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Park SH, Peters M, Aguayo C, Farris MK, Hughes RT, Moore J, Munley MT, Reno KE, Gardin J, Cline JM, Peters CM, Willey JS. Secretory factors released from high dose radiation-activated osteoclasts increase the expression level of pain-associated neuropeptides in sensory neuronal cultures. RESEARCH SQUARE 2024:rs.3.rs-4534694. [PMID: 39011106 PMCID: PMC11247937 DOI: 10.21203/rs.3.rs-4534694/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Stereotactic Body Radiation Therapy for lung tumors near the chest wall often causes significant chest wall pain (CWP), negatively impacting patients' quality of life. The mechanisms behind SBRT-induced CWP remain unclear and may involve multiple factors. We investigated the potential crosstalk between radiation-activated osteoclasts and sensory neurons, focusing on osteoclast-derived factors in CWP. Using the murine pre-osteoclast cell line Raw264.7, we induced differentiation with RANKL, followed by 10Gy gamma-irradiation. Conditioned media from these irradiated osteoclasts was used to treat sensory neuronal cultures from mouse dorsal root ganglia. Neuronal cultures were also directly exposed to 10Gy radiation, with and without osteoclast co-culture. Analysis of osteoclast markers and pain-associated neuropeptides was conducted using RT-qPCR and histochemical staining. Osteoclast differentiation and activity were inhibited using Osteoprotegerin and risedronate. Results showed that high-dose radiation significantly increased osteoclast size, resorption pit size, and activity biomarkers. Neurons treated with CM from irradiated osteoclasts showed increased expression of pain-associated neuropeptides CGRP and Substance P, which was mitigated by osteoprotegerin and risedronate. This study suggests that high-dose radiation enhances osteoclast activity, upregulating pain-associated neuropeptides in sensory neurons, and that inhibitors like osteoprotegerin and risedronate may offer therapeutic strategies for managing radiation-induced pain.
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Affiliation(s)
- Sun H Park
- Wake Forest University School of Medicine
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Li Y, Jiang J, Jiang Q, Lu W, Cui H, Song Y, Li W, Zhang T, Li L. Advanced navigation technology enables endobronchial brachytherapy for peripheral lung cancer: An old technique plays a new role. Brachytherapy 2024; 23:199-206. [PMID: 38161082 DOI: 10.1016/j.brachy.2023.12.003] [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: 08/09/2023] [Revised: 11/19/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To investigate the feasibility of super-selectively endobronchial brachytherapy in the treatment of peripheral lung cancer guided by advanced navigation technology. METHODS AND MATERIALS Six patients with peripheral lung tumors successfully underwent treatment with super-selectively endobronchial brachytherapy guided by advanced navigation technology following pathway planning and were subsequently followed up to assess survival and treatment-related toxicities. RESULTS The endobronchial applicators were successfully placed inside the tumors of all patients using advanced navigation techniques according to the pretreatment plan, and brachytherapy was delivered at curative doses after evaluation using radiotherapy planning software. None of the patients showed local progression of the treated lesions during the follow-up for a duration ranging from 11 months to 35 months, with a median follow-up time of 23 months. The patient with the longest follow-up, nearly 3 years, exhibited a stable condition. After undergoing endobronchial brachytherapy, patients predominantly experienced localized fibrosis as indicated. No significant alterations in cardiopulmonary function were detected during the follow-up, and no other adverse effects were found. CONCLUSIONS The use of endobronchial brachytherapy for the curative treatment of peripheral lung cancers is feasible. Furthermore, the development of novel bronchial navigation techniques has the potential to broaden the application of endobronchial brachytherapy.
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Affiliation(s)
- Yishi Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juan Jiang
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingfeng Jiang
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenli Lu
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haixia Cui
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanbo Song
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wencong Li
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Zhang
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Longhao Li
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Pierre-Louis Odoom J, Freeberg MAT, Camus SV, Toft R, Szomju BB, Sanchez Rosado RM, Jackson PD, Allegood JC, Silvey S, Liu J, Cowart LA, Weiss E, Thatcher TH, Sime PJ. Exhaled breath condensate identifies metabolic dysregulation in patients with radiation-induced lung injury. Am J Physiol Lung Cell Mol Physiol 2023; 324:L863-L869. [PMID: 37039378 PMCID: PMC10243533 DOI: 10.1152/ajplung.00439.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/04/2023] [Accepted: 04/10/2023] [Indexed: 04/12/2023] Open
Abstract
Radiation-induced lung injury (RILI) is a consequence of therapeutic thoracic irradiation (TR) for many cancers, and there are no FDA-approved curative strategies. Studies report that 80% of patients who undergo TR will have CT-detectable interstitial lung abnormalities, and strategies to limit the risk of RILI may make radiotherapy less effective at treating cancer. Our lab and others have reported that lung tissue from patients with idiopathic pulmonary fibrosis (IPF) exhibits metabolic defects including increased glycolysis and lactate production. In this pilot study, we hypothesized that patients with radiation-induced lung damage will exhibit distinct changes in lung metabolism that may be associated with the incidence of fibrosis. Using liquid chromatography/tandem mass spectrometry to identify metabolic compounds, we analyzed exhaled breath condensate (EBC) in subjects with CT-confirmed lung lesions after TR for lung cancer, compared with healthy subjects, smokers, and cancer patients who had not yet received TR. The lung metabolomic profile of the irradiated group was significantly different from the three nonirradiated control groups, highlighted by increased levels of lactate. Pathway enrichment analysis revealed that EBC from the case patients exhibited concurrent alterations in lipid, amino acid, and carbohydrate energy metabolism associated with the energy-producing tricarboxylic acid (TCA) cycle. Radiation-induced glycolysis and diversion of lactate to the extracellular space suggests that pyruvate, a precursor metabolite, converts to lactate rather than acetyl-CoA, which contributes to the TCA cycle. This TCA cycle deficiency may be compensated by these alternate energy sources to meet the metabolic demands of chronic wound repair. Using an "omics" approach to probe lung disease in a noninvasive manner could inform future mechanistic investigations and the development of novel therapeutic targets.NEW & NOTEWORTHY We report that exhaled breath condensate (EBC) identifies cellular metabolic dysregulation in patients with radiation-induced lung injury. In this pilot study, untargeted metabolomics revealed a striking metabolic signature in EBC from patients with radiation-induced lung fibrosis compared to patients with lung cancer, at-risk smokers, and healthy volunteers. Patients with radiation-induced fibrosis exhibit specific changes in tricarboxylic acid (TCA) cycle energy metabolism that may be required to support the increased energy demands of fibroproliferation.
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Affiliation(s)
- Josly Pierre-Louis Odoom
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, United States
- Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Margaret A T Freeberg
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Sarah V Camus
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Robin Toft
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Barbara B Szomju
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Rose Marie Sanchez Rosado
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Peter D Jackson
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Jeremy C Allegood
- Department of Biochemistry and Molecular Biology, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Scott Silvey
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Jinze Liu
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, United States
| | - L Ashley Cowart
- Department of Biochemistry and Molecular Biology, Virginia Commonwealth University, Richmond, Virginia, United States
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, United States
| | - Elisabeth Weiss
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Thomas H Thatcher
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Patricia J Sime
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, United States
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Carducci MP, Sundaram B, Greenberger BA, Werner-Wasik M, Kane GC. Predictors and characteristics of Rib fracture following SBRT for lung tumors. BMC Cancer 2023; 23:337. [PMID: 37046249 PMCID: PMC10100199 DOI: 10.1186/s12885-023-10776-8] [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: 12/08/2022] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The utilization of stereotactic body radiation therapy (SBRT) is increasing for primary and secondary lung neoplasms. Despite encouraging results, SBRT is associated with an increased risk of osteoradionecrosis-induced rib fracture. We aimed to (1) evaluate potential clinical, demographic, and procedure-related risk factors for rib fractures and (2) describe the radiographic features of post-SBRT rib fractures. METHODS We retrospectively identified 106 patients who received SBRT between 2015 and 2018 for a primary or metastatic lung tumor with at least 12 months of follow up. Exclusion criteria were incomplete records, previous ipsilateral thoracic radiation, or relevant prior trauma. Computed tomography (CT) images were reviewed to identify and characterize rib fractures. Multivariate logistic regression modeling was employed to determine clinical, demographic, and procedural risk factors (e.g., age, sex, race, medical comorbidities, dosage, and tumor location). RESULTS A total of 106 patients with 111 treated tumors met the inclusion criteria, 35 (32%) of whom developed at least one fractured rib (60 total fractured ribs). The highest number of fractured ribs per patient was five. Multivariate regression identified posterolateral tumor location as the only independent risk factor for rib fracture. On CT, fractures showed discontinuity between healing edges in 77% of affected patients. CONCLUSIONS Nearly one third of patients receiving SBRT for lung tumors experienced rib fractures, 34% of whom experienced pain. Many patients developed multiple fractures. Post-SBRT fractures demonstrated a unique discontinuity between the healing edges of the rib, a distinct feature of post-SBRT rib fractures. The only independent predictor of rib fracture was tumor location along the posterolateral chest wall. Given its increasing frequency of use, describing the risk profile of SBRT is vital to ensure patient safety and adequately inform patient expectations.
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Affiliation(s)
- Michael P Carducci
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St, suite 840, 19107, Philadelphia, PA, USA.
| | - Baskaran Sundaram
- Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th St, Floor 10, 19107, Philadelphia, PA, USA
| | - Benjamin A Greenberger
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, 111 South 11th St Suite G-301, 19107, Philadelphia, PA, USA
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, 111 South 11th St Suite G-301, 19107, Philadelphia, PA, USA
| | - Gregory C Kane
- Department of Medicine, Jane and Leonard Korman Respiratory institute at Thomas Jefferson University Hospital, 834 Walnut St, Suite 650, 19107, Philadelphia, PA, USA
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Abdelkarem OAI, Choudhury A, Burnet NG, Summersgill HR, West CML. Effect of Race and Ethnicity on Risk of Radiotherapy Toxicity and Implications for Radiogenomics. Clin Oncol (R Coll Radiol) 2022; 34:653-669. [PMID: 35431121 DOI: 10.1016/j.clon.2022.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/21/2022] [Accepted: 03/16/2022] [Indexed: 11/03/2022]
Abstract
AIMS Patient factors affect the risk of radiotherapy toxicity, but many are poorly defined. Studies have shown that race affects cancer incidence, survival, drug response, molecular pathways and epigenetics. Effects on radiosensitivity and radiotherapy toxicity are not well studied. The aim of the present study was to identify the effects of race and ethnicity on the risk of radiotherapy toxicity. MATERIALS AND METHODS A systematic review was carried out of PubMed, Ovid Medline and Ovid Embase with no year limit. PRISMA 2020 guidelines were followed. Two independent assessors reviewed papers. RESULTS Of 607 papers screened, 46 fulfilled the inclusion criteria. Papers were published between 1996 and 2021 and involved 30-28,354 individuals (median 433). Most involved patients with prostate (33%), breast (26%) and lung (9%) cancer. Both early and late toxicities were studied. Some studies reported a higher risk of toxicity in White men with prostate cancer compared with other races and ethnicities. For breast cancer patients, some reported an increased risk of toxicity in White women compared with other race and ethnic groups. In general, it was difficult to draw conclusions due to insufficient reporting and analysis of race and ethnicity in published literature. CONCLUSIONS Reporting of race and ethnicity in radiotherapy studies must be harmonised and improved and frameworks are needed to improve the quality of reporting. Further research is needed to understand how ancestral heritage might affect radiosensitivity and risk of radiotherapy toxicity.
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Affiliation(s)
- O A I Abdelkarem
- Chemical Pathology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt; Translational Radiobiology Group, Division of Cancer Sciences, Manchester Academic Health Science Centre, The University of Manchester, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - A Choudhury
- Proton Beam Therapy Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - N G Burnet
- Proton Beam Therapy Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - H R Summersgill
- Translational Radiobiology Group, Division of Cancer Sciences, Manchester Academic Health Science Centre, The University of Manchester, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - C M L West
- Translational Radiobiology Group, Division of Cancer Sciences, Manchester Academic Health Science Centre, The University of Manchester, Christie Hospital NHS Foundation Trust, Manchester, UK.
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Rydzewski NR, Yadav P, Musunuru HB, Condit KM, Francis D, Zhao SG, Baschnagel AM. Radiomic Modeling of Bone Density and Rib Fracture Risk After Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer. Adv Radiat Oncol 2022; 7:100884. [PMID: 35647405 PMCID: PMC9133372 DOI: 10.1016/j.adro.2021.100884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/21/2021] [Indexed: 11/01/2022] Open
Abstract
Purpose Our purpose was to determine whether bone density and bone-derived radiomic metrics in combination with dosimetric variables could improve risk stratification of rib fractures after stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC). Methods and Materials A retrospective analysis was conducted of patients with early-stage NSCLC treated with SBRT. Dosimetric data and rib radiomic data extracted using PyRadiomics were used for the analysis. A subset of patients had bone density scans that were used to create a predicted bone density score for all patients. A 10-fold cross validated approach with 10 resamples was used to find the top univariate logistic models and elastic net regression models that predicted for rib fracture. Results A total of 192 treatment plans were included in the study with a rib fracture rate of 16.1%. A predicted bone density score was created from a multivariate model with vertebral body Hounsfield units and patient weight, with an R-squared of 0.518 compared with patient dual-energy x-ray absorptiometry T-scores. When analyzing all patients, a low predicted bone density score approached significance for increased risk of rib fracture (P = .07). On competing risk analysis, when stratifying patients based on chest wall V30 Gy and bone density score, those with a V30 Gy ≥30 cc and a low bone density score had a significantly higher risk of rib fracture compared with all other patients (P < .001), with a predicted 2-year risk of rib fracture of 28.6% (95% confidence interval, 17.2%-41.1%) and 4.9% (95% confidence interval, 2.3%-9.0%), respectively. Dosimetric variables were the primary drivers of fracture risk. A multivariate elastic net regression model including all dosimetric variables was the best predictor of rib fracture (area under the curve [AUC], 0.864). Bone density variables (AUC, 0.618) and radiomic variables (AUC, 0.617) have better predictive power than clinical variables that exclude bone density (AUC, 0.538). Conclusion Radiomic features, including a bone density score that includes vertebral body Hounsfield units and radiomic signatures from the ribs, can be used to stratify risk of rib fracture after SBRT for NSCLC.
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Affiliation(s)
- Nicholas R. Rydzewski
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
- Carbone Cancer Center, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Poonam Yadav
- Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hima Bindu Musunuru
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kevin M. Condit
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
- Carbone Cancer Center, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - David Francis
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
- Carbone Cancer Center, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Shuang G. Zhao
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
- Carbone Cancer Center, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Andrew M. Baschnagel
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
- Carbone Cancer Center, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
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Hardy-Abeloos C, Lehrer EJ, Nehlsen AD, Sindhu KK, Rowley JP, Sheu R, Rosenzweig KE, Buckstein M. Characterization of rib fracture development following liver directed stereotactic body radiation therapy. JOURNAL OF RADIOSURGERY AND SBRT 2022; 8:109-116. [PMID: 36275138 PMCID: PMC9489079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/20/2022] [Indexed: 01/03/2023]
Abstract
Purpose Rib fractures are a well-described complication following thoracic stereotactic body radiation therapy (SBRT). However, there are limited data in the setting of liver-directed SBRT. Methods Patients who underwent liver SBRT from 2014 to 2019 were analyzed. Logistic regression models were used to identify the demographic, clinical, and dosimetric factors associated with the development of rib fractures. Results Three hundred and forty-three consecutive patients were reviewed with median follow-up of 9.3 months (interquartile range [IQR]: 4.7-17.4 months); 81% of patients had primary liver tumors and 19% had liver metastases. Twenty-one patients (6.2%) developed rib fractures with a median time to diagnosis of 7 months following SBRT (IQR: 5-19 months). Of those patients, 11 experienced concomitant chest wall pain, while 10 patients had an incidental finding of a rib fracture on imaging. On univariate analysis, female gender (odds ratio [OR]: 2.29; p = 0.05), V30 Gy (OR: 1.02; p < 0.001), V40 Gy (OR: 1.08; p < 0.001), maximum chest wall dose (OR: 1.1; p < 0.001), and chest wall D30 cm3 (OR: 1.09; p < 0.001) were associated with an increased probability of developing a rib fracture. On multivariate analysis, maximum chest wall dose (OR: 1.1; p < 0.001) was associated with developing a rib fracture. Receipt of more than one course of SBRT (p = 0.34), left versus right sided lesion (p = 0.69), osteoporosis (p = 0.54), age (p = 0.82), and PTV volume (p = 0.55) were not significant. Conclusions Rib fractures following liver SBRT were observed in 6.2% of patients with the majority being asymptomatic. To mitigate this risk, clinicians should minimize dose delivery to the chest wall. Female patients may be at increased risk.
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Affiliation(s)
- Camille Hardy-Abeloos
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA, Department of Radiation Oncology, NYU Langone Medical Center, New York, NY, USA
| | - Eric J. Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anthony D. Nehlsen
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kunal K. Sindhu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jared P. Rowley
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rendi Sheu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth E. Rosenzweig
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Buckstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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El Haddi J, Layton CR, Negmadjanov U, Roberts J. Gamma Radiation-Induced Rib Necrosis and Stereotactic Radiosurgery Failure. Cureus 2021; 13:e14302. [PMID: 33968514 PMCID: PMC8099002 DOI: 10.7759/cureus.14302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Stereotactic radiosurgery, or SRS, uses focused beams of gamma radiation targeted to specific areas of the body and has been used for multiple forms of non-small cell lung cancer. In this article, the authors describe two incidental cases of osteonecrosis in patients who had previously undergone stereotactic radiosurgery with recurrence of tumor. While this is a known side effect of traditional radiation therapy, it has not been described in the context of stereotactic radiosurgery. Further, these lesions were immediately deep to a rib, which may have shielded the lesion, and led to SRS failure. Osteonecrosis of the rib is a rare clinical entity but has been found to occur with glucocorticoid use, bisphosphonates, radiation therapy, and radiofrequency ablation. In the authors' review of the literature on SRS for lung cancer and intrathoracic pathology, rib osteonecrosis was not described and has not been mentioned as a possible side effect. Patients who have undergone thoracic stereotactic radiotherapy may develop side effects of traditional radiotherapy. We identified two patients who developed rib osteonecrosis though that has not been previously described as an adverse effect of stereotactic radiotherapy. The patients described in this case did not have any radiographic evidence of disease on imaging, suggesting that further research is warranted on the diagnosis and management of this rare disease entity.
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Affiliation(s)
| | | | | | - John Roberts
- Thoracic Surgery, Boca Raton Regional Hospital/Lynn Cancer Institute, Boca Raton, USA
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9
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Response to Is Cryoablation Really Safe and Efficacious: Analyzing Results Within SOLSTICE Trial. J Thorac Oncol 2021; 16:e6-e7. [PMID: 33384060 DOI: 10.1016/j.jtho.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/22/2022]
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10
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Saha A, Beasley M, Hatton N, Dickinson P, Franks K, Clarke K, Jain P, Teo M, Murray P, Lilley J. Clinical and dosimetric predictors of radiation pneumonitis in early-stage lung cancer treated with Stereotactic Ablative radiotherapy (SABR) - An analysis of UK's largest cohort of lung SABR patients. Radiother Oncol 2021; 156:153-159. [PMID: 33333139 DOI: 10.1016/j.radonc.2020.12.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/17/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Stereotactic Ablative Radiotherapy (SABR) is the standard treatment for early-stage medically inoperable lung cancer. Predictors of radiation pneumonitis (RP) in patients treated with SABR are poorly defined. In this study, we investigate clinical and dosimetric parameters, which can predict symptomatic RP in early-stage lung cancer patients treated with SABR. MATERIALS AND METHODS Patients treated with lung SABR between May 2009 and August 2018, in a single United Kingdom (UK) radiotherapy center were included. The patient's baseline characteristics, treatment details, and toxicity were retrieved from the electronic medical record. Dosimetric data was extracted from Xio and Monaco treatment planning systems. Patients were treated according to the UK SABR consortium guidelines. RP was graded retrospectively using Common Terminology Criteria for Adverse Events (CTCAE) version 4.0, based on available clinical and imaging information. Univariate and multivariate binary logistic regression was performed to determine predictive factors for grade ≥ 2 radiation pneumonitis, using Statistical Package for the Social Sciences (SPSS) statistics version 21 software. The goodness of fit was assessed using the Hosmer and Lemeshow test. The optimal diagnostic threshold was tested using the Receiver operating characteristics (ROC) curve. The chi-square test was carried out to test the different risk factors against the likelihood of developing grade ≥ 2 pneumonitis. RESULTS A total of 1266 patients included in the analysis. The median age of patients was 75 years. Six hundred sixty-six patients (52.6%) were female. Median follow up was 56 months. Sixty-five percent of patients received 55 Gy in 5 fractions. Forty-three percent of patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2 and 16.2% had PS of 3. The Median Charlson comorbidity index was 6 (range 2-11). Median Standardized Uptake Value (SUV) max of the tumor was 6.5. Four hundred two patients (31.8%) had confirmed histological diagnosis; other patients were treated based on a radiological diagnosis. The median tumor size was 20 mm (range 4 mm-63 mm). Median Planning Target Volume (PTV) was 30.3 cc. Median values of R100, R50, and D2cm were 1.1, 5.6, 32.8 Gy. The median value of mean lung dose, V20, and V12.5 were 3.9 Gy, 5 %and 9.3% respectively. Eighty-five (6.7%) patients developed symptomatic RP (grade ≥ 2) with only 5(0.4%) developing grade 3 RP. Five percent of patients developed rib fractures but only 28% of these were symptomatic. On univariate analysis lower lobe tumor location, larger tumor size, PTV, mean lung dose, lung V20Gy, and V12.5 Gy were significantly associated with grade ≥ 2 RP. On multivariate analysis, only mean lung dose was associated with grade ≥ 2 pneumonitis. ROC curve analysis showed optimal diagnostic threshold for tumour size, PTV, mean lung dose, V20 and V12.5; are 22.5 mm ((Area Under Curve (AUC)-0.565)), 27.15 cc (AUC-0.58), 3.7 Gy (AUC-0.633), 4.6% (AUC-0.597), 9.5% (AUC-0.616). The incidence of ≥grade 2 RP was significantly high for values higher than the ROC threshold. CONCLUSION SABR treatment resulted in a very low rate of grade 3 pneumonitis. Lower lobe tumor location, larger tumor size, PTV, mean lung dose, V20, and V12.5 were found to be significant predictors of symptomatic radiation pneumonitis.
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Affiliation(s)
- Animesh Saha
- Department of Oncology, Apollo Gleneagles Cancer Hospital, Kolkata, India.
| | - Matthew Beasley
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Nathaniel Hatton
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Peter Dickinson
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Kevin Franks
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Katy Clarke
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Pooja Jain
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Mark Teo
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Patrick Murray
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - John Lilley
- Department of Medical Physics, St James's University Hospital, Leeds, UK
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Callstrom MR, Woodrum DA, Nichols FC, Palussiere J, Buy X, Suh RD, Abtin FG, Pua BB, Madoff DC, Bagla SL, Papadouris DC, Fernando HC, Dupuy DE, Healey TT, Moore WH, Bilfinger TV, Solomon SB, Yarmohammadi H, Krebs HJ, Fulp CJ, Hakime A, Tselikas L, de Baere T. Multicenter Study of Metastatic Lung Tumors Targeted by Interventional Cryoablation Evaluation (SOLSTICE). J Thorac Oncol 2020; 15:1200-1209. [PMID: 32151777 DOI: 10.1016/j.jtho.2020.02.022] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/14/2020] [Accepted: 02/20/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the safety and local recurrence-free survival in patients after cryoablation for treatment of pulmonary metastases. METHODS This multicenter, prospective, single-arm, phase 2 study included 128 patients with 224 lung metastases treated with percutaneous cryoablation, with 12 and 24 months of follow-up. The patients were enrolled on the basis of the outlined key inclusion criteria, which include one to six metastases from extrapulmonary cancers with a maximal diameter of 3.5 cm. Time to progression of the index tumor(s), metastatic disease, and overall survival rates were estimated using the Kaplan-Meier method. Complications were captured for 30 days after the procedure, and changes in performance status and quality of life were also evaluated. RESULTS Median size of metastases was 1.0 plus or minus 0.6 cm (0.2-4.5) with a median number of tumors of 1.0 plus or minus 1.2 cm (one to six). Local recurrence-free response (local tumor efficacy) of the treated tumor was 172 of 202 (85.1%) at 12 months and 139 of 180 (77.2%) at 24 months after the initial treatment. After a second cryoablation treatment for recurrent tumor, secondary local recurrence-free response (local tumor efficacy) was 184 of 202 (91.1%) at 12 months and 152 of 180 (84.4%) at 24 months. Kaplan-Meier estimates of 12- and 24-month overall survival rates were 97.6% (95% confidence interval: 92.6-99.2) and 86.6% (95% confidence interval: 78.7-91.7), respectively. Rate of pneumothorax that required pleural catheter placement was 26% (44/169). There were eight grade 3 complication events in 169 procedures (4.7%) and one (0.6%) grade 4 event. CONCLUSION Percutaneous cryoablation is a safe and effective treatment for pulmonary metastases.
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Affiliation(s)
| | | | | | - Jean Palussiere
- Department of Interventional Radiology, Institut Bergonie, Bordeaux, France
| | - Xavier Buy
- Department of Interventional Radiology, Institut Bergonie, Bordeaux, France
| | - Robert D Suh
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Fereidoun G Abtin
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Bradley B Pua
- Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - David C Madoff
- Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Sandeep L Bagla
- Cardiovascular and Interventional Radiology Department, Inova Alexandria Hospital, Alexandria, Virginia
| | - Dimitrios C Papadouris
- Cardiovascular and Interventional Radiology Department, Inova Alexandria Hospital, Alexandria, Virginia
| | - Hiran C Fernando
- Department of Surgery, Inova Alexandria Hospital, Alexandria, Virginia
| | - Damian E Dupuy
- Department of Diagnostic Imaging, Alpert Medical School at Brown University, Providence, Rhode Island
| | - Terrance T Healey
- Department of Diagnostic Imaging, Alpert Medical School at Brown University, Providence, Rhode Island
| | - William H Moore
- Departments of Radiology and Surgery, State University of New York at Stony Brook, University Hospital, Stony Brook, New York
| | - Thomas V Bilfinger
- Departments of Radiology and Surgery, State University of New York at Stony Brook, University Hospital, Stony Brook, New York
| | - Stephen B Solomon
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Hooman Yarmohammadi
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Henry J Krebs
- Department of Radiology, Cancer Treatment Centers of America, Atlanta, Georgia
| | - Charles J Fulp
- Department of Radiology, Cancer Treatment Centers of America, Atlanta, Georgia
| | - Antoine Hakime
- Department of Interventional Radiology, Gustave Roussy-Cancer Campus, Villejuif, France
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy-Cancer Campus, Villejuif, France
| | - Thierry de Baere
- Department of Interventional Radiology, Gustave Roussy-Cancer Campus, Villejuif, France
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