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Yoo SS, Jorgensen TJ, Kennedy AR, Boice JD, Shapiro A, Hu TCC, Moyer BR, Grace MB, Kelloff GJ, Fenech M, Prasanna PGS, Coleman CN. Mitigating the risk of radiation-induced cancers: limitations and paradigms in drug development. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2014; 34:R25-52. [PMID: 24727460 PMCID: PMC7668684 DOI: 10.1088/0952-4746/34/2/r25] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The United States radiation medical countermeasures (MCM) programme for radiological and nuclear incidents has been focusing on developing mitigators for the acute radiation syndrome (ARS) and delayed effects of acute radiation exposure (DEARE), and biodosimetry technologies to provide radiation dose assessments for guiding treatment. Because a nuclear accident or terrorist incident could potentially expose a large number of people to low to moderate doses of ionising radiation, and thus increase their excess lifetime cancer risk, there is an interest in developing mitigators for this purpose. This article discusses the current status, issues, and challenges regarding development of mitigators against radiation-induced cancers. The challenges of developing mitigators for ARS include: the long latency between exposure and cancer manifestation, limitations of animal models, potential side effects of the mitigator itself, potential need for long-term use, the complexity of human trials to demonstrate effectiveness, and statistical power constraints for measuring health risks (and reduction of health risks after mitigation) following relatively low radiation doses (<0.75 Gy). Nevertheless, progress in the understanding of the molecular mechanisms resulting in radiation injury, along with parallel progress in dose assessment technologies, make this an opportune, if not critical, time to invest in research strategies that result in the development of agents to lower the risk of radiation-induced cancers for populations that survive a significant radiation exposure incident.
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Affiliation(s)
- Stephen S Yoo
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- SSY, PGSP and CNC had equal contribution in the preparation of this manuscript
| | - Timothy J Jorgensen
- Department of Radiation Medicine, Georgetown University School of Medicine, Washington DC, USA
| | - Ann R Kennedy
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - John D Boice
- Department of Medicine, Division of Epidemiology, Vanderbilt-Ingram Cancer Center, Vanderbilt School of Medicine, Nashville, TN, USA
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
| | - Alla Shapiro
- Office of Counter-Terrorism and Emergency Coordination, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Tom C-C Hu
- Division of CBRN Countermeasures, Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response, Office of the Secretary, Department of Health and Human Services, Washington, DC, USA
| | - Brian R Moyer
- Division of CBRN Countermeasures, Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response, Office of the Secretary, Department of Health and Human Services, Washington, DC, USA
| | - Marcy B Grace
- Division of CBRN Countermeasures, Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response, Office of the Secretary, Department of Health and Human Services, Washington, DC, USA
| | - Gary J Kelloff
- Cancer Imaging Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Michael Fenech
- Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| | - Pataje G S Prasanna
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- SSY, PGSP and CNC had equal contribution in the preparation of this manuscript
| | - C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- SSY, PGSP and CNC had equal contribution in the preparation of this manuscript
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Oliai C, Yang LX. Radioprotectants to reduce the risk of radiation-induced carcinogenesis. Int J Radiat Biol 2013; 90:203-13. [PMID: 24164532 DOI: 10.3109/09553002.2014.859762] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Development of radioprotective agents has focused primarily on cytoprotection from relatively high doses of therapeutic radiation and nuclear disasters. Epidemiological studies and radiobiological models report the potential for stochastic effects from relatively low-dose radiation exposure. Diagnostic studies like computed tomography (CT) expose the patient to a small but significant amount of radiation, which has been reported to increase the risk for carcinogenesis. Young patients expected to undergo multiple CT studies may benefit from a protective agent given prior to CT. This review includes published data of agents that have been shown to protect against radiation-induced carcinogenesis. A discussion follows regarding the data that describes the extent of radiation exposure during CT, as well as technical modifications, which also reduce radiation exposure. RESULTS/CONCLUSIONS Most experiments have used in vivo animal models or in vitro cell lines. Ethical barriers prevent large-scale human studies, although, there are two prospective human studies from the Chernobyl nuclear accident. Collectively, all of these studies provide evidence of statistically significant reductions in radiation-induced carcinogenesis. Protection is achieved by several mechanisms, which include free radical scavenging, caloric restriction, non-steroidal anti-inflammatory agents, humoral factors, and an oxidative agent. Enhanced efficacy is achieved when targeting multiple mechanisms. The data presented provides the scientific foundation for future development of a radioprotectant that may reduce the risk of carcinogenesis from low-dose exposure when certain at-risk populations undergo diagnostic studies like CT.
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Affiliation(s)
- Caspian Oliai
- Department of Radiation Oncology, California Pacific Medical Center , San Francisco, CA , USA
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Shoaib A, Rethnam U, Bansal R, De A, Makwana N. A comparison of radiation exposure with the conventional versus mini C arm in orthopedic extremity surgery. Foot Ankle Int 2008; 29:58-61. [PMID: 18275738 DOI: 10.3113/fai.2008.0058] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The mini C arm is a mobile fluoroscopic device for use on extremities. It has been reported that this type of device has several advantages over a conventional C arm, the most important of which is a decreased level of radiation scatter to the surgeon. METHODS This was a case control study. The radiation dose to the surgeon was calculated from the radiation exposure time and distance from the x-ray emitter. Cases using the mini C arm were compared with operation-matched controls that had the identical procedure performed with a conventional C arm. RESULTS The mini C arm caused statistically less radiation scatter to the surgeon, but there was no statistically significant difference in the radiation exposure to the patient. This was despite a significantly larger number of exposures with the mini C arm for each operation type. CONCLUSIONS The mini C arm should be used in preference to the conventional C arm for extremity surgery, if both are available.
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Affiliation(s)
- Amer Shoaib
- Robert Jones and Agnes Hunt Hospital, Oswestry, SY10 7AG United Kingdom.
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