of HNC treatment, and advancements in modern techniques and concurrent chemotherapy have improved local control and survival rates of HNC patients. However, these benefits also bring challenges in the management of toxicities. Due to the proximity of salivary glands and tumors, especially the highly radiosensitive parotid and submandibular glands, this condition is among the most common adverse effects of radiotherapy. Radiation damages acinar cells and ducts, causing glandular atrophy, fibrosis, and reduced saliva secretion, thereby leading to xerostomia and related complications. The risk and severity of injury are associated with the radiation dose and volume affecting the glands. Prevention and management strategies emphasize precise radiotherapy planning, target optimization, and supportive care. Emerging multimodal imaging techniques offer potential for non-invasive prediction and early diagnosis and treatment of radiation-induced salivary gland injury. Future research in regenerative medicine, tissue engineering, and molecular biology aims to elucidate molecular mechanisms, such as signaling pathways and genomics, facilitating personalized strategies to mitigate radiotherapy-induced toxicities and enhance the quality of life of patients.

Osteoradionecrosis of the jaws (ORNJ) is among the most severe oral complications following radiotherapy for head and neck tumors. It is essentially a form of pathological necrosis of the jawbone induced by radiation therapy. ORNJ is defined as bone damage, primarily characterized by inflammation and necrosis, occurring in the jawbone within the irradiated area and accompanied by soft tissue injury, persisting for more than 3 months without spontaneous healing. Diagnosis requires exclusion of other potential etiologies, including primary tumor recurrence, medication-related osteonecrosis, and radiation-induced neoplasms of the jawbone, etc. In this review, recent advances in the epidemiology, risk factors, diagnosis, classification and staging, dosimetric parameters, pathogenesis, treatment, and prevention of radiation-induced osteonecrosis of the jaws were summarized.

Radiation‐induced lung injury (RILI) is one of the common and serious complications in chest cancer patients after undergoing radiotherapy. In recent years, gut microbiota has garnered attention as a research hotspot. Multiple studies found that it has preventive and therapeutic effects on RILI. It can exert its effects through various mechanisms including the regulation of the immune system, the gut‐lung axis and its own metabolites, etc. In this article, the mechanism of RILI was elucidated and the protective mechanism of gut microbiota against RILI was comprehensively analyzed, providing new insights for the prevention and treatment of RILI in clinical practice and offering new methods to improve patient prognosis and enhance the quality of life.

Objective:To investigate the effects of different doses of whole abdominal ultra‐high dose rate (FLASH) irradiation on the intestinal microbiota of mice.Methods:A total of 25 healthy male C57BL/6J mice were randomly divided into the control ( n=5) and FLASH irradiation groups ( n=20) by simple randomization method, and the FLASH irradiation group was further divided into different radiation dose subgroups of 10, 15, 20, 25 Gy, 5 in each group. The mice were irradiated with a single whole abdomen at a dose rate of 100 Gy/s, then sacrificed 3.5 d after irradiation. Fresh fecal specimens and intestinal tissues of mice were collected for 16S rRNA sequencing, microbiota analysis, hematoxylin eosin (HE) staining and injury severity score analysis. Two-group comparison was performed by independent sample t-test. Multi-group comparison was conducted by one-way ANOVA. Results:HE staining revealed that the whole abdomen FLASH irradiation caused varying degree of intestinal injury in mice, and the intestinal injury reaction was aggravated with the increase of irradiation dose. β‐diversity analyses showed that there were differences in the composition of intestinal microbiota between FLASH irradiation group and control group ( P=0.001), but the differences in the relative abundance of the species between the irradiation groups at different doses were relatively small, and there were their own dominant genera of bacteria. Comparison of different doses of FLASH irradiation groups with control group screened out 16 species of bacteria with shared differences at the genus level, in which Lactobacillus, Ligilactobacillus and unclassified Lactobacillus were more abundant in the control group, while Escherichia, Allobaculum, and Muribaculum were more abundant in the FLASH irradiation groups. Conclusions:The whole‐abdominal FLASH irradiation induces intestinal damage in mice, and the intestinal damage response is worsened with the increase of irradiation dose. Different doses of whole abdominal FLASH irradiation alter the intestinal microbiota composition of mice. Sixteen species of common intestinal differential microbiota at the genus level are screened out in the different doses of FLASH irradiation groups compared with the control group, which may serve as a marker for measuring intestinal injury in mice irradiated with whole‐abdominal FLASH.