An MRI-based radiomics model performed better than visual assessment by experienced radiologists for diagnosing pathologic complete response in patients with locally advanced rectal cancer after ne... Background Preoperative assessment of pathologic complete response (pCR) in locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (nCRT) is increasingly needed for organ preserv...

PURPOSE: Leptomeningeal metastases (LMs) exhibit a high incidence in patients with epidermal growth factor receptor (EGFR)–mutated non–small cell lung cancer (NSCLC) post-treatment with first- or second-generation EGFR tyrosine kinase inhibitors (TKIs). This investigation evaluates the efficacy, safety, and pharmacokinetics of 80 mg once daily osimertinib in patients with LMs resistant to prior first- or second-generation EGFR TKIs. MATERIALS AND METHODS: In this phase II multicenter, open-label, single-arm study, 80 mg osimertinib was administered to patients with EGFR-mutated NSCLC who had developed LMs subsequent to treatment with prior EGFR TKIs. The primary end point was overall survival (OS), assessed alongside objective response rate by the blinded independent central review (BICR) and a pharmacokinetic analysis of plasma and cerebrospinal fluid (CSF) on the first day of cycles 3 and 6. RESULTS: A total of 73 patients diagnosed with LM were treated with osimertinib, including 64 patients evaluable for the LM efficacy set—T790M negative (n = 62) and T790M positive (n = 2). The median OS in the full-analysis set was 15.6 months (95% CI, 11.5 to 20.2). The objective response rate for LM was 51.6%, including a 15.6% complete response, and the disease control rate was 81.3% by BICR in the LM efficacy evaluable set. The median LM progression-free survival by BICR was 11.2 months (95% CI, 7.7 to 15.3), the duration of response was 12.6 months (95% CI, 7.6 to 17.7), and OS was 15.0 months (95% CI, 11.3 to 18.7). Pharmacokinetic analysis showed that the CSF to free plasma osimertinib ratio was 22%. Most safety profiles were grade 1 and 2. CONCLUSION: The study demonstrates significant intracranial efficacy and survival benefits of 80 mg once daily osimertinib in NSCLC patients with LMs. The data support considering daily 80 mg of osimertinib as a treatment option for EGFR-mutated NSCLC patients with LMs, irrespective of T790M mutation status.

Background: The role of intravascular ultrasound (IVUS)‐guided percutaneous coronary intervention (PCI) is still unclear in patients with acute myocardial infarction acute myocardial infarction. This study aimed to evaluate the long‐term impact of IVUS‐guided PCI in patients with acute myocardial infarction. Methods and Results: Among a total of 13 104 patients with acute myocardial infarction, enrolled in the Korea Acute Myocardial Infarction Registry‐National Institutes of Health, we selected patients who underwent PCI with second‐generation drug‐eluting stent implantation. The primary outcome was the risk of target lesion failure at 3 years. Among the study population, 1887 patients (21.0%) underwent IVUS‐guidance, and 7120 patients (79.0%) underwent angiography‐guidance for second‐generation drug‐eluting stent implantation. IVUS‐guided PCI was associated with a significantly lower risk of target lesion failure at 3 years (4.8% versus 8.0%; hazard ratio [HR], 0.59; 95% CI, 0.47 to 0.73; P <0.001) compared with angiography‐guided PCI. The difference was driven mainly by a lower risk of cardiac death and target vessel myocardial infarction. The results were consistent after confounder adjustment by multiple sensitivity analyses. Moreover, quartile analysis of volume of IVUS use showed that higher IVUS use was associated with a decreased risk of 3‐year target lesion failure (adjusted HR, 0.58; 95% CI, 0.45 to 0.75; P <0.001 for quartile 1 versus 4; P <0.001 for trend comparison across all quartiles). Conclusions: In patients with acute myocardial infarction who underwent PCI with second‐generation drug‐eluting stent implantation, the use of IVUS guidance was associated with a significant reduction in 3‐year target lesion failure, mainly driven by hard end points, such as cardiac death and target vessel myocardial infarction.

Although atrial fibrillation (AF) increases the risk of stroke, its relationship with atrial remodelling has not yet been studied. We hypothesized that the degree of electroanatomical remodelling of the left atrium (LA) is related to CHADS₂/CHA₂DS₂VASc score and events of stroke. We compared CHADS₂/CHA₂DS₂VASc score (0, 1, ≥2) or events of stroke with mean and regional LA volume [by three-dimensional (3D) computed tomography images] or LA endocardial voltage (by 3D-electroanatomical map) in 348 patients who underwent catheter ablation of AF (78.4% male, 55.4±11.0 years old, paroxysmal AF:persistent AF = 215:133). We graded LA volume index as Grade 1 (<48.3 mL/m²; n= 80), grade 2 (48.3–63.0 mL/m², n= 82), grade 3 (63.0–99.0 mL/m²; n= 94), and grade 4 (≥99.0 mL/m²; n= 92). Results (i) The percentage volume of anterior portion of LA enlarged at the early stage of LA remodelling (Grade 1 vs. grade 2, P= 0.006) and the voltage of posterior venous LA was significantly reduced with the degree of LA remodelling (P= 0.001). (ii) Mean LA volume/body surface area (BSA), especially anterior portion of LA, was greater in patients with high CHADS₂/CHA₂DS₂VASc score (P= 0.002). Mean LA voltage was significantly lower in patients with high CHA₂DS₂VASc score than low score (P= 0.007). (iii) In patients who experience stroke (n= 22), LA volume/BSA, especially anterior LA, was greater (P= 0.012), and LA endocardial voltage was lower (P= 0.039) than those without stroke. Electroanatomical remodelling of LA, estimated by LA volume and endocardial voltage, has significant relationship with the risk scores or events of stroke in patients with non-valvular AF.