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Quick AM, McLaughlin E, Krok Schoen JL, Felix AS, Presley CJ, Cespedes Feliciano EM, Shadyab AH, Jung SY, Luo J, King JJ, Rapp SR, Werts S, Chlebowski RT, Naughton M, Paskett E. Changes in physical function in older women with endometrial cancer with or without adjuvant therapy. J Cancer Surviv 2023:10.1007/s11764-023-01460-8. [PMID: 37668940 DOI: 10.1007/s11764-023-01460-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To evaluate changes in physical function (PF) for older women with endometrial cancer (EC) + / - adjuvant therapy in the Women's Health Initiative Life and Longevity after Cancer cohort. MATERIALS AND METHODS This study examined women ≥ 70 years of age with EC with available treatment records. Change in PF was measured using the RAND-36 and compared between groups using Wilcoxon rank-sum tests. Multivariable median regression was used to compare the changes in scores while adjusting for confounding variables. RESULTS Included in the study were 287 women, 150 (52.3%) women who did not receive adjuvant therapy and 137 (47.7%) who received adjuvant therapy. When comparing PF scores, there was a statistically significant difference in the median percent change in functional decline, with a greater decline in those who received adjuvant therapy (- 5.9% [- 23.5 to 0%]) compared to those who did not (0 [- 18.8 to + 6.7%]), p = 0.02). Results were not statistically significant after multivariable adjustment, but women who underwent chemotherapy had a greater percent change (median ∆ - 13.8% [- 35.5 to 0%]) compared to those who received radiation alone (median ∆ - 5.9% [- 31.3 to 0%]) or chemotherapy and radiation (median ∆ - 6.5% [- 25.8 to + 5.7%]. CONCLUSIONS Older women with EC who received adjuvant therapy experienced greater change in PF than those who did not receive adjuvant therapy, particularly women who received chemotherapy. These results were not statistically significant on multivariate analysis. IMPLICATIONS FOR CANCER SURVIVORS EC survivors may experience changes in PF because of chemotherapy and/or radiation therapy. Additional supportive care may need to be provided to older women to mitigate functional decline.
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Affiliation(s)
- Allison M Quick
- Department of Radiation Oncology, The Ohio State University Medical Center, Columbus, OH, USA.
| | - Eric McLaughlin
- Center for Biostatistics, The Ohio State University, The Ohio State University, Columbus, OH, USA
| | - Jessica L Krok Schoen
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ashley S Felix
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Su Yon Jung
- Translational Sciences Section, School of Nursing, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Jennifer J King
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Stephen R Rapp
- Department of Psychiatry & Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Samantha Werts
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Michelle Naughton
- Comprehensive Cancer Center, Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Electra Paskett
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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152
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Yang C, Liang Y, Liu N, Sun M. Role of the cGAS-STING pathway in radiotherapy for non-small cell lung cancer. Radiat Oncol 2023; 18:145. [PMID: 37667279 PMCID: PMC10478265 DOI: 10.1186/s13014-023-02335-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 08/22/2023] [Indexed: 09/06/2023] Open
Abstract
One of the most important therapeutic interventions for non-small cell lung cancer is radiotherapy. Ionizing radiation (IR) is classified by traditional radiobiology principles as a direct cytocidal therapeutic agent against cancer, although there is growing recognition of other antitumor immunological responses induced by this modality. The most effective therapeutic combinations to harness radiation-generated antitumor immunity and enhance treatment results for malignancies resistant to existing radiotherapy regimens could be determined by a more sophisticated understanding of the immunological pathways created by radiation. Innate immune signaling is triggered by the activation of cGAS-STING, and this promotes adaptive immune responses to help fight cancer. This identifies a molecular mechanism radiation can use to trigger antitumor immune responses by bridging the DNA-damaging ability of IR with the activation of CD8 + cytotoxic T cell-mediated killing of tumors. We also discuss radiotherapy-related parameters that affect cGAS-STING signaling, negative consequences of cGAS-STING activation, and intriguing treatment options being tested in conjunction with IR to support immune activation by activating STING-signaling. Improved therapeutic outcomes will result from a better understanding of how IR promotes cGAS-STING signaling in immune-based treatment regimens that maximize radiotherapy's anticancer effectiveness.
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Affiliation(s)
- Chunsheng Yang
- Department of Oncology, Central Hospital Affiliated to Shandong First Medical University, Jinan City, China
| | - Yan Liang
- Department of Radiation, The Second Affiliated Hospital of Xingtai Medical College, Xing Tai Shi, China
| | - Ning Liu
- Department of Oncology, Central Hospital Affiliated to Shandong First Medical University, Jinan City, China
| | - Meili Sun
- Department of Oncology, Central Hospital Affiliated to Shandong First Medical University, Jinan City, China.
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153
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Lee SS, Weil CR, Boyd LR, DeCesaris C, Gaffney D, Suneja G. Trends in use of radiation therapy, chemotherapy, and combination chemoradiotherapy in advanced uterine cancer before, during, and after GOG 258. Int J Gynecol Cancer 2023; 33:1408-1418. [PMID: 37487661 DOI: 10.1136/ijgc-2023-004617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE To explore the use of Gynecologic Oncology Group 258 (GOG 258) study regimens before, during, and after the study. METHODS Patients aged 18 years or older with endometrial cancer between 2004-2019 were identified in the National Cancer Database. Inclusion criteria were stage III or IVA of any histology and stage I-IVA clear cell or serous histologies with positive washings that received adjuvant therapy. Adjuvant therapy use was examined in the pre-GOG 258 era (before 2009), during GOG 258 enrollment and maturation (2010-2017), and after results presentation in 2017 (2018-2019). Two-sided Cochran-Armitage tests, Wilcoxen rank sum tests, and χ2 tests were used for continuous and categorical variables. Multi-variable logistic regression assessed factors associated with the receipt of chemoradiotherapy compared with chemotherapy only or radiation therapy only. RESULTS From 2004 to 2019, 41 408 high-risk endometrial cancer patients received adjuvant therapy (12% radiation therapy, 38% chemotherapy, 50% chemoradiotherapy). Chemoradiotherapy increased over the GOG 258 study period (40% before study opening, 54% during enrollment, and 59% after results). Serous (OR 0.6, 95% CI 0.6 to 0.7) and clear cell histology (0.7, 0.6 to 0.8), higher grade (0.8, 0.7 to 0.9), and lymph node positivity (0.8, 0.7 to 0.9) were negatively associated with receipt of chemoradiotherapy compared with single-modality treatment. Non-Hispanic Black ethnicity (0.8, 0.8 to 0.9) and residing ≥50 miles from the treatment facility (0.8, 0.7 to 0.9) were also negatively associated with chemoradiotherapy. Private insurance (1.2, 1.0 to 1.4) and treatment at community hospitals (1.2, 1.2 to 1.3) were positively associated with chemoradiotherapy. CONCLUSION Despite the lack of benefit in the GOG 258 experimental arm, chemoradiotherapy use increased during study enrollment and after results publication.
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Affiliation(s)
- Sarah S Lee
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York University Langone Health, New York, New York, USA
| | - Christopher R Weil
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Leslie R Boyd
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York University Langone Health, New York, New York, USA
| | - Cristina DeCesaris
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David Gaffney
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
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154
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Toyota K, Hashimoto Y, Sakashita Y, Yokoyama Y, Murakami Y, Takahashi S, Miyamoto K. Pathological Complete Response to Nivolumab, S1, Oxaliplatin, and Radiation in a Patient with Gastric Cancer: a Case Report. J Gastrointest Cancer 2023; 54:1000-1002. [PMID: 36469236 DOI: 10.1007/s12029-022-00895-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Kazuhiro Toyota
- Department of Surgery, Hiroshima Memorial Hospital, 1-4-3, Honkawa-Cho, Naka-Ku, Hiroshima, Hiroshima, 730-0802, Japan.
| | - Yasushi Hashimoto
- Department of Surgery, Hiroshima Memorial Hospital, 1-4-3, Honkawa-Cho, Naka-Ku, Hiroshima, Hiroshima, 730-0802, Japan
| | - Yoshihiro Sakashita
- Department of Surgery, Hiroshima Memorial Hospital, 1-4-3, Honkawa-Cho, Naka-Ku, Hiroshima, Hiroshima, 730-0802, Japan
| | - Yujiro Yokoyama
- Department of Surgery, Hiroshima Memorial Hospital, 1-4-3, Honkawa-Cho, Naka-Ku, Hiroshima, Hiroshima, 730-0802, Japan
| | - Yoshiaki Murakami
- Department of Surgery, Hiroshima Memorial Hospital, 1-4-3, Honkawa-Cho, Naka-Ku, Hiroshima, Hiroshima, 730-0802, Japan
| | - Shinya Takahashi
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Katsunari Miyamoto
- Department of Surgery, Hiroshima Memorial Hospital, 1-4-3, Honkawa-Cho, Naka-Ku, Hiroshima, Hiroshima, 730-0802, Japan
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155
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Wang KY, Lee CS, Vempati P, Sharma R, Kohn N, Seetharamu N. Characteristics of Patients With Second Primary Lung Cancer Following Breast Cancer: A Retrospective Descriptive Study. Clin Lung Cancer 2023; 24:e198-e204. [PMID: 37268494 DOI: 10.1016/j.cllc.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/08/2023] [Accepted: 04/13/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Breast cancer (BC) is the most common noncutaneous malignancy in women and survivors are at an increased risk for secondary malignancy with lung cancer (LC) being the most common. There are few studies that have explored the clinicopathological specifics of LC in BC survivors. METHODS In this single-institution, retrospective study, we identified BC survivors who subsequently developed LC, examined their breast and LC clinical and pathological characteristics and compared them to the general BC and LC population as published in the literature. RESULTS In our study, we found the following associations that could be meaningful: an association between receiving radiation (RT) and LC (including a statistically significant P = .03 chance of ipsilateral LC after BC treatment with RT), a higher incidence and amount of smoking and LC, high BRCA positivity (78.9%) in the few patients who had germline testing, and a higher incidence of EGFR mutations in NSCLC after BC (60.9%) as well as an earlier stage of NSCLC disease. CONCLUSION Treatments such as RT, genetic factors such as BRCA mutations, and tobacco use may increase the risk of developing LC amongst BC survivors. Exploring this further can potentially lead to better risk stratification through modified low-dose CT chest screening protocols to catch LCs earlier and ultimately improve outcomes. Past studies have shown that BC survivors who are subsequently diagnosed with NSCLC may have improved OS compared with primary NSCLC and our study showed a high incidence of EGFR mutated NSCLC, which also suggest both improved prognosis and a different molecular profile of NSCLC, which warrants further investigation. Lastly, BC survivors who subsequently are diagnosed with NSCLC had earlier stage disease in our study, perhaps a result of surveillance, highlighting the importance of close monitoring of BC survivors.
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Affiliation(s)
- Kevin Yu Wang
- Northwell Health/Zucker School of Medicine, Hofstra/Northwell, Manhasset, NY.
| | - Chung-Shien Lee
- Northwell Health/Zucker School of Medicine, Hofstra/Northwell, Manhasset, NY
| | - Prashant Vempati
- Northwell Health/Zucker School of Medicine, Hofstra/Northwell, Manhasset, NY
| | - Rajiv Sharma
- Northwell Health/Zucker School of Medicine, Hofstra/Northwell, Manhasset, NY
| | - Nina Kohn
- Northwell Health/Zucker School of Medicine, Hofstra/Northwell, Manhasset, NY
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156
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Zhang M, Lan H, Peng S, Zhou W, Wang X, Jiang M, Hong J, Zhang Q. MiR-223-3p attenuates radiation-induced inflammatory response and inhibits the activation of NLRP3 inflammasome in macrophages. Int Immunopharmacol 2023; 122:110616. [PMID: 37459784 DOI: 10.1016/j.intimp.2023.110616] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 08/25/2023]
Abstract
Macrophage pyroptosis plays an important role in the development of radiation-induced cell and tissue damage, leading to acute lung injury. However, the underlying mechanisms of NOD-like receptor thermal protein domain-associated protein 3 (NLRP3)-mediated macrophage pyroptosis and the regulatory factors involved in radiation-induced pyroptosis are unclear. In this study, the expression of the NLRP3 inflammasome and pyroptosis-associated factors in murine macrophage cell lines was investigated after ionizing radiation. High-throughput RNA sequencing was performed to identify and characterize miRNAs and mRNA transcripts associated with NLRP3-mediated cell death. Our results demonstrated that cleaved-caspase-1 (p10) and N-terminal domain of gasdermin-D (GSDMD-N) were upregulated, and the number of NLRP3 inflammasomes and pyroptotic cells increased in murine macrophage cell lines after irradiation (8 Gy). Comparativeprofiling of 300miRNAs revealed that 41 miRNAsexhibited significantly different expression after 8 Gy of irradiation. Granulocyte-specific microRNA-223-3p (miR-223-3p) is a negative regulator of NLRP3. In vitro experiments revealed that the expression of miR-223-3p was significantly altered by irradiation. Moreover, miR-223-3p decreased the expression of NLRP3 and proinflammatory factors, resulting in reduced pyroptosis in irradiated murine macrophages. Subsequently, in vivo experiments revealed the efficacy of miR-223-3p supplementation in ameliorating alveolar macrophage (AM) pyroptosis, attenuating the infiltration of inflammatory monocytes, and significantly alleviating the severity of acute radiation-induced lung injury (ARILI). Our findings suggest that the miR-223-3p/NLRP3/caspase-1 axis is involved in radiation-induced AM pyroptosis and ARILI.
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Affiliation(s)
- Mingwei Zhang
- Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China; Department of Radiotherapy, Cancer Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Hailin Lan
- Department of Radiotherapy, Cancer Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Shaoli Peng
- Department of Radiotherapy, Cancer Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Weitong Zhou
- Department of Radiotherapy, Cancer Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xuezhen Wang
- Department of Radiotherapy, Cancer Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Meina Jiang
- Department of Radiotherapy, Cancer Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jinsheng Hong
- Department of Radiotherapy, Cancer Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
| | - Qiuyu Zhang
- Institute of Immunotherapy, Fujian Medical University, Fuzhou, China.
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157
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Takehara Y, Matsuda N, Kobayashi D, Yoshida A, Takei J, Kanomata N, Tsunoda H, Yamauchi H, Hayashi N. Radiation-induced angiosarcoma of the breast: individual participant meta-analysis of Japanese population. Breast Cancer 2023; 30:739-747. [PMID: 37261705 DOI: 10.1007/s12282-023-01466-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/29/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Radiation-induced angiosarcoma (RIAS) of the breast is a very rare and poor prognostic disease. According to previous studies, the efficacy of chemotherapy for RIAS is still controversial. However, no study has assessed the prognosis of RIAS and the prognostic impact of preoperative or postoperative chemotherapy in Japanese patients. Our study aimed to assess them in Japanese people using publication data with our three patients. METHODS Thirty-nine patients diagnosed with RIAS, including 36 patients from 34 published case series, and three patients from our hospital were used for analysis. Disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) were assessed. RESULTS Among the 39 patients, 36 patients (92.3%) underwent surgery. The median DFS and OS periods were 14 months (range 1-75 months) and 23 months (range 4-84 months), respectively. Chemotherapy with taxane-based regimen was administered in 13 cases (33.2%) pre- or post-operatively. DFS was significantly improved with chemotherapy in addition to surgery (p = 0.037). However, addition of chemotherapy to surgery did not improve DDFS (p = 0.09) and OS (p = 0.878). In multivariate analysis, age ≥ 70 years was an independent but poor prognostic factor of DFS. Additionally, a lack of chemotherapy showed a trend to be associated with worse DFS. There was no independent variable contributing to DDFS and OS. CONCLUSIONS Chemotherapy may have reduced the recurrence rate of RIAS in Japanese patients but did not improve OS. Further data are needed to confirm the efficacy and proper regimen of chemotherapy.
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Affiliation(s)
- Yuri Takehara
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Naoko Matsuda
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Daiki Kobayashi
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Atsushi Yoshida
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Junko Takei
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Naoki Kanomata
- Department of Pathology, St. Luke's International Hospital, Tokyo, Japan
| | - Hiroko Tsunoda
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Hideko Yamauchi
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Naoki Hayashi
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan.
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158
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Elashwah A, Alsuhaibani A, Abduljabbar A, Alsanea N, Alhomoud S, Ashari L, Bazarbashi S, Aljubran A, Alzahrani A, Awad A, Almanea H, Alhussini H, Alshabanah M. Retrospective Evaluation of the Impact of Dose Escalation Using Pre-operative Simultaneous Integrated Boost Volumetric Modulated Arc Therapy on the Outcome of Locally Advanced Rectal Cancer Patients. J Gastrointest Cancer 2023; 54:927-936. [PMID: 36525233 DOI: 10.1007/s12029-022-00882-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Evaluating the outcome of pre-operative simultaneous integrated boost volumetric modulated arc therapy (SIB-VMAT) concomitant with capecitabine in patients diagnosed with locally advanced rectal cancer (LARC) at King Faisal Specialist Hospital and Research Centre (KFSH&RC), Riyadh, Saudi Arabia, during the period January 2013-December 2019. RESULTS A total of 134 patients were enrolled. The median age at diagnosis was 59 years. All patients received pre-operative concurrent chemo-radiation therapy (CCRT) using SIB-VMAT with oral capecitabine. Neoadjuvant chemotherapy was administered prior to CCRT in 32 patients (23.9%). The dose of radiation was 55 Gy in 94 patients (70.1%), while 40 patients (29.9%) received 50 Gy. All patients completed the CCRT treatment without breaks. No records of acute and late grade III and IV toxicities. Curative surgery was performed in all patients with a median interval of 11 (6-52) weeks between the end of CCRT and the date of surgery. No reported 30-day postoperative mortality and no grade III and IV Clavien-Dindo complications. PCR was reported in 26 patients (19.4%), while pathologically negative nodes (pN0) were achieved in 103 patients (76.9%). Adjuvant chemotherapy was utilized in 57 patients (42.5%). The 5-year local recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) were 93.2%, 67.1%, and 87.3%, respectively. Only tumor regression grade (TRG) was significantly correlated with LRFS, (p value 0.043). On multivariate analysis, only TRG and achievement of pN0 were significantly correlated with DFS (p value < 0.001). CONCLUSION Dose escalation utilization (SIB-VMAT) in the pre-operative treatment of LARC is well tolerated and provides effective local control.
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Affiliation(s)
- Ahmed Elashwah
- Section of Radiation Oncology, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
- Kasr Al-Eini Center of Clinical Oncology (NEMROCK), Cairo University, Cairo, Egypt.
| | | | - Alaa Abduljabbar
- Section of Colon and Rectal Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Nasser Alsanea
- Section of Colon and Rectal Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Samar Alhomoud
- Section of Colon and Rectal Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Luai Ashari
- Section of Colon and Rectal Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ali Aljubran
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ahmed Alzahrani
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ahmed Awad
- Section of Radiation Oncology, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
- Radiation Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - Hadeel Almanea
- Pathology and Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Hussah Alhussini
- Pathology and Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Alshabanah
- Section of Radiation Oncology, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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159
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Chen Y, Wu M. Exploration of molecular mechanism underlying protective effect of astragaloside IV against radiation-induced lung injury by suppressing ferroptosis. Arch Biochem Biophys 2023; 745:109717. [PMID: 37573925 DOI: 10.1016/j.abb.2023.109717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
In this study, we aimed to investigate the pharmacological effects and underlying mechanisms of astragaloside IV (AS IV) against radiation-induced lung injury. We established experimental models of radiation-induced lung injury and observed the effect of AS IV on cell viability, cell death, inflammatory responses and ferroptosis. Accordingly, we found that AS IV restored the suppressed cell viability and promoted cell death induced by X-ray irradiation. Moreover, radiation-induced up-regulation of lactate dehydrogenase (LDH) release, ferroptosis, reactive oxygen species (ROS) and inflammatory responses were also restored by AS IV in a dose-dependent manner. Besides, in radiation-induced lung injury C57BL/6 mice, AS IV evidently alleviated lung injury and promoted the survival rate of lung-injured mice. And the ferroptosis level in mice lung tissues were also alleviated by the administration of AS IV in a dose-dependent manner. As a conclusion, by comparing the changes of ferroptosis, ROS and inflammatory responses in the experimental models, we validated that AS IV could inhibit inflammatory responses and cell injury in the treatment of radiation-induced lung injury by suppressing ferroptosis. This finding not only find potentially effective treatments to mitigate radiation-induced lung injury, but also provides supporting evidence for clinical application of AS IV to improve the management of radiation-treated patients and minimize the associated lung complications or other adverse effects. Moreover, as inflammation and ROS are key contributors to tissue damage in various diseases, our study suggested the potential application of AS IV in the treatments for other diseases.
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Affiliation(s)
- Yunlong Chen
- Department of Oncology, Rudong County Hospital of Traditional Chinese Medicine, Rudong, Jiangsu, 226400, China
| | - Mianhua Wu
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210046, China.
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Liu J, West H, McGee HM, Williams TM, Lee P, Amini A. Challenges in synergizing radiotherapy with immunotherapy to unlock the abscopal effect in metastatic NSCLC: A systematic review. Neoplasia 2023; 43:100914. [PMID: 37348427 PMCID: PMC10314288 DOI: 10.1016/j.neo.2023.100914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/04/2022] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND With the recent success of immunotherapy, there is a growing interest in combining radiation with immunotherapy to boost abscopal response rates. Several challenges exist in determining how to synergize these two modalities in the treatment of metastatic NSCLC. METHODS References for this review were identified through searches of MEDLINE/PubMed and Clinicaltrials.gov databases with the search terms "abscopal", "radiation OR radiotherapy," "NSCLC", and "lung" on the index date of July 2022 from 2000-2022. This systematic review focuses primarily on clinical papers. DISCUSSION Early work combining radiotherapy with immunotherapy show promise in unlocking the abscopal effect. Preliminary evidence suggests that radiotherapy regimens with <5 fractions and smaller fields may be superior to regimens with 15 fractions and larger fields. There does not appear to be enough evidence to draw conclusions about the optimal timing of radiotherapy in relation to immunotherapy or the optimal anatomical location of radiation to induce the abscopal effect. Several studies suggest selecting patients with a higher absolute lymphocyte count (ALC) and lower neutrophil-to-lymphocyte ratio (NLR) may help to further boost abscopal response rates. Furthermore, selecting tumors with programmed death ligand-1 (PD-L1) expression, mismatch repair deficiency, and higher tumor mutational burden may similarly achieve this goal. Lastly, additional work is needed to minimize and predict for severe toxicity associated with combination therapy.
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Affiliation(s)
- Jason Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States
| | - Howard West
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States
| | - Heather M McGee
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States; Department of Immuno-Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States
| | - Terence M Williams
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States
| | - Percy Lee
- Department of Radiation Oncology, City of Hope Orange County, Irvine, CA 92618, United States
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States.
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161
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Dean NS, Krambeck AE. Contemporary Use of Computed Tomography (CT) Imaging in Suspected Urolithiasis in Pregnancy. Curr Urol Rep 2023; 24:443-449. [PMID: 37314612 DOI: 10.1007/s11934-023-01171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE OF REVIEW We aimed to examine the role of low-dose CT (LDCT) in the diagnostic work-up for suspected urolithiasis in pregnancy. We reviewed contemporary urologic recommendations for CT in pregnancy, its utilization for suspected urolithiasis, and explored barriers to its use. RECENT FINDINGS National urologic guidelines and the American College of Obstetricians and Gynecologists recommend the judicious use of LDCT imaging in pregnancy when necessary. We noted inconsistencies in review article management pathways and recommendations for CT imaging for suspected urolithiasis in pregnancy. Overall CT utilization in pregnancy for suspected urolithiasis is low. Proposed barriers to LDCT use in pregnancy include fears of litigation and misperceptions of the harm of diagnostic radiation. Recent advancements in imaging technologies for urolithiasis in pregnancy are limited. More specific diagnostic pathway recommendations from national urologic guideline bodies for when to use LDCT to investigate renal colic in pregnancy may reduce diagnostic and intervention delays.
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Affiliation(s)
- Nicholas S Dean
- Department of Urology, Northwestern University, 676 N. St. Clair, Suite 2300, Chicago, IL, 60611, United States.
| | - Amy E Krambeck
- Department of Urology, Northwestern University, 676 N. St. Clair, Suite 2300, Chicago, IL, 60611, United States
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Calabrese EJ. Thresholds for radiation induced mutation? The Muller-Evans debate: A turning point for cancer risk assessment. Chem Biol Interact 2023; 382:110614. [PMID: 37356557 DOI: 10.1016/j.cbi.2023.110614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 06/27/2023]
Abstract
In 1949 Robley Evans [1] published a paper in Science supporting a threshold dose response for ionizing radiation-induced mutation, contradicting comments of Hermann Muller during his 1946 Nobel Prize Lecture [2] and subsequent presentations. Evans sent a final draft [3] prior to publication to over 50 leading geneticists/radiologists, including Muller, with this correspondence being generally extremely supportive, including letters from the radiation geneticists Curt Stern, James Neel and Donald Charles. Of interest is that Muller engaged in a dispute with Evans, with Evans dismissing Muller's comments as containing "a few points of scientific interest, and many matters pertaining to personalities and prejudices." A foundation of the Evans threshold position was the study by Ernst Caspari, which was done under the direction of Curt Stern, at the University of Rochester/Manhattan Project, and for which Muller was a paid consultant, thereby having insider knowledge of the research team, results and internal debates. Muller published a series of articles after the Evans Science publication that marginalized the Caspari findings, claiming that his control group was aberrantly high, which caused his threshold conclusion to be incorrect. Internal correspondence in 1947 between Muller and Stern reveals that Muller supported the use of the Caspari control group based on consistency with his own laboratory data. This correspondence shows that Muller reversed his position three years later, soon after the Evans publication. In that same 1947 correspondence with Stern, Muller also claimed that the mutational findings of Delta Uphoff, who was replicating the Caspari study, could not be supported because of aberrantly low control group values only to reverse himself to support the LNT model. The present paper links Muller's threshold rejection/LNT supporting actions to the timing of the debate with Evans concerning Evans' use of the Caspari data to support the threshold model. It is of historical significance that the duplicitous actions of Muller were rewarded, with his newly expressed reversed views becoming generally accepted (while his previously documented contrary views were hidden/remained private). At the same time, the marginalizing of the Caspari findings greatly impacted recommendations to support LNT by major advisory committees.
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Affiliation(s)
- Edward J Calabrese
- Department of Environmental Health Sciences, Morrill I, N344, University of Massachusetts, Amherst, MA, 01003, USA.
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Rao S, Kini V, Hegde SK, Meera S, Rao P, George T, Baliga MS. Ayurvedic Drug Triphala in Combination with Providone Iodine Mitigates Radiation-Induced Mucositis in Head and Neck Cancer Patients without Affecting the Tumor Response. Indian J Otolaryngol Head Neck Surg 2023; 75:1480-1489. [PMID: 37636651 PMCID: PMC10447701 DOI: 10.1007/s12070-023-03516-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/19/2023] [Indexed: 03/06/2023] Open
Abstract
Radiation-induced mucositis is a dose-limiting concern in the treatment of head and neck cancers (HNC). This study was conducted to determine the effectiveness of the Ayurvedic drug Triphala in reducing radiation-induced mucositis and influencing tumour control when combined with providone iodine. Data from patient files of HNC patients who received Triphala in conjunction with iodine or iodine alone over the course of curative radiotherapy (> 60 Gy) from May 2013 to February 2015 were extracted for this retrospective chart based study. Data was subjected to statistical analysis, X2 and unpaired t test using the Statistical Package for Social Sciences (SPSS), version 17 (IBM, Chicago, USA). When compared to iodine alone, the group that utilised Triphala gargling was very efficient in delaying mucositis, the extent of weight loss (p = 0.038), the incidence (p = 0.03), and the number (p = 0.02) of treatment breaks. However, it had no influence on the radiation-induced tumour response. According to the observations, Triphala coupled with iodine was more successful in preventing radiation mucositis, and without affecting the killing of tumour cells than iodine gargle alone. According to the authors, this is the first observation to demonstrate the value of combining providone iodine with Triphala in preventing radiation-induced oral mucositis.
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Affiliation(s)
- Suresh Rao
- Department of Radiation Oncology, Mangalore Institute of Oncology, Mangalore, 575002 India
| | - Venkataraman Kini
- Department of Radiation Oncology, Mangalore Institute of Oncology, Mangalore, 575002 India
| | - Sanath Kumar Hegde
- Department of Radiation Oncology, Mangalore Institute of Oncology, Mangalore, 575002 India
| | | | - Pratima Rao
- Department of Dentistry, Mangalore Institute of Oncology, Mangalore, 575002 India
| | - Thomas George
- Research Unit, Mangalore Institute of Oncology, Mangalore, 575002 India
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Landry J, Shows K, Jagdeesh A, Shah A, Pokhriyal M, Yakovlev V. Regulatory miRNAs in cancer cell recovery from therapy exposure and its implications as a novel therapeutic strategy for preventing disease recurrence. Enzymes 2023; 53:113-196. [PMID: 37748835 DOI: 10.1016/bs.enz.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
The desired outcome of cancer therapies is the eradication of disease. This can be achieved when therapy exposure leads to therapy-induced cancer cell death as the dominant outcome. Theoretically, a permanent therapy-induced growth arrest could also contribute to a complete response, which has the potential to lead to remission. However, preclinical models have shown that therapy-induced growth arrest is not always durable, as recovering cancer cell populations can contribute to the recurrence of cancer. Significant research efforts have been expended to develop strategies focusing on the prevention of recurrence. Recovery of cells from therapy exposure can occur as a result of several cell stress adaptations. These include cytoprotective autophagy, cellular quiescence, a reversable form of senescence, and the suppression of apoptosis and necroptosis. It is well documented that microRNAs regulate the response of cancer cells to anti-cancer therapies, making targeting microRNAs therapeutically a viable strategy to sensitization and the prevention of recovery. We propose that the use of microRNA-targeting therapies in prolonged sequence, that is, a significant period after initial therapy exposure, could reduce toxicity from the standard combination strategy, and could exploit new epigenetic states essential for cancer cells to recover from therapy exposure. In a step toward supporting this strategy, we survey the available scientific literature to identify microRNAs which could be targeted in sequence to eliminate residual cancer cell populations that were arrested as a result of therapy exposure. It is our hope that by successfully identifying microRNAs which could be targeted in sequence we can prevent disease recurrence.
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Affiliation(s)
- Joseph Landry
- Department of Human and Molecular Genetics, VCU Institute of Molecular Medicine, Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, VA, United States.
| | - Kathryn Shows
- Department of Biology, Virginia State University, Petersburg, VA, United States
| | - Akash Jagdeesh
- Department of Human and Molecular Genetics, VCU Institute of Molecular Medicine, Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Aashka Shah
- Department of Human and Molecular Genetics, VCU Institute of Molecular Medicine, Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Mihir Pokhriyal
- Department of Human and Molecular Genetics, VCU Institute of Molecular Medicine, Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Vasily Yakovlev
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, United States.
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Corrales-Guerrero S, Cui T, Castro-Aceituno V, Yang L, Nair S, Feng H, Venere M, Yoon S, DeWees T, Shen C, Williams TM. Inhibition of RRM2 radiosensitizes glioblastoma and uncovers synthetic lethality in combination with targeting CHK1. Cancer Lett 2023; 570:216308. [PMID: 37482342 DOI: 10.1016/j.canlet.2023.216308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
Glioblastoma (GBM) is an aggressive malignant primary brain tumor. Radioresistance largely contributes to poor clinical outcomes in GBM patients. We targeted ribonucleotide reductase subunit 2 (RRM2) with triapine to radiosensitize GBM. We found RRM2 is associated with increasing tumor grade, is overexpressed in GBM over lower grade gliomas and normal tissue, and is associated with worse survival. We found silencing or inhibition of RRM2 by siRNA or triapine sensitized GBM cells to ionizing radiation (IR) and delayed resolution of IR-induced γ-H2AX nuclear foci. In vivo, triapine and IR reduced tumor growth and increased mouse survival. Intriguingly, triapine led to RRM2 upregulation and CHK1 activation, suggesting a CHK1-dependent RRM2 upregulation following RRM2 inhibition. Consistently, silencing or inhibition of CHK1 with rabusertib abolished the triapine-induced RRM2 upregulation. Accordingly, combining rabusertib and triapine resulted in synthetic lethality in GBM cells. Collectively, our results suggest RRM2 is a promising therapeutic target for GBM, and targeting RRM2 with triapine sensitizes GBM cells to radiation and independently induces synthetic lethality of GBM cells with CHK1 inhibition. Our findings suggest combining triapine with radiation or rabusertib may improve therapeutic outcomes in GBM.
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Affiliation(s)
- Sergio Corrales-Guerrero
- Biomedical Sciences Graduate Program, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Tiantian Cui
- Department of Radiation Oncology, City of Hope, Duarte, CA, USA
| | | | - Linlin Yang
- Department of Radiation Oncology, City of Hope, Duarte, CA, USA
| | - Sindhu Nair
- Department of Radiation Oncology, City of Hope, Duarte, CA, USA
| | - Haihua Feng
- Department of Radiation Oncology, City of Hope, Duarte, CA, USA
| | - Monica Venere
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, OH, USA
| | - Stephanie Yoon
- Department of Radiation Oncology, City of Hope, Duarte, CA, USA
| | - Todd DeWees
- Division of Biostatistics, City of Hope, Duarte, CA, USA
| | - Changxian Shen
- Department of Radiation Oncology, City of Hope, Duarte, CA, USA
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Bedi R, Ahmad A, Horbal P, Mar PL. Radiation-associated Arrhythmias: Putative Pathophysiological Mechanisms, Prevalence, Screening and Management Strategies. Arrhythm Electrophysiol Rev 2023; 12:e24. [PMID: 37680206 PMCID: PMC10481379 DOI: 10.15420/aer.2022.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/16/2023] [Indexed: 09/09/2023] Open
Abstract
Radiation-associated cardiovascular disease, an increasingly recognised disease process, is a significant adverse effect of radiation therapy for common malignancies that involve the chest, and include lymphomas, lung, mediastinal and breast cancers. Two factors contribute to the increasing incidence of radiation-associated cardiovascular disease: advances in malignancy detection and the improved survival of cancer patients, by which many symptoms of radiation-associated cardiovascular disease, specifically radiation-associated arrhythmias, present years and/or decades following initial radiotherapy. We present a focused overview of the currently understood pathophysiology, prevalence and management strategies of radiation-associated arrhythmias, which include bradyarrhythmias, tachyarrhythmias and autonomic dysfunction.
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Affiliation(s)
- Rohil Bedi
- Department of Internal Medicine, Saint Louis University School of Medicine St Louis, Missouri, US
| | - Ali Ahmad
- Department of Internal Medicine, Saint Louis University School of Medicine St Louis, Missouri, US
| | - Piotr Horbal
- Department of Internal Medicine, Saint Louis University School of Medicine St Louis, Missouri, US
- Division of Cardiovascular Medicine, Department of Internal Medicine, Ohio State University Columbus, Ohio, US
| | - Philip L Mar
- Division of Cardiology, Department of Internal Medicine, Saint Louis University School of Medicine St Louis, Missouri, US
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167
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Liu J, Chen S, Zhou Y, Zheng X, Meng R, Tan N, Liu Y. Effect of cumulative radiation exposure from Coronary catheterization on lung cancer mortality. BMC Cancer 2023; 23:757. [PMID: 37582730 PMCID: PMC10426196 DOI: 10.1186/s12885-023-11231-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/26/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Coronary catheterization (CC) procedure inevitably exposes patients with cardiovascular disease (CVD) to radiation, while cumulative radiation exposure may lead to higher risk of cancer. METHODS This multi-center, retrospective study was based on the CC procedure in Cardiorenal ImprovemeNt II cohort (CIN-II, NCT05050877) among five regional central tertiary teaching hospitals in China between 2007 and 2020. Patients without known cancer were stratified according to the times they received CC procedure. Baseline information from their last CC procedure was analyzed. Cox regression and Fine-Gray competing risk models were used to assess the relationship between cumulative radiation exposure from CC procedures and cancer-specific, all-cause and cardiovascular mortality. RESULTS Of 136,495 hospitalized survivors without cancer at baseline (mean age: 62.3 ± 11.1 years, 30.9% female), 116,992 patients (85.7%) underwent CC procedure once, 15,184 patients (11.1%) on twice, and 4,319 patients (3.2%) underwent CC procedure more than three times. During the median follow-up of 4.7 years (IQR: 2.5 to 7.4), totally 18,656 patients (13.7%) died after discharge, of which 617 (0.5%) died of lung cancer. Compared with the patients who underwent CC procedure once, the risk of lung cancer mortality increased significantly with the increase of the number of CC procedure (CC 2 times vs. 1 time: HR 1.42, 95% CI 1.13 to 1.78, P < 0.001; CC ≥ 3 times vs. 1 time: HR 1.64, 95%CI 1.13 to 2.39, P < 0.05). Similar results were observed in all-cause mortality and cardiovascular mortality, but not in other cancer-specific mortality. CONCLUSIONS Our data suggest that substantial proportion of CVD patients are exposed to multiple high levels of low-dose ionizing radiation from CC procedure, which is associated with an increased risk of cancer mortality in this population. TRIAL REGISTRATION ClinicalTrials.gov: NCT05050877; URL: http://www. CLINICALTRIALS gov ; 21/09/2021.
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Affiliation(s)
- Jin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Yang Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xueyan Zheng
- Institute of Control and Prevention for Chronic Non-Infective Disease, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Ruilin Meng
- Institute of Control and Prevention for Chronic Non-Infective Disease, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- School of Medicine, Guangdong Provincial People's Hospital, South China University of Technology, Guangzhou, China.
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- School of Medicine, Guangdong Provincial People's Hospital, South China University of Technology, Guangzhou, China.
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168
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Donlon NE, Davern M, Sheppard A, O'Connell F, Moran B, Nugent TS, Heeran A, Phelan JJ, Bhardwaj A, Butler C, Ravi N, Donohoe CL, Lynam-Lennon N, Maher S, Reynolds JV, Lysaght J. Potential of damage associated molecular patterns in synergising radiation and the immune response in oesophageal cancer. World J Gastrointest Oncol 2023; 15:1349-1365. [PMID: 37663943 PMCID: PMC10473939 DOI: 10.4251/wjgo.v15.i8.1349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/29/2023] [Accepted: 06/25/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND There is an intimate crosstalk between cancer formation, dissemination, treatment response and the host immune system, with inducing tumour cell death the ultimate therapeutic goal for most anti-cancer treatments. However, inducing a purposeful synergistic response between conventional therapies and the immune system remains evasive. The release of damage associated molecular patterns (DAMPs) is indicative of immunogenic cell death and propagation of established immune responses. However, there is a gap in the literature regarding the importance of DAMP expression in oesophageal adenocarcinoma (OAC) or by immune cells themselves. AIM To investigate the effects of conventional therapies on DAMP expression and to determine whether OAC is an immunogenic cancer. METHODS We investigated the levels of immunogenic cell death-associated DAMPs, calreticulin (CRT) and HMGB1 using an OAC isogenic model of radioresistance. DAMP expression was also assessed directly using ex vivo cancer patient T cells (n = 10) and within tumour biopsies (n = 9) both pre and post-treatment with clinically relevant chemo(radio)therapeutics. RESULTS Hypoxia in combination with nutrient deprivation significantly reduces DAMP expression by OAC cells in vitro. Significantly increased frequencies of T cell DAMP expression in OAC patients were observed following chemo(radio)therapy, which was significantly higher in tumour tissue compared with peripheral blood. Patients with high expression of HMGB1 had a significantly better tumour regression grade (TRG 1-2) compared to low expressors. CONCLUSION In conclusion, OAC expresses an immunogenic phenotype with two distinct subgroups of high and low DAMP expressors, which correlated with tumour regression grade and lymphatic invasion. It also identifies DAMPs namely CRT and HMGB1 as potential promising biomarkers in predicting good pathological responses to conventional chemo(radio)therapies currently used in the multimodal management of locally advanced disease.
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Affiliation(s)
- Noel E Donlon
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity College Dublin, St James’s Hospital, Dublin D08, Ireland
| | - Maria Davern
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity College Dublin, St James’s Hospital, Dublin D08, Ireland
| | - Andrew Sheppard
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity College Dublin, St James’s Hospital, Dublin D08, Ireland
| | - Fiona O'Connell
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity College Dublin, St James’s Hospital, Dublin D08, Ireland
| | - Brendan Moran
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity College Dublin, St James’s Hospital, Dublin D08, Ireland
| | - Timothy S Nugent
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity College Dublin, St James’s Hospital, Dublin D08, Ireland
| | - Aisling Heeran
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity College Dublin, St James’s Hospital, Dublin D08, Ireland
| | - James J Phelan
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity College Dublin, St James’s Hospital, Dublin D08, Ireland
| | - Anshul Bhardwaj
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity College Dublin, St James’s Hospital, Dublin D08, Ireland
| | - Christine Butler
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity College Dublin, St James’s Hospital, Dublin D08, Ireland
| | - Narayanasamy Ravi
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity College Dublin, St James’s Hospital, Dublin D08, Ireland
| | - Claire L Donohoe
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity College Dublin, St James’s Hospital, Dublin D08, Ireland
| | - Niamh Lynam-Lennon
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity College Dublin, St James’s Hospital, Dublin D08, Ireland
| | - Stephen Maher
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity College Dublin, St James’s Hospital, Dublin D08, Ireland
| | - John V Reynolds
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity College Dublin, St James’s Hospital, Dublin D08, Ireland
| | - Joanne Lysaght
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity College Dublin, St James’s Hospital, Dublin D08, Ireland
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169
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Amit U, Mohiuddin JJ, Wojcieszynski AP, Harton J, Williams G, Manjunath S, Grandhi N, Doucette A, Plastaras JP, Metz JM, Ben-Josef E. Radiation dose is associated with improved local control for large, but not small, hepatocellular carcinomas. Radiat Oncol 2023; 18:133. [PMID: 37568200 PMCID: PMC10422771 DOI: 10.1186/s13014-023-02318-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/06/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND With advances in understanding liver tolerance, conformal techniques, image guidance, and motion management, dose-escalated radiotherapy has become a potential treatment for inoperable hepatocellular carcinoma (HCC). We aimed to evaluate the possible impact of biologically effective dose (BED) on local control and toxicity among patients with HCC. METHODS AND MATERIALS Patients treated at our institution from 2009 to 2018 were included in this retrospective analysis if they received definitive-intent radiotherapy with a nominal BED of at least 60 Gy. Patients were stratified into small and large tumors using a cutoff of 5 cm, based on our clinical practice. Toxicity was assessed using ALBI scores and rates of clinical liver function deterioration. RESULTS One hundred and twenty-eight patients were included, with a mean follow-up of 16 months. The majority of patients (90.5%) had a good performance status (ECOG 0-1), with Child-Pugh A (66.4%) and ALBI Grade 2 liver function at baseline (55.4%). Twenty (15.6%) patients had a local recurrence in the irradiated field during the follow-up period. Univariate and multivariate Cox proportional hazard analyses showed that only BED significantly predicted local tumor recurrence. Higher BED was associated with improved local control in tumors with equivalent diameters over 5 cm but not in smaller tumors. There was no difference in liver toxicity between the low and high-dose groups. CONCLUSIONS Higher radiotherapy dose is associated with improved local control in large tumors but not in tumors smaller than 5 cm in diameter. High-dose radiotherapy was not associated with increased liver toxicity.
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Affiliation(s)
- Uri Amit
- Department of Radiation Oncology, Perelman School of Medicine, Philadelphia, PA, USA.
- Department of Radiation Oncology, Tel Aviv Medical Center, Tel Aviv, Israel.
| | - Jahan J Mohiuddin
- Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
- Southeast Radiation Oncology Group, Charlotte, NC, USA
| | | | | | - Graeme Williams
- Department of Radiation Oncology, Perelman School of Medicine, Philadelphia, PA, USA
| | - Shwetha Manjunath
- Department of Radiation Oncology, Perelman School of Medicine, Philadelphia, PA, USA
| | - Nikhil Grandhi
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Abigail Doucette
- Abramson Cancer Center, Perelman School of Medicine, Philadelphia, PA, USA
| | - John P Plastaras
- Department of Radiation Oncology, Perelman School of Medicine, Philadelphia, PA, USA
| | - James M Metz
- Department of Radiation Oncology, Perelman School of Medicine, Philadelphia, PA, USA
| | - Edgar Ben-Josef
- Department of Radiation Oncology, Perelman School of Medicine, Philadelphia, PA, USA
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Beaton-Green LA, Mayenburg JM, Marro L, Hassan EM, Cuadros Sanchez S, Darwish R, Lachapelle S, Adam N, Burtt JJ, Van Den Hanenberg C, Rodrigues MA, Wang Q, Brenner DJ, Turner HC, Wilkins RC. Application of the Cytokinesis-Block Micronucleus Assay for High-Dose Exposures Using Imaging Flow Cytometry. Cytogenet Genome Res 2023; 163:131-142. [PMID: 37527635 DOI: 10.1159/000532124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
The cytokinesis-block micronucleus assay is a well-established method to assess radiation-induced genetic damage in human cells. This assay has been adapted to imaging flow cytometry (IFC), allowing automated analysis of many cells, and eliminating the need to create microscope slides. Furthermore, to improve the efficiency of assay performance, a small-volume method previously developed was employed. Irradiated human blood samples were cultured, stained, and analyzed by IFC to produce images of the cells. Samples were run using both manual and 96-well plate automated acquisition. Multiple parameter-based image features were collected for each sample, and the results were compared to confirm that these acquisition methods are functionally identical. This paper details the multi-parametric analysis developed and the resulting calibration curves up to 10 Gy. The calibration curves were created using a quadratic random coefficient model with Poisson errors, as well as a logistic discriminant function. The curves were then validated with blinded, irradiated samples, using relative bias and relative mean square error. Overall, the accuracy of the dose estimates was adequate for triage dosimetry (within 1 Gy of the true dose) over 90% of the time for lower doses and about half the time for higher doses, with the lowest success rate between 5 and 6 Gy where the calibration curve reached its peak and there was the smallest change in MN/BNC with dose. This work describes the application of a novel multi-parametric analysis that fits the calibration curves and allows dose estimates up to 10 Gy, which were previously limited to 4 Gy. Furthermore, it demonstrates that the results from samples acquired manually and with the autosampler are functionally similar.
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Affiliation(s)
- Lindsay A Beaton-Green
- Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Jessica M Mayenburg
- Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Leonora Marro
- Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Eman M Hassan
- Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Sarita Cuadros Sanchez
- Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Riham Darwish
- Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Sylvie Lachapelle
- Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Nadine Adam
- Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Julie J Burtt
- Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Cyndi Van Den Hanenberg
- Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | | | - Qi Wang
- Center for Radiological Research, Columbia University Medical Center, New York, New York, USA
| | - David J Brenner
- Center for Radiological Research, Columbia University Medical Center, New York, New York, USA
| | - Helen C Turner
- Center for Radiological Research, Columbia University Medical Center, New York, New York, USA
| | - Ruth C Wilkins
- Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
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171
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de Haan A, van Nes JGH, Kolff MW, van der Toorn PP, Westenberg AH, van der Vegt AE, Groen H, Overbosch J, van der Laan HP, Werker PMN, Langendijk JA, Steenbakkers RJHM. Radiotherapy for Ledderhose disease: Results of the LedRad-study, a prospective multicentre randomised double-blind phase 3 trial. Radiother Oncol 2023; 185:109718. [PMID: 37211283 DOI: 10.1016/j.radonc.2023.109718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND AND PURPOSE Radiotherapy is considered a treatment option for Ledderhose disease. However, its benefits have never been confirmed in a randomised controlled trial. Therefore, the LedRad-study was conducted. MATERIALS AND METHODS The LedRad-study is a prospective multicentre randomised double-blind phase three trial. Patients were randomised to sham-radiotherapy (placebo) or radiotherapy. The primary endpoint was pain reduction at 12 months after treatment, measured with the Numeric Rating Scale (NRS). Secondary endpoints were pain reduction at 6 and 18 months after treatment, quality of life (QoL), walking abilities and toxicity. RESULTS A total of 84 patients were enrolled. At 12 and 18 months, patients in the radiotherapy group had a lower mean pain score compared to patients in the sham-radiotherapy group (2.5 versus 3.6 (p = 0.03) and 2.1 versus 3.4 (p = 0.008), respectively). Pain relief at 12 months was 74% in the radiotherapy group and 56% in the sham-radiotherapy group (p = 0.002). Multilevel testing for QoL scores showed higher QoL scores in the radiotherapy group compared to the sham-radiotherapy group (p < 0.001). Moreover, patients in the radiotherapy group had a higher mean walking speed and step rate with barefoot speed walking (p = 0.02). Erythema, skin dryness, burning sensations and increased pain were the most frequently reported side effects. These side effects were generally graded as mild (95%) and the majority (87%) were resolved at 18 months follow-up. CONCLUSION Radiotherapy for symptomatic Ledderhose disease is an effective treatment resulting in a significant pain reduction, improvement of QoL scores and bare feet walking abilities, in comparison to sham-radiotherapy.
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Affiliation(s)
- Anneke de Haan
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands.
| | | | - M Willemijn Kolff
- Amsterdam University Medical Center, Department of Radiation Oncology, Amsterdam, the Netherlands
| | | | | | - Annelies E van der Vegt
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Henk Groen
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Jelle Overbosch
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - Hans Paul van der Laan
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Paul M N Werker
- University of Groningen, University Medical Center Groningen, Department of Plastic Surgery, Groningen, the Netherlands
| | - Johannes A Langendijk
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Roel J H M Steenbakkers
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
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172
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He X, Cai L, Tang H, Chen W, Hu W. Epigenetic modifications in radiation-induced non-targeted effects and their clinical significance. Biochim Biophys Acta Gen Subj 2023; 1867:130386. [PMID: 37230420 DOI: 10.1016/j.bbagen.2023.130386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/19/2023] [Accepted: 05/19/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Ionizing radiation (IR) plays an important role in the diagnosis and treatment of cancer. Besides the targeted effects, the non-targeted effects, which cause damage to non-irradiated cells and genomic instability in normal tissues, also play a role in the side effects of radiotherapy and have been shown to involve both alterations in DNA sequence and regulation of epigenetic modifications. SCOPE OF REVIEW We summarize the recent findings regarding epigenetic modifications that are involved in radiation-induced non-targeted effects as well as their clinical significance in radiotherapy and radioprotection. MAJOR CONCLUSIONS Epigenetic modifications play an important role in both the realization and modulation of radiobiological effects. However, the molecular mechanisms underlying non-targeted effects still need to be clarified. GENERAL SIGNIFICANCE A better understanding of the epigenetic mechanisms related to radiation-induced non-targeted effects will guide both individualized clinical radiotherapy and individualized precise radioprotection.
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Affiliation(s)
- Xiangyang He
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou 215123, China
| | - Luwei Cai
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou 215123, China
| | - Haoyi Tang
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou 215123, China
| | - Weibo Chen
- Nuclear and Radiation Incident Medical Emergency Office, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China.
| | - Wentao Hu
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou 215123, China.
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173
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Sharma D, Xuan Leong K, Palhares D, Czarnota GJ. Radiation combined with ultrasound and microbubbles: A potential novel strategy for cancer treatment. Z Med Phys 2023; 33:407-426. [PMID: 37586962 PMCID: PMC10517408 DOI: 10.1016/j.zemedi.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 08/18/2023]
Abstract
Cancer is one of the leading causes of death worldwide. Several emerging technologies are helping to battle cancer. Cancer therapies have been effective at killing cancer cells, but a large portion of patients still die to this disease every year. As such, more aggressive treatments of primary cancers are employed and have been shown to be capable of saving a greater number of lives. Recent research advances the field of cancer therapy by employing the use of physical methods to alter tumor biology. It uses microbubbles to enhance radiation effect by damaging tumor vasculature followed by tumor cell death. The technique can specifically target tumor volumes by conforming ultrasound fields capable of microbubbles stimulation and localizing it to avoid vascular damage in surrounding tissues. Thus, this new application of ultrasound-stimulated microbubbles (USMB) can be utilized as a novel approach to cancer therapy by inducing vascular disruption resulting in tumor cell death. Using USMB alongside radiation has showed to augment the anti-vascular effect of radiation, resulting in enhanced tumor response. Recent work with nanobubbles has shown vascular permeation into intracellular space, extending the use of this new treatment method to potentially further improve the therapeutic effect of the ultrasound-based therapy. The significant enhancement of localized tumor cell kill means that radiation-based treatments can be made more potent with lower doses of radiation. This technique can manifest a greater impact on radiation oncology practice by increasing treatment effectiveness significantly while reducing normal tissue toxicity. This review article summarizes the past and recent advances in USMB enhancement of radiation treatments. The review mainly focuses on preclinical findings but also highlights some clinical findings that use USMB as a therapeutic modality in cancer therapy.
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Affiliation(s)
- Deepa Sharma
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Departments of Radiation Oncology, and Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Kai Xuan Leong
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Daniel Palhares
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Departments of Radiation Oncology, and Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Gregory J Czarnota
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Departments of Radiation Oncology, and Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.
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174
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Ricciardi NR, Modarresi F, Lohse I, Andrade NS, Newman IR, Brown JM, Borja C, Marples B, Wahlestedt CR, Volmar CH. Investigating the Synergistic Potential of Low-Dose HDAC3 Inhibition and Radiotherapy in Alzheimer's Disease Models. Mol Neurobiol 2023; 60:4811-4827. [PMID: 37171575 PMCID: PMC10293392 DOI: 10.1007/s12035-023-03373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Abstract
We have previously shown that histone deacetylase (HDAC) inhibition and cranial radiotherapy (RT) independently improve molecular and behavioral Alzheimer's disease (AD)-like phenotypes. In the present study, we investigate the synergistic potential of using both RT and HDACi as a low-dose combination therapy (LDCT) to maximize disease modification (reduce neuroinflammation and amyloidogenic APP processing, increase neurotrophic gene expression) while minimizing the potential for treatment-associated side effects.LDCT consisted of daily administration of the HDAC3 inhibitor RGFP966 and/or bi-weekly cranial x-irradiation. Amyloid-beta precursor protein (APP) processing and innate immune response to LDCT were assessed in vitro and in vivo using human and murine cell models and 3xTg-AD mice. After 2 months of LDCT in mice, behavioral analyses as well as expression and modification of key AD-related targets (Aβ, tau, Csf1r, Bdnf, etc.) were assessed in the hippocampus (HIP) and prefrontal cortex (PFC).LDCT induced a tolerant, anti-inflammatory innate immune response in microglia and increased non-amyloidogenic APP processing in vitro. Both RT and LDCT improved the rate of learning and spatial memory in the Barnes maze test. LDCT induced a unique anti-AD HIP gene expression profile that included upregulation of neurotrophic genes and downregulation of inflammation-related genes. RT lowered HIP Aβ42/40 ratio and Bace1 protein, while LDCT lowered PFC p-tau181 and HIP Bace1 levels.Our study supports the rationale for combining complementary therapeutic approaches at low doses to target multifactorial AD pathology synergistically. Namely, LDCT with RGFP966 and cranial RT shows disease-modifying potential against a wide range of AD-related hallmarks.
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Affiliation(s)
- Natalie R. Ricciardi
- Department of Biochemistry and Molecular Biology, University of Miami, Miami, FL 33136 USA
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL 33136 USA
- Center for Therapeutic Innovation, University of Miami, Miami, FL 33136 USA
| | - Farzaneh Modarresi
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL 33136 USA
| | - Ines Lohse
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL 33136 USA
- Center for Therapeutic Innovation, University of Miami, Miami, FL 33136 USA
| | - Nadja S. Andrade
- Department of Biochemistry and Molecular Biology, University of Miami, Miami, FL 33136 USA
- Center for Therapeutic Innovation, University of Miami, Miami, FL 33136 USA
| | - Ian R. Newman
- Department of Biochemistry and Molecular Biology, University of Miami, Miami, FL 33136 USA
| | - Jonathan M. Brown
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL 33136 USA
- Center for Therapeutic Innovation, University of Miami, Miami, FL 33136 USA
| | - Caroline Borja
- Center for Therapeutic Innovation, University of Miami, Miami, FL 33136 USA
| | - Brian Marples
- Department of Radiation Oncology, University of Miami, Miami, FL 33136 USA
| | - Claes R. Wahlestedt
- Department of Biochemistry and Molecular Biology, University of Miami, Miami, FL 33136 USA
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL 33136 USA
- Center for Therapeutic Innovation, University of Miami, Miami, FL 33136 USA
| | - Claude-Henry Volmar
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL 33136 USA
- Center for Therapeutic Innovation, University of Miami, Miami, FL 33136 USA
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175
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Maaroof AA, Smith JD, Zangana MH. Design and simulation of a utility oilfield flare in Iraq/Kurdistan region using CFD and API-521 methodology. Heliyon 2023; 9:e18581. [PMID: 37593608 PMCID: PMC10432168 DOI: 10.1016/j.heliyon.2023.e18581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/21/2023] [Accepted: 07/21/2023] [Indexed: 08/19/2023] Open
Abstract
This paper aims at reviewing and analyzing the operation and design of a utility flare in an oilfield in the Iraq/Kurdistan region. The flare supports a gas separation unit that separates 100 MMSCFD of natural gas from other liquid compounds in petroleum refining. The actual flare dimensions are 50 m high and 0.6 m diameter and works in summer where the crosswind speed is 9 m/s and a flow of 1.2 MMSCFD of treated natural gas is flaring through it. At the beginning, the flare design was performed using the API-521 recommended approach based on full operating capacity of the unit and composition of the gas to be flared. The API-521 based design resulted in a flare with a 0.76 m diameter and 48.19 m height. The effects of stack height on heat radiation in case of full capacity firing showed that as the flare height increases from 42.34 m to 133.05 m, the heat radiation decreases from 15.8 kW/m^2 to 1.6 kW/m^2 within 45.7 m dimeter. Furthermore, the relation between stack height and heat radiation was studied for the actual firing rate 1.2MMSCFD using simulation, where the results showed that as the stack height increasing from 10 m to 50 m the heat radiation decreasing from over 1000 w/m^2 to around 150 W/m^2. In fact, CFD code C3d was used to analyze flare performance at normal firing condition during summer operation of 1.2 MMSCFD with a flare diameter and height of 50 m and 0.6 m, respectively. The code was able to predict the flame shape and size during actual flare operation. The results of the simulation demonstrated by defining four locations in the domain to measure the average temperatures and emissions, and to calculate the Combustion Efficiency (CE) and Destruction and Removal Efficiency (DRE). These points were 6 m, 8 m, 10 m, 12 m far from the tip on x-axis and at height of 52 m. The results showed that the average temperature at 6 m far from the flare is 658 K and it decreasing to 490 K at 12 m away from the tip. The CO and CO2 also decreased from 7.27E-5 and 0.033 mass% to 4.53E-6 and 0.027 mass%, respectively. Generally, soot formation was low but at points 8 m and 10 m from the tip the soot formation was considerably lower, respectively at 6.16E-5 and 8.71E-5 mass%. The emissions of C1, C2, C3 and C6+ were measured at 7.46E-9, 5.39E-9, 5.13E-9 and 4.35E-9 mass% at 6 m away from the tip. The emissions increased slightly at 8 m and 10 m from the tip but at 12 m they were observed to decrease. The flare CE and DRE were estimated to be 98% and 100%, respectively. Analysis results confirmed that the flare design was safe and the flare operation was highly efficient with very little smoke produced as indicated by the predicted CE and DRE.
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Affiliation(s)
- Ahmed A. Maaroof
- Petroleum Engineering Department, Koya University, Koya KOY45 AB64, Kurdistan Region, Iraq
| | - Joseph D. Smith
- Department of Chemical and Biochemical Engineering, Missouri University of Science and Technology, Rolla, MO, 65409, USA
| | - Mohammed H.S. Zangana
- Petroleum Engineering Department, Koya University, Koya KOY45 AB64, Kurdistan Region, Iraq
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176
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Sooksamran A, Pichai P, Suphannaphong M, Singthong S. Previous therapy and the recurrence rate of basal cell carcinoma after Mohs surgery: a meta-analysis. Arch Dermatol Res 2023; 315:1747-1754. [PMID: 36847828 DOI: 10.1007/s00403-023-02558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 12/15/2022] [Accepted: 01/30/2023] [Indexed: 03/01/2023]
Abstract
Mohs micrographic surgery (MMS) for basal cell carcinoma (BCC) is indicated for patients at high risk of recurrence; other therapies, including standard surgical excision, cryotherapy, electrodesiccation and curettage, and radiotherapy, are used in low-risk BCC and in patients who cannot undergo surgery. However, in the case of recurrence following treatment with any of these methods, MMS is indicated. This study aimed to examine how preoperative treatment before MMS affects the recurrence rate after surgery. We conducted a meta-analysis to compare the recurrence rates of primary BCC and previously treated BCC in patients undergoing MMS, with a 5-year follow-up. The secondary outcomes were the recurrence rate after MMS based on previous radiation therapy status, mean time to recurrence, and number of cases undergoing more than one stage of MMS. The recurrence rate in the previously treated group was 2.44 times greater than that of the primary BCC group. In the previous treatment group, the patients who underwent previous radiation showed a 2.52-fold higher recurrence rate than those with no previous radiation therapy. However, there was no significant difference in the mean time to recurrence and the number of cases requiring MMS > 1 stage between the previously treated and non-treated groups. Patients with previously treated BCC, especially those treated using radiation, had a higher likelihood of recurrence.
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Affiliation(s)
- Apasee Sooksamran
- Department of Medical Services, Institute of Dermatology, Phayathai, Bangkok, 10400, Thailand.
| | - Pitchayasak Pichai
- Department of Medical Services, Institute of Dermatology, Phayathai, Bangkok, 10400, Thailand
| | - Mingkwan Suphannaphong
- Department of Medical Services, Institute of Dermatology, Phayathai, Bangkok, 10400, Thailand
| | - Sasathorn Singthong
- Department of Medical Services, Institute of Dermatology, Phayathai, Bangkok, 10400, Thailand
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177
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Sartor O, Karrison TG, Sandler HM, Gomella LG, Amin MB, Purdy J, Michalski JM, Garzotto MG, Pervez N, Balogh AG, Rodrigues GB, Souhami L, Reaume MN, Williams SG, Hannan R, Jones CU, Horwitz EM, Rodgers JP, Feng FY, Rosenthal SA. Androgen Deprivation and Radiotherapy with or Without Docetaxel for Localized High-risk Prostate Cancer: Long-term Follow-up from the Randomized NRG Oncology RTOG 0521 Trial. Eur Urol 2023; 84:156-163. [PMID: 37179241 PMCID: PMC10662642 DOI: 10.1016/j.eururo.2023.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/18/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Intensification of therapy may improve outcomes for patients with high-risk localized prostate cancer. OBJECTIVE To provide long-term follow-up data from phase III RTOG 0521, which compared a combination of androgen deprivation therapy (ADT) + external beam radiation therapy (EBRT) + docetaxel with ADT + EBRT. DESIGN, SETTING, AND PARTICIPANTS High-risk localized prostate cancer patients (>50% of patients had Gleason 9-10 disease) were prospectively randomized to 2 yr of ADT + EBRT or ADT + EBRT + six cycles of docetaxel. A total of 612 patients were accrued, and 563 were eligible and included in the modified intent-to-treat analysis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was overall survival (OS). Analyses with Cox proportional hazards were performed as prespecified in the protocol; however, there was evidence of nonproportional hazards. Thus, a post hoc analysis was performed using the restricted mean survival time (RMST). The secondary endpoints included biochemical failure, distant metastasis (DM) as detected by conventional imaging, and disease-free survival (DFS). RESULTS AND LIMITATIONS After 10.4 yr of median follow-up among survivors, the hazard ratio (HR) for OS was 0.89 (90% confidence interval [CI] 0.70-1.14; one-sided log-rank p = 0.22). Survival at 10 yr was 64% for ADT + EBRT and 69% for ADT + EBRT + docetaxel. The RMST at 12 yr was 0.45 yr and not statistically significant (one-sided p = 0.053). No differences were detected in the incidence of DFS (HR = 0.92, 95% CI 0.73-1.14), DM (HR = 0.84, 95% CI 0.73-1.14), or prostate-specific antigen recurrence risk (HR = 0.97, 95% CI 0.74-1.29). Two patients had grade 5 toxicity in the chemotherapy arm and zero patients in the control arm. CONCLUSIONS After a median follow-up of 10.4 yr among surviving patients, no significant differences are observed in clinical outcomes between the experimental and control arms. These data suggest that docetaxel should not be used for high-risk localized prostate cancer. Additional research may be warranted using novel predictive biomarkers. PATIENT SUMMARY No significant differences in survival were noted after long-term follow-up for high-risk localized prostate cancer patients in a large prospective trial where patients were treated with androgen deprivation therapy + radiation to the prostate ± docetaxel.
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Affiliation(s)
- Oliver Sartor
- Tulane University Health Services Center, New Orleans, LA, USA.
| | - Theodore G Karrison
- NRG Oncology Statistics and Data Management Center, Chicago, IL and Philadelphia, PA, USA
| | | | | | - Mahul B Amin
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - James Purdy
- UC Davis Medical Center, Sacramento, CA, USA
| | | | | | | | | | | | | | - M Neil Reaume
- The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | | | - Raquibul Hannan
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Christopher U Jones
- Sutter Cancer Center (accruals under Radiological Associates of Sacramento), Sacramento, CA, USA
| | | | - Joseph P Rodgers
- NRG Oncology Statistics and Data Management Center, Chicago, IL and Philadelphia, PA, USA
| | | | - Seth A Rosenthal
- Sutter Cancer Center (accruals under Radiological Associates of Sacramento), Sacramento, CA, USA
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178
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Safarbalou A, Ebrahimi F, Talebpour Amiri F, Hosseinimehr SJ. Radioprotective effect of piperine, as a major component of black pepper, against radiation-induced colon injury: biochemical and histological studies. Curr Radiopharm 2023:CRP-EPUB-133109. [PMID: 37489775 DOI: 10.2174/1874471016666230725112319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/16/2023] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Patients undergoing radiotherapy are prone to radiation-induced gastrointestinal injury. Piperine is an alkaloid component in black pepper with a unique chemopreventive activity against oxidative stress-related damage in healthy tissues. The purpose of this study was to investigate the effects of piperine on intestinal damage. METHODS In this study, mice were divided into eight groups: including the control, piperine (10, 25, and 50 mg/kg), radiation (6 Gy), and piperine+radiation (10, 25 and 50 mg/kg + 6 Gy) groups. The radioprotective effects of piperine were evaluated by biochemical (MDA, GSH, and PC) and histopathological assessments in colon tissues. RESULTS The 10 mg/kg dose of piperine significantly reduced the levels of oxidative stress biomarkers compared to the group that received only radiation. In addition, pre-treatment with 10 mg/kg piperine diminished the histopathological changes like vascular congestion in the submucosa, while the dose of 50 mg/kg led to the infiltration of inflammatory cells. CONCLUSION Based on this study, it is concluded that piperine, at low dose, with its antioxidant properties, could reduce the colon damage caused by radiation.
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Affiliation(s)
- Asal Safarbalou
- Department of Pharmacy, Ramsar Campous, Mazandaran University of Medical Sciences, Ramsar, Iran
| | - Fatemeh Ebrahimi
- Department of Radiopharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fereshteh Talebpour Amiri
- Department of Anatomy, Faculty of Medicine, Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Jalal Hosseinimehr
- Department of Radiopharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
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179
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Mianowski S, De Angelis N, Brylew K, Hulsman J, Kowalski T, Kusyk S, Mianowska Z, Mietelski J, Rybka D, Swakon J, Wrobel D. Proton ir radiation of plastic scintillator bars for POLAR-2. Exp Astron (Dordr) 2023; 56:355-370. [PMID: 38145002 PMCID: PMC10746763 DOI: 10.1007/s10686-023-09906-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/21/2023] [Indexed: 12/26/2023]
Abstract
POLAR-2, a plastic scintillator based Compton polarimeter, is currently under development and planned for a launch to the China Space Station in 2025. It is intended to shed a new light on our understanding of Gamma-Ray Bursts by performing high precision polarization measurements of their prompt emission. The instrument will be orbiting at an average altitude of 383 km with an inclination of 42° and will be subject to background radiation from cosmic rays and solar events. In this work, we tested the performance of plastic scintillation bars, EJ-200 and EJ-248M from Eljen Technology, under space-like conditions, that were chosen as possible candidates for POLAR-2. Both scintillator types were irradiated with 58 MeV protons at several doses from 1.89 Gy(corresponding to about 13 years in space for POLAR-2) up to 18.7 Gy, that goes far beyond the expected POLAR-2 life time. Their respective properties, expressed in terms of light yield, emission and absorption spectra, and activation analysis due to proton irradiation are discussed. Scintillators activation analyses showed a dominant contribution of β + decay with a typical for this process gamma-ray energy line of 511 keV.
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Affiliation(s)
- Slawomir Mianowski
- National Centre for Nuclear Research, A. Soltana 7 Street, 05400 Otwock, Poland
| | - Nicolas De Angelis
- DPNC, University of Geneva, 24 Quai Ernest-Ansermet, CH-1205 Geneva, Switzerland
| | - Kamil Brylew
- National Centre for Nuclear Research, A. Soltana 7 Street, 05400 Otwock, Poland
| | - Johannes Hulsman
- DPNC, University of Geneva, 24 Quai Ernest-Ansermet, CH-1205 Geneva, Switzerland
| | - Tomasz Kowalski
- Institute of Nuclear Physics Polish Academy of Sciences, Radzikowskiego 152 Street, 31342 Krakow, Poland
| | - Sebastian Kusyk
- Institute of Nuclear Physics Polish Academy of Sciences, Radzikowskiego 152 Street, 31342 Krakow, Poland
| | - Zuzanna Mianowska
- National Centre for Nuclear Research, A. Soltana 7 Street, 05400 Otwock, Poland
| | - Jerzy Mietelski
- Institute of Nuclear Physics Polish Academy of Sciences, Radzikowskiego 152 Street, 31342 Krakow, Poland
| | - Dominik Rybka
- National Centre for Nuclear Research, A. Soltana 7 Street, 05400 Otwock, Poland
| | - Jan Swakon
- Institute of Nuclear Physics Polish Academy of Sciences, Radzikowskiego 152 Street, 31342 Krakow, Poland
| | - Damian Wrobel
- Institute of Nuclear Physics Polish Academy of Sciences, Radzikowskiego 152 Street, 31342 Krakow, Poland
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180
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He Y, Yang Y, Huang W, Yang S, Xue X, Zhu K, Tan H, Sun T, Yang W. Manganese facilitated cGAS-STING-IFNI pathway activation induced by ionizing radiation in glioma cells. Int J Radiat Biol 2023; 99:1890-1907. [PMID: 37406172 DOI: 10.1080/09553002.2023.2232011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/29/2023] [Accepted: 06/16/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE After irradiation, double-stranded DNA leaked into the cytoplasm activates the cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) pathway, leading to the production of type I interferon (IFNI). In this study, we sought to probe the effect of ionizing radiation on activity of cGAS-STING-IFNI pathway in normoxic or hypoxic glioma cells and explore a more effective method to activate the signaling pathway, thereby activating the anti-tumor immune response and improving the therapeutic effect of radiotherapy for glioma. MATERIALS AND METHODS Human glioma cells U251 and T98G cultured in normoxia or hypoxia (1% O2) were irradiated with different doses of X-ray. The relative expressions of cGAS, IFN-I stimulated genes (ISGs), and three-prime repair exonuclease 1 (TREX1) were detected by qPCR. The expression levels of interferon regulatory factor 3 (IRF3) and p-IRF3 proteins were detected by Western blot. The production of cGAMP and IFN-β in the supernatant was detected by ELISA assay. U251 and T98G cell lines with stable knockdown of TREX1 were established after transfection with lentivirus vectors. EdU cell proliferation assay was used to screen suitable metal ions concentrations. The phagocytosis of DCs was observed by immunofluorescence microscope. The phenotype of DCs was detected by flow cytometry. The migration ability of DCs was detected by a transwell experiment. RESULTS We found that cytosolic dsDNA, 2'3'-cGAMP, cGAS and ISGs expression, and IFN-β in cell supernatant were all increased with the doses of X-ray in the range of 0-16 Gy in normoxic glioma cells. Nevertheless, hypoxia significantly inhibited the radiation-induced dose-dependent activation of cGAS-STING-IFNI pathway. Furthermore, manganese (II) ion (Mn2+) significantly improved cGAS-STING-IFNI pathway activation induced by X-ray in both normoxic and hypoxic glioma cells, thereby promoting the maturation and migration of DCs. CONCLUSIONS The responses of cGAS-STING-IFNI pathway to ionizing radiation were mainly investigated under normoxic condition, but the experiments described here indicated that hypoxia could hinder the pathway activation. However, Mn2+ showed radiosensitizing effects on the pathway under either normoxic or hypoxic conditions demonstrating its potential as a radiosensitizer for glioma through activating an anti-tumor immune response.
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Affiliation(s)
- Yuping He
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, Jiangsu, China
| | - Ying Yang
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, Jiangsu, China
| | - Wenpeng Huang
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, Jiangsu, China
| | - Shuangyu Yang
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, Jiangsu, China
| | - Xuefei Xue
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, Jiangsu, China
| | - Kun Zhu
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, Jiangsu, China
| | - Huiling Tan
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, Jiangsu, China
| | - Ting Sun
- Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wei Yang
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, Jiangsu, China
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181
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Wang L, Dou X, Chen S, Yu X, Huang X, Zhang L, Chen Y, Wang J, Yang K, Bugno J, Pitroda S, Ding X, Piffko A, Si W, Chen C, Jiang H, Zhou B, Chmura SJ, Luo C, Liang HL, He C, Weichselbaum RR. YTHDF2 inhibition potentiates radiotherapy antitumor efficacy. Cancer Cell 2023; 41:1294-1308.e8. [PMID: 37236197 PMCID: PMC10524856 DOI: 10.1016/j.ccell.2023.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/23/2022] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Abstract
RNA N6-methyladenosine (m6A) modification is implicated in cancer progression. However, the impact of m6A on the antitumor effects of radiotherapy and the related mechanisms are unknown. Here we show that ionizing radiation (IR) induces immunosuppressive myeloid-derived suppressor cell (MDSC) expansion and YTHDF2 expression in both murine models and humans. Following IR, loss of Ythdf2 in myeloid cells augments antitumor immunity and overcomes tumor radioresistance by altering MDSC differentiation and inhibiting MDSC infiltration and suppressive function. The remodeling of the landscape of MDSC populations by local IR is reversed by Ythdf2 deficiency. IR-induced YTHDF2 expression relies on NF-κB signaling; YTHDF2 in turn leads to NF-κB activation by directly binding and degrading transcripts encoding negative regulators of NF-κB signaling, resulting in an IR-YTHDF2-NF-κB circuit. Pharmacological inhibition of YTHDF2 overcomes MDSC-induced immunosuppression and improves combined IR and/or anti-PD-L1 treatment. Thus, YTHDF2 is a promising target to improve radiotherapy (RT) and RT/immunotherapy combinations.
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Affiliation(s)
- Liangliang Wang
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA; Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL 60637, USA
| | - Xiaoyang Dou
- Department of Chemistry, Department of Biochemistry and Molecular Biology, and Institute for Biophysical Dynamics, The University of Chicago, Chicago, IL 60637, USA; Howard Hughes Medical Institute, University of Chicago, Chicago, IL 60637, USA
| | - Shijie Chen
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Xianbin Yu
- Department of Chemistry, Department of Biochemistry and Molecular Biology, and Institute for Biophysical Dynamics, The University of Chicago, Chicago, IL 60637, USA; Howard Hughes Medical Institute, University of Chicago, Chicago, IL 60637, USA
| | - Xiaona Huang
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA; Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL 60637, USA
| | - Linda Zhang
- Department of Chemistry, Department of Biochemistry and Molecular Biology, and Institute for Biophysical Dynamics, The University of Chicago, Chicago, IL 60637, USA; Howard Hughes Medical Institute, University of Chicago, Chicago, IL 60637, USA
| | - Yantao Chen
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Jiaai Wang
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA; Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL 60637, USA
| | - Kaiting Yang
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA; Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL 60637, USA
| | - Jason Bugno
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA; Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL 60637, USA; The Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, IL 600637, USA
| | - Sean Pitroda
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA; Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL 60637, USA
| | - Xingchen Ding
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Andras Piffko
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA; Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL 60637, USA; Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Wei Si
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - Chao Chen
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Hualiang Jiang
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Bing Zhou
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Steven J Chmura
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA
| | - Cheng Luo
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China; Zhongshan Institute for Drug Discovery, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Zhongshan 528437, China.
| | - Hua Laura Liang
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA; Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL 60637, USA.
| | - Chuan He
- Department of Chemistry, Department of Biochemistry and Molecular Biology, and Institute for Biophysical Dynamics, The University of Chicago, Chicago, IL 60637, USA; Howard Hughes Medical Institute, University of Chicago, Chicago, IL 60637, USA; Department of Biochemistry and Molecular Biology, University of Chicago, Chicago, IL 60637, USA.
| | - Ralph R Weichselbaum
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA; Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL 60637, USA.
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182
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Dossin C, Di Perri D, Whenham N, Bocchio AP, Tatar IG. SMART Syndrome: Case Report and Review of the Literature. J Belg Soc Radiol 2023; 107:49. [PMID: 37427025 PMCID: PMC10327860 DOI: 10.5334/jbsr.3198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/04/2023] [Indexed: 07/11/2023] Open
Abstract
Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare condition characterized by stroke-like deficits, seizures, and headache that can occur years after radiation therapy (RT) to the brain. RT is a cornerstone in the treatment of primary brain tumours and is indicated in more than 90% of patients. It is therefore essential to be aware of this entity to prevent misdiagnosis leading to inappropriate treatment. In this article, typical imaging findings of this condition are presented through a case report and review of the literature.
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Affiliation(s)
| | - Dario Di Perri
- Cliniques universitaires Saint Luc, Department of radiotherapy, BE
| | - Nicolas Whenham
- Cliniques universitaires Saint Luc, Department of radiation oncology, BE
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183
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Yamamoto A, Ieki H, Shimamura M, Tsujiura M, Yokoe T, Sanuki N, Ojima E, Uchida K, Mohri Y. Symptom palliation with QUAD Shot radiation therapy to penile metastasis derived from descending colon cancer: a case report. Int Cancer Conf J 2023; 12:210-215. [PMID: 37251007 PMCID: PMC10212838 DOI: 10.1007/s13691-023-00604-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023] Open
Abstract
A 54-year-old man was diagnosed with descending colon cancer with metastases in the liver, para-aortic lymph nodes, and penis, and chemotherapy was introduced after construction of a colostomy. The patient reported only mild penile pain at the time of diagnosis; however, the pain gradually worsened and interfered with his daily life. Opioids did not provide sufficient analgesia, and the patient developed dysuria and priapism. Through construction of a cystostomy, palliative radiotherapy with QUAD Shot regimen (14 Gy in 4 fractions twice-daily on 2 days repeated every 4 weeks) to the penile metastasis was started for pain relief and tumor shrinkage. The radiation rapidly improved the penile symptoms, enabling opioid reduction and cystostomy removal. The patient remained pain-free and able to urinate on his own until his death. Metastatic penile tumors are rare, especially those derived from colon cancer. Penile metastases occur mainly in the late stages of cancer and may impair the patient's quality of life. In such cases, palliative radiotherapy, especially with QUAD Shot regimen, is useful with short treatment time, durable symptom control, and little adverse effect, maintaining quality of life.
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Affiliation(s)
- Akira Yamamoto
- Department of Gastrointestinal and General Surgery, Mie Prefectural General Medical Center, 5450-132, Hinaga, Yokkaichi, Mie 514-8561 Japan
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie 514-8507 Japan
| | - Hideharu Ieki
- Department of Gastrointestinal and General Surgery, Mie Prefectural General Medical Center, 5450-132, Hinaga, Yokkaichi, Mie 514-8561 Japan
| | - Mai Shimamura
- Department of Gastrointestinal and General Surgery, Mie Prefectural General Medical Center, 5450-132, Hinaga, Yokkaichi, Mie 514-8561 Japan
| | - Masahiro Tsujiura
- Department of Gastrointestinal and General Surgery, Mie Prefectural General Medical Center, 5450-132, Hinaga, Yokkaichi, Mie 514-8561 Japan
| | - Takeshi Yokoe
- Department of Gastrointestinal and General Surgery, Mie Prefectural General Medical Center, 5450-132, Hinaga, Yokkaichi, Mie 514-8561 Japan
| | - Naoko Sanuki
- Department of Radiation Oncology, Mie Prefectural General Medical Center, 5450-132 Hinaga, Yokkaichi, Mie 514-8561 Japan
| | - Eiki Ojima
- Department of Gastrointestinal and General Surgery, Mie Prefectural General Medical Center, 5450-132, Hinaga, Yokkaichi, Mie 514-8561 Japan
| | - Keiichi Uchida
- Department of Pediatric Surgery, Mie Prefectural General Medical Center, 5450-132 Hinaga, Yokkaichi, Mie 514-8561 Japan
| | - Yasuhiko Mohri
- Department of Gastrointestinal and General Surgery, Mie Prefectural General Medical Center, 5450-132, Hinaga, Yokkaichi, Mie 514-8561 Japan
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184
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Lussier L, Wallner K, Kearney KE, Tiwana J, Kim EY, Parvathaneni U, Lombardi WL, Phillips M, Don C, Kim M. Image-guided intravascular brachytherapy dose escalation. Brachytherapy 2023; 22:518-523. [PMID: 37211487 DOI: 10.1016/j.brachy.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/15/2023] [Accepted: 04/05/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE Coronary stents reduce IVBT radiation dose with a single layer by 10-30%. However, the impact of multiple stent layers and stent expansion remains unexplored. Individualized dose adjustments considering variations in stent layers and expansion could improve radiation delivery effectiveness. METHODS EGSnrc was used to compute the delivered vessel wall dose in various IVBT scenarios. Stent effects were modeled for the stent density of 25%, 50%, and 75% with 1, 2, and 3 layers respectively. Doses were calculated at 1.75 to 5.00 mm away from the source center, normalized to 100% at 2 mm. RESULTS Dose fall-off increased with increasing stent density. With a single layer, the dose at 2 mm from source fell from 100% of prescription to 92%, 83% and 73% at 25%, 50% and 75% density, respectively. The computed dose to points with increasing radial distance from the source decreased progressively with increasing stent layers. With three layers, at 75% stent density, the dose at 2 mm from source center fell to 38%. CONCLUSIONS A schema for image-guided IVBT dose adjustment is described. While it would be an improvement over current standard of care, myriad factors remain to be addressed in a comprehensive effort to optimize IVBT.
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Affiliation(s)
- Luke Lussier
- Department of Physics, St. Mary's University, San Antonio, TX
| | - Kent Wallner
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | | | - Jasleen Tiwana
- Department of Cardiology, University of Washington, Seattle, WA
| | - Edward Y Kim
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | | | | | - Mark Phillips
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Creighton Don
- Department of Cardiology, University of Washington, Seattle, WA
| | - Minsun Kim
- Department of Radiation Oncology, University of Washington, Seattle, WA.
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185
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Zhang YW, Wang B, An SY, Liu WH, Wang C, Yan H, Xu YL, Wang YZ, Jia WQ. Clinical management and prognosis of spinal myxopapillary ependymoma: a single-institution cohort of 72 patients. Eur Spine J 2023; 32:2459-2467. [PMID: 37027035 DOI: 10.1007/s00586-023-07690-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/12/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE Myxopapillary ependymoma (MPE) was classified as grade 2 tumor in the 2021 World Health Organization central nervous system classification because of its high recurrence probability. This study aimed to investigate predictive factors and management of tumor recurrence. METHODS Seventy-two patients with spinal MPE underwent initial surgical treatment at our hospital between 2011 and 2021. Kaplan-Meier curves and Cox regression were used to analyze the correlation between clinical variables and progression-free survival (PFS). RESULTS The median age at diagnosis was 33.5 years (range 8-60 years). Twenty-one patients (29.2%) had preoperative spinal drop metastases. Gross total resection (GTR) was performed in 37 patients (51.4%). The median follow-up was 7.2 years, and the follow-up rate was 88.9% (64 of 72 cases). Twelve of the 64 patients (18.9%) relapsed, and preoperative drop metastasis occurred in 7 patients (58.3%). The estimated 5-year and 10-year PFS rates were 82% and 77%, respectively. Univariate analysis showed that GTR was associated with improved PFS (hazard ratio [HR] 0.149, p = 0.014), while preoperative drop metastasis (HR 3.648, p = 0.027) and tumor involvement sacrococcygeal region (HR 7.563, p = 0.003) were associated with tumor recurrence. Adjuvant radiotherapy (RT) was significantly associated with improved PFS in patients with preoperative drop metastasis (p = 0.039). CONCLUSION Complete surgical resection under the premise of protecting neurological function is an important factor in reducing spinal MPE recurrence. Adjuvant RT is recommended when the tumor invades the capsule with preoperative drop metastasis or adhesion to the nerve and cannot reach GTR.
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Affiliation(s)
- Yao-Wu Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Bo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Song-Yuan An
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Wei-Hao Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Chong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Hao Yan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Yu-Lun Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Yong-Zhi Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
| | - Wen-Qing Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
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Rose LD, Williams R, Ajayi B, Abdalla M, Bernard J, Bishop T, Papadakos N, Lui DF. Reducing radiation exposure and cancer risk for children with scoliosis: EOS the new gold standard. Spine Deform 2023; 11:847-851. [PMID: 36947393 PMCID: PMC10261215 DOI: 10.1007/s43390-023-00653-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/21/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Children are exposed to significant radiation doses during the investigation and treatment phases of scoliosis. EOS is a new form of low-dose radiation scan which also yields great image quality. However, currently its use is discouraged in the UK due to higher costs. We aimed to quantify the additional radiation dose and cancer risk. METHODS We retrospectively reviewed all paediatric cases who received both standing whole spine roentgenograms and EOS scans as part of their investigations for scoliosis during a six-month period. We compared the radiation doses between the two modalities and estimated the additional mean lifetime cancer risk per study. RESULTS We identified 206 children (mean age 14.4) who met the criteria of having both scans. Dose area products (dGycm2) were converted to estimated effective doses (mSv). The total mean doses were 0.68 mSv (PA 0.49 + Lat 0.19) for plain films, and 0.13 mSv (PA 0.08 + Lat 0.04) for EOS scans (p < 0.001). Additional lifetime cancer risk of a plain film was 543% greater than EOS for both sexes (1/10727 versus 1/5827 in males, 1/34483 versus 1/6350 in females). CONCLUSION There is approximately 5.4-fold increase in risk of cancer for both boys and girls with roentgenograms over EOS, with girls being the most impacted. This carries a significant impact when considering the need for repeat imaging on additional lifetime malignancy risk in children. In our opinion, EOS dual planar scanning is the new gold standard when X-ray of the whole spine is required. LEVEL OF EVIDENCE III.
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Affiliation(s)
- L. D. Rose
- Department of Trauma and Orthopaedic Surgery, St George’s University Hospital, London, UK
| | - R. Williams
- Department of Trauma and Orthopaedic Surgery, St George’s University Hospital, London, UK
| | - B. Ajayi
- Department of Trauma and Orthopaedic Surgery, St George’s University Hospital, London, UK
| | - M. Abdalla
- Department of Trauma and Orthopaedic Surgery, St George’s University Hospital, London, UK
| | - J. Bernard
- Department of Trauma and Orthopaedic Surgery, St George’s University Hospital, London, UK
| | - T. Bishop
- Department of Trauma and Orthopaedic Surgery, St George’s University Hospital, London, UK
| | - N. Papadakos
- Department of Trauma and Orthopaedic Surgery, St George’s University Hospital, London, UK
| | - D. F. Lui
- Department of Trauma and Orthopaedic Surgery, St George’s University Hospital, London, UK
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187
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Kelly-Reif K, Bertke SJ, Rage E, Demers PA, Fenske N, Deffner V, Kreuzer M, Samet J, Schubauer-Berigan MK, Tomasek L, Zablotska LB, Wiggins C, Laurier D, Richardson DB. Radon and lung cancer in the pooled uranium miners analysis (PUMA): highly exposed early miners and all miners. Occup Environ Med 2023; 80:385-391. [PMID: 37164624 PMCID: PMC10369304 DOI: 10.1136/oemed-2022-108532] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Radon is a ubiquitous occupational and environmental lung carcinogen. We aim to quantify the association between radon progeny and lung cancer mortality in the largest and most up-to-date pooled study of uranium miners. METHODS The pooled uranium miners analysis combines 7 cohorts of male uranium miners with 7754 lung cancer deaths and 4.3 million person-years of follow-up. Vital status and lung cancer deaths were ascertained between 1946 and 2014. The association between cumulative radon exposure in working level months (WLM) and lung cancer was modelled as the excess relative rate (ERR) per 100 WLM using Poisson regression; variation in the association by temporal and exposure factors was examined. We also examined analyses restricted to miners first hired before 1960 and with <100 WLM cumulative exposure. RESULTS In a model that allows for variation by attained age, time since exposure and annual exposure rate, the ERR/100 WLM was 4.68 (95% CI 2.88 to 6.96) among miners who were less than 55 years of age and were exposed in the prior 5 to <15 years at annual exposure rates of <0.5 WL. This association decreased with older attained age, longer time since exposure and higher annual exposure rate. In analyses restricted to men first hired before 1960, we observed similar patterns of association but a slightly lower estimate of the ERR/100 WLM. CONCLUSIONS This new large, pooled study confirms and supports a linear exposure-response relationship between cumulative radon exposure and lung cancer mortality which is jointly modified by temporal and exposure factors.
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Affiliation(s)
- Kaitlin Kelly-Reif
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Stephen J Bertke
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Estelle Rage
- Institute for Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nora Fenske
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - Veronika Deffner
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - Michaela Kreuzer
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | | | - Mary K Schubauer-Berigan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Lydia B Zablotska
- Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Charles Wiggins
- University of New Mexico, Albuquerque, New Mexico, USA
- New Mexico Tumor Registry, Albuquerque, Mexico, USA
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France
| | - David B Richardson
- Department of Environmental and Occupational Health, University of California, Irvine, Program in Public Health, Irvine, California, USA
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188
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Holcomb AJ, Farrokhian N, Tolan C, Whiteford E, Villwock M, Kakarala K, Shnayder Y, Sykes K, Lominska C, Gan G, Buchakjian MR, Harding B, Dooley L, Shinn J, Burton Wood C, Rohde S, Khaja S, Abt NB, Varvares M, Bur AM. Adjuvant radiotherapy mitigates impact of perineural invasion on oncologic outcomes in early-stage oral cavity squamous cell carcinoma. A multi-institutional analysis of 557 patients. Oral Oncol 2023; 142:106420. [PMID: 37182430 PMCID: PMC10575471 DOI: 10.1016/j.oraloncology.2023.106420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/13/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVES Understand the prognostic impact of perineural invasion (PNI) in early-stage oral cavity squamous cell carcinoma (OCSCC). Assess the influence of adjuvant radiotherapy on outcomes of patients with PNI-positive early-stage OCSCC. MATERIALS AND METHODS Retrospective seven-institution cohort study including patients with pathologic T1-2 N0-1 OCSCC who underwent primary surgery with negative margins. Outcomes included disease-free survival (DFS) and locoregional control (LRC). Cox proportional hazards models were used to evaluate oncologic outcomes. Interaction terms were introduced to assess relationships between PNI and adjuvant radiotherapy. RESULTS Among 557 patients (mean (SD) age 61.0 (13.9), 47.2% female, 66.6% pathologic T1, 93.5% pathologic N0), 93 had PNI-positive tumors, among which 87.1% underwent neck dissection and 39.6% received radiotherapy. On multivariable analysis, PNI was associated with lower DFS and LRC. Adjuvant radiotherapy was not associated with improved outcomes on multivariable analysis of the entire cohort. However, among patients with PNI-positive tumors, adjuvant radiotherapy significantly decreased hazard for DFS. CONCLUSION Among patients with low-risk, early-stage OCSCC, PNI was associated with worse DFS and LRC. In patients with PNI-positive tumors, adjuvant radiotherapy lowered hazard for DFS on multivariable analysis. These data support using adjuvant radiotherapy for patients with early-stage OCSCC with PNI.
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Affiliation(s)
- Andrew J Holcomb
- Department of Head & Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, NE, United States.
| | - Nathan Farrokhian
- University of Kansas Department of Otolaryngology Head & Neck Surgery, Kansas City, KS, United States
| | - Claire Tolan
- Department of Head & Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, NE, United States
| | - Erin Whiteford
- Department of Head & Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, NE, United States
| | - Mark Villwock
- University of Kansas Department of Otolaryngology Head & Neck Surgery, Kansas City, KS, United States
| | - Kiran Kakarala
- University of Kansas Department of Otolaryngology Head & Neck Surgery, Kansas City, KS, United States
| | - Yelizaveta Shnayder
- University of Kansas Department of Otolaryngology Head & Neck Surgery, Kansas City, KS, United States
| | - Kevin Sykes
- University of Kansas Department of Otolaryngology Head & Neck Surgery, Kansas City, KS, United States
| | - Christopher Lominska
- University of Kansas Department of Otolaryngology Head & Neck Surgery, Kansas City, KS, United States
| | - Gregory Gan
- University of Kansas Department of Otolaryngology Head & Neck Surgery, Kansas City, KS, United States
| | - Marisa R Buchakjian
- University of Iowa Department of Otolaryngology Head & Neck Surgery, Iowa City, IA, United States
| | - Brette Harding
- University of Missouri Department of Otolaryngology Head & Neck Surgery, Columbia, MO, United States
| | - Laura Dooley
- University of Missouri Department of Otolaryngology Head & Neck Surgery, Columbia, MO, United States
| | - Justin Shinn
- Vanderbilt University Department of Otolaryngology Head & Neck Surgery, Nashville, TN, United States
| | - C Burton Wood
- Vanderbilt University Department of Otolaryngology Head & Neck Surgery, Nashville, TN, United States
| | - Sarah Rohde
- Vanderbilt University Department of Otolaryngology Head & Neck Surgery, Nashville, TN, United States
| | - Sobia Khaja
- University of Minnesota Department of Otolaryngology Head & Neck Surgery, Minneapolis, MN, United States
| | - Nicholas B Abt
- Massachusetts Eye and Ear, Harvard Medical School Department of Otolaryngology Head & Neck Surgery, Boston, MA, United States
| | - Mark Varvares
- Massachusetts Eye and Ear, Harvard Medical School Department of Otolaryngology Head & Neck Surgery, Boston, MA, United States
| | - Andrés M Bur
- University of Kansas Department of Otolaryngology Head & Neck Surgery, Kansas City, KS, United States
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Fukasawa M, Nishi D, Umeda M, Akiyama T, Horikoshi N, Yasumura S, Yabe H, Suzuki Y, Bromet EJ, Kawakami N. Effects of disaster-related traumatic events on worry about radiation and COVID-19: A decade after the Fukushima nuclear power plant accident. J Psychiatr Res 2023; 163:135-141. [PMID: 37210831 DOI: 10.1016/j.jpsychires.2023.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/01/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023]
Abstract
Community residents exposed to nuclear power plant (NPP) accidents have long-term worry about the effects of radiation. After the 2011 Fukushima NPP accident, those who experienced traumatic events during the Great East Japan Earthquake (GEJE) tended to have greater worry about radiation. Along with the prolonged worry about radiation, there may also be cognitive changes caused by the traumatic events. We hypothesized that if there were cognitive changes underlying the prolonged worry about radiation, those who experienced the traumatic events would tend to have greater worry about other issues unrelated to radiation. We examined the effects of the traumatic events during the GEJE on community residents' worry about radiation and COVID-19 a decade after the Fukushima NPP accident. Using the data of a longitudinal questionnaire survey following a random sample of 4900 community residents outside the evacuation zone in Fukushima, this study analyzed 774 responses (15.8%). The traumatic events consisted of (1) injury, (2) injury or death of a family member, and (3) the loss of a house or other property. We developed a mediation model drawing paths from the traumatic events to worry about radiation and COVID-19, including posttraumatic stress symptoms (PTSS) as a mediator, using structural equation modeling. The traumatic events directly affected worry about radiation. Although it did not directly affect worry about COVID-19, it did so indirectly through worry about radiation and PTSS. Traumatic events can increase trauma-related worry independently of PTSS and increase trauma-unrelated worry indirectly through trauma-related worry and PTSS.
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Affiliation(s)
- Maiko Fukasawa
- Health Promotion Center, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan.
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-0033, Japan; Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
| | - Maki Umeda
- Research Institute of Nursing Care for People and Community, University of Hyogo, 13-71 Kitaoji-cho, Akashi City, Hyogo, 673-8588, Japan
| | - Tsuyoshi Akiyama
- Department of Neuropsychiatry, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Naoko Horikoshi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Seiji Yasumura
- Department of Public Health, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Hirooki Yabe
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Yuriko Suzuki
- Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
| | - Evelyn J Bromet
- Department of Psychiatry and Behavioural Health, Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Norito Kawakami
- Department of Digital Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-0033, Japan
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190
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Leskinen S, Shah HA, Yaffe B, Schneider SJ, Ben-Shalom N, Boockvar JA, D'Amico RS, Wernicke AG. Hippocampal avoidance in whole brain radiotherapy and prophylactic cranial ir radiation: a systematic review and meta-analysis. J Neurooncol 2023; 163:515-527. [PMID: 37395975 DOI: 10.1007/s11060-023-04384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE We systematically reviewed the current landscape of hippocampal-avoidance radiotherapy, focusing specifically on rates of hippocampal tumor recurrence and changes in neurocognitive function. METHODS PubMed was queried for studies involving hippocampal-avoidance radiation therapy and results were screened using PRISMA guidelines. Results were analyzed for median overall survival, progression-free survival, hippocampal relapse rates, and neurocognitive function testing. RESULTS Of 3709 search results, 19 articles were included and a total of 1611 patients analyzed. Of these studies, 7 were randomized controlled trials, 4 prospective cohort studies, and 8 retrospective cohort studies. All studies evaluated hippocampal-avoidance whole brain radiation treatment (WBRT) and/or prophylactic cranial irradiation (PCI) in patients with brain metastases. Hippocampal relapse rates were low (overall effect size = 0.04; 95% confidence interval [0.03, 0.05]) and there was no significant difference in risk of relapse between the five studies that compared HA-WBRT/HA-PCI and WBRT/PCI groups (risk difference = 0.01; 95% confidence interval [- 0.02, 0.03]; p = 0.63). 11 out of 19 studies included neurocognitive function testing. Significant differences were reported in overall cognitive function and memory and verbal learning 3-24 months post-RT. Differences in executive function were reported by one study, Brown et al., at 4 months. No studies reported differences in verbal fluency, visual learning, concentration, processing speed, and psychomotor speed at any timepoint. CONCLUSION Current studies in HA-WBRT/HA-PCI showed low hippocampal relapse or metastasis rates. Significant differences in neurocognitive testing were most prominent in overall cognitive function, memory, and verbal learning. Studies were hampered by loss to follow-up.
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Affiliation(s)
- Sandra Leskinen
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Harshal A Shah
- Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Beril Yaffe
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY, USA
| | - Shonna J Schneider
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY, USA
| | - Netanel Ben-Shalom
- Department of Neurological Surgery, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY, USA
| | - John A Boockvar
- Department of Neurological Surgery, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY, USA
| | - Randy S D'Amico
- Department of Neurological Surgery, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY, USA
| | - A Gabriella Wernicke
- Department of Radiation Oncology, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY, USA.
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191
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Holdaway M, Starner J, Patel RR, Salama J, Langer DJ, Ellis JA, Boockvar JA, D'Amico RS, Wernicke AG. Improvement in visual outcomes of patients with base of skull meningioma as a result of evolution in the treatment techniques in the last three decades: a systematic review. J Neurooncol 2023; 163:485-503. [PMID: 37354356 DOI: 10.1007/s11060-023-04366-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/07/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE We systematically reviewed visual outcomes over the last three decades in patients undergoing treatment for base of skull (BOS) meningiomas and provide recommendations to preserve vision. METHODS In accordance with the PRISMA guidelines for systematic reviews, a search was conducted from 6/1/2022-9/1/2022 using PubMed and Web of Science. Inclusion criteria included (1) patients treated for BOS meningiomas (2) treatment modality specified (3) specifics of surgical techniques and/or dose/fractions of radiotherapy (4) individual patient outcomes of treatment. Each study was assessed for bias based on study design and heterogeneity of results. RESULTS A total of 50 studies were included (N = 2911). When comparing improved vision versus unchanged or worsened vision, studies investigating surgery alone published from 2006 and onward had significantly better visual outcomes compared to pre-2006 studies (p = 0.02). When comparing improved vision versus unchanged or worsened vision, studies investigating combined therapy with surgery and radiation published from 2008 and onward had significantly better visual outcomes compared to pre-2008 studies (p < 0.01). Combined modality therapy was less likely to worsen vision compared to either surgery or radiation monotherapy (p < 0.01). However, surgery and radiation monotherapy were more likely to actually improve outcomes compared to combination therapy (p < 0.01). CONCLUSION For over a decade we have observed improvement in visual outcomes in patients managed for meningioma of BOS, likely attributing the innovation in microsurgical and more targeted and conformal radiation techniques. Combination therapy may be the safest option for preventing worsening of vision, but the highest rates of improving visual function are achieved through monotherapy when indicated.
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Affiliation(s)
| | - John Starner
- Department of Radiation Medicine, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 130 East 77th Street, New York, NY, 10065, USA
| | - Roshal R Patel
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Joshua Salama
- SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - David J Langer
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - Jason A Ellis
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - John A Boockvar
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - Randy S D'Amico
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - A Gabriella Wernicke
- Department of Radiation Medicine, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 130 East 77th Street, New York, NY, 10065, USA.
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA.
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192
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Hakim SG, von der Gracht A, Pries R, Rades D, Steller D. Protective impact of nicotinamide mononucleotide (NMN) and platelet-rich fibrin (PRF) on replicative and radiation-induced senescence of human osteoblasts. J Craniomaxillofac Surg 2023; 51:497-507. [PMID: 37438229 DOI: 10.1016/j.jcms.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/04/2023] [Accepted: 06/25/2023] [Indexed: 07/14/2023] Open
Abstract
The aim of this study was to investigate the cellular changes induced by spontaneous/replicative senescence and radiation in human osteoblasts (OBs), and the impact of cultivation with nicotinamide mononucleotide (NMN) and platelet-rich fibrin (PRF) on apoptosis, senescence-associated β-galactosidase staining (SA β-gal), and senescence-related gene expression using RT2 Profiler PCR array. The results showed that replicative OB aging follows a different pattern from that of radiation-induced cellular senescence. SA β-gal intensity score showed a significant elevation after spontaneous replicative aging of OB (agiT1) 7 days following the start of the experiment, compared with their initial control condition (T0) (T0 = 2.1 ± 0.47; agiT1 = 9.60 ± 1.56; p = 0.001). Concurrent treatment by NMN and PRF showed a protective effect on OBs undergoing replicative senescence, and reduced SA β-gal staining significantly (agiT1 = 9.60 ± 1.56; agiT1+PRF = 3.19 ± 0.52; agiT1+NMN = 3.38 ± 0.36; p < 0.001). These results provide evidence for the potential clinical implications of systematic NMN administration and local PRF application to prevent age-related bone disturbances in elderly patients.
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Affiliation(s)
- Samer G Hakim
- Department of Oral and Maxillofacial Surgery, Helios Medical Center, Schwerin, Germany; Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Campus Lübeck), Lübeck, Germany.
| | - Anij von der Gracht
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Campus Lübeck), Lübeck, Germany
| | - Ralph Pries
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein (Campus Lübeck), Lübeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University Hospital Schleswig-Holstein (Campus Lübeck), Lübeck, Germany
| | - Daniel Steller
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Campus Lübeck), Lübeck, Germany
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Cibula D, Rosaria Raspollini M, Planchamp F, Centeno C, Chargari C, Felix A, Fischerová D, Jahnn-Kuch D, Joly F, Kohler C, Lax S, Lorusso D, Mahantshetty U, Mathevet P, Raj Naik M, Nout RA, Oaknin A, Peccatori F, Persson J, Querleu D, Rubio Bernabé S, Schmid MP, Stepanyan A, Svintsitskyi V, Tamussino K, Zapardiel I, Lindegaard J. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer - Update 2023. Radiother Oncol 2023; 184:109682. [PMID: 37336614 DOI: 10.1016/j.radonc.2023.109682] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for the management of patients with cervical cancer. Given the large body of new evidence addressing the management of cervical cancer, the three sister societies jointly decided to update these evidence-based guidelines. The update includes new topics to provide comprehensive guidelines on all relevant issues of diagnosis and treatment in cervical cancer. To serve on the expert panel (27 experts across Europe) ESGO/ESTRO/ESP nominated practicing clinicians who are involved in managing patients with cervical cancer and have demonstrated leadership through their expertise in clinical care and research, national and international engagement, profile, and dedication to the topics addressed. To ensure the statements were evidence based, new data identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Before publication, the guidelines were reviewed by 155 independent international practitioners in cancer care delivery and patient representatives. These updated guidelines are comprehensive and cover staging, management, follow-up, long-term survivorship, quality of life and palliative care. Management includes fertility sparing treatment, early and locally advanced cervical cancer, invasive cervical cancer diagnosed on a simple hysterectomy specimen, cervical cancer in pregnancy, rare tumors, recurrent and metastatic diseases. The management algorithms and the principles of radiotherapy and pathological evaluation are also defined.
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Affiliation(s)
- David Cibula
- Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine, Prague, Czech Republic; General University Hospital in Prague, Prague, Czech Republic.
| | | | | | - Carlos Centeno
- Department of Palliative Medicine, University of Navarra, Pamplona, Spain
| | - Cyrus Chargari
- Service d'Oncologie Radiothérapie, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | - Ana Felix
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal; Universidade Nova de Lisboa, Lisboa, Portugal
| | - Daniela Fischerová
- Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine, Prague, Czech Republic; General University Hospital in Prague, Prague, Czech Republic
| | - Daniela Jahnn-Kuch
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florence Joly
- François Baclesse Centre de Lutte Contre le Cancer, Caen, France
| | - Christhardt Kohler
- Asklepios Clinic Altona, Hamburg, Germany; Asklepios Comprehensive Tumor Center, Hamburg, Germany
| | - Sigurd Lax
- Hospital Graz II, Graz, Austria; Johannes Kepler Universitat Linz, Linz, Austria
| | - Domenica Lorusso
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy; Catholic University of Sacred Heart, Rome, Italy
| | - Umesh Mahantshetty
- Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, Andhra Pradesh, India
| | | | - Mr Raj Naik
- Northern Gynaecological Oncology Centre, Gateshead, UK
| | - Remi A Nout
- Radiotherapy, Erasmus MC Cancer Centre, Rotterdam, the Netherlands; University Medical Center, Rotterdam, the Netherlands
| | - Ana Oaknin
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Jan Persson
- Department of Obstetrics and Gynecology, Lund University Hosptial, Lund, Sweden; Skåne University Hospital Lund, Lund, Sweden
| | - Denis Querleu
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy; University Hospitals Strasbourg, Strasbourg, France
| | | | - Maximilian P Schmid
- Department of Radiation Oncology, Medical University of Vienna, Wien, Austria
| | - Artem Stepanyan
- Gynecologic Oncology, Nairi Medical Center, Yerevan, Armenia
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Yadav R, Patil RB, Umbare DK, Vajpayee A, Thakur PR, Chauhan I. Quality of Life of Oral Squamous Cell Carcinoma Patients before and after Primary Treatment. J Pharm Bioallied Sci 2023; 15:S1093-S1096. [PMID: 37693965 PMCID: PMC10485519 DOI: 10.4103/jpbs.jpbs_208_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/05/2023] [Accepted: 03/07/2023] [Indexed: 09/12/2023] Open
Abstract
Background HNSCC (head and neck squamous cell carcinoma) is a serious global health problem, with estimated more than 550,000 new cases and 300,000 deaths annually. More than 90% of these malignancies are oral squamous cell carcinoma (OSCC). Materials and Methods Patients selected were asked to fill the detailed structured case history proforma and thorough clinical examination, structured, pre-designed, pre-evaluated (UW-QOL) UW Questionnaire version 4 on quality of life (QOL) of oral squamous cell carcinoma patients containing thirteen subjective questionnaires and three global questionnaires. All the patients of OSCC after one month (1 month) of radiation and chemotherapy were assessed for quality of life by questionnaire. Result Post-treatment QOL assessment of OSCC patients reveals a number of problems such as chewing, swallowing, saliva, lack of activity, and mood disturbances. Preoperative clinical features including tumor site, tumor stage, and extent of mouth opening have a significant impact on post-treatment problems in different ways. Conclusion The need to balance clinician's need and use of health-related quality of life (HRQOL) data against patient's burden should be considered in the selection process.
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Affiliation(s)
- Renu Yadav
- Department of Oral Pathology and Microbiology, MGV’S KBH Dental College and Hospital, Nashik, Maharashtra, India
| | - Rahul B. Patil
- Department of Oral Pathology and Microbiology, Rural Dental College, PIMS (DU), Loni, Maharashtra, India
| | - Dhiraj K. Umbare
- Department of Oral Pathology and Microbiology, Rural Dental College, PIMS (DU), Loni, Maharashtra, India
| | - Akhilesh Vajpayee
- Department of Conservative Dentistry and Endodontics, Daswani Dental College and Research Centre, Kota, Rajasthan, India
| | - Pranay R. Thakur
- Department of Oral and Maxillofacial Surgery, Rishiraj College of Dental Science, Bhopal, Madhya Pradesh, India
| | - Isha Chauhan
- Department of Oral Pathology and Microbiology, India
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195
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Friedman R, Spiegel DY, Kinney J, Willcox J, Recht A, Singhal D. Quantifying radiation in the axillary bed at the site of lymphedema surgical prevention. Breast Cancer Res Treat 2023:10.1007/s10549-023-06988-y. [PMID: 37382815 DOI: 10.1007/s10549-023-06988-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/24/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE Immediate lymphatic reconstruction (ILR) is a procedure known to reduce the risk of lymphedema in patients undergoing axillary lymph node dissection (ALND). However, patients who receive adjuvant radiotherapy are at increased risk of lymphedema. The aim of this study was to quantify the extent of radiation at the site of surgical prevention. METHODS We recently began deploying clips at the site of ILR to identify the site during radiation planning. A retrospective review was performed to identify breast cancer patients who underwent ILR with clip deployment and adjuvant radiation therapy from October 2020 to April 2022. Patients were excluded if they had not completed radiotherapy. The exposure and dose of radiation received by the site was determined and recorded. RESULTS In a cohort of 11 patients, the site fell within the radiation field in 7 patients (64%) and received a median dose of 4280 cGy. Among these 7 patients, 3 had sites located within tissue considered at risk of oncologic recurrence and the remaining 4 sites received radiation from a tangential field treating the breast or chest wall. The median dose to the ILR site for the 4 patients whose sites were outside the radiation fields was 233 cGy. CONCLUSION Our findings suggest that even when the site of surgical prevention was not within the targeted radiation field during treatment planning, it remains susceptible to radiation. Strategies for limiting radiation at this site are needed.
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Affiliation(s)
- Rosie Friedman
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Suite 5A, Boston, MA, 02215, USA
| | - Daphna Y Spiegel
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - JacqueLyn Kinney
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Suite 5A, Boston, MA, 02215, USA
| | - Julia Willcox
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Abram Recht
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Dhruv Singhal
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Suite 5A, Boston, MA, 02215, USA.
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196
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Lacombe J, Summers AJ, Khanishayan A, Khorsandian Y, Hacey I, Blackson W, Zenhausern F. Paper-Based Vertical Flow Immunoassay for the Point-of-Care Multiplex Detection of Radiation Dosimetry Genes. Cytogenet Genome Res 2023; 163:178-186. [PMID: 37369178 PMCID: PMC10751381 DOI: 10.1159/000531702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 06/18/2023] [Indexed: 06/29/2023] Open
Abstract
In a nuclear or radiological incident, first responders must quickly and accurately measure radiation exposure among civilians as medical countermeasures are radiation dose-dependent and time-sensitive. Although several approaches have been explored to measure absorbed radiation dose, there is an important need to develop point-of-care (POC) bioassay devices that can be used immediately to triage thousands of individuals potentially exposed to radiation. Here we present a proof-of-concept study showing the use of a paper-based vertical flow immunoassay (VFI) to detect radiation dosimetry genes. Using labeled primers during amplification and a multiplex membrane, our results showed that the nucleic acid VFI can simultaneously detect two biodosimetry genes, CDKN1A and DDB2, as well as one housekeeping gene MRPS5. The assay demonstrated good linearity and precision with an inter- and intra-assay coefficient of variance <20% and <10%, respectively. Moreover, the assay showed its ability to discriminate non-irradiated controls (0 Gy) from irradiated samples (1 + 2 Gy) with an overall sensitivity of 62.5% and specificity of 100% (AUC = 0.8672, 95% CI: 0.723-1.000; p = 0.004). Interestingly, the gene combination also showed a dose-dependent response for 0, 1, and 2 Gy, similar to data obtained by real-time PCR benchmark. These preliminary results suggest that a VFI platform can be used to detect simultaneously multiple genes that can be then quantified, thus offering a new approach for a POC biodosimetry assay that could be rapidly deployed on-site to test a large population and help triage and medical management after radiological event.
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Affiliation(s)
- Jerome Lacombe
- Center for Applied NanoBioscience and Medicine, College of Medicine Phoenix, University of Arizona, Phoenix, AZ, USA
- Department of Basic Medical Sciences, College of Medicine Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Alexander J. Summers
- Center for Applied NanoBioscience and Medicine, College of Medicine Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Ashkan Khanishayan
- Center for Applied NanoBioscience and Medicine, College of Medicine Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Yasaman Khorsandian
- Center for Applied NanoBioscience and Medicine, College of Medicine Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Isabella Hacey
- Center for Applied NanoBioscience and Medicine, College of Medicine Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Wyatt Blackson
- Center for Applied NanoBioscience and Medicine, College of Medicine Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Frederic Zenhausern
- Center for Applied NanoBioscience and Medicine, College of Medicine Phoenix, University of Arizona, Phoenix, AZ, USA
- Department of Basic Medical Sciences, College of Medicine Phoenix, University of Arizona, Phoenix, AZ, USA
- Department of Biomedical Engineering, College of Engineering, University of Arizona, Tucson, AZ, USA
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197
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Mwalongo DA, Haneklaus NH, Carvalho FP, Lisuma JB, Kivevele TT, Mtei KM. Influence of phosphate fertilizers on the radioactivity of agricultural soils and tobacco plants in Kenya, Tanzania, and Uganda. Environ Sci Pollut Res Int 2023:10.1007/s11356-023-27543-8. [PMID: 37340157 DOI: 10.1007/s11356-023-27543-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/06/2023] [Indexed: 06/22/2023]
Abstract
Three brands of NPK fertilizers that contain variable concentrations of natural radioactivity are commonly used in tobacco plantations in Kenya, Tanzania, and Uganda. Tobacco plants are known for hyper-accumulation of natural radionuclides, particularly 238U. This study investigated if the elevated radioactivity in phosphate fertilizers could enhance radioactivity in soils and tobacco plant leaves. The 232Th, 238U, and 40K radionuclide levels in NPK-fertilized soils and tobacco leaves were measured using gamma-ray spectroscopy. The research included a one-year reference experiment with tobacco growing in plots, a ten-year semi-controlled experiment in well-managed tobacco farms, and a field survey of radioactivity in soils and tobacco leaves at three traditional tobacco fields in Migori (Kenya), Urambo (Tanzania), and Kanungu (Uganda). The findings demonstrated that soils and tobacco leaves exposed to NPK fertilizers with increased radioactivity had activity concentrations of 232Th, 238U, and 40K that were considerably higher (at all sites) than in the control samples (with no use of NPK fertilizers). As the continued application of NPK fertilizers raises concentrations of 232Th, 238U, and 40K in agricultural soils, the study assessed radiological risks for humans from exposure to agricultural soils enriched with phosphate fertilizers, and it was found to be below the exposure limit of 1 mSvy-1 suggested by the International Commission on Radiological Protection (ICRP). However, tobacco consumers, both by snuffing and smoking, may face significant radiological risks, as the snuffing and smoking resulted in effective doses that were 2.41 to 6.53 and 1.14 to 2.45 times greater than the average yearly dose that the general public receives from inhalation of natural radionuclides (United Nations Scientific Committee on Atomic Radiations estimates). Furthermore, the results indicate that the lifetime excess cancer risk for tobacco snuffers and smokers ranged from 5 × 10-5 to 24.48 × 10-3 and 2.0 × 10-5 to 9.18 × 10-3, respectively. The influence of phosphorus-derived fertilizer containing relatively high natural radioactivity, potential human radiation exposure, and radiological risk due to gamma radionuclides is estimated and discussed. The results reveal that applying phosphate fertilizers enhances natural radioactivity in soil and is subsequently influenced by soil to tobacco plant uptake. Therefore, the study recommends that countries use fertilizers with lower radionuclide content to conserve soil quality and reduce gamma-emitting radionuclides in tobacco plants.
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Affiliation(s)
- Dennis A Mwalongo
- Tanzania Atomic Energy Commission, Directorate of Nuclear Technology and Technical Services, P.O. Box 743, Arusha, Tanzania
- Nelson Mandela African Institution of Science and Technology (NM-AIST), School for Materials, Energy, Water, Environmental Science and Engineering, P.O. Box 447, Arusha, Tanzania
| | - Nils H Haneklaus
- Technische Universität Bergakademie Freiberg, Leipziger Straße 29, 09599, Freiberg, Germany.
- Nelson Mandela African Institution of Science and Technology (NM-AIST), School for Materials, Energy, Water, Environmental Science and Engineering, P.O. Box 447, Arusha, Tanzania.
- Universität für Weiterbildung Krems, Td-Lab Sustainable Mineral Resources, Dr.-Karl-Dorrek-Straße 30, 3500, Krems an der Donau, Austria.
| | - Fernando P Carvalho
- Laboratório de Protecção e Segurança Radiológica, Instituto Superior Técnico/Campus Tecnológico Nuclear, Universidade de Lisboa, Lisboa, Portugal
| | - Jacob B Lisuma
- Tobacco Research Institute of Tanzania (TORITA), P.O. Box 431, Tabora, Tanzania
| | - Thomas T Kivevele
- Nelson Mandela African Institution of Science and Technology (NM-AIST), School for Materials, Energy, Water, Environmental Science and Engineering, P.O. Box 447, Arusha, Tanzania
| | - Kelvin M Mtei
- Nelson Mandela African Institution of Science and Technology (NM-AIST), School for Materials, Energy, Water, Environmental Science and Engineering, P.O. Box 447, Arusha, Tanzania
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Ma L, Gonzalez-Junca A, Chou W, Barcellos-Hoff MH. Monitoring TGFβ signaling in irradiated tumors. Methods Cell Biol 2023; 180:49-67. [PMID: 37890932 DOI: 10.1016/bs.mcb.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Transforming growth factor β (TGFβ) is exquisitely regulated under physiological conditions but its activity is highly dysregulated in cancer. All cells make TGFβ and have receptors for the ligand, which is sequestered in the extracellular matrix in a latent form. Ionizing radiation elicits rapid release of TGFβ from these stores, so-called activation, over a wide range of doses and exposures, including low dose (<1Gy) whole-body irradiation, creating an extraordinarily potent signal in the irradiated tissue or tumor. Hence, accurate evaluation of TGFβ activity is complicated because of its ubiquitous distribution as a latent complex. Here we describe conditions for assays that reveal TGFβ activity in situ using either tissue preparations or functional imaging.
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Affiliation(s)
- Lin Ma
- Department of Radiation Oncology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
| | - Alba Gonzalez-Junca
- Department of Radiation Oncology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
| | - William Chou
- Department of Radiation Oncology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
| | - Mary Helen Barcellos-Hoff
- Department of Radiation Oncology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States.
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Aryankalayil M, Bylicky MA, Chopra S, Dalo J, Scott K, Ueda Y, Coleman CN. Biomarkers for Biodosimetry and Their Role in Predicting Radiation Injury. Cytogenet Genome Res 2023; 163:103-109. [PMID: 37285811 PMCID: PMC10946629 DOI: 10.1159/000531444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/06/2023] [Indexed: 06/09/2023] Open
Abstract
Radiation-related normal tissue injury sustained during cancer radiotherapy or in a radiological or mass casualty nuclear incident is a major health concern. Reducing the risk and mitigating consequences of radiation injury could have a broad impact on cancer patients and citizens. Efforts to discover biomarkers that can determine radiation dose, predict tissue damage, and aid medical triage are underway. Exposure to ionizing radiation causes changes in gene, protein, and metabolite expression that needs to be understood to provide a holistic picture for treating acute and chronic radiation-induced toxicities. We present evidence that both RNA (mRNA, microRNA, long noncoding RNA) and metabolomic assays may provide useful biomarkers of radiation injury. RNA markers may provide information on early pathway alterations after radiation injury that can predict damage and implicate downstream targets for mitigation. In contrast, metabolomics is impacted by changes in epigenetics, genetics, and proteomics and can be considered a downstream marker that incorporates all these changes to provide an assessment of what is currently happening within an organ. We highlight research from the past 10 years to understand how biomarkers may be used to improve personalized medicine in cancer therapy and medical decision-making in mass casualty scenarios.
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Affiliation(s)
- Molykutty Aryankalayil
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michelle A Bylicky
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA,
| | - Sunita Chopra
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Juan Dalo
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kevin Scott
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Yuki Ueda
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - C Norman Coleman
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
- Radiation Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
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200
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Mundra V, Yang Y, von Itzstein MS, Fattah F, Gonugunta AS, Hannan R, Pop LM, Zhang Y, Wang Y, Sheffield T, Xie Y, Dowell JE, Homsi J, Rashdan S, Park J, Li QZ, Wakeland EK, Gerber DE. Systemic immune parameters after prior radiation therapy in patients receiving immune checkpoint inhibitors. Transl Oncol 2023; 34:101689. [PMID: 37285748 DOI: 10.1016/j.tranon.2023.101689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/30/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Preclinical studies have demonstrated the ability of radiation therapy (RT) to augment immune response and tumor control by immune checkpoint inhibitors (ICI). However, numerous clinical trials combining RT and ICI have yielded relatively disappointing results. To improve understanding of optimal use of these therapies, we assessed systemic immune effects of prior RT in patients receiving ICI. METHODS AND MATERIALS Pre- and post-ICI blood samples were collected from patients enrolled in a prospective immunotherapy biospecimen protocol. Mutiplex panels of 40 cytokines and 120 autoantibodies (Ab) were analyzed. We identified differences in these parameters according to receipt, timing, and type of prior RT. We calculated P values using the Pearson product-moment correlation coefficient and false discovery rate (FDR) using the Benjamini-Hochberg Procedure. RESULTS Among 277 total patients, 69 (25%) received RT in the 6 months prior to ICI initiation. Among RT-treated patients, 23 (33%) received stereotactic RT, and 33 (48%) received curative intent RT. There was no significant difference in demographics or type of immunotherapy between patients according to prior RT exposure. Baseline complement C8 Ab and MIP-1d/CCL15 were significantly higher among patients with prior RT. For MIP-1d/CCL15, only prior stereotactic RT was associated with significant differences. CONCLUSIONS Prior RT is associated with few changes in systemic immune parameters in patients receiving ICI. The underlying mechanisms and optimal approach to harnessing the potential synergy of RT and ICI require further prospective clinical investigation.
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Affiliation(s)
- Vatsala Mundra
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Yuqiu Yang
- Peter O'Donnell, Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Mitchell S von Itzstein
- Department of Internal Medicine (Division of Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, Texas, United States of America; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Farjana Fattah
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Amrit S Gonugunta
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Raquibul Hannan
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America; Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Laurentiu M Pop
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America; Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Yuanyuan Zhang
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America; Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Yiqing Wang
- Peter O'Donnell, Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Thomas Sheffield
- Peter O'Donnell, Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Yang Xie
- Peter O'Donnell, Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Jonathan E Dowell
- Department of Internal Medicine (Division of Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, Texas, United States of America; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Jade Homsi
- Department of Internal Medicine (Division of Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, Texas, United States of America; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Sawsan Rashdan
- Department of Internal Medicine (Division of Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, Texas, United States of America; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Jason Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Quan-Zhen Li
- Department of Immunology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Edward K Wakeland
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America; Department of Immunology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - David E Gerber
- Peter O'Donnell, Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America; Department of Internal Medicine (Division of Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, Texas, United States of America; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America.
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