Bin Shen’s research while affiliated with Linyi People's Hospital and other places

Background Cryotherapy plays a crucial role in managing radio-recurrent prostate cancer (PCa) after initial treatment. This study aims to provide a comprehensive review of its effectiveness and associated complications. Methods A systematic review was conducted using PubMed and EMBASE databases up to June 2024, focusing on recurrence-free survival (RFS) with salvage cryotherapy across various subgroups. Severe complications were also assessed. Survival curves were reconstructed using WebPlotDigitizer and a newly developed Shiny application. The incidence of complications was summarized with a 95% confidence interval (CI) using a random-effects model. Complications were evaluated using the Clavien-Dindo Scale (CDS). Results Thirty-six studies were included, with 15 papers (3174 patients) contributing to survival curve reconstruction. Among 1593 patients treated with salvage cryotherapy, the median RFS was 56.7 months, with 2-, 3-, and 5-year rates of 67.6%, 59.5%, and 47.3%, respectively. Factors associated with better RFS included a longer time from primary treatment to salvage therapy (TRS) [> 70 months vs. < 70 months, hazard ratio (HR) (95% CI):0.75(0.58-0.97), p=0.031], lower pre-salvage prostate-specific antigen (PSA) levels [< 5 ng/mL vs. > 5 ng/mL, HR (95% CI):0.78 (0.65-0.93), p=0.005], salvage whole-gland cryotherapy (SWC) [whole vs. focal, HR (95% CI):0.45 (0.37-0.56), p < 0.001], neoadjuvant androgen deprivation therapy (ADT) [Yes vs. No, HR (95% CI):0.79 (0.69-0.89), p < 0.001], and higher adjuvant ADT usage [16.5-34.2% vs. 0-10.5%, HR (95% CI):0.47(0.39-0.56), p < 0.001]. Concerning severe complications, 78 out of 876 patients (8.9%, 95% CI: 7-11) experienced genitourinary (GU) events, 53 out of 633 patients (8.5%, 95% CI: 6-11) suffered from urinary incontinence, 15 out of 493 patients (3.0%, 95% CI: 2-5) had urethral sloughing/stenosis, and 6 out of 522 patients (1.1%, 95% CI: 0-2) developed recto-urethral/vesical fistula. No cases of severe haematuria, urinary tract infection, or urinary retention were reported. Conclusions Cryotherapy demonstrates a favorable safety profile and significant RFS benefits for salvage treatment of radio-recurrent PCa. Longer TRS, lower pre-salvage PSA, SWC, and peri-salvage ADT usage appear to be promising prognostic factors for RFS. However, confirmation of these findings requires randomized controlled trials (RCTs) due to the low evidence levels and study heterogeneity.

Objective To summarise the efficacy and toxicity of salvage low‐dose‐rate brachytherapy (LDR‐BT) and compare these findings with the published data on salvage high‐dose‐rate brachytherapy (HDR‐BT). Methods We reviewed PubMed and EMBASE for studies published up to May 2024, mainly focusing on recurrence‐free survival (RFS) with salvage LDR‐BT across subgroups. We also compared RFS and adverse events with HDR‐BT as a secondary objective. We reconstructed survival curves using a semi‐automated tool called WebPlotDigitizer, along with a new shiny application integrated with R. Results A total of 31 studies (891 patients) met the inclusion criteria for salvage LDR‐BT. The median RFS of patients treated with salvage LDR‐BT was 131.6 months, with 2‐, 3‐ and 5‐year rates of 84.6%, 74.3% and 63.5%. Lower median age (65–70 years vs 72.3–75 years, hazard ratio [HR] 0.50, 95% confidence interval [CI] 0.35–0.70; P < 0.0001) and higher adjuvant androgen deprivation therapy (ADT) proportion (83.8%–100% vs 0%–47%, HR 0.60, 95% CI 0.55–0.65; P = 0.036) were positive RFS factors. Compared to HDR‐BT, salvage LDR‐BT demonstrated improved RFS for all patients (HR 0.67, 95% CI 0.55–0.81; P < 0.0001). Specifically, salvage LDR‐BT exhibited superior RFS (P < 0.05) for patients with a median age ≤70 years at recurrence, a median time from primary treatment to salvage therapy (TPTS) of ≥70 months, a median pre‐salvage prostate‐specific antigen level of ≥5 ng/mL, and a proportion of adjuvant ADT of ≥53%, compared to HDR‐BT. However, LDR‐BT was associated with a higher rate of severe gastrointestinal (GI; 3.5% vs 0.3%, odds ratio [OR] 0.08, 95% CI 0.03–0.28; P < 0.0001) and genitourinary (GU) toxicities (12.7% vs 5.8%, OR 0.42, 95% CI 0.30–0.60; P < 0.001) compared to HDR‐BT. Conclusions In specific cohorts, salvage LDR‐BT appears to yield superior RFS but entails a higher incidence of severe GI/GU toxicities compared to HDR‐BT.

Objective The effect of Meaning-Centered Interventions (MCI) in advanced cancer patients requires further comprehensive research. Methods Two researchers independently searched the PubMed, EMBASE, SCOPUS, Cochrane, and PsycINFO databases to investigate the impact of MCI on anxiety and depressive symptoms, sense of meaning, and quality of life (QoL) in patients with advanced cancer from inception to April 2024. Statistical analyses were conducted using standardized mean difference (SMD) as the effect size with Stata 17.0 software for analysis, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was employed to assess the certainty of evidence. Results Data from 12 eligible studies, involving a total of 1,459 participants, were included in the review. The analysis found that 3 studies with 321 participants reported an improvement in the quality of life (QoL) of patients with advanced cancer within one month after the intervention, compared to the control group (SMD, 0.27; 95% CI, 0.03 to 0.52; I² = 0%; p = 0.03). However, this effect did not persist during the 2–6 months following the intervention. In addition, 4 studies with 434 participants indicated that MCI was associated with an enhanced sense of meaning (SMD, 0.22; 95% CI, 0.09 to 0.36; I² = 0%; p = 0.002). Furthermore, 8 studies with 1,192 participants and 7 studies with 1,156 participants found that MCI was associated with a reduction in depressive symptoms (SMD, -0.15; 95% CI, -0.24 to -0.05; I² = 44.8%; p = 0.002) and anxiety symptoms (SMD, -0.16; 95% CI, -0.26 to -0.07; I² = 46.3%; p = 0.001), respectively. Conclusions Moderate-quality evidence indicates that MCI enhances the sense of meaning among patients with advanced cancer and reduces depressive and anxiety symptoms, but it does not improve their QoL.

Objectives This study explores the impact of family dignity interventions (FDI) on palliative patients and their family caregivers through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods A systematic search was conducted in PubMed, Embase, and Cochrane databases for RCTs related to family-centered dignity interventions, with the search period extending from the inception of the databases up to July 2024. Statistical analyses were conducted using standardized mean difference (SMD) as the effect size with Stata 17.0 software for analysis, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was employed to assess the certainty of evidence. Results A total of 7 RCTs involving 556 pairs of palliative patients and their caregivers were included. Compared to the control group, palliative patients who received FDI demonstrated greater improvements in dignity (SMD, − 0.27; 95% confidence interval (CI), − 0.43; − 0.10), hope (SMD, 0.50; 95% CI, 0.24; 0.75), sense of meaning (SMD, 0.39; 95% CI, 0.18; 0.75), and spiritual well-being (SMD, 0.43; 95% CI, 0.24; 0.61). Concurrently, their family caregivers experienced more significant reductions in anxiety (SMD, − 0.61; 95% CI, − 0.92; − 0.30), depression (SMD, − 0.52; 95% CI, − 0.69; − 0.34), and anticipatory grief (SMD, − 0.71; 95% CI, − 1.12; − 0.31). Subgroup analysis indicated that the benefits gained by palliative patients disappeared 2 months after the intervention, whereas the benefits for their family caregivers persisted 2 months after the intervention. Conclusion Current low-quality evidence suggests that FDI may have short-term positive effects on the psycho-spiritual well-being of palliative care patients and reduce psychological distress in their family caregivers. Future research should focus on conducting high-quality RCTs to assess the dose–response effect of FDI on the families of palliative care patients, providing evidence to optimize intervention strategies.

Background: Stereotactic body radiotherapy (SBRT) is pivotal in managing radio-recurrent prostate cancer (PCa). This study aims to comprehensively review its efficacy and associated severe toxicities. Methods: A thorough review of PubMed and EMBASE databases up to July 2024 was conducted to assess recurrence-free survival (RFS) with salvage SBRT across various subgroups. Survival curves were reconstructed using WebPlotDigitizer and a newly developed shiny application. Results: Thirty-six studies were analyzed, with 15 papers (682 patients) contributing to survival curve reconstruction. Median RFS was 36.2 months, with 2-, 3-, and 5-year rates of 64.8%, 50.7%, and 40.6%, respectively. Factors associated with improved RFS included whole-gland irradiation [focal vs. whole, hazard ratio (HR) 1.83 (95% CI: 1.16-2.87), p = 0.008], and higher biologically effective dose (BED) [120-138.1 Gy vs. 144-167.7 Gy, HR 1.40 (95% CI: 1.07-1.83), p = 0.015]. Severe (grade ≥ 3) acute and late genitourinary (GU) toxicities occurred in 1.4% (95% CI: 0.8-2.3) and 3.7% (95% CI: 2.6-4.9) of patients, respectively. Severe acute and late gastrointestinal (GI) toxicities were reported in 0.5% (95% CI: 0.2-1.1) and 0.4% (95% CI: 0.1-1.0) of patients, respectively. Combined severe GU and GI toxicities were observed in 5.8% (95% CI: 4.5-7.4) and 1.3% (95% CI: 0.7-2.2) of patients, respectively. Conclusions: This study provides a comprehensive assessment of toxicities and conducts a pooled analysis of RFS for salvage SBRT in radio-recurrent PCa. Factors such as whole-gland irradiation, and higher BED show promise as prognostic indicators for RFS. However, confirmation through randomized controlled trials is essential due to the low levels of evidence and study heterogeneity.

Background High-dose-rate brachytherapy (HDR-BT) plays an important role in the treatment of locally recurrent prostate cancer after definitive treatment. The objective of this study is to summarize the efficacy and toxicity of HDR-BT in these patients. Methods We performed a systematic review of PubMed and EMBASE from inception to July 2023. The primary endpoint was relapse-free survival (RFS) in different subgroups, and the secondary endpoint was gastrointestinal (GI) and genitourinary (GU) toxicity. A semi-automated tool (WebPlotDigitizer) and a new Shiny application combined with R software (R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria; https://www.R-project.org/) helped to reconstruct survival curves. Results Twenty-six studies met the inclusion criteria for quantitative analysis, including 1447 patients. A total of 761 patients from 13 studies were included in survival reconstruction, and the median RFS time was 61.2 months (57.6–72.0 months). The estimated 2‑, 3‑, and 5‑year rates were 75.9% (95% confidence interval [CI] 72.8 ~ 79.2%), 66.7% (95% CI 63.0 ~ 70.5%), and 52.3% (95% CI 47.5 ~ 57.4%), respectively. Whole-gland irradiation with multiple fractions (≥ 2 F) resulted in better RFS compared with focal gland irradiation with fewer fractions (1 F mostly; hazard ratio [HR]: 0.60, 95% CI 0.47–0.77, p < 0.0001). According to the different median time from primary treatment to salvage therapy (TRS) and median age at recurrence, short median TRS (56–67.2 months vs. 70–120 months; HR 0.52, 95% CI 0.68–0.40; p < 0.0001) and younger median age (60–70 years vs. 71–75 years; HR 0.58, 95% CI 0.46–0.74; p < 0.0001) were positive factors for RFS. The cumulative incidences estimated for grade ≥ 3 acute and late GU toxicities were 1% (95% CI 0 ~ 1%) and 5% (95% CI 4 ~ 7%), respectively. Three patients (3/992) experienced grade ≥ 3 late GI toxicity, and no cases of grade ≥ 3 acute GI toxicity were reported. Conclusion HDR-BT has a high safety profile and good RFS benefit for salvage treatment of radiorecurrent prostate cancer. In terms of RFS, whole-gland irradiation with multiple fractions seems to be better than focal gland irradiation with fewer fractions, while short TRS and younger age are good prognostic factors. In view of the low level of evidence in the included studies and the large heterogeneity of each study, these conclusions still need to be confirmed by randomized controlled trials.

Numerous studies have examined the effectiveness of photobiomodulation therapy (PBMT) in reducing chemoradiotherapy (CRT)‐induced oral mucositis (OM) in patients with head and neck cancer (HNC). Despite this, there is an urgent need to update the meta‐analyses on this topic. This meta‐analysis aims to explore the impact of PBMT on CRT‐induced OM in these patients. We conducted a systematic search in PubMed, Embase, Cochrane, LILACS, and Web of Science from January 2000 to October 2023. This search focused on randomized controlled trials (RCTs) that assessed the effects of PBMT on CRT‐induced OM. The study included a total of 14 RCTs encompassing 869 patients with HNC. The incidence of OM in the PBMT group was significantly lower from the second week onwards compared to the control group (RR = 0.49, CI = 0.25–0.97, I ² = 71%, p = 0.04), and this was present until the seventh week (RR = 0.77, CI = 0.61–0.99, I ² = 89%, p = 0.04). Furthermore, the occurrence of severe mucositis in the PBMT group decreased from the third week (RR = 0.51, CI = 0.29–0.90, I ² = 12%, p = 0.02) until the conclusion of the intervention (RR = 0.45, CI = 0.24–0.85, I ² = 80%, p = 0.01). Additionally, PBMT showed beneficial effects in alleviating OM‐related pain (WMD = −1.09, 95% CI = −1.38 to −0.880, I ² = 13%, p < 0.00001). The use of He‐Ne or InGaAlP lasers with a power range of 10–25 mW demonstrated the most favorable outcomes in preventing and treating OM. PBMT has shown considerable efficacy in reducing the incidence, severity, and pain associated with OM in patients with HNC. Future studies are encouraged to further investigate the most effective parameters for PBMT in the management of OM.

Background: The use of adjuvant first-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKIs) in patients with resected EGFR-mutant non-small cell lung cancer (NSCLC) remains controversial. Therefore, we performed a systematic review with meta-analysis to investigate the overall survival (OS) in patients with resected NSCLC. Methods: Relevant studies were identified from the PubMed and EMBASE databases, and pooled hazard risks were obtained by random-effects models. Results: Three prospective phase III and one phase II randomized controlled trials were identified, including a total of 839 patients who had undergone resection of EGFR-sensitive mutation in our analysis, 429 of whom received adjuvant first-generation TKIs therapy. For all patients with complete resection, adjuvant first-generation TKIs therapy was associated with improved disease-free survival (DFS) [hazard ratio (HR): 0.50, 95% confidence interval (CI): 0.30-0. 82] but not OS (HR: 0.78, 95% CI: 0.48-1.27) compared with adjuvant chemotherapy. In addition, we reconstructed the OS curves of the ADJUVANT and IMPACT studies, and the pooled 3- and 5-year OS rates of stage II-III patients in the TKI group and chemotherapy group were 80% vs. 79% and 66% vs. 64%, respectively. We also reconstructed the DFS curves based on the ADJUVANT, IMPACT, and EVIDENCE studies, and the pooled 1-, 3- and 5-year DFS rates of stage II-III patients in the TKI group and chemotherapy group were 87% vs. 70%, 49% vs. 37% and 28% vs. 29%, respectively. Conclusions: In patients with completely resected EGFR-mutant NSCLC, adjuvant first-generation TKIs may delay disease progression but still fail to improve long-term survival compared with conventional chemotherapy.

Introduction Small cell lung cancer (SCLC) is a highly aggressive lung cancer variant known for its elevated risk of brain metastases (BM). While earlier meta‐analyses supported the use of prophylactic cranial irradiation (PCI) to reduce BM incidence and enhance overall survival, modern MRI capabilities raise questions about PCI's universal benefit for limited‐stage SCLC (LS‐SCLC) patients. As a response, we have created a predictive model for BM, aiming to identify low‐risk individuals who may not require PCI. Methods A total of 194 LS‐SCLC patients without PCI treated between 2009 and 2021 were included. We conducted both univariate and multivariate analyses to pinpoint the factors associated with the development of BM. A nomogram for predicting the 2‐ and 3‐year probabilities of BM was then constructed. Results Univariate and multivariate analyses revealed several significant independent risk factors for the development of BM. These factors include TNM stage, the number of chemotherapy (ChT) cycles, Ki‐67 expression level, pretreatment serum lactate dehydrogenase (LDH) levels, and haemoglobin (HGB) levels. These findings underscore their respective roles as independent predictors of BM. Based on the results of the final multivariable analysis, a nomogram model was created. In the training cohort, the nomogram yielded an area under the receiver operating characteristic curve (AUC) of 0.870 at 2 years and 0.828 at 3 years. In the validation cohort, the AUC values were 0.897 at 2 years and 0.789 at 3 years. The calibration curve demonstrated good agreement between the predicted and observed probabilities of BM. Conclusions A novel nomogram has been developed to forecast the likelihood of BM in patients diagnosed with LS‐SCLC. This tool holds the potential to assist healthcare professionals in formulating more informed and tailored treatment plans.