Immunotherapy has been widely used in cancer treatment in recent years and functions by stimulating the immune system to kill tumor cells. Radiation therapy (RT) uses radiation to induce DNA damage and kill tumor cells. However, this activates the body's immune system, promoting the release of tumor-related antigens from inactive dendritic cells, which stimulates the recurrence and metastasis of tumors in immune system tissues. The combination of RT and immunotherapy has been increasingly evaluated in recent years, with studies confirming the synergistic effect of the two antitumor therapies. Particularly, the combination of RT by dose adjustment with different immunotherapies has positive implications on antitumor immunity as well as disease prognosis compared with respective monotherapies. This review summarizes the current research status, progress, and prospects of RT combined with immunotherapy in cancer treatment. It additionally discusses the prevalent concerns regarding the dose, time window, and toxicity of this combination therapy.
Humans ; Neoplasms/radiotherapy* ; Immunotherapy/methods* ; Combined Modality Therapy ; Radiotherapy/methods*

BACKGROUND: Concurrent chemo-radiotherapy (CCRT) is the standard treatment for locally advanced cervical cancer (LACC), but there are still many patients who suffer tumor recurrence. However, valuable predictors of treatment outcomes remain limited. This study aimed to assess the value of the serum immune biomarkers to predict the prognosis. METHODS: We reviewed cervical cancer patients treated with CCRT between January 2014 and May 2018 at Peking Union Medical College Hospital. The systemic immune inflammation index (SII), systemic inflammation response index (SIRI), and lactate dehydrogenase (LDH) were calculated using blood samples. The relationship between immune markers and the treatment outcome was analyzed. The area under the receiver operating characteristic (ROC) curve was used to evaluate the predictive efficiency. The Cox proportional hazards model and log-rank were used to predict overall survival (OS) and disease-free survival (DFS). RESULTS: This study included 667 patients. Among them, 195 (29.2%) patients were defined as treatment failure, including 127 (19.0%) patients with pelvic failure, 94 (14.1%) distant failure, and 25 (3.7%) concurrent pelvic and distant failure. It revealed that the tumor stage, size, metastatic lymph nodes (MLNs), and serum immune biomarkers, such as SII, SIRI, and LDH, were significantly related to treatment outcomes. We demonstrated that the optimal cut-off of the SII, SIRI, and LDH were 970.4 × 10 9 /L, 1.3 × 10 9 /L, and 207.52 U/L, respectively. Importantly, this study presented that LDH level had the highest OR (OR = 4.2; 95% CI [2.3-10.8]). Furthermore, the OS and DFS for patients with pre-SII ≥970.5 × 10 9 /L were significantly worse than those with pre-SII <970.5 × 10 9 /L. Similarly, pre-SIRI ≥1.25 × 10 9 /L and pre-LDH ≥207.5 U/L were related to poor survival outcomes. CONCLUSIONS This study demonstrated that the baseline SII, SIRI, and LDH levels can be used to accurately and effectively predict the treatment outcomes after CCRT and long-term prognosis. Our results may offer additional prognostic information in clinical, which helps to detect the potential recurrent metastasis in time.
Humans ; Female ; Uterine Cervical Neoplasms/drug therapy* ; Middle Aged ; Adult ; Aged ; Chemoradiotherapy/methods* ; L-Lactate Dehydrogenase/blood* ; Treatment Outcome ; Disease-Free Survival ; Prognosis ; ROC Curve ; Biomarkers, Tumor/blood* ; Proportional Hazards Models

This paper aims to propose a noninvasive radiotherapy patient positioning system based on structured light surface imaging, and evaluate its clinical feasibility. First, structured light sensors were used to obtain the panoramic point clouds during radiotherapy positioning in real time. The fusion of different point clouds and coordinate transformation were realized based on optical calibration and pose estimation, and the body surface was segmented referring to the preset region of interest (ROI). Then, the global-local registration of cross-source point cloud was achieved based on algorithms such as random sample consensus (RANSAC) and iterative closest point (ICP), to calculate 6 degrees of freedom (DoF) positioning deviation and provide guidance for the correction of couch shifts. The evaluation of the system was carried out based on a rigid adult phantom and volunteers' body, which included positioning error, correlation analysis, and receiver operating characteristic (ROC) analysis. Using Cone Beam CT (CBCT) as the gold standard, the maximum translation and rotation errors of this system were (1.5 ± 0.9) mm along Vrt direction (chest) and (0.7 ± 0.3) ° along Pitch direction (head and neck). The Pearson correlation coefficient between results of system outputs and CBCT verification distributed in an interval of [0.80, 0.84]. Results of ROC analysis showed that the translational and rotational AUC values were 0.82 and 0.85, respectively. In the 4D freedom accuracy test on the human body of volunteers, the maximum translation and rotation errors were (2.6 ± 1.1) mm (Vrt direction, chest and abdomen) and (0.8 ± 0.4)° (Rtn direction, chest and abdomen) respectively. In summary, the positioning system based on structured light body surface imaging proposed in this article can ensure positioning accuracy without surface markers and additional doses, and is feasible for clinical application.
Humans ; Patient Positioning/methods* ; Phantoms, Imaging ; Cone-Beam Computed Tomography ; Algorithms ; Radiotherapy, Image-Guided/methods* ; Radiotherapy Planning, Computer-Assisted/methods*

To address the issues of difficulty in preserving anatomical structures, low realism of generated images, and loss of high-frequency image information in medical image cross-modal translation, this paper proposes a medical image cross-modal translation method based on diffusion generative adversarial networks. First, an unsupervised translation module is used to convert magnetic resonance imaging (MRI) into pseudo-computed tomography (CT) images. Subsequently, a nonlinear frequency decomposition module is used to extract high-frequency CT images. Finally, the pseudo-CT image is input into the forward process, while the high-frequency CT image as a conditional input is used to guide the reverse process to generate the final CT image. The proposed model is evaluated on the SynthRAD2023 dataset, which is used for CT image generation for radiotherapy planning. The generated brain CT images achieve a Fréchet Inception Distance (FID) score of 33.159 7, a structure similarity index measure (SSIM) of 89.84%, a peak signal-to-noise ratio (PSNR) of 35.596 5 dB, and a mean squared error (MSE) of 17.873 9. The generated pelvic CT images yield an FID score of 33.951 6, a structural similarity index of 91.30%, a PSNR of 34.870 7 dB, and an MSE of 17.465 8. Experimental results show that the proposed model generates highly realistic CT images while preserving anatomical accuracy as much as possible. The transformed CT images can be effectively used in radiotherapy planning, further enhancing diagnostic efficiency.
Humans ; Tomography, X-Ray Computed/methods* ; Magnetic Resonance Imaging/methods* ; Image Processing, Computer-Assisted/methods* ; Neural Networks, Computer ; Brain/diagnostic imaging* ; Algorithms ; Radiotherapy Planning, Computer-Assisted ; Generative Adversarial Networks

OBJECTIVE

This is a case report of a 60-year-old woman with a juxtapapillary choroidal melanoma who underwent globe-sparing treatment using linear-accelerator (LINAC)-based hypofractionated stereotactic radiotherapy (FSRT).

Clinical data, ophthalmologic findings, and imaging results were obtained through retrospective chart review.

At three months and nine months post-treatment, tumor thickness decreased by 20.5% (from 13.00 mm to 10.34 mm) and 33.2% (to 8.69 mm), respectively. Partial resolution of subretinal fluid and vitreous hemorrhage was confirmed clinically and by B-scan. No metastatic spread was detected on liver ultrasound and chest radiography. Best-corrected visual acuity in the treated eye remained stable at hand motion. Radiation-induced dry eye was managed effectively with preservative-free sodium hyaluronate eye drops.

LINAC-based hypofractionated FSRT achieved marked local control and tumor regression in this case of a medium-large, juxtapapillary choroidal melanoma, while preserving the globe and the baseline vision. In regions without access to plaque brachytherapy, this technique offers a practical, cost-efficient, and multidisciplinary approach to eye-conserving therapy.

OBJECTIVES

The aim of the study is to estimate the cost of breast cancer diagnosis, treatment, and management in the Philippines. Specifically, it aims to identify the resource requirements and interventions related to breast cancer diagnosis, treatment, and management, measure resource volumes (number of units), learn to value resource items (unit costs), and determine the total cost of treatment per disease stage.

The study covered nine tertiary hospitals, seven of which were government hospitals and two were private hospitals, with all tertiary hospitals providing breast cancer services and accredited by Philippine Health Insurance Corporation (PHIC or PhilHealth) for the Z-Benefit Package. Interventions and services related to breast cancer included radiographic procedures, laboratory and imaging tests, chemotherapy drugs and medications, medical and surgical supplies, surgical rates (for breast surgery), accommodation, staff time and salary/professional fees, and other procedure fees. The study conducted in 2022, examined cost prices of breast cancer interventions and services from stage 1–3B.

Purposive and convenience sampling were used based on PhilHealth accreditation and willingness of hospitals to participate in the study. The study conducted a focus group discussion with oncologists, radiologists, anesthesiologists, and other health care providers to validate the clinical guideline used and to solicit inputs to the costing design, analysis framework, and tools for data collection. Data collection of financial cost information (charge price) was conducted using a set of costing matrices filled out by the various departments of the hospitals. Costs and median rates were calculated across hospitals on diagnostics and imaging tests, surgery costs of both public and private facilities, medical treatment, and radiotherapy.

Breast MRI, Breast Panel, and Chest CT Scan are the top 3 most expensive diagnostic procedures ranging from PhP 8,102.00 to PhP 9,800.00 per procedure. Surgical procedures for breast cancer at private hospitals and public hospitals showed huge differences in costs. The cost of a cycle of chemotherapy ranges from PhP 596.70 to PhP 3,700.00 per session, while the cost of targeted therapy can cost up to PhP 46,394.21 per session. A year of hormone therapy ranges from PhP 3,276.00 with the use of Tamoxifen, and up to PhP 68,284.00 with Goserelin. Aromatase inhibitors such as Anastrozole and Letrozole cost from PhP 18,000 to PhP 36,000, respectively. Multiple cycles depending on the diagnosis are prescribed per patient and used in combination with other chemotherapy medications or other therapies such as targeted therapy and hormone therapy are usually taken daily up to 5 to 10 years. Conventional radiotherapy can cost up to PhP 88,150.00 covering 28 sessions, CT simulation, and CT planning.

This cost study provides relevant information and better perspective on benefit development for the PHIC, policy development for Department of Health on where and how to focus their support for the patient’s financial preparedness to address medical and f inancial catastrophes.

PhilHealth needs to guide the health care providers of their costing method and to develop their own integrated, interoperable, and comprehensive cost data library.

It recommends that the government allocate budget and cover for screening and assessment for earlier stage diagnosis of patients and lower health expenditure costs on cancer treatment.

PURPOSE

To report the technical details and outcomes of a case of cervical cancer in pregnancy treated with reduced standard radiation volume via Intensity Modulated Radiation Therapy (IMRT).

A 33-year-old G4P3 (3003) was diagnosed with cervical squamous cell carcinoma at 17 weeks of gestation. She had a 5-year history of intermittent post-coital bleeding and an incidental finding of a cervical mass during prenatal ultrasound. Internal examination revealed a 6-cm mass with no extension to the upper vagina and pliable bilateral parametria, leading to a staging of IB3. A multidisciplinary meeting with a gynecologic oncologist, radiation oncologist, medical ethicist and the patient was held wherein different treatment options were discussed. She consented to definitive external beam radiation therapy (EBRT) with concurrent cisplatin and was administered during 19-25 weeks of gestation using IMRT. A prescribed dose of 45 Gy in 25 fractions was delivered to the entire cervix with a 1-cm geometric expansion covering the lower uterus, and upper vagina as well as the pelvic lymph nodes, followed by four fractions of brachytherapy.

The patient tolerated treatment with only grade 1 gastrointestinal and genitourinary adverse effects. After completion of concurrent chemoradiation, she underwent induction of labor and delivered a nonviable fetus. Three months post-treatment, MRI found no evidence of disease. At 15 months follow-up, she remains asymptomatic with no palpable disease.

This report demonstrates that treating only the involved uterus may be considered in cases wherein giving the full radiation dose to the whole uterus may lead to significant toxicities and eventual treatment interruption.

Cervical cancer during pregnancy poses a rare and complex clinical and ethical challenge, particularly in low- and middle-income countries such as the Philippines. The dual obligation to preserve maternal life while protecting fetal viability requires a nuanced balance between medical science, ethics, and cultural values.This commentary explores the ethical implications of treating cervical cancer in pregnancy using Intensity Modulated Radiation Therapy (IMRT) at reduced standard radiation volumes, highlighting how medical innovation intersects with the principles of biomedical ethics.

The paper reports one case of primary cutaneous amyloidosis (PCA) treated by tapping with plum-blossom needle combined with sulfur ointment and local irradiation. PCA in this case was manifested as generalized erythema, papules, plaques, lichenification, and severe pruritus. In treatment, tapping with plum-blossom needle was delivered at typical lesions to induce local congestion, redness, and minimal bleeding. After cleaned with sterile gauze for 10 s, 25% sulfur ointment was evenly applied, followed by local irradiation with a TDP lamp for 15 min. This session was repeated twice a week. In 1 month of treatment, the lesions turned flat and the skin was soft as the normal, with pigmentation and mild pruritus left. In 3 months of follow-up, no papules recurred, and mild pruritus presented occasionally.
Humans ; Ointments/administration & dosage* ; Sulfur/administration & dosage* ; Skin Diseases, Genetic/radiotherapy* ; Middle Aged ; Amyloidosis, Familial/radiotherapy* ; Male ; Acupuncture Therapy/instrumentation* ; Female ; Combined Modality Therapy

Definitive treatment of lung cancer with radiotherapy is challenging, as respiratory motion and anatomical changes can increase the risk of severe off-target effects during radiotherapy. Online adaptive radiotherapy (ART) is an evolving approach that enables timely modification of a treatment plan during the interfraction of radiotherapy, in response to physiologic or anatomic variations, aiming to improve the dose distribution for precise targeting and delivery in lung cancer patients. The effectiveness of online ART depends on the seamless integration of multiple components: sufficient quality of linear accelerator-integrated imaging guidance, deformable image registration, automatic recontouring, and efficient quality assurance and workflow. This review summarizes the present status of online ART for lung cancer, including key technologies, as well as the challenges and areas of active research in this field.
Humans ; Lung Neoplasms/radiotherapy* ; Radiotherapy Planning, Computer-Assisted/methods*