1
|
Yadav BS, Dey T. Hypofractionation for Regional Nodal Irradiation in Breast Cancer: Best of Both the Worlds. Clin Breast Cancer 2024; 24:399-410. [PMID: 38614852 DOI: 10.1016/j.clbc.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/03/2024] [Accepted: 03/09/2024] [Indexed: 04/15/2024]
Abstract
Locoregional radiotherapy play an important role in controlling the disease after surgery in patients with breast cancer. Radiotherapy schedules vary from conventional fraction to hypofractionation. The purpose of this review is to get an insight into the data on regional nodal irradiation (RNI) with hypofractionation in patients with breast cancer. This systematic review was constructed in accordance with Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) framework. Electronic databases such as PubMed, Cochrane and EMBASE were searched from January 1, 2023 to March 31, 2023 to identify studies published in English language on hypofractionated RNI in post mastectomy patients. The search was carried out with the National Library of Medicine's Medical Subject Heading (MeSH) terms like "regional nodal irradiation," "hypofractionated" and "hypofractionation in breast cancer" with different Boolean operators (and/or). A manual search of reference lists of included articles was also performed to make sure there were no additional cases unidentified from the primary search. Studies deemed potentially eligible were identified and assessed by same independent reviewers to confirm eligibility. RNI data are mainly from a randomized study from Beijing and pooled data from START trials. There are also data from retrospective and single institutional studies and a few phase II studies with limited number of patients using different dose fractionations and techniques of radiotherapy. Doses used in these trials ranged from 26-47.7 Gy in 5-19 fractions over 1-4 weeks. Grade ≥ 2 pulmonary fibrosis and lymphedema rate ranged from 2%-7.9% and 3%-19.8% respectively. Grade ≥ 2 shoulder dysfunction and brachial plexopathy ranged from 0.2%-28% and 0%-< 1%, respectively. Late effects with a dose range of 26-40 Gy delivered in 5 to 15 fractions over 1-3 weeks were less/similar to conventional fraction. Current data showed lower/similar rates of toxicity with hypofractionated RNI compared with conventional fractionation RNI. Doses of 26 Gy to 40 Gy delivered in 5 to 15 fractions over 1-3 weeks are safe for RNI. With limited data, ultra-hypofractionation 26 Gy/5 fractions/1 week also seems to be safe. However, long-term outcome is awaited and many trials are going on to address its efficacy and safety.
Collapse
Affiliation(s)
- Budhi Singh Yadav
- Department of Radiotherapy & Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
| | - Treshita Dey
- Department of Radiotherapy & Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
2
|
Schad MD, Richman AH, Diego EJ, McAuliffe PF, Johnson RR, Steiman J, Vargo JA, Beriwal S. Dosimetry and Toxicity Outcomes in Patients Treated with Hypofractionated Regional Nodal Irradiation for Breast Cancer: What is the Best Dose-Volume Limit to Minimize Risks of Radiation Pneumonitis? Pract Radiat Oncol 2023; 13:291-300. [PMID: 36332799 PMCID: PMC11189663 DOI: 10.1016/j.prro.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Although published data have supported the use of hypofractionated regional nodal irradiation (HF-RNI) for breast cancer, limited dosimetric data exist to evaluate predictors of lung toxicity. The ongoing RT CHARM trial limits the percentage of ipsilateral lung volume that receives ≥18 Gy to 35 to 40%. We assessed dosimetry, toxicity, and disease outcomes in patients with breast cancer treated with HF-RNI with a particular focus on pneumonitis. METHODS AND MATERIALS We retrospectively reviewed all patients with breast cancer treated with HF-RNI (40-43 Gy in 15-16 fractions) after either lumpectomy or mastectomy at The University of Pittsburgh Medical Center from September 2018 to December 2021 to collect dosimetric and outcomes data. All post-radiation therapy chest computed tomography (CT) scans were manually reviewed for evidence of acute (≤6 months postradiation) or chronic (>6 months postradiation) pneumonitis. RESULTS One-hundred-ninety-one patients qualified with a median follow-up of 20.3 months (range, 5.1-42.2). Acute grade 1 (G1) pneumonitis was observed in 6.8% of the overall cohort (13 of 191 patients) and 39.4% of the patients (13 of 33) who received a chest CT ≤6 months postradiation therapy. Only 1 patient developed acute G2 pneumonitis. Chronic G1 pneumonitis was observed in 29.8% of the overall cohort (57 of 191 patients) and 77% of patients (57 of 74 patients) who received a chest CT >6 months postradiation therapy. No patients developed acute G3+ or chronic G2+ pneumonitis. CONCLUSIONS Rates of symptomatic pneumonitis were low in this cohort of patients treated with HF-RNI, even with integration of HER2/neu-directed therapy, chemotherapy, hormone therapy, and internal mammary nodal irradiation. Lung V20Gy <26% appeared safe in this cohort to limit symptomatic pneumonitis, though this is not meant to represent the safe upper limit. Given the low event rate of symptomatic pneumonitis, data from larger cohorts will be needed to assess dosimetric predictors and the safe upper limit of lung dose.
Collapse
Affiliation(s)
- Michael D Schad
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Adam H Richman
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Emilia J Diego
- Department of Breast Surgical Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Priscilla F McAuliffe
- Department of Breast Surgical Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ronald R Johnson
- Department of Breast Surgical Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jennifer Steiman
- Department of Breast Surgical Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John A Vargo
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sushil Beriwal
- Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania; Varian Medical Systems, Palo Alto, California.
| |
Collapse
|
3
|
Aygün B, Şentürk M, Cinan E, Şimsek Ö, Abu Al-Sayyed MI, Karabulut A. Determination of biological radioprotective characteristics of some natural organic compounds for radiation shielding applications. RADIOCHIM ACTA 2022. [DOI: 10.1515/ract-2022-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Ionizing radiation is used in many fields in energy, medicine, and industrial applications. Those who are in these areas or cancer patients receiving radiotherapy are at risk for acute or long-term exposure to radiation damage due to these ionizing radiations. Non-toxic new agents are needed to protect intact tissue and cells. In this study, we aimed to determine the gamma and neutron radiation attenuation characteristics of seven different natural compounds (quercetin, menadione, naphthol, caffeine, quinine sulphate, cholesterol and riboflavin) to help users in radiation applications. Gamma radiation attenuation parameters such as the mean free path, mass attenuation coefficient, effective atom number, linear attenuation coefficient, and half-value layer were calculated theoretically with WinXCom software for the energy range 0.015–15 MeV. Fast neutron attenuation criteria, such as mean free path, half-value layer, effective removal cross-sections and transmission neutron number, were theoretically determined with Monte Carlo simulation codes (Geant4). Neutron absorption measurement experiments were also applied in addition to the theoretical results. The neutron radiation absorption capacities were determined for samples with an 241Am-Be 4.5 MeV energy neutron source and portatif-type Canberra brand BF3 gas neutron detector. Neutron attenuation parameters were compared with paraffin to determine the absorption capability of the samples. It was found that the dose 1.1094 (μSv/h) from the source was absorbed by the samples to the following extent: 31.76% (Quercetin), 21.85% (Menadione), 28.85% (Naphthol), 22.94% (Caffeine), 12.51% (Quinine sulphate), 40.44% (Cholesterol) and 20.94% (Riboflavin). From the results, it can be clearly seen that all these drug samples had a good neutron radiation attenuation capacity. This revealed that the examined samples had radiation absorption abilities. It was found that the cholesterol sample had an especially excellent absorption power for both neutron and gamma radiation. The samples investigated in this study could be used to develop radiation-protective drugs.
Collapse
Affiliation(s)
- Bünyamin Aygün
- Department of Electronics and Automation , Vocational School, Agri Ibrahim Cecen University , Agri , Turkey
| | - Murat Şentürk
- Department of Basic Pharmaceutical Sciences , Faculty of Pharmacy, Agri Ibrahim Cecen University , Agri , Turkey
| | - Esra Cinan
- Department of Physics , Faculty of Science, Atatürk University , Erzurum , Turkey
| | - Önder Şimsek
- Central Application and Research Laboratory (MERLAB), Agri Ibrahim Cecen University , Agri , Turkey
| | | | - Abdulhalik Karabulut
- Department of Physics , Faculty of Science, Atatürk University , Erzurum , Turkey
| |
Collapse
|
4
|
Ten-year outcomes of hypofractionated postmastectomy radiation therapy of 26 Gy in 6 fractions. Int J Radiat Oncol Biol Phys 2021; 112:1105-1114. [PMID: 34963557 DOI: 10.1016/j.ijrobp.2021.12.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/11/2021] [Accepted: 12/15/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate the efficacy and long-term side effects of hypofractionated postmastectomy radiation therapy (HFRT-PM) of 26 Gy in 6 fractions over 5 weeks. MATERIALS & METHODS We retrospectively reviewed characteristics and outcomes of patients with stage I-III breast cancer treated with HFRT-PM between 2000-2009. Treatment provided four fractions of 4 Gy (day (d)1, d3, d15, d17) then two fractions of 5 Gy (d29, d31) over 5 weeks. The treatment techniques were applied by using 3D conformal radiotherapy of chest wall with regional nodal volume if required. RESULTS 454 patients were identified, with a median follow-up of 10.6 years (range 0.5-22.9). Regional nodal irradiation was made in 84.1 % of patients. At 10 years, the cumulative incidence of locoregional relapse was 15.1 %. In multivariate analysis, regional lymph nodes involvement (≥ 4 nodes) was associated with worse locoregional control (HR 1.68; [95% CI 1.06-2.67], p = 0.03) and overall survival (HR 2.16; [95% CI 1.59-2.95], p < 0.001). The toxicities were acceptable. The incidence of cardiac disorders (3.3 %), and symptomatic lung fibrosis (1.5 %) was low during follow-up. At 10 years, the cumulative rate of arm lymphedema was 9.5 % and considered severe in 20 patients (4.4 %). CONCLUSION The long-term results of this study show that HFRT-PM of 26 Gy in 6 fractions over 5 weeks seems safes but locoregional recurrence seems slightly higher than those observed in the literature, highlighting that long-term follow-up is needed and the need of randomized trials for hypofractionated radiotherapy therapy in postmastectomy situation.
Collapse
|
5
|
De Matteis S, Facondo G, Valeriani M, Vullo G, De Sanctis V, Ascolese AM, Campanella B, Scalabrino G, Osti MF. Hypofractionated Radiation Therapy (HFRT) of Breast/Chest Wall and Regional Nodes in Locally Advanced Breast Cancer: Toxicity Profile and Survival Outcomes in Retrospective Monoistitutional Study. Clin Breast Cancer 2021; 22:e332-e340. [PMID: 34670727 DOI: 10.1016/j.clbc.2021.09.008] [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: 06/03/2021] [Revised: 09/07/2021] [Accepted: 09/20/2021] [Indexed: 11/03/2022]
Abstract
AIM To evaluate the efficacy and safety of hypofractionated radiation therapy (HFRT) of the breast/chest wall and regional nodes in patients with locally advanced breast cancer and positive lymph nodes. MATERIALS AND METHODS One hundred and twenty-two patients treated between October 2016 and March 2020 with HFRT were retrospectively reviewed. A total dose of 42.4 Gy was delivered to the chest wall and lymph nodes in 16 fractions of 2.65 Gy each, using the IMRT technique. Patients treated with breast-conserving surgery received an overdose (concomitant boost of 3 Gy daily) with the SIB (Simultaneous Integrated Boost) technique. RESULTS Median age at diagnosis was 58 years (range 34-86 years) and median follow-up was 22 months (range 6-48 months). Overall survival (OS) at 1, 2 and 3 years was 100%, 97.3% and 90%, respectively. Disease-free survival (DFS) at 1, 2, and 3 years was 91.4%, 87%, and 84.8%, respectively. Distant metastasis-free survival (MFS) at 1, 2 and 3 years was 93.1%, 88% and 85.7%, respectively. Two patients (1.6%) experienced local recurrence on the chest wall during FUP. Twenty-one patients (17%) showed a grade 2 dermal toxicity, no grade 3 acute skin toxicity was found. Sixteen patients (13%) showed early-stage arm lymphedema (grade ≤ 2). Twenty-three patients (19%) showed a grade 2 late skin toxicity. Twenty patients (16%) had grade ≤ 2 late arm lymphedema. CONCLUSION Given the excellent local control, survival rates and the low toxicity profile demonstrated, HFRT could be considered a valid therapeutic option in patients with locally advanced breast cancer.
Collapse
Affiliation(s)
- Sara De Matteis
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Giuseppe Facondo
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Maurizio Valeriani
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Gianluca Vullo
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy.
| | - Vitaliana De Sanctis
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Anna Maria Ascolese
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Barbara Campanella
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Giovanna Scalabrino
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Mattia Falchetto Osti
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| |
Collapse
|
6
|
Long-Term Results of Postoperative Hypofractionated Accelerated Breast and Lymph Node Radiotherapy (HypoAR) with Hypofractionated Boost. ACTA ACUST UNITED AC 2021; 28:3474-3487. [PMID: 34590607 PMCID: PMC8482084 DOI: 10.3390/curroncol28050300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/22/2021] [Accepted: 09/04/2021] [Indexed: 11/28/2022]
Abstract
We report long-term results (median follow-up 12 years) of hypofractionated accelerated radiotherapy (HypoAR) in patients treated with breast-conserving surgery. In total, 367 women were treated with HypoAR. Axillary and supraclavicular area (ASA) were treated in patients with involved nodes. In total, 290 patients (scheme A) received 3.5 Gy/day ×10 fractions (breast/ASA) followed by two 4 Gy fractions with electrons to the affected breast quadrant within 16 days. In total, 77 patients (Scheme B) received 2.7 Gy/day for 16 consecutive fractions (breast/ASA) within 22 days, while concurrently, the affected breast quadrant received an electron booster dose of 0.8 Gy for the first 13 fractions. Amifostine was offered to 252/367 patients. Early radiation toxicity was minimal. Regarding late toxicities, symptomatic breast edema was noted in 2.2%, asymptomatic breast fibrosis in 1.9%, and arm lymphedema in 3.7% of patients. Amifostine reduced early radiation dermatitis (p = 0.001). In total, 2.2% of patients developed contralateral breast and 1.6% other carcinomas. Locoregional recurrence (LR) occurred in 3.1% of patients (0% for in situ carcinomas). Positive margins after surgery, extracapsular node invasion, and HER2-enriched/triple-negative tumors were linked with significantly worse LR-free survival. The involvement of more than three nodes and luminal type other than A were independent prognostic variables of metastasis and death events. HypoAR delivering a biological dose of 50–52 Gy to the breast/ASA is a safe and effective therapy for patients treated with conservative surgery. The risk of carcinogenesis is low. Positive surgical margins, extracapsular node invasion, and HER2-enriched/triple-negative phenotypes appear as a cluster of features linked with a higher risk for locoregional relapse.
Collapse
|
7
|
Molecular and Biologic Targets for Radiation Fibrosis: Implications for Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00321-8] [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]
|
8
|
Koukourakis IM, Zygogianni A, Kouloulias V, Koukourakis MI. Successful Treatment of a Locally Recurrent and Metastatic Malignant Phyllodes Tumor with Accelerated Radiotherapy and Nab-Paclitaxel, Cisplatin, and Liposomal Doxorubicin Chemotherapy. Chemotherapy 2021; 66:82-86. [PMID: 34233328 DOI: 10.1159/000517246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/30/2021] [Indexed: 11/19/2022]
Abstract
Phyllodes tumors are rare breast lesions of fibroepithelial origin. Malignant transformation with metastases is linked with poor prognosis. We present a case of a 62-year-old woman with a recurrent malignant phyllodes tumor of the breast and lung metastases. The patient was originally presented with a borderline phyllodes tumor (7.4 cm) of the left breast, treated with wide local excision. A year later, the patient returned with palpable left breast masses. On PET-CT, increased uptake of 18F-FDG by large breast tumors was evident. A right lung lesion of metastatic origin was also present. A simple left breast mastectomy was performed. Histopathological report described 2 malignant phyllodes tumors (7 cm and 6.5 cm). One month later, during the CT simulation for radiotherapy planning, encysted fluid in the chest wall and 2 additional pulmonary lesions of the right lung were identified, confirming progressive lung metastatic disease. Both the chest wall and the regional lymph node area were irradiated with hypofractionated and accelerated radiotherapy. Biweekly chemotherapy with albumin-bound paclitaxel, cisplatin, and liposomal doxorubicin was also prescribed at the start of radiotherapy for 12 cycles. At the end of chemotherapy, complete regression of lung metastases was achieved, and there was no evidence of local recurrence. Within 2 years of follow-up, the patient is free of disease and treatment-related toxicities. Accelerated hypofractionated radiotherapy is effective in the locoregional control of malignant phyllodes tumors. The combination of cisplatin with nab-paclitaxel and liposomal doxorubicin chemotherapy has acceptable toxicity and is highly effective in eradicating metastatic lesions.
Collapse
Affiliation(s)
- Ioannis M Koukourakis
- 1st Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Zygogianni
- 1st Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilios Kouloulias
- 2nd Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael I Koukourakis
- Department of Radiotherapy/Oncology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| |
Collapse
|
9
|
Ivanov IM, Nikiforov AS, Yudin MA, Chepur SV, Proshina YA, Sventitskaya AM. Prospects for Inhalation Delivery of Medical Protectors against Radiation Damage. BIOL BULL+ 2020. [DOI: 10.1134/s106235902012002x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
10
|
Oladeru OT, Dunn SA, Vanbenthuysen LT, Depauw N, Ho AY. New Frontiers in Hypofractionation for Regional Nodal Irradiation in Breast Cancer. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00385-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
Yadav BS, Bansal A, Kuttikat PG, Das D, Gupta A, Dahiya D. Late-term effects of hypofractionated chest wall and regional nodal radiotherapy with two-dimensional technique in patients with breast cancer. Radiat Oncol J 2020; 38:109-118. [PMID: 33012154 PMCID: PMC7533408 DOI: 10.3857/roj.2020.00129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/04/2020] [Indexed: 11/03/2022] Open
Abstract
PURPOSE Hypofractionated radiotherapy (RT) is becoming a new standard in postoperative treatment of patients with early stage breast cancer after breast conservation surgery. However, data on hypofractionation in patients with advanced stage disease who undergo mastectomy followed by local and regional nodal irradiation (RNI) is lacking. In this retrospective study, we report late-term effects of 3 weeks post-mastectomy hypofractionated local and RNI with two-dimensional (2D) technique in patients with stage II and III breast cancer. METHODS Between January 1990 and December 2007, 1,770 women with breast cancer who were given radical treatment with mastectomy, systemic therapy and RT at least 10 years ago were included. RT dose was 35 Gy/15 fractions/3 weeks to chest wall by two tangential fields and 40 Gy in same fractions to supraclavicular fossa (SCF) and internal mammary nodes (IMNs). SCF and IMNs dose was prescribed at dmax and 3 cm depth, respectively. Chemotherapy and hormonal therapy was given in 64% and 74% patients, respectively. Late-term toxicities were assessed with the Radiation Therapy Oncology Group (RTOG) scores and LENT-SOMA scales (the Late Effects Normal Tissue Task Force-Subjective, Objective, Management, Analytic scales). RESULTS Mean age was 48 years (range, 19 to 75 years). Median follow-up was 12 years (range, 10 to 27 years). Moderate/marked arm/shoulder pain was reported by 254 (14.3%) patients. Moderate/marked shoulder stiffness was reported by 219 (12.3%) patients. Moderate/marked arm edema was seen in 131 (7.4%) patients. Brachial plexopathy was not seen in any patient. Rib fractures were noted in 6 (0.3%) patients. Late cardiac and lung toxicity was seen in 29 (1.6%) and 23 (1.3%) patients, respectively. Second malignancy developed in 105 (5.9%) patients. CONCLUSION RNI with 40 Gy/15 fractions/3 weeks hypofractionation with 2D technique seems safe and comparable to historical data of conventional fractionation (ClinicalTrial.gov Registration No. XXXX).
Collapse
Affiliation(s)
- Budhi Singh Yadav
- Department of Radiation Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Anshuma Bansal
- Department of Radiation Oncology, Rajindra Hospital, Patiala, Punjab, India
| | - Philip George Kuttikat
- Department of Radiation Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Deepak Das
- Department of Radiation Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ankita Gupta
- Department of Radiation Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Divya Dahiya
- Department of General Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
12
|
Poppe MM, Yehia ZA, Baker C, Goyal S, Toppmeyer D, Kirstein L, Chen C, Moore DF, Haffty BG, Khan AJ. 5-Year Update of a Multi-Institution, Prospective Phase 2 Hypofractionated Postmastectomy Radiation Therapy Trial. Int J Radiat Oncol Biol Phys 2020; 107:694-700. [PMID: 32289474 DOI: 10.1016/j.ijrobp.2020.03.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Hypofractionation in the setting of postmastectomy radiation (PMRT) is not currently the standard of care in most countries. Here we present a 5-year update of our multi-institutional, phase 2 prospective trial evaluating a novel 15-day hypofractionated PMRT regimen. METHODS AND MATERIALS Patients were enrolled to receive 3.33 Gy daily to the chest wall (or reconstructed breast) and regional lymphatics in 11 fractions with an optional 4-fraction mastectomy scar boost. The primary endpoint was freedom from grade 3 or higher late non-reconstruction-related radiation toxicities. Toxicities were scored using Common Terminology Criteria for Adverse Events v4.0. Secondary endpoints included local and locoregional recurrence rates, cosmesis, and reconstruction complications. RESULTS After enrolling 69 patients with stage II-IIIa breast cancer, 67 women were eligible for analysis. At a median follow up of 54 months, there were no acute or late grade 3 and 4 nonreconstruction reported toxicities. The grade 2 or greater late toxicity rate was only 12% and comprised grade 2 pain, fatigue, and lymphedema that persisted beyond 6 months after completion of radiation therapy. Only 3 women (4.6%) experienced a chest wall or nodal recurrence as a first site of relapse. Freedom from local failure, including local failure after distant relapse, was 92% at 5 years, and the 5-year overall survival was 90%. CONCLUSIONS This is the first prospective trial conducted in the United States to demonstrate the safe and effective use of hypofractionated PMRT. We have demonstrated a low complication rate while achieving excellent local control. Toxicity was better than anticipated based on previously published series of PMRT toxicities. Although our fractionation was novel, the radiobiological equivalent dose is similar to other hypofractionation schedules. This trial was the basis for the creation of Alliance A221505 (RT CHARM), which is currently accruing patients in a phase 3 randomized design.
Collapse
Affiliation(s)
- Matthew M Poppe
- Huntsman Cancer Hospital, University of Utah, Salt Lake City, Utah.
| | - Zeinab A Yehia
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | | | | | | | - Laurie Kirstein
- Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Chunxia Chen
- Rutgers School of Public Health, Piscataway, New Jersey
| | - D F Moore
- Rutgers School of Public Health, Piscataway, New Jersey
| | - Bruce G Haffty
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Atif J Khan
- Memorial Sloan Kettering Cancer Center, New York City, New York
| |
Collapse
|
13
|
Liu L, Yang Y, Guo Q, Ren B, Peng Q, Zou L, Zhu Y, Tian Y. Comparing hypofractionated to conventional fractionated radiotherapy in postmastectomy breast cancer: a meta-analysis and systematic review. Radiat Oncol 2020; 15:17. [PMID: 31952507 PMCID: PMC6969477 DOI: 10.1186/s13014-020-1463-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/07/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose To compare the efficacy and toxicity of hypofractionated radiotherapy versus conventional fractionated radiotherapy in postmastectomy breast cancer using meta-analysis. Methods The PubMed, EMbase, Cochrane Library, Google Scholar, Wan Fang and CNKI databases were searched to identify controlled clinical trials comparing hypofractionated radiotherapy versus conventional fractionated radiotherapy in postmastectomy breast cancer. Overall survival (OS) was the primary endpoint, and disease-free survival (DFS), locoregional recurrence (LRR), distant metastasis (DM), acute skin toxicity, acute lung toxicity, late skin toxicity, lymphedema,, shoulder restriction, and late cardiac related toxicity were the secondary endpoints. Results Twenty-five controlled clinical trials involving 3871 postmastectomy breast cancer patients were included in this meta-analysis according to the selection criteria. The meta-analysis revealed that there were no significant differences in OS (OR = 1.08, 95% CI = 0.87~1.33, P = 0.49), DFS (OR = 1.13, 95% CI = 0.91~1.40, P = 0.28), LRR (OR = 1.01, 95% CI = 0.76~1.33, P = 0.96), DM (OR = 1.16, 95% CI = 0.85~1.58, P = 0.34), acute skin toxicity (OR = 0.94, 95% CI = 0.67~1.32, P = 0.72), acute lung toxicity (OR = 0.94, 95% CI = 0.74~1.20, P = 0.62), late skin toxicity (OR = 0.98, 95% CI = 0.75~1.27, P = 0.88), lymphedema (OR = 0.99, 95% CI = 0.77~1.28, P = 0.94), shoulder restriction (OR = 0.75, 95% CI = 0.43~1.31, P = 0.31), or late cardiac related toxicity (OR = 1.17, 95% CI = 0.82~1.65, P = 0.39) between the two groups. Conclusions The results of this study show that compared to conventional fractionated radiotherapy, hypofractionated radiotherapy is not significantly different with respect to efficacy or toxicity in postmastectomy breast cancer. Additional large randomized clinical trials are needed to further confirm this conclusion.
Collapse
Affiliation(s)
- Lei Liu
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Institute of Radiotherapy and Oncology of Soochow University, San Xiang Road No. 1055, Suzhou, 215004, Jiangsu, China
| | - Yongqiang Yang
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Institute of Radiotherapy and Oncology of Soochow University, San Xiang Road No. 1055, Suzhou, 215004, Jiangsu, China
| | - Qi Guo
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Institute of Radiotherapy and Oncology of Soochow University, San Xiang Road No. 1055, Suzhou, 215004, Jiangsu, China
| | - Bixin Ren
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Institute of Radiotherapy and Oncology of Soochow University, San Xiang Road No. 1055, Suzhou, 215004, Jiangsu, China
| | - Qiliang Peng
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Institute of Radiotherapy and Oncology of Soochow University, San Xiang Road No. 1055, Suzhou, 215004, Jiangsu, China
| | - Li Zou
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Institute of Radiotherapy and Oncology of Soochow University, San Xiang Road No. 1055, Suzhou, 215004, Jiangsu, China
| | - Yaqun Zhu
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Institute of Radiotherapy and Oncology of Soochow University, San Xiang Road No. 1055, Suzhou, 215004, Jiangsu, China
| | - Ye Tian
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Institute of Radiotherapy and Oncology of Soochow University, San Xiang Road No. 1055, Suzhou, 215004, Jiangsu, China.
| |
Collapse
|
14
|
Advances in pathogenic mechanisms and management of radiation-induced fibrosis. Biomed Pharmacother 2020; 121:109560. [DOI: 10.1016/j.biopha.2019.109560] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/04/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022] Open
|
15
|
King M, Joseph S, Albert A, Thomas TV, Nittala MR, Woods WC, Vijayakumar S, Packianathan S. Use of Amifostine for Cytoprotection during Radiation Therapy: A Review. Oncology 2019; 98:61-80. [PMID: 31846959 DOI: 10.1159/000502979] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Radiation therapy is a cornerstone of the therapeutic modalities used in modern oncology. However, it is sometimes limited in its ability to achieve optimal tumor control by radiation-induced normal tissue toxicity. In delivering radiation therapy, a balance must be achieved between maximizing the dose to the tumor and minimizing any injury to the normal tissues. Amifostine was the first Food and Drug Administration (FDA)-approved clinical radiation protector intended to reduce the impact of radiation on normal tissue, lessening its toxicity and potentially allowing for increased tumor dose/control. Despite being FDA-approved almost 20 years ago, Amifostine has yet to achieve widespread clinical use. SUMMARY A thorough review of Amifostine's development, mechanism of action, and current clinical status were conducted. A brief history of Amifostine is given, from its development at Walter Reid Institute of Research to its approval for clinical use. The mechanism of action of Amifostine is explored. The results of a complete literature review of all prospective randomized trials to date involving the use of Amifostine in radiation therapy are presented. The results are arranged by treatment site and salient findings discussed. Side effects and complications to consider in using Amifostine are reviewed. Key Messages: Amifostine has been explored as a radiation protectant in most radiation treatment sites. Studies have demonstrated efficacy of Amifostine in all treatment sites reviewed, but results are heterogeneous. The heterogeneity of studies looking at Amifostine as a clinical radiation protectant has precluded a definitive answer on its efficacy. Complicating its clinical use is its toxicity and delivery requirements. Amifostine has largely fallen out of use with the advent of intensity modulated radiation therapy (IMRT). However, side effects with IMRT remain a challenge and concern. The use of Amifostine in the IMRT era has been poorly explored and is worthy of future study.
Collapse
Affiliation(s)
- Maurice King
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Sanjay Joseph
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ashley Albert
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Toms V Thomas
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Mary R Nittala
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA,
| | - William C Woods
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Srinivasan Vijayakumar
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Satyaseelan Packianathan
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| |
Collapse
|
16
|
Abstract
Radiation therapy is one of the most commonly used treatments for cancer. Radiation modifiers are agents that alter tumor or normal tissue response to radiation, such as radiation sensitizers and radiation protectors. Radiation sensitizers target aspects of tumor molecular biology or physiology to enhance tumor cell killing after irradiation. Radioprotectors prevent damage of normal tissues selectively. Radiation modifiers remain largely investigational at present, with the promise that molecular characterization of tumors may enhance the capacity for successful clinical development moving forward. A variety of radiation modifiers are described.
Collapse
Affiliation(s)
- Deborah E Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10 CRC, Room B2-3500, 10 Center Drive, Bethesda, MD 20892, USA.
| |
Collapse
|
17
|
Park HJ, Oh DH, Shin KH, Kim JH, Choi DH, Park W, Suh CO, Kim YB, Ahn SD, Kim SS. Patterns of Practice in Radiotherapy for Breast Cancer in Korea. J Breast Cancer 2018; 21:244-250. [PMID: 30275852 PMCID: PMC6158163 DOI: 10.4048/jbc.2018.21.e37] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/06/2018] [Indexed: 11/30/2022] Open
Abstract
Adjuvant radiotherapy (RT) is a well-established treatment for breast cancer. However, there is a large degree of variation and controversy in practice patterns. A nationwide survey on the patterns of practice in breast RT was designed by the Division for Breast Cancer of the Korean Radiation Oncology Group. All board-certified members of the Korean Society for Radiation Oncology were sent a questionnaire comprising 39 questions on six domains: hypofractionated whole breast RT, accelerated partial breast RT, postmastectomy RT (PMRT), regional nodal RT, RT for ductal carcinoma in situ, and RT toxicity. Sixty-four radiation oncologists from 54 of 86 (62.8%) hospitals responded. Twenty-three respondents (35.9%) used hypofractionated whole breast RT, and the most common schedule was 43.2 Gy in 16 fractions. Only three (4.7%) used accelerated partial breast RT. Five (7.8%) used hypofractionated PMRT, and 40 (62.5%) had never used boost RT after chest wall irradiation. Indications for regional nodal RT varied; ≥pN2 (n=7) versus ≥pN1 (n=17) versus ≥pN1 with pathologic risk factors (n=40). Selection criteria for internal mammary lymph node (IMN) irradiation also varied; only four (6.3%) always treated IMN when regional nodal RT was administered and 30 (46.9%) treated IMN only if IMN involvement was identified through imaging. Thirty-one (48.4%) considered omission of whole breast RT after breast-conserving surgery for ductal carcinoma in situ based on clinical and pathologic risk factors. Fifty-two (81.3%) used heart-sparing techniques. Overall, there were wide variations in the patterns of practice in breast RT in Korea. Standard guidelines are needed, especially for regional nodal RT and omission of RT for ductal carcinoma in situ.
Collapse
Affiliation(s)
- Hae Jin Park
- Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Korea
| | - Do Hoon Oh
- Department of Radiation Oncology, Myongji Hospital, Goyang, Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | |
Collapse
|
18
|
Chang H, Yi W, Wang X, Tao Y, Yang X, Chen C, Zhang W, Zhou S, Liu S, Li X, Ding S, Li J, Li G, Shao X, Liu Y, Song W, Xia Y. Effectiveness and safety of different amifostine regimens: Preliminary results of a phase II multicenter randomized controlled trial. Chin J Cancer Res 2018; 30:307-314. [PMID: 30046225 DOI: 10.21147/j.issn.1000-9604.2018.03.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective The radioprotective effects of amifostine remain uncertain in patients with nasopharyngeal carcinoma (NPC), and adverse effects and cost limit generalization of its classical everyday regimen. This phase II multicenter randomized controlled trial aimed to explore whether amifostine could ameliorate the toxicities of NPC patients in the era of intensity-modulated radiotherapy (IMRT), and to compare different regimens of amifostine on effectiveness and safety. Methods Patients with stage I-IVB NPC were involved prospectively from January 1st, 2013. All patients received radical treatment based on IMRT. After a randomization stratified by their stage, these patients were allocated into 3 groups: the group treated without amifostine, the group treated with the everyday regimen of amifostine, and the group treated with the every-other-day regimen. The 3 groups of patients were compared on radiotherapy-related acute toxicities, treatment effects of NPC, and amifostine-related complications. This trial was registered on the clinicaltrials.gov (ID: NCT01762514). Results Until August 31st, 2017, totally 187 patients completed experimental intervention. Only amifostine of everyday regimen appeared to reduce the patient proportion of mucositis (79.1% vs. 96.8%, P=0.002). Hypocalcemia was less common in patients treated without amifostine than in those treated with amifostine (22.6% vs. 53.4% vs. 41.8%, P=0.002). Neither complete remission rates nor the survivals were affected by amifostine. Conclusions Amifostine of everyday regimen could reduce mucositis in NPC patients who received IMRT, though it also had the possibility to cause more hypocalcemia.
Collapse
Affiliation(s)
- Hui Chang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China
| | - Wei Yi
- Department of Radiation Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xiaohui Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China
| | - Yalan Tao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China
| | - Xin Yang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China
| | - Chen Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China
| | - Wenwen Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China
| | - Shu Zhou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China
| | - Songran Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China
| | - Xiaohui Li
- Department of Oncology, People's Liberation Army 421 Hospital, Guangzhou 510318, China
| | - Shirong Ding
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China
| | - Jing Li
- Department of Oncology, the Main Guangzhou Hospital of the Guangzhou Military Region, Guangzhou 510010, China
| | - Gong Li
- Department of Oncology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510530, China
| | - Xunfan Shao
- Department of Radiation Oncology, the Affiliated Cancer Hospital of Guangzhou Medical College, Guangzhou 510095, China
| | - Yimin Liu
- Department of Radiation Oncology, the Second Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510120, China
| | - Weishu Song
- Department of Oncology, Guangdong Second People's Hospital, Guangzhou 510317, China
| | - Yunfei Xia
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China
| |
Collapse
|
19
|
Trends and Patterns of Utilization of Hypofractionated Postmastectomy Radiotherapy: A National Cancer Database Analysis. Clin Breast Cancer 2018; 18:e899-e908. [PMID: 29550285 DOI: 10.1016/j.clbc.2018.02.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/08/2018] [Accepted: 02/14/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND The acceptance of hypofractionated radiotherapy in treating breast cancer in the breast conservation therapy setting has stimulated interest in hypofractionated postmastectomy radiotherapy (PMRT). We assessed national trends and patterns of utilization of hypofractionated PMRT. PATIENTS AND METHODS Women 18 years of age or older with breast cancer treated with mastectomy and PMRT to the chest wall with or without regional lymph nodes from 2004 to 2014 were identified from the National Cancer Database. A standard fractionation cohort was defined as patients receiving 180 to 200 cGy per fraction to a total dose of 4500 to 7000 cGy over 5 to 7 weeks, and a hypofractionation cohort was defined as those receiving 250 to 400 cGy per fraction to a total dose of 3000 to 6000 cGy over 2 to 5 weeks. Multivariable logistic regression was used to determine factors associated with hypofractionated PMRT use. RESULTS We identified 113,981 patients who met study criteria. Overall, hypofractionated PMRT use was low (1.1%) although utilization increased over time (P ≤ .001). Older age, greater comorbidity, further distance from treatment facility, treatment at academic facilities, less extensive disease, and recent treatment year were statistically significant predictors of hypofractionation use compared with standard fractionation. Conversely, breast reconstruction and receipt of chemotherapy were negative predictors. CONCLUSION Because of the absence of high-level evidence to support its use, hypofractionated PMRT was uncommonly utilized in the United States from 2004 to 2014, although a small increase in use was noted over time. Findings from this study might be useful in designing future studies, and might serve as a baseline for evaluation of future changes in practice patterns.
Collapse
|
20
|
Singh VK, Garcia M, Seed TM. A review of radiation countermeasures focusing on injury-specific medicinals and regulatory approval status: part II. Countermeasures for limited indications, internalized radionuclides, emesis, late effects, and agents demonstrating efficacy in large animals with or without FDA IND status. Int J Radiat Biol 2017; 93:870-884. [DOI: 10.1080/09553002.2017.1338782] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Vijay K. Singh
- Division of Radioprotection, Department of Pharmacology and Molecular Therapeutics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Melissa Garcia
- Division of Radioprotection, Department of Pharmacology and Molecular Therapeutics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | |
Collapse
|
21
|
Rabender C, Mezzaroma E, Mauro AG, Mullangi R, Abbate A, Anscher M, Hart B, Mikkelsen R. IPW-5371 Proves Effective as a Radiation Countermeasure by Mitigating Radiation-Induced Late Effects. Radiat Res 2017; 186:478-488. [PMID: 27841740 DOI: 10.1667/rr14403.2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There is an ongoing and significant need for radiation countermeasures to reduce morbidities and mortalities associated with exposure of the heart and lungs from a radiological or nuclear incidents. Radiation-induced late effects occur months to years after exposure, stemming from significant tissue damage and remodeling, resulting in fibrosis and loss of function. TGF-β is reported to play a role in both pulmonary and cardiac fibrosis. We investigated the ability of a small molecule TGF-β receptor 1 inhibitor, IPW-5371, to mitigate the effects of thoracic irradiation in C57L/J mice, a murine model that most closely resembles that observed in humans in the induction of fibrosis and dose response. To simulate a radiological event, radiation was administered in two doses: 5 Gy total-body irradiation (eliciting a whole-body response) and immediately after that, a thoracic "top-up" of 6.5 Gy irradiation, for a total dose of 11.5 Gy to the thorax. IPW-5371 was administered once daily, orally, starting 24 h postirradiation for 6 or 20 weeks at a dose of 10 mg/kg or 30 mg/kg. Animals were monitored for a period of 180 days for survival, and cardiopulmonary injury was assessed by echocardiography, breathing rate and arterial oxygen saturation. Exposure of the thorax (11.5 Gy) induced both pulmonary and cardiac injury, resulting in a reduced life span with median survival of 135 days. IPW-5371 treatment for 6 weeks, at both 10 mg/kg and 30 mg/kg, delayed disease onset and mortality, with median survival of 165 days. Twenty weeks of IPW-5371 treatment at 30 mg/kg preserved arterial O2 saturation and cardiac contractile reserve and resulted in significant decreases in breathing frequency and cardiac and pulmonary fibrosis. This led to dramatic improvement in survival compared to the irradiated, vehicle-treated group (P < 0.001), and was statistically insignificant from the nonirradiated group. We observed that IPW-5371 treatment resulted in decreased pSmad3 tissue levels, confirming the effect of IPW-5371 on TGF-β signaling. These results demonstrate that IPW-5371 represents a potentially promising radiation countermeasure for the treatment of radiation-induced late effects.
Collapse
Affiliation(s)
- Christopher Rabender
- a Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia 23298
| | - Eleonora Mezzaroma
- b Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia 23298.,c VCU Victoria Johnson Center, Virginia Commonwealth University, Richmond, Virginia 23298.,d School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia 23298
| | - Adolfo G Mauro
- b Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia 23298.,c VCU Victoria Johnson Center, Virginia Commonwealth University, Richmond, Virginia 23298
| | - Ramesh Mullangi
- f Jubilant Biosys Ltd., Yeshwanthpur, Bangalore-560022, Karnataka, India
| | - Antonio Abbate
- b Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia 23298.,c VCU Victoria Johnson Center, Virginia Commonwealth University, Richmond, Virginia 23298
| | - Mitchell Anscher
- a Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia 23298
| | - Barry Hart
- e Innovation Pathways, Palo Alto, California 94301
| | - Ross Mikkelsen
- a Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia 23298
| |
Collapse
|
22
|
Deng G, Liang N, Xie J, Luo H, Qiao L, Zhang J, Wang D, Zhang J. Pulmonary toxicity generated from radiotherapeutic treatment of thoracic malignancies. Oncol Lett 2017; 14:501-511. [PMID: 28693198 PMCID: PMC5494764 DOI: 10.3892/ol.2017.6268] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/14/2017] [Indexed: 02/06/2023] Open
Abstract
Radiation-induced lung injury (RILI) remains a major obstacle for thoracic radiotherapy for the treatment of lung cancer, esophageal cancer and lymphoma. It is the principal dose-limiting complication, and can markedly impair the therapeutic ratio as well as a patient's quality of life. The current review presents the relevant concepts associated with RILI, including the pathogenic mechanisms and the potential treatment strategies, so as to achieve a general understanding of this issue. RILI comprises an acute radiation pneumonitis phase and subsequent late lung fibrosis. The established assessment criteria are clinical manifestations, imaging changes and the necessity for medical assistance. Risk factors are also considered in order to optimize treatment planning. Due to the underlying molecular mechanisms of RILI, the present review also discusses several targeted pharmacological approaches for its treatment, as well as corticosteroid therapy.
Collapse
Affiliation(s)
- Guodong Deng
- Department of Radiation Oncology, Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Ning Liang
- Department of Radiation Oncology, Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Jian Xie
- Department of Radiation Oncology, Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Hui Luo
- Department of Radiation Oncology, Henan Cancer Hospital, Zhengzhou University, Zhengzhou, Henan 450001, P.R. China
| | - Lili Qiao
- Department of Oncology, The Fifth People's Hospital of Jinan, Jinan, Shandong 250022, P.R. China
| | - Jingxin Zhang
- Division of Oncology, Graduate School, Weifang Medical College, Weifang, Shandong 261053, P.R. China
| | - Dawei Wang
- Department of Radiology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, P.R. China
| | - Jiandong Zhang
- Department of Radiation Oncology, Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| |
Collapse
|
23
|
Radioprotection as a Method to Enhance the Therapeutic Ratio of Radiotherapy. CANCER DRUG DISCOVERY AND DEVELOPMENT 2017. [DOI: 10.1007/978-3-319-40854-5_4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
24
|
Bellefqih S, Elmajjaoui S, Aarab J, Khalil J, Afif M, Lachgar A, El Kacemi H, Kebdani T, Benjaafar N. Hypofractionated Regional Nodal Irradiation for Women With Node-Positive Breast Cancer. Int J Radiat Oncol Biol Phys 2016; 97:563-570. [PMID: 28126305 DOI: 10.1016/j.ijrobp.2016.11.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 10/03/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the effect of hypofractionated radiation therapy (HFRT) of the breast/chest wall and regional nodes on overall survival (OS), disease-free survival (DFS), locoregional control and on treatment-related toxicity in patients with breast cancer and nodal involvement. METHODS AND MATERIALS Two hundred fifty-seven patients treated between October 2009 and June 2011 with hypofractionated locoregional radiation therapy (42 Gy in 15 fractions) were retrospectively reviewed, 51 (19.8%) after breast-conserving surgery and 206 (80.2%) after radical surgery. Patients treated with breast-conserving surgery received a boost dose to the tumor bed (delivered by photons, electrons, or interstitial high-dose-rate brachytherapy). Two hundred fifty-six (99.6%) patients underwent chemotherapy, 209 (81.3%) had hormonal treatment, and 65 (25.3%) had anti-HER2 targeted therapy. RESULTS The median follow-up time was 64 months (range, 11-88 months). The rates of 5-year OS, DFS, locoregional recurrence (LRR)-free survival, and distant metastasis (DM)-free survival were 86.6%, 84.4%, 93.9%, and 83.1%, respectively. In multivariate analysis (MVA), lymph node ratio >65%, lymphovascular invasion, and negative hormone receptor status predicted for OS, DSF, and DM. T3 to 4 stage was also associated with worse DFS and DM. Finally, for LRR the independent prognostic factors on MVA were N2 to 3 stage and grade 3. Hyperpigmentation was observed in 19.2% of patients, telangiectasia in 12.3%, and fibrosis in 30.7%. Grade ≥2 lymphedema was recorded in 5.8% of cases. During the study follow-up, no cardiac or symptomatic pneumonitis was observed, nor were plexopathy or rib fractures. CONCLUSION According to the findings from this retrospective study, HFRT seems to be an acceptable alternative for patients with breast cancer who need regional nodal irradiation. However, prospective randomized trials are necessary to confirm these preliminary results.
Collapse
Affiliation(s)
- Sara Bellefqih
- Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
| | - Sanaa Elmajjaoui
- Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Jihan Aarab
- Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Jihane Khalil
- Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Mohamed Afif
- Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Amine Lachgar
- Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Hanan El Kacemi
- Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Tayeb Kebdani
- Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Noureddine Benjaafar
- Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| |
Collapse
|
25
|
Wright JL, Takita C, Reis IM, Zhao W, Lee E, Nelson OL, Hu JJ. Prospective evaluation of radiation-induced skin toxicity in a race/ethnically diverse breast cancer population. Cancer Med 2016; 5:454-64. [PMID: 26763411 PMCID: PMC4799959 DOI: 10.1002/cam4.608] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/18/2015] [Indexed: 01/08/2023] Open
Abstract
We evaluated predictors of radiation‐induced skin toxicity in a prospective study of a tri‐racial/ethnic breast cancer population. We evaluated patient demographics, tumor characteristics, and treatment variables in the first 392 patients in a prospective study assessing radiation‐induced skin toxicity. Logistic regression analyses were conducted to evaluate potential predictors of skin toxicity. The study consists of 59 non‐Hispanic whites (NHW; 15%), 241 Hispanic Whites (HW; 62%), 79 black or African Americans (AA; 20%), and 13 others (3%). Overall, 48% developed grade 0–1 skin toxicity, 49.8% grade 2, and 2.2% grade 3 by the National Cancer Institute's Common Toxicity Criteria for Adverse Events (CTCAE) scale. Twenty‐one percent developed moist desquamation. In multivariate analysis, higher body mass index (BMI; OR = 2.09; 95%CI = 1.15, 3.82), higher disease stage (OR = 1.82; 95%CI = 1.06, 3.11), ER‐positive/PR‐negative status (OR = 2.74; 95%CI = 1.26, 5.98), and conventionally fractionated regimens (OR = 3.25; 95%CI = 1.76, 6.01) were significantly associated with higher skin toxicity grade after adjustment for age, race, ethnicity, ER status, and breast volume. BMI specifically predicted for moist desquamation, but not degree of erythema. In this racially and ethnically diverse cohort of breast cancer patients receiving radiation to the intact breast, risk factors including BMI, disease stage, and conventionally fractionated radiation predicted for higher skin toxicity grade, whereas age, race, ethnicity, and breast volume did not. BMI specifically predicted for moist desquamation, suggesting that preventive measures to address this particular outcome should be investigated.
Collapse
Affiliation(s)
- Jean L Wright
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Cristiane Takita
- Department of Radiation Oncology, University of Miami School of Medicine, Miami, Florida
| | - Isildinha M Reis
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida
| | - Eunkyung Lee
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
| | - Omar L Nelson
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida
| | - Jennifer J Hu
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida
| |
Collapse
|
26
|
Shin SM, No HS, Vega RM, Fenton-Kerimian M, Maisonet O, Hitchen C, Keith DeWyngaert J, Formenti SC. Breast, chest wall, and nodal irradiation with prone set-up: Results of a hypofractionated trial with a median follow-up of 35 months. Pract Radiat Oncol 2015; 6:e81-e88. [PMID: 26723552 DOI: 10.1016/j.prro.2015.10.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 10/28/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To test clinical feasibility, safety, and toxicity of prone hypofractionated breast, chest wall, and nodal radiation therapy. METHODS AND MATERIALS Following either segmental or total mastectomy with axillary node dissection, patients were treated in an institutional review board-approved prospective trial of prone radiation therapy to the breast, chest wall, and supraclavicular and level III axillary lymph nodes. A dose of 40.5 Gy/15 fractions with a concomitant daily boost to the tumor bed of 0.5 Gy (total dose, 48 Gy) was prescribed. In postmastectomy patients, the same treatment was prescribed, but without a tumor bed boost. The primary endpoint was incidence of >grade 2 acute skin toxicity. The secondary endpoints were feasibility of treatment using prone set-up, compliance with protocol-defined dosimetric constraints, and incidence of late toxicity. A dosimetric comparison was performed between protocol plans (prone) and nonprotocol plans (supine), targeting the same treatment volumes. RESULTS Sixty-nine patients with stage IB-IIIA breast cancer enrolled in this trial. Surgery was segmental mastectomy (n = 45), mastectomy (n = 23), and bilateral mastectomy (n = 1), resulting in 70 cases. None experienced >grade 2 acute skin toxicity according to the Common Terminology Criteria for Adverse Events, v 3.0, meeting our primary endpoint. Ninety-six percent of patients could be treated with this technique prone. However, 17 plans (24%) exceeded protocol constraints to the brachial plexus. Maximum long-term toxicity was 1 grade 2 arm lymphedema, 1 grade 3 breast retraction, and no occurrence of brachial plexopathy. Dosimetric comparison of protocol with nonprotocol plans demonstrated significantly decreased lung and heart doses in prone plans. CONCLUSIONS Prone hypofractionated breast, chest wall, and nodal radiation therapy is safe and well tolerated in this study. Although the initial pattern of local and regional control is encouraging, longer follow-up is warranted for efficacy and late toxicity assessment, particularly to the brachial plexus.
Collapse
Affiliation(s)
- Samuel Minkee Shin
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Hyun Soo No
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Raymond Mailhot Vega
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Maria Fenton-Kerimian
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Olivier Maisonet
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Christine Hitchen
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - J Keith DeWyngaert
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Silvia Chiara Formenti
- Department of Radiation Oncology, New York Weill Cornell Medical Center, New York, New York.
| |
Collapse
|
27
|
Rosen EM, Day R, Singh VK. New approaches to radiation protection. Front Oncol 2015; 4:381. [PMID: 25653923 PMCID: PMC4299410 DOI: 10.3389/fonc.2014.00381] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 12/19/2014] [Indexed: 12/16/2022] Open
Abstract
Radioprotectors are compounds that protect against radiation injury when given prior to radiation exposure. Mitigators can protect against radiation injury when given after exposure but before symptoms appear. Radioprotectors and mitigators can potentially improve the outcomes of radiotherapy for cancer treatment by allowing higher doses of radiation and/or reduced damage to normal tissues. Such compounds can also potentially counteract the effects of accidental exposure to radiation or deliberate exposure (e.g., nuclear reactor meltdown, dirty bomb, or nuclear bomb explosion); hence they are called radiation countermeasures. Here, we will review the general principles of radiation injury and protection and describe selected examples of radioprotectors/mitigators ranging from small-molecules to proteins to cell-based treatments. We will emphasize agents that are in more advanced stages of development.
Collapse
Affiliation(s)
- Eliot M Rosen
- Departments of Oncology, Biochemistry and Molecular & Cellular Biology, and Radiation Medicine, Lombardi Comprehensive Cancer Center, Georgetown University School of Medicine , Washington, DC , USA
| | - Regina Day
- Department of Pharmacology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
| | - Vijay K Singh
- Department of Radiation Biology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD , USA ; Radiation Countermeasures Program, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
| |
Collapse
|
28
|
Vasin MV, Ushakov IB. Comparative efficacy and the window of radioprotection for adrenergic and serotoninergic agents and aminothiols in experiments with small and large animals. JOURNAL OF RADIATION RESEARCH 2015; 56:1-10. [PMID: 25312329 PMCID: PMC4572585 DOI: 10.1093/jrr/rru087] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 08/25/2014] [Accepted: 09/05/2014] [Indexed: 06/04/2023]
Abstract
This review gives a comparative evaluation of the radioprotective properties and the therapeutic index (TI) of radioprotectors from various pharmacological group in experiments on both small and large animals. It presents a hypothesis explaining the decrease in the TI of cystamine and 5-methoxytryptamine (mexamine), and the retention of that of α1-adrenomimetic indralin, and also compares the effects on large and small animals. The considerable differences in the therapeutic indices of catecholamines, serotonin and cystamine are a consequence of specific features of their mechanisms of radioprotective action. Radioprotectors acting via receptor mediation tend to provide a more expanded window of protection. The reduction in the TI of cystamine in larger animals, such as dogs, may be caused by the greater increase in toxicity of aminothiols in relation to the decrease in their optimal doses for radioprotective effect in going from mice to dogs, which is a consequence of the slower metabolic processes in larger animals. The somatogenic phase of intoxication by cystamine is significantly longer than the duration of its radioprotective effect, and increases with irradiation. The decrease in the radioprotective effect and the TI of mexamine in experiments with dogs may be caused by their lower sensitivity to the acute hypoxia induced by the mexamine. This is because of lower gradient in oxygen tension between tissue cells and blood capillaries under acute hypoxia that is determined by lower initial oxygen consumption in a large animal as compared with a small animal. Indralin likely provides optimal radioprotective effects and a higher TI for large animals via the increased specificity of its adrenergic effect on tissue respiration, which supports the development of acute hypoxia in the radiosensitive tissues of large animals. The stimulatory effect of indralin on early post-irradiation haematopoietic recovery cannot provide a high level of radioprotective action for large animals, but it may promote recovery.
Collapse
Affiliation(s)
- Mikhail V Vasin
- State Scientific Center Russian Federation - Institute of Biomedical Problems, Russian Academy of Science, 76a Khoroshovskoe schuss, Moscow123007, Russia
| | - Igor B Ushakov
- State Scientific Center Russian Federation - Institute of Biomedical Problems, Russian Academy of Science, 76a Khoroshovskoe schuss, Moscow123007, Russia
| |
Collapse
|
29
|
Wright JL, Takita C, Reis IM, Zhao W, Lee E, Hu JJ. Racial Variations in Radiation-Induced Skin Toxicity Severity: Data From a Prospective Cohort Receiving Postmastectomy Radiation. Int J Radiat Oncol Biol Phys 2014; 90:335-43. [DOI: 10.1016/j.ijrobp.2014.06.042] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 06/09/2014] [Accepted: 06/16/2014] [Indexed: 10/24/2022]
|
30
|
Vasin MV. Comments on the mechanisms of action of radiation protective agents: basis components and their polyvalence. SPRINGERPLUS 2014; 3:414. [PMID: 25133093 PMCID: PMC4132458 DOI: 10.1186/2193-1801-3-414] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/31/2014] [Indexed: 12/18/2022]
Abstract
Purpose These comments suggest a division of radiation protective agents on the grounds of their mechanism of action that increase the radio resistance of an organism. Conclusion Given below is the division of radiation protective agents on the basis of their mechanism of action into 3 groups: 1) Radiation protective agents, with the implementation of radiation protective action taking place at the cellular level in the course of rapidly proceeding radiation-chemical reactions. At the same time, when the ionizing radiation energy is absorbed, these agents partially neutralize the “oxygen effect” as a radiobiological phenomenon, especially in the radiolysis of DNA; 2) Radiation protective agents that exert their effect at the system level by accelerating the post-radiation recovery of radiosensitive tissues through activation of a number of pro-inflammatory signaling pathways and an increase in the secretion of hematopoietic growth factors, including their use as mitigators in the early period after irradiation prior to the clinical development of acute radiation syndrome (ARS). 3) Radiomodulators including drugs and nutritional supplements that can elevate the resistance of the organism to adverse environmental factors, including exposure to ionization by means of modulating the gene expression through a hormetic effect of small doses of stressors and a “substrate” maintenance of adaptive changes, resulting in an increased antioxidant protection of the organism. Radiation protective agents having polyvalence in implementation of their action may simultaneously induce radioprotective effect by various routes with a prevalence of basis mechanisms of the action.
Collapse
Affiliation(s)
- Mikhail V Vasin
- Department of Medicine of Catastrophe, Russian Medical Academy of Post-Graduate Education, St. Polikarpova 10, 125284 Moscow, Russia
| |
Collapse
|
31
|
Mancini ML, Sonis ST. Mechanisms of cellular fibrosis associated with cancer regimen-related toxicities. Front Pharmacol 2014; 5:51. [PMID: 24734020 PMCID: PMC3973915 DOI: 10.3389/fphar.2014.00051] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 03/09/2014] [Indexed: 11/26/2022] Open
Abstract
Fibrosis is a common, persistent and potentially debilitating complication of chemotherapy and radiation regimens used for the treatment of cancer. The molecular mechanisms underlying fibrosis have been well studied and reveal overall processes that are largely ubiquitous. However, it is important to note that although the processes are similar, they result in cellular phenotypes that are highly tissue specific. These tissue specific differences may present opportunities for therapeutic interventions to prevent or treat this often irreversible condition. Data generated from animal models of cancer therapy-related tissue toxicities have revealed that the signaling pathways involved in fibrosis are the same as those involved in the normal injury response and include the transforming growth factor β superfamily and a range of pro-inflammatory cytokines. The critical difference between normal wound healing and fibrosis development appears to be, that in fibrosis, these signaling pathways escape normal cellular regulation. As a result, an injury state is maintained and processes involved in normal healing are usurped. There are a few, if any, therapeutics that effectively prevent or treat fibrosis in patients. Consequently, cancer survivors may be chronically plagued with a variety of life-altering fibrosis-related symptoms. Uncovering the signaling pathways that drive cellular fibrosis is paramount to the development of specific therapeutics that will mitigate this potentially devastating condition.
Collapse
|
32
|
Hypofractionated regional nodal irradiation for breast cancer: Examining the data and potential for future studies. Radiother Oncol 2014; 110:39-44. [DOI: 10.1016/j.radonc.2013.12.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/23/2013] [Accepted: 12/23/2013] [Indexed: 12/25/2022]
|
33
|
Bourgier C, Lemanski C, Riou O, Charissoux M, Fenoglietto P, Azria D. [Hypofractionated radiotherapy, a standard in breast cancer?]. Cancer Radiother 2013; 17:705-7. [PMID: 24176662 DOI: 10.1016/j.canrad.2013.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 09/12/2013] [Accepted: 09/20/2013] [Indexed: 01/08/2023]
Abstract
In the era of high-tech radiotherapy, hypofractionated schema is more and more widely used regardless of tumour sites. In this article, we expose the role, techniques and indications of hypofractionated radiotherapy in adjuvant breast radiotherapy.
Collapse
Affiliation(s)
- C Bourgier
- Département de radiothérapie oncologique, institut du cancer de Montpellier, 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France.
| | | | | | | | | | | |
Collapse
|
34
|
Ding NH, Li JJ, Sun LQ. Molecular mechanisms and treatment of radiation-induced lung fibrosis. Curr Drug Targets 2013; 14:1347-56. [PMID: 23909719 PMCID: PMC4156316 DOI: 10.2174/13894501113149990198] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/11/2013] [Accepted: 07/11/2013] [Indexed: 02/06/2023]
Abstract
Radiation-induced lung fibrosis (RILF) is a severe side effect of radiotherapy in lung cancer patients that presents as a progressive pulmonary injury combined with chronic inflammation and exaggerated organ repair. RILF is a major barrier to improving the cure rate and well-being of lung cancer patients because it limits the radiation dose that is required to effectively kill tumor cells and diminishes normal lung function. Although the exact mechanism is unclear, accumulating evidence suggests that various cells, cytokines and regulatory molecules are involved in the tissue reorganization and immune response modulation that occur in RILF. In this review, we will summarize the general symptoms, diagnostics, and current understanding of the cells and molecular factors that are linked to the signaling networks implicated in RILF. Potential approaches for the treatment of RILF will also be discussed. Elucidating the key molecular mediators that initiate and control the extent of RILF in response to therapeutic radiation may reveal additional targets for RILF treatment to significantly improve the efficacy of radiotherapy for lung cancer patients.
Collapse
Affiliation(s)
- Nian-Hua Ding
- Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410078, China
| | - Jian Jian Li
- Department of Radiation Oncology, NCI-Designated Comprehensive Cancer Center, University of California at Davis, Sacramento, CA 95817, USA
| | - Lun-Quan Sun
- Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410078, China
| |
Collapse
|
35
|
A G, Ren L, Zhou Z, Lu D, Wang S. Design and evaluation of biodegradable enteric microcapsules of amifostine for oral delivery. Int J Pharm 2013; 453:441-7. [PMID: 23796837 DOI: 10.1016/j.ijpharm.2013.06.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 04/30/2013] [Accepted: 06/12/2013] [Indexed: 11/26/2022]
Abstract
Amifostine is the first FDA approved cytoprotective and chemoprotective agent in the treatment of cancer. However, it is not used widely because of its ineffectiveness when administered orally. The objective of this study was to prepare and evaluate the radioprotective efficacy of orally active amifostine enteric microcapsules (amifostine mc). The microcapsules were prepared by spray drying technique using Eudragit L100-55, and the yield was more than 80%. The particle size and surface morphology were determined by particle analyzer and scanning electron microscopy. Thermal characterization and infrared spectroscopy were evaluated as well. In vitro release assay found that more than 60% amifostine was released during the first 4h and the cumulative release ratio was up to approximately 90% in 24h at 37°C. The radioprotective efficacy was determined by 30-day survival study in mice acutely exposed to 6 Gy γ-ray irradiation. The results showed that all dose groups of amifostine microcapsules could significantly improve survival animal numbers and time. Furthermore, tissue distribution studies indicated the concentrations of the active metabolite WR-1065 in mice tissues of microcapsule group were higher than that of oral amifostine group at 180 min (p<0.01). These results demonstrated that oral administration of amifostine microcapsules provided effective radioprotection compared to the bulk drug.
Collapse
Affiliation(s)
- Gula A
- Beijing Institute of Radiation Medicine, Beijing 100850, PR China
| | | | | | | | | |
Collapse
|