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Jelonek K, Mrowiec K, Gabryś D, Widłak P. The Metabolic Footprint of Systemic Effects in the Blood Caused by Radiotherapy and Inflammatory Conditions: A Systematic Review. Metabolites 2023; 13:1000. [PMID: 37755280 PMCID: PMC10534379 DOI: 10.3390/metabo13091000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/27/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
Response to radiotherapy (RT) includes tissue toxicity, which may involve inflammatory reactions. We aimed to compare changes in metabolic patterns induced at the systemic level by radiation and inflammation itself. Patients treated with RT due to head and neck cancer and patients with inflammation-related diseases located in the corresponding anatomical regions were selected. PubMed and Web of Science databases were searched from 1 January 2000 to 10 August 2023. Twenty-five relevant studies where serum/plasma metabolic profiles were analyzed using different metabolomics approaches were identified. The studies showed different metabolic patterns of acute and chronic inflammatory diseases, yet changes in metabolites linked to the urea cycle and metabolism of arginine and proline were common features of both conditions. Although the reviewed reports showed only a few specific metabolites common for early RT response and inflammatory diseases, partly due to differences in metabolomics approaches, several common metabolic pathways linked to metabolites affected by radiation and inflammation were revealed. They included pathways involved in energy metabolism (e.g., metabolism of ketone bodies, mitochondrial electron transport chain, Warburg effect, citric acid cycle, urea cycle) and metabolism of certain amino acids (Arg, Pro, Gly, Ser, Met, Ala, Glu) and lipids (glycerolipids, branched-chain fatty acids). However, metabolites common for RT and inflammation-related diseases could show opposite patterns of changes. This could be exemplified by the lysophosphatidylcholine to phosphatidylcholine ratio (LPC/PC) that increased during chronic inflammation and decreased during the early phase of response to RT. One should be aware of dynamic metabolic changes during different phases of response to radiation, which involve increased levels of LPC in later phases. Hence, metabolomics studies that would address molecular features of both types of biological responses using comparable analytical and clinical approaches are needed to unravel the complexities of these phenomena, ultimately contributing to a deeper understanding of their impact on biological systems.
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Affiliation(s)
- Karol Jelonek
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-100 Gliwice, Poland;
| | - Katarzyna Mrowiec
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-100 Gliwice, Poland;
| | - Dorota Gabryś
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-100 Gliwice, Poland;
| | - Piotr Widłak
- 2nd Department of Radiology, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
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Ko J, Kim J, Choi YK, Nahm SS, Kim J, Seo SM, Seo JS, Lee W, Chung WK, Eom K. Clinical evaluation of toll-like receptor-5 agonist for radiation-induced oral mucositis in beagle dogs. Front Vet Sci 2022; 9:839467. [PMID: 36032288 PMCID: PMC9412099 DOI: 10.3389/fvets.2022.839467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to evaluate the clinical safety and validate the radiomitigative effect of KMRC011, against radiation-induced oral mucositis in beagle dogs. Clinical safety was evaluated by assessing tolerability, complete blood tests, and plasma biochemistry after drug administration. The radiomitigative effect of KMRC011 was evaluated macropathologically and histopathologically after inducing oral mucositis iatrogenically using 20 Gy irradiation. The plasma concentration of interleukin-6 was measured via enzyme-linked immunosorbent assay, as a biomarker of KMRC011 bioreactivity. Decreased tolerability, increased neutrophil count, hepatic enzyme concentration, C-reactive protein concentration, and interleukin-6 concentration after the administration was observed and ceased within 24 h without additional treatment. Although all animals included in the present study developed severe mucositis in the late course of the study, animals administered KMRC011 showed less erythema, ulcer, inflammatory infiltration. These results suggest that KMRC011 may be used as an adjuvant for radiotherapy without severe adverse effects, especially during short-term radiotherapy, such as hypofractionated radiotherapy or stereotactic radiotherapy.
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Affiliation(s)
- Jaeeun Ko
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Jaehwan Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Yang-Kyu Choi
- Department of Laboratory Animal Medicine, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Sang-Soep Nahm
- Department of Anatomy, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Jayon Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Sun-Min Seo
- Department of Laboratory Animal Medicine, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Jin-Seok Seo
- Department of Anatomy, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | | | - Weon Kuu Chung
- Department of Radiation Oncology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
- Weon Kuu Chung
| | - Kidong Eom
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
- *Correspondence: Kidong Eom
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3
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Socha J, Wasilewska-Teśluk E, Stando R, Kuncman L, Kepka L. Duration of acute esophageal toxicity in concomitant radio-chemotherapy for non-small cell lung cancer with different fractionation schedules. Br J Radiol 2021; 94:20210776. [PMID: 34538071 DOI: 10.1259/bjr.20210776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES In our previous prospective trial on accelerated hypofractionated concomitant radiochemotherapy (AHRT-CHT) for non-small-cell lung cancer (NSCLC), the incidence of grade ≥3 acute esophageal toxicity (AET) was similar to that reported for conventionally fractionated concomitant radiochemotherapy (CFRT-CHT), but its duration was prolonged. Thus, we aimed to compare the duration of grade ≥3 AET between AHRT-CHT and CFRT-CHT. METHODS Clinical data of 76 NSCLC patients treated with CFRT-CHT (60-66 Gy/2 Gy) during 2015-2020 were retrospectively compared with the data of 92 patients treated with AHRT-CHT (58.8 Gy/2.8 Gy) in the prospective trial. The maximum grade of AET, incidence, and duration of grade ≥3 AET were the end points. Univariate and multivariate analyses were applied to correlate clinical and treatment variables with these end points. RESULTS Neither the maximum grade of AET (p = 0.71), nor the incidence of grade ≥3 AET (p = 0.87) differed between the two groups. The number of CHT cycles delivered (2 vs 1, p = 0.005) and higher esophagus mean BED (p = 0.009) were significant predictors for a higher maximum grade of AET; older age was a significant predictor for higher incidence of grade ≥3 AET (p = 0.03). The median duration of grade ≥3 AET in AHRT-CHT and CFRT-CHT group was 30 days (range 5-150) vs 7 days (range 3-20), respectively, p = 0.0005. In multivariate analysis, only the AHRT-CHT schedule (p=0.003) was a significant predictor for a longer duration of grade ≥3 AET. CONCLUSION Despite similar incidence of grade ≥3 AET, its duration is significantly prolonged in NSCLC patients treated with AHRT-CHT compared to CFRT-CHT. ADVANCES IN KNOWLEDGE Reporting only the rate of grade ≥3 AET in clinical trials may underestimate the real extent of the esophageal toxicity; its duration should also be routinely reported.
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Affiliation(s)
- Joanna Socha
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland.,Department of Radiotherapy, Regional Oncology Centre, Czestochowa, Poland
| | - Ewa Wasilewska-Teśluk
- Independent Public Health Care Facility of the Ministry of the Interior and Warmian & Mazurian Oncology Centre, Olsztyn, Poland.,Department of Oncology, Faculty of Medicine, University of Warmia & Mazury, Olsztyn, Poland
| | - Rafal Stando
- Department of Radiotherapy, Holy Cross Cancer Center, Kielce, Poland
| | - Lukasz Kuncman
- Department of Radiotherapy, Medical University of Lodz, Lodz, Poland
| | - Lucyna Kepka
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland
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Knitschke M, Sonnabend S, Bäcker C, Schmermund D, Böttger S, Howaldt HP, Attia S. Partial and Total Flap Failure after Fibula Free Flap in Head and Neck Reconstructive Surgery: Retrospective Analysis of 180 Flaps over 19 Years. Cancers (Basel) 2021; 13:cancers13040865. [PMID: 33670721 PMCID: PMC7922890 DOI: 10.3390/cancers13040865] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 11/16/2022] Open
Abstract
Fibula free flap (FFF) is widely used in head and neck reconstructive surgery and is considered as a standard and therapy of choice after ablative cancer surgery. The aim of this retrospective monocenter study was to determine the success rates of fibula free flaps for jaw reconstruction after ablative tumor surgery. The disease course of patients who underwent jaw reconstructive surgery with FFF from January 2002 to June 2020 was evaluated regarding the flap success rate. Flap failure was analyzed in detail and categorized into two groups: partial flap failure (PFF) and total flap failure (TFF). A total of 180 free fibular flaps were performed over the last 19 years and a total of 36 flap failures were recorded. TFF occurred in n = 20 (56.6%) and PFF in n = 16 cases (44.4%) cases. No statistically significant differences were found concerning patients' age at flap transfer, sex, BMI, ASA-Score, preoperative non-virtual or virtual surgical planning (non-VSP vs. VSP), and time of reconstruction (immediately vs. delayed). Duration of hospitalization shows statistically significant differences between both groups (p = 0.038), but no differences concerning operating time and duration on Intensive Care Unit (ICU). Partial flap failure appears to be underreported in literature. Sub- and complete failure of the skin paddle leads to clinical complaints like uncovered bone segments and plate exposure. Partial or complete FFF failure lead to infections on the recipient site and prolonged wound healing and therefore may cause a delay of the beginning of adjuvant radiation therapy (RT). PFF of hard tissue can be induced by RT.
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Vansant MB, Parker LA, McWhorter AJ, Bluoin D, Kunduk M. Predicting Swallowing Outcomes from Objective Videofluoroscopic Timing and Displacement Measures in Head and Neck Cancer Patients. Dysphagia 2020; 35:853-863. [PMID: 32048022 DOI: 10.1007/s00455-020-10091-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 01/29/2020] [Indexed: 11/27/2022]
Abstract
Radiation therapy with or without chemotherapy compromises swallowing efficiency and safety in patients with head and neck cancer (HNC). The resulting dysphagia leads to overall morbidity, with altered diets, reduced nutritional intake, reduced quality of life, and potential interruption of curative cancer treatment. Despite well-documented radiation-related changes in swallowing physiology, scarce research exists on the potential clinical value for measurements of swallowing timing and displacement in this population. This study investigated the discriminatory value of quantitative timing and displacement parameters for the Functional Oral Intake Scale and Penetration Aspiration Scale scores using pre- and post-radiation videofluoroscopy data. Swallowtail Software Version 1 (Belldev Medical, Arlington Heights, IL) was used to obtain objective timing and displacement measurements from the pre- and post-radiation videofluoroscopy data for 31 patients who underwent radiation therapy, with or without chemotherapy, for head and neck cancer. The total pharyngeal transit time (BP2) (p < 0.000, r = 0.43) in pudding bolus trials and the maximal upper esophageal sphincter opening (PESMax/cm) (p = 0.001, r = 0.31) in thin bolus trials were discriminatory for Functional Oral Intake Scale (FOIS). Findings suggest that measurement of post-radiation changes using objective and quantitative parameters may offer some discriminatory value regarding future dysphagia risk and prognosis based on total pharyngeal transit time and degree of UES opening. In addition, the results suggest that different bolus types may offer different discriminatory values in HNC population, and that some timing and displacement variables may have discriminatory value for patients' diet levels independent from any aspiration risk.
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Affiliation(s)
- Mathew B Vansant
- Department of Communication Science and Disorders, Louisiana State University, 68 Hatcher Hall, Field House Drive, Baton Rouge, LA, 70803, USA.,Our Lady of the Lake Regional Medical Center -Voice Center, 4950 Essen Lane, Suite 401, Baton Rouge, LA, 70809, USA.,Department of Communication Science and Disorders, University of Montevallo, Station 6720 Wallace Speech and Hearing Center, Montevallo, AL, 35115, USA
| | - Lindsey A Parker
- Department of Communication Science and Disorders, Louisiana State University, 68 Hatcher Hall, Field House Drive, Baton Rouge, LA, 70803, USA.,Our Lady of the Lake Regional Medical Center -Voice Center, 4950 Essen Lane, Suite 401, Baton Rouge, LA, 70809, USA
| | - Andrew J McWhorter
- Department of Communication Science and Disorders, Louisiana State University, 68 Hatcher Hall, Field House Drive, Baton Rouge, LA, 70803, USA.,Our Lady of the Lake Regional Medical Center -Voice Center, 4950 Essen Lane, Suite 401, Baton Rouge, LA, 70809, USA.,Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, 433 Bolivar Street, New Orleans, LA, 70112, USA
| | - David Bluoin
- Department of Experimental Statics, Louisiana State University, 61 M. D. Woodin Hall, Baton Rouge, LA, 70803, USA
| | - Melda Kunduk
- Department of Communication Science and Disorders, Louisiana State University, 68 Hatcher Hall, Field House Drive, Baton Rouge, LA, 70803, USA. .,Our Lady of the Lake Regional Medical Center -Voice Center, 4950 Essen Lane, Suite 401, Baton Rouge, LA, 70809, USA. .,Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, 433 Bolivar Street, New Orleans, LA, 70112, USA.
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6
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Gruber S, Frings K, Kuess P, Dörr W. Protective effects of systemic dermatan sulfate treatment in a preclinical model of radiation-induced oral mucositis. Strahlenther Onkol 2018; 194:675-685. [PMID: 29497792 PMCID: PMC6008363 DOI: 10.1007/s00066-018-1280-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 02/08/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE Oral mucositis is a frequent, dose-limiting side effect of radio(chemo)therapy of head-and-neck malignancies. The epithelial radiation response is based on multiple tissue changes, which could offer targets for a biologically tailored treatment. The potential of dermatan sulfate (DS) to modulate radiation-induced oral mucositis was tested in an established preclinical mucositis model. METHODS Irradiation was either applied alone or in combination with daily DS treatment (4 mg/kg, subcutaneously) over varying time intervals. Irradiation comprised single dose irradiation with graded doses to the lower tongue surface or daily fractionated irradiation of the whole tongue. Fractionation protocols (5 × 3 Gy/week) over one (days 0-4) or two weeks (days 0-4, 7-11) were terminated by an additional local single dose irradiation to a defined treatment field on the lower tongue surface to induce the mucosal radiation response. The additional single dose irradiation (top-up) on day 7 (after one week of fractionation) or day 14 (after 2 weeks of fractionation) comprised graded doses in order to generate full dose-effect curves. Ulceration of the epithelium of the lower tongue, corresponding to confluent mucositis, was analysed as clinically relevant endpoint. Additionally, the time course parameters, latent time and ulcer duration were analysed. RESULTS DS treatment significantly reduced the incidence of ulcerations. DS application over longer time intervals resulted in a more pronounced reduction of ulcer frequency, increased latent times and reduced ulcer duration. CONCLUSION DS has a significant mucositis-ameliorating activity with pronounced effects on mucositis frequency as well as on time course parameters.
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Affiliation(s)
- Sylvia Gruber
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.
- Department of Radiation Oncology, Applied and Translational Radiobiology (ATRAB), Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Katharina Frings
- Department of Radiation Oncology, Applied and Translational Radiobiology (ATRAB), Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Platform Radiooncology and Nuclear Medicine, Department for Companion Animals and Horses, University of Veterinary Medicine of Vienna, Vienna, Austria
| | - Peter Kuess
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
- Department of Radiation Oncology, Applied and Translational Radiobiology (ATRAB), Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolfgang Dörr
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
- Department of Radiation Oncology, Applied and Translational Radiobiology (ATRAB), Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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7
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Gruber S, Bozsaky E, Roitinger E, Schwarz K, Schmidt M, Dörr W. Early inflammatory changes in radiation-induced oral mucositis : Effect of pentoxifylline in a mouse model. Strahlenther Onkol 2017; 193:499-507. [PMID: 28258409 PMCID: PMC5438416 DOI: 10.1007/s00066-017-1119-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/07/2017] [Indexed: 01/05/2023]
Abstract
Purpose Early inflammation is a major factor of mucosal reactions to radiotherapy. Pentoxifylline administration resulted in a significant amelioration of radiation-induced oral mucositis in the mouse tongue model. The underlying mechanisms may be related to the immunomodulatory properties of the drug. The present study hence focuses on the manifestation of early inflammatory changes in mouse tongue during daily fractionated irradiation and their potential modulation by pentoxifylline. Materials and methods Daily fractionated irradiation with 5 fractions of 3 Gy/week (days 0–4, 7–11) was given to the snouts of mice. Groups of 3 animals per day were euthanized every second day between day 0 and 14. Pentoxifylline (15 mg/kg, s. c.) was administered daily from day 5 to the day before sacrifice. The expression of the inflammatory proteins TNFα, NF-κB, and IL-1β were analysed. Results Fractionated irradiation increased the expression of all inflammatory markers. Pentoxifylline significantly reduced the expression of TNFα and IL-1β, but not NF-κB. Conclusion Early inflammation, as indicated by the expression of the inflammatory markers TNFα, NF-κB, and IL-1β, is an essential component of early radiogenic oral mucositis. Pentoxifylline differentially modulated the expression of different inflammatory markers. The mucoprotective effect of pentoxifylline does not appear to be based on modulation of NF-κB-associated inflammation.
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Affiliation(s)
- Sylvia Gruber
- Applied and Translational Radiobiology, Dept. Radiation Oncology/CD Lab. Med. Radiation Research for Radiation Oncology, Medical University/AKH Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Eva Bozsaky
- Applied and Translational Radiobiology, Dept. Radiation Oncology/CD Lab. Med. Radiation Research for Radiation Oncology, Medical University/AKH Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Eva Roitinger
- Applied and Translational Radiobiology, Dept. Radiation Oncology/CD Lab. Med. Radiation Research for Radiation Oncology, Medical University/AKH Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Karoline Schwarz
- Applied and Translational Radiobiology, Dept. Radiation Oncology/CD Lab. Med. Radiation Research for Radiation Oncology, Medical University/AKH Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Margret Schmidt
- Dept. Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, 01307, Dresden, Germany
| | - Wolfgang Dörr
- Applied and Translational Radiobiology, Dept. Radiation Oncology/CD Lab. Med. Radiation Research for Radiation Oncology, Medical University/AKH Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Dept. Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, 01307, Dresden, Germany
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King SN, Dunlap NE, Tennant PA, Pitts T. Pathophysiology of Radiation-Induced Dysphagia in Head and Neck Cancer. Dysphagia 2016; 31:339-51. [PMID: 27098922 PMCID: PMC5340192 DOI: 10.1007/s00455-016-9710-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 04/08/2016] [Indexed: 11/25/2022]
Abstract
Oncologic treatments, such as curative radiotherapy and chemoradiation, for head and neck cancer can cause long-term swallowing impairments (dysphagia) that negatively impact quality of life. Radiation-induced dysphagia comprised a broad spectrum of structural, mechanical, and neurologic deficits. An understanding of the biomolecular effects of radiation on the time course of wound healing and underlying morphological tissue responses that precede radiation damage will improve options available for dysphagia treatment. The goal of this review is to discuss the pathophysiology of radiation-induced injury and elucidate areas that need further exploration.
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Affiliation(s)
- Suzanne N King
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, 511 South Floyd St MDR 616, Louisville, KY, 40202, USA
| | - Neal E Dunlap
- Department of Radiation Oncology, University of Louisville, Louisville, USA
| | - Paul A Tennant
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, USA
| | - Teresa Pitts
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, 511 South Floyd St MDR 616, Louisville, KY, 40202, USA.
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9
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Gruber S, Hamedinger D, Bozsaky E, Schmidt M, Wolfram K, Haagen J, Habelt B, Puttrich M, Dörr W. Local hypoxia in oral mucosa (mouse) during daily fractionated irradiation – Effect of pentoxifylline. Radiother Oncol 2015; 116:404-8. [DOI: 10.1016/j.radonc.2015.03.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/13/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
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10
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Haefner MF, Lang K, Krug D, Koerber SA, Uhlmann L, Kieser M, Debus J, Sterzing F. Prognostic factors, patterns of recurrence and toxicity for patients with esophageal cancer undergoing definitive radiotherapy or chemo-radiotherapy. JOURNAL OF RADIATION RESEARCH 2015; 56:742-749. [PMID: 25907360 PMCID: PMC4497395 DOI: 10.1093/jrr/rrv022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 03/12/2015] [Accepted: 03/16/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to evaluate the effectiveness and tolerability of definitive chemo-radiation or radiotherapy alone in patients with esophageal cancer. We retrospectively analyzed the medical records of n = 238 patients with squamous cell carcinoma or adenocarcinoma of the esophagus treated with definitive radiotherapy with or without concomitant chemotherapy at our institution between 2000 and 2012. Patients of all stages were included to represent actual clinical routine. We performed univariate and multivariate analysis to identify prognostic factors for overall survival (OS) and progression-free survival (PFS). Moreover, treatment-related toxicity and patterns of recurrence were assessed. Patients recieved either chemo-radiation (64%), radiotherapy plus cetuximab (10%) or radiotherapy alone (26%). In 69%, a boost was applied, resulting in a median cumulative dose of 55.8 Gy; the remaining 31% received a median total dose of 50 Gy. For the entire cohort, the median OS and PFS were 15.0 and 11.0 months, respectively. In multivariate analysis, important prognostic factors for OS and PFS were T stage (OS: P = 0.005; PFS: P = 0.006), M stage (OS: P = 0.015; PFS: P = 0.003), concomitant chemotherapy (P < 0.001) and radiation doses of >55 Gy (OS: P = 0.019; PFS: P = 0.022). Recurrences occurred predominantly as local in-field relapse or distant metastases. Toxicity was dominated by nutritional impairment (12.6% with G3/4 dysphagia) and chemo-associated side effects. Definitive chemo-radiation in patients with esophageal cancer results in survival rates comparable with surgical treatment approaches. However, local and distant recurrence considerably restrict prognosis. Further advances in radio-oncological treatment strategies are necessary for improving outcome.
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Affiliation(s)
- Matthias F Haefner
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Kristin Lang
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - David Krug
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Lorenz Uhlmann
- Department of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, Heidelberg 69120, Germany
| | - Meinhard Kieser
- Department of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, Heidelberg 69120, Germany
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany German Cancer Research Center (DKFZ), Clinical Cooperation Unit Radiation Oncology, Im Neuenheimer Feld 280, Heidelberg 69120, Germany
| | - Florian Sterzing
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany German Cancer Research Center (DKFZ), Clinical Cooperation Unit Radiation Oncology, Im Neuenheimer Feld 280, Heidelberg 69120, Germany
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8-prenylnaringenin and tamoxifen inhibit the shedding of irradiated epithelial cells and increase the latency period of radiation-induced oral mucositis. Strahlenther Onkol 2014; 191:429-36. [DOI: 10.1007/s00066-014-0782-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/30/2014] [Indexed: 10/24/2022]
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12
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Gruber S, Schmidt M, Bozsaky E, Wolfram K, Haagen J, Habelt B, Puttrich M, Dörr W. Modulation of radiation-induced oral mucositis by pentoxifylline: Preclinical studies. Strahlenther Onkol 2014; 191:242-7. [DOI: 10.1007/s00066-014-0775-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 10/09/2014] [Indexed: 02/07/2023]
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Burdak-Rothkamm S, Smith A, Lobachevsky P, Martin R, Prise KM. Radioprotection of targeted and bystander cells by methylproamine. Strahlenther Onkol 2014; 191:248-55. [PMID: 25245467 PMCID: PMC4338360 DOI: 10.1007/s00066-014-0751-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/02/2014] [Indexed: 11/25/2022]
Abstract
Introduction Radioprotective agents are of interest for application in radiotherapy for cancer and in public health medicine in the context of accidental radiation exposure. Methylproamine is the lead compound of a class of radioprotectors which act as DNA binding anti-oxidants, enabling the repair of transient radiation-induced oxidative DNA lesions. This study tested methylproamine for the radioprotection of both directly targeted and bystander cells. Methods T98G glioma cells were treated with 15 μM methylproamine and exposed to 137Cs γ-ray/X-ray irradiation and He2+ microbeam irradiation. Radioprotection of directly targeted cells and bystander cells was measured by clonogenic survival or γH2AX assay. Results Radioprotection of directly targeted T98G cells by methylproamine was observed for 137Cs γ-rays and X-rays but not for He2+ charged particle irradiation. The effect of methylproamine on the bystander cell population was tested for both X-ray irradiation and He2+ ion microbeam irradiation. The X-ray bystander experiments were carried out by medium transfer from irradiated to non-irradiated cultures and three experimental designs were tested. Radioprotection was only observed when recipient cells were pretreated with the drug prior to exposure to the conditioned medium. In microbeam bystander experiments targeted and nontargeted cells were co-cultured with continuous methylproamine treatment during irradiation and postradiation incubation; radioprotection of bystander cells was observed. Discussion and conclusion Methylproamine protected targeted cells from DNA damage caused by γ-ray or X-ray radiation but not He2+ ion radiation. Protection of bystander cells was independent of the type of radiation which the donor population received.
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Wierzbicka M, Leszczyńska M, Szyfter W. [Re-evaluation of 191 larynx cancer surgeries according to the Open Partial Horizontal Laryngectomies classification proposed by European Laryngological Society working committee in 2014]. Otolaryngol Pol 2014; 68:281-6. [PMID: 25152380 DOI: 10.1016/j.otpol.2014.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 07/08/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
Abstract
AIM of study was to present material of open partial horizontal laryngectomies (OPHL) in T1b, T2 and T3 larynx cancer treatment in single tertiary referral institution. MATERIAL AND METHODS Retrospective analysis of operating protocols in patients treated in Poznań ENT University Department between 2000-2012 with glottis (T1b - 185, T2 - 185, T3 - 231) and supraglottis tumors (T1 - 80, T2 - 104, T3 - 206), potentially available for organ preservation treatment. Transoral laser microsurgery, OPHL, radiotherapy and total laryngectomy were treatment options in 210, 191, 271 and 326 patients respectively. OPHL was applied in glottic tumors: 21 - T1b, 103 - T2, 27 - T3 and in supraglottic tumors: 4 - T1, 29 - T2. All procedures were re-evaluated acc. to European Laryngogical Society working committee on nomenclature new classification presented in 2014. RESULTS There was no discrepancies in supraglottic laryngectomies (4 cases), classified as OPHL Typ I. All the rest: 84 transglottic, 96 supracricoid with CHEP and 7 supracricoid with CHP laryngectomies were re-classified into Typ II (172) and Type III (15) OPHL. Thus, revision of inferior incision changed classification of procedure into supratracheal laryngectomy in 15 cases. Transglottic laryngectomies, in which upper part of thyroid cartilage was preserved and crito-thyreo-pexy was performed (84 pts), have not been distinguished any more. In 7 cases superior incision included epiglottis; thus 165 patients were distinguished as Typ II a and 7 patients as Typ IIb OPHL. The most pronounced difference was stated in description of structures additionally included into surgical specimen: arytenoid (+ARY) in 24, crico-arytenoid-unit (+CAU) in 5 and piriform sinus (+PIR) in 17 cases; none had the base of tongue (+BOT) resected. CONCLUSIONS In 36/191 additional structures and in 15/191 the cricoid ring resection was re-evaluated and pointed out. All these data were available retrospectively in the operating protocols but not pronounced in surgery headlines. Thanks to the univocal, simple new classification all operation details can be included into operation title.
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Affiliation(s)
- Małgorzata Wierzbicka
- Klinika Otolaryngologii i Onkologii Laryngologicznej, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu, Kierownik: prof. dr hab. med. Witold Szyfter, Poznań, Polska.
| | - Małgorzata Leszczyńska
- Klinika Otolaryngologii i Onkologii Laryngologicznej, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu, Kierownik: prof. dr hab. med. Witold Szyfter, Poznań, Polska
| | - Witold Szyfter
- Klinika Otolaryngologii i Onkologii Laryngologicznej, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu, Kierownik: prof. dr hab. med. Witold Szyfter, Poznań, Polska
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Radiation recall dermatitis after docetaxel chemotherapy. Treatment by antioxidant ointment. Strahlenther Onkol 2014; 190:491-3. [PMID: 24615187 DOI: 10.1007/s00066-014-0609-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 12/18/2013] [Indexed: 11/26/2022]
Abstract
Radiation recall dermatitis (RRD) is an acute skin toxicity caused by different anticancer or antibiotic drugs within a former completely healed irradiation field. Predictive factors for RRD are not known and its mechanisms are not completely understood. A case of RRD induced by docetaxel and successfully treated by an antioxidant ointment (Mapisal(®)) is presented here. Such an ointment might be useful not only in RRD therapy, but also in the treatment of high-grade dermatitis induced by radiotherapy and thus may contribute to the improvement of patients' quality of life and to the scheduled completion of cancer therapies.
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Effects of bone marrow or mesenchymal stem cell transplantation on oral mucositis (mouse) induced by fractionated irradiation. Strahlenther Onkol 2014; 190:399-404. [DOI: 10.1007/s00066-013-0510-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 11/08/2013] [Indexed: 10/25/2022]
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