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Apte V, Ghose A, Linares CA, Adeleke S, Papadopoulos V, Rassy E, Boussios S. Paediatric Anatomical Models in Radiotherapy Applications. Clin Oncol (R Coll Radiol) 2024; 36:562-575. [PMID: 39013657 DOI: 10.1016/j.clon.2024.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/18/2024]
Abstract
Anatomical models have key applications in radiotherapy, notably to help understand the relationship between radiation dose and risk of developing side effects. This review analyses whether age-specific computational phantoms, developed from healthy subjects and paediatric cancer patient data, are adequate to model a paediatric population. The phantoms used in the study were International Commission on Radiological Protection (ICRP), 4D extended cardiac torso (XCAT) and Radiotherapy Paediatric Atlas (RT-PAL), which were also compared to literature data. Organ volume data for 19 organs was collected for all phantoms and literature. ICRP was treated as the reference for comparison, and percentage difference (P.D) for the other phantoms were calculated relative to ICRP. Overall comparisons were made for each age category (1, 5, 10, 15) and each organ. Statistical analysis was performed using Microsoft Excel (version 16.59). The smallest P.D to ICRP was for Literature (-17.4%), closely followed by XCAT (26.6%). The largest was for RT-PAL (88.1%). The rectum had the largest average P.D (1,049.2%) and the large bowel had the smallest (2.0%). The P.D was 122.6% at age 1 but this decreased to 43.5% by age 15. Linear regression analysis showed a correlation between organ volume and age to be the strongest for ICRP (R2 = 0.943) and weakest for XCAT (R2 = 0.676). The phantoms are similar enough to ICRP for potential use in modelling paediatric populations. ICRP and XCAT could be used to model a healthy population, whereas RT-PAL could be used for a population undergoing/after radiotherapy.
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Affiliation(s)
- V Apte
- Medical School, University College London, London WC1E 6BT, UK
| | - A Ghose
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK; Department of Medical Oncology, Barts Cancer Centre, St Bartholomew's Hospital, Barts Heath NHS Trust, London EC1A 7BE, UK; Department of Medical Oncology, Mount Vernon Cancer Centre, East and North Hertfordshire Trust, London HA6 2RN, UK; Health Systems and Treatment Optimisation Network, European Cancer Organisation, Brussels 1040, Belgium; Oncology Council, Royal Society of Medicine, London W1G 0AE, UK
| | - C A Linares
- Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - S Adeleke
- Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK; School of Cancer & Pharmaceutical Sciences, King's College London, Strand, London WC2R 2LS, UK
| | - V Papadopoulos
- Department of Urology, Kent and Canterbury Hospital, Canterbury CT1 3NG, UK
| | - E Rassy
- Department of Medical Oncology, Gustave Roussy Institut, Villejuif 94805, France
| | - S Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK; School of Cancer & Pharmaceutical Sciences, King's College London, Strand, London WC2R 2LS, UK; Kent Medway Medical School, University of Kent, Canterbury CT2 7LX, UK; Canterbury Christ Church University, Canterbury CT2 7PB, UK; AELIA Organization, 9th Km Thessaloniki - Thermi, Thessaloniki 57001, Greece.
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Eraqi WA, El-Sabbagh WA, Aziz RK, Elshahed MS, Youssef NH, Elkenawy NM. Gastroprotective and microbiome-modulating effects of ubiquinol in rats with radiation-induced enteropathy. Anim Microbiome 2024; 6:40. [PMID: 39030597 PMCID: PMC11264694 DOI: 10.1186/s42523-024-00320-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 06/02/2024] [Indexed: 07/21/2024] Open
Abstract
Radiation enteritis is a frequently encountered issue for patients receiving radiotherapy and has a significant impact on cancer patients' quality of life. The gut microbiota plays a pivotal role in intestinal function, yet the impact of irradiation on gut microorganisms is not fully understood. This study explores the gastroprotective effect and gut microbiome-modulating potential of ubiquinol (Ubq), the reduced form of the powerful antioxidant CoQ-10. For this purpose, male albino rats were randomly assigned to four groups: Control, IRR (acute 7 Gy γ-radiation), Ubq_Post (Ubq for 7 days post-irradiation), and Ubq_Pre/Post (Ubq for 7 days pre and 7 days post-irradiation). The fecal microbiomes of all groups were profiled by 16S rRNA amplicon sequencing followed by bioinformatics and statistical analysis. Histopathological examination of intestinal tissue indicated severe damage in the irradiated group, which was mitigated by ubiquinol with enhanced regeneration, goblet cells, and intestinal alkaline phosphatase expression. Compared to the irradiated group, the Ubq-treated groups had a significant recovery of intestinal interleukin-1β, caspase-3, nitric oxide metabolites, and thio-barbituric reactive substances to near-healthy levels. Ubq_Pre/Post group displayed elevated peroxisome proliferator-activated receptor (PPAR-γ) level, suggesting heightened benefits. Serum insulin reduction in irradiated rats improved post-Ubq treatment, with a possible anti-inflammatory effect on the pancreatic tissue. Fecal microbiota profiling revealed a dysbiosis state with a reduction of bacterial diversity post-irradiation, which was re-modulated in the Ubq treated groups to profiles that are indistinguishable from the control group. These findings underscore Ubq's gastroprotective effects against radiation-induced enteritis and its potential in restoring the gut microbiota's diversity and balance.
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Affiliation(s)
- Walaa A Eraqi
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt.
| | - Walaa A El-Sabbagh
- Drug Radiation Research Department, National Center of Radiation and Research Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, 11787, Egypt
| | - Ramy K Aziz
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
- Microbiology and Immunology Research Program, Children's Cancer Hospital Egypt 57357, Cairo, 11617, Egypt
| | - Mostafa S Elshahed
- Department of Microbiology and Molecular Genetics, Oklahoma State University, Stillwater, OK, 74074, USA
| | - Noha H Youssef
- Department of Microbiology and Molecular Genetics, Oklahoma State University, Stillwater, OK, 74074, USA
| | - Nora M Elkenawy
- Drug Radiation Research Department, National Center of Radiation and Research Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, 11787, Egypt.
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Berk L. The effects of high-dose radiation therapy on bone: a scoping review. Radiat Oncol J 2024; 42:95-103. [PMID: 38946071 PMCID: PMC11215508 DOI: 10.3857/roj.2023.00969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 07/02/2024] Open
Abstract
PURPOSE This scoping review presents the preclinical and clinical data on the effects of high-dose radiation therapy (RT) on bone structure and function. MATERIALS AND METHODS An extensive PubMed search was performed for the relevant questions. The data were then synthesized into a comprehensive summary of the available relevant in-vitro, preclinical and clinical literature. RESULTS In-vitro studies of high-dose RT on cell cultures show considerable damage in the viability and functional capacity of the primary cells of the bones; the osteoclasts, the osteoblasts, and the osteocytes. In-vivo animal models show that high-dose RT induces significant morphological changes to the bone, inhibits the ability of bone to repair damage, and increases the fragility of the bone. Clinical data show that there is an increasing risk over time of damage to the bone, such as fractures, after high-dose RT. CONCLUSION These findings suggest that there may be a limit to the safe dose for single-fraction RT, and the long-term consequences of high-dose RT for the patients must be considered.
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Affiliation(s)
- Lawrence Berk
- Winter Haven Hospital, Baycare Health System, Winter Haven, FL, USA
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Malikova H, Nadova K, Reginacova K, Kremenova K, Rob L. Radiation-Related Fractures after Radical Radiotherapy for Cervical and Endometrial Cancers: Are There Any Differences? Diagnostics (Basel) 2024; 14:810. [PMID: 38667456 PMCID: PMC11049002 DOI: 10.3390/diagnostics14080810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
In this study, we reviewed CT/MRI scans and studied the rates of radiation-related fractures in subjects treated for cervical cancer (CC, 63 subjects) by radical radiotherapy (RT) and in subjects treated for endometrial cancer (EC, 64 subjects) by radical surgery and RT. The differences between bone density measured in L1 on pretreatment CT, age and body mass index (BMI) were evaluated. Despite significant differences in RT total dose, age, BMI, etc., between both groups, the rate of radiation-related fractures was similar: 28.6% of CC versus 26.6% of EC subjects. CC subjects with fractures were significantly older (62.4 ± 10.1 vs. 49.0 ± 12.4 years; p < 0.001), and their bone densities were significantly lower (106.3 ± 40.0 vs. 168.2 ± 49.5 HU; p < 0.001); no difference in BMI was found. EC subjects with fractures were without significant difference in age but had significantly lower bone densities (103.8 ± 29.0 vs. 133.8 ± 42.3 HU; p = 0.009) and BMIs (26.1 ± 4.9 vs. 31.8 ± 6.9 kg/m2; p = 0.003). Bone density strongly correlated with age (r = -0.755) only in CC subjects. Subjects with fractures from both groups had similarly low bone densities (106.3 ± 40.0 vs. 103.8 ± 29.0 HU; p = 0.829); however, no correlation between bone density and BMI was found. The rate of radiation-related fractures in both groups was clearly associated only with low pretreatment bone density, reflecting osteoporosis.
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Affiliation(s)
- Hana Malikova
- Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 11000 Prague, Czech Republic; (K.N.); (K.K.)
- Institute of Anatomy, Second Faculty of Medicine, Charles University, 11000 Prague, Czech Republic
| | - Katarina Nadova
- Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 11000 Prague, Czech Republic; (K.N.); (K.K.)
- Institute of Anatomy, Second Faculty of Medicine, Charles University, 11000 Prague, Czech Republic
| | - Klaudia Reginacova
- Department of Oncology, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 11000 Prague, Czech Republic;
| | - Karin Kremenova
- Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 11000 Prague, Czech Republic; (K.N.); (K.K.)
| | - Lukas Rob
- Department of Obstetrics and Gynaecology, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 11000 Prague, Czech Republic;
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Sarkar A, Chakrabarti B, Manna A, Mitra D. A prospective study of changes in bone health in adult cancer patients treated with pelvic radiotherapy. Rep Pract Oncol Radiother 2024; 29:55-61. [PMID: 39165595 PMCID: PMC11333075 DOI: 10.5603/rpor.99099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 01/16/2024] [Indexed: 08/22/2024] Open
Abstract
Background Cancer is a major health problem in today's world. Many patients of pelvic malignancies need treatment by radiation therapy. Post-treatment morbidity due to loss of bone health is less commonly studied. Our study aims at studying the impact of pelvic radiation therapy on bone health including bone mineral density and blood parameters and time of maximum change in Indian patients after pelvic radiotherapy. Materials and methods Patients suffering from histologically confirmed pelvic malignancies were included. Patients having metastasis, primary bone tumor or uncontrolled co-morbid conditions were excluded. Patients were treated with concomitant chemoradiation using conventional fractionation of external beam radiotherapy followed by brachytherapy where indicated. T score and Z score of bone mineral density, serum alkaline phosphatase, vitamin D3, phosphorus and calcium were measured before radiation therapy and 6 weeks, three months, and six months after completion of radiation therapy. A p-value ≤ 0.05 was considered statistically significant. Results We found that there was a significant decrease in mean Z score and a significant rise of mean serum alkaline phosphatase at three months post radiation therapy. This was associated with an insignificant changes of mean T score, vitamin D3, phosphorus and calcium after radiation therapy. No pelvic insufficiency fractures were detected. Conclusion In Indian patients, alkaline phosphatase rises, and Z score falls significantly after radiation therapy at three months after treatment. This suggests maximum bone turnover at three months after treatment. Pharmacological intervention, when necessary, may be considered by careful monitoring of patients by this time.
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Affiliation(s)
- Arpita Sarkar
- Department of Radiotherapy, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Bikramjit Chakrabarti
- Department of Radiotherapy, Bankura Sammilani Medical College, Kenduadihi, Bankura, India
| | - Amitava Manna
- Department of Radiotherapy, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Debabrata Mitra
- Department of Radiotherapy, Institute of Postgraduate Medical Education and Research, Kolkata, India
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Ke J, Xie Y, Huang S, Wang W, Zhao Z, Lin W. Comparison of esophageal cancer survival after neoadjuvant chemoradiotherapy plus surgery versus definitive chemoradiotherapy: A systematic review and meta-analysis. Asian J Surg 2024:S1015-9584(24)00361-0. [PMID: 38448293 DOI: 10.1016/j.asjsur.2024.02.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/31/2023] [Accepted: 02/16/2024] [Indexed: 03/08/2024] Open
Abstract
Surgery after neoadjuvant chemoradiotherapy remains the gold standard for the treatment of resectable esophageal cancer (EC); however, chemoradiotherapy without surgery has been recommended in specific cases. The aim of this meta-analysis is to analyse the survival between surgeries after neoadjuvant chemoradiotherapy compared with definitive chemoradiotherapy in order to provide a theoretical basis for clinically individualised differential treatment. We conducted an initial search of MEDLINE (PubMed), the Cochrane Library, and Embase for English-only articles that compared treatment regimens and provided survival data. According to the final I2 value of the two survival indicators, the random effect model or fixed effect model was used to calculate the overall hazard ratio (HR) and 95% confidence intervals (CI). Cochrane's Q test was used to judge the heterogeneity of the studies, and a funnel plot was used to evaluate for publication bias. A sensitivity analysis was performed to verify the stability of the included studies. A total of 38 studies involving 29161 patients (neoadjuvant therapy: 15401, definitive chemoradiotherapy: 13760) were included in the analysis. The final pooled results (HR = 0.74, 95% CI: 0.67-0.82) showed a statistically significant increase in overall survival with neoadjuvant chemoradiotherapy plus surgery compared with definitive chemoradiotherapy. Subgroup analyses were performed to determine the effects of heterogeneity, additional treatment regimens, study types, and geographic regions, as well as histologic differences, complications, and recurrence, on the overall results. For people with esophageal cancer that can be removed, neoadjuvant chemoradiotherapy combined with surgery improves survival compared to definitive chemoradiotherapy. However, more research is needed to confirm these results and help doctors make decisions about treatment.
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Affiliation(s)
- Junli Ke
- Department of Thoracic Surgery, Gaozhou People's Hospital Affiliated to Guangdong Medical University, Maoming, China
| | - Yujie Xie
- Department of Thoracic Surgery, Gaozhou People's Hospital Affiliated to Guangdong Medical University, Maoming, China
| | - Shenyang Huang
- Department of Cardiothoracic Surgery, Guangdong Medical University, Zhanjiang, China
| | - Wei Wang
- Graduate School of Guangdong Medical University, Zhanjiang, China
| | - Zhengang Zhao
- Department of Cardiothoracic Surgery, Guangdong Medical University, Zhanjiang, China
| | - Wanli Lin
- Department of Thoracic Surgery, Gaozhou People's Hospital Affiliated to Guangdong Medical University, Maoming, China.
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Holzleitner N, Cwojdzinski T, Beck R, Urtz-Urban N, Hillhouse CC, Grundler PV, van der Meulen NP, Talip Z, Ramaekers S, Van de Voorde M, Ponsard B, Casini A, Günther T. Preclinical Evaluation of Gastrin-Releasing Peptide Receptor Antagonists Labeled with 161Tb and 177Lu: A Comparative Study. J Nucl Med 2024; 65:481-484. [PMID: 38124121 PMCID: PMC10924159 DOI: 10.2967/jnumed.123.266233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
To elucidate potential benefits of the Auger-electron-emitting radionuclide 161Tb, we compared the preclinical performance of the gastrin-releasing peptide receptor antagonists RM2 (DOTA-Pip5-d-Phe6-Gln7-Trp8-Ala9-Val10-Gly11-His12-Sta13-Leu14-NH2) and AMTG (α-Me-Trp8-RM2), each labeled with both 177Lu and 161Tb. Methods: 161Tb/177Lu labeling (90°C, 5 min) and cell-based experiments (PC-3 cells) were performed. In vivo stability (30 min after injection) and biodistribution studies (1-72 h after injection) were performed on PC-3 tumor-bearing CB17-SCID mice. Results: Gastrin-releasing peptide receptor affinity was high for all compounds (half-maximal inhibitory concentration [nM]: [161Tb]Tb-RM2, 2.46 ± 0.16; [161Tb]Tb-AMTG, 2.16 ± 0.09; [177Lu]Lu-RM2, 3.45 ± 0.18; [177Lu]Lu-AMTG, 3.04 ± 0.08), and 75%-84% of cell-associated activity was receptor-bound. In vivo, both AMTG analogs displayed distinctly higher stability (30 min after injection) and noticeably higher tumor retention than their RM2 counterparts. Conclusion: On the basis of preclinical results, [161Tb]Tb-/[177Lu]Lu-AMTG might reveal a higher therapeutic efficacy than [161Tb]Tb-/[177Lu]Lu-RM2, particularly [161Tb]Tb-AMTG because of additional Auger-electron emissions at the cell membrane level.
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Affiliation(s)
- Nadine Holzleitner
- Department of Chemistry, School of Natural Sciences, Technical University of Munich, Garching, Germany
| | - Tatjana Cwojdzinski
- Department of Chemistry, School of Natural Sciences, Technical University of Munich, Garching, Germany
| | - Roswitha Beck
- Department of Chemistry, School of Natural Sciences, Technical University of Munich, Garching, Germany
| | - Nicole Urtz-Urban
- Department of Chemistry, School of Natural Sciences, Technical University of Munich, Garching, Germany
| | - Colin C Hillhouse
- Center for Radiopharmaceutical Sciences ETH-PSI, Paul Scherrer Institute, Villigen, Switzerland; and
| | - Pascal V Grundler
- Center for Radiopharmaceutical Sciences ETH-PSI, Paul Scherrer Institute, Villigen, Switzerland; and
| | - Nicholas P van der Meulen
- Center for Radiopharmaceutical Sciences ETH-PSI, Paul Scherrer Institute, Villigen, Switzerland; and
| | - Zeynep Talip
- Center for Radiopharmaceutical Sciences ETH-PSI, Paul Scherrer Institute, Villigen, Switzerland; and
| | - Stijn Ramaekers
- Nuclear Medical Applications, Belgian Nuclear Research Centre, Mol, Belgium
| | | | - Bernard Ponsard
- Nuclear Medical Applications, Belgian Nuclear Research Centre, Mol, Belgium
| | - Angela Casini
- Department of Chemistry, School of Natural Sciences, Technical University of Munich, Garching, Germany;
| | - Thomas Günther
- Department of Chemistry, School of Natural Sciences, Technical University of Munich, Garching, Germany;
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Ciftel S, Tumkaya L, Saral S, Mercantepe T, Akyildiz K, Yilmaz A, Mercantepe F. The impact of apelin-13 on cisplatin-induced endocrine pancreas damage in rats: an in vivo study. Histochem Cell Biol 2024:10.1007/s00418-024-02269-x. [PMID: 38368592 DOI: 10.1007/s00418-024-02269-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/19/2024]
Abstract
Apelin-13 is a peptide hormone that regulates pancreatic endocrine functions, and its benefits on the endocrine pancreas are of interest. This study aims to investigate the potential protective effects of apelin-13 in cisplatin-induced endocrine pancreatic damage. Twenty-four rats were divided into four groups: control, apelin-13, cisplatin, and cisplatin + apelin-13. Caspase-3, TUNEL, and Ki-67 immunohistochemical staining were used as markers of apoptosis and mitosis. NF-κB/p65 and TNFα were used to show inflammation. β-cells and α-cells were also evaluated with insulin and glucagon staining in the microscopic examination. Pancreatic tissue was subjected to biochemical analyses of glutathione (GSH) and malondialdehyde (MDA). Apelin-13 ameliorated cisplatin-induced damage in the islets of Langerhans. The immunopositivity of apelin-13 on β-cells and α-cells was found to be increased compared to the cisplatin group (p = 0.001, p = 0.001). Mitosis and apoptosis were significantly higher in the cisplatin group (p = 0.001). Apelin-13 reduced TNFα, NF-κB/p65 positivity, and apoptosis caused by cisplatin (p = 0.001, p = 0.001, p = 0.001). While cisplatin caused a significant increase in MDA levels (p = 0.001), apelin caused a significant decrease in MDA levels (p = 0.001). The results demonstrated a significant decrease in pancreatic tissue GSH levels following cisplatin treatment (p = 0.001). Nevertheless, apelin-13 significantly enhanced cisplatin-induced GSH reduction (p = 0.001). On the other hand, the serum glucose level, which was measured as 18.7 ± 2.5 mmol/L in the cisplatin group, decreased to 13.8 ± 0.7 mmol/L in the cisplatin + apelin-13 group (p = 0.001). The study shows that apelin-13 ameliorated cisplatin-induced endocrine pancreas damage by reducing oxidative stress and preventing apoptosis.
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Affiliation(s)
- Serpil Ciftel
- Department of Endocrinology and Metabolism, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Levent Tumkaya
- Department of Histology and Embryology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Sinan Saral
- Department of Physiology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Tolga Mercantepe
- Department of Histology and Embryology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Kerimali Akyildiz
- Department of Biochemistry, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Adnan Yilmaz
- Department of Biochemistry, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Filiz Mercantepe
- Department of Endocrinology and Metabolism, Faculty of Medicine Recep, Tayyip Erdogan University, 53010, Rize, Turkey.
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Prasad A, Verghese D, Vijaya Rangan S, Sunadarajan N. Spontaneous tumour lysis secondary to gastric adenocarcinoma. BMJ Case Rep 2024; 17:e258369. [PMID: 38191220 PMCID: PMC10806900 DOI: 10.1136/bcr-2023-258369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
We present a case of a man in his 70s who presented with worsening rectal and back pain associated with weight loss, dyspnoea and brownish discolouration of urine. Physical examination noted abdominal distention and epigastric tenderness. Laboratory investigations revealed acute kidney injury, hyperkalaemia, hyperphosphataemia and hyperuricaemia. Contrast CT of the abdomen/pelvis showed multiple, low-density masses throughout the liver, suspicious for metastatic disease. Oesophagogastroduodenoscopy demonstrated a large, fungating, infiltrative and ulcerated mass in the gastric body and lesser curvature of the stomach. Surgical pathology confirmed invasive moderately differentiated gastric adenocarcinoma. He met both the laboratory and clinical criteria for spontaneous tumour lysis syndrome (STLS) as per the Cairo-Bishop criteria. He was managed with aggressive fluid hydration, rasburicase and allopurinol, resulting in improvement in his renal function and laboratory findings. STLS of solid organ tumours, especially gastric adenocarcinoma, is rare and requires early detection with timely management to ensure favourable outcomes.
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Affiliation(s)
- Apurwa Prasad
- AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois, USA
| | - Dhiran Verghese
- AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois, USA
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Kumar V, Kaushik NK, Tiwari SK, Singh D, Singh B. Green synthesis of iron nanoparticles: Sources and multifarious biotechnological applications. Int J Biol Macromol 2023; 253:127017. [PMID: 37742902 DOI: 10.1016/j.ijbiomac.2023.127017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 09/26/2023]
Abstract
Green synthesis of iron nanoparticles is a highly fascinating research area and has gained importance due to reliable, sustainable and ecofriendly protocol for synthesizing nanoparticles, along with the easy availability of plant materials and their pharmacological significance. As an alternate to physical and chemical synthesis, the biological materials, like microorganisms and plants are considered to be less costly and environment-friendly. Iron nanoparticles with diverse morphology and size have been synthesized using biological extracts. Microbial (bacteria, fungi, algae etc.) and plant extracts have been employed in green synthesis of iron nanoparticles due to the presence of various metabolites and biomolecules. Physical and biochemical properties of biologically synthesized iron nanoparticles are superior to that are synthesized using physical and chemical agents. Iron nanoparticles have magnetic property with thermal and electrical conductivity. Iron nanoparticles below a certain size (generally 10-20 nm), can exhibit a unique form of magnetism called superparamagnetism. They are non-toxic and highly dispersible with targeted delivery, which are suitable for efficient drug delivery to the target. Green synthesized iron nanoparticles have been explored for multifarious biotechnological applications. These iron nanoparticles exhibited antimicrobial and anticancerous properties. Iron nanoparticles adversely affect the cell viability, division and metabolic activity. Iron nanoparticles have been used in the purification and immobilization of various enzymes/proteins. Iron nanoparticles have shown potential in bioremediation of various organic and inorganic pollutants. This review describes various biological sources used in the green synthesis of iron nanoparticles and their potential applications in biotechnology, diagnostics and mitigation of environmental pollutants.
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Affiliation(s)
- Vinod Kumar
- Department of Biotechnology, Central University of Haryana, Jant-Pali, Mahendergarh 123031, Haryana, India
| | - Naveen Kumar Kaushik
- Amity Institute of Virology and Immunology, Amity University Uttar Pradesh, Sector 125, Noida, Uttar Pradesh 201313, India
| | - S K Tiwari
- Department of Genetics, Maharshi Dayanand University, Rohtak 124001, Haryana, India
| | - Davender Singh
- Department of Physics, RPS Degree College, Balana, Satnali Road, Mahendragarh 123029, Haryana, India
| | - Bijender Singh
- Department of Biotechnology, Central University of Haryana, Jant-Pali, Mahendergarh 123031, Haryana, India; Laboratory of Bioprocess Technology, Department of Microbiology, Maharshi Dayanand University, Rohtak 124001, Haryana, India.
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11
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Xu S, Zhang G, Zhang J, Liu W, Wang Y, Fu X. Advances in Brain Tumor Therapy Based on the Magnetic Nanoparticles. Int J Nanomedicine 2023; 18:7803-7823. [PMID: 38144513 PMCID: PMC10749175 DOI: 10.2147/ijn.s444319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023] Open
Abstract
Brain tumors, including primary gliomas and brain metastases, are one of the deadliest tumors because effective macromolecular antitumor drugs cannot easily penetrate the blood-brain barrier (BBB) and blood-brain tumor barrier (BTB). Magnetic nanoparticles (MNPs) are considered the most suitable nanocarriers for the delivery of brain tumor drugs because of their unique properties compared to other nanoparticles. Numerous preclinical and clinical studies have demonstrated the potential of these nanoparticles in magnetic targeting, nuclear magnetic resonance, magnetic thermal therapy, and ultrasonic hyperthermia. To further develop and optimize MNPs for the diagnosis and treatment of brain tumors, we attempt to outline recent advances in the use of MNPs to deliver drugs, with a particular focus on their efficacy in the delivery of anti-brain tumor drugs based on magnetic targeting and low-intensity focused ultrasound, magnetic resonance imaging for surgical real-time guidance, and magnetothermal and ultrasonic hyperthermia therapy. Furthermore, we summarize recent findings on the clinical application of MNPs and the research limitations that need to be addressed in clinical translation.
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Affiliation(s)
- Songbai Xu
- Department of Neurosurgery, Department of Obstetrics, Obstetrics and Gynaecology Center, the First Hospital Jilin University, Changchun, People’s Republic of China
| | - Guangxin Zhang
- Department of Endocrinology, Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, Department of Thoracic Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Jiaomei Zhang
- Department of Neurosurgery, Department of Obstetrics, Obstetrics and Gynaecology Center, the First Hospital Jilin University, Changchun, People’s Republic of China
| | - Wei Liu
- Department of Endocrinology, Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, Department of Thoracic Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Yicun Wang
- Department of Endocrinology, Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, Department of Thoracic Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Xiying Fu
- Department of Endocrinology, Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, Department of Thoracic Surgery, the Second Hospital of Jilin University, Changchun, People’s Republic of China
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12
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Yilmaz H, Mercantepe F, Tumkaya L, Mercantepe T, Yilmaz A, Yilmaz Rakici S. The potential antioxidant effect of N-acetylcysteine on X-ray ionizing radiation-induced pancreas islet cell toxicity. Biochem Biophys Res Commun 2023; 685:149154. [PMID: 37913693 DOI: 10.1016/j.bbrc.2023.149154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE Previous research has highlighted the impact of X-ray irradiation-induced organ damage, on cancer patients after radiation therapy. The ionizing radiation-induced oxidative stress causes injury to the pancreatic islet cells of Langerhans. We used histopathological, immunohistochemical, and biochemical analyses to examine α- and β-cells in the islets of Langerhans in rats undergoing whole-body x-ray ionizing radiation, a group of which was treated with NAC. MATERIAL AND METHODS Twenty-four male rats were randomly divided into 3 groups, one control, and two experimental groups. Group I (Control) was administered only saline solution (0.09% NaCl) by oral gavage for 7 days. Group II (IR) was administrated whole body single dose 6 Gray ionizing radiation (IR) and saline solution (0.09% NaCl) by oral gavage for 7 days. Group III (IR + NAC) was administered 300 mg/kg NAC (N-acetylcysteine) by oral gavage for 7 days, 5 days before, and 2 days after 6 Gray IR application. RESULTS In the X-ray irradiation group, we observed diffuse necrotic endocrine cells in the islets of Langerhans. In addition, we found that Caspase-3, malondialdehyde (MDA) levels increased, and insulin, glucagon, and glutathione (GSH) levels decreased in the IR group compared to the control group. In contrast, we observed a decrease in Caspase-3, and MDA levels in necrotic endocrine cells, and an increase in insulin, glucagon, and GSH levels in the IR + NAC group compared to the IR group. CONCLUSION This study provides evidence for the beneficial effects of N-acetyl cysteine on islets of Langerhans cells with X-ray ionizing-radiation-induced damage in a rat model.
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Affiliation(s)
- Hamit Yilmaz
- Department of Biophysics, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey.
| | - Filiz Mercantepe
- Department of Endocrinology and Metabolic Diseases, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Levent Tumkaya
- Department of Histology and Embryology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Tolga Mercantepe
- Department of Histology and Embryology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Adnan Yilmaz
- Department of Biochemistry, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Sema Yilmaz Rakici
- Department of Radiation Oncology, Faculty of Medicine, Recep Tayyip Erdogan University, 53100, Rize, Turkey
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13
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Hong G. Afatinib-Induced Tumor Lysis Syndrome in Pulmonary Adenocarcinoma: A Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2144. [PMID: 38138247 PMCID: PMC10745128 DOI: 10.3390/medicina59122144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Tumor lysis syndrome (TLS) is a potentially fatal oncological emergency that typically develops during the treatment of rapidly proliferating malignancies. It is infrequently reported in solid tumors, such as pulmonary adenocarcinoma. A 59-year-old male patient with shortness of breath presented with a 3.3 cm × 3.0 cm mass in the right upper lobe, along with massive right-sided pleural effusion. A percutaneous needle biopsy was performed, and a diagnosis of pulmonary adenocarcinoma with an epidermal growth factor receptor (EGFR) mutation was made. The patient was treated with afatinib because of the malignant pleural effusion and multiple metastases to the intrathoracic lymph nodes, left scapula, and brain. After 4 days of afatinib treatment, he developed oliguric acute kidney injury and progressively worsening dyspnea. Based on the clinical and laboratory findings, the patient was diagnosed with afatinib-induced TLS. To the best of our knowledge, this is the first reported case of afatinib-induced TLS in pulmonary adenocarcinoma.
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Affiliation(s)
- Goohyeon Hong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Republic of Korea
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14
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Croagh D, Michalski CW, van Berge Henegouwen MI, Alfieri S. Diagnosis and management of pancreatic insufficiency in patients with gastrectomy due to cancer or gastric ulcers: a virtual roundtable expert discussion. Expert Rev Gastroenterol Hepatol 2023; 17:1313-1319. [PMID: 38108090 DOI: 10.1080/17474124.2023.2296762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Pancreatic exocrine insufficiency (PEI) is common after gastric resection for cancer or ulcers but is under-recognized and undertreated. Although pancreatic enzyme replacement therapy (PERT) is the mainstay of PEI management, robust evidence supporting its use after gastric surgery is limited. AREAS COVERED In the absence of guideline recommendations specific for patients with pancreatic insufficiency after gastrectomy, a panel of experts from different geographical regions convened in a virtual meeting to discuss their approach to patient management. EXPERT OPINION Pancreatic insufficiency after gastrointestinal surgery is not a simple post-surgical complication as several factors contribute to its development. Although the pancreas is unimpaired after gastrectomy, it cannot function normally in the altered environment. Pancreatic insufficiency can be challenging to diagnose in gastrectomy patients due to nonspecific symptoms and the absence of a simple diagnostic test. Fecal elastase appears to be the default test, although it is not sufficiently sensitive nor reliable for diagnosing or monitoring PEI. Patients with maldigestion symptoms after gastrectomy are treated pragmatically: those with clinical suspicion of pancreatic insufficiency receive a trial of PERT and are monitored for symptom improvement. There is a clear need for high-quality evidence from clinical trials to guide the management of this patient population.
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Affiliation(s)
- Daniel Croagh
- Department of General Surgery, Monash Health, Melbourne, Victoria, Australia; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | | | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Sergio Alfieri
- Divisione di Chirurgia Digestiva, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
- CRMPG (Advanced Pancreatic Research Center), Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Rome, Italy
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15
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Guo W, Hoque J, Garcia CJG, Spiller KV, Leinroth AP, Puviindran V, Potnis CK, Gunn KA, Newman H, Ishikawa K, Fujimoto TN, Neill DW, Delahoussaye AM, Williams NT, Kirsch DG, Hilton MJ, Varghese S, Taniguchi CM, Wu C. Radiation-induced bone loss in mice is ameliorated by inhibition of HIF-2α in skeletal progenitor cells. Sci Transl Med 2023; 15:eabo5217. [PMID: 38019933 PMCID: PMC10804914 DOI: 10.1126/scitranslmed.abo5217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
Radiotherapy remains a common treatment modality for cancer despite skeletal complications. However, there are currently no effective treatments for radiation-induced bone loss, and the consequences of radiotherapy on skeletal progenitor cell (SPC) survival and function remain unclear. After radiation, leptin receptor-expressing cells, which include a population of SPCs, become localized to hypoxic regions of the bone and stabilize the transcription factor hypoxia-inducible factor-2α (HIF-2α), thus suggesting a role for HIF-2α in the skeletal response to radiation. Here, we conditionally knocked out HIF-2α in leptin receptor-expressing cells and their descendants in mice. Radiation therapy in littermate control mice reduced bone mass; however, HIF-2α conditional knockout mice maintained bone mass comparable to nonirradiated control animals. HIF-2α negatively regulated the number of SPCs, bone formation, and bone mineralization. To test whether blocking HIF-2α pharmacologically could reduce bone loss during radiation, we administered a selective HIF-2α inhibitor called PT2399 (a structural analog of which was recently FDA-approved) to wild-type mice before radiation exposure. Pharmacological inhibition of HIF-2α was sufficient to prevent radiation-induced bone loss in a single-limb irradiation mouse model. Given that ~90% of patients who receive a HIF-2α inhibitor develop anemia because of off-target effects, we developed a bone-targeting nanocarrier formulation to deliver the HIF-2α inhibitor to mouse bone, to increase on-target efficacy and reduce off-target toxicities. Nanocarrier-loaded PT2399 prevented radiation-induced bone loss in mice while reducing drug accumulation in the kidney. Targeted inhibition of HIF-2α may represent a therapeutic approach for protecting bone during radiation therapy.
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Affiliation(s)
- Wendi Guo
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine; Durham, NC 27705, USA
| | - Jiaul Hoque
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
| | - Carolina J. Garcia Garcia
- UTHealth Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center; Houston, TX 77030, USA
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center; Houston, TX 77030, USA
| | - Kassandra V. Spiller
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Surgery, Duke University School of Medicine, Durham, NC 27705, USA
| | - Abigail P. Leinroth
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Regeneron Pharmaceuticals, Tarrytown, NY 10591, USA
| | - Vijitha Puviindran
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
| | - Cahil K. Potnis
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
| | - Kiana A. Gunn
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine; Durham, NC 27705, USA
| | - Hunter Newman
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Mechanical Engineering and Materials Science, Duke University; Durham, NC 27705, USA
| | - Koji Ishikawa
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, 142-8666, JP
| | - Tara N. Fujimoto
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center; Houston, TX 77030, USA
| | - Denae W. Neill
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center; Houston, TX 77030, USA
| | - Abagail M. Delahoussaye
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center; Houston, TX 77030, USA
| | - Nerissa T. Williams
- Department of Radiation Oncology, Duke University School of Medicine; Durham, NC 27705, USA
| | - David G. Kirsch
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Radiation Oncology, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Biomedical Biophysics, University of Toronto, Toronto, ON, M5S 1A8, CA
- Department of Radiation Oncology, University of Toronto, Toronto, ON, M5T 1O5, CA
- Princess Margarat Cancer Centre, University Health Network, Toronto, ON, M5G 2C1, CA
| | - Matthew J. Hilton
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Cell Biology, Duke University School of Medicine; Durham, NC 27705, USA
| | - Shyni Varghese
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Mechanical Engineering and Materials Science, Duke University; Durham, NC 27705, USA
- Department of Biomedical Engineering, Duke University School of Medicine; Durham, NC 27705, USA
| | - Cullen M. Taniguchi
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center; Houston, TX 77030, USA
- Department of GI Radiation Oncology, The University of Texas MD Anderson Cancer Center; Houston, TX 77030, USA
| | - Colleen Wu
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Radiation Oncology, University of Toronto, Toronto, ON, M5T 1O5, CA
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16
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Lam L, Koopowitz S, Thompson A, Smith G, Tan S, Gupta A, Kovoor J, Harroud A, Bacchi S, Slee M. A systematic review of the symptomatic management of Lhermitte's phenomenon. J Clin Neurosci 2023; 116:32-36. [PMID: 37603922 DOI: 10.1016/j.jocn.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/20/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Lhermitte's phenomenon (LP) is a transient shock-like sensation that radiates down the spine into the extremities, usually with neck flexion. The potential efficacy and tolerability of various symptomatic therapies in the management of LP have not been systematically reviewed previously. METHOD A systematic review was conducted using PubMed, EMBASE, and the Cochrane Library from inception to August 2022 for peer-reviewed articles describing the treatment of patients with Lhermitte's phenomenon. The review adheres to the PRISMA guidelines and was registered on PROSPERO. RESULTS This systematic review included sixty-six articles, which included 450 patients with LP. Treatment of the underlying cause varied by aetiology. Whilst LP is most commonly considered in the context of structural pathology of the cervical cord, medication-induced LP was a common theme in the literature. The most common cause of medication-induced LP was platinum-based chemotherapy agents such as cisplatin and oxaliplatin. In medication-induced LP, symptoms typically resolved with cessation of the causative agent. Non-pharmacological treatment options were associated with mild-moderate symptomatic improvement. The most commonly used agents to treat patients with LP were carbamazepine and gabapentin, which resulted in variable degrees of symptomatic benefit. CONCLUSIONS No randomised studies currently exist to support the use of symptomatic therapies to treat LP. Observational data suggest that some therapies may yield a symptomatic benefit in the management of LP. However, this systematic review identified a significant paucity of evidence in the literature, which suggests that further controlled studies are needed to investigate the optimal management of this common neurologic phenomenon.
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Affiliation(s)
- Lydia Lam
- Royal Adelaide Hospital, Adelaide, SA 5000, Australia; University of Adelaide, Adelaide, SA 5005, Australia.
| | | | | | - Georgia Smith
- Flinders University, Bedford Park, SA 5042, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Aashray Gupta
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Joshua Kovoor
- Royal Adelaide Hospital, Adelaide, SA 5000, Australia; University of Adelaide, Adelaide, SA 5005, Australia
| | - Adil Harroud
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec H3A 0G4, Canada
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, SA 5000, Australia; University of Adelaide, Adelaide, SA 5005, Australia; Flinders University, Bedford Park, SA 5042, Australia
| | - Mark Slee
- Flinders University, Bedford Park, SA 5042, Australia
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17
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Wu XQ, Zhang TY, Yang F, Feng XY, Feng YL, Wang LL, Chen TW, Li CP, Li R. Association of radiotherapy with thoracic vertebral fractures in esophageal squamous cell carcinoma: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e35304. [PMID: 37773852 PMCID: PMC10545250 DOI: 10.1097/md.0000000000035304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/30/2023] [Indexed: 10/01/2023] Open
Abstract
To investigate the association between radiotherapy (RT) and thoracic vertebral fractures in esophageal squamous cell carcinoma (ESCC) and explore the risk factors of thoracic vertebral fracture in ESCC who underwent RT. This retrospective cohort study including 602 consecutive ESCC patients examined the association between RT and thoracic vertebral fractures using multivariable Cox proportional hazard models and relevant risk factors of thoracic vertebral fractures based on clinical and RT parameters in patients with ESCC. Followed for a median follow-up of 24 months, 54 patients had thoracic vertebral fractures. The multivariable analysis revealed RT as an independent risk factor after adjusting for clinical risk factors. Univariable analyses associated a 5-Gy increase in vertebral dose to single vertebrae and a 1-time increase in RT fraction with higher risk of vertebral fracture. Adding RT factors (vertebral dose and fraction) and mean vertebral hounsfield unit to the Cox models containing conventional clinical risk factors significantly improved the χ2 value for predicting vertebral fractures (all P < .001). This study revealed RT, as well as increased vertebral dose and RT fractions, as a significant, consistent, and strong vertebral fracture predictor in ESCC. Combined vertebral dose, RT fractions, and vertebral hounsfield unit provided optimal risk stratification for ESCC patients.
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Affiliation(s)
- Xing-Qiang Wu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, and Sichuan Key Laboratory of Medical Imaging, Sichuan, China
- Department of Radiology, The second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tian-Yue Zhang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, and Sichuan Key Laboratory of Medical Imaging, Sichuan, China
| | - Fan Yang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, and Sichuan Key Laboratory of Medical Imaging, Sichuan, China
| | - Xin-Yi Feng
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, and Sichuan Key Laboratory of Medical Imaging, Sichuan, China
| | - Yu-Ling Feng
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, and Sichuan Key Laboratory of Medical Imaging, Sichuan, China
| | - Ling-Li Wang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, and Sichuan Key Laboratory of Medical Imaging, Sichuan, China
| | - Tian-Wu Chen
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, and Sichuan Key Laboratory of Medical Imaging, Sichuan, China
| | - Chun-Ping Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, and Sichuan Key Laboratory of Medical Imaging, Sichuan, China
| | - Rui Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, and Sichuan Key Laboratory of Medical Imaging, Sichuan, China
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Mercantepe F, Tumkaya L, Mercantepe T, Rakici SY, Ciftel S, Ciftel S. Radioprotective effects of α2-adrenergic receptor agonist dexmedetomidine on X-ray irradiation-induced pancreatic islet cell damage. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2023; 396:1827-1836. [PMID: 36877270 DOI: 10.1007/s00210-023-02454-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
Comprehensive epidemiological analyses conducted in the last 30 years have revealed a link between radiation and DM. We aimed to determine the effects of dexmedetomidine pretreatment on radiation-induced pancreatic islet cell damage. Twenty-four rats were divided into three groups: group 1 (control group), group 2 (only X-ray irradiation group), and group 3 (X-ray irradiation + dexmedetomidine). We observed necrotic cells with vacuoles accompanying loss of cytoplasm in the islets of Langerhans, extensive edematous areas, and vascular congestions in group 2. In group 3, we observed a decrease in necrotic cells in the islets of Langerhans, and edematous areas and vascular congestion was also reduced. We determined a decrease in β-cells, α-cells, and D-cells in the islets of Langerhans in group 2 compared to the control group. In group 3, β-cells, α-cells, and D-cells were elevated compared to group 2. Ionizing radiation may induce DM. Dexmedetomidine appears to exert a radioprotective effect.
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Affiliation(s)
- Filiz Mercantepe
- Department of Endocrinology and Metabolism, Faculty of Medicine, Recep Tayyip Erdogan University, 2 Nolu Sehitler Street, Rize, 53020, Turkey.
| | - Levent Tumkaya
- Department of Histology and Embryology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Tolga Mercantepe
- Department of Histology and Embryology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Sema Yilmaz Rakici
- Department of Radiation Oncology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Serpil Ciftel
- Department of Endocrinology and Metabolism, Faculty of Medicine, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Sedat Ciftel
- Department of Gastroenterology, Faculty of Medicine, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
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Papapanou M, Athanasopoulos AE, Georgiadi E, Maragkos SA, Liontos M, Ziogas DC, Damaskos D, Schizas D. Spontaneous tumor lysis syndrome in patients with solid tumors: a scoping review of the literature. Med Oncol 2023; 40:233. [PMID: 37432468 PMCID: PMC10335952 DOI: 10.1007/s12032-023-02108-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
No systematic synthesis of all cases of spontaneous tumor lysis syndrome (STLS) in adult patients with solid tumors is available to date. Herein, we aim to recognize specific STLS characteristics and parameters related to a worse prognosis. We conducted a systematic search for randomized controlled trials, cohorts, case-control studies, and case reports. The primary endpoints were death and the need for renal replacement therapy (RRT) due to STLS. We estimated crude odds ratios (ORs) with 95% confidence intervals (95%CI) via univariate binary logistic regression. We included one cohort of 9 patients and 66 case reports of 71 patients [lung cancer 15(21.1%)]. Regarding the case reports, most patients [61(87.1%)] had metastatic disease [liver 46(75.4%)], developed acute kidney injury [59(83.1%)], needed RRT [25(37.3%)], and died due to STLS [36(55.4%)]. Metastatic disease, especially in the liver [p = 0.035; OR (95%CI): 9.88 (1.09, 89.29)] or lungs [p = 0.024; 14.00 (1.37, 142.89)], was significantly associated with STLS-related death compared to no metastasis. Cases resulting in death had a significantly higher probability of receiving rasburicase monotherapy than receiving no urate-lowering agents [p = 0.034; 5.33 (1.09, 26.61)], or the allopurinol-rasburicase combination [p = 0.023; 7.47 (1.40, 39.84)]. Patients receiving allopurinol were less likely to need RRT compared to those not receiving it or those receiving rasburicase. In conclusion, current anecdotal evidence demonstrated that metastatic disease, especially in the liver and lungs, may be associated with STLS-related death compared to no metastatic status. Careful surveillance of high-risk cases within larger studies is essential to identify markers predicting morbidity or mortality.
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Affiliation(s)
- Michail Papapanou
- Society of Junior Doctors, Athens, 15123, Greece.
- Second Department of Obstetrics and Gynecology, Medical School, "Aretaieion Hospital", National and Kapodistrian University of Athens, 76 Vas. Sofias Ave, Athens, 11528, Greece.
| | | | - Eleni Georgiadi
- 2nd Department of Radiology, Medical School, University General Hospital "Attikon", National and Kapodistrian University of Athens, 1 Rimini Str, Haidari/Athens, 12462, Greece
- School of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | | | - Michalis Liontos
- Department of Clinical Therapeutics, Division of Oncology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vas. Sofias Ave, Athens, 10679, Greece
| | - Dimitrios C Ziogas
- First Department of Internal Medicine, Unit of Medical Oncology, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, Athens, 11527, Greece
| | - Dimitrios Damaskos
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, Athens, 11527, Greece
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20
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Emerzian SR, Wu T, Vaidya R, Tang SY, Abergel RJ, Keaveny TM. Relative Effects of Radiation-Induced Changes in Bone Mass, Structure, and Tissue Material on Vertebral Strength in a Rat Model. J Bone Miner Res 2023; 38:1032-1042. [PMID: 37191221 PMCID: PMC10524463 DOI: 10.1002/jbmr.4828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/06/2023] [Accepted: 05/07/2023] [Indexed: 05/17/2023]
Abstract
The observed increased risk of fracture after cancer radiation therapy is presumably due to a radiation-induced reduction in whole-bone strength. However, the mechanisms for impaired strength remain unclear, as the increased fracture risk is not fully explained by changes in bone mass. To provide insight, a small animal model was used to determine how much of this whole-bone weakening effect for the spine is attributable to changes in bone mass, structure, and material properties of the bone tissue and their relative effects. Further, because women have a greater risk of fracture after radiation therapy than men, we investigated if sex had a significant influence on bone's response to irradiation. Fractionated in vivo irradiation (10 × 3 Gy) or sham irradiation (0 Gy) was administered daily to the lumbar spine in twenty-seven 17-week-old Sprague-Dawley rats (n = 6-7/sex/group). Twelve weeks after final treatment, animals were euthanized, and lumbar vertebrae (L4 and L5 ) were isolated. Using a combination of biomechanical testing, micro-CT-based finite element analysis, and statistical regression analysis, we separated out the effect of mass, structural, and tissue material changes on vertebral strength. Compared with the sham group (mean ± SD strength = 420 ± 88 N), the mean strength of the irradiated group was lower by 28% (117 N/420 N, p < 0.0001). Overall, the response of treatment did not differ with sex. By combining results from both general linear regression and finite element analyses, we calculated that mean changes in bone mass, structure, and material properties of the bone tissue accounted for 56% (66 N/117 N), 20% (23 N/117 N), and 24% (28 N/117 N), respectively, of the overall change in strength. As such, these results provide insight into why an elevated clinical fracture risk for patients undergoing radiation therapy is not well explained by changes in bone mass alone. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Shannon R. Emerzian
- Department of Mechanical Engineering, University of
California, Berkeley, California, USA
| | - Tongge Wu
- Department of Mechanical Engineering, University of
California, Berkeley, California, USA
| | - Rachana Vaidya
- Department of Orthopaedic Surgery, Washington University,
St. Louis, Missouri, USA
| | - Simon Y. Tang
- Department of Orthopaedic Surgery, Washington University,
St. Louis, Missouri, USA
- Department of Biomedical Engineering, Washington
University, St. Louis, Missouri, USA
- Department of Material Science & Mechanical
Engineering, Washington University, St. Louis, Missouri, USA
| | - Rebecca J. Abergel
- Department of Nuclear Engineering, University of
California, Berkeley, California, USA
| | - Tony M. Keaveny
- Department of Mechanical Engineering, University of
California, Berkeley, California, USA
- Department of Bioengineering, University of California,
Berkeley, California, USA
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21
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Halle-Smith JM, Powell-Brett SF, Hall LA, Duggan SN, Griffin O, Phillips ME, Roberts KJ. Recent Advances in Pancreatic Ductal Adenocarcinoma: Strategies to Optimise the Perioperative Nutritional Status in Pancreatoduodenectomy Patients. Cancers (Basel) 2023; 15:cancers15092466. [PMID: 37173931 PMCID: PMC10177139 DOI: 10.3390/cancers15092466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy for which the mainstay of treatment is surgical resection, followed by adjuvant chemotherapy. Patients with PDAC are disproportionately affected by malnutrition, which increases the rate of perioperative morbidity and mortality, as well as reducing the chance of completing adjuvant chemotherapy. This review presents the current evidence for pre-, intra-, and post-operative strategies to improve the nutritional status of PDAC patients. Such preoperative strategies include accurate assessment of nutritional status, diagnosis and appropriate treatment of pancreatic exocrine insufficiency, and prehabilitation. Postoperative interventions include accurate monitoring of nutritional intake and proactive use of supplementary feeding methods, as required. There is early evidence to suggest that perioperative supplementation with immunonutrition and probiotics may be beneficial, but further study and understanding of the underlying mechanism of action are required.
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Affiliation(s)
- James M Halle-Smith
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, UK
| | - Sarah F Powell-Brett
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, UK
| | - Lewis A Hall
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, UK
| | - Sinead N Duggan
- Department of Surgery, Trinity College Dublin, University of Dublin, Tallaght University Hospital, D24 NR0A Dublin, Ireland
| | - Oonagh Griffin
- Department of Nutrition and Dietetics, St. Vincent's University Hospital, D04 T6F4 Dublin, Ireland
| | - Mary E Phillips
- Department of Nutrition and Dietetics, Royal Surrey County Hospital, Guildford GU2 7XX, UK
| | - Keith J Roberts
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, UK
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22
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Codjia T, Roussel E, Papet E, Pinson J, Monge M, Tortajada P, Tuech JJ, Schwarz L. Can the Realization of an External Wirsungostomy be an Option for High-Risk Pancreatic Anastomosis After Pancreaticoduodenectomy? World J Surg 2023; 47:1533-1539. [PMID: 36884081 DOI: 10.1007/s00268-023-06927-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Clinically relevant postoperative pancreatic fistula (POPF) occurs in 15-20% of patients after pancreaticoduodenectomy (PD) and reintervention in the setting of Grade C POPF remains associated with a mortality rate of up to 25%. In patients at high risk of POPF, PD with external wirsungostomy (EW) could be a safe alternative that avoids pancreatico-enteric anastomosis while preserving the remnant pancreas. METHODS Of the 155 consecutive patients who underwent PD from November 2015 to December 2020, 10 patients were managed using an EW, all with a fistula risk score (FRS) ≥ 7 and BMI ≥30 kg/m2, and/or major associated abdominal surgery. The pancreatic duct was cannulated with a polyethylene tube to allow good external drainage of the pancreatic fluid. We retrospectively analyzed postoperative complications and endocrine and exocrine insufficiencies. RESULTS The median alternative FRS was 36.9% [22.1-45.2]. There was no postoperative death. The 90-day overall severe complication (grade ≥3) rate was 30% (n = 3 patients), no patient required reoperation, and 2 hospital readmissions occurred. 3 patients experienced Grade B POPF (30%), managed using image-guided drainage for 2 patients. The external pancreatic drain was removed after a median drainage time of 75 days [63-80]. Two patients presented with late symptoms (> 6 months) warranting interventional management (pancreaticojejunostomy and transgastric drainage). Six patients experienced significant weight loss (> 2 kg) 3 months after surgery. One year after surgery, 4 patients still complained of diarrhea and were treated with transit-delaying drugs. One patient presented new-onset diabetes one year after surgery, and 1 of the 4 patients with preexisting diabetes experienced worsening disease. CONCLUSION EW after PD might be a solution to reduce post-operative mortality following PD in high-risk patients.
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Affiliation(s)
- Tatiana Codjia
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | - Edouard Roussel
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | - Eloise Papet
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | - Jean Pinson
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | - Matthieu Monge
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | - Pauline Tortajada
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | - Jean-Jacques Tuech
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
- Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Rouen University Hospital, UNIROUEN, UMR 1245 INSERM, Normandie ROUEN University, 76000, Rouen, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France.
- Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Rouen University Hospital, UNIROUEN, UMR 1245 INSERM, Normandie ROUEN University, 76000, Rouen, France.
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23
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Becker SJ, Lipson EJ, Jozsef G, Molitoris JK, Silverman JS, Presser J, Kondziolka D. How many brain metastases can be treated with stereotactic radiosurgery before the radiation dose delivered to normal brain tissue rivals that associated with standard whole brain radiotherapy? J Appl Clin Med Phys 2023; 24:e13856. [PMID: 36628586 PMCID: PMC10018670 DOI: 10.1002/acm2.13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/03/2022] [Accepted: 11/14/2022] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Clinical trial data comparing outcomes after administration of stereotactic radiosurgery (SRS) or whole-brain radiotherapy (WBRT) to patients with brain metastases (BM) suggest that SRS better preserves cognitive function and quality of life without negatively impacting overall survival. Here, we estimate the maximum number of BM that can be treated using single and multi-session SRS while limiting the dose of radiation delivered to normal brain tissue to that associated with WBRT. METHODS Multiple-tumor SRS was simulated using a Monte Carlo - type approach and a pre-calculated dose kernel method. Tumors with diameters ≤36 mm were randomly placed throughout the contoured brain parenchyma until the brain mean dose reached 3 Gy, equivalent to the radiation dose delivered during a single fraction of a standard course of WBRT (a total dose of 30 Gy in 10 daily fractions of 3 Gy). Distribution of tumor sizes, dose coverage, selectivity, normalization, and maximum dose data used in the simulations were based on institutional clinical metastases data. RESULTS The mean number of tumors treated, mean volume of healthy brain tissue receiving > 12 Gy (V12) per tumor, and total tumor volume treated using mixed tumor size distributions were 12.7 ± 4.2, 2.2 cc, and 12.9 cc, respectively. Thus, we estimate that treating 12-13 tumors per day over 10 days would deliver the dose of radiation to healthy brain tissue typically associated with a standard course of WBRT. CONCLUSION Although in clinical practice, treatment with SRS is often limited to patients with ≤15 BM, our findings suggest that many more lesions could be targeted while still minimizing the negative impacts on quality of life and neurocognition often associated with WBRT. Results from this in silico analysis require clinical validation.
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Affiliation(s)
- Stewart J Becker
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Evan J Lipson
- Bloomberg∼Kimmel Institute for Cancer Immunotherapy and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gabor Jozsef
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Jason K Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Joshua S Silverman
- Department of Radiation Oncology, New York University Langone Medical Center, New York, New York, USA
| | - Joseph Presser
- Department of Radiation Oncology, Mount Sinai South Nassau, Oceanside, New York, USA
| | - Douglas Kondziolka
- Department of Radiation Oncology, New York University Langone Medical Center, New York, New York, USA.,Department of Neurosurgery, New York University Langone Medical Center, New York, New York, USA
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24
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Raman S, Jia F, Liu Z, Wenz J, Carter M, Dickie C, Liu FF, Letourneau D. Forecasting Institutional LINAC Utilization in Response to Varying Workload. Technol Cancer Res Treat 2022; 21:15330338221123108. [PMID: 36285543 PMCID: PMC9608060 DOI: 10.1177/15330338221123108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
ObjectivesPandemics, natural disasters, and other unforeseen circumstances can cause short-term variation in radiotherapy utilization. In this study, we aim to develop a model to forecast linear accelerator (LINAC) utilization during periods of varying workloads. Methods: Using computed tomography (CT)-simulation data and the rate of new LINAC appointment bookings in the preceding week as input parameters, a multiple linear regression model to forecast LINAC utilization over a 15-working day horizon was developed and tested on institutional data. Results: Future LINAC utilization was estimated in our training dataset with a forecasting error of 3.3%, 5.9%, and 7.2% on days 5, 10, and 15, respectively. The model identified significant variations (≥5% absolute differences) in LINAC utilization with an accuracy of 69%, 62%, and 60% on days 5, 10, and 15, respectively. The results were similar in the validation dataset with forecasting errors of 3.4%, 5.3%, and 6.2% and accuracy of 67%, 60%, and 58% on days 5, 10, and 15, respectively. These results compared favorably to moving average and exponential smoothing forecasting techniques. Conclusions: The developed linear regression model was able to accurately forecast future LINAC utilization based on LINAC booking rate and CT simulation data, and has been incorporated into our institutional dashboard for broad distribution. Advances in knowledge: Our proposed linear regression model is a practical and intuitive approach to forecasting short-term LINAC utilization, which can be used for resource planning and allocation during periods with varying LINAC workloads.
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Affiliation(s)
- Srinivas Raman
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada,Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Srinivas Raman MD, FRCPC, Department of Radiation Oncology, University of Toronto, 700 University Avenue, Room 7-610, Toronto, Ontario, Canada M5G 2M9.
| | - Fan Jia
- Department of Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Zhihui Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Julie Wenz
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada,Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michael Carter
- Department of Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Colleen Dickie
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada,Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Fei-Fei Liu
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada,Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Daniel Letourneau
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada,Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Daniel Letourneau PhD, DABR, Department of Radiation Oncology, University of Toronto, 700 University Avenue, Room 7-424, Toronto, Ontario, Canada M5G 2M9.
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25
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Alqurashi RM, Tamim HH, Alsubhi ZD, Alzahrani AA, Tashkandi E. Tumor Lysis Syndrome in Patients With Solid Tumors: A Systematic Review of Reported Cases. Cureus 2022; 14:e30652. [DOI: 10.7759/cureus.30652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
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26
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Barakat S, Abdallah B, Finianos A, Mahmasani LA. Tumor Lysis Syndrome: A Rare Complication of Metastatic Gastric Cancer and a Possible Indicator of Disease Progression. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2022; 15:11795476221129238. [PMID: 36277906 PMCID: PMC9585557 DOI: 10.1177/11795476221129238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/01/2022] [Indexed: 11/08/2022]
Abstract
Tumor lysis syndrome (TLS) is an oncologic emergency that is usually associated with hematologic malignancies either spontaneously or following early chemotherapy and is caused by massive tumor cell lysis. However, it has been rarely reported in solid tumors. We report a case of 25-year-old lady recently diagnosed with metastatic gastric adenocarcinoma who developed TLS after the fourth cycle of chemoimmunotherapy (FOLFOX plus Nivolumab). She presented with abdominal pain, decrease in oral intake and decreased urine output. Laboratory studies showed acute kidney injury with electrolyte disturbances and was diagnosed initially with autoimmune nephritis secondary to Nivolumab but was later found to have TLS and recovered after appropriate treatment. Soon after this complication, our patient was found to have disease progression on imaging which makes the incidence of TLS an indicator of disease progression.
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Affiliation(s)
- Salim Barakat
- Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Batoul Abdallah
- Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Antoine Finianos
- Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Layal Al Mahmasani
- Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon,Layal Al Mahmasani, Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Cairo Street, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
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27
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Dose-Volume Constraints fOr oRganS At risk In Radiotherapy (CORSAIR): An "All-in-One" Multicenter-Multidisciplinary Practical Summary. Curr Oncol 2022; 29:7021-7050. [PMID: 36290829 PMCID: PMC9600677 DOI: 10.3390/curroncol29100552] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The safe use of radiotherapy (RT) requires compliance with dose/volume constraints (DVCs) for organs at risk (OaRs). However, the available recommendations are sometimes conflicting and scattered across a number of different documents. Therefore, the aim of this work is to provide, in a single document, practical indications on DVCs for OaRs in external beam RT available in the literature. MATERIAL AND METHODS A multidisciplinary team collected bibliographic information on the anatomical definition of OaRs, on the imaging methods needed for their definition, and on DVCs in general and in specific settings (curative RT of Hodgkin's lymphomas, postoperative RT of breast tumors, curative RT of pediatric cancers, stereotactic ablative RT of ventricular arrythmia). The information provided in terms of DVCs was graded based on levels of evidence. RESULTS Over 650 papers/documents/websites were examined. The search results, together with the levels of evidence, are presented in tabular form. CONCLUSIONS A working tool, based on collected guidelines on DVCs in different settings, is provided to help in daily clinical practice of RT departments. This could be a first step for further optimizations.
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28
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Kunimoto S, Tashima L, Ito K, Hori K. Advanced ovarian cancer that resulted in death from intestinal perforation following tumor lysis syndrome: A case report. Int J Surg Case Rep 2022; 98:107518. [PMID: 35994800 PMCID: PMC9420503 DOI: 10.1016/j.ijscr.2022.107518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 01/20/2023] Open
Abstract
Introduction and importance Case presentation Clinical discussion Conclusion Tumor lysis syndrome (TLS) in solid tumors is rare, but predictable to an extent. TLS risk should be evaluated and precautions taken. Chemotherapy-related intestinal perforation is still a risk even after recovering from TLS.
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Affiliation(s)
- Saki Kunimoto
- Department of Obstetrics & Gynecology, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki City, Hyogo 660-8511, Japan.
| | - Lena Tashima
- Department of Obstetrics & Gynecology, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki City, Hyogo 660-8511, Japan
| | - Kimihiko Ito
- Department of Obstetrics & Gynecology, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki City, Hyogo 660-8511, Japan
| | - Kensuke Hori
- Department of Obstetrics & Gynecology, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki City, Hyogo 660-8511, Japan
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29
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Dejanovic D, Specht L, Czyzewska D, Kiil Berthelsen A, Loft A. Response Evaluation Following Radiation Therapy With 18F-FDG PET/CT: Common Variants of Radiation-Induced Changes and Potential Pitfalls. Semin Nucl Med 2022; 52:681-706. [PMID: 35835618 DOI: 10.1053/j.semnuclmed.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/11/2022]
Abstract
Radiation therapy (RT) is one of the cornerstones in cancer treatment and approximately half of all patients will receive some form of RT during the course of their cancer management. Response evaluation after RT and follow-up imaging with 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) can be complicated by RT-induced acute, chronic or consequential effects. There is a general consensus that 18F-FDG PET/CT for response evaluation should be delayed for 12 weeks after completing RT to minimize the risk of false-positive findings. Radiation-induced late side effects in normal tissue can take years to develop and eventually cause symptoms that on imaging can potentially mimic recurrent disease. Imaging findings in radiation induced injuries depend on the normal tissue included in the irradiated volume and the radiation therapy regime including the total dose delivered, dose per fraction and treatment schedule. The intent for radiation therapy should be taken in consideration when evaluating the response on imaging, that is palliative vs curative or neoadjuvant vs adjuvant RT. Imaging findings can further be distorted by altered anatomy and sequelae following surgery within the radiation field. An awareness of common PET/CT-induced changes/injuries is essential when interpreting 18F-FDG PET/CT as well as obtaining a complete medical history, as patients are occasionally scanned for an unrelated cause to previously RT treated malignancy. In addition, secondary malignancies due to carcinogenic effects of radiation exposure in long-term cancer survivors should not be overlooked. 18F-FDG PET/CT can be very useful in response evaluation and follow-up in patients treated with RT, however, variants and pitfalls are common and it is important to remember that radiation-induced injury is often a diagnosis of exclusion.
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Affiliation(s)
- Danijela Dejanovic
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Lena Specht
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Dorota Czyzewska
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Kiil Berthelsen
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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30
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Obrador E, Salvador-Palmer R, Villaescusa JI, Gallego E, Pellicer B, Estrela JM, Montoro A. Nuclear and Radiological Emergencies: Biological Effects, Countermeasures and Biodosimetry. Antioxidants (Basel) 2022; 11:1098. [PMID: 35739995 PMCID: PMC9219873 DOI: 10.3390/antiox11061098] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022] Open
Abstract
Atomic and radiological crises can be caused by accidents, military activities, terrorist assaults involving atomic installations, the explosion of nuclear devices, or the utilization of concealed radiation exposure devices. Direct damage is caused when radiation interacts directly with cellular components. Indirect effects are mainly caused by the generation of reactive oxygen species due to radiolysis of water molecules. Acute and persistent oxidative stress associates to radiation-induced biological damages. Biological impacts of atomic radiation exposure can be deterministic (in a period range a posteriori of the event and because of destructive tissue/organ harm) or stochastic (irregular, for example cell mutation related pathologies and heritable infections). Potential countermeasures according to a specific scenario require considering basic issues, e.g., the type of radiation, people directly affected and first responders, range of doses received and whether the exposure or contamination has affected the total body or is partial. This review focuses on available medical countermeasures (radioprotectors, radiomitigators, radionuclide scavengers), biodosimetry (biological and biophysical techniques that can be quantitatively correlated with the magnitude of the radiation dose received), and strategies to implement the response to an accidental radiation exposure. In the case of large-scale atomic or radiological events, the most ideal choice for triage, dose assessment and victim classification, is the utilization of global biodosimetry networks, in combination with the automation of strategies based on modular platforms.
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Affiliation(s)
- Elena Obrador
- Department of Physiology, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain; (R.S.-P.); (B.P.); (J.M.E.)
| | - Rosario Salvador-Palmer
- Department of Physiology, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain; (R.S.-P.); (B.P.); (J.M.E.)
| | - Juan I. Villaescusa
- Service of Radiological Protection, Clinical Area of Medical Image, La Fe University Hospital, 46026 Valencia, Spain; (J.I.V.); (A.M.)
- Biomedical Imaging Research Group GIBI230, Health Research Institute (IISLaFe), La Fe University Hospital, 46026 Valencia, Spain
| | - Eduardo Gallego
- Energy Engineering Department, School of Industrial Engineering, Polytechnic University of Madrid, 28040 Madrid, Spain;
| | - Blanca Pellicer
- Department of Physiology, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain; (R.S.-P.); (B.P.); (J.M.E.)
| | - José M. Estrela
- Department of Physiology, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain; (R.S.-P.); (B.P.); (J.M.E.)
| | - Alegría Montoro
- Service of Radiological Protection, Clinical Area of Medical Image, La Fe University Hospital, 46026 Valencia, Spain; (J.I.V.); (A.M.)
- Biomedical Imaging Research Group GIBI230, Health Research Institute (IISLaFe), La Fe University Hospital, 46026 Valencia, Spain
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31
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Li H, Cai X, Yi T, Zeng Y, Ma J, Li L, Pang L, Li N, Hu H, Zhan Y. Tumor microenvironment responsive Mn3O4 nanoplatform for in vivo real-time monitoring of drug resistance and photothermal/chemodynamic synergistic therapy of gastric cancer. J Nanobiotechnology 2022; 20:240. [PMID: 35606848 PMCID: PMC9125909 DOI: 10.1186/s12951-022-01441-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/26/2022] [Indexed: 12/13/2022] Open
Abstract
Background Postoperative chemotherapy for gastric cancer often causes multidrug resistance (MDR), which has serious consequences for therapeutic effects. Individualized treatment based on accurate monitoring of MDR will greatly improve patient survival. Results In this article, a self-enhanced Mn3O4 nanoplatform (MPG NPs) was established, which can react with glutathione to produce Mn2+ to enhance T1-weighted magnetic resonance imaging (MRI) and mediate in vivo real-time MDR monitoring. In vitro MRI results showed that MRI signals could be enhanced in the presence of hydrogen peroxide and glutathione and at acidic pH. In vivo MRI results indicated that MPG NPs could specifically target MDR cells, thereby realizing real-time monitoring of MDR in gastric cancer. Furthermore, MPG NPs have good chemodynamic activity, which can convert the endogenous hydrogen peroxide of tumor cells into highly toxic hydroxyl radical through Fenton-like reaction at acidic pH to play the role of chemodynamic therapy. In addition, Mn3O4 can significantly enhance the chemodynamic therapy effect because of its good photothermal conversion effect. Furthermore, in situ photothermal/chemodynamic synergistic therapy obtained remarkable results, the tumors of the mice in the synergistic therapy group gradually became smaller or even disappeared. Conclusions MPG NPs have good biocompatibility, providing a good nanoplatform for real-time monitoring and precise diagnosis and treatment of MDR in gastric cancer. Graphical Abstract ![]()
Supplementary information The online version contains supplementary material available at 10.1186/s12951-022-01441-6.
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Chou SY, Lu HI, Chen YH, Lo CM, Lin YH, Huang TT, Fang FM, Chen LC, Chen Y, Chiu YC, Chou YP, Li SH, Wang YM. The Radiation Dose to the Left Supraclavicular Fossa is Critical for Anastomotic Leak Following Esophagectomy – A Dosimetric Outcome Analysis. Cancer Manag Res 2022; 14:1603-1613. [PMID: 35530530 PMCID: PMC9075167 DOI: 10.2147/cmar.s354667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/24/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Shang-Yu Chou
- Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung-I Lu
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Hao Chen
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Ming Lo
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yun-Hsuan Lin
- Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tzu-Ting Huang
- Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Min Fang
- Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Li-Chun Chen
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu Chen
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Chun Chiu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yeh-Pin Chou
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shau-Hsuan Li
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Shau-Hsuan Li, Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niaosong Dist., Kaohsiung, 833, Taiwan, Tel +886-7-7317123 ext. 8303, Fax +886-7-7322813, Email
| | - Yu-Ming Wang
- Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
- Correspondence: Yu-Ming Wang, Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 129, Ta-Pei Road, Niaosong Dist., Kaohsiung, 833, Taiwan, Tel +886-7-7317123 ext. 7000, Fax +886-7-7322813, Email
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Tatsukawa Y, Cordova K, Yamada M, Ohishi W, Imaizumi M, Hida A, Sposto R, Sakata R, Fujiwara S, Nakanishi S, Yoneda M. Incidence of Diabetes in the Atomic Bomb Survivors: 1969-2015. J Clin Endocrinol Metab 2022; 107:e2148-e2155. [PMID: 34918116 PMCID: PMC9016441 DOI: 10.1210/clinem/dgab902] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/30/2022]
Abstract
CONTEXT Recent epidemiological studies have shown increased risk of diabetes among childhood cancer survivors who received high therapeutic doses of radiation, particularly to the total body or to the abdomen. However, the effect of low-to-moderate dose radiation (<4 Gy) on the risk of diabetes is still unknown. OBJECTIVES To investigate the radiation effect on diabetes incidence among atomic bomb (A-bomb) survivors, and whether the dose response is modified by other factors including city, sex, and age at time of bombing (ATB). METHODS 9131 participants without diabetes at baseline were observed through biennial clinical exams from 1969 to 2015. A Cox proportional hazards model was used to estimate hazard ratios (HR) to evaluate the dose response for diabetes incidence. RESULTS During the study period, 1417 incident diabetes cases were identified. The overall crude incidence rate was 7.01/103 person-years. Radiation dose was significantly associated with diabetes incidence, with effect modification by city and age ATB. In Hiroshima, at ages 10 and 30 ATB, the HRs at 1 Gy of pancreatic radiation dose were 1.47 (95% CI, 1.31-1.66) and 1.13 (95% CI, 0.97-1.31), respectively. However, no significant radiation dose response was observed at these ages in Nagasaki. The HR for radiation dose was higher among those who were younger ATB and decreased 1% for each additional year of age. CONCLUSIONS Among A-bomb survivors, a radiation association was suggested for incidence of diabetes. Results were inconsistent by city and age ATB, which could indicate potential confounding of the radiation association with diabetes.
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Affiliation(s)
- Yoshimi Tatsukawa
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Kismet Cordova
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Michiko Yamada
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Waka Ohishi
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Misa Imaizumi
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Ayumi Hida
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Richard Sposto
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Ritsu Sakata
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Saeko Fujiwara
- Department of Pharmacy, Faculty of Pharmacy, Yasuda Women’s University, Hiroshima, Japan
| | - Shuhei Nakanishi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Kurashiki, Japan
| | - Masayasu Yoneda
- Department of Preventive Medicine for Diabetes and Lifestyle-related Diseases, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Cheung HH, She WH, Yap DY, Tsang SH, Cheung TT. A case report of tumor lysis syndrome after stage-one ALPPS. Medicine (Baltimore) 2022; 101:e29040. [PMID: 35451414 PMCID: PMC8913076 DOI: 10.1097/md.0000000000029040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/23/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Tumor lysis syndrome is a potentially lethal condition caused by rapid cell death, releasing a high level of toxic cytokines. It is common in patients with hematological malignancy but rare in solid tumors. PATIENT CONCERNS A 64-year-old patient presented to our unit with a 17.3-cm hepatocellular carcinoma and marginal liver reserve. The first-stage operation of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was performed. DIAGNOSIS The patient was found to be anuric with grossly deranged electrolytes after the first-stage operation. Tumor lysis syndrome was diagnosed. INTERVENTIONS The patient was transferred to the intensive care unit for aggressive fluid administration and continuous venovenous hemofiltration for the management of tumor lysis syndrome. OUTCOMES The patient recovered and then underwent the second-stage operation of ALPPS with extended right hepatectomy 8 days after the initial operation without any long-term sequelae. LESSONS ALPPS is a relatively new technique in liver surgery, entailing an increased risk of tumor lysis syndrome due to an in situ tumor after the first-stage operation. Clinicians should have a high index of suspicion regarding this potentially lethal complication with prompt management.
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Affiliation(s)
- Ho Hung Cheung
- Department of Surgery, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong, China
| | - Wong Hoi She
- Department of Surgery, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong, China
| | - Desmond Y.H. Yap
- Department of Medicine, University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Simon H.Y. Tsang
- Department of Surgery, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong, China
| | - Tan To Cheung
- Department of Surgery, University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
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Okumura T, Mitsui K, Daikuhara S, Tatai T, Itagaki H, Miyabayashi H, Gibo Y. Disseminated Carcinomatosis of Bone Marrow as the Initial Presentation of Intrahepatic Cholangiocarcinoma without Jaundice: An Autopsy Case Report. Intern Med 2022; 61:657-662. [PMID: 34483207 PMCID: PMC8943367 DOI: 10.2169/internalmedicine.7688-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Disseminated carcinomatosis of the bone marrow (DCBM) is often accompanied by disseminated intravascular coagulation (DIC) and has a poor prognosis. DCBM develops most frequently in gastric cancer and is rarely associated with intrahepatic cholangiocarcinoma. A 41-year-old man was incidentally found to have DIC on his regular visit for ulcerative colitis and was diagnosed with DCBM with intrahepatic cholangiocarcinoma. He received intensive care, including chemotherapy, but died suddenly from hyperkalemia, possibly due to tumor lysis syndrome (TLS). The autopsy showed the periductal infiltrating type of intrahepatic cholangiocarcinoma and tumor necrosis, possibly due to chemotherapy, indicating the effectiveness of chemotherapy for DCBM with intrahepatic cholangiocarcinoma.
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Affiliation(s)
- Taiki Okumura
- Department of Gastroenterology, National Hospital Organization Matsumoto Medical Center, Japan
| | - Kenta Mitsui
- Department of Gastroenterology, National Hospital Organization Matsumoto Medical Center, Japan
| | - Seiichi Daikuhara
- Department of Gastroenterology, National Hospital Organization Matsumoto Medical Center, Japan
| | - Toshiharu Tatai
- Department of Gastroenterology, National Hospital Organization Matsumoto Medical Center, Japan
| | - Hiroko Itagaki
- Department of Pathology, National Hospital Organization Matsumoto Medical Center, Japan
| | - Hideharu Miyabayashi
- Department of Gastroenterology, National Hospital Organization Matsumoto Medical Center, Japan
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Stereotactic Irradiation of the Pancreas: Case Study of a Patient With Persistent Pancreatic Fistula. Pancreas 2022; 51:e62-e63. [PMID: 35584391 DOI: 10.1097/mpa.0000000000002010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Challinor J, Sierra MFO, Burns K, Young A. Oncology nursing in the Global South during COVID-19. Ecancermedicalscience 2022; 15:1329. [PMID: 35211198 PMCID: PMC8816499 DOI: 10.3332/ecancer.2021.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Indexed: 11/06/2022] Open
Abstract
In mid-2020, a call was made to oncology nurses in the Global South to share their experiences managing patient care during the coronavirus disease 2019 (COVID-19) pandemic. Eighteen submissions were received from 16 countries across Latin America, Africa, Europe and Asia. Three were research-based and 15 were personal narratives on the psychosocial impact of COVID-19 on the nurses, colleagues, patients and families. Three narratives were from oncology nurses working with cancer-related non-governmental organisations locally or, in one case, internationally. A simultaneous literature search for publications (including grey literature) was performed to identify themes of COVID-19’s impact in these 16 countries and specifically on oncology nurses and patients/families. Four themes were identified: a) interruptions to care; b) support/resource shortages; c) psychosocial impact on nurses and patients and d) staffing and nursing role impacts. The three research-based studies describe oncology nursing in-depth efforts to explore the impact of COVID-19. Findings in the 15 narratives are briefly presented according to the four themes identified in the literature. Due to the severe shortage of physician adult and paediatric oncology specialists, oncology nurses in the Global South often shoulder much of the care for patients with cancer and even more so during COVID-19 with attendant oncology nursing shortages due to reassignment to COVID-19 units. It is important to hear from these critical members of the oncology nursing workforce who often lack the time, resources or training to publish in peer-reviewed journals in English, particularly in the middle of a pandemic. Giving voice to these nurses documents the reality of their work and ability to continue to provide care despite the chaos and rapidly changing guidelines and government action. Lessons learned by these nurses to improve mental health and psychosocial support of the nurses as well as their patients/families will be essential for the next global pandemic.
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Affiliation(s)
- Julia Challinor
- University of California San Francisco, 2 Koret Way, San Francisco, CA 94143, USA.,https://orcid.org/0000-0002-5008-8501
| | | | - Kathryn Burns
- Qualitative Research, Budapest, Hungary.,https://orcid.org/0000-0002-2695-1088
| | - Annie Young
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.,https://orcid.org/0000-0001-6611-6653
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Shafie M, Teymouri A, Parsa S, Sadeghian A, Zarei Jalalabadi N. Spontaneous tumor lysis syndrome in adrenal adenocarcinoma: a case report and review of the literature. J Med Case Rep 2022; 16:52. [PMID: 35139902 PMCID: PMC8830132 DOI: 10.1186/s13256-022-03263-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background Tumor lysis syndrome is an oncologic emergency that classically occurs following cancer therapy, although spontaneous tumor lysis syndrome can also occur in malignancies, albeit rarely. Spontaneous tumor lysis syndrome has previously been reported in some hematologic malignancies, but it rarely happens in solid tumors and seems to be associated with a higher mortality rate. This is the first case of adrenal adenocarcinoma that developed spontaneous tumor lysis syndrome. Case presentation We present a rare case of spontaneous tumor lysis syndrome occurring in a patient previously diagnosed with adrenal adenocarcinoma. The patient was a 64-year-old Persian man with abdominal pain, hypersomnia, and fatigue who was previously diagnosed with right adrenocortical carcinoma and had undergone right adrenalectomy with regional lymph nodes resection 5 months previously. On physical examination, the patient had abdominal distension and mild tenderness at the right upper quadrant. Pitting edema was detected bilaterally in the lower extremities. Initial imaging revealed multiple and large lesions suggestive of liver metastases. The laboratory data showed hyperkalemia, hyperuricemia, hyperphosphatemia, and elevated serum creatinine level indicative of spontaneous tumor lysis syndrome in the patient. Despite immediate and intensive care with antibiotics, hydration, treatment with a hypouricemic agent, and renal replacement therapy, the patient ultimately died from multiorgan failure. Conclusions Tumor lysis syndrome in solid tumors has high mortality. Patients susceptible to spontaneous tumor lysis syndrome must receive aggressive treatment immediately, which is crucial for preventing morbidity and mortality. Spontaneous tumor lysis syndrome may be underdiagnosed, and a high degree of clinical suspicion is needed to make the diagnosis and proceed with required interventions. Therefore, clinicians should be aware of this rare phenomenon. Supplementary Information The online version contains supplementary material available at 10.1186/s13256-022-03263-4.
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Affiliation(s)
- Mahan Shafie
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,NeuroTRACT Association, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Teymouri
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Parsa
- Department of Internal Medicine, Imam Khomeini Hospital Complex, Keshavarz Boulevard, Post code: 1419733141, Tehran, Iran.
| | - Ali Sadeghian
- NeuroTRACT Association, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Narjes Zarei Jalalabadi
- Department of Internal Medicine, Imam Khomeini Hospital Complex, Keshavarz Boulevard, Post code: 1419733141, Tehran, Iran
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Goyal N, Day A, Epstein J, Goodman J, Graboyes E, Jalisi S, Kiess AP, Ku JA, Miller MC, Panwar A, Patel VA, Sacco A, Sandulache V, Williams AM, Deschler D, Farwell DG, Nathan C, Fakhry C, Agrawal N. Head and neck cancer survivorship consensus statement from the American Head and Neck Society. Laryngoscope Investig Otolaryngol 2022; 7:70-92. [PMID: 35155786 PMCID: PMC8823162 DOI: 10.1002/lio2.702] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To provide a consensus statement describing best practices and evidence regarding head and neck cancer survivorship. METHODS Key topics regarding head and neck cancer survivorship were identified by the multidisciplinary membership of the American Head and Neck Society Survivorship, Supportive Care & Rehabilitation Service. Guidelines were generated by combining expert opinion and a review of the literature and categorized by level of evidence. RESULTS Several areas regarding survivorship including dysphonia, dysphagia, fatigue, chronic pain, intimacy, the ability to return to work, financial toxicity, lymphedema, psycho-oncology, physical activity, and substance abuse were identified and discussed. Additionally, the group identified and described the role of key clinicians in survivorship including surgical, medical and radiation oncologists; dentists; primary care physicians; psychotherapists; as well as physical, occupational, speech, and respiratory therapists. CONCLUSION Head and neck cancer survivorship is complex and requires a multidisciplinary approach centered around patients and their caregivers. As survival related to head and neck cancer treatment improves, addressing post-treatment concerns appropriately is critically important to our patient's quality of life. There continues to be a need to define effective and efficient programs that can coordinate this multidisciplinary effort toward survivorship.
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Affiliation(s)
- Neerav Goyal
- Department of Otolaryngology—Head and Neck SurgeryThe Pennsylvania State University, College of MedicineHersheyPennsylvaniaUSA
| | - Andrew Day
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Joel Epstein
- Department of SurgeryCedars SinaiLos AngelesCaliforniaUSA
- City of HopeCaliforniaDuarteUSA
| | - Joseph Goodman
- Ear, Nose and Throat CenterGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Evan Graboyes
- Department of Otolaryngology—Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Scharukh Jalisi
- Department of OtolaryngologyBeth Israel DeaconessBostonMassachusettsUSA
| | - Ana P. Kiess
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Jamie A. Ku
- Head and Neck InstituteCleveland ClinicClevelandOhioUSA
| | - Matthew C. Miller
- Department of OtolaryngologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Aru Panwar
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer CenterNebraska Methodist HospitalOmahaNebraskaUSA
| | - Vijay A. Patel
- Department of OtolaryngologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Assuntina Sacco
- Department of Medical OncologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Vlad Sandulache
- Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Amy M. Williams
- Department of Otolaryngology—Head and Neck SurgeryHenry Ford Health SystemDetroitMichiganUSA
| | - Daniel Deschler
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
| | - D. Gregory Farwell
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California DavisDavisCaliforniaUSA
| | - Cherie‐Ann Nathan
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State UniversityShreveportLouisianaUSA
| | - Carole Fakhry
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology—Head and Neck SurgeryUniversity of Chicago Pritzker School of MedicineChicagoIllinoisUSA
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Watanabe S, Nanke I, Uchidate K, Machida T, Igarashi A, Kobashi K, Negi M, Yauchi T. Case report of recurrent spontaneous tumor lysis syndrome in a patient with esophageal cancer recovered via chemotherapy. Int Cancer Conf J 2022; 11:97-103. [PMID: 35402131 PMCID: PMC8938533 DOI: 10.1007/s13691-021-00514-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/06/2021] [Indexed: 01/26/2023] Open
Abstract
Tumor lysis syndrome (TLS) is a life-threatening oncological emergency. Only one TLS case has been reported in patients with esophageal cancer. We report the case of a 61-year-old man with recurrent spontaneous TLS caused by esophageal cancer. He was admitted to our hospital to investigate low back pain and dysphagia. Endoscopy and computed tomography revealed esophageal cancer with multiple liver and bone metastases. He was diagnosed with laboratory TLS based on high serum uric acid and phosphorus. After intravenous fluids and allopurinol were administrated, chemotherapy with 5-fluorouracil and cisplatin was started the next day. Although he transiently developed clinical TLS, it was resolved with conservative treatment. However, mild renal dysfunction was prolonged and cisplatin was reduced in the second course. As a consequence, recurrence of spontaous TLS (sTLS) was induced at the end of the course. In the third course, docetaxel was added to the regimen, and since then the patient have not develop sTLS. To the best of our knowledge, this is the first report regarding recurrent sTLS developed on the basis of solid tumors and was successfully controlled by chemotherapy. Although TLS complications are rare in esophageal cancer, early diagnosis and the adjustment of regimen resulted in stable chemotherapy.
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Affiliation(s)
- Sho Watanabe
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560 Japan
| | - Ittoku Nanke
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560 Japan
| | - Kozue Uchidate
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560 Japan
| | - Tomoyo Machida
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560 Japan
| | - Akira Igarashi
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560 Japan
| | - Kenichiro Kobashi
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560 Japan
| | - Mariko Negi
- Department of Pathology, Soka Municipal Hospital, Saitama, Japan
| | - Tsunehito Yauchi
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560 Japan
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41
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Richardson KK, Ling W, Krager K, Fu Q, Byrum SD, Pathak R, Aykin-Burns N, Kim HN. Ionizing Radiation Activates Mitochondrial Function in Osteoclasts and Causes Bone Loss in Young Adult Male Mice. Int J Mol Sci 2022; 23:675. [PMID: 35054859 PMCID: PMC8775597 DOI: 10.3390/ijms23020675] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 12/13/2022] Open
Abstract
The damaging effects of ionizing radiation (IR) on bone mass are well-documented in mice and humans and are most likely due to increased osteoclast number and function. However, the mechanisms leading to inappropriate increases in osteoclastic bone resorption are only partially understood. Here, we show that exposure to multiple fractions of low-doses (10 fractions of 0.4 Gy total body irradiation [TBI]/week, i.e., fractionated exposure) and/or a single exposure to the same total dose of 4 Gy TBI causes a decrease in trabecular, but not cortical, bone mass in young adult male mice. This damaging effect was associated with highly activated bone resorption. Both osteoclast differentiation and maturation increased in cultures of bone marrow-derived macrophages from mice exposed to either fractionated or singular TBI. IR also increased the expression and enzymatic activity of mitochondrial deacetylase Sirtuin-3 (Sirt3)-an essential protein for osteoclast mitochondrial activity and bone resorption in the development of osteoporosis. Osteoclast progenitors lacking Sirt3 exposed to IR exhibited impaired resorptive activity. Taken together, targeting impairment of osteoclast mitochondrial activity could be a novel therapeutic strategy for IR-induced bone loss, and Sirt3 is likely a major mediator of this effect.
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Affiliation(s)
- Kimberly K. Richardson
- Center for Musculoskeletal Disease Research and Center for Osteoporosis and Metabolic Bone Diseases, Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (K.K.R.); (W.L.); (Q.F.)
| | - Wen Ling
- Center for Musculoskeletal Disease Research and Center for Osteoporosis and Metabolic Bone Diseases, Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (K.K.R.); (W.L.); (Q.F.)
| | - Kimberly Krager
- Division of Radiation Health, Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (K.K.); (R.P.); (N.A.-B.)
| | - Qiang Fu
- Center for Musculoskeletal Disease Research and Center for Osteoporosis and Metabolic Bone Diseases, Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (K.K.R.); (W.L.); (Q.F.)
| | - Stephanie D. Byrum
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Rupak Pathak
- Division of Radiation Health, Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (K.K.); (R.P.); (N.A.-B.)
| | - Nukhet Aykin-Burns
- Division of Radiation Health, Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (K.K.); (R.P.); (N.A.-B.)
| | - Ha-Neui Kim
- Center for Musculoskeletal Disease Research and Center for Osteoporosis and Metabolic Bone Diseases, Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (K.K.R.); (W.L.); (Q.F.)
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Shishak S, Kaliyath S, Rastogi S, Sharma DN. Have we ignored the sweetbread for long – Is it time to spare the pancreas? J Cancer Res Ther 2022; 18:860-861. [DOI: 10.4103/jcrt.jcrt_1581_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Dose constraints are essential for performing dosimetry, especially for intensity modulation and for radiotherapy under stereotaxic conditions. We present the update of the recommendations of the French society of oncological radiotherapy for the use of these doses in classical current practice but also for reirradiation.
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Affiliation(s)
- G Noël
- Département de radiothérapie-oncologie, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France.
| | - D Antoni
- Département de radiothérapie-oncologie, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France
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Abadi B, Yazdanpanah N, Nokhodchi A, Rezaei N. Smart biomaterials to enhance the efficiency of immunotherapy in glioblastoma: State of the art and future perspectives. Adv Drug Deliv Rev 2021; 179:114035. [PMID: 34740765 DOI: 10.1016/j.addr.2021.114035] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/20/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022]
Abstract
Glioblastoma multiform (GBM) is considered as the most lethal tumor among CNS malignancies. Although immunotherapy has achieved remarkable advances in cancer treatment, it has not shown satisfactory results in GBM patients. Biomaterial science, along with nanobiotechnology, is able to optimize the efficiency of immunotherapy in these patients. They can be employed to provide the specific activation of immune cells in tumor tissue and combinational therapy as well as preventing systemic adverse effects resulting from hyperactivation of immune responses and off-targeting effect. Advance biomaterials in this field are classified into targeting nanocarriers and localized delivery systems. This review will offer an overview of immunotherapy strategies for glioblastoma and advance delivery systems for immunotherapeutics that may have a high potential in glioblastoma treatment.
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Deterioration of pancreatic exocrine function in carbon ion radiotherapy for pancreatic cancer. Clin Transl Radiat Oncol 2021; 31:80-85. [PMID: 34746451 PMCID: PMC8551411 DOI: 10.1016/j.ctro.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/10/2021] [Accepted: 09/28/2021] [Indexed: 11/21/2022] Open
Abstract
Background and purpose In radiotherapy (RT) for pancreatic cancer, the pancreas is considered an important organ at risk. However, there are insufficient reports on pancreatic function deterioration after X-ray RT as organ at risk, and there are no reports on those after carbon ion (C-ion) RT. Here, we evaluated pancreatic exocrine insufficiency (PEI) after C-ion RT using dose-volume histogram (DVH) analysis. Materials and methods Data were retrospectively collected from patients who had undergone C-ion RT for pancreatic cancer between July 2013 and June 2019. The prescribed C-ion doses were 55.2 Gy (relative biological effectiveness) in 12 fractions. Serum pancreatic amylase and lipase values were measured before and after C-ion RT. In DVH analysis, we assessed V5Gy-50Gy and V<5 Gy-50Gy of pancreatic volume and analyzed whether these DVH parameters involved PEI. Results Thirty-three patients were included in the analysis. The median follow-up duration after the initiation of C-ion RT in these patients was 15.8 months (range, 4.3-64.8). During and after treatment, 57.6% of patients developed PEI within 13.6 months, defined as pancreatic amylase and lipase deficiencies. In DVH analysis, V<5Gy was the most effective factor for the PEI, and the cutoff value for developing PEI in V<5Gy was 4.57 cm3. Conclusion We showed that pancreatic exocrine function declined after C-ion RT for pancreatic cancer and that PEI was initiated early in the course of C-ion RT. Additionally, a low dose of DVH parameters, such as V<5Gy, was a prognostic factor of PEI.
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Pina Cabral J, Coelho J, Fortuna J, Rodrigues A. Spontaneous Tumor Lysis Syndrome in Prostate Cancer. Cureus 2021; 13:e18078. [PMID: 34692296 PMCID: PMC8523474 DOI: 10.7759/cureus.18078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 11/05/2022] Open
Abstract
Tumor lysis syndrome (TLS) is an oncological emergency that most frequently occurs in hematological and high-turnover solid neoplasia. Its incidence in solid, slowly proliferating neoplasia is unclear, primarily because of few published case reports. TLS may be triggered by chemotherapy or infection, or may spontaneously arise. Here, we present a review of the literature and a case of a 58-year-old male patient with prostate cancer who developed spontaneous TLS.
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Affiliation(s)
- João Pina Cabral
- Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Joana Coelho
- Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Jorge Fortuna
- Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Adriano Rodrigues
- Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
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Wang L, Li X, Zhao B, Mei D, Jiang J, Duan J. Immune Checkpoint Inhibitor-Associated Tumor Lysis Syndrome: A Real-World Pharmacovigilance Study. Front Pharmacol 2021; 12:679207. [PMID: 34630077 PMCID: PMC8495237 DOI: 10.3389/fphar.2021.679207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/04/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Immune checkpoint inhibitors (ICIs) have substantially improved the clinical outcomes of various malignancies. However, the adverse event of tumor lysis syndrome (TLS) has not been included in the National Comprehensive Cancer Network guidelines or drug inserts. In this study, we aimed to establish the relationship between ICI therapies and TLS events using data from a real-world pharmacovigilance database. Methods: The MedDRA terms of TLS and both generic and brand names of ICIs were retrieved from the FDA Adverse Event Reporting System. Four frequentist algorithms were employed to confirm the association between the TLS and the ICI regimens, involving anti-cytotoxic T lymphocyte antigen-4 (anti-CTLA-4), anti–programmed death receptor-1 (PD-1)/programmed cell death 1 ligand 1 (PD-L1), and anti-(CTLA-4 + PD-1). A descriptive and statistical analysis was performed according to the case information. Results: One hundred sixty-four TLS cases, where patients underwent anti-CTLA-4 (n = 14), anti-(PD-1)/(PD-L1) (n = 113), or anti-(CTLA-4 + PD-1) (n = 37) therapies, were collected between the first quarter of 2004 and the fourth quarter of 2020. The most coverage-reporting year, age-group, sex, reporter, region, country, and indication were 2020 (n = 62), 60–74 years (n = 65), males (n = 105), physician (n = 66), Asia (n = 80), Japan (n = 67), and lung and thymus malignancies (n = 40), respectively. The median TLS onset time associated with anti-CTLA-4, anti-(PD-1)/(PD-L1), and anti-(CTLA-4 + PD-1) therapies was 6 (IQR: 2–39.5), 9 (IQR: 2–40), and 20 (IQR: 7.5–37.75) days, respectively. Mortality distribution of 71 reported death outcomes among three groups was statistically significant. All four algorithm signal values of anti-(CTLA-4 + PD-1) were higher than those of anti-CTLA-4 and anti-(PD-1)/(PD-L1). Conclusion: Elderly male patients with lung and thymus malignancies are frequently predisposed to TLS. ICI therapies could induce TLS in both solid and hematological malignancies. The rapid onset time and poor outcomes of patients prompt caution from health-care professionals.
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Affiliation(s)
- Li Wang
- Department of Pharmacy, Peking University International Hospital, Beijing, China
| | - Xiaolin Li
- Department of Pharmacy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Zhao
- Department of Pharmacy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dan Mei
- Department of Pharmacy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiandong Jiang
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingli Duan
- Department of Pharmacy, Peking University International Hospital, Beijing, China
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Palliative radiotherapy indications during the COVID-19 pandemic and in future complex logistic settings: the NORMALITY model. Radiol Med 2021; 126:1619-1656. [PMID: 34570309 PMCID: PMC8475365 DOI: 10.1007/s11547-021-01414-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/30/2021] [Indexed: 12/03/2022]
Abstract
Introduction The COVID-19 pandemic has challenged healthcare systems worldwide over the last few months, and it continues to do so. Although some restrictions are being removed, it is not certain when the pandemic is going to be definitively over. Pandemics can be seen as a highly complex logistic scenario. From this perspective, some of the indications provided for palliative radiotherapy (PRT) during the COVID-19 pandemic could be maintained in the future in settings that limit the possibility of patients achieving symptom relief by radiotherapy.
This paper has two aims: (1) to provide a summary of the indications for PRT during the COVID-19 pandemic; since some indications can differ slightly, and to avoid any possible contradictions, an expert panel composed of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) and the Palliative Care and Supportive Therapies Working Group (AIRO-palliative) voted by consensus on the summary; (2) to introduce a clinical care model for PRT [endorsed by AIRO and by a spontaneous Italian collaborative network for PRT named “La Rete del Sollievo” (“The Net of Relief”)]. The proposed model, denoted “No cOmpRoMise on quality of life by pALliative radiotherapy” (NORMALITY), is based on an AIRO-palliative consensus-based list of clinical indications for PRT and on practical suggestions regarding the management of patients potentially suitable for PRT but dealing with highly complex logistics scenarios (similar to the ongoing logistics limits due to COVID-19).
Material and Methods First, a summary of the available literature guidelines for PRT published during the COVID-19 pandemic was prepared. A systematic literature search based on the PRISMA approach was performed to retrieve the available literature reporting guideline indications fully or partially focused on PRT. Tables reporting each addressed clinical presentation and respective literature indications were prepared and distributed into two main groups: palliative emergencies and palliative non-emergencies. These summaries were voted in by consensus by selected members of the AIRO and AIRO-palliative panels. Second, based on the summary for palliative indications during the COVID-19 pandemic, a clinical care model to facilitate recruitment and delivery of PRT to patients in complex logistic scenarios was proposed. The summary tables were critically integrated and shuffled according to clinical presentations and then voted on in a second consensus round. Along with the adapted guideline indications, some methods of performing the first triage of patients and facilitating a teleconsultation preliminary to the first in-person visit were developed.
Results After the revision of 161 documents, 13 papers were selected for analysis. From the papers, 19 clinical presentation items were collected; in total, 61 question items were extracted and voted on (i.e., for each presentation, more than one indication was provided from the literature). Two tables summarizing the PRT indications during the COVID-19 pandemic available from the literature (PRT COVID-19 summary tables) were developed: palliative emergencies and palliative non-emergencies. The consensus of the vote by the AIRO panel for the PRT COVID-19 summary was reached. The PRT COVID-19 summary tables for palliative emergencies and palliative non-emergencies were adapted for clinical presentations possibly associated with patients in complex clinical scenarios other than the COVID-19 pandemic. The two new indication tables (i.e., “Normality model of PRT indications”) for both palliative emergencies and palliative non-emergencies were voted on in a second consensus round. The consensus rate was reached and strong. Written forms facilitating two levels of teleconsultation (triage and remote visits) were also developed, both in English and in Italian, to evaluate the patients for possible indications for PRT before scheduling clinical visits. Conclusion We provide a comprehensive summary of the literature guideline indications for PRT during COVID-19 pandemic. We also propose a clinical care model including clinical indications and written forms facilitating two levels of teleconsultation (triage and remote visits) to evaluate the patients for indications of PRT before scheduling clinical visits. The normality model could facilitate the provision of PRT to patients in future complex logistic scenarios.
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Doolittle ML, Monroe DG, Farr JN, Khosla S. The role of senolytics in osteoporosis and other skeletal pathologies. Mech Ageing Dev 2021; 199:111565. [PMID: 34499959 DOI: 10.1016/j.mad.2021.111565] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/20/2021] [Accepted: 09/03/2021] [Indexed: 11/26/2022]
Abstract
The skeletal system undergoes irreversible structural deterioration with aging, leading to increased fracture risk and detrimental changes in mobility, posture, and gait. This state of low bone mass and microarchitectural changes, diagnosed as osteoporosis, affects millions of individuals worldwide and has high clinical and economic burdens. Recently, pre-clinical studies have linked the onset of age-related bone loss with an accumulation of senescent cells in the bone microenvironment. These senescent cells appear to be causal to age-related bone loss, as targeted clearance of these cells leads to improved bone mass and microarchitecture in old mice. Additionally, other pathologies leading to bone loss that result from DNA damage, such as cancer treatments, have shown improvements after clearance of senescent cells. The development of new therapies that clear senescent cells, termed "senolytics", is currently underway and may allow for the modulation of bone loss that results from states of high senescent cell burden, such as aging.
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Affiliation(s)
- Madison L Doolittle
- Kogod Center on Aging and Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, 55905, United States
| | - David G Monroe
- Kogod Center on Aging and Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, 55905, United States
| | - Joshua N Farr
- Kogod Center on Aging and Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, 55905, United States
| | - Sundeep Khosla
- Kogod Center on Aging and Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, 55905, United States.
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Wang K, Tepper JE. Radiation therapy-associated toxicity: Etiology, management, and prevention. CA Cancer J Clin 2021; 71:437-454. [PMID: 34255347 DOI: 10.3322/caac.21689] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 12/25/2022] Open
Abstract
Radiation therapy (RT) is a curative treatment for many malignancies and provides effective palliation in patients with tumor-related symptoms. However, the biophysical effects of RT are not specific to tumor cells and may produce toxicity due to exposure of surrounding organs and tissues. In this article, the authors review the clinical context, pathophysiology, risk factors, presentation, and management of RT side effects in each human organ system. Ionizing radiation works by producing DNA damage leading to tumor death, but effects on normal tissue may result in acute and/or late toxicity. The manifestation of toxicity depends on both cellular characteristics and affected organs' anatomy and physiology. There is usually a direct relationship between the radiation dose and volume to normal tissues and the risk of toxicity, which has led to guidelines and recommended dose limits for most tissues. Side effects are multifactorial, with contributions from baseline patient characteristics and other oncologic treatments. Technological advances in recent decades have decreased RT toxicity by dramatically improving the ability to deliver RT that maximizes tumor dose and minimizes organ dose. Thus the study of RT-associated toxicity is a complex, core component of radiation oncology training that continues to evolve alongside advances in cancer management. Because RT is used in up to one-half of all patients with cancer, an understanding of its acute and late effects in different organ systems is clinically pertinent to both oncologists and nononcologists.
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Affiliation(s)
- Kyle Wang
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Joel E Tepper
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
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