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Background: The poor overall prognosis of radioiodine refractory thyroid cancer is an inevitable challenge in managing this disease. A series of trials have demonstrated the antitumor activity of tyrosine kinase inhibitors (TKIs) in radioiodine refractory differentiated thyroid cancer (RAIR‐DTC). However, the available evidence cannot determine the optimal choice of TKI in RAIR‐DTC. Methods: This study searched PubMed, EMBASE, Cochrane databases, and the ClinicalTrials website. The Cochrane bias risk tool was used to assess the risk of bias, and to evaluate randomized clinical trials (RCT) of RAIR‐DTC patients treated with the TKI system. Outcomes, including progression‐free survival (PFS), overall survival (OS), and adverse events (AEs) were reported. Results: Seven studies involving 1310 patients with RAIR‐DTC was conducted to compare the PFS and OS of various TKI monotherapies with placebo. The results showed that all TKI monotherapies had a statistically significant benefit in terms of PFS compared with placebo, with lenvatinib demonstrating the greatest benefit (hazard ratio [HR] 0.19, 95% credible interval [CrI] 0.14–0.25). In terms of OS, only apatinib (HR 0.42, 95% CrI 0.18–0.97) and anlotinib (HR 0.36, 95% CrI 0.18–0.73) showed statistically significant benefits compared with placebo. TKIs also had a higher incidence of AEs of grade 3 or higher compared with placebo. The findings suggest that lenvatinib may be the preferred TKI for the treatment of RAIR‐DTC, although its high incidence of AEs should be considered. The results also indicate that TKI treatment may be similarly effective in RAIR‐DTC patients with BRAF or RAS mutations and in those with papillary or follicular subtypes of the disease, regardless of prior TKI treatment. Conclusions: The results of this meta‐analysis suggest that targeted therapy with TKIs may be beneficial for patients with radioiodine‐refractory advanced or metastatic differentiated thyroid cancer. Among the TKIs analyzed, lenvatinib appeared to be the most effective at improving PFS, although it also had the highest incidence of AEs. Further research through direct randomized controlled trials is needed to determine the optimal choice of TKI for treating patients with RAIR‐DTC. This study is beneficial for formulating patients' treatment plans and guides clinicians' decision‐making. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to dosimetrically compare volumetric‐modulated arc therapy (VMAT) with intensity‐modulated radiotherapy (IMRT) techniques using either 6‐ or 10‐MV photon beam energies in lung stereotactic body radiation therapy (SBRT) plans. Methods: Thirty patients with primary or metastatic lung tumors eligible for SBRT were randomly selected. VMAT and IMRT treatment plans using either 6‐ or 10‐MV photon energies were generated through automatic SBRT planning software in the RayStation treatment planning system. Results: For planning target volume, there was no difference in D95% for all plans, whereas D2% and D50% were significantly increased by 5.22%–5.98% and 2.47%–2.59%, respectively, using VMAT6/10‐MV plans compared to IMRT6/10‐MV plans. When comparing the Dmax of organs at risk (OARs), VMAT6/10‐MV was 18.32%–47.95% lower than IMRT6/10‐MV for almost all OARs. VMAT6/10‐MV obviously decreased Dmean, V5Gy, V10Gy, and V20Gy of whole lung by 9.68%–20.92% than IMRT6/10‐MV. Similar results were found when comparing VMAT6‐MV with IMRT10‐MV or VMAT10‐MV with IMRT6‐MV. The differences in the D2%, heterogeneity index, and conformity index between 6‐ and 10‐MV plans are not statistically significant. Plans using 6‐MV performed 4.68%–8.91% lower levels of Dmax of spinal cord, esophagus, great vessels, and trachea and proximal bronchial tree than those using 10‐MV plans. Similarly, Dmean, V5Gy, V10Gy, and V20Gy of whole lung were also reduced by 2.79%–5.25% using 6‐MV. For dose fall‐off analysis, the D2cm and R50% of VMAT6/10‐MV were lower than those of IMRT6/10‐MV. Dose fall‐off curve based on 10 rings was steeper for VMAT plans than IMRT plans regardless of the energy used. Conclusions: For lung SBRT plans, VMAT‐based plans significantly reduced OARs dose and steepened dose fall‐off curves compared to IMRT‐based plans. A 6‐MV energy level was a better choice than 10‐MV for lung SBRT. In addition, the dose differences between different techniques were more obvious than those between different energy levels. [ABSTRACT FROM AUTHOR]

Background: To evaluate the efficiency of local radiotherapy to metastatic lesions in patients with metastatic nasopharyngeal carcinoma (mNPC). Methods: The overall survival was observed and compared for mNPC patients who received local radiotherapy versus nonradiotherapy to metastatic lesions by using the Kaplan–Meier method and Cox analysis. Results: One hundred and nine patients with NPC were involved in this study, with 61 (56.0%) received radiotherapy to metastatic sites and 48 (44.0%) did not receive radiotherapy to metastatic sites. The 2‐ and 5‐year OS for patients who received local radiotherapy to metastatic lesions were 65.8% and 35.7%, and for patients who did not receive radiotherapy to metastatic lesions were 45.3% and 26.2%. The multivariable adjusted hazard radios for local radiotherapy versus nonradiotherapy to metastatic lesions were 0.482 (95% confidence interval is 0.278–0.834, p = 0.009). Conclusions: Local radiotherapy to metastatic lesions might be a protective factor for patients with mNPC. [ABSTRACT FROM AUTHOR]

Whether regular fish oil supplementation is associated with cancer risk is controversial. We aimed to evaluate the association of fish oil supplementation on cancer risk according to fatty fish consumption patterns. From the UK Biobank cohort, 470 804 participants with fish oil supplementation data were included. A total of 147 316 individuals with fish oil supplementation were in the exposed group; the other 323 488 were in the unexposed group. No association was found between self‐report regular fish oil supplementation and overall cancer risk (hazard ratio [HR] = 0.97, 95% confidence intervals [CIs] = 0.95‐1). Stratified by fatty fish consumption level, we found the association between fish oil supplementation and lower cancer risk in participants who consumed fatty fish less than two times per week, with association noted for both overall cancer (HR = 0.96, 95% CI = 0.94‐0.99) and some specific cancers (colon cancer: HR = 0.84, 95% CI = 0.75‐0.94; hepatobiliary cancer: HR = 0.74, 95% CI = 0.58‐0.96; lung cancer: HR = 0.87, 95% CI = 0.78‐0.98). On the contrary, a higher risk of breast cancer was observed (HR = 1.16, 95% CI = 1.01‐1.32) in participants who consumed fatty fish at least two times per week. In conclusion, our findings underscore the need to refine recommendations for nutritional supplements according to inherent diet habits. What's new? Previous evidence from randomised controlled trials and meta‐analyses suggests that fish oil supplementation may not lower overall cancer risk, but the results were largely inconsistent. This large‐scale prospective real‐world analysis of half a million U.K. Biobank participants found that regular fish oil supplementation was not associated with overall cancer risk. When stratifying the participants based on their dietary fish oil consumption, however, regular fish oil supplementation was associated with lower cancer incidence in participants with insufficient dietary fish oil consumption. These findings underscore the need to refine recommendations for fish oil supplementation according to dietary habits. [ABSTRACT FROM AUTHOR]

Objectives: The optimal treatment strategy of combining systemic chemotherapy and radiotherapy for nasopharyngeal carcinoma (NPC) is controversial. This study aimed to compare the efficacy and toxicities of induction chemotherapy followed by intensity‐modulated radiotherapy (IC‐RT) versus concurrent chemoradiotherapy (CCRT) in NPC. Methods: Of 448 stage II‐IVb NPC patients treated with IC‐RT or CCRT were retrospectively analysed. The primary outcome was overall survival, which was analysed by using Kaplan‐Meier curves and log‐rank (Mantel‐Cox) test. Results: The median follow‐up was 66 months (interquartile range, 46‐84 months). There was no statistically significant difference in the estimated 5‐year overall survival (OS), progression‐free survival (PFS), distance metastasis‐free survival (DMFS) and locoregional relapse‐free survival (LRFS) between IC‐RT group and CCRT group (OS: 89.5% vs 91.7%, P =.568; PFS: 85.2% vs 87.5%, P =.615; DMFS: 90.9% vs 91.7%, P =.847; LRFS: 92.0% vs 96.9%, P =.104). In the multivariate analysis, the treatment group (IC‐RT vs CCRT) was not an independent prognostic factor for OS, PFS, DMFS and LRFS. Less advanced tumour stage and lymph node stage were predictive of higher OS. EBV‐DNA level was an independent prognostic factor that was only significantly associated with LRFS. Conclusions: IC‐RT achieves similar survival outcomes and treatment‐related toxicities as CCRT in OS, PFS, DMFS and LRFS for patients with NPC. We need multicentre randomised controlled trials to reconfirm our data. [ABSTRACT FROM AUTHOR]

Background: A Bayesian network meta‐analysis was performed to compare the efficacy and toxicities among different induction chemotherapy regimens in locally advanced nasopharyngeal carcinoma (LA‐NPC). Methods: Electronic databases were searched for literature up to September 16, 2019. Two researchers independently selected the articles, evaluated the quality of the literature, and extracted and analyzed the data. Results: There were no significant differences in survival outcomes, mucositis, or gastrointestinal adverse events among the four regimens. The probability of GP being the best induction scheme to improve OS was 43.7%. The completion rate of concurrent chemotherapy with the GP regimen was significantly reduced than the other three regimens. Conclusions: The survival outcomes of the four regimens in LA‐NPC were comparable. Considering only OS, GP showed the highest probability of improving the survival of LA‐NPC, while it also affected the completion of concurrent chemotherapy. [ABSTRACT FROM AUTHOR]

Background: Adenoid cystic carcinoma (ACC) is a relatively uncommon tumor. The existing prediction model is limited to the head and neck. We aim to construct a prognostic nomogram combined with the clinical features and treatment options of ACC to predict the disease‐specific survival (DSS) of patients diagnosed with ACC in different anatomic sites. Methods: A novel predictive model was constructed using 1285 patients with ACC from the Surveillance, Epidemiology, and End Results (SEER) registry between 2010 and 2015. The performance of this model was externally validated using 118 patients with ACC in the West China Hospital, Sichuan University between 2010 and 2017. Results: The prognostic model demonstrated that age, primary site, lymph node metastasis, distant metastasis, radiotherapy and surgery were independent factors for DSS. The validation of the model using an external cohort proved its reliability. Conclusion: The developed novel predictive model is shown to provide accurate and efficient predictive information for patients with ACC for different anatomic sites. [ABSTRACT FROM AUTHOR]

Background: Induction chemotherapy followed by concurrent chemoradiotherapy is one of the standards of care for patients with nasopharyngeal carcinoma, but the optimal number of induction cycles is unclear. Here we compared survival data from patients treated with 2 to 4 cycles. Methods: Patients with nasopharyngeal carcinoma at West China Hospital of Sichuan University between January 2009 and December 2015 were retrospectively analyzed. Results: Six hundred and seventy three patients met eligibility criteria. After a median follow‐up of 53 months (interquartile range, 38‐74), there was no difference between 2 and 3 cycles in overall survival (88.14% vs 91.24%). But four cycles were associated with worse overall survival (79.12%) and higher incidence of treatment‐related toxicities. Multivariate analysis showed that the number of induction cycles and lymph node classification were prognostic factors. Conclusions: Two and three cycles of induction chemotherapy are associated with similar survival, while four cycles reduce survival and increase treatment‐related toxicity in endemic regions. [ABSTRACT FROM AUTHOR]

High‐grade serous ovarian cancer (HGS‐OvCa) is one of the most lethal gynaecological malignancies. Molecular classification identified an immunoreactive subtype of HGS‐OvCa; however, the immunologic characteristics of immunoreactive HGS‐OvcA remain unclear. In this study, 121 immunoreactive HGS‐OvCa samples were identified from a meta‐analysis of 5 large transcriptome profiling data sets using a cross‐platform immunoreactive HGS‐OvCa subgroup‐specific classifier. By comparing the gene expression profiles of immunoreactive HGS‐OvCa samples and normal tissues, 653 differentially expressed genes (DEGs) were identified. KEGG pathway analysis revealed that the leukocyte transendothelial migration pathways were significantly enriched in the immunoreactive HGS‐OvCa. Protein‐protein interaction analysis identified a module that showed strong involvement of the immune‐related chemokine signalling pathway. Moreover, the GSEA enrichment analysis showed a T‐cell subgroup and M1 macrophages were significantly enriched in immunoreactive OvCa compared with normal samples. Macrophage infiltration levels were significantly elevated in immunoreactive HGS‐OvCa compared with other OvCa subtypes. In addition, expression of immune checkpoint molecules VTCN1 and IDO1 was significantly increased in immunoreactive HGS‐OvCa. In summary, our results suggest that the immunoreactive HGS‐OvCa has unique molecular characteristics and a tumour‐associated immune microenvironment featured by increased infiltration of macrophages, rather than lymphocytes. VTCN1 could be potential targets for the treatment of immunoreactive HGS‐OvCa. [ABSTRACT FROM AUTHOR]