Background: Because the vast majority of nasopharyngeal carcinoma (NPC) in Chinese patients is a direct result of Epstein–Barr virus (EBV) infection, there is a dearth of data for EBV-negative patients in this population. This multicenter study sought to examine the clinical characteristics of EBV-negative patients and compare long-term outcomes with a propensity-matched (1:1.5) EBV-positive cohort. Methods: NPC patients with known EBV status from four hospitals were collated (2013–2021). A logistic regression model was conducted to evaluate the relationship between patient characteristics and EBV status. The Kaplan–Meier method and Cox regression analysis were used to analyze survival data. Results: This study analyzed 48 (40%) EBV-negative and 72 (60%) EBV-positive patients. The median follow-up time was 63.5 months. Most EBV-negative NPC patients (77.1%) were diagnosed in advanced stages with a higher rate (87.5%) of positive lymph node disease, and no significant prognostic factors were discerned in this subpopulation. The EBV-negative disease was more associated with the keratinizing subtype (18.8% vs. 1.4%, p < 0.05). Compared to EBV-negative NPC patients, EBV-positive NPC patients were more likely to develop a local recurrence (9.7% vs. 0%, p = 0.026). There was no statistical difference in mortality (EBV-negative vs. EBV- positive, 8.3% vs. 4.2%, p = 0.34) during the follow-up period. Although the median PFS and median OS were not reached, the 3-year PFS rate was 68.8% vs. 70.8% (EBV-negative vs. EBV-positive, p = 0.06), the 3-year OS rate was 70.8% vs. 76.4% (EBV-negative vs. EBV-positive, p = 0.464), the 5-year PFS rate was 56.3% vs. 50% (EBV-negative vs. EBV-positive, p = 0.451), and the 5-year OS rate was 56.3% vs. 58.3% (EBV-negative vs. EBV-positive, p = 0.051), respectively. These data show that EBV-positive NPC patients seem to have a tendency to gain better survival compared with EBV-negative NPC patients. Conclusions: Most of the EBV-negative patients were in the middle and late stages at the time of diagnosis and were more associated with the keratinizing subtype. EBV status may be associated with prognosis in NPC. EBV positivity seems to be associated with better survival in NPC patients. Still, due to the small cohort of patients and the short observation period for a number of patients, further work is required to corroborate these conclusions.

Thyroid-associated ophthalmopathy (TAO) is a hallmark autoimmune condition, and the treatment of TAO requires a multidisciplinary approach. Radiation therapy (RT) is a viable treatment option for active TAO, IMRT is a more precise technology in radiation oncology. This study aims to evaluate the efficacy, feasibility, and safety of orbital intensity-modulated radiation therapy (IMRT) in the treatment of TAO. A single-center retrospective analysis was conducted, including patients diagnosed with moderate to severe active TAO at the Department of Radiation Oncology, Peking University Third Hospital, from October 2020 to October 2023, who had poor responses to corticosteroid treatment. These patients subsequently received IMRT treatment, followed by a period of follow-up and retrospective analysis. The study focused on the outcomes of treatment efficacy, safety, and acute toxic reactions induced by radiation therapy. Improvements in clinical activity score (CAS) at 4 and 12 months were considered as primary and secondary study endpoints, respectively, along with the incidence rate of adverse events. The median follow-up period was 12 months. The median follow-up time after radiation therapy was 12 months. There was no statistically significant difference in CAS between before and 4 months after radiation therapy (CAS: 5.53 ± 2.07 vs.4.68 ± 2.62; R squared: 0.21; 95% CI: − 1.01–0.02; P = 0.054). However, there was a significant reduction in CAS 12 months post-treatment compared to pre-treatment (CAS: 5.53 ± 2.07 vs. 3.06 ± 2.38; R squared: 0.66; 95% CI: 3.42 − 1.52; P < 0.001). The CAS showed a progressively decreasing trend at both 4 months and 12 months post-treatment. In the combined radiotherapy with glucocorticoid treatment group, a statistically significant difference was found between the CAS before treatment and 12 months after radiotherapy (CAS: 6.38 ± 2.00 vs. 3.88 ± 2.85; R squared: 0.66; 95% CI − 4.11 to 0.89; P = 0.008). In the radiotherapy alone group, a statistically significant difference was found between the CAS before treatment and 12 months after radiotherapy (CAS: 4.78 ± 1.92 vs. 2.33 ± 1.73; R squared: 0.66; 95% CI − 3.89 to 1.00; P = 0.005). A few patients experienced Grade I periorbital edema, conjunctival congestion, and dry eye syndrome, but no adverse events such as cataracts, radiation retinopathy, or radiation-induced optic neuropathy were observed by the end of the follow-up period. Orbital IMRT is an effective treatment modality for moderate to severe active TAO, demonstrating significant efficacy even in patients who had not achieved success with previous treatments such as corticosteroids. This retrospective study was approved by the Ethics Committee of Peking University Third Hospital. The permit number was M2024220 and data of registration was April I, 2024.

Permanent I-125 seed implantation is one of the most commonly used brachytherapy (BT) forms, potentially applicable to almost any solid tumor as a standalone anti-tumor therapy or in combination with external beam radiotherapy (EBRT). The main advantage of I-125 seed implantation BT is its ability to deliver a high radiation dose within target volumes while maintaining a sharp dose drop-off profile, thereby protecting adjacent normal tissue. The clinical use of I-125 seed implantation in China has significantly increased in the past decades due to the application of an image-guided BT treatment planning system with reverse optimization capabilities and 3D printing individual template (3D-PIT) assistance. Computed tomography-guided I-125 seed implantation became a widely common modality of BT and has been used in many clinical settings for a variety of refractory cancer in China since 2002. The application has been expanded significantly not only for prostate cancer as monotherapy but also in combination with EBRT for the salvage treatment for refractory/recurrent head-and-neck carcinoma (HNC). With the assistance of 3D-PIT, since 2015, the quality control of I-125 seed implantation has been significantly adapted with high precision and real-time dose optimization. This review aims to summarize the developments and status of 3D-PIT-based I-125 seed implantation BT for the treatment of refractory HNC and standardized workflow in China.

Head and neck cancer (HNC) encompasses a range of malignancies that originate from the upper aerodigestive tract. Despite employing a multimodal treatment approach, the recurrence rate for HNC remains high with limited treatment options. One effective treatment method for HNC is interstitial brachytherapy with radioactive seeds, which delivers high localized doses of radiation while minimizing damage to surrounding healthy tissues. The integration of three-dimensional-printed templates (3D-PT) with computed tomography (CT)-guided techniques enhances the precision and control of radioactive seed implantation. This approach enhances treatment accuracy and efficacy, making it a valuable option in the management of HNC and other malignancies. Several factors, such as the specific target site, puncture trajectory, and radiation dosage distribution, can influence the efficacy and safety of seed implantation. At present, there is a lack of comprehensive reports detailing the clinical and technical processes and standards related to 3D-PT-assisted CT-guided particle implantation therapy for recurrent HNC. This consensus aims to address this gap by focusing on the application of 3D-PTs for interstitial brachytherapy using iodine-125 seeds in the treatment of recurrent HNC.

Accurate automatic medical image segmentation relies on high-quality, dense annotations, which are costly and time-consuming. Weakly supervised learning provides a more efficient alternative by leveraging sparse and coarse annotations instead of dense, precise ones. However, segmentation performance degradation and overfitting caused by sparse annotations remain key challenges. To address these issues, we propose CmFNet, a novel 3D weakly supervised cross-modal medical image segmentation approach. CmFNet consists of three main components: a modality-specific feature learning network, a cross-modal feature learning network, and a hybrid-supervised learning strategy. Specifically, the modality-specific feature learning network and the cross-modal feature learning network effectively integrate complementary information from multi-modal images, enhancing shared features across modalities to improve segmentation performance. Additionally, the hybrid-supervised learning strategy guides segmentation through scribble supervision, intra-modal regularization, and inter-modal consistency, modeling spatial and contextual relationships while promoting feature alignment. Our approach effectively mitigates overfitting, delivering robust segmentation results. It excels in segmenting both challenging small tumor regions and common anatomical structures. Extensive experiments on a clinical cross-modal nasopharyngeal carcinoma (NPC) dataset (including CT and MR imaging) and the publicly available CT Whole Abdominal Organ dataset (WORD) show that our approach outperforms state-of-the-art weakly supervised methods. In addition, our approach also outperforms fully supervised methods when full annotation is used. Our approach can facilitate clinical therapy and benefit various specialists, including physicists, radiologists, pathologists, and oncologists.