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Li Z, Guo M, Liu L, Deng S. Association between postoperative radiotherapy for young-onset nonsmall cell lung cancer and risk of second primary malignancies: comparative study. Int J Surg 2024; 110:4617-4623. [PMID: 38716897 PMCID: PMC11325970 DOI: 10.1097/js9.0000000000001580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/25/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND The most common form of therapy for nonsmall cell lung cancer (NSCLC) in early stage is surgery-based combination therapy, including radiotherapy and immunotherapy. However, postoperative radiotherapy (PORT) of cancer is correlated with increasing risk of second primary malignancy (SPM), especially young-onset cancer cases. The authors aimed to quantify the risks of SPM associated with PORT treatment for young‑onset NSCLC in early stage. METHODS The authors screened for SPM that developed over 5 years since the diagnosis of NSCLC. Using the data from the Surveillance, Epidemiology, and End Results database, PORT-correlated risks were estimated with multivariate Logistic regression analysis. Moreover, Fine-Gray's competing risk regression analysis was used to calculate the cumulative incidence of SPMs. RESULTS Among the 30 308 young-onset NSCLC patients in early stage undergoing surgery, a total of 3728 patients have received PORT. Logistic regression analyses showed that PORT showed substantial correlation with elevated risks of second solid malignancies [relative risks (RR)=1.31; 95% CI: 1.17-1.46], lung cancer (RR=1.23; 95% CI: 1.07-1.42), breast cancer (RR=1.74; 95% CI: 1.16-2.74), and colon and rectum cancers (RR=1.37; 95% CI: 1.07-2.06) as well as a negligible risk of second hematologic malignancies (RR=1.15; 95% CI: 0.82-1.67). The cumulative incidence of SPMs revealed similar findings. Higher RR was obtained in NSCLC patients aged 60-69 years (RR=1.33), in white race (RR=1.36), diagnosed in 1975-2000 (RR=1.23) and 2001-2015 (RR=1.40), or diagnosed with lung adenocarcinoma (RR=1.55). CONCLUSION PORT for young-onset NSCLC in early stage was correlated with elevated risks of SPMs (lung cancer, breast cancer, as well as colon and rectum cancers), supporting the need for long-term surveillance of these patients.
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Affiliation(s)
- Zuwei Li
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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2
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Fukushima A, Hande V, Wakeham K, Barton MB, Zaghloul MS, Moreira DC, Bhakta N, Pritchard-Jones K, Sullivan M, Mazhar Qureshi B, Njiraini PN, Polo A. Estimation of the optimal radiotherapy utilization rate for childhood neuroblastoma. Radiother Oncol 2024; 197:110343. [PMID: 38806114 DOI: 10.1016/j.radonc.2024.110343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/14/2024] [Accepted: 05/19/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND AND PURPOSE The optimal utilization rate of radiotherapy (oRUR) serves as a benchmark for assessing service demand and improving access to cancer care. While it is estimated that approximately 50 % of adult cancer patients require external beam radiotherapy during their treatment, there is a scarcity of data regarding the optimal use of radiotherapy in pediatric cancer. In this study, we adopted an established method and developed a model to estimate the oRUR in childhood neuroblastoma. MATERIALS AND METHODS We developed a decision tree model to calculate the oRUR using indications for radiotherapy and corresponding epidemiological data collected through systematic review and meta-analysis. Sensitivity analyses were performed to evaluate the impact of variations in radiotherapy indications between treatment protocols and variables in the model. We calculated and compared the oRUR for global, high-income, and low- and middle-income settings. RESULTS The oRUR for pediatric neuroblastoma was 64 % (95 % CI: 58 %-71 %) in the global setting, 50 % in high-income countries, and 68 % in low- and middle-income countries. The impact of variation in radiotherapy indications between major international treatment protocols was negligible. CONCLUSION The knowledge of oRUR is crucial for evaluating current practices, identifying gaps in access, and planning future radiotherapy services for treating childhood cancer. Based on our results, 64 % of children with neuroblastoma have an indication for radiotherapy. Patients in low- and middle-income countries have more indications for radiotherapy than those in high-income countries, due to a more adverse tumour stage distribution caused by limited access to healthcare resources.
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Affiliation(s)
- Azumi Fukushima
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria; Department of Health Risk Communication, Fukushima Medical University, Fukushima, Japan.
| | - Varsha Hande
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Katherine Wakeham
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Michael B Barton
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales (UNSW), Liverpool, Australia
| | - Mohamed S Zaghloul
- National Cancer Institute, Cairo University, Cairo, Egypt; Children's Cancer Hospital, Cairo, Egypt
| | - Daniel C Moreira
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, United States
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, United States
| | - Kathy Pritchard-Jones
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Michael Sullivan
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia
| | - Bilal Mazhar Qureshi
- Radiation Oncology Section, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | | | - Alfredo Polo
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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3
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Rathi S, Oh JH, Zhang W, Mladek AC, Garcia DA, Xue Z, Burgenske DM, Zhang W, Le J, Zhong W, Sarkaria JN, Elmquist WF. Preclinical Systemic Pharmacokinetics, Dose Proportionality, and Central Nervous System Distribution of the ATM Inhibitor WSD0628, a Novel Radiosensitizer for the Treatment of Brain Tumors. J Pharmacol Exp Ther 2024; 390:260-275. [PMID: 38858089 PMCID: PMC11264258 DOI: 10.1124/jpet.123.001971] [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: 10/11/2023] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024] Open
Abstract
Radiation therapy, a standard treatment option for many cancer patients, induces DNA double-strand breaks (DSBs), leading to cell death. Ataxia telangiectasia mutated (ATM) kinase is a key regulator of DSB repair, and ATM inhibitors are being explored as radiosensitizers for various tumors, including primary and metastatic brain tumors. Efficacy of radiosensitizers for brain tumors may be influenced by a lack of effective drug delivery across the blood-brain barrier. The objective of this study was to evaluate the systemic pharmacokinetics and mechanisms that influence the central nervous system (CNS) distribution of WSD0628, a novel and potent ATM inhibitor, in the mouse. Further, we have used these observations to form the basis of predicting effective exposures for clinical application. We observed a greater than dose proportional increase in exposure, likely due to saturation of clearance processes. Our results show that WSD0628 is orally bioavailable and CNS penetrant, with unbound partitioning in CNS (i.e., unbound tissue partition coefficient) between 0.15 and 0.3. CNS distribution is not limited by the efflux transporters P-glycoprotein and breast cancer resistant protein. WSD0628 is distributed uniformly among different brain regions. Thus, WSD0628 has favorable pharmacokinetic properties and potential for further exploration to determine the pharmacodynamics-pharmacokinetics efficacy relationship in CNS tumors. This approach will provide critical insights for the clinical translation of WSD0628 for the treatment of primary and secondary brain tumors. SIGNIFICANCE STATEMENT: This study evaluates the preclinical systemic pharmacokinetics, dose proportionality, and mechanisms influencing CNS distribution of WSD0628, a novel ATM inhibitor for the treatment of brain tumors. Results indicate that WSD0628 is orally bioavailable and CNS penetrant without efflux transporter liability. We also observed a greater than dose proportional increase in exposure in both the plasma and brain. These favorable pharmacokinetic properties indicate WSD0628 has potential for further exploration for use as a radiosensitizer in the treatment of brain tumors.
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Affiliation(s)
- Sneha Rathi
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Ju-Hee Oh
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Wenjuan Zhang
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Ann C Mladek
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Darwin A Garcia
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Zhiyi Xue
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Danielle M Burgenske
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Wenqiu Zhang
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Jiayan Le
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Wei Zhong
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Jann N Sarkaria
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - William F Elmquist
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
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Cramp L, Burrows T, Surjan Y. Perceived barriers and facilitators affecting utilisation of radiation therapy services: Scoping review findings - Health professional influences. Radiother Oncol 2024; 199:110423. [PMID: 39002569 DOI: 10.1016/j.radonc.2024.110423] [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: 04/01/2024] [Revised: 06/19/2024] [Accepted: 06/30/2024] [Indexed: 07/15/2024]
Abstract
The underutilisation of radiation therapy (RT) is contributing to the significant global burden of cancer with studies identifying actual utilisation rates are significantly lower than evidence-based optimal utilisation rates. Attributing factors vary considerably, ranging from patient preference, referrer bias, to geographic variations. The aim of this scoping review is to map and synthesise the current literature reporting on barriers and facilitators influencing utilisation of RT globally. Four online databases; Medline, Embase, Scopus and CINAHL identified articles dated between 1993 and 2023. Study eligibility included reporting on RT services, specifically barriers and influences on utilisation of RT. Title and abstract screening, followed by full text review was performed as per PRISMA guidelines. Variables were extracted and categorised into patient, health professional (HP) and department level influences. In total, 340 studies were included in the scoping review. HP influences (included in this specific review) were reported in 225 (66 %) papers with the most prevalent HP influence being referral (n = 187; 83 %). Of the HP papers, 114 (51 %) identified knowledge and education as an influence on RT utilisation. Subsequently, role interpretation, describing the assumed role adopted by the General Practitioner as the patients advocate, educator, manager or carer was identified in 89 (40 %) studies. This scoping review demonstrates the range of factors impacting RT utilisation. The results suggest referrer knowledge and understanding gaps impact RT utilisation internationally. Future research and intervention into referrer RT education is required to limit the impact of such influences.
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Affiliation(s)
- Leah Cramp
- College of Health, Medicine and Wellbeing - The University of Newcastle, University Drive Callaghan, New South Wales 2308, Australia; Global Centre for Research and Training in Radiation Oncology - The University of Newcastle, University Drive Callaghan, New South Wales 2308, Australia
| | - Tracy Burrows
- College of Health, Medicine and Wellbeing - The University of Newcastle, University Drive Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute (HMRI), The University of Newcastle, University Drive Callaghan, New South Wales 2308, Australia
| | - Yolanda Surjan
- College of Health, Medicine and Wellbeing - The University of Newcastle, University Drive Callaghan, New South Wales 2308, Australia; Global Centre for Research and Training in Radiation Oncology - The University of Newcastle, University Drive Callaghan, New South Wales 2308, Australia.
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5
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Subiel A, Bourgouin A, Kranzer R, Peier P, Frei F, Gomez F, Knyziak A, Fleta C, Bailat C, Schüller A. Metrology for advanced radiotherapy using particle beams with ultra-high dose rates. Phys Med Biol 2024; 69:14TR01. [PMID: 38830362 DOI: 10.1088/1361-6560/ad539d] [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: 10/15/2023] [Accepted: 06/03/2024] [Indexed: 06/05/2024]
Abstract
Dosimetry of ultra-high dose rate beams is one of the critical components which is required for safe implementation of FLASH radiotherapy (RT) into clinical practice. In the past years several national and international programmes have emerged with the aim to address some of the needs that are required for translation of this modality to clinics. These involve the establishment of dosimetry standards as well as the validation of protocols and dosimetry procedures. This review provides an overview of recent developments in the field of dosimetry for FLASH RT, with particular focus on primary and secondary standard instruments, and provides a brief outlook on the future work which is required to enable clinical implementation of FLASH RT.
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Affiliation(s)
- Anna Subiel
- National Physical Laboratory, Hampton Road, Teddington TW11 0LW, United Kingdom
- University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Alexandra Bourgouin
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig, Germany
- National Research Council of Canada (NRC), 1200 Montreal Road, Ottawa, ON, K1A0R6, Canada
| | | | - Peter Peier
- Federal Institute of Metrology METAS, Lindenweg 50, 3003 Bern-Wabern, Switzerland
| | - Franziska Frei
- Federal Institute of Metrology METAS, Lindenweg 50, 3003 Bern-Wabern, Switzerland
| | - Faustino Gomez
- University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Adrian Knyziak
- Central Office of Measures (GUM), Elektoralna 2 Str., 00-139 Warsaw, Poland
| | - Celeste Fleta
- Instituto de Microelectrónica de Barcelona, Centro Nacional de Microelectrónica, IMB-CNM (CSIC), Barcelona, Spain
| | - Claude Bailat
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andreas Schüller
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig, Germany
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6
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Pan T, Luo D. Data-driven gated positron emission tomography/computed tomography for radiotherapy. Phys Imaging Radiat Oncol 2024; 31:100601. [PMID: 39040434 PMCID: PMC11261283 DOI: 10.1016/j.phro.2024.100601] [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] [Received: 04/07/2023] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 07/24/2024] Open
Abstract
Purpose Software-based data-driven gated (DDG) positron emission tomography/computed tomography (PET/CT) has replaced hardware-based 4D PET/CT. The purpose of this article was to review DDG PET/CT, which could improve the accuracy of treatment response assessment, tumor motion evaluation, and target tumor contouring with whole-body (WB) PET/CT for radiotherapy (RT). Material and methods This review covered the topics of 4D PET/CT with hardware gating, advancements in PET instrumentation, DDG PET, DDG CT, and DDG PET/CT based on a systematic literature review. It included a discussion of the large axial field-of-view (AFOV) PET detector and a review of the clinical results of DDG PET and DDG PET/CT. Results DDG PET matched or outperformed 4D PET with hardware gating. DDG CT was more compatible with DDG PET than 4D CT, which required hardware gating. DDG CT could replace 4D CT for RT. DDG PET and DDG CT for DDG PET/CT can be incorporated in a WB PET/CT of less than 15 min scan time on a PET/CT scanner of at least 25 cm AFOV PET detector. Conclusions DDG PET/CT could correct the misregistration and tumor motion artifacts in a WB PET/CT and provide the quantitative PET and tumor motion information of a registered PET/CT for RT.
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Affiliation(s)
- Tinsu Pan
- Department of Imaging Physics, M.D. Anderson Cancer Center, University of Texas, United States
| | - Dershan Luo
- Department of Radiation Physics, M.D. Anderson Cancer Center, University of Texas, United States
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Loo BW, Verginadis II, Sørensen BS, Mascia AE, Perentesis JP, Koong AC, Schüler E, Rankin EB, Maxim PG, Limoli CL, Vozenin MC. Navigating the Critical Translational Questions for Implementing FLASH in the Clinic. Semin Radiat Oncol 2024; 34:351-364. [PMID: 38880544 DOI: 10.1016/j.semradonc.2024.04.008] [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] [Indexed: 06/18/2024]
Abstract
The "FLASH effect" is an increased therapeutic index, that is, reduced normal tissue toxicity for a given degree of anti-cancer efficacy, produced by ultra-rapid irradiation delivered on time scales orders of magnitude shorter than currently conventional in the clinic for the same doses. This phenomenon has been observed in numerous preclinical in vivo tumor and normal tissue models. While the underlying biological mechanism(s) remain to be elucidated, a path to clinical implementation of FLASH can be paved by addressing several critical translational questions. Technological questions pertinent to each beam type (eg, electron, proton, photon) also dictate the logical progression of experimentation required to move forward in safe and decisive clinical trials. Here we review the available preclinical data pertaining to these questions and how they may inform strategies for FLASH cancer therapy clinical trials.
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Affiliation(s)
- Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA.
| | - Ioannis I Verginadis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brita Singers Sørensen
- Danish Centre for Particle Therapy & Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Anthony E Mascia
- Division of Oncology, Cincinnati Children's Hospital and Departments of Pediatrics and Radiation Oncology, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - John P Perentesis
- Division of Oncology, Cincinnati Children's Hospital and Departments of Pediatrics and Radiation Oncology, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Albert C Koong
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Emil Schüler
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erinn B Rankin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Peter G Maxim
- Department of Radiation Oncology, University of California, Irvine School of Medicine, Irvine, CA
| | - Charles L Limoli
- Department of Radiation Oncology, University of California, Irvine School of Medicine, Irvine, CA
| | - Marie-Catherine Vozenin
- Secteur Radio-Oncologie et Radiobiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland; LiRR - laboratory of innovation in radiobiology applied to radiotherapy, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Laboratory of Radiation Oncology, Radiation Oncology Service, Department of Oncology, CHUV Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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8
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Loewen SK, Ruan Y, Wu CHD, Arifin A, Kim M, Bashir B, Halperin R, McKenzie M, Archambault J, Thompson R, Ringash J, Brundage M, Brenner D, Stuckless T. Supply and Demand for Radiation Oncologists in Canada: Workforce Planning Projections From 2020 to 2040. Int J Radiat Oncol Biol Phys 2024; 119:756-770. [PMID: 37562734 DOI: 10.1016/j.ijrobp.2023.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE The number of Canadians diagnosed with cancer, and subsequent demand for radiation therapy, are expected to increase over time. This study aimed to update our needs-based workforce planning model to ensure appropriate staffing levels in the future. METHODS AND MATERIALS The supply of radiation oncologists, by age group, sex, and full-time equivalent status, was projected from 2020 to 2040 using a recursive-aging, input-output model developed with seeding parameters derived from national sources. The demand for radiation oncologists until 2040 was estimated using referral patterns for radiation therapy and consultation workload metrics applied to projected annual cancer incident cases to calculate required full-time equivalent positions. Baseline model parameters were also applied to the 2005-2019 workforce and incident case data to evaluate preprojection supply and demand trends. RESULTS Preprojection trends for 2005 to 2019 revealed accelerated staffing growth that transitioned from a workforce shortage to a surplus state in 2014 followed by substantial growth slowdown in 2016. The model predicts a transient surplus of radiation oncologists until 2026 followed by a projected deficit in subsequent years. Sensitivity analyses using the plausible range for each parameter continued to favor an undersupply, suggesting a trainee shortage unable to meet workforce expansion needs. Considering possible future declining trends in radiotherapy utilization and workload, calculations to inform corrective efforts in resident numbers resulted in 25 entry positions per year, up from 21 per year currently. Geographic distribution of trainees, relative to workforce and cancer incidence distributions, could be improved with more residency positions in Canadian regions outside Ontario. CONCLUSIONS Demand for radiation therapy and radiation oncologists in Canada are expected to grow more quickly than future expansion in staffing levels. Our workforce planning model provides evidence for more trainee requirements to inform stakeholders of possible corrective actions to training programs and recruitment. Further research is needed to explore additional strategies to expand capacity and high-quality delivery of radiation therapy to meet the foreseeable increase in Canadian patients with cancer.
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Affiliation(s)
- Shaun K Loewen
- Division of Radiation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada.
| | - Yibing Ruan
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Che Hsuan David Wu
- Division of Radiation Oncology, BC Cancer, Victoria, British Columbia, Canada
| | - Andrew Arifin
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Michael Kim
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bashir Bashir
- Division of Radiation Oncology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Ross Halperin
- Division of Radiation Oncology, BC Cancer, Kelowna, British Columbia, Canada
| | - Michael McKenzie
- Division of Radiation Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Jean Archambault
- Department of Radiation Oncology, Centre Hospitalier Universitaire de Québec - Université Laval, Quebec City, Quebec, Canada
| | - Robert Thompson
- Department of Radiation Oncology, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Michael Brundage
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada
| | - Darren Brenner
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Teri Stuckless
- Department of Radiation Oncology, Cancer Care Program of Eastern Health, St. John's, Newfoundland, Canada
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9
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Gomis Sellés E, Picón García F, Muñoz Muñoz Ó, Delgado León BD, Cabrera Roldán P, Borrego Reina M, López Guerra JL. Saving lives, saving earth: hypofractionation and carbon footprint. Clin Transl Oncol 2024:10.1007/s12094-024-03552-y. [PMID: 38867027 DOI: 10.1007/s12094-024-03552-y] [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: 03/13/2024] [Accepted: 06/04/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE The healthcare system contributes approximately 5% of global greenhouse gas emissions, yet the environmental impact of radiotherapy treatments remains inadequately assessed. MATERIAL AND METHODS We selected all breast cancer patients (1959 patients) treated with adjuvant radiotherapy between 2015 and 2023 in one institution. We analyzed the CO2 emissions associated with travel. We also selected 60 patients randomly to analyze treatment-associated carbon emissions. We compared three different fractionation schemes: normofractionation (25-30 fractions, fx), hypofractionation (15-18fx), and ultra-hypofractionation (5-6fx). RESULTS Our study revealed a significant reduction in carbon emissions within the 5-fractions group compared to the 15-fractions group (26.69kg vs 57.13kg, p < 0.001), saving approximately the CO2 emissions associated with the electricity consumption of an average Spanish household for 12 days, or the emissions of a passenger flying from Madrid to Barcelona. CONCLUSION Most of the carbon footprint of radiotherapy is due to travel. Hypofractionation could be an appropriate solution to protect the environment.
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Affiliation(s)
- Elías Gomis Sellés
- Radiation Oncology Department, University Hospital Virgen del Rocío, Biomedical Institute of Seville (IBIS)/CSIC/University of Seville, Seville, Spain.
| | | | - Óscar Muñoz Muñoz
- Radiation Oncology Department, University Hospital Virgen del Rocío, Biomedical Institute of Seville (IBIS)/CSIC/University of Seville, Seville, Spain
| | - Blas David Delgado León
- Radiation Oncology Department, University Hospital Virgen del Rocío, Biomedical Institute of Seville (IBIS)/CSIC/University of Seville, Seville, Spain
| | - Patricia Cabrera Roldán
- Radiation Oncology Department, University Hospital Virgen del Rocío, Biomedical Institute of Seville (IBIS)/CSIC/University of Seville, Seville, Spain
| | - Manuel Borrego Reina
- Radiation Oncology Department, University Hospital Virgen del Rocío, Biomedical Institute of Seville (IBIS)/CSIC/University of Seville, Seville, Spain
| | - José Luis López Guerra
- Radiation Oncology Department, University Hospital Virgen del Rocío, Biomedical Institute of Seville (IBIS)/CSIC/University of Seville, Seville, Spain
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Esmati E, Ghalehtaki R, Lashkari M, Babaei M, Saraee A, Mortazavi H, Saraee E. Examining the impact of the device used for contouring in saving time and increasing the ease of contouring patients in radiotherapy treatment. J Med Imaging Radiat Sci 2024; 55:203-211. [PMID: 38431450 DOI: 10.1016/j.jmir.2024.01.010] [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: 09/30/2023] [Revised: 01/12/2024] [Accepted: 01/25/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION/BACKGROUND This study was designed to investigate the amount of time saved and the degree of contour difficulty between the two methods of contouring, mouse/keyboard, versus touch screen/stylus in radiotherapy. METHODS Each of 94 patients consisting of 26 breast cancer cases, 24 lymph nodes cases, 25 rectal cancer cases, and 19 heart cases has been contoured twice. One with a mouse/keyboard, and the next one with the touch screen/stylus. Three radiation oncologists participated in this study. Contouring information including measured time, estimated time spent, volume of contour performed and organ contoured are recorded. To evaluate the differences between the contouring methods, the results regarding target volume and time to completion were analyzed using two-way robust ANOVA. Ease of use and contouring difficulty were compared for differences in distribution of the response choices between the groups using Pearson chi-square test. RESULTS In this study, 94 clinical cases were studied. The average time required for contouring with the touch screen/stylus method was half the time needed for contouring patients with the mouse/keyboard method. The reduction in the time in breast cancer cases was the highest (48.2%) and the lowest in head and neck cancer cases (32.4%). In comparing the contoured volumes, no significant difference was observed between the two methods. the mean estimated time reported by the radiation oncologist in the mouse/keyboard method was 5.6 minutes longer and, in the touch screen/stylus method, was 3.9 minutes less than the actual measured time. CONCLUSIONS All the measured and analyzed variables show the superiority of contouring with the touch screen/stylus method and reduced the time required for patient contouring by an average of 50%.
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Affiliation(s)
- Ebrahim Esmati
- Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Reza Ghalehtaki
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Lashkari
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Babaei
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Saraee
- Department of plastic and reconstructive surgery, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamideh Mortazavi
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Saraee
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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11
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Shestovskaya MV, Luss AL, Bezborodova OA, Kulikov PP, Antufrieva DA, Plotnikova EA, Makarov VV, Yudin VS, Pankratov AA, Keskinov AA. Radiosensitizing effects of heparinized magnetic iron oxide nanoparticles in colon cancer. Biomed Pharmacother 2024; 175:116668. [PMID: 38701565 DOI: 10.1016/j.biopha.2024.116668] [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: 01/26/2024] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
The combination of radiation treatment and chemotherapy is currently the standard for management of cancer patients. However, safe doses do not often provide effective therapy, then pre-treated patients are forced to repeat treatment with often already increased tumor resistance to drugs and irradiation. One of the solutions we suggest is to improve primary course of radiation treatment via enhancing radiosensitivity of tumors by magnetic-guided iron oxide nanoparticles (magnetite). We obtained spherical heparinized iron oxide nanoparticles (hIONPs, ∼20 nm), characterized it by TEM, Infrared spectroscopy and DLS. Then hIONPs cytotoxicity was assessed for colon cancer cells (XTT assay) and cellular uptake of nanoparticles was analyzed with X-ray fluorescence. Combination of ionizing radiation (IR) and hIONPs in vitro caused an increase of G2/M arrest of cell cycle, mitotic errors and decrease in survival (compared with samples exposed to IR and hIONPs separately). The promising results were shown for magnetic-guided hIONPs in CT26-grafted BALB/C mice: the combination of intravenously administrated hIONPs and IR showed 20,8% T/C ratio (related to non-treated mice), while single radiation had no shown significant decrease in tumor growth (72,4%). Non-guided by magnets hIONPs with IR showed 57,9% of T/C. This indicates that ultra-small size and biocompatible molecule are not the key to successful nano-drug design, in each case, delivery technologies need to be improved when transferred to in vivo model.
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Affiliation(s)
- Maria V Shestovskaya
- Federal State Budgetary Institution "Centre for Strategic Planning and Management of Biomedical Health Risks" of the Federal Medical Biological Agency, Pogodinskaya st. 10/1, Moscow 119435, Russia.
| | - Anna L Luss
- Federal State Budgetary Institution "Centre for Strategic Planning and Management of Biomedical Health Risks" of the Federal Medical Biological Agency, Pogodinskaya st. 10/1, Moscow 119435, Russia
| | - Olga A Bezborodova
- P. Hertsen Moscow Oncology Research Institute - Branch of the National Medical Research Radiological Centre, Ministry of Health of the Russian Federation, 2nd Botkinskiy p. 3, Moscow 125284, Russia
| | - Pavel P Kulikov
- Federal State Budgetary Institution "Centre for Strategic Planning and Management of Biomedical Health Risks" of the Federal Medical Biological Agency, Pogodinskaya st. 10/1, Moscow 119435, Russia
| | - Daria A Antufrieva
- Federal State Budgetary Institution "Centre for Strategic Planning and Management of Biomedical Health Risks" of the Federal Medical Biological Agency, Pogodinskaya st. 10/1, Moscow 119435, Russia
| | - Ekaterina A Plotnikova
- P. Hertsen Moscow Oncology Research Institute - Branch of the National Medical Research Radiological Centre, Ministry of Health of the Russian Federation, 2nd Botkinskiy p. 3, Moscow 125284, Russia
| | - Valentin V Makarov
- Federal State Budgetary Institution "Centre for Strategic Planning and Management of Biomedical Health Risks" of the Federal Medical Biological Agency, Pogodinskaya st. 10/1, Moscow 119435, Russia
| | - Vladimir S Yudin
- Federal State Budgetary Institution "Centre for Strategic Planning and Management of Biomedical Health Risks" of the Federal Medical Biological Agency, Pogodinskaya st. 10/1, Moscow 119435, Russia
| | - Andrey A Pankratov
- P. Hertsen Moscow Oncology Research Institute - Branch of the National Medical Research Radiological Centre, Ministry of Health of the Russian Federation, 2nd Botkinskiy p. 3, Moscow 125284, Russia
| | - Anton A Keskinov
- Federal State Budgetary Institution "Centre for Strategic Planning and Management of Biomedical Health Risks" of the Federal Medical Biological Agency, Pogodinskaya st. 10/1, Moscow 119435, Russia
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12
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Arumugam S, Sidhom M. Robust Optimization for Prostate Radiation Therapy: Assessment of Delivered Dose by Incorporating Intrafraction Prostate Position Deviations. Adv Radiat Oncol 2024; 9:101455. [PMID: 38596454 PMCID: PMC11002539 DOI: 10.1016/j.adro.2024.101455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/18/2024] [Indexed: 04/11/2024] Open
Abstract
Purpose To assess the robustness of the dose delivered to the clinical target volume (CTV) between planning target volume (PTV)-based and robust optimization planning approaches in localized prostate cancer radiation therapy. Methods and Materials Retrospective data of 20 patients with prostate cancer, including radiation therapy and real-time prostate position, were analyzed. Two sets of volumetric modulated arc therapy plans were generated per patient: PTV-based and robust optimization. PTV-based planning used a 7-mm CTV-PTV margin, whereas robust planning considered same-magnitude position deviations. Differences in CTV dose delivered to 99% volume (D99), PTV dose delivered to 95% volume (D95), and bladder and rectum V40 (volume receiving 40 Gy) and V60 (volume receiving 60 Gy) values were evaluated. The target position, determined by in-house position monitoring system, was incorporated for dose assessment with and without position deviation correction. Results In the robust optimization approach, compared with PTV-based planning, the mean (standard deviation) V40 and V60 values of the bladder were reduced by 5.2% (4.1%) and 5.1% (1.9%), respectively. Similarly, for the rectum, the reductions were 0.8% (0.5%) and 0.6% (0.6%). In corrected treatment scenarios, both planning approaches resulted in a mean (standard deviation) CTV D99 difference of 0.1 Gy (0.1 Gy). In the not corrected scenario, PTV-based planning reduced CTV D99 by 0.1 Gy (0.5 Gy), whereas robust planning reduced it by 0.2 Gy (0.6 Gy). There was no statistically significant difference observed in the planned and delivered rectum and bladder dose for both corrected and not corrected scenarios. Conclusions Robust optimization resulted in lower V40 and V60 values for the bladder compared with PTV-based planning. However, no difference in CTV dose accuracy was found between the 2 approaches.
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Affiliation(s)
- Sankar Arumugam
- Department of Medical Physics, Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, New South Wales, Australia
- South Western Sydney, Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Sidhom
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, New South Wales, Australia
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13
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Szlasa W, Sztuder A, Kaczmar-Dybko A, Maciejczyk A, Dybko J. Efficient combination of radiotherapy and CAR-T - A systematic review. Biomed Pharmacother 2024; 174:116532. [PMID: 38574625 DOI: 10.1016/j.biopha.2024.116532] [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: 01/09/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024] Open
Abstract
Chimeric antigen receptor T (CAR-T) cell therapy, a groundbreaking immunotherapy. However, it faces formidable challenges in treating solid tumors, grappling with issues like poor trafficking, limited penetration, and insufficient persistence within the tumor microenvironment (TME). CAR-T cells are engineered to express receptors that target specific cancer antigens, enhancing their ability to recognize and eliminate cancer cells. This review paper explores the intricate interplay between CAR-T therapy and radiotherapy (RT), investigating their synergistic potential. Radiotherapy, a standard cancer treatment, involves using high doses of radiation to target and damage cancer cells, disrupting their ability to grow and divide. We highlight that RT modulates the TME, augments antigen presentation, and promotes immune cell infiltration, bolstering CAR-T cell-mediated tumor eradication. Molecular insights shed light on RT-induced alterations in tumor stroma, T cell recruitment promotion, and induction of immunogenic cell death. Noteworthy, strategies, such as combining hypofractionated radiotherapy with myeloid-derived suppressor cell blockade, underscore innovative approaches to enhance CAR-T cell therapy in solid tumors. Bridging indications for RT and CAR-T cells in hematological malignancies are discussed, emphasizing scenarios where RT strategically enhances CAR-T cell efficacy. The paper critically evaluates the RT as a bridge compared to traditional chemotherapy, highlighting timing and dosage considerations crucial for optimizing CAR-T therapy outcomes. In summary, the paper provides valuable insights into the intricate molecular mechanisms activated by RT and innovative strategies to improve CAR-T cell therapy, fostering a deeper understanding of their combined potential in cancer treatment.
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Affiliation(s)
- Wojciech Szlasa
- Lower Silesian Centre of Oncology, Pulmonology and Hematology, Wroclaw 53-413, Poland; Medical University Hospital, Borowska 213, Wrocław 50-556, Poland.
| | - Aleksandra Sztuder
- Lower Silesian Centre of Oncology, Pulmonology and Hematology, Wroclaw 53-413, Poland; Department of Oncology, Wroclaw Medical University, Wroclaw 50-367, Poland
| | | | - Adam Maciejczyk
- Lower Silesian Centre of Oncology, Pulmonology and Hematology, Wroclaw 53-413, Poland; Department of Oncology, Wroclaw Medical University, Wroclaw 50-367, Poland
| | - Jarosław Dybko
- Lower Silesian Centre of Oncology, Pulmonology and Hematology, Wroclaw 53-413, Poland; Department of Oncology and Hematology, Wroclaw University of Science and Technology, Wrocław 50-370, Poland
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14
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Rao S, Sharan K, Chandraguthi SG, Dsouza RN, David LR, Ravichandran S, Mustapha MT, Shettigar D, Uzun B, Kadavigere R, Sukumar S, Ozsahin DU. Advanced Computational Methods for Radiation Dose Optimization in CT. Diagnostics (Basel) 2024; 14:921. [PMID: 38732335 PMCID: PMC11083136 DOI: 10.3390/diagnostics14090921] [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: 01/01/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND In planning radiotherapy treatments, computed tomography (CT) has become a crucial tool. CT scans involve exposure to ionizing radiation, which can increase the risk of cancer and other adverse health effects in patients. Ionizing radiation doses for medical exposure must be kept "As Low As Reasonably Achievable". Very few articles on guidelines for radiotherapy-computed tomography scans are available. This paper reviews the current literature on radiation dose optimization based on the effective dose and diagnostic reference level (DRL) for head, neck, and pelvic CT procedures used in radiation therapy planning. This paper explores the strategies used to optimize radiation doses, and high-quality images for diagnosis and treatment planning. METHODS A cross-sectional study was conducted on 300 patients with head, neck, and pelvic region cancer in our institution. The DRL, effective dose, volumetric CT dose index (CTDIvol), and dose-length product (DLP) for the present and optimized protocol were calculated. DRLs were proposed for the DLP using the 75th percentile of the distribution. The DLP is a measure of the radiation dose received by a patient during a CT scan and is calculated by multiplying the CT dose index (CTDI) by the scan length. To calculate a DRL from a DLP, a large dataset of DLP values obtained from a specific imaging procedure must be collected and can be used to determine the median or 75th-percentile DLP value for each imaging procedure. RESULTS Significant variations were found in the DLP, CTDIvol, and effective dose when we compared both the standard protocol and the optimized protocol. Also, the optimized protocol was compared with other diagnostic and radiotherapy CT scan studies conducted by other centers. As a result, we found that our institution's DRL was significantly low. The optimized dose protocol showed a reduction in the CTDIvol (70% and 63%), DLP (60% and 61%), and effective dose (67% and 62%) for both head, neck, and pelvic scans. CONCLUSIONS Optimized protocol DRLs were proposed for comparison purposes.
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Affiliation(s)
- Shreekripa Rao
- Department of Radiotherapy and Oncology, Manipal College of Health Professions, Manipal 576104, India (R.N.D.)
| | - Krishna Sharan
- Department of Radiotherapy and Oncology, Kasturba Medical College and Hospital, Manipal 576104, India; (K.S.); (S.G.C.)
| | | | - Rechal Nisha Dsouza
- Department of Radiotherapy and Oncology, Manipal College of Health Professions, Manipal 576104, India (R.N.D.)
| | - Leena R. David
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal 576104, India; (L.R.D.); (S.R.); (D.S.)
- Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Sneha Ravichandran
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal 576104, India; (L.R.D.); (S.R.); (D.S.)
| | - Mubarak Taiwo Mustapha
- Operational Research Centre in Healthcare, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey; (M.T.M.); (B.U.)
- Department of Biomedical Engineering, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey
| | - Dilip Shettigar
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal 576104, India; (L.R.D.); (S.R.); (D.S.)
| | - Berna Uzun
- Operational Research Centre in Healthcare, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey; (M.T.M.); (B.U.)
- Department of Mathematics, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey
| | - Rajagopal Kadavigere
- Department of Radiodiagnosis and Imaging, Kasturba Medical College and Hospital, Manipal 576104, India;
| | - Suresh Sukumar
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal 576104, India; (L.R.D.); (S.R.); (D.S.)
| | - Dilber Uzun Ozsahin
- Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Operational Research Centre in Healthcare, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey; (M.T.M.); (B.U.)
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
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15
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Yin L, Hu X, Pei G, Tang M, Zhou Y, Zhang H, Huang M, Li S, Zhang J, Citu C, Zhao Z, Debeb BG, Feng X, Chen J. Genome-wide CRISPR screen reveals the synthetic lethality between BCL2L1 inhibition and radiotherapy. Life Sci Alliance 2024; 7:e202302353. [PMID: 38316463 PMCID: PMC10844523 DOI: 10.26508/lsa.202302353] [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: 09/02/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
Radiation therapy (RT) is one of the most commonly used anticancer therapies. However, the landscape of cellular response to irradiation, especially to a single high-dose irradiation, remains largely unknown. In this study, we performed a whole-genome CRISPR loss-of-function screen and revealed temporal inherent and acquired responses to RT. Specifically, we found that loss of the IL1R1 pathway led to cellular resistance to RT. This is in part because of the involvement of radiation-induced IL1R1-dependent transcriptional regulation, which relies on the NF-κB pathway. Moreover, the mitochondrial anti-apoptotic pathway, particularly the BCL2L1 gene, is crucially important for cell survival after radiation. BCL2L1 inhibition combined with RT dramatically impeded tumor growth in several breast cancer cell lines and syngeneic models. Taken together, our results suggest that the combination of an apoptosis inhibitor such as a BCL2L1 inhibitor with RT may represent a promising anticancer strategy for solid cancers including breast cancer.
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Affiliation(s)
- Ling Yin
- https://ror.org/04twxam07 Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiaoding Hu
- https://ror.org/04twxam07 Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- https://ror.org/04twxam07 Morgan Welch Inflammatory Breast Cancer Clinic and Research Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guangsheng Pei
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mengfan Tang
- https://ror.org/04twxam07 Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - You Zhou
- https://ror.org/04twxam07 Department of Pediatrics Research, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Huimin Zhang
- https://ror.org/04twxam07 Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Min Huang
- https://ror.org/04twxam07 Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Siting Li
- https://ror.org/04twxam07 Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jie Zhang
- https://ror.org/04twxam07 Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Citu Citu
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Zhongming Zhao
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Bisrat G Debeb
- https://ror.org/04twxam07 Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- https://ror.org/04twxam07 Morgan Welch Inflammatory Breast Cancer Clinic and Research Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xu Feng
- https://ror.org/04twxam07 Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Pancreas Center, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Junjie Chen
- https://ror.org/04twxam07 Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Perecko T, Pereckova J, Hoferova Z, Falk M. Cell-type specific anti-cancerous effects of nitro-oleic acid and its combination with gamma irradiation. Biol Chem 2024; 405:177-187. [PMID: 37712609 DOI: 10.1515/hsz-2023-0150] [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: 03/03/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023]
Abstract
Nitro-fatty acids (NFAs) are endogenous lipid mediators capable of post-translational modifications of selected regulatory proteins. Here, we investigated the anti-cancerous effects of nitro-oleic acid (NO2OA) and its combination with gamma irradiation on different cancer cell lines. The effects of NO2OA on cell death, cell cycle distribution, or expression of p21 and cyclin D1 proteins were analyzed in cancer (A-549, HT-29 and FaDu) or normal cell lines (HGF, HFF-1). Dose enhancement ratio at 50 % survival fraction (DERIC50) was calculated for samples pre-treated with NO2OA followed by gamma irradiation. NO2OA suppressed viability and induced apoptotic cell death. These effects were cell line specific but not in general selective for cancer cells. HT-29 cell line exerted higher sensitivity toward NO2OA treatment among cancer cell lines tested: induction of cell cycle arrest in the G2/M phase was associated with an increase in p21 and a decrease in cyclin D1 expression. Pre-treatment of HT-29 cells with NO2OA prior irradiation showed a significantly increased DERIC50, demonstrating radiosensitizing effects. In conclusion, NO2OA exhibited potential for combined chemoradiotherapy. Our results encourage the development of new NFAs with improved features for cancer chemoradiation.
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Affiliation(s)
- Tomas Perecko
- Institute of Biophysics of the Czech Academy of Sciences, Kralovopolska 135, CZ-612 00 Brno, Czech Republic
| | - Jana Pereckova
- Institute of Biophysics of the Czech Academy of Sciences, Kralovopolska 135, CZ-612 00 Brno, Czech Republic
| | - Zuzana Hoferova
- Institute of Biophysics of the Czech Academy of Sciences, Kralovopolska 135, CZ-612 00 Brno, Czech Republic
| | - Martin Falk
- Institute of Biophysics of the Czech Academy of Sciences, Kralovopolska 135, CZ-612 00 Brno, Czech Republic
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Saeedian A, Tabatabaei FS, Azimi A, Babaei M, Lashkari M, Esmati E, Abiar Z, Moadabshoar L, Sandoughdaran S, Kamrava M, Amini A, Ghalehtaki R. PErspective and current status of Radiotherapy Service in IRan (PERSIR)-1 study: assessment of current external beam radiotherapy facilities, staff and techniques compared to the international guidelines. BMC Cancer 2024; 24:324. [PMID: 38459443 PMCID: PMC10921664 DOI: 10.1186/s12885-024-12078-z] [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: 10/16/2023] [Accepted: 03/04/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND AND PURPOSE Radiotherapy (RT) is an essential treatment modality against cancer and becoming even more in demand due to the anticipated increase in cancer incidence. Due to the rapid development of RT technologies amid financial challenges, we aimed to assess the available RT facilities and the issues with achieving health equity based on current equipment compared to the previous reports from Iran. MATERIALS AND METHODS A survey arranged by the Iran Cancer Institute's Radiation Oncology Research Center (RORC) was sent to all of the country's radiotherapy centers in 2022. Four components were retrieved: the reimbursement type, equipment, human resources, and patient load. To calculate the radiotherapy utilization rate (RUR), the Lancet Commission was used. The findings were compared with the previous national data. RESULTS Seventy-six active radiotherapy centers with 123 Linear accelerators (LINACs) were identified. The centers have been directed in three ways. 10 (20 LINACs), 36 (50 LINACs), and 30 centers (53 LINACs) were charity-, private-, and public-based, respectively. Four provinces had no centers. There was no active intraoperative radiotherapy machine despite its availability in 4 centers. One orthovoltage X-ray machine was active and 14 brachytherapy devices were treating patients. There were 344, 252, and 419 active radiation oncologists, medical physicists, and radiation therapy technologists, respectively. The ratio of LINAC and radiation oncologists to one million populations was 1.68 and 4.10, respectively. Since 2017, 35±5 radiation oncology residents have been trained each year. CONCLUSION There has been a notable growth in RT facilities since the previous reports and Iran's situation is currently acceptable among LMICs. However, there is an urgent need to improve the distribution of the RT infrastructure and provide more facilities that can deliver advanced techniques.
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Affiliation(s)
- Arefeh Saeedian
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh-Sadat Tabatabaei
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirali Azimi
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Babaei
- Department of Radiation Oncology, Cancer Institute, IKHC, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Lashkari
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiation Oncology, Cancer Institute, IKHC, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Esmati
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiation Oncology, Cancer Institute, IKHC, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Abiar
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Moadabshoar
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mitchell Kamrava
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Reza Ghalehtaki
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Radiation Oncology Research Center, Radio-Oncology Ward, Cancer Institute, Keshavarz Blvd, Qarib Street, Tehran, Iran.
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Court LE, Aggarwal A, Jhingran A, Naidoo K, Netherton T, Olanrewaju A, Peterson C, Parkes J, Simonds H, Trauernicht C, Zhang L, Beadle BM. Artificial Intelligence-Based Radiotherapy Contouring and Planning to Improve Global Access to Cancer Care. JCO Glob Oncol 2024; 10:e2300376. [PMID: 38484191 PMCID: PMC10954080 DOI: 10.1200/go.23.00376] [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: 10/03/2023] [Revised: 11/22/2023] [Accepted: 01/22/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE Increased automation has been identified as one approach to improving global cancer care. The Radiation Planning Assistant (RPA) is a web-based tool offering automated radiotherapy (RT) contouring and planning to low-resource clinics. In this study, the RPA workflow and clinical acceptability were assessed by physicians around the world. METHODS The RPA output for 75 cases was reviewed by at least three physicians; 31 radiation oncologists at 16 institutions in six countries on five continents reviewed RPA contours and plans for clinical acceptability using a 5-point Likert scale. RESULTS For cervical cancer, RPA plans using bony landmarks were scored as usable as-is in 81% (with minor edits 93%); using soft tissue contours, plans were scored as usable as-is in 79% (with minor edits 96%). For postmastectomy breast cancer, RPA plans were scored as usable as-is in 44% (with minor edits 91%). For whole-brain treatment, RPA plans were scored as usable as-is in 67% (with minor edits 99%). For head/neck cancer, the normal tissue autocontours were acceptable as-is in 89% (with minor edits 97%). The clinical target volumes (CTVs) were acceptable as-is in 40% (with minor edits 93%). The volumetric-modulated arc therapy (VMAT) plans were acceptable as-is in 87% (with minor edits 96%). For cervical cancer, the normal tissue autocontours were acceptable as-is in 92% (with minor edits 99%). The CTVs for cervical cancer were scored as acceptable as-is in 83% (with minor edits 92%). The VMAT plans for cervical cancer were acceptable as-is in 99% (with minor edits 100%). CONCLUSION The RPA, a web-based tool designed to improve access to high-quality RT in low-resource settings, has high rates of clinical acceptability by practicing clinicians around the world. It has significant potential for successful implementation in low-resource clinics.
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Affiliation(s)
| | - Ajay Aggarwal
- Guy's and St Thomas Hospitals, London, United Kingdom
| | - Anuja Jhingran
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | - Lifei Zhang
- University of Texas MD Anderson Cancer Center, Houston, TX
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Corral J, Borras JM, Lievens Y. Utilisation of radiotherapy in lung cancer: A scoping narrative literature review with a focus on the introduction of evidence-based therapeutic approaches in Europe. Clin Transl Radiat Oncol 2024; 45:100717. [PMID: 38226026 PMCID: PMC10788411 DOI: 10.1016/j.ctro.2023.100717] [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] [Received: 11/13/2023] [Accepted: 12/16/2023] [Indexed: 01/17/2024] Open
Abstract
Background and purpose The aim of this study was to review the published studies on the utilisation of radiotherapy in lung cancer (both small and non-small cell lung cancer, SCLC and NSCLC) patients in European countries with a population-based perspective. Material and methods A literature search since January 2000 until December 2022 was carried out. Only English-published papers were included, and only European data was considered. PRISMA guidelines were followed. A scoping narrative review was undertaken due to the hetereogeneity of the published papers. Results 38 papers were included in the analysis, with the majority from the Netherlands (52.6%) and the UK (18.4%). Large variability is observed in the reported radiotherapy utilisation, around 40% for NSCLC in general and between 26 and 42% in stage I NSCLC. Stereotactic body radiotherapy (SBRT) shows a wide range of utilisation across countries and over time, from 8 to 63%. Similary, in stage III lung cancer, chemoradiotherapy (CRT) utilisation varied considerably (11-70%). Eleven studies compared radiotherapy utilisation between older and younger age-groups, showing that younger patients receive more CRT, while the opposite applies for SBRT. An widespreadlack of data on relevant covariates such as comorbidty and health-services related variables is observed. Conclusion The actual utilisation of radiotherapy for lung cancer reported in patterns-of-care studies (POCs) is notably lower than the evidence-based optimal utilisation. Important variability is observed by country, time period, stage at diagnosis and age. A wider use of POCs should be promoted to improve our knowledge on the actual application of evidence-based treatment recommendations.
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Affiliation(s)
- Julieta Corral
- Catalonian Cancer Plan, Department of Health, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet, Barcelona, Spain
| | - Josep M. Borras
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Spain
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Sola AB, Otón LF, Guedea F, Arenas M. A nationwide survey of the current status of radiation oncology teaching in Spanish medical schools. Rep Pract Oncol Radiother 2024; 28:794-800. [PMID: 38515816 PMCID: PMC10954273 DOI: 10.5603/rpor.98741] [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] [Received: 02/24/2023] [Accepted: 12/29/2023] [Indexed: 03/23/2024] Open
Abstract
Background The present study was designed to collect information on the current status of radiation oncology (RO) teaching in undergraduate medical schools in Spain. Materials and methods A cross-sectional survey was conducted with the support of the Spanish Society of Radiation Oncology (SEOR). An anonymous questionnaire was sent in two waves, one month apart, between January and June 2022, to all Medical Schools and affiliated Institutions having radiotherapy departments throughout the country. Data on load, curricular location of OR, the academic course (or courses) in which the subject of OR was taught, and teachers position were recorded. Results Responses were obtained from 26 of the 46 available Medical Schools (response rate 56.5%). The average number of theoretical classes was 13 (0-30), seminars: 4.5 (0-12) and hours of practical training 17 (0-60). The scientific content of RO was covered very evenly. Medical physics and radiobiology were taught with different extension in 24 medical schools (92.3%). Information on technological equipment, brachytherapy, indications, and clinical results was provided in all but one medical school. In 13 medical schools (50.0%) the contents of RO were taught in more than one course, but the distribution of RO teaching during the six years of undergraduate training was quite dispersed. The teaching staff included 4 full professors, 8 tenured professors, and 68 clinical associate professors. The average number of associate professors per medical school was 2.2. Also, the average number of full professors and tenured lecturers was 0.42 per medical school, although there were none in 16 centers. Conclusions The overall teaching content of RO in Spanish medical schools seems appropriate but actions to improve the heterogeneity in the curricular location of RO and the shortage of teachers should be implemented.
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Affiliation(s)
- Albert Biete Sola
- Radiotherapy Oncology Service, Hospital Clinic; Department de Fonaments Clinics, Universitat de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Luis Fernando Otón
- Radiotherapy Oncology Service, Hospital Clínico, Universidad de La Laguna, Tenerife, Spain
| | - Ferran Guedea
- Radiotherapy Oncology Service, Institut Català d'Oncologia (ICO), L'Hospitalt de Llobregat, Barcelona, Faculty of Medicine (Unidad Docente de Bellvitge), Universitat de Barcelona, Barcelona, Spain
| | - Meritxell Arenas
- Radiotherapy Oncology Service, Hospital de Sant Joan, Reus, Tarragona, Faculty of Medicine, University Rovira i Virgili, Tarragona, Spain
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Lievens Y. Modelling radiotherapy availability in the Asia-Pacific region. Lancet Oncol 2024; 25:152-154. [PMID: 38301685 DOI: 10.1016/s1470-2045(23)00655-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 02/03/2024]
Affiliation(s)
- Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Gent 9000, Belgium.
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22
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Snyder J, Smith B, Aubin JS, Shepard A, Hyer D. Simulating an intra-fraction adaptive workflow to enable PTV margin reduction in MRIgART volumetric modulated arc therapy for prostate SBRT. Front Oncol 2024; 13:1325105. [PMID: 38260830 PMCID: PMC10800949 DOI: 10.3389/fonc.2023.1325105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose This study simulates a novel prostate SBRT intra-fraction re-optimization workflow in MRIgART to account for prostate intra-fraction motion and evaluates the dosimetric benefit of reducing PTV margins. Materials and methods VMAT prostate SBRT treatment plans were created for 10 patients using two different PTV margins, one with a 5 mm margin except 3 mm posteriorly (standard) and another using uniform 2 mm margins (reduced). All plans were prescribed to 36.25 Gy in 5 fractions and adapted onto each daily MRI dataset. An intra-fraction adaptive workflow was simulated for the reduced margin group by synchronizing the radiation delivery with target position from cine MRI imaging. Intra-fraction delivered dose was reconstructed and prostate DVH metrics were evaluated under three conditions for the reduced margin plans: Without motion compensation (no-adapt), with a single adapt prior to treatment (ATP), and lastly for intra-fraction re-optimization during delivery (intra). Bladder and rectum DVH metrics were compared between the standard and reduced margin plans. Results As expected, rectum V18 Gy was reduced by 4.4 ± 3.9%, D1cc was reduced by 12.2 ± 6.8% (3.4 ± 2.3 Gy), while bladder reductions were 7.8 ± 5.6% for V18 Gy, and 9.6 ± 7.3% (3.4 ± 2.5 Gy) for D1cc for the reduced margin reference plans compared to the standard PTV margin. For the intrafraction replanning approach, average intra-fraction optimization times were 40.0 ± 2.9 seconds, less than the time to deliver one of the four VMAT arcs (104.4 ± 9.3 seconds) used for treatment delivery. When accounting for intra-fraction motion, prostate V36.25 Gy was on average 96.5 ± 4.0%, 99.1 ± 1.3%, and 99.6 ± 0.4 for the non-adapt, ATP, and intra-adapt groups, respectively. The minimum dose received by the prostate was less than 95% of the prescription dose in 84%, 36%, and 10% of fractions, for the non-adapt, ATP, and intra-adapt groups, respectively. Conclusions Intra-fraction re-optimization improves prostate coverage, specifically the minimum dose to the prostate, and enables PTV margin reduction and subsequent OAR sparing. Fast re-optimizations enable uninterrupted treatment delivery.
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Affiliation(s)
- Jeffrey Snyder
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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Malekzadeh H, Surucu Y, Chinnapaka S, Yang KS, Arellano JA, Samadi Y, Epperly MW, Greenberger JS, Rubin JP, Ejaz A. Metformin and adipose-derived stem cell combination therapy alleviates radiation-induced skin fibrosis in mice. Stem Cell Res Ther 2024; 15:13. [PMID: 38185658 PMCID: PMC10773046 DOI: 10.1186/s13287-023-03627-7] [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: 11/14/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Radiation therapy often leads to late radiation-induced skin fibrosis (RISF), causing movement impairment and discomfort. We conducted a comprehensive study to assess the effectiveness of metformin and adipose-derived stem cells (ASCs), whether autologous or allogeneic, individually or in combination therapy, in mitigating RISF. METHODS Using a female C57BL/6J mouse model subjected to hind limb irradiation as a representative RISF model, we evaluated metformin, ASCs, or their combination in two contexts: prophylactic (started on day 1 post-irradiation) and therapeutic (initiated on day 14 post-irradiation, coinciding with fibrosis symptoms). We measured limb movement, examined skin histology, and analyzed gene expression to assess treatment efficacy. RESULTS Prophylactic metformin and ASCs, whether autologous or allogeneic, effectively prevented late fibrosis, with metformin showing promising results. However, combination therapy did not provide additional benefits when used prophylactically. Autologous ASCs, alone or with metformin, proved most effective against late-stage RISF. Prophylactic intervention outperformed late therapy for mitigating radiation skin damage. Co-culture studies revealed that ASCs and metformin downregulated inflammation and fibrotic gene expression in both mouse and human fibroblasts. CONCLUSIONS Our study suggests metformin's potential as a prophylactic measure to prevent RISF, and the combination of ASCs and metformin holds promise for late-stage RISF treatment. These findings have clinical implications for improving the quality of life for those affected by radiation-induced skin fibrosis.
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Affiliation(s)
- Hamid Malekzadeh
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA, 15261, USA
| | - Yusuf Surucu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA, 15261, USA
| | - Somaiah Chinnapaka
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA, 15261, USA
| | - Katherine S Yang
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA, 15261, USA
| | - José A Arellano
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA, 15261, USA
| | - Yasamin Samadi
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA, 15261, USA
| | - Michael W Epperly
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Joel S Greenberger
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - J Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA, 15261, USA
- McGowan Institute, University of Pittsburgh, Pittsburgh, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, USA
| | - Asim Ejaz
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA, 15261, USA.
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Gan DEH, Bustam AZ. Cancer trend and radiotherapy utilization at a tertiary academic hospital in Malaysia. J Cancer Res Ther 2024; 20:358-362. [PMID: 38554346 DOI: 10.4103/jcrt.jcrt_1953_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/10/2022] [Indexed: 04/01/2024]
Abstract
AIMS To determine the trend of cancer cases referred to the Department of Clinical Oncology in UMMC in terms of patient volumes over a period of 10 years. To define the stage at presentation of the top five cancers in males and females, respectively. To determine the overall radiotherapy utilization rates. METHODS AND MATERIAL This is a retrospective analysis of all new cases seen at the Department of Clinical Oncology, University of Malaya Medical Centre (UMMC), from the year 2009 to 2018 inclusive. The top five cancers in males and females were defined in terms of patient volumes and stage at presentation. The overall actual radiotherapy utilization rates were determined. RESULTS A total of 12,672 patients were included for analysis. A total of 62.9% of the cases were females and 37.1% were males. The median age of presentation was 59 years old. Breast cancer was the most common cancer, followed by colorectal, lung, thyroid, and prostate cancer. The most common presenting stage was stage 4. The overall actual radiotherapy utilization rate (aRTU) was 40.1%. Curative intent makes up 74.3% of radiotherapy and 66.6% of chemotherapy utilization. CONCLUSIONS The cancer distribution and trends among our patients are comparable with national and regional data. The overall actual radiotherapy utilization rate in the UMMC was lower than the estimated optimal rate of 53% but higher than the actual rate of 28% for Malaysia. This study provides valuable insight into current cancer trends and treatment demands to facilitate service planning.
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Affiliation(s)
- Daniel E H Gan
- Department of Clinical Oncology, University of Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, Lembah Pantai, Kuala Lumpur, Malaysia
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Zhu KY, Karimi AH, Lavu M, Burkhart RJ, Kamath AF. Impact of external beam radiation on total shoulder arthroplasty outcomes: a propensity-matched cohort study. Arch Orthop Trauma Surg 2024; 144:113-119. [PMID: 37670152 DOI: 10.1007/s00402-023-05048-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/26/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND External beam radiation therapy has a number of deleterious effects on the body, and a number of post-operative complications have been reported for several surgeries including total knee arthroplasty. However, few studies have investigated the impact of external beam radiation therapy for total shoulder arthroplasty (TSA). Our study aimed to assess the systemic and joint complications associated with TSA in patients with prior radiation exposures, as well as evaluate the surgical outcomes of radiation patients compared to non-radiation TSA patients. MATERIALS AND METHODS A retrospective cohort analysis was conducted using the TriNetX Analytics Network. A 1:1 propensity score matching function was utilized to create two cohorts with matched baseline characteristics within the TriNetX network. Comparisons of the primary and secondary outcomes between the two cohorts were made using odds ratios. A p value of < 0.05 was determined to be significant. RESULTS A total of 75,510 patients that received TSA were identified with 1505 having a history of radiation therapy (RT) and 73,605 with no radiation therapy (non-RT). After propensity matching, both groups contained 1484 patients. RT patients were at higher risk for developing prosthetic joint infection, acute renal failure, altered mental state, cerebrovascular event, DVT, PE, pneumonia, respiratory failure, and UTI compared to non-RT patients at different time points (p < 0.5). CONCLUSION Patients with prior history of external beam radiation undergoing TSA had a higher risk of systemic complications and prosthetic joint infection compared to patients without a prior history. These complications suggest a more complicated post-operative management course for these patients.
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Affiliation(s)
- Kevin Y Zhu
- Department of Orthopedic Surgery, Center for Hip Preservation, Cleveland Clinic Foundation, 9500 Euclid Ave, Mail Code A41, Cleveland, OH, 44195, USA
| | - Amir H Karimi
- Department of Orthopedic Surgery, Center for Hip Preservation, Cleveland Clinic Foundation, 9500 Euclid Ave, Mail Code A41, Cleveland, OH, 44195, USA
| | - Monish Lavu
- Department of Orthopedic Surgery, Center for Hip Preservation, Cleveland Clinic Foundation, 9500 Euclid Ave, Mail Code A41, Cleveland, OH, 44195, USA
| | - Robert J Burkhart
- Department of Orthopedic Surgery, Center for Hip Preservation, Cleveland Clinic Foundation, 9500 Euclid Ave, Mail Code A41, Cleveland, OH, 44195, USA
| | - Atul F Kamath
- Department of Orthopedic Surgery, Center for Hip Preservation, Cleveland Clinic Foundation, 9500 Euclid Ave, Mail Code A41, Cleveland, OH, 44195, USA.
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Busschaert SL, Kimpe E, Barbé K, De Ridder M, Putman K. Introduction of ultra-hypofractionation in breast cancer: Implications for costs and resource use. Radiother Oncol 2024; 190:110010. [PMID: 37956888 DOI: 10.1016/j.radonc.2023.110010] [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: 08/08/2023] [Revised: 10/14/2023] [Accepted: 11/04/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE A shift towards (ultra-)hypofractionated breast irradiation can have important implications for the practice of contemporary radiation oncology. This paper presents a systematic analysis of the impact of different fractionation schedules on multiple key performance indicators, namely resource use, costs, work times, throughput and waiting times. MATERIALS AND METHODS Time-driven activity-based costing (TD-ABC) is applied to calculate the costs and resources consumed where the perspective of the radiotherapy department in adopted. Three fractionation regimens are considered: ultra-hypofractionation (5 x 5.2 Gy, UHF), moderate hypofractionation (15 x 2.67 Gy, HF) and conventional fractionation (25 x 2 Gy, CF). Subsequently, a discrete event simulation (DES) model of the radiotherapy care pathway is developed and scenarios are compared in which the following factors are varied: distribution of fractionation regimens, patient volume and operating hours. RESULTS The application of (U)HF can permit radiotherapy departments to reduce the use of scarce resources, realise work time and cost savings, increase throughput and reduce waiting times. The financial advantages of (U)HF are, however, reduced in cases of excess capacity and cost savings may therefore be limited in the short-term. Moreover, although an extension of operating hours has favourable effects on throughput and waiting times, it may also reduce cost differences between fractionation schedules by increasing the capacity of resources. CONCLUSION By providing an in-depth analysis of the consequences associated with a shift towards (U)HF in breast cancer, the present study demonstrates how a DES model based on TD-ABC costing can assist radiotherapy professionals in making data-driven decisions.
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Affiliation(s)
- Sara-Lise Busschaert
- Department of Public Health, Vrije Universiteit Brussel, Laarbeeklaan, 101 - 1090 Brussels, Belgium.
| | - Eva Kimpe
- Department of Public Health, Vrije Universiteit Brussel, Laarbeeklaan, 101 - 1090 Brussels, Belgium
| | - Kurt Barbé
- Department of Public Health, Vrije Universiteit Brussel, Laarbeeklaan, 101 - 1090 Brussels, Belgium
| | - Mark De Ridder
- Department of Radiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan, 101 - 1090 Brussels, Belgium
| | - Koen Putman
- Department of Public Health, Vrije Universiteit Brussel, Laarbeeklaan, 101 - 1090 Brussels, Belgium; Department of Radiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan, 101 - 1090 Brussels, Belgium
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Li J, Lv Z, Guo Y, Fang J, Wang A, Feng Y, Zhang Y, Zhu J, Zhao Z, Cheng X, Shi H. Hafnium (Hf)-Chelating Porphyrin-Decorated Gold Nanosensitizers for Enhanced Radio-Radiodynamic Therapy of Colon Carcinoma. ACS NANO 2023; 17:25147-25156. [PMID: 38063344 DOI: 10.1021/acsnano.3c08068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
X-ray-induced radiodynamic therapy (RDT) that can significantly reduce radiation dose with an improved anticancer effect has emerged as an attractive and promising therapeutic modality for tumors. However, it is highly significant to develop safe and efficient radiosensitizing agents for tumor radiation therapy. Herein, we present a smart nanotheranostic system FA-Au-CH that consists of gold nanoradiosensitizers, photosensitizer chlorin e6 (Ce6), and folic acid (FA) as a folate-receptor-targeting ligand for improved tumor specificity. FA-Au-CH nanoparticles have been demonstrated to be able to simultaneously serve as radiosensitizers and RDT agents for enhanced computed tomography (CT) imaging-guided radiotherapy (RT) of colon carcinoma, owing to the strong X-ray attenuation capability of high-Z elements Au and Hf, as well as the characteristics of Hf that can transfer radiation energy to Ce6 to generate ROS from Ce6 under X-ray irradiation. The integration of RT and RDT in this study demonstrates great efficacy and offers a promising therapeutic modality for the treatment of malignant tumors.
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Affiliation(s)
- Jiachen Li
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Zhengzhong Lv
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Yirui Guo
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Jing Fang
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Anna Wang
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Yali Feng
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Yuqi Zhang
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Jinfeng Zhu
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, 00133 Roma, Italy
| | - Zhongsheng Zhao
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Xiaju Cheng
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Haibin Shi
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
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Yu B, Lu X, Feng X, Zhao T, Li J, Lu Y, Ye F, Liu X, Zheng X, Shen Z, Jin X, Chen W, Li Q. Gadolinium Oxide Nanoparticles Reinforce the Fractionated Radiotherapy-Induced Immune Response in Tri-Negative Breast Cancer via cGAS-STING Pathway. Int J Nanomedicine 2023; 18:7713-7728. [PMID: 38115988 PMCID: PMC10729773 DOI: 10.2147/ijn.s428044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/02/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Radiotherapy is a widely recognized first-line clinical treatment for cancer, but its efficacy may be impeded by the radioresistance of advanced tumors. It is urgent to improve the sensitivity of radioresistant tumors to radiotherapy. In this work, gadolinium oxide nanocrystals (GONs) were utilized as radiosensitizers to enhance the killing effect and reinforce the immune activation of X-ray irradiation on 4T1 breast cancer cells in vitro and in vivo. Methods 1.0 T small animal MR imaging (MRI) system was employed to trace GONs in vivo, while 225 kVp X-ray irradiation equipment was utilized for investigating the radiosensitization of GONs in 4T1 breast cancer cells in vitro and in vivo. Western blot, quantitative real-time PCR (RT-qPCR), immunohistochemistry, immunofluorescence, clonal survival assay, flow cytometry and reactive oxygen species assay were used to explore the biological mechanism of GON sensitization. Results GONs exhibited exceptional utility as contrast agents for both in vivo and in vitro MRI imaging. Interestingly, a single dose of 8.0 Gy X-rays together with GONs failed to confer superior therapeutic effects in tumor-bearing mice, while only 3.0 Gy × 3 fractions X-rays combined with GONs exhibited effective tumor growth inhibition. Moreover, fractionated X-ray irradiation with GONs demonstrated a superior capacity to activate the cGAS-STING pathway. Discussion Fractionated X-ray irradiation in the presence of GONs has demonstrated the most significant activation of the anti-tumor immune response by boosting the cGAS-STING pathway.
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Affiliation(s)
- Boyi Yu
- Biomedical Center, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Heavy Ion Radiation Biology and Medicine, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, Gansu Province, People’s Republic of China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Xuanyi Lu
- School of Biomedical Engineering, Southern Medical University, Guangzhou, People’s Republic of China
| | - Xianglong Feng
- Biomedical Center, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Heavy Ion Radiation Biology and Medicine, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, Gansu Province, People’s Republic of China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Ting Zhao
- Biomedical Center, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Heavy Ion Radiation Biology and Medicine, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, Gansu Province, People’s Republic of China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Jiaxin Li
- Biomedical Center, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Heavy Ion Radiation Biology and Medicine, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, Gansu Province, People’s Republic of China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Yudie Lu
- School of Biomedical Engineering, Southern Medical University, Guangzhou, People’s Republic of China
| | - Fei Ye
- Biomedical Center, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Heavy Ion Radiation Biology and Medicine, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, Gansu Province, People’s Republic of China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Xiongxiong Liu
- Biomedical Center, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Heavy Ion Radiation Biology and Medicine, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, Gansu Province, People’s Republic of China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Xiaogang Zheng
- Biomedical Center, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Heavy Ion Radiation Biology and Medicine, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, Gansu Province, People’s Republic of China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Zheyu Shen
- School of Biomedical Engineering, Southern Medical University, Guangzhou, People’s Republic of China
| | - Xiaodong Jin
- Biomedical Center, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Heavy Ion Radiation Biology and Medicine, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, Gansu Province, People’s Republic of China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Weiqiang Chen
- Biomedical Center, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Heavy Ion Radiation Biology and Medicine, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, Gansu Province, People’s Republic of China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Qiang Li
- Biomedical Center, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Heavy Ion Radiation Biology and Medicine, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
- Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, Gansu Province, People’s Republic of China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
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Hoque SMH, Pirrone G, Matrone F, Donofrio A, Fanetti G, Caroli A, Rista RS, Bortolus R, Avanzo M, Drigo A, Chiovati P. Clinical Use of a Commercial Artificial Intelligence-Based Software for Autocontouring in Radiation Therapy: Geometric Performance and Dosimetric Impact. Cancers (Basel) 2023; 15:5735. [PMID: 38136281 PMCID: PMC10741804 DOI: 10.3390/cancers15245735] [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: 10/11/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE When autocontouring based on artificial intelligence (AI) is used in the radiotherapy (RT) workflow, the contours are reviewed and eventually adjusted by a radiation oncologist before an RT treatment plan is generated, with the purpose of improving dosimetry and reducing both interobserver variability and time for contouring. The purpose of this study was to evaluate the results of application of a commercial AI-based autocontouring for RT, assessing both geometric accuracies and the influence on optimized dose from automatically generated contours after review by human operator. MATERIALS AND METHODS A commercial autocontouring system was applied to a retrospective database of 40 patients, of which 20 were treated with radiotherapy for prostate cancer (PCa) and 20 for head and neck cancer (HNC). Contours resulting from AI were compared against AI contours reviewed by human operator and human-only contours using Dice similarity coefficient (DSC), Hausdorff distance (HD), and relative volume difference (RVD). Dosimetric indices such as Dmean, D0.03cc, and normalized plan quality metrics were used to compare dose distributions from RT plans generated from structure sets contoured by humans assisted by AI against plans from manual contours. The reduction in contouring time obtained by using automated tools was also assessed. A Wilcoxon rank sum test was computed to assess the significance of differences. Interobserver variability of the comparison of manual vs. AI-assisted contours was also assessed among two radiation oncologists for PCa. RESULTS For PCa, AI-assisted segmentation showed good agreement with expert radiation oncologist structures with average DSC among patients ≥ 0.7 for all structures, and minimal radiation oncology adjustment of structures (DSC of adjusted versus AI structures ≥ 0.91). For HNC, results of comparison between manual and AI contouring varied considerably e.g., 0.77 for oral cavity and 0.11-0.13 for brachial plexus, but again, adjustment was generally minimal (DSC of adjusted against AI contours 0.97 for oral cavity, 0.92-0.93 for brachial plexus). The difference in dose for the target and organs at risk were not statistically significant between human and AI-assisted, with the only exceptions of D0.03cc to the anal canal and Dmean to the brachial plexus. The observed average differences in plan quality for PCa and HNC cases were 8% and 6.7%, respectively. The dose parameter changes due to interobserver variability in PCa were small, with the exception of the anal canal, where large dose variations were observed. The reduction in time required for contouring was 72% for PCa and 84% for HNC. CONCLUSIONS When an autocontouring system is used in combination with human review, the time of the RT workflow is significantly reduced without affecting dose distribution and plan quality.
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Affiliation(s)
- S M Hasibul Hoque
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (S.M.H.H.); (G.P.); (R.S.R.); (M.A.); (A.D.)
| | - Giovanni Pirrone
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (S.M.H.H.); (G.P.); (R.S.R.); (M.A.); (A.D.)
| | - Fabio Matrone
- Radiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (F.M.); (A.D.); (G.F.); (A.C.); (R.B.)
| | - Alessandra Donofrio
- Radiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (F.M.); (A.D.); (G.F.); (A.C.); (R.B.)
| | - Giuseppe Fanetti
- Radiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (F.M.); (A.D.); (G.F.); (A.C.); (R.B.)
| | - Angela Caroli
- Radiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (F.M.); (A.D.); (G.F.); (A.C.); (R.B.)
| | - Rahnuma Shahrin Rista
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (S.M.H.H.); (G.P.); (R.S.R.); (M.A.); (A.D.)
| | - Roberto Bortolus
- Radiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (F.M.); (A.D.); (G.F.); (A.C.); (R.B.)
| | - Michele Avanzo
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (S.M.H.H.); (G.P.); (R.S.R.); (M.A.); (A.D.)
| | - Annalisa Drigo
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (S.M.H.H.); (G.P.); (R.S.R.); (M.A.); (A.D.)
| | - Paola Chiovati
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (S.M.H.H.); (G.P.); (R.S.R.); (M.A.); (A.D.)
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Chen M, Xiao L, Jia H, Wang S, Jiang X, Lei X, Zhai Q, Lang J. Stereotactic ablative radiotherapy and FAPα-based cancer vaccine suppresses metastatic tumor growth in 4T1 mouse breast cancer. Radiother Oncol 2023; 189:109946. [PMID: 37806560 DOI: 10.1016/j.radonc.2023.109946] [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: 03/23/2023] [Revised: 09/09/2023] [Accepted: 09/30/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND AND PURPOSE This study tested the hypothesis that a novel combination of stereotactic ablation radiotherapy (SABR) and a cancer vaccine against fibroblast activation protein-alpha (FAPα) can suppress established tumor growth and impede potential metastasis. METHODS The poorly immunogenic metastatic mouse mammary carcinoma 4T1 was used as a model. Mice were randomly assigned to five treatment groups: (1) untreated control, (2) FAPα-based cancer vaccine, (3) SABR, (4) SABR + pCDH (lentiviral control vector), (5) SABR + FAPα-based cancer vaccine (SABR/FAPα-Vax). FAPα-based cancer vaccine were administered subcutaneously every week for a total of three treatments. SABR was delivered to the primary tumor by 3 × 8 Gy after the first vaccination. RESULTS Consistent with the poorly immunogenic nature of 4T1, tumor-bearing mice receiving FAPα-based cancer vaccine or SABR monotherapy showed a modest reduction in tumor volume and increased animal lifespan. In contrast, SABR/FAPα-Vax was well-tolerated, significantly reduced tumor burden, and increased survival compared to monotherapy. The increased survival correlated with inhibition of extracellular matrix (ECM) production, tumor vascularization and lymphangiogenesis. SABR/FAPα-Vax also resulted in an abscopal effect capable of eliminating lung metastases. SABR/FAPα-Vax recruited and activated CD8 + T cells to attack tumor cells and FAPα + stromal cells, and initiated suppressor cell reprogramming, including facilitating macrophage polarization toward an anti-tumor (M1) state, as well as depleting myeloid-derived suppressor cells (MDSCs) and regulatory T cells (Tregs). CONCLUSION These findings provide a novel therapeutic combination of radiation and FAPα-based cancer vaccine with promising results against poorly immunogenic metastatic cancer. This study may pave the way to overcome the therapeutic resistance caused by FAPα + CAFs.
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Affiliation(s)
- Meihua Chen
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
| | - Ling Xiao
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
| | - Hongyuan Jia
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
| | - Shubin Wang
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
| | - Xiao Jiang
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China; Institute of Isotope, China Institute of Atomic Energy, Beijing, China.
| | - Xudan Lei
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
| | - Qiming Zhai
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.
| | - Jinyi Lang
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
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Guo W, Hoque J, Garcia CJG, Spiller KV, Leinroth AP, Puviindran V, Potnis CK, Gunn KA, Newman H, Ishikawa K, Fujimoto TN, Neill DW, Delahoussaye AM, Williams NT, Kirsch DG, Hilton MJ, Varghese S, Taniguchi CM, Wu C. Radiation-induced bone loss in mice is ameliorated by inhibition of HIF-2α in skeletal progenitor cells. Sci Transl Med 2023; 15:eabo5217. [PMID: 38019933 PMCID: PMC10804914 DOI: 10.1126/scitranslmed.abo5217] [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: 02/10/2022] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
Radiotherapy remains a common treatment modality for cancer despite skeletal complications. However, there are currently no effective treatments for radiation-induced bone loss, and the consequences of radiotherapy on skeletal progenitor cell (SPC) survival and function remain unclear. After radiation, leptin receptor-expressing cells, which include a population of SPCs, become localized to hypoxic regions of the bone and stabilize the transcription factor hypoxia-inducible factor-2α (HIF-2α), thus suggesting a role for HIF-2α in the skeletal response to radiation. Here, we conditionally knocked out HIF-2α in leptin receptor-expressing cells and their descendants in mice. Radiation therapy in littermate control mice reduced bone mass; however, HIF-2α conditional knockout mice maintained bone mass comparable to nonirradiated control animals. HIF-2α negatively regulated the number of SPCs, bone formation, and bone mineralization. To test whether blocking HIF-2α pharmacologically could reduce bone loss during radiation, we administered a selective HIF-2α inhibitor called PT2399 (a structural analog of which was recently FDA-approved) to wild-type mice before radiation exposure. Pharmacological inhibition of HIF-2α was sufficient to prevent radiation-induced bone loss in a single-limb irradiation mouse model. Given that ~90% of patients who receive a HIF-2α inhibitor develop anemia because of off-target effects, we developed a bone-targeting nanocarrier formulation to deliver the HIF-2α inhibitor to mouse bone, to increase on-target efficacy and reduce off-target toxicities. Nanocarrier-loaded PT2399 prevented radiation-induced bone loss in mice while reducing drug accumulation in the kidney. Targeted inhibition of HIF-2α may represent a therapeutic approach for protecting bone during radiation therapy.
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Affiliation(s)
- Wendi Guo
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine; Durham, NC 27705, USA
| | - Jiaul Hoque
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
| | - Carolina J. Garcia Garcia
- UTHealth Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center; Houston, TX 77030, USA
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center; Houston, TX 77030, USA
| | - Kassandra V. Spiller
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Surgery, Duke University School of Medicine, Durham, NC 27705, USA
| | - Abigail P. Leinroth
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Regeneron Pharmaceuticals, Tarrytown, NY 10591, USA
| | - Vijitha Puviindran
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
| | - Cahil K. Potnis
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
| | - Kiana A. Gunn
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine; Durham, NC 27705, USA
| | - Hunter Newman
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Mechanical Engineering and Materials Science, Duke University; Durham, NC 27705, USA
| | - Koji Ishikawa
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, 142-8666, JP
| | - Tara N. Fujimoto
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center; Houston, TX 77030, USA
| | - Denae W. Neill
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center; Houston, TX 77030, USA
| | - Abagail M. Delahoussaye
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center; Houston, TX 77030, USA
| | - Nerissa T. Williams
- Department of Radiation Oncology, Duke University School of Medicine; Durham, NC 27705, USA
| | - David G. Kirsch
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Radiation Oncology, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Biomedical Biophysics, University of Toronto, Toronto, ON, M5S 1A8, CA
- Department of Radiation Oncology, University of Toronto, Toronto, ON, M5T 1O5, CA
- Princess Margarat Cancer Centre, University Health Network, Toronto, ON, M5G 2C1, CA
| | - Matthew J. Hilton
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Cell Biology, Duke University School of Medicine; Durham, NC 27705, USA
| | - Shyni Varghese
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Mechanical Engineering and Materials Science, Duke University; Durham, NC 27705, USA
- Department of Biomedical Engineering, Duke University School of Medicine; Durham, NC 27705, USA
| | - Cullen M. Taniguchi
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center; Houston, TX 77030, USA
- Department of GI Radiation Oncology, The University of Texas MD Anderson Cancer Center; Houston, TX 77030, USA
| | - Colleen Wu
- Department of Orthopaedic Surgery, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine; Durham, NC 27705, USA
- Department of Radiation Oncology, University of Toronto, Toronto, ON, M5T 1O5, CA
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Pan S, Sun Z, Zhao B, Miao L, Zhou Q, Chen T, Zhu X. Therapeutic application of manganese-based nanosystems in cancer radiotherapy. Biomaterials 2023; 302:122321. [PMID: 37722183 DOI: 10.1016/j.biomaterials.2023.122321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 09/20/2023]
Abstract
Radiotherapy is an important therapeutic modality in the treatment of cancers. Nevertheless, the characteristics of the tumor microenvironment (TME), such as hypoxia and high glutathione (GSH), limit the efficacy of radiotherapy. Manganese-based (Mn-based) nanomaterials offer a promising prospect for sensitizing radiotherapy due to their good responsiveness to the TME. In this review, we focus on the mechanisms of radiosensitization of Mn-based nanosystems, including alleviating tumor hypoxia, increasing reactive oxygen species production, increasing GSH conversion, and promoting antitumor immunity. We further illustrate the applications of these mechanisms in cancer radiotherapy, including the development and delivery of radiosensitizers, as well as their combination with other therapeutic modalities. Finally, we summarize the application of Mn-based nanosystems as contrast agents in realizing precision therapy. Hopefully, the present review will provide new insights into the biological mechanisms of Mn-based nanosystems, as well as their applications in radiotherapy, in order to address the difficulties and challenges that remain in their clinical application in the future.
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Affiliation(s)
- Shuya Pan
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, China
| | - Zhengwei Sun
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, China
| | - Bo Zhao
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, China
| | - Liqing Miao
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, China
| | - Qingfeng Zhou
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, China
| | - Tianfeng Chen
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, China; Department of Chemistry, Jinan University, China.
| | - Xueqiong Zhu
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, China.
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Mackenzie P, Vajdic C, Delaney G, Comans T, Agar M, Gabriel G, Barton M. Development of an age- and comorbidity- adjusted optimal radiotherapy utilisation rate for lung, rectal, prostate and cervical cancers. Radiother Oncol 2023; 188:109862. [PMID: 37619661 DOI: 10.1016/j.radonc.2023.109862] [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: 01/08/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Optimal radiotherapy utilisation (RTU) modelling estimates the proportion of people with cancer who would benefit from radiotherapy. Assessment of comorbidities is an important component of the assessment of suitability for radiotherapy in addition to chronological age and life expectancy. Comorbidities have not been considered in previous optimal RTU models. We aimed to develop an age- and comorbidity- adjusted optimal RTU model for patients with lung, rectal, prostate, and cervical cancer, and compare them to actual RTU rates, with a particular focus on those aged 80+ years, METHODS: New South Wales (NSW) Cancer Registry data (2010-2014) linked to radiotherapy data (2010-2015) and hospitalisation data (2008-2015) were used to determine the number of patients diagnosed with lung, rectal, prostate and cervical cancer. The Cancer Specific C3 'all sites' comorbidity index was calculated from hospital diagnosis data for each patient to determine suitability for radiotherapy. The index was then incorporated into a tumour site-specific decision tree model. The actual RTU was also calculated using the linked datasets. RESULTS 14,696 patients were diagnosed with non-small cell lung cancer (NSCLC), 1839 with small cell lung cancer (SCLC), 5551 with rectal cancer, 30,935 with prostate cancer and 1216 with cervical cancer in New South Wales from 2010-2014. The proportion of patients aged 80+ years at cancer diagnosis was 25% (3603 patients), 15% (279 patients), 17% (943 patients), 12% (3745 patients), and 7% (88 patients) respectively. The age- and comorbidity- adjusted optimal RTU rates for patients aged 80+ years using the C3 index were 49% (NSCLC), 49% (SCLC), 43% (rectal), 51% (prostate) and 40% (cervical). The corresponding actual RTU rates for patients aged 80+ years were 25%, 32%, 27%, 16%, and 56%. CONCLUSION Even after adjusting for age and comorbidities, the actual radiotherapy utilisation rates were lower than optimal radiotherapy utilisation rates in patients aged 80+ years except for patients with cervical cancer. This warrants further assessment and research into reasons and solutions.
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Affiliation(s)
- Penny Mackenzie
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), The University of New South Wales, Sydney, Australia; The Royal Brisbane and Women's Hospital, Queensland, Australia.
| | - Claire Vajdic
- The Kirby Insitute, The University of New South Wales, Sydney, Australia
| | - Geoff Delaney
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), The University of New South Wales, Sydney, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Australia
| | - Meera Agar
- The University of Technology, Sydney, Australia
| | - Gabriel Gabriel
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), The University of New South Wales, Sydney, Australia
| | - Michael Barton
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), The University of New South Wales, Sydney, Australia
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Laurent PA, Milic M, Quevrin C, Meziani L, Liu W, Morel D, Signolle N, Clémenson C, Levy A, Mondini M, Deutsch E. KRAS G12C inhibition using MRTX1257: a novel radio-sensitizing partner. J Transl Med 2023; 21:773. [PMID: 37907934 PMCID: PMC10619254 DOI: 10.1186/s12967-023-04619-0] [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: 03/11/2023] [Accepted: 10/11/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND KRAS activating mutations are considered the most frequent oncogenic drivers and are correlated with radio-resistance in multiple cancers including non-small cell lung cancer (NSCLC) and colorectal cancer. Although KRAS was considered undruggable until recently, several KRAS inhibitors have recently reached clinical development. Among them, MRTX849 (Mirati Therapeutics) showed encouraging clinical outcomes for the treatment of selected patients with KRASG12C mutated NSCLC and colorectal cancers. In this work, we explore the ability of MRTX1257, a KRASG12C inhibitor analogous to MRTX849, to radio-sensitize KRASG12C+/+ mutated cell lines and tumors. METHODS Both in vitro and in vivo models of radiotherapy (RT) in association with MRTX1257 were used, with different RAS mutational profiles. We assessed in vitro the radio-sensitizing effect of MRTX1257 in CT26 KRASG12C+/+, CT26 WT, LL2 WT and LL2 NRAS KO (LL2 NRAS-/-) cell lines. In vivo, we used syngeneic models of subcutaneous CT26 KRASG12C+/+ tumors in BALB/c mice and T cell deficient athymic nu/nu mice to assess both the radio-sensitizing effect of MRTX1257 and its immunological features. RESULTS MRTX1257 was able to radio-sensitize CT26 KRASG12C+/+ cells in vitro in a time and dose dependent manner. Moreover, RT in association with MRTX1257 in BALB/c mice bearing CT26 KRASG12C+/+ subcutaneous tumors resulted in an observable cure rate of 20%. However, no durable response was observed with similar treatment in athymic nude mice. The analysis of the immune microenvironment of CT26 KRASG12C+/+ tumors following RT and MRTX1257 showed an increase in the proportion of various cell subtypes including conventional CD4 + T cells, dendritic cells type 2 (cDC2) and inflammatory monocytes. Furthermore, the expression of PD-L1 was dramatically down-regulated within both tumor and myeloid cells, thus illustrating the polarization of the tumor microenvironment towards a pro-inflammatory and anti-tumor phenotype following the combined treatment. CONCLUSION This work is the first to demonstrate in vitro as in vivo the radio-sensitizing effect of MRTX1257, a potent KRASG12C inhibitor compatible with oral administration, in CT26 KRASG12C mutated cell lines and tumors. This is a first step towards the use of new combinatorial strategies using KRAS inhibitors and RT in KRASG12C mutated tumors, which are the most represented in NSCLC with 14% of patients harboring this mutational profile.
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Affiliation(s)
- Pierre-Antoine Laurent
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
- INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, University of Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
- SIRIC SOCRATE, Gustave Roussy, Villejuif, France
| | - Marina Milic
- INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, University of Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
- SIRIC SOCRATE, Gustave Roussy, Villejuif, France
| | - Clément Quevrin
- INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, University of Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
- SIRIC SOCRATE, Gustave Roussy, Villejuif, France
| | - Lydia Meziani
- INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, University of Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
- SIRIC SOCRATE, Gustave Roussy, Villejuif, France
| | - Winchygn Liu
- INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, University of Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
- SIRIC SOCRATE, Gustave Roussy, Villejuif, France
| | - Daphné Morel
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Villejuif, France
| | - Nicolas Signolle
- Experimental and Translational Pathology Platform (PETRA), AMMICa, INSERM US23/UAR3655, Gustave Roussy Cancer Campus, Villejuif, France
| | - Céline Clémenson
- INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, University of Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
- SIRIC SOCRATE, Gustave Roussy, Villejuif, France
| | - Antonin Levy
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
- INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, University of Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
- SIRIC SOCRATE, Gustave Roussy, Villejuif, France
| | - Michele Mondini
- INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, University of Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
- SIRIC SOCRATE, Gustave Roussy, Villejuif, France
| | - Eric Deutsch
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France.
- INSERM U1030, Molecular Radiation Therapy and Therapeutic Innovation, Gustave Roussy Cancer Campus, University of Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France.
- SIRIC SOCRATE, Gustave Roussy, Villejuif, France.
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Kasikasetsiri J, Apaijai N, Aschaitrakool Y, Kerdphoo S, Sriyaranya N, Chattipakorn N, Chattipakorn SC. Hyperbaric oxygen therapy restores wound healing in irradiated gingiva to a similar level to that in healthy gingiva. J Wound Care 2023; 32:676-684. [PMID: 37830829 DOI: 10.12968/jowc.2023.32.10.676] [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] [Indexed: 10/14/2023]
Abstract
OBJECTIVE This study aimed to investigate the involvement of mitochondrial biogenesis, and determine the extent of fibroblast proliferation and cellular apoptosis, in the gingiva of patients who had undergone head and neck radiation, after receiving hyperbaric oxygen therapy (HBOT), in comparison with normal gingiva. METHOD A total of 16 patients who had undergone head and neck radiation with HBOT and six healthy subjects were included in the study. After the completion of radiation therapy, patients received HBOT at 2 ATA for 90 minutes per session, and for 20 sessions per patient. Samples of gingival tissues were then taken. The levels of: transforming growth factor beta (TGF-β); phospho-nuclear factor kappa-light-chain-enhancer of activated B cells (p-NFϰB); nuclear factor kappa-light-chain-enhancer of activated B cells (NFϰB); proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α); phospho-dynamin-related protein 1 at ser616 (p-Drp1ser616); dynamin-related protein 1 (Drp1); Bcl-2-associated X-protein (Bax); and B-cell lymphoma 2 (Bcl-2) were determined using a Western blot. Independent t-test and Chi-squared tests were used in the study. RESULTS There were no differences in the levels of TGF-β, p-NFϰB, NFϰB, p-Drp1ser616, Drp1, Bax and Bcl-2 between the two groups. However, the level of PGC-1α was greater in irradiated gingival tissues with HBOT than in the healthy gingiva. CONCLUSION Radiation-induced impaired wound healing can be improved by HBOT as indicated by levels of apoptosis, mitochondrial dynamics, cell proliferation and inflammation in irradiated gingiva with HBOT to a similar level to normal healthy gingiva. These findings may occur through an increase in mitochondrial biogenesis following HBOT.
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Affiliation(s)
- Juthathip Kasikasetsiri
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Nattayaporn Apaijai
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Yuthakran Aschaitrakool
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Sasiwan Kerdphoo
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Nutchada Sriyaranya
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
- Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
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Shunmugasundaram C, Sundaresan P, White K, King MT, Milross C, Rodd L, Fuller M, Rutherford C. Development and implementation barriers of a new patient-reported measure: The Radiation therapy-related Inconvenience Questionnaire (RIQ). J Med Imaging Radiat Oncol 2023; 67:777-788. [PMID: 37742323 DOI: 10.1111/1754-9485.13586] [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: 01/24/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Radiation therapy (RT) can benefit approximately 50% of cancer patients and contribute to 40% of all cancer cures, yet its utilisation in cancer is low globally. Several factors contribute to this including perceived inconvenience related to accessing and utilising RT. To quantitatively assess the latter, a new tool - the Radiation therapy-related Inconvenience Questionnaire (RIQ) - was developed. This study aimed to pre-test the RIQ and explore barriers and facilitators to implementing it in routine clinical practice and clinical trials. METHODS Semi-structured cognitive interviews were conducted with patients undertaking RT, recruited via three hospitals to examine content validity, acceptability, and comprehensibility of the RIQ. Interviews identified inconsistencies, relevance, and clarity of items. Semi-structured interviews with healthcare professionals involved in the delivery of care to individuals undertaking RT explored barriers and facilitators to routine usage. Thematic analysis was used to identify themes. RESULTS Patients (N = 15) identified problems in content, instructions, layout, length, and response options; consequently, 25 items were revised and eight removed, resulting in a final 29-item questionnaire. Clinicians identified staff- and patient-specific barriers to implementing RIQ in clinical practice. Perceived facilitators included the following: (a) workplace factors, (b) mode of administration, and (c) imparting knowledge. CONCLUSION This study demonstrated acceptability and comprehensibility of the 29-item RIQ amongst cancer patients undertaking RT and treating clinicians. The next phase will evaluate the RIQ's measurement properties in a larger clinical study. The barriers and facilitators identified can guide future implementation of RIQ in clinical practice and clinical trials.
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Affiliation(s)
- Chindhu Shunmugasundaram
- Faculty of Science, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making, The University of Sydney, New South Wales, Sydney, Australia
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney Quality of Life Office, The University of Sydney, New South Wales, Sydney, Australia
| | - Puma Sundaresan
- Radiation Oncology Network, Western Sydney Local Health District, New South Wales, Sydney, Australia
- Sydney Medical School, The University of Sydney, New South Wales, Sydney, Australia
| | - Kate White
- Cancer Nursing Research Unit, The University of Sydney, Susan Wakil School of Nursing and Midwifery, New South Wales, Sydney, Australia
| | - Madeleine T King
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney Quality of Life Office, The University of Sydney, New South Wales, Sydney, Australia
| | - Chris Milross
- Sydney Medical School, The University of Sydney, New South Wales, Sydney, Australia
- Radiation Oncology and Medical Services, Chris O'Brien Lifehouse, New South Wales, Sydney, Australia
| | - Lucinda Rodd
- Radiation Oncology, Central West Cancer Centre, New South Wales, Orange, Australia
| | - Matthew Fuller
- Radiation Oncology, Central West Cancer Centre, New South Wales, Orange, Australia
| | - Claudia Rutherford
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney Quality of Life Office, The University of Sydney, New South Wales, Sydney, Australia
- Cancer Nursing Research Unit, The University of Sydney, Susan Wakil School of Nursing and Midwifery, New South Wales, Sydney, Australia
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Forbes E, Baker AL, Britton B, Clover K, Skelton E, Moore L, Handley T, Oultram S, Oldmeadow C, Gibberd A, McCarter K. A systematic review of nonpharmacological interventions to reduce procedural anxiety among patients undergoing radiation therapy for cancer. Cancer Med 2023; 12:20396-20422. [PMID: 37803922 PMCID: PMC10652309 DOI: 10.1002/cam4.6573] [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: 02/09/2023] [Revised: 08/30/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023] Open
Abstract
Procedural anxiety is a concern for a number of patients undergoing radiation therapy. While procedural anxiety is often treated pharmacologically, there is a clinical need for effective alternative strategies for patients who are contraindicated from medication use, and those who prefer not to take unnecessary medications. OBJECTIVES The primary objective was to assess the efficacy of nonpharmacological interventions delivered to adults with cancer, in the radiation oncology department, just prior to, or during radiation therapy, in reducing levels of self-reported procedural anxiety. The secondary objectives were to assess the efficacy of these interventions in reducing physiological symptoms of procedural anxiety and anxiety-related treatment disruptions. DESIGN Systematic review. DATA SOURCES Electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO and Cochrane Central Register of Controlled Trials) were searched from inception up until February 2022. INCLUSION CRITERIA Population: Adult patients with cancer undergoing external beam radiation therapy. INTERVENTION Nonpharmacological interventions delivered within the radiation therapy department. Comparison: standard care controls, or standard care plus an alternative intervention. OUTCOMES level of self-reported procedural anxiety (primary), physiological symptoms of anxiety (secondary) and measures of anxiety-related treatment disruptions (secondary). DATA EXTRACTION AND ANALYSIS Two reviewers independently extracted data. A meta-analysis was originally planned but deemed not feasible as the studies could not be confidently pooled for meta-analysis, due to the variability in the interventions, study designs and the generally low number of studies. Therefore, a narrative synthesis is presented. RESULTS Screening of 2363 records identified nine studies that met inclusion criteria: six studies of music interventions, two of video-based patient education and one of aromatherapy. Overall, three studies received a global rating of strong methodological quality and low risk of bias. Three studies reported a significant effect of the intervention on reducing the primary outcome of self-reported procedural anxiety: two music interventions (both strong methodological quality), and one video-based patient education (moderate methodological quality). One of the studies (a music intervention) also reported a significant reduction in the secondary outcome of physiological symptoms of procedural anxiety (systolic blood pressure). CONCLUSIONS The evidence for nonpharmacological interventions delivered to adults with cancer just prior to, or during radiation therapy, in reducing levels of self-reported procedural anxiety is limited, with very few well-designed studies. There is a need for interventions for procedural anxiety during radiation therapy to be evaluated through rigorous randomised controlled trials.
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Affiliation(s)
- Erin Forbes
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanAustralia
| | - Amanda L. Baker
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanAustralia
| | - Ben Britton
- Hunter New England Mental Health ServicesNewcastleAustralia
| | - Kerrie Clover
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanAustralia
- Psycho‐Oncology Service, Department of Consultation Liaison PsychiatryCalvary Mater NewcastleWaratahAustralia
| | - Eliza Skelton
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanAustralia
| | - Lyndell Moore
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanAustralia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders UniversityBedford ParkAustralia
| | - Tonelle Handley
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanAustralia
| | - Sharon Oultram
- Department of Radiation OncologyCalvary Mater NewcastleWaratahAustralia
| | | | - Alison Gibberd
- Data Sciences, Hunter Medical Research InstituteNew LambtonAustralia
| | - Kristen McCarter
- School of Psychological Sciences, College of Engineering, Science and EnvironmentUniversity of NewcastleCallaghanAustralia
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Kasanda E, Bildstein V, Hymers D, Easter J, Richard AL, Baumann T, Spyrou A, Höhr C, Mücher D. Range verification in heavy-ion therapy using a hadron tumour marker. Phys Med Biol 2023; 68:195018. [PMID: 37747082 DOI: 10.1088/1361-6560/acf557] [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: 03/02/2023] [Accepted: 08/30/2023] [Indexed: 09/26/2023]
Abstract
Objective.A new method to estimate the range of an ion beam in a patient during heavy-ion therapy was investigated, which was previously verified for application in proton therapy.Approach.The method consists of placing a hadron tumour marker (HTM) close to the tumour. As the treatment beam impinges on the HTM, the marker undergoes nuclear reactions. When the HTM material is carefully chosen, the activation results in the emission of several delayed, characteristicγrays, whose intensities are correlated with the remaining range inside the patient. When not just one but two reaction channels are investigated, the ratio between these twoγray emissions can be measured, and the ratio is independent of any beam delivery uncertainties.Main results.A proof-of-principle experiment with an16O ion beam and Ag foils as HTM was successfully executed. The107Ag(16O,x)112Sb and the107Ag(16O,x)114Sb reaction channels were identified as suitable for the HTM technique. When only oneγ-ray emission is measured, the resulting range-uncertainty estimation is at the 0.5 mm scale. When both channels are considered, a theoretical limit on the range uncertainty of a clinical fiducal marker was found to be ±290μm.Significance.Range uncertainty of a heavy-ion beam limits the prescribed treatment plan for cancer patients, especially the direction of the ion beam in relation to any organ at risk. An easy to implement range-verification technique which can be utilized during clinical treatment would allow treatment plans to take full advantage of the sharp fall-off of the Bragg peak without the risk of depositing excessive dose into healthy tissue.
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Affiliation(s)
- E Kasanda
- Department of Physics, University of Guelph, 50 Stone Rd E, Guelph, Ontario, N1G 2W1, Canada
- Laboratory for High Energy Physics, Universität Bern, Sidlerstrasse 5, 3012 Bern, Switzerland
| | - V Bildstein
- Department of Physics, University of Guelph, 50 Stone Rd E, Guelph, Ontario, N1G 2W1, Canada
| | - D Hymers
- Department of Physics, University of Guelph, 50 Stone Rd E, Guelph, Ontario, N1G 2W1, Canada
- Institut für Kernphysik der Universität zu Köln, Zülpicher Strasse 77, D-50937 Köln, Germany
| | - J Easter
- Department of Physics, University of Guelph, 50 Stone Rd E, Guelph, Ontario, N1G 2W1, Canada
| | - A L Richard
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, MI 48824, United States of America
- Department of Physics and Astronomy, Michigan State University, East Lansing, MI 48824, United States of America
| | - T Baumann
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, MI 48824, United States of America
| | - A Spyrou
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, MI 48824, United States of America
- Department of Physics and Astronomy, Michigan State University, East Lansing, MI 48824, United States of America
| | - C Höhr
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia, V6T 2A3, Canada
- Department of Physics and Astronomy, University of Victoria, 3800 Finnerty Road, Victoria, British Columbia, V8P 5C2, Canada
| | - D Mücher
- Department of Physics, University of Guelph, 50 Stone Rd E, Guelph, Ontario, N1G 2W1, Canada
- Institut für Kernphysik der Universität zu Köln, Zülpicher Strasse 77, D-50937 Köln, Germany
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia, V6T 2A3, Canada
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Chinnapaka S, Yang KS, Surucu Y, Bengur FB, Arellano JA, Tirmizi Z, Malekzadeh H, Epperly MW, Hou W, Greenberger JS, Rubin JP, Ejaz A. Human adipose ECM alleviates radiation-induced skin fibrosis via endothelial cell-mediated M2 macrophage polarization. iScience 2023; 26:107660. [PMID: 37705953 PMCID: PMC10495661 DOI: 10.1016/j.isci.2023.107660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/30/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023] Open
Abstract
Radiation therapy can lead to late radiation-induced skin fibrosis (RISF), causing movement restriction, pain, and organ dysfunction. This study evaluated adipose-derived extracellular matrix (Ad-ECM) as a mitigator of RISF. Female C57BL/6J mice that were irradiated developed fibrosis, which was mitigated by a single local Ad-ECM injection, improving limb movement and reducing epithelium thickness and collagen deposition. Ad-ECM treatment resulted in decreased expression of pro-inflammatory and fibrotic genes, and upregulation of anti-inflammatory cytokines, promoting M2 macrophage polarization. Co-culture of irradiated human fibroblasts with Ad-ECM down-modulated fibrotic gene expression and enhanced bone marrow cell migration. Ad-ECM treatment also increased interleukin (IL)-4, IL-5, and IL-15 expression in endothelial cells, stimulating M2 macrophage polarization and alleviating RISF. Prophylactic use of Ad-ECM showed effectiveness in mitigation. This study suggests Ad-ECM's potential in treating chronic-stage fibrosis.
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Affiliation(s)
- Somaiah Chinnapaka
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Katherine S. Yang
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yusuf Surucu
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Fuat B. Bengur
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - José A. Arellano
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zayaan Tirmizi
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hamid Malekzadeh
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael W. Epperly
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Wen Hou
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Joel S. Greenberger
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - J. Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Asim Ejaz
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Elbanna M, Pynda Y, Kalinchuk O, Rosa A, Abdel-Wahab M. Radiotherapy resources in Latin America and the Caribbean: a review of current and projected needs based on International Atomic Energy Agency data. Lancet Oncol 2023; 24:e376-e384. [PMID: 37657478 DOI: 10.1016/s1470-2045(23)00299-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 09/03/2023]
Abstract
The inequitable access to radiotherapy globally is a complex undertaking that will require sustained work identifying gaps and mobilising efforts to resolve. The purpose of this review is to identify gaps and needs in radiotherapy in Latin America and the Caribbean. Data from 41 countries in Latin America and the Caribbean on teletherapy megavoltage units and brachytherapy resources were extracted from the International Atomic Energy Agency (IAEA) Directory of Radiotherapy Centers. These data were then matched to open-source data from GLOBOCAN and World Bank Data which included data on population size, gross national income per capita, cancer incidence, and mortality. These data were matched to current and projected cancer incidence and mortality (as estimated by the Global Cancer Observatory in 2020) to calculate current and projected gaps in external beam radiotherapy facilities. For brachytherapy, the analysis was focused on cervical cancer and included high dose rate and low dose rate machines. As of Oct 22, 2022, external beam radiotherapy was available in 32 (78%) of 41 countries, representing 742 radiotherapy centres and 1122 megavoltage units. Average coverage was 63%. LINACs accounted for 85% (955 of 1122) of megavoltage units and Cobalt-60 capacity decreased to 12% compared with in 2018. Median megavoltage units per 1000 cancer cases were 0·8 (IQR 0·54-1·03). Most countries clustered in the same range of gross national income per capita for teletherapy units per 1000 cases at a median of US$9380. The current deficit in megavoltage units is estimated at 668 units and is projected to be 2455 units by 2030. 28 (68%) of 41 countries had 279 installed brachytherapy services, both high dose rate and low dose rate, which could treat 108 420 patients with cervical cancer per year and meet the current needs, albeit with inequitable distribution of resources. Overall, this review indicated a 15% improvement in the current external beam radiotherapy capacity in Latin America and the Caribbean compared with 2018. However, there is still a current shortage of at least 668 extra units. By 2030, the need for megavoltage units will be double the current capacity. There is inequitable distribution of brachytherapy resources across the region primarily in the Caribbean. Adoption of hypofractionation can help overcome machine shortage; however, it will present technical challenges that need to be taken into account. Rays of Hope, is a novel IAEA initiative that is designed to mobilise global efforts to address radiotherapy gaps while ensuring the highest return on investment.
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Affiliation(s)
- May Elbanna
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA; Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Yaroslav Pynda
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Oleksandr Kalinchuk
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Arthur Rosa
- Department of Radiation Oncology, Oncoclinicas Salvador and Hospital Santa Izabel, Salvador, BA, Brazil
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
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Jaffray DA, Knaul F, Baumann M, Gospodarowicz M. Harnessing progress in radiotherapy for global cancer control. NATURE CANCER 2023; 4:1228-1238. [PMID: 37749355 DOI: 10.1038/s43018-023-00619-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/22/2023] [Indexed: 09/27/2023]
Abstract
The pace of technological innovation over the past three decades has transformed the field of radiotherapy into one of the most technologically intense disciplines in medicine. However, the global barriers to access this highly effective treatment are complex and extend beyond technological limitations. Here, we review the technological advancement and current status of radiotherapy and discuss the efforts of the global radiation oncology community to formulate a more integrative 'diagonal approach' in which the agendas of science-driven advances in individual outcomes and the sociotechnological task of global cancer control can be aligned to bring the benefit of this proven therapy to patients with cancer everywhere.
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Affiliation(s)
- David A Jaffray
- Departments of Radiation Physics and Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Felicia Knaul
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Mary Gospodarowicz
- Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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Rooney MK, Andring LM, Corrigan KL, Bernard V, Williamson TD, Fuller CD, Garden AS, Gunn B, Lee A, Moreno AC, Morrison WH, Phan J, Rosenthal DI, Spiotto M, Frank SJ. Hypothyroidism following Radiotherapy for Head and Neck Cancer: A Systematic Review of the Literature and Opportunities to Improve the Therapeutic Ratio. Cancers (Basel) 2023; 15:4321. [PMID: 37686597 PMCID: PMC10486996 DOI: 10.3390/cancers15174321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
(1) Background: Radiotherapy (RT) is a central component for the treatment of many head and neck cancers. In this systematic review of the literature, we aimed to characterize and quantify the published evidence on RT-related hypothyroidism, including estimated incidence, clinical risk factors, and dosimetric parameters that may be used to guide clinical decision making. Furthermore, we aimed to identify potential areas of improvement in the prevention and clinical management of RT-induced hypothyroidism, including the role of modern advanced therapeutic techniques. (2) Methods: We conducted a systemic review of the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed and Google Scholar were searched to identify original research articles describing the incidence, mechanism, dosimetry, treatment, or prevention of radiation-related hypothyroidism for adults receiving RT for the treatment of head and neck cancers. The snowball method was used to identify additional articles. For identified articles, we tabulated several datapoints, including publication date, patient sample size, estimated hypothyroidism incidence, cancer site/type, follow-up period, radiation modality and technique, use of multimodality therapy, method of thyroid function evaluation, and proposed dosimetric predictors of hypothyroidism. (3) Results: One hundred and eleven articles met inclusion criteria, reflecting a range of head and neck cancer subtypes. There was a large variation in the estimated incidence of RT-related hypothyroidism, with a median estimate of 36% (range 3% to 79%). Reported incidence increased in later publication dates, which was likely related to improved screening and longer follow up. There were a wide variety of predictive metrics used to identify patients at high risk of hypothyroidism, the most common of which were volumetric and mean dosimetrics related to the thyroid gland (Vxx%, Dmean). More recently, there has been increasing evidence to suggest that the thyroid gland volume itself and the volume of the thyroid gland spared from high-dose radiation (VSxx) may better predict thyroid function after RT. There were no identified studies investigating the role of advanced radiotherapeutic techniques such as MRI-guided RT or particle therapy to decrease RT-related hypothyroidism. Conclusions: Hypothyroidism is a common toxicity resulting from therapeutic radiation for head and neck cancer with recent estimates suggesting 40-50% of patients may experience hypothyroidism after treatment. Dosimetric predictive models are increasingly able to accurately identify patients at risk of hypothyroidism, especially those utilizing thyroid VS metrics. Further investigation regarding the potential for advanced radiotherapeutic therapies to decrease RT-induced thyroid dysfunction is needed.
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Affiliation(s)
- Michael K. Rooney
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA (V.B.); (T.D.W.); (S.J.F.)
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Chow JCL, Wong V, Sanders L, Li K. Developing an AI-Assisted Educational Chatbot for Radiotherapy Using the IBM Watson Assistant Platform. Healthcare (Basel) 2023; 11:2417. [PMID: 37685452 PMCID: PMC10487627 DOI: 10.3390/healthcare11172417] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Objectives: This study aims to make radiotherapy knowledge regarding healthcare accessible to the general public by developing an AI-powered chatbot. The interactive nature of the chatbot is expected to facilitate better understanding of information on radiotherapy through communication with users. Methods: Using the IBM Watson Assistant platform on IBM Cloud, the chatbot was constructed following a pre-designed flowchart that outlines the conversation flow. This approach ensured the development of the chatbot with a clear mindset and allowed for effective tracking of the conversation. The chatbot is equipped to furnish users with information and quizzes on radiotherapy to assess their understanding of the subject. Results: By adopting a question-and-answer approach, the chatbot can engage in human-like communication with users seeking information about radiotherapy. As some users may feel anxious and struggle to articulate their queries, the chatbot is designed to be user-friendly and reassuring, providing a list of questions for the user to choose from. Feedback on the chatbot's content was mostly positive, despite a few limitations. The chatbot performed well and successfully conveyed knowledge as intended. Conclusions: There is a need to enhance the chatbot's conversation approach to improve user interaction. Including translation capabilities to cater to individuals with different first languages would also be advantageous. Lastly, the newly launched ChatGPT could potentially be developed into a medical chatbot to facilitate knowledge transfer.
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Affiliation(s)
- James C. L. Chow
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1X6, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Valerie Wong
- Department of Physics, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada;
| | - Leslie Sanders
- Department of Humanities, York University, Toronto, ON M3J 1P3, Canada;
| | - Kay Li
- Department of English, University of Toronto, Toronto, ON M5R 2M8, Canada;
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Lee SF, Wong HCY, Chan AW, Caini S, Shariati S, Rades D, Chan RJ, Kennedy SKF, Wolf JR, van den Hurk C, Behroozian T, Bonomo P, Ho FCH, Chow E, Herst P. Mepitel Film for the prevention of acute radiation dermatitis in head and neck cancer: a systematic review and meta-analysis of randomized controlled trials. Support Care Cancer 2023; 31:527. [PMID: 37594538 DOI: 10.1007/s00520-023-07988-w] [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: 06/30/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE This systematic review and meta-analysis evaluates the efficacy of Mepitel Film in preventing acute radiation dermatitis (RD) in patients with head and neck cancer (HNC) across randomized controlled trials (RCTs). METHODS Embase, MEDLINE, and Cochrane Central Register of Controlled Trials were searched on 5 March 2023 to identify relevant RCTs. RD assessment tools and outcomes were compared across studies. Pooled effect sizes and 95% confidence intervals (CI) were estimated based on random-effects analysis using RevMan 5.4. RESULTS Three RCTs conducted between 2018 and 2020 were included. Mepitel Film decreased RD severity when compared to Sorbolene or Biafine but not when compared to mometasone. A per-protocol analysis of two of the trials revealed that, overall, Mepitel Film significantly reduced the incidence of grade 2-3 RD (odds ratio (OR), 0.24; 95% CI, 0.09-0.65; p = 0.005) and moist desquamation (OR, 0.21; 95% CI, 0.10-0.46; p < 0.0001) and decreased average patient, researcher, and combined components of the Radiation-Induced Skin Reaction Assessment Scale (the standardized mean difference (SMD) for patient ratings, - 2.56; 95% CI, - 3.15 to - 1.96, p < 0.00001; SMD for researcher ratings, - 3.47; 95% CI, - 6.63 to - 0.31, p = 0.03; SMD for combined scores, - 3.68; 95% CI, - 6.43 to - 0.92, p = 0.009). Noted issues with Mepitel Film included itchiness and poor adherence. CONCLUSION While there were discrepancies across studies, Mepitel Film demonstrated a decrease in the incidence of grade 2-3 RD and moist desquamation. These findings emphasize the need for further examining Mepitel Film's efficacy across diverse patient groups and the importance of standardizing RD severity assessment methodologies and control arms.
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Affiliation(s)
- Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, 119228, Singapore.
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Tuen Mun, Hong Kong.
| | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Tuen Mun, Hong Kong
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPO), Florence, Italy
| | - Saba Shariati
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Samantha K F Kennedy
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Corina van den Hurk
- Research and Development Department, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Tara Behroozian
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Francis C H Ho
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, 119228, Singapore
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Patries Herst
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
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Closset L, Gultekin O, Salehi S, Sarhan D, Lehti K, Gonzalez-Molina J. The extracellular matrix - immune microenvironment crosstalk in cancer therapy: Challenges and opportunities. Matrix Biol 2023; 121:217-228. [PMID: 37524251 DOI: 10.1016/j.matbio.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 08/02/2023]
Abstract
Targeting the tumour immune microenvironment (TIME) by cancer immunotherapy has led to improved patient outcomes. However, response to these treatments is heterogeneous and cancer-type dependant. The therapeutic activity of classical cancer therapies such as chemotherapy, radiotherapy, and surgical oncology is modulated by alterations of the TIME. A major regulator of immune cell function and resistance to both immune and classical therapies is the extracellular matrix (ECM). Concurrently, cancer therapies reshape the TIME as well as the ECM, causing both pro- and anti-tumour responses. Accordingly, the TIME-ECM crosstalk presents attractive opportunities to improve therapy outcomes. Here, we review the molecular crosstalk between the TIME and the ECM in cancer and its implications in cancer progression and clinical intervention. Additionally, we discuss examples and future directions of ECM and TIME co-targeting in combination with oncological therapies including surgery, chemotherapy, and radiotherapy.
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Affiliation(s)
- Lara Closset
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solnavägen 9, Stockholm 171 65, Sweden; Saint-Antoine Research center (CRSA), UMR_S 938, INSERM, Sorbonne Université, Paris F-75012, France
| | - Okan Gultekin
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solnavägen 9, Stockholm 171 65, Sweden
| | - Sahar Salehi
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solnavägen 9, Stockholm 171 65, Sweden; Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Dhifaf Sarhan
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Kaisa Lehti
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solnavägen 9, Stockholm 171 65, Sweden; Department of Biomedical Laboratory Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jordi Gonzalez-Molina
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solnavägen 9, Stockholm 171 65, Sweden.
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Rosa AA, de Sousa CFPM, Pimentel LCF, Martins HL, Moraes FY, Marta GN, Castilho MS. Radiotherapy resources in Brazil (RT2030): a comprehensive analysis and projections for 2030. Lancet Oncol 2023; 24:903-912. [PMID: 37541272 DOI: 10.1016/s1470-2045(23)00284-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The demand for radiotherapy in Brazil is unfulfilled, and the scarcity of data on the national network hampers the development of effective policies. We aimed to evaluate the current situation, estimate demands and requirements, and provide an action plan to ensure access to radiotherapy for those in need by 2030. METHODS The Brazilian Society for Radiation Oncology created a task force (RT2030) including physicians, medical physicists, policy makers, patient advocates, and suppliers, all of whom were major stakeholders involved in Brazilian radiotherapy care. The group was further divided into seven working groups to address themes associated with radiotherapy care in Brazil. From March 1, 2019, to Aug 3, 2020, there were monthly meetings between the group's leaders and the Central Committee and six general meetings. First, a comprehensive search of all different national databases was done to identify all radiotherapy centres. Questionnaires evaluating radiotherapy infrastructure and human resources and assing the availability, distribution, capacity, and workload of resources were created and sent to the radioprotection supervisor of each centre. Results were analysed nationally and across the country's regions and health-care systems. A pre-planned review of available databases was done to gather data on active radiation oncology centres and the distribution of radiotherapy machines (linear accelerators [LINACs]) across Brazil. We used national population and cancer incidence projections, recommended radiotherapy usage from the medical literature, and national working patterns to project radiotherapy demands in 2030. An action plan was established with suggestions to address the gaps and meet the demands. FINDINGS The database search yielded 279 centres with an active radiotherapy registry. After applying predefined exclusion criteria, 263 centres were identified that provided external beam radiotherapy machines with or without brachytherapy. All 263 operational centres answered the questionnaires sent on Dec 9, 2019, which were then returned between Jan 1 and June 30, 2020. There were 409 therapy machines, 646 radiation oncologists, 533 physicists, and 230 989 patients undergoing radiotherapy (150 628 [65·2%] in the public health-care system and 80 937 [35·0%] in private). The mean annual occupation rate was 566 patients per treatment machine (SD 250). The number of residents per treatment machine ranged from 258 333 to 1 800 000. Technology availability varied considerably among regions and systems. In 2030, 639 994 new cancer cases are expected, which will require 332 797 radiotherapy courses. Therefore, 530 LINACs, 1079 radiation oncologists, and 1060 medical physicists will be needed. INTERPRETATION The expected increase in cancer incidence in the coming years will probably increase the disparities in cancer care and the burden for Brazilian patients. We provide a roadmap of the current situation and the particularities of the Brazilian radiotherapy network, which can serve as a starting point for cancer policy planning to improve this scenario. FUNDING Accuray, BRAINLAB, Elekta, IBA, ONE medical solution, SUN NUCLEAR corporation, VARIAN, and ZIGMA.
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Affiliation(s)
- Arthur Accioly Rosa
- Grupo Oncoclínicas, Salvador, Bahia, Brazil; Latin America Cooperative Oncology Group, Porto Alegre, Brazil
| | | | | | | | - Fabio Ynoe Moraes
- Latin America Cooperative Oncology Group, Porto Alegre, Brazil; Department of Oncology, Division of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
| | - Gustavo Nader Marta
- Latin America Cooperative Oncology Group, Porto Alegre, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
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Nijskens L, van den Berg CAT, Verhoeff JJC, Maspero M. Exploring contrast generalisation in deep learning-based brain MRI-to-CT synthesis. Phys Med 2023; 112:102642. [PMID: 37473612 DOI: 10.1016/j.ejmp.2023.102642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/24/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Synthetic computed tomography (sCT) has been proposed and increasingly clinically adopted to enable magnetic resonance imaging (MRI)-based radiotherapy. Deep learning (DL) has recently demonstrated the ability to generate accurate sCT from fixed MRI acquisitions. However, MRI protocols may change over time or differ between centres resulting in low-quality sCT due to poor model generalisation. PURPOSE investigating domain randomisation (DR) to increase the generalisation of a DL model for brain sCT generation. METHODS CT and corresponding T1-weighted MRI with/without contrast, T2-weighted, and FLAIR MRI from 95 patients undergoing RT were collected, considering FLAIR the unseen sequence where to investigate generalisation. A "Baseline" generative adversarial network was trained with/without the FLAIR sequence to test how a model performs without DR. Image similarity and accuracy of sCT-based dose plans were assessed against CT to select the best-performing DR approach against the Baseline. RESULTS The Baseline model had the poorest performance on FLAIR, with mean absolute error (MAE) = 106 ± 20.7 HU (mean ±σ). Performance on FLAIR significantly improved for the DR model with MAE = 99.0 ± 14.9 HU, but still inferior to the performance of the Baseline+FLAIR model (MAE = 72.6 ± 10.1 HU). Similarly, an improvement in γ-pass rate was obtained for DR vs Baseline. CONCLUSION DR improved image similarity and dose accuracy on the unseen sequence compared to training only on acquired MRI. DR makes the model more robust, reducing the need for re-training when applying a model on sequences unseen and unavailable for retraining.
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Affiliation(s)
- Lotte Nijskens
- Computational Imaging Group for MR Diagnostics & Therapy, Center for Image Science, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, The Netherlands; Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, The Netherlands
| | - Cornelis A T van den Berg
- Computational Imaging Group for MR Diagnostics & Therapy, Center for Image Science, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, The Netherlands; Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, The Netherlands
| | - Joost J C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, The Netherlands
| | - Matteo Maspero
- Computational Imaging Group for MR Diagnostics & Therapy, Center for Image Science, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, The Netherlands; Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, The Netherlands.
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Arumugam S, Wong K, Do V, Sidhom M. Reducing the margin in prostate radiotherapy: optimizing radiotherapy with a general-purpose linear accelerator using an in-house position monitoring system. Front Oncol 2023; 13:1116999. [PMID: 37519807 PMCID: PMC10373585 DOI: 10.3389/fonc.2023.1116999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To study the feasibility of optimizing the Clinical Target Volume to Planning Target Volume (CTV-PTV) margin in prostate radiotherapy(RT) with a general-purpose linear accelerator using an in-house developed position monitoring system, SeedTracker. Methods A cohort of 30 patients having definitive prostate radiotherapy treated within an ethics-approved prospective trial was considered for this study. The intrafraction prostate motion and the position deviations were measured using SeedTracker system during each treatment fraction. Using this data the CTV-PTV margin required to cover 90% of the patients with a minimum of 95% of the prescription dose to CTV was calculated using van Herk's formula. The margin calculations were performed for treatment scenarios both with and without applying the position corrections for observed position deviations. The feasibility of margin reduction with real-time monitoring was studied by assessing the delivered dose that incorporates the actual target position during treatment delivery and comparing it with the planned dose. This assessment was performed for plans generated with reduced CTV-PTV margin in the range of 7mm-3mm. Results With real-time monitoring and position corrections applied the margin of 2.0mm, 2.1mm and 2.1mm in LR, AP and SI directions were required to meet the criteria of 90% population to receive 95% of the dose prescription to CTV. Without position corrections applied for observed position deviations a margin of 3.1mm, 4.0mm and 3.0mm was required in LR, AP and SI directions to meet the same criteria. A mean ± SD reduction of 0.5 ± 1.8% and 3 ± 7% of V60 for the rectum and bladder can be achieved for every 1mm reduction of PTV margin. With position corrections applied, the CTV D99 can be delivered within -0.2 ± 0.3 Gy of the planned dose for plans with a 3mm margin. Without applying corrections for position deviations the CTV D99 was reduced by a maximum of 1.1 ± 1.1 Gy for the 3mm margin plan and there was a statistically significant difference between planned and delivered dose for 3mm and 4mm margin plans. Conclusion This study demonstrates the feasibility of reducing the margin in prostate radiotherapy with SeedTracker system without compromising the dose delivery accuracy to CTV while reducing dose to critical structures.
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Affiliation(s)
- Sankar Arumugam
- Department of Medical Physics, Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Karen Wong
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Viet Do
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Mark Sidhom
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
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Hindley N, Shieh CC, Keall P. A patient-specific deep learning framework for 3D motion estimation and volumetric imaging during lung cancer radiotherapy. Phys Med Biol 2023; 68:14NT01. [PMID: 37364571 DOI: 10.1088/1361-6560/ace1d0] [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: 02/17/2023] [Accepted: 06/26/2023] [Indexed: 06/28/2023]
Abstract
Objective. Respiration introduces a constant source of irregular motion that poses a significant challenge for the precise irradiation of thoracic and abdominal cancers. Current real-time motion management strategies require dedicated systems that are not available in most radiotherapy centers. We sought to develop a system that estimates and visualises the impact of respiratory motion in 3D given the 2D images acquired on a standard linear accelerator.Approach. In this paper we introduceVoxelmap, a patient-specific deep learning framework that achieves 3D motion estimation and volumetric imaging using the data and resources available in standard clinical settings. Here we perform a simulation study of this framework using imaging data from two lung cancer patients.Main results. Using 2D images as input and 3D-3DElastixregistrations as ground-truth,Voxelmapwas able to continuously predict 3D tumor motion with mean errors of 0.1 ± 0.5, -0.6 ± 0.8, and 0.0 ± 0.2 mm along the left-right, superior-inferior, and anterior-posterior axes respectively.Voxelmapalso predicted 3D thoracoabdominal motion with mean errors of -0.1 ± 0.3, -0.1 ± 0.6, and -0.2 ± 0.2 mm respectively. Moreover, volumetric imaging was achieved with mean average error 0.0003, root-mean-squared error 0.0007, structural similarity 1.0 and peak-signal-to-noise ratio 65.8.Significance. The results of this study demonstrate the possibility of achieving 3D motion estimation and volumetric imaging during lung cancer treatments on a standard linear accelerator.
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Affiliation(s)
| | - Chun-Chien Shieh
- Image X Institute, University of Sydney, Sydney, NSW, Australia
- Sydney Neuroimaging Analysis Centre, University of Sydney, Sydney, Australia
| | - Paul Keall
- Image X Institute, University of Sydney, Sydney, NSW, Australia
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Debrot E, Liu P, Gardner M, Heng SM, Chan CH, Corde S, Downes S, Jackson M, Keall P. Nano X Image Guidance in radiation therapy: feasibility study protocol for cone beam computed tomography imaging with gravity-induced motion. Pilot Feasibility Stud 2023; 9:95. [PMID: 37312127 DOI: 10.1186/s40814-023-01340-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/07/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND This paper describes the protocol for the Nano X Image Guidance (Nano X IG) trial, a single-institution, clinical imaging study. The Nano X is a prototype fixed-beam radiotherapy system developed to investigate the feasibility of a low-cost, compact radiotherapy system to increase global access to radiation therapy. This study aims to assess the feasibility of volumetric image guidance with cone beam computed tomography (CBCT) acquired during horizontal patient rotation on the Nano X radiotherapy system. METHODS In the Nano X IG study, we will determine whether radiotherapy image guidance can be performed with the Nano X radiotherapy system where the patient is horizontally rotated while scan projections are acquired. We will acquire both conventional CBCT scans and Nano X CBCT scans for 30 patients aged 18 and above and receiving radiotherapy for head/neck or upper abdomen cancers. For each patient, a panel of experts will assess the image quality of Nano X CBCT scans against conventional CBCT scans. Each patient will receive two Nano X CBCT scans to determine the image quality reproducibility, the extent and reproducibility of patient motion and assess patient tolerance. DISCUSSION Fixed-beam radiotherapy systems have the potential to help ease the current shortfall and increase global access to radiotherapy treatment. Advances in image guidance could facilitate fixed-beam radiotherapy using horizontal patient rotation. The efficacy of this radiotherapy approach is dependent on our ability to image and adapt to motion due to rotation and for patients to tolerate rotation during treatment. TRIAL REGISTRATION ClinicalTrials.gov, NCT04488224. Registered on 27 July 2020.
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Affiliation(s)
- Emily Debrot
- Faculty of Medicine and Health, ACRF Image X Institute, The University of Sydney, Camperdown, NSW, Australia
| | - Paul Liu
- Faculty of Medicine and Health, ACRF Image X Institute, The University of Sydney, Camperdown, NSW, Australia
| | - Mark Gardner
- Faculty of Medicine and Health, ACRF Image X Institute, The University of Sydney, Camperdown, NSW, Australia.
| | - Soo Min Heng
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Chin Hwa Chan
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Stephanie Corde
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Simon Downes
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Michael Jackson
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Paul Keall
- Faculty of Medicine and Health, ACRF Image X Institute, The University of Sydney, Camperdown, NSW, Australia
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