We sought to systematically review and summarize dosimetric factors associated with radiation-induced brachial plexopathy (RIBP) after stereotactic body radiation therapy (SBRT) or hypofractionated image guided radiation therapy (HIGRT). From published studies identified from searches of PubMed and Embase databases, data quantifying risks of RIBP after 1- to 10-fraction SBRT/HIGRT were extracted and summarized. Published studies have reported ∼10% risks of RIBP with maximum doses (Dmax) to the inferior aspect of the brachial plexus of 32 Gy in 5 fractions and 25 Gy in 3 fractions. For 10-fraction HIGRT, risks of RIBP appear to be low with Dmax < 40 to 50 Gy. For a given dose value, greater risks are anticipated with point volume-based metrics (ie, D0.03-0.035cc: minimum dose to hottest 0.03-0.035 cc) versus Dmax. With SBRT/HIGRT, there were insufficient published data to predict risks of RIBP relative to brachial plexus dose-volume exposure. Minimizing maximum doses and possibly volume exposure of the brachial plexus can reduce risks of RIBP after SBRT/HIGRT. Further study is needed to better understand the effect of volume exposure on the brachial plexus and whether there are location-specific susceptibilities along or within the brachial plexus structure. 

Hypofractionated Stereotactic Radiation Therapy Dosimetric Tolerances for the Inferior Aspect of the Brachial Plexus: A Systematic Review.

Radiation-Induced Inferior Brachial Plexopathy after Stereotactic Body Radiotherapy: Pooled Analyses of Risks.

Nasopharyngeal carcinoma (NPC) risk prediction models based on Epstein-Barr virus (EBV)-antibody testing have shown potential for screening of NPC; however, the long-term stability is unclear. Here, we investigated the kinetics of two EBV-antibody NPC risk scores within the Taiwan NPC Multiplex Family Study. Among 545 participants with multiple blood samples, we evaluated the stability of a 2-marker enzyme-linked immunosorbent assay score and 13-marker multiplex serology score using the intra-class correlation coefficient (ICC) by fitting a linear mixed model that accounted for the clustering effect of multiple measurements per subject and age. We also estimated the clustering of positive tests using Fleiss's kappa statistic. Over an average 20-year follow-up, the 2-marker score showed high stability over time, whereas the 13-marker score was more variable (p < .05). Case-control status is associated with the kinetics of the antibody response, with higher ICCs among cases. Positive tests were more likely to cluster within the same individual for the 2-marker score than the 13-marker score (p < .05). The 2-marker score had an increase in specificity from ~90% for single measurement to ~96% with repeat testing. The 13-marker score had a specificity of ~73% for a single measurement that increased to ~92% with repeat testing. Among individuals who developed NPC, none experienced score reversion. Our findings suggest that repeated testing could improve the specificity of NPC screening in high-risk NPC multiplex families. Further studies are required to determine the impact on sensitivity, establish optimal screening intervals, and generalize these findings to general population settings in high-risk regions. 

Kinetics of EBV antibody‐based NPC risk scores in Taiwan NPC multiplex families

Screening with anti-Epstein-Barr Virus (EBV) serology and endoscopy decreased nasopharyngeal carcinoma (NPC) mortality in Guangdong in a randomized trial. We conducted a secondary analysis of this trial using local incidence and cost data to optimize screening programs, hypothesizing that screening could be cost-effective in southern China. 

Optimization and Local Cost-Effectiveness of Nasopharyngeal Carcinoma Screening Strategies in Southern China: Secondary Analysis of the Guangdong Randomized Trial

PURPOSE
Two Epstein-Barr virus (EBV)-based testing approaches have shown promise for early detection of nasopharyngeal carcinoma (NPC). Neither has been independently validated nor their performance compared. We compared their diagnostic performance in an independent population.


METHODS
We tested blood samples from 819 incident Taiwanese NPC cases (213 early-stage, American Joint Committee on Cancer version 7 stages I and II) diagnosed from 2010 to 2014 and from 1,768 controls from the same region, frequency matched to cases on age and sex. We compared an EBV antibody score using immunoglobulin A antibodies measured by enzyme-linked immunosorbent assay (EBV antibody score) and plasma EBV DNA load measured by real-time PCR followed by next-generation sequencing (NGS) among EBV DNA-positive individuals (EBV DNA algorithm).


RESULTS
EBV antibodies and DNA load were measured for 2,522 (802 cases; 1,720 controls) and 2,542 (797 cases; 1,745 controls) individuals, respectively. Of the 898 individuals positive for plasma EBV DNA and therefore eligible for NGS, we selected 442 (49%) for NGS testing. The EBV antibody score had a sensitivity of 88.4% (95% CI, 86.1 to 90.6) and a specificity of 94.9% (95% CI, 93.8 to 96.0) for NPC. The EBV DNA algorithm yielded significantly higher sensitivity (93.2%; 95% CI, 91.3 to 94.9; P = 1.33 × 10-4) and specificity (98.1%; 95% CI, 97.3 to 98.8; P = 3.53 × 10-7). For early-stage NPC, the sensitivities were 87.1% (95% CI, 82.7 to 92.4) for the EBV antibody score and 87.0% (95% CI, 81.9 to 91.5) for the EBV DNA algorithm (P = .514). For regions with a NPC incidence of 20-100/100,000 person-years (eg, residents in southern China and Hong Kong), these two approaches yielded similar numbers needed to screen (EBV antibody score: 5,656-1,131; EBV DNA algorithm: 5,365-1,073); positive predictive values ranged from 0.4% to 1.7% and 1.0% to 4.7%, respectively.


CONCLUSION
We demonstrated high sensitivity and specificity of EBV antibody and plasma EBV DNA for NPC detection, with slightly inferior performance of the EBV antibody score. Cost-effectiveness studies are needed to guide screening implementation.

Performance and Operational Feasibility of Epstein-Barr Virus-Based Screening for Detection of Nasopharyngeal Carcinoma: Direct Comparison of Two Alternative Approaches.

Purpose: To estimate the effectiveness of an Epstein Barr virus (EBV) serology-based screening program to reduce nasopharyngeal carcinoma (NPC) mortality in a cluster randomized controlled trial in an NPC high-risk population. Methods: Sixteen towns in Sihui and Zhongshan Cities, China were selected; eight were randomly allocated to the screening group and eight to the control group. Cantonese residents aged 30-69 years with no history of NPC were included January 1, 2008 to December 31, 2015. Residents in the screening towns were invited to undergo serum EBV VCA/EBNA1 IgA antibody tests; others received no intervention. Screening lasted through December 31, 2015; the population was followed through December 31, 2017. Results: A total of 175,037 residents in the screening group and 184,526 residents in the control group were included. NPC incidence was similar in screening and control groups. A 28% reduction in NPC mortality was observed in the screening versus control arms in the overall study population (8.0 NPC deaths per 1000 person years versus 11.1; adjusted rate ratio [aRR]=0.72; 95% confidence interval=0.48-1.09; p=0.12). A stronger benefit was observed among individuals aged >50 (aRR=0.63; p=0.048) compared to those <50 (aRR 0.93; p=0.75). The reduction was increased among individuals from towns randomized to screening who participated in the screening program (aRR=0.38, p=0.001). Conclusion: In this near 10-year trial, serology EBV VCA and EBNA1 IgA antibody testing led to a reduction in NPC mortality, particularly among individuals aged larger than 50. EBV antibody-based screening for NPC is effective at reducing NPC mortality in high-risk populations.

Effect of EBV Serology-based Screening Program on NPC Mortality: A Cluster Randomized Controlled Trial

<h3>Purpose/Objective(s)</h3> Radiation-induced brachial plexopathy (RIBP) is quality of life impairing, with uncertain dosimetric limits for stereotactic body radiation therapy (SBRT) in lung cancer. This study aimed to examine its relationship with the dosimetric factors of brachial plexus (BP) and determine the effect of BP definition. <h3>Materials/Methods</h3> The primary study population started from an institutional database of 6291 patients. Lesions with PTV ≤2 cm from the BP treated with SBRT from Jan 2016 to Feb 2021 were eligible. All patients had simulation CT scans on 1.25-mm-thickness. BP was delineated according to the atlas of RTOG1106. The primary endpoint was radiation-induced brachial plexopathy (RIBP), with symptoms graded by LENT-SOMA scales. The primary dosimetric variable of our interest was the maximum BP dose (BP-Dmax). The best constraint for BP was determined using logistic regression and the Youden index. <h3>Results</h3> At a median follow-up of 30. 5 months (range 10.9 - 71.0), 126 patients (128 lesions) were eligible for this study. Nine out of 126 patients (7.1%) experienced grade 1-3 (G1-3) RIBP (4 grade 1, 4 grade 2, and 1 grade 3). For patients with RIBP-related symptoms, the median maximum BP dose (BP-Dmax) reached 45.7Gy (range 36.4 - 61.5) with 4-6 fractions (61.5Gy/4f, 42.23-53.11Gy/5f, 41.80-58.13Gy/6f). The best-estimate of fitting variables for logistic regression was BEDmax (α/β=3, LQ model) of BP (BP-BEDmax), and generated a best cut-off BEDmax of 159.44 Gy, with AUC of 0.859 (95% CI: 0.774-0.943). The 2-year Kaplan-Meier risk of RIBP was 33.5% vs 2.0% (p < 0.001) for BP-BEDmax more or less than 159.44 Gy, respectively. Using subclavian vein (SV) for the BP surrogate, the maximum dose was significantly lower than that of the BP defined according to RTOG1106. This underestimation was significantly greater for lesions with PTV ≤ 1 cm from the BP (median dose difference 9.42Gy, range -13.22-43.20). <h3>Conclusion</h3> This study demonstrated that the BP-BEDmax threshold of 150 Gy (less than 36Gy/4F, 40Gy/5F, 43Gy/6F) and improperness of using vascular bundle as a surrogate BP for dosimetric assessment as this severely underestimated the maximum point dose received by anatomic BP 

Dosimetric Analysis of Radiation-Induced Brachial Plexopathy after Stereotactic Body Radiotherapy: The Contouring of Brachial Plexus Matters

Effect of card taker-in speed on fiber length in flat strips

<h3>Purpose/Objective(s)</h3> We aimed to examine whether elective inclusion of the posterolateral supraclavicular node (SCL) region to the standard medial SCL target volume improves survival outcomes in patients with high-risk node-positive breast cancer undergoing regional nodal irradiation (RNI). <h3>Materials/Methods</h3> We retrospectively reviewed 544 consecutive women with high-risk breast cancer treated with postoperative chest wall/breast and RNI in our center from 1/2015-12/2016. High-risk features were defined as clinical or pathological stage N2-3b disease. Patients were classified into standard medial supraclavicular nodal irradiation (M-SCLI) group and the entire supraclavicular nodal irradiation (E-SCLI) group, which included both the medial and posterolateral SCL region. Disease-free survival (DFS) and overall survival (OS) curves were analyzed by the Kaplan-Meier method and compared using the log-rank test. Propensity-score matching (PSM) and multivariate cox regression analysis were used to evaluate the effect of SCL irradiation target volume on survival outcomes. <h3>Results</h3> The median follow-up time is 64.2 months (range, 6.2-82.6). In the entire cohort, the 5-year DFS rates were 78.5% in the M-SCLI group and 78.8% in the E-SCLI group(P=0.772), and the 5-year OS rates were 92.2% and 90.0% (P=0.210), respectively. Similarly, in the matched cohort, there was no significant difference between the M-SCLI and E-SCLI groups for 5-year DFS (78.2% vs. 77.7%, P=0.892) and OS (92.1% vs. 87.6%, P=0.071). Multivariate analysis demonstrated that E-SCLI was not independently prognostic for DFS (HR 0.80; 95%CI, 0.51 to 1.27; P=0.350) and OS (HR, 1.52; 95%CI, 0.79 to 2.94; P=0.212). The rate of SCL recurrence was low in both groups. <h3>Conclusion</h3> E-SCLI does not appear to be associated with improved DFS and OS in high-risk node-positive breast cancer. This study suggests that M-SCLI should remain standard for most node-positive breast cancer patients (≤N3b disease). 

Entire vs. Medial Supraclavicular Nodal Irradiation for Patients with High-Risk Node-Positive Breast Cancer

Purpose/Objective(s)Approximately half of patients with advanced HER2-positive breast cancer (BC) will develop brain metastases (BM) over time. Local therapy including stereotactic radiotherapy (SRT) and whole brain radiotherapy (WBRT) is the main initial treatment in malignant tumor patients with BM. However, more than 50% patients after radiotherapy in one year suffered intracranial recurrence. Pyrotinib, a small molecule, irreversible, pan-ErbB receptor tyrosine kinase inhibitor (TKI), has a high potency for controlling BM and reducing the occurrence of brain metastases in advanced HER2-positive BC patients. We hypothesized that SRT or WBRT combined with pyrotinib and capecitabine could decrease intracranial progression in HER2 positive BC with newly diagnosed BM.Materials/MethodsIn this prospective single-arm phase Ib/II trial (NCT 04582968), eligible patients were assigned to either fractionated stereotactic radiotherapy (FSRT) or whole-brain radiation therapy (WBRT), combined with pyrotinib and capecitabine. The primary endpoint was one-year CNS progression-free survival (PFS) rate. Secondary endpoints included intracranial objective response rate (IC-ORR) according to RANO-BM criteria, progression-free survival (PFS), overall survival (OS) and evaluation of safety and neurocognitive function.ResultsFrom January 2020 to August 2022, 40 patients were enrolled. Twenty-nine patients were treated with FSRT in 8 Gy per fraction with 3 to 5 fractions and 11 were treated with WBRT in 3 Gy per fraction with 10 fractions, and then received chemotherapy in a time frame starting from 0 to 7 days after radiotherapy. At a median follow-up of 17.3 months, 1-year CNS-PFS rate was 74.9% (95% CI 61.9-90.7%) and median CNS-PFS was 18 months (95% CI, 15.5 to NA months). One-year PFS rate was 66.9% (53.1-84.2%) and median PFS time was 17.6 months (95% CI 12.8-34.1 months). The best intracranial response rate (IC-ORR: complete response and partial response) was 92.5% (37/40). The most common grade 3 or worse toxicity was diarrhea (7.5%) and asymptomatic radiation necrosis was detected in 4 of 67(6.0%) lesions treated with FSRT. No differences of neurocognitive function evaluated by MMSE (Mini-Mental State Exam) were observed between different groups at any time point.ConclusionRadiotherapy combined with pyrotinib and capecitabine resulted in a promising efficacy that crossed the pre-specified boundary in patients with HER2-positive advanced breast cancer with brain metastases. This is the first prospective study showing the efficacy and safety of CNS radiotherapy concurrent with pyrotinib and capecitabine in patients with BM from HER2-positive breast cancer. Further investigation in a randomized controlled study is warranted. Approximately half of patients with advanced HER2-positive breast cancer (BC) will develop brain metastases (BM) over time. Local therapy including stereotactic radiotherapy (SRT) and whole brain radiotherapy (WBRT) is the main initial treatment in malignant tumor patients with BM. However, more than 50% patients after radiotherapy in one year suffered intracranial recurrence. Pyrotinib, a small molecule, irreversible, pan-ErbB receptor tyrosine kinase inhibitor (TKI), has a high potency for controlling BM and reducing the occurrence of brain metastases in advanced HER2-positive BC patients. We hypothesized that SRT or WBRT combined with pyrotinib and capecitabine could decrease intracranial progression in HER2 positive BC with newly diagnosed BM. In this prospective single-arm phase Ib/II trial (NCT 04582968), eligible patients were assigned to either fractionated stereotactic radiotherapy (FSRT) or whole-brain radiation therapy (WBRT), combined with pyrotinib and capecitabine. The primary endpoint was one-year CNS progression-free survival (PFS) rate. Secondary endpoints included intracranial objective response rate (IC-ORR) according to RANO-BM criteria, progression-free survival (PFS), overall survival (OS) and evaluation of safety and neurocognitive function. From January 2020 to August 2022, 40 patients were enrolled. Twenty-nine patients were treated with FSRT in 8 Gy per fraction with 3 to 5 fractions and 11 were treated with WBRT in 3 Gy per fraction with 10 fractions, and then received chemotherapy in a time frame starting from 0 to 7 days after radiotherapy. At a median follow-up of 17.3 months, 1-year CNS-PFS rate was 74.9% (95% CI 61.9-90.7%) and median CNS-PFS was 18 months (95% CI, 15.5 to NA months). One-year PFS rate was 66.9% (53.1-84.2%) and median PFS time was 17.6 months (95% CI 12.8-34.1 months). The best intracranial response rate (IC-ORR: complete response and partial response) was 92.5% (37/40). The most common grade 3 or worse toxicity was diarrhea (7.5%) and asymptomatic radiation necrosis was detected in 4 of 67(6.0%) lesions treated with FSRT. No differences of neurocognitive function evaluated by MMSE (Mini-Mental State Exam) were observed between different groups at any time point. Radiotherapy combined with pyrotinib and capecitabine resulted in a promising efficacy that crossed the pre-specified boundary in patients with HER2-positive advanced breast cancer with brain metastases. This is the first prospective study showing the efficacy and safety of CNS radiotherapy concurrent with pyrotinib and capecitabine in patients with BM from HER2-positive breast cancer. Further investigation in a randomized controlled study is warranted. 

Stereotactic Radiotherapy or Whole Brain Radiotherapy Combined with Pyrotinib and Capecitabine in HER2-Positive Advanced Breast Cancer Patients with Brain Metastases (BROPTIMA): A Prospective, Phase Ib/II Single-Arm Clinical Study.

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

X Guo

Author Tools

Chat about Author