Radiation-induced pulmonary fibrosis (RIPF) is a common complication in patients with lung cancer and breast cancer after receiving thoracic radiotherapy. The average incidence of RIPF is 16%-28% after radiotherapy. RIPF includes a heterogeneous group of lung disorders characterized by progressive and irreversible destruction of lung architecture and disruption of gas exchange. The clinical signs of RIPF include increasing dyspnea, deteriorating lung function, and accumulation of interstitial fluid, eventually leading to respiratory failure. No medical therapy for RIPF has been approved for routine clinical use despite the apparent need for an effective treatment. Numerous signaling pathways are involved in the initiation and progression of RIPF. Also, various approaches for RIPF treatments have focused on several aspects of the current understanding of the molecular pathology of RIPF. This review used the mechanistic categories of associated cell signaling pathways, epithelial cell dysfunction and senescence, abnormal lung remodeling, and aberrant innate and adaptive immunity to review the published literature on RIPF to date and then to identify potential areas for the effective treatment of RIPF.

Purpose: Evidence for radiotherapy (RT) in oligoprogressive hepatocellular carcinoma (OP-HCC) is limited. We evaluated the efficacy and safety of progression-directed RT (PDRT) alongside ongoing first-line systemic therapy (FLST) in patients with OP-HCC. Patients and Methods: Patients who developed OP-HCC during FLST were enrolled and received PDRT with a biologically effective dose of at least 60 Gy while continuing FLST. The primary endpoint was progression-free survival (PFS); secondary endpoints were overall survival (OS), objective response rate (ORR), disease control rate (DCR), duration of response (DOR), toxicities, and quality of life (QoL). Results: From March 2024 through May 2025, 36 patients were enrolled from 10 cancer centers. At a median follow-up time of 10.9 months, median PFS time was 7.0 months (95% confidence interval 4.9–9.7), with 3-, 6-, and 9-month PFS rates of 73.7%, 64%, and 38.8%, respectively. Type of FLST and albumin–bilirubin (ALBI) grade at oligoprogression were independently associated with PFS. Median OS and DOR times were not reached; 1-year OS rates were 86.4%, and 3-, 6-, and 9-month DOR rates were 84.6%, 79.6%, and 70.8%, respectively. ORR and DCR were 64.7% and 98.0%, respectively. QoL measures generally remained stable, except for transient increases in fatigue and pain scores 1 month after PDRT. RT-related toxicities (mostly grades 1–2) occurred in 16 patients (44.4%), including grade ≥3 events in four patients (11.1%). Conclusions: Maintaining FLST with PDRT was effective, safe, and preserved QoL, supporting its feasibility for OP-HCC. FLST type and baseline ALBI grade may provide risk stratification and prognosis for PFS.

Background Late course accelerated hyperfractionation radiotherapy (LCAHR) is used as a standard treatment option for locally advanced esophageal squamous cell carcinoma (LAESCC) in China, but concerns remain regarding its efficacy and safety. The purpose of this paper was to evaluate the efficacy and safety of LCAHR. The comparisons examined were as follows: LCAHR versus conventional fractionation radiotherapy (CFR) and LCAHR plus chemotherapy (CT) versus LCAHR alone. Methods We searched the Cochrane Library, MEDLINE, EMBASE, CENTRAL, CBMdisc, and CNKI, as well as employing manual searches. The primary end points were survival and local control. The second end point was toxicities. Results Based on search criteria, we found 29 trials involving 3187 patients. Our results showed that LCAHR, compared with CFR, improved the survival and local control, and was, thus, more therapeutically beneficial. Further analysis revealed that LCAHR plus CT proved to be better for patients' survival and local control compared to LCAHR alone. Acute toxicities were increased rather than late toxicities. Conclusions There was a significant survival and local control benefit of LCAHR over CFR, as well as LCAHR plus CT over LCAHR alone. Considering the strength of the evidence, the results of this study indicate that this regimen would be a new promising modality worth further investigation.

Background: Concomitant boost irradiation (CB) in adjuvant whole breast radiotherapy (WBI) is increasingly prevalent. Multiple studies have reported the effect of CB; however, long-term outcomes after CB remain unknown. Methods: Totally 266 patients administered breast-conserving surgery from March 2007 to November 2012 were included in this retrospective analysis. They were administered WBI at 45 Gy (range, 43.2-46) in 23 fractions (range, 18-25). CB irradiation was delivered shortly after WBI completion with 9 or 12 Mevβ electrons at a dose of 13.8 Gy (range, 7.2-15) in 23 fractions (range, 18-25). Sequential boost irradiation (SB) was conducted sequentially after the entire WBI treatment at a dose of 14 Gy (range, 10-15) in 7 fractions (range, 4-8). Then, 10-year survival, local control, and toxicity in these two groups were analyzed. Results: Median follow-up time was 124 months, ranging from 121.6 to 126.4. The 10-year disease-free (DFS) and overall (OS) survival rates were similar in both groups, both before and after PSM. Both distant metastasis and recurrence rates in the CB group were similar to those of the SB group after PSM. Moreover, both groups had similar cosmetic outcomes and radiation-associated late toxicity. Conclusions: Survival, local tumor control, cosmetic outcome, and late toxicity were comparable in the CB and SB groups. WBI with CB can be considered an effective therapeutic tool in early-stage breast cancer.

Supplementary tables, figures and protocol.