A new preconfigured CyberKnife system was introduced to improve the SRS/SBRT commissioning efficiency. The vendor provides a reference beam data set, termed "beam data model (BDM)", and recommends its validation and combination with measurement data to develop a hybrid beam data model (h-BDM). However, the validation method by the user and the clinical acceptability with the h-BDM has not been established.

This study reports the first clinical validation of the BDM and aims to demonstrate the SRS/SBRT commissioning process with the h-BDM is clinically acceptable.

The BDM was validated by comparing with the measurements of tissue phantom ratios (TPRs), off-center ratios (OCRs), and output factors (OFs) for fixed and Iris collimators and MLC in CyberKnife S7 system. Dose difference (DD) and distance-to-agreement (DTA) between BDM and measurement data were assessed against predefined thresholds: DDs of 1.0% for TPRs; DDs of 1.0% at d_15mm and d_100mm and 1.5% at d_300mm for central regions in OCRs; and DTAs of 0.3-1.0 mm for penumbra regions. The h-BDM was constructed by supplementing the BDM with the measurement beam data for all OFs, and for the TPRs and OCRs of the three smallest field sizes with each collimator. Additional replacements were also made when discrepancies exceeded the proposed thresholds based on clinical usability considerations. The conventional measurement beam data model (m-BDM) was also developed with only measurement data. Single-beam validation was performed in homogeneous water-equivalent phantom and heterogeneous phantoms, including lung-equivalent slabs, by comparing between the measured and calculated point doses with h-BDM and m-BDM at multiple depths. Finally, patient-specific quality assurance (PSQA) was performed for SRS/SBRT plans. In phantom case, SRS/SBRT plans were created for a single spherical target on the CT images of the StereoPHAN phantom and anthropomorphic lung phantom for brain and lung sites, respectively. For the SBRT plans of spine and prostate sites, the C-shape and test-prostate structure sets, provided by the AAPM TG 119, were employed. In clinical case, six SRS/SBRT plans for each patients' CT images in brain, lung, spine, and prostate sites, were employed and the PSQA plans were generated using the CT images of the StereoPHAN phantom, anthropomorphic lung phantom, and the I'mRT phantom. The point dose and γ pass rate were evaluated using micro ionization chamber and radiochromic film, respectively.

Differences between the BDM and measurement exceeded the specific thresholds for the OCRs with three largest MLC field sizes. In the single-beam validation, dose differences between measurements and calculations with h-BDM were within 2.0% for field sizes of > 10.0 mm, except up to 3.0% at 140 mm depth with MLC, and within 5.0% for field sizes of ≤10.0 mm. In PSQA with the h-BDMs, the point dose differences were within 3.0% and the γ pass rates (2%/2 mm and 3%/1 mm) were > 95.0% for all SRS/SBRT plans. The single-beam validation and PSQA results of the h-BDM were comparable to those of the conventional m-BDM.

The SRS/SBRT commissioning process with the proposed h-BDM provides a new clinically acceptable framework.

Thermoplastic immobilization remains standard for head and neck radiation therapy, but rigid face masks may produce clinically meaningful anxiety, claustrophobia, and treatment intolerance in some patients. Surface-guided radiation therapy (SGRT) provides non-ionizing surface setup guidance and continuous intrafraction motion monitoring, potentially enabling reduced-immobilization treatment approaches.

To describe and initially evaluate the clinical feasibility of a thermoplastic-maskless head and neck radiation therapy workflow using a posterior dorsal shell, SGRT-guided setup, cone-beam computed tomography (CBCT) verification, and real-time intrafraction monitoring with automatic beam-hold.

Ten patients with head and neck cancer were treated without a thermoplastic face mask. Patients were positioned in a posterior dorsal shell. Daily setup began with SGRT followed by CBCT verification and couch correction. During delivery, SGRT (AlignRT v6.3, Vision RT, London, UK) monitored head position in six degrees of freedom (6DoF); automatic beam-hold was triggered when translational displacement exceeded 2 mm or rotational displacement exceeded 2°. Post-treatment CBCT and SGRT log files were reviewed for every fraction to characterize residual displacement, threshold events, and repositioning. Intrafraction motion and residual displacement were summarized as medians with interquartile range (IQR).

Across 330 delivered fractions, sgrt-recorded intrafraction motion was small:: per-axis signed real-time deltas had a median [IQR] of 0.10 mm [-0.15, 0.30] translationally and 0.10° [-0.05, 0.20] rotationally. No fraction had a mean real-time delta exceeding the ± 2 mm/ ± 2° tolerance, and automatic beam-hold interruptions occurred in approximately 2% of fractions (7 of 330); no fraction was abandoned. Per-axis post-treatment CBCT residuals were -0.01 mm [-0.04, 0.05] translationally and 0.15° [-0.40, 0.55] rotationally. All patients completed the maskless course; 3 of 10 had previously declined or been unable to tolerate mask-based treatment, and all reported the maskless workflow to be well tolerated on an end-of-course questionnaire.

A thermoplastic-maskless head and neck workflow using SGRT, CBCT verification, predefined beam-hold thresholds, and dorsal shell support was feasible in this initial 10-patient experience, maintaining small observed intrafraction motion while directly addressing mask intolerance. Larger prospective evaluation with validated patient-reported outcomes, dosimetric analysis, and multi-institutional QA is warranted.

Isolated hyperthermic limb perfusion (ILP) is a limb-salvage technique used in the treatment of malignant melanoma and soft tissue sarcomas with in-transit or locally advanced disease. ILP allows regional administration of high-dose chemotherapy with minimal systemic toxicity. This study aims to evaluate postoperative complications and identify predictive factors influencing outcomes in patients undergoing ILP. We retrospectively analyzed 49 patients with malignant melanoma or extremity soft tissue sarcoma who underwent ILP at a single tertiary center between 2014 and 2024. Complications were classified using the Clavien-Dindo system; toxicity was graded via the Wieberdink scale. Logistic regression and univariate analyses were used to evaluate clinical, surgical, and laboratory parameters predictive of severe complications, toxicity, and mortality. Of the patients, 32 (65.3%) experienced complications, primarily within the first 3 postoperative days. Severe complications (Clavien-Dindo grade ≥ 3) occurred in 11 patients (22.4%). Severe regional toxicity (Wieberdink grade ≥ 4) was observed in 6.1%. Early mortality occurred in 3 cases. Preoperative and postoperative albumin levels, along with C-reactive protein levels on postoperative days 3 and 5, were significantly associated with severe complications. No significant relationship was found between modified Systemic Inflammation Scores and postoperative outcomes. ILP remains a valuable regional treatment option for carefully selected patients with advanced melanoma and extremity soft tissue sarcoma. Preoperative nutritional status and early postoperative inflammatory markers, particularly albumin and C-reactive protein, may serve as valuable predictors for adverse outcomes. Optimization of these parameters could improve postoperative recovery and treatment planning.

In recent years, immunotherapy has significantly reshaped the pattern of non-small cell lung cancer (NSCLC) treatment. However, the issue of how to pinpoint potential responsive populations more accurately warrants immediate and focused attention. This study mainly explored the correlation between baseline peripheral blood biomarkers and prognosis in patients with advanced NSCLC undergoing immunotherapy. A retrospective analysis was performed on 139 patients diagnosed with advanced NSCLC who underwent first-line immunotherapy treatment between 2019 and 2022. Baseline demographic information and peripheral blood parameter data were collected. The Cox proportional hazards regression model was used to estimate hazard ratios and 95% confidence intervals to identify independent prognostic factors, while Kaplan-Meier survival analysis with log-rank tests was applied to compare survival differences between groups. Finally, the predictive efficacy of biomarkers was assessed utilizing the receiver operating characteristic curve. C-reactive protein (CRP) and carcinoembryonic antigen (CEA) were independent predictors for both progression-free survival (PFS) and overall survival (OS). Eosinophils > 0.23 × 109/L, PLT (platelets) > 228 × 109/L, albumin ≤ 37.2g/L, CRP > 6.21mg/L, or CEA > 6.23ng/ml was associated with poorer PFS. Meanwhile, (hemoglobin) ≤ 132g/L, platelets > 228 × 109/L, CRP > 7.59mg/L, or CEA > 7.39ng/ml may imply an inferior OS outcome. And the combination of CRP and CEA yielded areas under the curve with 0.675 and 0.656 for predicting PFS and OS, respectively. CRP and CEA hold the potential to predict the prognosis of advanced NSCLC patients undergoing first-line immunotherapy.

This article explores the clinical value of the artificial intelligence computer-aided diagnosis system in the diagnosis of superficial lymph nodes. In this study, characteristic ultrasonic parameters of 185 cases of lymph nodes (including 110 benign and 75 malignant) confirmed by pathology were quantified by the superficial lymphadenopathy computer-aided diagnosis system, including margin, appearance, medulla proportion, medulla distribution, echogenicity, echogeneity, vascular density, and vascular pattern. A nonparametric rank sum test was used between the parameters. The sensitivity, specificity, and accuracy of the artificial intelligence computer-aided diagnosis system in the diagnosis of superficial lymph nodes were 80.0%, 80.9%, and 80.5%. The characteristics of margin, appearance, medulla proportion, medulla distribution, echogenicity, echogeneity, vascular density, and vascular pattern could identify benign and malignant lymph nodes. The artificial intelligence superficial lymphadenopathy computer-aided diagnosis system can screen out the characteristic ultrasonic parameters of benign and malignant lymph nodes, which has important value in lymph node clinical diagnosis.

Minimally invasive esophagectomy is the preferred treatment for esophageal cancer. However, postoperative opioid analgesics are commonly used, and a nasogastric tube (NGT) is usually retained after surgery. There are few studies on the correlation between postoperative NGT retention duration and total postoperative opioid consumption. This study investigates the correlation between postoperative opioid consumption and NGT retention duration in patients undergoing minimally invasive esophagectomy. This single-center retrospective cohort study collected data from patients with esophageal cancer who underwent minimally invasive esophagectomy at the Department of Cardiothoracic Surgery, Affiliated Hospital of Putian University from January 2020 to December 2024. A total of 168 patients were included and divided into groups based on whether the NGT retention duration exceeded 7 days. The total postoperative opioid consumption was calculated and converted to daily oral morphine equivalent doses. Univariate analysis showed that postoperative hospital stay, NGT retention duration, fasting days, ICU stay, and postoperative complication grade were significantly correlated with postoperative morphine dose. Multivariate linear regression analysis showed that compared with the group with NGT retention duration ≤ 7 days, the group with NGT retention duration > 7 days had an average increase of 77.13 mg in postoperative morphine consumption (95% confidence interval: 31.62-122.65, P = .001). After adjusting for all covariates, the β value and 95% CI were 52.71 (3.84-101.59). Subgroup analysis and curve fitting results showed a significant linear positive correlation between NGT retention duration and total postoperative morphine consumption (P for overall = .001). There is a significant linear positive correlation between postoperative opioid consumption and NGT retention duration in patients undergoing minimally invasive esophagectomy. Clinicians should pay attention to the impact of NGT retention duration on postoperative pain. By optimizing postoperative management strategies and reducing unnecessary NGT retention duration, the quality of postoperative recovery can be improved.

Plasma lipids play a crucial role at every stage of cancer progression, and a deficiency or excess of plasma lipids can lead to an increased risk of cancer. Previous observational studies and randomized controlled trials on the association between plasma lipids and cancer risk have been limited. We conducted a Mendelian randomization (MR) analysis to assess the impact of 179 plasma lipid species on the risk of 15 types of cancer. Through bidirectional 2-sample MR analysis and colocalization analysis, we systematically studied the association between 179 plasma lipid species and 15 types of cancer. In the MR study, we primarily used inverse variance weighting as our analytical strategy. Sensitivity analyses were carried out using the MR-Egger method and the MR Pleiotropy Residual Sum and Outlier method. We rigorously assessed heterogeneity through the application of Cochrane Q test. To ensure the robustness of the MR results, we employed the "leave-one-out" method and tested the strength of the causal relationships through false discovery rate correction. We identified a significant causal relationship between 20 plasma lipid species and the risk of 5 types of cancer. Specifically, in the forward MR analysis, the level of plasma phosphatidylethanolamine (18:0_20:4) was causally linked with pancreatic cancer; the level of plasma phosphatidylcholine (O-18:0_16:1) was causally linked with breast cancer (estrogen receptor [ER]+); the level of plasma phosphatidylcholine (O-16:0_20:3) was causally linked with endometrial cancer (endometrioid histology); 3 plasma lipid species were causally linked with lung cancer; and 14 plasma lipid species were causally linked with colorectal cancer. Strong evidence from colocalization analysis confirmed that 11 plasma lipid species shared causal variants with the risk of colorectal cancer. In the reverse analysis, an increased risk of colorectal cancer was associated with elevated levels of plasma phosphatidylcholine (18:1_18:2). This discovery held strong in comprehensive sensitivity analyses. We did not find a clear link between other plasma lipids and cancer. Our research results powerfully demonstrated the role of plasma lipids in cancer risk.

Ovarian cancer is one of the most lethal gynecological malignancies globally, with significant variations in incidence, prevalence, and outcomes across regions and population subgroups. This study systematically evaluates the global, regional, and national burden of ovarian cancer from 1990 to 2021, utilizing data from the Global Burden of Disease 2021 framework. Trends in incidence, prevalence, mortality, and disability-adjusted life years were analyzed, with an emphasis on their associations with the Socio-Demographic Index (SDI) and other key risk factors. The analysis highlights substantial disparities in ovarian cancer burden, with low- and middle-SDI regions experiencing the highest mortality-to-incidence ratios. In 2021, ovarian cancer accounted for approximately 298,876 new cases globally, with age-standardized incidence rates declining in high-SDI regions but increasing in low-SDI regions. Mortality trends mirrored this pattern, with significant disparities between high- and low-resource settings. The findings underscore the critical influence of age, genetics, and access to early detection and treatment. Forecasts using an ARIMA model indicate a continued rise in the global burden, particularly in regions with limited healthcare resources. This study underscores the urgent need for targeted interventions to improve ovarian cancer outcomes, including enhanced screening, equitable access to treatment, and strategies addressing modifiable risk factors, particularly in underserved regions.

Preoperative evaluation of axillary lymph node metastasis is crucial for selecting the optimal perioperative treatment for breast cancer. The most common methods for this evaluation include imaging tests, such as ultrasonography, and pathological assessments. This study investigated the utility of computed tomography (CT) Hounsfield units (HU) in diagnosing axillary lymph node metastasis. This retrospective study examined 218 patients with breast cancer who underwent surgery at our hospital between June 2017 and December 2023. We measured the HU of axillary lymph nodes using preoperative CT scans and defined the highest value as CT-HUmax. We explored the relationship between axillary lymph node CT-HUmax and the presence of metastasis. There were 56 patients in the axillary lymph node metastasis-positive group (P group) and 162 in the axillary lymph node metastasis-negative group (N group). The median CT-HUmax value was 48 (-25-69) for the P group and 30 (-17-73) for the N group, with the former having significantly higher values than those of the latter (P < .001). Similar findings were obtained with contrast-enhanced CT (CE-CT). Multivariate analysis revealed that CT-HUmax was a predictive factor for metastasis (odds ratio [OR]: 1.035; 95% confidence interval [CI]: 1.019-1.072; P = .011). The area under the receiver operating characteristic curve for CT-HUmax was 0.761 (95% CI: 0.688-0.834, P < .001). The cutoff value for CT-HUmax was 46, while the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate using this value were 61%, 84%, 57%, 86%, and 78%, respectively. When CE-CT was used, the cutoff value was 134, and accuracy was 79%. CT-HU may be an effective predictor of axillary lymph node metastasis in breast cancer.

Neutrophil percentage-to-albumin ratio (NPAR) reflects both systemic inflammation and nutritional status, 2 factors closely linked to cancer progression and cardiovascular disease (CVD). While NPAR has been associated with adverse outcomes in various populations, its prognostic value in cancer survivors with comorbid CVD remains unclear. This study aimed to evaluate the association between NPAR and all-cause mortality in this high-risk population using nationally representative US data. We conducted a retrospective cohort study using data from the US National Health and Nutrition Examination Survey (NHANES, 1999-2018). A total of 1101 adult patients with both cancer and CVD were included. NPAR was evaluated as the exposure variable, and all-cause mortality was the outcome. Participants were categorized into tertiles according to NPAR. Kaplan-Meier survival curves were used to compare mortality across groups, and Cox proportional hazards regression models were applied to assess the independent association between NPAR and mortality risk. During a median follow-up of 77.9 months, higher NPAR levels were significantly associated with increased all-cause mortality. Kaplan-Meier analysis demonstrated significant differences in survival among tertiles (P < .0001). The median survival times were 73.0 months (IQR: 41.0-127.0), 70.0 months (IQR: 36.0-116.0), and 53.0 months (IQR: 26.8-102.0) for the lowest, middle, and highest tertiles, respectively. Multivariable Cox regression analysis confirmed that participants in the highest tertile had a significantly increased mortality risk compared with those in the middle tertile (HR = 1.54, 95% CI: 1.24-1.90, P < .001). Elevated NPAR is independently associated with higher all-cause mortality in adult cancer survivors with comorbid CVD. As a simple and readily available biomarker, NPAR may serve as a useful tool for early risk stratification and individualized management in this high-risk population.