Purpose/Objectives
We analyzed outcomes after stereotactic ablative body radiotherapy for oligometastatic (1‐5 metastatic foci) head‐and‐neck squamous cell carcinoma (OM‐HNSCC).
Materials/Methods
We ...reviewed patients treated between 2012 and 2016. Endpoints included overall survival (OS), distant progression, and treated‐metastasis local control (TM‐LC).
Results
We analyzed 27 patients with 60 primarily metachronous metastases (81.5%). Median follow‐up was 1.6 years (0.2‐5.2). Median time from diagnosis to treatment was 1.1 years (0.08‐8.5). Overall, 44.4% had solitary, 44.4% had 2‐3, and 11.1% had >3 metastases; most metastases were in the lung (44 of 60 metastases). Median OS was 1.9 years; at 1 and 2 years, 78% and 43% were alive (14% without disease progression). Median time to progression was 0.5 years. The 1‐year and 2‐year TM‐LC rates were 75% and 57%.
Conclusions
OS is encouraging and disease‐free survival remains poor; nevertheless, patients with OM‐HNSCC may represent a more favorable subset of patients with metastatic HNSCC.
Functional amyloids produced in bacteria as nanoscale inclusion bodies are intriguing but poorly explored protein materials with wide therapeutic potential. Since they release functional polypeptides ...under physiological conditions, these materials can be potentially tailored as mimetic of secretory granules for slow systemic delivery of smart protein drugs. To explore this possibility, bacterial inclusion bodies formed by a self‐assembled, tumor‐targeted Pseudomonas exotoxin (PE24) are administered subcutaneously in mouse models of human metastatic colorectal cancer, for sustained secretion of tumor‐targeted therapeutic nanoparticles. These proteins are functionalized with a peptidic ligand of CXCR4, a chemokine receptor overexpressed in metastatic cancer stem cells that confers high selective cytotoxicity in vitro and in vivo. In the mouse models of human colorectal cancer, time‐deferred anticancer activity is detected after the subcutaneous deposition of 500 µg of PE24‐based amyloids, which promotes a dramatic arrest of tumor growth in the absence of side toxicity. In addition, long‐term prevention of lymphatic, hematogenous, and peritoneal metastases is achieved. These results reveal the biomedical potential and versatility of bacterial inclusion bodies as novel tunable secretory materials usable in delivery, and they also instruct how therapeutic proteins, even with high functional and structural complexity, can be packaged in this convenient format.
Bacterial inclusion bodies are engineered as secretory amyloids for subcutaneous implantation and physiological release of antitumoral protein drugs. These granules slowly secrete self‐assembling, CXCR4‐targeted protein nanoparticles based on the Pseudomonas exotoxin, which selectively destroys metastatic colorectal cancer stem cells, promoting a dramatic reduction of metastatic foci in the absence of undesired side toxicity.
Progress in cancer treatment has improved the survival of patients with advanced-stage cancers. Consequently, the clinical courses of patients are prolonged and often accompanied by morbidity due to ...bone metastases. Skeletal-related events (SREs), such as pathological fractures and spinal paralysis, cause impairment in activities of daily life and quality of life (QOL). To avoid serious SREs causing impairment in QOL and survival, early diagnosis and a prophylactic approach are required. It is necessary to initiate a bone management program concurrently with the initiation of cancer treatment to prevent complications of bone metastasis. In addition, the requirement of a multidisciplinary approach through a cancer board focusing on the management of bone metastases and involving a team of specialists in oncology, palliative care, radiotherapy, orthopedics, nuclear medicine, radiology, and physiatrists has been emphasized. In the cancer board, a strong focus is placed on the prevention of complications due to bone metastases and on reductions in the high morbidity, hospitalization rate, and overall costs associated with advanced-stage cancers. Recent reports suggest the usefulness of such approaches. The multidisciplinary approach through a cancer board would improve QOL and prognosis of patients, leading to new or continued systemic therapy for primary cancers.
Biosensors for metastatic cancer cell detection Kalashgrani, Masoomeh Yari; Mousavi, Seyyed Mojtaba; Akmal, Muhammad Hussnain ...
Clinica chimica acta,
06/2024, Letnik:
559
Journal Article
Recenzirano
•Early Metastatic Cancer Cell Detection.•Diagnosis of cancer.•Mechanism of metastasis.•Biomarkers in metastatic cancer cells.•Healthcare and Biomedical Interests.
Early detection and effective cancer ...treatment are critical to improving metastatic cancer cell diagnosis and management today. In particular, accurate qualitative diagnosis of metastatic cancer cell represents an important step in the diagnosis of cancer. Today, biosensors have been widely developed due to the daily need to measure different chemical and biological species. Biosensors are utilized to quantify chemical and biological phenomena by generating signals that are directly proportional to the quantity of the analyte present in the reaction. Biosensors are widely used in disease control, drug delivery, infection detection, detection of pathogenic microorganisms, and markers that indicate a specific disease in the body. These devices have been especially popular in the field of metastatic cancer cell diagnosis and treatment due to their portability, high sensitivity, high specificity, ease of use and short response time. This article examines biosensors for metastatic cancer cells. It also studies metastatic cancer cells and the mechanism of metastasis. Finally, the function of biosensors and biomarkers in metastatic cancer cells is investigated.
This commentary attempts to discuss the required standardization of circulating tumor DNA (ctDNA) analyses and thereby improve the clinical validity of ctDNA monitoring in the metastatic setting of ...solid tumors.
Metastatic carcinomas of bone marrow (MCBM) are characterized as tumors of non-hematopoietic origin spreading to the bone marrow through blood or lymphatic circulation. The diagnosis is critical for ...tumor staging, treatment selection and prognostic risk stratification. However, the identification of metastatic carcinoma cells on bone marrow aspiration smears is technically challenging by conventional microscopic screening.
The aim of this study is to develop an automatic recognition system using deep learning algorithms applied to bone marrow cells image analysis. The system takes advantage of an artificial intelligence (AI)-based method in recognizing metastatic atypical cancer clusters and promoting rapid diagnosis.
We retrospectively reviewed metastatic non-hematopoietic malignancies in bone marrow aspirate smears collected from 60 cases of patients admitted to Zhongshan Hospital. High resolution digital bone marrow aspirate smear images were generated and automatically analyzed by
AI based system.
system was trained and validated using 20748 cell cluster images from randomly selected 50 MCBM patients. 5469 pre-classified cell cluster images from the remaining 10 MCBM patients were used to test the recognition performance between Morphogo and experienced pathologists.
exhibited a sensitivity of 56.6%, a specificity of 91.3%, and an accuracy of 82.2% in the recognition of metastatic cancer cells.
's classification result was in general agreement with the conventional standard in the diagnosis of metastatic cancer clusters, with a Kappa value of 0.513. The test results between
and pathologists H1, H2 and H3 agreement demonstrated a reliability coefficient of 0.827. The area under the curve (AUC) for
to diagnose the cancer cell clusters was 0.865.
In patients with clinical history of cancer, the
system was validated as a useful screening tool in the identification of metastatic cancer cells in the bone marrow aspirate smears. It has potential clinical application in the diagnostic assessment of metastatic cancers for staging and in screening MCBM during morphology examination when the symptoms of the primary site are indolent.
Nanoparticles as drug delivery systems enable unique approaches for cancer treatment. Over the last two decades, a large number of nanoparticle delivery systems have been developed for cancer ...therapy, including organic and inorganic materials. Many liposomal, polymer-drug conjugates, and micellar formulations are part of the state of the art in the clinics, and an even greater number of nanoparticle platforms are currently in the preclinical stages of development. More recently developed nanoparticles are demonstrating the potential sophistication of these delivery systems by incorporating multifunctional capabilities and targeting strategies in an effort to increase the efficacy of these systems against the most difficult cancer challenges, including drug resistance and metastatic disease. In this chapter, we will review the available preclinical and clinical nanoparticle technology platforms and their impact for cancer therapy.
L’objectif de cette enquête était d’établir, au travers d’un regard croisé oncologues et patients, un état des lieux de la perception de l’activité physique adaptée et d’identifier les freins et les ...leviers à sa pratique chez les patients suivis pour un cancer métastatique.
Entre octobre 2019 et mars 2020, 60 oncologues médicaux et 305 patients atteints d’un cancer métastatique ont été interrogés via un auto-questionnaire.
Les bénéfices de l’activité physique sont reconnus par la majorité des oncologues et des patients. Ces bénéfices sont davantage perçus par les oncologues en prévention (78 %) ou à un stade précoce (72 %) de la maladie qu’au stade métastatique (55 %) (p=0,01). L’état physique (45 %), l’âge des patients (37 %) mais aussi le manque de temps en consultation pour expliquer les soins de supports (35 %) sont les principaux freins identifiés par l’oncologue à l’intégration de l’activité physique dans la prise en charge. De plus, le manque de connaissance de programmes adaptés est la principale raison évoquée par les médecins n’ayant jamais prescrit d’activité physique (51 %). Du côté des patients, alors que 88 % d’entre eux avaient entendu parler des bénéfices de l’activité physique, seuls 11 % ont bénéficié d’une prescription. La plupart des oncologues et des patients étaient très intéressés pour recevoir des informations sur les lieux de pratique, les types d’activités à privilégier ou à éviter.
Des efforts en termes d’information des oncologues et des patients semblent nécessaires pour augmenter le niveau de prescription et de pratique de l’activité physique pour les patients suivis pour un cancer métastatique.
This French study aimed to evaluate oncologists’ and patients’ perception of physical activity, particularly adapted physical activity, in order to identify the obstacles and levers to its practice in patients with metastatic cancer.
Between October 2019 and March 2020, 60 medical oncologists and 305 patients with metastatic cancer were asked to fill in a self-completed questionnaire.
The benefits of physical activity are recognised by most oncologists and patients. These benefits were perceived more by oncologists in prevention (78%) or in the early stage (72%) of the disease than in the metastatic stage (55%) (P=0.01). Patient's physical condition (45%) and age (37%) but also the lack of time during the consultation to explain supportive care (35%) are the main obstacles identified by the oncologist to the integration of physical activity into patient care. Furthermore, lack of knowledge of adapted programmes is the main reason given by the physicians who have never prescribed physical activity (51%). On the patient side, while 88% of them had heard of the benefits of physical activity, only 11% had received a prescription. Most oncologists and patients were very interested in receiving information on where and what types of activities to practice, as well as what to avoid.
Efforts in terms of information for both oncologists and patients seem necessary to increase the level of physical activity prescription and practice for patients followed for metastatic cancer.
People with metastatic cancers experience poor quality of life (QoL), fatigue, and decreased physical function. Exercise improves these symptoms in the curative setting, but the efficacy and safety ...of exercise in the metastatic setting is uncertain.
Prospective, randomized trials of moderate/high-intensity aerobic exercise or resistance training vs. control in patients with advanced/metastatic solid cancers were identified from prior reviews and updated using a search of PubMed. The mean and SD for validated outcome measures (QoL, physical function, and fatigue) were extracted for intervention and control groups at baseline and postintervention. The Mann-Whitney test was used to evaluate the effect of exercise on the pooled change between baseline and postintervention. Safety was evaluated qualitatively.
Sixteen trials were analyzed. Among patients with scores at the mean or 2SD above, exercise was not associated with significant or clinical difference in QoL or fatigue. In patients with baseline scores 2SD below mean, exercise was associated with nonsignificant difference meeting minimal clinical important difference in QoL (−2.8 vs. 4.6, P = 0.28). For function, patients at the mean had nonstatistically significant, but clinically meaningful difference in the six-minute walk test (6-MWT) (14.7 vs. 29.0 m, P = 0.44). In patients 2 SD below the mean, there was a clinically meaningful difference in two patient-reported functional subscales (0.1 vs. 5.3, P = 0.076 and 0.44 vs. 8.5, P = 0.465) and a clinically meaningful improvement in the 6-MWT (−7.5 vs. 27.0 m, P = 0.34), although none of these associations met statistical significance. There were no differences in falls, fractures, or pain.
Exercise is associated with clinically meaningful improvements in QoL, function, and 6-MWT in some patients with metastatic cancer. Despite poor reporting of safety, there was no signal of increased harm from exercise in this setting.
1. Differentiate between several forms of predictive analytics designed to identify patients who could benefit from specialty palliative care (PC) involvement
2. Describe the design and ...implementation of an artificial intelligence/machine learning model to predict the need for specialty PC consult
Predictive models may help providers identify patients who are most likely to benefit from specialty palliative care (PC) but to date have focused largely on proxies such as mortality to identify such patients.
We sought to address this gap by building a predictive model into a comprehensive clinical framework predictive of specialty PC need with the aims to identify in a timely fashion hospitalized patients likely to benefit from a PC consult and intervene for such patients by contacting their care team.
Electronic health record data for 68,349 inpatient PC consultations in 2017 at a large hospital were used to train an artificial intelligence/machine learning (AI/ML) model to predict the need for PC consult with PC consultation itself treated as a time-to-event outcome. This model was published as a web service, connected to institutional data pipelines, and consumed by a downstream display application monitored by the PC consult team. For those patients that the PC team deems appropriate, a team member then contacts the patient's care team.
Training performance area under the curve (AUC) based on a 20% holdout validation set was 0.90. The most influential variables were previous PC engagement, hospital unit location, albumin, troponin, and metastatic cancer. The model has been successfully integrated into the clinical workflow, making real-time predictions on hundreds of patients per day. The model had an “in-production” AUC of 0.91. A pragmatic clinical trial to assess the effect on clinical outcomes was recently completed, the results of which will be submitted in a separate abstract.
An AI/ML model can effectively predict the need for an inpatient PC consult and has been successfully integrated into practice.
AI/ML models can be integrated into clinical practice through a more finely targeted outcome, namely time until PC intervention, rather than a proxy, such as mortality.
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