1
|
Ouedraogo S, Grosjean M, Brigaud I, Carneiro K, Luchnikov V, Mathieu N, Garric X, Nottelet B, Anselme K, Pieuchot L, Ponche A. Fabrication and characterization of thin self-rolling film for anti-inflammatory drug delivery. Colloids Surf B Biointerfaces 2024; 241:114039. [PMID: 38879896 DOI: 10.1016/j.colsurfb.2024.114039] [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: 02/23/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 06/18/2024]
Abstract
Thin films have been identified as an alternative approach for targeting sensitive site as drug delivery tool. In this work, the preparation of self-rolling thin films to form tubes for wound healing and easy placement (e.g. in the colon via colonoscopy) have been studied. We explored the use of thin films as a protective dressing combined to local release of an anti-inflammatory in order to improve drug efficacy and limit the side effects of the oral route. Non-cytotoxic poly(ethylene) glycol and poly(lactic acid) photo-crosslinkable star copolymers were used for rapid UV crosslinking of bilayered films loaded with prednisolone. The films, crosslinked under UV lamp without the need of photoinitiator, are optimized and compared in terms of water uptake, swelling ratio, final tube diameter and morphology, anti-inflammatory drug loading and release. Our studies showed the spontaneous rolling of bilayer constructs directly after immersion in water. Tubular geometry allows application of the patch through minimally invasive procedures such as colonoscopy. Moreover, the rolled-up bilayers highlighted efficient release of encapsulated drug following Fickian diffusion mechanism. We also confirmed the anti-inflammatory activity of the released anti-inflammatory drug that inhibits the pro-inflammatory cytokine IL-1β in RAW 264.7 macrophages stimulated by Escherichia coli (E. coli).
Collapse
Affiliation(s)
- Sidzigui Ouedraogo
- Institut de Science des Matériaux de Mulhouse, Université de Haute-Alsace, CNRS/UHA UMR 7361, Mulhouse, France
| | - Mathilde Grosjean
- Polymer for Health and Biomaterials, IBMM, Université de Montpellier, CNRS, ENSCM, Montpellier, France
| | - Isabelle Brigaud
- Institut de Science des Matériaux de Mulhouse, Université de Haute-Alsace, CNRS/UHA UMR 7361, Mulhouse, France
| | - Katia Carneiro
- Graduate School in Pathological Anatomy and Morphological Sciences, Federal University of Rio de Janeiro, Brazil
| | - Valeriy Luchnikov
- Institut de Science des Matériaux de Mulhouse, Université de Haute-Alsace, CNRS/UHA UMR 7361, Mulhouse, France
| | - Noëlle Mathieu
- Institute for Radioprotection and Nuclear Safety, (IRSN), PSE-SANTE/SERAMED/LRMed, Fontenay-aux-Roses F-92262, France
| | - Xavier Garric
- Polymer for Health and Biomaterials, IBMM, Université de Montpellier, CNRS, ENSCM, Montpellier, France; Department of Pharmacy, Nîmes University Hospital, Nimes, France
| | - Benjamin Nottelet
- Polymer for Health and Biomaterials, IBMM, Université de Montpellier, CNRS, ENSCM, Montpellier, France; Department of Pharmacy, Nîmes University Hospital, Nimes, France
| | - Karine Anselme
- Institut de Science des Matériaux de Mulhouse, Université de Haute-Alsace, CNRS/UHA UMR 7361, Mulhouse, France
| | - Laurent Pieuchot
- Institut de Science des Matériaux de Mulhouse, Université de Haute-Alsace, CNRS/UHA UMR 7361, Mulhouse, France
| | - Arnaud Ponche
- Institut de Science des Matériaux de Mulhouse, Université de Haute-Alsace, CNRS/UHA UMR 7361, Mulhouse, France.
| |
Collapse
|
2
|
Berasaluce Gómez A, Martín-Calvo N, Boria F, Manzour N, Chacón E, Bizzarri N, Chiva L. SUCCOR Nodes: May Sentinel Node Biopsy Determine the Need for Adjuvant Treatment? Ann Surg Oncol 2023; 30:4975-4985. [PMID: 37208571 PMCID: PMC10319697 DOI: 10.1245/s10434-023-13529-w] [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: 10/03/2022] [Accepted: 04/03/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND The SUCCOR cohort was developed to analyse the overall and disease-free survival at 5 years in women with FIGO 2009 stage IB1 cervical cancer. The aim of this study was to compare the use of adjuvant therapy in these women, depending on the method used to diagnose lymphatic node metastasis. PATIENTS AND METHODS We used data from the SUCCOR cohort, which collected information from 1049 women with FIGO 2009 stage IB1 cervical cancer who were operated on between January 2013 and December 2014 in Europe. We calculated the adjusted proportion of women who received adjuvant therapy depending on the lymph node diagnosis method and compared disease free and overall survival using Cox proportional-hazards regression models. Inverse probability weighting was used to adjust for baseline potential confounders. RESULTS The adjusted proportion of women who received adjuvant therapy was 33.8% in the sentinel node biopsy + lymphadenectomy (SNB+LA) group and 44.7% in the LA group (p = 0.02), although the proportion of positive nodal status was similar (p = 0.30). That difference was greater in women with negative nodal status and positive Sedlis criteria (difference 31.2%, p = 0.01). Here, those who underwent a SNB+LA had an increased risk of relapse [hazard ratio (HR) 2.49, 95% confidence interval (CI) 0.98-6.33, p = 0.056] and risk of death (HR 3.49, 95% CI 1.04-11.7, p = 0.042) compared with those who underwent LA. CONCLUSIONS Women in this study were less likely to receive adjuvant therapy if their nodal invasion was determined using SNB+LA compared with LA. These results suggest a lack of therapeutic measures available when a negative result is obtained by SNB+LA, which may have an impact on the risk of recurrence and survival.
Collapse
Affiliation(s)
- Arantxa Berasaluce Gómez
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
| | - Nerea Martín-Calvo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
- CIBER de Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Félix Boria
- Department of Obstetrics and Gynecology, Universidad de Navarra Clinic, Madrid, Spain
| | - Nabil Manzour
- Department of Obstetrics and Gynecology, Universidad de Navarra Clinic, Pamplona, Spain
| | - Enrique Chacón
- Department of Obstetrics and Gynecology, Universidad de Navarra Clinic, Pamplona, Spain
| | - Nicolò Bizzarri
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Rome, Italy
| | - Luis Chiva
- Department of Obstetrics and Gynecology, Universidad de Navarra Clinic, Madrid, Spain.
| |
Collapse
|
3
|
Dalsania RM, Shah KP, Stotsky-Himelfarb E, Hoffe S, Willingham FF. Management of Long-Term Toxicity From Pelvic Radiation Therapy. Am Soc Clin Oncol Educ Book 2021; 41:1-11. [PMID: 33793314 DOI: 10.1200/edbk_323525] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pelvic radiation therapy is an integral component in the treatment of various gastrointestinal, gynecologic, and genitourinary cancers. As survival rates from these malignancies improve, the prevalence of toxicity secondary to pelvic radiation has increased. Gastrointestinal toxicities are the most common complications and greatly impact quality of life. Toxicities can present in acute or late stages; although symptoms may be similar during both, the management may differ. Acute toxicities represent an inflammatory reaction in response to the radiation exposure, whereas late toxicities may arise as a result of small vessel disease, ischemia, and fibrosis. Currently, there are no large clinical trials and only limited guidelines on the management of late gastrointestinal radiation toxicities. Therapy is generally approached in a stepwise manner from medical to endoscopic to surgical methods. Several endoscopic therapies, such as the treatment of radiation proctitis with argon plasma coagulation and dilation of radiation bowel strictures, may prevent the need for surgical intervention, which may be associated with high morbidity and mortality. Given that late toxicities can occur years after radiation therapy, they are often difficult to recognize and diagnose. Successful management of late toxicities requires recognition, an understanding of the underlying pathophysiology, and a multidisciplinary approach. More dedicated research could clarify the prevalence of gastrointestinal pelvic radiation toxicities, permit a better understanding of the efficacy and safety profile of current therapies, and allow for the development of novel therapeutic approaches.
Collapse
Affiliation(s)
- Raj M Dalsania
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Kevin P Shah
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | | | | | - Field F Willingham
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| |
Collapse
|
4
|
Image-Guided Brachytherapy for Salvage Reirradiation: A Systematic Review. Cancers (Basel) 2021; 13:cancers13061226. [PMID: 33799617 PMCID: PMC7999189 DOI: 10.3390/cancers13061226] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Local recurrence in gynecological malignancies occurring in a previously irradiated field is a difficult clinical issue. Curative-intent treatment is salvage surgery and is associated with non-negligible peri-operative morbidity and has a substantial impact on long-term quality of life. Reirradiation, using three-dimensional image-guided brachytherapy (3D-IGBT), might be a suitable alternative, especially in non-operable patients. The aim of this review is to report outcomes and toxicities of reirradiation 3D-IGBT in this context. 3D-IGBT appears to be a feasible alternative to salvage surgery in inoperable patients, with an acceptable outcome for patients who have no other curative therapeutic options, however long-term toxicities were high in some studies. Each case should be referred to highly experienced expert centers. Abstract Background: Local recurrence in gynecological malignancies occurring in a previously irradiated field is a challenging clinical issue. The most frequent curative-intent treatment is salvage surgery. Reirradiation, using three-dimensional image-guided brachytherapy (3D-IGBT), might be a suitable alternative. We reviewed recent literature concerning 3D-IGBT for reirradiation in the context of local recurrences from gynecological malignancies. Methods: We conducted a large-scale literature research, and 15 original studies, responding to our research criteria, were finally selected. Results: Local control rates ranged from 44% to 71.4% at 2–5 years, and overall survival rates ranged from 39.5% to 78% at 2–5 years. Grade ≥3 toxicities ranged from 1.7% to 50%, with only one study reporting a grade 5 event. Results in terms of outcome and toxicities were highly variable depending on studies. Several studies suggested that local control could be improved with 2 Gy equivalent doses >40 Gy. Conclusion: IGBT appears to be a feasible alternative to salvage surgery in inoperable patients or patients refusing surgery, with an acceptable outcome for patients who have no other curative therapeutic options, however at a high cost of long-term grade ≥3 toxicities in some studies. We recommend that patients with local recurrence from gynecologic neoplasm occurring in previously irradiated fields should be referred to highly experienced expert centers. Centralization of data and large-scale multicentric international prospective trials are warranted. Efforts should be made to improve local control while limiting the risk of toxicities.
Collapse
|
5
|
Effect of Kegel exercises on the prevention of urinary and fecal incontinence in patients with prostate cancer undergoing radiotherapy. Eur J Oncol Nurs 2021; 51:101913. [PMID: 33639454 DOI: 10.1016/j.ejon.2021.101913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 01/26/2021] [Accepted: 02/05/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This is a nonrandomized experimental study conducted to evaluate the effect of Kegel exercises on the prevention of urinary and fecal incontinence in prostate cancer patients undergoing radiotherapy. METHOD The study was conducted with 30 patients in the intervention group (IG) and 30 patients in the control group (CG). Data were collected using a patient information form, CTCAE, EORTC QLQ-C30, and a follow-up form reporting weekly Kegel exercises. Before radiotherapy, the IG was provided with Kegel exercise training via visual training material; exercises were performed under the supervision of the researcher, and the exercise pamphlet was handed out. During radiotherapy, weekly follow-ups were performed by face-to-face contact or phone calls. No similar application was provided to the CG. CTCAE and EORTC QLQ-C30 were evaluated three times (baseline, 4th and 8th weeks of exercises). RESULTS At the end of the 4th week of exercises, 1st-grade urinary incontinence (UI) developed in the IG (10%) and in the CG (13.3%). At the end of the 8th week, 2nd-grade UI (3.3%) developed in the IG and 1st-grade (10%) and 2nd-grade UI (6.7%) developed in the CG. Fecal incontinence developed in neither group. At the end of the intervention, there was a significant improvement in Role, Social function and Global Health Status in the IG compared with the 4th week scores. In addition, less Fatigue, Diarrhea, Anorexia and Constipation scores were found compared with the baseline. CONCLUSION Kegel exercises can be recommended as an approach in the prevention of urinary incontinence and to improve quality of life.
Collapse
|
6
|
Kwak SY, Park S, Kim H, Lee SJ, Jang WS, Kim MJ, Lee S, Jang WI, Kim AR, Kim EH, Shim S, Jang H. Atorvastatin Inhibits Endothelial PAI-1-Mediated Monocyte Migration and Alleviates Radiation-Induced Enteropathy. Int J Mol Sci 2021; 22:ijms22041828. [PMID: 33673196 PMCID: PMC7917640 DOI: 10.3390/ijms22041828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 01/15/2023] Open
Abstract
Intestinal injury is observed in cancer patients after radiotherapy and in individuals exposed to radiation after a nuclear accident. Radiation disrupts normal vascular homeostasis in the gastrointestinal system by inducing endothelial damage and senescence. Despite advances in medical technology, the toxicity of radiation to healthy tissue remains an issue. To address this issue, we investigated the effect of atorvastatin, a commonly prescribed hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor of cholesterol synthesis, on radiation-induced enteropathy and inflammatory responses. We selected atorvastatin based on its pleiotropic anti-fibrotic and anti-inflammatory effects. We found that atorvastatin mitigated radiation-induced endothelial damage by regulating plasminogen activator inhibitor-1 (PAI-1) using human umbilical vein endothelial cells (HUVECs) and mouse model. PAI-1 secreted by HUVECs contributed to endothelial dysfunction and trans-endothelial monocyte migration after radiation exposure. We observed that PAI-1 production and secretion was inhibited by atorvastatin in irradiated HUVECs and radiation-induced enteropathy mouse model. More specifically, atorvastatin inhibited PAI-1 production following radiation through the JNK/c-Jun signaling pathway. Together, our findings suggest that atorvastatin alleviates radiation-induced enteropathy and supports the investigation of atorvastatin as a radio-mitigator in patients receiving radiotherapy.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Sehwan Shim
- Correspondence: (S.S.); (H.J.); Tel.: +82-2-3399-5873 (S.S.); +82-2-970-1302 (H.J.)
| | - Hyosun Jang
- Correspondence: (S.S.); (H.J.); Tel.: +82-2-3399-5873 (S.S.); +82-2-970-1302 (H.J.)
| |
Collapse
|
7
|
Kashihara T, Inaba K, Komiyama M, Nakayama H, Iijima K, Nishioka S, Okamoto H, Kikkawa N, Kubo Y, Shima S, Nakamura S, Takahashi A, Takahashi K, Okuma K, Murakami N, Igaki H, Nakayama Y, Fukunaga A, Matsui Y, Fujimoto H, Itami J. The use of hyperbaric oxygen to treat actinic rectal fistula after SpaceOAR use and radiotherapy for prostate cancer: a case report. BMC Urol 2020; 20:196. [PMID: 33317509 PMCID: PMC7737272 DOI: 10.1186/s12894-020-00767-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background In definitive radiation therapy for prostate cancer, the SpaceOAR® System, a hydrogel spacer, is widely used to decrease the irradiated dose and toxicity of rectum. On the other hand, periprostatic abscesses formation and rectal perforation are known as rare adverse effects of SpaceOAR. Nevertheless, there is a lack of reports clarifying the association between aggravation of abscesses and radiation therapy, and hyperbaric oxygen therapy (HBOT) is effective for a peri-SpaceOAR abscess and rectal perforation. Case presentation We report a case of a 78-year-old high-risk prostate cancer patient. After SpaceOAR insertion into the correct space, he started to receive external beam radiation therapy (EBRT). He developed a fever, perineal pain and frequent urination after the completion of EBRT, and the magnetic resonance imaging (MRI) revealed a peri-SpaceOAR abscess. Scheduled brachytherapy was postponed, administration of antibiotics and opioid via intravenous drip was commenced, and transperineal drainage was performed. After the alleviation of the abscess, additional EBRT instead of brachytherapy was performed with MRI-guided radiation therapy (MRgRT). On the last day of the MRgRT, perineal pain reoccurred, and MRI and colonoscopy detected the rectal perforation. He received an intravenous antibiotics drip and HBOT, and fully recovered from the rectal perforation. Conclusions Our report indicates that EBRT can lead to a severe rectum complication by causing inflammation for patients with a peri-SpaceOAR abscess. Furthermore, HBOT was effective for the peri-SpaceOAR abscess and rectal perforation associated with EBRT.
Collapse
Affiliation(s)
- Tairo Kashihara
- Department of Radiation Therapy, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, Japan.
| | - Koji Inaba
- Department of Radiation Therapy, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, Japan
| | - Motokiyo Komiyama
- Department of Urological Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroki Nakayama
- Department of Radiation Therapy, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, Japan
| | - Kotaro Iijima
- Department of Radiation Therapy, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, Japan
| | - Shie Nishioka
- Department of Radiation Therapy, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, Japan
| | - Hiroyuki Okamoto
- Department of Radiation Therapy, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, Japan
| | - Nao Kikkawa
- Department of Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Kubo
- Department of Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Shima
- Department of Radiation Therapy, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, Japan
| | - Satoshi Nakamura
- Department of Radiation Therapy, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, Japan
| | - Ayaka Takahashi
- Department of Radiation Therapy, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, Japan
| | - Kana Takahashi
- Department of Radiation Therapy, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, Japan
| | - Kae Okuma
- Department of Radiation Therapy, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, Japan
| | - Naoya Murakami
- Department of Radiation Therapy, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Therapy, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, Japan
| | - Yuko Nakayama
- Department of Radiation Therapy, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, Japan
| | - Arinobu Fukunaga
- Department of Urological Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiyuki Matsui
- Department of Urological Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Fujimoto
- Department of Urological Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Itami
- Department of Radiation Therapy, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, Japan
| |
Collapse
|
8
|
Rosli D, Shahar S, Manaf ZA, Lau HJ, Yusof NYM, Haron MR, Majid HA. Randomized Controlled Trial on the Effect of Partially Hydrolyzed Guar Gum Supplementation on Diarrhea Frequency and Gut Microbiome Count Among Pelvic Radiation Patients. JPEN J Parenter Enteral Nutr 2020; 45:277-286. [DOI: 10.1002/jpen.1987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/28/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Dzairudzee Rosli
- Hospital Tawau Ministry of Health Malaysia 67, Peti Surat Tawau Sabah 91007 Malaysia
- Dietetic Programme, Centre for Healthy Aging and Wellness, Faculty of Health Sciences Universiti Kebangsaan Malaysia Jalan Raja Muda Abdul Aziz Kuala Lumpur 50300 Malaysia
| | - Suzana Shahar
- Dietetic Programme, Centre for Healthy Aging and Wellness, Faculty of Health Sciences Universiti Kebangsaan Malaysia Jalan Raja Muda Abdul Aziz Kuala Lumpur 50300 Malaysia
| | - Zahara Abdul Manaf
- Dietetic Programme, Centre for Healthy Aging and Wellness, Faculty of Health Sciences Universiti Kebangsaan Malaysia Jalan Raja Muda Abdul Aziz Kuala Lumpur 50300 Malaysia
| | - Hui Jin Lau
- Nutrition Programme, Centre for Healthy Aging and Wellness Universiti Kebangsaan Malaysia Jalan Raja Muda Abdul Aziz Kuala Lumpur 50300 Malaysia
| | | | - Mohd Roslan Haron
- Hospital Sultan Ismail Ministry of Health Malaysia Jalan Mutiara Emas Utama Johor 81100 Malaysia
| | - Hazreen Abdul Majid
- Centre for Population Health and Department of Social and Preventive Medicine, Faculty of Medicine University Malaya Jalan Universiti Kuala Lumpur 50603 Malaysia
- Department of Nutrition, Faculty of Public Health Universitas Airlangga Surabaya Indonesia
| |
Collapse
|
9
|
Abstract
Abdominal pelvic radiation therapy can induce acute or chronic lesions in the small bowel wall, called radiation enteritis. Treatment of acute radiation enteritis is essentially symptomatic; symptoms regress when radiation is discontinued. Conversely, late toxicity can occur up to 30 years after discontinuation of radiation therapy, posing diagnostic problems. Approximately one out of five patients treated by radiation therapy will present clinical signs of radiation enteritis, including obstruction, malabsorption, malnutrition and/or other complications. Management should be multidisciplinary, centered mainly on correction of malnutrition. Surgery is indicated in case of complications (i.e., abscess, perforation, fistula) and/or resistance to medical treatment; intestinal resection should be preferred over internal bypass. The main risk in case of iterative resections is the short bowel syndrome and the need for definitive nutritional assistance.
Collapse
Affiliation(s)
- L Loge
- Department of digestive surgery, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - C Florescu
- Department of radiotherapy, centre François-Baclesse, avenue du Général-Harris, 14045 Caen cedex, France
| | - A Alves
- Department of digestive surgery, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; ANTICIPE Inserm U 1086, centre François-Baclesse, avenue du Général-Harris, 14045 Caen cedex, France; Health Training and Research Center, 2, rue des Rochambelles, 14032 Caen cedex, France
| | - B Menahem
- Department of digestive surgery, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; ANTICIPE Inserm U 1086, centre François-Baclesse, avenue du Général-Harris, 14045 Caen cedex, France; Health Training and Research Center, 2, rue des Rochambelles, 14032 Caen cedex, France.
| |
Collapse
|
10
|
Zvirych VV, Makhmudov DE, Paliiy MI, Ashykhmin AV, Kolesnik OO. BILATERAL AVASCULAR NECROSIS OF SACRAL LATERAL MASSES AFTER A COMPLETE RADIOLOGICAL RESPONSE OF LOCALLY ADVANCED RECTAL CANCER TREATED WITH NEOADJUVANT CHEMORADIATION THERAPY. CASE REPORT. PROBLEMY RADIAT︠S︡IĬNOÏ MEDYT︠S︡YNY TA RADIOBIOLOHIÏ 2020; 24:537-551. [PMID: 31841494 DOI: 10.33145/2304-8336-2019-24-537-551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Indexed: 11/10/2022]
Abstract
We present a rare case report of a bilateral avascular necrosis of lateral sacral masses in a patient who developed a sustainable complete clinical and radiological response after chemoradiotherapy for locally advanced rectal cancer. It is shown that despite the standardized and precise planning and fractioning for neoadjuvant chemoradiation therapy for locally advanced rectal cancer, the biological effects of ionizing radiation on critical organs can be va- ried both in time of occurrence and in structure. Evaluating the effect of neoadjuvant chemoradiation therapy, one should take into account the possibility of the development of even very rare effects of ionizing radiation on criti- cal organs and include their early detection in the diagnostic algorithm.
Collapse
Affiliation(s)
- V V Zvirych
- National Cancer Institute, 33/43 Lomonosova St., Kyiv, Ukraine
| | - D E Makhmudov
- National Cancer Institute, 33/43 Lomonosova St., Kyiv, Ukraine
| | - M I Paliiy
- National Cancer Institute, 33/43 Lomonosova St., Kyiv, Ukraine
| | - A V Ashykhmin
- National Cancer Institute, 33/43 Lomonosova St., Kyiv, Ukraine
| | - O O Kolesnik
- National Cancer Institute, 33/43 Lomonosova St., Kyiv, Ukraine
| |
Collapse
|
11
|
Morgan SC, Morton GC, Berlin A, Cheung P, Chung P, Ménard C, Pickles T, Souhami L, Warde PR, Lukka HR. Current topics in radiotherapy for genitourinary cancers: Consensus statements of the Genitourinary Radiation Oncologists of Canada. Can Urol Assoc J 2020; 14:E588-E593. [PMID: 33079647 DOI: 10.5489/cuaj.6649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The biennial meeting of the Genitourinary Radiation Oncologists of Canada (GUROC) took place November 22-23, 2019. A consensus-building session was held during the meeting addressing topics of emerging interest or controversy in the management of genitourinary malignancies. METHODS Draft statements were debated among all meeting attendees in an open forum with anonymous live voting. Statements for which there was at least 75% agreement among attendees were adopted as GUROC consensus. RESULTS Four evidence-based consensus statements were developed. First, the use of prostate radiotherapy is recommended in the setting of de novo low-volume metastatic hormone-sensitive prostate cancer to improve overall survival. Second, the support of ongoing randomized trials evaluating metastasis-directed ablative local therapy in oligometastatic prostate cancer is recommended; where such trials are available, off-trial use of oligometastasis-directed ablative radiotherapy at this time is strongly discouraged. Third, routine use of prostate-rectal hydrogel spacer devices in patients with localized prostate cancer planned to receive external beam radiotherapy is not recommended; instead, selective use in patients at highest risk of rectal toxicity may be considered. Finally, multidisciplinary consultation is recommended for all patients with newly diagnosed localized muscle-invasive bladder cancer. CONCLUSIONS The GUROC consensus statements provide practical guidance to clinicians in areas of current controversy in the management of prostate and bladder cancer, and it is hoped that their implementation will contribute to improved outcomes in real-world practice and greater support of clinical trials.
Collapse
Affiliation(s)
- Scott C Morgan
- Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada.,Division of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Gerard C Morton
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Patrick Cheung
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Cynthia Ménard
- Département de radio-oncologie, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Tom Pickles
- Radiation Oncology Program, BC Cancer, Vancouver, BC, Canada.,Division of Radiation Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Luis Souhami
- Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Padraig R Warde
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Himanshu R Lukka
- Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada.,Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
12
|
Pessia B, Romano L, Giuliani A, Lazzarin G, Carlei F, Schietroma M. Squamous cell anal cancer: Management and therapeutic options. Ann Med Surg (Lond) 2020; 55:36-46. [PMID: 32461801 PMCID: PMC7240186 DOI: 10.1016/j.amsu.2020.04.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/02/2020] [Accepted: 04/19/2020] [Indexed: 02/06/2023] Open
Abstract
The incidence of anal cancer has increased during the second half of the 20th century, with an incidence rate over 2.9% greater than in the decade of 1992-2001. Yet, it still constitutes a small percentage, about 4%, of all anorectal tumours. Its risk factors are human papillomavirus infection, a history of sexually transmitted diseases, a history of vulvar or cervical carcinoma, immunosuppression related to human immunodeficiency virus infection or after organ transplantation, haematological or immunological disorders, and smoking. The most frequent symptom is rectal bleeding (45%), followed by anal pain, and sensation of a rectal mass. The diagnosis requires clinical examination, palpation of the inguinal lymph nodes, high resolution anoscopy followed by fine-needle aspiration biopsy or core biopsy. Subsequent histologic diagnosis is necessary, as well as computed tomography or magnetic resonance imaging evaluation of the pelvic lymph nodes. Since 1980, patients with a diagnosis of anal cancer have shown a significant improvement in survival. In Europe during the years 1983-1994, 1-year survival increased from 78% to 81%, and the improvement over 5 years was between 48% and 54%. Prior to 1974, patients with invasive cancer were routinely scheduled for abdominoperineal amputation, after which it was demonstrated that treatment with 5-fluorouracil and radiotherapy associated with mitomycin or capecitabine could be adequate to treat the tumour without surgery. Today, numerous studies have confirmed that combined multimodal treatment is effective and sufficient.
Collapse
Affiliation(s)
- Beatrice Pessia
- Department of Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Lucia Romano
- Department of Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Antonio Giuliani
- Department of Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Gianni Lazzarin
- Department of Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Francesco Carlei
- Department of Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Mario Schietroma
- Department of Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
13
|
Yuan JH, Song LM, Liu Y, Li MW, Lin Q, Wang R, Zhang CS, Dong J. The Effects of Hyperbaric Oxygen Therapy on Pelvic Radiation Induced Gastrointestinal Complications (Rectal Bleeding, Diarrhea, and Pain): A Meta-Analysis. Front Oncol 2020; 10:390. [PMID: 32328454 PMCID: PMC7160697 DOI: 10.3389/fonc.2020.00390] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/04/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Radiotherapy is a routine treatment for pelvic cancer patients. While it had been proven effective, gastrointestinal side effects remain a concern, impairing the quality of life. A few studies focused on the effects of hyperbaric oxygen (HBO) treatment to alleviate radiation-induced gastrointestinal complications. This meta-analysis aimed to critically review and summarize existing literature, assessing the effectiveness of HBO therapy for the treatment of radiation-induced gastrointestinal side effects. Methods: Medical literature search was performed with PubMed, Cochrane Library, and EMBASE up to March 14, 2019. Literatures about HBO treatment upon patients undergoing pelvic cancer (endometrial, cervix, rectum, or prostate cancers) radiotherapy were collected, and the effects of HBO treatment on radiotherapy-induced gastrointestinal complications were evaluated. A random-effects model was used to calculate the pooled effect size. Subgroup analyses were performed to search for sources of heterogeneity. Publication bias was detected with Funnel plots and Egger's test. Results: Three different radiotherapy-related gastrointestinal complications, including rectal bleeding, diarrhea, and pain, were analyzed after screening. It was revealed that the improvement rates were considerable in rectal bleeding (0.81, 95% CI: 0.74-0.89) and diarrhea (0.75, 95% CI: 0.61-0.90) and slightly in pain (0.58, 95% CI: 0.38-0.79). Subgroup analysis revealed factors that significantly influenced the heterogeneity of rectal bleeding, diarrhea, and pain (evaluation criteria, follow-up time, and scoring system, respectively). No significant publication bias was detected. Conclusion: HBO treatment might have the potential to alleviate radiotherapy-related gastrointestinal complications, including rectal bleeding, diarrhea, and pain, but more data are needed for further conclusions. Other symptoms were not further analyzed, as the number of studies was insufficient. More large-scale and prospective studies are needed for better evaluation of HBO's therapeutic values.
Collapse
Affiliation(s)
- Jun-hua Yuan
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Li-min Song
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Yuan Liu
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Man-wen Li
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Qian Lin
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Rui Wang
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Cai-shun Zhang
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Jing Dong
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao, China
- Department of Physiology, School of Basic Medicine, Qingdao University, Qingdao, China
| |
Collapse
|
14
|
Dilalla V, Chaput G, Williams T, Sultanem K. Radiotherapy side effects: integrating a survivorship clinical lens to better serve patients. Curr Oncol 2020; 27:107-112. [PMID: 32489253 PMCID: PMC7253739 DOI: 10.3747/co.27.6233] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The Canadian Cancer Society estimated that 220,400 new cases of cancer would be diagnosed in 2019. Of the affected patients, more than 60% will survive for 5 years or longer after their cancer diagnosis. Furthermore, nearly 40% will receive at least 1 course of radiotherapy (rt). Radiotherapy is used with both curative and palliative intent: to treat early-stage or locally advanced tumours (curative) and for symptom management in advanced disease (palliative). It can be delivered systemically (external-beam rt) or internally (brachytherapy). Although technique improvements have drastically reduced the occurrence of rt-related toxicity, most patients still experience burdensome rt side effects (seffs). Radiotherapy seffs are local or locoregional, and manifest in tissues or organs that were irradiated. Side effects manifesting within weeks after rt completion are termed "early seffs," and those occurring months or years after treatment are termed "late seffs." In addition to radiation oncologists, general practitioners in oncology and primary care providers are involved in survivorship care and management of rt seffs. Here, we present an overview of common seffs and their respective management: anxiety, depression, fatigue, and effects related to the head-and-neck, thoracic, and pelvic treatment sites.
Collapse
Affiliation(s)
- V Dilalla
- Division of Radiation Oncology, McGill University, Montreal, QC
| | - G Chaput
- Department of Family Medicine (Secondary Care), Division of Supportive and Palliative Medicine, McGill University Health Centre, and McGill University, Montreal, QC
| | - T Williams
- Cancer Care Mission Patients' Committee, McGill University Health Centre, Montreal, QC
| | - K Sultanem
- Department of Oncology, Division of Radiation Oncology, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| |
Collapse
|
15
|
Verma YK, Singh AK, Gurudutta GU. Survival genes expression analysis following ionizing radiation to LiCl treated KG1a cells. Int J Radiat Biol 2020; 96:671-688. [PMID: 31985347 DOI: 10.1080/09553002.2020.1721592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose: Lithium chloride (LiCl) is clinically used for manic disorders. Its role has been shown in improving cell survival by decreasing Bax and p53 expression and increasing Bcl-2 concentration in the cell. This potential of LiCl is responsible for reducing irradiated cell death. In this study, we have explored the role of LiCl as a radioprotectant affecting survival genes.Materials and methods: To find out the cellular response upon LiCl pretreatment to radiation-exposed KG1a cells; viability, clonogenic assay and microarray studies were performed. This was followed by the detection of transcription factor binding motif in coregulated genes. These results were confirmed by reverse transcription-polymerase chain reaction (RT-PCR) and chromatin immunoprecipitation (CHIP).Results: LiCl improved irradiated KG1a cell survival and its clonogenicity at 2 mM concentration (clinically used). Microarray data analysis showed differential expression of cell-protecting genes playing an important role in apoptosis, cell cycle, adhesion and inflammation, etc. The coregulation analysis revealed genes involved in bile acid biosynthesis were also affected by LiCl treatment, these genes are likely to be responsible for radiation-induced gastrointestinal (GI) syndrome through bile production.Conclusions: This is the first study with respect to global genetic expression upon LiCl treatment to radiation-exposed cells. Our results suggest considering repurposing of LiCl as a protective agent for radiation injury.
Collapse
Affiliation(s)
- Yogesh Kumar Verma
- Division of Stem Cell & Gene Therapy Research, Institute of Nuclear Medicine & Allied Sciences (INMAS), Defence Research and Development Organisation (DRDO), Delhi, India
| | - Ajay Kumar Singh
- Division of Stem Cell & Gene Therapy Research, Institute of Nuclear Medicine & Allied Sciences (INMAS), Defence Research and Development Organisation (DRDO), Delhi, India
| | - Gangenahalli Ugraiah Gurudutta
- Division of Stem Cell & Gene Therapy Research, Institute of Nuclear Medicine & Allied Sciences (INMAS), Defence Research and Development Organisation (DRDO), Delhi, India
| |
Collapse
|
16
|
Yakan S, Aydin T, Gulmez C, Ozden O, Eren Erdogan K, Daglioglu YK, Andic F, Atakisi O, Cakir A. The protective role of jervine against radiation-induced gastrointestinal toxicity. J Enzyme Inhib Med Chem 2019; 34:789-798. [PMID: 30871382 PMCID: PMC6419660 DOI: 10.1080/14756366.2019.1586681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/16/2019] [Accepted: 02/19/2019] [Indexed: 12/21/2022] Open
Abstract
In this study, we investigated whether jervine (J) could prevent gastrointestinal (GI) side effects of abdominopelvic radiotherapy (RT) in Wistar-Albino female rats. Rats were divided into five groups: control (C), J only (J), J administered at 5 mg/kg/days for 7 days, RT only (RT), J before RT (J + RT), J administered for seven days before RT, J both before and after RT (J + RT + J), and J administered for 7 days before RT and after RT for 3 days. The weights of rats were measured on the 1st, 7th, and 10th days of the study. Rats were sacrificed to obtain tissues from the liver and intestine, which was followed by taking blood samples intracardially. In addition, the tissues were stained with pyruvate dehydrogenase (PDH) immunohistochemically. In our study, J supplementation markedly reduced weight loss, and histopathological, immunohistochemical, biochemical results suggest that J had a protective effect on GI toxicity following RT.
Collapse
Affiliation(s)
- Selvinaz Yakan
- Animal Health Department, Agri Ibrahim Cecen University Eleskirt Celal Oruc School of Animal Production, Agri, Turkey
| | - Tuba Aydin
- Faculty of Pharmacy, Agri Ibrahim Cecen University, Agri, Turkey
| | - Canan Gulmez
- Department of Pharmacy Services, Tuzluca Vocational School, Igdir University, Igdir, Turkey
| | - Ozkan Ozden
- Department of Bioengineering, Faculty of Engineering and Architecture, Kafkas University, Kars, Turkey
| | | | | | - Fundagul Andic
- Department of Radiation Oncology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Onur Atakisi
- Department of Chemistry, Faculty of Science and Letter, Kafkas University, Kars, Turkey
| | - Ahmet Cakir
- Department of Chemistry, Faculty of Science and Literature, Kilis 7 Aralık University, Kilis, Turkey
| |
Collapse
|
17
|
Hasse FC, Koerber SA, Prigge ES, Liermann J, von Knebel Doeberitz M, Debus J, Sterzing F. Overcoming radioresistance in WiDr cells with heavy ion irradiation and radiosensitization by 2-deoxyglucose with photon irradiation. Clin Transl Radiat Oncol 2019; 19:52-58. [PMID: 31517070 PMCID: PMC6733777 DOI: 10.1016/j.ctro.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/14/2019] [Accepted: 08/17/2019] [Indexed: 12/31/2022] Open
Abstract
2-DG acts as a radiosensitizer to photons depending on the time of its application. There is no sensitization to 12C irradiation by 2-DG. 12C combination therapy still has the higher dose effectiveness.
Background and purpose Radiosensitizers and heavy ion irradiation could improve therapy for female patients with malignant tumors located in the pelvic region through dose reduction. Aim of the study was to investigate the radiosensitizing potential of 2-deoxy-d-glucose (2-DG) in combination with carbon ion-irradiation (12C) in representative cell lines of cancer in the female pelvic region. Materials and methods The human cervix carcinoma cell line CaSki and the colorectal carcinoma cell line WiDr were used. 2-DG was employed in two different settings, pretreatment and treatment simultaneous to irradiation. Clonogenic survival, α and β values for application of the linear quadratic model and relative biological effectiveness (RBE) were determined. ANOVA tests were used for statistical group comparison. Isobolograms were generated for curve comparisons. Results The comparison of monotherapy with 12C versus photons yielded RBE values of 2.4 for CaSki and 3.5 for WiDr along with a significant increase of α values in the 12C setting. 2-DG monotherapy reduced the colony formation of both cell lines. Radiosensitization was found in WiDr for the combination of photon irradiation with synchronous application of 2-DG. The same setup for 12C showed no radiosensitization, but rather an additive effect. In all settings with CaSki, the combination of irradiation and 2-DG exhibited additive properties. Conclusion The combination of 2-DG and photon therapy, as well as irradiation with carbon ions can overcome radioresistance of tumor cells such as WiDr.
Collapse
Affiliation(s)
- Felix Christian Hasse
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Stefan Alexander Koerber
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Elena Sophie Prigge
- Department of Applied Tumor Biology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Jakob Liermann
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Magnus von Knebel Doeberitz
- Department of Applied Tumor Biology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Juergen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Florian Sterzing
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| |
Collapse
|
18
|
Kumagai T, Rahman F, Smith AM. The Microbiome and Radiation Induced-Bowel Injury: Evidence for Potential Mechanistic Role in Disease Pathogenesis. Nutrients 2018; 10:E1405. [PMID: 30279338 PMCID: PMC6213333 DOI: 10.3390/nu10101405] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/18/2018] [Accepted: 09/25/2018] [Indexed: 12/15/2022] Open
Abstract
Radiotherapy has played a major role in both the curative and palliative treatment of cancer patients for decades. However, its toxic effect to the surrounding normal healthy tissue remains a major drawback. In cases of intra-abdominal and/or pelvic malignancy, healthy bowel is inevitably included in the radiation field, causing undesirable consequences that subsequently manifest as radiation-induced bowel injury, which is associated with significant morbidity and mortality. The pathophysiology of radiation-induced bowel injury is poorly understood, although we now know that it derives from a complex interplay of epithelial injury and alterations in the enteric immune, nervous, and vascular systems in genetically predisposed individuals. Furthermore, evidence supporting a pivotal role for the gut microbiota in the development of radiation-induced bowel injury has been growing. In this review, we aim to appraise our current understanding of radiation-induced bowel injury and the role of the microbiome in its pathogenesis as well as prevention and treatment. Greater understanding of the relationship between the disease mechanism of radiation-induced bowel injury and gut microbiome might shed light on potential future prevention and treatment strategies through the modification of a patient's gut microbiome.
Collapse
Affiliation(s)
- Tomoko Kumagai
- UCL Eastman Dental Institute, University College London (UCL), Rayne Institute, 5 University Street, London WC1E 6JF, UK.
| | - Farooq Rahman
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK.
| | - Andrew M Smith
- UCL Eastman Dental Institute, University College London (UCL), Rayne Institute, 5 University Street, London WC1E 6JF, UK.
| |
Collapse
|
19
|
Wei D, Heus P, van de Wetering FT, van Tienhoven G, Verleye L, Scholten RJPM. Probiotics for the prevention or treatment of chemotherapy- or radiotherapy-related diarrhoea in people with cancer. Cochrane Database Syst Rev 2018; 8:CD008831. [PMID: 30168576 PMCID: PMC6513393 DOI: 10.1002/14651858.cd008831.pub3] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Treament-related diarrhoea is one of the most common and troublesome adverse effects related to chemotherapy or radiotherapy in people with cancer. Its reported incidence has been as high as 50% to 80%. Severe treatment-related diarrhoea can lead to fluid and electrolyte losses and nutritional deficiencies and could adversely affect quality of life (QoL). It is also associated with increased risk of infection in people with neutropenia due to anticancer therapy and often leads to treatment delays, dose reductions, or treatment discontinuation. Probiotics may be effective in preventing or treating chemotherapy- or radiotherapy-induced diarrhoea. OBJECTIVES To evaluate the clinical effectiveness and side effects of probiotics used alone or combined with other agents for prevention or treatment of chemotherapy- or radiotherapy-related diarrhoea in people with cancer. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 7), MEDLINE (1946 to July week 2, 2017), and Embase (1980 to 2017, week 30). We also searched prospective clinical trial registers and the reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) investigating the effects of probiotics for prevention or treatment of chemotherapy- or radiotherapy-related diarrhoea in people with cancer. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data, and assessed risk of bias. We used random-effects models for all meta-analyses. If meta-analysis was not possible, we summarised the results narratively. MAIN RESULTS We included 12 studies involving 1554 participants. Eleven studies were prevention studies, of which seven compared probiotics with placebo (887 participants), one compared two doses of probiotics with each other and with placebo (246 participants), and three compared probiotics with another active agent (216 participants).The remaining study assessed the effectiveness of probiotics compared with placebo for treatment of radiotherapy-related diarrhoea (205 participants).For prevention of radiotherapy (with or without chemotherapy)-induced diarrhoea, review authors identified five heterogeneous placebo-controlled studies (with 926 participants analysed). Owing to heterogeneity, we could not carry out a meta-analysis, except for two outcomes. For occurrence of any diarrhoea, risk ratios (RRs) ranged from 0.35 (95% confidence interval (CI) 0.26 to 0.47) to 1.0 (95% CI 0.94 to 1.06) (three studies; low-certainty evidence). A beneficial effect of probiotics on quality of life could neither be demonstrated nor refuted (two studies; low-certainty evidence). For occurrence of grade 2 or higher diarrhoea, the pooled RR was 0.75 (95% CI 0.55 to 1.03; four studies; 420 participants; low-certainty evidence), and for grade 3 or higher diarrhoea, RRs ranged from 0.11 (95% CI 0.06 to 0.23) to 1.24 (95% CI 0.74 to 2.08) (three studies; low-certainty evidence). For probiotic users, time to rescue medication was 36 hours longer in one study (95% CI 34.7 to 37.3), but another study reported no difference (moderate-certainty evidence). For the need for rescue medication, the pooled RR was 0.50 (95% CI 0.15 to 1.66; three studies; 194 participants; very low-certainty evidence). No study reported major differences between groups with respect to adverse effects. Although not mentioned explicitly, no studies reported deaths, except one in which one participant in the probiotics group died of myocardial infarction after three sessions of radiotherapy.Three placebo-controlled studies, with 128 analysed participants, addressed prevention of chemotherapy-induced diarrhoea. For occurrence of any diarrhoea, the pooled RR was 0.59 (95% CI 0.36 to 0.96; two studies; 106 participants; low-certainty evidence). For all other outcomes, a beneficial effect of probiotics could be neither demonstrated nor refuted (one to two studies; 46 to 106 participants; all low-certainty evidence). Studies did not address quality of life nor time to rescue medication.Three studies compared probiotics with another intervention in 213 participants treated with radiotherapy (with or without chemotherapy). One very small study (21 participants) reported less diarrhoea six weeks after treatment when dietary counselling was provided (RR 0.30, 95% CI 0.11 to 0.81; very low-certainty evidence). In another study (148 participants), grade 3 or 4 diarrhoea occurred less often in the probiotics group than in the control group (guar gum containing nutritional supplement) (odds ratio (OR) 0.38, 95% CI 0.16 to 0.89; low-certainty evidence), and two studies (63 participants) found less need for rescue medication of probiotics versus another active treatment (RR 0.44, 95% CI 0.22 to 0.86; very low-certainty evidence). Studies did not address quality of life nor time to rescue medication.One placebo-controlled study with 205 participants addressed treatment for radiotherapy-induced diarrhoea and could not demonstrate or refute a beneficial effect of probiotics on average diarrhoea grade, time to rescue medication for diarrhoea (13 hours longer in the probiotics group; 95% CI -0.9 to 26.9 hours), or need for rescue medication (RR 0.74, 95% CI 0.53 to 1.03; moderate-certainty evidence). This study did not address quality of life.No studies reported serious adverse events or diarrhoea-related deaths. AUTHORS' CONCLUSIONS This review presents limited low- or very low-certainty evidence supporting the effects of probiotics for prevention and treatment of diarrhoea related to radiotherapy (with or without chemotherapy) or chemotherapy alone, need for rescue medication, or occurrence of adverse events. All studies were underpowered and heterogeneous. Severe side effects were absent from all studies.Robust evidence on this topic must be provided by future methodologically well-designed trials.
Collapse
Affiliation(s)
- Dang Wei
- Karolinska InstitutetDepartment of Public Health SciencesSolnavägen 1EStockholmSweden11365, Solna
| | - Pauline Heus
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityCochrane NetherlandsRoom Str. 6.131PO Box 85500UtrechtNetherlands3508 GA
| | - Fleur T van de Wetering
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityCochrane NetherlandsRoom Str. 6.131PO Box 85500UtrechtNetherlands3508 GA
| | - Geertjan van Tienhoven
- Academic Medical CenterRadiation Oncology and HyperthermiaP.O. Box 22700Meibergdreef 9AmsterdamNetherlands1100 DE
| | - Leen Verleye
- Belgian Health Care Knowledge CentreKruidtuinlaan 55BrusselsBelgium1000
| | - Rob JPM Scholten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityCochrane NetherlandsRoom Str. 6.131PO Box 85500UtrechtNetherlands3508 GA
| | | |
Collapse
|
20
|
Ippolito E, Guido A, Macchia G, Deodato F, Giaccherini L, Farioli A, Arcelli A, Cuicchi D, Frazzoni L, Cilla S, Buwenge M, Mantini G, Alitto AR, Nuzzo M, Valentini V, Ingrosso M, Morganti AG, Fuccio L. Predictive Factors of Late-onset Rectal Mucosal Changes After Radiotherapy of Prostate Cancer. ACTA ACUST UNITED AC 2018; 31:961-966. [PMID: 28882966 DOI: 10.21873/invivo.11154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND/AIM The Vienna Rectoscopy Score (VRS; from 0, absence of rectal mucosal changes, to 5) assessed 1 year after radiotherapy is a surrogate end-point of late rectal toxicity. The aim of this study was to investigate the association between treatment-related factors and 1-year VRS. PATIENTS AND METHODS We performed a retrospective analysis of prospectively collected data. Patients with prostate adenocarcinoma treated with definitive or postoperative radiotherapy (RT) underwent endoscopy 1 year after RT. Relationships between VRS of 2 or more and treatment parameters were investigated by univariate and multivariate logistic analyses. RESULTS One hundred and ninety-five patients (mean age=69 years; range=43-81 years) were considered eligible for the study. At univariate analysis, patients treated with hypofractionation plus radiosurgery boost (p<0.001) and an equivalent dose in 2 Gy per fraction (EQD2) (α/β=3) ≥75 Gy (p<0.001) was associated with a significantly higher incidence of VRS ≥2 after 1 year of follow-up. At multivariate analysis, radiosurgery boost was an independent risk factor for developing rectal mucosal lesions (VRS ≥2), yielding an odds ratio (OR) of 4.14 (95% confidence interval (CI)=1.2-13.8), while pelvic surgery was inversely associated with VRS ≥2 (OR=0.39; 95% CI=0.17-0.94). CONCLUSION Hypofractionation followed by radiosurgery boost significantly increased the risk of developing late-onset rectal mucosal changes. Therefore, special care and preventative treatment strategies are needed when using radiosurgery boost after hypofractionated RT.
Collapse
Affiliation(s)
- Edy Ippolito
- Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
| | - Alessandra Guido
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine DIMES, University of Bologna, Bologna, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Giovanni Paolo II Research and Care Foundation, Campobasso, Italy
| | - Francesco Deodato
- Radiotherapy Unit, Giovanni Paolo II Research and Care Foundation, Campobasso, Italy
| | - Lucia Giaccherini
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine DIMES, University of Bologna, Bologna, Italy
| | - Andrea Farioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Alessandra Arcelli
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine DIMES, University of Bologna, Bologna, Italy
| | - Dajana Cuicchi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Leonardo Frazzoni
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Giovanni Paolo II Research and Care Foundation, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine DIMES, University of Bologna, Bologna, Italy
| | - Giovanna Mantini
- Department of Radiotherapy, A. Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - Anna R Alitto
- Department of Radiotherapy, A. Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - Marianna Nuzzo
- Radiotherapy Unit, Giovanni Paolo II Research and Care Foundation, Campobasso, Italy
| | - Vincenzo Valentini
- Department of Radiotherapy, A. Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - Marcello Ingrosso
- Endoscopy Unit, Giovanni Paolo II Research and Care Foundation, Campobasso, Italy
| | - Alessio G Morganti
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine DIMES, University of Bologna, Bologna, Italy
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| |
Collapse
|
21
|
Ludmir EB, Kachnic LA, Czito BG. Evolution and Management of Treatment-Related Toxicity in Anal Cancer. Surg Oncol Clin N Am 2018; 26:91-113. [PMID: 27889040 DOI: 10.1016/j.soc.2016.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Over the past several decades, clinical trials have demonstrated improved disease-related outcomes in the definitive treatment of anal cancer. Although treatment with radiation and concurrent chemotherapy results in high rates of cure, significant acute and late toxicities are seen. This review focuses on the evolution of treatment-related toxicity for anal cancer. Management of these adverse effects is reviewed, as are future directions in anal cancer treatment and their impact on toxicity.
Collapse
Affiliation(s)
- Ethan B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1422, Houston, TX 77030, USA
| | - Lisa A Kachnic
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Avenue, Suite B1034, Nashville, TN 37232, USA
| | - Brian G Czito
- Department of Radiation Oncology, Duke University Medical Center, Box 3085, Durham, NC 27710, USA.
| |
Collapse
|
22
|
|
23
|
Frazzoni L, La Marca M, Guido A, Morganti AG, Bazzoli F, Fuccio L. Pelvic radiation disease: Updates on treatment options. World J Clin Oncol 2015; 6:272-280. [PMID: 26677440 PMCID: PMC4675912 DOI: 10.5306/wjco.v6.i6.272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/18/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiation-treated patients say that their quality of life is affected by GI symptoms (e.g., rectal bleeding, diarrhoea). The constellation of GI symptoms - from transient to long-term, from mild to very severe - experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e., medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e., causing chronic anemia) should firstly be considered for medical management (i.e., sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments.
Collapse
|
24
|
Fuccio L, Frazzoni L, Guido A. Prevention of pelvic radiation disease. World J Gastrointest Pharmacol Ther 2015; 6:1-9. [PMID: 25664197 PMCID: PMC4318744 DOI: 10.4292/wjgpt.v6.i1.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 09/02/2014] [Accepted: 11/10/2014] [Indexed: 02/06/2023] Open
Abstract
Pelvic cancers are among the most frequently diagnosed cancers worldwide. Treatment of patients requires a multidisciplinary approach that frequently includes radiotherapy. Gastrointestinal (GI) radiation-induced toxicity is a major complication and the transient or long-term problems, ranging from mild to very severe, arising in non-cancerous tissues resulting from radiation treatment to a tumor of pelvic origin, are actually called as pelvic radiation disease. The incidence of pelvic radiation disease changes according to the radiation technique, the length of follow up, the assessment method, the type and stage of cancer and several other variables. Notably, even with the most recent radiation techniques, i.e., intensity-modulated radiotherapy, the incidence of radiation-induced GI side effects is overall reduced but still not negligible. In addition, radiation-induced GI side effects can develop even after several decades; therefore, the improvement of patient life expectancy will unavoidably increase the risk of developing radiation-induced complications. Once developed, the management of pelvic radiation disease may be challenging. Therefore, the prevention of radiation-induced toxicity represents a reasonable way to avoid a dramatic drop of the quality of life of these patients. In the current manuscript we provide an updated and practical review on the best available evidences in the field of the prevention of pelvic radiation disease.
Collapse
|
25
|
Abstract
Diarrhoea induced by chemotherapy in cancer patients is common, causes notable morbidity and mortality, and is managed inconsistently. Previous management guidelines were based on poor evidence and neglect physiological causes of chemotherapy-induced diarrhoea. In the absence of level 1 evidence from randomised controlled trials, we developed practical guidance for clinicians based on a literature review by a multidisciplinary team of clinical oncologists, dietitians, gastroenterologists, medical oncologists, nurses, pharmacist, and a surgeon. Education of patients and their carers about the risks associated with, and management of, chemotherapy-induced diarrhoea is the foundation for optimum treatment of toxic effects. Adequate--and, if necessary, repeated--assessment, appropriate use of loperamide, and knowledge of fluid resuscitation requirements of affected patients is the second crucial step. Use of octreotide and seeking specialist advice early for patients who do not respond to treatment will reduce morbidity and mortality. In view of the burden of chemotherapy-induced diarrhoea, appropriate multidisciplinary research to assess meaningful endpoints is urgently required.
Collapse
|
26
|
Abstract
With the implementation of total mesorectal excision surgery and neoadjuvant (chemo) radiotherapy, the outcome of rectal cancer patients has improved and a substantial proportion of them have become long-term survivors. These advances come at the expense of radiation- and chemotherapy-related toxicity which remains an underestimated problem. Radiation-induced early toxicity in rectal cancer treatment mainly includes diarrhea, cystitis, and perineal dermatitis, while bowel dysfunction, fecal incontinence, bleeding, and perforation, genitourinary dysfunction, and pelvic fractures constitute the majority of late toxicity. It is now generally accepted that short-course radiotherapy (SCRT) and immediate surgery is associated with less early toxicity compared to conventionally fractionated chemoradiotherapy with delayed surgery. There are no significant differences in late toxicity between both treatment regimens. While there is hardly an increase in early toxicity after preoperative SCRT with immediate surgery, late toxicity is substantial compared to surgery alone. Early toxicity is more frequent when a longer interval between SCRT and surgery is used and is comparable to the toxicity observed with conventionally fractionated radiotherapy except that it occurs after the end of the radiotherapy. So far, randomized phase III trials failed to demonstrate a substantial gain in tumoural response when oxaliplatin or molecular agents are added to the multimodality treatment. Moreover, the addition of these drugs increases toxicity and remains therefore experimental.
Collapse
|
27
|
Laterza L, Cecinato P, Guido A, Mussetto A, Fuccio L. Management of radiation-induced rectal bleeding. Curr Gastroenterol Rep 2014; 15:355. [PMID: 24101202 DOI: 10.1007/s11894-013-0355-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pelvic radiation disease is one of the major complication after radiotherapy for pelvic cancers. The most commonly reported symptom is rectal bleeding which affects patients' quality of life. Therapeutic strategies for rectal bleeding are generally ignored and include medical, endoscopic, and hyperbaric oxygen treatments. Most cases of radiation-induced bleeding are mild and self-limiting, and treatment is normally not indicated. In cases of clinically significant bleeding (i.e. anaemia), medical therapies, including stool softeners, sucralfate enemas, and metronidazole, should be considered as first-line treatment options. In cases of failure, endoscopic therapy, mainly represented by argon plasma coagulation and hyperbaric oxygen treatments, are valid and complementary second-line treatment strategies. Although current treatment options are not always supported by high-quality studies, patients should be reassured that treatment options exist and success is achieved in most cases if the patient is referred to a dedicated centre.
Collapse
Affiliation(s)
- Liboria Laterza
- Unit of Gastroenterology, Department of Medical and Surgical Sciences, S.Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | | | | | | | | |
Collapse
|
28
|
Razzaghdoust A, Mozdarani H, Mofid B. Famotidine as a radioprotector for rectal mucosa in prostate cancer patients treated with radiotherapy: phase I/II randomized placebo-controlled trial. Strahlenther Onkol 2014; 190:739-44. [PMID: 24619016 DOI: 10.1007/s00066-014-0602-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE Acute bowel toxicity significantly affects the quality of life of patients treated with pelvic radiotherapy. This study was performed to assess whether pretreatment with famotidine can reduce acute radiation toxicities in patients undergoing radiotherapy for prostate cancer. PATIENTS AND METHODS Between April 2012 and February 2013, 36 patients undergoing radiotherapy for prostate cancer were enrolled to receive either placebo or famotidine. The patients received external-beam radiotherapy up to 70 Gy at daily fractions of 1.8-2 Gy (5 days/week). Oral famotidine 40 mg (80 mg/day) or placebo was administered twice daily (4 and 3 h prior to each radiotherapy fraction). Bowel and bladder acute toxicities were evaluated weekly during radiotherapy and once thereafter according to RTOG grading criteria. RESULTS Famotidine was well tolerated. No grade III or higher acute toxicities were noted in the two groups. Grade II rectal toxicity developed significantly more often in patients receiving placebo than in patients receiving famotidine (10/18 vs. 2/16, p=0.009). Moreover, no rectal bleeding occurred in the famotidine group, while 5 patients in the placebo group experienced rectal bleeding during treatment (p=0.046). The duration of rectal toxicity in the radiotherapy course was also reduced in the famotidine group (15.7 vs. 25.2 days, p=0.027). No significant difference between the two groups was observed in terms of urinary toxicity. CONCLUSION We demonstrated for the first time that famotidine significantly reduces radiation-induced injury on rectal mucosa representing a suitable radioprotector for patients treated with radiotherapy for prostate cancer.
Collapse
Affiliation(s)
- A Razzaghdoust
- Department of Radiology, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
| | | | | |
Collapse
|
29
|
Lacave-Lapalun JV, Benderitter M, Linard C. Flagellin and LPS each restores rat lymphocyte populations after colorectal irradiation. J Leukoc Biol 2014; 95:931-40. [PMID: 24532644 DOI: 10.1189/jlb.0413209] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Radiation-induced gastrointestinal toxicity, including its shift of the immune balance, remains a major limitation to delivering tumoricidal doses of abdominal radiation therapy. This study evaluates the effect on the colon's innate and adaptive immune responses to moderate irradiation doses and the therapeutic possibilities of maintaining immune homeostasis. We investigated whether administration of the TLR4 agonist LPS or of the TLR5 agonist flagellin, 3 days after a single 20-Gy colorectal irradiation, modified recruitment of neutrophils, NK cells, or CD4⁺ or CD8⁺ T cells, 7 days postirradiation. Flow cytometric analysis showed that LPS and flagellin reduced irradiation-induced neutrophil infiltration and normalized NK frequency. LPS normalized the CD4⁺ population and enhanced the CD8⁺ population, whereas flagellin maintained the radiation-induced elevation in the frequencies of both. Irradiation also modified TLR4 and TLR5 expression on the surface of both populations, but LPS and flagellin each subsequently normalized them. LPS and flagellin were strong inducers of Th1 cytokines (IL-12p35, IL-12p40, and IFN-γ) and thus, contributed to a shift from the Th2 polarization induced by irradiation toward a Th1 polarization, confirmed by an increase of the T-bet:GATA3 ratio, which assesses the Th1 or Th2 status in mixed cell populations. LPS and flagellin treatment resulted in overexpression of FoxP3, IL-2Rα (CD25), IL-2, and OX40, all expressed specifically and involved in high levels of Treg cell expansion. We observed no variation in Treg function-related expression of IL-10 or CTLA-4. These data suggest that the use of TLR ligands limits the effects of irradiation on innate and adaptive immunity.
Collapse
Affiliation(s)
- Jean-Victor Lacave-Lapalun
- Laboratory of Radiopathology and Experimental Therapies, Institute for Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France
| | - Marc Benderitter
- Laboratory of Radiopathology and Experimental Therapies, Institute for Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France
| | - Christine Linard
- Laboratory of Radiopathology and Experimental Therapies, Institute for Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France
| |
Collapse
|
30
|
Duska LR, Fader AN, Dizon DS. Survivorship in gynecologic cancer: enduring the treatment toward a new normal. Am Soc Clin Oncol Educ Book 2014:e288-e294. [PMID: 24857115 DOI: 10.14694/edbook_am.2014.34.e288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Women are living longer after a cancer diagnosis because of advances in early detection and treatment. However, although our ability to effectively treat gynecologic malignancies has improved, survivors of gynecologic cancer often face profound physical, emotional, sexual, and psychosocial challenges as a result of their cancer diagnosis and treatment. In this article, we discuss how patient comorbidities (i.e., obesity) and cancer treatment effects may adversely affect sexual health outcomes, gastrointestinal function, and general health among survivors of gynecologic cancer. The importance of a multidisciplinary, patient-centered approach to survivorship care is emphasized.
Collapse
Affiliation(s)
- Linda R Duska
- From the Thornton Gynecologic Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD; Gillette Center for Gynecological Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Amanda N Fader
- From the Thornton Gynecologic Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD; Gillette Center for Gynecological Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Don S Dizon
- From the Thornton Gynecologic Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD; Gillette Center for Gynecological Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| |
Collapse
|
31
|
Fuccio L, Guido A. Probiotics supplementation for the prevention of gastrointestinal radiation-induced side effects: the time is now. Am J Gastroenterol 2013; 108:277. [PMID: 23381075 DOI: 10.1038/ajg.2012.418] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|