Intensity modulated radiotherapy matches proton beam therapy for head and neck cancer: Study

Intensity-modulated radiotherapy is as good as proton beam therapy for treating people with head and neck cancer, according to the results of a Cancer Research UK-funded clinical trial.

The TORPEdO trial funded by Cancer Research UK and The Taylor Family Foundation, led by The Christie NHS Foundation Trust and sponsored by the Institute of Cancer Research, London, compared two forms of highly targeted radiotherapy for head and neck cancer – proton beam therapy (PBT) and intensity-modulated radiotherapy (IMRT).

Presented at the American Society of Radiation Oncology (ASTRO) Annual Meeting in San Francisco, California, the initial results of this multi-centre trial found that there was no need for PBT for most people with head and neck cancer. Similar levels of side-effects from the treatment were observed in both groups.

PBT directs a beam of highly charged particles called protons onto a tumour to destroy the cancerous cells. IMRT uses advanced computer programmes to create a beam of radiation that matches the shape of a patient’s tumour, which the computer then directs onto the tumour using a machine called a linear accelerator (LINAC). Both forms of radiotherapy can be customised to maximise the radiation delivered to tumours and minimise damage to nearby healthy cells.

PBT is available in the UK at The Christie NHS Foundation Trust in Manchester and University College London Hospital. It is currently used routinely to treat brain tumours and cancers affecting children and young people in England, where it successfully reduces damage to the brain, spinal cord and developing cells in children and young people.

Further clinical trials are underway to find out if proton beam therapy should be used to treat cancers where it could reduce damage to sensitive tissues near the tumour site. This includes breast cancer, liver cancer and lung cancer.

IMRT is more widely available, with the Royal College of Radiologists estimating that there are around 340 linear accelerator (LINAC) machines in England*. However, many of these machines are outdated and require upgrading to deliver cutting-edge radiotherapy like IMRT.

In the TORPEdO trial, 205 patients with head and neck cancer were randomly assigned to either PBT or IMRT at centres across the UK between 2020 and 2023.

One year after treatment, no differences were observed between the PBT and IMRT groups in terms of key side effects. Both groups reported similar outcomes in taste, chewing, swallowing, speech, saliva function and appearance post-treatment.

Clinical lead for head and neck cancer at the Christie NHS Foundation Trust and Chief Investigator of the TORPEdO trial, Professor David Thomson, said:

“What our trial shows is that high quality radiotherapy is essential to give people with head and neck cancer the best possible treatment. This trial compared two sophisticated forms of radiotherapy which deliver targeted doses of radiation.

“For most people with head and neck cancer, IMRT and proton beam therapy are equally effective treatments, giving similar results in terms of survival and quality of life afterwards. But as IMRT can be delivered with more widely available equipment, this trial provides reassurance that people with head and neck cancer can more readily access the best treatments in their local area.”

Professor of Oncology Trials at the Institute of Cancer Research, London, and TORPEdO trial co-lead, Professor Emma Hall, said:

“The TORPEdO trial has demonstrated the importance of conducting randomised clinical studies to inform how we guide treatment decisions and deliver cancer care. For most people with head and neck cancer, proton beam therapy did not reduce side effects compared to IMRT.

“These findings reinforce the importance of ensuring that high-quality IMRT is accessible to patients across the UK, which will require further investment in modern linear accelerator machines.”

Tex Leece, a 52-year-old married father of two from Rivington in Bolton, received curative treatment on the TORPEdO clinical trial at The Christie NHS Foundation Trust in Manchester for oropharynx (throat) cancer and is cancer free more than three years later.

Tex, a Warburton’s delivery driver, who walked his daughter Holly down the aisle just six weeks after finishing cancer treatment and getting the all-clear in May 2022, was randomised to the standard radiotherapy arm of the trial.

The nine times triathlete, who now enjoys cycling and DIY, having just built a log cabin in his garden, said:

“I’m really well, and still super active thanks to the treatment I received. I’m not surprised by the results of the trial as I’d done so well with the standard radiotherapy I was given.

“I was very happy to be part of the TORPEdO trial and saw it as a bit of an adventure as you know you’re contributing to science and helping future patients in the process. It’s a way of giving back. I’d say to anyone thinking of taking part in a trial to stay as positive as you can, although it’s not going to be easy, having a good mental attitude really helps.”

Director of Research at Cancer Research UK, Dr Catherine Elliott, said:

“The results of the TORPEdO trial show how important it is for people with cancer to have access to the best quality radiotherapy. Modern radiotherapy is now far more advanced, far more targeted and far more effective than ever before.

“The UK Government’s recent commitment to fund new LINAC machines to replace outdated ones is welcome, but it is a one-off commitment. Between now and 2040, we expect 6 million new cancer cases to be diagnosed across England, and we will need to ensure that health services are prepared for the increased capacity this will require.

“If we are to continue to deliver the best outcomes for people with cancer, the UK Government needs to tackle staff shortages in radiology and there needs to be sustained investment in equipment. The upcoming National Cancer Plan for England is the perfect opportunity to unlock better access to a wider range of cutting-edge treatments, which ensure that more people will live longer, better lives, free from the fear of cancer.”

The TORPEdO trial tested the two radiotherapy regimes in combination with cisplatin chemotherapy. Whether proton beam therapy selectively improves patient outcomes in other tumour types or when combined with immunotherapy or molecular targeted therapies, is the subject of ongoing and future clinical trials.

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IBS Patients Face Higher Risk of Developing IBD, suggests study

Researchers have discovered in a new study that irritable bowel syndrome (IBS) patients have a much greater long-term risk of acquiring inflammatory bowel disease (IBD) than the general population. The study concluded that IBS patients, particularly those with the diarrhea-predominant subtype (IBS-D), had a higher risk of developing ulcerative colitis (UC) or Crohn’s disease (CD) in the long run. The study was published in the Journal of Gastroenterology by Huixin S. and colleagues.

IBS and IBD are two prevalent but different gastrointestinal disorders. IBS is defined as a functional disorder in which there is abdominal pain, bloating, diarrhea, or constipation, whereas IBD, encompassing UC and CD, is a chronic inflammatory bowel disease of the gastrointestinal tract with ongoing complications. This UK Biobank large-scale study gives the strongest evidence to date that IBS patients are at a significantly increased risk of developing IBD.

The study team examined 447,631 baseline participants without IBD (2006–2010) for longitudinal cohort analysis and 76,992 participants who filled out the Digestive Health Questionnaire (2017–2018) for cross-sectional analysis. The main outcome in the cohort study was incident new cases of IBD, with Cox proportional hazards models calculating hazard ratios (HRs). In the cross-sectional design, prevalent IBD was taken as the outcome, and logistic regression calculated odds ratios (ORs).

Results

  • During a median follow-up of 14.2 years, the cohort study ascertained 2,916 new cases of IBD, including 2,097 ulcerative colitis (UC) and 1,015 Crohn’s disease (CD) cases.

In comparison with non-IBS participants, IBS patients exhibited:

  • 68% increased risk of IBD (HR = 1.68, 95% CI: 1.47–1.92).

  • 60% increased risk of UC (HR = 1.60, 95% CI: 1.36–1.89).

  • 104% increased risk of CD (HR = 2.04, 95% CI: 1.66–2.51).

  • Notably, the risk continued to persist in the long term, with IBS patients continuing to have a 55% increased risk of IBD at 10 years (HR = 1.55, 95% CI: 1.27–1.89).

In cross-sectional analysis, IBS patients had markedly increased odds of IBD:

  • 2.40-fold increased odds of overall IBD (OR = 2.40, 95% CI: 2.14–2.70).

  • 2.18-fold increased odds of UC (OR = 2.18, 95% CI: 1.92–2.48).

  • 3.15-fold increased odds of CD (OR = 3.15, 95% CI: 2.68–3.70).

  • Among the IBS subtypes, the IBS-D group had the highest odds with a 3.72 times higher risk of IBD (OR = 3.72, 95% CI: 3.24–4.28).

This large population study in UK Biobank produces strong evidence that IBS patients, particularly IBS-D, have a significantly higher risk of developing IBD, including UC and CD, compared to the general population. This elevated risk is maintained for more than a decade, supporting the requirement for long-term watchfulness among IBS patients. These findings suggest that IBS might not only be thought of as a functional disorder but also as an occult risk factor for the future development of inflammatory bowel diseases.

Reference:

Song, H., Zhou, Y., Liu, S. et al. Long-term risk of inflammatory bowel disease in patients with irritable bowel syndrome: the cross-sectional and longitudinal relationship. J Gastroenterol (2025). https://doi.org/10.1007/s00535-025-02304-1

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High Stress-Induced Blood Sugar Linked to Increased ARDS and Mortality in Sepsis Patients: Study

China: Researchers have found that a higher stress hyperglycemia ratio (SHR) is strongly associated with an increased risk of acute respiratory distress syndrome (ARDS) and in-hospital mortality among patients with sepsis.

The study, published in Scientific Reports, analyzed data from 1,946 sepsis patients and highlighted that individuals in the highest SHR quartile faced a 42% higher risk of developing ARDS and a 40% greater risk of dying during hospitalization compared with those in the lowest quartile.
The study, led by Xianwei Jin and colleagues from the Department of Medicine, Graduate School, Nanchang University, China, aimed to investigate the relationship between SHR—a measure comparing acute blood glucose elevation to baseline glycemic status—and ARDS risk in sepsis patients. Data were sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, a comprehensive repository of intensive care unit patient records in the United States.
Patients were stratified into four groups based on SHR quartiles. The primary outcome assessed was the occurrence of in-hospital ARDS. Researchers employed multivariate Cox proportional-hazards regression and restricted cubic spline models to examine the correlation between SHR and ARDS risk. Subgroup analyses and Kaplan-Meier survival curves further supported the findings.
The study led to the following notable findings:
  • 34% of participants developed acute respiratory distress syndrome (ARDS).
  • 13% of participants died during hospitalization.
  • The stress hyperglycemia ratio (SHR) was independently associated with both ARDS and in-hospital mortality after adjusting for confounders.
  • Risk of ARDS and mortality increased approximately linearly with rising SHR levels, especially for mild and moderate ARDS.
  • Subgroup analyses showed that the association between SHR and adverse outcomes was consistent across different patient populations.
According to the researchers, these findings suggest that SHR can serve as a valuable early indicator for identifying patients with sepsis at high risk of ARDS, potentially enabling timely interventions and improved clinical management. The study emphasizes the clinical relevance of monitoring stress-induced hyperglycemia as part of comprehensive sepsis care.
The study had some limitations: it included only U.S. patients, mostly White, limiting generalizability; its retrospective, observational design precludes causal conclusions; and as a single-center study with a modest sample size, residual confounding may still affect the results.
The authors recommend that prospective, multicenter studies be conducted to validate these results and further explore the mechanistic links between SHR and ARDS.
“Elevated SHR is significantly linked to higher in-hospital mortality and ARDS risk in patients with sepsis. Monitoring SHR could help clinicians identify high-risk individuals early, enabling better risk stratification and guiding timely interventions. Future prospective studies are necessary to confirm these findings and inform clinical strategies for managing stress hyperglycemia in sepsis patients,” the authors concluded.
Reference:
Jin, X., Deng, W., Weng, Q., Liu, F., & Min, J. (2025). Correlation between stress hyperglycemia ratio and risk of acute respiratory distress syndrome in patients with sepsis: A MIMIC-IV cohort study. Scientific Reports, 15(1), 1-13. https://doi.org/10.1038/s41598-025-18349-4

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Anticoagulant Monotherapy alone, best for Stroke Prevention in AF with Atherosclerosis: JAMA

Researchers have found in a new study that in patients with nonvalvular atrial fibrillation (AF) and atherosclerosis, the addition of antiplatelet therapy to anticoagulants did not reduce ischemic events but significantly increased bleeding risk. Researchers conclude that anticoagulant monotherapy may be a safer option for this high-risk population. The study was published in JAMA Neurology by Shuhei O. and colleagues.

This multicenter, open-label, randomized clinical trial was conducted across 41 sites in Japan between November 2016 and March 2025, including adults with ischemic stroke or transient ischemic attack (TIA) within 8 to 360 days of onset, confirmed nonvalvular atrial fibrillation, and at least one manifestation of atherosclerotic cardiovascular disease (ASCVD) (such as carotid or intracranial artery stenosis, ischemic heart disease, peripheral artery disease, or noncardioembolic stroke). The trial was arranged to check if an antiplatelet drug added to anticoagulant therapy would enhance clinical outcomes over anticoagulant monotherapy.

316 patients were randomized and enrolled into two groups: 159 in combination therapy (anticoagulant + antiplatelet) and 157 in anticoagulant monotherapy. The mean (SD) age was 77.2 (7.4) years, and 28.5% (n = 90) were women. The data were analyzed between April and October 2024.

The main outcome was a composite of ischemic cardiovascular events and major bleeding during two years. Secondary endpoints were ischemic cardiovascular events, and safety endpoints were major and clinically relevant nonmajor bleeding. The study was prematurely stopped on July 18, 2023, after an interim analysis revealed that there was no additional benefit expected from further enrollment.

Key Findings

The outcomes showed no significant ischemic difference between the two treatment arms but a significantly higher risk of bleeding in the combination arm:

  • The main outcome occurred in 17.8% of combination therapy group patients and 19.6% of monotherapy group patients (HR, 0.91; 95% CI, 0.53–1.55; P = .64), with no significant advantage to the addition of an antiplatelet.

  • Ischemic cardiovascular events occurred in 11.1% of the patients who were on combination therapy and 14.2% of the patients on monotherapy (HR, 0.76; 95% CI, 0.39–1.48; P = .41), once more indicating no notable decrease in ischemic risk.

  • Yet, for major and clinically significant nonmajor bleeding, 19.5% of the combination therapy group experienced events in comparison to 8.6% of the monotherapy group (HR, 2.42; 95% CI, 1.23–4.76; P = .008), a greater than twofold increase in risk.

These results affirm that although theoretical benefits for dual therapy may exist in reducing thrombotic events, these do not translate to a benefit in total outcomes and significantly increase the risk of harm from bleeding.

In this randomized clinical trial of patients with ischemic stroke or TIA and concurrent nonvalvular atrial fibrillation and atherosclerotic cardiovascular disease, the addition of an antiplatelet agent to anticoagulant therapy did not enhance clinical outcomes but rather enhanced bleeding risk. This research supports maintaining the reduction of unnecessary dual therapy to weigh efficacy with safety for the patient.

Reference:

Okazaki S, Tanaka K, Yazawa Y, et al. Optimal Antithrombotics for Ischemic Stroke and Concurrent Atrial Fibrillation and Atherosclerosis: A Randomized Clinical Trial. JAMA Neurol. Published online October 06, 2025. doi:10.1001/jamaneurol.2025.3662

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Inside Coldrif Scandal: Tamil Nadu Plant Used Paint-Grade Chemicals, Violated 300+ Drug Norms

Chennai: Officials from the Tamil Nadu Drugs Control Department uncovered horrific conditions at the Sresan Pharmaceuticals unit in Kancheepuram, where the now-banned Coldrif cough syrup was manufactured. The raid exposed open vats of boiling chemicals, leaking rusted pipes, and workers handling toxic substances without masks or gloves, a scene investigators described as a “factory of death.”

Acoording to a recent media report in the MoneyControl, batch SR-13 of Coldrif Syrup, linked to multiple child deaths in Madhya Pradesh’s Chhindwara district, was produced in May 2025 and carried an expiry date of April 2027. For months, the syrup had been in circulation before being flagged for contamination. During the inspection conducted on October 1 and 2, authorities found that the company was using industrial-grade chemicals meant for paints and adhesives instead of pharmaceutical-grade raw materials. Purchases were made from two Chennai-based dealers — Sunrise Biotech and Pandia Chemicals — through cash and Google Pay to avoid leaving financial trails.

Also Read: Factory manufacturing banned oxytocin injections busted in Lucknow, 4 arrested

The probe revealed that the propylene glycol used in the syrup contained diethylene glycol (DEG), a highly toxic compound commonly found in brake fluid and lubricants. Laboratory analysis later confirmed that 48.6% of the offending batch consisted of DEG — nearly 500 times the permissible limit. Post-mortem samples from affected children confirmed kidney failure caused by DEG poisoning.

Inspectors catalogued 39 critical and 325 major violations of the Drugs and Cosmetics Act, 1940, at the Kancheepuram facility. The lapses included the absence of qualified chemists, unhygienic conditions, use of untreated water, missing quality control records, open drains, and lack of pest control. Investigators said the facility lacked any semblance of Good Manufacturing Practices (GMP), with safety protocols ignored and documentation falsified.

Batch SR-13 of Coldrif was distributed in Tamil Nadu, Odisha, Puducherry, and Madhya Pradesh. The children who consumed it developed fever and cough before suffering acute kidney failure. Reports indicate that at least 15 children have died so far. Following the findings, Tamil Nadu’s Drugs Control Department suspended Sresan Pharmaceuticals’ license and issued a show-cause notice. Meanwhile, in Madhya Pradesh, several drug inspectors and a deputy director were suspended, the state’s Drug Controller was transferred, and a local doctor was arrested for alleged negligence, reports Moneycontrol.

The revelations have sparked nationwide outrage and renewed scrutiny of India’s pharmaceutical manufacturing practices, exposing severe lapses in raw material procurement, quality assurance, and post-market surveillance.

Also Read: Coldrif Cough Syrup banned in Punjab amid child deaths

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Dupilumab use in Atopic Dermatitis may Reduce Risk of Otitis Media and Surgical Interventions: Study

According to a new study, Patients with atopic dermatitis (AD) treated with dupilumab have a lower risk of developing otitis media and needing related surgical procedures compared to those treated with pimecrolimus. The study was published in Pediatric Dermatology journal by Matthew H. and colleagues. The findings highlight dupilumab’s added benefit beyond skin disease management, underscoring its potential to reduce ear-related complications in AD.

This study was a retrospective cohort study that was carried out through the use of the TriNetX research network, a population-based large database. Outcomes between AD patients that received dupilumab and pimecrolimus were compared in the analysis. For comparability, propensity score matching for age at index, current age, sex, race, other atopic diseases, and tobacco smoke exposure was used.

The main outcomes measured were the 5-year risks of all otitis media, nonsuppurative OM, suppurative OM, and future surgical procedures. Cox proportional hazards regression models with 95% confidence intervals (CIs) evaluated relative differences in risk between the two treatment arms. An age-stratified analysis was also conducted to examine specifically children’s risks.

Results

The analysis revealed a reduced risk for dupilumab-treated patients compared to pimecrolimus:

  • All OM: Hazard ratio (HR) 0.60; 95% CI, 0.54–0.67; p < 0.001

  • Nonsuppurative OM: HR 0.60; 95% CI, 0.52–0.70; p < 0.001

  • Suppurative OM: HR 0.61; 95% CI, 0.55–0.69; p < 0.001

  • OM-related surgical procedures: HR 0.73; 95% CI, 0.58–0.90; p = 0.004

  • Notably, comparable reductions in risk were also seen in individuals younger than 18 years, indicating dupilumab has protective effects against complications of OM in all age groups.

This population-based study on a large cohort showed that dupilumab decreases the risk of 5-year otitis media and accompanying surgeries in patients with atopic dermatitis by more than pimecrolimus, with benefits seen consistently in both children and adults. The findings propose that dupilumab can provide additional protection against frequent ENT complications in AD, further endorsing its status as a first-line treatment option.

Reference:

Lanehart, M. H., Hayes, B., Zinn, Z., & Skoner, D. P. (2025). Dupilumab treatment for atopic dermatitis is associated with decreased risk of otitis media and related surgical procedures: A retrospective cohort study. Pediatric Dermatology. https://doi.org/10.1111/pde.16008

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Genetically engineered pig livers can support key hepatic functions in humans, xenotransplant study shows

A new study in the Journal of Hepatology reports on an auxiliary liver xenotransplant from a genetically engineered pig to a living human recipient.

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Tens of thousands of children aged under five suffering acute malnutrition in Gaza, recent estimates suggest

More than 54,600 children in Gaza are estimated to be acutely malnourished, including over 12,800 severely so, with few therapeutic options available to them. With measurements up to the middle of August 2025, the study comprehensively tracks wasting among children during the war, estimates population prevalence, and highlights unprecedented increases in child malnutrition following periods of blockades and severe aid restrictions.

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Prostate testing may not target those most likely to benefit, warn experts

Current prostate specific antigen (PSA) testing “may not effectively target testing to those most likely to benefit, raising concerns about overtesting” warn researchers from the University of Oxford in a study of over 10 million men across England published by The BMJ .

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Physicians investigate Reddit to better understand self-management of inflammatory bowel disease

Reddit’s popularity as a tool for self-managing inflammatory bowel disease highlights opportunities for improvements in clinical care, according to a paper published in Journal of Medical Internet Research.

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