Incidental pituitary uptake on 18F-deoxy-glucose positron emission tomography combined with computed tomography (18F-FDG PET/CT) is rare, occurring in <1% of scans, yet its identification carries significant clinical implications. Accurate interpretation requires a systematic diagnostic approach integrating metabolic, structural, and hormonal assessment. While the normal pituitary gland demonstrates low-level or background FDG activity, focal uptake may suggest pathology ranging from physiologic hyperplasia and benign adenomas to inflammatory conditions such as hypophysitis, or malignant etiologies including pituitary neuroendocrine tumors and metastatic disease. The intensity of uptake, quantified by the maximum standardized uptake value (SUVmax), serves as a critical diagnostic indicator; an SUVmax threshold above 4.1 has been proposed to differentiate benign from malignant lesions with high sensitivity and specificity. Complementary pituitary magnetic resonance imaging (MRI) offers essential anatomic correlation to define lesion morphology, extension, and contrast enhancement patterns, while endocrine evaluation helps establish functional activity and hormonal imbalance. Histopathologic confirmation remains reserved for cases with inconclusive imaging or atypical presentation. This review synthesizes available literature, emphasizing PET-based metabolic features and interpretive pitfalls, while acknowledging the role of computed tomography and MRI in comprehensive lesion characterization. Early recognition and appropriate follow-up are crucial to avoid misdiagnosis and to guide timely management of clinically significant pituitary lesions.
Breast cancer is the most prevalent malignancy among women worldwide, and radiotherapy (RT) plays a central role in reducing local recurrence and improving survival. Technological advances such as three-dimensional conformal RT (3D-CRT), intensity-modulated RT (IMRT), volumetric-modulated arc therapy (VMAT), and particle therapies have enhanced dose conformity and reduced exposure to surrounding healthy tissues, particularly the lungs. Nevertheless, radiation-induced lung injury (RILI) remains a clinically relevant concern because of the close anatomical relationship between the breast and lung. RILI is a biphasic process, comprising early radiation pneumonitis and late radiation-induced pulmonary fibrosis, with severity influenced by dose distribution and treatment modality. While 3D-CRT carries a moderate risk due to limited beam modulation, IMRT and VMAT improve target coverage but may increase low-dose exposure to larger lung volumes, potentially increasing the risks of subclinical injury and, in the long term, secondary malignancy. Adjunctive lung-sparing strategies, including deep inspiration breath-hold and image-guided techniques, further reduce pulmonary dose. Proton beam therapy, particularly pencil beam scanning, offers additional lung protection through Bragg peak-based dose deposition, minimizing exit dose and irradiation of non-target tissues. Early clinical data suggest a lower incidence of RILI with PBT, although long-term outcomes remain under investigation. Carbon ion RT remains investigational in breast cancer. This review summarizes current evidence on RILI risk across modern RT modalities. A deeper understanding of modality-specific risks is essential for guiding personalized treatment planning and implementing effective lung-sparing strategies.
Non-Hodgkin lymphoma (NHL) is a biologically heterogeneous group of lymphoid malignancies with variable clinical outcomes despite advances in chemotherapy, immunotherapy, and cellular therapies. The C-X-C chemokine receptor 4 (CXCR4)/ C-X-C motif chemokine ligand 12 (CXCL12) axis plays a central role in lymphocyte trafficking, survival, and tumor microenvironment interactions. It is frequently dysregulated in NHL, making it an attractive target for precision oncology. CXCR4- directed theranostics combines molecular imaging and targeted radionuclide therapy, enabling real-time assessment of receptor expression, patient stratification, and personalized treatment delivery. Diagnostic positron emission tomography imaging using 68Ga-pentixafor reliably visualizes CXCR4-expressing disease, while therapeutic agents, such as 177Lu- or 90Y-pentixather and CXCR4-targeted antibody- drug conjugates demonstrate selective tumor targeting and potent cytotoxicity in preclinical and early clinical studies. Despite promising antitumor activity and manageable toxicity, several challenges remain, including heterogeneous and dynamically regulated CXCR4 expression, protective microenvironmental niches, hematologic toxicity, radiopharmaceutical limitations, and infrastructural requirements for widespread clinical implementation. Ongoing research is focused on optimizing dosing, refining patient selection, combining CXCR4-targeted therapies with other modalities, and expanding clinical trials to establish efficacy and safety. CXCR4 theranostics holds substantial potential to improve precision management of NHL by integrating diagnostic and therapeutic modalities into a unified, patient-tailored approach.
Teleradiology, an innovative and disruptive technology, has demonstrated a track record in enhancing remote healthcare delivery in multiple clinical and healthcare settings. With the aim of understanding the impact of teleradiology on healthcare delivery in Saudi Arabia, a retrospective descriptive study was carried out between January 2014 and January 2024. Over the 10 years, 103,730 scans were transmitted for interpretation, thus providing consistent remote healthcare delivery in the Kingdom of Saudi Arabia (KSA). The highest category of scans was computed tomography (45.96%), followed by radiographs (40.27%), magnetic resonance imaging (9.06%), mammograms (4.17%), ultrasound (0.53%), and nuclear medicine (NM) (0.01%). For the study, global turnaround time (TAT) was calculated as the interval between submission of examination to the time report available online, and/or verbal confirmation of results, with a mean time of 19.48 h (95% confidence interval: 19.39-19.56), which is seminal under teleradiology in KSA. The outcomes reflect the use of teleradiology across different clinical locations and the criticality of care, whereas TAT was within accepted local and global standards. Previously published value-addition of teleradiology includes after-hours coverage and use during the COVID-19 pandemic. In the context of KSA, teleradiology using public-private partnership model supports equitable access to underserved areas while maintaining TAT, aligned with KSA Vision 2030 healthcare goals. The current study postulates that teleradiology connectivity may help complement on-site radiologists, optimize and enhance workflow, provide on-demand staffing solutions for ever-growing radiology examinations, while incremental use of round-the-clock subspecialists can help in second opinions, and address quality assurance, such as peer review, all aiding improved healthcare outcomes in KSA hospitals.
Immunotherapy breakthroughs have revolutionized the treatment of nasopharyngeal carcinoma (NPC). The addition of toripalimab to gemcitabine-cisplatin (GP) chemotherapy as a first-line treatment for patients with NPC resulted in a manageable safety profile and superior progression-free survival compared with GP alone. However, the treatment benefited only a subset of patients. Therefore, we evaluated response patterns in patients with NPC who were treated with programmed cell death protein 1 (PD-1) inhibitors to assess the influence of the tumor immune microenvironment on the efficacy of immunotherapies. Fifty NPC patients treated with PD-1 inhibitors at the Sun Yat-sen University Cancer Center were identified, and 50 and 28 samples were collected before and during treatment, respectively. mRNA expression levels of 289 tumor-immune-related genes were analyzed using the NanoString nCounter. Immune infiltration and correlations between clinical characteristics and the expression of immune-related genes were assessed. Tumors that responded to immunotherapy had significantly lower T helper 1 cell infiltration and higher chemokine signature scores compared with non-responding tumors. Notably, anti-PD-1 immunotherapy-responsive tumors had higher CXCR6 expression levels, suggesting that CXCR6 may be involved in the immune surveillance of NPC and in shaping the tumor microenvironment (TME). In addition, significant differences in the TME were observed between pre-treatment and treatment samples. Overall, CXCR6 expression was identified as a predictive biomarker for response to immunotherapy in NPC.
Tumor geometry can change during radiotherapy, and interfractional anatomical variations may compromise target coverage and dose conformity if not properly addressed. Magnetic resonance-guided adaptive radiotherapy (MRgART) enables ongoing visualization of tumor morphology and provides a framework for individualized treatment adaptation. This study quantitatively evaluated interfractional gross tumor volume (GTV) changes in patients treated with a ViewRay MRIdian LINAC system and investigated which similarity metric most reliably characterizes these variations. Retrospective MR images from 37 patients were analyzed and grouped by anatomical region into the pelvis, abdomen, and thorax. Baseline GTV (GTV) was compared with GTVs from five consecutive fractions (GTV₁-GTV₅). Geometric agreement was assessed using four similarity metrics: Dice similarity coefficient (DSC), Jaccard similarity coefficient (JSC), Tanimoto similarity coefficient (TSC), and Ochiai similarity coefficient (OSC). Interfractional stability was evaluated using mean similarity values and standard deviations across fractions. The abdominal region exhibited the greatest interfractional variability, with marked volume changes observed particularly in pancreatic cancer patients. Pelvic and thoracic tumors demonstrated relatively greater geometric stability, with lung tumors showing comparatively consistent agreement across fractions. Across all anatomical regions, OSC showed the highest mean similarity values and the lowest variability, indicating greater robustness than the other metrics. Statistical analysis confirmed that OSC performed significantly better than DSC, JSC, and TSC in the pelvis and abdomen (p<0.05), while showing comparable behavior to DSC in the thorax. These findings indicate that OSC is a reliable metric for monitoring interfractional tumor geometry in MR-guided adaptive radiotherapy and may support more precise and efficient adaptive treatment strategies.
Thymic epithelial tumors (TETs) are rare malignancies with diverse histologic subtypes and complex clinical behavior, necessitating a multidisciplinary approach to care. We conducted a retrospective analysis of 52 patients with TETs treated at a tertiary cancer center, including 41 with thymoma and 11 with thymic carcinoma. The median age was 50 years for thymoma and 56 years for thymic carcinoma. Paraneoplastic syndromes, particularly myasthenia gravis, were more frequent in thymoma (46.3%) than in thymic carcinoma (9.1%). Most patients presented with advanced-stage disease (stage IIIA or higher accounted for 75.7% of thymoma cases and 72.8% of thymic carcinoma cases). Neoadjuvant chemotherapy was administered to 26.8% of thymoma cases and 27.3% of thymic carcinoma cases. Surgical resection was performed in 90.2% of thymoma and 63.6% of thymic carcinoma patients, with complete resection (R0) achieved in 83.8% and 71.4%, respectively. Post-operative radiotherapy (RT) was widely utilized, delivered via volumetric-modulated arc therapy or tomotherapy. Four patients with stage IVA thymoma received hyperthermic intrathoracic chemotherapy after cytoreductive surgery. At a median follow-up of 6 years, the 5-year overall survival for thymoma and thymic carcinoma was 70.0% and 30.7%, respectively, while the 5-year progression-free survival for thymoma and thymic carcinoma was 85.1% and 26%, respectively. Relapse occurred in 17.1% of thymoma and 63.6% of thymic carcinoma patients. Despite the predominance of advanced-stage disease and large tumor burden at presentation, an aggressive, multimodal treatment approach—including high rates of R0 resection, advanced RT techniques (e.g., volumetric modulated arc therapy, tomotherapy), multiline systemic therapy, and selective hyperthermic intrathoracic chemotherapy—demonstrates potential to improve treatment outcomes. Recurrence is the strongest predictor of mortality in both thymoma and thymic carcinoma.
Recent advancements in negative deuterium and negative hydrogen ion source technology, as well as the commercial availability of high-frequency alternating-current high-voltage power supplies, have enabled the development of mini neutron generators using low-energy nuclear reactions. By operating these neutron tubes near the threshold energy of the p-7Li reaction, a useful flux of epithermal energy neutrons can be obtained. The new epithermal neutron sources can be configured for the treatment of deep-seeded tumors through boron neutron capture therapy (BNCT), for performing BNCT-brachytherapy or for the determination of 10B distribution in the tumor using the neutron transmission imaging technique. The new epithermal neutron tube is very compact and requires very low power for operation. It can easily combine BNCT with intraoperative radiotherapy or fast neutron therapy to enhance cancer treatment.
Hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome are life-threatening hyperinflammatory conditions marked by uncontrolled immune activation, excessive cytokine release, and pathologic hemophagocytosis, causing multi-organ dysfunction. Traditionally classified as primary (genetic) or secondary (acquired), HLH is now understood as a spectrum of overlapping mechanisms extending to therapy-related immune toxicities such as immune effector cell-associated HLH-like syndrome. Despite diagnostic advances, HLH remains associated with high morbidity and mortality, especially in malignancy-associated cases. Standard-of-care regimens—HLH-94 and HLH-2004 protocols using dexamethasone, etoposide, and cyclosporine—remain essential but are limited by toxicity, relapse, and poor applicability to secondary forms. Over the past decade, immunotherapy has transformed HLH management. Targeted cytokine blockade with emapalumab (anti-interferon gamma), anakinra (anti-interleukin [IL]-1), and tocilizumab (anti-IL-6) shows encouraging efficacy in refractory or secondary disease. Emerging macrophage-directed therapies, including anti-CD163 and experimental strategies targeting the signal regulatory protein alpha-CD47 axis, may further modulate hemophagocytosis. Translational studies also highlight the potential of Janus kinase inhibition, checkpoint blockade, and chimeric antigen receptor T-cell modulation for refractory disease. This structured review of literature (2000-2025) across PubMed, Embase, and ClinicalTrials.gov synthesizes preclinical and clinical evidence. Our analysis indicates that while biologics offer unprecedented opportunities for personalized treatment, challenges persist due to infection risk, trigger heterogeneity, and limited randomized data. Precision medicine integrating cytokine profiling, genomic sequencing, and artificial intelligence may enable individualized therapy. Overall, immunotherapy is reshaping HLH management, but its safe, effective integration demands international collaboration, well-designed trials, and sustained translational research.