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Chen L, Hu H, Pan Y, Lu Y, Zhao M, Zhao Y, Wang L, Liu K, Yu Z. The role of HPV11 E7 in modulating STING-dependent interferon β response in recurrent respiratory papillomatosis. J Virol 2024; 98:e0192523. [PMID: 38624230 PMCID: PMC11092327 DOI: 10.1128/jvi.01925-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
Recurrent respiratory papillomatosis (RRP) is a rare benign tumor caused mainly by the infection of the respiratory tract epithelial cells by the human papillomavirus (HPV) type 6/11. However, the specific mechanisms underlying the inhibition of the host's innate immune response by HPV remain unclear. For this purpose, we employed single-cell RNA sequencing to analyze the states of various immune cells in RRP samples post-HPV infection and utilized a cellular model of HPV infection to elucidate the mechanisms by which HPV evades the innate immune system in RRP. The results revealed distinct immune cell heterogeneity in RRP and demonstrated that HPV11 E7 can inhibit the phosphorylation of the stimulator of interferon genes protein, thereby circumventing the body's antiviral response. In vitro co-culture experiments demonstrated that stimulation of macrophages to produce interferon-beta induced the death of HPV-infected epithelial cells, also reducing HPV viral levels. In summary, our study preliminarily identifies the potential mechanisms by which HPV evades the host's antiviral immune response, as well as the latent antiviral functions exhibited by activated macrophages. This research serves as an initial exploration of antiviral immune evasion in RRP, laying a solid foundation for investigating immunotherapeutic approaches for the disease.IMPORTANCESurgical tumor reduction is the most common treatment for recurrent respiratory papillomatosis (RRP). One of the characteristics of RRP is its persistent recurrence, and multiple surgeries are usually required to control the symptoms. Recently, some adjuvant therapies have shown effectiveness, but none of them can completely clear human papillomavirus (HPV) infection, and thus, a localized antiviral immune response is significant for disease control; after all, HPV infection is limited to the epithelium. Inhibition of interferon-beta (IFN-β) secretion by HPV11 E7 viral proteins in epithelial cells by affecting stimulator of interferon genes phosphorylation may account for the persistence of low-risk HPV replication in the RRP. Moreover, suppression of the IFN-I pathway in RRP cell types might provide clues regarding the hyporeactive function of local immune cells. However, activation of macrophage groups to produce IFN-β can still destroy HPV-infected cells.
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Affiliation(s)
- Lijuan Chen
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
| | - Huiying Hu
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
| | - Yufei Pan
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
| | - Yuanyuan Lu
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
| | - Mengyuan Zhao
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
| | - Yun Zhao
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
| | - Lixin Wang
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
| | - Kai Liu
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
| | - Zhenkun Yu
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
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Kiseleva VI, Mkrtchyan LS, Ivanov SA, Lyubina LV, Bezyaeva GP, Panarina LV, Krikunova LI, Zamulaeva IA. The Presence of Human Papillomavirus DNA Integration is Associated with Poor Clinical Results in Patients with Third-Stage Cervical Cancer. Bull Exp Biol Med 2019; 168:87-91. [PMID: 31768781 DOI: 10.1007/s10517-019-04654-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Indexed: 11/26/2022]
Abstract
The presence of virus DNA integration into the cell genome was studied for 47 primary HPV16-positive patients with morphologically verified stage III cervical cancer. By using ROC analysis, the patients were divided into two groups: with and without HPV DNA integration into the host cell genome. The differences between the groups by the histological type, degree of tumor differentiation, and primary response to therapy were statistically insignificant. Virus DNA integration more than 7-fold reduced 5-year relapse-free survival and 1.7-fold reduced overall survival rate in comparison with patients without HPV DNA integration (p=0.0002 and p=0.05, respectively). The relative risk of adverse outcome of the disease in patients with the presence of HPV16 DNA integration increases by 4 times over a period of less than 3 years (р=0.0006) at high AUC level. The probability of earlier progression of the disease in patients with of HPV DNA integration calculated according to the Cox proportional hazards model was 85.5% (hazard ratio 5.96; p=0.002). Thus, the results suggest that the presence of HPV16 DNA integration into the cell genome is an independent factor in predicting clinical outcome of advanced cervical cancer and can serve as an effective criterion for the individual choice of treatment tactics for the patients.
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Affiliation(s)
- V I Kiseleva
- A. F. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center, Ministry of Health of the Russian Federation, Obninsk, Russia.
| | - L S Mkrtchyan
- A. F. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center, Ministry of Health of the Russian Federation, Obninsk, Russia
| | - S A Ivanov
- A. F. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center, Ministry of Health of the Russian Federation, Obninsk, Russia
| | - L V Lyubina
- A. F. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center, Ministry of Health of the Russian Federation, Obninsk, Russia
| | - G P Bezyaeva
- A. F. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center, Ministry of Health of the Russian Federation, Obninsk, Russia
| | - L V Panarina
- A. F. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center, Ministry of Health of the Russian Federation, Obninsk, Russia
| | - L I Krikunova
- A. F. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center, Ministry of Health of the Russian Federation, Obninsk, Russia
| | - I A Zamulaeva
- A. F. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center, Ministry of Health of the Russian Federation, Obninsk, Russia
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3
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HPV16 E2 variants correlated with radiotherapy treatment and biological significance in cervical cell carcinoma. INFECTION GENETICS AND EVOLUTION 2018; 65:238-243. [DOI: 10.1016/j.meegid.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/05/2018] [Accepted: 08/01/2018] [Indexed: 11/21/2022]
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Bu X, Zhang J, Tian F, Wang X, Wu L, Tian W. Value of Diffusion-Weighted Magnetic Resonance Imaging Combined with miR-18a Level in Predicting Radiosensitivity of Cervical Cancer. Med Sci Monit 2018; 24:7271-7278. [PMID: 30308669 PMCID: PMC6194752 DOI: 10.12659/msm.910990] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Radioresistance during radiotherapy of cervical cancer often leads to treatment failure; therefore, there is an urgent need to develop effective predictive indicators of radiosensitivity for cervical cancer patients. Material/Methods Cervical cancer cells were collected from 40 patients who received surgical resections. The relationships between apparent diffusion coefficient (ADC) values of masses before surgery and different micro-RNAs (miRNA) levels (miR-18a, miR-132, and miR-145) of these cells were investigated. Cervical cancer cells were divided into 4 groups according to the ADC values of original tumor tissues and expression level of miR-18a. Then, these cells were exposed with irradiation both in vitro and in vivo. Results Advanced cervical cancer showed lower ADC values in magnetic resonance imaging. miR-18a, miR-132, and miR-145 all were increased in the cervical cancer tissues, while miR-18a showed a more marked negative correlation with ADC values. The results of in vitro and in vivo assays showed that higher expression of miR-18a in cervical cancer cells leads to more radiosensitivity, especially in cells from cancer tissues with lower ADC values. Conclusions The combination of ADC values with expression level of miR-18a may be a new and reliable predictor for radiosensitivity of cervical cancer, helping cervical cancer patients with low ADC values and high expressions of miR-18a to achieve better outcomes in radiotherapy.
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Affiliation(s)
- Xinhua Bu
- Department of Gynecology and Obstetrics, Taizhou People's Hospital, Taizhou, Jiangsu, China (mainland)
| | - Ji Zhang
- Department of Radiology, Taizhou People's Hospital, Taizhou, Jiangsu, China (mainland)
| | - Fangzheng Tian
- Department of Radiology, Taizhou People's Hospital, Taizhou, Jiangsu, China (mainland)
| | - Xiulan Wang
- Department of Radiology, Taizhou People's Hospital, Taizhou, Jiangsu, China (mainland)
| | - Linyun Wu
- Taizhou Polytechnic College, Taizhou, Jiangsu, China (mainland)
| | - Weizhong Tian
- Department of Radiology, Taizhou People's Hospital, Taizhou, Jiangsu, China (mainland)
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Yang D, Zhang W, Liu Y, Liang J, Zhang T, Bai Y, Hao W, Ma K, Lu D, Chen J. Single-cell whole-genome sequencing identifies human papillomavirus integration in cervical tumour cells prior to and following radiotherapy. Oncol Lett 2018; 15:9633-9640. [PMID: 29928338 PMCID: PMC6004640 DOI: 10.3892/ol.2018.8567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/13/2017] [Indexed: 02/07/2023] Open
Abstract
Single-cell sequencing technology is a promising systematic and comprehensive approach to delineate clonal associations between cells. The present study collected 13 and 12 cervical cells from fresh tumour tissue prior to and following radiotherapy, respectively, from a 46-year-old female patient with exogenous-type cervical carcinoma. Next, single-cell whole-genome sequencing analysis was performed on each cell. Examination revealed that normal cells could be clearly distinguished from tumour cells among the 25 cells. Tumour cells prior to and following radiotherapy almost represented two independent clones, with the main subpopulation prior to radiotherapy being killed and the minor subpopulation prior to radiotherapy becoming the main subpopulation following radiotherapy. A human papillomavirus (HPV) integration site was detected in POU class 5 homeobox 1B (POU5F1B) in tumour cells following radiotherapy, which has been reported to be a frequent HPV integration site in cervical carcinoma. These results indicate that tumour cells with HPV integration in POU5F1B survive radiotherapy, and that tumour cells prior to and following radiotherapy exhibit distinct characteristics.
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Affiliation(s)
- Dong Yang
- Department of Gynaecology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing 100026, P.R. China
| | - Weiyuan Zhang
- Department of Gynaecology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing 100026, P.R. China
| | - Yang Liu
- Department of Gynaecology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing 100026, P.R. China
| | - Junqing Liang
- Department of Gynaecology, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Tongqing Zhang
- Department of Gynaecology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing 100026, P.R. China
| | - Yunbo Bai
- Department of Gynaecology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing 100026, P.R. China
| | - Wenjing Hao
- Department of Gynaecology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing 100026, P.R. China
| | - Kexin Ma
- Department of Gynaecology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing 100026, P.R. China
| | - Danni Lu
- Department of Gynaecology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing 100026, P.R. China
| | - Jing Chen
- Department of Gynaecology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, P.R. China
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Broglie MA, Stoeckli SJ, Sauter R, Pasche P, Reinhard A, de Leval L, Huber GF, Pezier TF, Soltermann A, Giger R, Arnold A, Dettmer M, Arnoux A, Müller M, Spreitzer S, Lang F, Lutchmaya M, Stauffer E, Espeli V, Martucci F, Bongiovanni M, Foerbs D, Jochum W. Impact of human papillomavirus on outcome in patients with oropharyngeal cancer treated with primary surgery. Head Neck 2017; 39:2004-2015. [DOI: 10.1002/hed.24865] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 03/09/2017] [Accepted: 05/22/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Martina A. Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Sandro J. Stoeckli
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Rafael Sauter
- Clinical Trials Unit; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Philippe Pasche
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospital of Lausanne; Lausanne Switzerland
| | - Antoine Reinhard
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospital of Lausanne; Lausanne Switzerland
| | - Laurence de Leval
- Department of Pathology; University Hospital of Lausanne; Lausanne Switzerland
| | - Gerhard F. Huber
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospital of Zurich; Switzerland
| | - Thomas F. Pezier
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospital of Zurich; Switzerland
| | - Alex Soltermann
- Institute of Surgical Pathology; University Hospital of Zurich; Zurich Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery; Bern University Hospital; Inselspital Switzerland
| | - Andreas Arnold
- Department of Otorhinolaryngology, Head and Neck Surgery; Bern University Hospital; Inselspital Switzerland
| | - Matthias Dettmer
- Department of Pathology; Bern University Hospital; Inselspital Switzerland
| | - Andre Arnoux
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital Aarau; Switzerland
| | - Martin Müller
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital Aarau; Switzerland
| | | | - Florian Lang
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital Fribourg; Switzerland
| | - Mathieu Lutchmaya
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital Fribourg; Switzerland
| | | | - Vittoria Espeli
- Oncology Institute of Southern Switzerland (IOSI); Bellinzona Switzerland
| | - Francesco Martucci
- Department of Radiooncology; Oncology Institute of Southern Switzerland (IOSI); Bellinzona Switzerland
| | - Massimo Bongiovanni
- Department of Pathology; University Hospital of Lausanne; Lausanne Switzerland
| | - Diana Foerbs
- Institute of Pathology; Kantonsspital St. Gallen; Switzerland
| | - Wolfram Jochum
- Institute of Pathology; Kantonsspital St. Gallen; Switzerland
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7
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Guigay J, Even C, Mayache-Badis L, Debbah M, Saada-Bouzid E, Tao Y, Deschamps F, Janot F, Lezghed N, Michel C. Long-term response in patient with recurrent oropharyngeal carcinoma treated with cetuximab, docetaxel and cisplatin (TPEx) as first-line treatment followed by cetuximab maintenance. Oral Oncol 2017; 68:114-118. [PMID: 28347701 DOI: 10.1016/j.oraloncology.2017.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 03/14/2017] [Accepted: 03/16/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Cetuximab, an anti-EGFR monoclonal antibody in combination with platinum and 5FU is the standard of care in first-line treatment of patients with recurrent head and neck squamous cell carcinoma (HNSCC), with an expected median outcome of 10months. For this population, development of efficacious and safer therapies is still needed. CASE REPORT A 62-year-old male with a first recurrence of human papillomavirus positive stage IVA (T3N2bM0) adenocarcinoma of the glossotonsillar sulcus not amenable to locoregional curative treatment was offered chemotherapy as part of the TPEx clinical trial. He was treated by cetuximab (loading dose 400mg/m2 on day 1 cycle 1, then 250mg/m2 weekly), and chemotherapy (cisplatin 75mg/m2 and docetaxel 75mg/m2, on day 1). Cycles were repeated every 21days for 4 cycles (TPEx regimen) with systematic granulocyte colony-stimulating factor support at each cycle. Bi-monthly maintenance cetuximab 500mg/m2 was then administered. The patient showed a clinical complete response according to RECIST 1.1 criteria after 5months maintenance, with progression-free survival of 25months. Relapses that followed were treated with stereotactic irradiation, radiofrequency ablation, cetuximab and paclitaxel. The patient is alive eleven years after cancer diagnosis and remains controlled for his disease, with a cumulative period of 59months of cetuximab administration (equivalence of 121 injections). CONCLUSION This case report demonstrated that TPEx regimen, by synergistic interaction between taxanes and cetuximab, followed by bimonthly cetuximab maintenance may lead to patient complete remission within the first year of treatment. Furthermore, prolonged intermittent treatment with cetuximab seems to participate in the improved survival associated with preserved quality of life. Key favorable prognostic factors may be moderate tumor differentiation, oropharyngeal location, HPV p16 positive tumor status.
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Affiliation(s)
- J Guigay
- Department of Medical Oncology, Antoine Lacassagne Cancer Research Center, Nice, France.
| | - C Even
- Department of Head and Neck Cancer, Gustave Roussy, Villejuif, France
| | - L Mayache-Badis
- Department of Head and Neck Cancer, Gustave Roussy, Villejuif, France
| | - M Debbah
- Department of Head and Neck Cancer, Gustave Roussy, Villejuif, France
| | - E Saada-Bouzid
- Department of Medical Oncology, Antoine Lacassagne Cancer Research Center, Nice, France
| | - Y Tao
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - F Deschamps
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France
| | - F Janot
- Department of Head and Neck Cancer, Gustave Roussy, Villejuif, France
| | - N Lezghed
- Department of Head and Neck Cancer, Gustave Roussy, Villejuif, France
| | - C Michel
- GORTEC, Oncology Cooperative Group in Head and Neck Cancer, Tours, France
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Dok R, Nuyts S. HPV Positive Head and Neck Cancers: Molecular Pathogenesis and Evolving Treatment Strategies. Cancers (Basel) 2016; 8:cancers8040041. [PMID: 27043631 PMCID: PMC4846850 DOI: 10.3390/cancers8040041] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/09/2016] [Accepted: 03/23/2016] [Indexed: 01/02/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is a highly heterogeneous disease that is the result of tobacco and/or alcohol abuse or infection with high-risk Human papillomaviruses. Despite the fact that HPV positive HNSCC cancers form a distinct clinical entity with better treatment outcome, all HNSCC are currently treated uniformly with the same treatment modality. At present, biologic basis of these different outcomes and their therapeutic influence are areas of intense investigation. In this review, we will summarize the molecular basis for this different outcome, novel treatment opportunities and possible biomarkers for HPV positive HNSCC. In particular, the focus will be on several molecular targeted strategies that can improve the chemoradiation response by influencing DNA repair mechanisms.
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Affiliation(s)
- Rüveyda Dok
- Laboratory of Experimental Radiotherapy, Department of Oncology, Katholieke Universiteit Leuven (KU Leuven), 3000 Leuven, Belgium.
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, Katholieke Universiteit Leuven (KU Leuven), 3000 Leuven, Belgium.
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium.
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9
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Datta NR, Rogers S, Ordóñez SG, Puric E, Bodis S. Hyperthermia and radiotherapy in the management of head and neck cancers: A systematic review and meta-analysis. Int J Hyperthermia 2015; 32:31-40. [PMID: 26928474 DOI: 10.3109/02656736.2015.1099746] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE A systematic review and meta-analysis was conducted to evaluate the outcome of controlled clinical trials in head and neck cancers (HNCs) using hyperthermia and radiotherapy versus radiotherapy alone. MATERIAL AND METHODS A total of 498 abstracts were screened from four databases and hand searched as per the PRISMA guidelines. Only two-arm studies treating HNCs with either radiotherapy alone, or hyperthermia and radiotherapy without concurrent chemotherapy or surgery were considered. The evaluated end point was complete response (CR). RESULTS Following a detailed screening of the titles, abstracts and full text papers, six articles fulfilling the above eligibility criteria were considered. In total 451 clinical cases from six studies were included in the meta-analysis. Five of six trials were randomised. The overall CR with radiotherapy alone was 39.6% (92/232) and varied between 31.3% and 46.9% across the six trials. With thermoradiotherapy, the overall CR reported was 62.5% (137/219), (range 33.9-83.3%). The odds ratio was 2.92 (95% CI: 1.58-5.42, p = 0.001); the risk ratio was 1.61 (95% CI: 1.32-1.97, p < 0.0001) and the risk difference was 0.25 (95% CI: 0.12-0.39, p < 0.0001), all in favour of combined treatment with hyperthermia and radiotherapy over radiotherapy alone. Acute and late grade III/IV toxicities were reported to be similar in both the groups. CONCLUSIONS Hyperthermia along with radiotherapy enhances the likelihood of CR in HNCs by around 25% compared to radiotherapy alone with no significant additional acute and late morbidities. This level I evidence should justify the integration of hyperthermia into the multimodality therapy of HNCs.
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Affiliation(s)
- Niloy R Datta
- a Centre for Radiation Oncology , KSA-KSB, Kantonsspital , Aarau , Switzerland and
| | - Susanne Rogers
- a Centre for Radiation Oncology , KSA-KSB, Kantonsspital , Aarau , Switzerland and
| | - Silvia Gómez Ordóñez
- a Centre for Radiation Oncology , KSA-KSB, Kantonsspital , Aarau , Switzerland and
| | - Emsad Puric
- a Centre for Radiation Oncology , KSA-KSB, Kantonsspital , Aarau , Switzerland and
| | - Stephan Bodis
- a Centre for Radiation Oncology , KSA-KSB, Kantonsspital , Aarau , Switzerland and.,b Department of Radiation Oncology , University Hospital , Zurich , Switzerland
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10
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Wu CC, Horowitz DP, Deutsch I, Rahmati R, Schecter JM, Saqi A, Wang TJC. De-escalation of radiation dose for human papillomavirus-positive oropharyngeal head and neck squamous cell carcinoma: A case report and preclinical and clinical literature review. Oncol Lett 2015; 11:141-149. [PMID: 26870181 PMCID: PMC4727039 DOI: 10.3892/ol.2015.3836] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 07/28/2015] [Indexed: 12/21/2022] Open
Abstract
Traditionally, head and neck squamous cell carcinoma (HNSCC) has been considered to be a relatively homogeneous disease. However, recent data have demonstrated that human papillomavirus (HPV)-positive and HPV-negative disease are two different clinical entities associated with different outcomes. Preclinical and clinical studies have reported a divergence in treatment strategies as well as prognostic outcomes for HNSCCs that are HPV-positive versus HPV-negative. The present study describes the case of a 52-year-old man who presented with stage IVB cT2N3M0 right tonsillar HPV-positive squamous cell carcinoma. Induction chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF), followed by chemoradiation therapy with carboplatin and 70 Gray (Gy) radiation in daily fractions was recommended. The patient completed the TPF and carboplatin treatment; however, he was unable to tolerate the radiation course, receiving a final dose of 46 Gy. A 60-day follow-up right neck salvage dissection was subsequently performed. Despite having received a partial radiation treatment of 46 Gy, the patient had no pathological evidence of disease at 60 days post radiation treatment. Repeat positron emission tomography-computed tomography at 32 months after the right neck dissection revealed no evidence of disease. The present study also discusses the current preclinical in vitro and in vivo targets for HPV-positive HNSCC and the obstacles presented in advancing clinical treatment modalities. Previous preclinical models investigating radiation sensitivity have yielded mixed results. Thus, it is important to understand and establish representative preclinical models for studying HPV and HNSCC to improve clinical research and therapeutic development. This review may guide future understanding of the role of HPV in HNSCC.
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Affiliation(s)
- Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - David P Horowitz
- Department of Radiation Oncology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Israel Deutsch
- Department of Radiation Oncology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA
| | - Rahmatullah Rahmati
- Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Jordan M Schecter
- Department of Medical Oncology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Anjali Saqi
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA; Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Tony J C Wang
- Department of Radiation Oncology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA
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Samuels SE, Eisbruch A, Beitler JJ, Corry J, Bradford CR, Saba NF, van den Brekel MWM, Smee R, Strojan P, Suárez C, Mendenhall WM, Takes RP, Rodrigo JP, Haigentz M, Rapidis AD, Rinaldo A, Ferlito A. Management of locally advanced HPV-related oropharyngeal squamous cell carcinoma: where are we? Eur Arch Otorhinolaryngol 2015; 273:2877-94. [PMID: 26463714 DOI: 10.1007/s00405-015-3771-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/25/2015] [Indexed: 12/13/2022]
Abstract
HPV-related (HPV+) oropharyngeal cancer (OPC) has a better prognosis compared to HPV unrelated (HPV-) OPC. This review summarizes and discusses several of the controversies regarding the management of HPV+ OPC, including the mechanism of its treatment sensitivity, modern surgical techniques, chemotherapy regimens, and treatment de-intensification protocols. We also discuss and reconsider potential adverse prognostic factors such as tumor EGFR expression, tumor hypoxia, and patient smoking history, as well as the significance of retropharyngeal adenopathy. Finally, we discuss elective nodal treatment of uninvolved lymph node stations. While this review does not exhaust all controversies related to the management of HPV+ OPC, it aims to highlight some of the most clinically relevant ones.
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Affiliation(s)
- Stuart E Samuels
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 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
| | - June Corry
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Michiel W M van den Brekel
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain
| | | | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Missak Haigentz
- Division of Oncology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Alexander D Rapidis
- Department of Head and Neck Surgery, Greek Anticancer Institute, Saint Savvas Hospital, Athens, Greece
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy.
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12
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Molecular Detection of Human Papillomavirus and Viral DNA Load after Radiotherapy for Cervical Carcinomas. TUMORI JOURNAL 2015; 102:521-526. [DOI: 10.5301/tj.5000401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 11/20/2022]
Abstract
Aims and background Infection with high-risk types of human papillomavirus (HPV) is a necessary cause for cervical carcinoma. Radiation therapy together with surgery is the most effective treatment. The purpose of this study was to investigate the molecular basis of the response to radiotherapy in cervical cancer cells. Methods and study design Tumor cells were obtained from biopsies of 44 cervical cancers, collected before and after radiotherapy. The presence of HPV was analyzed by polymerase chain reaction (PCR) using primers specific for the L1 region. Results The prevalence of HPV was 70.4%, with HPV16 being the most common (54.5%) and HPV18 the second (15.9%). Our analyses show that ionizing radiation does not influence HPV detection, as the percentage of HPV-positive biopsies was similar in patients before and after radiotherapy (HPV16 60% vs. 51.7% and HPV18 20% vs. 13.7%, respectively). However, the detection of HPV did vary by tumor stage, with the highest proportion observed in late-stage tumors (HPV16 and HPV18 in 80% and 60% of stage III tumors, respectively). We also found that HPV viral load is influenced by radiotherapy and tumor stage, with the highest viral loads in late-stage tumors (stage III) after 1 day since radiotherapy (p<0.05). According to Kaplan-Meier curves, higher HPV viral load was associated with significantly shortened progression-free survival (p = 0.04). Conclusions Our data provide prospective evidence that ionizing radiation can affect the HPV viral load and this might offer the best strategies for assessment of therapeutic efficacy.
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Datta NR, Singh S, Kumar P, Gupta D. Human papillomavirus confers radiosensitivity in cancer cervix: a hypothesis toward a possible restoration of apoptotic pathways based on clinical outcomes. Future Oncol 2015; 11:1363-71. [DOI: 10.2217/fon.15.53] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
ABSTRACT Aim: To evaluate if high baseline local human papillomavirus (HPV) titer confers radiosensitivity in cancer cervix. A hypothesis is proposed to explain the clinical outcomes. Materials & methods: 121 serial HPV titers from cervical smears of 21 patients were estimated during radiotherapy (RT) and correlated with RT dose–response curves, local response and local disease-free survival (LDFS). Results: Local response (p = 0.04) and LDFS (p = 0.06) were better in high HPV than low HPV baseline group. On multivariate analysis, RT doses for 50% tumor regression and baseline HPV titer were the only predictors for LDFS. Conclusion: Serial reductions of HPV titers following RT could restore the HPV induced temporarily downregulated p53 and pRb apoptotic pathways resulting in radiosensitivity of these tumors.
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Affiliation(s)
- Niloy Ranjan Datta
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
- Presently at, Centre for Radiation Oncology, KSA-KSB, Cantonal Hospital of Aarau, Switzerland
| | - Shalini Singh
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Piyush Kumar
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
- Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, India
| | - Dinesh Gupta
- National Clinical Reference Laboratory, Delhi, India
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Bol V, Bol A, Bouzin C, Labar D, Lee JA, Janssens G, Porporato PE, Sonveaux P, Feron O, Grégoire V. Reprogramming of tumor metabolism by targeting mitochondria improves tumor response to irradiation. Acta Oncol 2015; 54:266-74. [PMID: 25007226 DOI: 10.3109/0284186x.2014.932006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Warburg phenotype identified decades ago describes tumor cells with increased glycolysis and decreased mitochondrial respiration even in the presence of oxygen. This particular metabolism also termed 'aerobic glycolysis' reflects an adaptation of tumor cells to proliferation in a heterogeneous tumor microenvironment. Although metabolic alterations in cancer cells are common features, their impact on the response to radiotherapy is not yet fully elucidated. This study investigated the impact of cellular oxygen consumption inhibition on the tumor response to radiotherapy. MATERIAL AND METHODS Warburg-phenotype tumor cells with impaired mitochondrial respiration (MD) were produced and compared in respect to their metabolism to the genetically matched parental cells (WT). After characterization of their metabolism we compared the response of MD cells to irradiation in vivo and in vitro to the genetically matched parental cells (WT). RESULTS We first confirmed that MD cells were exclusively glycolytic while WT cells exhibited mitochondrial respiration. We then used these cells for assessing the response of WT and MD tumors to a single dose of radiation and showed that the in vivo tumor growth delay of the MD group was increased, indicating an increased radiosensitivity compared to WT while the in vitro ability of both cell lines to repair radiation-induced DNA damage was similar. CONCLUSION Taken together, these results indicate that in addition to intrinsic radiosensitivity parameters the tumor response to radiation will also depend on their metabolic rate of oxygen consumption.
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Affiliation(s)
- Vanesa Bol
- Center for Molecular Imaging, Radiotherapy and Oncology, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCL) , Brussels , Belgium
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15
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Kahla S, Kochbati L, Maalej M, Oueslati R. Situation of HPV16 E2 gene status during radiotherapy treatment of cervical carcinoma. Asian Pac J Cancer Prev 2015; 15:2869-73. [PMID: 24761916 DOI: 10.7314/apjcp.2014.15.6.2869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) integration within the E2 gene has been proposed as a critical event in cervical carcinogenesis. This study concerned whether HPV16 status and E2 gene intactness are predictive of radiation response in patients with cervical cancer. MATERIALS AND METHODS Biopsies of 44 patients with cervical cancer were collected before or after radiotherapy. The presence of HPV16 was assessed by polymerase chain reaction (PCR) using specific primers for the L1 region. E2 disruption was detected by amplifying the entire E2 gene. RESULTS HPV16 DNA was found in 54.5% of the clinical samples. Overall, 62.5% of the HPV16 positive tumors had integrated viral genome and 37.5% had episomal genome. There was a tendency of increase of HPV16 E2 negative tumors compared with HPV16 L1 ones in advanced stages (75% versus 20% in stage III respectively). Detection of E2 gene appeared influenced by the radiotherapy treatment, as the percentage of samples containing an intact HPV16 E2 was more frequent in pretreated patients compared to radiotherapy treated patients (66.6% versus 20%). The radiation therapy caused an eight-fold [OR= 8; CI=1.22-52.25; p=0.03] increase in the risk of HPV16 genome disruption. The integration status is influenced by the irradiation modalities, interestingly E2 disruption being found widely after radiotherapy treatment (75%) with a total fractioned dose of 50 Gy. CONCLUSIONS This study reveals that the status of the viral DNA may be used as a marker to optimize the radiation treatment.
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Affiliation(s)
- Saloua Kahla
- Unit of Immunology Microbiology Environmental and Carcinogenesis (IMEC), Science Faculty of Bizerte, University of Carthage, Jarzouna, Bizerte, Tunisia E-mail :
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Hoskin PJ, Rojas AM, Peiris SN, Mullassery V, Chong IY. Pre-treatment haemoglobin and peripheral blood lymphocyte count as independent predictors of outcome in carcinoma of cervix. Clin Oncol (R Coll Radiol) 2014; 26:179-84. [PMID: 24439272 DOI: 10.1016/j.clon.2013.11.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/14/2013] [Accepted: 10/17/2013] [Indexed: 10/25/2022]
Abstract
AIMS To evaluate pre-treatment haemoglobin and peripheral blood lymphocyte (PBL) counts as predictors of treatment outcome in cervix carcinoma treated with radical chemoradiation. MATERIALS AND METHODS Pre-treatment PBL counts and haemoglobin concentrations were retrieved from full blood count examinations from 111 patients who received concurrent chemoradiotherapy. Overall survival and relapse-free survival were obtained using the Kaplan-Meier method by ranking the data by median haemoglobin and PBL, singly and then in association. Their independence and significance as predictors of outcome were analysed using the Cox proportional hazard model. RESULTS Survival rates were significantly higher in patients whose haemoglobin level or PBL counts were at or above the corresponding median value. At 5 years, rates of overall survival were 77% versus 41% (P = 0.0003) and 75% versus 42% (P = 0.002), when dichotomised around median haemoglobin and PBL, respectively. In multivariate and univariate analyses, both PBL and haemoglobin were independent and significant predictors for risk of death and relapse. Their predictive power was dramatically enhanced when the data were stratified into four groups by associating patients with haemoglobin ≥ median or < median with those whose PBL was ≥ or < median. CONCLUSION Baseline PBL and haemoglobin seem to be strong, independent predictors of treatment outcome in carcinoma of the cervix, particularly if patient response is ranked using the predictors simultaneously. The hypothesis needs to be tested and, if confirmed, the markers should be used in combination to identify those at greater risk of failure who may benefit from additional therapy, with further validation in prospective trials offering treatment modification.
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Affiliation(s)
- P J Hoskin
- Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex, UK
| | - A M Rojas
- Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex, UK.
| | - S N Peiris
- Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex, UK
| | - V Mullassery
- Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex, UK
| | - I Y Chong
- Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex, UK
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Locally advanced cervical cancer in renal transplant patients: a dilemma between control and toxicity. Brachytherapy 2013; 13:88-93. [PMID: 24359670 DOI: 10.1016/j.brachy.2013.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/04/2013] [Accepted: 11/18/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE Treatment of locally advanced cervical cancer in patients with a renal graft requires precautions. The graft is usually in a pelvic position, close to the clinical target volume (CTV). Preserving the graft while ensuring local control is a challenge we have faced in two occasions. We report our experience. METHODS AND MATERIALS We report the cases of 2 patients treated at our institution with a modified workup and therapeutic approach compared with our standard approach. The clinical and technical aspects of both treatments were systematically reviewed and contrasted with reports previously cited in the literature. RESULTS The first patient received external beam conformal radiotherapy (total dose: 30 Gy in the pelvis) followed by two sessions of MRI-guided brachytherapy (2 × 15 Gy to 90% of the intermediate risk CTV). The second one received pelvic intensity-modulated radiation therapy (total dose: 45 Gy) followed by MRI-guided brachytherapy delivering 15 Gy to 90% of the intermediate risk CTV. Both patients had a complete response and were still in remission more than 2 years after treatment while retaining their graft. No severe late toxicity was reported. CONCLUSIONS External beam radiotherapy followed by brachytherapy is feasible in locally advanced cervical cancer, despite the presence of a kidney graft near the targets. Image-guided adaptive brachytherapy allowed an accurate evaluation of the dose distribution, reaching the recommended treatment thresholds with optimal protection of the graft.
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Azria D, Ardiet JM, Chauvet B, Denis F, Eschwège F, Hennequin C, Lartigau É, Rocher F, Mahé MA, Maingon P, Mazeron JJ, Metayer Y, Peiffert D, Thureau S, Mornex F. Implications récentes des équipes françaises en oncologie radiothérapie et radiobiologie clinique. Cancer Radiother 2012; 16:386-91. [DOI: 10.1016/j.canrad.2012.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 05/18/2012] [Indexed: 12/30/2022]
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Rades D, Seibold ND, Gebhard MP, Noack F, Schild SE, Thorns C. Prognostic factors (including HPV status) for irradiation of locally advanced squamous cell carcinoma of the head and neck (SCCHN). Strahlenther Onkol 2011; 187:626-32. [DOI: 10.1007/s00066-011-1139-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 06/14/2011] [Indexed: 10/17/2022]
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Huang SH, Rosewall T. Human Papillomavirus-related Oropharyngeal Carcinoma: Current Understanding and Enduring Uncertainties. J Med Imaging Radiat Sci 2011; 42:86-94. [DOI: 10.1016/j.jmir.2011.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 01/21/2011] [Accepted: 02/07/2011] [Indexed: 11/29/2022]
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