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Touraine C, Winter A, Castan F, Azria D, Gourgou S. Time-Dependent ROC Curve Analysis for Assessing the Capability of Radiation-Induced CD8 T-Lymphocyte Apoptosis to Predict Late Toxicities after Adjuvant Radiotherapy of Breast Cancer Patients. Cancers (Basel) 2023; 15:4676. [PMID: 37835370 PMCID: PMC10571898 DOI: 10.3390/cancers15194676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Late fibrosis can occur in breast cancer patients treated with curative-intent radiotherapy. Predicting this toxicity is of clinical interest in order to adapt the irradiation dose delivered. Radiation-induced CD8 T-lymphocyte apoptosis (RILA) had been proven to be associated with less grade ≥2 late radiation-induced toxicities in patients with miscellaneous cancers. Tobacco smoking status and adjuvant hormonotherapy were also identified as potential factors related to late-breast-fibrosis-free survival. This article evaluates the predictive performance of the RILA using a ROC curve analysis that takes into account the dynamic nature of fibrosis occurrence. This time-dependent ROC curve approach is also applied to evaluate the ability of the RILA combined with the other previously identified factors. Our analysis includes a Monte Carlo cross-validation procedure and the calculation of an expected cost of misclassification, which provides more importance to patients who have no risk of late fibrosis in order to be able to treat them with the maximal irradiation dose. Performance evaluation was assessed at 12, 24, 36 and 50 months. At 36 months, our results were comparable to those obtained in a previous study, thus underlying the predictive power of the RILA. Based on specificity and cost, RILA alone seemed to be the most performant, while its association with the other factors had better negative predictive value results.
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Affiliation(s)
- Célia Touraine
- Biometrics Unit, Cancer Institute of Montpellier (ICM), University Montpellier, 34090 Montpellier, France; (C.T.); (F.C.); (S.G.)
- French National Platform Quality of Life and Cancer, 34090 Montpellier, France
- Desbrest Institute of Epidemiology and Public Health (IDESP), University Montpellier, INSERM, 34090 Montpellier, France
| | - Audrey Winter
- Biometrics Unit, Cancer Institute of Montpellier (ICM), University Montpellier, 34090 Montpellier, France; (C.T.); (F.C.); (S.G.)
- French National Platform Quality of Life and Cancer, 34090 Montpellier, France
| | - Florence Castan
- Biometrics Unit, Cancer Institute of Montpellier (ICM), University Montpellier, 34090 Montpellier, France; (C.T.); (F.C.); (S.G.)
| | - David Azria
- Radiotherapy Unit, Cancer Institute of Montpellier (ICM), University Montpellier, 34090 Montpellier, France;
| | - Sophie Gourgou
- Biometrics Unit, Cancer Institute of Montpellier (ICM), University Montpellier, 34090 Montpellier, France; (C.T.); (F.C.); (S.G.)
- French National Platform Quality of Life and Cancer, 34090 Montpellier, France
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Liu J, West H, McGee HM, Williams TM, Lee P, Amini A. Challenges in synergizing radiotherapy with immunotherapy to unlock the abscopal effect in metastatic NSCLC: A systematic review. Neoplasia 2023; 43:100914. [PMID: 37348427 PMCID: PMC10314288 DOI: 10.1016/j.neo.2023.100914] [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: 08/15/2022] [Revised: 11/04/2022] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND With the recent success of immunotherapy, there is a growing interest in combining radiation with immunotherapy to boost abscopal response rates. Several challenges exist in determining how to synergize these two modalities in the treatment of metastatic NSCLC. METHODS References for this review were identified through searches of MEDLINE/PubMed and Clinicaltrials.gov databases with the search terms "abscopal", "radiation OR radiotherapy," "NSCLC", and "lung" on the index date of July 2022 from 2000-2022. This systematic review focuses primarily on clinical papers. DISCUSSION Early work combining radiotherapy with immunotherapy show promise in unlocking the abscopal effect. Preliminary evidence suggests that radiotherapy regimens with <5 fractions and smaller fields may be superior to regimens with 15 fractions and larger fields. There does not appear to be enough evidence to draw conclusions about the optimal timing of radiotherapy in relation to immunotherapy or the optimal anatomical location of radiation to induce the abscopal effect. Several studies suggest selecting patients with a higher absolute lymphocyte count (ALC) and lower neutrophil-to-lymphocyte ratio (NLR) may help to further boost abscopal response rates. Furthermore, selecting tumors with programmed death ligand-1 (PD-L1) expression, mismatch repair deficiency, and higher tumor mutational burden may similarly achieve this goal. Lastly, additional work is needed to minimize and predict for severe toxicity associated with combination therapy.
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Affiliation(s)
- Jason Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States
| | - Howard West
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States
| | - Heather M McGee
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States; Department of Immuno-Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States
| | - Terence M Williams
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States
| | - Percy Lee
- Department of Radiation Oncology, City of Hope Orange County, Irvine, CA 92618, United States
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States.
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Durdik M, Markova E, Kosik P, Vigasova K, Gulati S, Jakl L, Vrobelova K, Fekete M, Zavacka I, Pobijakova M, Dolinska Z, Belyaev I. Assessment of Individual Radiosensitivity in Breast Cancer Patients Using a Combination of Biomolecular Markers. Biomedicines 2023; 11:biomedicines11041122. [PMID: 37189740 DOI: 10.3390/biomedicines11041122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
About 5% of patients undergoing radiotherapy (RT) develop RT-related side effects. To assess individual radiosensitivity, we collected peripheral blood from breast cancer patients before, during and after the RT, and γH2AX/53BP1 foci, apoptosis, chromosomal aberrations (CAs) and micronuclei (MN) were analyzed and correlated with the healthy tissue side effects assessed by the RTOG/EORTC criteria. The results showed a significantly higher level of γH2AX/53BP1 foci before the RT in radiosensitive (RS) patients in comparison to normal responding patients (NOR). Analysis of apoptosis did not reveal any correlation with side effects. CA and MN assays displayed an increase in genomic instability during and after RT and a higher frequency of MN in the lymphocytes of RS patients. We also studied time kinetics of γH2AX/53BP1 foci and apoptosis after in vitro irradiation of lymphocytes. Higher levels of primary 53BP1 and co-localizing γH2AX/53BP1 foci were detected in cells from RS patients as compared to NOR patients, while no difference in the residual foci or apoptotic response was found. The data suggested impaired DNA damage response in cells from RS patients. We suggest γH2AX/53BP1 foci and MN as potential biomarkers of individual radiosensitivity, but they need to be evaluated with a larger cohort of patients for clinics.
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Affiliation(s)
- Matus Durdik
- Department of Radiobiology, Cancer Research Institute, Biomedical Research Center v.v.i., Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Eva Markova
- Department of Radiobiology, Cancer Research Institute, Biomedical Research Center v.v.i., Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Pavol Kosik
- Department of Radiobiology, Cancer Research Institute, Biomedical Research Center v.v.i., Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Katarina Vigasova
- Department of Radiobiology, Cancer Research Institute, Biomedical Research Center v.v.i., Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Sachin Gulati
- Department of Radiobiology, Cancer Research Institute, Biomedical Research Center v.v.i., Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Lukas Jakl
- Department of Radiobiology, Cancer Research Institute, Biomedical Research Center v.v.i., Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Katarina Vrobelova
- Department of Radiobiology, Cancer Research Institute, Biomedical Research Center v.v.i., Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Marta Fekete
- Department of Radiation Oncology, Radiological Centrum, National Cancer Institute, 812 50 Bratislava, Slovakia
| | - Ingrid Zavacka
- Department of Radiation Oncology, Radiological Centrum, National Cancer Institute, 812 50 Bratislava, Slovakia
| | - Margita Pobijakova
- Department of Radiation Oncology, Radiological Centrum, National Cancer Institute, 812 50 Bratislava, Slovakia
| | - Zuzana Dolinska
- Department of Radiation Oncology, Radiological Centrum, National Cancer Institute, 812 50 Bratislava, Slovakia
| | - Igor Belyaev
- Department of Radiobiology, Cancer Research Institute, Biomedical Research Center v.v.i., Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
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Histopathological and Haemogram Features Correlate with Prognosis in Rectal Cancer Patients Receiving Neoadjuvant Chemoradiation without Pathological Complete Response. J Clin Med 2022; 11:jcm11174947. [PMID: 36078877 PMCID: PMC9456328 DOI: 10.3390/jcm11174947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Neoadjuvant chemoradiation therapy (NCRT) followed by surgery is the standard treatment for locally advanced rectal cancer (LARC); approximately 80% of patients do not achieve complete response. Identifying prognostic factors predictive of survival in these patients to guide further management is needed. The intratumoural lymphocytic response (ILR), peritumoural lymphocytic reaction (PLR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PtLR) are correlated with the tumour microenvironment and cancer-related systemic inflammation. This study aimed to explore the ability of the ILR, PLR, NLR, and PtLR to predict survival in LARC patients without a complete response to NCRT. Methods: Sixty-nine patients who underwent NCRT and surgery were retrospectively reviewed. The ILR and PLR were assessed in surgical specimens, and the NLR and PtLR were calculated using pre- and post-NCRT blood count data. The Kaplan–Meier method and Cox regression analyses were performed for survival analysis. Results: A high PLR and high post-NCRT NLR and PtLR were significantly associated with better prognosis. Lymphovascular invasion (LVI), post-NCRT neutrophil count, and lymphocyte count were significant predictors of overall survival. LVI and the PLR were independent predictors of disease-free survival. Conclusions: NCRT-induced local and systemic immune responses are favourable prognostic predictors in LARC patients without complete response to NCRT.
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Andrejsová L, Čížková J, Filipová A, Lierová A, Šinkorová Z. NEW EXPERIMENTAL APPROACH IN BIODOSIMETRY: EX VIVO APOPTOSIS DETECTION. RADIATION PROTECTION DOSIMETRY 2022; 198:590-596. [PMID: 36005967 DOI: 10.1093/rpd/ncac103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 02/25/2022] [Indexed: 06/15/2023]
Abstract
This study establishes a new experimental approach for retrospective biodosimetric assessment by apoptosis detection ex vivo. For this purpose, we used mononuclear blood leukocytes isolated from the peripheral blood of irradiated Wistar rats and cultured them ex vivo for posterior analysis. Using flow cytometry, we distinguished apoptotic lymphocyte subsets individual biodosimetric potential at different time periods after exposure: B-lymphocytes 6-8 h (0-7 Gy), natural killer cells 24 h (0-7 Gy) and T-lymphocytes 24 h (0-1 Gy). This novel experimental design innovates through the need of a single blood sample from irradiated individuals for a complete biodosimetric assessment.
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Affiliation(s)
- Lenka Andrejsová
- Department of Radiobiology, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
| | - Jana Čížková
- Department of Radiobiology, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
| | - Alžběta Filipová
- Department of Radiobiology, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
| | - Anna Lierová
- Department of Radiobiology, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
| | - Zuzana Šinkorová
- Department of Radiobiology, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
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Lapierre A, Bourillon L, Larroque M, Gouveia T, Bourgier C, Ozsahin M, Pèlegrin A, Azria D, Brengues M. Improving Patients’ Life Quality after Radiotherapy Treatment by Predicting Late Toxicities. Cancers (Basel) 2022; 14:cancers14092097. [PMID: 35565227 PMCID: PMC9099838 DOI: 10.3390/cancers14092097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 11/26/2022] Open
Abstract
Simple Summary Over 50% of patients with cancer will receive radiotherapy treatment. Five to ten percent of patients who received radiotherapy will develop side effects. Identifying these patients before treatment start would allow for treatment modification to minimize these effects and improve the life quality of these patients. Our team developed a test, which allows predicting these secondary effects before starting the treatment. This will help in proposing personalized treatments to improve the outcome. This review presents how this test is performed, its results, as well as its modification in order to be used in hospitals. Abstract Personalized treatment and precision medicine have become the new standard of care in oncology and radiotherapy. Because treatment outcomes have considerably improved over the last few years, permanent side-effects are becoming an increasingly significant issue for cancer survivors. Five to ten percent of patients will develop severe late toxicity after radiotherapy. Identifying these patients before treatment start would allow for treatment adaptation to minimize definitive side effects that could impair their long-term quality of life. Over the last decades, several tests and biomarkers have been developed to identify these patients. However, out of these, only the Radiation-Induced Lymphocyte Apoptosis (RILA) assay has been prospectively validated in multi-center cohorts. This test, based on a simple blood draught, has been shown to be correlated with late radiation-induced toxicity in breast, prostate, cervical and head and neck cancer. It could therefore greatly improve decision making in precision radiation oncology. This literature review summarizes the development and bases of this assay, as well as its clinical results and compares its results to the other available assays.
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Affiliation(s)
- Ariane Lapierre
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
- Department of Radiotherapy-Oncology, Lyon-Sud Hospital Center, 69310 Pierre-Bénite, France
| | - Laura Bourillon
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | - Marion Larroque
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | - Tiphany Gouveia
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | - Céline Bourgier
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | | | - André Pèlegrin
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | - David Azria
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | - Muriel Brengues
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
- Correspondence: ; Tel.: +33-411-283-182
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7
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Qin VM, Haynes NM, D'Souza C, Neeson PJ, Zhu JJ. CAR-T Plus Radiotherapy: A Promising Combination for Immunosuppressive Tumors. Front Immunol 2022; 12:813832. [PMID: 35095911 PMCID: PMC8790144 DOI: 10.3389/fimmu.2021.813832] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/22/2021] [Indexed: 12/26/2022] Open
Abstract
Radiotherapy (RT) is the standard-of-care treatment for more than half of cancer patients with localized tumors and is also used as palliative care to facilitate symptom relief in metastatic cancers. In addition, RT can alter the immunosuppressive tumor microenvironment (TME) of solid tumors to augment the anti-tumor immune response of immune checkpoint blockade (ICB). The rationale of this combination therapy can also be extended to other forms of immunotherapy, such as chimeric antigen receptor T cell (CAR-T) therapy. Similar to ICB, the efficacy of CAR-T therapy is also significantly impacted by the immunosuppressive TME, leading to compromised T cell function and/or insufficient T cell infiltration. In this review, we will discuss some of the key barriers to the activity of CAR-T cells in the immunosuppressive TME and focus on how RT can be used to eliminate or bypass these barriers. We will present the challenges to achieving success with this therapeutic partnership. Looking forward, we will also provide strategies currently being investigated to ensure the success of this combination strategy in the clinic.
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Affiliation(s)
- Vicky Mengfei Qin
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Clinical Pathology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Nicole M Haynes
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Criselle D'Souza
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Paul J Neeson
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Joe Jiang Zhu
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
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Cullen D, Bryant J, Maguire A, Medipally D, McClean B, Shields L, Noone E, Bradshaw S, Finn M, Dunne M, Shannon AM, Armstrong J, Howe O, Meade AD, Lyng FM. Raman spectroscopy of lymphocytes for the identification of prostate cancer patients with late radiation toxicity following radiotherapy. TRANSLATIONAL BIOPHOTONICS 2020. [DOI: 10.1002/tbio.201900035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Daniel Cullen
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Physics and Clinical and Optometric Sciences Technological University Dublin Dublin Ireland
| | - Jane Bryant
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
| | - Adrian Maguire
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Physics and Clinical and Optometric Sciences Technological University Dublin Dublin Ireland
| | - Dinesh Medipally
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Physics and Clinical and Optometric Sciences Technological University Dublin Dublin Ireland
| | - Brendan McClean
- Department of Medical Physics Saint Luke's Radiation Oncology Network Dublin Ireland
| | - Laura Shields
- Department of Medical Physics Saint Luke's Radiation Oncology Network Dublin Ireland
| | - Emma Noone
- Clinical Trials Unit Saint Luke's Radiation Oncology Network at St Luke's Hospital Dublin Ireland
| | - Shirley Bradshaw
- Clinical Trials Unit Saint Luke's Radiation Oncology Network at St Luke's Hospital Dublin Ireland
| | - Marie Finn
- Clinical Trials Unit Saint Luke's Radiation Oncology Network at St Luke's Hospital Dublin Ireland
| | - Mary Dunne
- Clinical Trials Unit Saint Luke's Radiation Oncology Network at St Luke's Hospital Dublin Ireland
| | | | - John Armstrong
- Cancer Trials Ireland Dublin Ireland
- Department of Radiation Oncology Saint Luke's Radiation Oncology Network at St Luke's Hospital Dublin Ireland
| | - Orla Howe
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Biological and Health Sciences Technological University Dublin Dublin Ireland
| | - Aidan D. Meade
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Physics and Clinical and Optometric Sciences Technological University Dublin Dublin Ireland
| | - Fiona M. Lyng
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Physics and Clinical and Optometric Sciences Technological University Dublin Dublin Ireland
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Lee S, Cho O, Chun M, Chang SJ, Kong TW, Lee EJ, Lee Y. Association Between Radiation Tolerance of Lymphocytes and Clinical Outcomes in Cervical Cancer. In Vivo 2020; 33:2191-2198. [PMID: 31662555 DOI: 10.21873/invivo.11721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIM This study evaluated whether the lymphocyte tolerance factor (LTF) was an indicator of radiation tolerance of lymphocytes (RTL) using the relative lymphocyte count (RLC), and considering clinical outcomes. PATIENTS AND METHODS A total of 92 cervical cancer patients treated with concurrent chemoradiotherapy (CCRT) were analysed. RLC0 was pre-treatment RLC, and RLC1, and RLC2 were at the first and second week of CCRT, respectively. LTF1 was RLC1:RLC2. LTF2 was the dimension of the convex or concave shape comprising the three RLC vertexes. Patients were divided into three groups: good RTL group, low LTF1; moderate RTL group, high LTF1 and low LTF2; and poor RTL group, high LTF1 and high LTF2. RESULTS Patients with good tumour response to radiotherapy were mostly included in the good RTL group than in the other groups. The poor RTL group had lower 3-year progression-free survival (57.1% vs. 83.8% and 82%, p=0.01) and 5-year disease-specific survival (71.8% vs. 90.4% and 94.9%, p=0.062) rates than the moderate and good RTL groups. Multivariate analyses showed that poor RTL was a significant survival predictor. CONCLUSION The poor RTL group according to LTF is a potential predictor of clinical outcome.
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Affiliation(s)
- Shiho Lee
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Oyeon Cho
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Suk Jun Chang
- Department of Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Tae Wook Kong
- Department of Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Eun Ju Lee
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yonghee Lee
- Department of Pathology, Ajou University School of Medicine, Suwon, Republic of Korea
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Chaouni S, Lecomte DD, Stefan D, Leduc A, Barraux V, Leconte A, Grellard JM, Habrand JL, Guillamin M, Sichel F, Laurent C. The Possibility of Using Genotoxicity, Oxidative Stress and Inflammation Blood Biomarkers to Predict the Occurrence of Late Cutaneous Side Effects after Radiotherapy. Antioxidants (Basel) 2020; 9:antiox9030220. [PMID: 32156042 PMCID: PMC7139389 DOI: 10.3390/antiox9030220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 12/18/2022] Open
Abstract
Despite the progresses performed in the field of radiotherapy, toxicity to the healthy tissues remains a major limiting factor. The aim of this work was to highlight blood biomarkers whose variations could predict the occurrence of late cutaneous side effects. Two groups of nine patients treated for Merkel Cell Carcinoma (MCC) were established according to the grade of late skin toxicity after adjuvant irradiation for MCC: grade 0, 1 or 2 and grade 3 or 4 of RTOG (Radiation Therapy Oncology Group)/EORTC (European Organization for Research and Treatment of Cancer). To try to discriminate these 2 groups, biomarkers of interest were measured on the different blood compartments after ex vivo irradiation. In lymphocytes, cell cycle, apoptosis and genotoxicity were studied. Oxidative stress was evaluated by the determination of the erythrocyte antioxidant capacity (superoxide dismutase, catalase, glutathione peroxidase, reduced and oxidized glutathione) as well as degradation products (protein carbonylation, lipid peroxidation). Inflammation was assessed in the plasma by the measurement of 14 cytokines. The most radiosensitive patients presented a decrease in apoptosis, micronucleus frequency, antioxidant enzyme activities, glutathione and carbonyls; and an increase in TNF-a (Tumor Necrosis Factor a), IL-8 (Interleukin 8) and TGF-β1 (Transforming Growth Factor β1) levels. These findings have to be confirmed on a higher number of patients and before radiotherapy and could allow to predict the occurrence of late skin side effects after radiotherapy.
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Affiliation(s)
- Samia Chaouni
- ABTE-EA4651, ToxEMAC, Normandie University, UNICAEN, UNIROUEN, 14000 Caen, France, (S.C.)
| | - Delphine Dumont Lecomte
- ABTE-EA4651, ToxEMAC, Normandie University, UNICAEN, UNIROUEN, 14000 Caen, France, (S.C.)
- Radiotherapy Department, Hôpital Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
| | - Dinu Stefan
- ABTE-EA4651, ToxEMAC, Normandie University, UNICAEN, UNIROUEN, 14000 Caen, France, (S.C.)
- Radiotherapy Department, Cancer Centre François Baclesse, 14000 Caen France
| | - Alexandre Leduc
- ABTE-EA4651, ToxEMAC, Normandie University, UNICAEN, UNIROUEN, 14000 Caen, France, (S.C.)
| | - Victor Barraux
- Medical Physics Department, Cancer Centre François Baclesse, 14000 Caen, France,
| | - Alexandra Leconte
- Clinical Research Department, Cancer Centre François Baclesse, 14000 Caen, France, (A.L.)
| | - Jean-Michel Grellard
- Clinical Research Department, Cancer Centre François Baclesse, 14000 Caen, France, (A.L.)
| | - Jean-Louis Habrand
- ABTE-EA4651, ToxEMAC, Normandie University, UNICAEN, UNIROUEN, 14000 Caen, France, (S.C.)
- Radiotherapy Department, Cancer Centre François Baclesse, 14000 Caen France
| | - Marilyne Guillamin
- IFR ICORE-Flow Cytometry Platform, Normandie University, UNICAEN, 14000 Caen, France,
| | - François Sichel
- ABTE-EA4651, ToxEMAC, Normandie University, UNICAEN, UNIROUEN, 14000 Caen, France, (S.C.)
- Cancer Centre François Baclesse, 14000 Caen, France
| | - Carine Laurent
- ABTE-EA4651, ToxEMAC, Normandie University, UNICAEN, UNIROUEN, 14000 Caen, France, (S.C.)
- SAPHYN/ARCHADE (Advanced Resource Centre for HADrontherapy in Europe), Cancer Centre François Baclesse, 14000 Caen, France
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11
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Averbeck D, Candéias S, Chandna S, Foray N, Friedl AA, Haghdoost S, Jeggo PA, Lumniczky K, Paris F, Quintens R, Sabatier L. Establishing mechanisms affecting the individual response to ionizing radiation. Int J Radiat Biol 2020; 96:297-323. [PMID: 31852363 DOI: 10.1080/09553002.2019.1704908] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: Humans are increasingly exposed to ionizing radiation (IR). Both low (<100 mGy) and high doses can cause stochastic effects, including cancer; whereas doses above 100 mGy are needed to promote tissue or cell damage. 10-15% of radiotherapy (RT) patients suffer adverse reactions, described as displaying radiosensitivity (RS). Sensitivity to IR's stochastic effects is termed radiosusceptibility (RSu). To optimize radiation protection we need to understand the range of individual variability and underlying mechanisms. We review the potential mechanisms contributing to RS/RSu focusing on RS following RT, the most tractable RS group.Conclusions: The IR-induced DNA damage response (DDR) has been well characterized. Patients with mutations in the DDR have been identified and display marked RS but they represent only a small percentage of the RT patients with adverse reactions. We review the impacting mechanisms and additional factors influencing RS/RSu. We discuss whether RS/RSu might be genetically determined. As a recommendation, we propose that a prospective study be established to assess RS following RT. The study should detail tumor site and encompass a well-defined grading system. Predictive assays should be independently validated. Detailed analysis of the inflammatory, stress and immune responses, mitochondrial function and life style factors should be included. Existing cohorts should also be optimally exploited.
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Affiliation(s)
| | - Serge Candéias
- CEA, CNRS, LCMB, University of Grenoble Alpes, Grenoble, France
| | - Sudhir Chandna
- Division of Radiation Biosciences, Institute of Nuclear Medicine & Allied Sciences, Delhi, India
| | - Nicolas Foray
- Inserm UA8 Unit Radiations: Defense, Health and Environment, Lyon, France
| | - Anna A Friedl
- Department of Radiation Oncology, University Hospital, LMU, Munich, Germany
| | - Siamak Haghdoost
- Cimap-Laria, Advanced Resource Center for HADrontherapy in Europe (ARCHADE,), University of Caen Normandy, France.,Centre for Radiation Protection Research, Department of Molecular Bioscience, Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Penelope A Jeggo
- Genome Damage and Stability Centre, School of Life Sciences, University of Sussex, Brighton, UK
| | - Katalin Lumniczky
- Department of Radiation Medicine, Division of Radiobiology and Radiohygiene, National Public Health Center, Budapest, Hungary
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12
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[Predictive assays for responses of tumors and normal tissues in radiation oncology]. Cancer Radiother 2019; 23:666-673. [PMID: 31451357 DOI: 10.1016/j.canrad.2019.07.152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/07/2019] [Indexed: 11/24/2022]
Abstract
The impact of curative radiotherapy depends mainly on the total dose delivered homogenously in the target volume. Tumor sensitivity to radiotherapy may be particularly inconstant depending on location, histology, somatic genetic parameters and the capacity of the immune system to infiltrate the tumor. In addition, the dose delivered to the surrounding healthy tissues may reduce the therapeutic ratio of many radiation treatments. In a same population treated in one center with the same technique, it appears that individual radiosensitivity clearly exists, namely in terms of late side effects that are in principle non-reversible. This review details the different radiobiological approaches that have been developed to better predict the tumor response but also the radiation-induced late effects.
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13
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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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14
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Gomolka M, Blyth B, Bourguignon M, Badie C, Schmitz A, Talbot C, Hoeschen C, Salomaa S. Potential screening assays for individual radiation sensitivity and susceptibility and their current validation state. Int J Radiat Biol 2019; 96:280-296. [PMID: 31347938 DOI: 10.1080/09553002.2019.1642544] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose: The workshop on 'Individual Radiosensitivity and Radiosusceptibility' organized by MELODI and CONCERT on Malta in 2018, evaluated the current state of assays to identify sensitive and susceptible subgroups. The authors provide an overview on potential screening assays detecting individuals showing moderate to severe early and late radiation reactions or are at increased risk to develop cancer upon radiation exposure.Conclusion: It is necessary to separate clearly between tissue reactions and stochastic effects such as cancer when comparing the existing literature to validate various test systems. Requirements for the assays are set up. The literature is reviewed for assays that are reliable and robust. Sensitivity and specificity of the assays are regarded and scrutinized for modifying factors. Accuracy of an assay system is required to be more than 90% to balance risks of adverse reactions against risk to fail to cure the cancer. No assay/biomarker is in routine use. Assays that have shown predictive potential for radiosensitivity include SNPs, the RILA assay, and the pATM assay. A tree of risk guideline for radiologists is provided to assist medical treatment decisions. Recommendations for effective research include the setup of common retrospective and prospective cohorts/biobanks to validate current and future tests.
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Affiliation(s)
- Maria Gomolka
- Federal Office for Radiation Protection, Neuherberg, Germany
| | - Benjamin Blyth
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Christophe Badie
- Cancer Mechanisms and Biomarkers Group, Radiation Effects Department Centre for Radiation, Chemical and Environmental Hazards Public Health England, Didcot, United Kingdom
| | - Annette Schmitz
- Institut de Radiobiologie Cellulaire et Moléculaire, Institut de Biologie François Jacob, Direction de la Recherche Fondamentale, CEA, Paris, France
| | - Christopher Talbot
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
| | - Christoph Hoeschen
- Faculty of Electrical Engineering and Information Technology, Institute for Medical Technology, Otto-von-Guericke-University, Magdeburg, Germany
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15
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Fhoghlú MN, Barrett S. A Review of Radiation-Induced Lymphocyte Apoptosis as a Predictor of Late Toxicity After Breast Radiotherapy. J Med Imaging Radiat Sci 2019; 50:337-344. [PMID: 31176443 DOI: 10.1016/j.jmir.2019.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/28/2019] [Accepted: 02/20/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Improved survivorship in patients with breast cancer means many are currently living with the late effects of radiotherapy, particularly fibrosis. Personalized treatment is not currently considered for patients with breast cancer. Radiation-induced lymphocyte apoptosis (RILA), a predictive assay, could offer a novel approach in predicting patients at a higher risk of developing this late toxicity and therefore improving informed decision-making. MATERIALS AND METHODS A systematic search of PubMed and Embase was performed and eight clinical trials were identified that investigate RILA as a predictor of late breast fibrosis after radiotherapy. RESULTS Median RILA scores were lower in patients who experienced ≥ grade 2 fibrosis than in patients who experienced ≥ grade 1. A clear inverse relationship between RILA scores and late toxicity was reported in the literature; however, there were several other confounding factors involved in the development of fibrosis. CD8 lymphocytes were reported to have superior sensitivity and specificity over CD4 lymphocytes. CONCLUSION RILA was reported to be an effective biomarker in predicting fibrosis in breast cancer but other factors also need to be considered before clinical implementation.
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Affiliation(s)
- Meadhbh Ní Fhoghlú
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sarah Barrett
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland.
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16
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Multi-centre technical evaluation of the radiation-induced lymphocyte apoptosis assay as a predictive test for radiotherapy toxicity. Clin Transl Radiat Oncol 2019; 18:1-8. [PMID: 31341970 PMCID: PMC6610684 DOI: 10.1016/j.ctro.2019.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 11/21/2022] Open
Abstract
The RILA assay is the leading candidate biomarker for radiotherapy toxicity. We describe work to standardise its use across multiple centres. Patient factors including smoking and arthritis were found to affect RILA score. RILA predicts acute breast pain but not other acute end-points. This work establishes the basis for implementing the assay clinically.
Predicting which patients will develop adverse reactions to radiotherapy is important for personalised treatment. Prediction will require an algorithm or nomogram combining clinical and biological data. The radiation-induced lymphocyte apoptosis (RILA) assay is the leading candidate as a biological predictor of radiotherapy toxicity. In this study we tested the potential of the assay for standardisation and use in multiple testing laboratories. The assay was standardised and reproducibility determined using samples from healthy volunteers assayed concurrently in three laboratories in Leicester (UK), Mannheim (Germany) and Montpellier (France). RILA assays were performed on samples taken prior to radiotherapy from 1319 cancer patients enrolled in the REQUITE project at multiple centres. The patients were being treated for breast (n = 753), prostate (n = 506) or lung (n = 60) cancer. Inter-laboratory comparisons identified several factors affecting results: storage time, incubation periods and type of foetal calf serum. Following standardisation, there was no significant difference in results between the centres. Significant differences were seen in RILA scores between cancer types (prostate > breast > lung), by smoking status (non-smokers > smokers) and co-morbidity with rheumatoid arthritis (arthritics > non-arthritics). An analysis of acute radiotherapy toxicity showed as expected that RILA assay does not predict most end-points, but unexpectedly did predict acute breast pain. This result may elucidate the mechanism by which the RILA assay predicts late radiotherapy toxicity. The work shows clinical trials involving multiple laboratory measurement of the RILA assay are feasible and the need to account for tumour type and other variables when applying to predictive models.
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17
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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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18
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Veldwijk MR, Seibold P, Botma A, Helmbold I, Sperk E, Giordano FA, Gürth N, Kirchner A, Behrens S, Wenz F, Chang-Claude J, Herskind C. Association of CD4 + Radiation-Induced Lymphocyte Apoptosis with Fibrosis and Telangiectasia after Radiotherapy in 272 Breast Cancer Patients with >10-Year Follow-up. Clin Cancer Res 2019; 25:562-572. [PMID: 30327309 DOI: 10.1158/1078-0432.ccr-18-0777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/10/2018] [Accepted: 10/11/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Radiation-induced lymphocyte apoptosis (RILA) has been suggested as a predictive assay for adverse late reactions after radiotherapy. Thus, low RILA values of T-lymphocyte subpopulations have been associated with increased risk for various endpoints at 2 to 3 years of follow-up. The purpose was to test if such associations persist for specific endpoints (subcutaneous fibrosis, telangiectasia) in breast cancer patients with at least 10 years of follow-up.Experimental Design: Two hundred and seventy-two female patients who had received breast-conserving therapy within the German ISE study were included (median follow-up: 11.6 years). Radiotherapy-induced side effects were scored according to the Late Effects in Normal Tissues-Subjective, Objective, Management, and Analytic (LENT-SOMA) classification system. RILA in the CD4+, CD8+, and natural killer (NK) subpopulations from peripheral blood was analyzed by flow cytometry. Multivariate predictive modeling was performed including relevant clinical risk factors. RESULTS Low CD4+ RILA was associated with increased risk for both fibrosis (P = 0.011) and telangiectasia (P < 0.001). For fibrosis, the association was stronger outside the surgical area (Fibout; P = 0.004) than within (Fibin; P = 0.17). Predictive multivariate modeling including clinical risk factors yielded OR of 3.48 (95% confidence interval, 1.84-6.58) for any fibrosis and 8.60 (2.71-27.3) for telangiectasia. Addition of CD4+ RILA to the clinical variables improved discrimination (c statistics) from 0.62 to 0.68 for any fibrosis, 0.62 to 0.66 for Fibin, 0.61 to 0.69 for Fibout, and from 0.65 to 0.76 for telangiectasia. CD8+ and NK RILA were not significantly associated with radiotherapy-related late reactions. CONCLUSIONS The results provide first evidence that low CD4+ RILA is associated with increased subcutaneous fibrosis and telangiectasia even after 10 years. This supports the potential usefulness for predicting individual clinical risk.
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Affiliation(s)
- Marlon R Veldwijk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Akke Botma
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Irmgard Helmbold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elena Sperk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicole Gürth
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anne Kirchner
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Cancer Epidemiology Group, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Germany
| | - Carsten Herskind
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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19
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Chua KLM, Yeo ELL, Shihabudeen WA, Tan SH, Shwe TT, Ong EHW, Lam PYP, Soo KC, Soong YL, Fong KW, Tan TWK, Wee JTS, Chua MLK. Intra-patient and inter-patient comparisons of DNA damage response biomarkers in Nasopharynx Cancer (NPC): analysis of NCC0901 randomised controlled trial of induction chemotherapy in locally advanced NPC. BMC Cancer 2018; 18:1095. [PMID: 30419858 PMCID: PMC6233280 DOI: 10.1186/s12885-018-5005-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inter-patient heterogeneity in radiation-induced DNA damage responses is proposed to reflect intrinsic variations in tumour and normal tissue radiation sensitivity, but the prediction of phenotype by a molecular biomarker is influenced by clinical confounders and assay reproducibility. Here, we characterised the intrapatient and inter-patient heterogeneity in biomarkers of DNA damage and repair and radiation-induced apoptosis. METHODS We enrolled 85 of 172 patients with locally advanced nasopharynx cancer from a randomised controlled phase II/III trial of induction chemotherapy added to chemo-radiotherapy. G0 blood lymphocytes were harvested from these patients, and irradiated with 1, 4, and 8 Gy ex vivo. DNA damage induction (1 Gy 0.5 h) and repair (4 Gy 24 h) were assessed by duplicate γH2AX foci assays in 50-100 cells. Duplicate FLICA assays performed at 48 h post-8 Gy were employed as surrogate of radiation-induced apoptosis; %FLICA-positive cells were quantified by flow cytometry. RESULTS We observed limited intrapatient variation in γH2AX foci and %FLICA readouts; median difference of duplicate foci scores was - 0.37 (IQR = - 1.256-0.800) for 1 Gy 0.5 h and 0.09 (IQR = - 0.685-0.792) for 4 Gy 24 h; ICC of ≥0.80 was observed for duplicate %FLICA0Gy and %FLICA8Gy assays of CD4+ and CD8+ T lymphocytes. As expected, we observed wide inter-patient heterogeneity in both assays that was independent of intrapatient variation and clinical covariates, with the exception of age, which was inversely correlated with %FLICAbackground-corrected (Spearman R = - 0.406, P < 0.001 [CD4+]; R = - 0.220, P = 0.04 [CD8+]). Lastly, an exploratory case-control analysis indicates increased levels of γH2AX foci at 4 Gy 24 h in patients with severe late radiotherapy-induced xerostomia (P = 0.05). CONCLUSION Here, we confirmed the technical reproducibility of DNA damage response assays for clinical implementation as biomarkers of clinical radiosensitivity in nasopharynx cancer patients.
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Affiliation(s)
- Kevin Lee Min Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
| | - Eugenia Li Ling Yeo
- Division of Medical Sciences, National Cancer Centre, Singapore, Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
| | - Waseem Ahamed Shihabudeen
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
| | - Sze Huey Tan
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, Singapore, Singapore
| | - Than Than Shwe
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
| | - Enya Hui Wen Ong
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
| | - Paula Yeng Po Lam
- Division of Cellular and Molecular Research, National Cancer Centre, Singapore, Singapore
| | - Khee Chee Soo
- Division of Medical Sciences, National Cancer Centre, Singapore, Singapore
- Division of Surgical Oncology, National Cancer Centre, Singapore, Singapore
| | - Yoke Lim Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
| | - Kam Weng Fong
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
| | - Terence Wee Kiat Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
| | - Joseph Tien Seng Wee
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
| | - Melvin Lee Kiang Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- Division of Medical Sciences, National Cancer Centre, Singapore, Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
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20
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Vogin G, Merlin JL, Rousseau A, Peiffert D, Harlé A, Husson M, Hajj LE, Levitchi M, Simon T, Simon JM. Absence of correlation between radiation-induced CD8 T-lymphocyte apoptosis and sequelae in patients with prostate cancer accidentally overexposed to radiation. Oncotarget 2018; 9:32680-32689. [PMID: 30220974 PMCID: PMC6135683 DOI: 10.18632/oncotarget.26001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/04/2018] [Indexed: 01/16/2023] Open
Abstract
Purpose 454 patients with prostate adenocarcinoma were accidentally overexposed to radiation in Epinal hospital, France, between August 1999 and January 2007. We aimed toevaluate whether radiation-induced CD4 or CD8 T-lymphocyte apoptosis (RILA) correlates with the severity of radiation toxicity. Methods Between 2007 and 2013, all patients who received more than 108% of the prescribed radiation dose, after correction of the treatment plan, were convened, and blood was sampled at 6-months follow-up. Maximal Digestive toxicity (MDT) and maximal urinary toxicity (MUT) were graded using the Common Terminology Criteria for Adverse Events (NCI-CTCAE) v3.0 scale. RILA was assessed using flow cytometry. Results 245 patients were included in our study. After a median follow-up of 4.8 years, the MDT and MUT reached grade 3-4 in 37 patients and 56 patients, respectively. Patients with prostatectomy exhibited a statistically higher grade of MUT compared with those treated with definitive radiotherapy (p=0.03). The median RILA values were 11.8% and 15.3% for CD4 and CD8 T-lymphocytes, respectively. We found no significant correlation between CD4 or CD8 RILA and either MDT or MUT. Conclusion RILA does not correlate with the inter-individual variation in MDT or MUT in the largest cohort of patients overexposed to radiation. The magnitude of the overdosage probably overrides biological predictors of toxicity, including individual radiosensitivity.
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Affiliation(s)
- Guillaume Vogin
- Institut de Cancérologie de Lorraine, Département de Radiothérapie, 54500 Vandœuvre-lès-Nancy, France.,UMR 7365 CNRS-Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Jean-Louis Merlin
- Université de Lorraine, Faculté de Pharmacie, 54000 Nancy, France.,CNRS UMR 7039 CRAN Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France.,Institut de Cancérologie de Lorraine, Service de Biopathologie, 54500 Vandœuvre-lès-Nancy, France
| | - Alexandra Rousseau
- APHP, Unité de Recherche Clinique de l'Est Parisien (URC-Est), Hôpital Saint Antoine, 75012 Paris, France
| | - Didier Peiffert
- CNRS UMR 7039 CRAN Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Alexandre Harlé
- Institut de Cancérologie de Lorraine, Département de Radiothérapie, 54500 Vandœuvre-lès-Nancy, France.,UMR 7365 CNRS-Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France.,Université de Lorraine, Faculté de Pharmacie, 54000 Nancy, France
| | - Marie Husson
- Université de Lorraine, Faculté de Pharmacie, 54000 Nancy, France
| | - Labib El Hajj
- CNRS UMR 7039 CRAN Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Mihai Levitchi
- CNRS UMR 7039 CRAN Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Tabassome Simon
- APHP, Unité de Recherche Clinique de l'Est Parisien (URC-Est), Hôpital Saint Antoine, 75012 Paris, France
| | - Jean-Marc Simon
- APHP, Hôpital Universitaire de la Pitié Salpêtrière, Service de Radiothérapie, 75013 Paris, France
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21
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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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22
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Habash M, Bohorquez LC, Kyriakou E, Kron T, Martin OA, Blyth BJ. Clinical and Functional Assays of Radiosensitivity and Radiation-Induced Second Cancer. Cancers (Basel) 2017; 9:cancers9110147. [PMID: 29077012 PMCID: PMC5704165 DOI: 10.3390/cancers9110147] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 01/10/2023] Open
Abstract
Whilst the near instantaneous physical interaction of radiation energy with living cells leaves little opportunity for inter-individual variation in the initial yield of DNA damage, all the downstream processes in how damage is recognized, repaired or resolved and therefore the ultimate fate of cells can vary across the population. In the clinic, this variability is observed most readily as rare extreme sensitivity to radiotherapy with acute and late tissue toxic reactions. Though some radiosensitivity can be anticipated in individuals with known genetic predispositions manifest through recognizable phenotypes and clinical presentations, others exhibit unexpected radiosensitivity which nevertheless has an underlying genetic cause. Currently, functional assays for cellular radiosensitivity represent a strategy to identify patients with potential radiosensitivity before radiotherapy begins, without needing to discover or evaluate the impact of the precise genetic determinants. Yet, some of the genes responsible for extreme radiosensitivity would also be expected to confer susceptibility to radiation-induced cancer, which can be considered another late adverse event associated with radiotherapy. Here, the utility of functional assays of radiosensitivity for identifying individuals susceptible to radiotherapy-induced second cancer is discussed, considering both the common mechanisms and important differences between stochastic radiation carcinogenesis and the range of deterministic acute and late toxic effects of radiotherapy.
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Affiliation(s)
- Mohammad Habash
- Cancer Research Division, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC 3000, Australia.
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, VIC 3010, Australia.
| | - Luis C Bohorquez
- Physical Sciences, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC 3000, Australia.
| | - Elizabeth Kyriakou
- Physical Sciences, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC 3000, Australia.
| | - Tomas Kron
- Physical Sciences, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC 3000, Australia.
| | - Olga A Martin
- Cancer Research Division, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC 3000, Australia.
- Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC 3000, Australia.
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010, Australia.
| | - Benjamin J Blyth
- Cancer Research Division, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC 3000, Australia.
- Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC 3000, Australia.
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23
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Santos NFGD, Silva RF, Pinto MMPL, Silva EBDA, Tasat DR, Amaral A. Active caspase-3 expression levels as bioindicator of individual radiosensitivity. AN ACAD BRAS CIENC 2017; 89:649-659. [PMID: 28492727 DOI: 10.1590/0001-3765201720160697] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/11/2017] [Indexed: 12/11/2022] Open
Abstract
Several molecules and events involved in cell response to radiation-induced damage have been investigated towards a personalized radiotherapy. Considering the importance of active caspase-3 in the proteolytic cascade that ensures radiation-induced apoptosis execution, this research was designed to evaluate the expression levels of this protein as a bioindicator of individual radiosensitivity. Peripheral blood samples of 10 healthy individuals were gamma-irradiated (cobalt-60 source) with 1, 2 and 4 Gy (control: non-irradiated samples), and active caspase-3 expression levels were measured in lymphocytes, by flow cytometry, ex vivo and after different times of in vitro incubation (24, 48 and 72 hours). Short-term incubation of 24 h was the most adequate condition to evidence correlations between dose radiation and active caspase-3 expression. For each radiation dose, it was observed a significant inter-individual variation in active caspase-3 expression intensity, suggesting that this parameter may be suitable for evidence individual radiosensitivity. The methodology presented and discussed in this work may help to predict healthy tissues response to radiation exposure toward the better patient outcome.
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Affiliation(s)
- Neyliane F G Dos Santos
- Laboratório de Modelagem e Biodosimetria Aplicada, Departamento de Energia Nuclear, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Rafael F Silva
- Departamento de Ciências Naturais e Exatas, Universidade de Pernambuco, Garanhuns, PE, Brazil
| | - Marcela M P L Pinto
- Laboratório de Modelagem e Biodosimetria Aplicada, Departamento de Energia Nuclear, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Edvane B DA Silva
- Laboratório de Modelagem e Biodosimetria Aplicada, Departamento de Energia Nuclear, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Deborah R Tasat
- Laboratory of Lung Cell Biology, National University of General San Martín, Buenos Aires, Argentina
| | - Ademir Amaral
- Laboratório de Modelagem e Biodosimetria Aplicada, Departamento de Energia Nuclear, Universidade Federal de Pernambuco, Recife, PE, Brazil
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24
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van Oorschot B, Uitterhoeve L, Oomen I, Ten Cate R, Medema JP, Vrieling H, Stalpers LJA, Moerland PD, Franken NAP. Prostate Cancer Patients with Late Radiation Toxicity Exhibit Reduced Expression of Genes Involved in DNA Double-Strand Break Repair and Homologous Recombination. Cancer Res 2017; 77:1485-1491. [PMID: 28108515 DOI: 10.1158/0008-5472.can-16-1966] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 11/16/2022]
Abstract
Severe late damage to normal tissue is a major limitation of cancer radiotherapy in prostate cancer patients. In a recent retrospective study, late radiation toxicity was found to relate to a decreased decay of γ-H2AX foci and reduced induction of DNA double-strand break repair genes. Here, we report evidence of prognostic utility in prostate cancer for γ-H2AX foci decay ratios and gene expression profiles derived from ex vivo-irradiated patient lymphocytes. Patients were followed ≥2 years after radiotherapy. Clinical characteristics were assembled, and toxicity was recorded using the Common Terminology Criteria (CTCAE) v4.0. No clinical factor was correlated with late radiation toxicity. The γ-H2AX foci decay ratio correlated negatively with toxicity grade, with a significant difference between grade ≥3 and grade 0 patients (P = 0.02). A threshold foci decay ratio, determined in our retrospective study, correctly classified 23 of 28 patients with grade ≥3 toxicity (sensitivity 82%) and 9 of 14 patients with grade 0 toxicity (specificity 64%). Induction of homologous recombination (HR) repair genes was reduced with increasing toxicity grade. The difference in fold induction of the HR gene set was most pronounced between grade 0 and grade ≥3 toxicity (P = 0.008). Notably, reduced responsiveness of HR repair genes to irradiation and inefficient double-strand break repair correlated with severe late radiation toxicity. Using a decay ratio classifier, we correctly classified 82% of patients with grade ≥3 toxicity, suggesting a prognostic biomarker for cancer patients with a genetically enhanced risk for late radiation toxicity to normal tissues after radiotherapy. Cancer Res; 77(6); 1485-91. ©2017 AACR.
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Affiliation(s)
- Bregje van Oorschot
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Molecular Medicine (CEMM), Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Lon Uitterhoeve
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Molecular Medicine (CEMM), Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ilja Oomen
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Molecular Medicine (CEMM), Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Rosemarie Ten Cate
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Molecular Medicine (CEMM), Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan Paul Medema
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Molecular Medicine (CEMM), Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Harry Vrieling
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Lukas J A Stalpers
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Molecular Medicine (CEMM), Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Perry D Moerland
- Bioinformatics Laboratory, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Nicolaas A P Franken
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Molecular Medicine (CEMM), Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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25
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Herskind C, Talbot CJ, Kerns SL, Veldwijk MR, Rosenstein BS, West CML. Radiogenomics: A systems biology approach to understanding genetic risk factors for radiotherapy toxicity? Cancer Lett 2016; 382:95-109. [PMID: 26944314 PMCID: PMC5016239 DOI: 10.1016/j.canlet.2016.02.035] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/17/2016] [Accepted: 02/19/2016] [Indexed: 02/06/2023]
Abstract
Adverse reactions in normal tissue after radiotherapy (RT) limit the dose that can be given to tumour cells. Since 80% of individual variation in clinical response is estimated to be caused by patient-related factors, identifying these factors might allow prediction of patients with increased risk of developing severe reactions. While inactivation of cell renewal is considered a major cause of toxicity in early-reacting normal tissues, complex interactions involving multiple cell types, cytokines, and hypoxia seem important for late reactions. Here, we review 'omics' approaches such as screening of genetic polymorphisms or gene expression analysis, and assess the potential of epigenetic factors, posttranslational modification, signal transduction, and metabolism. Furthermore, functional assays have suggested possible associations with clinical risk of adverse reaction. Pathway analysis incorporating different 'omics' approaches may be more efficient in identifying critical pathways than pathway analysis based on single 'omics' data sets. Integrating these pathways with functional assays may be powerful in identifying multiple subgroups of RT patients characterised by different mechanisms. Thus 'omics' and functional approaches may synergise if they are integrated into radiogenomics 'systems biology' to facilitate the goal of individualised radiotherapy.
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Affiliation(s)
- Carsten Herskind
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.
| | | | - Sarah L Kerns
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, USA; Department of Radiation Oncology, University of Rochester Medical Center, Rochester, USA
| | - Marlon R Veldwijk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Barry S Rosenstein
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, USA; Department of Radiation Oncology, New York University School of Medicine, USA; Department of Dermatology, Mount Sinai School of Medicine, New York, USA
| | - Catharine M L West
- Institute of Cancer Sciences, University of Manchester, Christie Hospital, Manchester, UK
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26
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Vandevoorde C, Depuydt J, Veldeman L, De Neve W, Sebastià N, Wieme G, Baert A, De Langhe S, Philippé J, Thierens H, Vral A. In vitro cellular radiosensitivity in relationship to late normal tissue reactions in breast cancer patients: a multi-endpoint case-control study. Int J Radiat Biol 2016; 92:823-836. [PMID: 27586010 DOI: 10.1080/09553002.2016.1230238] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE A minority of patients exhibits severe late normal tissue toxicity after radiotherapy (RT), possibly related to their inherent individual radiation sensitivity. This study aimed to evaluate four different candidate in vitro cellular radiosensitivity assays for prediction of late normal tissue reactions, in a retrospective matched case-control set-up of breast cancer patients. METHODS The study population consists of breast cancer patients expressing severe radiation toxicity (12 cases) and no or minimal reactions (12 controls), with a follow-up for at least 3 years. Late adverse reactions were evaluated by comparing standardized photographs pre- and post-RT resulting in an overall cosmetic score and by clinical examination using the LENT-SOMA scale. Four cellular assays on peripheral blood lymphocytes reported to be associated with normal tissue reactions were performed after in vitro irradiation of patient blood samples to compare case and control radiation responses: radiation-induced CD8+ late apoptosis, residual DNA double-strand breaks, G0 and G2 micronucleus assay. RESULTS A significant difference was observed for all cellular endpoints when matched cases and controls were compared both pairwise and grouped. However, it is important to point out that most case-control pairs showed a substantial overlap in standard deviations, which questions the predictive value of the individual assays. The apoptosis assay performed best, with less apoptosis seen in CD8+ lymphocytes of the cases (average: 14.45%) than in their matched controls (average: 30.64%) for 11 out of 12 patient pairs (p < .01). The number of residual DNA DSB was higher in cases (average: 9.92 foci/cell) compared to their matched control patients (average: 9.17 foci/cell) (p < .01). The average dose response curve of the G0 MN assay for cases lies above the average dose response curve of the controls. Finally, a pairwise comparison of the G2 MN results showed a higher MN yield for cases (average: 351 MN/1000BN) compared to controls (average: 219 MN/1000BN) in 9 out of 10 pairs (p < .01). CONCLUSION This matched case-control study in breast cancer patients, using different endpoints for in vitro cellular radiosensitivity related to DNA repair and apoptosis, suggests that patients' intrinsic radiosensitivity is involved in the development of late normal tissue reactions after RT. Larger prospective studies are warranted to validate the retrospective findings and to use in vitro cellular assays in the future to predict late normal tissue radiosensitivity and discriminate individuals with marked RT responses.
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Affiliation(s)
- Charlot Vandevoorde
- a Ghent University , Department of Basic Medical Sciences , Ghent , Belgium.,b National Research Foundation (NRF) , iThemba LABS , Somerset West , South Africa
| | - Julie Depuydt
- a Ghent University , Department of Basic Medical Sciences , Ghent , Belgium
| | - Liv Veldeman
- c Department of Radiotherapy , Ghent University Hospital , Ghent , Belgium
| | - Wilfried De Neve
- c Department of Radiotherapy , Ghent University Hospital , Ghent , Belgium
| | - Natividad Sebastià
- d Radiation Protection Service , IISLAFE , Valencia , Spain.,e Grupo de Investigación Biomédica en Imagen GIBI230 , IISLAFE , Valencia , Spain
| | - Greet Wieme
- a Ghent University , Department of Basic Medical Sciences , Ghent , Belgium.,f Department of Pediatrics and Medical Genetics , Ghent University , Ghent , Belgium
| | - Annelot Baert
- a Ghent University , Department of Basic Medical Sciences , Ghent , Belgium
| | - Sofie De Langhe
- a Ghent University , Department of Basic Medical Sciences , Ghent , Belgium
| | - Jan Philippé
- g Department of Clinical Chemistry, Microbiology and Immunology , Ghent University , Ghent , Belgium
| | - Hubert Thierens
- a Ghent University , Department of Basic Medical Sciences , Ghent , Belgium
| | - Anne Vral
- a Ghent University , Department of Basic Medical Sciences , Ghent , Belgium
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27
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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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28
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Ex Vivo Apoptosis in CD8+ Lymphocytes Predicts Rectal Cancer Patient Outcome. Gastroenterol Res Pract 2016; 2016:5076542. [PMID: 27340400 PMCID: PMC4908238 DOI: 10.1155/2016/5076542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/21/2016] [Accepted: 04/03/2016] [Indexed: 11/25/2022] Open
Abstract
Background. Apoptotic rates in peripheral blood lymphocytes can predict radiation induced normal tissue toxicity. We studied whether apoptosis in lymphocytes has a prognostic value for therapy outcome. Methods. Lymphocytes of 87 rectal cancer patients were ex vivo irradiated with 2 Gy, 8 Gy, or a combination of 2 Gy ionizing radiation and Oxaliplatin. Cells were stained with Annexin V and 7-Aminoactinomycin D and apoptotic and necrotic rates were analyzed by multicolor flow cytometry. Results. After treatment, apoptotic and necrotic rates in CD8+ cells are consistently higher than in CD4+ cells, with lower corresponding necrotic rates. Apoptotic and necrotic rates of CD4+ cells and CD8+ cells correlated well within the 2 Gy, 8 Gy, and 2 Gy and Oxaliplatin arrangements (p ≤ 0.009). High apoptotic CD8+ rates after 2 Gy, 8 Gy, and 2 Gy + Oxaliplatin treatment were prognostically favorable for metastasis-free survival (p = 0.009, p = 0.038, and p = 0.009) and disease-free survival (p = 0.013, p = 0.098, and p = 0.013). Conclusions. Ex vivo CD8+ apoptotic rates are able to predict the patient outcome in regard to metastasis-free or disease-free survival. Patients with higher CD8+ apoptotic rates in the peripheral blood have a more favorable prognosis. In addition to the prediction of late-toxicity by utilization of CD4+ apoptotic rates, the therapy outcome can be predicted by CD8+ apoptotic rates.
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29
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Bourgier C, Kerns S, Gourgou S, Lemanski C, Gutowski M, Fenoglietto P, Romieu G, Crompton N, Lacombe J, Pèlegrin A, Ozsahin M, Rosenstein B, Azria D. Concurrent or sequential letrozole with adjuvant breast radiotherapy: final results of the CO-HO-RT phase II randomized trial. Ann Oncol 2015; 27:474-80. [PMID: 26681684 DOI: 10.1093/annonc/mdv602] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/28/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We present here final clinical results of the COHORT trial and both translational sub-studies aiming at identifying patients at risk of radiation-induced subcutaneous fibrosis (RISF): (i) radiation-induced lymphocyte apoptosis (RILA) and (ii) candidates of certain single-nucleotide polymorphisms (SNPs). PATIENTS AND METHODS Post-menopausal patients with stage I-II breast cancer (n = 150) were enrolled and assigned to either concurrent (arm A) or sequential radiotherapy (RT)-letrozole (arm B). Among them, 121 were eligible for RILA and SNP assays. Grade ≥2 RISF were the primary end point. Secondary end points were lung and heart events and carcinologic outcome. RILA was performed to predict differences in RISF between individuals. A genome-wide association study was performed to identify SNPs associated with RILA and RISF. Analyses were done by intention to treat. RESULTS After a median follow-up of 74 months, 5 patients developed a grade ≥2 RISF. No significant difference was observed between arms A and B. Neither grade ≥2 lung nor symptomatic cardiac toxicity was observed. Median RILA value of the five patients who had grade ≥2 RISF was significantly lower compared with those who developed grade ≤1 RISF (6.9% versus 13%, P = 0.02). Two SNPs were identified as being significantly associated with RILA: rs1182531 (P = 4.2 × 10(-9)) and rs1182532 (P = 3.6 × 10(-8)); both located within the PHACTR3 gene on chromosome 20q13.33. CONCLUSIONS With long-term follow-up, letrozole can safely be delivered concomitantly with adjuvant breast RT. Translational sub-studies showed that high RILA values were correlated with patients who did not develop RISF. REGISTERED CLINICAL TRIAL NCT00208273.
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Affiliation(s)
- C Bourgier
- Inserm, U1194, Institut de Recherche en Cancérologie de Montpellier (IRCM), Cancer Institute ICM-Val d'Aurelle, Montpellier Department of Radiation Oncology, Montpellier Cancer Institute ICM-Val d'Aurelle, Montpellier, France
| | - S Kerns
- University of Rochester Medical Centre, Rochester Icahn School of Medicine at Mount Sinai, New York, USA
| | - S Gourgou
- Biostatistics Unit, Cancer Institute ICM-Val d'Aurelle, Montpellier, France
| | - C Lemanski
- Department of Radiation Oncology, Montpellier Cancer Institute ICM-Val d'Aurelle, Montpellier, France
| | - M Gutowski
- Department of Surgery, Cancer Institute ICM-Val d'Aurelle, Montpellier, France
| | - P Fenoglietto
- Department of Radiation Oncology, Montpellier Cancer Institute ICM-Val d'Aurelle, Montpellier, France
| | - G Romieu
- Department of Medical Oncology, Cancer Institute ICM-Val d'Aurelle, Montpellier, France
| | - N Crompton
- Laboratory of Non-invasive Imaging and Radiation Biology, Van Andel Research Institute, Grand Rapids, USA
| | - J Lacombe
- Inserm, U1194, Institut de Recherche en Cancérologie de Montpellier (IRCM), Cancer Institute ICM-Val d'Aurelle, Montpellier
| | - A Pèlegrin
- Inserm, U1194, Institut de Recherche en Cancérologie de Montpellier (IRCM), Cancer Institute ICM-Val d'Aurelle, Montpellier
| | - M Ozsahin
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - B Rosenstein
- Mount Sinai School of Medicine and NYU School of Medicine, New York, USA
| | - D Azria
- Inserm, U1194, Institut de Recherche en Cancérologie de Montpellier (IRCM), Cancer Institute ICM-Val d'Aurelle, Montpellier Department of Radiation Oncology, Montpellier Cancer Institute ICM-Val d'Aurelle, Montpellier, France
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Fuentes-Raspall MJ, Caragol I, Alonso C, Ramón y Cajal T, Fisas D, Seoane A, Carvajal N, Bonache S, Díez O, Gutiérrez-Enríquez S. Apoptosis for prediction of radiotherapy late toxicity: lymphocyte subset sensitivity and potential effect of TP53 Arg72Pro polymorphism. Apoptosis 2015; 20:371-82. [PMID: 25398538 DOI: 10.1007/s10495-014-1056-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We tested apoptosis levels in in vitro irradiated T-lymphocytes from breast cancer (BC) patients with radiotherapy-induced late effects. Previous results reported in the literature were revised. We also examined the effect of TP53 Arg72Pro polymorphism on irradiation-induced apoptosis (IA). Twenty BC patients, ten with fibrosis and/or telangiectasias and ten matched controls with no late reactions, were selected from those receiving radiotherapy between 1993 and 2007. All patients were followed-up at least 6 years after radiotherapy. Using the combination of both CD3 and CD8 antibodies the in vitro IA was measured in CD3, CD8 and CD4 T-lymphocytes, and CD8 natural killer lymphocytes (CD8 NK) by flow cytometry. The TP53 Arg72Pro genotype was determined by sequencing. Patients with late radiotherapy toxicity showed less IA for all T-lymphocytes except for the CD8 NK. CD8 NK showed the highest spontaneous apoptosis and the lowest IA. IA in patients with toxicity appears to be lower than the control patients only in TP53 Arg/Arg patients (P = 0.077). This difference was not present in patients carrying at least one Pro allele (P = 0.8266). Our data indicate that late side effects induced by radiotherapy of BC are associated to low levels of IA. CD8 NK cells have a different response to in vitro irradiation compared to CD8 T-lymphocytes. It would be advisable to distinguish the CD8 NK lymphocytes from the pool of CD8+ lymphocytes in IA assays using CD8+ cells. Our data suggest that the 72Pro TP53 allele may influence the IA of patients with radiotherapy toxicity.
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Azria D, Riou O, Castan F, Nguyen TD, Peignaux K, Lemanski C, Lagrange JL, Kirova Y, Lartigau E, Belkacemi Y, Bourgier C, Rivera S, Noël G, Clippe S, Mornex F, Hennequin C, Kramar A, Gourgou S, Pèlegrin A, Fenoglietto P, Ozsahin EM. Radiation-induced CD8 T-lymphocyte Apoptosis as a Predictor of Breast Fibrosis After Radiotherapy: Results of the Prospective Multicenter French Trial. EBioMedicine 2015; 2:1965-73. [PMID: 26844275 PMCID: PMC4703704 DOI: 10.1016/j.ebiom.2015.10.024] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 10/21/2015] [Accepted: 10/23/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Monocentric cohorts suggested that radiation-induced CD8 T-lymphocyte apoptosis (RILA) can predict late toxicity after curative intent radiotherapy (RT). We assessed the role of RILA as a predictor of breast fibrosis (bf +) after adjuvant breast RT in a prospective multicenter trial. METHODS A total of 502 breast-cancer patients (pts) treated by conservative surgery and adjuvant RT were recruited at ten centers. RILA was assessed before RT by flow cytometry. Impact of RILA on bf + (primary endpoint) or relapse was assessed using a competing risk method. Receiver-operator characteristic (ROC) curve analyses were also performed in intention to treat. This study is registered with ClinicalTrials.gov, number NCT00893035 and final analyses are presented here. FINDINGS Four hundred and fifty-six pts (90.8%) were included in the final analysis. One hundred and eight pts (23.7%) received whole breast and node irradiation. A boost dose of 10-16 Gy was delivered in 449 pts (98.5%). Adjuvant hormonotherapy was administered to 349 pts (76.5%). With a median follow-up of 38.6 months, grade ≥ 2 bf + was observed in 64 pts (14%). A decreased incidence of grade ≥ 2 bf + was observed for increasing values of RILA (p = 0.012). No grade 3 bf + was observed for patients with RILA ≥ 12%. The area under the ROC curve was 0.62. For cut-off values of RILA ≥ 20% and < 12%, sensitivity and specificity were 80% and 34%, 56% and 67%, respectively. Negative predictive value for grade ≥ 2 bf + was equal to 91% for RILA ≥ 20% and positive predictive value was equal to 22% for RILA < 12% where the overall prevalence of grade ≥ 2 bf + was estimated at 14%. A significant decrease in the risk of grade ≥ 2 bf + was found if patients had no adjuvant hormonotherapy (sHR = 0.31, p = 0.007) and presented a RILA ≥ 12% (sHR = 0.45, p = 0.002). INTERPRETATION RILA significantly predicts the risk of breast fibrosis. This study validates the use of RILA as a rapid screening test before RT delivery and will change definitely our daily clinical practice in radiation oncology. FUNDING The French National Cancer Institute (INCa) through the "Program Hospitalier de Recherche Clinique (PHRC)".
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Affiliation(s)
- David Azria
- Montpellier Cancer Institute (ICM), Montpellier Cancer Research Institute (IRCM), University of Montpellier, Montpellier, France
| | - Olivier Riou
- Montpellier Cancer Institute (ICM), Montpellier Cancer Research Institute (IRCM), University of Montpellier, Montpellier, France
| | - Florence Castan
- Montpellier Cancer Institute (ICM), Montpellier Cancer Research Institute (IRCM), University of Montpellier, Montpellier, France
| | | | | | - Claire Lemanski
- Montpellier Cancer Institute (ICM), Montpellier Cancer Research Institute (IRCM), University of Montpellier, Montpellier, France
| | | | | | | | | | - Céline Bourgier
- Montpellier Cancer Institute (ICM), Montpellier Cancer Research Institute (IRCM), University of Montpellier, Montpellier, France
| | | | | | | | | | | | | | - Sophie Gourgou
- Montpellier Cancer Institute (ICM), Montpellier Cancer Research Institute (IRCM), University of Montpellier, Montpellier, France
| | - André Pèlegrin
- Montpellier Cancer Institute (ICM), Montpellier Cancer Research Institute (IRCM), University of Montpellier, Montpellier, France
| | - Pascal Fenoglietto
- Montpellier Cancer Institute (ICM), Montpellier Cancer Research Institute (IRCM), University of Montpellier, Montpellier, France
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Tavakoli MB, Kiani A, Roayaei M. The Effects of Fenugreek on Radiation Induced Toxicity for Human Blood T-Cells in Radiotherapy. JOURNAL OF MEDICAL SIGNALS & SENSORS 2015; 5:176-81. [PMID: 26284174 PMCID: PMC4528356 DOI: 10.4103/2228-7477.161492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/08/2015] [Indexed: 11/30/2022]
Abstract
Many cellular damages either in normal or cancerous tissues are the outcome of molecular events affected by ionizing radiation. T-cells are the most important among immune system agents and are used for biological radiation dose measurement in recommended standard methods. The herbs with immune modulating properties may be useful to reduce the risk of the damages and subsequently the diseases. The T-cells as the most important immune cells being targeted for biological dosimetry of radiation. This study proposes a flowcytometric-method based on fluorescein isothiocyanate- and propidium iodide (PI)-labeled annexin-V to assess apoptosis in blood T-cells after irradiation in both presence and absence of fenugreek extract. T-cells peripheral blood lymphocyte isolated from blood samples of healthy individuals with no irradiated job background. The media of cultured cells was irradiated 1-h after the fenugreek extract was added. The number of apoptotic cells was assessed by annexin-V protocol and multicolor flowcytometry. An obvious variation in apoptotic cells number was observed in presence of fenugreek extract (>80%). The results suggest that fenugreek extract can potentiate the radiation induced apoptosis or radiation toxicity in blood T-cells (P < 0.05).
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Affiliation(s)
- Mohamed Bagher Tavakoli
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Ali Kiani
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Mahnaz Roayaei
- Department of Radiotherapy, Seyyed Al-shohada Hospital of Isfahan, Isfahan, Iran
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Tavakoli MB, Kheirollahi M, Kiani A, Kazemi M, Javanmard SH, Mohebat L. Annexin V FITC conjugated as a radiation toxicity indicator in lymphocytes following radiation overexposure in radiotherapy programs. Adv Biomed Res 2015; 4:119. [PMID: 26261821 PMCID: PMC4513310 DOI: 10.4103/2277-9175.158025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 11/24/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Following human radiation exposure in hospital or accidents, dose assessments are of prime importance in radiation accidents. These issues are of continuing importance with respect to socioeconomic policy relating to the industrial and medical uses of ionizing radiation, and also for risk assessment among people who are occupationally exposed to low and/or high linear energy transfer (LET) radiation, such as astronauts, pilots, stewardesses, nuclear power plant workers, and victims of radiation accidents. MATERIALS AND METHODS In this study, an assay for assessing radiation dose based on the induction of apoptosis in human T-lymphocytes was done to examine T-lymphocyte cells isolated from the fresh blood of 16volunteers, cultured and exposed to gamma rays. Radiation-induced apoptosis (RIA) was assessed by flow cytometric identification of cells displaying apoptosis-associated DNA condensation. RESULTS Dose-response experiments showed that at 2Gy dose level of radiotherapy programs, the RIA frequency was significantly above control. Apoptotic levels significantly depend on the dose of radiation rather than the donor. CONCLUSION The results demonstrate the potential use of this assay as a biological indicator of radiation toxicity, optimizing patient dose in radiotherapy and biological dosimetry process.
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Affiliation(s)
- Mohammad Bagher Tavakoli
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Kheirollahi
- Department of Genetics, Pediatric Inherited Diseases Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Kiani
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Kazemi
- Department of Genetics, Pediatric Inherited Diseases Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Leili Mohebat
- Department of Oncology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Bourgier C, Lacombe J, Solassol J, Mange A, Pèlegrin A, Ozsahin M, Azria D. Late side-effects after curative intent radiotherapy: Identification of hypersensitive patients for personalized strategy. Crit Rev Oncol Hematol 2015; 93:312-9. [DOI: 10.1016/j.critrevonc.2014.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/22/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022] Open
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Foro P, Algara M, Lozano J, Rodriguez N, Sanz X, Torres E, Carles J, Reig A, Membrive I, Quera J, Fernandez-Velilla E, Pera O, Lacruz M, Bellosillo B. Relationship between radiation-induced apoptosis of T lymphocytes and chronic toxicity in patients with prostate cancer treated by radiation therapy: a prospective study. Int J Radiat Oncol Biol Phys 2014; 88:1057-63. [PMID: 24661659 DOI: 10.1016/j.ijrobp.2014.01.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/27/2013] [Accepted: 01/03/2014] [Indexed: 12/24/2022]
Abstract
PURPOSE To assess the correlation of radiation-induced apoptosis in vitro of CD4 and CD8 T lymphocytes with late toxicity of prostate cancer patients treated with radiation therapy. METHODS AND MATERIALS 214 patients were prospectively included in the study. Peripheral blood was drawn from patients before treatment and irradiated with 8 Gy. The percentage of CD4+ and CD8+ T lymphocytes that underwent radiation-induced apoptosis was assessed by flow cytometry. Toxicity and mortality were correlated in 198 cases with pretreatment apoptosis and clinical and biological variables by use of a Cox proportional hazards model. RESULTS The mean percentage of CD4+ and CD8+ T lymphocyte radiation-induced apoptosis was 28.58% (±14.23) and 50.76% (±18.9), respectively. Genitourinary (GU) toxicity was experienced by 39.9% of patients, while gastrointestinal (GI) toxicity was experienced by 19.7%. The probability of development of GU toxicity was nearly doubled (hazard ratio [HR] 1.99, P=.014) in those patients in whom the percentage of in vitro radiation-induced apoptosis of CD4+ T-lymphocytes was ≤28.58%. It was also almost double in patients who received doses ≥50 Gy in 65% of the bladder volume (V65 ≥50) (HR 1.92, P=.048). No correlation was found between GI toxicity and any of the variables studied. The probability of death during follow-up, after adjustment for different variables, was 2.7 times higher in patients with a percentage of CD8+ T lymphocyte apoptosis ≤50.76% (P=.022). CONCLUSIONS In conclusion, our study shows, in the largest prospective cohort of prostate cancer patients undergoing radiation therapy, that in vitro radiation-induced apoptosis of CD4+ T lymphocytes assessed before radiation therapy was associated with the probability of developing chronic GU toxicity. In addition, the radiation dose received in the urinary bladder (V65 ≥50) affected the occurrence of GU toxicity. Finally, we also demonstrate that radiation-induced apoptosis of CD8+ T lymphocytes was associated with overall survival, although larger series are needed to confirm this finding.
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Affiliation(s)
- Palmira Foro
- Department of Radiation Oncology, Parc de Salut Mar, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain.
| | - Manuel Algara
- Department of Radiation Oncology, Parc de Salut Mar, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | - Joan Lozano
- Department of Radiation Oncology, Parc de Salut Mar, Barcelona, Spain
| | - Nuria Rodriguez
- Department of Radiation Oncology, Parc de Salut Mar, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | - Xavier Sanz
- Department of Radiation Oncology, Parc de Salut Mar, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | - Erica Torres
- Pathology Department, Parc de Salut Mar, Barcelona, Spain
| | - Joan Carles
- Universitat Autonoma de Barcelona, Barcelona, Spain; Department of Oncology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Anna Reig
- Department of Radiation Oncology, Parc de Salut Mar, Barcelona, Spain
| | - Ismael Membrive
- Department of Radiation Oncology, Parc de Salut Mar, Barcelona, Spain
| | - Jaume Quera
- Department of Radiation Oncology, Parc de Salut Mar, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Oscar Pera
- Department of Radiation Oncology, Parc de Salut Mar, Barcelona, Spain
| | - Marti Lacruz
- Universitat Pompeu Fabra, Barcelona, Spain; Radiation Protection Department, Parc de Salut Mar, Barcelona, Spain
| | - Beatriz Bellosillo
- Universitat Pompeu Fabra, Barcelona, Spain; Pathology Department, Parc de Salut Mar, Barcelona, Spain
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Proud C. Radiogenomics: The Promise of Personalized Treatment in Radiation Oncology? Clin J Oncol Nurs 2014; 18:185-9. [DOI: 10.1188/14.cjon.185-189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lacombe J, Azria D, Mange A, Solassol J. Proteomic approaches to identify biomarkers predictive of radiotherapy outcomes. Expert Rev Proteomics 2014; 10:33-42. [DOI: 10.1586/epr.12.68] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Horn S, Barnard S, Brady D, Prise KM, Rothkamm K. Combined analysis of gamma-H2AX/53BP1 foci and caspase activation in lymphocyte subsets detects recent and more remote radiation exposures. Radiat Res 2013; 180:603-9. [PMID: 24219325 DOI: 10.1667/rr13342.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Analysis of gamma-H2AX foci in blood lymphocytes is a promising approach for rapid dose estimation to support patient triage after a radiation accident but has one major drawback: the rapid decline of foci levels post-exposure cause major uncertainties in situations where the exact timing between exposure and blood sampling is unknown. To address this issue, radiation-induced apoptosis (RIA) in lymphocytes was investigated using fluorogenic inhibitors of caspases (FLICA) as an independent biomarker for radiation exposure, which may complement the gamma-H2AX assay. Ex vivo X-irradiated peripheral blood lymphocytes from 17 volunteers showed dose- and time-dependent increases in radiation-induced apoptosis over the first 3 days after exposure, albeit with considerable interindividual variation. Comparison with gamma-H2AX and 53BP1 foci counts suggested an inverse correlation between numbers of residual foci and radiation-induced apoptosis in lymphocytes at 24 h postirradiation (P = 0.007). In T-helper (CD4), T-cytotoxic (CD8) and B-cells (CD19), some significant differences in radiation induced DSBs or apoptosis were observed, however no correlation between foci and apoptosis in lymphocyte subsets was observed at 24 h postirradiation. While gamma-H2AX and 53BP1 foci were rapidly induced and then repaired after exposure, radiation-induced apoptosis did not become apparent until 24 h after exposure. Data from six volunteers with different ex vivo doses and post-exposure times were used to test the capability of the combined assay. Results show that simultaneous analysis of gamma-H2AX and radiation-induced apoptosis may provide a rapid and more accurate triage tool in situations where the delay between exposure and blood sampling is unknown compared to gamma-H2AX alone. This combined approach may improve the accuracy of dose estimations in cases where blood sampling is performed days after the radiation exposure.
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Affiliation(s)
- Simon Horn
- a Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, Oxon, OX11 0RQ, United Kingdom; and
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Chua M, Rothkamm K. Biomarkers of Radiation Exposure: Can They Predict Normal Tissue Radiosensitivity? Clin Oncol (R Coll Radiol) 2013; 25:610-6. [DOI: 10.1016/j.clon.2013.06.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/23/2013] [Accepted: 06/26/2013] [Indexed: 11/29/2022]
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Lacombe J, Riou O, Solassol J, Mangé A, Bourgier C, Fenoglietto P, Pèlegrin A, Ozsahin M, Azria D. [Intrinsic radiosensitivity: predictive assays that will change daily practice]. Cancer Radiother 2013; 17:337-43. [PMID: 23999252 DOI: 10.1016/j.canrad.2013.07.137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 07/08/2013] [Indexed: 11/19/2022]
Abstract
The impact of curative radiotherapy depends mainly on the total dose delivered homogenously in the targeted volume. Nevertheless, the dose delivered to the surrounding healthy tissues may reduce the therapeutic ratio of many radiation treatments. In a same population treated in one center with the same technique, it appears that individual radiosensitivity clearly exists, namely in terms of late side effects that are in principle non-reversible. This review details the different radiobiological approaches that have been developed to better understand the mechanisms of radiation-induced late effects. We also present the possibilities of clinical use of predictive assays in the close future.
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Affiliation(s)
- J Lacombe
- Institut de recherche en cancérologie de Montpellier (IRCM), Inserm U896, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Avenue des Apothicaires, 34298 Montpellier cedex 05, France; Université Montpellier 1, avenue des Apothicaires, 34298 Montpellier cedex 05, France
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Lacombe J, Mange A, Azria D, Solassol J. Identification de marqueurs prédictifs de la réponse à la radiothérapie par approche protéomique. Cancer Radiother 2013; 17:62-9; quiz 70, 72. [DOI: 10.1016/j.canrad.2012.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 11/08/2012] [Accepted: 11/22/2012] [Indexed: 12/15/2022]
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[Radiosensitivity assays of normal tissues]. Bull Cancer 2011; 98:1469-75. [PMID: 22157594 DOI: 10.1684/bdc.2011.1497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Radiotherapy allows locoregional control with systemic impact in some indications. Technologic advances decrease the dose received by normal tissues leading to a low crude number of late side effects near to 5%. Intrinsic radiosensitivity are still of interest in this context of high level of technology and optimized treatments. Assays of radiosensitivity are detailed in this article arguing the negative results but also the perspectives.
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Ishihara S, Iinuma H, Fukushima Y, Akahane T, Horiuchi A, Shimada R, Shibuya H, Hayama T, Yamada H, Nozawa K, Matsuda K, Watanabe T. Radiation-Induced Apoptosis of Peripheral Blood Lymphocytes is Correlated with Histological Regression of Rectal Cancer in Response to Preoperative Chemoradiotherapy. Ann Surg Oncol 2011; 19:1192-8. [DOI: 10.1245/s10434-011-2057-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Indexed: 11/18/2022]
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Lacombe J, Solassol J, Coelho M, Ozsahin M, Azria D. [Interest of blood markers in predicting radiation-induced toxicity]. Cancer Radiother 2011; 15:390-3. [PMID: 21676639 DOI: 10.1016/j.canrad.2011.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 02/08/2011] [Accepted: 02/15/2011] [Indexed: 11/17/2022]
Abstract
The oncologic outcome and the total dose are highly correlated with the treatment by ionizing radiation. The dose increase (total or per fraction) may provoke late-side effects that are potentially irreversible. The radiation-induced CD8 lymphocyte apoptotic value and the molecular modifications within the lymphocyte are capable of predicting the level of risk of developing late-side effects after curative intent radiotherapy. In this review, we present the different blood assays in this setting and discuss the current possibilities of researches, namely those involving the proteomic process.
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Affiliation(s)
- J Lacombe
- Département de cancérologie radiothérapie, CRLC Val-d'Aurelle-Paul-Lamarque, rue Croix-Verte, Montpellier cedex 5, France
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Braccini A, Ozsahin M, Azria D. Paramètres biologiques de réponse tardive des tissus sains aux rayonnements ionisants. ONCOLOGIE 2010. [DOI: 10.1007/s10269-010-1909-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rübe CE, Fricke A, Schneider R, Simon K, Kühne M, Fleckenstein J, Gräber S, Graf N, Rübe C. DNA repair alterations in children with pediatric malignancies: novel opportunities to identify patients at risk for high-grade toxicities. Int J Radiat Oncol Biol Phys 2010; 78:359-69. [PMID: 20153123 DOI: 10.1016/j.ijrobp.2009.08.052] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 08/10/2009] [Accepted: 08/10/2009] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate, in a pilot study, the phosphorylated H2AX (γH2AX) foci approach for identifying patients with double-strand break (DSB) repair deficiencies, who may overreact to DNA-damaging cancer therapy. METHODS AND MATERIALS The DSB repair capacity of children with solid cancers was analyzed compared with that of age-matched control children and correlated with treatment-related normal-tissue responses (n = 47). Double-strand break repair was investigated by counting γH2AX foci in blood lymphocytes at defined time points after irradiation of blood samples. RESULTS Whereas all healthy control children exhibited proficient DSB repair, 3 children with tumors revealed clearly impaired DSB repair capacities, and 2 of these repair-deficient children developed life-threatening or even lethal normal-tissue toxicities. The underlying mutations affecting regulatory factors involved in DNA repair pathways were identified. Moreover, significant differences in mean DSB repair capacity were observed between children with tumors and control children, suggesting that childhood cancer is based on genetic alterations affecting DSB repair function. CONCLUSIONS Double-strand break repair alteration in children may predispose to cancer formation and may affect children's susceptibility to normal-tissue toxicities. Phosphorylated H2AX analysis of blood samples allows one to detect DSB repair deficiencies and thus enables identification of children at risk for high-grade toxicities.
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Affiliation(s)
- Claudia E Rübe
- Department of Radiation Oncology, Saarland University, Homburg/Saar, Germany.
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Concurrent or sequential adjuvant letrozole and radiotherapy after conservative surgery for early-stage breast cancer (CO-HO-RT): a phase 2 randomised trial. Lancet Oncol 2010; 11:258-65. [PMID: 20138810 DOI: 10.1016/s1470-2045(10)70013-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Letrozole radiosensitises breast cancer cells in vitro. In clinical settings, no data exist for the combination of letrozole and radiotherapy. We assessed concurrent and sequential radiotherapy and letrozole in the adjuvant setting. METHODS This phase 2 randomised trial was undertaken in two centres in France and one in Switzerland between Jan 12, 2005, and Feb 21, 2007. 150 postmenopausal women with early-stage breast cancer were randomly assigned after conserving surgery to either concurrent radiotherapy and letrozole (n=75) or sequential radiotherapy and letrozole (n=75). Randomisation was open label with a minimisation technique, stratified by investigational centres, chemotherapy (yes vs no), radiation boost (yes vs no), and value of radiation-induced lymphocyte apoptosis (< or = 16% vs >16%). Whole breast was irradiated to a total dose of 50 Gy in 25 fractions over 5 weeks. In the case of supraclavicular and internal mammary node irradiation, the dose was 44-50 Gy. Letrozole was administered orally once daily at a dose of 2.5 mg for 5 years (beginning 3 weeks pre-radiotherapy in the concomitant group, and 3 weeks post-radiotherapy in the sequential group). The primary endpoint was the occurrence of acute (during and within 6 weeks of radiotherapy) and late (within 2 years) radiation-induced grade 2 or worse toxic effects of the skin. Analyses were by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00208273. FINDINGS All patients were analysed apart from one in the concurrent group who withdrew consent before any treatment. During radiotherapy and within the first 12 weeks after radiotherapy, 31 patients in the concurrent group and 31 in the sequential group had any grade 2 or worse skin-related toxicity. The most common skin-related adverse event was dermatitis: four patients in the concurrent group and six in the sequential group had grade 3 acute skin dermatitis during radiotherapy. At a median follow-up of 26 months (range 3-40), two patients in each group had grade 2 or worse late effects (both radiation-induced subcutaneous fibrosis). INTERPRETATION Letrozole can be safely delivered shortly after surgery and concomitantly with radiotherapy. Long-term follow-up is needed to investigate cardiac side-effects and cancer-specific outcomes. FUNDING Novartis Oncology France.
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Bordón E, Henríquez Hernández LA, Lara PC, Pinar B, Fontes F, Rodríguez Gallego C, Lloret M. Prediction of clinical toxicity in localized cervical carcinoma by radio-induced apoptosis study in peripheral blood lymphocytes (PBLs). Radiat Oncol 2009; 4:58. [PMID: 19941649 PMCID: PMC2787528 DOI: 10.1186/1748-717x-4-58] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 11/26/2009] [Indexed: 11/10/2022] Open
Abstract
Background Cervical cancer is treated mainly by surgery and radiotherapy. Toxicity due to radiation is a limiting factor for treatment success. Determination of lymphocyte radiosensitivity by radio-induced apoptosis arises as a possible method for predictive test development. The aim of this study was to analyze radio-induced apoptosis of peripheral blood lymphocytes. Methods Ninety four consecutive patients suffering from cervical carcinoma, diagnosed and treated in our institution, and four healthy controls were included in the study. Toxicity was evaluated using the Lent-Soma scale. Peripheral blood lymphocytes were isolated and irradiated at 0, 1, 2 and 8 Gy during 24, 48 and 72 hours. Apoptosis was measured by flow cytometry using annexin V/propidium iodide to determine early and late apoptosis. Lymphocytes were marked with CD45 APC-conjugated monoclonal antibody. Results Radiation-induced apoptosis (RIA) increased with radiation dose and time of incubation. Data strongly fitted to a semi logarithmic model as follows: RIA = βln(Gy) + α. This mathematical model was defined by two constants: α, is the origin of the curve in the Y axis and determines the percentage of spontaneous cell death and β, is the slope of the curve and determines the percentage of cell death induced at a determined radiation dose (β = ΔRIA/Δln(Gy)). Higher β values (increased rate of RIA at given radiation doses) were observed in patients with low sexual toxicity (Exp(B) = 0.83, C.I. 95% (0.73-0.95), p = 0.007; Exp(B) = 0.88, C.I. 95% (0.82-0.94), p = 0.001; Exp(B) = 0.93, C.I. 95% (0.88-0.99), p = 0.026 for 24, 48 and 72 hours respectively). This relation was also found with rectal (Exp(B) = 0.89, C.I. 95% (0.81-0.98), p = 0.026; Exp(B) = 0.95, C.I. 95% (0.91-0.98), p = 0.013 for 48 and 72 hours respectively) and urinary (Exp(B) = 0.83, C.I. 95% (0.71-0.97), p = 0.021 for 24 hours) toxicity. Conclusion Radiation induced apoptosis at different time points and radiation doses fitted to a semi logarithmic model defined by a mathematical equation that gives an individual value of radiosensitivity and could predict late toxicity due to radiotherapy. Other prospective studies with higher number of patients are needed to validate these results.
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Affiliation(s)
- Elisa Bordón
- Canary Institute for Cancer Research (ICIC), Las Palmas, Spain
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Azria D, Ozsahin M, Rosenstein B. Radiation-induced sequelae measured by means of lymphocyte apoptosis: importance of certain single nucleotide polymorphisms: in regard to Schnarr et al. (Int J Radiat Oncol Biol Phys 2009). Int J Radiat Oncol Biol Phys 2009; 75:1275; author reply 1275-6. [PMID: 19857791 DOI: 10.1016/j.ijrobp.2009.06.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 06/10/2009] [Indexed: 10/20/2022]
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Dayes I, Schnarr K, Julian J, Sathya J, Boreham D. In Reply to Dr. Azria et al. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.06.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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