Radiation enhancement of lung nodule formation in mice is not potentiated by treatment with a perfluorochemical emulsion and carbogen

Subclinical vitamin A deficiency does not increase development of tumors in irradiated or unirradiated lungs

Cancer patients often have subclinical vitamin A deficiencies and low vitamin A lung levels. Previous studies showed that subclinical vitamin A deficiency increased the severity of pneumonitis induced by whole-lung irradiation in rats. Many studies have shown that lung irradiation increases the number of lung tumors developing from intravenously injected tumor cells in mice. We examined the impact of vitamin A deficiency on the development of lung metastases from a highly metastatic syngeneic rat rhabdomyosarcoma in normal rats and rats receiving prior lung irradiation. Weanling female WAGrijY rats were randomized to receive either a diet lacking both vitamin A and beta-carotene or a control diet. After five weeks, the deficient diet significantly decreased levels of retinol in the lung and liver but not in the serum, modeling the tissue and blood levels seen in prior studies of patients with subclinical vitamin A inadequacy. The vitamin A-deficient diet did not alter the number of lung tumors developing from intravenously injected tumor cells in unirradiated rats. Whole-lung irradiation produced dose-dependent increases in the number of lung tumors developing from tumor cells injected intravenously one or 29 d after irradiation. Vitamin A deficiency did not alter these dose-response curves, indicating that the more intense radiation-induced pneumonitis seen previously in vitamin A-deficient rats did not alter the enhancement of metastases produced by whole-lung irradiation. Moreover, inadequate vitamin A intake did not influence the growth of tumors implanted subcutaneously or increase the number or size of the spontaneous lung metastases developing from these subcutaneous tumors. Thus, although low vitamin A status influences the development of lung injury and is considered a possible modifiable risk factor increasing risk of primary cancer, it did not affect the growth of subcutaneous tumors or increase the development of artificial or spontaneous lung metastases in this rat model.

Vitamin A inhibits radiation-induced pneumonitis in rats

Radiation-induced lung injury frequently limits the total dose of thoracic radiotherapy that can be delivered, and the determinants of host susceptibility are poorly understood. To test the hypothesis that vitamin A status may be an important, modifiable host determinant of radiation-induced lung injury, we determined the effect of altered vitamin A status on radiation-induced lung inflammation in rats. WAG-Rij Y rats were fed a diet deficient in or supplemented with vitamin A (0 units/kg or 80,000 units/kg diet). After 5 wk of consuming the prescribed diet, rats were irradiated with 15 Gy of 250 kV X-rays to the whole thorax. At 4-5 wk post-irradiation, there were significantly fewer neutrophils on bronchoalveolar lavage in rats fed the vitamin A-supplemented diet (8.8 +/- 1.2% neutrophils) compared with those fed the vitamin A-deficient diet (20.8 +/- 3.4% neutrophils, P < 0.01). At the termination of the experiment, 4-5 wk postradiation, lung retinol levels of the vitamin A-supplemented group were 19.6 +/- 1.8 nmol/g, whereas those in the vitamin A-deficient group were significantly lower, 1.7 +/- 0.5 nmol/g (P < 0.01). These findings suggest that supplemental vitamin A may reduce lung inflammation after thoracic radiation and be an important modifiable radioprotective agent in the lung.

Preclinical evaluation of Oxygent as an adjunct to radiotherapy

These studies examine the potential value of a concentrated emulsion of perfluorooctylbromide (perflubron; Oxygent, Alliance Pharmaceutical Corp.) as an adjunct to radiotherapy. The effects of Oxygent on solid tumors were examined using EMT6 mammary tumors in BALB/c mice and BA1112 rhabdomyosarcomas in WAG/rij rats. Treatment with Oxygent plus O2, carbogen (95% O2/5% CO2), or hyperbaric oxygen (HBO) increased the effects of radiation on the tumors. Analyses of tumor cell survival curves and measurements of intratumor pO2 showed that this potentiation reflected an increase in the proportion of well-oxygenated tumor cells. Neither treatment of the animals with carbogen, O2, or HBO alone nor treatment of air-breathing rodents with Oxygent produced changes of similar magnitude. Treatment with a vehicle emulsion containing all the components of Oxygent except the perflubron did not alter tumor radiosensitivity, showing that tumor radiosensitization required the oxygen-transporting perfluorocarbon, and did not result from any biologic or physiologic effects of other components of the emulsion. These studies also examined the effects of Oxygent on the radiation responses of mouse skin and bone marrow. Oxygent selectively increased the radiation sensitivity of tumors relative to these normal tissues, thereby increasing the therapeutic ratio and producing therapeutic gain. Oxygent appears to warrant further testing as an adjunct to cancer therapy.

The use of fluorocarbon emulsions in cancer radiotherapy

The chemical and physical properties of perfluorochemical emulsions which highlight their advantages and disadvantages for use in cancer radiotherapy are summarized. The radiobiological properties of two emulsions are reviewed: we have chosen the Fluosol-DA 20% and the PFOB emulsion 100 v/w% which is one of the most promising second generation fluorocarbon emulsions. The radiosensitization obtained in a human tumor xenograft with PFOB emulsion is compared to that obtained with other modalities used to overcome the radioresistance of tumour cells linked to hypoxia.