Comparison of metastatic disease after local tumour treatment with radiotherapy or surgery in various tumour models

Prodding the Beast: Assessing the Impact of Treatment-Induced Metastasis

The arsenal of treatments for most cancers fit broadly into the categories of surgery, chemotherapy, radiation, and targeted therapy. All represent proven and successful strategies, yet each can trigger local (tumor) and systemic (host) processes that elicit unwanted, often opposing, influences on cancer growth. Under certain conditions, nearly all cancer treatments can facilitate metastatic spread, often in parallel (and sometimes in clear contrast) with tumor reducing benefits. The paradox of treatment-induced metastasis (TIM) is not new. Supporting preclinical studies span decades, but are often overlooked. With recent evidence of prometastatic effects following treatment with targeted agents blocking the tumor microenvironment, a closer inspection of this literature is warranted. The TIM phenomena may diminish the impact of effective therapies and play a critical role in eventual resistance. Alternatively, it may simply exemplify the gap between animal and human studies, and therefore have little impact for patient disease and treatment. This review will focus on the preclinical model systems used to evaluate TIM and explore the mechanisms that influence overall treatment efficacy. Understanding the role of TIM in established and emerging drug treatment strategies may help provide rationales for future drug combination approaches with antimetastatic agents to improve outcomes and reduce resistance.

Radiation enhances long-term metastasis potential of residual hepatocellular carcinoma in nude mice through TMPRSS4-induced epithelial-mesenchymal transition

Recurrence and metastasis are frequently observed after radiotherapy for hepatocellular carcinoma (HCC), although upregulation of matrix metalloproteinases (MMPs) and vascular endothelial growth factor (VEGF) induced by radiation has been claimed to be involved, the mechanism is not clarified yet. In the present study, by using MHCC97L, a human HCC cell line with metastatic potential, and its xenograft in nude mice, we found that radiation induced a 48- to 72-h temporary increase in the expression of MMP-2 and VEGF both in vitro and in vivo, but only the in vitro invasiveness of MHCC97L cells was enhanced, while the in vivo metastatic potential of tumors was suppressed. Whereas, 30 days after radiation, when the expression of MMP-2 and VEGF decreased to unirradiated control levels, the in vivo dissemination and metastatic potential of residual tumors have just begun to increase with overexpression of TMPRSS4, which induced loss of E-cadherin through induction of Smad-Interacting Protein 1 (SIP1), an E-cadherin transcriptional repressor, and led to epithelial-mesenchymal transition (EMT). This process was blocked by treatment of siRNA-TMPRSS4. In conclusion, our study revealed novel findings regarding the biphasic effect of radiation on the metastatic potential of residual HCC. Overexpression of TMPRSS4 has a critical role in radiation-induced long-term dissemination and metastasis of residual HCC by facilitating EMT. These findings may provide new clues to suppress the radiation-induced dissemination and metastasis, thereby improve the prognosis of HCC patients.

Tumor and host-mediated pathways of resistance and disease progression in response to antiangiogenic therapy

Despite early benefits seen in cancer patients treated with antivascular endothelial growth factor (VEGF) pathway-targeted drugs, the clinical benefits obtained in terms of progression-free or overall survival have been more modest than expected. This outcome is, at least in part, due to antiangiogenic drug resistance mechanisms that involve pathways mediated largely by the tumor, whether intrinsic or acquired in response to therapy, or by the host, which is either responding directly to therapy or indirectly to tumoral cues. The focus of this review is to distinguish, where possible, between such host and tumor-mediated pathways of resistance and discuss key challenges facing the preclinical and clinical development of antiangiogenic agents, including potential differences in drug efficacies when treating primary tumors or various stages of metastatic disease.

Accelerated metastasis after short-term treatment with a potent inhibitor of tumor angiogenesis

Herein we report that the VEGFR/PDGFR kinase inhibitor sunitinib/SU11248 can accelerate metastatic tumor growth and decrease overall survival in mice receiving short-term therapy in various metastasis assays, including after intravenous injection of tumor cells or after removal of primary orthotopically grown tumors. Acceleration of metastasis was also observed in mice receiving sunitinib prior to intravenous implantation of tumor cells, suggesting possible "metastatic conditioning" in multiple organs. Similar findings with additional VEGF receptor tyrosine kinase inhibitors implicate a class-specific effect for such agents. Importantly, these observations of metastatic acceleration were in contrast to the demonstrable antitumor benefits obtained when the same human breast cancer cells, as well as mouse or human melanoma cells, were grown orthotopically as primary tumors and subjected to identical sunitinib treatments.

Sublethal irradiation promotes invasiveness of neuroblastoma cells

Neuroblastoma is the most frequent extracranial solid tumour of childhood. Despite multiple clinical efforts, clinical outcome has remained poor. Neuroblastoma is considered to be radiosensitive, but some clinical studies including the German trial NB90 failed to show a clinical benefit of radiation therapy. The mechanisms underlying this apparent discrepancy are still unclear. We have therefore investigated the effects of radiation on neuroblastoma cell behaviour in vitro. We show that sublethal doses of irradiation up-regulated the expression of the hepatocyte growth factor (HGF) and its receptor c-Met in some neuroblastoma cell lines. The increase in HGF/c-Met expression was correlated with enhanced invasiveness and activation of proteases degrading the extracellular matrix. Thus, irradiation at sublethal doses may promote the metastatic dissemination of neuroblastoma cells through activating the HGF/c-Met pathway and triggering matrix degradation.

Increased Metastatic Dissemination in Human Melanoma Xenografts after Subcurative Radiation Treatment

Cancer patients showing local failure after radiation treatment have increased probability for developing metastatic disease. The mechanisms behind this observation have not been identified. In the present work, metastatic spread after inadequate radiation therapy was studied by using R-18 human melanoma xenografts as models of cancer in humans. Pimonidazole was used as a hypoxia marker, and hypoxia and urokinase-type plasminogen activator receptor (uPAR) expression were detected by immunohistochemistry. R-18 tumors regrowing after subcurative irradiation showed a higher frequency of lymph node metastasis than unirradiated tumors. The expression of uPAR was up-regulated in hypoxic tumor regions, and the fractions of hypoxic and uPAR-positive cells were approximately 2-fold higher in regrowing irradiated tumors than in untreated tumors. Treatment with anti-uPAR antibody blocked metastasis almost completely in irradiated as well as unirradiated tumors. The metastatic frequency was higher in tumors regrowing after irradiation than in unirradiated tumors because the irradiation induced tumor hypoxia, and tumor hypoxia induced up-regulation of uPAR.

Assessment of biomarkers in paired primary and recurrent colorectal adenocarcinomas

PURPOSE

Recurrent colorectal cancers respond poorly to anticancer treatment including radiotherapy. To better understand the biological characteristics of the recurrent colorectal tumor, we investigated various biomarkers regulating cell proliferation and cell loss in paired primary and recurrent colorectal tumor specimens within each individual.

METHODS AND MATERIALS

From a total of 11 colorectal adenocarcinoma patients, 22 specimens of paired primary and recurrent tumors were obtained for analysis. Apoptosis was evaluated by TUNEL labeling of apoptotic DNA fragmentation. Other biomarkers including proliferating cell nuclear antigen (PCNA), p53, WAF1, p34cdc2, and cyclins B1 and D1 were analyzed by immunohistochemical stains.

RESULTS

PCNA index (PCNAI) showed an increase in 6 and a decrease in 5 recurrent tumors compared to primary tumors. Median PCNAI in primary and recurrent tumors were 33.5 and 48.3, respectively (p = 0.16). In contrast, the apoptotic index (AI) decreased in 9 of 11 recurrent tumors compared to primary tumors. Median AI decreased from 4.3 in primary tumors to 1.4 in recurrent tumors (p = 0.04). The p53 expression increased in more than half of recurrent tumors compared to primary tumors. Mean staining score increased from 0.7 in primary tumors to 1.2 in recurrent tumors (p = 0.059). WAF1 and cyclin B1 did not show significant change. In contrast, both cyclin D1 and p34cdc2 increased significantly in recurrent tumors. These two biomarkers showed increased expression in 8 (cyclin D1) and 7 (p34cdc2) recurrent tumors, respectively, compared to their primary counterparts. Mean staining scores of both biomarkers in recurrent tumors increased by more than twofold compared to those in primary tumors and these differences were statistically significant (cyclin D1, p = 0.007; p34cdc2, p = 0.008).

CONCLUSION

This study showed significantly decreased apoptosis in recurrent colorectal tumors compared to their primary counterparts. The underlying regulatory mechanisms included increased expression of p53 and altered cell cycle regulators such as increased cyclin D1 and p34cdc2. With further study, it may be used for developing a new therapeutic strategy for the treatment of recurrent colorectal cancer.

Lymphatic metastasis from tumors transplanted into the pre-irradiated footpad of the rat

BACKGROUND

In the literature there is some evidence that the incidence of metastases may increase after radiation treatment.

METHODS

In order to investigate whether radiation-induced changes in the lymphatic drainage may alter the rate of lymph node metastasis, the center part of the left hind foot of rats was irradiated with a dose of 1 x 55 Gy before inoculation of tumor cells into the irradiated part of the footpad at different time intervals. Cells of 2 different tumor lines were employed. A rarely metastasising rhabdomyosarcoma, R-1, to look for a possible enhancement of lymphatic metastases, and a readily metastasising mammary carcinoma, Cl-2, in case of a possible decrease in the rate of lymphatic metastasis from tumors growing in pre-irradiated footpads.

RESULTS

The incidence of regional lymph node metastasis decreased for R-1 tumors growing in pre-irradiated footpads, but not for Cl-2 tumors. Furthermore, the average time required for lymph node metastasis to attain a reference volume of 100 mm3 is not significantly influenced by pre-irradiation of the footpad. No difference was observed in average times for doubling in volume of lymph node metastases originating from primary tumors in pre-irradiated footpads. Abscopal effects after footpad irradiation may cause a 50-fold increase in size of regional lymph nodes and, therefore, histological examination is essential for verification of lymph node metastases.

CONCLUSIONS

Damage to the lymphatic system to be expected in the irradiated footpad did not enhance the incidence of regional metastasis of R-1 tumors. A reduced rate of lymphatic metastasis contradicts earlier findings of enhanced lymphatic metastasis development of R-1 tumors, growing in pre-irradiated gastrocnemius muscles. The influence of irradiation on regional metastasis formation seems to be "tumor bed" dependent for R-1 tumors.

Spontaneous metastasis, proliferation characteristics and radiation sensitivity of fractionated irradiation recurrent and unirradiated human xenografts

PURPOSE

Do tumor cells which survive high dose fractionated irradiation exhibit modified metastasis activity, proliferation kinetics, and/or radiation sensitivity? To address this question experimentally, we have studied three recurrent human tumor xenograft systems.

METHODS AND MATERIALS

Three models were derived from a soft tissue sarcoma (HSTS26T), a colon adenocarcinoma (HCT15), and a glioblastoma (HGL21) which had recurred after 90 Gy, 109 Gy, or 77.4 Gy administered in 30 equal doses, respectively. Their production of spontaneous metastasis and cell proliferation characteristics were studied in early generation xenografts in SCID mice, and were compared to those in their previously unirradiated counterparts. As a control, we have also studied each tumor as a post-surgical recurrence. Specimens from the irradiated recurrent and their unirradiated primary tumors were cultured in vitro and their radiation sensitivity determined by clonogenic assay.

RESULTS

The three irradiated recurrent tumor systems retained the individual histological features of their unirradiated primary xenografts. A lower metastatic incidence was observed in two of the three irradiated recurrent tumor lines in comparison with their unirradiated control tumors and their surgical recurrent counterparts. No significant differences were found between the irradiated recurrent tumors and their unirradiated counterparts with respect to: volume doubling time, growth time, potential doubling time, mitotic index, PCNA index, and SF2 values.

CONCLUSIONS

High dose irradiation given in 30 fractions did not increase the metastatic activity in the three human tumor xenograft systems. Furthermore, the fractionated irradiation did not significantly change their proliferation characteristics and cellular radiation sensitivity.

Radiation enhancement of metastasis: a review

Virtually every modality employed in the treatment of cancer has demonstrated an adverse effect upon metastasis under some conditions. This review surveys the experimental and clinical literature pertaining to the untoward effects of ionizing radiation upon metastatic processes. Two processes are described: (1) enhancement of metastases following local tumor irradiation; (2) localization of metastasis in previously irradiated normal tissues. In the first process the experimental evidence indicates a local effect of irradiation upon the tumor-stroma interface. It predominates under conditions of non-curative radiation doses. There is no proof that this process occurs in clinical practice, but a review of data provides suggestive evidence for its existence following non-curative therapy. The second process is documented both experimentally and clinically. It requires the presence of viable, circulating tumor cells and appears mediated through vascular damage. The few clinical reports suggest that this effect is rare in practice. The clinical significance of both processes appears small under conditions of effective tumor therapy, but it is speculated that inadequate tumor irradiation, or irradiation of normal tissues with uncontrolled tumor elsewhere, may be deleterious.

The lymphnodal clonogenicity and kinetics of metastatic cells disseminated by a transplanted rat carcinoma

We report data on the transplantation of primary tumour cells and of lymph nodes containing metastatic cells disseminated by a mammary carcinoma (LMC1) implanted s.c. in the Johns' Strain Wistar rat. A new method is described for deriving the TD50 of metastatic cells and for comparing their lymphnodal clonogenicity in the transplanted and the original, i.e. 'primary' tumour host. The TD50 for transplanted primary LMC1 cells was approximately 12 (fiducial limits 8-20 cells), and the latency of the 8-10mm tumours formed (T8-10) after inocula of 10(2) to 10(5) cells decreased linearly with the logarithmic increase in the number of cells injected. From the T8-10 and tumour incidence data for transplanted inguinal, axillary and para-aortic nodes, the TD50 for metastatic cells was calculated to be 1120 cells (fiducial limits 790-1603 cells) indicating that the clonogenicity of naturally disseminated metastatic cells was about a 100 fold lower than that determined for transplanted primary tumour cells. The incidence and T8-10 data for axillary, inguinal and para-aortic lymph node metastases in primary-tumour-excised hosts suggests that, although metastatic cells may continue translymphnodal dissemination in situ, their TD50 is still consistent with that determined by node transplantation.

Metastasis and the excision of irradiated LMCI tumours in the rat

Lymph node metastases occurring within 150 days of local non-curative irradiation and excision of a transplantable mammary adenocarcinoma (LMCI) have been scored and their growth measured in isogeneic rats. Single doses (5-40 Gy) of 60Co gamma-rays were given to the primary at 8-10 mm diameter and these were excised either immediately or up to 30 days later. From the results it is concluded that approximately half of all rats have occult dissemination at the time of irradiation. Only these form metastases after the early excision of 10-40 Gy treated tumours but the number of positive sites per animal is significantly reduced. Delayed excision of the irradiated primary permits the further seeding of metastases and, with its regrowth, the incidence of positive rats and the mean number of metastases per animal is restored to that observed after control surgery. This process was dependent on the radiation-induced delay in growth of the primary tumour. However, all metastases, irrespective of site, radiation dose, and time of primary tumour excision showed a growth rate characteristic of the untreated LMCI tumour. No evidence was obtained for an enhancement in the dissemination of metastatic cells from the irradiated but regrowing primary tumour. However, an alteration in the pathways of lymphatic dissemination leading to an increased number of metastases seeding the mediastinum and abdominal lymph nodes may have occurred.

Influence of implantation site on formation of metastases

It has been suggested that local factors at the site of growth of a primary tumor might influence the outcome of the metastatic process. Compilation of the data from the literature revealed that growth of tumor cells in the selective medium of the intraperitoneal cavity, of the lymph node and/or of the spleen leads to progression towards a population of cells with a higher metastatic capacity. In search for an experimental model with transplantable rodent tumors that could be used to study the influence of the anatomic site of an implant on the formation of spontaneous metastases, we have considered heterogeneity of microenvironmental conditions in the subcutaneous milieu. For the MO4 mouse fibrosarcoma, a primary tumor growing subcutaneously in the tail was highly metastatic to lymph nodes and lungs while it failed to produce metastases when growing in the pinna. Implantation of a spheroidal aggregate of MO4 tumor cells, alternatively in the tail and in the pinna of syngeneic C3H/He mice, might be an appropriate model, which is discussed in this review.