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Medullary thyroid carcinoma (MTC) is a rare type of thyroid malignancy that accounts for approximately 1-2% of all thyroid cancers (TCs). MTC include hereditary and sporadic cases, the former derived from a germline mutation of rearrangement during transfection (RET) proto-oncogene, whereas somatic RET mutations are frequently present in the latter. Surgery is the standard treatment for early stage MTC, and the 10-year survival rate of early MTC is over 80%. While for metastatic MTC, chemotherapy showing low response rate, and there was a lack of effective systemic therapies in the past. Due to the high risk (ca. 15-20%) of distant metastasis and limited systemic therapies, the 10-year survival rate of patients with advanced MTC was only 10-40% from the time of first metastasis. Over the past decade, targeted therapy for RET has developed rapidly, bringing hopes to patients with advanced and progressive MTC. Two multi-kinase inhibitors (MKIs) including Cabozantinib and Vandetanib have been shown to increase progression-free survival (PFS) for patients with metastatic MTC and have been approved as choices of first-line treatment. However, these MKIs have not prolonged overall survival (OS) and their utility is limited due to high rates of off-target toxicities. Recently, new generation TKIs, including Selpercatinib and Pralsetinib, have demonstrated highly selective efficacy against RET and more favorable side effect profiles, and gained approval as second-line treatment options. Despite the ongoing development of RET inhibitors, the management of advanced and progressive MTC remains challenging, drug resistance remains the main reason for treatment failure, and the mechanisms are still unclear. Besides, new promising therapeutic approaches, such as novel drug combinations and next generation RET inhibitors are under development. Herein, we overview the pathogenesis, molecular genetics and current management approaches of MTC, and focus on the recent advances of RET inhibitors, summarize the current situation and unmet needs of these RET inhibitors in MTC, and provide an overview of novel strategies for optimizing therapeutic effects., (© 2024. The Author(s).)

Objective: this study aimed to investigate the clinical efficacy and feasibility of the treatment of advanced esophageal cancer with a combination of a 125I particle-integrated esophageal covered stent and hyperbaric oxygen., Methods: forty-five patients with advanced esophageal cancer were enrolled and were randomly divided into two groups: a treatment group and a control group. Patients in the treatment group were treated with a 125I particle-integrated esophageal covered stent and hyperbaric oxygen, while patients in the control group were treated with a 125I particle-integrated esophageal covered stent. The clinical effects and long-term survival time of the two groups were observed., Results: in the treatment group, the complete remission (CR) rate and partial remission (PR) rate of local lesions were 19.2 % and 61.5 %, respectively, and the total effective rate was 80.7 %. In the control group, the CR rate and PR rate of local lesions were 10.5 % and 52.6 %, respectively, and the total effective rate was 63.1 %. The total effective rate was higher in the treatment group than in the control group, which was statistically significant (p < 0.05)., Conclusion: the combination of a 125I particle-integrated esophageal covered stent and hyperbaric oxygen shows a good short- and long-term efficacy in the treatment of advanced esophageal cancer.

Objective: To investigate the distant metastasis after primary treatment of papillary thyroid cancer (PTC) in children and adolescents. Methods: A retrospective analysis of 180 cases (54 boys and 126 girls, with an age range of 6-18 years) with PTC treated at the Chinese Medical Academy Cancer Hospital and Zhejiang Cancer Hospital from January 1, 2001 to December 31, 2014 was performed. Patients' clinical and pathological data were collected. The follow-up results were statistically analyzed. The distant metastasis rate during the follow-up period was analyzed by the Kaplan-Meier method. Log-Rank test was used for univariate analysis and Cox regression model was established in multivariate analysis. Results: Twenty-four cases (13.3%) had distant metastases during following-up with a median of 92 months. The Log-Rank test showed that the younger age ≤15 years old (χ(2)=11.803, P =0.001), the larger tumor diameter >20 mm (χ(2)=5.776, P =0.016), multifocal (χ(2)=11.205, P =0.001), bilateral tumor distribution (χ(2)=19.804, P =0.001), invaded capsule (χ(2)=10.808, P =0.001), and bilateral lymph nodes metastasis (χ(2)=6.278, P =0.012) were risk factors for distant metastasis after initial treatment. The Cox regression analysis showed that age ≤15 years (hazard ratio [95% confidence interval]: 4.08[1.504-11.111], P =0.006) and bilateral tumor distribution (hazard ratio [95% confidence interval]: 4.77[1.903-11.966], P =0.001) were independent risk factors for distant metastasis after initial treatment. The risk factors for local recurrence and distant metastasis were similar, but the local recurrence could not be a significant predictor for distant metastasis. It was indicated that distant metastasis rate was lower in patients with total thyroidectomy in multifocal lesions groups (χ(2)=5.891, P =0.015). Conclusions: Age, tumor size, invaded capsule, bilateral lymph nodes metastasis, multifocal and bilateral lesions are factors for predicting distant metastasis after primary treatment of PTC in children and adolescents. Total thyroidectomy is recommended for patients with multifocal and bilateral lesions.

Objective: We aimed to evaluate whether the polymorphism of poly(ADP-ribose) polymerase-1 (PARP-1) is involved as potential risk factor in the development of spinal cord injury (SCI) among Chinese individuals., Patients and Methods: Patients with a confirmed diagnosis of SCI (other than traumatic injury) and healthy individuals with no clinical symptoms of SCI were enrolled at Spinal Cord Injury Care Center, The Third People's Hospital of Dalian, China. Genetic polymorphisms were studied in plasma samples by polymerase chain reaction-restriction fragment length polymorphism assay., Results: A total of 130 Chinese patients with SCI and 130 healthy Chinese individuals were included. We found that patients with the GG genotype (odds ratio [OR]: 4.09, 95% confidence interval [CI] 2.42-6.90, P <0.001) and carriers of the G allele (OR 3.96, 95% CI 2.33-6.74, P <0.0001) were at high risk of developing SCI. A del/ins polymorphism of the NF-κB1 gene (OR 3.32, 95% CI 1.96-5.61, P <0.001) was also found to be associated with SCI., Conclusion: Our study suggests that PARP-1 polymorphisms are involved in the development of SCI in Chinese individuals. Thus, PARP-1 polymorphisms can be considered as one of the potential risk factors for developing SCI., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: To study the clinical characteristics, treatment, and prognosis of thyroid cancer in children and adolescents., Methods: We performed a retrospective analysis of clinical data from 83 cases of thyroid cancer in children and adolescents from January 1990 to December 2010. We compared extra-thyroid extension, lymph node metastasis, distant metastasis, and prognosis between pediatric patients ≤12 years of age (27 cases) and those >12 years of age (56 cases). All the patients agreed to undergo thyroidectomy and endocrine therapy, and the consent was obtained from parents or guardians., Results: Histopathology included papillary carcinoma in 67 cases, papillary carcinoma with partial follicular growth pattern in 1 case, papillary carcinoma with squamous metaplasia in 4 cases, follicular carcinoma in 7 cases, medullary carcinoma in 3 cases, and poorly differentiated carcinoma in 1 case. The total lymph node metastasis rate was 78.31%. Patients ≤12 years of age showed a higher rate of lymph node metastasis than the older group (92.59% vs. 71.43%, P=0.028). The incidence rate in females in the older group was higher than that in the younger group (80.36% vs. 59.26%, P=0.041). There were no significant differences in extra-thyroid extension, distant metastasis, survival rate, or recurrent disease between the two groups., Conclusions: The lymph node metastasis of thyroid cancer is higher in patients ≤12 years of age than in those >12 years of age; the incidence rate is higher in females than in males. Childhood thyroid cancer has a good prognosis, surgery being the most effective treatment. Choosing a reasonable surgery method and comprehensive postoperative treatment can achieve a cure and satisfactory survival rate.

The preparation of primary fibers were performed from liquefied wood in phenol by melt-spinning with different spinnerettes of length/diameter ratio (L/D) (0, 2, and 4), to investigate the effect of the size of spinnerette on the thermal stability and structural properties of primary fibers. High thermal transition temperatures and small weight loss percentages of resultant primary fibers representing good thermal stability were obtained with L/D of spinnerette increasing. Besides, few defective structure occurred on cross section and surface of primary fibers in comparison with those prepared with spinnerette of L/D=0. We found that these improvements were caused by the formation of hydrogen bond among phenolic hydroxyl groups in the period of flow entering the cylindrical die of spinnerette. Thus, the precursor, with either porous structure for preparing activated carbon fibers or defect-free structure for preparing carbon fibers with high performance, can be probably prepared by controlling the spinnerette system., (Copyright © 2012. Published by Elsevier Ltd.)

We report five cases of primary synovial sarcomas arising in the parapharyngeal space. The patients were all men with a median age of 35 years (range 22 to 41 years). The tumors were non-encapsulated solid masses ranging from 2.0 to 6.6 cm in size. Histologically, three cases were biphasic subtype, and the other two cases were monophasic subtype. Immunohistochemically, the tumor cells were strongly positive for bcl-2 and CD99, partly positive for CK and EMA, and negative for CD117, CD34, SMA and desmin in all five cases. S-100 protein was detected in one case. The presence of an SYT-SSX1 and/or SYT-SSX2 gene fusion resulting from t(X;18) was demonstrated from paraffin blocks by reverse transcriptase polymerase chain reaction in five cases. All five patients received tumor radical excision and postoperative radiotherapy, and two patients with pulmonary metastasis received additional chemotherapy. Follow-up data revealed that two patients with tumor size <5 cm were alive without disease for 54 and 57 months, one patient with tumor size <5 cm was alive with pulmonary metastasis for 78 months, and two patients with tumor size >5 cm died of disease 26 and 37 months after the diagnosis, respectively. Primary parapharyngeal synovial sarcoma is a rare variant that occurs more frequently in males than females. Accurate diagnosis depends on morphologic and immunohistochemical examination and proper molecular analysis. The prognosis is relatively good in those patients whose tumor size is less than 5 cm.

Objective: To explore the diagnosis and treatment and prognosis of sinonasal neuroendocrine carcinoma., Methods: The clinical data of 11 cases with sinonasal neuroendocrine carcinoma treated in Zhejiang Cancer Hospital from 1998 to 2010 were analyzed retrospectively. Ten cases were small cell type and one case was atypical carcinoid. One case by only operation, one case by only radiotherapy, one case by only chemotherapy, two cases by radiotherapy and chemotherapy, 6 cases by combined treatment based on surgery (surgery combined with radiotherapy and chemotherapy)., Results: All cases have been followed up for 2 months to 12 years. Six cases by combined treatment one case died in 3 years and one case died in 4 years after treatment, one case has survived without tumor for 12 years and two cases have survived without tumor for 8 years, one case was still in treatment. Five cases of other treatment programs, four cases died in 12 months, one case died in 18 months., Conclusions: There's no standard treatment plan. Combined treatment based on surgery should be adopted to nasal neuroendocrine carcinoma. Reccurrence is frequent and the prognosis is poor. The key to improving the survival rate of the disease is early accurate diagnosis and combined treatment.

Objective: To evaluate the value of magnetic resonance imaging (MRI) in diagnosis and preoperative staging of uterine cervical cancer., Methods: MRI findings and staging in 72 patients with cervical carcinoma were retrospectively analyzed, and the size, location, signal intensity and invasion of the tumor were observed. MRI sequence included SE T1WI, (TSE)T2WI, T2WI/SPIR and contrast-enhanced T1WI., Results: MRI identified uterus cervical cancer in all cases with the exception of only 1 case of IA stage. The tumor was represented by hypointensity and isointensity on T1WI, heterogeneous and homogeneous hyperintensity on T2WI, mildly heterogeneous enhancement after bolus intravenous GD-DTPA injection. MRI had an accuracy of 86% in localization of the tumor, but its accuracy in clinical staging was only 64% (chi2=6.453, P<0.05). The tumor volume measured by MRI was similar with that by pathological measurement (1.94-/+1.15 vs 1.94-/+1.11, P>0.05)., Conclusion: MRI can accurately describe the size and invasion of uterine cervical cancer, especially useful in detecting parametrial invasion, but for diagnosis of IA uterine cervical cancer, MRI findings are not sufficient without considerations of clinical findings and cellular examination.

Objective: To evaluate the disadvantage of nonstandard operation for thyroid papillary cancer, and the value of re-operation., Methods: Eight hundred and ninety three thyroid papillary cancer patients (332 patients who received nonstandard operation received re-operation and 561 patients who received first standard operation in Zhejiang Cancer Hospital from January 1990 to January 2000) were retrospectively reviewed., Results: Pathological results confirmed that there were 53.9% cases with residual cancer in re-operative specimen. The parathyroid was preserved in 74.1% cases in re-operation and 93.0% cases in standard operation (P < 0.01). The recurrent laryngeal nerve was injured in 3.3% cases in reoperation and 1.2% cases in standard operation (P < 0.05). The positive neck lymph node was 39.2% and 37.4% (P > 0.05), the 5-year local recurrence rate was 7.5% and 3.7% (P < 0.01), the total 5-year and 10-year cum-survival rates were 90.2%, 84.4% in patients with re-operation and 94.0%, 92.5% in patients with standard operation. The 10-year cum-survival rate were 67. 8% in patients with recurrence and 92. 9% in patients with non-recurrence in primary site respectively. Statistical analysis showed that the cancer recurrence influences the survival rate significantly (P < 0.01)., Conclusions: In consideration of the higher residual tumor rate in patients who received nonstandard operations, the re-operations were necessary. But the re-operation could also leads to higher recurrence rate and more functional injuries. The standardized primary operation should therefore be formulated and advocated.

Objective: To investigate the clinical and imaging features of primary hepatic lymphoma (PHL)., Methods: Four PHL cases were analyzed retrospectively for clinical manifestations, transcatheter hepatic arterial angiography and CT features., Results: All the four cases were B-cell non-Hodgkin lymphoma proven by histological and immunohistochemical examination. The main clinical manifestations included pain in the right upper quadrant and B symptoms of the lymphoma (fever, night sweating, and weight loss) in 3 patients. Three cases were complicated by chronic hepatitis or cirrhosis, and the other had renal transplantation two years ago. All these cases exhibited elevated serum lactate dehydrogenase (LDH) level, which was reduced after surgery or chemotherapy. Plain CT scan all identified hypodense lesions which did not display marked enhancement on the arterial phase and portal venous phase scans. On delayed phase scan, the border of the lesions became clear, and slight enhancement was observed in the peripheral and some partitions of the lesions. Angiographic imaging displayed slight tumor staining and arterial displacement in the liver in all the cases with thin tumor-supplying vessels. Global staining or abnormally thickened vessels were not seen., Conclusion: A comprehensive evaluation of the clinical manifestations and imaging features can be helpful in the diagnosis of PHL, and serum LDH level may help to assess the therapeutic effect.

Objective: To evaluate the efficacy of surgery for the patients with pyriform sinus carcinoma and analyze the prognostic factors related to the cancer., Methods: Between December 1995 and December 2002, 62 patients with pyriform sinus cancer were treated in Zhejiang Tumor Hospital. There were 13 patients staged T1, 17 T2, 12 T3, 20 T4. Four patients received preoperative radiation and 40 patients had post-operative radiation. Among 62 patients, 33 patients were treated by partial laryngectomy, 29 patients were treated by total laryngectomy., Results: The survival rate was calculated with Kaplan-Meier method. The overall 3- and 5-year survival rates were 42.3% and 27.8%, respectively. The 3-year survival rate between partial and total laryngectomy was 51.9% and 29.9%. The 5-year survival rate between partial and total laryngectomy was 39.5% and 11.2% (chi2 = 4.14, P<0.05). Early stage and combined modality therapy were the independent favorable prognostic factors., Conclusions: Early diagnosis with treatment and combined treatment are the most important factors influencing the survival of patients with pyriform sinus carcinoma. Partial laryngopharyngectomy is a suitable treatment for early and selected advanced pyriform sinus carcinoma with a good function and oncologic outcome.

Objective: To evaluate the diagnostic value of (18)F-FDG positron emission tomography (PET) in mediastinal staging of lung cancer., Method: A retrospective analysis of mediastinal staging was carried out in 41 cases of lung cancer by comparing the preoperative mediastinal FDG PET and CT findings with the pathological results., Results: According to the pathological results, 18 patients had mediastinal metastasis, 17 of whom were correctly identified by FDG PET, and 10 by CT. Of the other 23 patients without mediastinal metastasis pathologically, 22 were correctly diagnosed by FDG PET and 20 by CT. The sensitivity and accuracy for diagnosis of regional mediastinal lymph node metastasis with FDG PET were 94.4% and 95.1%, obviously higher than those of CT (55.6% and 73.2%, P<0.05)., Conclusion: FDG PET is a better alternative for mediastinal staging of lung cancer, specially for identification of small lymph node metastasis escaping detection by CT, to provide important evidence for clinical staging and treatment planning of lung cancer.

Objective: To investigate whether (18)F-fluorodexyglucose (FDG) uptake in the primary hepatocellular carcinoma (HCC) correlates with serum alpha-fetoprotein (AFP)., Methods: Forty-five patients with histologically confirmed HCC underwent whole-body (18)F-FDG PET examination. Standardized uptake value (SUV) and tumor-to-nontumor ratio of the SUV (SUVratio) were calculated, and the relationship between serum AFP and glucose metabolism in HCC was analyzed., Results: Of the 45 cases, the primary tumor and metastatic lymph nodes were clearly displayed on PET images in 43 cases and the well-differentiated tumors were shown negative in the other 2 cases. A linear correlation of the AFP with SUV (r=0.426, P<0.05) and SUVratio (r=0.532, P<0.001) was noted., Conclusion: Serum AFP correlates significantly with both SUV and SUN ratio, indicating that AFP is involved in glucose metabolism and cell proliferation in HCC.

Objective: To study the effect and safety of transarterial embolization (TAE) in the management of massive hemorrhage in the nasopharyngeal and maxillofacial regions., Methods: Forty-two cases of massive hemorrhage in the nasopharyngeal and maxillofacial regions were treated by TAE. Gelfoam particles, polyvinyl acohol particles, and metallic coil were used to for embolism of the external carotid artery, maxillary artery, facial artery, occipital artery, sphenopalatine artery and ascending pharyngeal artery respectively according to the angiographic findings and the region of hemorrhage sites., Results: TAE was successfully performed in all the cases, and no recurrence or serious complications were observed in the 3 to 12-month follow-up., Conclusion: TAE is safe and effective in the treatment of massive hemorrhage in the nasopharyngeal and maxillofacial regions.