Although the combination of immune checkpoint blockades with high dose of radiation has indicated the potential of co-stimulatory effects, consistent clinical outcome has been yet to be demonstrated. Bulky tumors present challenges for radiation treatment to achieve high rate of tumor control due to large tumor sizes and normal tissue toxicities. As an alternative, spatially fractionated radiotherapy (SFRT) technique has been applied, in the forms of GRID or LATTICE radiation therapy (LRT), to safely treat bulky tumors. When used alone in a single or a few fractions, GRID or LRT can be best classified as palliative or tumor de-bulking treatments. Since only a small fraction of the tumor volume receive high dose in a SFRT treatment, even with the anticipated bystander effects, total tumor eradications are rare. Backed by the evidence of immune activation of high dose radiation, it is logical to postulate that the combination of High-Dose LATTICE radiation therapy (HDLRT) with immune checkpoint blockade would be effective and could subsequently lead to improved local tumor control without added toxicities, through augmenting the effects of radiation in-situ vaccine and T-cell priming. We herein present a case of non-small cell lung cancer (NSCLC) with multiple metastases. The patient received various types of palliative radiation treatments with combined chemotherapies and immunotherapies to multiple lesions. One of the metastatic lesions measuring 63.2 cc was treated with HDLRT combined with anti-PD1 immunotherapy. The metastatic mass regressed 77.84% over one month after the treatment, and had a complete local response (CR) five months after the treatment. No treatment-related side effects were observed during the follow-up exams. None of the other lesions receiving palliative treatments achieved CR. The dramatic differential outcome of this case lends support to the aforementioned postulate and prompts for further systemic clinical studies.

Esophageal cancer is the eighth most common malignancy and sixth most fatal disease worldwide. However, it is the fourth most common cause of death in China. Although surgery is currently the recommended course of treatment, there are some patients that do not receive radical treatment due to the presence of distant organ or lymph node metastasis. There is at present no established treatment standard for esophageal cancer patients with distant organ metastasis. The purpose of this study was to investigate the prognostic factors involved in determining survival of esophageal cancer patients with distant organ metastasis at initial diagnosis, and to provide a reference for the planning of a clinical treatment strategy. The data of 57 evaluable esophageal squamous cell carcinoma patients with distant organ metastasis at initial diagnosis were studied retrospectively. The survival rate was calculated using the Kaplan-Meier method, and the log-rank test was used to test the differences. Multivariable analysis was performed using the Cox proportion hazards model. The median survival time for all patients was 6 months (range, 1-55 months), and the 1- and 2-year survival rates were 21.1% and 11.8%, respectively. The median survival time for patients with single metastasis was 10 months with 1- and 2-year survival rates of 47.4% and 28.1%, respectively. For patients with multiple metastases, the survival duration was 5 months, with 1- and 2-year survival rates of 7.9% and 3.9%, respectively (p < 0.001). The 1- and 2-year survival rates with multimodality treatment were 70% and 45%, respectively, which were significantly better than chemotherapy alone (13.3% and 8.9%, respectively, p = 0.003) and best supportive care (5.9% and 0%, p < 0.001), but there was no significant difference between the latter two groups (p = 0.061). For esophageal squamous cell carcinoma patients with distant organ metastasis upon initial diagnosis, the presence of a single metastasis appeared to favor overall survival compared to multiple metastases. Multimodality treatment may also improve patient survival, but chemotherapy alone has not been established as a favorable prognostic factor.

To evaluate the predictive value of the apparent diffusion coefficient (ADC) for pathologic complete response (pCR) to neoadjuvant chemoradiotherapy (NCRT) in locally advanced rectal cancer. A total of 265 patients with rectal adenocarcinoma, whole Diffusion-Weighted MRI (DWI-MRI) images, clinically stage II to III (cT3-4 and/or cN+) and treated with NCRT followed by TME were screened. Fifty patients with pCR and another 50 patients without pCR with similar clinical charcacters and treatment regimens were selected for statistical analysis. All the patients’ pre-CRT and post-CRT average ADC values were calculated from the coefficient maps created by DWI-MRI and recorded independently. The difference in the ADC values between the pCR and non-pCR was analyzed by the Mann-Whitney U test. The cut-off ADC value of the receiver operating characteristic (ROC) curve with pCR was then established. The mean pre- and post-ADC values in all patients, and in pCR patients and non-pCR patients were 0.879±0.06 and 1.383±0.11, 0.859±0.04 and 1.440±0.10, 0.899±0.07 and 1.325±0.09 (×10^-3mm²/s), respectively. The difference between the pre- and post-ADC values in all patients, pCR patients, and non-pCR patients were considered to be statistically significant. The pre-ADC value was significantly lower in the pCR patients than in the non-pCR patients (p = 0.003), whereas the post-ADC values were significantly higher in the pCR patients than in the non-pCR patients. The percentage increase of the ADC value (ΔADC%) in the pCR and non-pCR patients were 68% and 48% respectively (p<0.001). The ROC curves of the cut-off value of the pre-CRT patient ADC value was 0.866×10^-3mm²/s. The AUC, sensitivity, specificity, PPV, NPV, and accuracy of diagnosing pCR were 0.670 (95% CI 0.563–0.777), 0.600, 0.640, 60%, 60%, and 60%, respectively. The cut-off value of ΔADC% was 58%. The corresponding AUC, sensitivity, specificity, PPV, NPV, and accuracy of diagnosing pCR were 0.856 (95% CI 0.783–0.930), 0.800, 0.760, 76.9%, 79.2%, and 78%, respectively. DWI-MRI technology can be efficient for predicting pCR for LARC after NCRT. Although the mean pre-CRT ADC value and the ΔADC% are moderate predictors for pCR, the latter would be more accurate.

Glioma is a common malignancy with poor prognosis. Recent evidence suggests that the pathogenesis and progression of glioma involve long noncoding RNAs (lncRNAs). Previously, we showed that glioma cell radioresistance was enhanced by lncRNA SNHG18 in vitro and in vivo. In the present study, we showed that SNHG18 promoted the invasion and migration of glioma cells. SNHG18 was demonstrated to regulate the progression of epithelial-mesenchymal transition and cytoskeleton remodeling, thereby affecting cell motility. Furthermore, the promotion of invasion evoked by SNHG18 overexpression could be rescued by α-enolase (ENO1) deletion. Moreover, rather than altering ENO1 expression, SNHG18 suppressed its nucleocytoplasmic transport by directly combining with ENO1 in glioma cells. The results suggested that SNHG18 inhibited the nucleocytoplasmic transport of ENO1 to promote cell motility. The results reveal the mechanism by which this lncRNA affects tumorigenesis and metastasis, forming the basis for further research that will lead to novel strategies to treat glioma.