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Belkacemi Y, Debbi K, Besnard C, Grellier N, Fonteneau G, Colson-Durand L, Lerouge D, Durdux C, Campana F, Pons P, Flandin I, Pasquier D, de Crevoisier R, Wachter T, Thureau S, Noël G, Conzague-Casabianca L, Petit A, Supiot S, Azria D. [The morbidity and mortality review meetings in radiotherapy departments: Procedure, implementation and prospects of the "Proust" French national project]. Cancer Radiother 2023; 27:474-479. [PMID: 37507286 DOI: 10.1016/j.canrad.2023.06.018] [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: 06/17/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023]
Abstract
Radiation-induced acute and late toxicity depends on several parameters. The type, severity and duration of morbidity are mainly related to irradiated volume, total dose and its fractionation and the intrinsic radiosensitivity of the patients. The follow-up of these toxicities is essential. However, unlike many specialties, morbidity and mortality reviews procedures are not developed as part of quality governance programs in radiation therapy departments for the monitoring of toxicity which sometimes hinder the patients' quality of life. One French survey published within the framework of the project entitled Prospective Registration of Morbidity and Mortality, Individual Radiosensitivity and Radiation Technique (Proust), conclude that there was a lack of knowledge of morbidity and mortality reviews and considerable confusion between these reviews and other quality processes without perspective for the local morbidity and mortality reviews development in a large number of the participated centers. In this article, we will discuss the procedure of the "ideal morbidity and mortality reviews" and its implementation through a monocentric experience started in 2015. Thus, the Proust project is a unique opportunity to implement and standardize a national morbidity and mortality reviews implementation in radiation therapy departments by involving the French regions.
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Affiliation(s)
- Y Belkacemi
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Équipe i-Biot, unité 955, Inserm, IMRB, université Paris-Est Créteil, Créteil, France.
| | - K Debbi
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Équipe i-Biot, unité 955, Inserm, IMRB, université Paris-Est Créteil, Créteil, France
| | - C Besnard
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France
| | - N Grellier
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France
| | - G Fonteneau
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France
| | - L Colson-Durand
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Service d'oncologie-radiothérapie, Institut oncologique Paris-Nord, Sarcelles, France
| | - D Lerouge
- Service d'oncologie-radiothérapie, centre François-Baclesse, Caen, France
| | - C Durdux
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, AP-HP, université Paris-Cité, Paris, France
| | - F Campana
- Service d'oncologie-radiothérapie, institut Hartmann, Levallois-Perret, France
| | - P Pons
- Service d'oncologie-radiothérapie, institut Hartmann, Levallois-Perret, France
| | - I Flandin
- Service d'oncologie-radiothérapie, centre hospitalier universitaire de Grenoble, Grenoble, France
| | - D Pasquier
- Département universitaire d'oncologie-radiothérapie, centre Oscar-Lambret, UMR 9189, université de Lille, Centre de recherche en informatique, signal et automatique de Lille (Cristal), Lille, France
| | - R de Crevoisier
- Service d'oncologie-radiothérapie, centre Eugène-Marquis, Rennes, France
| | - T Wachter
- Service d'oncologie-radiothérapie, centre hospitalier général d'Orléans, Orléans, France
| | - S Thureau
- Service d'oncologie-radiothérapie, centre Henri-Becquerel, QuantIF Litis unit EA 4108, université de Rouen, Rouen, France
| | - G Noël
- Service d'oncologie-radiothérapie, institut de cancérologie Strasbourg Europe (ICANS), université de Strasbourg, Strasbourg, France
| | | | - A Petit
- Service d'oncologie-radiothérapie, institut Bergonié, Bordeaux, France
| | - S Supiot
- Service d'oncologie-radiothérapie, institut de cancérologie de l'Ouest, centre René-Gauducheau, université de Nantes, Nantes, France
| | - D Azria
- Service d'oncologie-radiothérapie, Institut du cancer de Montpellier (ICM), université de Montpellier, Institut de recherche sur le cancer de Montpellier (IRCM), unit 1194, Inserm, Montpellier, France
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Constanzo J, Faget J, Ursino C, Badie C, Pouget JP. Radiation-Induced Immunity and Toxicities: The Versatility of the cGAS-STING Pathway. Front Immunol 2021; 12:680503. [PMID: 34079557 PMCID: PMC8165314 DOI: 10.3389/fimmu.2021.680503] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022] Open
Abstract
In the past decade, radiation therapy (RT) entered the era of personalized medicine, following the striking improvements in radiation delivery and treatment planning optimization, and in the understanding of the cancer response, including the immunological response. The next challenge is to identify the optimal radiation regimen(s) to induce a clinically relevant anti-tumor immunity response. Organs at risks and the tumor microenvironment (e.g. endothelial cells, macrophages and fibroblasts) often limit the radiation regimen effects due to adverse toxicities. Here, we reviewed how RT can modulate the immune response involved in the tumor control and side effects associated with inflammatory processes. Moreover, we discussed the versatile roles of tumor microenvironment components during RT, how the innate immune sensing of RT-induced genotoxicity, through the cGAS-STING pathway, might link the anti-tumor immune response, radiation-induced necrosis and radiation-induced fibrosis, and how a better understanding of the switch between favorable and deleterious events might help to define innovative approaches to increase RT benefits in patients with cancer.
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Affiliation(s)
- Julie Constanzo
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier, France
| | - Julien Faget
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier, France
| | - Chiara Ursino
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier, France
| | - Christophe Badie
- Cancer Mechanisms and Biomarkers Group, Radiation Effects Department, Centre for Radiation, Chemical & Environmental Hazards Public Health England Chilton, Didcot, United Kingdom
| | - Jean-Pierre Pouget
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier, France
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Correlation between toxicity and dosimetric parameters for adjuvant intensity modulated radiation therapy of breast cancer: a prospective study. Sci Rep 2021; 11:3626. [PMID: 33574446 PMCID: PMC7878810 DOI: 10.1038/s41598-021-83159-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
ORCID: 0000–0001-6019–7309. In the treatment of breast cancer, intensity-modulated radiation therapy (IMRT) reportedly reduces the high-dose irradiation of at-risk organs and decreases the frequency of adverse events (AEs). Comparisons with conventional radiotherapy have shown that IMRT is associated with lower frequencies of acute and late-onset AEs. Here, we extended a prospective, observational, single-center study of the safety of IMRT to a second investigating center. Patients scheduled for adjuvant IMRT after partial or total mastectomy were given a dose of 50 Gy (25 fractions of 2 Gy over 5 weeks), with a simultaneous integrated boost in patients having undergone conservative surgery. 300 patients were included in the study, and 288 were analyzed. The median follow-up period was 2.1 years. The 2-year disease-free survival rate [95% CI] was 93.4% [89.2–96.0%]. Most AEs were mild. The most common AEs were skin-related—mainly radiodermatitis [in 266 patients (92.4%)] and hyperpigmentation (in 178 (61.8%)). 35% and 6% of the patients presented with grade 2 acute skin and esophageal toxicity, respectively. Only 4 patients presented with a grade 3 event (radiodermatitis). Smoking (odds ratio) [95% CI] = 2.10 [1.14–3.87]; p = 0.017), no prior chemotherapy (0.52 [0.27–0.98]; p = 0.044), and D98% for subclavicular skin (1.030 [1.001–1.061]; p = 0.045) were associated with grade ≥ 2 acute AEs. In a univariate analysis, the mean dose, (p < 0.0001), D2% (p < 0.0001), D50% (p = 0.037), D95% (p = 0.0005), D98% (p = 0.0007), V30Gy (p < 0.0001), and V45Gy (p = 0.0001) were significantly associated with grade ≥ 1 acute esophageal AEs. In a multivariate analysis, D95% for the skin (p < 0.001), D98% for the subclavicular skin and low D95% for the internal mammary lymph nodes were associated with grade ≥ 1 medium-term AEs. The safety profile of adjuvant IMRT after partial or total mastectomy is influenced by dosimetric parameters. Trial registration: ClinicalTrials.gov NCT02281149.
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Bataille B, Raoudha B, Le Tinier F, Basson L, Escande A, Langin H, Tresch E, Crop F, Darloy F, Carlier D, Lartigau E, Pasquier D. Prospective Study of Intensity-Modulated Radiation Therapy for Locally Advanced Breast Cancer. Cancers (Basel) 2020; 12:cancers12123852. [PMID: 33419316 PMCID: PMC7766204 DOI: 10.3390/cancers12123852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/13/2020] [Accepted: 12/18/2020] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Tomotherapy is a modern intensity-modulated radiotherapy technique, whose aim is to reduce the high doses delivered to organs at risk. Thus, we conducted a prospective study evaluating the early and medium-term toxicities, the patient’s quality of life, and the aesthetic outcomes (evaluated by both physicians and patients) of tomotherapy for breast cancer. We wanted to show that this treatment is very well tolerated, with low-grade acute toxicities, and has only a moderate impact on patients’ quality of life and aesthetic outcome, in order to support its larger use in this very frequent situation. Abstract The objective of this study was to evaluate the acute and medium-term toxicities, the quality of life, and aesthetic results of patients with breast cancer (BC) treated with tomotherapy. This was a prospective study, including patients with BC treated by tomotherapy. Radiation therapy delivered 50 Gy in 25 fractions to the breast or chest wall and to lymph node areas, with a simultaneous integrated boost at a dose of 60 Gy at the tumor bed in cases of breast conservative surgery. We included 288 patients, 168 and 120 treated with breast-conserving surgery and mastectomy respectively. Two hundred sixty patients (90.3%) received lymph node irradiation. Median follow-up was 25 months (6–48). Acute dermatitis was observed in 278 patients (96.5%), mostly grade 1 (59.7%). The aesthetic aspect of the breast at one year was reported as “good” or “excellent” in 84.6% of patients. The patients’ quality of life improved over time, especially those treated with chemotherapy. The two-year overall survival and disease-free survival were 97.8% (95% confidence interval (CI): 94.1–99.2%), and 93.4% (95% CI: 89.2–96.0%) respectively. Tomotherapy for locally advanced BC has acceptable toxicity, supporting its use in this indication; however, longer follow-up is needed to assess long-term outcomes.
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Affiliation(s)
- Benoît Bataille
- Academic Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France; (B.B.); (B.R.); (F.L.T.); (L.B.); (A.E.); (H.L.); (E.L.)
| | - Bennadji Raoudha
- Academic Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France; (B.B.); (B.R.); (F.L.T.); (L.B.); (A.E.); (H.L.); (E.L.)
| | - Florence Le Tinier
- Academic Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France; (B.B.); (B.R.); (F.L.T.); (L.B.); (A.E.); (H.L.); (E.L.)
| | - Laurent Basson
- Academic Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France; (B.B.); (B.R.); (F.L.T.); (L.B.); (A.E.); (H.L.); (E.L.)
| | - Alexandre Escande
- Academic Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France; (B.B.); (B.R.); (F.L.T.); (L.B.); (A.E.); (H.L.); (E.L.)
| | - Hélène Langin
- Academic Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France; (B.B.); (B.R.); (F.L.T.); (L.B.); (A.E.); (H.L.); (E.L.)
| | - Emmanuelle Tresch
- Methodology and Biostatistics Department, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France;
| | - Frederik Crop
- Medical Physics Department, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France;
| | - Franck Darloy
- Department of Radiation Oncology, Leonard De Vinci center, 59187 Dechy, France; (F.D.); (D.C.)
| | - Damien Carlier
- Department of Radiation Oncology, Leonard De Vinci center, 59187 Dechy, France; (F.D.); (D.C.)
| | - Eric Lartigau
- Academic Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France; (B.B.); (B.R.); (F.L.T.); (L.B.); (A.E.); (H.L.); (E.L.)
- CRIStAL UMR CNRS 9189, Lille University, 59000 Lille, France
| | - David Pasquier
- Academic Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France; (B.B.); (B.R.); (F.L.T.); (L.B.); (A.E.); (H.L.); (E.L.)
- CRIStAL UMR CNRS 9189, Lille University, 59000 Lille, France
- Correspondence: ; Tel.: +33-3-20-29-59-11; Fax: +33-3-20-29-59-72
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Sharma A, Akagi K, Pattavina B, Wilson KA, Nelson C, Watson M, Maksoud E, Harata A, Ortega M, Brem RB, Kapahi P. Musashi expression in intestinal stem cells attenuates radiation-induced decline in intestinal permeability and survival in Drosophila. Sci Rep 2020; 10:19080. [PMID: 33154387 PMCID: PMC7644626 DOI: 10.1038/s41598-020-75867-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/17/2020] [Indexed: 11/30/2022] Open
Abstract
Exposure to genotoxic stress by environmental agents or treatments, such as radiation therapy, can diminish healthspan and accelerate aging. We have developed a Drosophila melanogaster model to study the molecular effects of radiation-induced damage and repair. Utilizing a quantitative intestinal permeability assay, we performed an unbiased GWAS screen (using 156 strains from the Drosophila Genetic Reference Panel) to search for natural genetic variants that regulate radiation-induced gut permeability in adult D. melanogaster. From this screen, we identified an RNA binding protein, Musashi (msi), as one of the possible genes associated with changes in intestinal permeability upon radiation. The overexpression of msi promoted intestinal stem cell proliferation, which increased survival after irradiation and rescued radiation-induced intestinal permeability. In summary, we have established D. melanogaster as an expedient model system to study the effects of radiation-induced damage to the intestine in adults and have identified msi as a potential therapeutic target.
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Affiliation(s)
- Amit Sharma
- SENS Research Foundation, 110 Pioneer Way, Suite J, Mountain View, CA, 94041, USA.
| | - Kazutaka Akagi
- National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi, 474-8511, Japan.
| | - Blaine Pattavina
- Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA, 94945, USA
| | - Kenneth A Wilson
- Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA, 94945, USA
| | - Christopher Nelson
- Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA, 94945, USA
| | - Mark Watson
- Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA, 94945, USA
| | - Elie Maksoud
- Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA, 94945, USA
| | - Ayano Harata
- National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi, 474-8511, Japan
| | - Mauricio Ortega
- Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA, 94945, USA
| | - Rachel B Brem
- Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA, 94945, USA
| | - Pankaj Kapahi
- Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA, 94945, USA.
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Azria D, Hennequin C, Giraud P. [Practical update of total dose compensation in case of temporary interruption of external radiotherapy in the COVID-19 pandemic context]. Cancer Radiother 2020; 24:182-187. [PMID: 32307313 PMCID: PMC7146696 DOI: 10.1016/j.canrad.2020.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/25/2022]
Abstract
L’étalement est un facteur important de récidive locale et indirectement d’évolution à distance, notamment, en cas de durée de traitement allongée. La pandémie actuelle a un impact sur les patients en cours de radiothérapie qui doivent interrompre leur traitement de manière parfois prolongée du fait de la nécessité de soins respiratoires induits par le COVID-19. Les modèles utilisés de compensation de la dose totale en cas d’interruption prolongée de la radiothérapie sont connus, mais il nous a semblé important de synthétiser afin que chaque oncologue radiothérapeute puisse proposer un traitement le plus optimal possible tant en termes de risque de récidive locale que de protection des tissus sains. L’objectif de ce type de recommandation est d’homogénéiser les pratiques de l’ensemble de la discipline.
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Affiliation(s)
- D Azria
- IRCM, Institut de recherche en cancérologie de Montpellier (U1194), 208, avenue des Apothicaires, 34298 Montpellier cedex 5, France; Inserm, U1194, 208, avenue des Apothicaires, 34298 Montpellier cedex 5, France; Université de Montpellier, centre de recherche U1194, 208, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Fédération universitaire d'oncologie radiothérapie, ICM, institut régional du cancer de Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France.
| | - C Hennequin
- Service de cancérologie-radiothérapie, AP-HP, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris, France
| | - P Giraud
- Service d'oncologie radiothérapie, AP-HP, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université de Paris, 20, rue Leblanc, 75015 Paris, France
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7
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Lacombe J, Brengues M, Mangé A, Bourgier C, Gourgou S, Pèlegrin A, Ozsahin M, Solassol J, Azria D. Quantitative proteomic analysis reveals AK2 as potential biomarker for late normal tissue radiotoxicity. Radiat Oncol 2019; 14:142. [PMID: 31399108 PMCID: PMC6688300 DOI: 10.1186/s13014-019-1351-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 08/01/2019] [Indexed: 12/27/2022] Open
Abstract
Background Biomarkers for predicting late normal tissue toxicity to radiotherapy are necessary to personalize treatments and to optimize clinical benefit. Many radiogenomic studies have been published on this topic. Conversely, proteomics approaches are not much developed, despite their advantages. Methods We used the isobaric tags for relative and absolute quantitation (iTRAQ) proteomic approach to analyze differences in protein expression levels in ex-vivo irradiated (8 Gy) T lymphocytes from patients with grade ≥ 2 radiation-induced breast fibrosis (grade ≥ 2 bf+) and patients with grade < 2 bf + after curative intent radiotherapy. Patients were selected from two prospective clinical trials (COHORT and PHRC 2005) and were used as discovery and confirmation cohorts. Results Among the 1979 quantified proteins, 23 fulfilled our stringent biological criteria. Immunoblotting analysis of four of these candidate proteins (adenylate kinase 2, AK2; annexin A1; heat shock cognate 71 kDa protein; and isocitrate dehydrogenase 2) confirmed AK2 overexpression in 8 Gy-irradiated T lymphocytes from patients with grade ≥ 2 bf + compared with patients with grade < 2 bf+. As these candidate proteins are involved in oxidative stress regulation, we also evaluated radiation-induced reactive oxygen species (ROS) production in peripheral blood mononuclear cells from patients with grade ≥ 2 bf + and grade < 2 bf+. Total ROS level, and especially superoxide anion level, increased upon ex-vivo 8 Gy-irradiation in all patients. Analysis of NADPH oxidases (NOXs), a major source of superoxide ion in the cell, showed a significant increase of NOX4 mRNA and protein levels after irradiation in both patient groups. Conversely, only NOX4 mRNA level was significantly different between groups (grade ≥ 2 bf + and grade < 2 bf+). Conclusion These findings identify AK2 as a potential radiosensitivity candidate biomarker. Overall, our proteomic approach highlights the important role of oxidative stress in late radiation-induced toxicity, and paves the way for additional studies on NOXs and superoxide ion metabolism. Electronic supplementary material The online version of this article (10.1186/s13014-019-1351-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jérôme Lacombe
- IRCM, INSERM, University Montpellier, ICM, Montpellier, France
| | - Muriel Brengues
- IRCM, INSERM, University Montpellier, ICM, Montpellier, France
| | - Alain Mangé
- IRCM, INSERM, University Montpellier, ICM, Montpellier, France
| | - Céline Bourgier
- IRCM, INSERM, University Montpellier, ICM, Montpellier, France
| | | | - André Pèlegrin
- IRCM, INSERM, University Montpellier, ICM, Montpellier, France
| | | | - Jérôme Solassol
- IRCM, INSERM, University Montpellier, ICM, Montpellier, France.,Department of Pathology and Onco-Biology, CHU Montpellier, Montpellier, France
| | - David Azria
- IRCM, INSERM, University Montpellier, ICM, Montpellier, France. .,Department of Radiation Oncology, ICM, 34298, Montpellier Cedex 5, France.
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8
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Mirjolet C, Merlin JL, Truc G, Noël G, Thariat J, Domont J, Sargos P, Renard-Oldrini S, Ray-Coquard I, Liem X, Chevreau C, Lagrange JL, Mahé MA, Collin F, Bonnetain F, Bertaut A, Maingon P. RILA blood biomarker as a predictor of radiation-induced sarcoma in a matched cohort study. EBioMedicine 2019; 41:420-426. [PMID: 30827931 PMCID: PMC6442988 DOI: 10.1016/j.ebiom.2019.02.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose Radiation-induced sarcoma (RIS) is a rare but serious event. Its occurrence has been discussed during the implementation of new radiation techniques and justified appropriate radioprotection requirements. New approaches targeting intrinsic radio-sensitivity have been described, such as radiation-induced CD8 T-lymphocyte apoptosis (RILA) able to predict late radio-induced toxicities. We studied the role of RILA as a predisposing factor for RIS as a late adverse event following radiation therapy (RT). Patients and methods In this prospective biological study, a total of 120 patients diagnosed with RIS were matched with 240 control patients with cancer other than sarcoma, for age, sex, primary tumor location and delay after radiation. RILA was prospectively assessed from blood samples using flow cytometry. Results Three hundred and forty-seven patients were analyzed (118 RIS patients and 229 matched control patients). A majority (74%) were initially treated by RT for breast cancer. The mean RT dose was comparable with a similar mean (± standard deviation) for RIS (53.7 ± 16.0 Gy) and control patients (57.1 ± 15.1 Gy) (p = .053). Median RILA values were significantly lower in RIS than in control patients with respectively 18.5% [5.5–55.7] and 22.3% [3.8–52.2] (p = .0008). Thus, patients with a RILA >21.3% are less likely to develop RIS (p < .0001, OR: 0.358, 95%CI [0.221–0.599]. Conclusion RILA is a promising indicator to predict an individual risk of developing RIS. Our results should be followed up and compared with molecular and genomic testing in order to better identify patients at risk. A dedicated strategy could be developed to define and inform high-risk patients who require a specific approach for primary tumor treatment and long term follow-up.
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Affiliation(s)
- C Mirjolet
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France
| | - J L Merlin
- Department of Biopathology, Université de Lorraine, CNRS UMR 7039 CRAN, Institut de Cancérologie de Lorraine, Nancy, France
| | - G Truc
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France
| | - G Noël
- Department of Radiation Oncology, Paul Strauss Center, Strasbourg, France
| | - J Thariat
- Department of Radiation Oncology, Antoine Lacassagne center, Nice, France; Department of Radiation Oncology, François Baclesse Center, Caen, France
| | - J Domont
- Department of Oncology, Gustave Roussy, Villejuif, France
| | - P Sargos
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - S Renard-Oldrini
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, NANCY, France
| | - I Ray-Coquard
- Department of Radiation Oncology, Léon Berard Center, Université Claude Bernard, Lyon, France
| | - X Liem
- Department of Radiation Oncology, Oscar Lambret Center, Lille, France
| | - C Chevreau
- Department of Radiation Oncology, IUCT Oncopole, Toulouse, France
| | - J L Lagrange
- Department of Radiation Oncology, Henri Mondor Hospital, Créteil, France
| | - M A Mahé
- Department of Radiation Oncology, ICO René Gauducheau, Saint Herblain, France
| | - F Collin
- Department of Biopathology, Georges François Leclerc Cancer Center, Dijon, France
| | - F Bonnetain
- Department of Statistics, Georges François Leclerc Cancer Center, Dijon, France
| | - A Bertaut
- Department of Statistics, Georges François Leclerc Cancer Center, Dijon, France
| | - P Maingon
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France; Department of Radiation Oncology, Sorbonne Université, GHU La Pitié Salpêtrière Charles Foix, Paris, France.
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9
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A Wake-Up Call for Routine Morbidity and Mortality Review Meeting Procedures as Part of a Quality Governance Programs in Radiation Therapy Departments: Results of the PROUST Survey. Pract Radiat Oncol 2018; 9:108-114. [PMID: 30268430 DOI: 10.1016/j.prro.2018.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/07/2018] [Accepted: 09/19/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Morbidity and mortality review (MMR) meetings in radiation therapy (RT) departments aim to monitor radiation-induced toxicities and identify potential factors that may be correlated with their development and severity, particularly treatment planning errors. The aims of the Prospective Registration of Morbidity and Mortality, Individual Radiosensitivity and Radiation Technique (PROUST) survey were to make an inventory of existing MMR procedures and to describe their procedures. METHODS AND MATERIALS The link to the web-based questionnaire of the PROUST survey was sent to 351 radiation oncologists working at 172 centers. The questionnaire included items related to organization, frequency, membership, governance, reasons for nonimplementation of MMR, and interest in its creation. RESULTS As of July 2017, 108 responses had been received from the 172 centers, of which 107 responses were completed for analysis. All centers declared that they had initiated a quality assurance program in their department, including implementation of feedback committees dedicated to the registration, analysis, and correction of precursor events. Less than half of the centers (47%) had implemented MMR procedures. However, there was significant confusion regarding feedback committees in a majority of the centers. MMRs were organized every 6 and 12 months in 21% and 15%, respectively, of the centers. In 60% of the centers, toxicity grade ≥3 was the main reason for the MMR initiation. In routine practice, contouring and dosimetry files were reviewed by 66% and 83%, respectively, of centers practicing MMR. However, only 40% of the centers enrolled data in a registry dedicated to surveillance. Finally, 78% of centers expressed interest in initiating a consensual procedure. CONCLUSIONS MMRs are not systematically implemented in RT departments worldwide. In France and in Europe, few departments with quality assurance programs have implemented MMRs. This survey showed that a large majority of centers are interested in implementing an MMR with a formalized procedure. Our project could help increase the interest of the RT community worldwide in this topic.
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10
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Azria D, Brengues M, Gourgou S, Bourgier C. Personalizing Breast Cancer Irradiation Using Biology: From Bench to the Accelerator. Front Oncol 2018; 8:83. [PMID: 29675397 PMCID: PMC5895767 DOI: 10.3389/fonc.2018.00083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/12/2018] [Indexed: 11/30/2022] Open
Abstract
While adjuvant treatments of early breast cancers (BCs) had significantly improved patients’ overall survival, some of them will still develop locoregional relapses and/or severe late radio-induced toxicities. Here, we propose to review how to personalize locoregional treatment by identifying patients at high and low risk of locoregional relapse, patients at risk of late radio-induced side effects. We will, therefore, discuss how to enhance BC radiosensitivity. Finally, we will address how personalized radiotherapy could be implemented in prospective clinical trials.
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Affiliation(s)
- David Azria
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Montpellier, France.,Université de Montpellier, Montpellier, France.,Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Muriel Brengues
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Montpellier, France
| | - Sophie Gourgou
- Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Celine Bourgier
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Montpellier, France.,Université de Montpellier, Montpellier, France.,Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
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11
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Bourgier C, Castan F, Riou O, Nguyen TD, Peignaux K, Lemanski C, Lagrange JL, Kirova Y, Lartigau E, Belkacemi Y, Rivera S, Noël G, Clippe S, Mornex F, Hennequin C, Gourgou S, Brengues M, Fenoglietto P, Ozsahin EM, Azria D. Impact of adjuvant hormonotherapy on radiation-induced breast fibrosis according to the individual radiosensitivity: results of a multicenter prospective French trial. Oncotarget 2018; 9:15757-15765. [PMID: 29644007 PMCID: PMC5884662 DOI: 10.18632/oncotarget.24606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/25/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To evaluate risk of severe breast fibrosis occurrence in patients treated by breast-conserving surgery, adjuvant radiotherapy and hormonotherapy (HT) according to individual radiosensitivity (RILA assay). RESULTS HT- and RILAhigh were the two independent factors associated with improved breast-fibrosis free survival (BFFS). BFFS rate at 36 months was lower in patients with RILAlow and HT+ than in patients with RILAhigh and HT- (75.8% and 100%, respectively; p = 0.004, hazard ratio 5.84 [95% confidence interval (CI) 1.8-19.1]). Conversely, BFFS at 36 months was comparable in patients with RILAhigh and HT+ and in patients with RILAlow and HT- (89.8% and 93.5%, respectively; p = 0.39, hazard ratio 1.7 [95% CI 0.51-5.65]), showing that these two parameters influenced independently the occurrence of severe breast fibrosis. BFFS rate was not affected by the HT type (tamoxifen or aromatase inhibitor) and timing (concomitant or sequential with radiotherapy). CONCLUSIONS HT and RILA score independently influenced BFFS rate at 36 months. Patients with RILAhigh and HT- presented an excellent BFFS at 36 months (100%). MATERIALS AND METHODS Breast Fibrosis-Free Survival (BFFS) rate was assessed relative to RILA categories and to adjuvant HT use (HT+ and HT-, respectively) in a prospective multicentre study (NCT00893035) which enrolled 502 breast cancer patients (456 evaluable patients). Breast fibrosis was recorded according to CTCAE v3.0 grading scale; RILA score was defined according to two categories (<12%: RILAlow; ≥12%: RILAhigh).
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Affiliation(s)
- Céline Bourgier
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Florence Castan
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Olivier Riou
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | | | | | - Claire Lemanski
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | | | | | | | | | | | | | | | | | | | - Sophie Gourgou
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Muriel Brengues
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Pascal Fenoglietto
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | | | - David Azria
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
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12
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Han ZQ, Liao H, Shi F, Chen XP, Hu HC, Tian MQ, Wang LH, Ying S. Inhibition of cyclooxygenase-2 sensitizes lung cancer cells to radiation-induced apoptosis. Oncol Lett 2017; 14:5959-5965. [PMID: 29113232 PMCID: PMC5661612 DOI: 10.3892/ol.2017.6940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/15/2017] [Indexed: 12/05/2022] Open
Abstract
Radiotherapy resistance is an enduring major setback in lung cancer therapy, and is responsible for a large proportion of treatment failures. In previous years, cyclooxygenase-2 (COX-2) has frequently been reported to promote tumor occurrence and development, suggesting a potential role in radiotherapy resistance. To investigate whether COX-2 inhibitors can be applied in radiosensitization, an MTT assay was performed to examine cell viability after X-ray radiation in the presence or absence of the specific COX-2 inhibitor Celecoxib. Cell apoptosis and cell cycle changes were also detected through laser confocal scanning microcopy and flow cytometry. X-ray treatment only caused mild cell death in lung cancer A549 cells. However, combination treatment using celecoxib and X-ray radiation exhibited improved inhibitory effects and significantly suppressed cell proliferation. Therefore, COX-2 inhibitors combined with radiotherapy can counteract radiation-induced high COX-2 expression, demonstrating that celecoxib can function as a radiosensitizer of lung cancer cells. It is therefore reasonable to predict COX-2 inhibitors to be potential clinical radiotherapy synergists.
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Affiliation(s)
- Zhi-Qiang Han
- Department of Respiratory Internal Medicine, People's Hospital of Quzhou City, Quzhou, Zhejiang 324000, P.R. China
| | - Hongwei Liao
- Institute of Respiratory Diseases, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, P.R. China
| | - Feng Shi
- Department of Respiratory Internal Medicine, People's Hospital of Quzhou City, Quzhou, Zhejiang 324000, P.R. China
| | - Xiao-Ping Chen
- Department of Respiratory Internal Medicine, People's Hospital of Quzhou City, Quzhou, Zhejiang 324000, P.R. China
| | - Hua-Cheng Hu
- Department of Respiratory Internal Medicine, The Second Affiliated Hospital, Suzhou University, Suzhou, Jiangsu 215004, P.R. China
| | - Ming-Qing Tian
- Department of Respiratory Internal Medicine, People's Hospital of Quzhou City, Quzhou, Zhejiang 324000, P.R. China
| | - Li-Hua Wang
- Department of Respiratory Internal Medicine, People's Hospital of Quzhou City, Quzhou, Zhejiang 324000, P.R. China
| | - Songmin Ying
- Institute of Respiratory Diseases, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, P.R. China
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13
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Strojan P, Hutcheson KA, Eisbruch A, Beitler JJ, Langendijk JA, Lee AWM, Corry J, Mendenhall WM, Smee R, Rinaldo A, Ferlito A. Treatment of late sequelae after radiotherapy for head and neck cancer. Cancer Treat Rev 2017; 59:79-92. [PMID: 28759822 PMCID: PMC5902026 DOI: 10.1016/j.ctrv.2017.07.003] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 06/05/2017] [Accepted: 07/09/2017] [Indexed: 12/21/2022]
Abstract
Radiotherapy (RT) is used to treat approximately 80% of patients with cancer of the head and neck. Despite enormous advances in RT planning and delivery, a significant number of patients will experience radiation-associated toxicities, especially those treated with concurrent systemic agents. Many effective management options are available for acute RT-associated toxicities, but treatment options are much more limited and of variable benefit among patients who develop late sequelae after RT. The adverse impact of developing late tissue damage in irradiated patients may range from bothersome symptoms that negatively affect their quality of life to severe life-threatening complications. In the region of the head and neck, among the most problematic late effects are impaired function of the salivary glands and swallowing apparatus. Other tissues and structures in the region may be at risk, depending mainly on the location of the irradiated tumor relative to the mandible and hearing apparatus. Here, we review the available evidence on the use of different therapeutic strategies to alleviate common late sequelae of RT in head and neck cancer patients, with a focus on the critical assessment of the treatment options for xerostomia, dysphagia, mandibular osteoradionecrosis, trismus, and hearing loss.
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Affiliation(s)
- Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, Section of Speech Pathology and Audiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan J Beitler
- Departments of Radiation Oncology, Otolaryngology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne W M Lee
- Center of Clinical Oncology, University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - June Corry
- Radiation Oncology, GenesisCare, St. Vincents's Hospital, Melbourne, Victoria, Australia
| | | | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Italy
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14
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Croco E, Marchionni S, Bocchini M, Angeloni C, Stamato T, Stefanelli C, Hrelia S, Sell C, Lorenzini A. DNA Damage Detection by 53BP1: Relationship to Species Longevity. J Gerontol A Biol Sci Med Sci 2017; 72:763-770. [PMID: 27573809 DOI: 10.1093/gerona/glw170] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 08/08/2016] [Indexed: 11/12/2022] Open
Abstract
In order to examine potential differences in genomic stability, we have challenged fibroblasts derived from five different mammalian species of variable longevity with the genotoxic agents, etoposide and neocarzinostatin. We report that cells from longer-lived species exhibit more tumor protein p53 binding protein 1 (53BP1) foci for a given degree of DNA damage relative to shorter-lived species. The presence of a greater number of 53BP1 foci was associated with decreased DNA fragmentation and a lower percentage of cells exhibiting micronuclei. These data suggest that cells from longer-lived species have an enhanced DNA damage response. We propose that the number of 53BP1 foci that form in response to damage reflects the intrinsic capacity of cells to detect and respond to DNA harms.
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Affiliation(s)
| | - Silvia Marchionni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Martine Bocchini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | | | - Thomas Stamato
- The Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | | | | | - Christian Sell
- Department of Pathology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Antonello Lorenzini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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15
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Brengues M, Lapierre A, Bourgier C, Pèlegrin A, Özsahin M, Azria D. T lymphocytes to predict radiation-induced late effects in normal tissues. Expert Rev Mol Diagn 2016; 17:119-127. [DOI: 10.1080/14737159.2017.1271715] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Muriel Brengues
- Immunotargeting and Radiobiology in Oncology, IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM, U1194, Montpellier, France
- Department of Radiation Oncology, Institut Cancer Montpellier, Montpellier, France
| | - Ariane Lapierre
- Immunotargeting and Radiobiology in Oncology, IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM, U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Department of Radiation Oncology, Institut Cancer Montpellier, Montpellier, France
| | - Céline Bourgier
- Immunotargeting and Radiobiology in Oncology, IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM, U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Department of Radiation Oncology, Institut Cancer Montpellier, Montpellier, France
| | - André Pèlegrin
- Immunotargeting and Radiobiology in Oncology, IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM, U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Department of Radiation Oncology, Institut Cancer Montpellier, Montpellier, France
| | | | - David Azria
- Immunotargeting and Radiobiology in Oncology, IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM, U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Department of Radiation Oncology, Institut Cancer Montpellier, Montpellier, France
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16
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Azria D, Bourgier C, Brengues M. One Size Fits All: Does the Dogma Stand in Radiation Oncology? EBioMedicine 2016; 10:19-20. [PMID: 27453323 PMCID: PMC5006722 DOI: 10.1016/j.ebiom.2016.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 07/18/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- David Azria
- Department of Radiation Oncology, Montpellier Cancer Institute (ICM), Montpellier Cancer Research Institute (IRCM), University of Montpellier, Montpellier, France; INSERM U1194, Montpellier Cancer Research Institute (IRCM), University of Montpellier, Montpellier, France.
| | - Celine Bourgier
- Department of Radiation Oncology, Montpellier Cancer Institute (ICM), Montpellier Cancer Research Institute (IRCM), University of Montpellier, Montpellier, France; INSERM U1194, Montpellier Cancer Research Institute (IRCM), University of Montpellier, Montpellier, France
| | - Muriel Brengues
- INSERM U1194, Montpellier Cancer Research Institute (IRCM), University of Montpellier, Montpellier, France
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17
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Mirjolet C, Merlin JL, Dalban C, Maingon P, Azria D. Correlation between radio-induced lymphocyte apoptosis measurements obtained from two French centres. Cancer Radiother 2016; 20:391-4. [PMID: 27372557 DOI: 10.1016/j.canrad.2016.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 03/07/2016] [Accepted: 03/09/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE OF THE RESEARCH In the era of modern treatment delivery, increasing the dose delivered to the target to improve local control might be modulated by the patient's intrinsic radio-sensitivity. A predictive assay based on radio-induced lymphocyte apoptosis quantification highlighted the significant correlation between CD4 and CD8 T-lymphocyte apoptosis and grade 2 or 3 radiation-induced late toxicities. By conducting this assay at several technical platforms, the aim of this study was to demonstrate that radio-induced lymphocyte apoptosis values obtained from two different platforms were comparable. MATERIALS AND METHODS For 25 patients included in the PARATOXOR trial running in Dijon the radio-induced lymphocyte apoptosis results obtained from the laboratory of Montpellier (IRCM, Inserm U1194, France), considered as the reference (referred to as Lab 1), were compared with those from the laboratory located at the Institut de cancérologie de Lorraine (ICL, France), referred to as Lab 2. Different statistical methods were used to measure the agreement between the radio-induced lymphocyte apoptosis data from the two laboratories (quantitative data). The Bland-Altman plot was used to identify potential bias. RESULTS All statistical tests demonstrated good agreement between radio-induced lymphocyte apoptosis values obtained from both sites and no major bias was identified. CONCLUSIONS Since radio-induced lymphocyte apoptosis values, which predict tolerance to radiotherapy, could be assessed by two laboratories and showed a high level of robustness and consistency, we can suggest that this assay be extended to any laboratories that use the same technique.
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Affiliation(s)
- C Mirjolet
- Département de radiothérapie, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21079 Dijon cedex, France.
| | - J L Merlin
- Université de Lorraine, UMR7039 Cran, Campus Sciences, boulevard des Aiguillettes, BP 70239, 54506 Vandœuvre-lès-Nancy, France; CNRS UMR7039 Cran, Campus Sciences, boulevard des Aiguillettes, BP 70239, 54506 Vandœuvre-lès-Nancy, France; Département de biopathologie, institut de cancérologie de Lorraine, Nancy, France
| | - C Dalban
- Département de biostatistiques, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21079 Dijon cedex, France
| | - P Maingon
- Département de radiothérapie, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21079 Dijon cedex, France
| | - D Azria
- Pôle de radiothérapie oncologique, institut du cancer de Montpellier-Val d'Aurelle, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France; Inserm U1194 Immunociblage et radiobiologie en oncologie, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France
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18
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Barnett GC, Kerns SL, Noble DJ, Dunning AM, West CML, Burnet NG. Incorporating Genetic Biomarkers into Predictive Models of Normal Tissue Toxicity. Clin Oncol (R Coll Radiol) 2015; 27:579-87. [PMID: 26166774 DOI: 10.1016/j.clon.2015.06.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/08/2015] [Accepted: 06/12/2015] [Indexed: 12/25/2022]
Abstract
There is considerable variation in the level of toxicity patients experience for a given dose of radiotherapy, which is associated with differences in underlying individual normal tissue radiosensitivity. A number of syndromes have a large effect on clinical radiosensitivity, but these are rare. Among non-syndromic patients, variation is less extreme, but equivalent to a ±20% variation in dose. Thus, if individual normal tissue radiosensitivity could be measured, it should be possible to optimise schedules for individual patients. Early investigations of in vitro cellular radiosensitivity supported a link with tissue response, but individual studies were equivocal. A lymphocyte apoptosis assay has potential, and is currently under prospective validation. The investigation of underlying genetic variation also has potential. Although early candidate gene studies were inconclusive, more recent genome-wide association studies are revealing definite associations between genotype and toxicity and highlighting the potential for future genetic testing. Genetic testing and individualised dose prescriptions could reduce toxicity in radiosensitive patients, and permit isotoxic dose escalation to increase local control in radioresistant individuals. The approach could improve outcomes for half the patients requiring radical radiotherapy. As a number of patient- and treatment-related factors also affect the risk of toxicity for a given dose, genetic testing data will need to be incorporated into models that combine patient, treatment and genetic data.
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Affiliation(s)
- G C Barnett
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - S L Kerns
- Rubin Center for Cancer Survivorship, Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - D J Noble
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - C M L West
- Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, Manchester, UK
| | - N G Burnet
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
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19
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Scaife JE, Barnett GC, Noble DJ, Jena R, Thomas SJ, West CML, Burnet NG. Exploiting biological and physical determinants of radiotherapy toxicity to individualize treatment. Br J Radiol 2015; 88:20150172. [PMID: 26084351 PMCID: PMC4628540 DOI: 10.1259/bjr.20150172] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/07/2015] [Accepted: 05/21/2015] [Indexed: 12/16/2022] Open
Abstract
The recent advances in radiation delivery can improve tumour control probability (TCP) and reduce treatment-related toxicity. The use of intensity-modulated radiotherapy (IMRT) in particular can reduce normal tissue toxicity, an objective in its own right, and can allow safe dose escalation in selected cases. Ideally, IMRT should be combined with image guidance to verify the position of the target, since patients, target and organs at risk can move day to day. Daily image guidance scans can be used to identify the position of normal tissue structures and potentially to compute the daily delivered dose. Fundamentally, it is still the tolerance of the normal tissues that limits radiotherapy (RT) dose and therefore tumour control. However, the dose-response relationships for both tumour and normal tissues are relatively steep, meaning that small dose differences can translate into clinically relevant improvements. Differences exist between individuals in the severity of toxicity experienced for a given dose of RT. Some of this difference may be the result of differences between the planned dose and the accumulated dose (DA). However, some may be owing to intrinsic differences in radiosensitivity of the normal tissues between individuals. This field has been developing rapidly, with the demonstration of definite associations between genetic polymorphisms and variation in toxicity recently described. It might be possible to identify more resistant patients who would be suitable for dose escalation, as well as more sensitive patients for whom toxicity could be reduced or avoided. Daily differences in delivered dose have been investigated within the VoxTox research programme, using the rectum as an example organ at risk. In patients with prostate cancer receiving curative RT, considerable daily variation in rectal position and dose can be demonstrated, although the median position matches the planning scan well. Overall, in 10 patients, the mean difference between planned and accumulated rectal equivalent uniform doses was -2.7 Gy (5%), and a dose reduction was seen in 7 of the 10 cases. If dose escalation was performed to take rectal dose back to the planned level, this should increase the mean TCP (as biochemical progression-free survival) by 5%. Combining radiogenomics with individual estimates of DA might identify almost half of patients undergoing radical RT who might benefit from either dose escalation, suggesting improved tumour cure or reduced toxicity or both.
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Affiliation(s)
- J E Scaife
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - G C Barnett
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D J Noble
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - R Jena
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - S J Thomas
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
- Medical Physics Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - C M L West
- Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, Manchester, UK
| | - N G Burnet
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
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