101
|
Teriparatide in individuals with a prior history of radiation therapy-a case series. Arch Osteoporos 2021; 16:149. [PMID: 34608566 DOI: 10.1007/s11657-021-01007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/19/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Teriparatide is a highly effective anabolic therapy for use in patients with osteoporosis at elevated fracture risk but carries a warning about an increased risk of osteosarcoma based on findings from pre-approval animal studies. Since approval, follow-up of individuals treated with teriparatide has not shown an increased risk of osteosarcoma, but it is still recommended to avoid teriparatide in patients with risk factors for osteosarcoma. One such risk factor is radiotherapy; deciding whether to use teriparatide therapy in patients at high risk of fracture but with a history of radiotherapy is therefore a frequent clinical problem. METHODS We sought to identify whether clinicians are using teriparatide in patients with a history of radiotherapy despite the warning and to explore the rationale for this choice. Herein, we describe six cases where the likelihood of fracture, osteosarcoma, and the benefits of teriparatide treatment are assessed to determine the appropriateness of prescribing teriparatide in the setting of prior or concurrent radiotherapy. RESULTS All six patients had severe osteoporosis with limited treatment options. For those who completed 2 years of teriparatide, no further fractures during the follow-up period have occurred, and improvements in bone density (as measured by dual-energy X-ray absorptiometry) were observed. CONCLUSION Despite radiotherapy being a relative contraindication to teriparatide use, there may be a role for teriparatide in select cases where osteoporosis is complex and severe and where other treatment options are not suitable or have been exhausted. The risks vs. benefits of prescribing teriparatide in this population should always be carefully considered, and both the patient and treating oncologist should be educated on the potential risk of osteosarcoma development when teriparatide is continued during radiotherapy.
Collapse
|
102
|
Yu C, Pathan F, Tan TC, Negishi K. The Utility of Advanced Cardiovascular Imaging in Cancer Patients-When, Why, How, and the Latest Developments. Front Cardiovasc Med 2021; 8:728215. [PMID: 34540922 PMCID: PMC8446374 DOI: 10.3389/fcvm.2021.728215] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/09/2021] [Indexed: 01/03/2023] Open
Abstract
Cardio-oncology encompasses the risk stratification, prognostication, identification and management of cancer therapeutics related cardiac dysfunction (CTRCD). Cardiovascular imaging (CVI) plays a significant role in each of these scenarios and has broadened from predominantly quantifying left ventricular function (specifically ejection fraction) to the identification of earlier bio-signatures of CTRCD. Recent data also demonstrate the impact of chemotherapy on the right ventricle, left atrium and pericardium and highlight a possible role for CVI in the identification of CTRCD through tissue characterization and assessment of these cardiac chambers. This review aims to provide a contemporary perspective on the role of multi-modal advanced cardiac imaging in cardio-oncology.
Collapse
Affiliation(s)
- Christopher Yu
- Nepean Clinical School, University of Sydney, University of Sydney, Sydney, NSW, Australia.,Cardiology Department, Nepean Hospital, Sydney, NSW, Australia
| | - Faraz Pathan
- Nepean Clinical School, University of Sydney, University of Sydney, Sydney, NSW, Australia.,Cardiology Department, Nepean Hospital, Sydney, NSW, Australia
| | - Timothy C Tan
- Nepean Clinical School, University of Sydney, University of Sydney, Sydney, NSW, Australia.,Cardiology Department, Blacktown Hospital, Sydney, NSW, Australia
| | - Kazuaki Negishi
- Nepean Clinical School, University of Sydney, University of Sydney, Sydney, NSW, Australia.,Cardiology Department, Nepean Hospital, Sydney, NSW, Australia
| |
Collapse
|
103
|
Abe T, Iino M, Saito S, Aoshika T, Ryuno Y, Ohta T, Igari M, Hirai R, Kumazaki Y, Miura Y, Kaira K, Kagamu H, Noda SE, Kato S. Feasibility of intensity modulated radiotherapy with involved field radiotherapy for Japanese patients with locally advanced non-small cell lung cancer. JOURNAL OF RADIATION RESEARCH 2021; 62:894-900. [PMID: 34260719 PMCID: PMC8438249 DOI: 10.1093/jrr/rrab063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/31/2021] [Indexed: 06/13/2023]
Abstract
The feasibility of intensity modulated radiotherapy (IMRT) with involved field radiotherapy (IFRT) for Japanese patients with locally advanced non-small cell lung cancer (LA-NSCLC) remains unclear. Here we reviewed our initial experience of IMRT with IFRT for Japanese patients with LA-NSCLC to evaluate the feasibility of the treatment. Twenty LA-NSCLC patients who were treated with IMRT with IFRT during November 2019 to October 2020 were retrospectively analyzed. All patients received 60 Gy in 30 fractions of IMRT and were administered concurrent platinum-based chemotherapy. The median patient age was 71 years old and the group included 15 men and 5 women. The patient group included 2 patients with stage IIB, 11 patients with stage IIIA, 5 patients with stage IIIB, and 2 patients with stage IIIC disease. Histological diagnosis was squamous cell carcinoma in 14 patients, adenocarcinoma in 5 patients, and non-small cell lung cancer in 1 patient. The median follow-up period was 8 months. The incidence of grade 3 or greater pneumonitis was 5%, and grade 3 or greater esophagitis was not observed. None of the patients developed regional lymph node, with only recurrence reported so far. These findings indicate that IMRT with IFRT for Japanese patients with LA-NSCLC is feasible in terms of acute toxicity. Further study with a larger number of patients and longer follow-up to clarify the effect of treatment on patient prognosis is required.
Collapse
MESH Headings
- Adenocarcinoma/drug therapy
- Adenocarcinoma/radiotherapy
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Non-Small-Cell Lung/diagnostic imaging
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/radiotherapy
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/radiotherapy
- Combined Modality Therapy
- Dose-Response Relationship, Radiation
- Feasibility Studies
- Female
- Humans
- Japan
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/drug therapy
- Lung Neoplasms/radiotherapy
- Male
- Middle Aged
- Multimodal Imaging
- Neoplasm Metastasis
- Organoplatinum Compounds/administration & dosage
- Organs at Risk/radiation effects
- Paclitaxel/administration & dosage
- Radiation Pneumonitis/etiology
- Radiotherapy Planning, Computer-Assisted
- Radiotherapy, Conformal
- Radiotherapy, Intensity-Modulated/adverse effects
- Radiotherapy, Intensity-Modulated/methods
- Retrospective Studies
- User-Computer Interface
Collapse
Affiliation(s)
- Takanori Abe
- Corresponding author. Takanori Abe, Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan. E-mail: ; Tel: +81429844136, Fax: +81429844136
| | - Misaki Iino
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Satoshi Saito
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Tomomi Aoshika
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Yasuhiro Ryuno
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Tomohiro Ohta
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Ryuta Hirai
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Yu Kumazaki
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Yu Miura
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Shin-ei Noda
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Shingo Kato
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| |
Collapse
|
104
|
Chauhan V, Hamada N, Monceau V, Ebrahimian T, Adam N, Wilkins RC, Sebastian S, Patel ZS, Huff JL, Simonetto C, Iwasaki T, Kaiser JC, Salomaa S, Moertl S, Azimzadeh O. Expert consultation is vital for adverse outcome pathway development: a case example of cardiovascular effects of ionizing radiation. Int J Radiat Biol 2021; 97:1516-1525. [PMID: 34402738 DOI: 10.1080/09553002.2021.1969466] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The circulatory system distributes nutrients, signaling molecules, and immune cells to vital organs and soft tissues. Epidemiological, animal, and in vitro cellular mechanistic studies have highlighted that exposure to ionizing radiation (IR) can induce molecular changes in cellular and subcellular milieus leading to long-term health impacts, particularly on the circulatory system. Although the mechanisms for the pathologies are not fully elucidated, endothelial dysfunction is proven to be a critical event via radiation-induced oxidative stress mediators. To delineate connectivities of events specifically to cardiovascular disease (CVD) initiation and progression, the adverse outcome pathway (AOP) approach was used with consultation from field experts. AOPs are a means to organize information around a disease of interest to a regulatory question. An AOP begins with a molecular initiating event and ends in an adverse outcome via sequential linkages of key event relationships that are supported by evidence in the form of the modified Bradford-Hill criteria. Detailed guidelines on building AOPs are provided by the Organisation for Economic Cooperation and Development (OECD) AOP program. Here, we report on the questions and discussions needed to develop an AOP for CVD resulting from IR exposure. A recent workshop jointly organized by the MELODI (Multidisciplinary European Low Dose Initiative) and the ALLIANCE (European Radioecology Alliance) associations brought together experts from the OECD to present the AOP approach and tools with examples from the toxicology field. As part of this workshop, four working groups were formed to discuss the identification of adverse outcomes relevant to radiation exposures and development of potential AOPs, one of which was focused on IR-induced cardiovascular effects. Each working group comprised subject matter experts and radiation researchers interested in the specific disease area and included an AOP coach. CONCLUSION The CVD working group identified the critical questions of interest for AOP development, including the exposure scenario that would inform the evidence, the mechanisms of toxicity, the initiating event, intermediate key events/relationships, and the type of data currently available. This commentary describes the four-day discussion of the CVD working group, its outcomes, and demonstrates how collaboration and expert consultation is vital to informing AOP construction.
Collapse
Affiliation(s)
- Vinita Chauhan
- Consumer and Clinical Radiation Bureau, Health Canada, Ottawa, Canada
| | - Nobuyuki Hamada
- Radiation Safety Unit, Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Tokyo, Japan
| | - Virginie Monceau
- Institute of Radiation and Nuclear Safety (IRSN), Radiotoxicology and Radiobiology Research Laboratory (LRTOX), Fontenay-Aux-Roses, France
| | - Teni Ebrahimian
- Institute of Radiation and Nuclear Safety (IRSN), Radiotoxicology and Radiobiology Research Laboratory (LRTOX), Fontenay-Aux-Roses, France
| | - Nadine Adam
- Consumer and Clinical Radiation Bureau, Health Canada, Ottawa, Canada
| | - Ruth C Wilkins
- Consumer and Clinical Radiation Bureau, Health Canada, Ottawa, Canada
| | - Soji Sebastian
- Radiobiology, Canadian Nuclear Laboratories, Chalk River, Canada
| | - Zarana S Patel
- KBR Inc, Houston, TX, USA.,NASA Johnson Space Center, Houston, TX, USA
| | | | - Cristoforo Simonetto
- Helmholtz Zentrum München, Institute of Radiation Medicine (HMGU-IRM), Neuherberg, Germany
| | - Toshiyasu Iwasaki
- Radiation Safety Unit, Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Tokyo, Japan
| | - Jan Christian Kaiser
- Helmholtz Zentrum München, Institute of Radiation Medicine (HMGU-IRM), Neuherberg, Germany
| | - Sisko Salomaa
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Simone Moertl
- Section Radiation Biology, Federal Office for Radiation Protection (BfS), Neuherberg, Germany
| | - Omid Azimzadeh
- Section Radiation Biology, Federal Office for Radiation Protection (BfS), Neuherberg, Germany
| |
Collapse
|
105
|
Steponavičienė R, Jonušas J, Griškevičius R, Venius J, Cicėnas S. A Pilot Study of Safer Radiation Dosage to the Heart and Its Subregions. ACTA ACUST UNITED AC 2021; 57:medicina57040320. [PMID: 33807209 PMCID: PMC8065397 DOI: 10.3390/medicina57040320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/24/2022]
Abstract
Background and Objectives: The real impact of ionizing radiation on the heart and poorer overall survival for patients with non small cell lung cancer (NSCLC) remains unclear. This study aims to determine the safe dose constraints to the heart’s subregions that could prevent patients’ early non-cancerous death and improve their quality of life. Methods and Materials: A retrospective cohort study was performed containing 51 consecutive patients diagnosed with stage III NSCLC and treated using 3D, Intensity-modulated radiation therapy (IMRT), and Volumetric modulated arc therapy (VMAT) radiotherapy. For a dosimetric analysis, these structures were chosen: heart, heart base (HB), and region of great blood vessels (GBV). Dose–volume histograms (DVH) were recorded for all mentioned structures. Maximum and mean doses to the heart, HB, the muscle mass of the HB, and GBV were obtained. V10–V60 (%) parameters were calculated from the DVH. After performed statistical analysis, logistic regression models were created, and critical doses calculated. Results: The critical dose for developing a fatal endpoint for HB was 30.5 Gy, while for GBV, it was 46.3 Gy. Increasing the average dose to the HB or GBV by 1 Gy from the critical dose further increases the possibility of early death by 22.0% and 15.8%, respectively. Conclusions: We suggest that the non-canonical sub-regions of the heart (HB and GBV) should be considered during the planning stage. Additional constraints of the heart subregions should be chosen accordingly, and we propose that the mean doses to these regions be 30.5 Gy and 46.3 Gy, respectively, or less. Extrapolated DVH curves for both regions may be used during the planning stage with care.
Collapse
Affiliation(s)
- Rita Steponavičienė
- External Beam Radiotherapy Department, National Cancer Institute, Santariskiu Str. 1, LT-08406 Vilnius, Lithuania
| | - Justinas Jonušas
- Vilnius University Hospital Santaros Klinikos, Santariskiu Str. 2, LT-08410 Vilnius, Lithuania
| | - Romualdas Griškevičius
- Medical Physics Department, National Cancer Institute, Santariskiu Str. 1, LT-08406 Vilnius, Lithuania
| | - Jonas Venius
- Medical Physics Department, National Cancer Institute, Santariskiu Str. 1, LT-08406 Vilnius, Lithuania
- Laboratory of Biomedical Physics, National Cancer Institute, Baublio 3b, LT-08406 Vilnius, Lithuania
| | - Saulius Cicėnas
- Department of Thoracic Surgery and Oncology, National Cancer Institute, Santariskiu Str. 1, LT-08406 Vilnius, Lithuania
| |
Collapse
|