The concept of competency-based standardized residency training is gaining global popularity. However, the process of assessing, continuously evaluating, and conducting final competency evaluations remains challenging. The Milestones 2.0 system, developed by the Accreditation Council for Graduate Medical Education, provides a framework for evaluating competencies in radiation oncology residents. The core objective of this system is to assess sub-competencies within core competencies, categorizing them from novice to expert across 5 levels. Evaluation occurs every 6 months, with the expectation that all residents reach level 4 in all sub-competencies by the end of their training. This approach aims to enhance the standardization of residency evaluations across the United States. This article aims to analyze the Milestones 2.0 competency framework and explore its potential applicability and reference value for standardized radiation oncology residency training in China.

Objective:To investigate the prevalence and severity of symptom burden among long-term survivors of oropharyngeal cancer after radiotherapy, to identify core symptom clusters, and to explore their correlation with quality of life.Methods:A previous retrospective study was conducted by the Cancer Hospital, Chinese Academy of Medical Sciences on patients with oropharyngeal cancer who underwent radiotherapy between January 2010 and December 2020. Patients who were still alive as of December 2023 were further followed and analyzed. From December 2023 to August 2024, symptom burden and quality of life were assessed using the Chinese version of the MD Anderson Symptom Inventory–Head and Neck Module (MDASI-HN) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ). Exploratory factor analysis (principal component analysis with Promax rotation) were used to identify symptom clusters. Spearman correlation analysis was performed to explore the relationship between total symptom cluster scores and standardized domain scores of quality of life. Multivariate linear regression analysis was further employed to determine the relationship between identified symptom clusters and overall quality of life.Results:A total of 273 patients were included, with a median follow-up duration of 6.2 years (range: 3.5-14.5 years) and a median age of 61 years (range: 27-88 years) at follow-up. The top 5 incidence rates of symptom reported by patients were mucus problems in the mouth or throat (147 cases, 53.8%), dental or gum issues (143 cases, 52.4%), xerostomia (140 cases, 51.3%), difficulty swallowing or chewing (95 cases, 34.8%), and taste disturbance (79 cases, 28.9%). Among them, xerostomia was the most serious symptom. The most frequently reported interference was impact on work (including household chores) (55 cases, 20.1%). Exploratory factor analysis identified 3 symptom clusters: fatigue-nausea cluster, eating-voice cluster, and xerostomia-sleep cluster, all of which were significantly correlated with lower overall quality of life of patients (all P<0.001). Conclusion:Long-term survivors of oropharyngeal cancer after radiotherapy experience substantial symptom burden. The fatigue-nausea, eating-voice, and xerostomia-sleep clusters are the core symptom clusters impacting quality of life.

Objective:To evaluate the role of a single PET-CT scan in predicting survival and prognosis in patients with non-small cell lung cancer (NSCLC) who did not undergo surgery but received radiotherapy after neoadjuvant chemotherapy combined with immunotherapy.Methods:A retrospective analysis was conducted on the data of 23 NSCLC patients treated at the Cancer Hospital of the Chinese Academy of Medical Sciences from May 2022 to June 2024. All patients were pathologically confirmed, received neoadjuvant chemotherapy combined with immunotherapy, did not undergo surgery for various reasons, and instead received radiotherapy. Each patient underwent only one PET-CT scan after neoadjuvant chemotherapy combined with immunotherapy and before radiotherapy. According to the maximum standardized uptake value (SUV max) on PET-CT, patients were divided into the low-uptake group (SUV max < 8, n=12) and high-uptake group (SUV max ≥ 8, n=11). Survival analysis was performed using the Kaplan-Meier method with survival curves plotted. Univariate analysis of influencing factors of survival was conducted using the Cox proportional hazards regression model. Clinical characteristics and survival outcomes of the two groups were compared, including progression-free survival (PFS) and overall survival (OS). Results:The 1-year PFS rates were 100% in the low-uptake group, 54.5% in the high-uptake group. This difference was statistically significant ( P=0.007). The 1-year and 2-year OS rates were both 100% in the low-uptake group, the 1-year and 2-year OS rates were both 90.9% in the high-uptake group, with no statistically significant difference ( P=0.394). Univariate Cox analysis identified age as an independent factor affecting PFS. Conclusions:For NSCLC patients who did not undergo surgical resection but received radiotherapy after neoadjuvant chemotherapy combined with immunotherapy, a single PET-CT scan before radiotherapy has potential value in predicting PFS. However, clinical studies with larger sample size and longer follow-up are required to evaluate its predictive value for OS.

Objectives:To analyze the clinical characteristics of upper cervical vertebrae with dumbbell schwannoma,and to explore its clinical symptoms,imaging features,and treatment plans.Methods:A retro-spective analysis was performed on 14 patients with upper cervical intra-and extraspinal dumbbell-shaped schwannoma admitted to the Spinal Surgery Department of Southern Theater General Hospital from January 2022 to June 2024,including 9 males and 5 females,aged 43.64±11.96 years(25-61 years).According to the location,size,scope of the tumor,and relationship with the surrounding important tissue structure in upper cervical spine,the relevant clinical treatment data were analyzed and the surgical treatment plan was dis-cussed.Cervical X-ray,CT and MRI examinations were regularly performed after surgery to evaluate the con-ditions of complete resection of tumor and recurrence,the stability of the upper cervical spine and whether the internal fixation was loose or broken.The recovery of spinal nerve function and pain improvement were evaluated by the Japanese Orthopaedic Association(JOA)and visual analogue scale(VAS)scores.Results:All the patients underwent complete tumor resection in one stage,and the postoperative JOA score(10.14±1.55 vs 13.86±1.06,P=0.005)and VAS score(2.42±1.29 vs 0.64±0.71,P=0.000)were statistically different from those before surgery.Postoperative tumor histopathology was confirmed as schwannoma in all the 14 patients.The follow-up time was 6 months to 2 years.No recurrence of tumor was found,neurological symptoms were significantly improved,and no upper cervical instability appeared.Conclusions:For patients with intra-and extra-spinal dumbbell-shaped schwannoma in the upper cervical spine,complete resection of the tumor in one stage of posterior approach can be given priority.If the important stable tissue structure of the upper cervical spine is destroyed,upper cervical spine fixation and fusion should be performed to ensure the stabil-ity of upper cervical spine after tumor resection.

Objectives:To analyze the clinical characteristics of upper cervical vertebrae with dumbbell schwannoma,and to explore its clinical symptoms,imaging features,and treatment plans.Methods:A retro-spective analysis was performed on 14 patients with upper cervical intra-and extraspinal dumbbell-shaped schwannoma admitted to the Spinal Surgery Department of Southern Theater General Hospital from January 2022 to June 2024,including 9 males and 5 females,aged 43.64±11.96 years(25-61 years).According to the location,size,scope of the tumor,and relationship with the surrounding important tissue structure in upper cervical spine,the relevant clinical treatment data were analyzed and the surgical treatment plan was dis-cussed.Cervical X-ray,CT and MRI examinations were regularly performed after surgery to evaluate the con-ditions of complete resection of tumor and recurrence,the stability of the upper cervical spine and whether the internal fixation was loose or broken.The recovery of spinal nerve function and pain improvement were evaluated by the Japanese Orthopaedic Association(JOA)and visual analogue scale(VAS)scores.Results:All the patients underwent complete tumor resection in one stage,and the postoperative JOA score(10.14±1.55 vs 13.86±1.06,P=0.005)and VAS score(2.42±1.29 vs 0.64±0.71,P=0.000)were statistically different from those before surgery.Postoperative tumor histopathology was confirmed as schwannoma in all the 14 patients.The follow-up time was 6 months to 2 years.No recurrence of tumor was found,neurological symptoms were significantly improved,and no upper cervical instability appeared.Conclusions:For patients with intra-and extra-spinal dumbbell-shaped schwannoma in the upper cervical spine,complete resection of the tumor in one stage of posterior approach can be given priority.If the important stable tissue structure of the upper cervical spine is destroyed,upper cervical spine fixation and fusion should be performed to ensure the stabil-ity of upper cervical spine after tumor resection.

The concept of competency-based standardized residency training is gaining global popularity. However, the process of assessing, continuously evaluating, and conducting final competency evaluations remains challenging. The Milestones 2.0 system, developed by the Accreditation Council for Graduate Medical Education, provides a framework for evaluating competencies in radiation oncology residents. The core objective of this system is to assess sub-competencies within core competencies, categorizing them from novice to expert across 5 levels. Evaluation occurs every 6 months, with the expectation that all residents reach level 4 in all sub-competencies by the end of their training. This approach aims to enhance the standardization of residency evaluations across the United States. This article aims to analyze the Milestones 2.0 competency framework and explore its potential applicability and reference value for standardized radiation oncology residency training in China.

Objective:To investigate the prevalence and severity of symptom burden among long-term survivors of oropharyngeal cancer after radiotherapy, to identify core symptom clusters, and to explore their correlation with quality of life.Methods:A previous retrospective study was conducted by the Cancer Hospital, Chinese Academy of Medical Sciences on patients with oropharyngeal cancer who underwent radiotherapy between January 2010 and December 2020. Patients who were still alive as of December 2023 were further followed and analyzed. From December 2023 to August 2024, symptom burden and quality of life were assessed using the Chinese version of the MD Anderson Symptom Inventory–Head and Neck Module (MDASI-HN) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ). Exploratory factor analysis (principal component analysis with Promax rotation) were used to identify symptom clusters. Spearman correlation analysis was performed to explore the relationship between total symptom cluster scores and standardized domain scores of quality of life. Multivariate linear regression analysis was further employed to determine the relationship between identified symptom clusters and overall quality of life.Results:A total of 273 patients were included, with a median follow-up duration of 6.2 years (range: 3.5-14.5 years) and a median age of 61 years (range: 27-88 years) at follow-up. The top 5 incidence rates of symptom reported by patients were mucus problems in the mouth or throat (147 cases, 53.8%), dental or gum issues (143 cases, 52.4%), xerostomia (140 cases, 51.3%), difficulty swallowing or chewing (95 cases, 34.8%), and taste disturbance (79 cases, 28.9%). Among them, xerostomia was the most serious symptom. The most frequently reported interference was impact on work (including household chores) (55 cases, 20.1%). Exploratory factor analysis identified 3 symptom clusters: fatigue-nausea cluster, eating-voice cluster, and xerostomia-sleep cluster, all of which were significantly correlated with lower overall quality of life of patients (all P<0.001). Conclusion:Long-term survivors of oropharyngeal cancer after radiotherapy experience substantial symptom burden. The fatigue-nausea, eating-voice, and xerostomia-sleep clusters are the core symptom clusters impacting quality of life.

Objective:To evaluate the role of a single PET-CT scan in predicting survival and prognosis in patients with non-small cell lung cancer (NSCLC) who did not undergo surgery but received radiotherapy after neoadjuvant chemotherapy combined with immunotherapy.Methods:A retrospective analysis was conducted on the data of 23 NSCLC patients treated at the Cancer Hospital of the Chinese Academy of Medical Sciences from May 2022 to June 2024. All patients were pathologically confirmed, received neoadjuvant chemotherapy combined with immunotherapy, did not undergo surgery for various reasons, and instead received radiotherapy. Each patient underwent only one PET-CT scan after neoadjuvant chemotherapy combined with immunotherapy and before radiotherapy. According to the maximum standardized uptake value (SUV max) on PET-CT, patients were divided into the low-uptake group (SUV max < 8, n=12) and high-uptake group (SUV max ≥ 8, n=11). Survival analysis was performed using the Kaplan-Meier method with survival curves plotted. Univariate analysis of influencing factors of survival was conducted using the Cox proportional hazards regression model. Clinical characteristics and survival outcomes of the two groups were compared, including progression-free survival (PFS) and overall survival (OS). Results:The 1-year PFS rates were 100% in the low-uptake group, 54.5% in the high-uptake group. This difference was statistically significant ( P=0.007). The 1-year and 2-year OS rates were both 100% in the low-uptake group, the 1-year and 2-year OS rates were both 90.9% in the high-uptake group, with no statistically significant difference ( P=0.394). Univariate Cox analysis identified age as an independent factor affecting PFS. Conclusions:For NSCLC patients who did not undergo surgical resection but received radiotherapy after neoadjuvant chemotherapy combined with immunotherapy, a single PET-CT scan before radiotherapy has potential value in predicting PFS. However, clinical studies with larger sample size and longer follow-up are required to evaluate its predictive value for OS.

Intensity-modulated radiotherapy (IMRT) is a radical treatment for oropharyngeal carcinoma. The 5-year overall survival (OS) is approximately 60%, and 80% for human papillomavirus (HPV)-related oropharyngeal carcinoma patients. Late toxicities after IMRT, including xerostomia, dysphagia, hypothyroidism, trismus, osteoradionecrosis and caries, and lower cranial neuropathy, seriously affect the quality of life of long-term survivors. The research on treatment de-intensification for HPV-related oropharyngeal cancer has been widely carried out at home and abroad, but there is little research focusing on late toxicity. In this article, related research progress in the incidence, treatment, prediction of late toxicity after IMRT was reviewed, aiming to provide reference for research on radiation-induced injury in de-intensification therapy research, thereby further optimizing comprehensive treatment strategies.

Objective:To prospectively observe the changes of tumor-related symptoms in patients with nasopharyngeal carcinoma following the administration of nimotuzumab one week before radiotherapy.Methods:Non-metastatic nasopharyngeal carcinoma patients with positive epidermal growth factor receptor (EGFR) expression and symptoms caused by the primary lesion or metastatic cervical lymph nodes admitted to Cancer Hospital of Chinese Academy of Medical Sciences were prospectively recruited. Investigators recorded tumor-related symptoms in recruited patients one day before the first administration of nimotuzumab (D0) and conducted follow-up visits from day 2 to day 7 after the first administration (D2-D7) to document symptom changes. All recruited patients were asked to assess tumor-related symptoms on D0 and D7 by visual analogue scale (VAS) scores. VAS scores were analyzed by paired t-test. Results:From June 2020 to April 2023, a total of 21 patients met the inclusion criteria. The median age was 49 years (range: 27-69 years), with a male-to-female ratio of 1.3:1. Among the patients, 17 patients (81%) received concurrent nimotuzumab for 8 cycles, 7 cycles for 3 cases (14%), and 6 cycles for 1 case (5%), respectively. All patients completed symptom assessments as required. The overall response rate of symptoms after the first administration of nimotuzumab was 62%, with response rates of 4/6、5/8、4/10、4/10、4/11、3/11 for tinnitus, headache, aural fullness, secondary pain caused by neck mass, nasal bleeding, and nasal obstruction, respectively. The VAS scores for overall symptoms were significantly decreased after the administration of nimotuzumab one week before radiotherapy ( P<0.001), with the most significant decrease in VAS scores for tinnitus, aural fullness, and headache. Conclusion:The administration of nimotuzumab one week before radiotherapy significantly alleviates tumor-related symptoms in patients with nasopharyngeal carcinoma, particularly in alleviating tinnitus, aural fullness, and headache.