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Potiron V, Delpon G, Ollivier L, Vaugier L, Doré M, Guimas V, Rio E, Thillays F, Llagostera C, Moignier A, Josset S, Chiavassa S, Perennec T, Supiot S. [Clinical research in radiation oncology: how to move from the laboratory to the patient?]. Cancer Radiother 2022; 26:808-813. [PMID: 35999162 DOI: 10.1016/j.canrad.2022.07.009] [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: 06/14/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 11/19/2022]
Abstract
Translational research in radiation oncology is undergoing intense development. An increasingly rapid transfer is taking place from the laboratory to the patients, both in the selection of patients who can benefit from radiotherapy and in the development of innovative irradiation strategies or the development of combinations with drugs. Accelerating the passage of discoveries from the laboratory to the clinic represents the ideal of any translational research program but requires taking into account the multiple obstacles that can slow this progress. The ambition of the RadioTransNet network, a project to structure preclinical research in radiation oncology in France, is precisely to promote scientific and clinical interactions at the interface of radiotherapy and radiobiology, in its preclinical positioning, in order to identify priorities for strategic research dedicated to innovation in radiotherapy. The multidisciplinary radiotherapy teams with experts in biology, medicine, medical physics, mathematics and engineering sciences are able to meet these new challenges which will allow these advances to be made available to patients as quickly as possible.
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Affiliation(s)
- V Potiron
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France; Unité en sciences biologiques et biotechnologies, UMR CNRS 6286, 2, rue de la Houssinière, 44322 Nantes, France
| | - G Delpon
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France; IMT Atlantique, UMR CNRS 6457/IN2P3, Subatech, laboratoire de physique subatomique et des technologies associées, Nantes, France
| | - L Ollivier
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - L Vaugier
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - M Doré
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - V Guimas
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - E Rio
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - F Thillays
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - C Llagostera
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - A Moignier
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - S Josset
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - S Chiavassa
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France; IMT Atlantique, UMR CNRS 6457/IN2P3, Subatech, laboratoire de physique subatomique et des technologies associées, Nantes, France
| | - T Perennec
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - S Supiot
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France; Unité en sciences biologiques et biotechnologies, UMR CNRS 6286, 2, rue de la Houssinière, 44322 Nantes, France.
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Cosset JM. [Hypofractionated irradiation of prostate cancer: What is the radiobiological understanding in 2017?]. Cancer Radiother 2017; 21:447-453. [PMID: 28847464 DOI: 10.1016/j.canrad.2017.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/16/2017] [Indexed: 01/10/2023]
Abstract
For prostate cancer, hypofractionation has been based since 1999 on radiobiological data, which calculated a very low alpha/beta ratio (1.2 to 1.5Gy). This suggested that a better local control could be obtained, without any toxicity increase. Consequently, two types of hypofractionated schemes were proposed: "moderate" hypofractionation, with fractions of 2.5 to 4Gy, and "extreme" hypofractionation, utilizing stereotactic techniques, with fractions of 7 to 10Gy. For moderate hypofractionation, the linear-quadratic (LQ) model has been used to calculate the equivalent doses of the new protocols. The available trials have often shown a "non-inferiority", but no advantage, while the equivalent doses calculated for the hypofractionated arms were sometimes very superior to the doses of the conventional arms. This finding could suggest either an alpha/beta ratio lower than previously calculated, or a negative impact of other radiobiological parameters, which had not been taken into account. For "extreme" hypofractionation, the use of the LQ model is discussed for high dose fractions. Moreover, a number of radiobiological questions are still pending. The reduced overall irradiation time could be either a positive point (better local control) or a negative one (reduced reoxygenation). The prolonged duration of the fractions could lead to a decrease of efficacy (because allowing for reparation of sublethal lesions). Finally, the impact of the large fractions on the microenvironment and/or immunity remains discussed. The reported series appear to show encouraging short to mid-term results, but the results of randomized trials are still awaited. Today, it seems reasonable to only propose those extreme hypofractionated schemes to well-selected patients, treating small volumes with high-level stereotactic techniques.
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Affiliation(s)
- J-M Cosset
- GIE Charlebourg, groupe Amethyst, 65, avenue Foch, 92250 La Garenne-Colombes, France.
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Endothelial Hey2 deletion reduces endothelial-to-mesenchymal transition and mitigates radiation proctitis in mice. Sci Rep 2017; 7:4933. [PMID: 28694461 PMCID: PMC5503994 DOI: 10.1038/s41598-017-05389-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/30/2017] [Indexed: 01/27/2023] Open
Abstract
The current study evaluated the role of Hey2 transcription factor in radiation-induced endothelial-to-mesenchymal transition (EndoMT) and its impact on radiation-induced tissue damage in mice. Phenotypic modifications of irradiated, Hey2 siRNA- and Hey2 vector plasmid-transfected human umbilical vein endothelial cells (HUVECs) resembling EndoMT were monitored by qPCR, immunocytochemistry and western blots. Subsequently, in mice, a Cre-LoxP strategy for inactivation of Hey2 specifically in the endothelium was used to study the biological consequences. Total body irradiation and radiation proctitis were monitored to investigate the impact of conditional Hey2 deletion on intestinal stem cells and microvascular compartment radiosensitivity, EndoMT and rectal damage severity. We found that EndoMT occurs in irradiated HUVECs with concomitant Hey2 mRNA and protein increase. While Hey2 silencing has no effect on radiation-induced EndoMT in vitro, Hey2 overexpression is sufficient to induce phenotypic conversion of endothelial cells. In mice, the conditional deletion of Hey2 reduces EndoMT frequency and the severity of rectal tissue damage. Our data indicate that the reduction in mucosal damage occurs through decline in stem/clonogenic epithelial cell loss mediated by microvascular protection. EndoMT is involved in radiation proctitis and this study demonstrates that a strategy based on the reduction of EndoMT mitigates intestinal tissue damage.
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Antoni D, Bockel S, Deutsch E, Mornex F. [Radiotherapy and targeted therapy/immunotherapy]. Cancer Radiother 2016; 20:434-41. [PMID: 27614521 DOI: 10.1016/j.canrad.2016.07.082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/29/2016] [Indexed: 12/15/2022]
Abstract
Thanks to recent advances achieved in oncologic systemic and local ablative treatment, the treatments become more and more efficient in term of local control and overall survival. Thus, the targeted therapies, immunotherapy or stereotactic radiotherapy have modified the management of patients, especially in case of oligometastatic disease. Many questions are raised by these innovations, particularly the diagnosis and management of new side effects or that of the combination of these different treatments, depending on the type of primary tumor. Fundamental data are available, while clinical data are still limited. Ongoing trials should help to clarify the clinical management protocols. This manuscript is a review of the combination of radiotherapy and targeted therapy/immunotherapy.
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Affiliation(s)
- D Antoni
- Département universitaire de radiothérapie, centre Paul-Strauss, UNICANCER, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; EA 3430, fédération de médecine translationnelle de Strasbourg (FMTS), université de Strasbourg, 67200 Strasbourg, France
| | - S Bockel
- Département universitaire de radiothérapie, centre Paul-Strauss, UNICANCER, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - E Deutsch
- Département de radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France; UMR 1030 « radiosensibilité des tumeurs et tissus sains », Inserm, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - F Mornex
- Département de radiothérapie oncologique, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; EA 3738, université Claude-Bernard Lyon-1, domaine Rockefeller, 8, avenue Rockefeller, 69373 Lyon cedex 08, France.
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Supiot S, Clément-Colmou K, Paris F, Corre I, Chiavassa S, Delpon G. [Which rules apply to hypofractionated radiotherapy?]. Cancer Radiother 2015; 19:421-5. [PMID: 26321647 DOI: 10.1016/j.canrad.2015.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 12/22/2022]
Abstract
Hypofractionated radiotherapy is now more widely prescribed due to improved targeting techniques (intensity modulated radiotherapy, image-guided radiotherapy and stereotactic radiotherapy). Low dose hypofractionated radiotherapy is routinely administered mostly for palliative purposes. High or very high dose hypofractionated irradiation must be delivered according to very strict procedures since every minor deviation can lead to major changes in dose delivery to the tumor volume and organs at risk. Thus, each stage of the processing must be carefully monitored starting from the limitations and the choice of the hypofractionation technique, tumour contouring and dose constraints prescription, planning and finally dose calculation and patient positioning verification.
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Affiliation(s)
- S Supiot
- Département de radiothérapie, institut de cancérologie de l'Ouest Nantes-Angers, boulevard Jacques-Monod, 44805 Saint-Herblain, France; Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France.
| | - K Clément-Colmou
- Département de radiothérapie, institut de cancérologie de l'Ouest Nantes-Angers, boulevard Jacques-Monod, 44805 Saint-Herblain, France; Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France
| | - F Paris
- Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France
| | - I Corre
- Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France
| | - S Chiavassa
- Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France; Département de radiophysique, institut de cancérologie de l'Ouest Nantes-Angers, boulevard Jacques-Monod, 44805 Saint-Herblain, France
| | - G Delpon
- Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France; Département de radiophysique, institut de cancérologie de l'Ouest Nantes-Angers, boulevard Jacques-Monod, 44805 Saint-Herblain, France
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Radiobiologie des doses ablatives en radiothérapie stéréotaxique : mise au point des données récentes. Cancer Radiother 2014; 18:264-9. [DOI: 10.1016/j.canrad.2014.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/15/2014] [Indexed: 11/24/2022]
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Radiothérapie stéréotaxique hypofractionnée des métastases osseuses. Cancer Radiother 2014; 18:342-9. [DOI: 10.1016/j.canrad.2014.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/14/2014] [Accepted: 04/29/2014] [Indexed: 11/21/2022]
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Potiron VA, Abderrahmani R, Clément-Colmou K, Marionneau-Lambot S, Oullier T, Paris F, Supiot S. Improved functionality of the vasculature during conventionally fractionated radiation therapy of prostate cancer. PLoS One 2013; 8:e84076. [PMID: 24391887 PMCID: PMC3877206 DOI: 10.1371/journal.pone.0084076] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 11/20/2013] [Indexed: 11/18/2022] Open
Abstract
Although endothelial cell apoptosis participates in the tumor shrinkage after single high-dose radiotherapy, little is known regarding the vascular response after conventionally fractionated radiation therapy. Therefore, we evaluated hypoxia, perfusion and vascular microenvironment changes in an orthotopic prostate cancer model of conventionally fractionated radiation therapy at clinically relevant doses (2 Gy fractions, 5 fractions/week). First, conventionally fractionated radiation therapy decreased tumor cell proliferation and increased cell death with kinetics comparable to human prostate cancer radiotherapy. Secondly, the injection of Hoechst 33342 or fluorescent-dextrans showed an increased tumor perfusion within 14 days in irradiated tumors, which was correlated with a clear reduction of hypoxia. Improved perfusion and decreased hypoxia were not explained by increased blood vessel density, size or network morphology. However, a tumor vascular maturation defined by perivascular desmin+/SMA+ cells coverage was clearly observed along with an increase in endothelial, zonula occludens (ZO)-1 positive, intercellular junctions. Our results show that, in addition to tumor cell killing, vascular maturation plays an uncovered role in tumor reoxygenation during fractionated radiation therapy.
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Affiliation(s)
- Vincent A. Potiron
- Inserm, UMR892, Nantes, France
- Université de Nantes, Nantes, France
- CNRS, UMR6299, Nantes, France
| | - Rym Abderrahmani
- Inserm, UMR892, Nantes, France
- Université de Nantes, Nantes, France
- CNRS, UMR6299, Nantes, France
| | - Karen Clément-Colmou
- Inserm, UMR892, Nantes, France
- Université de Nantes, Nantes, France
- CNRS, UMR6299, Nantes, France
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Saint-Herblain, France
| | | | | | - François Paris
- Inserm, UMR892, Nantes, France
- Université de Nantes, Nantes, France
- CNRS, UMR6299, Nantes, France
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Saint-Herblain, France
| | - Stéphane Supiot
- Inserm, UMR892, Nantes, France
- Université de Nantes, Nantes, France
- CNRS, UMR6299, Nantes, France
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Saint-Herblain, France
- * E-mail:
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Corre I, Guillonneau M, Paris F. Membrane signaling induced by high doses of ionizing radiation in the endothelial compartment. Relevance in radiation toxicity. Int J Mol Sci 2013; 14:22678-96. [PMID: 24252908 PMCID: PMC3856084 DOI: 10.3390/ijms141122678] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 11/01/2013] [Accepted: 11/06/2013] [Indexed: 01/30/2023] Open
Abstract
Tumor areas can now be very precisely delimited thanks to technical progress in imaging and ballistics. This has also led to the development of novel radiotherapy protocols, delivering higher doses of ionizing radiation directly to cancer cells. Despite this, radiation toxicity in healthy tissue remains a major issue, particularly with dose-escalation in these new protocols. Acute and late tissue damage following irradiation have both been linked to the endothelium irrigating normal tissues. The molecular mechanisms involved in the endothelial response to high doses of radiation are associated with signaling from the plasma membrane, mainly via the acid sphingomyelinase/ceramide pathway. This review describes this signaling pathway and discusses the relevance of targeting endothelial signaling to protect healthy tissues from the deleterious effects of high doses of radiation.
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Affiliation(s)
- Isabelle Corre
- CRCNA-UMR Inserm U892-CNRS 6299-Institut de Recherche en Santé de l'Université de Nantes, Nantes 44007, France.
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Supiot S, Créhange G, Latorzeff I, Pommier P, Paumier A, Rio E, Delaroche G, Guérif S, Catton C, Martin J, Lisbona A. [Hypofractionated radiotherapy in prostate cancer]. Cancer Radiother 2013; 17:349-54. [PMID: 23973460 DOI: 10.1016/j.canrad.2013.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 04/26/2013] [Accepted: 05/14/2013] [Indexed: 11/19/2022]
Abstract
Radiotherapy plays a central role in the management of localized prostate cancer, but the total duration of treatment of nearly 2 months poses not only problems of fatigue related to repetitive transports, especially for older patients, but also increases the overall cost of treatment including linear accelerators occupancy and patient transportation. To address this problem, various teams have developed hypofractionated radiotherapy protocols seeking to maintain the same efficacy and toxicity while reducing the total duration of treatment. These hypofractionated protocols require recent techniques such as image-guided radiation therapy (IGRT) and intensity-modulated radiation therapy (IMRT). Single centre series have validated the feasibility of "light" hypofractionation schemes at doses per fraction less than 6 Gy Similarly, different teams have shown the possibility of stereotactic irradiation for delivering "severe" hypofractionation schemes at doses greater than 6 Gy per fraction. Whatever the dose per fraction, the current clinical data support the conclusion that hypofractionated radiotherapy does not increase mid-term toxicity and could even improve biochemical control. Studies with the objective of demonstrating non-inferiority are expected to definitively validate the role of hypofractionated irradiation in the treatment of prostate cancer.
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Affiliation(s)
- S Supiot
- Département de radiothérapie, institut de cancérologie de l'Ouest Nantes-Angers, boulevard Jacques-Monod, 44805 Saint-Herblain, France.
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Lacombe J, Mange A, Azria D, Solassol J. Identification de marqueurs prédictifs de la réponse à la radiothérapie par approche protéomique. Cancer Radiother 2013; 17:62-9; quiz 70, 72. [DOI: 10.1016/j.canrad.2012.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 11/08/2012] [Accepted: 11/22/2012] [Indexed: 12/15/2022]
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Kintzinger C, Demoor-Goldschmidt C, Abderrahmani R, Paris F, Supiot S. Toxicité rectale de la radiothérapie : signes cliniques, physiopathologie et prise en charge. Cancer Radiother 2012; 16:372-6. [DOI: 10.1016/j.canrad.2012.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 05/28/2012] [Indexed: 12/29/2022]
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