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Cheng MB, Wang X, Huang Y, Zhang Y. Hyperthermia depletes Oct4 in mouse blastocysts and stem cells. Stem Cell Res Ther 2020; 11:195. [PMID: 32448390 PMCID: PMC7245852 DOI: 10.1186/s13287-020-01715-6] [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: 03/25/2020] [Revised: 04/17/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
Abstract
Temperature is an important microenvironmental factor that functions epigenetically in normal embryonic development. However, the effect of hyperthermia in the stem cells is not fully understood. Oct4 is a tightly regulated master regulator of pluripotency maintenance in stem cells and during early embryonic development. We report here that Oct4 protein level was significantly reduced under hyperthermia in mouse blastocysts and embryonic stem cells. The reduction in Oct4 in the mouse embryonic stem cells under hyperthermia was mediated by a ubiquitin-proteasome pathway that was dependent on the activity of death-associated protein kinase 1 (Dapk1) to phosphorylate its substrate, Pin1. Our results imply that the depletion of Oct4 via brief hyperthermia, such as a high fever, during early pregnancy might severely impair the growth of the mammalian embryo or even cause its death.
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Affiliation(s)
- Mo-Bin Cheng
- State Key Laboratory of Medical Molecular Biology, Department of Biochemistry and Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, 5 Dongdan Santiao, Beijing, 100005, China
| | - Xue Wang
- State Key Laboratory of Medical Molecular Biology, Department of Medical Genetics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China
| | - Yue Huang
- State Key Laboratory of Medical Molecular Biology, Department of Medical Genetics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China.
| | - Ye Zhang
- State Key Laboratory of Medical Molecular Biology, Department of Biochemistry and Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, 5 Dongdan Santiao, Beijing, 100005, China.
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Crezee J, Oei AL, Franken NAP, Stalpers LJA, Kok HP. Response: Commentary: The Impact of the Time Interval Between Radiation and Hyperthermia on Clinical Outcome in Patients With Locally Advanced Cervical Cancer. Front Oncol 2020; 10:528. [PMID: 32351897 PMCID: PMC7174773 DOI: 10.3389/fonc.2020.00528] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/24/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Johannes Crezee
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Arlene L Oei
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Laboratory of Experimental Oncology and Radiobiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Nicolaas A P Franken
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Laboratory of Experimental Oncology and Radiobiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Lukas J A Stalpers
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Laboratory of Experimental Oncology and Radiobiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - H Petra Kok
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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A moderate thermal dose is sufficient for effective free and TSL based thermochemotherapy. Adv Drug Deliv Rev 2020; 163-164:145-156. [PMID: 32247801 DOI: 10.1016/j.addr.2020.03.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
Hyperthermia, i.e. heating the tumor to a temperature of 40-43 °C is considered by many a valuable treatment to sensitize tumor cells to radiotherapy and chemotherapy. In recent randomized trials the great potential of adding hyperthermia to chemotherapy was demonstrated for treatment of high risk soft tissue sarcoma: +11.4% 5 yrs. overall survival (OS) and for ovarian cancer with peritoneal involvement nearly +12 months OS gain. As a result interest in combining chemotherapy with hyperthermia, i.e. thermochemotherapy, is growing. Extensive biological research has revealed that hyperthermia causes multiple effects, from direct cell kill to improved oxygenation, whereby each effect has a specific temperature range. Thermal sensitization of the tumor cell for chemotherapy occurs for many drugs at temperatures ranging from 40 to 42 °C with little additional increase of sensitization at higher temperatures. Increasing perfusion/oxygenation and increased extravasation are two other important hyperthermia induced mechanisms. The combination of free drug and hyperthermia has not been found to increase tumor drug concentration. Hence, enhanced effectiveness of free drug will depend on the thermal sensitization of the tumor cells for the applied drug. In contrast to free drugs, experimental animal studies combining hyperthermia and thermo-sensitive liposomal (TSL) drugs delivery have demonstrated to result in a substantial increase of the drug concentration in the tumor. For TSL based chemotherapy, hyperthermia is critical to both increase perfusion and extravasation as well as to trigger TSL drug release, whereby the temperature controlled induction of a local high drug concentration in a highly permeable vessel is driving the enhanced drug uptake in the tumor. Increased drug concentrations up to 26 times have been reported in rodents. Good control of the tissue temperature is required to keep temperatures below 43 °C to prevent vascular stasis. Further, careful timing of the drug application relative to the start of heating is required to benefit optimal from the combined treatment. From the available experimental data it follows that irrespective whether chemotherapy is applied as free drug or using a thermal sensitive liposomal carrier, the optimal thermal dose for thermochemotherapy should be 40-42 °C for 30-60 min, i.e. equivalent to a CEM43 of 1-15 min. Timing is critical: most free drug should be applied simultaneous with heating, whereas TSL drugs should be applied 20-30 min after the start of hyperthermia.
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Paulides M, Dobsicek Trefna H, Curto S, Rodrigues D. Recent technological advancements in radiofrequency- andmicrowave-mediated hyperthermia for enhancing drug delivery. Adv Drug Deliv Rev 2020; 163-164:3-18. [PMID: 32229271 DOI: 10.1016/j.addr.2020.03.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 12/23/2022]
Abstract
Hyperthermia therapy is a potent enhancer of chemotherapy and radiotherapy. In particular, microwave (MW) and radiofrequency (RF) hyperthermia devices provide a variety of heating approaches that can treat most cancers regardless the size. This review introduces the physics of MW/RF hyperthermia, the current state-of-the-art systems for both localized and regional heating, and recent advancements in hyperthermia treatment guidance using real-time computational simulations and magnetic resonance thermometry. Clinical trials involving RF/MW hyperthermia as adjuvant for chemotherapy are also presented per anatomical site. These studies favor the use of adjuvant hyperthermia since it significantly improves curative and palliative clinical outcomes. The main challenge of hyperthermia is the distribution of state-of-the-art heating systems. Nevertheless, we anticipate that recent technology advances will expand the use of hyperthermia to chemotherapy centers for enhanced drug delivery. These new technologies hold great promise not only for (image-guided) perfusion modulation and sensitization for cytotoxic drugs, but also for local delivery of various compounds using thermosensitive liposomes.
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55
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Notter M, Thomsen AR, Nitsche M, Hermann RM, Wolff HA, Habl G, Münch K, Grosu AL, Vaupel P. Combined wIRA-Hyperthermia and Hypofractionated Re-Irradiation in the Treatment of Locally Recurrent Breast Cancer: Evaluation of Therapeutic Outcome Based on a Novel Size Classification. Cancers (Basel) 2020; 12:cancers12030606. [PMID: 32155740 PMCID: PMC7139693 DOI: 10.3390/cancers12030606] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 02/06/2023] Open
Abstract
Effective tumor control in patients suffering from unresectable locally recurrent breast cancer (LRBC) in pre-irradiated areas can be achieved by re-irradiation combined with superficial hyperthermia. Using this combined modality, total re-irradiation dose and toxicity can be significantly reduced compared to conventionally fractionated treatment schedules with total doses of 60–66 Gy. Applying contact-free, thermography-controlled water-filtered infrared-A superficial hyperthermia, immediately followed by hypofractionated re-irradiation, consisting of 4 Gy once per week up to a total dose of 20 Gy, resulted in high overall response rates even in large-sized tumors. Comparability of clinical data between different combined Hyperthermia (HT)/Radiotherapy (RT) treatment schedules is impeded by the highly individual characteristics of this disease. Tumor size, ranging from microscopic disease and small lesions to large-sized cancer en cuirasse, is described as one of the most important prognostic factors. However, in clinical studies and analyses of LRBC, tumor size has so far been reported in a very heterogeneous way. Therefore, we suggest a novel, simple and feasible size classification (rClasses 0–IV). Applying this classification for the evaluation of 201 patients with pre-irradiated LRBC allowed for a stratification into distinct prognostic groups.
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Affiliation(s)
- Markus Notter
- Department of Radiation Oncology, Lindenhofspital Bern, 3012 Bern, Switzerland; (M.N.); (K.M.)
| | - Andreas R. Thomsen
- Department of Radiation Oncology, Medical Center, University of Freiburg, 79106 Freiburg, Germany; (A.R.T.); (A.-L.G.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Mirko Nitsche
- Center for Radiotherapy and Radiooncology Bremen and Westerstede, 28239 Bremen, Germany; (M.N.); (R.M.H.)
| | - Robert M. Hermann
- Center for Radiotherapy and Radiooncology Bremen and Westerstede, 28239 Bremen, Germany; (M.N.); (R.M.H.)
| | - Hendrik A. Wolff
- Department of Radiology, Nuclear Medicine and Radiotherapy, Radiology Munich, 80333 Munich, Germany; (H.A.W.); (G.H.)
- Department of Radiation Oncology, Medical Center, University of Regensburg, 93053 Regensburg, Germany
| | - Gregor Habl
- Department of Radiology, Nuclear Medicine and Radiotherapy, Radiology Munich, 80333 Munich, Germany; (H.A.W.); (G.H.)
- Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Karin Münch
- Department of Radiation Oncology, Lindenhofspital Bern, 3012 Bern, Switzerland; (M.N.); (K.M.)
| | - Anca-L. Grosu
- Department of Radiation Oncology, Medical Center, University of Freiburg, 79106 Freiburg, Germany; (A.R.T.); (A.-L.G.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Peter Vaupel
- Department of Radiation Oncology, Medical Center, University of Freiburg, 79106 Freiburg, Germany; (A.R.T.); (A.-L.G.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-171-124-0073
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Mei X, ten Cate R, van Leeuwen CM, Rodermond HM, de Leeuw L, Dimitrakopoulou D, Stalpers LJA, Crezee J, Kok HP, Franken NAP, Oei AL. Radiosensitization by Hyperthermia: The Effects of Temperature, Sequence, and Time Interval in Cervical Cell Lines. Cancers (Basel) 2020; 12:cancers12030582. [PMID: 32138173 PMCID: PMC7139900 DOI: 10.3390/cancers12030582] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/27/2020] [Accepted: 02/29/2020] [Indexed: 12/03/2022] Open
Abstract
Cervical cancers are almost exclusively caused by an infection with the human papillomavirus (HPV). When patients suffering from cervical cancer have contraindications for chemoradiotherapy, radiotherapy combined with hyperthermia is a good treatment option. Radiation-induced DNA breaks can be repaired by nonhomologous end-joining (NHEJ) or homologous recombination (HR). Hyperthermia can temporarily inactivate homologous recombination. Therefore, combining radiotherapy with hyperthermia can result in the persistence of more fatal radiation-induced DNA breaks. However, there is no consensus on the optimal sequence of radiotherapy and hyperthermia and the optimal time interval between these modalities. Moreover, the temperature of hyperthermia and HPV-type may also be important in radiosensitization by hyperthermia. In this study we thoroughly investigated the impact of different temperatures (37–42 °C), and the sequence of and time interval (0 up to 4 h) between ionizing radiation and hyperthermia on HPV16+: SiHa, Caski; HPV18+: HeLa, C4I; and HPV−: C33A, HT3 cervical cancer cell lines. Our results demonstrate that a short time interval between treatments caused more unrepaired DNA damages and more cell kill, especially at higher temperatures. Although hyperthermia before ionizing radiation may result in slightly more DNA damage, the sequence between hyperthermia and ionizing radiation yielded similar effects on cell survival.
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Affiliation(s)
- Xionge Mei
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (X.M.); (R.t.C.); (H.M.R.); (L.d.L.); (D.D.); (L.J.A.S.); (N.A.P.F.)
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Rosemarie ten Cate
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (X.M.); (R.t.C.); (H.M.R.); (L.d.L.); (D.D.); (L.J.A.S.); (N.A.P.F.)
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Caspar M. van Leeuwen
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Hans M. Rodermond
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (X.M.); (R.t.C.); (H.M.R.); (L.d.L.); (D.D.); (L.J.A.S.); (N.A.P.F.)
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Lidewij de Leeuw
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (X.M.); (R.t.C.); (H.M.R.); (L.d.L.); (D.D.); (L.J.A.S.); (N.A.P.F.)
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Dionysia Dimitrakopoulou
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (X.M.); (R.t.C.); (H.M.R.); (L.d.L.); (D.D.); (L.J.A.S.); (N.A.P.F.)
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Lukas J. A. Stalpers
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (X.M.); (R.t.C.); (H.M.R.); (L.d.L.); (D.D.); (L.J.A.S.); (N.A.P.F.)
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Johannes Crezee
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - H. Petra Kok
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Nicolaas A. P. Franken
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (X.M.); (R.t.C.); (H.M.R.); (L.d.L.); (D.D.); (L.J.A.S.); (N.A.P.F.)
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Arlene L. Oei
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (X.M.); (R.t.C.); (H.M.R.); (L.d.L.); (D.D.); (L.J.A.S.); (N.A.P.F.)
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
- Correspondence: ; Tel.: +31-205-663-641
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Piazena H, Müller W, Pendl W, von Ah S, Cap VH, Hug PJ, Sidler X, Pluschke G, Vaupel P. Thermal field formation during wIRA-hyperthermia: temperature measurements in skin and subcutis of piglets as a basis for thermotherapy of superficial tumors and local skin infections caused by thermosensitive microbial pathogens. Int J Hyperthermia 2020; 36:938-952. [PMID: 31535588 DOI: 10.1080/02656736.2019.1655594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Purpose: The temporal and spatial formation of the temperature field and its changes during/upon water-filtered infrared-A (wIRA)-irradiation in porcine skin and subcutis were investigated in vivo in order to get a detailed physical basis for thermotherapy of superficial tumors and infections caused by thermosensitive microbial pathogens (e.g., Mycobacterium ulcerans causing Buruli ulcer). Methods: Local wIRA-hyperthermia was performed in 11 anesthetized piglets using 85.0 mW cm-2, 103.2 mW cm-2 and 126.5 mW cm-2, respectively. Invasive temperature measurements were carried out simultaneously in 1-min intervals using eight fiber-optical probes at different tissue depths between 2 and 20 mm, and by an IR thermometer at the skin surface. Results: Tissue temperature distribution depended on incident irradiance, exposure time, tissue depths and individual 'physiologies' of the animals. Temperature maxima were found at depths between 4 and 7 mm, exceeding skin surface temperatures by about 1-2 K. Tissue temperatures above 37 °C, necessary to eradicate M. ulcerans at depths <20 mm, were reached reliably. Conclusions: wIRA-hyperthermia may be considered as a novel therapeutic option for treatment of local skin infections caused by thermosensitive pathogens (e.g., in Buruli ulcer). To ensure temperatures required for heat treatment of superficial tumors deeper than 4 mm, the incident irradiance needed can be controlled either by (a) invasive temperature measurements or (b) control of skin surface temperature and considering possible temperature increases up to 1-2 K in underlying tissue.
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Affiliation(s)
- Helmut Piazena
- Medical Photobiology Group, Department of Internal Medicine, Charité-University Medicine Berlin , Berlin , Germany
| | - Werner Müller
- Physical Optics Consultant Office , Wetzlar , Germany
| | - Wolfgang Pendl
- Department of Farm Animals, Division of Swine Medicine, Vetsuisse Faculty, University of Zürich , Zürich , Switzerland
| | - Sereina von Ah
- Department of Farm Animals, Division of Swine Medicine, Vetsuisse Faculty, University of Zürich , Zürich , Switzerland
| | - Veronika H Cap
- Section of Anaesthesiology, Equine Department, Vetsuisse Faculty, University of Zürich , Zürich , Switzerland
| | - Petra J Hug
- Section of Anaesthesiology, Equine Department, Vetsuisse Faculty, University of Zürich , Zürich , Switzerland
| | - Xaver Sidler
- Department of Farm Animals, Division of Swine Medicine, Vetsuisse Faculty, University of Zürich , Zürich , Switzerland
| | - Gerd Pluschke
- Department of Medical Parasitology and Infection Biology, Molecular Immunology Unit, Swiss Tropical and Public Health Institute , Basel , Switzerland
| | - Peter Vaupel
- Department of Radiation Oncology, University Medical Center , Freiburg i. Breisgau , Germany
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58
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Wu Q, Chen X, Wang P, Wu Q, Qi X, Han X, Chen L, Meng X, Xu K. Delivery of Arsenic Trioxide by Multifunction Nanoparticles To Improve the Treatment of Hepatocellular Carcinoma. ACS APPLIED MATERIALS & INTERFACES 2020; 12:8016-8029. [PMID: 31997633 DOI: 10.1021/acsami.9b22802] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Arsenic trioxide (ATO) is effective in the treatment of hematological malignancies and solid tumors. However, its toxicity and side effects are severe, posing an obstacle in its clinical application. A controlled-release ATO carrier with mitochondrial targeting was constructed in this study. The safety and efficacy in vitro were investigated using a hemolysis test, cytotoxicity, proliferation, migration, apoptosis, and other changes in cell behavior. The safety and efficacy were further evaluated in vivo by hematoxylin-eosin staining, terminal deoxyribonucleotide transferase-mediated dUTP nick end labeling staining, and blood testing in tumor-bearing mice. Immunohistochemically and western blotting experiments were conducted to explore the mechanism of combination therapy of material-based chemotherapy and microwave hyperthermia in vitro. We demonstrated that the nano-zirconia (ZrO2) loading platform may be used to administer the ATO, with local precision-controlled release and mitochondrial targeting. Furthermore, we showed the safety of this approach for delivering high doses of ATO. In addition, we explored this new method in combination with in vitro microwave heat therapy, providing a potentially novel intravenous approach to chemotherapy. We described a new non-invasive treatment that improved the efficacy of ATO chemotherapy against hepatocellular carcinoma through nano-ZrO2 carriers.
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MESH Headings
- Animals
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Apoptosis/drug effects
- Arsenic Trioxide/administration & dosage
- Arsenic Trioxide/pharmacology
- Arsenic Trioxide/therapeutic use
- Carcinoma, Hepatocellular/drug therapy
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/therapy
- Cell Movement/drug effects
- Cell Proliferation/drug effects
- Delayed-Action Preparations
- Drug Carriers/chemistry
- Drug Liberation
- Hep G2 Cells
- Humans
- Hyperthermia, Induced/instrumentation
- Hyperthermia, Induced/methods
- Liver Neoplasms/drug therapy
- Liver Neoplasms/pathology
- Liver Neoplasms/therapy
- Male
- Membrane Potential, Mitochondrial/drug effects
- Mice
- Microscopy, Electron, Scanning
- Microscopy, Electron, Transmission
- Mitochondria/drug effects
- Nanoparticles/chemistry
- Nanoparticles/ultrastructure
- Particle Size
- Xenograft Model Antitumor Assays
- Zirconium/chemistry
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Affiliation(s)
- Qirun Wu
- Department of Radiology , The First Affiliated Hospital of China Medical University , Shenyang 110001 , China
| | - Xiaowei Chen
- Department of Radiology , The First Affiliated Hospital of China Medical University , Shenyang 110001 , China
| | - Peng Wang
- Department of Radiology , The First Affiliated Hospital of China Medical University , Shenyang 110001 , China
| | - Qiong Wu
- Laboratory of Controllable Preparation and Application of Nanomaterials, Laboratory of Cryogenics, Technical Institute of Physics and Chemistry , Chinese Academy of Sciences , Beijing 100190 , China
| | - Xun Qi
- Department of Radiology , The First Affiliated Hospital of China Medical University , Shenyang 110001 , China
| | - Xiangjun Han
- Department of Radiology , The First Affiliated Hospital of China Medical University , Shenyang 110001 , China
| | - Lufeng Chen
- Department of Radiology , The First Affiliated Hospital of China Medical University , Shenyang 110001 , China
| | - Xianwei Meng
- Laboratory of Controllable Preparation and Application of Nanomaterials, Laboratory of Cryogenics, Technical Institute of Physics and Chemistry , Chinese Academy of Sciences , Beijing 100190 , China
| | - Ke Xu
- Department of Radiology , The First Affiliated Hospital of China Medical University , Shenyang 110001 , China
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59
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Dunne M, Regenold M, Allen C. Hyperthermia can alter tumor physiology and improve chemo- and radio-therapy efficacy. Adv Drug Deliv Rev 2020; 163-164:98-124. [PMID: 32681862 DOI: 10.1016/j.addr.2020.07.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 12/20/2022]
Abstract
Hyperthermia has demonstrated clinical success in improving the efficacy of both chemo- and radio-therapy in solid tumors. Pre-clinical and clinical research studies have demonstrated that targeted hyperthermia can increase tumor blood flow and increase the perfused fraction of the tumor in a temperature and time dependent manner. Changes in tumor blood circulation can produce significant physiological changes including enhanced vascular permeability, increased oxygenation, decreased interstitial fluid pressure, and reestablishment of normal physiological pH conditions. These alterations in tumor physiology can positively impact both small molecule and nanomedicine chemotherapy accumulation and distribution within the tumor, as well as the fraction of the tumor susceptible to radiation therapy. Hyperthermia can trigger drug release from thermosensitive formulations and further improve the accumulation, distribution, and efficacy of chemotherapy.
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60
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Oei A, Kok H, Oei S, Horsman M, Stalpers L, Franken N, Crezee J. Molecular and biological rationale of hyperthermia as radio- and chemosensitizer. Adv Drug Deliv Rev 2020; 163-164:84-97. [PMID: 31982475 DOI: 10.1016/j.addr.2020.01.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/11/2019] [Accepted: 01/20/2020] [Indexed: 12/24/2022]
Abstract
Mild hyperthermia, local heating of the tumour up to temperatures <43 °C, has been clinically applied for almost four decades and has been proven to substantially enhance the effectiveness of both radiotherapy and chemotherapy in treatment of primary and recurrent tumours. Clinical results and mechanisms of action are discussed in this review, including the molecular and biological rationale of hyperthermia as radio- and chemosensitizer as established in in vitro and in vivo experiments. Proven mechanisms include inhibition of different DNA repair processes, (in)direct reduction of the hypoxic tumour cell fraction, enhanced drug uptake, increased perfusion and oxygen levels. All mechanisms show different dose effect relationships and different optimal scheduling with radiotherapy and chemotherapy. Therefore, obtaining the ideal multi-modality treatment still requires elucidation of more detailed data on dose, sequence, duration, and possible synergisms between modalities. A multidisciplinary approach with different modalities including hyperthermia might further increase anti-tumour effects and diminish normal tissue damage.
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Szasz AM, Minnaar CA, Szentmártoni G, Szigeti GP, Dank M. Review of the Clinical Evidences of Modulated Electro-Hyperthermia (mEHT) Method: An Update for the Practicing Oncologist. Front Oncol 2019; 9:1012. [PMID: 31737558 PMCID: PMC6837995 DOI: 10.3389/fonc.2019.01012] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/20/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Modulated electro-hyperthermia (mEHT) is a variation of the conventional hyperthermia which selectively targets the malignant cell membranes in order to heat the malignant tissue and sensitize the tissue to oncology treatments. Although widely applied, the formulation of guidelines for the use thereof is still in progress for many tumors. Aim: In this paper we review the literature on the effects of mEHT in cancer patients on local disease control and survival. Methodology: Our review on data presents the collected experience with capacitive hyperthermia treatments with the EHY-2000+ device (OncoTherm Ltd., Germany). A literature search was conducted in Pubmed and articles were grouped and discussed according to: trial type, animal studies, in vitro studies, and reviews. Search results from Conference Abstracts; Trial Registries; Thesis and Dissertations and the Oncothermia Journal were included in the discussions. Results: Modulated electro-hyperthermia is a safe form of hyperthermia which has shown to effectively sensitizes deep tumors, regardless of the thickness of the adipose layers. The technology has demonstrated equal benefits compared to other forms of hyperthermia for a variety of tumors. Given the effective heating ability to moderate temperatures, the improved tumor perfusion, and ability to increase drug absorption, mEHT is a safe and effective heating technology which can be easily applied to sensitize tumors which have demonstrated benefits with the addition of hyperthermia. Modulated electro-hyperthermia also appears to improve local control and survival rates and appears to induce an abscopal (systemic) response to ionizing radiation. Conclusion: Based on clinical studies, the method mEHT is a feasible hyperthermia technology for oncological applications. Concomitant utilization of mEHT is supported by the preclinical and clinical data.
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Affiliation(s)
| | | | | | - Gyula P. Szigeti
- Institute of Human Physiology and Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - Magdolna Dank
- Cancer Center, Semmelweis University, Budapest, Hungary
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Sebeke L, Deenen DA, Maljaars E, Heijman E, de Jager B, Heemels WPMH, Grüll H. Model predictive control for MR-HIFU-mediated, uniform hyperthermia. Int J Hyperthermia 2019; 36:1040-1050. [DOI: 10.1080/02656736.2019.1668065] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- L. Sebeke
- Department of Mechanical Engineering, Computational Biology, Eindhoven University of Technology, Eindhoven, The Netherlands
- Faculty of Medicine and University Hospital of Cologne, Department of Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany
| | - D. A. Deenen
- Department of Mechanical Engineering, Control Systems Technology, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - E. Maljaars
- Department of Mechanical Engineering, Control Systems Technology, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - E. Heijman
- Faculty of Medicine and University Hospital of Cologne, Department of Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany
- Philips Research Eindhoven, Eindhoven, The Netherlands
| | - B. de Jager
- Department of Mechanical Engineering, Control Systems Technology, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - W. P. M. H. Heemels
- Department of Mechanical Engineering, Control Systems Technology, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - H. Grüll
- Department of Mechanical Engineering, Computational Biology, Eindhoven University of Technology, Eindhoven, The Netherlands
- Faculty of Medicine and University Hospital of Cologne, Department of Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany
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63
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Cellular Stress Responses in Radiotherapy. Cells 2019; 8:cells8091105. [PMID: 31540530 PMCID: PMC6769573 DOI: 10.3390/cells8091105] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/11/2019] [Accepted: 09/18/2019] [Indexed: 12/15/2022] Open
Abstract
Radiotherapy is one of the major cancer treatment strategies. Exposure to penetrating radiation causes cellular stress, directly or indirectly, due to the generation of reactive oxygen species, DNA damage, and subcellular organelle damage and autophagy. These radiation-induced damage responses cooperatively contribute to cancer cell death, but paradoxically, radiotherapy also causes the activation of damage-repair and survival signaling to alleviate radiation-induced cytotoxic effects in a small percentage of cancer cells, and these activations are responsible for tumor radio-resistance. The present study describes the molecular mechanisms responsible for radiation-induced cellular stress response and radioresistance, and the therapeutic approaches used to overcome radioresistance.
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64
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Kroesen M, Mulder HT, van Holthe JML, Aangeenbrug AA, Mens JWM, van Doorn HC, Paulides MM, Oomen-de Hoop E, Vernhout RM, Lutgens LC, van Rhoon GC, Franckena M. Confirmation of thermal dose as a predictor of local control in cervical carcinoma patients treated with state-of-the-art radiation therapy and hyperthermia. Radiother Oncol 2019; 140:150-158. [PMID: 31302345 DOI: 10.1016/j.radonc.2019.06.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Addition of deep hyperthermia results in improved local control (LC) and overall survival (OS) compared to radiotherapy alone in patients with cervical carcinoma. Previously, we showed that the thermal dose of hyperthermia significantly correlates with LC and disease specific survival (DSS). Over the last decade, new radiation techniques were introduced resulting in improved LC. AIM To validate the effect of thermal dose in a more recent cohort of patients treated with modern radiotherapy techniques, including image guided brachytherapy (IGBT). METHODS We analyzed primary cervical carcinoma patients treated with a combination of radiotherapy and deep hyperthermia between 2005 and 2016 at our institute. Data on patient, tumor and treatment were collected including the thermal dose parameters TRISE and CEM43T90. Follow-up data on LC, disease free survival, DSS, OS as well as late toxicity data were collected. Data were analyzed using the Cox proportional hazard and Kaplan-Meier analyses. RESULTS 227 patients were included. In multivariate analysis, histology, FIGO stage, lymphadenopathy, TRISE, CEM43T90 and IGBT had a significant effect on LC. In the patients treated with IGBT, the thermal dose parameter TRISE remained to have a significant effect on LC in univariate analysis. CONCLUSIONS The positive association between thermal dose and clinical outcome is replicated in an independent, recent cohort of cervical carcinoma patients. Importantly, in patients receiving IGBT, the effect of thermal dose on clinical outcome is still observed.
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Affiliation(s)
- Michiel Kroesen
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Hendrik T Mulder
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Jeanette M L van Holthe
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Aleida A Aangeenbrug
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Jan Willem M Mens
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Helena C van Doorn
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynaecology, The Netherlands
| | - Margarethus M Paulides
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands; Eindhoven University of Technology, Department of Electrical Engineering, The Netherlands
| | - Esther Oomen-de Hoop
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Rene M Vernhout
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Ludy C Lutgens
- University Medical Centre Maastricht, Department of Radiation Oncology (MAASTRO), Maastricht, The Netherlands
| | - Gerard C van Rhoon
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Martine Franckena
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands.
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65
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Minnaar CA, Kotzen JA, Ayeni OA, Naidoo T, Tunmer M, Sharma V, Vangu MDT, Baeyens A. The effect of modulated electro-hyperthermia on local disease control in HIV-positive and -negative cervical cancer women in South Africa: Early results from a phase III randomised controlled trial. PLoS One 2019; 14:e0217894. [PMID: 31216321 PMCID: PMC6584021 DOI: 10.1371/journal.pone.0217894] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/16/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The global burden of cervical cancer remains high with the highest morbidity and mortality rates reported in developing countries. Hyperthermia as a chemo- and radiosensitiser has shown to improve treatment outcomes. This is an analysis of the local control results at six months post-treatment of patients enrolled in an ongoing study investigating the effects of the addition of modulated electro-hyperthermia (mEHT) to chemoradiotherapy for the treatment of HIV-positive and -negative cervical cancer patients in a low-resource setting. METHODS This ongoing Phase III randomised controlled trial, conducted at a state hospital in Johannesburg, South Africa, was registered with the appropriate ethics committee. After signing an informed consent, participants with FIGO stages IIB to IIIB squamous cell carcinoma of the cervix were randomised to receive chemoradiotherapy with/without mEHT using a secure online random-sampling tool (stratum: HIV status) accounting for age and stage. Reporting physicians were blind to treatment allocation. HIV-positive participants on antiretroviral treatment, or with a CD4 count >200cell/μL were included. mEHT was administered 2/weekly immediately before external beam radiation. The primary end point is local disease control (LDC) and secondary endpoints are toxicity; quality of life analysis; and two year survival. We report on six month LDC, including nodes visualised in the radiation field on 18F-FDG PET/CT (censored for six month survival), and six month local disease free survival (LDFS) (based on intention to treat). Trial status: Recruitment closed (ClinicalTrials.gov: NCT03332069). RESULTS 271 participants were recruited between January 2014 and November 2017, of which 210 were randomised for trial and 202 were available for analysis at six months post-treatment (mEHT: n = 101; Control: n = 101). Six month LDFS was higher in the mEHT Group (n = 39[38.6%]), than in the Control Group (n = 20[19.8%]); p = 0.003). LDC was also higher in the mEHT Group (n = 40[45.5%]) than the Control Group (n = 20[24.1%]); (p = 0.003). CONCLUSION Our results show that mEHT is effective as a chemo-radiosensitiser for cervical cancer, even in high risk a patients and resource-constrained settings.
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Affiliation(s)
- Carrie Anne Minnaar
- Department of Radiation Sciences, Radiobiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeffrey Allan Kotzen
- Department of Radiation Oncology, Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Olusegun Akinwale Ayeni
- Department of Nuclear Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Thanushree Naidoo
- Department of Radiation Oncology, Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Mariza Tunmer
- Department of Radiation Oncology, Wits Donald Gordon Medical Centre, Johannesburg, South Africa
- Department of Radiation Sciences, Radiation Oncology, University of the Witwatersrand, Johannesburg, South Africa
| | - Vinay Sharma
- Department of Radiation Sciences, Radiation Oncology, University of the Witwatersrand, Johannesburg, South Africa
| | - Mboyo-Di-Tamba Vangu
- Department of Nuclear Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
- Department of Radiation Sciences, Nuclear Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Ans Baeyens
- Department of Radiation Sciences, Radiobiology, University of the Witwatersrand, Johannesburg, South Africa
- Department of Human Structure and Repair, Radiobiology, Ghent University, Ghent, Belgium
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66
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Abstract
The feasibility of using hydrogels as a water bolus during hyperthermia treatment was assessed. Three types of gels, high methoxyl (HM) pectin/alginate, xanthan/locust bean gum (LBG) and xanthan/LBG/agarose were evaluated based on their dielectric, rheological and mechanical properties. The most suitable, xanthan/LBG/agarose gel was further used as a water bolus in a hyperthermia array applicator. The gels composed of polysaccharides carrying low charge displayed dielectric properties close to those of water, while the dielectric properties of HM pectin/alginate gel was deemed unsuitable for the current application. The mechanical examination shows that the xanthan/LBG gel has a non-brittle behaviour at room temperature, in contrast to the agarose gel. The moduli of the xanthan/LBG gel weaken however considerably between the temperature range of 40 °C and 50 °C, reducing its potential to be used as water bolus. The ternary system of xanthan/LBG/agarose had advantageous behaviour as it was dominated by the thermal hysteresis typical of agarose upon temperature increase, but governed by the typical non-brittle behaviour of the xanthan/LBG at low temperatures. The final evaluation within the hyperthermia applicator showed excellent signal transmission from the antennas. The agarose/xanthan/LBG gel reduced the scattering of electromagnetic waves, enabled a tight closure between the body and the antennas, and offered a less bulky solution than the currently used water-filled plastic bags. The results presented here open up a new application area for hydrogels in improving heat delivery during hyperthermia treatment and other near-field microwave applications.
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Affiliation(s)
- Hana Dobšíček Trefná
- Department of Electrical Engineering, Chalmers University of Technology, Göteborg, Sweden
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67
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Datta NR, Bodis S. Hyperthermia with radiotherapy reduces tumour alpha/beta: Insights from trials of thermoradiotherapy vs radiotherapy alone. Radiother Oncol 2019; 138:1-8. [PMID: 31132683 DOI: 10.1016/j.radonc.2019.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/16/2019] [Accepted: 05/05/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Hyperthermia inhibits the repair of irradiation-induced DNA damage and thereby could alter the α/β values of tumours. This study estimates the clinical α/βHTRT values from clinical trials of thermoradiotherapy (HTRT) vs radiotherapy (RT) in recurrent breast (RcBC), head and neck (III/IV) (LAHNC) and cervix cancers (IIB-IVA) (LACC). METHODS Three recently published meta-analyses for HTRT vs RT in RcBC, LAHNC and LACC were evaluated for complete response (CR). Studies with specified RT dose (D), dose/fraction (d) and corresponding CRs were selected. Tumour biological effective dose (BED) for each study with RT (BEDRT) was computed assuming an α/βRT of 10 Gy. As outcomes were favourable with HTRT, thermoradiobiological BED (BEDHTRT) was calculated as a product of BEDRT and %CRHTRT/%CRRT. The α/βHTRT was estimated as Dd/(BEDHTRT - D). RESULTS 12 trials with 864 patients were shortlisted - RcBC (3 studies, n = 259), LAHNC (5 studies, n = 338) and LACC (4 studies, n = 267). Overall risk difference of 0.28 favoured HTRT (p < 0.001). Mean BEDRT and BEDHTRT were 64.7 Gy (SD: ±15.5) and 109.5 Gy (SD: ±32.1) respectively and global α/βHTRT was 2.25 Gy (SD: ±0.79). Mean α/βHTRT for RcBC, LAHNC and LACC were 2.05 Gy, 1.74 Gy and 3.03 Gy respectively. On meta-regression, α/βHTRT was the sole predictor for the corresponding risk differences of the studies (coefficient = -0.096; p = 0.03). CONCLUSION Thermoradiobiological effects on the repair of RT induced DNA damage results in reduction in α/β values of tumours. This should be considered to effectively optimize HTRT dose-fractionation schedules in the clinic.
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Affiliation(s)
- Niloy R Datta
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland.
| | - Stephan Bodis
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Switzerland
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68
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Crezee H, Kok HP, Oei AL, Franken NAP, Stalpers LJA. The Impact of the Time Interval Between Radiation and Hyperthermia on Clinical Outcome in Patients With Locally Advanced Cervical Cancer. Front Oncol 2019; 9:412. [PMID: 31165046 PMCID: PMC6536646 DOI: 10.3389/fonc.2019.00412] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/02/2019] [Indexed: 01/22/2023] Open
Affiliation(s)
- Hans Crezee
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - H P Kok
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Arlene L Oei
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Laboratory of Experimental Oncology and Radiobiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Nicolaas A P Franken
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Laboratory of Experimental Oncology and Radiobiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Lukas J A Stalpers
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Laboratory of Experimental Oncology and Radiobiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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69
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Lloret M, García-Cabrera L, Hernandez A, Santana N, López-Molina L, Lara PC. Feasibility of a deep hyperthermia and radiotherapy programme for advanced tumors: first Spanish experience. Clin Transl Oncol 2019; 21:1771-1775. [PMID: 31102061 DOI: 10.1007/s12094-019-02097-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/20/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hyperthermia (HT) is used to increase the temperature of the tumor-sensitizing cells to the effects of radiation/chemotherapy. We aimed to assess the feasibility, tolerability and safety of hyperthermia treatment in a Radiation Oncology Department. METHODS Between June 2015 and June 2017, 106 patients and a total of 159 tumor lesions were included in a prospective study (EudraCT 2018-001089-40) of HT concomitant with radiotherapy (RT). Systemic treatment was accepted. HT was given twice a week, 60 min per session, during RT treatment by a regional capacitive device (HY-DEEP 600WM system) at 13.56 MHz radiofrequency. RESULTS Most lesions (138 cases, 86.8%) received all HT sessions planned. Thirteen lesions (12 patients) withdrew treatment due to grade ≥3 QMHT toxicity. All these 12 patients completed the prescribed radiotherapy and/or systemic treatment. CONCLUSIONS Regional hyperthermia is a feasible and safe technique to be used in combination with radiotherapy and systemic treatment.
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Affiliation(s)
- M Lloret
- Department of Radiation Oncology, Dr. Negrin Hospital, Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain.
- Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain.
- Instituto Canario de Investigación del Cáncer, Las Palmas de Gran Canaria, Spain.
| | - L García-Cabrera
- Department of Radiation Oncology, Dr. Negrin Hospital, Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
| | - A Hernandez
- Department of Radiation Oncology, Dr. Negrin Hospital, Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
| | - N Santana
- Department of Radiation Oncology, Dr. Negrin Hospital, Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
| | - L López-Molina
- Department of Radiation Oncology, Dr. Negrin Hospital, Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
| | - P C Lara
- Instituto Canario de Investigación del Cáncer, Las Palmas de Gran Canaria, Spain
- Universidad Fernando Pessoa Canarias, Las Palmas, Spain
- Hospital Universitario San Roque, Las Palmas, Spain
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70
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Lassche G, Crezee J, Van Herpen CML. Whole-body hyperthermia in combination with systemic therapy in advanced solid malignancies. Crit Rev Oncol Hematol 2019; 139:67-74. [PMID: 31112883 DOI: 10.1016/j.critrevonc.2019.04.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/03/2019] [Accepted: 04/26/2019] [Indexed: 01/20/2023] Open
Abstract
Whole-body hyperthermia (WBH) might be beneficial for patients with metastasized solid malignancies when combined with systemic therapy. This review identified and summarized the phase I/II studies (n = 13/14) conducted using this combination of therapies. Most of the phase II studies used radiant heating methods in a thermal dose of 41.8 °C (1 h). All studies used classic chemotherapy. Great inter-study heterogeneity was observed regarding treatment regimes, included patients and reported response rates (12-89%). Ovarian cancer, colorectal adenocarcinoma, lung cancer and sarcoma have been studied most. Most reported toxicity (grade 3/4) was myelosuppression. Treatment related mortality was present (4 patients) in three out 14 phase II studies (350 evaluable patients, over 966 cycles of WBH with chemotherapy). Absence of phase III trials makes the additive value of WBH highly speculative. As modern oncology offers many less invasive treatments options, it is unlikely WBH will ever find its way in routine clinical care.
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Affiliation(s)
- G Lassche
- Department of medical oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Crezee
- Department of radiation oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - C M L Van Herpen
- Department of medical oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
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Zhu L, Altman MB, Laszlo A, Straube W, Zoberi I, Hallahan DE, Chen H. Ultrasound Hyperthermia Technology for Radiosensitization. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1025-1043. [PMID: 30773377 PMCID: PMC6475527 DOI: 10.1016/j.ultrasmedbio.2018.12.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 11/28/2018] [Accepted: 12/17/2018] [Indexed: 05/08/2023]
Abstract
Hyperthermia therapy (HT) raises tissue temperature to 40-45°C for up to 60 min. Hyperthermia is one of the most potent sensitizers of radiation therapy (RT). Ultrasound-mediated HT for radiosensitization has been used clinically since the 1960s. Recently, magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU), which has been approved by the United States Food and Drug Administration for thermal ablation therapy, has been adapted for HT. With emerging clinical trials using MRgHIFU HT for radiosensitization, there is a pressing need to review the ultrasound HT technology. The objective of this review is to overview existing HT technology, summarize available ultrasound HT devices, evaluate clinical studies combining ultrasound HT with RT and discuss challenges and future directions.
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Affiliation(s)
- Lifei Zhu
- Department of Biomedical Engineering, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Michael B Altman
- Department of Radiation Oncology, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Andrei Laszlo
- Department of Radiation Oncology, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - William Straube
- Department of Radiation Oncology, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Dennis E Hallahan
- Department of Radiation Oncology, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Hong Chen
- Department of Biomedical Engineering, Washington University in Saint Louis, Saint Louis, Missouri, USA; Department of Radiation Oncology, Washington University in Saint Louis, Saint Louis, Missouri, USA.
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72
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Kroesen M, Mulder HT, van Holthe JML, Aangeenbrug AA, Mens JWM, van Doorn HC, Paulides MM, Oomen-de Hoop E, Vernhout RM, Lutgens LC, van Rhoon GC, Franckena M. The Effect of the Time Interval Between Radiation and Hyperthermia on Clinical Outcome in 400 Locally Advanced Cervical Carcinoma Patients. Front Oncol 2019; 9:134. [PMID: 30906734 PMCID: PMC6418024 DOI: 10.3389/fonc.2019.00134] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/14/2019] [Indexed: 01/10/2023] Open
Abstract
Background: Addition of deep hyperthermia to radiotherapy results in improved local control (LC) and overall survival compared to radiotherapy alone in cervical carcinoma patients. Based on preclinical data, the time interval between radiotherapy, and hyperthermia is expected to influence treatment outcome. Clinical studies addressing the effect of time interval are sparse. The repercussions for clinical applications are substantial, as the time between radiotherapy and hyperthermia should be kept as short as possible. In this study, we therefore investigated the effect of the time interval between radiotherapy and hyperthermia on treatment outcome. Methods: We analyzed all primary cervical carcinoma patients treated between 1996 and 2016 with thermoradiotherapy at our institute. Data on patients, tumors and treatments were collected, including the thermal dose parameters TRISE and CEM43T90. Follow-up data on tumor status and survival as well as late toxicity were collected. Data was analyzed using Cox proportional hazards analysis and Kaplan Meier analysis. Results: 400 patients were included. Kaplan Meier and univariate Cox analysis showed no effect of the time interval (range 30-230 min) on any clinical outcome measure. Besides known prognostic factors, thermal dose parameters TRISE and CEM43T90 had a significant effect on LC. In multivariate analysis, the thermal dose parameter TRISE (HR 0.649; 95% CI 0.501-0.840) and the use of image guided brachytherapy (HR 0.432; 95% CI 0.214-0.972), but not the time interval, were significant predictors of LC and disease specific survival. Conclusions: The time interval between radiotherapy and hyperthermia, up to 4 h, has no effect on clinical outcome. These results are re-ensuring for our current practice of delivering hyperthermia within maximal 4 h after radiotherapy.
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Affiliation(s)
- M Kroesen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - H T Mulder
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - J M L van Holthe
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - A A Aangeenbrug
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - J W M Mens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - H C van Doorn
- Department of Obstetrics and Gynaecology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - M M Paulides
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - E Oomen-de Hoop
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - R M Vernhout
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - L C Lutgens
- Department of Radiation oncology, University Medical Centre Maastricht (MAASTRO), Maastricht, Netherlands
| | - G C van Rhoon
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - M Franckena
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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Cohen J, Anvari A, Samanta S, Poirier Y, Soman S, Alexander A, Ranjbar M, Pavlovic R, Zodda A, Jackson IL, Mahmood J, Vujaskovic Z, Sawant A. Mild hyperthermia as a localized radiosensitizer for deep-seated tumors: investigation in an orthotopic prostate cancer model in mice. Br J Radiol 2019; 92:20180759. [PMID: 30673305 PMCID: PMC6541201 DOI: 10.1259/bjr.20180759] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/02/2019] [Accepted: 01/16/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE: Non-ablative or mild hyperthermia (HT) has been shown in preclinical (and clinical) studies as a localized radiosensitizer that enhances the tumoricidal effects of radiation. Most preclinical in vivo HT studies use subcutaneous tumor models which do not adequately represent clinical conditions (e.g. proximity of normal/critical organs) or replicate the tumor microenvironment-both of which are important factors for eventual clinical translation. The purpose of this work is to demonstrate proof-of-concept of locoregional radiosensitization with superficially applied, radiofrequency (RF)-induced HT in an orthotopic mouse model of prostate cancer. METHODS: In a 4-arm study, 40 athymic male nude mice were inoculated in the prostate with luciferase-transfected human prostate cancer cells (PC3). Tumor volumes were allowed to reach 150-250 mm3 (as measured by ultrasound) following which, mice were randomized into (i) control (no intervention); (ii) HT alone; (iii) RT alone; and (iv) HT + RT. RF-induced HT was administered (Groups ii and iv) using the Oncotherm LAB EHY-100 device to achieve a target temperature of 41 °C in the prostate. RT was administered ~30 min following HT, using an image-guided small animal radiotherapy research platform. In each case, a dual arc plan was used to deliver 12 Gy to the target in a single fraction. One animal from each cohort was euthanized on Day 10 or 11 after treatment for caspase-9 and caspase-3 Western blot analysis. RESULTS: The inoculation success rate was 89%. Mean tumor size at randomization (~16 days post-inoculation) was ~189 mm3 . Following the administration of RT and HT, mean tumor doubling times in days were: control = 4.2; HT = 4.5; RT = 30.4; and HT + RT = 33.4. A significant difference (p = 0.036) was noted between normalized nadir volumes for the RT alone (0.76) and the HT + RT (0.40) groups. Increased caspase-3 expression was seen in the combination treatment group compared to the other treatment groups. CONCLUSION: These early results demonstrate the successful use of external mild HT as a localized radiosensitizer for deep-seated tumors. ADVANCES IN KNOWLEDGE: We successfully demonstrated the feasibility of administering external mild HT in an orthotopic tumor model and demonstrated preclinical proof-of-concept of HT-based localized radiosensitization in prostate cancer radiotherapy.
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Affiliation(s)
- Justin Cohen
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Akbar Anvari
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Santanu Samanta
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Yannick Poirier
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sandrine Soman
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Allen Alexander
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Maida Ranjbar
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ramilda Pavlovic
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew Zodda
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Isabel L Jackson
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Javed Mahmood
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Zeljko Vujaskovic
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amit Sawant
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
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Lee SY, Szigeti GP, Szasz AM. Oncological hyperthermia: The correct dosing in clinical applications. Int J Oncol 2019; 54:627-643. [PMID: 30483754 PMCID: PMC6317680 DOI: 10.3892/ijo.2018.4645] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/06/2018] [Indexed: 12/24/2022] Open
Abstract
The problem with the application of conventional hyperthermia in oncology is firmly connected to the dose definition, which conventionally uses the concept of the homogeneous (isothermal) temperature of the target. Its imprecise control and complex evaluation is the primary barrier to the extensive clinical applications. The aim of this study was to show the basis of the problems of the misleading dose concept. A clear clarification of the proper dose concept must begin with the description of the limitations of the present doses in conventional hyperthermia applications. The surmounting of the limits the dose of oncologic hyperthermia has to be based on the applicability of the Eyring transition state theory on thermal effects. In order to avoid the countereffects of thermal homeostasis, the use of precise heating on the nanoscale with highly efficient energy delivery is recommended. The nano‑scale heating allows for an energy‑based dose to control the process. The main aspects of the method are the following: i) It is not isothermal (no homogeneous heating); ii) malignant cells are heated selectively; and iii) it employs high heating efficacy, with less energy loss. The applied rigorous thermodynamical considerations show the proper terminology and dose concept of hyperthermia, which is based on the energy‑absorption (such as in the case of ionizing radiation) instead of the temperature‑based ideas. On the whole, according to the present study, the appropriate dose in oncological hyperthermia must use an energy‑based concept, as it is well‑known in all the ionizing radiation therapies. We propose the use of Gy (J/kg) in cases of non‑ionizing radiation (hyperthermia) as well.
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Affiliation(s)
- Sun-Young Lee
- Department of Radiation Oncology, Chonbuk National University Hospital-Chonbuk National University Medical School, Jeonju, Jeonbuk 561-712
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk 54907, Republic of Korea
| | - Gyula Peter Szigeti
- Institute of Human Physiology and Clinical Experimental Research, Semmelweis University
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Dimitriou NM, Pavlopoulou A, Tremi I, Kouloulias V, Tsigaridas G, Georgakilas AG. Prediction of Gold Nanoparticle and Microwave-Induced Hyperthermia Effects on Tumor Control via a Simulation Approach. NANOMATERIALS 2019; 9:nano9020167. [PMID: 30699996 PMCID: PMC6410344 DOI: 10.3390/nano9020167] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/18/2019] [Accepted: 01/20/2019] [Indexed: 12/12/2022]
Abstract
Hyperthermia acts as a powerful adjuvant to radiation therapy and chemotherapy. Recent advances show that gold nanoparticles (Au-NPs) can mediate highly localized thermal effects upon interaction with laser radiation. The purpose of the present study was to investigate via in silico simulations the mechanisms of Au-NPs and microwave-induced hyperthermia, in correlation to predictions of tumor control (biological endpoints: tumor shrinkage and cell death) after hyperthermia treatment. We also study in detail the dependence of the size, shape and structure of the gold nanoparticles on their absorption efficiency, and provide general guidelines on how one could modify the absorption spectrum of the nanoparticles in order to meet the needs of specific applications. We calculated the hyperthermia effect using two types of Au-NPs and two types of spherical tumors (prostate and melanoma) with a radius of 3 mm. The plasmon peak for the 30 nm Si-core Au-coated NPs and the 20 nm Au-NPs was found at 590 nm and 540 nm, respectively. Considering the plasmon peaks and the distribution of NPs in the tumor tissue, the induced thermal profile was estimated for different intervals of time. Predictions of hyperthermic cell death were performed by adopting a three-state mathematical model, where “three-state” includes (i) alive, (ii) vulnerable, and (iii) dead states of the cell, and it was coupled with a tumor growth model. Our proposed methodology and preliminary results could be considered as a proof-of-principle for the significance of simulating accurately the hyperthermia-based tumor control involving the immune system. We also propose a method for the optimization of treatment by overcoming thermoresistance by biological means and specifically through the targeting of the heat shock protein 90 (HSP90), which plays a critical role in the thermotolerance of cells and tissues.
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Affiliation(s)
- Nikolaos M Dimitriou
- Department of Physics, School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Zografou Campus, 15780 Athens, Greece.
- Department of Bioengineering, McGill University, Montreal, QC H3A 0E9, Canada.
| | - Athanasia Pavlopoulou
- Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, 35340 Balcova, Turkey.
| | - Ioanna Tremi
- Department of Physics, School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Zografou Campus, 15780 Athens, Greece.
| | - Vassilis Kouloulias
- Radiation Oncology Unit, 2nd Department of Radiology, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece.
| | - Georgios Tsigaridas
- Department of Physics, School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Zografou Campus, 15780 Athens, Greece.
| | - Alexandros G Georgakilas
- Department of Physics, School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Zografou Campus, 15780 Athens, Greece.
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Dobšíček Trefná H, Schmidt M, van Rhoon GC, Kok HP, Gordeyev SS, Lamprecht U, Marder D, Nadobny J, Ghadjar P, Abdel-Rahman S, Kukiełka AM, Strnad V, Hurwitz MD, Vujaskovic Z, Diederich CJ, Stauffer PR, Crezee J. Quality assurance guidelines for interstitial hyperthermia. Int J Hyperthermia 2019; 36:277-294. [PMID: 30676101 DOI: 10.1080/02656736.2018.1564155] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Quality assurance (QA) guidelines are essential to provide uniform execution of clinical hyperthermia treatments and trials. This document outlines the clinical and technical consequences of the specific properties of interstitial heat delivery and specifies recommendations for hyperthermia administration with interstitial techniques. Interstitial hyperthermia aims at tumor temperatures in the 40-44 °C range as an adjunct to radiation or chemotherapy. The clinical part of this document imparts specific clinical experience of interstitial heat delivery to various tumor sites as well as recommended interstitial hyperthermia workflow and procedures. The second part describes technical requirements for quality assurance of current interstitial heating equipment including electromagnetic (radiative and capacitive) and ultrasound heating techniques. Detailed instructions are provided on characterization and documentation of the performance of interstitial hyperthermia applicators to achieve reproducible hyperthermia treatments of uniform high quality. Output power and consequent temperature rise are the key parameters for characterization of applicator performance in these QA guidelines. These characteristics determine the specific maximum tumor size and depth that can be heated adequately. The guidelines were developed by the ESHO Technical Committee with participation of senior STM members and members of the Atzelsberg Circle.
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Affiliation(s)
- H Dobšíček Trefná
- a Department of Electrical Engineering , Chalmers University of Technology , Göteborg , Sweden
| | - M Schmidt
- b Department of Radiation Oncology , University Hospital Erlangen , Erlangen , Germany
| | - G C van Rhoon
- c Department of Radiation Oncology , Erasmus MC Cancer Institute , Rotterdam , the Netherlands
| | - H P Kok
- d Department of Radiation Oncology, Cancer Center Amsterdam , Amsterdam UMC, University of Amsterdam , Amsterdam , the Netherlands
| | - S S Gordeyev
- e Department of Colorectal Oncology , N.N.Blokhin Russian Cancer Research Center , Moscow, Russia
| | - U Lamprecht
- f Radioonkologische Klinik , Universitätsklinikum Tübingen , Tübingen , Germany
| | - D Marder
- g Kantonsspital Aarau , Radio-Onkologie-Zentrum KSA-KSB , Aarau , Switzerland
| | - J Nadobny
- h Klinik für Radioonkologie und Strahlentherapie , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - P Ghadjar
- h Klinik für Radioonkologie und Strahlentherapie , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - S Abdel-Rahman
- i Klinikum der Universität München-Campus Grosshadern , München , Germany
| | - A M Kukiełka
- j Department of Radiation Oncology , Centrum Diagnostyki i Terapii Onkologicznej Nu-Med , Zamość , Poland
| | - V Strnad
- b Department of Radiation Oncology , University Hospital Erlangen , Erlangen , Germany
| | - M D Hurwitz
- k Department of Radiation Oncology , Thomas Jefferson University , Philadelphia , PA , USA
| | - Z Vujaskovic
- l Department of Radiation Oncology , University of Maryland Baltimore , Baltimore , MD , USA
| | - C J Diederich
- m Department of Radiation Oncology , University of California , San Francisco , CA , USA
| | - P R Stauffer
- k Department of Radiation Oncology , Thomas Jefferson University , Philadelphia , PA , USA
| | - J Crezee
- d Department of Radiation Oncology, Cancer Center Amsterdam , Amsterdam UMC, University of Amsterdam , Amsterdam , the Netherlands
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77
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Hyperthermic chest wall re-irradiation in recurrent breast cancer: a prospective observational study. Strahlenther Onkol 2019; 195:318-326. [PMID: 30607453 DOI: 10.1007/s00066-018-1414-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/11/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE To prospectively investigate the role of re-irradiation (re-RT) combined with hyperthermia (HT) in a contemporary cohort of patients affected by recurrent breast cancer (RBC). METHODS Within the prospective registry HT03, patients with resected RBC and previous irradiation were included. Re-RT was applied to the recurrence region with doses of 50-50.4 Gy, with a boost up to 60-60.4 Gy to the microscopically or macroscopically positive resection margins (R1/R2) region. Concurrent HT was performed at 40-42 ℃. Primary endpoint was LC. Acute and late toxicity, overall survival, cancer-specific survival (CSS), and progression-free survival (PFS) were also evaluated. RESULTS 20 patients and 21 RBC were analyzed. Median re-RT dose was 50.4 Gy and a median of 11 HT fractions were applied. Re-RT+HT was well tolerated, with three patients who experienced a grade (G) 3 acute skin toxicity and no cases of ≥G3 late toxicity. With a median follow up of 24.7 months, two local relapses occurred. Ten patients experienced regional and/or distant disease progression. Five patients died, four of them from breast cancer. PFS was favorable in patients treated with re-RT+HT for the first recurrence with doses of 60 Gy. A trend towards better CSS was found in patients with negative or close margins and after doses of 60 Gy. CONCLUSION Full-dose re-RT+HT for RBC is well tolerated, provides good LC, and seems to be more effective when applied at the time of the first relapse and after doses of 60 Gy. The registry will be continued for validation in a larger cohort and with longer follow-up.
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78
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Bakker A, van der Zee J, van Tienhoven G, Kok HP, Rasch CRN, Crezee H. Temperature and thermal dose during radiotherapy and hyperthermia for recurrent breast cancer are related to clinical outcome and thermal toxicity: a systematic review. Int J Hyperthermia 2019; 36:1024-1039. [PMID: 31621437 DOI: 10.1080/02656736.2019.1665718] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/30/2019] [Accepted: 08/30/2019] [Indexed: 01/07/2023] Open
Abstract
Objective: Hyperthermia therapy (HT), heating tumors to 40-45 °C, is a known radiotherapy (RT) and chemotherapy sensitizer. The additional benefit of HT to RT for recurrent breast cancer has been proven in multiple randomized trials. However, published outcome after RT + HT varies widely. We performed a systematic review to investigate whether there is a relationship between achieved HT dose and clinical outcome and thermal toxicity for patients with recurrent breast cancer treated with RT + HT. Method: Four databases, EMBASE, PubMed, Cochrane library and clinicaltrials.gov, were searched with the terms breast, radiotherapy, hyperthermia therapy and their synonyms. Final search was performed on 3 April 2019. Twenty-two articles were included in the systematic review, reporting on 2330 patients with breast cancer treated with RT + HT. Results: Thirty-two HT parameters were tested for a relationship with clinical outcome. In studies reporting a relationship, the relationship was significant for complete response in 10/15 studies, in 10/13 studies for duration of local control, in 2/2 studies for overall survival and in 7/11 studies for thermal toxicity. Patients who received high thermal dose had on average 34% (range 27%-53%) more complete responses than patients who received low thermal dose. Patients who achieved higher HT parameters had increased odds/probability on improved clinical outcome and on thermal toxicity. Conclusion: Temperature and thermal dose during HT had significant influence on complete response, duration of local control, overall survival and thermal toxicity of patients with recurrent breast cancer treated with RT + HT. Higher temperature and thermal dose improved outcome, while higher maximum temperature increased incidence of thermal toxicity.
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Affiliation(s)
- Akke Bakker
- Department of Radiation Oncology, Amsterdam UMC , Amsterdam , The Netherlands
| | - Jacoba van der Zee
- Department of Radiation Oncology, Erasmus MC , Rotterdam , The Netherlands
| | | | - H Petra Kok
- Department of Radiation Oncology, Amsterdam UMC , Amsterdam , The Netherlands
| | - Coen R N Rasch
- Department of Radiation Oncology, Amsterdam UMC , Amsterdam , The Netherlands
- Department of Radiation Oncology, LUMC , Leiden , The Netherlands
| | - Hans Crezee
- Department of Radiation Oncology, Amsterdam UMC , Amsterdam , The Netherlands
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Kauscher U, Holme MN, Björnmalm M, Stevens MM. Physical stimuli-responsive vesicles in drug delivery: Beyond liposomes and polymersomes. Adv Drug Deliv Rev 2019; 138:259-275. [PMID: 30947810 PMCID: PMC7180078 DOI: 10.1016/j.addr.2018.10.012] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/30/2018] [Accepted: 10/22/2018] [Indexed: 12/11/2022]
Abstract
Over the past few decades, a range of vesicle-based drug delivery systems have entered clinical practice and several others are in various stages of clinical translation. While most of these vesicle constructs are lipid-based (liposomes), or polymer-based (polymersomes), recently new classes of vesicles have emerged that defy easy classification. Examples include assemblies with small molecule amphiphiles, biologically derived membranes, hybrid vesicles with two or more classes of amphiphiles, or more complex hierarchical structures such as vesicles incorporating gas bubbles or nanoparticulates in the lumen or membrane. In this review, we explore these recent advances and emerging trends at the edge and just beyond the research fields of conventional liposomes and polymersomes. A focus of this review is the distinct behaviors observed for these classes of vesicles when exposed to physical stimuli - such as ultrasound, heat, light and mechanical triggers - and we discuss the resulting potential for new types of drug delivery, with a special emphasis on current challenges and opportunities.
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Affiliation(s)
- Ulrike Kauscher
- Department of Materials, Imperial College London, London SW7 2AZ, UK; Department of Bioengineering, Imperial College London, London SW7 2AZ, UK; Institute of Biomedical Engineering, Imperial College London, London SW7 2AZ, UK
| | - Margaret N Holme
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | - Mattias Björnmalm
- Department of Materials, Imperial College London, London SW7 2AZ, UK; Department of Bioengineering, Imperial College London, London SW7 2AZ, UK; Institute of Biomedical Engineering, Imperial College London, London SW7 2AZ, UK
| | - Molly M Stevens
- Department of Materials, Imperial College London, London SW7 2AZ, UK; Department of Bioengineering, Imperial College London, London SW7 2AZ, UK; Institute of Biomedical Engineering, Imperial College London, London SW7 2AZ, UK; Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm SE-171 77, Sweden.
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80
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Kok HP, Van Dijk IWEM, Crama KF, Franken NAP, Rasch CRN, Merks JHM, Crezee J, Balgobind BV, Bel A. Re‑irradiation plus hyperthermia for recurrent pediatric sarcoma; a simulation study to investigate feasibility. Int J Oncol 2018; 54:209-218. [PMID: 30387837 DOI: 10.3892/ijo.2018.4622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/21/2018] [Indexed: 11/05/2022] Open
Abstract
Recurrent pediatric tumors pose a challenge since treatment options may be limited, particularly after previous irradiation. Positive results have been reported for chemotherapy and hyperthermia, but the combination of re‑irradiation and hyperthermia has not been investigated thus far, although it is a proven treatment strategy in adults. The theoretical feasibility of re‑irradiation plus hyperthermia was investigated for infield recurrent pediatric sarcoma in the pelvic region and the extremities. A total of 46 recurrent pediatric sarcoma cases diagnosed at the Academic Medical Center (Amsterdam, The Netherlands) between 2002 and 2017 were evaluated. Patients not previously irradiated, outfield recurrences and locations other than the pelvis and extremities were excluded, ultimately yielding four eligible patients: Two with sarcomas in the pelvis and two in an extremity. Re‑irradiation and hyperthermia treatment plans were simulated for 23x2 Gy treatment schedules and weekly hyperthermia. The radiosensitizing effect of hyperthermia was quantified using biological modelling with a temperature‑dependent change in the parameters of the linear‑quadratic model. The possible effectiveness of re‑irradiation plus hyperthermia was estimated by calculating the equivalent radiotherapy dose distribution. Treatment planning revealed that tumors located in the pelvis and the extremities can be effectively heated in children. Equivalent dose distributions indicated that hyperthermic radiosensitization can be quantified as a target‑selective additional D95% of typically 10 Gy, thereby delivering a possibly curative dose of 54 Gy, without substantially increasing the equivalent dose to the organs at risk. Therefore, re‑irradiation plus hyperthermia is a theoretically feasible and possibly effective treatment option for recurrent pediatric sarcoma in the pelvic region and the extremities, and its clinical feasibility is worthy of evaluation.
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Affiliation(s)
- H Petra Kok
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Irma W E M Van Dijk
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Koen F Crama
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Nicolaas A P Franken
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Coen R N Rasch
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Johannes H M Merks
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Johannes Crezee
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Brian V Balgobind
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Datta NR, Stutz E, Gomez S, Bodis S. Efficacy and Safety Evaluation of the Various Therapeutic Options in Locally Advanced Cervix Cancer: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials. Int J Radiat Oncol Biol Phys 2018; 103:411-437. [PMID: 30391522 DOI: 10.1016/j.ijrobp.2018.09.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 01/10/2023]
Abstract
Treatment options in locally advanced cervix cancer (LACC) have evolved around radiation therapy (RT) and/or chemotherapy (CT), hypoxic cell sensitizers, immunomodulators (Imm), and locoregional moderate hyperthermia (HT). A systematic review and network meta-analysis was conducted to synthesize the evidence for efficacy and safety in terms of long-term locoregional control (LRC), overall survival (OS), and grade ≥3 acute morbidity (AM) and late morbidity (LM). Five databases were searched, and 6285 articles (1974-2018) were screened per the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Fifty-nine randomized trials in untreated LACC without surgical intervention were shortlisted. These used 13 different interventions: RT alone and/or neoadjuvant CT (NACT), adjuvant CT (ACT), concurrent chemoradiation therapy (CTRT) (weekly cisplatin [CDDP]/3-weekly CDDP/combination CT with CDDP/non-CDDP-based CT), hypoxic cell sensitizers, Imm, or HT. Odds ratios (ORs) using random effects network meta-analysis were estimated. Interventions for each endpoint were ranked according to their corresponding surface under cumulative ranking curve values. Of the 9894 patients evaluated, the total events reported for LRC, OS, AM, and LM were 5431 of 8197, 4482 of 7958, 1710 of 7183, and 441 of 6333, respectively. ORs and 95% credible intervals (CrIs) for the 2 best strategies were HT + RT versus CTRT + ACT (OR, 1.23; 95% CrI, 0.49-3.19) for LRC, CTRT (3-weekly CDDP) versus HTCTRT (OR, 1.14; 95% CrI, 0.35-3.65) for OS, RT + ACT versus RT (OR, 0.01; 95% CrI, 0.00-1.04) for AM, and NACT + RT + ACT versus RT + Imm (OR, 0.42; 95% CrI, 0.02-7.39) for LM. The 3 interventions with the highest cumulative surface under cumulative ranking curve values for all 4 endpoints were HTRT, HTCTRT, and CTRT (3-weekly CDDP). Articles with low risk of bias and those published during 2004 to 2018 also retained these interventions as the best. Two-step cluster analysis grouped these 3 modalities in a single distinctive cluster. HTRT, HTCTRT, and CTRT with 3-weekly CDDP were identified as therapeutic modalities with the best comprehensive impact on key clinical endpoints in LACC. This warrants a phase 3 randomized trial among these strategies for a head-to-head comparison and additional validation.
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Affiliation(s)
- Niloy R Datta
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland.
| | - Emanuel Stutz
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland
| | - Silvia Gomez
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland
| | - Stephan Bodis
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Switzerland
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Santos MA, Wu SK, Li Z, Goertz DE, Hynynen K. Microbubble-assisted MRI-guided focused ultrasound for hyperthermia at reduced power levels. Int J Hyperthermia 2018; 35:599-611. [PMID: 30295119 DOI: 10.1080/02656736.2018.1514468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Ultrasound contrast agent microbubbles were combined with magnetic resonance imaging (MRI)-guided focused ultrasound (MRgFUS) as a means to achieve mild hyperthermia at reduced power levels. METHODS MRgFUS hyperthermia (42°C for 20 min) was evaluated in rabbit thigh muscle or Vx2 tumors using infusions of microbubbles (Definity, 20 µL/kg) or saline (sham) administered over 5 min. The impact of treatments on drug uptake was assessed with liposomal doxorubicin (Caelyx, 2.5 mg/kg). Applied power levels before and after the injection of microbubbles or saline were compared, and drug uptake was evaluated with fluorometry of tissues harvested 24 hr post-treatment. RESULTS MRgFUS hyperthermia in muscle and tumors resulted in accurate temperature control (mean =42.0°C, root mean square error (RMSE) = 0.3°C). The power dropped significantly following the injection of microbubbles in muscle and tumors compared to exposures without microbubbles (-21.9% ± 12.5% vs -5.9% ± 7.8%, p = .009 in muscle; -33.8% ± 9.9% vs -3.0% ± 7.2%, p < .001 in tumors). Cavitation monitoring indicated emission of subharmonic, ultraharmonic, and elevated levels of fourth to sixth harmonic frequencies following microbubble injection. The drug delivery was elevated significantly in muscle with the use of microbubble-assisted relative to conventional heating (0.5 ± 0.5 ng/mg vs 0.20 ± 0.04 ng/mg, p = .05), whereas in tumors similar levels were found (11 ± 3 ng/mg vs 16 ± 4 ng/mg, p = .13). CONCLUSIONS The finding that microbubbles reduce the applied power requirements for hyperthermia has considerable clinical implications. The elevated levels of drug found in muscle but not tumor tissue suggest a complex interplay between the heating effects of microbubbles with those of enhanced permeabilization and possible vascular damage.
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Affiliation(s)
- Marc A Santos
- a Physical Sciences Platform , Sunnybrook Research Institute , Toronto , Canada.,b Department of Medical Biophysics , University of Toronto , Toronto , Canada
| | - Sheng-Kai Wu
- a Physical Sciences Platform , Sunnybrook Research Institute , Toronto , Canada.,b Department of Medical Biophysics , University of Toronto , Toronto , Canada
| | - Zhe Li
- a Physical Sciences Platform , Sunnybrook Research Institute , Toronto , Canada
| | - David E Goertz
- a Physical Sciences Platform , Sunnybrook Research Institute , Toronto , Canada.,b Department of Medical Biophysics , University of Toronto , Toronto , Canada
| | - Kullervo Hynynen
- a Physical Sciences Platform , Sunnybrook Research Institute , Toronto , Canada.,b Department of Medical Biophysics , University of Toronto , Toronto , Canada.,c Institute of Biomaterials and Biomedical Engineering , University of Toronto , Toronto , Canada
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83
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Prieto C, Linares I. Nanoparticles and nanothermia for malignant brain tumors, a suggestion of treatment for further investigations. Rep Pract Oncol Radiother 2018; 23:474-480. [PMID: 30263017 PMCID: PMC6158037 DOI: 10.1016/j.rpor.2018.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/19/2018] [Accepted: 08/09/2018] [Indexed: 12/26/2022] Open
Abstract
The current treatment for brain tumors, such as glioblastoma multiforme (GBM), has not been developed enough yet in order to fully heal them. The main causes are the lack of specificity of the treatments, the difficulty of passage of drugs through the blood-brain barrier, heterogeneity and tumor aggressiveness, and widespread dissemination in the brain. The application of nanoparticles (Nps) have been a breakthrough for both diagnostic imaging and targeted therapies. There have been numerous studies with different types of Nps in brain tumors, but we have focused on thermosensitive liposomes, which are characterized by releasing the chemotherapeutic agent included within its lipophilic membranes through heat. Furthermore, increasing the temperature in brain tumors through hyperthermia has been proven therapeutically beneficial. Nanothermia or modulated-electro-hyperthermia (MEHT) is an improved technique that allows to create hot spots in nanorange at the membrane rafts, specifically in tumor cells, theoretically increasing the selectivity of the damage. In scientific records, experiments that combine both techniques (thermosensitive liposomes and nanothermia) have never been conducted. We propose a hypothesis for further research.
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Affiliation(s)
- Cristina Prieto
- Radiation Oncology Department, University Hospital San Cecilio, Av. Dr. Olóriz 16, 18012 Granada, Spain
| | - Isabel Linares
- Radiation Oncology Department, Institut Català d'Oncologia, Avinguda Granvia, 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
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84
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Katusic Bojanac A, Rogosic S, Sincic N, Juric-Lekic G, Vlahovic M, Serman L, Jezek D, Bulic-Jakus F. Influence of hyperthermal regimes on experimental teratoma development in vitro. Int J Exp Pathol 2018; 99:131-144. [PMID: 30066346 PMCID: PMC6104434 DOI: 10.1111/iep.12273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/15/2018] [Indexed: 12/15/2022] Open
Abstract
We screened for the impact of hyperthermal regimes varying in the cumulative equivalent minutes at 43°C (CEM43°C) and media composition on tumour development using an original teratoma in vitro model. Rat embryos (three germ layers) were microsurgically isolated and cultivated at the air‐liquid interface. During a two week period, ectodermal, mesodermal and endodermal derivatives developed within trilaminar teratomas. Controls were grown at 37°C. Overall growth was measured, and teratoma survival and differentiation were histologically assessed. Cell proliferation was stereologically quantified by the volume density of Proliferating Cell Nuclear Antigen. Hyperthermia of 42°C, applied for 15 minutes after plating (CEM43°C 3.75 minutes), diminished cell proliferation (P ˂ .0001) and enhanced differentiation of both myotubes (P ˂ .01) and cylindrical epithelium (P ˂ .05). Hyperthermia of 43°C applied each day for 30 minutes during the first week (CEM43°C 210 minutes) impaired overall growth (P ˂ .01) and diminished cell proliferation (P ˂ .0001). Long‐term hyperthermia of 40.5°C applied for two weeks (CEM43°C 630 minutes) significantly impaired survival (P ˂ .005). Long‐term hyperthermia of 40.5°C applied from the second day when differentiation of tissues begins (CEM43°C 585 minutes) impaired survival (P ˂ .0001), overall growth (P ˂ .01) and cartilage differentiation (P ˂ .05). No teratomas survived extreme regimes: 43°C for 24 hours (CEM43°C 1440 minutes), hyperthermia in the scant serum‐free medium (CEM43°C 630 minutes) or treatment with an anti‐HSP70 antibody before long‐term hyperthermia 40.5°C from the second day (CEM43°C 585 minutes). This in vitro research provided novel insights into the impact of hyperthermia on the development of experimental teratomas from their undifferentiated sources and are thus of potential interest for future therapeutic strategies in corresponding in vivo models.
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Affiliation(s)
- Ana Katusic Bojanac
- Department of Medical Biology, University of Zagreb School of Medicine, Zagreb, Croatia.,Centre of Excellence in Reproductive and Regenerative Medicine, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Srdjan Rogosic
- Department of Medical Biology, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Nino Sincic
- Department of Medical Biology, University of Zagreb School of Medicine, Zagreb, Croatia.,Centre of Excellence in Reproductive and Regenerative Medicine, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Gordana Juric-Lekic
- Centre of Excellence in Reproductive and Regenerative Medicine, University of Zagreb School of Medicine, Zagreb, Croatia.,Department of Histology and Embryology, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Maja Vlahovic
- Department of Medical Biology, University of Zagreb School of Medicine, Zagreb, Croatia.,Centre of Excellence in Reproductive and Regenerative Medicine, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Ljiljana Serman
- Department of Medical Biology, University of Zagreb School of Medicine, Zagreb, Croatia.,Centre of Excellence in Reproductive and Regenerative Medicine, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Davor Jezek
- Centre of Excellence in Reproductive and Regenerative Medicine, University of Zagreb School of Medicine, Zagreb, Croatia.,Department of Histology and Embryology, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Floriana Bulic-Jakus
- Department of Medical Biology, University of Zagreb School of Medicine, Zagreb, Croatia.,Centre of Excellence in Reproductive and Regenerative Medicine, University of Zagreb School of Medicine, Zagreb, Croatia
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85
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Lin FC, Hsu CH, Lin YY. Nano-therapeutic cancer immunotherapy using hyperthermia-induced heat shock proteins: insights from mathematical modeling. Int J Nanomedicine 2018; 13:3529-3539. [PMID: 29950833 PMCID: PMC6016258 DOI: 10.2147/ijn.s166000] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Nano-therapeutic utilizing hyperthermia therapy in combination with chemotherapy, surgery, and radiation is known to treat various types of cancer. These cancer treatments normally focus on reducing tumor burden. Nevertheless, it is still challenging to confine adequate thermal energy in a tumor and obtain a complete tumor ablation to avoid recurrence and metastasis while leaving normal tissues unaffected. Consequently, it is critical to attain an alternative tumor-killing mechanism to circumvent these challenges. Studies have demonstrated that extracellular heat shock proteins (HSPs) activate antitumor immunity during tumor cell necrosis. Such induced immunity was further shown to assist in regressing tumor and reducing recurrence and metastasis. However, only a narrow range of thermal dose is reported to be able to acquire the optimal antitumor immune outcome. Consequently, it is crucial to understand how extracellular HSPs are generated. MATERIALS AND METHODS In this work, a predictive model integrating HSP synthesis mechanism and cell death model is proposed to elucidate the HSP involvement in hyperthermia cancer immune therapy and its relation with dead tumor cells. This new model aims to provide insights into the thermally released extracellular HSPs by dead tumor cells for a more extensive set of conditions, including various temperatures and heating duration time. RESULTS Our model is capable of predicting the optimal thermal parameters to generate maximum HSPs for stimulating antitumor immunity, promoting tumor regression, and reducing metastasis. The obtained nonlinear relation between extracellular HSP concentration and increased dead cell number, along with rising temperature, shows that only a narrow range of thermal dose is able to generate the optimal antitumor immune result. CONCLUSION Our predictive model is capable of predicting the optimal temperature and exposure time to generate HSPs involved in the antitumor immune activation, with a goal to promote tumor regression and reduce metastasis.
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Affiliation(s)
- Fang-Chu Lin
- Department of Chemistry and Biochemistry, University of California, Los Angeles, CA, USA
| | - Chao-Hsiung Hsu
- Department of Chemistry and Biochemistry, University of California, Los Angeles, CA, USA
| | - Yung-Ya Lin
- Department of Chemistry and Biochemistry, University of California, Los Angeles, CA, USA
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86
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Vaupel P, Piazena H, Müller W, Notter M. Biophysical and photobiological basics of water-filtered infrared-A hyperthermia of superficial tumors. Int J Hyperthermia 2018; 35:26-36. [PMID: 29745269 DOI: 10.1080/02656736.2018.1469169] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Thermography-controlled, water-filtered infrared-A (wIRA) is a novel, effective and approved heating technique listed in the ESHO quality assurance guidelines for superficial hyperthermia clinical trials (2017). In order to assess the special features and the potential of wIRA-hyperthermia (wIRA-HT), detailed and updated information about its physical and photobiological background is presented. wIRA allows for (a) application of high irradiances without skin pain and acute grade 2-4 skin toxicities, (b) prolonged, therapeutically relevant exposure times using high irradiances (150-200 mW/cm2) and (c) faster and deeper heat extension within tissues. The deeper radiative penetration depth is mainly caused by forward Mie-scattering. At skin surface temperatures of 42-43 °C, the effective heating depth is 15 mm (T ≥ 40 °C) and 20 mm (T ≥ 39.5 °C). Advantages of wIRA include its contact-free energy input, easy power steering by a feed-back loop, extendable treatment fields, real-time and noninvasive surface temperature monitoring with observation of dynamic changes during HT, and - if necessary - rapid protection of temperature-sensitive structures. wIRA makes the compliant heating of ulcerated and/or bleeding tumors possible, allows for HT of irregularly shaped and diffusely spreading tumors, is independent of individual body contours, allows for very short 'transits' between HT and RT (1-4 min) or continuous heating between both therapeutic interventions. New treatment options for wIRA-HT may include malignant melanoma, vulvar carcinoma, skin metastases of different primary tumors, cutaneous T-and B-cell lymphoma, large-area hemangiomatosis, inoperable squamous cell, basal cell and eccrine carcinoma of the skin with depth extensions ≤20 mm.
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Affiliation(s)
- Peter Vaupel
- a Department of Radiation Oncology and Radiotherapy , Klinikum rechts der Isar, Technische Universität München (TUM) , München , Germany
| | - Helmut Piazena
- b Medical Photobiology Group, Department of Internal Medicine , Charité University Medicine , Berlin , Germany
| | - Werner Müller
- c Physical Optics Consultant Office , Wetzlar , Germany
| | - Markus Notter
- d Department of Radiation Oncology , Lindenhofspital , Bern , Switzerland
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87
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Kok HP, Navarro F, Strigari L, Cavagnaro M, Crezee J. Locoregional hyperthermia of deep-seated tumours applied with capacitive and radiative systems: a simulation study. Int J Hyperthermia 2018; 34:714-730. [PMID: 29509043 DOI: 10.1080/02656736.2018.1448119] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Locoregional hyperthermia is applied to deep-seated tumours in the pelvic region. Two very different heating techniques are often applied: capacitive and radiative heating. In this paper, numerical simulations are applied to compare the performance of both techniques in heating of deep-seated tumours. METHODS Phantom simulations were performed for small (30 × 20 × 50 cm3) and large (45 × 30 × 50 cm3), homogeneous fatless and inhomogeneous fat-muscle, tissue-equivalent phantoms with a central or eccentric target region. Radiative heating was simulated with the 70 MHz AMC-4 system and capacitive heating was simulated at 13.56 MHz. Simulations were performed for small fatless, small (i.e. fat layer typically <2 cm) and large (i.e. fat layer typically >3 cm) patients with cervix, prostate, bladder and rectum cancer. Temperature distributions were simulated using constant hyperthermic-level perfusion values with tissue constraints of 44 °C and compared for both heating techniques. RESULTS For the small homogeneous phantom, similar target heating was predicted with radiative and capacitive heating. For the large homogeneous phantom, most effective target heating was predicted with capacitive heating. For inhomogeneous phantoms, hot spots in the fat layer limit adequate capacitive heating, and simulated target temperatures with radiative heating were 2-4 °C higher. Patient simulations predicted therapeutic target temperatures with capacitive heating for fatless patients, but radiative heating was more robust for all tumour sites and patient sizes, yielding target temperatures 1-3 °C higher than those predicted for capacitive heating. CONCLUSION Generally, radiative locoregional heating yields more favourable simulated temperature distributions for deep-seated pelvic tumours, compared with capacitive heating. Therapeutic temperatures are predicted for capacitive heating in patients with (almost) no fat.
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Affiliation(s)
- H P Kok
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - F Navarro
- b Department of Medical Physics , Regional University Hospital of Málaga , Malaga , Spain
| | - L Strigari
- c Laboratory of Medical Physics and Expert Systems , Regina Elena National Cancer Institute , Rome , Italy
| | - M Cavagnaro
- d Department of Information Engineering, Electronics and Telecommunications , Sapienza University of Rome , Rome , Italy
| | - J Crezee
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
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88
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van den Tempel N, Laffeber C, Odijk H, van Cappellen WA, van Rhoon GC, Franckena M, Kanaar R. The effect of thermal dose on hyperthermia-mediated inhibition of DNA repair through homologous recombination. Oncotarget 2018; 8:44593-44604. [PMID: 28574821 PMCID: PMC5546504 DOI: 10.18632/oncotarget.17861] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/26/2017] [Indexed: 12/16/2022] Open
Abstract
Hyperthermia has a number of biological effects that sensitize tumors to radiotherapy in the range between 40-44 °C. One of these effects is heat-induced degradation of BRCA2 that in turn causes reduced RAD51 focus formation, which results in an attenuation of DNA repair through homologous recombination. Prompted by this molecular insight into how hyperthermia attenuates homologous recombination, we now quantitatively explore time and temperature dynamics of hyperthermia on BRCA2 levels and RAD51 focus formation in cell culture models, and link this to their clonogenic survival capacity after irradiation (0-6 Gy). For treatment temperatures above 41 °C, we found a decrease in cell survival, an increase in sensitization towards irradiation, a decrease of BRCA2 protein levels, and altered RAD51 focus formation. When the temperatures exceeded 43 °C, we found that hyperthermia alone killed more cells directly, and that processes other than homologous recombination were affected by the heat. This study demonstrates that optimal inhibition of HR is achieved by subjecting cells to hyperthermia at 41-43 °C for 30 to 60 minutes. Our data provides a guideline for the clinical application of novel combination treatments that could exploit hyperthermia's attenuation of homologous recombination, such as the combination of hyperthermia with PARP-inhibitors for non-BRCA mutations carriers.
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Affiliation(s)
- Nathalie van den Tempel
- Department of Molecular Genetics, Cancer Genomics Center Netherlands, Erasmus University Medical Center, 3000 CA, Rotterdam, The Netherlands
| | - Charlie Laffeber
- Department of Molecular Genetics, Cancer Genomics Center Netherlands, Erasmus University Medical Center, 3000 CA, Rotterdam, The Netherlands
| | - Hanny Odijk
- Department of Molecular Genetics, Cancer Genomics Center Netherlands, Erasmus University Medical Center, 3000 CA, Rotterdam, The Netherlands
| | - Wiggert A van Cappellen
- Optical Imaging Center, Department of Pathology, Erasmus University Medical Center, 3000 CA, Rotterdam, The Netherlands
| | - Gerard C van Rhoon
- Department of Radiation Oncology, Erasmus MC Cancer Institute, 3008 AE, Rotterdam, The Netherlands
| | - Martine Franckena
- Department of Radiation Oncology, Erasmus MC Cancer Institute, 3008 AE, Rotterdam, The Netherlands
| | - Roland Kanaar
- Department of Molecular Genetics, Cancer Genomics Center Netherlands, Erasmus University Medical Center, 3000 CA, Rotterdam, The Netherlands
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89
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Lee SY, Kim JH, Han YH, Cho DH. The effect of modulated electro-hyperthermia on temperature and blood flow in human cervical carcinoma. Int J Hyperthermia 2018; 34:953-960. [PMID: 29297234 DOI: 10.1080/02656736.2018.1423709] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Mild hyperthermia has been known to enhance the response of tumours to radiotherapy or chemotherapy by increasing tumour blood flow, thereby increasing tumour oxygenation or drug delivery. The purpose of this study was to assess the changes in temperature and blood flow in human cervical cancer in response to regional heating with modulated electro-hyperthermia (mEHT). METHODS The pelvic area of 20 patients with cervical carcinoma was heated with mEHT. The peri-tumour temperature was measured using an internal organ temperature probe. The tumour blood flow was measured using 3D colour Doppler ultrasound by determining the peak systolic velocity/end-diastolic velocity ratio (S/D ratio) and the resistance index (RI) within blood vessels. RESULTS The mean peri-tumour temperature was 36.7 ± 0.2 °C before heating and increased to 38.5 ± 0.8 °C at the end of heating for 60 min. The marked declines in RI and S/D values strongly demonstrated that heating significantly increased tumour blood perfusion. CONCLUSIONS Regional heating of the pelvic area with mEHT significantly increased the peri-tumour temperature and improved the blood flow in cervical cancer. This is the first demonstration that the blood flow in cervical cancer is increased by regional hyperthermia. Such increases in temperature and blood flow may account for the clinical observations that hyperthermia improves the response of cervical cancer to radiotherapy or chemotherapy.
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Affiliation(s)
- Sun-Young Lee
- a Department of Radiation Oncology , Chonbuk National University Hospital-Chonbuk National University Medical School , Jeonju , Republic of Korea.,b Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital , Jeonju , Republic of Korea
| | - Jong-Hun Kim
- b Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital , Jeonju , Republic of Korea.,c Division of Cardiovascular Thoracic Surgery , Chonbuk National University Hospital-Chonbuk National University Medical School , Jeonju , Republic of Korea
| | - Yeon-Hee Han
- b Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital , Jeonju , Republic of Korea.,d Department of Nuclear Medicine , Chonbuk National University Hospital-Chonbuk National University Medical School , Jeonju , Republic of Korea
| | - Dong-Hyu Cho
- e Department of Obstetrics and Gynecology , Chonbuk National University Hospital-Chonbuk National University Medical School , Jeonju , Republic of Korea
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90
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Adibzadeh F, Paulides MM, van Rhoon GC. SAR thresholds for electromagnetic exposure using functional thermal dose limits. Int J Hyperthermia 2018; 34:1248-1254. [DOI: 10.1080/02656736.2018.1424945] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Fatemeh Adibzadeh
- Department of Radiation Oncology, Hyperthermia Unit, Erasmus MC - Cancer Institute, Rotterdam, The Netherlands
| | - Margarethus M. Paulides
- Department of Radiation Oncology, Hyperthermia Unit, Erasmus MC - Cancer Institute, Rotterdam, The Netherlands
| | - Gerard C. van Rhoon
- Department of Radiation Oncology, Hyperthermia Unit, Erasmus MC - Cancer Institute, Rotterdam, The Netherlands
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91
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Herea DD, Danceanu C, Radu E, Labusca L, Lupu N, Chiriac H. Comparative effects of magnetic and water-based hyperthermia treatments on human osteosarcoma cells. Int J Nanomedicine 2018; 13:5743-5751. [PMID: 30310277 PMCID: PMC6165779 DOI: 10.2147/ijn.s174853] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Hyperthermia (HT) based on magnetic nanoparticles (MNPs) represents a promising approach to induce the apoptosis/necrosis of tumor cells through the heat generated by MNPs submitted to alternating magnetic fields. However, the effects of temperature distribution on the cancer cells' viability as well as heat resistance of various tumor cell types warrant further investigation. METHODS In this work, the effects induced by magnetic hyperthermia (MHT) and conventional water-based hyperthermia (WHT) on the viability of human osteosarcoma cells at different temperatures (37°C-47°C) was comparatively investigated. Fe-Cr-Nb-B magnetic nanoparticles were submitted either to alternating magnetic fields or to infrared radiation generated by a water-heated incubator. RESULTS In terms of cell viability, significant differences could be observed after applying the two HT treatment methods. At about equal equilibrium temperatures, MHT was on average 16% more efficient in inducing cytotoxicity effects compared to WHT, as assessed by MTT cytotoxicity assay. CONCLUSION We propose the phenomena can be explained by the significantly higher cytotoxic effects initiated during MHT treatment in the vicinity of the heat-generating MNPs compared to the effects triggered by the homogeneously distributed temperature during WHT. These in vitro results confirm other previous findings regarding the superior efficiency of MHT over WHT and explain the cytotoxicity differences observed between the two antitumor HT methods.
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Affiliation(s)
- Dumitru-Daniel Herea
- MDM Department, National Institute of Research and Development for Technical Physics, Iasi, Romania,
| | - Camelia Danceanu
- MDM Department, National Institute of Research and Development for Technical Physics, Iasi, Romania,
- University "Al I Cuza," University of Iasi, Iasi, Romania
| | - Ecaterina Radu
- MDM Department, National Institute of Research and Development for Technical Physics, Iasi, Romania,
- University "Al I Cuza," University of Iasi, Iasi, Romania
| | - Luminita Labusca
- MDM Department, National Institute of Research and Development for Technical Physics, Iasi, Romania,
- Systems Biomedical Informatics and Modeling (SBIM), Frankfurt, Germany
| | - Nicoleta Lupu
- MDM Department, National Institute of Research and Development for Technical Physics, Iasi, Romania,
| | - Horia Chiriac
- MDM Department, National Institute of Research and Development for Technical Physics, Iasi, Romania,
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Zohdi TI, Krone R. Estimates for the acoustical stimulation and heating of multiphase biotissue. Biomech Model Mechanobiol 2017; 17:717-725. [DOI: 10.1007/s10237-017-0988-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 11/14/2017] [Indexed: 12/01/2022]
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93
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Roussakow SV. Clinical and economic evaluation of modulated electrohyperthermia concurrent to dose-dense temozolomide 21/28 days regimen in the treatment of recurrent glioblastoma: a retrospective analysis of a two-centre German cohort trial with systematic comparison and effect-to-treatment analysis. BMJ Open 2017; 7:e017387. [PMID: 29102988 PMCID: PMC5722101 DOI: 10.1136/bmjopen-2017-017387] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To assess the efficacy and cost-effectiveness of modulated electrohyperthermia (mEHT) concurrent to dose-dense temozolomide (ddTMZ) 21/28 days regimen versus ddTMZ 21/28 days alone in patients with recurrent glioblastoma (GBM). DESIGN A cohort of 54 patients with recurrent GBM treated with ddTMZ+mEHT in 2000-2005 was systematically retrospectively compared with five pooled ddTMZ 21/28 days cohorts (114 patients) enrolled in 2008-2013. RESULTS The ddTMZ+mEHT cohort had a not significantly improved mean survival time (mST) versus the comparator (p=0.531) after a significantly less mean number of cycles (1.56 vs 3.98, p<0.001). Effect-to-treatment analysis (ETA) suggests that mEHT significantly enhances the efficacy of the ddTMZ 21/28 days regimen (p=0.011), with significantly less toxicity (no grade III-IV toxicity vs 45%-92%, p<0.0001). An estimated maximal attainable median survival time is 10.10 months (9.10-11.10). Cost-effectiveness analysis suggests that, unlike ddTMZ 21/28 days alone, ddTMZ+mEHT is cost-effective versus the applicable cost-effectiveness thresholds €US$25 000-50 000/quality-adjusted life year (QALY). Budget impact analysis suggests a significant saving of €8 577 947/$11 201 761 with 29.1-38.5 QALY gained per 1000 patients per year. Cost-benefit analysis suggests that mEHT is profitable and will generate revenues between €3 124 574 and $6 458 400, with a total economic effect (saving+revenues) of €5 700 034 to $8 237 432 per mEHT device over an 8-year period. CONCLUSIONS Our ETA suggests that mEHT significantly improves survival of patients receiving the ddTMZ 21/28 days regimen. Economic evaluation suggests that ddTMZ+mEHT is cost-effective, budget-saving and profitable. After confirmation of the results, mEHT could be recommended for the treatment of recurrent GBM as a cost-effective enhancer of ddTMZ regimens, and, probably, of the regular 5/28 days regimen. mEHT is applicable also as a single treatment if chemotherapy is impossible, and as a salvage treatment after the failure of chemotherapy.
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94
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Fu Q, Huang T, Wang X, Lu C, Liu F, Yang G, Wang Y, Wang B. Association of elevated reactive oxygen species and hyperthermia induced radiosensitivity in cancer stem-like cells. Oncotarget 2017; 8:101560-101571. [PMID: 29254186 PMCID: PMC5731896 DOI: 10.18632/oncotarget.21678] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/21/2017] [Indexed: 02/07/2023] Open
Abstract
Cancer stem-like cells (CSCs) are the principal causes of tumor radio-resistance, dormancy and recurrence after radiotherapy. Clinical trials show hyperthermia (HT) might be a potent radiation sensitizer. In this study, CSCs were found to be more susceptible to radiation when combined with HT treatment. Treated cells showed significantly reduced self-renewal, cell survival and proliferation in vitro, as well as significant reduced tumor formation in vivo. Further study demonstrated that the radiosensitization effect was associated with increased intracellular reactive oxygen species (ROS) level in CSCs, confirmed by modifying redox status in CSCs bidirectionally. Pharmacologic depletion of glutathione by buthionine sulphoximine mimicked HT induced radiosensitivity in CSCs. Antioxidant N-acetylcysteine could efficiently rescue HT induced radiosensitivity in CSCs. To our knowledge, this may be the first report suggesting the association between elevated intracellular ROS level and HT induced radiosensitization in human breast CSCs and pancreatic CSCs, which might provide new strategy for improving CSCs radiosensitivity.
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Affiliation(s)
- Qibin Fu
- Sino-French Institute of Nuclear Engineering and Technology, Sun Yat-sen University, Zhuhai 519082, P. R. China
| | - Tuchen Huang
- Sino-French Institute of Nuclear Engineering and Technology, Sun Yat-sen University, Zhuhai 519082, P. R. China
| | - Xudong Wang
- State Key Laboratory of Nuclear Physics and Technology, School of Physics, Peking University, Beijing 100871, P. R. China
| | - Chunyang Lu
- State Key Laboratory of Nuclear Physics and Technology, School of Physics, Peking University, Beijing 100871, P. R. China
| | - Feng Liu
- State Key Laboratory of Nuclear Physics and Technology, School of Physics, Peking University, Beijing 100871, P. R. China
| | - Gen Yang
- State Key Laboratory of Nuclear Physics and Technology, School of Physics, Peking University, Beijing 100871, P. R. China
| | - Yugang Wang
- State Key Laboratory of Nuclear Physics and Technology, School of Physics, Peking University, Beijing 100871, P. R. China
| | - Biao Wang
- Sino-French Institute of Nuclear Engineering and Technology, Sun Yat-sen University, Zhuhai 519082, P. R. China
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95
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Tudorancea I, Porumb V, Trandabăţ A, Neaga D, Tamba B, Iliescu R, Dimofte GM. New experimental model for single liver lobe hyperthermia in small animals using non-directional microwaves. PLoS One 2017; 12:e0184810. [PMID: 28934251 PMCID: PMC5608293 DOI: 10.1371/journal.pone.0184810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/31/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Our aim was to develop a new experimental model for in vivo hyperthermia using non-directional microwaves, applicable to small experimental animals. We present an affordable approach for targeted microwave heat delivery to an isolated liver lobe in rat, which allows rapid, precise and stable tissue temperature control. MATERIALS AND METHODS A new experimental model is proposed. We used a commercial available magnetron generating 2450 MHz, with 4.4V and 14A in the filament and 4500V anodic voltage. Modifications were required in order to adjust tissue heating such as to prevent overheating and to allow for fine adjustments according to real-time target temperature. The heating is controlled using a virtual instrument application implemented in LabView® and responds to 0.1° C variations in the target. Ten healthy adult male Wistar rats, weighing 250-270 g were used in this study. The middle liver lobe was the target for controlled heating, while the rest of the living animal was protected. RESULTS In vivo microwave delivery using our experimental setting is safe for the animals. Target tissue temperature rises from 30°C to 40°C with 3.375°C / second (R2 = 0.9551), while the increment is lower it the next two intervals (40-42°C and 42-44°C) with 0.291°C/ s (R2 = 0.9337) and 0.136°C/ s (R2 = 0.7894) respectively, when testing in sequences. After reaching the desired temperature, controlled microwave delivery insures a very stable temperature during the experiments. CONCLUSIONS We have developed an inexpensive and easy to manufacture system for targeted hyperthermia using non-directional microwave radiation. This system allows for fine and stable temperature adjustments within the target tissue and is ideal for experimental models testing below or above threshold hyperthermia.
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Affiliation(s)
- Ionuț Tudorancea
- Department of Physiology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Vlad Porumb
- Department of Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
- Department of Surgery, Regional Institute of Oncology, Iasi, Romania
- * E-mail:
| | - Alexandru Trandabăţ
- Faculty of Electrical Engineering, Gheorghe Asachi Technical University, Iaşi, Romania
| | - Decebal Neaga
- Department of Engineering, Regional Institute of Oncology, Iasi, Romania
| | - Bogdan Tamba
- Department of Pharmacology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Radu Iliescu
- Department of Pharmacology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Gabriel M. Dimofte
- Department of Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
- Department of Surgery, Regional Institute of Oncology, Iasi, Romania
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96
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van Rhoon GC, Paulides MM, van Holthe JML, Franckena M. Hyperthermia by electromagnetic fields to enhanced clinical results in oncology. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:359-362. [PMID: 28324929 DOI: 10.1109/embc.2016.7590714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Confining treatment to the tumor to improve therapeutic outcome and reduce toxicity, is a hot issue in cancer research. Hyperthermia is recognized as a strong sensitizer for radiotherapy and chemotherapy enhancing tumor control without increasing toxicity. Today's electromagnetic hyperthermia systems heat large tissue volumes with limited ability to selectively heat the tumor. Fortunately, tremendous improvements in 3-dimensional electromagnetic & temperature modelling provide an exciting opportunity to design advanced multi-element electromagnetic applicator systems. Together with feedback control using MR non-invasive thermometry and smart E-field sensors, this paves the way for selective tumor heating and potentially prescription of a thermal dose. A technological advanced hyperthermia system, with guaranteed delivery of high quality hyperthermia lowers the threshold for newcomers to apply hyperthermia. Combined with recent proof that hyperthermia blocks DNA repair and new, exciting, ways for controlled drug delivery using temperature sensitive liposome encapsulated drugs, this is expected to increase interest of the medical community in hyperthermia.
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97
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Curto S, Faridi P, Shrestha TB, Pyle M, Maurmann L, Troyer D, Bossmann SH, Prakash P. An integrated platform for small-animal hyperthermia investigations under ultra-high-field MRI guidance. Int J Hyperthermia 2017; 34:341-351. [PMID: 28728442 DOI: 10.1080/02656736.2017.1339126] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Integrating small-animal experimental hyperthermia instrumentation with magnetic resonance imaging (MRI) affords real-time monitoring of spatial temperature profiles. This study reports on the development and preliminary in vivo characterisation of a 2.45 GHz microwave hyperthermia system for pre-clinical small animal investigations, integrated within a 14 T ultra-high-field MRI scanner. MATERIALS AND METHODS The presented system incorporates a 3.5 mm (OD) directional microwave hyperthermia antenna, positioned adjacent to the small-animal target, radiating microwave energy for localised heating of subcutaneous tumours. The applicator is integrated within the 30 mm bore of the MRI system. 3D electromagnetic and biothermal simulations were implemented to characterise hyperthermia profiles from the directional microwave antenna. Experiments in tissue mimicking phantoms were performed to assess hyperthermia profiles and validate MR thermometry against fibre-optic temperature measurements. The feasibility of delivering in vivo hyperthermia exposures to subcutaneous 4T1 tumours in experimental mice under simultaneous MR thermometry guidance was assessed. RESULTS Simulations and experiments in tissue mimicking phantoms demonstrated the feasibility of heating 21-982 mm3 targets with 8-12 W input power. Minimal susceptibility and electrical artefacts introduced by the hyperthermia applicator were observed on MR imaging. MR thermometry was in excellent agreement with fibre-optic temperatures measurements (max. discrepancy ≤0.6 °C). Heating experiments with the reported system demonstrated the feasibility of heating subcutaneous tumours in vivo with simultaneous MR thermometry. CONCLUSIONS A platform for small-animal hyperthermia investigations under ultra-high-field MR thermometry was developed and applied to heating subcutaneous tumours in vivo.
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Affiliation(s)
- Sergio Curto
- a Department of Electrical and Computer Engineering , Kansas State University , Manhattan , KS , USA
| | - Pegah Faridi
- a Department of Electrical and Computer Engineering , Kansas State University , Manhattan , KS , USA
| | - Tej B Shrestha
- b Department of Anatomy and Physiology , Kansas State University , Manhattan , KS , USA
| | - Marla Pyle
- b Department of Anatomy and Physiology , Kansas State University , Manhattan , KS , USA
| | - Leila Maurmann
- c Department of Chemistry , Kansas State University , Manhattan , KS , USA
| | - Deryl Troyer
- b Department of Anatomy and Physiology , Kansas State University , Manhattan , KS , USA
| | - Stefan H Bossmann
- c Department of Chemistry , Kansas State University , Manhattan , KS , USA
| | - Punit Prakash
- a Department of Electrical and Computer Engineering , Kansas State University , Manhattan , KS , USA
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98
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Peeken JC, Vaupel P, Combs SE. Integrating Hyperthermia into Modern Radiation Oncology: What Evidence Is Necessary? Front Oncol 2017; 7:132. [PMID: 28713771 PMCID: PMC5492395 DOI: 10.3389/fonc.2017.00132] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/06/2017] [Indexed: 12/13/2022] Open
Abstract
Hyperthermia (HT) is one of the hot topics that have been discussed over decades. However, it never made its way into primetime. The basic biological rationale of heat to enhance the effect of radiation, chemotherapeutic agents, and immunotherapy is evident. Preclinical work has confirmed this effect. HT may trigger changes in perfusion and oxygenation as well as inhibition of DNA repair mechanisms. Moreover, there is evidence for immune stimulation and the induction of systemic immune responses. Despite the increasing number of solid clinical studies, only few centers have included this adjuvant treatment into their repertoire. Over the years, abundant prospective and randomized clinical data have emerged demonstrating a clear benefit of combined HT and radiotherapy for multiple entities such as superficial breast cancer recurrences, cervix carcinoma, or cancers of the head and neck. Regarding less investigated indications, the existing data are promising and more clinical trials are currently recruiting patients. How do we proceed from here? Preclinical evidence is present. Multiple indications benefit from additional HT in the clinical setting. This article summarizes the present evidence and develops ideas for future research.
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Affiliation(s)
- Jan C Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Peter Vaupel
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany.,Department of Radiation Sciences (DRS), Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Neuherberg, Germany
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99
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Kim W, Kim MS, Kim HJ, Lee E, Jeong JH, Park I, Jeong YK, Jang WI. Role of HIF-1α in response of tumors to a combination of hyperthermia and radiation in vivo. Int J Hyperthermia 2017; 34:276-283. [PMID: 28659004 DOI: 10.1080/02656736.2017.1335440] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Mild temperature hyperthermia (MTH) increases blood flow and oxygenation in tumours. On the other hand, high-dose-per-fraction irradiation damages blood vessels, decreases blood flow and increases hypoxia in tumours. The radiation-induced hypoxia in tumours activates hypoxia-inducible factor-1α (HIF-1α) and its target genes, such as vascular endothelial growth factor (VEGF), promoting revascularization and recurrence. In the present study, we examined the hypothesis that MTH inhibits radiation-induced upregulation of HIF-1α and its target genes by increasing tumour oxygenation. MATERIALS AND METHODS FSaII fibrosarcoma tumours grown subcutaneously in the legs of C3H mice were used. Tumours were irradiated with 15 Gy using a 60Co irradiator or heated at 41 °C for 30 min using an Oncothermia heating unit. Blood perfusion and hypoxia in tumours were assessed with Hoechst 33342 and pimonidazole staining, respectively. Expression levels of HIF-1α and VEGF were determined using immunohistochemical techniques. Apoptosis of tumour cells was quantitated via TUNEL staining and the effects of treatments on tumour growth rate were assessed by measuring tumour diameters. RESULTS Irradiation of FSaII tumours with a single dose of 15 Gy led to significantly decreased blood perfusion, increased hypoxia and upregulation of HIF-1α and VEGF. On the other hand, MTH at 41 °C for 30 min increased blood perfusion and tumour oxygenation, thereby suppressing radiation-induced HIF-1α and VEGF in tumours, leading to enhanced apoptosis of tumour cells and tumour growth delay. CONCLUSION MTH enhances the anti-tumour effect of high-dose irradiation, at least partly by inhibiting radiation-induced upregulation of HIF-1α.
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Affiliation(s)
- Wonwoo Kim
- a Radiation Non-clinic Center, Korea Institute of Radiological & Medical Sciences , Seoul , Korea
| | - Mi-Sook Kim
- a Radiation Non-clinic Center, Korea Institute of Radiological & Medical Sciences , Seoul , Korea.,b Department of Radiation Oncology , Korea Institute of Radiological & Medical Sciences , Seoul , Korea
| | - Hee-Jong Kim
- a Radiation Non-clinic Center, Korea Institute of Radiological & Medical Sciences , Seoul , Korea
| | - Eunjin Lee
- a Radiation Non-clinic Center, Korea Institute of Radiological & Medical Sciences , Seoul , Korea
| | - Jae-Hoon Jeong
- c Department of Radiation Therapeutics Development , Korea Institute of Radiological & Medical Sciences , Seoul , Korea
| | - Inhwan Park
- a Radiation Non-clinic Center, Korea Institute of Radiological & Medical Sciences , Seoul , Korea.,d Department of Radiological & Medico-Oncological Science , Korea University of Science and Technology , Daejeon , Korea
| | - Youn Kyoung Jeong
- a Radiation Non-clinic Center, Korea Institute of Radiological & Medical Sciences , Seoul , Korea
| | - Won Il Jang
- b Department of Radiation Oncology , Korea Institute of Radiological & Medical Sciences , Seoul , Korea
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100
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McWilliams BT, Wang H, Binns VJ, Curto S, Bossmann SH, Prakash P. Experimental Investigation of Magnetic Nanoparticle-Enhanced Microwave Hyperthermia. J Funct Biomater 2017; 8:E21. [PMID: 28640198 PMCID: PMC5618272 DOI: 10.3390/jfb8030021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/07/2017] [Accepted: 06/12/2017] [Indexed: 02/07/2023] Open
Abstract
The objective of this study was to evaluate microwave heating enhancements offered by iron/iron oxide nanoparticles dispersed within tissue-mimicking media for improving efficacy of microwave thermal therapy. The following dopamine-coated magnetic nanoparticles (MNPs) were considered: 10 and 20 nm diameter spherical core/shell Fe/Fe₃O₄, 20 nm edge-length cubic Fe₃O₄, and 45 nm edge-length/10 nm height hexagonal Fe₃O₄. Microwave heating enhancements were experimentally measured with MNPs dissolved in an agar phantom, placed within a rectangular waveguide. Effects of MNP concentration (2.5-20 mg/mL) and microwave frequency (2.0, 2.45 and 2.6 GHz) were evaluated. Further tests with 10 and 20 nm diameter spherical MNPs dispersed within a two-compartment tissue-mimicking phantom were performed with an interstitial dipole antenna radiating 15 W power at 2.45 GHz. Microwave heating of 5 mg/mL MNP-agar phantom mixtures with 10 and 20 nm spherical, and hexagonal MNPs in a waveguide yielded heating rates of 0.78 ± 0.02 °C/s, 0.72 ± 0.01 °C/s and 0.51 ± 0.03 °C/s, respectively, compared to 0.5 ± 0.1 °C/s for control. Greater heating enhancements were observed at 2.0 GHz compared to 2.45 and 2.6 GHz. Heating experiments in two-compartment phantoms with an interstitial dipole antenna demonstrated potential for extending the radial extent of therapeutic heating with 10 and 20 nm diameter spherical MNPs, compared to homogeneous phantoms (i.e., without MNPs). Of the MNPs considered in this study, spherical Fe/Fe₃O₄ nanoparticles offer the greatest heating enhancement when exposed to microwave radiation. These nanoparticles show strong potential for enhancing the rate of heating and radial extent of heating during microwave hyperthermia and ablation procedures.
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Affiliation(s)
- Brogan T McWilliams
- Department of Electrical and Computer Engineering, Kansas State University, 3078 Engineering Hall, Manhattan, KS 66506, USA.
| | - Hongwang Wang
- Department of Chemistry, Kansas State University, 213 CBC Building, Manhattan, KS 66506, USA.
| | - Valerie J Binns
- Department of Electrical and Computer Engineering, Kansas State University, 3078 Engineering Hall, Manhattan, KS 66506, USA.
| | - Sergio Curto
- Department of Electrical and Computer Engineering, Kansas State University, 3078 Engineering Hall, Manhattan, KS 66506, USA.
| | - Stefan H Bossmann
- Department of Chemistry, Kansas State University, 213 CBC Building, Manhattan, KS 66506, USA.
| | - Punit Prakash
- Department of Electrical and Computer Engineering, Kansas State University, 3078 Engineering Hall, Manhattan, KS 66506, USA.
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