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Correlation between clinical, CT features and EGFR gene in minimally invasive adenocarcinoma 2 2 Background: To analyze the correlation between epidermal growth factor receptor (EGFR) gene mutations and clinical as well as computed tomography (CT) signs in minimally invasive adenocarcinoma (MIA). Materials and Methods: A total of 118 patients with MIA treated at the Department of Thoracic Surgery, Tangshan Gongren Hospital, from December 2018 to December 2021 were included in this study. Patients were categorized into two groups based on their Epidermal Growth Factor Receptor(EGFR) mutation status: a mutation group and a wild-type group. Differences in clinical and CT features between the two groups were recorded and statistically analyzed. Results: Among the 118 patients, 69 were in the mutation group, while 49 were in the wild-type group. No significant differences were observed in gender, smoking history, age, mean nodule diameter, peripheral emphysema, air bronchogram, lobulation sign, pleural indentation sign, morphology, tumor-lung interface, peripheral fibrosis, and density between the two groups (P>0.05). However, significant differences were noted in the spiculation sign, vacuole sign, and vascular convergence sign between the groups (P<0.05). Logistic regression analysis identified the vacuole sign with an odds ratio (OR) of 0.410 (P>0.05) and the spiculation sign and vascular convergence sign with ORs of 1.498 and 2.262, respectively (P<0.05), as independent risk factors for predicting EGFR mutations. The areas under the ROC curves (AUC) for the spiculation sign and vascular convergence sign were 0.634 and 0.735, respectively, in distinguishing EGFR gene mutations in MIA. Conclusion: CT imaging demonstrated that MIA patients presenting with spiculation, vacuole, and vascular convergence signs had a higher likelihood of EGFR gene mutations. Among these, the spiculation and vascular convergence signs are critical, independent risk factors for predicting EGFR gene mutations in MIA patients. 833 838 2025/10/25 1404/8/3 2025/10/18 1404/7/26 L.P. Zhou L.P. Zhou Department of Function, The Fifth Hospital of Tangshan (CT/DR Room), Tangshan, China L.M. Chang L.M. Chang Department of Medical Imaging, Tangshan Gongren Hospital, Tangshan, China 240612799@qq.com H. Zhao H. Zhao Department of Medical Imaging, Tangshan Gongren Hospital, Tangshan, China X.Y. Yang X.Y. Yang Department of Medical Imaging, Tangshan Gongren Hospital, Tangshan, China L.L. Shi L.L. Shi Department of Radiology, Tangshan Maternal and Child Health Hospital, Tangshan, 063000, China Lung adenocarcinoma CT signs epidermal growth factor receptor tomography X-ray computed. 1. 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Key targets and mechanistic insights affecting radiotherapy effectiveness in renal carcinoma patients with concurrent renal failure 2 2 Background: To explore the key targets and regulatory mechanisms affecting the efficacy of radiotherapy (RT) in patients with renal carcinoma (RCC) complicated by renal failure. Materials and Methods: Differentially expressed genes (DEGs)(|log2FC|>2) in TCGA (n=537) and GEO data set (n=215) were screened by limma package in R software. Intersecting genes were accessed through the online site (InteractiVenn). The STRING and MCODE module of the Metascape website were used for key target screening and enriched pathway analysis. The preprocessCore R package was used for data normalization and batch effect processing. The survival/survminer R package was used to analyze the relationship between gene expression and patient survival. Results: High expression of ACADM, DLAT, SUCLA2 and SUCLG2 genes were all associated with significantly improved prognosis in renal cancer patients. The mOS time in the ACADM high expression group was 7.10 years [Hazard Ratio (HR) = 0.466, 95% Confidence Interval (CI): 0.353-0.615). The mOS time in the DLAT high expression group was 7.10 years (HR=0.489, 95% CI: 0.372-0.642). The mOS time in the SUCLA2 high expression group was 7.30 years (HR=0.458, 95% CI: 0.346-0.606). The mOS time in the SUCLG2 group was 7.00 years (HR=0.544, 95% CI: 0.415-0.715). Conclusion: The suppression of ACADM, DLAT, SUCLA2, and SUCLG2 can regulate fatty acid metabolism and tricarboxylic acid cycle-related pathways, which provides ideas for the prognosis of patients with RCC complicated by renal failure. 839 845 2025/10/252025/11/18 1404/8/27 2025/10/182025/10/18 1404/7/26 J. Wei J. Wei Department of Nephrology, Zibo First Hospital, Zibo Shandong, China P. Gao P. Gao Department of Nephrology, Zibo First Hospital, Zibo Shandong, China Z. Wang Z. Wang Department of Chinese Medicine, Zibo First Hospital, Zibo Shandong, China L. Fan L. Fan Hemodialysis Center, Zibo First Hospital, Zibo Shandong, China J. Zhao J. Zhao Department of Nephrology, Zibo First Hospital, Zibo Shandong, China zhaojin8490@dingtalk.com Prognosis radiotherapy renal carcinoma renal failure. 1. Zhang S, Xiong X, Xie N, et al. (2024) The efficacy and safety of stereotactic body radiotherapy combined with systematic therapy for metastatic renal cell carcinoma: a systematic review and meta-analysis. MedComm, 5: e544.##2. Naik P, Dudipala H, Chen YW, et al. (2024) The incidence, pathogenesis, and management of non-clear cell renal cell carcinoma. Therapeutic Advances in Urology, 16: 17562872241232578.##3. Schafer EJ, Jemal A, Wiese D, et al. (2023) Disparities and trends in genitourinary cancer incidence and mortality in the USA. European Urology, 84: 117-126.##4. 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Differentiating focal interstitial fibrosis from pulmonary adenocarcinoma in part-solid nodules using computed tomography features 2 2 Background: Distinguishing focal interstitial fibrosis from pulmonary adenocarcinoma based on computed tomography characteristics is challenging. We investigated the computed tomography features of part-solid lung nodules to identify characteristics useful for differentiating focal interstitial fibrosis from pre-invasive lesions or invasive pulmonary adenocarcinomas. Materials and Methods: Our research analyzed 182 part-solid lung nodules from 177 patients, comparing the computed tomography characteristics of focal interstitial fibrosis, pre-invasive lesions, and invasive pulmonary adenocarcinomas. Predictive factors for focal interstitial fibrosis were determined via binary logistic regression analysis. Predictive capability of the logistic regression model was assessed utilizing receiver operating characteristic curves. Results: Invasive pulmonary adenocarcinoma was seen in 124 part-solid lung nodules, while 21 nodules showed focal interstitial fibrosis. Binary logistic regression analysis between focal interstitial fibrosis and pre-invasive lesions revealed that irregular shape and concentrated distribution of the solid portion were significantly associated with focal interstitial fibrosis. Binary logistic regression analysis between focal interstitial fibrosis and invasive pulmonary adenocarcinomas revealed that smaller lesion size, ill-defined lesion borders, and solid portion’s well-defined borders were notable independent factors linked to focal interstitial fibrosis. The model using these three predictors to distinguish focal interstitial fibrosis from invasive pulmonary adenocarcinomas achieved a high receiver operating characteristic curve area of 0.845. Conclusion: Focal interstitial fibrosis exhibited distinct computed tomography features compared to pre-invasive lesions or invasive pulmonary adenocarcinomas; the solid portion of part-solid lung nodules might serve as a valuable distinguishing feature. 847 853 2025/10/252025/11/182025/11/18 1404/8/27 2025/10/182025/10/182025/10/18 1404/7/26 D. An D. An Department of Medical Imaging Center, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China Z. Zou Z. Zou Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China J. An J. An Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China Y. Tian Y. Tian Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China tianye0917@163.com Tomography X-Ray computed solitary pulmonary nodule pulmonary fibrosis adenocarcinoma of lung. 1. He X, Li X, Wu Y, et al. (2022) Differential diagnosis of nonabsorbable inflammatory and malignant subsolid nodules with a solid component ≤5 mm. Journal of Inflammation Research, 15: 1785-1796.##2. Lee H, Goo J, Lee C, et al. (2007) Nodular ground-glass opacities on thin-section CT: size change during follow-up and pathological results. Korean Journal of Radiology, 8: 22-31.##3. Henschke C, Yankelevitz D, Mirtcheva R, et al. (2002) CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. American Journal of Roentgenology, 178: 1053-1057.##4. Smyth R and Billatos E (2024) Novel strategies for lung cancer interventional diagnostics. J Clin Med, 13: 7207.##5. Woo JH, Kim JH, Jeong DY, et al. (2024) Differentiation between invasive adenocarcinoma and focal interstitial fibrosis among persistent pulmonary part-solid nodules: with emphasis on the CT morphologic analysis. Journal of Thoracic Imaging, 39: 335-341.##6. 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Journal of Korean Medical Science, 26: 237-242.##23. Qi L, Xue K, Li C, et al. (2019) Analysis of CT morphologic features and attenuation for differentiating among transient lesions, atypical adenomatous hyperplasia, adenocarcinoma in situ, minimally invasive and invasive adenocarcinoma presenting as pure ground-glass nodules. Sci Rep, 9: 14586.##24. Wu H, Zhang X, Zhong Z (2025) Exploration of CT-based discrimination and diagnosis of various pathological types of ground glass nodules in the lungs. BMC Med. Imaging, 25: 119.##25. Gao F, Sun Y, Zhang G, et al. (2019) CT characterization of different pathological types of subcentimeter pulmonary ground-glass nodular lesions. The British Journal of Radiology, 92: 20180204.##26. Park C, Goo J, Lee H, et al. (2007) Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up. Radiographics, 27: 391-408.##27. Wang H, Weng Q, Hui J, et al. 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Salivary metabolomic profiling reveals dynamic metabolic adaptations in nasopharyngeal carcinoma (NPC) patients during radiotherapy 2 2 Background: Nasopharyngeal carcinoma (NPC) is commonly treated with radiotherapy, which can induce systemic and local metabolic changes. Saliva, as a non-invasive biofluid, provides a valuable medium for monitoring such alterations. This study aimed to investigate salivary metabolic changes in NPC patients before and after radiotherapy using an untargeted metabolomics approach. Materials and Methods: Saliva samples were collected from 23 NPC patients both prior to and following radiotherapy. An untargeted metabolomics analysis was performed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Multivariate statistical analysis was employed to identify differential metabolites, and pathway enrichment analysis was conducted to elucidate the affected biological processes. Key metabolic features were selected using least absolute shrinkage and selection operator (LASSO) regression. Results: A total of 110 differential metabolites were identified, comprising 64 in positive ion mode (30 upregulated, 34 downregulated) and 46 in negative ion mode (31 upregulated, 15 downregulated). LASSO analysis highlighted four key metabolites: L-Carnitine and Kanosamine were significantly upregulated post-radiotherapy, whereas Phloroglucinol and Dibutyl phthalate were significantly downregulated. Pathway enrichment analysis revealed five significantly affected pathways: arginine biosynthesis, central carbon metabolism in cancer, arginine and proline metabolism, HIF-1 signaling pathway, and protein digestion and absorption. Conclusion: Salivary metabolomics revealed notable metabolic adaptations in NPC patients following radiotherapy, reflecting tissue repair and compensatory responses. These findings provide new insights into the metabolic impact of radiotherapy and may help identify potential therapeutic targets for optimizing treatment outcomes. 855 864 2025/10/252025/11/182025/11/182025/11/18 1404/8/27 2025/10/182025/10/182025/10/182025/10/18 1404/7/26 L. Ji L. Ji Department of Radiation Oncology, the First Affiliated Hospital of Soochow University, Soochow, China L. Wang L. Wang Department of Radiation Oncology, the First Affiliated Hospital of Soochow University, Soochow, China S. Qin S. Qin Department of Radiation Oncology, the First Affiliated Hospital of Soochow University, Soochow, China Y. Fan Y. Fan Department of Hematology, the First Affiliated Hospital of Soochow University, Soochow, China yifan.suda@vip.163.com J. Zhou J. Zhou Department of Radiation Oncology, the First Affiliated Hospital of Soochow University, Soochow, China zhoujuyingsy@163.com Nasopharyngeal neoplasms radiotherapy metabolomics saliva metabolic networks and pathways. 1. Sonis ST and Anderson CM (2023) Avasopasem for the treatment of radiotherapy-induced severe oral mucositis. Expert Opin Investig Drugs, 32(6): 463-70.##2. Fang Y, Wang L, Chen X, Cao C (2024) Maxillary sinus anterior wall recurrence after intensity-modulated radiotherapy for nasopharyngeal carcinoma. International Journal of Radiation Research, 22(3): 803-5.##3. Elad S, Yarom N, Zadik Y, Kuten-Shorrer M, Sonis ST (2022) The broadening scope of oral mucositis and oral ulcerative mucosal toxicities of anticancer therapies. CA Cancer J Clin, 72(1): 57-77.##4. Wu Z, Wang B, Zhou X, Xu B, Zeng Z (2022) Radiation-induced oral mucositis is a critical dilemma for patients and physicians during radiotherapy for nasopharyngeal carcinoma. Clinical Cancer Bulletin, 1(2): 95-9.##5. Tang J, Xu X, Chen M, Liu L, Zhan Z (2025) Efficacy and safety of hypofractionated radiotherapy and conventional fractionated radiotherapy in the treatment of early breast cancer patients after breast-conserving surgery. International Journal of Radiation Research, 23(1): 163-8.##6. Li Y, Yang Z, Cai T, Jiang D, Luo J, Zhou Z (2023) Untargeted metabolomics of saliva in caries-active and caries-free children in the mixed dentition. Frontiers in Cellular and Infection Microbiology, 13: 1104295.##7. Balakittnen J, Ekanayake Weeramange C, Wallace DF, Duijf PHG, Cristino AS, Hartel G, et al. A novel saliva-based miRNA profile to diagnose and predict oral cancer. Int J Oral Sci. 2024;16(1):14.##8. Tzimas K, Pappa E. Saliva Metabolomic Profile in Dental Medicine Research: A Narrative Review. Metabolites. 2023;13(3).##9. Liang L, Rasmussen MH, Piening B, Shen X, Chen S, Rost H, et al. (2020) Metabolic dynamics and prediction of gestational age and time to delivery in pregnant women. Cell, 181(7): 1680-92 e15.##10. Gardner A, Carpenter G, So PW (2020) Salivary metabolomics: from diagnostic biomarker discovery to investigating biological function. Metabolites, 10(2): 47.##11. Mikkonen JJ, Singh SP, Herrala M, Lappalainen R, Myllymaa S, Kullaa AM (2016) Salivary metabolomics in the diagnosis of oral cancer and periodontal diseases. J Periodontal Res, 51(4): 431-7.##12. Buzalaf MAR, Ortiz AdC, Carvalho TS, Fideles SOM, Araújo TT, Moraes SM, et al. (2020) Saliva as a diagnostic tool for dental caries, periodontal disease and cancer: is there a need for more biomarkers? Expert Review of Molecular Diagnostics, 20(5): 543-55.##13. Kim S, Kim HJ, Song Y, Lee HA, Kim S, Chung JJJocp (2021) Metabolic phenotyping of saliva to identify possible biomarkers of periodontitis using proton nuclear magnetic resonance. Journal of Clinical Periodontology, 48(9): 1240-9.##14. Zheng WB, Zou Y, Elsheikha HM, Liu GH, Hu MH, Wang SL, et al. (2019) Serum metabolomic alterations in Beagle dogs experimentally infected with Toxocara canis. Parasit Vectors, 12(1): 447.##15. Fritz IB, Yue KT. Long-Chain Carnitine Acyltransferase and the Role of Acylcarnitine Derivatives in the Catalytic Increase of Fatty Acid Oxidation Induced by Carnitine. J Lipid Res. 1963;4:279-88.##16. Graziano F, Bisonni R, Catalano V, Silva R, Rovidati S, Mencarini E, et al. (2002) Potential role of levocarnitine supplementation for the treatment of chemotherapy-induced fatigue in non-anaemic cancer patients. Br J Cancer, 86(12): 1854-7.##17. Kraft M, Kraft K, Gärtner S, Mayerle J, Simon P, Weber E, et al. (2012) L-Carnitine-supplementation in advanced pancreatic cancer (CARPAN)--a randomized multicentre trial. Nutrition Journal, 11: 52.##18. Longo N, Frigeni M, Pasquali M (2016) Carnitine transport and fatty acid oxidation. Biochim Biophys Acta, 1863(10): 2422-35.##19. Mahmud T (2003) The C7N aminocyclitol family of natural products. Nat Prod Rep, 20(1): 137-66.##20. Kudo F and Eguchi T (2009) Biosynthetic genes for aminoglycoside antibiotics. J Antibiot (Tokyo), 62(9): 471-81.##21. Vijayalaxmi S, Jayalakshmi SK, Sreeramulu K (2015) Polyphenols from different agricultural residues: extraction, identification and their antioxidant properties. Journal of Food Science and Technology, 52(5): 2761-9.##22. Benjamin S, Masai E, Kamimura N, Takahashi K, Anderson RC, Faisal PA (2017) Phthalates impact human health: Epidemiological evidences and plausible mechanism of action. J Hazard Mater, 340: 360-83.##23. Wu G, Bazer FW, Davis TA, Kim SW, Li P, Marc Rhoads J, et al. (2009) Arginine metabolism and nutrition in growth, health and disease. Amino Acids, 37(1): 153-68.##24. Morris SM, Jr. (2016) Arginine metabolism revisited. J Nutr, 146(12): 2579S-86S.##25. Geiger R, Rieckmann JC, Wolf T, Basso C, Feng Y, Fuhrer T, et al. (2016) L-arginine modulates T cell metabolism and enhances survival and anti-tumor activity. Cell, 167(3): 829-42 e13.##26. Song CW, Shakil A, Osborn JL, Iwata K (2009) Tumour oxygenation is increased by hyperthermia at mild temperatures. International Journal of Hyperthermia, 25(2): 91-5.##27. Xiong L, Teng JL, Botelho MG, Lo RC, Lau SK, Woo PC (2016) Arginine metabolism in bacterial pathogenesis and cancer therapy. Int J Mol Sci, 17(3): 363.##28. Wu G, Bazer FW, Burghardt RC, Johnson GA, Kim SW, Knabe DA, et al. (2011) Proline and hydroxyproline metabolism: implications for animal and human nutrition. Amino Acids, 40(4): 1053-63.##29. Phang JM, Donald SP, Pandhare J, Liu Y (2008) The metabolism of proline, a stress substrate, modulates carcinogenic pathways. Amino Acids, 35(4): 681-90.##30. Phang JM, Liu W, Hancock CN, Fischer JW (2015) Proline metabolism and cancer: emerging links to glutamine and collagen. Curr Opin Clin Nutr Metab Care, 18(1): 71-7.##31. Horsman MR and Overgaard J (2016) The impact of hypoxia and its modification of the outcome of radiotherapy. J Radiat Res, 57; Suppl 1(Suppl 1): i90-i8.##32. Semenza GL (2012) Hypoxia-inducible factors in physiology and medicine. Cell, 148(3): 399-408.##33. Balamurugan K (2016) HIF-1 at the crossroads of hypoxia, inflammation, and cancer. International Journal of Cancer, 138(5): 1058-66.##34. Gray LH, Conger AD, Ebert M, Hornsey S, Scott OJTBjor (1953) The concentration of oxygen dissolved in tissues at the time of irradiation as a factor in radiotherapy. Br J Radiol, 26(312): 638-48.##35. Kim JW, Tchernyshyov I, Semenza GL, Dang CV (2006) HIF-1-mediated expression of pyruvate dehydrogenase kinase: a metabolic switch required for cellular adaptation to hypoxia. Cell Metab, 3(3): 177-85.##36. Noman MZ, Desantis G, Janji B, Hasmim M, Karray S, Dessen P, et al. (2014) PD-L1 is a novel direct target of HIF-1α, and its blockade under hypoxia enhanced MDSC-mediated T cell activation. The Journal of Experimental Medicine, 211(5): 781-90.##37. 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Diagnostic accuracy of contrast enhanced spectral mammography in assessment of indeterminate breast lesions in patients who underwent breast conservation surgery 2 2 Background: Breast cancer stands out as a major health issue globally, being the most common type of cancer diagnosed in women around the world. Its impact in Egypt is particularly pronounced, accounting for a substantial proportion of new cancer cases. Contrast-Enhanced Spectral Mammography (CESM) has emerged as a promising diagnostic tool for breast tumors. By visualizing tumor angiogenesis, CESM offers improved accuracy compared to traditional mammography with or without ultrasound. Its ability to depict tumor neovascularity parallels that of breast magnetic resonance imaging (MRI). This study was done to assess how well CESM can accurately identify the nature of unclear breast lesions in patients who have had breast-conserving surgery (BCS). Materials and Methods: We carried out a retrospective study with 30 women who had breast-conserving surgery due to ambiguous breast lesions found by traditional mammography. Their ages varied between 32 and 77, averaging 50.07 years. Each patient received dual-energy contrast-enhanced spectral mammography. The definitive diagnosis was confirmed by examining tissue samples from surgery or biopsy through histopathology. Results: Examination of the 30 patients showed that 23 had benign lesions (69.7%) while 10 were malignant (30.3%). The diagnostic performance character of CESM was improved with the use of the malignancy potential score (MPS) in distinguishing between benign and malignant breast lesions. Conclusion: The results indicate that CESM serves as an effective supplement to traditional mammography for evaluating unclear breast lesions after breast-conserving surgery. Its enhanced sensitivity and accuracy could lead to better patient management and improved health outcomes. 865 871 2025/10/252025/11/182025/11/182025/11/182025/11/18 1404/8/27 2025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 D.A. Mohamed Shaban D.A. Mohamed Shaban Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt daliaashaban@gmail.com A.A. Ghaffar Boraei A.A. Ghaffar Boraei Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt N.A.E. Tawfik Chalabi N.A.E. Tawfik Chalabi Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt M.A.M. Ali Nagi M.A.M. Ali Nagi Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt Comprehensive Diagnostic accuracy breast cancer contrast-enhanced spectral mammography breast lesions breast-conserving surgeries. Lee CH, Phillips J, Sung JS, et al. (2024) Contrast enhanced mammography (CEM) (A supplement to ACR BI-RADS® mammography). American College of Radiology.##Azim HA and Ibrahim AS (2014) Breast cancer in Egypt, China and Chinese: statistics and beyond. Journal of Thoracic Dis, 6(7): 864-866. doi: 10.3978/j.issn.2072-1439.2014.06.38.##Nada O, El Fiky S, Chalabi N, et al. (2021) Role of contrast enhanced spectral mammography after conserving brest surgery. Ain Shams Medical Journal, 72(4): 767-779. doi: 10.21608/asmj.2021.222682.##Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA: A Cancer Journal for Clinicians, 69(1): 7-34. doi: 10.3322/caac.21551.##Helal M, Abu Samra M, Ibraheem M, et al. (2017) Accuracy of CESM versus conventional mammography and ultrasound in evaluation of BI-RADS 3 and 4 breast lesions with pathological correlation. The Egyptian Journal of Radiology and Nuclear Medicine, 48: 741-750. doi: 10.1016/j.ejrnm.2017.03.004. ##Petit JY, Veronesi U, Luini A, et al. (2005) When mastectomy becomes inevitable: the nipple-sparing approach. Breast, 14(6): 527-531. doi: 10.1016/j.breast.2005.08.028. ##Zeeneldin AA, Ramadan M, Gaber AA, et al. (2013) Clinico-pathological features of breast carcinoma in elderly Egyptian patients: a comparison with the non-elderly using population-based data. Journal of the Egyptian National Cancer Institute, 25(1): 5-11. doi: 10.1016/j.jnci.2012.10.003. ##Yousef AF, Khater HM, Jameel LM (2018) Contrast-enhanced spectral mammography versus magnetic resonance imaging in the assessment of breast masses. Benha Medical Journal, 35: 5-12.##Patel BK, Lobbes MBI, Lewin J (2018) Contrast Enhanced Spectral Mammography: A Review. Semin Ultrasound CT MR, 39(1): 70-79. doi: 10.1053/j.sult.2017.08.005.##Kamal RM, Helal MH, Wessam R, et al. (2015) Contrast-enhanced spectral mammography: Impact of the qualitative morphology descriptors on the diagnosis of breast lesions. European Journal of Radiology, 84(6): 1049-1055. doi: 10.1016/j.ejrad.2015.03.005.##Diekmann F and Bick U (2007) Tomosynthesis and contrast-enhanced digital mammography: recent advances in digital mammography. European Radiology, 17(12): 3086-3092. doi: 10.1007/s00330-007-0715-x.##Dromain C, Thibault F, Diekmann F, et al. (2013) Dual-energy contrast-enhanced digital mammography: initial clinical results of a multireader, multicase study. Breast Cancer Research, 14(3): R94. doi: 10.1186/bcr3210.##Fallenberg EM, Dromain C, Diekmann F, et al. (2014) Contrast-enhanced spectral mammography versus MRI: Initial results in the detection of breast cancer and assessment of tumour size. Eur Radiol, 24(1): 256-264. doi: 10.1007/s00330-013-3007-7.##While A, Krupinski E, Mordang JJ, et al. (2019) Detection of breast cancer with mammography: effect of an artificial intelligence support system. Radiology, 290(2): 305-314.##Hua B, Chen J, Li QR, et al. (2025) Breast non-mass enhancement lesions on contrast-enhanced mammography: modified breast image reporting and data system classification. Clin Radiol, 83: 106807. doi: 10.1016/j.crad.2025.106807.##Sanders JW, Pavlicek W, Stefan W, et al. (2025) Digital mammography, tomosynthesis, and contrast-enhanced mammography: intraindividual comparison of mean glandular dose for screening examinations. Am J Roentgenol, 224(3): e2432150. doi: 10.2214/AJR.24.32150.##Xu W, Chen L, Zeng W, et al. (2025) Addition of contrast-enhanced mammography enhancement patterns and morphology for differentiating benign from malignant papillary breast lesions. Br J Radiol, 98(1167): 383-391. doi: 10.1093/bjr/tqae241.##Long R, Luo Y, Cao M, et al. (2025) Malignancy risk stratification prediction of BI-RADS 4B calcifications based on contrast-enhanced mammographic features: a multicenter study. Breast Cancer Res Treat, 210(1): 135-145. doi: 10.1007/s10549-024-07546-w.##Ferrara F, Santonocito A, Vogel W, et al. 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Generation of computed tomography images with different tube voltages by generative adversarial network 2 2 Background: Single-energy computed tomography (SECT) requires different energies for disease diagnosis and detection. The patient must be scanned again after the CT scan to obtain other tube-voltage images, causing increased radiation exposure. One method for avoiding rescanning is virtual monochromatic images (VMI) by dual-energy computed tomography (DECT). However, VMI has not proven superior to SECT. Moreover, DECT is not available at all facilities. This study used generative adversarial networks to generate 120 kVp and Sn140 kVp CT images from 80 kVp CT images. Material and Methods: This study involved 35 patients with pulmonary hypertension who underwent CT scans with DECT. The peak signal-to-noise ratio (PSNR) and structural similarity (SSIM) were calculated to evaluate the difference between the real and pseudo images. Furthermore, the mean CT values of the pulmonary arteries (PA) were compared. Results: The SSIM was 0.99 ± 9.15×10-5 and 0.99 ± 3.38×10-3 at 120 kVp and Sn140 kVp, respectively. The PSNR was 69.1 ± 1.29 and 66.5 ± 5.40 at 120 kVp and Sn140 kVp, respectively. Additionally, no significant differences were observed in the mean CT values of PA (p > 0.05) between the real and pseudo images. Conclusion: The proposed model accurately generated 120 kVp and Sn140 kVp CT images from 80 kVp CT images. 873 879 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/19 1404/8/28 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 H. Takano H. Takano Department of Radiological Technology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan hirokazu.takano.a1@tohoku.ac.jp Y. Kondo Y. Kondo Graduate School of Health Sciences, Niigata University, 746 Asahimachidori 2bancho, Chuo-ku, Niigata City, Niigata, 951-8518, Japan Y. Ishizawa Y. Ishizawa Department of Radiological Technology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan S. Onodera S. Onodera Department of Radiological Technology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan M. Saito M. Saito Graduate School of Health Sciences, Niigata University, 746 Asahimachidori 2bancho, Chuo-ku, Niigata City, Niigata, 951-8518, Japan H. Ota H. Ota Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan Deep learning medical image processing dual-energy scanned projection radiography pulmonary artery. 1. Mayer C, Meyer M, Fink C, et al. (2014) Potential for radiation dose savings in abdominal and chest CT using automatic tube voltage selection in combination with automatic tube current modulation. Am J Roentgenol, 203(2): 292-299.##2. May MS, Kramer MR, Eller A, et al. 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(2020) Iodine dose optimization in portal venous phase virtual monochromatic images of the abdomen: Prospective study on rapid kVp switching dual energy CT. Eur J Radiol, 122: 108746.##15. Sugawara H, Suzuki S, Katada Y, et al. (2019) Comparison of full-iodine conventional CT and half-iodine virtual monochromatic imaging: advantages and disadvantages. Eur Radiol, 29(3): 1400-1407.##16. Hamersvelt RW van, Eijsvoogel NG, Mihl C, et al. (2018) Contrast agent concentration optimization in CTA using low tube voltage and dual-energy CT in multiple vendors: a phantom study. Int J Cardiovasc Imaging, 34(8): 1265-1275.##17. Yoshida M, Nakaura T, Sentaro T, et al. (2020) Prospective comparison of 70-kVp single-energy CT versus dual-energy CT: Which is more suitable for CT angiography with low contrast media dosage? Acad Radiol, 27(5): e116-e122.##18. Dai X, Schlemmer HP, Schmidt B, et al. (2013) Quantitative therapy response assessment by volumetric iodine-uptake measurement: Initial experience in patients with advanced hepatocellular carcinoma treated with sorafenib. Eur J Radiol, 82(2): 327-334. ##19. Im DJ, Hur J, Han K, et al. (2020) Prognostic value of dual-energy CT-based iodine quantification versus conventional CT in acute pulmonary embolism: A propensity-match analysis. Korean J Radiol, 21(9): 1095-1103. ##20. Foti G, Silva R, Faccioli N, et al. (2021) Identification of pulmonary embolism: diagnostic accuracy of venous-phase dual-energy CT in comparison to pulmonary arteries CT angiography. Eur Radiol, 31(4): 1923-1931. ##21. Ko JP, Brandman S, Stember J, Naidich DP (2012) Dual-energy computed tomography concepts, performance, and thoracic applications. J Thorac Imaging, 27(1): 7-22.##22. He J, Fang W, Lv B, et al. (2012) Diagnosis of chronic thromboembolic pulmonary hypertension: comparison of ventilation/perfusion scanning and multidetector computed tomography pulmonary angiography with pulmonary angiography. Nucl Med Commun, 33(5): 459-463.##23. Delcroix M, Torbicki A, Gopalan D, et al. (2021) ERS statement on chronic thromboembolic pulmonary hypertension. Eur Respir J, 57(6): 2002828.##24. Nakazawa T, Watanabe Y, Hori Y, et al. (2011) Lung perfused blood volume images with dual-energy computed tomography for chronic thromboembolic pulmonary hypertension: Correlation to scintigraphy with single-photon emission computed tomography. J Comput Assist Tomogr, 35(5): 590-595.##25. Takagi H, Ota H, Sugimura K, et al. (2016) Dual-energy CT to estimate clinical severity of chronic thromboembolic pulmonary hypertension: Comparison with invasive right heart catheterization. Eur J Radiol, 85(9): 1574-1580.##26. Goodfellow IJ, Pouget-Abadie J, Mirza M, et al. (2014) Generative Adversarial Networks. ArXiv Preprint arXiv: 1406.2661. ##27. Mirza M and Osindero S (2014) Conditional Generative Adversarial Nets. ArXiv Preprint arXiv: 1411.1784.##28. Yi X, Walia E, Babyn P (2019) Generative adversarial network in medical imaging: A review. Med Image Anal, 58: 101552.##29. Yi X and Babyn P (2018) Sharpness-aware low-dose CT denoising using conditional generative adversarial network. J Digit Imaging, 31(5): 655-669. ##30. Wang Y, Zhou L, Wang L, et al. (2018) Locality adaptive multi-modality GANs for high-quality PET image synthesis. Lect Notes Comput Sc, 11070: 329-337.##31.Gholamiankhah F, Mostafapour S, et al. (2022) Deep learning-based synthetic CT generation from MR images: comparison of generative adversarial and residual neural networks. Int J Radiat Res, 20(1): 121–130.##32. Kawahara D, Ozawa S, Kimura T, Nagata Y (2021) Image synthesis of monoenergetic CT image in dual‐energy CT using kilovoltage CT with deep convolutional generative adversarial networks. J Appl Clin Med Phys, 22(4): 184-192.##33. Zhao W, Lyu T, Chen Y, Xing L (2020) A deep learning approach for virtual monochromatic spectral CT imaging with a standard single energy CT scanner. ArXiv Preprint arXiv: 2005.09859.##34. Funama Y, Oda S, Kidoh M, et al. (2021) Conditional generative adversarial networks to generate pseudo low monoenergetic CT image from a single-tube voltage CT scanner. Phys Medica, 83: 46-51.##35. Zhou H, Liu X, Wang H, et al. (2022) The synthesis of high-energy CT images from low-energy CT images using an improved cycle generative adversarial network. Quantitative Imaging Medicine Surg, 12(1): 28-42.##36. Isola P, Zhu JY, Zhou T, Efros AA (2017) Image-to-image translation with conditional adversarial networks. 2017 Ieee Conf Comput Vis Pattern Recognit Cvpr: 5967-5976.##37. Rajkumar S and Malathi G (2016) A Comparative analysis on image quality assessment for real time satellite images. Indian J Sci Technology, 9(34): 1-11.##38. Wang Z, Bovik AC, Sheikh HR, Simoncelli EP (2004) Image Quality Assessment: From Error Visibility to Structural Similarity. Ieee T Image Process, 13(4): 600-612.##39. Sarah B, Ashrith G, Sandeep S. (2021) Evaluation, diagnosis, and classification of pulmonary hypertension. Methodist DeBakey Cardiovasc J, 17(2): 86-91.##40. Li S, Wang Y, Liao Y, et al. (2017) Pseudo dual energy CT imaging using deep learning-based framework: Initial study. ArXiv Preprint arXiv:1711.07118.##41. Zhao W, Lv T, Gao P, et al. (2019) Dual-energy CT imaging using a single-energy CT data is feasible via deep learning. ArXiv Preprint arXiv:1906.04874.##42. Charyyev S, Wang T, Lei Y, et al. (2021) Learning-based synthetic dual energy CT imaging from single energy CT for stopping power ratio calculation in proton radiation therapy. Br J Radiol, 95: 20210644.##43. Liu CK, Liu CC, Yang CH, Huang HM (2021) Generation of brain dual-energy CT from single-energy CT using deep learning. 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Impact of body contouring changes on dosimetric accuracy in volumetric modulated arc cherapy (VMAT) for cervical cancer: A method to identify target dose deviations beyond 5% 2 2 Background: This study evaluates the impact of body contouring changes on delivered dose and proposes a method to identify target dose deviations exceeding 5%. Materials and Methods: Five CT datasets were created by simulating body contouring reductions of 3mm, 6mm, 9mm, 12mm, and 15mm from the original planning CT. Using the same iso-center and Volumetric Modulated Arc Therapy (VMAT) plan, new plans (P3, P6, P9, P12, P15) were generated for new five CT datasets (body contouring reductions of 3mm, 6mm, 9mm, 12mm, and 15mm) respectively. Dose distributions and changes in dosimetric parameters for the Planning Target Volume (PTV) and Organs at Risk (OARs), including the small intestine, rectum, bone marrow, femoral head, and bladder, were analyzed. Results: Progressive weight loss increased doses to PTVs and OARs. PTV D50 increased by 1.32%, 2.35%, 3.62%, 5.18%, and 6.24% for 3mm, 6mm, 9mm, 12mm, and 15mm reductions, respectively. The small intestine V45 exceeded 195cc and the rectum V50 surpassed 50% at 12mm and 15mm. Bone marrow doses remained below the V40 threshold of 37%. When reductions reached 12mm and 15mm, regions with dose deviations >5% (250cGy) covered 31.81% and 178.08% of the PTV. Conclusion: Weight loss-induced body contouring reductions significantly affect PTV and OAR doses. Re-scanning and re-planning are recommended when contour reductions exceed 12mm or waist circumference decreases by >75mm. 881 887 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/19 1404/8/28 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 Z. Cao Z. Cao Department of Oncology, Maternal and Child Health Hospital of Hubei Province, Hubei, China W. Xu W. Xu Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, China J. Shen J. Shen Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, China L. Li L. Li Department of Oncology, Maternal and Child Health Hospital of Hubei Province, Hubei, China Lilinjun00417@126.com H. Liu H. Liu Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, China hbzkznyy@163.com C. Chen C. Chen Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, China chenc20022002@163.com Radiotherapy volumetric modulated arc therapy weight loss dosimetry cervical neoplasms. 1. Ali AN, Dhabaan AH, Jarrio CS, et al. (2012) Dosimetric comparison of volumetric modulated arc therapy and intensity-modulated radiation therapy for pancreatic malignancies. Medical Dosimetry, 37: 271-275.##2. Quan EM, Li X, Li Y, et al. (2012) A comprehensive comparison of IMRT and VMAT plan quality for prostate cancer treatment. Int J Radiat Oncol Biol Phys, 83: 1169-1178.##3. Ali AN, Dhabaan AH, Jarrio CS, et al. (2012) Dosimetric comparison of volumetric modulated arc therapy and intensity-modulated radiation therapy for pancreatic malignancies. Medical Dosimetry, 37: 271-275.##4. Zhang W, Cao Y, Ni X, et al. (2022) Study on the physical factors related to the exposure dose to organs at risk from radiotherapy for cervical cancer patients. Int J Radiat Res, 20: 587-591.##5. Xiong Q, Zhang T, Su S (2021) Efficacy of the inducing chemotherapy combined with synchronized chemotherapy and radiotherapy on the local advanced cervical cancer. Int J Radiat Res, 19: 1001-1007.##6. Lee J, Park JM, Wu HG, et al. (2015) The effect of body contouring on the dose distribution delivered with volumetric‐modulated arc therapy technique. Journal of Applied Clinical Medical Physics, 16: 365-375.##7. Robertson JM, Lockman D, Yan D, et al. (2008) The dose–volume relationship of small bowel irradiation and acute grade 3 diarrhea during chemoradiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys, 70: 413-418.##8. Robertson JM, Söhn M, Yan D (2010) Predicting grade 3 acute diarrhea during radiation therapy for rectal cancer using a cutoff-dose logistic regression normal tissue complication probability model. Int J Radiat Oncol Biol Phys, 77: 66-72.##9. Roeske JC, Bonta D, Mell LK, et al. (2003) A dosimetric analysis of acute gastrointestinal toxicity in women receiving intensity-modulated whole-pelvic radiation therapy. Radiotherapy and Oncology, 69: 201-207.##10. Li F, Guo H, Qiu H, et al. (2018) Urological complications after radical hysterectomy with postoperative radiotherapy and radiotherapy alone for cervical cancer. Medicine, 97: e0173.##11. Chong V and Rice M (2016) The effectiveness of hyperbaric oxygen therapy (HBOT) in radiation-induced haemorrhagic cystitis. The New Zealand Medical Journal, 129: 79.##12. Mell LK, Tiryaki H, Ahn KH, et al. (2008) Dosimetric comparison of bone marrow-sparing intensity-modulated radiotherapy versus conventional techniques for treatment of cervical cancer. Int J Radiat Oncol Biol Phys, 71: 1504-1510.##13. Mell LK, Schomas DA, Salama JK, et al. (2008) Association between bone marrow dosimetric parameters and acute hematologic toxicity in anal cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys, 70: 1431-1437.##14. Lujan AE, Mundt AJ, Yamada SD, et al. (2003) Intensity-modulated radiotherapy as a means of reducing dose to bone marrow in gynecologic patients receiving whole pelvic radiotherapy. Int J Radiat Oncol Biol Phys, 57: 516-521.##15.Shalek RJ (1977) Determination of absorbed dose in a patient irradiated by beams of X or gamma rays in radiotherapy procedures. Medical Physics, 4: 461.##16. Wambersie A, Landberg TG, Chavaudra J, et al. (1992) Prescribing, recording, and reporting photon beam therapy presentation of the ICRU report# 50. Journal of Medical Physics, 17: 5-7.##17. Chow JCL, Jiang R (2013) Dosimetry estimation on variations of patient size in prostate volumetric-modulated arc therapy. Medical Dosimetry, 38: 42-47.##18. Pair ML, Du W, Rojas HD, et al. (2013) Dosimetric effects of weight loss or gain during volumetric modulated arc therapy and intensity-modulated radiation therapy for prostate cancer. Medical Dosimetry, 38: 251-254.##19. Sun L, Kirkby C, Smith W (2019) Dosimetric effect of body contour changes for prostate and head and neck volumetric modulated arc therapy plans. Journal of Applied Clinical Medical Physics, 20: 115-124.##20. Moallim M, Maungwe P, Chamunyonga C (2015) CBCT-guided radiotherapy for locally advanced head and cancer: dosimetric impact of weight loss on VMAT and IMRT plans for selected organs at risk structures (OARs). Journal of Radiotherapy in Practice, 14: 336-342.##21. Chen C, Fei Z, Chen L, et al. (2014) Will weight loss cause significant dosimetric changes of target volumes and organs at risk in nasopharyngeal carcinoma treated with intensity-modulated radiation therapy? Medical Dosimetry, 39: 34-37.##22. Hodapp N (2012) The ICRU Report 83: prescribing, recording and reporting photon-beam intensity-modulated radiation therapy (IMRT). Strahlentherapie und Onkologie, 188: 97-99.##23. Kavanagh BD, Pan CC, Dawson LA, et al. (2010) Radiation dose–volume effects in the stomach and small bowel. Int J Radiat Oncol Biol Phys, 76: S101-S107.## ##

Preoperative assessment of gastric cancer using multi-slice spiral ct perfusion imaging: A study of its diagnostic value 2 2 Background: Globally, gastric cancer (GC) continues to be a primary driver of cancer deaths, as delayed diagnoses frequently lead to unfavorable clinical outcomes. Accurate preoperative assessment is critical for optimizing treatment strategies and enhancing patient outcomes. This research analyzed the preoperative evaluation value of multi-slice spiral computed tomography (MSCT) perfusion imaging in GC. Material and Methods: A cohort of 112 GC patients was recruited between January 2022 and April 2024 for quantification of MSCT perfusion metrics, including blood flow (BF), blood volume (BV), permeability surface (PS), and mean transit time (MTT). Results: Advanced-stage GC exhibited significantly higher BF, BV, and PS than early-stage disease (P<0.05). TNM stage progression (Ia+Ib → III+IIIa → III+IV) correlated with increasing BF, BV, and PS (P<0.05), while tumor location showed no significant parameter differences. Well-differentiated tumors had higher BF and PS but lower MTT than poorly differentiated cases (P<0.05). Patients without lymph node metastasis (LNM) or distant metastasis demonstrated reduced perfusion parameters, with BF and PS being statistically lower in non-metastatic groups (P<0.05). Conclusion: These findings suggest that MSCT perfusion imaging effectively reflects hemodynamic changes and provides valuable insights into tumor staging, differentiation, and metastasis, supporting its clinical utility in preoperative GC evaluation. 889 894 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/16 1404/9/25 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 F. Peng F. Peng Department of Radiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China J. Song J. Song Department of Radiology, the Second Affiliated Hospital Of Hainan Medical University, Hainan Haikou 570311, China Y. Zhang Y. Zhang Department of Breast Armor Surgery, the Second Affiliated Hospital Of Hainan Medical University Hainan Haikou 570311, China Q. Peng Q. Peng Large aperture CT room, Shandong Cancer Hospital, Jinan City, Shandong Province, 250117 China jack6558@163.com Stomach neoplasms multidetector computed tomography perfusion imaging preoperative period neoplasm staging hemodynamics. 1. Xu R, Chen XD, Ding Z (2022) Perioperative nutrition management for gastric cancer. Nutrition, 93: 111492.##2. Jaroenlapnopparat A, Bhatia K, Coban S (2022) Inflammation and gastric cancer. Diseases, 10(3): 35.##3. Zhang Y and Yu J (2020) The role of MRI in the diagnosis and treatment of gastric cancer. Diagn Interv Radiol. 26(3): 176-182.##4. Ferlay J, Colombet M, Soerjomataram I, et al. (2021) Cancer statistics for the year 2020: An overview. Int J Cancer, 149(4): 778-789.##5. Ilic M and Ilic I (2022) Epidemiology of stomach cancer. World J Gastroenterol, 28(12): 1187-1203.##6. Gao H, Wan Y, Fan X, et al. (2021) The Role of cholinesterase in differential diagnosis between gastric cancer and benign gastric diseases. Clin Lab, 67(2): 200525. ##7. Li Y, Hu X, Lin R, et al. (2022) Single-cell landscape reveals active cell subtypes and their interaction in the tumor microenvironment of gastric cancer. Theranostics, 12(8): 3818-3833.##8. López Sala P, Leturia Etxeberria M, Inchausti Iguíñiz E, et al. (2023) Gastric adenocarcinoma: A review of the TNM classification system and ways of spreading. Radiologia (Engl Ed), 65(1): 66-80.##9. Huang W, Wang L, Ye H (2024) Study on the application of multislice spiral CT in the diagnosis and evaluation of radiotherapy efficacy for esophageal cancer. International Journal of Radiation Research, 22(4): 823-829.##10. Zhao S, Bi Y, Wang Z, et al. (2022) Accuracy evaluation of combining gastroscopy, multi-slice spiral CT, Her-2, and tumor markers in gastric cancer staging diagnosis. World J Surg Oncol, 20(1): 152.##11. Liu W, Li Y, Zhang X, et al. (2022) Preoperative T and N restaging of rectal cancer after neoadjuvant chemoradiotherapy: An accuracy comparison between MSCT and MRI. Front Oncol, 11: 806749.##12. Hao R, Sun Y, Hu Y (2024) A comprehensive study on the diagnostic value of multi-slice computed tomography for peripancreatic infection in elderly with severe acute pancreatitis. Gastroenterology Res,17(2): 82-89.##13. Li CF, Wang DP, Xue YW (2018) Evaluation of a multi-slice spiral computed tomography perfusion for the prediction of the recurrence of gastric cancer. Future Oncol, 14(19): 1953-1963. ##14. Ajani JA, D'Amico TA, Bentrem DJ, et al. (2022) Gastric cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 20(2): 167-192.##15. Mranda GM, Xue Y, Zhou XG, et al. (2022) Revisiting the 8th AJCC system for gastric cancer: A review on validations, nomograms, lymph nodes impact, and proposed modifications. Ann Med Surg (Lond), 75: 103411.##16. Yang WJ, Zhao HP, Yu Y, et al. (2022) Updates on global epidemiology, risk and prognostic factors of gastric cancer. World J Gastroenterol, 29(16): 2452-2468.##17. Ugai T, Sasamoto N, Lee HY, et al. Is early-onset cancer an emerging global epidemic? Current evidence and future implications. Nat Rev Clin Oncol, 19(10): 656-673.##19. Liu X, Wang X and Mao T, et al. (2023) Characteristic analysis of early gastric cancer after Helicobacter pylori eradication: a multicenter retrospective propensity score-matched study. Ann Med, 55(1): 2231852.##19. Dong D, Tang La, Li ZY, et al. (2019) Development and validation of an individualized nomogram to identify occult peritoneal metastasis in patients with advanced gastric cancer. Ann Oncol, 30(3): 431-438.##20. Gao YL, Zhang YH, Cao M (2022) Preoperative evaluation of endoscopic submucosal dissection for early gastric cancer. Medicine (Baltimore), 101(37): e30582.##21. Li Q, Cui D, Feng Y, et al. (2021) Correlation between microvessel density (MVD) and multi-spiral CT (MSCT) perfusion parameters of esophageal cancer lesions and the diagnostic value of combined CtBP2 and P16. J Gastrointest Oncol, 12(3): 981-990. ##22. Wautier JL and Wautier MP (2022) Vascular permeability in diseases. Int J Mol Sci, 23(7): 3645.##23. Steeg PS (2021) The blood-tumor barrier in cancer biology and therapy. Nat Rev Clin Oncol, 18(11): 696-714.##24. Kanugula AK, Adapala RK, Jamaiyar A, et al. (2021) Endothelial TRPV4 channels prevent tumor growth and metastasis via modulation of tumor angiogenesis and vascular integrity. Angiogenesis, 24(3): 647-656.##25. Majidpoor J and Mortezaee K (2021) Steps in metastasis: an updated review. Med Oncol, 38(1): 3.##26. Feng G, Lei Z, Wang D, et al. (2014) The evaluation of anti-angiogenic effects of Endostar on rabbit VX2 portal vein tumor thrombus using perfusion MSCT. Cancer Imaging, 14(1): 17.##27. Xu N, Lei Z, Li XL, et al. (2013) Clinical study of tumor angiogenesis and perfusion imaging using multi-slice spiral computed tomography for breast cancer. Asian Pac J Cancer Prev. 14(1): 429-33.##28. Cao X and Jiang X (2013) Evaluating the effect of high-intensity focused ultrasound therapy on liver tumors using multislice CT perfusion. Oncol Lett, 5(2): 511-514.## ##

In vitro radiosensitivity of hepatoblastoma cell line huh-6 2 2 Background: As the predominant malignant embryonal liver tumor in children, hepatoblastoma (HB) demonstrates rising incidence rates. While surgical resection and chemotherapy remain primary treatments, radiation therapy emerges as a potential adjuvant option for refractory cases. However, clinical evidence supporting its application remains scarce. To address this knowledge gap, we investigated the radiobiological response of HB cell line Huh-6 through systematic in vitro analyses. Materials and Methods: The proliferation, morphology change, cell apoptosis and cell cycle of Huh-6 cells received gradient X-ray irradiation were systemically conducted with CCK-8 assay, microscopy, Annexin V/7-ADD and PI single staining, respectively. Results: Irradiation induced dose-dependent suppression of Huh-6 cell proliferation. Morphological assessment demonstrated escalating cytopathic effects with increasing radiation doses, characterized by cytoplasmic vacuolization in the early stage progressing to membrane disintegration and cytosolic debris formation in morphologically aberrant cells during the late stage. Cell apoptosis was enhanced with the increment of irradiation dose. The percentage of cells arrested in G2/M phase increased and meanwhile the proportion of cells in G0/G1 phase decreased with the rising dose gradient. Conclusion: Our findings demonstrate marked radiosensitivity in Huh-6 cells characterized by dose-responsive growth inhibition, cell apoptosis and cell morphological changes. These experimental results provide preliminary biological validation for considering radiotherapy in HB management protocols, particularly for treatment-resistant cases. 895 900 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/16 1404/9/25 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 L. Xu L. Xu Cancer Research Center Nantong, Affiliated Tumor Hospital of Nantong University, and Medical School of Nantong University, Nantong, China Q. Ge Q. Ge Department of Radiation Oncology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, China geqin.kelley@163.com Hepatoblastoma radiosensitivity Huh-6 cell line in vitro. 1. Cao Y, Wu S, Tang H (2024) An update on diagnosis and treatment of hepatoblastoma. Biosci Trends, 17: 445-457.##2. Guo C, Liu Z, Zhang X, Zhao S, Fan H, Wang H, et al. (2025) Global, regional, and national epidemiology of hepatoblastoma in children from 1990 to 2021: a trend analysis. Hepatol Int, 19(1): 156-165.##3. Meyers R, Hiyama E, Czauderna P, Tiao GM (2021) Liver tumors in pediatric patients. Surg Oncol Clin N Am, 30: 253-274.##4. Wu Z, Xia F, Wang W, Zhang K, Fan M, Lin R (2024) Worldwide burden of liver cancer across childhood and adolescence, 2000-2021: a systematic analysis of the global burden of disease study 2021. EClinicalMedicine, 75: 102765.##5. Yang L, Yu Z-Q, Zhang Y-Z, Deng Y-Q, Chen X, Liu H-Y, et al. (2025) Global, regional, and national burden of hepatoblastoma, 1990-2021: a systematic analysis of the global burden of disease study 2021. Int J Surg, 111(5): 3629-3633..##6. Wu PV and Rangaswami A (2022) Current Approaches in hepatoblastoma-new biological insights to inform therapy. Curr Oncol Rep, 24: 1209-1218.##7. Razvi Y, Chan S, Zhang L, Tsao M, Barnes E, Danjoux C, et al. (2019) A review of the Rapid Response Radiotherapy Program in patients with advanced cancer referred for palliative radiotherapy over two decades. Support Care Cancer, 27: 2131-2134.##8. Huang Z, Li N, Tang Y, Jin J, Liu W, Xu H, et al. (2022) Neoadjuvant radiotherapy for soft tissue sarcoma in China: a preliminary result. Ann Transl Med, 10: 452.##9. Sun D-E and Ye S-Y (2020) Emerging roles of long noncoding RNA regulator of reprogramming in cancer treatment. Cancer Manag Res, 12: 6103-6112.##10. Qi J-S, Wang W-H, Li F-Q (2015) Combination of interventional adenovirus-p53 introduction and ultrasonic irradiation in the treatment of liver cancer. Oncol Lett, 9: 1297-1302.##11. Ma F, Zhang W, Sun X (2024) m6A methylation pattern of SLC7A11 mediates the effects of cinobufagin on hepatocellular carcinoma cell proliferation and radioresistance. International Journal of Radiation Research, 2(2: 481-486.##12. Zhang K, Tao C, Siqin T, Wu J, Rong W (2021) Establishment, validation and evaluation of predictive model for early relapse after R0 resection in hepatocellular carcinoma patients with microvascular invasion. J Transl Med, 19: 293.##13. Leal-Leal CA, Imaz-Olguín V, Robles-Castro J, Shalkow-Klincovstein J, Palacios-Acosta JM (2010) Hepatoblastoma. Clinical experience at a single institution using the Siopel staging system. Ann Hepatol, 9: 75-79.##14. Wang Z-H, Liu Y, Guo J-Q, Liang H-L, Zhi W-W (2024) Research progress in the application of radiotherapy in the treatment of pediatric tumors. International Journal of Radiation Research, 22: 65-75.##15. Lu Z, Xu H, Yu X, Wang Y, Huang L, Jin X, et al. (2018) 20(S)-Protopanaxadiol induces apoptosis in human hepatoblastoma HepG2 cells by downregulating the protein kinase B signaling pathway. Exp Ther Med, 15: 1277-1284.##16. Makimoto A, Matsui M, Chin M, Koh K, Tomotsune M, Kaneko T, et al. (2019) Magnesium supplementation therapy to prevent cisplatin-induced acute nephrotoxicity in pediatric cancer: A protocol for a randomized phase 2 trial. Contemp Clin Trials Commun, 16: 100440.##17. Pariset E, Bertucci A, Petay M, Malkani S, Lopez Macha A, Paulino Lima IG, et al. (2020) DNA damage baseline predicts resilience to space radiation and radiotherapy. Cell Rep, 33: 108434.##18. Qin H, Ke J, Dong S, Li H, Zhu K, Fu S, et al. (2022) Effect of thoracic radiotherapy dose on the prognosis of advanced lung adenocarcinoma harboring EGFR mutations. BMC Cancer, 22: 1012.##19. Wang J, Liu J, Wang J, Wang S, Li F, Li R, et al. (2022) Identification of proteomic markers for prediction of the response to 5-Fluorouracil based neoadjuvant chemoradiotherapy in locally advanced rectal cancer patients. Cancer Cell Int, 22: 117.##20. Jiang H, Li Q, Chen B, Xi M, Makelike K, Liu S, et al. (2023) Phase I study of cisplatin and nanoparticle albumin-bound-paclitaxel combined with concurrent radiotherapy in locally advanced esophageal squamous cell carcinoma. Cancer Med, 12: 15187-15198.##21. Hong J-D, Wang X, Peng Y-P, Peng J-H, Wang J, Dong Y-P, et al. (2017) Silencing platelet-derived growth factor receptor-β enhances the radiosensitivity of C6 glioma cells in vitro and in vivo. Oncol Lett, 14: 329-336.##22. Zhang A-D, Su X-H, Wang Y-F, Shi G-F, Han C, Zhang N (2021) Predicting the effects of radiotherapy based on diffusion kurtosis imaging in a xenograft mouse model of esophageal carcinoma. Exp Ther Med, 21: 327.##23. Fei Z, Chen T, Qiu X, Chen C (2020) Effect of relevant factors on radiation-induced nasopharyngeal ulcer in patients with primary nasopharyngeal carcinoma treated with intensity-modulated radiation therapy. Laryngoscope Investig Otolaryngol, 5: 228-234.## ##

Complications in CT-guided biopsy of tiny pulmonary nodules: a case-control study 2 2 Background: This investigation explores the effectiveness and physiological consequences of CT-guided percutaneous lung biopsies, a common technique for analysing pulmonary nodules. Materials and Methods: The study involved a paired comparison involving 211 patients who received CT-guided lung biopsies and an equal number of matched controls who did not undergo the procedure. Variables such as demographic and baseline health characteristics, changes in cardiorespiratory parameters, and patient outcomes were meticulously recorded and analysed. Results: Both groups exhibited comparable baseline demographics and health statuses. The procedure confirmed the presence of malignancy or other diseases in 90% of cases (190 out of 211 patients). Significant physiological responses post-biopsy included elevated heart rate, increased systolic and diastolic blood pressure, enhanced respiratory rate, and reduced oxygen saturation levels, all statistically significant compared to controls. However, metrics such as hospital stay duration, rate of readmission within 30 days, and survival after one year showed no statistical difference between the groups. The incidence of complications following the biopsies was calculated at 15%. Conclusion: CT-guided percutaneous lung biopsy is a reliable diagnostic tool for pulmonary nodules, as evidenced by its high diagnostic yield. The procedure, however, leads to noticeable transient cardiorespiratory changes, underscoring the necessity for vigilant monitoring and supportive care during and after the procedure. Long-term patient outcomes did not differ significantly between the groups, indicating the procedure’s safety profile in a clinical setting. 901 906 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/16 1404/9/25 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 G. Wang G. Wang Thoracic Surgery, Huoshan County Hospital, Anhui Province, China 237200 wangguozhong8268@163.com P. Liu P. Liu Medical imaging department, Armed Police Force Hospital of Sichuan, Leshan 614000, Sichuan province X. Qubie X. Qubie Medical imaging department, Armed Police Force Hospital of Sichuan, Leshan 614000, Sichuan province C. Fan C. Fan Medical imaging department, Armed Police Force Hospital of Sichuan, Leshan 614000, Sichuan province Y. Fang Y. Fang Medical imaging department, Armed Police Force Hospital of Sichuan, Leshan 614000, Sichuan province CT-guided percutaneous lung biopsy diagnostic yield cardiorespiratory changes patient outcomes. Rivera MP, Mehta AC, Wahidi MM (2013) Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer 3rd ed. American college of chest physicians’ evidence-based clinical practice guidelines. Chest, 143: e142S-e165S.##Mondoni M, Sotgiu G, Bonifazi M, et al. (2016) Transbronchial needle aspiration in peripheral pulmonary lesions: a systematic review and meta-analysis. Eur Respir J, 48: 196-204.##Steinfort DP, Khor YH, Manser RL, Irving LB (2011) Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis. Eur Respir J, 37: 902-910.##Ali MS, Trick W, Mba BL, Mohananey D, Setni J, Musani A (2017) Radial endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions: A systematic review and meta-analysis. Respirology, 22: 443-453.##Zhan P, Zhu QQ, Miu YY, et al. (2017) Comparison between endobronchial ultrasound-guided transbronchial biopsy and CT-guided transthoracic lung biopsy for the diagnosis of peripheral lung cancer: A systematic review and meta-analysis. Transl Lung Cancer Res, 6: 23-34.##Fielding DI, Chia C, Nguyen P, et al. (2012) Prospective randomized trial of endobronchial ultrasound-guide sheath versus computed tomography-guided percutaneous core biopsies for peripheral lung lesions. Intern Med J, 42: 894-900.##Han Y, Kim HJ, Kong KA, et al. (2018) Diagnosis of small pulmonary lesions by transbronchial lung biopsy with radial endobronchial ultrasound and virtual bronchoscopic navigation versus CT-guided transthoracic needle biopsy: A systematic review and meta-analysis. PLoS One, 13: e0191590.##Hur J, Lee HJ, Nam JE, et al. (2009) Diagnostic accuracy of CT fluoroscopy-guided needle aspiration biopsy of ground-glass opacity pulmonary lesions. Am J Roentgenol, 192: 629-634.##Yamauchi Y, Izumi Y, Nakatsuka S, et al. (2011) Diagnostic performance of percutaneous core needle lung biopsy under multi-CT fluoroscopic guidance for ground-glass opacity pulmonary lesions. Eur J Radiol, 79: e85-e89.##Inoue D, Gobara H, Hiraki T, et al. (2012) CT fluoroscopy-guided cutting needle biopsy of focal pure ground-glass opacity lung lesions: Diagnostic yield in 83 lesions. Eur J Radiol, 81: 354-359.##Yamagami T, Yoshimatsu R, Miura H, et al. (2013) Diagnostic performance of percutaneous lung biopsy using automated biopsy needles under CT-fluoroscopic guidance for ground-glass opacity lesions. Br J Radiol, 86: 20120447.##Nakamura K, Matsumoto K, Inoue C, Matsusue E, Fujii S (2021) Computed tomography-guided lung biopsy: A review of techniques for reducing the incidence of complications. Interv Radiol (Higashimatsuyama), 6(3): 83-92. ##Khan MF, Straub R, Moghaddam SR, et al. (2008) Variables affecting the risk of pneumothorax and intrapulmonal haemorrhage in CT-guided transthoracic biopsy. Eur Radiol, 18: 1356-1363.##Kakizawa H, Toyota N, Hieda M, et al. (2010) Risk factors for severity of pneumothorax after CT-guided percutaneous lung biopsy using the single-needle method. Hiroshima J Med Sci, 59: 43-50.##Hiraki T, Mimura H, Gobara H, et al. (2010) Incidence of and risk factors for pneumothorax and tube placement after CT fluoroscopy-guided percutaneous lung biopsy: retrospective analysis of the procedures conducted over a 9-year period. Am J Roentgenol, 194: 809-814.##Loh SEK, Wu DDF, Venkatesh SK, et al. (2013) CT-guided thoracic biopsy: evaluating diagnostic yield and complications. Ann Acad Med Singap, 42: 285-290.##Nakatani M, Tanigawa N, Kariya S, Komemushi A, Yagi R, Sawada S (2012) Analysis of factors influencing accuracy and complications in CT-guided lung biopsy. Minim Invasive Ther, 21: 415-422.##Vagn-Hansen C, Pedersen MR, Rafaeisen SR (2016) Diagnostic yield and complications of transthoracic computed tomography-guided biopsies. Dan Med J, 63: A5239.##Modi P and Uppe A (2024) Lung Biopsy Techniques and Clinical Significance. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563153/.##Haas BM, Clayton JD, Elicker BM, Ordovas KG, Naeger DM (2017) CT-guided percutaneous lung biopsies in patients with suspicion for infection may yield clinically useful information. AJR Am J Roentgenol, 208(2): 459-463. doi: 10.2214/AJR.16.16255.##Lee HN, Do KH, Kim EY, Choe J, Sung H, Choi SH, Kim HJ (2024) Comparative analysis of CT findings and clinical outcomes in adult patients with disseminated and localized pulmonary nocardiosis. J Korean Med Sci, 39(11): e107. doi: 10.3346/jkms.2024.39.e107.##Ming M, Lu N, Qian W (2023) Evaluation of computed tomography images under deep learning in the diagnosis of severe pulmonary infection. Front Comput Neurosci, 17: 1115167. doi: 10.3389/fncom.2023.1115167.##Watane GV, Hammer MM, Barile MF (2019) CT-guided core-needle biopsy of the lung is safe and more effective than fine-needle aspiration biopsy in patients with hematologic malignancies. 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Cancer Imaging, 19(1): 51. doi: 10.1186/s40644-019-0240-6.##Iguchi T, Hiraki T, Matsui Y, Tomita K, Uka M, Tanaka T, Munetomo K, Gobara H, Kanazawa S (2021) CT-guided biopsy of lung nodules with pleural contact: Comparison of two puncture routes. Diagn Interv Imaging, 102(9): 539-544. doi: 10.1016/j.diii.2021.05.005.## ##

Application of dual-parameter MRI-based radiomics in the differentiation of prostate cancer and benign prostatic hyperplasia: Diagnostic efficacy and predictive modeling 2 2 Background: Prostate cancer (PCa) and benign prostatic hyperplasia (BPH) present with similar clinical symptoms, particularly in patients with borderline prostate-specific antigen (PSA) levels (4–10 ng/mL), making accurate diagnosis challenging. MRI-based radiomics enables non-invasive extraction of quantitative imaging features that may aid in differentiating these conditions. Materials and Methods: In this retrospective study, 150 patients (56 PCa, 94 BPH) underwent prostate MRI including T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI). Radiomics features were extracted from manually segmented lesions using PyRadiomics. Logistic regression was used for feature selection and model construction. Three predictive models were developed based on T2WI, DWI, and combined T2WI+DWI features. Model performance was assessed using receiver operating characteristic (ROC) analysis, evaluating area under the curve (AUC), sensitivity, and specificity on training and validation sets. Results: The combined T2WI+DWI model showed the best diagnostic performance with an AUC of 0.942 in the validation set, sensitivity of 0.821, and specificity of 1.000. This outperformed model based on T2WI or DWI alone, as well as the clinical model using PSA and prostate volume. Conclusion: Dual-parameter MRI-based radiomics enhances the non-invasive differentiation of PCa from BPH. The combined T2WI and DWI model offers superior diagnostic accuracy and may reduce unnecessary biopsies in patients with indeterminate PSA levels. 907 912 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/16 1404/9/25 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 Y. Hu Y. Hu Department of Radiology,The First Affiliated Hospital of Chongqing Medical University, Chongqing, China C. Hou C. Hou Department of Oncology, The First Hospital of Neijiang, Neijiang, Sichuan, China M. Wen M. Wen Department of Radiology,The First Affiliated Hospital of Chongqing Medical University, Chongqing, China mingwen_dc@163.com Prostatic neoplasms radiomics diffusion magnetic resonance imaging computer-assisted machine learning. 1. Berenguer CV, Pereira F, Câmara JS, Pereira JAM (2023) Underlying features of prostate cancer-statistics, risk factors, and emerging methods for its diagnosis. Curr Oncol, 30(2): 2300-21.##2. Miernik A and Gratzke C (2020) Current treatment for benign prostatic hyperplasia. Dtsch Arztebl Int, 117(49): 843-54.##3. Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. (2017) EAU-ESTRO-SIOG Guidelines on prostate cancer. Part 1: Screening, diagnosis, and local treatment with curative intent. Eur Urol, 71(4): 618-29.##4. Siegel RL, Miller KD, Fuchs HE, Jemal A (2021) Cancer Statistics, 2021. CA Cancer J Clin, 71(1): 7-33.##5. Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, et al. (2009) Screening and prostate-cancer mortality in a randomized European study. N Engl J Med, 360(13): 1320-8.##6. Loeb S, Bjurlin MA, Nicholson J, Tammela TL, Penson DF, Carter HB, et al. (2014) Overdiagnosis and overtreatment of prostate cancer. Eur Urol, 65(6): 1046-55.##7. Barry MJ and Simmons LH (2017) Prevention of prostate cancer morbidity and mortality: Primary prevention and early detection. Med Clin North Am, 101(4): 787-806.##8. Fernandes MC, Yildirim O, Woo S, Vargas HA, Hricak H (2022) The role of MRI in prostate cancer: current and future directions. Magma, 35(4): 503-21.##9. Barentsz JO, Weinreb JC, Verma S, Thoeny HC, Tempany CM, Shtern F, et al. (2016) Synopsis of the PI-RADS v2 Guidelines for multiparametric prostate magnetic resonance imaging and recommendations for use. Eur Urol, 69(1): 41-9.##10. Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. (2017) Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet, 389(10071): 815-22.##11. Gillies RJ, Kinahan PE, Hricak H (2016) Radiomics: Images are more than pictures, they are data. Radiology, 278(2): 563-77.##12. Li C, Deng M, Zhong X, Ren J, Chen X, Chen J, et al. (2023) Multi-view radiomics and deep learning modeling for prostate cancer detection based on multi-parametric MRI. Front Oncol, 13: 1198899.##13. Cuocolo R, Cipullo MB, Stanzione A, Ugga L, Romeo V, Radice L, et al. (2019) Machine learning applications in prostate cancer magnetic resonance imaging. Eur Radiol Exp, 3(1): 35.##14. van der Leest M, Cornel E, Israël B, Hendriks R, Padhani AR, Hoogenboom M, et al. (2019) Head-to-head comparison of transrectal ultrasound-guided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-naïve men with elevated prostate-specific antigen: A large prospective multicenter clinical study. Eur Urol, 75(4): 570-8.##15. Lee HW, Kim E, Na I, Kim CK, Seo SI, Park H (2023) Novel multiparametric magnetic resonance imaging-based deep learning and clinical parameter integration for the prediction of long-term biochemical recurrence-free survival in prostate cancer after radical prostatectomy. Cancers (Basel), 15(13): 3416##16. Felker ER, Margolis DJ, Nassiri N, Marks LS (2016) Prostate cancer risk stratification with magnetic resonance imaging. Urol Oncol, 34(7): 311-9.##17. Algohary A, Viswanath S, Shiradkar R, Ghose S, Pahwa S, Moses D, et al. (2018) Radiomic features on MRI enable risk categorization of prostate cancer patients on active surveillance: Preliminary findings. J Magn Reson Imaging, 48(3): 818-828.##18. Lambin P, Rios-Velazquez E, Leijenaar R, Carvalho S, van Stiphout RG, Granton P, et al. (2012) Radiomics: extracting more information from medical images using advanced feature analysis. Eur J Cancer, 48(4): 441-6.##19. Fütterer JJ, Briganti A, De Visschere P, Emberton M, Giannarini G, Kirkham A, et al. (2015) Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature. Eur Urol, 68(6): 1045-53.##20. Haider MA, Brown J, Yao X, Chin J, Perlis N, Schieda N, et al. (2021) Multiparametric Magnetic resonance imaging in the diagnosis of clinically significant prostate cancer: an updated systematic review. Clin Oncol (R Coll Radiol), 33(12): e599-e612.##21. Sun Y, Reynolds HM, Parameswaran B, Wraith D, Finnegan ME, Williams S, et al. (2019) Multiparametric MRI and radiomics in prostate cancer: a review. Australas Phys Eng Sci Med, 42(1): 3-25.##22. Yoo S, Kim JK, Jeong IG (2015) Multiparametric magnetic resonance imaging for prostate cancer: A review and update for urologists. Korean J Urol, 56(7): 487-97.##23. Chaddad A, Kucharczyk MJ, Cheddad A, Clarke SE, Hassan L, Ding S, et al. (2021) Magnetic resonance imaging based radiomic models of prostate cancer: A narrative review. Cancers (Basel), 13(3): 552.##24. Ferro M, de Cobelli O, Vartolomei MD, Lucarelli G, Crocetto F, Barone B, et al. (2021) Prostate cancer radiogenomics-from imaging to molecular characterization. Int J Mol Sci, 22(18): 9971.##25. He X, Xiong H, Zhang H, Liu X, Zhou J, Guo D (2021) Value of MRI texture analysis for predicting new Gleason grade group. Br J Radiol, 94(1121): 20210005.##26. Stanzione A, Gambardella M, Cuocolo R, Ponsiglione A, Romeo V, Imbriaco M (2020) Prostate MRI radiomics: A systematic review and radiomic quality score assessment. European Journal of Radiology, 129: 109095.##27. Bonekamp D, Kohl S, Wiesenfarth M, Schelb P, Radtke JP, Götz M, et al. (2018) Radiomic machine learning for characterization of prostate lesions with mri: comparison to ADC values. Radiology, 289(1): 128-37.##28. Fan X, Xie N, Chen J, Li T, Cao R, Yu H, et al. (2022) Multiparametric MRI and machine learning based radiomic models for preoperative prediction of multiple biological characteristics in prostate cancer. Front Oncol, 12: 839621.## ##

Survival advantage of radiotherapy in triple-negative inflammatory breast cancer: A national cohort study 2 2 Background: Inflammatory breast cancer (IBC) is an aggressive subtype of breast carcinoma for which radiotherapy (RT) is a recommended treatment. This retrospective analysis aimed to clarify the impact of RT on survival outcomes among patients with IBC, stratified by molecular subtype. Materials and Methods: Data concerning IBC patients diagnosed from 2010 through 2015 was based on the SEER (Surveillance, Epidemiology, and End Results) database. To evaluate survival differences among women with diverse molecular subtypes, comparisons were drawn between those treated with RT and those untreated, employing Cox proportional hazards modeling, Kaplan-Meier (KM) curves, and chi-square analysis. Results: The cohort included 532 female patients, of whom 263 (49.4%) received radiotherapy. Nodal involvement, metastatic status, and chemotherapy use were each significantly correlated with the likelihood of receiving RT (all P < 0.05). Longer survival was exhibited in overall molecular subtypes who received RT(P<0.001). RT significantly improved outcomes in IBC cases of the hormone receptor (HR)-/human epidermal growth factor (HER2)- phenotype (OR, odds ratio = 0.525 [0.334–0.823], P = 0.005), whereas those with HR+/HER2-, HR+/HER2+ or HR-/HER2+ subtypes had a comparable prognosis between the RT cohort and non-RT cohort. HR-/HER2- patients with pathologic stage N0-2M0 had longer survival with RT (OR=0.354 [0.178-0.704], P=0.003), whereas those with N3M0 stage (P=0.880) or M1 stage (P=0.443) derived no benefit. Conclusion: Marked improvements in survival following RT were noted for HR−/HER2− IBC with pathologic N0–2M0 staging. 913 919 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/16 1404/9/25 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 Z.H. Zhang Z.H. Zhang Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China Y.Y. Li Y.Y. Li Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China Z.Y. He Z.Y. He Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China hezhy2253@163.com Inflammatory breast neoplasms radiotherapy survival analysis retrospective studies SEER program. 1. Robertson FM, Bondy M, Yang W, Yamauchi H, Wiggins S, Kamrudin S, et al. (2010) Inflammatory breast cancer: the disease, the biology, the treatment. CA Cancer J Clin, 60(6): 351-75.##2. Gonzalez-Angulo AM, Hennessy BT, Broglio K, Meric-Bernstam F, Cristofanilli M, Giordano SH, et al. (2007) Trends for inflammatory breast cancer: is survival improving? Oncologist, 12(8): 904-12.##3. Abraham HG, Xia Y, Mukherjee B, Merajver SD (2021) Incidence and survival of inflammatory breast cancer between 1973 and 2015 in the SEER database. Breast Cancer Res Treat, 185(1): 229-38.##4. Dawood S, Ueno NT, Valero V, Woodward WA, Buchholz TA, Hortobagyi GN, et al. (2011) Differences in survival among women with stage III inflammatory and noninflammatory locally advanced breast cancer appear early: a large population-based study. Cancer, 117(9): 1819-26.##5. Ibrahim SA, Gadalla R, El-Ghonaimy EA, Samir O, Mohamed HT, Hassan H, et al. (2017) Syndecan-1 is a novel molecular marker for triple negative inflammatory breast cancer and modulates the cancer stem cell phenotype via the IL-6/STAT3, Notch and EGFR signaling pathways. Molecular Cancer, 16(1): 57.##6. Fouad TM, Kogawa T, Liu DD, Shen Y, Masuda H, El-Zein R, et al. (2015) Overall survival differences between patients with inflammatory and noninflammatory breast cancer presenting with distant metastasis at diagnosis. Breast Cancer Research and Treatment, 152(2): 407-16.##7. Mamouch F, Berrada N, Aoullay Z, El Khanoussi B, Errihani H (2018) Inflammatory breast cancer: a literature review. World Journal of Oncology, 9(5-6): 129-35.##8. Takahashi Y, Sridhar N, Iwase T, Marumoto A, Fukui J, Pradhan A, et al. (2025) Inflammatory breast cancer, best practice in the community setting. Breast Cancer, 11(1): 52.##9. Moshfegh S, Jadidi M, Hasanzadeh H, Nasr R, Mirmohammadkhani M (2022) Efficacy of Hematoporphyrin mediated photo-sonodynamic therapy on mice breast cancer. International Journal of Radiation Research, 20(3): 555-61.##10. Chainitikun S, Saleem S, Lim B, Valero V, Ueno NT (2021) Update on systemic treatment for newly diagnosed inflammatory breast cancer. Journal of Advanced Research, 29: 1-12.##11. Dawood S, Lei X, Dent R, Gupta S, Sirohi B, Cortes J, et al. (2014) Survival of women with inflammatory breast cancer: a large population-based study. Ann Oncol, 25(6): 1143-51.##12. Bertucci F, Finetti P, Colpaert C, Mamessier E, Parizel M, Dirix L, et al. (2015) PDL1 expression in inflammatory breast cancer is frequent and predicts for the pathological response to chemotherapy. Oncotarget, 6(15): 13506-19.##13. Holly Dushkin M and Cristofanilli M (2011) Inflammatory breast cancer. Journal of the National Comprehensive Cancer Network, 9(2): 233-40.##14. Rueth NM, Lin HY, Bedrosian I, Shaitelman SF, Ueno NT, Shen Y, et al. (2014) Underuse of trimodality treatment affects survival for patients with inflammatory breast cancer: an analysis of treatment and survival trends from the National Cancer Database. J Clin Oncol, 32(19): 2018-24.##15. Ma Y, Pan Y, Zhang B, Zhang Y, Fan W (2024) Clinicopathological characteristics of breast cancer patients underwent radiotherapy with different genotypes in relation to the risk of recurrence. International Journal of Radiation Research, 22(4): 1043-50.##16. Arora S, Velichinskii R, Lesh RW, Ali U, Kubiak M, Bansal P, et al. (2019) Existing and emerging biomarkers for immune checkpoint immunotherapy in solid tumors. Adv Ther, 36(10): 2638-78.##17. Tramacere F, Pisani AR, Maggiulli E, Moschetta M, Sardaro A, Altini C, et al. (2023) Effective management of a patient with secondary male breast cancer after neck radiotherapy for tonsillar lymphoma. International Journal of Radiation Research, 21(1): 163-7.##18. Fouad TM, Barrera AMG, Reuben JM, Lucci A, Woodward WA, Stauder MC, et al. (2017) Inflammatory breast cancer: a proposed conceptual shift in the UICC–AJCC TNM staging system. The Lancet Oncology, 18(4): e228-e32.##19. Borri F and Granaglia A (2021) Pathology of triple negative breast cancer. Semin Cancer Biol, 72: 136-45.##20. Nicaise B, Loap P, Loirat D, Laki F, Pierga JY, Fourquet A, et al. (2021) Radiotherapy in the management of non-metastatic inflammatory breast cancers: a retrospective observational study. Cancers (Basel), 14(1): 107.##21. Kwon YS, Lee MG, Kim NY, Nam GS, Nam KS, Jang H, et al. (2024) Overcoming radioresistance of breast cancer cells with MAP4K4 inhibitors. Sci Rep, 14(1): 7410.##22. Fattahi S, Mullikin TC, Aziz KA, Afzal A, Smith NL, Francis LN, et al. (2022) Proton therapy for the treatment of inflammatory breast cancer. Radiother Oncol, 171: 77-83.##23. Parisi S, Sciacca M, Critelli P, Ferrantelli G, Chillari F, Venuti V, et al. (2024) Lattice radiotherapy in inflammatory breast cancer: report of a first case treated with curative aim. Radiation Oncology Journal, 42(2): 160-5.##24. Wang X, Zhao L, Song X, Wu X, Krishnamurthy S, Semba T, et al. (2024) Genomic and transcriptomic analyses identify distinctive features of triple-negative inflammatory breast cancer. NPJ Precis Oncol, 8(1): 265.##25. Zhou J, Tang LY, Zhang XH, Wang JW, Yang LC, Wu SG (2020) Increasing radiosensitivity by the combined inhibition of PARP1 and PI3K in BRCA1-mutated triple negative breast cancer. International Journal of Radiation Research, 18(2): 283-93.##26. Chow R, Hasan S, Choi JI, Fox J, Chhabra AM, Marshall DC, et al. (2023) Effect of treatment interruptions on overall survival in patients with triple-negative breast cancer. JNCI: Journal of the National Cancer Institute, 115(9): 1029-35.##27. Huang J, Barbera L, Brouwers M, Browman G, Mackillop WJ (2003) Does delay in starting treatment affect the outcomes of radiotherapy? a systematic review. Journal of Clinical Oncology, 21(3): 555-63.##28. Fayanju OM, Ren Y, Greenup RA, Plichta JK, Rosenberger LH, Force J, et al. (2020) Extent of axillary surgery in inflammatory breast cancer: a survival analysis of 3500 patients. Breast Cancer Res Treat, 180(1): 207-17.##29. Smith AE, Ferraro E, Safonov A, Morales CB, Lahuerta EJA, Li Q, et al. (2021) HER2 + breast cancers evade anti-HER2 therapy via a switch in driver pathway. Nature Communications, 12(1): 6667.##30. Bahar ME, Kim HJ, Kim DR (2023) Targeting the RAS/RAF/MAPK pathway for cancer therapy: from mechanism to clinical studies. Signal Transduction and Targeted Therapy, 8(1): 455.##31. Garrido-Castro AC, Regan MM, Niman SM, Nakhlis F, Remolano C, Rosenbluth JM, et al. (2023) Clinical outcomes of de novo metastatic HER2-positive inflammatory breast cancer. npj Breast Cancer, 9(1): 50.##32. Ploumen RAW, van Nijnatten TJA, Kooreman LFS, Voogd AC, Keymeulen K, Siesling S, et al. (2025) Surgical treatment after neoadjuvant systemic therapy for HER2-positive invasive breast cancer in the Netherlands: 10-Year trends and the influence an accompanying DCIS component. Breast (Edinburgh, Scotland), 79: 103854.##33. Liang Y, Liu X, Yun Z, Li K, Li H (2024) Endocrine therapy plus HER2-targeted therapy, another favorable option for HR+/HER2+ advanced breast cancer patients. Therapeutic Advances in Medical Oncology, 16: 17588359231220501.##34. Iwase T, Harano K, Masuda H, Kida K, Hess KR, Wang Y, et al. (2020) Quantitative hormone receptor (HR) expression and gene expression analysis in HR+ inflammatory breast cancer (IBC) vs non-IBC. BMC Cancer, 20(1): 430.## ##

Assessment of outdoor radiation dose and radiological health hazards 2 2 Background: All generations of living beings have been and will be exposed to ionizing radiation. Until the discovery of radioactivity, man was not aware that ionizing radiation was a part of him and his environment. Humans are mainly exposed to gamma and beta radiation from terrestrial radionuclides, which represent the main source of irradiation of the human body. Materials and Methods: This paper presents the research overview of the dose rates of gamma and beta radiation, measured outdoors in the research locations by the Gamma–Scout device. The measurements were performed at fifteen locations in the area of Tuzla Canton, Bosnia and Herzegovina. The Gamma–Scout device was mounted outside on the table, at a height of 50 cm above ground in the vicinity of residential buildings in periods of 30 minutes. Results: The results presented include gamma, gamma+beta, and beta dose rate measurements. Based on these results, the annual effective doses originating from gamma and beta radiation were estimated. Results of measurements taken by this method showed that the values of the annual effective dose of gamma and gamma+beta radiation were in the interval of (0.21-0.32) mSv and (0.22-0.33) mSv, respectively. The estimated annual effective dose received by beta radiation was in the interval of (0-0.04) mSv. Conclusion: For all investigated locations, excess lifetime cancer risk (ELCR) was below the recommended risk value. 921 926 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/16 1404/9/25 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 A. Kasić A. Kasić Department of Physics, Faculty of Natural Sciences and Mathematics, University of Tuzla, Urfeta Vejzagića 4, 75 000 Tuzla, Bosnia and Herzegovina amela.dedic@untz.ba Z. Sakić Z. Sakić Department of Physics, Faculty of Natural Sciences and Mathematics, University of Tuzla, Urfeta Vejzagića 4, 75 000 Tuzla, Bosnia and Herzegovina A. Kasumović A. Kasumović Department of Physics, Faculty of Natural Sciences and Mathematics, University of Tuzla, Urfeta Vejzagića 4, 75 000 Tuzla, Bosnia and Herzegovina Radiation exposure gamma radiation beta radiation annual effective dose risk assessment. Jakobović Z (1991) Ionizirajuće zračenje i čovjek [Ionizing radiation and man]. Školska knjiga, Zagreb. (In Croatian)##Termizi Ramli A, Aliyu AS, Agba EH, Saleh MA (2014) Effective dose from natural background radiation in Keffi and Akwanga towns, central Nigeria. Int J Rad Res, 12(1): 47-52.##Ramachandran TV (2011) Background radiation, people and environment. 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Dosimetric and biological evaluation of respiratory motion effects on dose distribution in lung cancer SIB-SBRT 2 2 Background: Simultaneous integrated boost-stereotactic body radiotherapy (SIB-SBRT) is an effective technique for lung cancer treatment but is significantly affected by respiratory motion. This study employed a four-dimensional (4D) dose calculation method to evaluate the impact of respiratory motion on dose delivery. Materials and Methods: Retrospective analysis was performed on data from 17 lung cancer patients who underwent four-dimensional computed tomography (4DCT). Volumetric modulated arc therapy (VMAT) plans, referred to as the original plans, were designed with dose prescriptions of 6 Gy per fraction for the internal target volume (ITV) and 5 Gy per fraction for the planning target volume (PTV). Control points (CPs) and monitor units (MUs) from the original plans were mapped onto ten respiratory phases of the 4DCT to generate sub-plans. These sub-plans were combined to form a 4D dose plan, followed by evaluation of physical and biological dose effects. Results: Compared to the original plans, respiratory motion reduced V100 by 1.4% for the ITV and 3.5% for the PTV. Additionally, it decreased the tumor control probability (TCP) by 0.1% for the ITV and 4.2% for the PTV. Gamma analysis revealed hot spots at the target periphery and cold spots within the target. Conclusion: Respiratory motion has a greater impact on PTV than ITV in SIB-SBRT. Dose deviations and distribution should be considered to enhance treatment accuracy. 927 934 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/16 1404/9/25 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 L. Liu L. Liu University of Science and Technology of China, Hefei, 230026, Anhui, China Z. Fei Z. Fei Department of Radiation Oncology, The 901st Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army, Hefei, 230031, Anhui, China X. Pei X. Pei Technology Development Department, Anhui Wisdom Technology Company Limited, Hefei, 230000, Anhui, China Q. Ren Q. Ren Technology Development Department, Anhui Wisdom Technology Company Limited, Hefei, 230000, Anhui, China J. Li J. Li University of Science and Technology of China, Hefei, 230026, Anhui, China X. Cui X. Cui Hefei Cancer Hospital of CAS, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, Anhui, China xlcui@cmpt.ac.cn H. Wang H. Wang University of Science and Technology of China, Hefei, 230026, Anhui, China wanghz@hfcas.ac.cn Lung neoplasms stereotactic body radiotherapy four-dimensional computed tomography respiratory motion. 1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 71(3): 209-249. ##2. Timmerman R, Paulus R, Galvin J, Michalski J, Straube W, Bradley J, et al. (2010) Stereotactic body radiation therapy for inoperable early-stage lung cancer. JAMA, 303(11): 1070-1076. ##3. Bezjak A, Paulus R, Gaspar LE, Timmerman RD, Straube WL, Ryan WF, et al. (2016) Efficacy and toxicity analysis of NRG Oncology/RTOG 0813 trial of stereotactic body radiation therapy (SBRT) for centrally located non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys, 96(2): S8.##4. Tandberg DJ, Tong BC, Ackerson BG, Kelsey CR (2018) Surgery versus stereotactic body radiation therapy for stage I non-small cell lung cancer: A comprehensive review. Cancer, 124(4): 667-678.##5. Zhang Q, Cai XW, Feng W, Yu W, Fu XL (2022) Dose-escalation by hypofractionated simultaneous integrated boost IMRT in unresectable stage III non-small-cell lung cancer. BMC Cancer, 22(1): 96.##6. Hurkmans CW, Cuijpers JP, Lagerwaard FJ, Widder J, van der Heide UA, Schuring D, et al. (2009) Recommendations for implementing stereotactic radiotherapy in peripheral stage IA non-small cell lung cancer: report from the Quality Assurance Working Party of the randomised phase III ROSEL study. Radiat Oncol, 4(1): 1-14. ##7. Kelada OJ, Decker RH, Nath SK, Johung KL, Zheng MQ, Huang YY, et al. (2018) High single doses of radiation may induce elevated levels of hypoxia in early-stage non-small cell lung cancer tumors. Int J Radiat Oncol Biol Phys, 102(1): 174-183. ##8. Haque WM, Endres EC, Szeja S, Hatch SS, Joyner MM, Internationals O (2016) Simultaneous integrated boost using conformal radiation therapy for treatment of cervical cancer. Int J Cancer, 3(1): 1-7. ##9. Tanabe Y, Deguchi T, Kiritani M, Hira N, Tomimoto S, Nishikawa H, et al. (2024) Evaluation of statistical prediction model fitting by combining fiducial markers and lung volume for stereotactic body radiotherapy. Int J Radiat Res, 22(1): 17-22.##10. Kaviarasu K, Raj NAN, Murthy KK (2021) Dosimetric evaluation of intensity modulated radiation therapy for different duty cycles of the gated beam delivery. Int J Radiat Res, 19(3): 669-683.##11. Chung H, Jung J, Jeong C, Kwaket J, Park J, Kim JJ, et al. (2018) Evaluation of delivered dose to a moving target by 4D dose reconstruction in gated volumetric modulated arc therapy. PLoS ONE, 13(9): e0202765. ##12. Zeng YL, Chang Y, Zhang S, Han J, Liu HY, Xiao F, et al. (2023) Clinical evaluation of 4D dynamic dose for thoracic tumor stereotactic body radiation therapy with variable parameters. Radiat Med Prot, 4(3): 150-158. ##13. Kauweloa KI, Gutierrez AN, Bergamo A, Stathakis S, Papanikolaou N, Mavroidis P (2014) Practical aspects and uncertainty analysis of biological effective dose (BED) regarding its three-dimensional calculation in multiphase radiotherapy treatment plans. Med Phys, 41(7): 071707. ##14. Karava K, Ehrbar S, Riesterer O, Roesch J, Glatz S, Klöck S, et al. (2017) Potential dosimetric benefits of adaptive tumor tracking over the internal target volume concept for stereotactic body radiation therapy of pancreatic cancer. Radiat Oncol, 12(1): 175.##15. Tian Y, Wang ZH, Ge H, Zhang T, Cai J, Kelsey C, et al. (2012) Dosimetric comparison of treatment plans based on free breathing, maximum, and average intensity projection CTs for lung cancer SBRT. Med Phys, 39(5): 2754-2760.##16. Chan MKH, Kwong DLW, Ng SCY, Tam EKW, Tong ASM. (2012) Investigation of four-dimensional (4D) Monte Carlo dose calculation in real-time tumor tracking stereotatic body radiotherapy for lung cancers. 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Biomed Phys Eng Express, 7(1): 015020. ##22. Chang JH, Gehrke C, Prabhakar R, Gill S, Wada M, Joon DL, et al. (2016) RADBIOMOD: A simple program for utilising biological modelling in radiotherapy plan evaluation. Phys Med, 32(1): 248-254. ##23. Gay HA and Niemierko A (2007) A free program for calculating EUD-based NTCP and TCP in external beam radiotherapy. Phys Med, 23(3-4): 115-125.##24. ]Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, et al. (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys, 21(1): 109-122. ##25. Chaikh A and Balosso J (2016) The use of radiobiological TCP and NTCP models to validate the dose calculation algorithm and readjust the prescribed dose. Radiother Oncol, 118(1): S24.##26. Li X, Yang Y, Li TF, Fallon K, Heron DE and, Huq MS (2013) Dosimetric effect of respiratory motion on volumetric-modulated arc therapy-based lung SBRT treatment delivered by TrueBeam machine with flattening filter-free beam. 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Cyclotron 30 MeV 1.5 mA shielding design for boron neutron capture therapy 2 2 Background: Effective radiation shielding in Boron Neutron Capture Therapy (BNCT) facilities is essential to protect patients, staff, and the environment from secondary radiation. This study aims to determine the optimal thickness of Portland, boron, and barite concretes for shielding the Beam Shaping Assembly (BSA) in BNCT facilities, ensuring compliance with International Atomic Energy Agency (IAEA) and Indonesia’s BAPETEN (Nuclear Energy Regulatory Agency of Indonesia) safety standards. Materials and Methods: Monte Carlo simulations were performed using the Particle and Heavy Ion Transport Code System (PHITS) to model radiation interactions. The shielding performance of the three concretes was evaluated across five critical areas of the BSA: front, left side, external labyrinth, top, and bottom, utilizing 100,000,000 particles for statistical accuracy. Results: Barite concrete required the least thickness due to its high density and superior photon attenuation, with optimal thicknesses of 0.56 m, 0.4 m, 1.0 m, 0.4 m, and 0.32 m in the respective areas. Boron concrete provided enhanced neutron protection with thicknesses of 0.79 m, 0.35 m, 1.0 m, 0.45 m, and 0.32 m. Portland concrete, while needing greater thickness for gamma shielding, remained cost-effective and accessible with thicknesses of 0.7 m, 0.5 m, 1.0 m, 0.5 m, and 0.37 m. Conclusion: All three concretes met IAEA and BAPETEN safety standards. Barite concrete was most effective for photon attenuation, boron concrete excelled in neutron protection, and Portland concrete offered a practical balance between effectiveness and cost. These findings aid in designing safe and efficient BNCT facilities, especially in resource-limited settings. 935 943 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/16 1404/9/25 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 A.R.W. Wicaksana A.R.W. Wicaksana Department of Nuclear Engineering and Engineering Physics, Faculty of Engineering, Universitas Gadjah Mada, 2 Grafika Street, Yogyakarta 55281, Indonesia A. Muharini A. Muharini Department of Nuclear Engineering and Engineering Physics, Faculty of Engineering, Universitas Gadjah Mada, 2 Grafika Street, Yogyakarta 55281, Indonesia Y. Sardjono Y. Sardjono Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia G.S. Wijaya G.S. Wijaya Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia Z. Ismail Z. Ismail Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia I.M. Triatmoko I.M. Triatmoko Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia S. Ulya S. Ulya Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia syar015@brin.go.id H. Prasetio H. Prasetio Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia N. Nuraeni N. Nuraeni Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia N.R. Hidayati N.R. Hidayati Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia F. Fendinugroho F. Fendinugroho Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia Y. Kasesaz Y. Kasesaz BNCT radiation shielding Monte Carlo simulation PHITS concrete materials. 1. Frick C, Rumgay H, Vignat J, Ginsburg O, Nolte E, Bray F, et al. (2023) Quantitative estimates of preventable and treatable deaths from 36 cancers worldwide: a population-based study. Lancet Glob Health, 11(11): e1700-12. Available from: https://doi.org/10.1016/S2214-109X(23)00406-0##2. 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Integrative analysis of immune gene features and radiotherapy sensitivity in rectal cancer 2 2 Background: To investigate the correlation between immune gene expression patterns and radiotherapy (RT) response, aiming to identify novel biomarkers for personalized rectal cancer treatment. Materials and Methods: Data from rectal cancer patients were clustered into two subgroups based on immune gene expression. Differentially expressed genes (DEGs) between subgroups were identified by using the limma package, and survival analysis was conducted with the Kaplan-Meier (KM) method. ClusterProfiler was used to conduct GO and KEGG pathway enrichment analyses on the DEGs. Protein-protein interaction (PPI) networks were utilized to pinpoint key modules or hub genes through interaction scores. In the TCGA rectal cancer dataset, 165 samples were divided into high (n=39) and low (n=126) immune gene expression groups based on the expression of 1,959 immune-related genes. Results: Between the two groups, 775 DEGs were up-regulated and 35 were down-regulated. Analysis of the GSE35452 dataset revealed 308 up-regulated and 209 down-regulated DEGs between the RT-responsive group (n=24) and the non-responsive group (n=22). PPI analysis showed that PLA2G2A and PLA2G4A exhibited the highest interaction score (value = 0.918). Conclusion: Through gene enrichment and PPI network analysis, potential core targets PLA2G2A and PLA2G4A were identified, providing new biomarkers for personalized treatment in rectal cancer. 945 951 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/16 1404/9/25 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 J. Gao J. Gao Department of Gastrointestinal Surgery Zone 1,Ningde Municipal Hospital of Ningde Normal University, Ningde, Fujian, China H.C. Li H.C. Li Department of Gastrointestinal Surgery Zone 1,Ningde Municipal Hospital of Ningde Normal University, Ningde, Fujian, China Z.J. Ruan Z.J. Ruan Department of Gastrointestinal Surgery Zone 1,Ningde Municipal Hospital of Ningde Normal University, Ningde, Fujian, China J. Liu J. Liu Breast and Thyroid Surgery, Shanghai First Hospital Ningde City Hospital, Ningde, Fujian, China T.T. Yang T.T. Yang Department of Radiation Oncology, Mengchao Hepatobiliary Hospital, Fujian Medical University, Ningde, Fujian, China K.L. Lin K.L. Lin School of Medicine, Ningde Normal University, Ningde, Fujian, China K.J. Chen K.J. Chen Department of Gastrointestinal Surgery Zone 1,Ningde Municipal Hospital of Ningde Normal University, Ningde, Fujian, China chenkejie1@126.com C.L. Liao C.L. 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Intravenous dexmedetomidine administration prior to radiotherapy in lung cancer patients: Effects on hemodynamics, stress response, and pulmonary protection 2 2 Background: To assess the clinical benefits of intravenous dexmedetomidine infusion administered before radiotherapy in patients with lung cancer, focusing on hemodynamic stability, stress response modulation, and pulmonary protection. Materials and Methods: A total of 120 lung cancer patients scheduled for thoracic radiotherapy (6 MV linear accelerator, Varian Clinac iX, USA; 2 Gy/fraction, 30 fractions, total dose 60 Gy) between April 2022 and January 2024 were divided into the control group (n = 60) and dexmedetomidine group (n = 60). Prior to each radiotherapy session, the control group received intravenous 0.6 μg/kg normal saline, while the study group received 0.6 μg/kg dexmedetomidine. Hemodynamic parameters, oxidative stress markers, and stress hormone levels were recorded at baseline (T0), midway (T1), end of session (T2), and 24 hours post-radiotherapy (T3). Pulmonary complications, cognitive impairment, and adverse reactions were documented. Results: The dexmedetomidine group maintained significantly more stable mean arterial pressure, heart rate, arterial oxygen partial pressure (PaO₂), and oxidative stress profiles (P < 0.05). Compared to controls, they showed lower arterial carbon dioxide partial pressure (PaCO₂), malondialdehyde, cortisol, and adrenocorticotropic hormone (ACTH) levels. Pulmonary injury occurred in 5.0% vs. 16.7% (P = 0.041), and cognitive impairment in 6.7% vs. 20.0% (P = 0.031). Adverse reaction rates were similar between groups (P > 0.05). Conclusion: Pre-radiotherapy dexmedetomidine stabilizes hemodynamics, attenuates oxidative and neuroendocrine stress responses, and reduces pulmonary and cognitive complications without increasing adverse events, suggesting a valuable role in peri-radiotherapy management of lung cancer patients.   953 958 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/16 1404/9/25 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 J. Zheng J. Zheng Department of Anesthesiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226000, China J. Zhu J. Zhu Department of Anesthesiology, Haimen District Peoples Hospital, Nantong, Jiangsu 226000, China J. Sun J. Sun Department of Anesthesiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226000, China sunjiafengntyy@163.com Dexmedetomidine lung neoplasms radiotherapy hemodynamics oxidative stress cognitive dysfunction. 1. Thandra KC, Barsouk A, Saginala K, Aluru JS, Barsouk A (2021) Epidemiology of lung cancer. Contemp Oncol (Pozn), 25(1): 45-52.##2. Li C, Lei S, Ding L, Xu Y, Wu X, Wang H, et al. (2023) Global burden and trends of lung cancer incidence and mortality. Chin Med J, 136(13): 1583-90.##3. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 74(3): 229-63.##4. Hirji SA and Swanson SJ (2018) T1a lung carcinoma: the place of segmentectomy in the treatment array. J Thorac Dis, 10(Suppl 10): S1151-s6.##5. Lederman D, Easwar J, Feldman J, Shapiro V (2019) Anesthetic considerations for lung resection: preoperative assessment, intraoperative challenges and postoperative analgesia. Ann Transl Med, 7(15): 356.##6. Ivascu R, Torsin LI, Hostiuc L, Nitipir C, Corneci D, Dutu M (2024) The surgical stress response and anesthesia: a narrative review. J Clin Med, 13(10): 3017.##7. Kaye AD, Chernobylsky DJ, Thakur P, Siddaiah H, Kaye RJ, Eng LK, et al. (2020) Dexmedetomidine in enhanced recovery after surgery (ERAS) protocols for postoperative pain. Curr Pain Headache Rep, 24(5): 21.##8. Bao N and Tang B (2020) Organ-protective effects and the underlying mechanism of dexmedetomidine. Mediators Inflamm, 2020: 6136105.##9. Zhou Y, Dong X, Zhang L (2023) Dexmedetomidine can reduce the level of oxidative stress and serum mir-10a in patients with lung cancer after surgery. Thorac Cardiovasc Surg, 71(3): 197-205. ##10. Xu Y, Zhou Y, Maloney JD, Shan G (2023) Effects of dexmedetomidine on inflammation and pulmonary function after thoracoscopic surgery for lung cancer: a systematic review and meta-analysis. J Thorac Dis, 15(6): 3397-3408.##11. Kutanis D, Erturk E, Besir A, et al. (2016) Dexmedetomidine acts as an oxidative damage prophylactic in rats exposed to ionizing radiation. J. Clin. Anesthesia , 34, 577-585.##12. Wang K, Wu M, Xu J, Wu C, Zhang B, Wang G, et al. (2019) Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis. British Journal of Anaesthesia, 123(6): 777-94.##13. Bao N and Tang B (2020) Organ-protective effects and the underlying mechanism of dexmedetomidine. Mediators of Inflammation, 2020: 6136105.##14. Li H, Liu J, Shi H (2021) Effect of dexmedetomidine on perioperative hemodynamics and myocardial protection in thoracoscopic-assisted thoracic surgery. Med Sci Monit, 27: e929949.##15. Liu H, Gao M, Zheng Y, Sun C, Lu Q, Shao D (2023) Effects of dexmedetomidine at different dosages on perioperative haemodynamics and postoperative recovery quality in elderly patients undergoing hip replacement surgery under general anaesthesia: a randomized controlled trial. Trials, 24(1): 386.##16. Cekic B, Geze S, Ozkan G, Besir A, Sonmez M, Karahan SC, et al. (2014) The effect of dexmedetomidine on oxidative stress during pneumoperitoneum. Biomed Res Int, 2014: 760323.##17. Chen X, Chen Q, Qin Z, Alam A, Zhao H, West R, et al. (2024) Dexmedetomidine attenuates inflammation in elderly patients following major hepatobiliary and pancreatic surgery: A randomized clinical trial. Clin Interv Aging, 19: 981-91.##18. Mei B, Yang X, Yang YY, Weng JT, Cao SD, Yang R, et al. (2024) Intraoperative dexmedetomidine infusion improved postoperative sleep quality and melatonin secretion in patients undergoing elective thoracoscopic lung surgery: A prospective, randomized study. Nat Sci Sleep, 16: 2009-20.##19. Xu CY, An MZ, Hou YR, Zhou QH (2024) Effect of dexmedetomidine on postoperative high-sensitivity cardiac troponin T in patients undergoing video-assisted thoracoscopic surgery: a prospective, randomised controlled trial. BMC Pulm Med, 24(1): 500.##20. Zdravković R, Vicković S, Preveden M, Drobnjak V, Lukić-Šarkanović M, Miljević IB, et al. (2025) Effect of continuous intraoperative dexmedetomidine on interleukin-6 and other inflammatory markers after coronary artery bypass graft surgery: A randomized controlled trial. Medicina (Kaunas), 61(5): 787.##21. Huang SQ, Zhang J, Zhang XX, Liu L, Yu Y, Kang XH, et al. (2017) Can dexmedetomidine improve arterial oxygenation and intrapulmonary shunt during one-lung ventilation in adults undergoing thoracic surgery? A meta-analysis of randomized, placebo-controlled trials. Chin Med J, 130(14): 1707-14.##22. 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The role of color doppler echocardiography in evaluating ventricular remodeling and cardiotoxicity following radiotherapy in thoracic cancer patients 2 2 Background: Radiotherapy (RT) for thoracic malignancies, such as breast and lung cancer, can induce cardiac injury, leading to ventricular remodeling and heart failure (HF), which negatively impacts long-term health outcomes. This study aimed to evaluate the effectiveness of color Doppler echocardiography in detecting early signs of ventricular remodeling and cardiotoxicity in patients undergoing thoracic RT. Materials and Methods: A retrospective analysis was performed on 80 patients with thoracic cancers who underwent RT between June 2022 and December 2024. Patients were divided into high-dose RT (n=49) and standard-dose RT groups (n=31). Serial color Doppler echocardiography was conducted before, immediately after, and at a 6-month follow-up to assess changes in cardiac structure and function. Results: Post-RT, both groups showed an increase in left ventricular end-diastolic volume index (LVEDVI), with the high-dose group showing significantly greater changes (P<0.05). Eleven patients in the high-dose group showed signs of HF, including increased left ventricular diameters and reduced ejection fraction (LVEF) (P<0.05). Color Doppler echocardiography demonstrated high sensitivity and specificity in detecting RT-related cardiotoxicity. Conclusion: Color doppler echocardiography is a valuable, non-invasive tool for monitoring ventricular remodeling and detecting early cardiotoxic effects of RT in thoracic cancer patients, enabling timely interventions and improved cardiac outcomes. 959 965 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/16 1404/9/25 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 X. Peng X. Peng Department of Ultrasound, Affiliated Rehabilitation Hospital of Nanchang University, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China X. Xiong X. Xiong Department of Ultrasound, Affiliated Rehabilitation Hospital of Nanchang University, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China J. Wang J. Wang Department of Ultrasound, Affiliated Rehabilitation Hospital of Nanchang University, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China m13576064516@163.com Radiotherapy color doppler echocardiography cardiotoxicity ventricular remodeling heart failure thoracic cancer. 1. Finazzi T, Schneiders FL, Senan S (2021) Developments in radiation techniques for thoracic malignancies. Eur Respir Rev, 30(160): 200224. DOI: 10.1183/16000617.0224-2020.##2. Mechanic OJ, Gavin M, Grossman SA (2023) Acute myocardial infarction. StatPearls. Treasure Island (FL): StatPearls Publishing LLC.; 2025.##3. Yu YY, Zhao BW, Ma L, Dai XC (2021) Association between out-of-hour admission and short- and long-term mortality in acute myocardial infarction: A systematic review and meta-analysis. 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(2024) The spectrum of post-myocardial infarction care: From acute ischemia to heart failure. Progress in Cardiovascular Diseases, 82: 15-25. DOI: 10.1016/j.pcad.2024.01.017.##13. Gaspar A, Azevedo P, Roncon-Albuquerque R, Jr. (2018) Non-invasive hemodynamic evaluation by Doppler echocardiography. Rev Bras Ter Intensiva, 30(3): 385-393. DOI: 10.5935/0103-507x.20180055.##14. Abbas MM, Mahmoud AH, Abdelmonem HA (2022) Modulatory effects of Zn oxide nanoparticles on cardiotoxicity and hematological changes in irradiated rats. International Journal of Radiation Research, 20(4): 851–855. DOI: 10.52547/ijrr.20.4.18.##15. Ling HJ, Bernard O, Ducros N, Garcia D (2023) Phase unwrapping of color doppler echocardiography using deep learning. IEEE Trans Ultrason Ferroelectr Freq Control, 70(8): 810-820. DOI: 10.1109/tuffc.2023.3289621.##16. Petersen JW, Forder JR, Thomas JD, et al. 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(2014) Thrombolysis followed by early percutaneous coronary intervention via transradial artery approach in patients with ST-segment elevation infarction. Acta Cardiol Sin, 30(4): 284-91. ##21. Arnautu DA, Andor M, Buz BF, et al. (2022) Left Ventricular Remodeling and heart failure predictors in acute myocardial infarction patients with preserved left ventricular ejection fraction after successful percutaneous intervention in Western Romania. Life (Basel), 12(10): 1636. DOI: 10.3390/life12101636.##22. Stiermaier T, Eitel I, de Waha S, et al. (2017) Myocardial salvage after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction presenting early versus late after symptom onset. Int J Cardiovasc Imaging, 33(10): 1571-1579. DOI: 10.1007/s10554-017-1143-x.##23. Ibáñez B, Heusch G, Ovize M, Van de Werf F (2015) Evolving Therapies for myocardial ischemia/reperfusion injury. Journal of the American College of Cardiology, 65(14): 1454-1471. 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Effect of host anti-tumor immune response following endoscopic mucosal resection combined with photodynamic treatment in patients with early gastrointestinal cancer 2 2 Background: To investigate the host anti-tumor immune response induced by the combination of endoscopic mucosal resection (EMR) and photodynamic therapy (PDT) in patients with early gastrointestinal cancer (EGIC), and its impact on recurrence and immune modulation. Materials and Methods: A total of 120 patients diagnosed with EGIC were enrolled and divided into EMR-only (n=60) and EMR+PDT (n=60) groups. Peripheral blood samples were taken before treatment, and on days 7 and 30 post-treatment. Immune markers (CD4+, CD8+ T cells, NK cells) were measured by flow cytometry. Serum cytokines (IL-2, IL-6, IFN-γ, TNF-α, IL-10) were assessed using ELISA. Recurrence was tracked over 6 months using endoscopic follow-up. Results: At day 30, the EMR+PDT group showed significantly elevated CD8+ T cell counts (P<0.01), IFN-γ levels (P<0.01), and NK cell activity (P<0.05) compared to EMR-only. There was a marked decrease in Treg cells and IL-10 in the EMR+PDT group (P<0.05). Recurrence rate was 5% in the PDT group versus 18% in EMR-only (P=0.01). Conclusion: PDT combined with EMR enhances host immune responses against tumor cells via immunogenic cell death, improving clinical outcomes in early gastrointestinal cancers. 967 972 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/28 1404/10/7 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 B. Xia B. Xia Department of Gastroenterology, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of PLA Joint Logistics Support Force, Fuzhou City, Fujian Province, China M. Qiu M. Qiu Department of Gastroenterology, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of PLA Joint Logistics Support Force, Fuzhou City, Fujian Province, China 15980276855@163.com Photodynamic therapy endoscopic mucosal resection T cell response gastrointestinal cancer host immune modulation. 1. Nishiguchi A, Kurihara Y, Taguchi T (2019) Underwater-adhesive microparticle dressing composed of hydrophobically-modified Alaska pollock gelatin for gastrointestinal tract wound healing. Acta Biomater, 99: 387-96.##2. Zhang H, Zhao C, Song C, Wu Y, Wei D, Li X (2023) Knowledge, attitude, and practice of healthcare workers on early gastrointestinal cancer in China. Front Public Health,11: 1191699.##3. Ben-Aharon I, van Laarhoven HWM, Fontana E, Obermannova R, Nilsson M, Lordick F (2023) Early-onset cancer in the gastrointestinal tract is on the rise-evidence and implications. Cancer Discov, 13(3): 538-51.##4. Weinberg BA, Murphy CC, Freyer DR, Greathouse KL, Blancato JK, Stoffel EM, et al. (2025) Rethinking the rise of early-onset gastrointestinal cancers: a call to action. JNCI Cancer Spectr, 9(1): pkaf002. ##5. Yanagida M, Hosoi Y, Kawano T, Otake Y, Yamanaka Y, Baba T, et al. (2024) Noniatrogenic meningitis caused by streptococcus salivarius associated with early esophageal cancer and early gastric cancer. Intern Med, 63(3): 457-60.##6. Park CH, Yang DH, Kim JW, Kim JH, Kim JH, Min YW, et al. (2020) Clinical practice guideline for endoscopic resection of early gastrointestinal cancer. Clin Endosc, 53(2): 142-66.##7. Du Y, Zhu H, Liu J, Li J, Chang X, Zhou L, et al. (2020) Consensus on eradication of Helicobacter pylori and prevention and control of gastric cancer in China (2019, Shanghai). J Gastroenterol Hepatol, 35(4): 624-9.##8. Patil M, Jr., Gharde P, Reddy K, Nayak K (2024) Comparative analysis of laparoscopic versus open procedures in specific general surgical interventions. Cureus, 16(2): e54433.##9. Feng Q, Yu C, Li R, Ren Q, Xie F, Chen S, et al. (2023) The efficacy and safety of endoscopic mucosal dissection for early gastrointestinal cancer and precancerous lesions. J Gastrointest Oncol,14(6): 2671-2.##10. Shi B, Wang L, Huang S (2021) Effect of high-quality nursing on psychological status and prognosis of patients undergoing brain tumor surgery. Am J Transl Res, 13(10): 11974-80.##11. Shi L, Wang L, Cui Q (2021) The clinical effects of high-quality nursing interventions after a diagnosis of upper gastrointestinal bulging lesions with mEUS. Am J Transl Res, 13(8): 9655-62.##12. Oosterveld-Vlug MG, Custers B, Hofstede J, Donker GA, Rijken PM, Korevaar JC, et al. (2019) What are essential elements of high-quality palliative care at home? An interview study among patients and relatives faced with advanced cancer. BMC Palliat Care, 18(1): 96.##13. Nishiguchi A, Sasaki F, Maeda H, Kabayama M, Ido A, Taguchi T (2019) Multifunctional hydrophobized microparticles for accelerated wound healing after endoscopic submucosal dissection. Small,15(35): e1901566.##14. Yin L (2023) The application value of the clinical nursing pathway for patients with head and neck cancer. J Cancer Res Clin Oncol, 149(12): 9629-34.##15. Kelly R, Gordon P, Thompson R, Semple C (2023) Availability and use of web-based interventions for patients with head and neck cancer: a scoping review. J Cancer Surviv, 17(5): 1309-26.##16. Harrington KJ, Affronti ML, Schneider SM, Razzak AR, Smith TJ (2019) Improving Attitudes and perceptions about end-of-life nursing on a hospital-based palliative care unit. J Hosp Palliat Nurs, 21(4): 272-9.##17. Wen FH, Chou WC, Hou MM, Su PJ, Shen WC, Chen JS, et al. (2022) Caregivers' death-preparedness states impact caregiving outcomes and patients' end-of-life care. J Pain Symptom Manage, 63(2): 199-209.##18. Wang M, Sun Y, Zhang M, Yu R, Fu J (2022) Effects of high-quality nursing care on quality of life, survival, and recurrence in patients with advanced nonsmall cell lung cancer. Medicine (Baltimore), 101(37): e30569.##19. Alvero AB, Fox A, Madina B, Krady M, Gogoi R, Chehade H, et al. (2023) Immune modulation of innate and adaptive responses restores immune surveillance and establishes anti-tumor immunological memory. bioRxiv.##20. Jin P, Sun LL, Li BX, Li M, Tian W (2022) High-quality nursing care on psychological disorder in ovarian cancer during perioperative period: A systematic review and meta-analysis. Medicine (Baltimore), 101(27): e29849.##21. Zhang L, Zhang X, Cui Z, Zhou L, Qu K, Wang N (2020) Effects of high-quality nursing care on psychological outcomes and quality of life in patients with hepatocellular carcinoma: A protocol of systematic review and meta-analysis. Medicine (Baltimore), 99(35): e21855.##22. He XL and Cao ZM (2020) Effect of high-quality nursing intervention on the psychological disorder in patients with gastric cancer during perioperative period: A protocol of systematic review and meta-analysis. Medicine (Baltimore), 99(23): e20381.##23. Cui Y and Li YX (2020) Effect of high-quality nursing on alleviating depression and anxiety in patients with thyroid cancer during perioperative period: A protocol for systematic review. Medicine (Baltimore), 99(45): e23018.## ##

Predicting prostate movement during early-stage radiotherapy treatment 2 2 Background: Predicting the direction and amount of movement of the patient-specific prostate at an early stage of treatment is important for estimating systematic errors and avoiding large dose differences between planning and actual treatment. This study aimed to evaluate a two-plane analysis of prostate movement for multiple-image matching and examine the accuracy of predicting the amount of prostate movement for inter- and intra-fraction setup errors at the early stage of treatment. Materials and Methods: Sixty-five patients who underwent prostate intensity-modulated rotating radiotherapy with fiducial markers were examined for setup errors in bone matching and inter- and intra-marker matching. The two-plane setup errors in the anterior-posterior (AP), left-right (LR), and superior-inferior (SI) directions were analyzed. Correlation analysis was performed by calculating the relationship between the total average setup error and each average setup error (2‒5 fractions), increasing from the first to the sixth fraction. Results: The inter- and intra-fraction setup errors between the AP and SI directions of prostate movement were moderately correlated (r: 0.63, r =0.58, respectively). The average setup error of >4 fractions was strongly correlated (r >0.7), and the standard deviation of the >3 fraction setup errors was moderately correlated (r >0.4) with total and early setup errors. Conclusions: Prostate movement during radiotherapy was linear in the AP-SI direction. The evaluation of early fraction setup errors may be used to predict prostate movement in individual patients during the treatment period. 973 977 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/28 1404/10/7 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 R. Kojima R. Kojima Facilty of Health Sciences, Okayama University Medical School, Okayama University, 2-5-1 Shikata, Kita-ku, Okayama, Japan Y. Tanaka Y. Tanaka Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, 2-5-1, Shikata, Kita, Okayama, Japan N. Irie N. Irie Facilty of Health Sciences, Okayama University Medical School, Okayama University, 2-5-1 Shikata, Kita-ku, Okayama, Japan H. Sasaki H. Sasaki Facilty of Health Sciences, Okayama University Medical School, Okayama University, 2-5-1 Shikata, Kita-ku, Okayama, Japan T. Morishita T. Morishita Facilty of Health Sciences, Okayama University Medical School, Okayama University, 2-5-1 Shikata, Kita-ku, Okayama, Japan A. Nakamoto A. Nakamoto Department of Radiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Yamaguchi, Japan K. Nishioka K. Nishioka Department of Radiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Yamaguchi, Japan S. Takahashi S. Takahashi Department of Radiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Yamaguchi, Japan Y. Tanabe Y. Tanabe Faculty of Medicine, Graduate School of Health Sciences, Okayama University, 2-5-1 Shikata, Kita-ku, Okayama, Japan tanabey@okayama-u.ac.jp Prostate cancer two-plane analysis prostate movement setup errors adaptive radiation therapy. 1. Rawla P (2019) Epidemiology of prostate cancer. World J Oncol, 10(2): 63-89. doi: 10.14740/wjon1191.##2. Martin JM, Frantzis J, Eade T, Chung P (2010) Clinician’s guide to prostate IMRT plan assessment and optimization. J Med Imaging Radiat Oncol, 54(6): 569-75. doi:10.1111/j.1754-9485.2010.02217.x.##3. Bauman G, Rumble RB, Chen J, Loblaw A, Warde P (2012) Members of the IMRT Indications Expert Panel. Intensity-modulated radiotherapy in the treatment of prostate cancer. Clin Oncol, 24(7): 461-73. doi: 10.1016/j.clon.2012.05.002.##4. Colvill E, Poulsen PR, Booth JT, O’Brien RT, Ng JA, Keall PJ (2014) DMLC tracking and gating can improve dose coverage for prostate VMAT. Med Phys, 41(9): 091705. doi: 10.1118/1.4892605.##5. Venkatesan K, Raphael CJ, Varghese KM, Gopu P, Sivakumar S, Boban M, et al. (2020). Volume and dosimetric analysis of rectum and bladder for prostate carcinoma patients by using kilo voltage cone beam computed tomography (CBCT). Int J Radiat Res, 18(3): 557-569. doi: 10.18869/acadpub.ijrr.18.3.557.##6. Mahdavi SR, Gharehbagh EJ, Mofid, B, Jafari A H, Nikoofar AR (2017). Accuracy of the dose delivery in prostate cancer patients-using an electronic portal imaging device (EPID). Int J Radiat Res, 15(1): 39. doi: 10.18869/acadpub.ijrr.15.1.39.##7. Tanabe Y and Ishida T (2019) Optimizing multiple acquisition planning CT for prostate cancer IMRT. Biomed Phys Eng Express, 5(3): 035011. doi: 10.1088/2057-1976/ab0dc7.##8. Tanabe Y, Ishida T, Eto H, Sera T, Emoto Y (2019) Evaluation of the correlation between prostatic displacement and rectal deformation using the Dice similarity coefficient of the rectum. Med Dosim, 44(4): e39-43. doi: 10.1016/j.meddos.2018.12.005.##9. Pathmanathan AU, van As NJ, Kerkmeijer LGW, Christodouleas J, Lawton CAF, Vesprini D, et al. (2018) Magnetic resonance imaging-guided adaptive radiation therapy: a “game changer” for prostate treatment? Int J Radiat Oncol Biol Phys, 100(2): 361-73. doi: 10.1016/j.ijrobp.2017.10.020.##10. Boubaker MB, Haboussi M, Ganghoffer JF, Aletti P (2009) Finite element simulation of interactions between pelvic organs: predictive model of the prostate motion in the context of radiotherapy. J Biomech, 42(12): 1862-8. doi:10.1016/j.jbiomech.2009.05.022.##11. Budiharto T, Slagmolen P, Haustermans K, Maes F, Junius S, Verstraete J, et al. (2011) Intrafractional prostate motion during online image guided intensity-modulated radiotherapy for prostate cancer. Radiother Oncol, 98(2): 181-6. https://doi.org/10.1016/j.radonc.2010.12.019.##12. Kiriyama T, Fukui A, Ishikawa H, Doi M, Nishimoto Y, Cyosei K, Kishimoto K, Tanabe Y (2025). Efficacy of hydrogel spacer compared with intensity-modulated radiotherapy for 3-dimensional conformal radiotherapy for prostate cancer. Med Dosim, in press. doi:10.1016/j.meddos.2025.01.005.##13. Tanabe Y and Eto H (2022) Evaluation of patient-specific motion management for radiotherapy planning computed tomography using a statistical method. Med Dosim, 47(2): e13-8. doi: 10.1016/j.meddos.2021.12.002.##14. Tanabe Y, Ishida T, Eto H, Sera T, Emoto Y, Shimokawa M (2021) Patient-specific radiotherapy quality assurance for estimating actual treatment dose. Med Dosim, 46(1): e5-e10. doi:10.1016/j.meddos.2020.08.003.##15. Sasaki H, Morishita T, Irie N, Kojima R, Kiriyama T, Nakamoto A, Nishioka K, Takahashi S, Tanabe, Y. (2024). Evaluation of the trend of set-up errors during the treatment period using set-up margin in prostate radiotherapy. Med Dosim, 49(4). 291-297. doi: 10.1016/j.meddos.2024.02.004.##16. Brand VJ, Milder MT, Christianen M E, Hoogeman MS, Incrocci L (2022) Seminal vesicle inter-and intra-fraction motion during radiotherapy for prostate cancer: A review. Radiother Oncol, 169: 15-24. doi: 10.1016/j.radonc.2022.02.002.##17. Feng SQ, Brouwer CL, Korevaar EW, Vapiwala N, Kang-Hsin Wang KKH, Deville Jr C, et al. (2023) Dose evaluation of inter- and intra-fraction prostate motion in extremely hypofractionated intensity-modulated proton therapy for prostate cancer. Phys Imaging Radiat Oncol, 27: 100474. doi: 10.1016/j.phro.2023.100474.##18. Sihono DSK, Ehmann M, Heitmann S, von Swietochowski S, Grimm M, Boda-Heggemann J, et al. (2018) Determination of intrafraction prostate motion during external beam radiation therapy with a transperineal 4-dimensional ultrasound real-time tracking system. Int J Radiat Oncol Biol Phys, 101(1): 136-43. doi: 10.1016/j.ijrobp.2018.01.040.##19. Yagihashi T, Inoue K, Nagata H, Yamanaka M, Yamano A, Suzuki S, et al. (2023) Effectiveness of robust optimization against geometric uncertainties in TomoHelical planning for prostate cancer. J Appl Clin Med Phys, 24(4): e13881. doi: 10.1002/acm2.13881.##20. Tanabe Y, Ishida T, Eto H, Sera T, Emoto Y (2020) Optimizing planning CT using past CT images for prostate cancer volumetric modulated arc therapy. Med Dosim, 45(3): 213-8. doi: 10.1016/j.meddos.2019.12.008.## ##

FGR and MNDA as prognostic biomarkers in lung adenocarcinoma patients undergoing radiotherapy: A bioinformatics analysis of M2 macrophage-derived exosome-related genes 2 2 Background: Lung adenocarcinoma (LUAD), a subtype of non-small cell lung cancer, has a poor prognosis in patients undergoing radiotherapy. M2 macrophage polarization and their derived exosomes play key roles in tumor progression, but their impact on LUAD prognosis remains unclear. This study aims to identify M2 macrophage-derived exosome-related genes associated with prognosis in radiotherapy-treated LUAD patients. Materials and Methods: Transcriptomic data from TCGA-LUAD, ExoRBase, ExoCarta, and GEO were analyzed. The CIBERSORT algorithm quantified immune cell infiltration, and differentially expressed genes (DEGs) were identified. Prognostic genes were screened via univariate Cox regression, LASSO regression, and Kaplan–Meier survival analysis. Gene function was explored using enrichment analysis and immune infiltration correlation. Results: A total of 2,592 DEGs were identified in LUAD, of which 17 were exosome-related and associated with M2 macrophages. Among these, FGR and MNDA emerged as key prognostic markers. High expression levels of both genes were associated with better outcomes: median overall survival of 45.2 months versus 28.7 months in the low-expression group. Improved progression-free interval and disease-specific survival were also observed. Multivariate analysis confirmed FGR and MNDA as independent prognostic indicators. Their high expression correlated with favorable radiotherapy response and enhanced immune infiltration, particularly of CD8⁺ T cells. Conclusion: FGR and MNDA, as M2 macrophage-derived exosome-related genes, are associated with favorable prognosis and enhanced radiotherapy response in LUAD. These biomarkers may offer novel insights into tumor immunity and therapeutic targeting in LUAD patients receiving radiotherapy. 979 986 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/28 1404/10/7 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 S. Huang S. Huang Department of Thoracic Surgery, Ningbo No.2 Hospital, Ningbo, Zhejiang Province, China J. Miao J. Miao The Yangtze River Delta Biological Medicine Research and Development Center of Zhejiang Province, Yangtze Delta Region Institution of Tsinghua University, Hangzhou, Zhejiang, China Y. Gu Y. Gu Department of Respiratory and Critical Care Medicine, Jiaxing Second Hospital, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China guyyjiaxing@163.com Lung neoplasms exosomes macrophages biomarkers radiotherapy gene expression profiling. 1. Thandra KC, Barsouk A, Saginala K, Aluru JS, Barsouk A (2021) Epidemiology of lung cancer. Contemp Oncol (Pozn), 25(1) :45-52.##2. Dela Cruz CS, Tanoue LT, Matthay RA (2011) Lung cancer: epidemiology, etiology, and prevention. Clin Chest Med, 32(4): 605-44.##3. Tang FH, Wong HYT, Tsang PSW, Yau M, Tam SY, Law L, et al. (2025) Recent advancements in lung cancer research: a narrative review. Transl Lung Cancer Res, 14(3): 975-90.##4. He S, Li H, Cao M, Sun D, Yang F, Yan X, et al. (2022) Survival of 7,311 lung cancer patients by pathological stage and histological classification: a multicenter hospital-based study in China. Transl Lung Cancer Res, 11(8): 1591-605.##5. 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Experimental insights into high background radiation: reduced cancer risks in a murine model study 2 2 Background: Natural background radiation varies geographically and has potential implications for cancer development. High-level natural radiation areas (HLNRAs), like Ramsar, Iran, offer unique opportunities to study the biological effects of radiation exposure. This study investigates the relationship between high background radiation and tumor progression in a murine model. Materials and Methods: Thirty-two C57BL/6 mice were exposed to varying levels of natural radiation (0.097 μSv/h to 9.24 μSv/h) for two months, simulating conditions in Ramsar. Mice were divided into four groups based on radiation intensity. After exposure, 1106 B16-F10 melanoma cells were injected subcutaneously, and tumor growth was monitored for 24 days. Tumor morphology was assessed using Magnetic Resonance Imaging (MRI), and survival rates were recorded. Statistical analyses included mixed-model and Kaplan-Meier methods. Results: Tumor volume and growth rates were significantly reduced in groups exposed to the highest radiation levels (100X Bkg). Mice in this group also exhibited the highest survival rates (100%) compared to the control group (55.6%). Tumor reduction and disintegration were observed, especially in female mice, suggesting a potential protective effect of elevated radiation exposure against melanoma progression. Conclusion: Findings challenge the Linear No-Threshold (LNT) model by demonstrating that high background radiation may not correlate with increased cancer risk. Instead, elevated radiation levels appear to confer protective effects against tumor growth in this murine model. These results highlight the need to reassess radiation safety standards and explore the complex interplay between radiation and cancer biology. 987 994 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/28 1404/10/7 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 S.M.J. Mortazavi S.M.J. Mortazavi Ionizing and Non-Ionizing Radiation Protection Research Center (INIRPRC), Shiraz University of Medical Sciences, Shiraz, Iran M. Arshadi M. Arshadi Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran B.F. Baha'addini Baigy Zarandi B.F. Baha'addini Baigy Zarandi Department of, Pharmacology School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran J.S. Welsh J.S. Welsh Department of Radiation Oncology, Edward Hines Jr VA Hospital, Hines, IL, United States H. Mozdarani H. Mozdarani Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran M. Haghani M. Haghani Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran N. Jooyan N. Jooyan Ionizing and Non-Ionizing Radiation Protection Research Center (INIRPRC), Shiraz University of Medical Sciences, Shiraz, Iran S. Nematollahi S. Nematollahi Noncommunicable Diseases Research Center, Bam University of Medical Sciences, Bam, Iran A.A. Fallah A.A. Fallah Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran A. Mortazavi A. Mortazavi MVLS College, The University of Glasgow, Glasgow, Scotland, UK Z. Farshidfar Z. Farshidfar Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran N. Azarpira N. Azarpira Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran azarpiran@sums.ac.ir L. Sihver L. Sihver Department of Informatics and Engineering Systems, College of Engineering and Computer Science, University of Texas Rio Grande Valley, TX, USA Background radiation Radioactivity Melanoma Mice. Nations U (1993) Sources and effects of ionizing radiation. UNSCEAR Report.##Radiation UNSCotEoA (2000) Sources and Effects of Ionizing Radiation, United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) 2000 Report, Volume I: Report to the General Assembly, with Scientific Annexes. United Nations.##Bugała E and Fornalski KW (2024) Radiation adaptive response for constant dose-rate irradiation in high background radiation areas. 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Study of radiation attenuation properties by incorporating a zinc oxide and conjugated hole transport material into polystyrene 2 2 Background: This study aims to understand the impact of material composition on radiation attenuation by integrating polystyrene (PS) composites with a conjugated hole transport material (MADN) and zinc oxide (ZnO). The high atomic number of zinc is expected to enhance photon interactions, making ZnO a promising additive for radiation shielding applications. Materials and Methods: PS composites with varying concentrations of MADN (1.3%–4.5%, denoted as PM0–PM5) and ZnO (PMZnO1–PMZnO5) were prepared. Linear and mass attenuation coefficients were measured at photon energies of 59.5 keV, 661.7 keV, 1173.2 keV, and 1332.5 keV. Furthermore, the half value layer (HVL) and mean free path (MFP) were evaluated to assess the attenuation behavior at these energy levels. Results: The PM0–PM5 samples exhibited similar mass attenuation coefficients, which is attributed to the predominant presence of carbon and hydrogen atoms. The addition of ZnO significantly increased the mass attenuation coefficient, especially at lower photon energies, owing to the higher atomic number of zinc, which enhances photoelectric absorption and photon interactions. ZnO addition also reduced the HVL, particularly at 59.5 keV, where composites with higher ZnO concentrations exhibited significantly lower HVL values, indicating stronger attenuation. Conclusion: The findings highlight the crucial roles of atomic number and material density in radiation attenuation, with ZnO effectively enhancing photon attenuation in PS composites. This effect is particularly significant at lower photon energies, validating ZnO’s potential as a useful additive for improved radiation shielding in PS composites. 995 1001 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/28 1404/10/7 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 M. Marashdeh M. Marashdeh Department of Physics, College of Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia mwmarashdeh@imamu.edu.sa M.J. Aljaafreh M.J. 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Quality of life > 5 years after prostate cancer radiation therapy with a radiopaque viscous hydrogel spacer 2 2 Background: Perirectal spacers are injected to decrease the dose to the rectum and prevent rectal toxicity in prostate cancer radiotherapy. Advantages of a radiopaque viscous hydrogel spacer are a good visibility in computed tomography and improved placement control. The aim of this study was to demonstrate unaffected long-term bowel quality of life (QoL) in comparison to baseline levels, independently from radiotherapy (RT) treatment technique. Materials and Methods: Patients responded to the EPIC (Expanded Prostate Cancer Index Composite) questionnaire before RT, at the last day of RT, 3 months, >12 months and >60 months after RT (n=27). A significant QoL change was defined as a statistically significant mean change >5 points in comparison to baseline. Results: The largest mean bowel domain changes were found at the end of RT (>10 points in the function and bother subdomains, respectively). Function subdomain changes remained without a significant difference in comparison to baseline at all later points in time (<3 points, respectively). In the bother subdomain, changes remained >5 points and statistically significant (8 and 6 points after >12 and >60 months, repsectively). In contrast to patients after pelvic node RT, the difference after >60 months was <5 points for patients after prostate only RT (12 vs. 4 points with vs. without pelvic node RT). Conclusion: The first QoL analysis after RT with a radiopaque viscous hydrogel spacer showed unaffected long-term bowel QoL in patients with limitation of the target volume to the prostate.  1003 1007 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/28 1404/10/7 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 M. Pinkawa M. Pinkawa Department of Radiation Oncology, Wege Klinik, Bonn, Germany michael.pinkawa@post.rwth-aachen.de H. Haddad H. Haddad Department of Radiation Oncology, Wege Klinik, Bonn, Germany A. Rashid A. Rashid Department of Radiation Oncology, Wege Klinik, Bonn, Germany S. Temming S. Temming Department of Radiation Oncology, Wege Klinik, Bonn, Germany H. Hermani H. Hermani Department of Radiation Oncology, Wege Klinik, Bonn, Germany M. Schlenter M. Schlenter Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany Prostate cancer radiotherapy brachytherapy hydrogel quality of life. 1. Pinkawa M (2023) Gastrointestinal quality-of-life trajectories after radiotherapy for prostate cancer-which patients suffer from persisting problems? Cancers (Basel), 15: 4295.##2. Lane JA, Donovan JL, Young GJ, Davis M, Walsh EI, Avery KNL, et al. (2022) Functional and quality of life outcomes of localised prostate cancer treatments (Prostate Testing for Cancer and Treatment [ProtecT] study). BJU Int, 130: 370-80.##3. Resnick MJ, Koyama T, Fan KH, Albertsen PC, Goodman M, Hamilton AS, et al. (2013) Long-term functional outcomes after treatment for localized prostate cancer. N Engl J Med, 368: 436-45.##4. Pinkawa M, Schubert C, Escobar-Corral N, Berneking V, Eble MJ (2018) Optimization of prostate cancer radiotherapy using of a spacer gel, volumetric modulated arc therapy and a single biological organ at risk objective. International Journal of Radiation Research, 16: 169-76.##5. Seymour ZA, Pinkawa M, Daignault-Newton S, Bosch W, Michalski JM, Gay H, et al. (2023) A pooled long-term follow-up after radiotherapy for prostate cancer with and without a rectal hydrogel spacer: impact of hydrogel on decline in sexual quality of life. Front Oncol, 13: 1239104.##6. Armstrong N, Bahl A, Pinkawa M, Ryder S, Ahmadu C, Ross J, et al. (2021) SpaceOAR hydrogel spacer for reducing radiation toxicity during radiotherapy for prostate cancer. A systematic review. Urology, 156: e74-e85.##7. Pinkawa M, Haddad H, Schlenter M, Hermani H, Ho H, Kovacs A, et al. (2024) Application of a radiopaque viscous hydrogel spacer for prostate cancer radiation therapy: A prospective phase 2 study. Pract Radiat Oncol, 14: 57-64.##8. Hatiboglu G, Pinkawa M, Vallee JP, Hadaschik B, Hohenfellner M (2012) Application technique: placement of a prostate-rectum spacer in men undergoing prostate radiation therapy. BJU Int, 110: E647-52.##9. Pinkawa M, Berneking V, Schlenter M, Krenkel B, Eble MJ (2017) Quality of life after radiation therapy for prostate cancer with a hydrogel spacer: 5-year results. Int J Radiat Oncol Biol Phys, 99: 374-7.##10. Wei JT, Dunn RL, Litwin MS, Sandler HM, Sanda MG (2000) Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology, 56: 899-905.##11. Volz-Sidiropoulou E, Pinkawa M, Fischedick K, Jakse G, Gauggel S, Eble MJ (2008) Factor Analysis of the expanded prostate cancer index composite (EPIC) in a patient group after primary (external beam radiotherapy and permanent iodine-125 brachytherapy) and postoperative radiotherapy for prostate cancer. Curr Urol, 2: 122-9.##12. Osoba D, Rodrigues G, Myles J, Zee B, Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol, 16: 139-44.##13. Cornford P, van den Bergh RCN, Briers E, Van den Broeck T, Brunckhorst O, Darraugh J, et al. (2024) EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on prostate cancer-2024 update. Part I: screening, diagnosis, and local treatment with curative intent. Eur Urol, 68: 148-163.##14. Pinkawa M, Hermani H, Bischoff P, Hanitzsch H, Heidrich A, Schafer A, et al. (2022) Focal injection of a radiopaque viscous spacer before focal brachytherapy as re-irradiation for locally recurrent prostate cancer. Brachytherapy, 21: 848-52.##15. Mariados NF, Orio PF, 3rd, Schiffman Z, Van TJ, Engelman A, Nurani R, et al. (2023) Hyaluronic acid spacer for hypofractionated prostate radiation therapy: A randomized clinical trial. JAMA Oncol, 9: 511-8.##16. Song D, Dabkowski M, Costa P, Nurani R, Kos M, Vanneste B, et al. (2024) Prospective, randomized controlled pivotal trial of biodegradable balloon rectal spacer for prostate radiation therapy. Int J Radiat Oncol Biol Phys, 120: 1410-20.##17. Kim HJ, Lee JS, Kim WC (2021) Moderate hypofractionated volumetric modulated Arc therapy with daily image guidance for patients with localized prostate cancer. International Journal of Radiation Research, 19: 243-9.##18. Ozturk N, Ozbek N, Depboylu B (2022) Dosimetric comparison of IMRT, VMAT and HYBRID treatment methods in radical radiation therapy of prostate cancer. International Journal of Radiation Research, 20: 411-6.##19. Seymour ZA, Hamstra DA, Daignault-Newton S, Bosch W, Michalski J, Gay HA, et al. (2020) Long-term follow-up after radiotherapy for prostate cancer with and without rectal hydrogel spacer: a pooled prospective evaluation of bowel-associated quality of life. BJU Int, 126: 367-72.##20. Pinkawa M, Berneking V, Konig L, Frank D, Bretgeld M, Eble MJ (2017) Hydrogel injection reduces rectal toxicity after radiotherapy for localized prostate cancer. Strahlenther Onkol, 193: 22-8.##21. Ishii K, Yamanaga T, Ogino R, Hosokawa Y, Kishimoto S, Nakahara R, et al. (2018) Bowel and urinary quality of life after whole-pelvic versus prostate-only volumetric-modulated arc therapy for localized prostate cancer. Pract Radiat Oncol, 8: e49-e55.##22. Link C, Honeck P, Lohr F, Bolenz C, Schaefer J, Bohrer M, et al. (2019) Quality of life and decision regret after postoperative radiation therapy to the prostatic bed region with or without elective pelvic nodal radiation therapy. Pract Radiat Oncol, 9: e516-e27.##23. Miller LE, Efstathiou JA, Bhattacharyya SK, Payne HA, Woodward E, Pinkawa M (2020) Association of the placement of a perirectal hydrogel spacer with the clinical outcomes of men receiving radiotherapy for prostate cancer: A systematic review and meta-analysis. JAMA Netw Open, 3: e208221.##24. Hamstra DA, Mariados N, Sylvester J, Shah D, Karsh L, Hudes R, et al. (2017) Continued benefit to rectal separation for prostate radiation therapy: Final results of a phase III trial. Int J Radiat Oncol Biol Phys, 97: 976-85.##25. Hadigal SR and Gupta AK (2022) Application of hydrogel spacer SpaceOAR Vue for prostate radiotherapy. Tomography, 8: 2648-61.## ##

Volumetric changes in meningioma after six-month follow-up of single session gamma knife radiosurgery: A single-centre study 2 2 Background: Gamma Knife Radiosurgery is a type of radiation therapy that uses a very intense beam of gamma rays that is used in destroying brain tumors like meningiomas without the need to make a surgical interface. The current study aims to assess the impact of Gamma Knife Radiosurgery in meningioma treatment by estimating the changes in meningioma volumes after six months of follow-up. Materials and Methods: 43 participants' data was collected at the Saad Al-Watari Gamma Knife Center in Baghdad, Iraq. The data was gathered from June 2022 to December 2022, and each patient followed after 6 months after the gamma knife surgery. Results: The outcomes show a decrease in meningioma volumes of 83.7% of patients. Only 2.3% of the patients recorded no change in meningioma size. Also, 9.3% of the patients recorded an increase in meningioma size. And finally, the tumor completely disappeared in 4.7% of the patients. Conclusion: Gamma knife treatment is a beneficial option for reducing the meningioma volume. The study demonstrated a significant decrease in tumor size for most patients. Furthermore, a small percentage of patients reported no change or an increase in tumor size, indicating that gamma knife treatment may not be equally effective for all individuals. However, it is essential to mention that two patients reported the complete disappearance of their tumors, suggesting a potential for successful tumor eradication with this treatment. 1009 1015 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/28 1404/10/7 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 R.S. Ahmed R.S. Ahmed Department of Physiology and Medical Physics, College of Medicine, Al-Nahrain University, Baghdad, Iraq rasha.sabeeh.ahmed@colmed-alnahrain.edu.iq Y.M. Hassen Y.M. Hassen Department of Surgery, College of Medicine, Al-Nahrain University, Baghdad, Iraq F.H. Hameed F.H. Hameed Department of Physiology and Medical Physics, College of Medicine, Al-Nahrain University, Baghdad, Iraq S.A. Abd El-Azeem S.A. Abd El-Azeem Physics Department, College of Sciences and Humanities, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia M.Y.A. Mostafa M.Y.A. Mostafa Physics Department, Faculty of Science, Minia University, El-Minia, Egypt Mostafa.youness@mu.edu.eg Meningioma gamma knife radiosurgery Iraq tumor. 1. Wechsler W and Reifenberger G (1996) Histopathological classification of brain tumors according to the revised WHO classification: Current State and perspectives BT - brain tumor. In: Nagai M (ed). Springer Japan, Tokyo, pp 3-20.##2. Zulch MDKJ (1957) Brain tumors, their biology and pathology. Springer; First Edition (January 1, 1957).##3. Mennel H-D (1991) Grading of intracranial tumors following the WHO classification. Neurosurgical Review, 14: 249-260. https://doi.org/10.1007/BF00383256##4. Couldwell WT, Fukushima T, Giannotta SL, Weiss MH (1996) Petroclival meningiomas: surgical experience in 109 cases. Journal of Neurosurgery 84: 20-28. https://doi.org/10.3171/jns.1996.84.1.0020##5. Zhu W, Mao Y, Zhou L-F, et al. (2007) Combined subtemporal and retrosigmoid keyhole approach for extensive petroclival meningioma surgery: report of experience with 7 cases. Minimally Invasive Neurosurgery: MIN, 50: 106-110. https://doi.org/10.1055/s-2007-984384##6. Nadeem A, Khan A, Habib A, et al. (2024) Intracranial intricacies: Comprehensive analysis of rare skull base meningiomas-A single-center case series. Clinical Case Reports, 12: e8376.##7. Sheikhbahaei S, Sadaghiani MS, Rowe SP, Solnes LB (2021) Neuroendocrine tumor theranostics: An update and emerging applications in clinical practice. American Journal of Roentgenology, 217: 495-506. https://doi.org/10.2214/AJR.20.23349##8. Richter S, Steenblock C, Fischer A, et al. (2024) Improving susceptibility of neuroendocrine tumors to radionuclide therapies: personalized approaches towards complementary treatments. Theranostics, 14: 17-32. https://doi.org/10.7150/thno.87345##9. Mishra S, Kumar AG, Garg K, et al. (2023) Role of stereotactic radiosurgery for cavernous sinus hemangiomas - an individual patient data-based meta-analysis. Neurology India, 71: S21-S30. https://doi.org/10.4103/0028-3886.373654##10. Speckter H, Bido J, Hernandez G, et al. (2016) SU-F-J-92: Predictive value of diffusion tensor imaging parameters for gamma knife radiosurgery in meningiomas. Medical Physics, 43: 3427-3428. https://doi.org/https://doi.org/10.1118/1.4956000##11. Lee JA, Kim SR, Yoon SH, et al. (2022) Evaluation and analysis of radiation exposure to normal tissues during gamma knife radiosurgery for vestibular schwannoma. Int J Radiat Res, 20: 571-578. https://doi.org/10.52547/ijrr.20.3.8##12. Sarihan S, Tunc SG, Irem ZK, Kahraman A (2024) Stereotactic radiotherapy for brain metastases in patients with non-small cell lung cancer: CyberKnife-M6 experience. Int J Radiat Res, 22: 117-124. https://doi.org/10.61186/ijrr.22.1.117##13. Lippitz BE, Bartek JJ, Mathiesen T, Förander P (2020) Ten-year follow-up after Gamma Knife radiosurgery of meningioma and review of the literature. Acta Neurochirurgica, 162: 2183-2196. https://doi.org/10.1007/s00701-020-04350-5##14. Ganz JC (2014) Stockholm radiosurgery developing 1968-1982. Progress in Brain Research, 215: 85-94. https://doi.org/10.1016/B978-0-444-63520-4.00009-0##15. Mori Y, Nakazawa H, Hashizume C, et al. (2019) Dosimetric comparison of hypofractionated stereotactic radiotherapy by three different modalities for benign skull base tumors adjacent to functioning optic pathways. Int J Radiat Res, 17: 519-530##16. Ibrahim RT, Ahmed RS, Hassan YM (2023) The evaluation of tumor volume and radiological features in patients with meningioma treated by multi-session, single session and hypo fractionation gamma knife radiosurgery. Onkologia i Radioterapia, 17: 231-234.##17. Fallows P, Wright G, Bownes P (2019) A standardised method for use of the Leksell GammaPlan Inverse Planning module for metastases. Journal of radiosurgery and SBRT, 6: 227-233.##18. Schmutzer M, Skrap B, Thorsteinsdottir J, et al. (2023) Meningioma involving the superior sagittal sinus: long-term outcome after robotic radiosurgery in primary and recurrent situation. Frontiers in Oncology, 13: 1206059. https://doi.org/10.3389/fonc.2023.1206059##19. Zada G, Pagnini PG, Yu C, et al. (2010) Long-term outcomes and patterns of tumor progression after gamma knife radiosurgery for benign meningiomas. Neurosurgery, 67: 322-329. https://doi.org/10.1227/01.NEU.0000371974.88873.15##20. Maksoud Z, Schmidt MA, Huang Y, et al. (2022) Transient enlargement in meningiomas treated with stereotactic radiotherapy. Cancers, 14: 1547. https://doi.org/10.3390/cancers14061547##21. Ogasawara C, Philbrick BD, Adamson DC (2021) Meningioma: A review of epidemiology, pathology, diagnosis, treatment, and future directions. Biomedicines, 9(3): 319. https://doi.org/10.3390/biomedicines9030319##22. Samanic CM, Teer JK, Thompson ZJ, et al. (2021) Mitochondrial DNA sequence variation and risk of meningioma. Journal of Neuro-oncology, 155: 319-324. https://doi.org/10.1007/s11060-021-03878-5##23. Ullah MS, Khan MA, Masood A, et al. (2024) Brain tumor classification from MRI scans: a framework of hybrid deep learning model with Bayesian optimization and quantum theory-based marine predator algorithm. Frontiers in Oncology, 14: 1335740. https://doi.org/10.3389/fonc.2024.1335740##24. Hosseini-Siyanaki MR, Hasanpour Segherlou Z, Liu S, et al. (2023) Recurrent meningioma: When to intervene. 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Effects of mindfulness-based cognitive therapy on self-efficacy and mental health in lung cancer patients undergoing radiotherapy: A randomized controlled trial 2 2 Background: This study aimed to evaluate the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in improving self-efficacy, quality of life, and mental health outcomes in patients with lung cancer undergoing radiotherapy. Materials and Methods: A randomized controlled trial was conducted involving 60 patients diagnosed with lung cancer and scheduled to receive radiotherapy between January 2024 and February 2025. Patients were randomly assigned to either the intervention group (IG, n=30), which received MBCT in addition to standard oncological care, or the control group (CG, n=30), which received standard oncological care alone. The MBCT program was delivered over eight weekly sessions during the radiotherapy course. Outcome measures included quality of life (QoL), self-efficacy (SE), cancer-related fatigue, and levels of depression and anxiety. Assessments were conducted at baseline, one day after completing radiotherapy, and seven days post-treatment. Results: Compared to baseline, patients in the intervention group showed significant improvements in QoL, self-relaxation, positive attitude, decision-making confidence, and overall self-efficacy (P<0.05). These improvements were significantly greater than those observed in the control group at both follow-up points. Furthermore, the intervention group exhibited markedly reduced symptoms of depression, anxiety, and cancer-related fatigue-particularly emotional and cognitive fatigue-seven days post-treatment (P<0.05). Conclusion: MBCT significantly enhances self-efficacy and mental health outcomes in lung cancer patients undergoing radiotherapy. These findings support the integration of MBCT as a complementary psychosocial intervention in radiotherapy care to improve patients’ psychological resilience and quality of life. 1017 1022 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/28 1404/10/7 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 B. Xie B. Xie Zhejiang 1Class 2, Nursing, 21st Batch, Equal Academic Qualification Program, Zhejiang Chinese Medical University, Hangzhou, 310002, Zhejiang Province, China 18058445771@163.com X. Ma X. Ma Department of Medical Engineering, Hangzhou First People's Hospital, Hangzhou, 310000, Zhejiang Province, China Mindfulness-based cognitive therapy (MBCT) lung cancer radiotherapy self-efficacy mental health quality of life. 1. Smolarz B, Łukasiewicz H, Samulak D, Piekarska E, Kołaciński R, Romanowicz H (2025) Lung cancer-epidemiology, pathogenesis, treatment and molecular aspect. Int J Mol Sci, 26(5): 2049.##2. Liu H and Tang T (2022) Pan-cancer genetic analysis of cuproptosis and copper metabolism-related gene set. Front Oncol, 12: 952290.##3. Li AH, Bu S, Wang L, Liang AM, Luo HY (2024) Impact of propofol and sevoflurane anesthesia on cognition and emotion in gastric cancer patients undergoing radical resection. World J Gastrointest Oncol, 16(1): 79-89.##4. Baskar R, Dai J, Wenlong N, Yeo R, Yeoh KW (2014) Biological response of cancer cells to radiation treatment. Front Mol Biosci, 1: 24.##5. Seol KH, Bong SH, Kang DH, Kim JW (2021) Factors Associated with the quality of life of patients with cancer undergoing radiotherapy. Psychiatry Investig, 18(1): 80-7.##6. Koul R, Tse R, Karreman E, Dubey A, Tai P (2015) Overall quality of life assessment in the patients undergoing external beam radiation in outpatient radiation oncology department. Int J Hematol Oncol Stem Cell Res, 9(3): 122-7.##7. Arias F, Arrarás JI, Asín G, Zarandona U, Mora I, Errasti M, et al. (2018) To what extent does radiotherapy improve the quality of life of patients with bone metastasis?: A prospective, single-institutional study. Am J Clin Oncol, 41(2): 163-6.##8. Hofmann SG and Gómez AF (2017) Mindfulness-based interventions for anxiety and depression. Psychiatr Clin North Am, 40(4): 739-49.##9. Fereidouni Z, Dehghan Abnavi S, Ghanbari Z, Gashmard R, Zarepour F, Khalili Samani N, et al. (2024) The impact of cancer on mental health and the importance of supportive services. Galen Med J, 13:e3327.##10. Looijmans M, van Manen AS, Traa MJ, Kloover JS, Kessels BLJ, de Vries J (2018) Psychosocial consequences of diagnosis and treatment of lung cancer and evaluation of the need for a lung cancer specific instrument using focus group methodology. Support Care Cancer, 26(12): 4177-85.##11. Shivappa P, Bernhardt GV, Gatti P, Radhakrishnan V (2024) Exploring Psychosocial distress in cancer patients and survivors: A quick overview. New Emirates Medical Journal, 5: e02506882320073.##12. Li S, Gao Z, Xu Y, Zhong X, Bai X (2025) Self-efficacy for coping with cancer and quality of life in head and neck cancer patients: a cross-sectional study. Scientific Reports, 15(1): 7056.##13. Merluzzi TV, Pustejovsky JE, Philip EJ, Sohl SJ, Berendsen M, Salsman JM (2019) Interventions to enhance self-efficacy in cancer patients: A meta-analysis of randomized controlled trials. Psychooncology, 28(9): 1781-90.##14. Chang YC, Tseng TA, Lin GM, Hu WY, Wang CK, Chang YM (2023) Immediate impact of mindfulness-based cognitive therapy (MBCT) among women with breast cancer: a systematic review and meta-analysis. BMC Womens Health, 23(1): 331.##15. Sheikhzadeh M, Zanjani Z, Baari A (2021) Efficacy of mindfulness-based cognitive therapy and cognitive behavioral therapy for anxiety, depression, and fatigue in cancer patients: A randomized clinical trial. Iran J Psychiatry, 16(3): 271-80.##16. Feng L and Yang D (2022) Observation on the Effect of high-quality nursing intervention plus health education in chemotherapy for non-small cell lung cancer and its influence on the physical and mental health of patients. Evid Based Complement Alternat Med, 2022: 2459013.##17. Yu J, Huang T, Xu J, Xiao J, Chen Q, Zhang L (2022) Effect of nursing method of psychological intervention combined with health education on lung cancer patients undergoing chemotherapy. J Healthc Eng, 2022: 2438612.##18. Park S, Sato Y, Takita Y, Tamura N, Ninomiya A, Kosugi T, et al. (2020) Mindfulness-based cognitive therapy for psychological distress, fear of cancer recurrence, fatigue, spiritual well-being, and quality of life in patients with breast cancer-A randomized controlled trial. Journal of Pain and Symptom Management, 60(2): 381-9.##19. Johns SA, Tarver WL, Secinti E, Mosher CE, Stutz PV, Carnahan JL, et al. (2021) Effects of mindfulness-based interventions on fatigue in cancer survivors: A systematic review and meta-analysis of randomized controlled trials. Crit Rev Oncol Hematol, 160: 103290.## ##

Evaluation of the critical organ doses in high dose rate brachytherapy plans using single-and multi-channel applicators 2 2 Background: The purpose of our study was to investigate the doses received by critical organs, namely the bladder, rectum, and sigmoid colon, in the treatment plans using single-channel (SC) or multi-channel (MC) applicators in high dose rate (HDR) brachytherapy treatments for vaginal cancer patients. Materials and Methods: We established treatment plans for 10 patients received 45Gy (1.8Gy×25fractions) external radiotherapy and then subsequently treated with HDR brachytherapy using MC applicators in the Oncentra Brachytherapy Treatment Planning System (OBTPS). These plans, originally created with MC applicator in the OBTPS, were redefined to simulate an SC applicator, where only the central channel active was kept active. To compare the doses to critical organs, new plans were generated with a prescribed dose of 5Gy to the clinical target volume (CTV). During optimization, it was ensured that 90% of the CTV received the prescribed dose (5Gy), in accordance with Groupe Européen de Curiethérapie and the European SocieTy for Radiotherapy and Oncology (GEC-ESTRO) criteria. The doses received by critical organs were analyzed for volumes of 0.1, 1, and 2cc in both SC and MC applicator plans. Results: A significant difference was found in rectal doses at 1cc and 2cc (p=0.022 and p=0.022, respectively); bladder doses at 0.1cc 1cc and 2cc (p=0.013 for all); and sigmoid colon dose at 1cc (p=0.012). Conclusion: HDR brachytherapy plans using MC applicators delivered lower doses to critical organs compared to SC applicators. Thus, MC applicators are preferable for better organ sparing in vaginal cancer treatment. 1023 1027 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/29 1404/10/8 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 L. Suncak L. Suncak The Institute of Health Sciences at Istanbul University, Istanbul, Turkey lxleyla@hotmail.com C.K. Akbas C.K. Akbas Division of Medical Physics, Istanbul University Oncology Institute, Istanbul, Turkey G.U. Alveroglu G.U. Alveroglu Division of Medical Physics, Istanbul University Oncology Institute, Istanbul, Turkey S. Özkurt S. Özkurt Division of Radiation Oncology, Istanbul University Oncology Institute, Istanbul, Turkey K.A. İbiş K.A. İbiş Division of Radiation Oncology, Istanbul University Oncology Institute, Istanbul, Turkey S. Küçücük S. Küçücük Division of Radiation Oncology, Istanbul University Oncology Institute, Istanbul, Turkey H.B. Becerir H.B. Becerir Division of Medical Physics, Istanbul University Oncology Institute, Istanbul, Turkey Brachytherapy rectum sigmoid colon urinary bladder applicators. Horowitz NS, Peters WA 3rd, Smith MR, Drescher CW, Atwood M, Mate TP (2002) Adjuvant high dose rate vaginal brachytherapy as treatment of stage I and II endometrial carcinoma. Obstet Gynecol, 99(2): 235-240. doi:10.1016/s0029-7844(01)01672-6##Pearcey RG and Petereit DG (2000) Post-operative high dose rate brachytherapy in patients with low to intermediate risk endometrial cancer. Radiother Oncol, 56(1): 17-22. doi:10.1016/s0167-8140(00)00171-7##Sabater S, Andres I, Lopez-Honrubia V, Berenguer R, Sevillano M, Jimenez-Jimenez E, Rovirosa A, Arenas M (2017) Vaginal cuff brachytherapy in endometrial cancer - a technically easy treatment? Cancer Manag Res, 9: 351-362. doi:10.2147/CMAR.S119125##Iftimia I, Cirino ET, Mower HW, McKee AB (2013) Treatment planning methodology for the Miami Multichannel Applicator following the American Brachytherapy Society recently published guidelines: the Lahey Clinic experience. J Appl Clin Med Phys, 14(1): 4098. doi:10.1120/jacmp.v14i1.4098##Bahadur YA, Constantinescu C, Hassouna AH, Eltaher MM, Ghassal NM, Awad NA. (2015) Single versus multichannel applicator in high-dose-rate vaginal brachytherapy optimized by inverse treatment planning. J Contemp Brachytherapy, 6(4): 362-370. doi:10.5114/jcb.2014.47816##Demanes DJ, Rege S, Rodriquez RR, Schutz KL, Altieri GA, Wong T (1999) The use and advantages of a multichannel vaginal cylinder in high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys, 44(1): 211-219. doi:10.1016/s0360-3016(98)00453-2##Kim H, Rajagopalan MS, Houser C, Beriwal S (2014) Dosimetric comparison of multichannel with one single-channel vaginal cylinder for vaginal cancer treatments with high-dose-rate brachytherapy. Brachytherapy, 13: 263-267. doi:10.1016/j.brachy.2013.08.009##Shin SM, Duckworth TL, Cooper BT, Curtin JP, Schiff PB, DeWyngaert JK, Lymberis SC (2015) Use of a flexible inflatable multi-channel applicator for vaginal brachytherapy in the management of gynecologic cancer. Front Oncol, 5: 201. doi:10.3389/fonc.2015.00201##Zhang Z, He W, Yang L, Li D, Zhong L, Shi X, Tan L, Wen Q, Pang H (2021) Dosimetric comparison between the use of insertion needles and Fletcher applicator in brachytherapy for cervical cancer. Int J Radiat Res, 19(4): 819-820.##Pötter R, Haie-Meder C, Van Limbergen E, Barillot I, De Brabandere M, Dimopoulos J, et al. (2006) Recommendations from gynaecological (GYN) GEC ESTRO working group (II): Concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol, 78(1): 67-77. doi:10.1016/j.radonc.2005.11.014##Celik Y, (editor). (2011) Nasıl? Biyoistatistik Bilimsel Araştırma SPSS.##Gebhardt BJ, Vargo JA, Kim H, Houser CJ, Glaser SM, Sukumvanich P, et al. (2018) Image-based multichannel vaginal cylinder brachytherapy for the definitive treatment of gynecologic malignancies in the vagina. Gynecol Oncol, 150(2): 293-299. doi:10.1016/j.ygyno.2018.06.011##Feng C, Wen X, Li S, Hua L, Chen S (2024) Comparison of 3D-printed multichannel non–co-planar vaginal applicators and single-channel vaginal applicators for brachytherapy with positive or close surgical margins in cervical cancer. Brachytherapy, 23(4): 641-647.## ##

Dosimetric assessment of photon, proton, and carbon ion beams in a magnetic field; a Monte Carlo simulation study 2 2 Background: The advent of Magnetic Resonance-guided (MR-guided) radiotherapy, facilitated by MR-guided linear accelerators (MR-LINACs), has significantly enhanced the availability of online adaptive radiotherapy treatments. Research indicates that a static magnetic field influences the amount of radiation absorbed by patients undergoing MR-guided radiotherapy. This study employed Monte Carlo simulations to assess the dose distribution of Photon, Proton, and Carbon ion beams in the absence and presence of magnetic fields. Materials and Methods: All simulations were performed using version 9.1 of the GATE software. The experimental configuration consisted of a water phantom equipped with a one mm-thick air slit oriented parallel to the x-y plane. Energy and dose measurements from both the primary beam and secondary electrons were conducted using DoseActor. Results: The observed magnetic field shifted the Bragg peak for both proton and carbon ion beams, with an increasing displacement correlating to higher primary beam energy levels. Furthermore, there was a positive correlation between secondary electron doses and magnetic field intensity; in scenarios involving a 7 Tesla magnetic field, photon doses at the water-air interface increased considerably. Additionally, at the air slit location, doses from photon-induced secondary electrons markedly increased at this interface. Conclusion: The Electron Return Effect (ERE) influences dose distribution at water-air boundaries. Increased initial energies and more robust magnetic fields exacerbate these phenomena, emphasizing the critical importance of rigorous deliberation in the treatment planning process. 1029 1036 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/292025/12/29 1404/10/8 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 S. Bagherzadeh S. Bagherzadeh Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran H. Rajabi H. Rajabi Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran hrajabi@modares.ac.ir Comprehensive Magnetic Fields Carbon-Ion Therapy Monte Carlo Method Proton Therapy Protons. 1. Ahmad R, Barcellini A, Baumann K, et al. (2024) Particle Beam Radiobiology Status and Challenges: A PTCOG Radiobiology Subcommittee Report. Int J Particle Ther, 13: 100626.##2. Hamad Morad K (2021) Bragg-curve simulation of carbon-ion beams for particle-therapy applications: A study with the GEANT4 toolkit. Nucl Eng Technol, 53(8): 2767-2773.##3. Loeffler J and Durante M (2013) Charged particle therapy-optimization, challenges and future directions. Nat Rev Clin Oncol, 10: 411-424.##4. Tinganelli W and Durante M (2020) Carbon ion radiobiology. Cancers, 12(10): 3022.##5. Kleynhans J, Sathekge M, Ebenhan T (2021) Obstacles and recommendations for clinical translation of nanoparticle system-based targeted alpha-particle therapy. Materials, 14(17): 4784.##6. Kurz C, Buizza G, Landry G, et al. (2020) Medical physics challenges in clinical MR-guided radiotherapy. Radiat Oncol, 15: 93.##7. Xia W, Li T, Chen Y, et al. (2020) Magnetic field-induced dose distortions in carbon-ion therapy: a Monte Carlo study. Med Phys, 47: 4415-4425.##8. Nahum A (2021) Interactions of charged particles with matter. In: Handbook of Radiotherapy Physics, CRC Press, pp. Vol1-25.##9. Raaijmakers AJ, Raaymakers BW, Lagendijk JJ (2005) Integrating a MRI scanner with a 6 MV radiotherapy accelerator: dose increase at tissue–air interfaces in a lateral magnetic field due to returning electrons. Phys Med Biol, 50(7): 1363.##10. Santos DM, Wachowicz K, Burke B, Fallone BG (2019) Proton beam behavior in a parallel configured MRI-proton therapy hybrid: effects of time-varying gradient magnetic fields. Med Phys, 46(2): 822-838.##11. Fuchs H, Padilla-Cabal F, Oborn BM, Georg D (2023) Commissioning a beam line for MR-guided particle therapy assisted by in silico methods. Med Phys, 50(2): 1019-1028.##12. Pham TT, Tran LT, Hoang NH, et al. (2022) Optimizing proton beam energies in the presence of magnetic fields for MR-guided therapy. Radiother Oncol, 170: 54-61.##13. Karger CP, Glowa C, Peschke P, et al. (2021) The RBE in ion beam radiotherapy: In vivo studies and clinical application. Z Med Phys, 31(2): 105-121.##14. Wang X, Zhou J, Fan L, et al. (2021) Integration of MR guidance in carbon-ion therapy: challenges and opportunities. J Radiat Oncol, 36: 327-335.##15. Loap P, Vischioni B, Bonora M, et al. (2021) Biological rationale and clinical evidence of carbon ion radiation therapy for adenoid cystic carcinoma: a narrative review. Front Oncol, 11: 789079.##16. Muraro S, Battistoni G, Kraan AC (2020) Challenges in Monte Carlo simulations as clinical and research tool in particle therapy: a review. Front Phys, 8: 567800.##17. Mesbahi A, Mohammadi M, Mahdavi SR (2007) Application of Monte Carlo calculations in evaluation of neutron and capture gamma doses for a high-energy photon beam. Int J Radiat Res, 5: 143-148.##18. Durante M and Paganetti H (2016) Nuclear physics in particle therapy: a review. Rep Prog Phys, 79(9): 096702.##19. Haberl, D. (2021). Implementation and verification of Monte Carlo particle transport in electromagnetic fields in GATE, Doctoral dissertation, Technische Universität Wien, Austria.##20. Grevillot L, Boersma DJ, Fuchs H, et al. (2020) GATE-RTion: a GATE/Geant4 release for clinical applications in scanned ion beam therapy. Med Phys, 47(8): 3675-3681.##21. Reis CAC (2024) Development of a Monte Carlo framework to simulate 3D-printed plastics in proton therapy beams, Master's thesis, Universidade de Lisboa (Portugal).##22. Makarova A, Gottschalk B, Sauerwein W (2017) Comparison of Geant4 multiple Coulomb scattering models with theory for radiotherapy protons. 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Development and in-vitro evaluation of gallium-68 labelled Staphylococcus aureus -specific aptamer as a potential PET agent for infection imaging 2 2 Background: Staphylococcus aureus (S. aureus) is the most common causative pathogen associated with a wide range of infections, from mild to life-threatening conditions such as osteomyelitis, endocarditis, and pneumonia. Early detection and reliable differentiation between infection and sterile inflammation are essential for accurate diagnosis and effective treatment. However, most radiopharmaceuticals currently available fail to discriminate between these conditions, underscoring the need for infection-specific imaging agents. Materials and Methods: In this study, a Gallium-68 (Ga-68)-labeled S. aureus-specific aptamer was developed as a potential PET infection imaging probe. Aptamers were selected using the cell- systematic evolution of ligands by exponential enrichment (SELEX) method, and their specificity was verified by fluorescence-based binding assays. Radiolabeling was achieved via DOTA chelation, and radiochemical purity was determined. Additionally, in vitro binding assays were performed with S. aureus, while Escherichia coli (E. coli) served as a control. Results: The aptamer exhibited an affinity constant (Kₐ) of 2260 ± 634 CFU/mL and a linear detection range of 250-2×10⁴ CFU/mL, with a limit of detection of 171 CFU/mL for S. aureus. The Ga-68-labeled aptamer demonstrated radiochemical purity greater than 99%. In vitro binding increased linearly with rising S. aureus concentrations (10³-2×10⁴ CFU/mL), while minimal binding to E. coli confirmed its specificity. Conclusion: These results demonstrate that the Ga-68-labeled S. aureus-specific aptamer holds promise as an infection-targeted PET imaging agent. Although currently limited to in vitro evaluation, such aptamer-based radiopharmaceuticals may contribute to improved diagnosis and imaging of infectious diseases. 1037 1042 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/292025/12/292025/12/29 1404/10/8 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 S. Bargh S. Bargh Department of Radiopharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkiye C. Ozkul C. Ozkul Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkiye S.S. Timur S.S. Timur Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkiye V.C. Ozalp V.C. Ozalp Department of Biology, Faculty of Medicine, Atılım University, Ankara, Turkiye S. Erdogan S. Erdogan Department of Radiopharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkiye serdogan@hacettepe.edu.tr Aptamer gallium-68 Staphylococcus aureus PET agent for infection imaging. dos Santos AL, Santos DO, de Freitas CC, Alves Ferreira BL, Afonso IF, Rodrigues CR, Castro HC (2007) Staphylococcus aureus: visitando uma cepa de importância hospitalar. J Bras Patol Med Lab, 43 :413-23.##Hatzenbuehler J and Pulling TJ (2011) Diagnosis and management of osteomyelitis. Am Fam Physician, 84(9): 1027-33.##Navalkissoor S, Nowosinska E, Gnanasegaran G, Buscombe JR (2013) Single-photon emission computed tomography–computed tomography in imaging infection. Nucl Med Commun, 34(4): 283-90.##Patel RD, Patel PM, Patel NM (2011) A review on radiopharmaceuticals and radiochemical method in analysis. Int J Pharm Biol Arch, 2: 1062-7.##Salmanoglu E, Kim S, Thakur ML (2018) Currently available radiopharmaceuticals for imaging infection and the holy grail. Semin Nucl Med, 48(2): 86-99.##Mokoala KM, Ndlovu H, Lawal I, Sathekge MM (2024) PET/CT and SPECT/CT for infection in joints and bones: an overview and future directions. Semin Nucl Med, 54(3): 394-408.##dos Santos SR, Corrêa CR, de Barros AL, Serakides R, Fernandes SO, Cardoso VN, et al. (2015) Identification of Staphylococcus aureus infection by aptamers directly radiolabeled with technetium-99m. Nucl Med Biol, 42(3): 292-8.##Ferreira IM, de Sousa Lacerda CM, dos Santos SR, de Barros ALB, Fernandes SO, Cardoso VN, et al. (2017) Detection of bacterial infection by a technetium-99m-labeled peptidoglycan aptamer. Biomed Pharmacother, 93: 931-8.##Correa CR, Miranda AS, Simionatto CS, Lima WM, Souto AA, Silva RG, et al. 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(2022) Selection and identification of a DNA aptamer for multidrug-resistant Acinetobacter baumannii using an in-house cell-SELEX methodology. Front Cell Infect Microbiol, 12: 818737.##Timur SS (2023) Anticancer potential of novel nanoemulgel formulations in melanoma. FABAD J Pharm Sci, 48(3): 443-58.##Sicco E, Báez J, Margenat J, García F, Ibarra M, Cabral P, et al. (2018) Derivatizations of Sgc8-c aptamer to prepare metallic radiopharmaceuticals as imaging diagnostic agents: Syntheses, isolations, and physicochemical characterizations. Chem Biol Drug Des, 91(3): 747-55.##Tayeri H, Sattarzadeh Khameneh E, Zolghadri S, Kakaei S, Sardari D (2020) Optimized production, quality control and biological assessment of 68Ga-bleomycin as a possible PET imaging agent. Int J Radiat Res, 18(2): 235-41.##Liu X, Zhao Y, Wang X, Wu L, Zhang Y, Lu W, et al. 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Does the high dose to the vertebral body in the treatment of esophageal cancer lead to increased hematological toxicity? 2 2 Background: To investigate the effect of radiation dose to thoracic vertebrae (TV) on the development of hematologic toxicity in esophageal cancer patients treated with intensity-modulated radiotherapy. Materials and Methods: We identified 28 patients with esophageal cancer treated with chemoradiotherapy between 2014-2021.Vertebral volumes receiving 5-50 Gy (TV5-50) and the mean vertebral and thoracic blood pool dose were collected from the dose-volume-histogram. Complete blood cell counts were analyzed and hematologic toxicities were graded according to the Common Terminology Criteria for Adverse Events version5.0 (CTCAE v5.0). Results: TV50 was negatively linearly associated with mean lymphocyte nadir by percentage. TV20 was negatively linearly associated with mean platelet nadir by cc. Planning Target Volume (PTV) length was negatively linearly associated with mean hemoglobin nadir. The optimal threshold dose values for avoiding grade ≥4 lymphopenia was TV40 of <22.3%, TV50 of <9.09%, mean thoracic blood pool dose of < 16.9 Gy, PTV volume of <652 cc and PTV length of <16.7 cm. The optimal threshold dose values for avoiding grade ≥3 leukopenia were TV10 of <47.6%, TV20  of <39.7%, TV30 of< 34.69%,and mean vertebral dose of <17.7Gy. Conclusion: This study demonstrated a statistically significant negative correlation between vertebral doses and hematologic parameters. The optimal threshold dose values for avoiding grade ≥3 leukopenia were TV10 of <47.6% and mean vertebral dose of <17.7Gy. 1043 1049 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/292025/12/292025/12/292025/12/29 1404/10/8 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 C. Barlas C. Barlas Department of Radiation Oncology, Sivas Numune Hospital, Sivas, Turkey dr.cerencicibiyik@gmail.com T.K. Çatal T.K. Çatal Department of Radiation Oncology, Kahramanmaraş Necip Fazil City Hospital, Kahramanmaraş, Turkey H.C. Yıldırım H.C. Yıldırım Department of Radiation Oncology, Istanbul University- Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey E.S. Akovalı E.S. Akovalı Department of Radiation Oncology, Sakarya Training and Research Hospital, Sakarya, Turkey S.Ç. Karaçam S.Ç. Karaçam Istanbul University-Cerrahpaşa, Vocational School of Health Services, Radiotherapy Program, Turkey Ş.A. Ergen Ş.A. Ergen Department of Radiation Oncology, Istanbul University- Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey D.Ç. Öksüz D.Ç. Öksüz Department of Radiation Oncology, Istanbul University- Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey Esophageal neoplasms chemoradiotherapy hematologic toxicity complete blood cell counts dosimetry parameter. Crosby T, Hurt CN, Falk S, Gollins S, Mukherjee S, Staffurth J, et al. (2013) Chemoradiotherapy with or without cetuximab in patients with oesophageal cancer (SCOPE1): a multicentre, phase 2/3 randomised trial. The Lancet Oncology, 14(7): 627-37.##Fukuzawa T, Nagao R, Kuroki T, Mikami T, Akiba T, Nakano Y, et al. (2024) Clinical outcomes and prognostic factors of volumetric modulated arc therapy (VMAT) of esophageal cancer. Reports of Practical Oncology and Radiotherapy, 29(4): 426-36.##Conroy T, Galais M-P, Raoul J-L, Bouché O, Gourgou-Bourgade S, Douillard J-Y, et al. (2014) Definitive chemoradiotherapy with FOLFOX versus fluorouracil and cisplatin in patients with oesophageal cancer (PRODIGE5/ACCORD17): final results of a randomised, phase 2/3 trial. The Lancet Oncology, 15(3): 305-14.##Hallemeier CL, Moughan J, Haddock MG, Herskovic AM, Minsky BD, Suntharalingam M, et al. (2023) Association of radiotherapy duration with clinical outcomes in patients with esophageal cancer treated in NRG Oncology trials: a secondary analysis of NRG Oncology randomized clinical trials. JAMA Network Open, 6(4): e238504-e.##Damen PJ, Kroese TE, van Hillegersberg R, Schuit E, Peters M, Verhoeff JJ, et al. (2021) The influence of severe radiation-induced lymphopenia on overall survival in solid tumors: a systematic review and meta-analysis. Int J Radiat Oncol Biol Phys, 111(4): 936-48.##Mell LK, Kochanski JD, Roeske JC, Haslam JJ, Mehta N, Yamada SD, et al. (2006) Dosimetric predictors of acute hematologic toxicity in cervical cancer patients treated with concurrent cisplatin and intensity-modulated pelvic radiotherapy. Int J Radiat Oncol Biol Phys, 66(5): 1356-65.##Mell LK, Schomas DA, Salama JK, Devisetty K, Aydogan B, Miller RC, et al. (2008) Association between bone marrow dosimetric parameters and acute hematologic toxicity in anal cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys, 70(5): 1431-7.##Deek MP, Benenati B, Kim S, Chen T, Ahmed I, Zou W, et al. (2016) Thoracic vertebral body irradiation contributes to acute hematologic toxicity during chemoradiation therapy for non-small cell lung cancer. Int J Radiat Oncol Biol Phys, 94(1): 147-54.##Lee J, Lin J-B, Sun F-J, Lu K-W, Lee C-H, Chen Y-J, et al. (2016) Dosimetric predictors of acute haematological toxicity in oesophageal cancer patients treated with neoadjuvant chemoradiotherapy. The British Journal of Radiology, 89(1066): 20160350.##Zhang A, Deek MP, Kim S, Sayan M, Grann A, Wagman RT, et al. (2019) Vertebral body irradiation during chemoradiation therapy for esophageal cancer contributes to acute bone marrow toxicity. Journal of Gastrointestinal Oncology, 10(3): 513.##Wu AJ, Bosch WR, Chang DT, Hong TS, Jabbour SK, Kleinberg LR, et al. (2015) Expert consensus contouring guidelines for intensity modulated radiation therapy in esophageal and gastroesophageal junction cancer. 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The Oncologist, 24(8): e677-e86.##Tseng I, Li F, Ai D, Chen Y, Xu Y, Yu L, et al. (2023) Less irradiation to lymphocyte-related organs reduced the risk of G4 Lymphopenia in Esophageal Cancer: re-analysis of prospective trials. The Oncologist, 28(8): e645-e52.##Wang Q, Qiu Q, Zhang Z, Zhang J, Yang G, Liu C, et al. (2021) Bone marrow dosimetric analysis of lymphopenia in patients with esophageal squamous cell carcinoma treated with chemoradiotherapy. Cancer Medicine, 10(17): 5847-58.##Newman N, Sherry A, Anderson J, Osmundson E (2018) Dose-dependent association of vertebral body irradiation and lymphopenia during chemoradiation for esophageal cancer. Int J Radiat Oncol Biol Phys, 102(3): e37-e8.##Wang J-j, Shao H, Zhang L, Jing M, Xu W-j, Sun H-w, et al. (2023) Preoperative chemoradiation-induced hematological toxicity and related vertebral dosimetry evaluations in patients with locally advanced gastric cancer: data from a phase III clinical trial. 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Endurance exercise exerts hepatoprotection against electromagnetic radiation via targeting oxidative stress in male rats 2 2 Background: The effects of electromagnetic radiation (EMR) on the body are an emerging field of research. The evidence supports the production of oxidative stress (OS) through EMR and the positive role of exercise in reducing liver damage. The evidence supports the production of OS through EMR and the positive role of exercise in reducing liver damage. Materials and Methods: 32 Wistar male rats were randomly divided into four groups: control, EMR, endurance training (ET), and EMR+ET. The ET and EMR+ET groups ran on the treadmill with the maximum speed and duration of 30 m/ min and 35 min, respectively (5 sessions/weeks, during four weeks). The ET and EMR+ ET groups were exposed to a 2.45GHZ Wi-Fi router for four weeks (4 h/day, 7days/weeks). Forty-eight hours after the last training session, the blood and liver tissue of the animals were sampled for histological, biochemical evaluations and measurement of oxidative stress markers. Results: Histopathological findings confirmed the protective role of ET in rats exposed to EMR. The results showed that in the EMR group, the concentration of malondialdehyde (MDA) and the serum levels of liver enzymes (AST, ALT, and ALP) increased significantly, and the activity of antioxidant enzymes decreased significantly (P<0.05). In the ET and EMR+ET groups, compared to the EMR group, the concentration of MDA and the serum levels of liver enzymes significantly decreased, and the activity of antioxidant enzymes increased significantly (P<0.05). Conclusion: Our findings show that ET can improve the state of OS and liver damage caused by EMR. 1051 1056 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/292025/12/292025/12/292025/12/292025/12/30 1404/10/9 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 H. Amiri H. Amiri Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran K. Rakhshan K. Rakhshan Department of Physiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran F. Shabkhiz F. Shabkhiz Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran R. Zeighami fard R. Zeighami fard Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran N. Aboutaleb N. Aboutaleb Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran dr.nabotaleb@gmail.com Endurance training electromagnetic radiation oxidative stress transaminases pathology. 1. Ansal K, Jose DS, Rajan RK (2018) Review on biological effect of electromagnetic radiation. Proc Int Conf Circuits Syst Digit Enterprise Technol (ICCSDET): 1-5.##2. Dongus S, Jalilian H, Schürmann D, et al. (2022) Health effects of WiFi radiation: a review based on systematic quality evaluation. Crit Rev Environ Sci Technol, 52(19): 3547-66.##3. Batool S, Bibi A, Frezza F, et al. (2019) Benefits and hazards of electromagnetic waves, telecommunication, physical and biomedical: a review. 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The protective effect of melatonin on liver damage induced by mobile phone radiation in mice model. Int J Radiat Res, 18(1): 133-41.##15. Pooladi M, Montzeri A, Nazarian N, et al. (2018) Effect of WiFi waves (2.45 GHz) on aminotransaminases (ALP, ALT and AST) in liver of rat. Arch Adv Biosci, 9(2): 13-20.##16. Anderson E and Durstine JL (2019) Physical activity, exercise, and chronic diseases: A brief review. Sports Med Health Sci, 1(1): 3-10.##17. Ahmadian M, Dabidi Roshan V, Leicht AS (2018) Age-related effect of aerobic exercise training on antioxidant and oxidative markers in the liver challenged by doxorubicin in rats. Free Radic Res, 52(7): 775-82.##18. Amiri H, Shabkhiz F, Pournemati P, et al. (2023) Swimming exercise reduces oxidative stress and liver damage indices of male rats exposed to electromagnetic radiation. Life Sci, 317: 121461.##19. DastAmooz S, Boroujeni ST, Shahbazi M, et al. (2018) Physical activity as an option to reduce adverse effect of EMF exposure during pregnancy. Int J Dev Neurosci, 71: 10-7.##20. Akbari HA, Gaeini AA, Choobineh S (2020) Moderate exercise training reduced the harmful effects of electromagnetic radiation emitted from a cell phone on hematological parameters in male Wistar rats. Sport Sci Health, 16: 267-72.##21. Akbari H and Gaeini A (2021) Moderate exercise training as an effective strategy to reduce the harmful effects of cell phone radiation on Wistar rat's semen quality. Int J Radiat Res, 19(2): 317-23.##22. Pilch W, Szygula Z, Tyka AK, et al. (2014) Disturbances in pro-oxidant-antioxidant balance after passive body overheating and after exercise in elevated ambient temperatures in athletes and untrained men. PLoS One, 9(1): e85320.##23. Wei D, Zhang XL, Wang YZ, et al. (2010) Lipid peroxidation levels, total oxidant status and superoxide dismutase in serum, saliva and gingival crevicular fluid in chronic periodontitis patients before and after periodontal therapy. Aust Dent J, 55(1): 70-8.##24. Farzanegi P, Abbaszadeh H, Farokhi F, et al. (2020) Attenuated renal and hepatic cells apoptosis following swimming exercise supplemented with garlic extract in old rats. Clin Interv Aging, 15: 1409.##25. Fathi R, Nasiri K, Akbari A, et al. (2020) Exercise protects against ethanol-induced damage in rat heart and liver through the inhibition of apoptosis and activation of Nrf2/Keap-1/HO-1 pathway. Life Sci, 256: 117958.##26. Okudan N and Belviranli M (2016) Effects of exercise training on hepatic oxidative stress and antioxidant status in aged rats. Arch Physiol Biochem, 122(4): 180-5.##27. Hajighasem A, Farzanegi P, Mazaheri Z (2018) Effects of combined therapy with resveratrol, continuous and interval exercises on apoptosis and lipid profile in the liver tissue of rats with nonalcoholic fatty liver disease. Report of Health Care, 4(4): 21-9.##28. Sadeghipour HR, Yeganeh G, Zar A, et al. (2020) The effect of 4-week endurance training on serum levels of irisin and betatrophin in streptozotocin-induced diabetic rats. Arch Physiol Biochem, 129(3): 575-81.##29. Varghese R, Majumdar A, Kumar G, et al. (2018) Rats exposed to 2.45 GHz of non-ionizing radiation exhibit behavioral changes with increased brain expression of apoptotic caspase 3. Pathophysiology, 25(1): 19-30.##30. Mahmoudi R, Mortazavi S, Safari S, et al. (2015) Effects of microwave electromagnetic radiations emitted from common Wi-Fi routers on rats’ sperm count and motility. Int J Radiat Res, 13: 363-8.##31. Gürler HŞ, Bilgici B, Akar AK, et al. (2014) Increased DNA oxidation (8-OHdG) and protein oxidation (AOPP) by low level electromagnetic field (2.45 GHz) in rat brain and protective effect of garlic. Int J Radiat Biol, 90(10): 892-6.##32. Adebayo E, Adeeyo A, Ogundiran MA, et al. (2018) Bio-physical effects of radiofrequency electromagnetic radiation (RF-EMR) on blood parameters, spermatozoa, liver, kidney and heart of albino rats. J King Saud Univ Sci, 31(4): 813-821.##33. Ismaiil LA, Joumaa WH, Moustafa ME (2019) The impact of exposure of diabetic rats to 900 MHz electromagnetic radiation emitted from mobile phone antenna on hepatic oxidative stress. Electromagn Biol Med, 38(4): 287-96.##34. Jaffar FHF, Osman K, Hui CK, et al. (2024) Effect of Wi-Fi exposure and edible bird nest supplementation on the testicular oxidative stress status and sperm quality in male Sprague-Dawley rat pups. Int J Radiat Res, 22(2): 329-38.##35. 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Radiologic value of computerized tomography angiography (CTA) for assessment of carotid artery Tortuosity Index and its impact on stroke recovery 2 2 Background: This study investigated the relationship between extracranial internal carotid artery (EICA) and extracranial carotid artery (ECA) tortuosity and clinical prognosis in acute anterior circulation ischemic stroke (AIS). Materials and Methods: We retrospectively analyzed 201 patients with anterior circulation AIS who underwent head and neck CT angiography (CTA) between January–December 2023.CTA was performed using a Discovery CT750 HD scanner (GE Medical Systems), with scanning extending from the aortic arch to the skull vertex. Iopromide contrast agent (37g iodine/100ml) was administered intravenously. Images were reconstructed at 0.63-mm slice thickness using multiplanar reformation (MPR) and 3D volume rendering (VR). Results: Tortuosity Index (TI) of EICA and ECA were independent predictors of poor 90-day prognosis (modified Rankin Scale [mRS] ≥3) in multivariate regression (Model I: EICA OR=1.038, P=0.007.ECA OR=1.052, P=0.015). ROC analysis showed ECA-TI≥12.5 predicted poor prognosis with higher specificity (AUC=0.623,sensitivity 55.6%,specificity 68.3%) than EICA-TI ≥14.5 (AUC=0.601,sensitivity 61.9%,specificity60.7%). Conclusions: Increased EICA/ECA tortuosity independently correlates with poor AIS outcomes, with ECA-TI being a superior prognostic indicator. 1057 1063 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/292025/12/292025/12/292025/12/292025/12/302025/12/30 1404/10/9 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 Y. Wang Y. Wang Department of Neurology, Jingxian Hospital, Xuancheng, Anhui 242500, China W. Cui W. Cui Department of Neurology, Shahe Hospital Changping District, Beijing 102206, China ssamsca2001@163.com Carotid arteries stroke prognosis intracranial arteriosclerosis x-ray computed risk factors. Kim ST, Brinjikji W, Lehman VT, Carr CM, Luetmer PH, Rydberg CH (2018) Association between carotid artery tortuosity and carotid dissection: a case-control study. Journal of Neurosurgical Sciences, 62(4): 413-417.##Krzyzewski RM, Klis KM, Kwinta BM, et al. (2022) Subarachnoid hemorrhage from ruptured internal carotid artery aneurysm: Association with arterial tortuosity. World Neurosurgery, 166: e84-e92.##Chen KP, Wang JJ, Wang LJ, et al. (2017) Study of correlation between carotid artery tortuosity and atherosclerotic carotid artery stenosis. Zhonghua Wai Ke Za Zhi, 55(8): 608-612.##Georgakarakos E and Fiska A (2022) Dolichoarteriopathy of common carotid artery: an unusual entity. 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Astragaloside IV enhances Paclitaxel chemosensitivity in breast cancer cells via regulating Nrf-2 signaling 2 2 Background: Chemotherapy resistance has become a problem for the treatment of breast cancer patients. This study aimed to investigate whether astragaloside IV (AS-IV) has synergistic effects to enhance Paclitaxel (PTX) chemosensitivity in breast cancer cells. Materials and Methods: CCK-8 assays were performed to evaluate the sensitivity of the cell to AS-IV and PTX. The flow cytometric analysis of Annexin-V-fluoresceine isothiocyanate (FITC)/propidium iodide (PI) staining was carried out to evaluate cell apoptosis. The western blotting assay was used to measure the apoptosis-related proteins and Nrf-2 levels. ROS levels were measured using Dichlorofluorescein (DCF) assay. Results: AS-IV enhances PTX chemosensitivity in MDA-MB-231 and MCF-7 cells by enhancing the inhibitory effect of cell viability and promotion effect on cell apoptosis of PTX. The synergistic effects of AS-IV to PTX could decrease the Nrf-2 expression and increase the ROS levels. Nrf-2 signaling was related to ROS generation. Conclusion: AS-IV may enhance PTX chemosensitivity in breast cancer via regulating Nrf-2 signaling. AS-IV might be used as a potential adjuvant drug to increase PTX sensitivity in breast cancer cells. 1065 1070 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/292025/12/292025/12/292025/12/292025/12/302025/12/302026/01/1 1404/10/11 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 T. Runwei T. Runwei General Surgery Department, Liqun Hospital, Putuo District, Shanghai, China L. Chaoran L. Chaoran Breast Surgery/Medical Department, Baoshan District Integrated Traditional Chinese and Western Medicine Hospital, Shanghai, China Z. Yinghui Z. Yinghui Breast Surgery Department, Jiading Maternal and Child Health Hospital, Shanghai, China postop.tsin@foxmail.com Astragaloside IV breast cancer chemosensitivity nuclear factor erythroid 2-related factor 2 reactive oxygen species. 1. Siegel RL, Miller KD, Wagle NS, Jemal A (2023) Cancer statistics, 2023. CA Cancer J Clin, 73(1): 17-48. doi:10.3322/caac.21763##2. Ding Y, Chen X, Zhang Q, Liu Q (2020) Historical trends in breast cancer among women in China from age-period-cohort modeling of the 1990-2015 breast cancer mortality data. BMC Public Health, 20(1): 1280. doi:10.1186/s12889-020-09375-0.##3. Fisusi FA and Akala EO (2019) Drug combinations in breast cancer therapy. Pharm Nanotechnol, 7(1): 3-23. doi: 10.2174/2211738507666190122111224##4. 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Neuroprotective role of remote ischemic post-conditioning in radiotherapy-induced cognitive decline: Modulating hippocampal phospho-tau and autophagy via Nrf2-ARE pathway 2 2 Background: Cranial radiotherapy (RT), while critical for treating brain tumors, often leads to delayed cognitive dysfunction due to neuronal damage and Tau protein accumulation. Remote ischemic post-conditioning (RIPC) has emerged as a potential strategy to mitigate RT-induced neurotoxicity. This study explores the neuroprotective role of RIPC in modulating hippocampal autophagy and phospho-Tau (P-Tau) expression through the Nrf2-antioxidant response element (ARE) signaling pathway following cranial irradiation. Materials and Methods: Male Sprague-Dawley rats were subjected to focal cranial RT to induce radiation-associated hippocampal injury. A subgroup received RIPC through intermittent limb ischemia. Behavioral evaluations, including Morris water maze, elevated plus maze, and novel object recognition tests, were conducted at weeks 4 and 8 post-irradiation. Hippocampal expression levels of Nrf2, HO-1, SOD2, Tau, and P-Tau were assessed via qPCR and ELISA. Immunohistochemistry and immunofluorescence were employed to localize and quantify neuronal changes and autophagy markers. Results: Rats receiving RIPC demonstrated significant improvements in memory and spatial learning compared to non-conditioned controls. RIPC upregulated hippocampal Nrf2, HO-1, and SOD2, while decreasing Tau and P-Tau accumulation. Additionally, increased neuronal autophagy and reduced oxidative stress were observed, correlating with better cognitive outcomes. Conclusion: RIPC exerts neuroprotective effects in a RT-induced brain injury model by activating the Nrf2-ARE pathway, promoting autophagy, and reducing Tau pathology. These findings support the therapeutic potential of RIPC as an adjunct to RT for preserving cognitive function in cancer patients. 1071 1077 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/292025/12/292025/12/292025/12/292025/12/302025/12/302026/01/12026/01/4 1404/10/14 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 F. Yang F. Yang Qingdao Huanghai University, Qingdao, Shandong, China W. Qi W. Qi School of Nursing, Qingdao Binhai University, Qingdao, Shandong, China; Department of Pathology, Chengdu Medical College, Sichuan, 610500, China; Philippine Women's University, 1743 Taft Avenue, Malate, Manila 1004 793219993@qq.com F. Zhou F. Zhou Sichuan Medical College, Nanchong, Sichuan, China S. Li S. Li Department of Pathology, Chengdu Medical College, Sichuan, China M. Zhang M. Zhang Department of Pathology, Chengdu Medical College, Sichuan, China Y. Zong Y. Zong Department of Pathology, Chengdu Medical College, Sichuan, China H. Yang H. Yang Department of Pathology, Chengdu Medical College, Sichuan, China X. Hu X. Hu Department of Pathology, Chengdu Medical College, Sichuan, China Radiotherapy cognitive dysfunction ischemic preconditioning hippocampus Tau proteins autophagy. 1. Gondi V, Meyer J, Shih HA (2021) Advances in radiotherapy for brain metastases. Neurooncol Adv, 3(Suppl 5): v26-v34.##2. Mantovani C, Gastino A, Cerrato M, Badellino S, Ricardi U, Levis M (2021) Modern radiation therapy for the management of brain metastases from non-small cell lung cancer: current approaches and future directions. Front Oncol, 11: 772789.##3. Shamsesfandabadi P, Patel A, Liang Y, Shepard MJ, Wegner RE (2024) Radiation-induced cognitive decline: challenges and solutions. Cancer Manag Res, 16: 1043-52.##4. Cramer CK, Cummings TL, Andrews RN, Strowd R, Rapp SR, Shaw EG, et al. (2019) Treatment of radiation-induced cognitive decline in adult brain tumor patients. Curr Treat Options Oncol, 20(5): 42.##5. Vysakh R, Ganapathi Raman R, Muhammed SO, Puzhakkkal N (2023) Fixed field technique for hippocampal avoidance whole-brain radiotherapy: A feasibility study using Elekta system. International Journal of Radiation Research, 21(1): 105-9.##6. Raj JAT, Shah J, Ghanekar S, John G, Goda JS, Chatterjee A (2025) Pharmacological and therapeutic innovation to mitigate radiation-induced cognitive decline (RICD) in brain tumor patients. Cancer Lett, 620: 217700.##7. Haldbo-Classen L, Amidi A, Wu LM, Lukacova S, Oettingen Gv, Gottrup H, et al. (2019) Long-term cognitive dysfunction after radiation therapy for primary brain tumors. Acta Oncologica, 58(5): 745-52.##8. Guo D, Liu Z, Zhou J, Ke C, Li D (2024) Significance of programmed cell death pathways in neurodegenerative diseases. Int J Mol Sci, 25(18): 9947.##9. Cui J, Zhao S, Li Y, Zhang D, Wang B, Xie J, et al. (2021) Regulated cell death: discovery, features and implications for neurodegenerative diseases. Cell Communication and Signaling, 19: 1-29.##10. Sharma C and Kim SR (2021) Linking oxidative stress and proteinopathy in Alzheimer's disease. Antioxidants (Basel), 10(8): 1231.##11. 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Significant decrease in the radiation low-dose delivered to normal tissue in a novel cervical cancer VMAT plan using sub-arc collimator angle optimization 2 2 Background: Traditionally, volumetric modulated arc therapy (VMAT) plans have depended on a predefined gantry range and a fixed collimator angle. Herein, we develop a novel sub-arc collimator angle optimization (SACAO) method for VMAT in cervical cancer. Materials and Methods: Twenty patients with cervical cancer were retrieved in the retrospective planning study. Two plans for traditional optimization were generated using dual arcs with two static collimator angles of 0˚ and 45˚ (named VMAT_0 and VMAT_45, respectively). A new plan was also developed using SACAO (named VMAT_SACAO). The dynamic gantry range segmentation of the full arc was calculated according to the continuity of the best conformity index (CI). The dose-volumetric parameters, average x-jaw size, and total monitor units (MUs) were compared. Results: The HI (uniformity index) and CI (conformity index) were improved in VMAT_SACAO compared to VMAT_0 and VMAT_45. The average x-jaw size of VMAT_SACAO was lower than VMAT_0 and VMAT_45 (18.7 ± 0.9 cm2, 20.7 ± 1.1 cm2, and 20.2 ± 1.0 cm2), as well as the total MUs (402 ± 19.0, 450 ± 18.8, and 432 ± 18.5). The average low-dose delivered to normal tissue was lowest in VMAT_SACAO compared to VMAT_0 and VMAT_45 (15.8 ± 0.4 Gy, 18.6 ± 0.3 Gy, and 17.0 ± 0.4 Gy). Conclusion: Compared to the two VMAT plans, the VMAT_SACAO improved the HI and CI, decreased the low-dose delivered to normal tissue, the V50, V45, and V15 of the small bowel, and the total MUs when applied in treating cervical cancer patients. 1079 1084 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/292025/12/292025/12/292025/12/292025/12/302025/12/302026/01/12026/01/42026/01/5 1404/10/15 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 C. Chen C. Chen Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China W. Xu W. Xu Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China J. Shen J. Shen Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China C. Xie C. Xie Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China Y. Zhou Y. Zhou Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China X. Wang X. Wang Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China J. Zhang J. Zhang Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China D. Jiang D. Jiang Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China Y. Zhong Y. Zhong Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China doctorzyh73@163.com H. Liu H. Liu Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China liuhui69_wh@hotmail.com H. Yu H. Yu Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China haijunyu@whu.edu.cn Radiotherapy cervical cancer volumetric modulated arc therapy collimator angle optimization normal tissue protection. 1. Otto K (2008) Volumetric modulated arc therapy: IMRT in a single gantry arc. Medical Physics, 35(1): 310-317.##2. 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The role of electrocardiography in monitoring cardiac function in patients undergoing tumor radiotherapy: A systematic literature review 2 2 Background: Radiotherapy, an essential treatment for numerous malignancies, can lead to radiation-induced heart disease (RIHD), including pericarditis, coronary artery disease, cardiomyopathy, valvular dysfunction, or arrhythmias. Early cardiac monitoring is crucial for timely interventions. Electrocardiography (ECG), a widely available, non-invasive diagnostic tool, provides real-time insights into cardiac electrical activity. However, its utility in detecting and managing RIHD remains underexplored. Materials and Methods: A systematic literature search was performed using PubMed, Embase, and Web of Science, focusing on studies published in English up to 2025 in order to evaluate the role of ECG in monitoring cardiac function in patients undergoing radiotherapy, its diagnostic potential, limitations, and emerging advancements. Results: ECG can detect early signs of RIHD, including ST-segment changes, QT interval prolongation, T-wave abnormalities, and conduction disturbances. While ECG is useful for baseline assessment and ongoing surveillance, its specificity for RIHD-related structural and functional changes is limited. Clinical guidelines recommend ECG as part of routine cardio-oncology care, particularly for high-risk patients. Advancements in wearable devices, such as smartwatches that can measure ECG and artificial intelligence-driven ECG interpretation, may improve early detection, enabling real-time monitoring and improving patient outcomes. Conclusions: ECG allows for early detection and monitoring of RIHD in patients undergoing radiotherapy. Integrating ECG with multimodal imaging and biomarkers can enhance diagnostic accuracy. Future research should focus on refining ECG-based risk stratification models, improving detection algorithms, and optimizing clinical guidelines for cardio-oncology surveillance. Emerging technologies, including AI and remote monitoring, can advance the utility of ECG. 1085 1090 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/292025/12/292025/12/292025/12/292025/12/302025/12/302026/01/12026/01/42026/01/52026/01/6 1404/10/16 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 Q. Wei Q. Wei Electrocardiogram room, Zibo First Hospital, Zibo City, Shandong Province, China Z. Zhang Z. 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Disease Burden of Gynecological Tumors and radiotherapy effectiveness: A Systematic Review based on Epidemiological Insights 2 2 Background: Gynecological cancers-including cervical, ovarian, endometrial, vulvar, vaginal, and gestational trophoblastic neoplasms-pose significant global health challenges, particularly in low- and middle-income countries (LMICs). Radiotherapy is a cornerstone of treatment, yet access remains limited in under-resourced regions, contributing to poor outcomes. This systematic review investigates the epidemiology and disease burden of gynecological cancers, focusing on incidence trends, risk factors, geographical variation, histopathological subtypes, and tumor mutational burden (TMB). It also evaluates the effectiveness of radiotherapy and the potential of personalized approaches guided by molecular profiling. Materials and Methods: A systematic search following PRISMA guidelines was conducted across PubMed, Scopus, Web of Science, and Embase for studies published between 2000 and 2023. Study quality was assessed using the QUADAS-2 tool. Results: Nine studies met the inclusion criteria. Cervical cancer showed the highest incidence, with increasing trends in some regions. High TMB was associated with aggressive histological subtypes and poorer survival, highlighting its value as a predictive biomarker. Radiotherapy significantly improved outcomes, especially when integrated into personalized treatment plans based on molecular characteristics. Conclusion: The global burden of gynecological cancers is rising, with substantial disparities in diagnosis and treatment access, especially in LMICs. Radiotherapy remains vital, but outcomes may be further improved through TMB-guided personalization. Expanding radiotherapy infrastructure and integrating molecular diagnostics are crucial for addressing global inequities and enhancing treatment efficacy. 1091 1099 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/292025/12/292025/12/292025/12/292025/12/302025/12/302026/01/12026/01/42026/01/52026/01/62026/01/7 1404/10/17 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 X. Zhang X. Zhang Department of Oncology and Hematology, People's Hospital of Leshan, Leshan, 614000, China J. Liu J. Liu Department of Oncology and Hematology, People's Hospital of Leshan, Leshan, 614000, China Y. Fu Y. Fu Department of Oncology and Hematology, People's Hospital of Leshan, Leshan, 614000, China 13388266807@163.com Gynecologic neoplasms radiotherapy tumor mutational burden precision medicine uterine cervical neoplasms. 1. Kataki AC, Tiwari P, Thilagavthi R, Krishnatreya M. Epidemiology of gynaecological cancers. Fundamentals in Gynaecologic Malignancy: Springer; 2023. p. 1–8.##2. Kyrgiou M, Bowden S, Denny L, Fagotti A, Abu-Rustum NR, Ramirez PT, et al. (2024) Innovation in gynaecological cancer: highlighting global disparities. The Lancet Oncology, 25(4): 425-30.##3. Nanda S (2020) Evaluation and management of high-risk pregnancies: Emerging Research and Opportunities.1st edition, Medical Info Science Reference.##4. Zadeh SAH (2018) Histopathological spectrum of non-neoplastic and neoplastic lesions of the uterine cervix: Rajiv Gandhi University of Health Sciences (India).##5. Bah Camara H (2018) Human papillomavirus genotype distribution and co-infection with sexually transmitted pathogens in reproductive age women in urban Gambia: University of Westminster.##6. Duhoranenayo D (2022) Clinical staging versus pelvic MRI staging before and after chemoradiation among patients with cervical cancer in Rwanda: patients seen at RMH and KFH: University of Rwanda.##7. Sankaranarayanan R and Ferlay J (2006) Worldwide burden of gynaecological cancer: the size of the problem. Best Pract Res Clinl Obstet Gynaecol, 20(2): 207-25.##8. Iyoke CA and Ugwu GO (2013) Burden of gynaecological cancers in developing countries. World Journal of Obstetrics and Gynecology, 2(1): 1-7.##9. Castellano T, ElHabr AK, Washington C, Ting J, Zhang YJ, Musa F, et al. (2024) Health disparities in cervical cancer: Estimating geographic variations of disease burden and association with key socioeconomic and demographic factors in the US. Plos one, 19(7): e0307282.##10. Ginsburg O, Bray F, Coleman MP, Vanderpuye V, Eniu A, Kotha SR, et al. (2017) The global burden of women’s cancers: a grand challenge in global health. The Lancet, 389(10071): 847-60.##11. Chan CK, Aimagambetova G, Ukybassova T, Kongrtay K, Azizan A (2019) Human papillomavirus infection and cervical cancer: epidemiology, screening, and vaccination-review of current perspectives. Journal of Oncology, 2019(1): 3257939.##12. Sankaranarayanan R (2014) Screening for cancer in low-and middle-income countries. Annals of Global Health, 80(5): 412-7.##13. Black E and Richmond R (2018) Prevention of cervical cancer in sub-Saharan Africa: the advantages and challenges of HPV vaccination. Vaccines, 6(3): 61.##14. Temkin SM, Rimel B, Bruegl AS, Gunderson CC, Beavis AL, Doll KM (2018) A contemporary framework of health equity applied to gynecologic cancer care: a Society of Gynecologic Oncology evidenced-based review. Gynecologic Oncology, 149(1): 70-7.##15. dos Santos Silva I. Cancer epidemiology: principles and methods: IARC; 1999.##16. Schottenfeld D and Fraumeni Jr JF. Cancer epidemiology and prevention: Oxford University Press; 2006.##17. Fabian A, Krug D, Alkatout I (2020) Radiotherapy and Its intersections with surgery in the management of localized gynecological malignancies: A comprehensive overview for clinicians. J Clin Med, 10(1): 93.##18. Samiei M (2013) Challenges of making radiotherapy accessible in developing countries. Cancer Control, 2013: 83-96.##19. Gebretsadik A, Bogale N, Dulla D (2022) Descriptive epidemiology of gynaecological cancers in southern Ethiopia: retrospective cross-sectional review. BMJ open, 12(12): e062633.##20. Hailu HE, Mondul AM, Rozek LS, Geleta T (2020) Descriptive epidemiology of breast and gynecological cancers among patients attending Saint Paul’s Hospital Millennium Medical College, Ethiopia. PloS one, 15(3): e0230625.##21. Bernard J, Abreu P, Alexis L, Joseph E, Suprien V, Auguste J, et al. 2019239 Gynecological cancers in haiti: epidemiological characteristics and diagnostic challenges. International Journal of Gynecological Cancer, 29(Suppl 3): A102.3-A103##22. Abdullahi H and Ayogu M (2020) Pattern and relative frequencies of gynecological malignancies at the University of Abuja Teaching Hospital, Abuja. Tropical Journal of Obstetrics and Gynaecology, 37(1): 177-81.##23. Wang M, Fan W, Ye M, Tian C, Zhao L, Wang J, et al. (2018) Molecular profiles and tumor mutational burden analysis in Chinese patients with gynecologic cancers. Scientific Reports, 8(1): 8990.##24. Zhao Y, Qiu P, Yan L, Li S, Yang Z, Zhang H, et al. (2022) Epidemiological trends of female breast and gynecologic cancers in adolescents and young adults in China from 1990 to 2019: Results from the Global Burden of Disease Study 2019. Frontiers in Oncology, 12: 1003710.##25. Schildkraut JM, Alberg AJ, Bandera EV, Barnholtz-Sloan J, Bondy M, Cote ML, et al. (2014) A multi-center population-based case–control study of ovarian cancer in African-American women: the African American Cancer Epidemiology Study (AACES). BMC cancer, 14: 1-13.##26. You W, Dainty LA, Rose GS, Krivak T, McHale MT, Olsen CH, et al. (2005) Gynecologic malignancies in women aged less than 25 years. Obstetrics & Gynecology, 105(6): 1405-9.##27. Münstedt K, Wagner M, Kullmer U, Hackethal A, Franke FE (2008) Influence of body mass index on prognosis in gynecological malignancies. Cancer Causes & Control, 19: 909-16.##28. Zhu B, Gu H, Mao Z, Beeraka NM, Zhao X, Anand MP, et al. (2024) Global burden of gynaecological cancers in 2022 and projections to 2050. J Glob Health, 14: 04155.##29. Wen X, Yin B, Lin L, Liu L, Weng S, Xu H, et al. (2024) The T cell-mediated tumor killing patterns revealed tumor heterogeneous and proposed treatment recommendation in ovary cancer. Discov Oncol, 15(1): 753.##30. Khanna D, Sharma P, Budukh A, Vishwakarma R, Sharma AN, Bagal S, et al. (2024) Rural-urban disparity in cancer burden and care: findings from an Indian cancer registry. BMC Cancer, 24(1): 308.##31. Patel D, Tayade S, Tidke VP, Toshniwal S, Tilva H (2023) Radiotherapy versus chemotherapy in locally advanced cervical cancer. Cureus, 15(9): e44726.##32. Ao M, Ding T, Tang D, Xi M (2020) Efficacy and toxicity of adjuvant therapies for high-risk endometrial cancer in stage I-III: A systematic review and network meta-analysis. Med Sci Monit, 26: e925595.##33. Kuhn TM, Dhanani S, Ahmad S (2023) An overview of endometrial cancer with novel therapeutic strategies. Curr Oncol, 30(9): 7904-19.##34. Ramashia PN, Nkosi PB, Mbonane TP (2025) Improving access to radiotherapy: exploring structural quality indicators for radiotherapy in Gauteng Province, South Africa. Int J Environ Res Public Health, 22(4), 544.##35. Haileselassie W, Mulugeta T, Tigeneh W, Kaba M, Labisso WL (2019) The situation of cancer treatment in Ethiopia: Challenges and opportunities. J Cancer Prev, 24(1): 33-42.##36. Bhatia R, Lichter KE, Gurram L, MacDuffie E, Lombe D, Sarria GR, et al. (2022) The state of gynecologic radiation therapy in low- and middle-income countries. Int J Gynecol Can, 32(3): 421-8.##37. Koka K, Verma A, Dwarakanath BS, Papineni RVL (2022) Technological advancements in external beam radiation therapy (EBRT): An indispensable tool for cancer treatment. Cancer Manag Res, 14: 1421-9.##38. Grisham RN, Slomovitz BM, Andrews N, Banerjee S, Brown J, Carey MS, et al. (2023) Low-grade serous ovarian cancer: expert consensus report on the state of the science. 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Enhancing radiotherapy for gastric cancer: A systematic review on the role of predictive models in clinical decision-making 2 2 Predictive models have become essential tools in modern oncology, significantly advancing gastric cancer management—one of the most prevalent and lethal cancers worldwide. This systematic review investigates the application of predictive models derived from public databases, emphasizing their role in improving radiotherapy outcomes. Various modeling techniques are explored, including statistical methods like logistic regression and Cox proportional hazards models, machine learning approaches such as random forests and support vector machines, and deep learning models like convolutional and recurrent neural networks. These models contribute to early detection, prognosis estimation, treatment response prediction, and tumor classification. Notably, in the context of radiotherapy, predictive models enhance tumor delineation, assist in selecting optimal radiation doses, and forecast individual treatment responses, reducing toxicity and improving precision. Other key clinical applications include molecular subtyping, biomarker discovery, and image-based diagnostics, especially through endoscopic and histopathological image analysis. These applications support the development of personalized treatment regimens and improve long-term patient outcomes. Despite their promise, several challenges remain, including inconsistent or imbalanced data, limited interpretability of complex algorithms, and concerns regarding clinical trust and AI transparency. Addressing these issues requires the development of high-quality standardized databases, stronger data-sharing frameworks, the adoption of federated learning methods, and the integration of explainable AI models into clinical workflows. This review concludes that predictive models, when properly validated and implemented, hold substantial potential to transform gastric cancer radiotherapy by enabling more tailored, data-driven treatment strategies, ultimately improving survival rates and quality of life for patients. 1101 1114 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/292025/12/292025/12/292025/12/292025/12/302025/12/302026/01/12026/01/42026/01/52026/01/62026/01/72026/01/7 1404/10/17 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 Sh. Chen Sh. Chen Department of Gastric Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian Province, China Sh. Wei Sh. Wei Department of Gastric Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian Province, China Y. Wang Y. Wang Department of Gastric Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian Province, China L. Chen L. Chen Department of Gastric Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian Province, China Zh. Lin Zh. Lin Department of Urological Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian Province, China hxsf803@163.com Stomach neoplasms radiotherapy predictive value of tests machine learning clinical decision-making. 1. Tan N, Wu H, Cao M, Yang F, Yan X, He S, et al. (2024) Global, regional, and national burden of early-onset gastric cancer. Cancer Biol Med, 21(8): 667-78.##2. rawla p and barsouk a (2019) epidemiology of gastric cancer: global trends, risk factors and prevention. prz gastroenterol, 14(1): 26-38.##3. Kang K, Bagaoisan Ma, Zhang Y (2024) Unveiling the younger face of gastric cancer: a comprehensive review of epidemiology, risk factors, and prevention strategies. Cureus, 16(6): e62826.##4. Yu JI (2023) Role of adjuvant radiotherapy in gastric cancer. j Gastric Cancer, 23(1): 194-206.##5. Chen HHW and Kuo MT (2017) improving radiotherapy in cancer treatment: Promises and challenges. Oncotarget, 8(37): 62742-58.##6. Lei C, Sun W, Wang K, Weng R, Kan X, li R (2025) Artificial intelligence-assisted diagnosis of early gastric cancer: present practice and future prospects. Ann Med, 57(1): 2461679.##7. Eloranta S and Boman M (2022) Predictive models for clinical decision making: deep dives in practical machine learning. J Intern Med, 292(2): 278-95.##8. Li S and Zhou B (2022) A review of radiomics and genomics applications in cancers: the way towards precision medicine. Radiat Oncol, 17(1): 217.##9. Isaksson LJ, Pepa M, Zaffaroni M, Marvaso G, Alterio D, Volpe S, et al. (2020) Machine learning-based models for prediction of toxicity outcomes in radiotherapy. Front Oncol, 10: 790.##10. Mcgrail KM, Teng J, Bentley C, O'doherty KC, Burgess MM (2024) Research data use in a digital society: a deliberative public engagement. Int j Popul Data Sci, 9(1): 2372.##11. Brito DMS, Lima OG, Mesquita FP, Da Silva EL, De Moraes MEA, Burbano RMR, et al. (2023) A shortcut from genome to drug: the employment of bioinformatic tools to find new targets for gastric cancer treatment. Pharmaceutics, 15(9): 2303.##12. Zhang Z, Shao X, Wu H, Su X, Wang G, Zhu L, et al. (2023) Prognostic impact of aberrantly expressed protein-coding gene associated with gastric cancer's regulatory t cells, based on online databases. Altern Ther Health Med, 29(3): 160-5.##13. Ramesh P, Nisar M, Neha, Ammankallu S, Babu S, Nandakumar R, et al. (2024) Delineating protein biomarkers for gastric cancers: a catalogue of mass spectrometry-based markers and assessment of their suitability for targeted proteomics applications. J Proteomics, 306: 105262.##14. Conroy MC, Lacey B, Bešević J, Omiyale W, Feng Q, Effingham M, et al. (2023) UK biobank: a globally important resource for cancer research. Br J Cancer, 128(4): 519-27.##15. Almeda AF, Grimes SM, lee H, Greer S, Shin G, Mcnamara M, et al. (2022) The gastric cancer registry: a genomic translational resource for multidisciplinary research in gastric cancer. Cancer Epidemiol Biomarkers Prev, 31(9): 1693-700.##16. Martin AN, Chan NW, Cheung DC, Fong ZV (2024) A guide to large data sets for population-based cancer research: strengths, limitations, and pitfalls. Cancer, 130(22): 3802-14.##17. Hicks-Courant K, Ko EM, Matsuo K, Melamed A, Nasioudis D, Rauh-Hain JA, et al. (2024) Secondary databases in gynecologic cancer research. Int J Gynecol Cancer, 34(10): 1619-29.##18. Karamoozian A, Baneshi MR, Bahrampour A (2021) Short-term and long-term survival of patients with gastric cancer. Gastroenterol Hepatol Bed Bench, 14(2): 115-22.##19. Jin Q, Cao J, Wang G, He N (2025) Neoadjuvant chemotherapy can effectively avoid unnecessary extended resection for gastric cancer with clinical evidence of duodenum or pancreas head involvement. J Cancer, 16(4): 1181–8.##20. Allen CJ, Pointer DT, Jr., Blumenthaler AN, Mehta Rj, Hoffe SE, Minsky BD, et al. (2021) Chemotherapy versus chemotherapy plus chemoradiation as neoadjuvant therapy for resectable gastric adenocarcinoma: a multi-institutional analysis. Ann Surg, 274(4): 544–8.##21. Sabbagh S, Jabbal IS, Iska S, Mohanna M, Itani M, Dominguez B, et al. (2023) Survival analysis comparing neoadjuvant chemoradiotherapy versus perioperative chemotherapy for locoregional gastric cancer. Journal of Clinical Oncology, 41(16-suppl): e16097–e.##22. Darang E, Pezeshkian- Z, Mirhoseini SZ, Ghovvati S (2023) Bioinformatics and pathway enrichment analysis identified hub genes and potential biomarker for gastric cancer prognosis. Front Oncol, 13: 1187521.##23. Shamsi S, Larizadeh MH, Bahador M, Nouri M (2024) A five-year survival analysis of patients with gastric cancer in kerman province. Frontiers in Biomedical Technologies, 11(4): 607-615##24. Park B, Kim CH, Jun JK, Suh M, Choi KS, Choi IJ, et al. (2024) A machine learning risk prediction model for gastric cancer with shapley additive explanations. Cancer Res Treat, 57(3): 821-829.##25. Zhou H, Gu Q, Bao R, Qiu L, Zhang Y, Wang F, et al. (2024) Machine learning based models for predicting presentation delay risk among gastric cancer patients. Front Oncol, 14: 1503047.##26. Xu L and Guo C (2024) Imbalanced survival prediction for gastric cancer patients based on improved xgboost with cost sensitive and focal loss. Expert Systems, 41(11): e13666.##27. Mao S and Liu J (2025) Mulitdeepsurv: survival analysis of gastric cancer based on deep learning multimodal fusion models. Biomed Opt Express, 16(1): 126-41.##28. Maheswari R, Allah IM, Mukesh B, Britto SS, Editors. Discerning and leveraging gastric cancer using deep analytics algorithms. 2024 International Conference on Signal Processing and Advance Research in Computing (SPARC); 2024 12–13 sept. 2024.##29. Bhardwaj P, Kim S, Koul A, Kumar Y, Changela A, Shafi J, et al. (2024) Advanced cnn models in gastric cancer diagnosis: enhancing endoscopic image analysis with deep transfer learning. Front Oncol, 14: 1431912.##30. Wu Z, Wang T, Lan J, Wang J, Chen G, Tong T, et al. (2025) Deep learning-based prediction of her2 status and trastuzumab treatment efficacy of gastric adenocarcinoma based on morphological features. j Transl Med, 23(1): 13.##31. Thota M, Mahajan S, Boppana SH, Boppana SL, Komati SSK, Mintz D (2025) Predicting mortality in upper gastrointestinal tract cancer using long short-term memory neural networks. Journal of Clinical Oncology, 43(4_Suppl): 340-340##32. Li S, Deng YQ, Zhu ZL, Hua HL, Tao ZZ (2021) A comprehensive review on radiomics and deep learning for nasopharyngeal carcinoma imaging. Diagnostics (Basel), 11(9): 1523.##33. Sasagawa S, Honma Y, Peng X, Maejima K, Nagaoka K, Kobayashi Y, et al. (2025) Predicting chemotherapy responsiveness in gastric cancer through machine learning analysis of genome, immune, and neutrophil signatures. Gastric Cancer, 28(2): 228–44.##34. Rubini D, Gagliardi F, Menditti VS, D'ambrosio L, Gallo P, D'onofrio I, et al. (2024) Genetic profiling in radiotherapy: a comprehensive review. Front Oncol, 14: 1337815.##35. Yu S, Jiang H, Xia J, Gu J, Chen M, Wang Y, et al. (2025) Construction of machine learning-based models for screening the high-risk patients with gastric precancerous lesions. Chin Med, 20(1): 7.##36. Eweje f, Li Z, Gopaulchan M, Attaranzadeh A, Kloker L, Jiang Y, et al. (2024) Use of artificial intelligence–based digital pathology to predict outcomes for immune checkpoint inhibitor therapy in advanced gastro-esophageal cancer. j Clin Oncol, 42 (Suppl 16; Abstr 4013).##37. Bai Z, Wang H, Han J, An J, Yang Z, Mo X (2024) Multiomics integration and machine learning reveal prognostic programmed cell death signatures in gastric cancer. Sci Rep, 14(1): 31060.##38. Zubair M, Owais M, Mahmood T, Iqbal S, Usman SM, Hussain I (2024) Enhanced gastric cancer classification and quantification interpretable framework using digital histopathology images. Sci Rep, 14(1): 22533.##39. Huang L, Feng B, Yang Z, Feng ST, Liu Y, Xue H, et al. (2025) A transfer learning radiomics nomogram to predict the postoperative recurrence of advanced gastric cancer. 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Application value of transvaginal ultrasonography combined with abdominal ultrasonography in the diagnosis of gynecological acute abdomen 2 2 Background: To explore the value of transvaginal ultrasonography (TVUS) combined with abdominal ultrasonography (AUS) in gynecological acute abdomen diagnosis. Materials and Methods: One hundred patients with gynecological acute abdomen admitted to our hospital from January 2022 to January 2023 were enrolled in this study. Patients were separated into observation group (OG, n=50) and control group (CG, n=50). The OG underwent routine abdominal ultrasound examination. On the basis of the OG, the CG received transvaginal ultrasound examination. The diagnosis of all patients was confirmed by pathological examination after ultrasound examination. The detection rate of diseases (acute pelvic inflammatory disease, ectopic pregnancy, rupture of ovarian cyst, and torsion of the pedicle of ovarian cyst) as well as the coincidence rate of ultrasonic diagnosis with pathological examination were assessed in the two groups. Results: OG showed significantly higher disease detection rate relative to CG (P<0.01). The total coincidence rate of diagnosis of gynecological acute abdomen in the OG was 96.00%, which was also higher than that of 74.00% in the CG (P<0.01). Conclusion: Transvaginal ultrasonography combined with abdominal ultrasonography can improve the overall diagnostic coincidence rate of gynecological acute abdomen. 1115 1118 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/292025/12/292025/12/292025/12/292025/12/302025/12/302026/01/12026/01/42026/01/52026/01/62026/01/72026/01/72026/01/7 1404/10/17 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 Y. Zhang Y. Zhang Department of Ultrasound, Tangshan Maternal and Child Health Hospital, Tangshan, Hebei, China m18331591022@163.com Acute abdomen ultrasonography diagnosis. 1. Zachariah SK, Fenn M, Jacob K, et al. (2019) Management of acute abdomen in pregnancy: current perspectives. International Journal of Women's Health, 11: 119-34.##2. Arora D, Bhattacharyya TK, Kathpalia SK, et al. (2005) Acute Abdomen in Gynaecological Practice. Medical Journal, Armed Forces India, 61(1): 66-70.##3. Fecteau G, Desrochers A, Francoz D, et al. (2018) Diagnostic Approach to the Acute Abdomen. Vet Clin North Am Food Anim Pract, 34(1): 19-33.##4. Navez B and Navez J (2014) Laparoscopy in the acute abdomen. Best Practice & Research Clinical Gastroenterology, 28(1): 3-17.##5. Eiberg JP, Grantcharov TP, Eriksen JR, et al. (2008) Ultrasound of the acute abdomen performed by surgeons in training. Minerva Chir, 63(1): 17-22.##6. Xu Y, Qian J, Wang F, et al. (2024) Study on diagnostic value of ultrasound combined with mammography in breast cancer with different clinical and pathological features. International Journal of Radiation Research, 22(1): 49-54.##7. Wu J, Cui SH, Li HZ, et al. (2016) Ultrasound diagnosis in gynecological acute abdomen. J Biol Regul Homeost Agents, 30(1): 211-7.##8. Bokemeyer A, Ochs K, Fuhrmann V (2020) Acute abdomen: Diagnostic management. Dtsch Med Wochenschr, 145(21): 1544-51.##9. Kong M, Paramesparan K, Keshvala C, et al. (2020) Acute abdomen or life-threatening heterotopic pregnancy with tubal rupture: where does imaging play a role? BMJ Case Rep, 13(12).##10. Bondi M, Miller R, Zbar A, et al. (2012) Improving the diagnostic accuracy of ultrasonography in suspected acute appendicitis by the combined transabdominal and transvaginal approach. The American Surgeon, 78(1): 98-103.##11. Ritchie J, Birsner ML, Zighelboim I, et al. (2023) Common obstetrics and gynecologic topics in critical care: A narrative review. Int J Crit Illn Inj Sci, 13(1): 38-43.##12. Huang DY, Yusuf GT, Daneshi M, et al. (2018) Contrast-enhanced ultrasound (CEUS) in abdominal intervention. Abdom Radiol (NY), 43(4): 960-76.##13. Minten L, Messiaen P, Van der Hilst J. (2022) Acute abdominal pain: a challenging diagnosis. Acta Gastroenterol Belg, 85(4): 646-7.##14. Cartwright SL, Knudson MP. (2015) Diagnostic imaging of acute abdominal pain in adults. Am Fam Physician, 91(7): 452-9.##15. Dunphy L, Wood F, Hallchurch J, et al. (2022) Ruptured ovarian ectopic pregnancy presenting with an acute abdomen. BMJ Case Rep, 15(12).##16. Malvadkar SM, Malvadkar MS, Domkundwar SV, et al. (2016) Spontaneous rupture of pyometra causing peritonitis in elderly female diagnosed on dynamic transvaginal ultrasound. Case Rep Radiol, 2016: 1738521.##17. Frasca DJ, Jarrio CE, Perdue J (2023) Evaluation of acute pelvic pain in women. Am Fam Physician, 108(2): 175-80.##18. Frijlingh M, Juffermans L, de Leeuw R, et al. (2022) How to use power Doppler ultrasound in transvaginal assessment of uterine fibroids. Ultrasound Obstet Gynecol, 60(2): 277-83.##19. Van den Bosch T, Van Schoubroeck D (2018) Ultrasound diagnosis of endometriosis and adenomyosis: State of the art. Best Pract Res Clin Obstet Gynaecol, 51: 16-24.##20. Yang H, Wang R, Zhao L, et al. (2021) Diagnosis and analysis of transabdominal and intracavitary ultrasound in gynecological acute abdomen. Comput Math Methods Med, 2021: 9508838.## ##

Ultrasound measurement of sheath nerve diameter for guided drug therapy for severe craniocerebral injury 2 2 Background: Severe traumatic brain injured (STBI) is a leading reason for death and long-term disabilities, and improved real-time management of intracranial pressure (ICP) is necessary. This study evaluated the efficacy of drug therapy with ultrasound-guided in patients with STBI by measuring optic nerves sheath diameters (ONSD). Materials and Methods: This retrospective case-control study involved 263 patients with STBI who were treated between March 2019 and June 2021. Patients were categorized in an ultrasound group (n=125), which received ONSD-guided therapy, and a regular group (n=138), which received conventional treatment. Neurogenic and inflammatory markers, clinical scales, and functional recovery metrics were assessed. Results: The ultrasound group showed remarkably improved early-treatment outcomes, such as decreased abnormal breathing (27.20% vs. 40.58%, P=0.022) and lower ICP (54.40% < 350 mmHg vs. 40.58%, P=0.025). This group also showed increased neurogenic factors (brain-derived neurotrophic factors (BDNF) and nerve growth factors (NGF)) and notable decreases in inflammatory indicators like tumor necrosis factor α (TNF-α) (P<0.05). Post-treatment neurological scores were better in the ultrasound group (National Institutes of Health Stroke Scale (NIHSS): 18.32 vs. 18.96 (P=0.018); Glasgow Coma Scale (GCS): 11.19 vs. 10.54 (P=0.007)). Functional assessments (Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Modified Barthel Indexs (MBI)) and quality of life (Simplified Form of Health Questionnaire-36 (SF-36)) indices also favored the ultrasound group. Conclusion: Ultrasound-guided ONSD measurement enhances real-time ICP management in drug therapy for patients with STBI. The measurement has positive effects on neurogenic and inflammatory profiles, functional recoveries, and quality of life. 1119 1123 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/292025/12/292025/12/292025/12/292025/12/302025/12/302026/01/12026/01/42026/01/52026/01/62026/01/72026/01/72026/01/72026/01/7 1404/10/17 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 Y. Fan Y. Fan Department of Critical Care Medicine, Shaoxing Second Hospital FanYaoq998@hotmail.com J. Niu J. Niu Department of Critical Care Medicine, The First Affiliated Hospital, Medical College, Zhejiang University Q. Lu Q. Lu Department of Critical Care Medicine, Shaoxing Second Hospital Severe traumatic brain injury ultrasound measurement optic nerve sheath diameter neurogenic markers functional recovery. 1. Visser K, Koggel M, Blaauw J, et al. (2022) Blood-based biomarkers of inflammation in mild traumatic brain injury: A systematic review. Neurosci Biobehav Rev, 132: 154-168.##2. Das AS, Vicenty-Padilla JC, Chua MMJ, et al. (2022) Cerebrovascular injuries in traumatic brain injury. Clin Neurol Neurosurg, 223: 107479.##3. Graham NS and Sharp DJ (2023) Dementia after traumatic brain injury. BMJ, 383: 2065.##4. Olsen CM and Corrigan JD (2022) Does Traumatic brain injury cause risky substance use or substance use disorder? Biol Psychiatry, 91(5): 421-437.##5. Muehlschlegel S, Rajajee V, Wartenberg KE, et al. (2024) Guidelines for neuroprognostication in critically Ill adults with moderate-severe traumatic brain injury. Neurocrit Care, 40(2): 448-476.##6. Patel RH, Foltz EA, Witkowski A, et al. (2023) Analysis of artificial intelligence-based approaches applied to non-invasive imaging for early detection of melanoma: A systematic review. Cancers, 15(19): 4694.##7. Soroushmehr R, Rajajee K, Williamson C, et al. (2019) Automated optic nerve sheath diameter measurement using super-pixel analysis. Annual International Conference of the IEEE Engineering in Medicine and Biology Society IEEE, 2019: 2793-2796.##8. Sener K, Cakır A, Altug E, et al. (2023) Is optic nerve sheath diameter diagnostic in methanol intoxication? Alcohol (Fayettev, NY), 113: 27-31.##9. Cho J (2021) Ocular Ultrasound abnormalities and optic nerve sheath diameter in dogs and cats. Vet Clin North Am Small Anim Pract, 51(6): 1295-1314.##10. Stevens RRF, Gommer ED, Aries MJH, et al. (2021) Optic nerve sheath diameter assessment by neurosonology: A review of methodologic discrepancies. J Neuroimaging, 31(5): 814-825.##11. Sadaka F, Patel D, Lakshmanan R (2012) The FOUR score predicts outcome in patients after traumatic brain injury. Neurocrit Care, 16(1): 95-101.##12. Amano S, Umeji A, Takebayashi T, et al. (2020) Clinimetric properties of the shortened Fugl-Meyer Assessment for the assessment of arm motor function in hemiparetic patients after stroke. Top Stroke Rehabil, 27(4): 290-295.##13. Downs S, Marquez J, Chiarelli P (2013) The Berg Balance Scale has high intra- and inter-rater reliability but absolute reliability varies across the scale: a systematic review. J Physiother, 59(2): 93-99.##14. Shah S, Vanclay F, Cooper B (1989) Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol, 42(8): 703-709.##15. Wu Q, Chen Y, Zhou Y, et al. (2023) Reliability, validity, and sensitivity of short-form 36 health survey (SF-36) in patients with sick sinus syndrome. Medicine, 102(24): e33979.##16. Schepici G, Silvestro S, Bramanti P, et al. (2020) Traumatic brain injury and stem cells: an overview of clinical trials, the current treatments and future therapeutic approaches. Medicina (Kaunas), 56(3): 137.##17. Li R, Zhang P, Lu J, et al. (2023) Case report: Ultrasound-guided median nerve electrical stimulation on functional recovery of hemiplegic upper limb after stroke. Front Neurol, 14: 1244192.##18. Kerscher SR, Zipfel J, Haas-Lude K, et al. (2024) Ultrasound-guided initial diagnosis and follow-up of pediatric idiopathic intracranial hypertension. Pediatr Radiology, 54(6): 1001-1011.##19. Lioi F, Ramm-Pettersen J, Fratini A, et al. (2024) Ultrasonographic assessment of optic nerve sheath diameter as a screening tool for intracranial hypertension in traumatic brain injury. World Neurosurg, 192: e42-e48.##20. Liu L, Ni Xx, Zhang Lw, et al. (2021) Effects of ultrasound-guided erector spinae plane block on postoperative analgesia and plasma cytokine levels after uniportal VATS: a prospective randomized controlled trial. J Anesth, 35: 3-9.## ##

Diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in malignant biliary obstruction 2 2 Background: Our investigation employed a retrospective methodological approach, examining a sample of 45 participants (55.6% male, 44.4% female). The average age was 64 years. All participants presented clinical manifestations suggestive of malignant biliary obstruction. Initial diagnoses were established through advanced imaging techniques, specifically endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP). The study design involved a retrospective analysis of data obtained from the entire cohort to ascertain the diagnostic precision of FDG-PET imaging protocol in this specific clinical context. We also conducted a comparative analysis between the imaging results and the definitive findings from surgical interventions and pathological examinations. To quantitatively assess the diagnostic efficacy of FDG-PET scans, we employed ROC curve analysis as our primary statistical instrument. Results: Imaging studies through FDG-PET scans yielded a sensitivity value at 86.1% with a relatively lower specificity level standing at around 66.7%. These diagnostic parameters underscore the FDG-PET modality's particular strength in precise lesion localization. The imaging technique exhibited marked efficacy in delineating areas of concern, proving especially valuable in guiding targeted diagnostic sampling procedures. Conclusion: Despite exhibiting only moderate specificity, integrating FDG-PET imaging into surgical planning protocols afforded significant alterations in patient treatment plans. The modality’s value manifests in two critical domains: detection and localization of malignant biliary obstructions and informing the subsequent management approach. It represents a valuable diagnostic and prognostic tool in the clinical context. 1125 1129 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/292025/12/292025/12/292025/12/292025/12/302025/12/302026/01/12026/01/42026/01/52026/01/62026/01/72026/01/72026/01/72026/01/72026/01/7 1404/10/17 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 Z.P. Koç Z.P. Koç Nuclear Medicine Department, Mersin University, Mersin, Turkey zehrapinarkoc@gmail.com P.P. Özcan P.P. Özcan Nuclear Medicine Department, Mersin University, Mersin, Turkey E. Reyhan E. Reyhan Surgical Oncology Department, Mersin University, Mersin, Turkey M. Yaldız M. Yaldız Pathology Department, Mersin University, Mersin, Turkey E. Üçbilek E. Üçbilek Gastroenterology Department, Mersin University, Mersin, Turkey Biliary stasis 18F-FDG positron emission tomography. Khan SA, Davidson BR, Goldin RD, et al. (2012) Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut, 61(12): 1657-1669.##Schulick RD (2008) Primary sclerosing cholangitis: detection of cancer in strictures. J Gastrointest Surg, 12(3): 420-2.##Wang SB, Wu HB, Wang QS, et al. (2015) 18F-FDG PET/CT in differentiating malignant from benign origins of obstructive jaundice. Hepatobiliary Pancreat Dis Int, 14(5): 516-22.##De Gaetano AM, Rufini V, Castaldi P, et al. (2012) Clinical applications of (18)F-FDG PET in the management of hepatobiliary and pancreatic tumors. Abdom Imaging, 37(6): 983-1003. ##Martins PN, Sheiner P, Facciuto M (2012) Xanthogranulomatous cholecystitis mimicking gallbladder cancer and causing obstructive cholestasis. Hepatobiliary Pancreat Dis Int, 11(5): 549-52. ##Delbeke D and Pinson CW (2004) Pancreatic tumors: role of imaging in the diagnosis, staging, and treatment. J Hepatobiliary Pancreat Surg, 11(1): 4-10.##Mertz HR, Sechopoulos P, Delbeke D (2000) EUS, PET, and CT scanning for evaluation of pancreatic adenocarcinoma. Gastrointest Endosc, 52(3): 367-71.##Delbeke D, Chapman WC, Pinson CW, Martin WH, Beauchamp DR, Leach S (1999) F-18 fluorodeoxyglucose imaging with positron emission tomography (FDG PET) has a significant impact on diagnosis and management of pancreatic ductal adenocarcinoma. J Nucl Med, 40:1784-92.##Franke C, Klapdor R, Meyerhoff K, Schauman M (1999) 18-F Positron emission tomography of the pancreas: diagnostic benefit in the follow-up of pancreatic carcinoma. Anticancer Res, 19(4A): 2437- 42.##Rajekar H (2017) Synchronous gall bladder and bile duct cancer: A short series of seven cases and a brief review of literature. J Clin Exp Hepatol, 7(2): 115-20. ##Nagasaki Y, Yamane H, Ochi N, Honda Y, Takigawa N (2016) High uptake of FDG along a biliary stent. Clin Nucl Med, 41(11): 890-1. ##Patel D and Lu Y (2015) FDG-PET/CT manifestation of tumor seeding along percutaneous biliary drainage catheter tract. Clin Nucl Med, 40(10): 830-1. ##O'Neill RS, Duong T, Dionela W, Rogge C, Brungs D (2020) Pancreatitis and biliary obstruction secondary to duodenal metastasis from rapidly progressing lung adenocarcinoma treated with common bile duct stenting. Case Rep Oncol, 13(2): 962-7. ##Wakabayashi H, Akamoto S, Yachida S, et al. (2005) Significance of fluorodeoxyglucose PET imaging in the diagnosis of malignancies in patients with biliary stricture. Eur J Surg Oncol, 31(10): 1175-9. ##Dubaniewicz A and Dubaniewicz A (2003) Cholangiocarcinoma--bile ducts cancer. Wiad Lek, 56(1-2): 57-60.##Fujiwara Y, Ioka T, Matsui H, et al. (2021) A case of intrahepatic cholangiocarcinoma in the elderly patient with curative resection after neoadjuvant chemotherapy. Gan To Kagaku Ryoho, 48(13): 2085-7.##Lan L, Zhang S, Xu T, et al. (2022) Prospective comparison of 68Ga-FAPI versus 18F-FDG PET/CT for tumor staging in biliary tract cancers. Radiology, 304(3): 648-57. ## ##

Primary retroperitoneal Ewing's sarcoma in a young woman: A case report 2 2 Ewing's sarcoma (EWS) is a rare malignant tumour that is more likely to occur in children and young people, especially in people of European ancestry, with an annual incidence rate of one in a million, and the incidence of extra-skeletal EWS is even lower, among which retroperitoneal EWS is advanced once detected because of the deep location of the lesion and other characteristics, which makes treatment difficult. The following case report describes an EWS in the retroperitoneal region in a young healthy female patient. A 28-year-old young female patient with a negative family history underwent gynaecologic ultrasound examination for difficulty in defaecation and lower abdominal pain, which revealed a solid cystic mass behind the cervix, tenderness of the mass, and compression of the vagina and rectum. Therefore, surgery was recommended. A retroperitoneal tumour was found during intraoperative exploration, and laparoscopic surgery was changed to open surgery. Postoperative pathology suggested EWS. After postoperative radiation therapy and close follow-up, tumour recurrence occurred six months after surgery, and bone metastasis occurred one year after surgery. Retroperitoneal EWS is a rare and poorly documented disease. Radical surgery remains the first-line treatment of this disease. 1131 1135 2025/10/252025/11/182025/11/182025/11/182025/11/182025/11/192025/11/192025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/162025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/282025/12/292025/12/292025/12/292025/12/292025/12/302025/12/302026/01/12026/01/42026/01/52026/01/62026/01/72026/01/72026/01/72026/01/72026/01/72026/01/7 1404/10/17 2025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/182025/10/18 1404/7/26 Z. Zhang Z. Zhang Department II of Gynecology, Affiliated Hospital of Shandong Second Medical University,School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong Province, China W. Wang W. Wang Department II of Gynecology, Affiliated Hospital of Shandong Second Medical University,School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong Province, China H. Wang H. Wang Department II of Gynecology, Affiliated Hospital of Shandong Second Medical University,School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong Province, China wanghui201@163.com Ewing sarcoma retroperitoneal space primary neoplasms radiotherapy case report. 1. Nedham FN, Nagaraj V, Darwish A, Al-Abbasi TA (2022) Retroperitoneal blue cell round tumor (Ewing sarcoma in a 35 years old male)- case report. Int J Surg Case Reports, 94: 107045. https://doi.org/10.1016/j.ijscr.2022.107045##2. Javalgi AP, Karigoudar MH, Palur K (2016) Blue cell tumor at unusual site: retroperitoneal Ewing’s sarcoma. J Clin Diag Res,,JCDR, 10(4): ED19-ED20. https://doi.org/10.7860/JCDR/2016/18302.7618##3. AlRashed R, AlHarbi H, Abdulfattah F, Alhasan I, Alsannaa F (2022) A case report of retroperitoneal Ewing sarcoma requiring adrenalectomy. Int J Surg Case Reports, 95, 106966. https://doi.org/10.1016/j.ijscr.2022.106966##4. Chen S, Li Y, Zhao H, Yang X (2022) The giant retroperitoneal extraosseous Ewing's sarcoma: A case report. Asian Journal of Surgery, 45(2): 804–806. https://doi.org/10.1016/j.asjsur.2021.12.009##5. Reis F, Macedo E, França Junior MC, Amstalden EI, Appenzeller S (2017) Retroperitoneal Ewing's sarcoma/embryonal tumor: a rare differential diagnosis of back pain. Radiologia Brasileira, 50(6): 409-410. https://doi.org/10.1590/0100-3984.2015.0236##6. Kong L, Zhang X, Zhang Y, Kong Z (2024) Primary retroperitoneal Ewing's sarcoma in a young woman. Asian J Surg, 47(2): 1281-1282. doi:10.1016/j.asjsur.2023.11.067##7. Wu SY, Hsu CK, Yue CT, Tsai YC (2023) Large retroperitoneal extra-skeletal Ewing's sarcoma with renal pedicle invasion: a case report. BMC Urology, 23(1): 95. https://doi.org/10.1186/s12894-023-01272-z##8. Riggi N, Suvà ML, Stamenkovic I (2021) Ewing's sarcoma. The New England Journal of Medicine, 384(2): 154-164. https://doi.org/10.1056/NEJMra2028910##9. National Comprehensive Cancer Network. Bone Cancer (Version 2.2023). https://www.nccn.org/professionals/physician_gls/pdf/bone.pdf.##10. Van Mater D and Wagner L (2019) Management of recurrent Ewing sarcoma: challenges and approaches.  OncoTargets and therapy, 12: 2279–2288. https://doi.org/10.2147/OTT.S170585##11. Wang Y, Wang C, Xia M, Tian Z, Zhou J, Berger JM, Zhang XH, Xiao H (2024) Engineering small-molecule and protein drugs for targeting bone tumors. Molecular Therapy, 32(5): 1219-1237. https://doi.org/10.1016/j.ymthe.2024.03.001## ##