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CDK6 is stimulated by hyperthermia and protects gastric cancer cells from hyperthermia‑induced damage. Mol Med Rep 2021; 23:240. [PMID: 33537819 PMCID: PMC7893798 DOI: 10.3892/mmr.2021.11879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 12/15/2020] [Indexed: 12/17/2022] Open
Abstract
Hyperthermia is one of the most widely employed adjuvant treatments for cancer, especially for hyperthermic intraperitoneal chemotherapy, and has few side effects. Gastric cancer has various hyperthermia sensitivities, but the exact molecular mechanisms remain to be elucidated. In the present study, western blotting was performed to detect differential expression of proteins that have been reported to be upregulated in gastric cancer. Following knockdown of these proteins, apoptosis was measured by Annexin V-FITC/propidium iodide (PI) double staining and hyperthermia treatment was applied. To evaluate the effect of cyclin-dependent kinase 6 (CDK6) on hyperthermia-induced apoptosis, CDK6 was knocked down or inhibited by the addition of a specific inhibitor and subsequent PI staining and cell proliferation, migration and invasion assays were performed. Hyperthermia-induced protein kinase B (AKT) expression and phosphorylation inhibition were detected. As demonstrated in the present study, the hyperthermia-induced proteins kinesin family member 11 (KIF11), cyclin-dependent kinase 6 (CDK6), stromal antigen 2, NIMA-related kinase 2 and karyopherin subunit α 4 were highly expressed in gastric cancer cells, including SH-10-TC and HGC-27 cells. Knockdown of KIF11 significantly increased apoptosis without hyperthermia treatment and CDK6 significantly increased hyperthermia-induced apoptosis, prompting the present study to focus on CDK6. It was further confirmed that CDK6 activity was critical for decreasing hyperthermia-induced apoptosis and for cell proliferation. Hyperthermia-induced AKT expression and phosphorylation inhibition is potentially the main cause of CDK6 transcriptional upregulation. Taken together, these findings demonstrated that CDK6 is upregulated via hyperthermia-induced AKT inhibition and subsequently protected gastric cancer cells from hyperthermia-induced apoptosis, indicating that it is a potential therapeutic target to sensitize gastric cancer cells to hyperthermia-based therapy.
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2
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Synergic effects of nanoparticles-mediated hyperthermia in radiotherapy/chemotherapy of cancer. Life Sci 2021; 269:119020. [PMID: 33450258 DOI: 10.1016/j.lfs.2021.119020] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/05/2020] [Accepted: 01/02/2021] [Indexed: 12/15/2022]
Abstract
The conventional cancer treatment modalities such as radiotherapy and chemotherapy suffer from several limitations; hence, their efficiency needs to be improved with other complementary modalities. Hyperthermia, as an adjuvant therapeutic modality for cancer, can result in a synergistic effect on radiotherapy (radiosensitizer) and chemotherapy (chemosensitizer). Conventional hyperthermia methods affect both tumoral and healthy tissues and have low specificity. In addition, a temperature gradient generates in the tissues situated along the path of the heat source, which is a more serious for deep-seated tumors. Nanoparticles (NPs)-induced hyperthermia can resolve these drawbacks through localization around/within tumoral tissue and generating local hyperthermia. Although there are several review articles dealing with NPs-induced hyperthermia, lack of a paper discussing the combination of NPs-induced hyperthermia with the conventional chemotherapy or radiotherapy is tangible. Accordingly, the main focus of the current paper is to summarize the principles of NPs-induced hyperthermia and more importantly its synergic effects on the conventional chemotherapy or radiotherapy. The heat-producing nanostructures such as gold NPs, iron oxide NPs, and carbon NPs, as well as the non-heat-producing nanostructures, such as lipid-based, polymeric, and silica-based NPs, as the carrier for heat-producing NPs, are discussed and their pros and cons highlighted.
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3
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Ranieri G, Laface C, Laforgia M, De Summa S, Porcelli M, Macina F, Ammendola M, Molinari P, Lauletta G, Di Palo A, Rubini G, Ferrari C, Gadaleta CD. Bevacizumab Plus FOLFOX-4 Combined With Deep Electro-Hyperthermia as First-line Therapy in Metastatic Colon Cancer: A Pilot Study. Front Oncol 2020; 10:590707. [PMID: 33224885 PMCID: PMC7670056 DOI: 10.3389/fonc.2020.590707] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/08/2020] [Indexed: 12/21/2022] Open
Abstract
Bevacizumab plus FOLFOX-4 regimen represents the first-line therapy in patients affected by metastatic colorectal cancer (mCRC). Hyperthermia has been considered an effective ancillary treatment for cancer therapy through several anti-tumor mechanisms, sharing with Bevacizumab the inhibition of angiogenesis. Up to now, scientific literature offers very few clinical data on the combination of bevacizumab plus oxaliplatin-based chemotherapy with deep electro-hyperthermia (DEHY) for metastatic colon cancer (mCC) patients. Therefore, we aimed at evaluating the efficacy of this combination based on the possible interaction between the DEHY and bevacizumab anti-tumor mechanisms. We conducted a retrospective analysis on 40 patients affected by mCC treated with the combination of bevacizumab plus FOLFOX-4 (fluorouracil/folinic acid plus oxaliplatin) and DEHY (EHY2000), between January 2017 and May 2020. DEHY treatment was performed weekly, with capacitive electrodes at 80-110 W for 50 min, during and between subsequent bevacizumab administrations, on abdomen for liver or abdominal lymph nodes metastases and thorax for lung metastases. Treatment response assessment was performed according to the Response Evaluation Criteria for Solid Tumors (RECIST). The primary endpoints were disease control rate (DCR) and progression-free survival (PFS). The secondary endpoint was overall survival (OS). DCR, counted as the percentage of patients who had the best response rating [complete response (CR), partial response (PR), or stable disease (SD)], was assessed at 90 days (timepoint-1) and at 180 days (timepoint-2). DCR was 95% and 89.5% at timepoint-1 and timepoint-2, respectively. The median PFS was 12.1 months, whereas the median OS was 21.4 months. No major toxicity related to DEHY was registered; overall, this combination regimen was safe. Our results suggest that the combined treatment of DEHY with bevacizumab plus FOLFOX-4 as first-line therapy in mCC is feasible and effective with a favorable disease control, prolonging PFS of 2.7 months with respect to standard treatment without DEHY for mCC patients. Further studies will be required to prove its merit and explore its potentiality, especially if compared to conventional treatment.
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Affiliation(s)
- Girolamo Ranieri
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori "G. Paolo II", Bari, Italy
| | - Carmelo Laface
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori "G. Paolo II", Bari, Italy
| | | | - Simona De Summa
- Molecular Diagnostics and Pharmacogenetics Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Mariangela Porcelli
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori "G. Paolo II", Bari, Italy
| | - Francesco Macina
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori "G. Paolo II", Bari, Italy
| | - Michele Ammendola
- Department of Health Science, Digestive Surgery Unit, University "Magna Graecia" Medical School, Germaneto, Italy
| | - Pasquale Molinari
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori "G. Paolo II", Bari, Italy
| | - Gianfranco Lauletta
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine "G. Baccelli", University of Bari Medical School, Bari, Italy
| | - Alessandra Di Palo
- Nuclear Medicine Unit, D.I.M., University of Bari "Aldo Moro", Bari, Italy
| | - Giuseppe Rubini
- Nuclear Medicine Unit, D.I.M., University of Bari "Aldo Moro", Bari, Italy
| | - Cristina Ferrari
- Nuclear Medicine Unit, D.I.M., University of Bari "Aldo Moro", Bari, Italy
| | - Cosmo Damiano Gadaleta
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori "G. Paolo II", Bari, Italy
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4
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Crezee J, Oei AL, Franken NAP, Stalpers LJA, Kok HP. Response: Commentary: The Impact of the Time Interval Between Radiation and Hyperthermia on Clinical Outcome in Patients With Locally Advanced Cervical Cancer. Front Oncol 2020; 10:528. [PMID: 32351897 PMCID: PMC7174773 DOI: 10.3389/fonc.2020.00528] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/24/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Johannes Crezee
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Arlene L Oei
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Laboratory of Experimental Oncology and Radiobiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Nicolaas A P Franken
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Laboratory of Experimental Oncology and Radiobiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Lukas J A Stalpers
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Laboratory of Experimental Oncology and Radiobiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - H Petra Kok
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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Mei X, ten Cate R, van Leeuwen CM, Rodermond HM, de Leeuw L, Dimitrakopoulou D, Stalpers LJA, Crezee J, Kok HP, Franken NAP, Oei AL. Radiosensitization by Hyperthermia: The Effects of Temperature, Sequence, and Time Interval in Cervical Cell Lines. Cancers (Basel) 2020; 12:cancers12030582. [PMID: 32138173 PMCID: PMC7139900 DOI: 10.3390/cancers12030582] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/27/2020] [Accepted: 02/29/2020] [Indexed: 12/03/2022] Open
Abstract
Cervical cancers are almost exclusively caused by an infection with the human papillomavirus (HPV). When patients suffering from cervical cancer have contraindications for chemoradiotherapy, radiotherapy combined with hyperthermia is a good treatment option. Radiation-induced DNA breaks can be repaired by nonhomologous end-joining (NHEJ) or homologous recombination (HR). Hyperthermia can temporarily inactivate homologous recombination. Therefore, combining radiotherapy with hyperthermia can result in the persistence of more fatal radiation-induced DNA breaks. However, there is no consensus on the optimal sequence of radiotherapy and hyperthermia and the optimal time interval between these modalities. Moreover, the temperature of hyperthermia and HPV-type may also be important in radiosensitization by hyperthermia. In this study we thoroughly investigated the impact of different temperatures (37–42 °C), and the sequence of and time interval (0 up to 4 h) between ionizing radiation and hyperthermia on HPV16+: SiHa, Caski; HPV18+: HeLa, C4I; and HPV−: C33A, HT3 cervical cancer cell lines. Our results demonstrate that a short time interval between treatments caused more unrepaired DNA damages and more cell kill, especially at higher temperatures. Although hyperthermia before ionizing radiation may result in slightly more DNA damage, the sequence between hyperthermia and ionizing radiation yielded similar effects on cell survival.
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Affiliation(s)
- Xionge Mei
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (X.M.); (R.t.C.); (H.M.R.); (L.d.L.); (D.D.); (L.J.A.S.); (N.A.P.F.)
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Rosemarie ten Cate
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (X.M.); (R.t.C.); (H.M.R.); (L.d.L.); (D.D.); (L.J.A.S.); (N.A.P.F.)
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Caspar M. van Leeuwen
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Hans M. Rodermond
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (X.M.); (R.t.C.); (H.M.R.); (L.d.L.); (D.D.); (L.J.A.S.); (N.A.P.F.)
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Lidewij de Leeuw
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (X.M.); (R.t.C.); (H.M.R.); (L.d.L.); (D.D.); (L.J.A.S.); (N.A.P.F.)
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Dionysia Dimitrakopoulou
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (X.M.); (R.t.C.); (H.M.R.); (L.d.L.); (D.D.); (L.J.A.S.); (N.A.P.F.)
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Lukas J. A. Stalpers
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (X.M.); (R.t.C.); (H.M.R.); (L.d.L.); (D.D.); (L.J.A.S.); (N.A.P.F.)
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Johannes Crezee
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - H. Petra Kok
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Nicolaas A. P. Franken
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (X.M.); (R.t.C.); (H.M.R.); (L.d.L.); (D.D.); (L.J.A.S.); (N.A.P.F.)
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
| | - Arlene L. Oei
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (X.M.); (R.t.C.); (H.M.R.); (L.d.L.); (D.D.); (L.J.A.S.); (N.A.P.F.)
- Department of Radiotherapy, Amsterdam University Medical Centers, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; (C.M.v.L.); (J.C.); (H.P.K.)
- Correspondence: ; Tel.: +31-205-663-641
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Spirou SV, Basini M, Lascialfari A, Sangregorio C, Innocenti C. Magnetic Hyperthermia and Radiation Therapy: Radiobiological Principles and Current Practice †. NANOMATERIALS 2018; 8:nano8060401. [PMID: 29865277 PMCID: PMC6027353 DOI: 10.3390/nano8060401] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 02/07/2023]
Abstract
Hyperthermia, though by itself generally non-curative for cancer, can significantly increase the efficacy of radiation therapy, as demonstrated by in vitro, in vivo, and clinical results. Its limited use in the clinic is mainly due to various practical implementation difficulties, the most important being how to adequately heat the tumor, especially deep-seated ones. In this work, we first review the effects of hyperthermia on tissue, the limitations of radiation therapy and the radiobiological rationale for combining the two treatment modalities. Subsequently, we review the theory and evidence for magnetic hyperthermia that is based on magnetic nanoparticles, its advantages compared with other methods of hyperthermia, and how it can be used to overcome the problems associated with traditional techniques of hyperthermia.
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Affiliation(s)
- Spiridon V Spirou
- Department of Radiology, Sismanoglio General Hospital of Attica, Sismanogliou 1, Marousi 15126, Greece.
| | - Martina Basini
- Università degli Studi di Milano, Dipartimento di Fisica, Via Celoria 16, 20133 Milano, Italy.
| | - Alessandro Lascialfari
- Università degli Studi di Milano, Dipartimento di Fisica, Via Celoria 16, 20133 Milano, Italy.
| | - Claudio Sangregorio
- ICCOM-CNR via Madonna del Piano 10, 50019 Sesto Fiorentino, Italy.
- INSTM and Dept. Of Chemistry "U. Schiff", University of Florence, via della Lastruccia 3, 50019 Sesto Fiorentino, Italy.
| | - Claudia Innocenti
- ICCOM-CNR via Madonna del Piano 10, 50019 Sesto Fiorentino, Italy.
- INSTM and Dept. Of Chemistry "U. Schiff", University of Florence, via della Lastruccia 3, 50019 Sesto Fiorentino, Italy.
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7
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Spirou SV, Costa Lima SA, Bouziotis P, Vranješ-Djurić S, Efthimiadou EΚ, Laurenzana A, Barbosa AI, Garcia-Alonso I, Jones C, Jankovic D, Gobbo OL. Recommendations for In Vitro and In Vivo Testing of Magnetic Nanoparticle Hyperthermia Combined with Radiation Therapy. NANOMATERIALS (BASEL, SWITZERLAND) 2018; 8:E306. [PMID: 29734795 PMCID: PMC5977320 DOI: 10.3390/nano8050306] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/22/2018] [Accepted: 04/29/2018] [Indexed: 12/23/2022]
Abstract
Magnetic nanoparticle (MNP)-mediated hyperthermia (MH) coupled with radiation therapy (RT) is a novel approach that has the potential to overcome various practical difficulties encountered in cancer treatment. In this work, we present recommendations for the in vitro and in vivo testing and application of the two treatment techniques. These recommendations were developed by the members of Working Group 3 of COST Action TD 1402: Multifunctional Nanoparticles for Magnetic Hyperthermia and Indirect Radiation Therapy ("Radiomag"). The purpose of the recommendations is not to provide definitive answers and directions but, rather, to outline those tests and considerations that a researcher must address in order to perform in vitro and in vivo studies. The recommendations are divided into 5 parts: (a) in vitro evaluation of MNPs; (b) in vitro evaluation of MNP-cell interactions; (c) in vivo evaluation of the MNPs; (d) MH combined with RT; and (e) pharmacokinetic studies of MNPs. Synthesis and characterization of the MNPs, as well as RT protocols, are beyond the scope of this work.
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Affiliation(s)
- Spiridon V Spirou
- Department of Radiology, Sismanoglio General Hospital of Attica, Sismanogliou 1, Marousi 15126, Athens, Greece.
| | - Sofia A Costa Lima
- LAQV, REQUIMTE, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, Porto 4050-313, Portugal.
| | - Penelope Bouziotis
- Institute of Nuclear & Radiological Sciences & Technology, Energy & Safety, National Center for Scientific Research "Demokritos", Aghia Paraskevi, Athens 15310, Greece.
| | - Sanja Vranješ-Djurić
- "Vinča" Institute of Nuclear Sciences, University of Belgrade, Belgrade 11351, Serbia.
| | - Eleni Κ Efthimiadou
- Inorganic Chemistry Laboratory, Chemistry Department, National and Kapodistrian University of Athens, Panepistimiopolis, Zografou 15784, Greece.
- Institute of Nanoscience and Nanotechnology, NCSR Demokritos, Agia Paraskevi Attikis, Athens 15310, Greece.
| | - Anna Laurenzana
- Department of Biomedical and Clinical Science "Mario Serio", University of Florence, 50134 Firenze, Italy.
| | - Ana Isabel Barbosa
- LAQV, REQUIMTE, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, Porto 4050-313, Portugal.
| | - Ignacio Garcia-Alonso
- Department of Surgery, Radiology & Ph.M. University of the Basque Country, Bilbao E48940, Spain.
| | - Carlton Jones
- NanoTherics Ltd., Studio 3, Unit 3, Silverdale Enterprise Centre Kents Lane, Newcastle under Lyme ST5 6SR, UK.
| | - Drina Jankovic
- "Vinča" Institute of Nuclear Sciences, University of Belgrade, Belgrade 11351, Serbia.
| | - Oliviero L Gobbo
- School of Pharmacy and Pharmaceutical Sciences, Panoz Institute, Trinity College Dublin, D02PN40 Dublin, Ireland.
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8
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Reirradiation + hyperthermia for recurrent breast cancer en cuirasse. Strahlenther Onkol 2017; 194:206-214. [PMID: 29264624 PMCID: PMC5847022 DOI: 10.1007/s00066-017-1241-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/19/2017] [Indexed: 11/03/2022]
Abstract
Background and purpose Patients with irresectable locoregional recurrent breast cancer en cuirasse (BCEC) do not have effective curative treatment options. Hyperthermia, the elevation of tumor temperature to 40–45 °C, is a well-established radio- and chemotherapy sensitizer. A total of 196 patients were treated with reirradiation and hyperthermia (reRT+HT) at two Dutch institutes from 1982–2005. The palliative effect was evaluated in terms of clinical outcome and toxicity. Patients and methods All patients received previous irradiation to a median dose of 50 Gy. In all, 75% of patients received 1–6 treatment modalities for previous tumor recurrences. ReRT consisted of 8 × 4 Gy given twice a week or 12 × 3 Gy given four times a week. Superficial hyperthermia was added once or twice a week. Tumor area comprised ≥½ of the ipsilateral chest wall. Results Overall clinical response rate was 72% (complete response [CR] 30%, partial response [PR] 42%, stable disease [SD] 22%, progressive disease [PD] 6%). The local progression-free rate at 1 year was 24%. Median survival was 6.9 months. Forty-three percent of our patients with CR, PR, SD after treatment remained infield progression-free until death or last follow-up. Acute ≥grade 3 toxicity occurred in 33% of patients, while late ≥grade 3 toxicity was recorded in 14% of patients. Tumor ulceration prior to treatment had a negative impact on both clinical outcome and toxicity. Conclusion ReRT+HT provides sustainable palliative tumor control, despite refractory, extensive tumor growth. Compared to currently available systemic treatment options, reRT+HT is more effective with less toxicity. Electronic supplementary material The online version of this article (10.1007/s00066-017-1241-7) contains supplementary material, which is available to authorized users.
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9
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Oldenborg S, Griesdoorn V, van Os R, Kusumanto YH, Oei BS, Venselaar JL, Zum Vörde Sive Vörding PJ, Heymans MW, Kolff MW, Rasch CRN, Crezee H, van Tienhoven G. Reirradiation and hyperthermia for irresectable locoregional recurrent breast cancer in previously irradiated area: Size matters. Radiother Oncol 2015; 117:223-8. [PMID: 26542015 DOI: 10.1016/j.radonc.2015.10.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 10/17/2015] [Accepted: 10/17/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND/PURPOSE Treatment options for irresectable locoregional recurrent breast cancer in previously irradiated area are limited. Hyperthermia, elevating tumor temperature to 40-45°C, sensitizes radio-and-chemotherapy. Four hundred and fourteen patients treated with reirradiation+hyperthermia (reRT+HT) in the AMC(n=301) and the BVI(n=113), from 1982 to 2005 were retrospectively analyzed for treatment response, locoregional control (LC) and prognostic factors for LC and toxicity. PATIENTS/METHODS All patients received previous irradiation (median 50 Gy). reRT consisted of 8 × 4 Gy-2/week (AMC) or 12 × 3 Gy-4/week (BVI). Hyperthermia was added once (AMC)/twice (BVI) a week. RESULTS Overall clinical response rate was 86%. The 3-year LC rate was 25%. The number of recurrence episodes, distant metastases (DM), tumor site, tumor size, time to recurrence and treatment year were significant for LC. Acute ⩾ grade 3 toxicity occurred in 24% of patients. Actuarial late ⩾ grade 3 toxicity was 23% at 3-years. In multivariable analysis reRT fraction dose was significantly related to late ⩾ grade 3 toxicity. CONCLUSION reRT+HT is an effective curative and palliative treatment option for patients with irresectable locoregional recurrent breast cancer in previously irradiated area. Early referral, treatment of chest wall recurrences ⩽ 5 cm in the absence of distant metastases, provided the highest local control rates. The cumulative effects of past and present treatments should be accounted for by adjusting treatment protocol to minimize toxicity.
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Affiliation(s)
- Sabine Oldenborg
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands.
| | - Vanessa Griesdoorn
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands
| | - Rob van Os
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands
| | - Yoka H Kusumanto
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands
| | - Bing S Oei
- Department of Radiation Oncology, Institute Verbeeten (BVI), Tilburg, The Netherlands
| | - Jack L Venselaar
- Department of Radiation Oncology, Institute Verbeeten (BVI), Tilburg, The Netherlands
| | | | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Merel Willemijn Kolff
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands
| | - Coen R N Rasch
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands
| | - Hans Crezee
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands
| | - Geertjan van Tienhoven
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands
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10
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Amaya C, Kurisetty V, Stiles J, Nyakeriga AM, Arumugam A, Lakshmanaswamy R, Botez CE, Mitchell DC, Bryan BA. A genomics approach to identify susceptibilities of breast cancer cells to "fever-range" hyperthermia. BMC Cancer 2014; 14:81. [PMID: 24511912 PMCID: PMC3931319 DOI: 10.1186/1471-2407-14-81] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 01/22/2014] [Indexed: 12/22/2022] Open
Abstract
Background Preclinical and clinical studies have shown for decades that tumor cells demonstrate significantly enhanced sensitivity to “fever range” hyperthermia (increasing the intratumoral temperature to 42-45°C) than normal cells, although it is unknown why cancer cells exhibit this distinctive susceptibility. Methods To address this issue, mammary epithelial cells and three malignant breast cancer lines were subjected to hyperthermic shock and microarray, bioinformatics, and network analysis of the global transcription changes was subsequently performed. Results Bioinformatics analysis differentiated the gene expression patterns that distinguish the heat shock response of normal cells from malignant breast cancer cells, revealing that the gene expression profiles of mammary epithelial cells are completely distinct from malignant breast cancer lines following this treatment. Using gene network analysis, we identified altered expression of transcripts involved in mitotic regulators, histones, and non-protein coding RNAs as the significant processes that differed between the hyperthermic response of mammary epithelial cells and breast cancer cells. We confirmed our data via qPCR and flow cytometric analysis to demonstrate that hyperthermia specifically disrupts the expression of key mitotic regulators and G2/M phase progression in the breast cancer cells. Conclusion These data have identified molecular mechanisms by which breast cancer lines may exhibit enhanced susceptibility to hyperthermic shock.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Brad A Bryan
- Department of Biomedical Sciences, Paul L, Foster School of Medicine, Texas Tech University Health Sciences Center, 5001 El Paso Drive, MSB1 Room 2111, El Paso, Texas 79905, USA.
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11
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Vaupel PW, Kelleher DK. Blood flow and associated pathophysiology of uterine cervix cancers: Characterisation and relevance for localised hyperthermia. Int J Hyperthermia 2012; 28:518-27. [DOI: 10.3109/02656736.2012.699134] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Vaupel PW, Kelleher DK. Pathophysiological and vascular characteristics of tumours and their importance for hyperthermia: heterogeneity is the key issue. Int J Hyperthermia 2010; 26:211-23. [PMID: 20345270 DOI: 10.3109/02656731003596259] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Tumour blood flow before and during clinically relevant mild hyperthermia exhibits pronounced heterogeneity. Flow changes upon heating are not predictable and are both spatially and temporally highly variable. Flow increases may result in improved heat dissipation to the extent that therapeutically relevant tissue temperatures may not be achieved. This holds especially true for tumours or tumour regions in which flow rates are substantially higher than in the surrounding normal tissues. Changes in tumour oxygenation tend to reflect alterations in blood flow upon hyperthermia. An initial improvement in the oxygenation status, followed by a return to baseline levels (or even a drop to below baseline at high thermal doses) has been reported for some tumours, whereas a predictable and universal occurrence of sustained increases in O(2) tensions upon mild hyperthermia is questionable and still needs to be verified in the clinical setting. Clarification of the pathogenetic mechanisms behind possible sustained increases is mandatory. High-dose hyperthermia leads to a decrease in the extracellular and intracellular pH and a deterioration of the energy status, both of which are known to be parameters capable of acting as direct sensitisers and thus pivotal factors in hyperthermia treatment. The role of the tumour microcirculatory function, hypoxia, acidosis and energy status is complex and is further complicated by a pronounced heterogeneity. These latter aspects require additional critical evaluation in clinically relevant tumour models in order for their impact on the response to heat to be clarified.
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Affiliation(s)
- Peter W Vaupel
- Department of Radiotherapy and Radiooncology, Klinikum rechts der Isar, Technical University, Munich, Germany
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Xu Y, Choi J, Hylander B, Sen A, Evans SS, Kraybill WG, Repasky EA. Fever-range whole body hyperthermia increases the number of perfused tumor blood vessels and therapeutic efficacy of liposomally encapsulated doxorubicin. Int J Hyperthermia 2008; 23:513-27. [PMID: 17952765 DOI: 10.1080/02656730701666112] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Two major questions were addressed: (1) Can fever-range whole body hyperthermia (FR-WBH) affect the number of perfused tumor blood vessels? (2) Can pre-treatment with FR-WBH improve accumulation or anti-tumor efficacy of doxorubicin or DOXIL (liposomal doxorubicin)? MATERIALS AND METHODS Perfused blood vessels were visualized by intravenous injection of the fluorescent dye (DiOC7(3)) and the number of labeled vessels in tumors and normal organs of unheated mice and those previously heated to 39.5 degrees C for 6 hours were compared. Using three animal tumor models (one syngeneic murine model and two human tumor xenografts in SCID mice) we also compared tumor growth and amount of intratumoral doxorubicin (given as free drug or as DOXIL) in control mice or those given pre-treatment with FR-WBH. RESULTS FR-WBH had no effect on the number of CD-31 labeled blood vessels. However, in tumors, but not in normal organs of the same animals, FR-WBH resulted in a significant increase in those blood vessels which could take up dye over a prolonged period of time after heating. There was also an increase in DOXIL uptake in the tumors of mice given FR-WBH prior to drug injection as well as enhanced therapeutic efficacy in all three tumor models. CONCLUSIONS FR-WBH increases the number of perfused blood vessels in tumors over a prolonged period following FR-WBH and thus may be useful for improving tumor targeting of cancer therapeutics. We discuss these data in relation to long-conserved thermoregulatory features in normal vasculature, which may be deficient in tumor vasculature.
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Affiliation(s)
- Yan Xu
- Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
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Jones E, Thrall D, Dewhirst MW, Vujaskovic Z. Prospective thermal dosimetry: the key to hyperthermia's future. Int J Hyperthermia 2006; 22:247-53. [PMID: 16754346 DOI: 10.1080/02656730600765072] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
PURPOSE This review summarizes recent results from two randomized trials testing the complete response rate and local control benefits for the addition of hyperthermia to external beam radiation. METHODS In both series, there was a statistically significant benefit to adjuvant hyperthermia. RESULTS The establishment of a standardized nomenclature for clinical hyperthermia prescription will help to facilitate the broader usage of hyperthermia. CONCLUSIONS Carefully conducted phase III trials with rigorous quality assurance must employ prospective thermal dosimetry to validate the role of hyperthermia in multi-modality therapy.
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Affiliation(s)
- Ellen Jones
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.
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15
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Milani V, Noessner E. Effects of thermal stress on tumor antigenicity and recognition by immune effector cells. Cancer Immunol Immunother 2006; 55:312-9. [PMID: 16151807 PMCID: PMC11030255 DOI: 10.1007/s00262-005-0052-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Accepted: 06/21/2005] [Indexed: 12/26/2022]
Abstract
The primary rationale for the application of clinical hyperthermia in the therapy of cancer is based on the direct cytotoxic effect of heat and the radio-chemosensitization of tumor cells. More recently, additional attention is given to the observation that heat and heat-shock proteins can activate the host's immune system. The expression of heat-shock genes and proteins provides an adaptive mechanism for stress tolerance, allowing cells to survive non-physiologic conditions. However, the same adaptive mechanism can ultimately favor malignant transformation by interfering with pathways that regulate cell growth and apoptosis. Cytoprotection and thermotolerance raised the concern that heat-treated tumor cells might also be resistant to attack by immune effector mechanisms. Many studies, including those from our group, address this concern and document that heat-exposure, although transiently modulating sensitivity to CTL, do not hinder CTL attack. Moreover, there are promising reports of heat-related upregulation of NK-activating ligands, rendering those tumors which have lost MHC class I molecules target for NK cell attack. Heat-induced cytoprotection, therefore, does not necessarily extend protection from cytotoxic immune mechanisms. When interpreting the effects of heat, it is important to keep in mind that thermal effects on cell physiology are strongly dependent on the thermal dose, which is a function of the magnitude of change in temperature and the duration of heat exposure. The thermal dose required to induce cell death in vitro strongly varies from cell type to cell type and depends on microenvironmental factors (Dewey 1994). Therefore, to dissect the immunological behaviour of a given tumor and its micro-environment at different thermal doses, it is essential to characterize the thermosensitivity of every single tumor type and assess the proportion of cells surviving a given heat treatment. In this review, we summarize the pleiotropic effects that heat exposure has on tumor cells. In particular, we focus on the effects of heat on the antigen presentation of tumor cells and their susceptibility to immune effector mechanisms. We emphasize that the response to thermal stress is not a one-time point event, but rather a time period starting with the heat exposure and extending over several days of recovery. In addition, the response of tumor cells and their susceptibility to immune effector cells is strongly dependent on the model system, on the magnitude and duration of the thermal stress and on the time of recovery after heat exposure. Consideration of these aspects might help to explain some of the conflicting results that are reported in the field of thermal stress response.
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Affiliation(s)
- Valeria Milani
- Clinical Cooperation Group on Hyperthermia, Internal Medicine Department III, Klinikum Grosshadern, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
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16
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Thomas CT, Ammar A, Farrell JJ, Elsaleh H. Radiation Modifiers: Treatment Overview and Future Investigations. Hematol Oncol Clin North Am 2006; 20:119-39. [PMID: 16580560 DOI: 10.1016/j.hoc.2006.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Many radiosensitizers are in current clinical use. In addition, a myriad of potential new targeted therapies, which may also interact with radiation, are in clinical development. The clinical utility of new targeted therapies, in combination with existing radiation sensitizers (chemotherapies) requires further evaluation, as does the understanding of their acute and late radiation effects. Free radical scavengers appear to show promise as radioprotectors, but data for mucoprotection are less convincing.
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Affiliation(s)
- C T Thomas
- Department of Radiation Oncology, David Geffen School of Medicine at University of California Los Angeles, 200 Medical Plaza, Suite B265, Los Angeles, CA 90095, USA
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17
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Jones EL, Oleson JR, Prosnitz LR, Samulski TV, Vujaskovic Z, Yu D, Sanders LL, Dewhirst MW. Randomized trial of hyperthermia and radiation for superficial tumors. J Clin Oncol 2005; 23:3079-85. [PMID: 15860867 DOI: 10.1200/jco.2005.05.520] [Citation(s) in RCA: 430] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Randomized clinical trials have demonstrated hyperthermia (HT) enhances radiation response. These trials, however, generally lacked rigorous thermal dose prescription and administration. We report the final results of a prospective randomized trial of superficial tumors (</= 3 cm depth) comparing radiotherapy versus HT combined with radiotherapy, using the parameter describing the number of cumulative equivalent minutes at 43 degrees C exceeded by 90% of monitored points within the tumor (CEM 43 degrees C T(90)) as a measure of thermal dose. METHODS This trial was designed to test whether a thermal dose of more than 10 CEM 43 degrees C T(90) results in improved complete response and duration of local control compared with a thermal dose of </= 1 CEM 43 degrees C T(90). Patients received a test dose of HT </= 1 CEM 43 degrees C T(90) and tumors deemed heatable were randomly assigned to additional HT versus no additional HT. HT was given using microwave spiral strip applicators operating at 433 MHz. RESULTS One hundred twenty-two patients were enrolled; 109 (89%) were deemed heatable and were randomly assigned. The complete response rate was 66.1% in the HT arm and 42.3% in the no-HT arm. The odds ratio for complete response was 2.7 (95% CI, 1.2 to 5.8; P = .02). Previously irradiated patients had the greatest incremental gain in complete response: 23.5% in the no-HT arm versus 68.2% in the HT arm. No overall survival benefit was seen. CONCLUSION Adjuvant hyperthermia with a thermal dose more than 10 CEM 43 degrees C T(90) confers a significant local control benefit in patients with superficial tumors receiving radiation therapy.
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Affiliation(s)
- Ellen L Jones
- Radiation Oncology, Duke University Medical Center, DUMC Box 3085, Durham, NC 27710, USA.
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18
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Pelz J, Mollwitz M, Stremmel C, Goehl J, Dimmler A, Hohenberger W, Meyer T. The impact of surgery and mild hyperthermia on tumor response and angioneogenesis of malignant melanoma in a rat perfusion model. BMC Cancer 2004; 4:53. [PMID: 15324457 PMCID: PMC516035 DOI: 10.1186/1471-2407-4-53] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Accepted: 08/23/2004] [Indexed: 11/14/2022] Open
Abstract
Background The aim of this experimental study was to determine the effect of mild hyperthermia on tumor response and angioneogenesis in an isolated limb perfusion model with a human melanoma xenograft. Methods A human melanoma xenograft was implanted into the hindlimbs of 30 athymic nude rats. The animals were randomized into five groups: group I: control, group II: sham group, group III: external hyperthermia with a tissue temperature of 41.5°C for 30 minutes without ILP, group IV: normothermic ILP (tissue temperature 37°C for 30 minutes, group V: hyperthermic ILP (tissue temperature 41.5°C for 30 minutes). Tumor response was evaluated by tumor size determination and immunohistochemical analysis 6 weeks postoperatively. Tissue sections were investigated for expression of CD34 and basic fibroblast growth factor (bFGF). Results Average tumor volumes of the controls (I) increased from 105 mm3 to 1388 mm3. In the sham operated group (II) tumor volumes were significantly larger than in group I. Tumor volumes in group IV were significantly smaller than in group I and lowest in group V. There were no significant differences in size between group I and group III after six weeks. In group III and IV each, 5 animals showed tumor progression and one had a partial tumor response. In group V only 2 animals showed tumor progression. Immunhistochemical analysis of the tissue sections demonstrated that angioneogenesis was more pronounced in group II than in group I and less pronounced in group IV and V compared with group I. Conclusions Our results suggest that even a surgical manipulation such as a skin incision promotes tumor growth, probably by induction of growth factors like bFGF. External hyperthermia of 41.5°C tissue temperature for 30 minutes only has no impact on tumor growth and angioneogenesis in vivo.
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Affiliation(s)
- Joerg Pelz
- Department of Surgery, University of Erlangen-Nuremberg, Germany
| | - Marco Mollwitz
- Department of Surgery, University of Erlangen-Nuremberg, Germany
| | | | - Jonas Goehl
- Department of Surgery, University of Erlangen-Nuremberg, Germany
| | - Arno Dimmler
- Institute of Pathology, University of Erlangen-Nuremberg, Germany
| | | | - Thomas Meyer
- Department of Surgery, University of Erlangen-Nuremberg, Germany
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Lau WY, Leung TWT, Yu SCH, Ho SKW. Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg 2003. [PMID: 12560774 DOI: 10.1097/00000658-200302000-00005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To review and compare treatment result for percutaneous local ablative therapy (PLAT) with surgical resection in the treatment of small hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA PLAT is indicated for small unresectable HCC localized to the liver. From the use of ethanol to the latest technology of radiofrequency ablation, ablative techniques have been refined and their role in the management of HCC established. This review aims to give an overview of various ablative methods, including their efficacy, indications, and limitations, and also tries to look into the future of clinical trials in PLAT. METHODS The authors reviewed recent papers in the English medical literature about the use of local ablative therapy for HCC. Focus was given to the results of treatment in terms of local control, progression-free survival, and overall survival, and to compare treatment results with those of surgery. RESULTS PLAT for small HCC (<5 cm) with thermal ablation (radiofrequency ablation or microwave coagulation) can achieve effective local control of disease and is superior to ethanol injection. Progressive disease in untreated areas is a common reason for failure. Overall progression-free survival is similar to that of surgical resection. CONCLUSIONS Thermal ablation gives good local control of small HCC, is superior to ethanol, and may be comparable to surgical resection in long-term outcome.
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Affiliation(s)
- W Y Lau
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
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20
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Lau WY, Leung TWT, Yu SCH, Ho SKW. Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg 2003; 237:171-9. [PMID: 12560774 PMCID: PMC1522146 DOI: 10.1097/01.sla.0000048443.71734.bf] [Citation(s) in RCA: 187] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review and compare treatment result for percutaneous local ablative therapy (PLAT) with surgical resection in the treatment of small hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA PLAT is indicated for small unresectable HCC localized to the liver. From the use of ethanol to the latest technology of radiofrequency ablation, ablative techniques have been refined and their role in the management of HCC established. This review aims to give an overview of various ablative methods, including their efficacy, indications, and limitations, and also tries to look into the future of clinical trials in PLAT. METHODS The authors reviewed recent papers in the English medical literature about the use of local ablative therapy for HCC. Focus was given to the results of treatment in terms of local control, progression-free survival, and overall survival, and to compare treatment results with those of surgery. RESULTS PLAT for small HCC (<5 cm) with thermal ablation (radiofrequency ablation or microwave coagulation) can achieve effective local control of disease and is superior to ethanol injection. Progressive disease in untreated areas is a common reason for failure. Overall progression-free survival is similar to that of surgical resection. CONCLUSIONS Thermal ablation gives good local control of small HCC, is superior to ethanol, and may be comparable to surgical resection in long-term outcome.
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Affiliation(s)
- W Y Lau
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
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21
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Jayasundar R, Honess D, Hall LD, Bleehen NM. Simultaneous evaluation of the effects of RF hyperthermia on the intra- and extracellular tumor pH. Magn Reson Med 2000; 43:1-8. [PMID: 10642725 DOI: 10.1002/(sici)1522-2594(200001)43:1<1::aid-mrm1>3.0.co;2-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
31P-magnetic resonance spectroscopy (MRS) and a fiberoptic pH meter were used simultaneously to follow the changes in intra- (pHi) and extracellular pH (pHe), respectively, of murine RIF-1 tumors with hyperthermia. Hyperthermia was induced at 34 MHz using the same coil used for MR. The study was carried out until 3.5 hr after hyperthermia. In untreated tumors (n = 29), pHi was always higher than pHe. pHi was reduced after hyperthermia (30 min) at both 42 degrees C and 45 degrees C. pHe registered an increase after 42 degrees C and a decrease after 45 degrees C. The reduction in pHi was larger than the initial differential between pHi and pHe, and the change in pHe was relatively small. Hyperthermia changed the acidity of the intra- and extracellular compartments, such that pHe became more alkaline than pHi by 0.15 +/- 0.13 units after 42 degrees C [pHe (7.20 +/- 0.12) and pHi (7.03 +/- 0.05)], and by 0.12 +/- 0.14 units after 45 degrees C [pHe (6.84 +/- 0.24) and pHi (6.72 +/- 0.19)]. Simultaneous measurements of pH from the intra- and extracellular compartments demonstrated reversal in the pH gradient after hyperthermic treatment.
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Affiliation(s)
- R Jayasundar
- Clinical Oncology and Radiotherapeutics Unit, Medical Research Council, Cambridge, UK.
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22
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Abstract
The application of 31P MR spectroscopy in the characterization and treatment of malignant human extremity tumors is reviewed and placed in the perspective of results obtained in murine sarcomas. Despite the now widespread acquisition of gradient localized spectral maps, the low spatial resolution that can be achieved at 1.5 or 2 T with 31P MRS, greatly limits its use in the study of tumor heterogeneity. The potential of 31P MRS is in the evaluation and monitoring of large inoperable extremity tumors. There are early spectral changes in human extremity sarcomas monitored after therapy, and recent studies have shown that the 31P MR spectra measured before treatment, and the changes in phosphate metabolites measured shortly thereafter, correlate with the clinical response after 2 or 3 months. Larger clinical studies are needed to confirm whether correlations of, for instance, pretreatment tumor pH with necrosis at resection and Pi decrease with tumor regression, can be used as a predictive test for clinical response.
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Affiliation(s)
- P E Sijens
- Department of Radiology, Dr Daniel den Hoed Cancer Center, University Hospital Rotterdam, The Netherlands.
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Street JC, Szwergold BS, Matei C, Kappler F, Mahmood U, Brown TR, Koutcher JA. Study of the metabolism of choline and phosphatidylcholine in tumors in vivo using phosphonium-choline. Magn Reson Med 1997; 38:769-75. [PMID: 9358451 DOI: 10.1002/mrm.1910380513] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The results of an initial study on the feasibility of using the phosphonium analog of choline to follow the metabolism of phosphatidylcholine in tumors in vivo using 31P NMR are reported. C3H/He mice bearing a mammary carcinoma tumor on the foot pad were fed a choline-free diet supplemented with the phosphonium analog of choline. Metabolites of this compound, including the phosphonium analogs of phosphatidylcholine, phosphocholine, glycerophosphocholine, and betaine were observed noninvasively in vivo in tumors by 31P NMR after 2-3 weeks of feeding. Clearance of these phosphonium-labeled metabolites from tumors was measured after a change to a choline-containing diet. Significant decreases were seen in the levels of the analogs of betaine (P < 0.003) and phosphatidylcholine (P < 0.004) by Day 4. A significant increase in the level of authentic phosphocholine (P < 0.003) occurred over the same time period.
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Affiliation(s)
- J C Street
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Street JC, Alfieri AA, Traganos F, Koutcher JA. In vivo and ex vivo study of metabolic and cellular effects of 5-fluorouracil chemotherapy in a mouse mammary carcinoma. Magn Reson Imaging 1997; 15:587-96. [PMID: 9254003 DOI: 10.1016/s0730-725x(97)00013-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The effect of 5-fluorouracil (5FU) on the 31P nuclear magnetic resonance (NMR) profile of a mouse mammary carcinoma, implanted on the foot of CH3/He mice, was studied both in vivo and in perchloric acid extracts. In vivo, significant increases in the ratios, nucleotide triphosphate:inorganic phosphate (Pi) (p < 0.02) and phosphocreatine:Pi (p < 0.005), were observed 48 h after 5FU, relative to control. Two readily resolvable peaks were observed in the phosphomonoester region of the in vivo NMR spectrum, phosphocholine (PC) and a peak (denoted PME') comprised of mainly phosphoethanolamine (PE). PME':PC was significantly elevated relative to control from 24 h to 168 h (p < 0.0001 at 48 h). Perchloric acid extract data indicate that the change in this ratio was due to an increase in the PE concentration rather than a decrease in PC. PE increased from 0.56 +/- 0.11 micromol/g tissue in controls to 0.95 +/- 0.29 micromol/g tissue 48 h after 5FU (p < 0.006). Perchloric acid extracts also revealed a significant increase in phosphodiesters. Glycerophosphocholine increased from 0.82 +/- 0.24 micromol/g tissue in controls to 1.82 +/- 0.61 micromol/g tissue in 5FU treated tumors after 48 h (p < 0.002), and glycerophosphoethanolamine increased from 0.25 +/- 0.06 micromol/g tissue in controls to 0.36 +/- 0.10 micromol/g tissue in treated tumors (p < 0.004). These changes suggest that ethanolamine and choline containing metabolites in this tumor may be metabolized via different pathways. Cell cycle analysis showed only relatively small changes in cell cycle distribution and apoptotic fraction following 5FU.
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Affiliation(s)
- J C Street
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Hentschel M, Mirtsch S, Jordan A, Wust P, Vogl T, Semmler W, Wolf KJ, Felix R. Heat response of HT29 cells depends strongly on perfusion--a 31P NMR spectroscopy, HPLC and cell survival analysis. Int J Hyperthermia 1997; 13:69-82. [PMID: 9024928 DOI: 10.3109/02656739709056431] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A model system of perfused human colon adenocarcinoma cells (HT29) encapsulated in alginate was used to examine metabolic response to heat therapy with 31P NMR spectroscopy, HPLC and cell survival analysis. The presented data show, that perfused (medium flow during hyperthermia) and non-perfused (no medium flow during hyperthermia) cells are very difficult in their sensitivity to hyperthermia. Under equivalent experimental conditions with respect to medium pH, oxygen and nutrient concentration, encapsulated perfused HT 29 cells display a significantly lower thermal sensitivity than non-perfused cells. This reduced sensitivity of perfused cells is characterized by an increased cell survival and relative ATP concentration, and reduced drop of the NTP/Pi ratio in the long-term follow up towards zero. The relative ATP concentration determined by HPLC after hyperthermia is correlated with the clonogenic survival fraction. There is a direct relationship, depending on the specific experimental conditions (perfused, non-perfused). For perfused cells only a slight dependency of survival and relative ATP concentration on heat dose is observed. In consequence, the correlation between survival and relative ATP concentration is weak, described by log(SFperf) = 0.7*[ATP-12.4, R2 = 0.79, p < 0.04. For non-perfused cells the correlation is stronger resulting in a relationship of log(SFno perf) = 0.6*[ATP]-9.0, R2 = 0.98, p < 0.0002. Altogether, the presented data suggest that the relative ATP concentration measured by HPLC after hyperthermia might be predictive for cell survival. On the other hand, a dependence between cell survival and long-term changes of NTP/Pi has been found. The results confirm the importance of tumour perfusion for hyperthermia-induced metabolic changes and cytotoxicity and therefore, for the therapeutic outcome.
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Affiliation(s)
- M Hentschel
- Department of Radiation Oncology, Virchow Clinic, Humboldt University at Berlin, Germany
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Busse M, Vaupel P. Accumulation of purine catabolites in solid tumors exposed to therapeutic hyperthermia. EXPERIENTIA 1996; 52:469-73. [PMID: 8641385 DOI: 10.1007/bf01919318] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Intensified adenosine triphosphate (ATP) degradation following therapeutic hyperthermia is often observed in solid tumors. As a result, accumulation of purine catabolites can be expected together with formation of protons at several stages during degradation to the final product, uric acid. Proton formation in turn can contribute to the development of heat-induced acidosis. Furthermore, oxidation of hypoxanthine and xanthine may result in generation of reactive oxygen species, which may lead to DNA damage, lipid peroxidation and protein denaturation, thus also contributing to heat-induced cytotoxicity. In hyperthermia experiments a tumor-size-dependent, significant increase in the levels of the following catabolites has been demonstrated: [symbol: see text] [IMP + GMP] (sum of guanosine and inosine monophosphate levels), inosine, hypoxanthine, xanthine and uric acid, along with a drop in ATP and guanosine triphosphate (GTP) levels. These data suggest that formation of reactive oxygen species and protons during purine degradation may indeed play a significant role in the antitumor effect of hyperthermia.
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Affiliation(s)
- M Busse
- Institute of Physiology and Pathophysiology, University of Mainz, Germany
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27
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Street JC, Mahmood U, Matei C, Koutcher JA. In vivo and in vitro studies of cyclophosphamide chemotherapy in a mouse mammary carcinoma by 31P NMR spectroscopy. NMR IN BIOMEDICINE 1995; 8:149-158. [PMID: 8771089 DOI: 10.1002/nbm.1940080403] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The effect of cyclophosphamide on the metabolic profile of a mammary carcinoma implanted on the foot of mouse was studied by 31P NMR spectroscopy both in vivo and in perchloric acid extracts. The ratio nucleotide triphosphate:P(i) was significantly elevated in cyclophosphamide treated tumours relative to untreated tumours after 96 h in vivo (p < 0.05). Phosphocreatine:P(i) was similarly elevated from 48 to 168 h (p < 0.01). Resolution of the phosphomonoester peak into two distinct resonances allowed us to estimate the ratio of PME' to phosphocholine (PC), where PME' is a composite peak consisting, in part, of phosphoethanolamine (PE). PME':PC was found to be significantly higher in treated animals relative to control animals in vivo (p < 0.01 from 48 to 168 h). Perchloric acid extract spectra suggest that the increase in PME':PC was in part due to a decrease in PC concentration and also due to an increase in a previously unidentified resonance which was coresonant with PE. Extract data show that there was a significant increase in the concentration of the phosphodiesters, glycerophosphocholine (p < 0.01) and glycerophosphoethanolamine (p < 0.05) in treated relative to control tumours. The changes in the phosphomonoester resonances are qualitatively similar to previously described changes following radiation and suggest that they may be a marker of cell kill or lack of cell growth after antineoplastic therapy.
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Affiliation(s)
- J C Street
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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28
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Castrén-Persons M. Laserthermia kills acidotic cancer cells more effectively than conventional hyperthermia. Lasers Med Sci 1995. [DOI: 10.1007/bf02133161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gerweck LE, Koutcher J, Zaidi ST. Energy status parameters, hypoxia fraction and radiocurability across tumor types. Acta Oncol 1995; 34:335-8. [PMID: 7779419 DOI: 10.3109/02841869509093985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Under full nutrient in vitro conditions, the cellular adenylate energy charge of six different rodent and human tumor cell types was identical, i.e., 0.94 +/- 0.01, suggesting the potential utility of this parameter as a cell (and tissue) independent marker of nutrient deprivation and hypoxia, across tumor types. The adenylate energy charge values of tumors, arising from these cells, was reduced and variable ranging from 0.72 to 0.91 for the various tumor types. However, neither the tumor adenylate energy charge, NTP/Pi, nor PCr/Pi ratios correlated with the radiobiologic hypoxic cell fractions across tumor types. The reduced adenylate energy charge in vivo suggests varying degrees of nutrient deprivation in the different tumor types, however, factors other than or in addition to hypoxia likely contribute to tumor energy status.
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MESH Headings
- Adenine Nucleotides/metabolism
- Animals
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/radiotherapy
- Cell Hypoxia
- Cell Line
- Cell Survival/radiation effects
- Energy Metabolism
- Female
- Glioma/metabolism
- Glioma/radiotherapy
- Humans
- Male
- Mammary Neoplasms, Experimental/metabolism
- Mammary Neoplasms, Experimental/radiotherapy
- Mice
- Mice, Inbred C3H
- Mice, Nude
- Neoplasms/metabolism
- Neoplasms/radiotherapy
- Neoplasms, Experimental/metabolism
- Neoplasms, Experimental/radiotherapy
- Pharyngeal Neoplasms/metabolism
- Pharyngeal Neoplasms/radiotherapy
- Phosphates/metabolism
- Phosphocreatine/metabolism
- Ribonucleotides/metabolism
- Sarcoma, Experimental/metabolism
- Sarcoma, Experimental/radiotherapy
- Transplantation, Heterologous
- Tumor Cells, Cultured
- Whole-Body Irradiation
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Affiliation(s)
- L E Gerweck
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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31
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Kurhanewicz J, Char DH, Stauffer P, Quivey JM, James TL. 31P magnetic resonance spectroscopy after combined hyperthermia and radiation. Curr Eye Res 1994; 13:151-6. [PMID: 8194362 DOI: 10.3109/02713689409042410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Mechanisms of uveal melanoma response to therapy are poorly understood. There are a paucity of changes that have been detected immediately after tumor treatment to differentiate successful from ineffective therapy. In this study we used in vivo 31P magnetic resonance spectroscopy (MRS) to assess intra-tumor treatment alterations. The metabolic consequences of effective and ineffective levels of solitary hyperthermia and combined hyperthermia-radiation were investigated. We have previously noted a characteristic 31P MRS pattern with successful hyperthermia in this intraocular melanoma model. The metabolic response after effective or ineffective combined radiation/hyperthermia therapy was indistinguishable from solitary radiation therapy and opposite to that with successful hyperthermia therapy. In contrast to solitary hyperthermia therapy, early changes in 31P spectral ratios following radiation or combined hyperthermia/radiation therapy of uveal melanoma were not predictive of treatment response. Twenty-four to 48 hours after effective or ineffective radiation or combined treatment the Pi/beta-NTP ratio decreased significantly (delta Pi/beta-NTP = -0.433 +/- 0.08 and -0.478 +/- .13 and .10 +/- 0.2, respectively). There was over a 2.0 thermal enhancement of radiation with heat. The increased tumor cell death after combined therapy was reflected by a two-fold larger decrease in beta-NTP signal-to-noise (S/N).
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Affiliation(s)
- J Kurhanewicz
- Department of Ophthalmology, University of California, San Francisco
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Mueller-Klieser W, Walenta S. Geographical mapping of metabolites in biological tissue with quantitative bioluminescence and single photon imaging. THE HISTOCHEMICAL JOURNAL 1993; 25:407-20. [PMID: 7689547 DOI: 10.1007/bf00157805] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This article features a novel technique for measuring the spatial distribution of metabolites, such as ATP, glucose, and lactate, in rapidly frozen tissue. Concentration values are obtained in absolute terms and with a spatial resolution of single-cell dimension. The method is based on enzymatic reactions that link the metabolite of interest to luciferase with subsequent light emission. Using a specific array, cryosections are brought into contact with the enzymes in a well-defined, reproducible way inducing a distribution of light across the section with an intensity that is proportional to the metabolite concentration. The emitted light can be visualized through a microscope and an imaging photon counting system, and the respective image can be transferred to a computer for image analysis. Measurements in spherical cell aggregates with central necrosis demonstrate a close correlation between the distribution of ATP and of cellular viability at a microregional level. Similarly, ATP and glucose are correlated with the geometrical arrangement of more viable and more necrotic tissue regions in human melanomas xenografted in nude mice. Lactate did not show such a structure-related distribution in these tumours. Structure-related distributions of ATP, glucose, and lactate are found in cervix tumours of patients. In contrast to the heterogeneous distributions in tumours, the distribution patterns were much more homogeneous in normal tissues. Regional differences were present, but were much more gradual than in malignancies. This was illustrated for heart muscle where ATP concentrations were found that agreed with data in the literature, and that showed a decrease in periventricular areas.
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Affiliation(s)
- W Mueller-Klieser
- Institute of Physiology & Pathophysiology, University of Mainz, Germany
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Hahn EW, Peschke P, Mason RP, Babcock EE, Antich PP. Isolated tumor growth in a surgically formed skin pedicle in the rat: a new tumor model for NMR studies. Magn Reson Imaging 1993; 11:1007-17. [PMID: 8231664 DOI: 10.1016/0730-725x(93)90219-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We have developed a new tumor model, the skin flap pedicle, which is ideally suited for study by such techniques as magnetic resonance imaging (MRI) and spectroscopy (MRS) and positron emission tomography (PET) to evaluate changes in metabolism/physiology in tumors before and after treatment. Heretofore, results from such studies were generally obtained from tumors growing in the thigh or flank region and these sites of growth often compromised the quality of the results, because of the contribution of normal tissues such as muscle and bone. In an attempt to circumvent such problems, we developed a surgical technique for creating a tubular skin pedicle and subsequently transplanting tumors in the lumen of such pedicles. We have successfully grown Dunning Prostate tumors (R-3327) as PEDICLE-TUMORS (PED-TUM). This paper describes the surgical procedure for formation of the skin pedicle, implantation of the tumor, data on the growth and histology and discusses the application of the PED-TUM to research problems. We compare the NMR characteristics of the tumor grown in the traditional SC thigh position with that growth in the pedicle and demonstrate the utility and advantages of the new model for studies of tumor physiological function and structure.
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Affiliation(s)
- E W Hahn
- Department of Radiology, German Cancer Research Center, Heidelberg
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Gerweck LE, Koutcher JA, Zaidi ST, Seneviratne T. Energy status in the murine FSaII and MCaIV tumors under aerobic and hypoxic conditions: an in-vivo and in-vitro analysis. Int J Radiat Oncol Biol Phys 1992; 23:557-61. [PMID: 1612956 DOI: 10.1016/0360-3016(92)90011-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The relationship between energy status and hypoxia was examined in two murine tumors with substantially different hypoxic cell fractions in situ and in cells derived from these tumors in vitro. Parameters of tumor energy status were NTP/Pi and PCr/Pi obtained by 31P-NMR spectroscopy and adenylate energy charge and energy status obtained by high-pressure liquid chromatographic analysis of tumor extracts. Adenylate energy charge and rates of high-energy phosphate degradation were determined on cells obtained from both tumor types (MCaIV and FSaII) under identical nutrient and oxygen conditions, that is, air and nitrogen for various durations (0-6 hr). No consistent or substantial differences were noted in the various parameters of tumor energy status obtained by nuclear magnetic resonance analysis or analysis of tumor extracts, even though the MCaIV contains a substantially larger hypoxic fraction (49% vs 12%). Under in vitro conditions, the two cell lines exhibited different responses to oxygen deprivation, the MCaIV being substantially more refractory to energy changes secondary to hypoxia. Noting with caution that this study is based on only two tumor types, our results suggest that differences in cellular capacity for energy maintenance preclude quantitative inferences regarding tumor oxygen status from energy status between tumor types.
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Affiliation(s)
- L E Gerweck
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston 02114
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Krüger W, Mayer WK, Schaefer C, Stohrer M, Vaupel P. Acute changes of systemic parameters in tumour-bearing rats, and of tumour glucose, lactate, and ATP levels upon local hyperthermia and/or hyperglycaemia. J Cancer Res Clin Oncol 1991; 117:409-15. [PMID: 1909697 DOI: 10.1007/bf01612759] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Arterial blood pressure and relevant parameters of the arterial blood (O2 and CO2 tensions, pH, haematocrit, serum electrolytes and osmolality) were determined in tumour-bearing rats upon local hyperthermia (HT) and/or hyperglycaemia (HG). Tumour heating was performed in a saline bath (44 degrees C) for 120 min; hyperglycaemia was induced by i.v. infusion of 40% glucose solution for 150 min [blood glucose levels: 35-40 mM during heating; total amount of glucose: 1.19 g/100 g body wt.; infusion rates: 0.31 ml (100 g body wt.)-1 min-1 for 2 min, 0.02 ml (100 g body wt.)-1 min-1 for 88 min, and 0.01 ml (100 g body wt.)-1 min-1 for 60 min]. Immediately after treatment, glucose, lactate and ATP levels were determined in tumour and muscle specimens and compared to these values under normothermic (NT) and/or normoglycaemic (NG) conditions. In all groups (NT/NG, NT/HG, HT/NG, HT/HG) there were only minor but characteristic changes in blood parameters, which were mainly due to the volume and type of the infused fluids (glucose solution, saline). During hyperglycaemia, tumour glucose levels rose 13- to 17-fold, whereas muscle glucose concentrations exhibited only a 3- to 5-fold increase; lactate levels were 1.9-2.5 times higher in tumours than in muscle, indicating an increase in the metabolic differences between normal and malignant tissues. Despite an increased glucose availability, tumours did not show an improved energy status and, thus, would not be expected to develop a decrease in thermal sensitivity or stimulation in growth rate. The good systemic tolerability of the combined treatment (HT/HG) and the differential changes in malignant and normal tissue occurring under these conditions, support further attempts to manipulate tumour metabolic environment by glucose in order to achieve better therapeutic results.
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Affiliation(s)
- W Krüger
- Institute of Physiology and Pathophysiology, University of Mainz, Federal Republic of Germany
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Mueller-Klieser W, Kroeger M, Walenta S, Rofstad EK. Comparative imaging of structure and metabolites in tumours. Int J Radiat Biol 1991; 60:147-59. [PMID: 1677963 DOI: 10.1080/09553009114551741] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A novel technique for metabolic imaging using quantitative bioluminescence and single photon imaging was used to measure the distribution of ATP and lactate in two types of human melanoma xenografts with different radiobiologically hypoxic cell fractions (MF: 45 +/- 17% and EE: 6 +/- 3%; mean +/- SD). The tumours were s.c. grown in nude mice and were used for measurement at volumes of 153-3072 mm3. For metabolic imaging the rapidly frozen tumours were serially sectioned, and each cryosection was brought into contact with a frozen bioluminescent enzyme cocktail using a specially designed glass sandwich system. After thawing section and cocktail the luminescence was started, and light was emitted from the section with an intensity that is proportional to the local metabolite concentration. The photons were imaged directly through a microscope and an imaging photon counting system. A clear-cut correlation was documented between the distribution of relatively high ATP concentrations and of viable cell regions. The data obtained showed lower ATP concentrations in the tumour centres compared to the periphery, whereas lactate was inversely distributed within the melanomas. There was a trend towards a decrease in ATP with increasing tumour size in central, but not in peripheral, parts of both melanoma types. The concentration of neither ATP nor lactate measured in corresponding tumour areas showed differences related to the melanoma type. Thus, these two metabolites did not reflect the difference in the radiosensitivity of these tumours.
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Affiliation(s)
- W Mueller-Klieser
- Institute of Physiology and Pathophysiology, Pathophysiology Division, University of Mainz, Germany
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38
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Koutcher JA, Sawyer RC, Kornblith AB, Stolfi RL, Martin DS, Devitt ML, Cowburn D, Young CW. In vivo monitoring of changes in 5-fluorouracil metabolism induced by methotrexate measured by 19F NMR spectroscopy. Magn Reson Med 1991; 19:113-23. [PMID: 2046526 DOI: 10.1002/mrm.1910190111] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We have used in vivo 19F NMR spectroscopy to study the metabolism of 5-fluorouracil (FUra) in tumors with and without pretreatment with methotrexate (MTX). Using the CD8F1 murine mammary tumor as an in vivo model, we observed signals from FUra, alpha-fluoro-beta-alanine (F beta ALA), alpha-fluoro-beta-ureidopropionic acid (FUPA), and 5-fluorouracil-nucleotides (FUN) after intravenous or intraperitoneal injection of 150 mg/kg FUra. Formation of FUN was increased about 1.7-fold in CD8F1 tumor with methotrexate pretreatment as determined by acid extraction and HPLC analysis. A comparison of in vivo NMR spectra from FUra and sequential MTX + FUra-treated tumors showed a significantly higher ratio of the FUN signal to the initial total 19F signal in the MTX + FUra-treated tumors (p less than 0.001) for animals receiving FUra either intravenously or intraperitoneally. In addition, tumors treated with MTX + FUra had significantly longer time durations during which FUN was detected, independent of the mode of administration. These experiments indicate that in vivo 19F NMR spectroscopy can be used to noninvasively monitor alterations of 5-fluorouracil metabolism that occur with administration of modulating agents such as methotrexate. Further studies, in both murine tumor models and patients, are indicated to determine if these results can be correlated with tumor response.
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Affiliation(s)
- J A Koutcher
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
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