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Jarvers JS, Lange M, Schiemann S, Pfränger J, Heyde CE, Osterhoff G. Risk factors for wound-related complications after surgical stabilization of spinal metastases with a special focus on the effect of postoperative radiation therapy. BMC Surg 2021; 21:423. [PMID: 34920720 PMCID: PMC8684154 DOI: 10.1186/s12893-021-01431-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advancements in the field of oncological therapies during the last decades have led to a significantly prolonged survival of cancer patients. This has led to an increase in the incidence of spinal metastases. The purpose of this study was to assess risk factors for wound-related complications after surgical stabilization of spinal metastases with a special focus on the effect of postoperative RT and its timing. METHODS Patients who had been treated for metastatic spine disease by surgical stabilization followed by radiotherapy between 01/2012 and 03/2019 were included and a retrospective chart review was performed. RESULTS Of 604 patients who underwent stabilizing surgery for spinal metastases, 237 patients (mean age 66 years, SD 11) with a mean follow-up of 11 months (SD 7) were eligible for further analysis. Forty-one patients (17.3%) had wound-related complications, 32 of them before and 9 after beginning of the RT. Revision surgery was necessary in 26 patients (11.0%). Body weight (p = 0.021), obesity (p = 0.018), ASA > 2 (p = 0.001), and start of radiation therapy within 21 days after surgery (p = 0.047) were associated with an increased risk for wound complications. Patients with chemotherapy within 3 weeks of surgery (12%) were more likely to have a wound-related surgical revision (p = 0.031). CONCLUSION Body weight, obesity and ASA > 2 were associated with an increased risk for wound complications. Patients with chemotherapy within 3 weeks of the surgery were more likely to have a wound-related revision surgery. Patients who had begun radiation therapy within 21 days after surgery were more likely to have a wound complication compared to patients who waited longer.
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Affiliation(s)
- Jan-Sven Jarvers
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Maximilian Lange
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Samuel Schiemann
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Jan Pfränger
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany.
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Kumar N, Madhu S, Bohra H, Pandita N, Wang SSY, Lopez KG, Tan JH, Vellayappan BA. Is there an optimal timing between radiotherapy and surgery to reduce wound complications in metastatic spine disease? A systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:3080-3115. [DOI: 10.1007/s00586-020-06478-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/25/2020] [Indexed: 12/13/2022]
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Seo DK, Park JH, Oh SK, Ahn Y, Jeon SR. Practicality of using the figure-of-eight bandage to prevent fatal wound dehiscence after spinal tumor surgery for upper thoracic metastasis. Br J Neurosurg 2017; 32:389-395. [PMID: 29124954 DOI: 10.1080/02688697.2017.1400520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECT Serious postoperative wound problems can frequently develop after surgery with perioperative RT for upper thoracic metastatic lesions. The figure-of-eight bandage can restrict excessive shoulder motion, which could prevent wound dehiscence. The purpose of this study was to describe the efficacy of using the figure-of-eight bandage to prevent postoperative wound dehiscence. METHODS Between February 2005 and July 2015, we retrospectively evaluated the medical records of cancer patients who underwent surgery with or without RT for spinal metastasis involving the upper thoracic spine. From January 2009, all patients received figure-of-eight bandaging immediately postoperatively, which was then maintained for 2 months. The outcome measures were the incidence and successful management of wound dehiscence following application of the figure-of-eight bandage. RESULTS One hundred and fifteen patients (71 men and 44 women) were enrolled in the present study. A figure-of-eight bandage in conjunction with a thoracolumbosacral orthosis (TLSO) was applied to 78 patients, while only TLSO was applied to 37 patients. The overall rate of wound dehiscence was 4.34% and the mean duration before wound dehiscence was 27.0 days (range, 22-31 days) after surgery. In the TLSO-only group, wound dehiscence occurred in four patients (10.81%), meanwhile there was only one case (1.33%) of wound dehiscence in the group that had received the figure-of-eight bandage with TLSO. Three of four patients with wound dehiscence in the TLSO only group died from unresolved wound problems and another patient was treated with wound closure followed by the application of the figure-of-eight bandage. The only patient with wound dehiscence among the patients who received both the figure-of-eight bandage and TLSO was managed by primary wound closure without further complication. CONCLUSION Current study suggests that the figure-of-eight bandage could prevent wound dehiscence and be used to treat wound problems easily.
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Affiliation(s)
- Dong Kwang Seo
- a Department of Neurological Surgery , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Jin-Hoon Park
- b Department of Neurological Surgery , Gangneung Asan Hospital, University of Ulsan College of Medicine , Republic of Korea
| | - Sun Kyu Oh
- a Department of Neurological Surgery , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Yongchel Ahn
- c Department of Hematology and Oncology , Gangneung Asan Hospital, University of Ulsan College of Medicine , Republic of Korea
| | - Sang Ryong Jeon
- a Department of Neurological Surgery , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
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Keam J, Bilsky MH, Laufer I, Shi W, Zhang Z, Tam M, Zatcky J, Lovelock DM, Yamada Y. No association between excessive wound complications and preoperative high-dose, hypofractionated, image-guided radiation therapy for spine metastasis. J Neurosurg Spine 2014; 20:411-20. [DOI: 10.3171/2013.12.spine12811] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Radiation therapy is known to impair wound healing. Higher dose per fraction is believed to increase this risk. This study sought to quantify rates of wound complication in patients receiving preoperative conventionally fractionated radiotherapy (XRT) or high-dose hypofractionated image-guided radiation therapy (IGRT) for spinal metastasis, and to identify predictors of wound complication.
Methods
The records of 165 consecutive patients who underwent spine surgery for metastasis at Memorial Sloan–Kettering Cancer Center between 1999 and 2010, with a history of prior radiation therapy, were reviewed. Patients with primary spine tumors, 2 courses of prior radiation therapy to the surgical site, total dose < 9 Gy, or radiation therapy adjacent to or partially overlapping the surgical site, were excluded. One hundred thirty patients received XRT (≤ 3 Gy/fraction) and 35 received IGRT (> 3 Gy/fraction). The total dose prescribed to the 100% isodose line to treat the planning target volume was 18–30 Gy in 1–5 fractions. Clinical factors evaluated included age, Karnofsky Performance Scale score, body mass index, presence of diabetes, smoking, ambulatory status, prior surgery at same spinal site, preoperative laboratory results (hemoglobin, lymphocyte count, and albumin), perioperative chemotherapy or steroids, estimated blood loss, extent of stabilization hardware, time between radiation therapy and surgery, number of vertebral bodies irradiated, total radiation dose, and dose per fraction of radiation therapy. Wound complication was defined as poor healing, dehiscence, or infection. Potential predictors of wound complication were assessed by univariate analyses using competing-risk methods to adjust for risk of death.
Results
For XRT patients, median dose was 30 Gy (range 11.5–70 Gy) with 72% of them receiving 3 Gy × 10 fractions. For IGRT patients, 66% received 18–24 Gy × 1 fraction and 23% received 6 Gy × 5 fractions. Groups differed only by the mean number of vertebral bodies treated (4.6 XRT and 1.8 IGRT, p < 0.0001). Wound complications occurred at a median of 0.95 months (range 0.4–3.9 months). A total of 22 wound events occurred in the XRT group and 2 in the IGRT group. The 6-month cumulative incidence of wound complications for XRT was 17% and for IGRT was 6%. There was no significant difference in wound complications between groups (IGRT vs XRT: hazard ratio 0.31, 95% CI 0.08–1.3; p = 0.11). Higher dose per fraction appeared to be associated with a lower risk of wound complication (hazard ratio 0.27, 95% CI 0.06–1.15; p = 0.08), which trended toward significance. Univariate analyses did not reveal any significant predictors of wound complications.
Conclusions
Patients who underwent XRT or IGRT did not have significantly different rates of postoperative wound complications. This finding may be explained by the treatment of fewer vertebral bodies in IGRT patients, or by the low overall number of total events. With a wound complication rate of 6%, preoperative IGRT, a highly conformal treatment, resulted in a very low rate of surgical wound complication.
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Affiliation(s)
| | | | | | - Weiji Shi
- 3Epidemiology and Biostatistics, and
| | | | - Moses Tam
- 4School of Medicine, New York University Medical Center, New York, New York
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Bufacchi A, Nardiello B, Capparella R, Begnozzi L. Clinical implications in the use of the PBC algorithm versus the AAA by comparison of different NTCP models/parameters. Radiat Oncol 2013; 8:164. [PMID: 23826854 PMCID: PMC3750611 DOI: 10.1186/1748-717x-8-164] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 06/13/2013] [Indexed: 12/25/2022] Open
Abstract
Purpose Retrospective analysis of 3D clinical treatment plans to investigate qualitative, possible, clinical consequences of the use of PBC versus AAA. Methods The 3D dose distributions of 80 treatment plans at four different tumour sites, produced using PBC algorithm, were recalculated using AAA and the same number of monitor units provided by PBC and clinically delivered to each patient; the consequences of the difference on the dose-effect relations for normal tissue injury were studied by comparing different NTCP model/parameters extracted from a review of published studies. In this study the AAA dose calculation is considered as benchmark data. The paired Student t-test was used for statistical comparison of all results obtained from the use of the two algorithms. Results In the prostate plans, the AAA predicted lower NTCP value (NTCPAAA) for the risk of late rectal bleeding for each of the seven combinations of NTCP parameters, the maximum mean decrease was 2.2%. In the head-and-neck treatments, each combination of parameters used for the risk of xerostemia from irradiation of the parotid glands involved lower NTCPAAA, that varied from 12.8% (sd=3.0%) to 57.5% (sd=4.0%), while when the PBC algorithm was used the NTCPPBC’s ranging was from 15.2% (sd=2.7%) to 63.8% (sd=3.8%), according the combination of parameters used; the differences were statistically significant. Also NTCPAAA regarding the risk of radiation pneumonitis in the lung treatments was found to be lower than NTCPPBC for each of the eight sets of NTCP parameters; the maximum mean decrease was 4.5%. A mean increase of 4.3% was found when the NTCPAAA was calculated by the parameters evaluated from dose distribution calculated by a convolution-superposition (CS) algorithm. A markedly different pattern was observed for the risk relating to the development of pneumonitis following breast treatments: the AAA predicted higher NTCP value. The mean NTCPAAA varied from 0.2% (sd = 0.1%) to 2.1% (sd = 0.3%), while the mean NTCPPBC varied from 0.1% (sd = 0.0%) to 1.8% (sd = 0.2%) depending on the chosen parameters set. Conclusions When the original PBC treatment plans were recalculated using AAA with the same number of monitor units provided by PBC, the NTCPAAA was lower than the NTCPPBC, except for the breast treatments. The NTCP is strongly affected by the wide-ranging values of radiobiological parameters.
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Affiliation(s)
- Antonella Bufacchi
- Medical Physics, PioXI Clinic and UOC Medical Physics, S Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy.
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Jelveh S, Kaspler P, Bhogal N, Mahmood J, Lindsay PE, Okunieff P, Doctrow SR, Bristow RG, Hill RP. Investigations of antioxidant-mediated protection and mitigation of radiation-induced DNA damage and lipid peroxidation in murine skin. Int J Radiat Biol 2013; 89:618-27. [DOI: 10.3109/09553002.2013.782450] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Kaspler P, Chen R, Hyrien O, Jelveh S, Bristow RG, Hill RP. Biodosimetry using radiation-induced micronuclei in skin fibroblasts. Int J Radiat Biol 2012; 87:824-38. [PMID: 21801108 DOI: 10.3109/09553002.2011.582927] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE We assessed micronuclei in dermal fibroblasts as a local biodosimeter for estimating accidental in vivo radiation exposure. MATERIALS AND METHODS Male and female C3H/HeJ and C57Bl6 mice of four age groups (∼11, 36, 60 and 99 weeks) received a single whole body dose of gamma radiation (0-10 Gy) and radiation-induced micronuclei per 1,000 binucleated cells were assessed in skin fibroblasts in their first division after isolation from biopsies taken on days 1 and 7 post irradiation. The method of generalized estimating equations was used for statistical analyses. RESULTS Total micronuclei were increased on day 1 in a dose-dependent manner in the range of 1-10 Gy, with no significant attenuation of response between day 1 and day 7 and no significant effect of gender. Between-strain differences were observed with C3H/HeJ mice showing lower background micronuclei and a slightly steeper dose response. Age affected only the background micronuclei (moderate increase with age). The model demonstrated that the assay yields 'unbiased' prediction of the dose between 0 and 7 Gy. Within this dose range, the predicted dose was found to be accurate within ±1.5-2 Gy. When the specificity is set to 95%, the assay can distinguish between unexposed and 2 Gy exposed mice with a sensitivity of around 60%. The sensitivity approached 100% when discriminating between unexposed mice and mice receiving doses equal to or greater than 4 Gy. The percentage of binucleated cells with micronuclei was shown to be useful as a simpler and slightly faster substitute for the total micronuclei count. CONCLUSION Micronuclei in dermal fibroblasts isolated up to 1 week after irradiation can be a useful biodosimeter for local dose after accidental radiation exposure.
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Affiliation(s)
- Pavel Kaspler
- Ontario Cancer Institute/Princess Margaret Hospital, University Health Network and Campbell Family Institute for Cancer Research, Toronto, Ontario, Canada
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Hill RP, Zaidi A, Mahmood J, Jelveh S. Investigations into the role of inflammation in normal tissue response to irradiation. Radiother Oncol 2011; 101:73-9. [PMID: 21726914 DOI: 10.1016/j.radonc.2011.06.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 06/07/2011] [Accepted: 06/07/2011] [Indexed: 12/20/2022]
Abstract
PURPOSE Radiation-induced inflammation and production of reactive oxygen species (ROS) play a critical role in normal tissue response. In this study we have examined some aspects of these effects in lung and skin. METHODS The superoxide dismutase (SOD) catalase mimetic, EUK-207, and genistein, an isoflavone with anti-inflammatory properties, were given post-irradiation and micronuclei (MN) formation was determined in cells derived from irradiated lung and skin. Changes in breathing rate were measured using a plethysmograph following irradiation of C57Bl6 mice knocked out for tumor necrosis factor (TNF)-alpha or its receptors, TNFR1/2, or treated with endotoxin (lipopolysaccharide - LPS). RESULTS Both EUK-207 and genistein given after irradiation caused a large reduction in MN levels observed in lung cells during 14 weeks post-irradiation but ceasing treatment resulted in a rebound in MN levels at 28 weeks post-irradiation. In contrast, treatment with EUK-207 was largely ineffective in reducing MN observed in skin cells post-irradiation. Knock-out of TNF-alpha resulted in a reduced increase in breathing rate (peak at 12 weeks post-irradiation) relative to wild-type and TNFR1/2 knock-out. Treatment with LPS 1 h post-irradiation also reduced the increase in breathing rate. CONCLUSIONS The increase in MN in lung cells after treatment with EUK-207 or genistein was stopped suggests that continuing ROS production contributes to DNA damage in lung cells over prolonged periods. That this effect was not seen in skin suggests this mechanism is less prominent in this tissue. The reduced level of radiation pneumonitis (as monitored by breathing rate changes) in animals knocked out for TNF-alpha suggests that this cytokine plays a significant role in inducing inflammation in lung following irradiation. The similar effect observed following LPS given post-irradiation suggests the possibility that such treatment modifies the long-term cyclic inflammatory response following irradiation in lungs.
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Intrinsic radiosensitivity correlated with radiation-induced ROS and cell cycle regulation. Mol Cell Toxicol 2010. [DOI: 10.1007/s13273-010-0001-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Kaspler P, Hyrien O, Hill RP. Dynamics of micronuclei in mouse skin fibroblasts after gamma irradiation. HEALTH PHYSICS 2010; 98:228-233. [PMID: 20065687 DOI: 10.1097/hp.0b013e3181b02f90] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Micronuclei (MN) were assessed in dermal fibroblasts from C3H HeJ and C57 Bl6 mice (6-10 mo of age) irradiated in vivo as a potential method of biodosimetry. Radiation-induced MN [per 1,000 binucleated (BN) cells], assessed in fibroblasts obtained 1 d post-irradiation, increased in a dose-dependent manner in the range of 1 - 10 Gy per single dose. Analysis at 1 wk post irradiation showed some attenuation of MN response in C3H HeJ male mice, suggesting partial recovery of DNA damage. This was not observed in C57 Bl6 mice. Monomicronucleated cells predominated in unirradiated fibroblasts, whereas in irradiated fibroblasts multimicronucleated cells predominated at dose levels above about 5 Gy (more than 1,000 MN per 1,000 BN cells). Modeling of the data indicate that assaying total MN in dermal fibroblasts from samples of irradiated skin taken up to 1 wk after irradiation can provide biodosimetric information (with an accuracy of 1-2 Gy) for doses up to at least 6 Gy with lesser accuracy at higher doses. Percentage of multimicronucleated cells may be useful as a substitute of total MN at the higher doses, but total percentage of micronucleated cells is of limited value as a substitute.
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Affiliation(s)
- Pavel Kaspler
- Applied Molecular Oncology, Ontario Cancer Institute/Princess Margaret Hospital, 610, University Ave, Toronto, Ontario, Canada, M5G2M9
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Prasanna PGS, Blakely WF, Bertho JM, Chute JP, Cohen EP, Goans RE, Grace MB, Lillis-Hearne PK, Lloyd DC, Lutgens LCHW, Meineke V, Ossetrova NI, Romanyukha A, Saba JD, Weisdorf DJ, Wojcik A, Yukihara EG, Pellmar TC. Synopsis of partial-body radiation diagnostic biomarkers and medical management of radiation injury workshop. Radiat Res 2010; 173:245-53. [PMID: 20095857 PMCID: PMC8914528 DOI: 10.1667/rr1993.1] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Radiation exposures from accidents, nuclear detonations or terrorist incidents are unlikely to be homogeneous; however, current biodosimetric approaches are developed and validated primarily in whole-body irradiation models. A workshop was held at the Armed Forces Radiobiology Research Institute in May 2008 to draw attention to the need for partial-body biodosimetry, to discuss current knowledge, and to identify the gaps to be filled. A panel of international experts and the workshop attendees discussed the requirements and concepts for a path forward. This report addresses eight key areas identified by the Workshop Program Committee for future focus: (1) improved cytogenetics, (2) clinical signs and symptoms, (3) cutaneous bioindicators, (4) organ-specific biomarkers, (5) biophysical markers of dose, (6) integrated diagnostic approaches, (7) confounding factors, and (8) requirements for post-event medical follow-up. For each area, the status, advantages and limitations of existing approaches and suggestions for new directions are presented.
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Affiliation(s)
- Pataje G. S. Prasanna
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20889
| | - William F. Blakely
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20889
| | - Jean-Marc Bertho
- Institut de Radioprotection et de Sûreté Nucléaire, 92262 Fontenay aux roses cedex, France
| | - John P. Chute
- Division of Cellular Therapy and Stem Cell Transplantation, Duke University Medical Center, Durham, North Carolina 27710
| | - Eric P. Cohen
- Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - Ronald E. Goans
- MJW Corp., Amherst, New York 14228, and Radiation Emergency Assistance Center/Training Site, Oak Ridge, Tennessee, 37830
| | - Marcy B. Grace
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20889
| | - Patricia K. Lillis-Hearne
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20889
| | - David C. Lloyd
- UK Health Protection Agency, Centre for Radiation, Chemical, and Environmental Hazards, Chilton, OX11 0RQ, United Kingdom
| | - Ludy C. H. W. Lutgens
- Maastricht Radiotherapy and Oncology Clinic (MAASTRO Clinic), Maastricht, the Netherlands
| | - Viktor Meineke
- Bundeswehr Institute of Radiobiology, D-80937 Munich, Germany
| | - Natalia I. Ossetrova
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20889
| | - Alexander Romanyukha
- Naval Dosimetry Center, Bethesda, Maryland 20889, and Uniformed Services University, Bethesda, Maryland 20814
| | - Julie D. Saba
- Children's Hospital Oakland Research Institute (CHORI), Oakland, California 94609
| | | | | | | | - Terry C. Pellmar
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20889
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Landry Y, Lê O, Mace KA, Restivo TE, Beauséjour CM. Secretion of SDF-1alpha by bone marrow-derived stromal cells enhances skin wound healing of C57BL/6 mice exposed to ionizing radiation. J Cell Mol Med 2009; 14:1594-604. [PMID: 19725920 PMCID: PMC3829023 DOI: 10.1111/j.1582-4934.2009.00887.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Patients treated for cancer therapy using ionizing radiation (IR) have delayed tissue repair and regeneration. The mechanisms mediating these defects remain largely unknown at present, thus limiting the development of therapeutic approaches. Using a wound healing model, we here investigate the mechanisms by which IR exposure limits skin regeneration. Our data show that induction of the stromal cell-derived growth factor 1α (SDF-1α) is severely impaired in the wounded skin of irradiated, compared to non-irradiated, mice. Hence, we evaluated the potential of bone marrow-derived multipotent stromal cells (MSCs), which secrete high levels of SDF-1α, to improve skin regeneration in irradiated mice. Injection of MSCs into the wound margin led to remarkable enhancement of skin healing in mice exposed to IR. Injection of irradiated MSCs into the wound periphery of non-irradiated mice delayed wound closure, also suggesting an important role for the stromal microenvironment in skin repair. The beneficial actions of MSCs were mainly paracrine, as the cells did not differentiate into keratinocytes. Specific knockdown of SDF-1α expression led to drastically reduced efficiency of MSCs in improving wound closure, indicating that SDF-1α secretion by MSCs is largely responsible for their beneficial action. We also found that one mechanism by which SDF-1α enhances wound closure likely involves increased skin vascularization. Our findings collectively indicate that SDF-1α is an important deregulated cytokine in irradiated wounded skin, and that the decline in tissue regeneration potential following IR can be reversed, given adequate microenvironmental support
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Affiliation(s)
- Yannick Landry
- CHU Ste-Justine and Département de pharmacologie, Université de Montréal, Montréal, Québec, Canada
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Kaspler P, Pintilie M, Hill RP. Dynamics of micronuclei in rat skin fibroblasts after X irradiation. Radiat Res 2009; 172:106-13. [PMID: 19580512 DOI: 10.1667/rr1649.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In a previous study, we demonstrated DNA damage, expressed as micronuclei, in binucleate dermal fibroblasts obtained from human skin 2-9 weeks after fractionated radiotherapy. Here we assessed micronuclei in X-irradiated skin fibroblasts from 9-14-week-old female Lewis rats as a function of time after a single dose of radiation to determine the lifetime of such damage in the skin. After irradiation with 5, 10, 15 and 18 Gy, formation of micronuclei at 1 day or 2 months postirradiation increased up to about 10 Gy, with evidence for a plateau at higher doses. The time course of micronuclei present in the skin fibroblasts demonstrated a plateau region (approximately 20 days after 18 Gy and about 2 months after 10 Gy) before the number of micronuclei started to decline. Residual micronuclei were observed for more than 1 year after irradiation. Monomicronucleated cells predominated in fibroblasts from nonirradiated skin, whereas in fibroblasts from irradiated skin, multimicronucleated cells predominated and persisted (together with monomicronucleated cells) in the residual levels of damage at late times. The results suggest that DNA damage in dermal fibroblasts can be assayed by the micronucleus assay in samples from irradiated skin up to 1 month after irradiation for doses up to at least 10 Gy. Further studies are needed to define the dose-response relationship in detail.
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Affiliation(s)
- P Kaspler
- Applied Molecular Oncology, Ontario Cancer Institute/Princess Margaret Hospital, Department of Medical Biophysics and Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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Comparison between the ideal reference dose level and the actual reference dose level from clinical 3D radiotherapy treatment plans. Radiother Oncol 2009; 92:68-75. [DOI: 10.1016/j.radonc.2009.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 02/23/2009] [Accepted: 02/24/2009] [Indexed: 11/21/2022]
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Begg A, van der Kogel A. Clinical radiobiology in 2008. Radiother Oncol 2008; 86:295-9. [PMID: 18313778 DOI: 10.1016/j.radonc.2008.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 02/01/2008] [Accepted: 02/01/2008] [Indexed: 11/18/2022]
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