1
|
Affiliation(s)
- Alexis Kelekis
- From the 2nd Radiology and Radiation Therapy Department, National and Kapodistrian University of Athens, Attikon General University Hospital, Rimin 1, Haidari, Athens 12467, Greece
| |
Collapse
|
2
|
Dennstädt F, Treffers T, Iseli T, Panje C, Putora PM. Creation of clinical algorithms for decision-making in oncology: an example with dose prescription in radiation oncology. BMC Med Inform Decis Mak 2021; 21:212. [PMID: 34247596 PMCID: PMC8274051 DOI: 10.1186/s12911-021-01568-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/29/2021] [Indexed: 12/03/2022] Open
Abstract
In oncology, decision-making in individual situations is often very complex. To deal with such complexity, people tend to reduce it by relying on their initial intuition. The downside of this intuitive, subjective way of decision-making is that it is prone to cognitive and emotional biases such as overestimating the quality of its judgements or being influenced by one’s current mood. Hence, clinical predictions based on intuition often turn out to be wrong and to be outperformed by statistical predictions. Structuring and objectivizing oncological decision-making may thus overcome some of these issues and have advantages such as avoidance of unwarranted clinical practice variance or error-prevention. Even for uncertain situations with limited medical evidence available or controversies about the best treatment option, structured decision-making approaches like clinical algorithms could outperform intuitive decision-making. However, the idea of such algorithms is not to prescribe the clinician which decision to make nor to abolish medical judgement, but to support physicians in making decisions in a systematic and structured manner. An example for a use-case scenario where such an approach may be feasible is the selection of treatment dose in radiation oncology. In this paper, we will describe how a clinical algorithm for selection of a fractionation scheme for palliative irradiation of bone metastases can be created. We explain which steps in the creation process of a clinical algorithm for supporting decision-making need to be performed and which challenges and limitations have to be considered.
Collapse
Affiliation(s)
- Fabio Dennstädt
- Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9000, St. Gallen, Switzerland.
| | - Theresa Treffers
- Seeburg Castle University, Seekirchen am Wallersee, Austria.,TUM School of Management, Technical University of Munich, Munich, Germany
| | - Thomas Iseli
- Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9000, St. Gallen, Switzerland
| | - Cédric Panje
- Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9000, St. Gallen, Switzerland.,Department of Radiation Oncology, University of Berne, Berne, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9000, St. Gallen, Switzerland.,Department of Radiation Oncology, University of Berne, Berne, Switzerland
| |
Collapse
|
3
|
Chen Z, Yu H, Lu W, Shen J, Wang Y, Wang Y. Bone-Seeking Albumin-Nanomedicine for In Vivo Imaging and Therapeutic Monitoring. ACS Biomater Sci Eng 2019; 6:647-653. [PMID: 33463196 DOI: 10.1021/acsbiomaterials.9b01195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Malignant osteolysis associated with irreversible primary bone tumors and bone metastases remains a clinically urgent problem. Exploiting the imaging and therapy function of flexible nanomedicine can provide an alternative for therapeutic navigation and monitoring of malignant osteolysis. Here, we report the development of albumin-based gadolinium oxide nanoparticles loaded with doxorubicin and conjugated with bone-seeking alendronate for targeted delivery and therapeutic monitoring. Compared with nontargeted nanomedicine, bone-seeking accumulation and retention can be proven by MRI in a rat model of focal malignant osteolysis. Meanwhile, we observed a whole-body distribution in the consecutive SPECT imaging after radiolabeling with 125I, SPECT imaging also indicated the enhanced bone tumor accumulation and prolonged retention. Resulting from the high drug loading and 131I labeling efficiency, the targeted nanomedicine exhibited significant chemotherapy and inter-radiotherapy capacity. Ultimately, the tumor burden of rats was obviously decreased except for the nontargeted group and the empty carrier group. In vivo CT imaging and pathological analysis revealed that the combined therapy was an efficient measure for antiosteolysis. Our findings suggest that albumin-based nanomedicine can provide a platform for bone-seeking diagnosis and therapeutic monitoring.
Collapse
Affiliation(s)
- Zhizhong Chen
- The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou 215004, P. R. China
| | - Hongchang Yu
- The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou 215004, P. R. China
| | - Wei Lu
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University, 199 Renai Road, Suzhou Industrial Park, Suzhou 215123, P. R. China
| | - Junkang Shen
- The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou 215004, P. R. China
| | - Yong Wang
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University, 199 Renai Road, Suzhou Industrial Park, Suzhou 215123, P. R. China
| | - Yangyun Wang
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University, 199 Renai Road, Suzhou Industrial Park, Suzhou 215123, P. R. China
| |
Collapse
|
4
|
Fakhari A, Gharepapagh E, Dabiri S, Gilani N. Correlation of cancer antigen 15-3 (CA15-3) serum level and bony metastases in breast cancer patients. Med J Islam Repub Iran 2019; 33:142. [PMID: 32280648 PMCID: PMC7137849 DOI: 10.34171/mjiri.33.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Indexed: 01/10/2023] Open
Abstract
Background: Cancer antigen 15-3 (CA15-3) is a common tumor marker and the serum level of this tumor marker is evaluated during the treatment period (periodically) in breast cancer patients. Assuming that the elevated serum levels of this tumor marker can be a potential risk, this study was conducted to determine the association between CA15-3 and bone metastasis and CA15-3 and metastasis spreading rate in breast cancer patients. Methods: In this study, 70 women with the mean of age 51.69 (10.77) years who suffered from breast cancer were studied by performing both bone scintigraphy and measuring CA15-3. Independent sample t test, Fisher's exact test, Spearman rho correlation, and logistic regression were used for inferential section. To determine the new cross section, Roc curve and coordinates of the curve were applied. Also, significance level was set at p<0.05. Data were analyzed by SPSS 16 software. Results: There was no difference among patients in age (p=0.123). Assuming the CA15-3 (≥ 30 U/mL) as a potential risk, there was no association between CA15-3 and bone metastases (p=0.167). Based on Spearman's rank correlation coefficient, there was no significant correlation between CA15-3 and metastasis spreading rate (r=-0.07, p=0.851). Based on ROC curve and Youden's J statistic index, the new cutoff was pointed at CA15-3 ≥21.76 Unit/mL, which correlated with bone metastases (p<0.001). Conclusion: This study found a decreased cutoff point at CA15-3 (≥21.76) against 30 (routine value). Based on CA15-3 (≥21.76), there was a correlation between bone metastases and CA15-3, indicating that patients with CA15-3 (≥21.76) were most likely to experience bone metastases.
Collapse
Affiliation(s)
- Ashraf Fakhari
- Medical Radiation Sciences Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Radiology, Medical School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Esmaeil Gharepapagh
- Medical Radiation Sciences Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Radiology, Medical School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahram Dabiri
- Medical Radiation Sciences Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Radiology, Medical School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Gilani
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
5
|
Lee CH, Decker AM, Cackowski FC, Taichman RS. Bone microenvironment signaling of cancer stem cells as a therapeutic target in metastatic prostate cancer. Cell Biol Toxicol 2019; 36:115-130. [PMID: 31250347 DOI: 10.1007/s10565-019-09483-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/18/2019] [Indexed: 01/06/2023]
Abstract
Prostate cancer (PCa) is one of the most prevalent cancers and the second leading cause of cancer death among US males. When diagnosed in an early disease stage, primary tumors of PCa may be treated with surgical resection or radiation, sometimes combined with androgen deprivation therapy, with favorable outcomes. Unfortunately, the treatment efficacy of each approach decreases significantly in later stages of PCa that involve metastasis to soft tissues and bone. Metastatic PCa is a heterogeneous disease containing host cells, mature cancer cells, and subpopulation of cancer stem cells (CSC). CSCs are highly tumorigenic due to their self-renewing and differentiating potential, clinically resulting in recurrence and resistance to standard therapies. Therefore, there is a large unmet clinical need to develop therapies, which target CSC activity. In this review, we summarize the main signaling pathways that are implicated in the current pre-clinical and clinical studies of recurrent metastatic PCa within the bone microenvironment targeting CSCs and discuss the trajectory of therapeutics moving forward.
Collapse
Affiliation(s)
- Clara H Lee
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, 48109, USA
| | - Ann M Decker
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, 48109, USA
| | - Frank C Cackowski
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, 48109, USA.,Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan School of Medicine, Ann Arbor, MI, 48109, USA
| | - Russell S Taichman
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, 48109, USA. .,Department of Periodontology, University of Alabama Birmingham School of Dentistry, Birmingham, Alabama, USA.
| |
Collapse
|
6
|
Bitton RR, Webb TD, Pauly KB, Ghanouni P. Prolonged heating in nontargeted tissue during MR‐guided focused ultrasound of bone tumors. J Magn Reson Imaging 2019; 50:1526-1533. [DOI: 10.1002/jmri.26726] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 12/16/2022] Open
Affiliation(s)
- Rachel R. Bitton
- School of Medicine, Department of RadiologyStanford University Stanford California USA
| | - Taylor D. Webb
- Department of Electrical EngineeringStanford University Stanford California USA
| | - Kim Butts Pauly
- School of Medicine, Department of RadiologyStanford University Stanford California USA
| | - Pejman Ghanouni
- School of Medicine, Department of RadiologyStanford University Stanford California USA
| |
Collapse
|
7
|
Bertrand AS, Iannessi A, Natale R, Beaumont H, Patriti S, Xiong-Ying J, Baudin G, Thyss A. Focused ultrasound for the treatment of bone metastases: effectiveness and feasibility. J Ther Ultrasound 2018; 6:8. [PMID: 30519467 PMCID: PMC6267064 DOI: 10.1186/s40349-018-0117-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 11/01/2018] [Indexed: 12/25/2022] Open
Abstract
Background To evaluate the effectiveness and feasibility of high-intensity focused ultrasound (HIFU) for the treatment of bone metastases. Methods A single-center prospective study was made involving 17 consecutive patients with symptomatic bone metastases. Patients were treated by Focused Ultrasound (FUs) performed with magnetic resonance (MR) guidance. Surgical treatment or radiotherapy treatment was not indicated for patients who underwent FUs. Lesions were located in the appendicular and axial skeleton and consisted of secondary symptomatic lesions. The clinical course of pain was evaluated using the Visual Analog Scale (VAS) before treatment, at 1 week, and at 1 month after treatment and the Oral Morphine Equivalent Daily Dose (OMEDD) was also recorded. We used Wilcoxon signed rank test to assess change in patient pain (R CRAN software V 3.1.1). Results We observed a significant decrease in the pain felt by patients between pre- procedure and 1 week post-procedure (p = 2.9.10-4), and pre-procedure and 1 month post-procedure (p = 3.10-4). The proportion of responders according to the International Bone Metastases Consensus Working Party was: Partial Response 50% (8/16) and Complete Response 37.5% (6/16). Conclusions HIFU under MR-guidance seems to be an effective and safe procedure in the treatment of symptomatic bone lesions for patients suffering from metastatic disease. A significant decrease of patient pain was observed. Trial registration NCT01091883. Registered 24 March 2010. Level of evidence: Level 3.
Collapse
Affiliation(s)
- Anne-Sophie Bertrand
- Department of Interventional Radiology, Centre de Lutte contre le Cancer Antoine Lacassagne, 33 Avenue de Valombrose, 06100 NICE, France
| | - Antoine Iannessi
- Department of Interventional Radiology, Centre de Lutte contre le Cancer Antoine Lacassagne, 33 Avenue de Valombrose, 06100 NICE, France
| | - Romain Natale
- Department of Radiotherapy, Centre de Lutte contre le Cancer Antoine Lacassagne, 33 Avenue de Valombrose, 06100 NICE, France
| | - Hubert Beaumont
- 3Department of Statistics, University of Nice Sophia Antipolis, 28 Avenue Valrose, 06000 NICE, France
| | - Sebastien Patriti
- Department of Interventional Radiology, Centre de Lutte contre le Cancer Antoine Lacassagne, 33 Avenue de Valombrose, 06100 NICE, France
| | - Jiang Xiong-Ying
- Department of Interventional Radiology, Centre de Lutte contre le Cancer Antoine Lacassagne, 33 Avenue de Valombrose, 06100 NICE, France
| | - Guillaume Baudin
- Department of Interventional Radiology, Centre de Lutte contre le Cancer Antoine Lacassagne, 33 Avenue de Valombrose, 06100 NICE, France
| | - Antoine Thyss
- Department of Oncology, Centre de Lutte anti-Cancer Antoine Lacassagne, 33 Avenue de Valombrose, 06100 NICE, France
| |
Collapse
|
8
|
Bing F, Vappou J, de Mathelin M, Gangi A. Targetability of osteoid osteomas and bone metastases by MR-guided high intensity focused ultrasound (MRgHIFU). Int J Hyperthermia 2018; 35:471-479. [DOI: 10.1080/02656736.2018.1508758] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Fabrice Bing
- Radiology Department, Hôpital d’Annecy, Metz-Tessy, France
- ICube, University of Strasbourg, Strasbourg, France
- Interventional Radiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | | | - Afshin Gangi
- ICube, University of Strasbourg, Strasbourg, France
- Interventional Radiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| |
Collapse
|
9
|
Connolly KA, Belt BA, Figueroa NM, Murthy A, Patel A, Kim M, Lord EM, Linehan DC, Gerber SA. Increasing the efficacy of radiotherapy by modulating the CCR2/CCR5 chemokine axes. Oncotarget 2018; 7:86522-86535. [PMID: 27852031 PMCID: PMC5349932 DOI: 10.18632/oncotarget.13287] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/29/2016] [Indexed: 02/04/2023] Open
Abstract
Although radiotherapy (RT) is widely used to control tumor growth across many cancer types, there is a relatively high incidence of RT failure exhibited by tumor recurrence, therefore a clear need exists to achieve improved effectiveness of RT. The RT-elicited immune response largely impacts the efficacy of RT and includes immune cells that kill tumor cells, but also immunosuppressive cells, which dampen anti-tumor immunity. Using murine models in which syngeneic tumor cell lines (Colon38, Glioma261, Line1) are grown intramuscularly and treated with 15 Gy local RT, we assessed the effects of RT on both the systemic and intratumoral immune response. Here we demonstrate that RT stimulates increased production of two chemokines, CCL2 and CCL5, at the tumor site. Further, that this leads to increased CCR2+ CCR5+ monocytes in circulation and subsequently alters the intratumoral immune infiltrate favoring the largely immunosuppressive CCR2+ CCR5+ monocytes. Importantly, a CCR2/CCR5 antagonist administered daily (15 mg/kg subcutaneously) starting two days prior to RT reduces both circulating and intratumoral monocytes resulting in increased efficacy of RT in radioresponsive tumors. Overall, these data have important implications for the mechanism of RT and present a means to improve RT efficacy across many cancer types.
Collapse
Affiliation(s)
- Kelli A Connolly
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Brian A Belt
- Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Nathania M Figueroa
- Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Aditi Murthy
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Ankit Patel
- Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Minsoo Kim
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Edith M Lord
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - David C Linehan
- Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Scott A Gerber
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY 14642, USA.,Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA
| |
Collapse
|