1
|
Robitaille M, Ménard C, Famulari G, Béliveau-Nadeau D, Enger SA. 169Yb-based high dose rate intensity modulated brachytherapy for focal treatment of prostate cancer. Brachytherapy 2024:S1538-4721(24)00076-X. [PMID: 39038997 DOI: 10.1016/j.brachy.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 04/24/2024] [Accepted: 05/20/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE This study compares conventional 192Ir-based high dose rate brachytherapy (HDR-BT) with 169Yb-based HDR intensity modulated brachytherapy (IMBT) for focal prostate cancer treatment. Additionally, the study explores the potential to generate less invasive treatment plans with IMBT by reducing the number of catheters needed to achieve acceptable outcomes. METHODS AND MATERIALS A retrospective dosimetric study of ten prostate cancer patients initially treated with conventional 192Ir-based HDR-BT and 5-14 catheters was employed. RapidBrachyMCTPS, a Monte Carlo-based treatment planning system was used to calculate and optimize dose distributions. For 169Yb-based HDR IMBT, a custom 169Yb source combined with 0.8 mm thick platinum shields placed inside 6F catheters was used. Furthermore, dose distributions were investigated when iteratively removing catheters for less invasive treatments. RESULTS With IMBT, the urethra D10 and D0.1cc decreased on average by 15.89 and 15.65 percentage points (pp) and the rectum V75 and D2cc by 1.53 and 11.54 pp, respectively, compared to the conventional clinical plans. Similar trends were observed when the number of catheters decreased. On average, there was an observed increase in PTV V150 from 2.84 pp with IMBT when utilizing all catheters to 8.83 pp when four catheters were removed. PTV V200 increased from 0.42 to 2.96 pp on average. Hotspots in the body were however lower with IMBT compared to conventional clinical plans. CONCLUSIONS 169Yb-based HDR IMBT for focal treatment of prostate cancer has the potential to successfully deliver clinically acceptable, less invasive treatment with reduced dose to organs at risk.
Collapse
Affiliation(s)
- Maude Robitaille
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Medical Physics Unit, Department of Oncology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Cynthia Ménard
- Department of Radiation Oncology, CHUM, Montreal, Quebec, Canada
| | - Gabriel Famulari
- Department of Radiation Oncology, Jewish General Hospital, Montreal, Quebec, Canada; Medical Physics Unit, Department of Oncology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Shirin A Enger
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Medical Physics Unit, Department of Oncology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
2
|
Takashima ME, Berg TJ, Morris ZS. The Effects of Radiation Dose Heterogeneity on the Tumor Microenvironment and Anti-Tumor Immunity. Semin Radiat Oncol 2024; 34:262-271. [PMID: 38880534 DOI: 10.1016/j.semradonc.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Radiotherapy elicits dose- and lineage-dependent effects on immune cell survival, migration, activation, and proliferation in targeted tumor microenvironments. Radiation also stimulates phenotypic changes that modulate the immune susceptibility of tumor cells. This has raised interest in using radiotherapy to promote greater response to immunotherapies. To clarify the potential of such combinations, it is critical to understand how best to administer radiation therapy to achieve activation of desired immunologic mechanisms. In considering the multifaceted process of priming and propagating anti-tumor immune response, radiation dose heterogeneity emerges as a potential means for simultaneously engaging diverse dose-dependent effects in a single tumor environment. Recent work in spatially fractionated external beam radiation therapy demonstrates the expansive immune responses achievable when a range of high to low dose radiation is delivered in a tumor. Brachytherapy and radiopharmaceutical therapies deliver inherently heterogeneous distributions of radiation that may contribute to immunogenicity. This review evaluates the interplay of radiation dose and anti-tumor immune response and explores emerging methodological approaches for investigating the effects of heterogeneous dose distribution on immune responses.
Collapse
Affiliation(s)
- Maya E Takashima
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tracy J Berg
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Zachary S Morris
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| |
Collapse
|
3
|
Bernasconi R, Kuster GM. Non-coding RNAs and their potential exploitation in cancer therapy-related cardiotoxicity. Br J Pharmacol 2024. [PMID: 38802331 DOI: 10.1111/bph.16416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/28/2024] [Accepted: 03/26/2024] [Indexed: 05/29/2024] Open
Abstract
Life expectancy in cancer patients has been extended in recent years, thanks to major breakthroughs in therapeutic developments. However, this also unmasked an increased incidence of cardiovascular diseases in cancer survivors, which is in part attributable to cancer therapy-related cardiovascular toxicity. Non-coding RNAs (ncRNAs) have received much appreciation due to their impact on gene expression. NcRNAs, which include microRNAs, long ncRNAs and circular RNAs, are non-protein-coding transcripts that are involved in the regulation of various biological processes, hence shaping cell identity and behaviour. They have also been implicated in disease development, including cardiovascular diseases, cancer and, more recently, cancer therapy-associated cardiotoxicity. This review outlines key features of cancer therapy-associated cardiotoxicity, what is known about the roles of ncRNAs in these processes and how ncRNAs could be exploited as therapeutic targets for cardioprotection.
Collapse
Affiliation(s)
- Riccardo Bernasconi
- Myocardial Research, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gabriela M Kuster
- Myocardial Research, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Cardiology, University Heart Center Basel, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
4
|
Guan P, Han X, Li D, Liao B. Effect of nurse-physician collaboration on the incidence of complications, negative emotions and quality of life in cervical cancer patients: a randomized controlled study. J Interprof Care 2024:1-9. [PMID: 38525553 DOI: 10.1080/13561820.2024.2327621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/02/2024] [Indexed: 03/26/2024]
Abstract
The aim of this study was to evaluate the effect of nurse-physician collaboration on the incidence of complications, anxiety and depression, quality of life, and satisfaction with nursing care among cervical cancer patients undergoing three-dimensional intracavitary brachytherapy. In this randomized, single-blinded, placebo-controlled trial, 92 eligible cervical cancer patients were equally divided into two groups upon admission. The control group was given routine nursing, and the intervention group received a nurse-physician collaboration in addition to routine care. Anxiety, depression, and health-related quality of life in both groups were assessed and compared at baseline and discharge. The intervention group had significantly fewer complications and showed marked improvements in mental health and quality of life compared to the control group. Satisfaction with nursing care was substantially greater in the intervention group. These results support the clinical adoption of a nurse-physician collaborative care model in the management of cervical cancer with three-dimensional intracavitary brachytherapy.
Collapse
Affiliation(s)
- Ping Guan
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xingping Han
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Dan Li
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Bizhen Liao
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
5
|
Ghosh S, Lee SJ, Hsu JC, Chakraborty S, Chakravarty R, Cai W. Cancer Brachytherapy at the Nanoscale: An Emerging Paradigm. CHEMICAL & BIOMEDICAL IMAGING 2024; 2:4-26. [PMID: 38274040 PMCID: PMC10806911 DOI: 10.1021/cbmi.3c00092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/09/2023] [Accepted: 11/01/2023] [Indexed: 01/27/2024]
Abstract
Brachytherapy is an established treatment modality that has been globally utilized for the therapy of malignant solid tumors. However, classic therapeutic sealed sources used in brachytherapy must be surgically implanted directly into the tumor site and removed after the requisite period of treatment. In order to avoid the trauma involved in the surgical procedures and prevent undesirable radioactive distribution at the cancerous site, well-dispersed radiolabeled nanomaterials are now being explored for brachytherapy applications. This emerging field has been coined "nanoscale brachytherapy". Despite present-day advancements, an ongoing challenge is obtaining an advanced, functional nanomaterial that concurrently incorporates features of high radiolabeling yield, short labeling time, good radiolabeling stability, and long tumor retention time without leakage of radioactivity to the nontargeted organs. Further, attachment of suitable targeting ligands to the nanoplatforms would widen the nanoscale brachytherapy approach to tumors expressing various phenotypes. Molecular imaging using radiolabeled nanoplatforms enables noninvasive visualization of cellular functions and biological processes in vivo. In vivo imaging also aids in visualizing the localization and retention of the radiolabeled nanoplatforms at the tumor site for the requisite time period to render safe and effective therapy. Herein, we review the advancements over the last several years in the synthesis and use of functionalized radiolabeled nanoplatforms as a noninvasive substitute to standard brachytherapy sources. The limitations of present-day brachytherapy sealed sources are analyzed, while highlighting the advantages of using radiolabeled nanoparticles (NPs) for this purpose. The recent progress in the development of different radiolabeling methods, delivery techniques and nanoparticle internalization mechanisms are discussed. The preclinical studies performed to date are summarized with an emphasis on the current challenges toward the future translation of nanoscale brachytherapy in routine clinical practices.
Collapse
Affiliation(s)
- Sanchita Ghosh
- Radiopharmaceuticals
Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India
- Homi
Bhabha National Institute, Anushaktinagar, Mumbai 400094, India
| | - Sophia J. Lee
- Departments
of Radiology and Medical Physics, University
of Wisconsin-Madison, Madison, Wisconsin 53705, United States
| | - Jessica C. Hsu
- Departments
of Radiology and Medical Physics, University
of Wisconsin-Madison, Madison, Wisconsin 53705, United States
| | - Sudipta Chakraborty
- Radiopharmaceuticals
Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India
- Homi
Bhabha National Institute, Anushaktinagar, Mumbai 400094, India
| | - Rubel Chakravarty
- Radiopharmaceuticals
Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India
- Homi
Bhabha National Institute, Anushaktinagar, Mumbai 400094, India
| | - Weibo Cai
- Departments
of Radiology and Medical Physics, University
of Wisconsin-Madison, Madison, Wisconsin 53705, United States
| |
Collapse
|
6
|
Xiang X, Ji Z, Jin J. Brachytherapy is an effective and safe salvage option for re-irradiation in recurrent glioblastoma (rGBM): A systematic review. Radiother Oncol 2024; 190:110012. [PMID: 37972737 DOI: 10.1016/j.radonc.2023.110012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To evaluate the clinical efficacy and toxicity of brachytherapy as a salvage therapy for patients with recurrent glioblastoma (rGBM). METHODS AND MATERIALS We searched the PubMed, Embase, and Cochrane libraries from its inception to June 2023, for eligible studies in which patients underwent brachytherapy for rGBM. Outcomes of interest were mOS, mPFS, OS, PFS, and adverse events (AEs). For individual clinical survival outcomes and common AEs, weighted-mean descriptive statistics were calculated as a summary measure using study sample size as the weight. The calculation formula is as follows: weighted-mean = Σwx/Σw (w is the sample size and x is the outcome). RESULTS This review included 29 studies with a total of 1202 rGBM patients, including 22 retrospective and 7 prospective studies. The results showed that from the time of brachytherapy, the mOS and mPFS were 6.8 to 24.4 months and 3.7 to 11.7 months. The OS of 6 months, 1 year, 18 months, 2 years, and 3 years after brachytherapy were 58.3 % to 85.2 % (weighted-mean 76.2 %), 26 % to 66 % (weighted-mean 41.9 %), 20 % to 37 % (weighted-mean 27.6 %), 11 % to 23 % (weighted-mean 14.8 %), and 8 % to 15 % (weighted-mean 12.1 %), respectively. The PFS of 6 months and 1 year after brachytherapy were 26.7 % to 86 % (weighted-mean 53.4 %) and 14 % to 81 % (weighted-mean 24.1 %). Most patients with rGBM will experience treatment failure again during the follow-up period, mainly local (10.7 % to 79.4 %) or marginal(3.6 % to 22.2 %) recurrence, followed by distant failure (6.7 % to 57.7 %). Although therapeutic AEs had not been uniformly reported, the overall toxicity rate was considered to be low. The common AEs reported included progressive neurologic deterioration, seizures, CSF leak, brain necrosis, hemorrhage, and infection/meningitis, with a weighted-mean incidence of 1.9 %, 2.4 %, 4.1 %, 5.4 %, 2.1 %, and 3.8 %, respectively. CONCLUSIONS The evidence summarized above, albeit mostly level III, suggests that brachytherapy has acceptable safety and good post-treatment clinical efficacy for selected patients with rGBM. Well-designed, high-quality, large-sample randomized controlled and prospective studies are needed to further validate these findings.
Collapse
Affiliation(s)
- Xiaoyong Xiang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Zhe Ji
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China; Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| |
Collapse
|
7
|
Chow JCL, Wong V, Sanders L, Li K. Developing an AI-Assisted Educational Chatbot for Radiotherapy Using the IBM Watson Assistant Platform. Healthcare (Basel) 2023; 11:2417. [PMID: 37685452 PMCID: PMC10487627 DOI: 10.3390/healthcare11172417] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Objectives: This study aims to make radiotherapy knowledge regarding healthcare accessible to the general public by developing an AI-powered chatbot. The interactive nature of the chatbot is expected to facilitate better understanding of information on radiotherapy through communication with users. Methods: Using the IBM Watson Assistant platform on IBM Cloud, the chatbot was constructed following a pre-designed flowchart that outlines the conversation flow. This approach ensured the development of the chatbot with a clear mindset and allowed for effective tracking of the conversation. The chatbot is equipped to furnish users with information and quizzes on radiotherapy to assess their understanding of the subject. Results: By adopting a question-and-answer approach, the chatbot can engage in human-like communication with users seeking information about radiotherapy. As some users may feel anxious and struggle to articulate their queries, the chatbot is designed to be user-friendly and reassuring, providing a list of questions for the user to choose from. Feedback on the chatbot's content was mostly positive, despite a few limitations. The chatbot performed well and successfully conveyed knowledge as intended. Conclusions: There is a need to enhance the chatbot's conversation approach to improve user interaction. Including translation capabilities to cater to individuals with different first languages would also be advantageous. Lastly, the newly launched ChatGPT could potentially be developed into a medical chatbot to facilitate knowledge transfer.
Collapse
Affiliation(s)
- James C. L. Chow
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1X6, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Valerie Wong
- Department of Physics, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada;
| | - Leslie Sanders
- Department of Humanities, York University, Toronto, ON M3J 1P3, Canada;
| | - Kay Li
- Department of English, University of Toronto, Toronto, ON M5R 2M8, Canada;
| |
Collapse
|
8
|
Hu P, Huang J, Zhang Y, Guo H, Chen G, Zhang F. Iodine-125 seed implantation in the treatment of malignant tumors. J Interv Med 2023; 6:111-115. [PMID: 37846333 PMCID: PMC10577067 DOI: 10.1016/j.jimed.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 10/18/2023] Open
Abstract
Malignant tumors are major causes of morbidity and mortality in China. Despite advances in surgical, radiological, chemotherapeutic, molecular targeting, and immunotherapeutic treatments, patients with malignant tumors still have poor prognoses. Low-dose-rate brachytherapy, specifically 125I seed implantation, is beneficial because of its high local delivery dose and minimal damage to surrounding tissues. Consequently, it has gained increasing acceptance as a treatment modality for various malignant tumors. In this study, we explored the fundamental principles, clinical applications, and new technologies associated with 125I radioactive seed implantation.
Collapse
Affiliation(s)
- Pan Hu
- Department of Minimally Invasive & Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People’s Republic of China
| | - Jianwen Huang
- Department of Intervention, Zhuhai People’s Hospital, Zhuhai, Guangdong, 519000, People’s Republic of China
| | - Yanling Zhang
- School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
| | - Huanqing Guo
- Department of Minimally Invasive & Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People’s Republic of China
| | - Guanyu Chen
- Department of Minimally Invasive & Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People’s Republic of China
| | - Fujun Zhang
- Department of Minimally Invasive & Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People’s Republic of China
| |
Collapse
|
9
|
Sproull M, Wilson E, Miller R, Camphausen K. The Future of Radioactive Medicine. Radiat Res 2023; 200:80-91. [PMID: 37141143 PMCID: PMC10466314 DOI: 10.1667/rade-23-00031.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/07/2023] [Indexed: 05/05/2023]
Abstract
The discovery of X rays in the late 19th century heralded the beginning of a new age in medicine, and the advent of channeling the power of radiation to diagnose and treat human disease. Radiation has been leveraged in medicine in a multitude of ways and is a critical element of cancer care including screening, diagnosis, surveillance, and interventional treatments. Modern radiotherapy techniques include a multitude of methodologies utilizing both externally and internally delivered radiation from a variety of approaches. This review provides a comprehensive overview of contemporary radiotherapy methodologies, the field of radiopharmaceuticals and theranostics, effects of low dose radiation and highlights the phenomena of fear of exposure to radiation and its impact in modern medicine.
Collapse
Affiliation(s)
- M. Sproull
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - E. Wilson
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - R.W. Miller
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - K. Camphausen
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland
| |
Collapse
|
10
|
Yang S, Wang M, Wang T, Sun M, Huang H, Shi X, Duan S, Wu Y, Zhu J, Liu F. Self-assembled short peptides: Recent advances and strategies for potential pharmaceutical applications. Mater Today Bio 2023; 20:100644. [PMID: 37214549 PMCID: PMC10199221 DOI: 10.1016/j.mtbio.2023.100644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/10/2023] [Accepted: 04/23/2023] [Indexed: 05/24/2023] Open
Abstract
Self-assembled short peptides have intrigued scientists due to the convenience of synthesis, good biocompatibility, low toxicity, inherent biodegradability and fast response to change in the physiological environment. Therefore, it is necessary to present a comprehensive summary of the recent advances in the last decade regarding the construction, route of administration and application of self-assembled short peptides based on the knowledge on their unique and specific ability of self-assembly. Herein, we firstly explored the molecular mechanisms of self-assembly of short peptides, such as non-modified amino acids, as well as Fmoc-modified, N-functionalized, and C-functionalized peptides. Next, cell penetration, fusion, and peptide targeting in peptide-based drug delivery were characterized. Then, the common administration routes and the potential pharmaceutical applications (drug delivery, antibacterial activity, stabilizers, imaging agents, and applications in bioengineering) of peptide drugs were respectively summarized. Last but not least, some general conclusions and future perspectives in the relevant fields were briefly listed. Although with certain challenges, great opportunities are offered by self-assembled short peptides to the fascinating area of drug development.
Collapse
Affiliation(s)
- Shihua Yang
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, China Medical University, Ministry of Education, Shenyang, 110001, China
- Department of Phase I Clinical Trials Center, The First Hospital of China Medical University, Shenyang, 110102, China
| | - Mingge Wang
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - Tianye Wang
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, China Medical University, Ministry of Education, Shenyang, 110001, China
- Department of Anus and Intestine Surgery, The First Hospital of Dalian Medical University, Dalian, 116000, China
| | - Mengchi Sun
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - Hanwei Huang
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, China Medical University, Ministry of Education, Shenyang, 110001, China
- Department of Phase I Clinical Trials Center, The First Hospital of China Medical University, Shenyang, 110102, China
| | - Xianbao Shi
- Department of Pharmacy, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121001, China
| | - Shijie Duan
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, China Medical University, Ministry of Education, Shenyang, 110001, China
- Department of Phase I Clinical Trials Center, The First Hospital of China Medical University, Shenyang, 110102, China
| | - Ying Wu
- Department of Phase I Clinical Trials Center, The First Hospital of China Medical University, Shenyang, 110102, China
| | - Jiaming Zhu
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, China Medical University, Ministry of Education, Shenyang, 110001, China
| | - Funan Liu
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, China Medical University, Ministry of Education, Shenyang, 110001, China
- Department of Phase I Clinical Trials Center, The First Hospital of China Medical University, Shenyang, 110102, China
| |
Collapse
|
11
|
Xie Y, Liu M, Cai C, Ye C, Guo T, Yang K, Xiao H, Tang X, Liu H. Recent progress of hydrogel-based local drug delivery systems for postoperative radiotherapy. Front Oncol 2023; 13:1027254. [PMID: 36860309 PMCID: PMC9969147 DOI: 10.3389/fonc.2023.1027254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023] Open
Abstract
Surgical resection and postoperative radiotherapy remained the most common therapeutic modalities for malignant tumors. However, tumor recurrence after receiving such combination is difficult to be avoided because of high invasiveness and radiation resistance of cancer cells during long-term therapy. Hydrogels, as novel local drug delivery systems, presented excellent biocompatibility, high drug loading capacity and sustained drug release property. Compared with conventional drug formulations, hydrogels are able to be administered intraoperatively and directly release the entrapped therapeutic agents to the unresectable tumor sites. Therefore, hydrogel-based local drug delivery systems have their unique advantages especially in sensitizing postoperative radiotherapy. In this context, classification and biological properties of hydrogels were firstly introduced. Then, recent progress and application of hydrogels for postoperative radiotherapy were summarized. Finally, the prospects and challenges of hydrogels in postoperative radiotherapy were discussed.
Collapse
Affiliation(s)
- Yandong Xie
- Department of Neurosurgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China,Department of Neurosurgery, The Suqian Clinical College of Xuzhou Medical University, Suqian, China
| | - Mingxi Liu
- Department of Neurosurgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Chang Cai
- Department of Neurosurgery, The Suqian Clinical College of Xuzhou Medical University, Suqian, China
| | - Chengkun Ye
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Tangjun Guo
- Department of Neurosurgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Kun Yang
- Department of Neurosurgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Hong Xiao
- Department of Neuro-Psychiatric Institute, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China,*Correspondence: Hongyi Liu, ; Xianglong Tang, ; Hong Xiao,
| | - Xianglong Tang
- Department of Neurosurgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China,Department of Neuro-Psychiatric Institute, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China,*Correspondence: Hongyi Liu, ; Xianglong Tang, ; Hong Xiao,
| | - Hongyi Liu
- Department of Neurosurgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China,*Correspondence: Hongyi Liu, ; Xianglong Tang, ; Hong Xiao,
| |
Collapse
|
12
|
Zhou D, Nakamura M, Sawada Y, Ono T, Hirashima H, Iramina H, Adachi T, Fujimoto T, Mizowaki T. Development of independent dose verification plugin using Eclipse scripting API for brachytherapy. JOURNAL OF RADIATION RESEARCH 2023; 64:180-185. [PMID: 36214326 PMCID: PMC9855340 DOI: 10.1093/jrr/rrac063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/14/2022] [Indexed: 06/16/2023]
Abstract
In this study, an independent dose verification plugin (DVP) using the Eclipse Scripting Application Programming Interface (ESAPI) for brachytherapy was developed. The DVP was based on the general 2D formalism reported in AAPM-TG43U1. The coordinate and orientation of each source position were extracted from the translation matrix acquired from the treatment planning system (TPS), and the distance between the source and verification point (r) was calculated. Moreover, the angles subtended by the center-tip and tip-tip of the hypothetical line source with respect to the verification point (θ and β) were calculated. With r, θ, β and the active length of the source acquired from the TPS, the geometry function was calculated. As the TPS calculated the radial dose function, g(r), and 2D anisotropy function, F(r,θ), by interpolating and extrapolating the corresponding table stored in the TPS, the DVP calculated g(r) and F(r,θ) independently from equations fitted with the Monte Carlo data. The relative deviation of the fitted g(r) and F(r,θ) for the GammaMed Plus HDR 192Ir source was 0.5% and 0.9%, respectively. The acceptance range of the relative dose difference was set to ±1.03% based on the relative deviation between the fitted functions and Monte Carlo data, and the linear error propagation law. For 64 verification points from sixteen plans, the mean of absolute values of the relative dose difference was 0.19%. The standard deviation (SD) of the relative dose difference was 0.17%. The DVP maximizes efficiency and minimizes human error for the brachytherapy plan check.
Collapse
Affiliation(s)
- Dejun Zhou
- Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Mitsuhiro Nakamura
- Corresponding author. Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan. Tel: +81-75-751-4176; E-mail:
| | - Yohei Sawada
- Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto 606-8507, Japan
| | - Tomohiro Ono
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Hideaki Hirashima
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Hiraku Iramina
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Takanori Adachi
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Takahiro Fujimoto
- Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| |
Collapse
|
13
|
Ishiguro A, Ogata D, Okuma K, Kashihara T, Murakami N, Hiki K, Yamakawa K, Jinnai S, Takahashi A, Namikawa K, Igaki H, Yamazaki N. Malignant melanoma treatment using brachytherapy: Two case reports and 15 case series. J Dermatol 2023; 50:94-97. [PMID: 36196042 DOI: 10.1111/1346-8138.16599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 01/04/2023]
Abstract
Malignant melanoma (MM) is usually resistant to radiotherapy. Brachytherapy may be an option in patients with bleeding or pain, and those in whom surgery is difficult. Brachytherapy has few side effects and can be used in combination with external beam radiotherapy or chemotherapy. We summarize the demographic and clinical characteristics of 15 patients who received brachytherapy for MM at our hospital and describe two of these representative cases. Patient 1 had an approximately 10-mm, dark-red nodule near the external urethral meatus. Excision was not performed to preserve urethral function. A gradual improvement was observed after 48 Gy of remote afterloading system (RALS) brachytherapy and nivolumab therapy. Patient 2 had a 38-mm, black tumor on the vagina. Post-resection, RALS brachytherapy was administered to treat the residual black macule and a lesion quickly disappeared. In all 15 cases, nine patients received radiotherapy for local control and six patients received palliative radiotherapy to reduce symptoms such as bleeding and pain. The irradiation site was the vagina in six patients, lymph node metastasis in five, head and neck in two, skin or subcutaneous metastases in two, and the anus in one. Treatment effect for local control and palliative care was 75% and 83% of patients, respectively. In particular, disappearance of the tumor or disappearance of symptoms was observed in half of the cases of brachytherapy to the vagina. On the other hand, brachytherapy was not very effective for lymph node metastases. Immediately after radiotherapy, eight (53%) patients experienced dermatitis or mucositis. Due to the histological and structural characteristics of mucosal melanoma of the luminal organs, brachytherapy may be an effective therapy. Hence, widespread use of brachytherapy with an appropriate irradiation technique aiming for local control and palliative care in case of unresectable MM should be considered.
Collapse
Affiliation(s)
- Akihiro Ishiguro
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Dai Ogata
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kae Okuma
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tairo Kashihara
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kojiro Hiki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kohei Yamakawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shunichi Jinnai
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Akira Takahashi
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kenjiro Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
14
|
Abstract
The benefit of radiation is immense in the field of gastroenterology. Radiation is used daily in different gastrointestinal imaging and diagnostic and therapeutic interventional procedures. Radiotherapy is one of the primary modalities of treatment of gastrointestinal malignancies. There are various modalities of radiotherapy. Radiotherapy can injure malignant cells by directly damaging DNA, RNA, proteins, and lipids and indirectly by forming free radicals. External beam radiation, internal beam radiation and radio-isotope therapy are the major ways of delivering radiation to the malignant tissue. Radiation can also cause inflammation, fibrosis, organ dysfunction, and malignancy. Patients with repeated exposure to radiation for diagnostic imaging and therapeutic procedures are at slightly increased risk of malignancy. Gastrointestinal endoscopists performing fluoroscopy-guided procedures are also at increased risk of malignancy and cataract formation. The radiological protection society recommends certain preventive and protective measures to avoid side effects of radiation. Gastrointestinal complications related to radiation therapy for oncologic processes, and exposure risks for patients and health care providers involved in diagnostic or therapeutic imaging will be discussed in this review.
Collapse
Affiliation(s)
- Monjur Ahmed
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA 19107, USA,Corresponding Author: Monjur Ahmed, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | - Razin Ahmed
- California Cancer Associates for Research and Excellence, Fresno, CA, USA
| |
Collapse
|
15
|
Zhou R, Zhao D, Beeraka NM, Wang X, Lu P, Song R, Chen K, Liu J. Novel Implications of Nanoparticle-Enhanced Radiotherapy and Brachytherapy: Z-Effect and Tumor Hypoxia. Metabolites 2022; 12:943. [PMID: 36295845 PMCID: PMC9612299 DOI: 10.3390/metabo12100943] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 10/29/2023] Open
Abstract
Radiotherapy and internal radioisotope therapy (brachytherapy) induce tumor cell death through different molecular signaling pathways. However, these therapies in cancer patients are constrained by dose-related adverse effects and local discomfort due to the prolonged exposure to the surrounding tissues. Technological advancements in nanotechnology have resulted in synthesis of high atomic elements such as nanomaterials, which can be used as radiosensitizers due to their photoelectric characteristics. The aim of this review is to elucidate the effects of novel nanomaterials in the field of radiation oncology to ameliorate dose-related toxicity through the application of ideal nanoparticle-based radiosensitizers such as Au (gold), Bi (bismuth), and Lu (Lutetium-177) for enhancing cytotoxic effects of radiotherapy via the high-Z effect. In addition, we discuss the role of nanoparticle-enhanced radiotherapy in alleviating tumor hypoxia through the nanodelivery of genes/drugs and other functional anticancer molecules. The implications of engineered nanoparticles in preclinical and clinical studies still need to be studied in order to explore potential mechanisms for radiosensitization by minimizing tumor hypoxia, operational/logistic complications and by overcoming tumor heterogeneity in radiotherapy/brachytherapy.
Collapse
Affiliation(s)
- Runze Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Di Zhao
- Endocrinology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Narasimha M. Beeraka
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
- Department of Pharmaceutical Chemistry, Jagadguru Sri Shivarathreeswara Academy of Higher Education and Research (JSS AHER), Jagadguru Sri Shivarathreeswara College of Pharmacy, Mysuru 570015, India
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 119991 Moscow, Russia
| | - Xiaoyan Wang
- Endocrinology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Pengwei Lu
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Ruixia Song
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Kuo Chen
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Junqi Liu
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| |
Collapse
|
16
|
Muacevic A, Adler JR. GammaTile: Comprehensive Review of a Novel Radioactive Intraoperative Seed-Loading Device for the Treatment of Brain Tumors. Cureus 2022; 14:e29970. [PMID: 36225241 PMCID: PMC9541893 DOI: 10.7759/cureus.29970] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
GammaTile is a Food and Drug Administration (FDA)-licensed device consisting of four cesium-131 (Cs-131) radiation-emitting seeds in the collagen tile about the postage stamp size. The tiles are utilized to line the brain cavity immediately after tumor resection. GammaTile therapy is a surgically targeted radiation therapy (STaRT) that helps provide instant, dose-intense treatment after the completion of resection. The objective of this study is to explore the safety and efficacy of GammaTile surgically targeted radiation therapy for brain tumors. This study also reviews the differences between GammaTile surgically targeted radiation therapy (STaRT) and other traditional treatment options for brain tumors. The electronic database searches utilized in this study include PubMed, Google Scholar, and ScienceDirect. A total of 4,150 articles were identified based on the search strategy. Out of these articles, 900 articles were retrieved. A total of 650 articles were excluded for various reasons, thus retrieving 250 citations. We applied the exclusion and inclusion criteria to these retrieved articles by screening their full text and excluding 180 articles. Therefore, 70 citations were retrieved and included in this comprehensive literature review, as outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram. Based on the findings of this study, GammaTile surgically targeted radiation therapy (STaRT) is safe and effective for treating brain tumors. Similarly, the findings have also shown that the efficacy of GammaTile therapy can be enhanced by combining it with other standard-of-care treatment options/external beam radiation therapy (EBRT). Also, the results show that patients diagnosed with recurrent glioblastoma (GBM) exhibit poor median overall survival because of the possibility of the tumor returning. Therefore, combining STaRT with other standard-of-care treatment options/EBRT can improve the patient's overall survival (OS). GammaTile therapy enhances access to care, guarantees 100% compliance, and eliminates patients' need to travel regularly to hospitals for radiation treatments. Its implementation requires collaboration from various specialties, such as radiation oncology, medical physics, and neurosurgery.
Collapse
|
17
|
Ghazbani A, Abdolahi M, Mansourzadeh MJ, BasirianJahromi R, Behzadipour S, Mohseni Azad A, Talebzadeh B, Khosravi A, Hamidi A. Knowledge domain and emerging trends in brachytherapy: A scientometric analysis. PRECISION RADIATION ONCOLOGY 2022. [DOI: 10.1002/pro6.1171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Arash Ghazbani
- Student Research Committee Bushehr University of Medical Sciences Bushehr Iran
| | - Mohammad Abdolahi
- Department of Radiology Faculty of Paramedicine Bushehr University of Medical Sciences Bushehr Iran
| | | | - Reza BasirianJahromi
- Department of Medical Library and Information Sciences Faculty of Paramedicine Bushehr University of Medical Sciences Bushehr Iran
| | - Sina Behzadipour
- Student Research Committee Bushehr University of Medical Sciences Bushehr Iran
| | - Anali Mohseni Azad
- Department of Surgery Faculty of Medicine Bushehr University of Medical Sciences Bushehr Iran
| | | | - Abdolrasoul Khosravi
- Department of Medical Library and Information Sciences Faculty of Paramedicine Bushehr University of Medical Sciences Bushehr Iran
| | - Ali Hamidi
- Department of Medical Library and Information Sciences Faculty of Paramedicine Bushehr University of Medical Sciences Bushehr Iran
| |
Collapse
|
18
|
Gao Z, Yu H, Di X, Zhao J, Liang Y, Liu Z, Wang J, Zhang H. Case report: 125I seed implantation for rare malignant solitary fibrous tumor in the pelvic cavity: a case report. Front Oncol 2022; 12:884491. [PMID: 35978802 PMCID: PMC9376293 DOI: 10.3389/fonc.2022.884491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022] Open
Abstract
Solitary fibrous tumor (SFT) is a rare spindle cell tumor, benign or low-grade malignant, with an extremely low possibility of occurrence of malignant solitary fibrous tumor (MSFT). Surgery is an effective way for treating SFT, but it is often difficult to resect completely due to a large size, with a high recurrence rate and mortality rate after operation. Additionally, SFT is relatively resistant to chemotherapy, and there is a lack of effective systemic drug treatment. These lead to certain difficulties in the treatment of SFT. We report a case of a rare MSFT in the pelvic cavity. With a history of recurrence after two surgeries, this patient underwent surgical removal combined with 125I seed implantation at our hospital in the context that the tumor could not be completely removed because it was large and adhered to surrounding tissues; after up to 43 months of progression-free survival (PFS), the patient underwent 125I seed implantation alone, and achieved a complete remission, with a PFS up to 35 months. 125I seed implantation can be a safe and effective treatment option for unresectable MSFT as well as a potential solution to repeated local recurrence.
Collapse
|
19
|
Vukadinović A, Milanović Z, Ognjanović M, Janković D, Radović M, Mirković M, Karageorgou MA, Bouziotis P, Erić S, Vranješ-Đurić S, Antić B, Prijović Ž. 90Y-CA/SPIONs for dual magnetic hyperthermia-radionuclide nanobrachytherapy of solid tumours. NANOTECHNOLOGY 2022; 33:405102. [PMID: 35728572 DOI: 10.1088/1361-6528/ac7ac0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
Radiolabelled superparamagnetic iron oxide nanoparticles (SPIONs) are a promising nanomaterial for the development of dual radiation/hyperthermia cancer therapy. To that purpose, flower-shaped SPIONs with an exceptional heating capability were synthesised and coated with citrate, dextran or (3-aminopropyl)triethoxysilane. Both non-coated and coated SPIONs were nontoxic to CT-26 mouse colon cancer cells up to 1.0 mg ml-1in vitro. In an oscillating magnetic field, citrate-coated SPIONs (CA/SPIONs) displayed the highest heating rate (SAR ∼ 253 W g-1) and the strongest hyperthermia effects against CT-26 cells. Labelling of the CA/SPIONs by the90Y radionuclide, emitting β-radiation with an average/maximum energy of 0.94/2.23 MeV, and deep tissue penetration generated90Y-CA/SPIONs intended for the therapy of solid tumours. However, intravenous injection of90Y-CA/SPIONs in CT-26 xenograft-bearing mice resulted in low tumour accumulation. On the contrary, intratumoural injection resulted in long-term retention at the injection site. A single intratumoural injection of 0.25 mg CA/SPIONs followed by 30-min courses of magnetic hyperthermia for four consecutive days caused a moderate antitumour effect against CT-26 and 4T1 mouse tumour xenografts. Intratumoural application of 1.85 MBq/0.25 mg90Y-CA/SPIONs, alone or combined with hyperthermia, caused a significant (P ≤ 0.01) antitumour effect without signs of systemic toxicity. The results confirm the suitability of90Y-CA/SPIONs for monotherapy or dual magnetic hyperthermia-radionuclide nanobrachytherapy (NBT) of solid tumours.
Collapse
Affiliation(s)
- Aleksandar Vukadinović
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| | - Zorana Milanović
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| | - Miloš Ognjanović
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| | - Drina Janković
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| | - Magdalena Radović
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| | - Marija Mirković
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| | - Maria-Argyro Karageorgou
- Department of Physics, National and Kapodistrian University of Athens, Zografou Panepistimioupolis, GR-15784 Athens, Greece
- Institute of Nuclear & Radiological Sciences & Technology, Energy & Safety, National Center for Scientific Research 'Demokritos', Aghia Paraskevi, 15341 Athens, Greece
| | - Penelope Bouziotis
- Institute of Nuclear & Radiological Sciences & Technology, Energy & Safety, National Center for Scientific Research 'Demokritos', Aghia Paraskevi, 15341 Athens, Greece
| | - Slavica Erić
- Faculty of Pharmacy, University of Belgrade, 11001 Belgrade, Serbia
| | - Sanja Vranješ-Đurić
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| | - Bratislav Antić
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| | - Željko Prijović
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| |
Collapse
|
20
|
Palmisciano P, Haider AS, Balasubramanian K, D'Amico RS, Wernicke AG. The role of cesium-131 brachytherapy in brain tumors: a scoping review of the literature and ongoing clinical trials. J Neurooncol 2022; 159:117-133. [PMID: 35696019 DOI: 10.1007/s11060-022-04050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Cesium-131 radioactive isotope has favored the resurgence of intracavitary brachytherapy in neuro-oncology, minimizing radiation-induced complications and maximizing logistical and clinical outcomes. We reviewed the literature on cesium-131 brachytherapy for brain tumors. METHODS PubMed, Web-of-Science, Scopus, Clinicaltrial.gov, and Cochrane were searched following the PRISMA extension for scoping reviews to include published studies and ongoing trials reporting cesium-131 brachytherapy for brain tumors. RESULTS We included 27 published studies comprising 279 patients with 293 lesions, and 3 ongoing trials. Most patients had brain metastases (63.1%), followed by high-grade gliomas (23.3%), of WHO Grade III (15.2%) and Grade IV (84.8%), and meningiomas (13.6%), mostly of WHO Grade II (62.8%) and Grade III (27.9%). Most brain metastases were newly diagnosed (72.3%), while most gliomas and meningiomas were recurrent (95.4% and 88.4%). Patients underwent gross-total (91.1%) or subtotal (8.9%) resection, with median postoperative cavity size of 3.5 cm (range 1-5.8 cm). A median of 20, 28, and 16 seeds were implanted in gliomas, meningiomas, and brain metastases, with median seed activity of 3.8 mCi (range 2.4-5 mCi). Median follow-up was 16.2 months (range 0.6-72 months). 1-year freedom from progression rates were local 94% (range 57-100%), regional 85.1% (range 55.6-93.8%), and distant 53.5% (range 26.3-67.4%). Post-treatment radiation necrosis, seizure, and surgical wound infection occurred in 3.4%, 4.7%, and 4.3% patients. CONCLUSION Initial data suggest that cesium-131 brachytherapy is safe and effective in primary or metastatic malignant brain tumors. Ongoing trials are evaluating long-term locoregional tumor control and future studies should analyze its role in multimodal systemic tumor management.
Collapse
Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ali S Haider
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | | | - Randy S D'Amico
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, New York, NY, USA
| | - Alla Gabriella Wernicke
- Department of Radiation Oncology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, New York, NY, USA. .,Department of Radiation Medicine, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, 130 East 77th Street, New York, NY, 10075, USA.
| |
Collapse
|
21
|
Knowledge-based three-dimensional dose prediction for tandem-and-ovoid brachytherapy. Brachytherapy 2022; 21:532-542. [PMID: 35562285 DOI: 10.1016/j.brachy.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/28/2022] [Accepted: 03/12/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this work was to develop a knowledge-based dose prediction system using a convolution neural network (CNN) for cervical brachytherapy treatments with a tandem-and-ovoid applicator. METHODS A 3D U-NET CNN was utilized to make voxel-wise dose predictions based on organ-at-risk (OAR), high-risk clinical target volume (HRCTV), and possible source location geometry. The model comprised 395 previously treated cases: training (273), validation (61), test (61). To assess voxel prediction accuracy, we evaluated dose differences in all cohorts across the dose range of 20-130% of prescription, mean(SD) and standard deviation (σ), as well as isodose dice similarity coefficients for clinical and/or predicted dose distributions. We examined discrete Dose-Volume Histogram(DVH) metrics utilized for brachytherapy plan quality assessment (HRCTV D90%, and bladder and/or rectum and/or sigmoid D2cc) with ΔDx=Dx,actual-Dx,predicted Pearson correlation coefficient, standard deviation, and mean further quantifying model performance. RESULTS Ranges of voxel-wise dose difference accuracy (δD¯±σ) for 20-130% dose interval in training (test) sets ranged from [-0.5% ± 2.0% to +2.0% ± 14.0%] ([-0.1% ± 4.0% to +4.0% ± 26.0%]) in all voxels, [-1.7% ± 5.1% to -3.5% ± 12.8%] ([-2.9% ± 4.8% to -2.6% ± 18.9%]) in HRCTV, [-0.02% ± 2.40% to +3.2% ± 12.0%] ([-2.5% ± 3.6% to +0.8% ± 12.7%]) in bladder, [-0.7% ± 2.4% to +15.5% ± 11.0%] ([-0.9% ± 3.2% to +27.8% ± 11.6%]) in rectum, and [-0.7% ± 2.3% to +10.7% ± 15.0%] ([-0.4% ± 3.0% to +18.4% ± 11.4%]) in sigmoid. Isodose dice similarity coefficients ranged from [0.96,0.91] for training and [0.94,0.87] for test cohorts. Relative DVH metric prediction in the training (test) set were HRCTV ΔD¯90±σΔD=-0.19 ± 0.55Gy(-0.09 ± 0.67 Gy), bladder ΔD¯2cc±σΔD= -0.06 ± 0.54Gy(-0.17 ± 0.67 Gy), rectum ΔD¯2cc±σΔD= -0.03 ± 0.36Gy(-0.04 ± 0.46 Gy), and sigmoid ΔD¯2cc±σΔD= -0.01 ± 0.34Gy(0.00 ± 0.44 Gy). CONCLUSIONS A 3D knowledge-based dose predictions provide voxel-level and DVH metric estimates that could be used for treatment plan quality control and data-driven plan guidance.
Collapse
|
22
|
Kesaria AZ, Bimali M, Patel M, Prabhu A, Kesaria S, Xia F. #Brachytherapy: Physicians As Influencers on Instagram. Cureus 2022; 14:e22524. [PMID: 35371782 PMCID: PMC8953911 DOI: 10.7759/cureus.22524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose We aimed to evaluate brachytherapy-related posts on Instagram by identifying patient concerns, the content of related posts, and user outreach. Methods and materials A list of top posts from searching #brachytherapy on May 7, 2021, were generated on a mobile device and all data are representative as of May 7, 2021. Searching for #brachytherapy resulted in 1010 posts which were analyzed using Instagram. The content was categorized by source (physician, patient, hospital, or not otherwise specified), type (education or experiences), disease site (cervical, endometrial, other), and user influence (number of posts, number of followers). Patient posts were specifically analyzed and all captions and hashtags were reviewed. Results The distribution of users with brachytherapy-related posts was as follows: 23% patients, 15% physicians, 9% hospitals, 53% not otherwise specified. Physicians only made up 11% of posts analyzed while the majority, 79%, were from patients and other Instagram users. From the accounts linked to patients, 99% of them were experience-based and 1% were educational. Posts made by physicians were educational in content 66% of the time, with 34% of posts being experiences. The median number of followers from least to greatest were not otherwise specified (NOS) 450.5, patients (501), hospital-affiliated (527), and physicians (608). In gynecological cancer patients, the reported side effects were as follows: fatigue 31%, gastrointestinal (GI) 16%, genitourinary (GU) 16%, pain 28%, and anxiety 50%. Conclusion: This study shows the influential power physicians have on social media and the need for increased brachytherapy awareness on platforms such as Instagram. Patients have voiced apprehension to pursue radiation due to lack of information provided and fear of the unknown. With this concern in mind, physicians are responsible to increase the availability of knowledge to patients in a more relaxed environment than the clinic. With increased physician social media presence, patients will have another avenue for support and reliable source of treatment information.
Collapse
|
23
|
Shalgunov V, Engudar G, Bohrmann L, Wharton L, Maskell K, Johann K, Barz M, Schaffer P, Herth MM, Radchenko V. Radiolabeling of a polypeptide polymer for intratumoral delivery of alpha-particle emitter, 225Ac, and beta-particle emitter, 177Lu. Nucl Med Biol 2021; 104-105:11-21. [PMID: 34839209 DOI: 10.1016/j.nucmedbio.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/22/2021] [Accepted: 11/08/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Radiotherapy of cancer requires both alpha- and beta-particle emitting radionuclides, as these radionuclide types are efficient at destroying different types of tumors. Both classes of radionuclides require a vehicle, such as an antibody or a polymer, to be delivered and retained within the tumor. Polyglutamic acid (pGlu) is a polymer that has proven itself effective as a basis of drug-polymer conjugates in the clinic, while its derivatives have been used for pretargeted tumor imaging in a research setup. trans-Cyclooctene (TCO) modified pGlu is suitable for pretargeted imaging or therapy, as well as for intratumoral radionuclide therapy. In all cases, it becomes indirectly radiolabeled via the bioorthogonal click reaction with the tetrazine (Tz) molecule carrying the radionuclide. In this study, we report the radiolabeling of TCO-modified pGlu with either lutetium-177 (177Lu), a beta-particle emitter, or actinium-225 (225Ac), an alpha-particle emitter, using the click reaction between TCO and Tz. METHODS A panel of Tz derivatives containing a metal ion binding chelator (DOTA or macropa) connected to the Tz moiety directly or through a polyethylene glycol (PEG) linker was synthesized and tested for their ability to chelate 177Lu and 225Ac, and click to pGlu-TCO. Radiolabeled 177Lu-pGlu and 225Ac-pGlu were isolated by size exclusion chromatography. The retention of 177Lu or 225Ac by the obtained conjugates was investigated in vitro in human serum. RESULTS All DOTA-modified Tzs efficiently chelated 177Lu resulting in average radiochemical conversions (RCC) of >75%. Isolated radiochemical yields (RCY) for 177Lu-pGlu prepared from 177Lu-Tzs ranged from 31% to 55%. TLC analyses detected <5% unchelated 177Lu for all 177Lu-pGlu preparations over six days in human serum. For 225Ac chelation, optimized RCCs ranged from 61 ± 34% to quantitative for DOTA-Tzs and were quantitative for the macropa-modified Tz (>98%). Isolated radiochemical yields (RCY) for 225Ac-pGlu prepared from 225Ac-Tzs ranged from 28% to 51%. For 3 out of 5 225Ac-pGlu conjugates prepared from DOTA-Tzs, the amount of unchelated 225Ac stayed below 10% over six days in human serum, while 225Ac-pGlu prepared from macropa-Tz showed a steady release of up to 37% 225Ac. CONCLUSION We labeled TCO-modified pGlu polymers with alpha- and beta-emitting radionuclides in acceptable RCYs. All 177Lu-pGlu preparations and some 225Ac-pGlu preparations showed excellent stability in human plasma. Our work shows the potential of pGlu as a vehicle for alpha- and beta-radiotherapy of tumors and demonstrated the usefulness of Tz ligation for indirect radiolabeling.
Collapse
Affiliation(s)
- Vladimir Shalgunov
- Department for Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen, Denmark
| | - Gokce Engudar
- Life Sciences Division, TRIUMF, 4004 Wesbrook Mall, Vancouver, BC V6T 2A3, Canada
| | - Lennart Bohrmann
- Department for Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen, Denmark; Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada
| | - Luke Wharton
- Life Sciences Division, TRIUMF, 4004 Wesbrook Mall, Vancouver, BC V6T 2A3, Canada; Medicinal Inorganic Chemistry Group, Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, BC V6T 1Z, Canada
| | - Keiran Maskell
- Life Sciences Division, TRIUMF, 4004 Wesbrook Mall, Vancouver, BC V6T 2A3, Canada; Department of Chemistry, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 0A7, Canada
| | - Kerstin Johann
- Department of Chemistry, Johannes Gutenberg University, Duesbergweg 10-14, 55128 Mainz, Germany
| | - Matthias Barz
- Department of Chemistry, Johannes Gutenberg University, Duesbergweg 10-14, 55128 Mainz, Germany; Division of Biotherapeutics, Leiden Academic Center for Drug Research (LACDR), Einsteinweg 55, 2333CC Leiden, the Netherlands
| | - Paul Schaffer
- Life Sciences Division, TRIUMF, 4004 Wesbrook Mall, Vancouver, BC V6T 2A3, Canada; Department of Chemistry, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 0A7, Canada; Department of Radiology, University of British Columbia, 2775 Lauret St, Vancouver, BC V5Z 1M9, Canada
| | - Matthias M Herth
- Department for Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Valery Radchenko
- Life Sciences Division, TRIUMF, 4004 Wesbrook Mall, Vancouver, BC V6T 2A3, Canada; Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, BC V6T 1Z, Canada.
| |
Collapse
|
24
|
Zhang J, Yang L, Huang F, Zhao C, Liu J, Zhang Y, Liu J. Multifunctional Hybrid Hydrogel Enhanced Antitumor Therapy through Multiple Destroying DNA Functions by a Triple-Combination Synergistic Therapy. Adv Healthc Mater 2021; 10:e2101190. [PMID: 34382378 DOI: 10.1002/adhm.202101190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/03/2021] [Indexed: 11/06/2022]
Abstract
Brachytherapy, as an effective setting for precise cancer therapy in clinic, can lead to serious DNA damage. However, its therapeutic efficacy is always limited by the DNA self-repair property, tumor hypoxia-associated radiation resistance as well as inhomogeneous distribution of the radioactive material. Herein, a multifunctional hybrid hydrogel (131 I-hydrogel/DOX/GNPs aggregates) is developed by loading gold nanoparticle aggregates (GNPs aggregates) and DOX into a radionuclide iodine-131 (131 I) labelled polymeric hydrogels (131 I-PEG-P(Tyr)8 ) for tumor destruction by completely damaging DNA self-repair functions. This hybrid hydrogel exhibits excellent photothermal/radiolabel stability, biocompatibility, and fluorescence/photothermal /SPECT imaging properties. After local injection, the sustained releasing DOX within tumor greatly inhibits the DNA replication. Meanwhile, GNPs aggregates as a radiosensitizer and photosensitizer show a significant improvement of brachytherapeutic efficacy and cause serious DNA damage. Simultaneously, GNPs aggregates induce mild photothermal therapy under 808 nm laser irradiation, which not only inhibits self-repair of the damaged DNA but also effectively relieves tumor hypoxic condition to enhance the therapeutic effects of brachytherapy, leading to a triple-synergistic destruction of DNA functions. Therefore, this study provides a highly efficient tumor synergistic therapy platform and insight into the synergistic antitumor mechanism in DNA level.
Collapse
Affiliation(s)
- Jiamin Zhang
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs Chinese Academy of Medical Sciences and Institute of Radiation Medicine Chinese Academy of Medical Sciences and Peking Union Medical College Tianjin 300192 P. R. China
| | - Lijun Yang
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs Chinese Academy of Medical Sciences and Institute of Radiation Medicine Chinese Academy of Medical Sciences and Peking Union Medical College Tianjin 300192 P. R. China
| | - Fan Huang
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs Chinese Academy of Medical Sciences and Institute of Radiation Medicine Chinese Academy of Medical Sciences and Peking Union Medical College Tianjin 300192 P. R. China
| | - Cuicui Zhao
- Department of VIP Ward Tianjin Medical University Cancer Institute and Hospital National Clinical Research Center for Cancer Tianjin's Clinical Research Center for Cancer Key Laboratory of Cancer Prevention and Therapy Key Laboratory of Breast Cancer Prevention and Therapy Tianjin Medical University Ministry of Education Tianjin 300060 P. R. China
| | - Jinjian Liu
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs Chinese Academy of Medical Sciences and Institute of Radiation Medicine Chinese Academy of Medical Sciences and Peking Union Medical College Tianjin 300192 P. R. China
| | - Yumin Zhang
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs Chinese Academy of Medical Sciences and Institute of Radiation Medicine Chinese Academy of Medical Sciences and Peking Union Medical College Tianjin 300192 P. R. China
| | - Jianfeng Liu
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs Chinese Academy of Medical Sciences and Institute of Radiation Medicine Chinese Academy of Medical Sciences and Peking Union Medical College Tianjin 300192 P. R. China
| |
Collapse
|
25
|
Yuan FK, Fu YF, Shi YB, Yang N. Radioactive Seed Strand Efficacy in Superior Vena Cava Stenting Due to Non-small-cell Lung Cancer Obstruction. Vasc Endovascular Surg 2021; 56:173-179. [PMID: 34704875 DOI: 10.1177/15385744211054300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aims to determine the clinical effectiveness of a stent with radioactive seed strand (RSS) inserted in patients with superior vena cava (SVC) obstruction (SVCO) secondary to non-small-cell lung cancer (NSCLC). METHODS Between January 2013 and December 2019, 63 patients with SVCO related to NSCLC received stent implantation with (n = 30) or without (n = 33) RSS insertion at our center. The clinical efficacy, stent patency duration, and overall survival (OS) were compared between these two groups. RESULTS Both groups achieved 100% clinical and technical success rates. There were no obstacles associated with the procedure performed for the patients. Two patients in the RSS group and 7 patients in the stent-alone group experienced stent re-stenosis. The rate of re-stenosis between the two groups was not significantly different (P = .099). Patients in the RSS group had significantly longer median patency than those in the stent-alone group (381 vs 309 days, P = .045). All patients died because of the development of tumors during the follow-up. Patients in the RSS group had a significantly longer median OS than those in the stent-alone group (229 vs 178 days, P = .026). During the follow-up, no patient in the RSS group suffered RSS migration or brachytherapy-related complications. CONCLUSION For patients with SVCO secondary to NSCLC, a stent with RSS insertion is efficacious and safe, and it may improve stent patency and OS.
Collapse
Affiliation(s)
- Fu-Kang Yuan
- Department of Vascular Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Yu-Fei Fu
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Yi-Bing Shi
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Ning Yang
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| |
Collapse
|
26
|
Wei S, Li C, Li M, Xiong Y, Jiang Y, Sun H, Qiu B, Lin CJ, Wang J. Radioactive Iodine-125 in Tumor Therapy: Advances and Future Directions. Front Oncol 2021; 11:717180. [PMID: 34660280 PMCID: PMC8514864 DOI: 10.3389/fonc.2021.717180] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022] Open
Abstract
Radioactive iodine-125 (I-125) is the most widely used radioactive sealed source for interstitial permanent brachytherapy (BT). BT has the exceptional ability to deliver extremely high doses that external beam radiotherapy (EBRT) could never achieve within treated lesions, with the added benefit that doses drop off rapidly outside the target lesion by minimizing the exposure of uninvolved surrounding normal tissue. Spurred by multiple biological and technological advances, BT application has experienced substantial alteration over the past few decades. The procedure of I-125 radioactive seed implantation evolved from ultrasound guidance to computed tomography guidance. Compellingly, the creative introduction of 3D-printed individual templates, BT treatment planning systems, and artificial intelligence navigator systems remarkably increased the accuracy of I-125 BT and individualized I-125 ablative radiotherapy. Of note, utilizing I-125 to treat carcinoma in hollow cavity organs was enabled by the utility of self-expandable metal stents (SEMSs). Initially, I-125 BT was only used in the treatment of rare tumors. However, an increasing number of clinical trials upheld the efficacy and safety of I-125 BT in almost all tumors. Therefore, this study aims to summarize the recent advances of I-125 BT in cancer therapy, which cover experimental research to clinical investigations, including the development of novel techniques. This review also raises unanswered questions that may prompt future clinical trials and experimental work.
Collapse
Affiliation(s)
- Shuhua Wei
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Chunxiao Li
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Mengyuan Li
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Yan Xiong
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Bin Qiu
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | | | - Junjie Wang
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| |
Collapse
|
27
|
Chen W, Luo YK, Zhang Y, Song Q, Tang J. Ultrasound-guided implantation of radioactive 125I seed in radioiodine refractory differentiated thyroid carcinoma. BMC Cancer 2021; 21:834. [PMID: 34284748 PMCID: PMC8290620 DOI: 10.1186/s12885-021-08500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment for radioiodine refractory differentiated thyroid carcinoma (RR-DTC) is challenging. The purpose of this study was to assess the efficacy and safety of ultrasound-guided implantation of radioactive 125I-seed in radioiodine refractory differentiated thyroid carcinoma. METHODS Thirty-six cervical metastatic lymph nodes (CMLNs) diagnosed with RR-DTC from 18 patients were enrolled in this retrospective study. US and contrast-enhanced ultrasound (CEUS) examinations were performed before implantation. Follow-up comprised US, CEUS, thyroglobulin (Tg) level and routine hematology at 1-3, 6, 9 and 12 months and every 6 months thereafter. The volumes of the nodules were compared before implantation and at each follow-up point. The volume reduction rate (VRR) of nodules was also recorded. RESULTS The median volume of the nodules was 523 mm3 (148, 2010mm3) initially, which decreased significantly to 53mm3 (0, 286mm3) (P < 0.01) at the follow-up point of 24 months with a median VRR as 95% (86,100%). During the follow-up period (the range was 24-50 months), 25 (69%) nodules had VRR greater than 90%, of which 12 (33%) nodules had VVR ≈ 100% with unclear structures and only 125I seed images were visible in the US. At the last follow-up visit, the serum Tg level decreased from 57.0 (8.6, 114.8) ng/ml to 4.9 (0.7, 50.3) ng/ml, (P < 0.01). CONCLUSION US-guided 125I seed implantation is safety and efficacy in treating RR- DTC. It could be an effective supplement for the comprehensive treatment of thyroid cancer.
Collapse
Affiliation(s)
- Wei Chen
- Department of Ultrasound, The Seventh Medical Center, Medical College of PLA, Chinese PLA General Hospital, Beijing, China
| | - Yu Kun Luo
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
| | - Ying Zhang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qing Song
- Department of Ultrasound, The Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jie Tang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
28
|
Xue H, Qiu B, Wang H, Jiang P, Sukocheva O, Fan R, Xue L, Wang J. Stereotactic Ablative Brachytherapy: Recent Advances in Optimization of Radiobiological Cancer Therapy. Cancers (Basel) 2021; 13:cancers13143493. [PMID: 34298703 PMCID: PMC8304109 DOI: 10.3390/cancers13143493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023] Open
Abstract
Brachytherapy (BT), a type of focal anti-cancer radiotherapy, delivers a highly focused radiation dose to localized tumors, sparing surrounding normal tissues. Recent technological advances have helped to increase the accuracy of BT and, thus, improve BT-based cancer treatment. Stereotactic ablative brachytherapy (SABT) was designed to improve the ablative effect of radiation, which was achieved via improved image guidance, and calculation of ablative dose, shorter treatment duration, and better organ preservation. Recently collected data characterized SABT as having the potential to cure various early-stage cancers. The method provides higher tumor control rate levels that were previously achievable only by surgical resection. Notably, SABT is suitable for application with unresectable malignancies. However, the pathological assessment of SABT irradiated tumors is limited due to difficulties in specimen acquisition. Prostate, lung, liver, and gynecological cancers are the most commonly reported SABT-treated malignancies. This study will give an overview of SABT, focusing on the advances in SABT optimization, and provide insights on the future benefits of the combined application of SABT with cancer immunotherapies.
Collapse
Affiliation(s)
- Hui Xue
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
| | - Bin Qiu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
| | - Hao Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
| | - Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
| | - Olga Sukocheva
- Discipline of Health Sciences, College of Nursing and Health Sciences, Flinders University of South Australia, Bedford Park, SA 5042, Australia;
| | - Ruitai Fan
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China;
| | - Lixiang Xue
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
- Correspondence: (L.X.); (J.W.); Tel.: +86-13701076310 (L.X.); +86-13701076310 (J.W.)
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
- Correspondence: (L.X.); (J.W.); Tel.: +86-13701076310 (L.X.); +86-13701076310 (J.W.)
| |
Collapse
|
29
|
Facondo G, Vullo G, DE Sanctis V, Valeriani M, Ascolese AM, Massaro M, Anzellini D, Osti MF. Stereotactic Body Radiation Therapy Boost in Patients With Cervical Cancer Ineligible for Brachytherapy. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:53-60. [PMID: 35403131 PMCID: PMC8962763 DOI: 10.21873/cdp.10008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 04/13/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Standard treatment for locally advanced cervical cancer is external beam radiotherapy followed by brachytherapy (BT). Stereotactic body radiation therapy (SBRT) is a possible option for treating patients ineligible for BT. PATIENTS AND METHODS From October 2012 to July 2020, nine women with cervical cancer received SBRT to high-risk volumes. The Kaplan-Meier method was used to estimate the rates of overall and disease-free survival. RESULTS The median age was 52 years; 88% of patients had squamous carcinoma. Reasons for forgoing BT were cervical canal stenosis, treatment refusal and hematological disease. The median boost dose was 18 Gy and the median dose per fraction was 6 Gy. Median follow-up was 16 months. The median survival was 24 months, the actuarial 2-year OS rate was 70%, and median disease-free survival was 11 months. One grade 3 late vaginal toxicity was reported. No acute nor late grade 4 toxicities were observed. CONCLUSION SBRT boost in patients with cervical cancer ineligible for BT led to acceptable survival outcomes and a safe toxicity profile.
Collapse
Affiliation(s)
- Giuseppe Facondo
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Gianluca Vullo
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Vitaliana DE Sanctis
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Maurizio Valeriani
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Anna Maria Ascolese
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Maria Massaro
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Dimitri Anzellini
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Mattia Falchetto Osti
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| |
Collapse
|
30
|
Zhou Z, Yang Z, Jiang S, Ma X, Zhang F, Yan H. Surgical Navigation System for Low-Dose-Rate Brachytherapy Based on Mixed Reality. IEEE COMPUTER GRAPHICS AND APPLICATIONS 2021; 41:113-123. [PMID: 31902757 DOI: 10.1109/mcg.2019.2963657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article presents a personalized mixed reality (MR) surgical assistance system for brachytherapy. Using a novel, modified multi-information fusion method, the fusion of virtual organs and a preoperative plan for an actual patient and the real-time tracking of surgical tools were achieved. Using the quaternion-based iterative closest point (QICP) algorithm and a hand-eye calibration method, the preoperative plan can be fused into individual patients. Using the electromagnetic (EM) tracker, users can track the surgery tools in real time, without multiple CT scans, and doctors can immediately perform the surgery. We performed a series of experiments, including phantom and animal experiments, to test the accuracy and efficiency of the system. In the phantom experiment, the average needle location error was 0.957 mm. Based on the results of animal experiments, the needle insertion error was 2.416 mm. All experimental results indicated that the procedure could be applied in further clinical studies.
Collapse
|
31
|
Makvandi P, Baghbantaraghdari Z, Zhou W, Zhang Y, Manchanda R, Agarwal T, Wu A, Maiti TK, Varma RS, Smith BR. Gum polysaccharide/nanometal hybrid biocomposites in cancer diagnosis and therapy. Biotechnol Adv 2021; 48:107711. [PMID: 33592279 DOI: 10.1016/j.biotechadv.2021.107711] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/26/2020] [Accepted: 02/02/2021] [Indexed: 12/26/2022]
Abstract
Biopolymers are of prime importance among which gum polysaccharides hold an eminent standing owing to their high availability and non-toxic nature. Gum biopolymers offer a greener alternative to synthetic polymers and toxic chemicals in the synthesis of metal nanostructures. Metal nanostructures accessible via eco-friendly means endow astounding characteristics to gum-based biocomposites in the field of diagnosis and therapy towards cancer diseases. In this review, assorted approaches for the assembly of nanomaterials mediated by gum biopolymers are presented and their utility in cancer diagnosis and therapy, e.g., bioimaging, radiotherapy, and phototherapy, are deliberated to provide a groundwork for future stimulative research.
Collapse
Affiliation(s)
- Pooyan Makvandi
- Istituto Italiano di Tecnologia, Center for Materials Interface, Pontedera 56025, Pisa, Italy.
| | - Zahra Baghbantaraghdari
- Department of Chemical, Materials & Industrial Production Engineering, University of Naples Federico II, Naples 80125, Italy
| | - Wenxian Zhou
- Department of Orthopaedics, Zhejiang Provincial Key Laboratory of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Yapei Zhang
- Department of Biomedical Engineering, Institute for Quantitative Health Science & Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - Romila Manchanda
- Department of Biomedical Engineering, Institute for Quantitative Health Science & Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - Tarun Agarwal
- Department of Biotechnology, Indian Institute of Technology, Kharagpur 721302, India
| | - Aimin Wu
- Department of Orthopaedics, Zhejiang Provincial Key Laboratory of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Tapas Kumar Maiti
- Department of Biotechnology, Indian Institute of Technology, Kharagpur 721302, India
| | - Rajender S Varma
- Regional Centre of Advanced Technologies and Materials (RCPTM), Palacky University, Olomouc, Šlechtitelů 11, 783 71, Olomouc, Czech Republic.
| | - Bryan Ronain Smith
- Department of Biomedical Engineering, Institute for Quantitative Health Science & Engineering, Michigan State University, East Lansing, MI 48824, USA; Department of Radiology and the Molecular Imaging Program, Stanford University, Stanford, CA, 94305, USA.
| |
Collapse
|
32
|
Abstract
Malignant biliary obstruction (MBO), result of pancreatobiliary diseases is a challenging condition. Most patients with MBO are inoperable at the time of diagnosis, and the disease is poorly controlled using external-beam radiotherapy and chemotherapy. Biliary stent therapy emerged as a promising strategy for alleviating MBO and prolonging life. However, physicians find it difficult to determine the optimal type of biliary stent for the palliation of MBO. Here, we review the safety and efficacy of available biliary stents, used alone or in combination with brachytherapy, photodynamic therapy and advanced chemotherapeutics, in patients with pancreatobiliary malignancies and put forward countermeasures involving stent obstruction. Furthermore, 3D-printing stents and nanoparticle-loaded stents have broad application prospects for fabricating tailor-made biliary stents.
Collapse
|
33
|
Feasibility and early toxicity of focal or partial brachytherapy in prostate cancer patients. J Contemp Brachytherapy 2020; 12:420-426. [PMID: 33299430 PMCID: PMC7701917 DOI: 10.5114/jcb.2020.100374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/03/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of this study was to compare short-term oncologic outcomes and toxicity of focal or partial low-dose-rate brachytherapy (focal/partial LDR-BT) with whole gland low-dose-rate brachytherapy (whole LDR-BT) in localized prostate cancer patients. Material and methods Medical records of eligible patients who underwent focal/partial LDR-BT and whole LDR-BT between 2015 and 2017 at our institution were reviewed retrospectively. Clinical characteristics and pathologic outcomes were compared between focal/partial LDR-BT group and whole LDR-BT group. Biochemical recurrence-free survival was analyzed using Kaplan-Meier method and difference between two groups was assessed with log-rank test. Genitourinary and rectal toxicity were also evaluated between the two groups. Results Of the 60 patients analyzed, 30 focal/partial LDR-BT patients and 30 whole LDR-BT brachytherapy patients were included. Relative to the whole LDR-BT group, the focal/partial LDR-BT group had significantly higher initial PSA level (p = 0.002), smaller number of implanted seeds (p < 0.001), and shorter follow-up duration (p < 0.001). There was no significant difference between the two groups with regard to prostate volume, biopsy Gleason score, and risk group stratification. The 3-year biochemical recurrence-free survival estimates for focal/partial LDR-BT group and whole LDR-BT group were 91.8% and 89.6%, respectively, which was not significantly different (p = 0.554). Genitourinary symptoms were significantly worse in whole LDR-BT group than in focal/partial LDR-BT group. The incidence of rectal toxicity was similar between two groups. Conclusions Our findings indicate that the focal/partial LDR-BT is comparable to the whole LDR-BT with respect to short-term biochemical recurrence and toxicities.
Collapse
|
34
|
Wang X, Wang P, Tang B, Kang S, Hou Q, Wu Z, Gou C, Li L, Orlandini L, Lang J, Li J. An Inverse Dose Optimization Algorithm for Three-Dimensional Brachytherapy. Front Oncol 2020; 10:564580. [PMID: 33194640 PMCID: PMC7606999 DOI: 10.3389/fonc.2020.564580] [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: 05/22/2020] [Accepted: 09/30/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To investigate an implementation method and the results of an inverse dose optimization algorithm, Gradient Based Planning Optimization (GBPO), for three-dimensional brachytherapy. METHODS The GBPO used a quadratic objective function, and a dwell time modulation item was added to the objective function to restrict the dwell time variance. We retrospectively studied 4 cervical cancer patients using different applicators and 15 cervical cancer patients using the Fletcher applicator. We assessed the plan quality of GBPO by isodose lines for the patients using different applicators. For the 15 patients using the Fletcher applicator, we utilized dose-volume histogram (DVH) parameters of HR-CTV (D100%, V150%) and organs at risk (OARs) (D0.1cc, D1cc, D2cc) to evaluate the difference between the GBPO plans and the IPSA (Inverse Planning Simulated Annealing) plans, as well as the GBPO plans and the Graphic plans. RESULTS For the 4 patients using different applicators, the dose distributions are conformable. For the 15 patients using the Fletcher applicator, when the dwell time modulation factor (DTMF) is less than 20, the dwell time deviation reduces quickly; however, after the DTMF increased to 100, the dwell time deviation has no remarkable change. The difference in dosimetric parameters between the GBPO plans and the IPSA plans is not statistically significant (P>0.05). The GBPO plans have a higher D100% (3.57 ± 0.36, 3.38 ± 0.34; P<0.01) and a lower V150% (55.73 ± 4.06, 57.75 ± 3.79; P<0.01) than those of the Graphic plans. The differences in other DVH parameters are negligible between the GBPO plans and the Graphic plans. CONCLUSIONS The GBPO plans have a comparable quality as the IPSA plans and the Graphic plans for the studied cervical cancer cases. The GBPO algorithm could be integrated into a three-dimensional brachytherapy treatment planning system after studying more sites.
Collapse
Affiliation(s)
- Xianliang Wang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory Of Sichuan Province, Chengdu, China
| | - Pei Wang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory Of Sichuan Province, Chengdu, China
| | - Bin Tang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory Of Sichuan Province, Chengdu, China
| | - Shengwei Kang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory Of Sichuan Province, Chengdu, China
| | - Qing Hou
- Key Laboratory of Radiation Physics and Technology, Institute of Nuclear Science and Technology, Sichuan University, Chengdu, China
| | - Zhangwen Wu
- Key Laboratory of Radiation Physics and Technology, Institute of Nuclear Science and Technology, Sichuan University, Chengdu, China
| | - Chengjun Gou
- Key Laboratory of Radiation Physics and Technology, Institute of Nuclear Science and Technology, Sichuan University, Chengdu, China
| | - Lintao Li
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory Of Sichuan Province, Chengdu, China
| | - Lucia Orlandini
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory Of Sichuan Province, Chengdu, China
| | - Jinyi Lang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory Of Sichuan Province, Chengdu, China
| | - Jie Li
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory Of Sichuan Province, Chengdu, China
| |
Collapse
|
35
|
Zeng Y, Hu C, Shu L, Pan Y, Zhao L, Pu X, Wu F. Clinical treatment options for early-stage and advanced conjunctival melanoma. Surv Ophthalmol 2020; 66:461-470. [PMID: 32980421 DOI: 10.1016/j.survophthal.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/13/2022]
Abstract
Conjunctival melanoma (CM) is an ocular malignant tumor arising from the bulbar and palpebral conjunctiva and from the caruncle. The treatment of early-stage CM is wide local excision, followed by cryotherapy to the margins and adjuvant therapy postoperatively. Advanced CM has a poor prognosis, and there is no consensus on its management. With the development of precision medicine, the identification of genetic alterations assumes great importance. The genetic characteristics of CM, such as BRAF, NRAS, and NF1 mutations, may provide potential therapeutic targets. For locally advanced tumors and metastatic disease, targeted therapy such as BRAF inhibitors and MEK inhibitors in vitro show therapeutic benefit. Some individual case reports indicate their potential effectiveness in advanced CM. In addition, immune checkpoint inhibitors, such as programmed cell death-1 and cytotoxic T lymphocyte antigen-4 inhibitors, have been successfully used for advanced cutaneous melanoma and may be effective in CM. Limited clinical case reports found immune checkpoint inhibitors effective in advanced CM. More clinical studies are needed.
Collapse
Affiliation(s)
- Yue Zeng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chunhong Hu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Long Shu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yue Pan
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lishu Zhao
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xingxiang Pu
- Department of Thoracic Medical Oncology, Hunan Cancer Hospital/the affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Fang Wu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| |
Collapse
|
36
|
Liu J, Zhang Y, Li Q, Feng Z, Huang P, Wang W, Liu J. Development of injectable thermosensitive polypeptide hydrogel as facile radioisotope and radiosensitizer hotspot for synergistic brachytherapy. Acta Biomater 2020; 114:133-145. [PMID: 32688087 DOI: 10.1016/j.actbio.2020.07.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 01/02/2023]
Abstract
Brachytherapy is considered to be an unparalleled form of conformal radiation therapy, which involves the delivery of radiation directly to tumor lesions or the postoperative cavity. With the development of specific applicators, the exploitation of in situ drug-delivery platform introduces opportunities for the synchronous administration of radiosensitizers. In this study, an iodine-131 (I131)-labeled injectable thermosensitive methoxy poly(ethylene glycol)-b-poly(tyrosine) hydrogel (denoted as PETyr-I131) was developed via a facile method. The radioactive source of I131 was immobilized at the subcutaneous injection site and monitored via single-photon emission computed tomography in real time, and hematological and histopathological analyses revealed no obvious side effects. Additionally, the SmacN7 peptide conjugated with cell membrane-permeable oligosarginine (denoted as SmacN7-R9) was used to enhance the radiosensitivity of cancer cells, as confirmed by the results of reactive oxygen species detection, DNA damage assay, cell apoptosis assay, and clonogenic evaluation. Importantly, a synergistic brachytherapy treatment effect on tumor-bearing nude mice was achieved. The proposed thermosensitive supramolecular hydrogel platform, which conformally immobilizes radionuclides and delivers radiosensitizers by virtue of its proximity to the site of the primary tumor or the postoperative cavity, has great potential for achieving synergistic treatment outcomes with reduced radiation-related side effects. STATEMENT OF SIGNIFICANCE: In this work, a kind of radioiodinated thermosensitive supramolecular hydrogel was developed, which was facilely used as the radioactive source for brachytherapy. Meanwhile, SmacN7-R9 peptide was combined as a model radiosensitizer to facilitate the activation of tumor cell apoptosis pathways and promotion of radiation-induced cytotoxicity. Synergistic brachytherapy outcomes were achieved from the in vitro and in vivo evaluations. Therefore, from the practical standpoint, this thermosensitive supramolecular hydrogel platform holds great potential for the 3D-conformally immobilizing radionuclide and delivering radiosensitizer by virtue of its proximity to the site of primary tumor lesions or postoperative cavity, resulting in synergetic treatment outcomes with reduced radiation associated side effects.
Collapse
|
37
|
Kanani A, Owrangi AM, Mosleh-Shirazi MA. Comprehensive methodology for commissioning modern 3D-image-based treatment planning systems for high dose rate gynaecological brachytherapy: A review. Phys Med 2020; 77:21-29. [PMID: 32768917 DOI: 10.1016/j.ejmp.2020.07.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/19/2020] [Accepted: 07/28/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Correct commissioning of treatment planning systems (TPSs) is important for reducing treatment failure events. There is currently no comprehensive and robust methodology available for TPS commissioning in modern brachytherapy. This review aimed to develop a comprehensive template for commissioning modern 3D-image-based brachytherapy TPSs for high dose rate (HDR) gynaecological applications. METHODS The literature relevant to TPS commissioning, including both external beam radiation therapy (EBRT) and brachytherapy, as well as guidelines by the International Atomic Energy Agency (IAEA), the American Association of Physicists in Medicine (AAPM), and the European Society for Radiotherapy and Oncology (ESTRO) were searched, studied and appraised. The applied relevant EBRT TPS commissioning tests were applied to brachytherapy. The developed template aimed to cover all dosimetric and non-dosimetric issues. RESULTS The essential commissioning items could be categorized into six parts: geometry, dose calculation, plan evaluation tools, plan optimization, TPS output, and end-to-end verification. The final template consists of 43 items. This paper presents the purpose and role of each test, as well as tolerance limits, to facilitate the use of the template. CONCLUSION The information and recommendations available in a collection of publications over many years have been reviewed in order to develop a comprehensive template for commissioning complex modern 3D-image-based brachytherapy TPSs for HDR gynaecological applications. The up-to-date and concise information contained in the template can aid brachytherapy physicists during TPS commissioning as well as devising a regular quality assurance program and allocation of time and resources.
Collapse
Affiliation(s)
- Abolfazl Kanani
- Ionizing and Non-Ionizing Radiation Protection Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir M Owrangi
- Department of Radiation Oncology, UT Southwestern Medical Center, 2280 Inwood Rd, EC2.242, Dallas, TX 75235, USA
| | - Mohammad Amin Mosleh-Shirazi
- Ionizing and Non-Ionizing Radiation Protection Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Physics Unit, Department of Radio-oncology, School of Medicine, Shiraz University of Medical Sciences, Shiraz 71936-13311, Iran.
| |
Collapse
|
38
|
Reuvers TGA, Kanaar R, Nonnekens J. DNA Damage-Inducing Anticancer Therapies: From Global to Precision Damage. Cancers (Basel) 2020; 12:E2098. [PMID: 32731592 PMCID: PMC7463878 DOI: 10.3390/cancers12082098] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 12/11/2022] Open
Abstract
DNA damage-inducing therapies are of tremendous value for cancer treatment and function by the direct or indirect formation of DNA lesions and subsequent inhibition of cellular proliferation. Of central importance in the cellular response to therapy-induced DNA damage is the DNA damage response (DDR), a protein network guiding both DNA damage repair and the induction of cancer-eradicating mechanisms such as apoptosis. A detailed understanding of DNA damage induction and the DDR has greatly improved our knowledge of the classical DNA damage-inducing therapies, radiotherapy and cytotoxic chemotherapy, and has paved the way for rational improvement of these treatments. Moreover, compounds targeting specific DDR proteins, selectively impairing DNA damage repair in cancer cells, form a promising novel therapy class that is now entering the clinic. In this review, we give an overview of the current state and ongoing developments, and discuss potential avenues for improvement for DNA damage-inducing therapies, with a central focus on the role of the DDR in therapy response, toxicity and resistance. Furthermore, we describe the relevance of using combination regimens containing DNA damage-inducing therapies and how they can be utilized to potentiate other anticancer strategies such as immunotherapy.
Collapse
Affiliation(s)
- Thom G. A. Reuvers
- Department of Molecular Genetics, Erasmus MC, Dr. Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands; (T.G.A.R.); (R.K.)
- Department of Radiology and Nuclear Medicine, Erasmus MC, Dr. Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Roland Kanaar
- Department of Molecular Genetics, Erasmus MC, Dr. Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands; (T.G.A.R.); (R.K.)
- Oncode Institute, Office Jaarbeurs Innovation Mile (JIM), Jaarbeursplein 6, 3561 AL Utrecht, The Netherlands
| | - Julie Nonnekens
- Department of Molecular Genetics, Erasmus MC, Dr. Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands; (T.G.A.R.); (R.K.)
- Department of Radiology and Nuclear Medicine, Erasmus MC, Dr. Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands
- Oncode Institute, Office Jaarbeurs Innovation Mile (JIM), Jaarbeursplein 6, 3561 AL Utrecht, The Netherlands
| |
Collapse
|
39
|
Salembier C, De Hertogh O, Daisne JF, Palumbo S, Van Gestel D. Brachytherapy in Belgium in 2018. A national survey of the brachytherapy study group of the Belgian SocieTy for Radiotherapy and Oncology (BeSTRO). Radiother Oncol 2020; 150:245-252. [PMID: 32679309 DOI: 10.1016/j.radonc.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/01/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To explore the current practices patterns and evaluate the actual brachytherapy (BT) resources in Belgium. MATERIAL AND METHODS In 2019, the Brachytherapy Study Group proposed to conduct a survey on behalf of the Belgian SocieTy of Radiation Oncology (BeSTRO) in order to identify current BT practice patterns. An electronic questionnaire was sent to all primary radiotherapy centers in Belgium. This questionnaire was based on the questionnaire that was used by the Italian Association of Radiation Oncology (AIRO) in 2016, asking for: (a) General information on the Radiation Oncology Centre; (b) BT equipment and human resources; (c) BT procedures; (d) BT assessment (number of patients treated annually, treated sites, and different modalities of treatments). RESULTS All 24 radiation oncology centers (100% response rate) answered the questionnaire and gave also information on the performance of brachytherapy in their (eventual) satellite centers. Eighteen (18) BT afterloader units were installed and operational in 2018. Thirteen centers mentioned a prostate seed implant program, one center a prostate and eye plaque program and one center only an eye plaque program. Less than 50% of centers have the infrastructure to offer the full-range of BT in their own department. In 2018, 1486 patients received a BT-treatment, 28% of them were treated by prostate seed implant, 8% were treated by eye-(seed) BT and 64% by high dose rate (HDR)/pulsed dose rate (PDR) BT. Forty-five percent of HDR/PDR patients were treated by vaginal dome BT, 22% by intra-uterine BT, 11% by skin BT, 10% by breast BT (almost exclusively in one centre), 8% for benign pathology (keloid) and the remaining 4% were treated for prostate (as a boost or as salvage in one centre), anal, penile, lung or oesophageal cancer. CONCLUSIONS Belgian radiotherapy departments often perform BT only in a (highly) selected group of pathologies, resulting in a limited number of patients treated by this technique despite the sufficient availability of BT equipment. Modern indications are often not covered, hence patients do not have regular access to recognized treatment options, possibly leading to inferior oncological outcome. BeSTRO will use the results of this survey to stimulate improvements in training, awareness, education, implementation, collaboration and cooperation in the field of brachytherapy.
Collapse
Affiliation(s)
- Carl Salembier
- Department of Radiation Oncology, Europe Hospitals Brussels, Brussels, Belgium.
| | - Olivier De Hertogh
- Department of Radiation Oncology, CHR Verviers East Belgium, Verviers, Belgium
| | | | - Samuel Palumbo
- Department of Radiation Oncology, CHU UCL Namur - Sainte Elisabeth, Namur, Belgium
| | - Dirk Van Gestel
- Department of Radiation Oncology, Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
40
|
Grégoire V, Guckenberger M, Haustermans K, Lagendijk JJW, Ménard C, Pötter R, Slotman BJ, Tanderup K, Thorwarth D, van Herk M, Zips D. Image guidance in radiation therapy for better cure of cancer. Mol Oncol 2020; 14:1470-1491. [PMID: 32536001 PMCID: PMC7332209 DOI: 10.1002/1878-0261.12751] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
The key goal and main challenge of radiation therapy is the elimination of tumors without any concurring damages of the surrounding healthy tissues and organs. Radiation doses required to achieve sufficient cancer-cell kill exceed in most clinical situations the dose that can be tolerated by the healthy tissues, especially when large parts of the affected organ are irradiated. High-precision radiation oncology aims at optimizing tumor coverage, while sparing normal tissues. Medical imaging during the preparation phase, as well as in the treatment room for localization of the tumor and directing the beam, referred to as image-guided radiotherapy (IGRT), is the cornerstone of precision radiation oncology. Sophisticated high-resolution real-time IGRT using X-rays, computer tomography, magnetic resonance imaging, or ultrasound, enables delivery of high radiation doses to tumors without significant damage of healthy organs. IGRT is the most convincing success story of radiation oncology over the last decades, and it remains a major driving force of innovation, contributing to the development of personalized oncology, for example, through the use of real-time imaging biomarkers for individualized dose delivery.
Collapse
Affiliation(s)
- Vincent Grégoire
- Department of Radiation OncologyLéon Bérard Cancer CenterLyonFrance
| | - Matthias Guckenberger
- Department for Radiation OncologyUniversity Hospital ZurichUniversity of ZurichSwitzerland
| | - Karin Haustermans
- Department of Radiation OncologyLeuven Cancer InstituteUniversity Hospital GasthuisbergLeuvenBelgium
| | | | | | - Richard Pötter
- Department of Radiation OncologyMedical UniversityGeneral Hospital of ViennaAustria
| | - Ben J. Slotman
- Department of Radiation OncologyAmsterdam University Medical CentersThe Netherlands
| | - Kari Tanderup
- Department of OncologyAarhus University HospitalDenmark
| | - Daniela Thorwarth
- Section for Biomedical PhysicsDepartment of Radiation OncologyUniversity of TübingenGermany
| | - Marcel van Herk
- Department of Biomedical Engineering and PhysicsCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamThe Netherlands
- Institute of Cancer SciencesUniversity of ManchesterUK
- Department of Radiotherapy Related ResearchThe Christie NHS Foundation TrustManchesterUK
| | - Daniel Zips
- Department of Radiation OncologyUniversity of TübingenGermany
| |
Collapse
|
41
|
Kang SW, Chung JB, Kim KH, Park JY, Park HJ, Cho W, Olberg S, Suh TS, Park JC. Development of Volumetric Independent Dose Calculation System for Verification of the Treatment Plan in Image-Guided Adaptive Brachytherapy. Front Oncol 2020; 10:609. [PMID: 32477931 PMCID: PMC7237701 DOI: 10.3389/fonc.2020.00609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/03/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose: This study aimed to develop a volumetric independent dose calculation (vIDC) system for verification of the treatment plan in image-guided adaptive brachytherapy (IGABT) and to evaluate the feasibility of the vIDC in clinical practice with simulated cases. Methods: The vIDC is based on the formalism of TG-43. Four simulated cases of cervical cancer were selected to retrospectively evaluate the dose distributions in IGABT. Some reference point doses, such as points A and B and rectal points, were calculated by vIDC using absolute coordinate. The 3D dose volume was also calculated to acquire dose-volume histograms (DVHs) with grid resolutions of 1.0 × 1.0 (G1.0), 2.5 × 2.5 (G2.5), and 0.5 × 0.5 mm2 (G0.5). Dosimetric parameters such as D90% and D2cc doses covering 90% of the high-risk critical target volume (HR-CTV) and 2 cc of the organs at risk (OARs) were obtained from DVHs. D90% also converted to equivalent dose in 2-Gy fractions (EQD2) to produce the same radiobiological effect as external beam radiotherapy. In addition, D90% was obtained in two types with or without the applicator volume to confirm the effect of the applicator itself. Validation of the vIDC was also performed using gamma evaluation by comparison with Monte Carlo simulation. Results: The average percentage difference of point doses was <2.28%. The DVHs for the HR-CTV and OARs showed no significant differences between the vIDC and the treatment planning system (TPS). Without considering the applicator volume, the D90% of the HR-CTV calculated by the vIDC decreases with a decreasing calculated dose-grid size (32.4, 5.65, and −2.20 cGy in G2.5, G1.0, and G0.5, respectively). The overall D90% is higher when considering the applicator volume. The converted D90% by EQD2 ranged from −1.29 to 1.00%. The D2cc of the OARs showed that the averaged dose deviation is <10 cGy regardless of the dose-grid size. Based on gamma analysis, the passing rate was 98.81% for 3%/3-mm criteria. Conclusion: The vIDC was developed as an independent dose verification system for verification of the treatment plan in IGABT. We confirmed that the vIDC is suitable for second-check dose validation of the TPS under various conditions.
Collapse
Affiliation(s)
- Sang-Won Kang
- Department of Biomedical Engineering, Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,College of Medicine, Research Institute of Biomedical Engineering, The Catholic University of Korea, Seoul, South Korea
| | - Jin-Beom Chung
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyeong-Hyeon Kim
- Department of Biomedical Engineering, Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,College of Medicine, Research Institute of Biomedical Engineering, The Catholic University of Korea, Seoul, South Korea
| | - Ji-Yeon Park
- Department of Radiation Oncology, University of Florida Health Proton Therapy Institute, Jacksonville, FL, United States
| | - Hae-Jin Park
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, South Korea
| | - Woong Cho
- Department of Radiation Oncology, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sven Olberg
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States.,Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Tae Suk Suh
- Department of Biomedical Engineering, Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,College of Medicine, Research Institute of Biomedical Engineering, The Catholic University of Korea, Seoul, South Korea
| | - Justin C Park
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States.,Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| |
Collapse
|
42
|
Wang W, Fliedner FP, Hansen AE, Eliasen R, Melander F, Kjaer A, Andresen TL, Jensen AI, Henriksen JR. Preclinical evaluation of cationic DOTA-triarginine-lipid conjugates for theranostic liquid brachytherapy. Nanotheranostics 2020; 4:142-155. [PMID: 32483520 PMCID: PMC7256013 DOI: 10.7150/ntno.44562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022] Open
Abstract
Liquid brachytherapy is an emerging technology for internal radiation therapy where liquids containing radionuclides are administered directly into solid tumors. These technologies are less invasive than conventional brachytherapy, and can potentially improve the dose coverage and homogeneity of the radioactivity distribution within the tumor. For this purpose, we have developed a novel cationic micelle system for delivery of a range of radionuclides. The system is applicable for emitters of alpha, beta or photon radiation, and enables dose-mapping via theranostic nuclear imaging. Methods: The cationic micelles were developed as linear surfactants comprising the chelator DOTA, a triarginine sequence and a palmitoyl or stearoyl fatty acid chain. The critical micelle concentration of the surfactants was determined, and the micelles were radiolabelled with 64Cu or 177Lu in high radiochemical purity (>95%). The tumor retention and biodistribution of the 64Cu-radiolabeled surfactants, administered as micelles or formulated in liposomes, were investigated in vivo by PET/CT in a tumor bearing mouse model. Results: The interaction of the micelles with anionic lipid membranes was demonstrated to be favourable, using a liposome partition assay. In vivo, the surfactants formulated both as cationic micelles and liposomes displayed the best intratumoral retention, with micelles providing more homogeneous activity distribution. Conclusion: A cationic, surfactant-based drug delivery system was developed and demonstrated promise as a vehicle for liquid brachytherapy when formulated as micelles or in liposomes. The system enables accurate dosimetry due to the flexible radiochemistry of DOTA.
Collapse
Affiliation(s)
- Wenbo Wang
- Department of Health Technology, Technical University of Denmark, Produktionstorvet Building 423, DK 2800 Lyngby, Denmark.,Center for Nanomedicine and Theranostics, Technical University of Denmark, 2800 Lyngby, Denmark
| | - Frederikke P Fliedner
- Rigshospitalet and University of Copenhagen, Dept. of Clinical Physiology, Nuclear Medicine & PET, Cluster for Molecular Imaging, 2100 Copenhagen, Denmark
| | - Anders E Hansen
- Department of Health Technology, Technical University of Denmark, Produktionstorvet Building 423, DK 2800 Lyngby, Denmark.,Rigshospitalet and University of Copenhagen, Dept. of Clinical Physiology, Nuclear Medicine & PET, Cluster for Molecular Imaging, 2100 Copenhagen, Denmark.,Center for Nanomedicine and Theranostics, Technical University of Denmark, 2800 Lyngby, Denmark
| | - Rasmus Eliasen
- Department of Health Technology, Technical University of Denmark, Produktionstorvet Building 423, DK 2800 Lyngby, Denmark.,Center for Nanomedicine and Theranostics, Technical University of Denmark, 2800 Lyngby, Denmark
| | - Fredrik Melander
- Department of Health Technology, Technical University of Denmark, Produktionstorvet Building 423, DK 2800 Lyngby, Denmark.,Center for Nanomedicine and Theranostics, Technical University of Denmark, 2800 Lyngby, Denmark
| | - Andreas Kjaer
- Rigshospitalet and University of Copenhagen, Dept. of Clinical Physiology, Nuclear Medicine & PET, Cluster for Molecular Imaging, 2100 Copenhagen, Denmark
| | - Thomas L Andresen
- Department of Health Technology, Technical University of Denmark, Produktionstorvet Building 423, DK 2800 Lyngby, Denmark.,Center for Nanomedicine and Theranostics, Technical University of Denmark, 2800 Lyngby, Denmark
| | - Andreas I Jensen
- The Hevesy Laboratory, Department of Health Technology, Technical University of Denmark, Frederiksborgvej 399, DK, 4000 Roskilde, Denmark.,Center for Nanomedicine and Theranostics, Technical University of Denmark, 2800 Lyngby, Denmark
| | - Jonas R Henriksen
- Department of Health Technology, Technical University of Denmark, Produktionstorvet Building 423, DK 2800 Lyngby, Denmark.,Center for Nanomedicine and Theranostics, Technical University of Denmark, 2800 Lyngby, Denmark
| |
Collapse
|
43
|
Fiorino C, Guckemberger M, Schwarz M, van der Heide UA, Heijmen B. Technology-driven research for radiotherapy innovation. Mol Oncol 2020; 14:1500-1513. [PMID: 32124546 PMCID: PMC7332218 DOI: 10.1002/1878-0261.12659] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/27/2020] [Accepted: 02/10/2020] [Indexed: 12/16/2022] Open
Abstract
Technology has a pivotal role in the continuous development of radiotherapy. The long road toward modern ‘high‐tech’ radiation oncology has been studded with discoveries and technological innovations that resulted from the interaction of various disciplines. In the last decades, a dramatic technology‐driven revolution has hugely improved the capability of accurately and safely delivering complex‐shaped dose distributions. This has contributed to many clinical improvements, such as the successful management of lung cancer and oligometastatic disease through stereotactic body radiotherapy. Technology‐driven research is an active and lively field with promising potential in several domains, including image guidance, adaptive radiotherapy, integration of artificial intelligence, heavy‐particle therapy, and ‘flash’ ultra‐high dose‐rate radiotherapy. The evolution toward personalized Oncology will deeply influence technology‐driven research, aiming to integrate predictive models and omics analyses into fast and efficient solutions to deliver the best treatment for each single patient. Personalized radiation oncology will need affordable technological solutions for middle‐/low‐income countries, as these are expected to experience the highest increase of cancer incidence and mortality. Moreover, technology solutions for automation of commissioning, quality assurance, safety tests, image segmentation, and plan optimization will be required. Although a large fraction of cancer patients receive radiotherapy, this is certainly not reflected in the worldwide budget for radiotherapy research. Differently from the pharmaceutical companies‐driven research, resources for research in radiotherapy are highly limited to equipment vendors, who can, in turn, initiate a limited number of collaborations with academic research centers. Thus, enhancement of investments in technology‐driven radiotherapy research via public funds, national governments, and the European Union would have a crucial societal impact. It would allow for radiotherapy to further strengthen its role as a highly effective and cost‐efficient cancer treatment modality, and it could facilitate a rapid and equalitarian large‐scale transfer of technology to clinic, with direct impact on patient care.
Collapse
Affiliation(s)
- Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Matthias Guckemberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Marco Schwarz
- Protontherapy Department, Trento Hospital and TIFPA-INFN, Trento, Italy
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ben Heijmen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| |
Collapse
|
44
|
Kobayashi D, Isobe T, Takada K, Mori Y, Takei H, Kumada H, Kamizawa S, Tomita T, Sato E, Yokota H, Sakae T. Establishment of a New Three-Dimensional Dose Evaluation Method Considering Variable Relative Biological Effectiveness and Dose Fractionation in Proton Therapy Combined with High-Dose-Rate Brachytherapy. J Med Phys 2020; 44:270-275. [PMID: 31908386 PMCID: PMC6936203 DOI: 10.4103/jmp.jmp_117_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 09/18/2019] [Accepted: 11/01/2019] [Indexed: 11/07/2022] Open
Abstract
Purpose: The purpose of this study is to evaluate the influence of variable relative biological effectiveness (RBE) of proton beam and dose fractionation has on dose distribution and to establish a new three-dimensional dose evaluation method for proton therapy combined with high-dose-rate (HDR) brachytherapy. Materials and Methods: To evaluate the influence of variable RBE and dose fractionation on dose distribution in proton beam therapy, the depth-dose distribution of proton therapy was compared with clinical dose, RBE-weighted dose, and equivalent dose in 2 Gy fractions using a linear-quadratic-linear model (EQD2LQL). The clinical dose was calculated by multiplying the physical dose by RBE of 1.1. The RBE-weighted dose is a biological dose that takes into account RBE variation calculated by microdosimetric kinetic model implemented in Monte Carlo code. The EQD2LQL is a biological dose that makes the RBE-weighted dose equivalent to 2 Gy using a linear-quadratic-linear (LQL) model. Finally, we evaluated the three-dimensional dose by taking into account RBE variation and LQL model for proton therapy combined with HDR brachytherapy. Results: The RBE-weighted dose increased at the distal of the spread-out Bragg peak (SOBP). With the difference in the dose fractionation taken into account, the EQD2LQL at the distal of the SOBP increased more than the RBE-weighted dose. In proton therapy combined with HDR brachytherapy, a divergence of 103% or more was observed between the conventional dose estimation method and the dose estimation method we propose. Conclusions: Our dose evaluation method can evaluate the EQD2LQL considering RBE changes in the dose distribution.
Collapse
Affiliation(s)
- Daisuke Kobayashi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Department of Radiology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Tomonori Isobe
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Proton Medical Research Center, University of Tsukuba Hospital, Ibaraki, Japan
| | - Kenta Takada
- Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, Gunma, Japan
| | - Yutaro Mori
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Proton Medical Research Center, University of Tsukuba Hospital, Ibaraki, Japan
| | - Hideyuki Takei
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Proton Medical Research Center, University of Tsukuba Hospital, Ibaraki, Japan
| | - Hiroaki Kumada
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Proton Medical Research Center, University of Tsukuba Hospital, Ibaraki, Japan
| | - Satoshi Kamizawa
- Proton Medical Research Center, University of Tsukuba Hospital, Ibaraki, Japan
| | - Tetsuya Tomita
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Department of Radiology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Eisuke Sato
- Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Hiroshi Yokota
- Department of Radiology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Takeji Sakae
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Proton Medical Research Center, University of Tsukuba Hospital, Ibaraki, Japan
| |
Collapse
|
45
|
Chen Y, Gao P, Wu T, Pan W, Li N, Tang B. Organelle-localized radiosensitizers. Chem Commun (Camb) 2020; 56:10621-10630. [DOI: 10.1039/d0cc03245j] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This feature article highlights the recent advances of organelle-localized radiosensitizers and discusses the current challenges and future directions.
Collapse
Affiliation(s)
- Yuanyuan Chen
- College of Chemistry
- Chemical Engineering and Materials Science
- Key Laboratory of Molecular and Nano Probes
- Ministry of Education
- Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong
| | - Peng Gao
- College of Chemistry
- Chemical Engineering and Materials Science
- Key Laboratory of Molecular and Nano Probes
- Ministry of Education
- Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong
| | - Tong Wu
- College of Chemistry
- Chemical Engineering and Materials Science
- Key Laboratory of Molecular and Nano Probes
- Ministry of Education
- Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong
| | - Wei Pan
- College of Chemistry
- Chemical Engineering and Materials Science
- Key Laboratory of Molecular and Nano Probes
- Ministry of Education
- Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong
| | - Na Li
- College of Chemistry
- Chemical Engineering and Materials Science
- Key Laboratory of Molecular and Nano Probes
- Ministry of Education
- Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong
| | - Bo Tang
- College of Chemistry
- Chemical Engineering and Materials Science
- Key Laboratory of Molecular and Nano Probes
- Ministry of Education
- Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong
| |
Collapse
|
46
|
Kallis K, Abu-Hossin N, Kreppner S, Lotter M, Strnad V, Fietkau R, Bert C. Estimation of inter-fractional variations in interstitial multi-catheter breast brachytherapy using a hybrid treatment delivery system. Radiother Oncol 2019; 141:312-320. [PMID: 31495517 DOI: 10.1016/j.radonc.2019.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Irradiation of the tumor bed using interstitial multi-catheter brachytherapy is one of the treatment options for breast cancer patients. In order to ensure the planned dose delivery an advanced quality intervention method using an electromagnetic tracking (EMT) system is presented. The system is used to assess inter-fractional variations within the framework of a patient study. METHODS AND MATERIALS Until now 41 patients were included in the study for the evaluation and overall 355 EMT measurements were performed. The catheter traces are measured automatically and sequentially using an afterloader prototype (Flexitron, Elekta, Veenendaal, The Netherlands) equipped with an EMT sensor. The implant geometry is tracked directly after implantation, after CT imaging and after each irradiation fraction. The acquired data is rigidly registered to the catheter traces defined in the treatment plan and the dwell positions (DP) are reconstructed. DPs defined in treatment planning serve as reference. Breathing motion was corrected and recorded using three reference 6DoF sensors placed on the patients' skin. The Euclidean distance between the planned and reconstructed DPs provides information about possible inter-fractional deviations. Further, the influence of various factors on the occurrence of large deviations was investigated, like the patients' age, the length of the catheter, the breast volume, etc. RESULTS: Over all patient measurements a median Euclidean distance of 2.19 mm was determined between the reconstructed DPs and the reference DPs. The median deviation combining all datasets was minimal (1.67 mm) at the measurement directly after CT imaging. The deviations between the different fractions have a median distance of 2.31 mm which could be improved to 2.05 mm by adapting the treatment plan according to the follow-up CT. No correlation between the distance to the skin, ribs, mammilla or the breast volume and the occurrences of large deviations was found. The largest deviations were determined in the upper inner quadrant of the breast. CONCLUSION The afterloader prototype could be well integrated into the clinical routine and is beneficial for ensuring the quality of the brachytherapy. Overall, a small median DP deviation, lower than the used step size of 2.5 mm, was detected.
Collapse
Affiliation(s)
- Karoline Kallis
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Nadin Abu-Hossin
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stephan Kreppner
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Lotter
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Vratislav Strnad
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| |
Collapse
|
47
|
Puttemans J, Lahoutte T, D'Huyvetter M, Devoogdt N. Beyond the Barrier: Targeted Radionuclide Therapy in Brain Tumors and Metastases. Pharmaceutics 2019; 11:pharmaceutics11080376. [PMID: 31374991 PMCID: PMC6723032 DOI: 10.3390/pharmaceutics11080376] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/12/2019] [Accepted: 07/17/2019] [Indexed: 01/10/2023] Open
Abstract
Brain tumors are notoriously difficult to treat. The blood-brain barrier provides a sanctuary site where residual and metastatic cancer cells can evade most therapeutic modalities. The delicate nature of the brain further complicates the decision of eliminating as much tumorous tissue as possible while protecting healthy tissue. Despite recent advances in immunotherapy, radiotherapy and systemic treatments, prognosis of newly diagnosed patients remains dismal, and recurrence is still a universal problem. Several strategies are now under preclinical and clinical investigation to optimize delivery and maximize the cytotoxic potential of pharmaceuticals with regards to brain tumors. This review provides an overview of targeted radionuclide therapy approaches for the treatment of primary brain tumors and brain metastases, with an emphasis on biological targeting moieties that specifically target key biomarkers involved in cancer development.
Collapse
Affiliation(s)
- Janik Puttemans
- In Vivo Cellular and Molecular Imaging Lab, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.
| | - Tony Lahoutte
- In Vivo Cellular and Molecular Imaging Lab, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Nuclear Medicine Department, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Matthias D'Huyvetter
- In Vivo Cellular and Molecular Imaging Lab, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Nick Devoogdt
- In Vivo Cellular and Molecular Imaging Lab, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| |
Collapse
|
48
|
Zhou Z, Yang Z, Jiang S, Zhang F, Yan H. Design and validation of a surgical navigation system for brachytherapy based on mixed reality. Med Phys 2019; 46:3709-3718. [PMID: 31169914 DOI: 10.1002/mp.13645] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/07/2022] Open
Abstract
PURPOSE An accurate position of the needle is vitally important in low-dose-rate seed implantation brachytherapy. Our paper aims to implement a mixed reality navigation system to assist with the placement of the I125 seed implantation thoracoabdominal tumor brachytherapy needle and to validate the accuracy and quality of this type of method. METHODS With the surgical navigation system, based on mixed reality through a novel modified multi-information fusion method, the fusion of virtual organs and a preoperative plan for a real patient and the tracking of surgical tools in real time were achieved. Personalized image recognition and pose estimation were used to track needle punctures in real time and to perform registration processes. After a one-time registration with a hexagonal prism tracker that used an iterative closest point algorithm, all information, including medical images and volume renderings of organs, needles, and seeds, was precisely merged with the patient. Doctors were able to observe the tumor target and to visualize the preoperative plan. This system was validated in both phantom and animal experiments. The accuracy of this system was validated by calculating the positional and rotational error of each needle insertion. The accuracy of implantation of each seed was determined in an animal experiment to test the accuracy in low-dose-rate brachytherapy. The efficiency of this system was also validated through time consumption assessments. RESULTS In the phantom experiment, the average error of the needle locations was 0.664 mm and the angle error was 4.74°, average time consumption was 16.1 min with six needles inserted. Based on the results of the animal experiment, the accuracy of the needle insertion was 1.617 mm, while the angle error was 5.574° and the average error of the seed positions was 1.925 mm. CONCLUSIONS This paper describes the design and experimental validation of a novel surgical navigation system based on mixed reality for I125 seed brachytherapy for thoracoabdominal tumors. This system was validated through a series of experiments, including phantom experiments and animal experiments. Compared with the traditional image-guided system, the procedure presented here is convenient, displays clinically acceptable accuracy and reduces the number of CT scans, allowing doctors to perform surgery based on a visualized plan. All the experimental results indicated that the procedure is ready to be applied in further clinical studies.
Collapse
Affiliation(s)
- Zeyang Zhou
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China
| | - Zhiyong Yang
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China
| | - Shan Jiang
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China.,Centre for advanced Mechanisms and Robotics, Tianjin University, Tianjin, 300350, China
| | - Fujun Zhang
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou, 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
| | - Huzheng Yan
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou, 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
| |
Collapse
|
49
|
Beld E, Seevinck PR, Schuurman J, Viergever MA, Lagendijk JJ, Moerland MA. Development and Testing of a Magnetic Resonance (MR) Conditional Afterloader for Source Tracking in Magnetic Resonance Imaging-Guided High-Dose-Rate (HDR) Brachytherapy. Int J Radiat Oncol Biol Phys 2018; 102:960-968. [DOI: 10.1016/j.ijrobp.2018.04.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/13/2018] [Accepted: 04/24/2018] [Indexed: 01/18/2023]
|
50
|
An automated dose verification software for brachytherapy. J Contemp Brachytherapy 2018; 10:478-482. [PMID: 30479626 PMCID: PMC6251445 DOI: 10.5114/jcb.2018.79396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/15/2018] [Indexed: 11/27/2022] Open
Abstract
Purpose To report an implementation method and the results of independent brachytherapy dose verification software (DVS). Material and methods The DVS was developed based on Visual C++ and adopted a modular structure design. The DICOM RT files exported from a treatment planning system (TPS) were automatically loaded into the DVS. The DVS used the TG-43 formalism for dose calculation. A total of 15 cervical cancer patients who underwent brachytherapy were retrospectively selected to test the DVS. Dosimetric parameters and γ analysis (0.1 cm, 5%) were used to evaluate the dose differences between the DVS and the TPS. Results Compared with the TPS dose, the γ pass rates of the dose calculated by the DVS were higher than 98%. For the clinical target volume (CTV), the dosimetric differences were less than 0.63% for D90% and D100%. For the bladder, rectum, and sigmoid, the agreement of D0.1cc, D1cc, and D2cc were within a 0.78% level. Conclusions With minimal human-computer interactions, the DVS can verify the accuracy of doses calculated by the TPS.
Collapse
|