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Lyng FM, Azzam EI. Abscopal Effects, Clastogenic Effects and Bystander Effects: 70 Years of Non-Targeted Effects of Radiation. Radiat Res 2024; 202:355-367. [PMID: 38986531 DOI: 10.1667/rade-24-00040.1] [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: 01/31/2024] [Accepted: 04/29/2024] [Indexed: 07/12/2024]
Abstract
In vitro and in vivo observations accumulated over several decades have firmly shown that the biological effects of ionizing radiation can spread from irradiated cells/tissues to non-targeted cells/tissues. Redox-modulated intercellular communication mechanisms that include a role for secreted factors and gap junctions, can mediate these non-targeted effects. Clearly, the expression of such effects and their transmission to progeny cells has implications for issues related to radiation protection. Their elucidation is also relevant towards enhancing the efficacy of cancer radiotherapy and reducing its impact on the development of normal tissue toxicities. In addition, the study of non-targeted effects is pertinent to our basic understanding of intercellular communications under conditions of oxidative stress. This review will trace the history of non-targeted effects of radiation starting with early reports of abscopal effects which described radiation induced effects in tissues distant from the site of radiation exposure. A related effect involved the production of clastogenic factors in plasma following irradiation which can induce chromosome damage in unirradiated cells. Despite these early reports suggesting non-targeted effects of radiation, the classical paradigm that a direct deposition of energy in the nucleus was required still dominated. This paradigm was challenged by papers describing radiation induced bystander effects. This review will cover mechanisms of radiation-induced bystander effects and the potential impacts on radiation protection and radiation therapy.
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Affiliation(s)
- Fiona M Lyng
- Radiation and Environmental Science Centre, FOCAS Research Institute
- School of Physics, Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Edouard I Azzam
- Department of Radiology, Rutgers New Jersey Medical School Cancer Center, Newark, New Jersey
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Wang L, Zhao W, Ning X, Wang C, Liang S. Effect of X-ray irradiation combined with PD-1 inhibitor treatment on lung tissue injury in mice. Int Immunopharmacol 2023; 123:110775. [PMID: 37562291 DOI: 10.1016/j.intimp.2023.110775] [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: 03/28/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE To determine the effect of X-ray irradiation combined with PD-1 immune checkpoint inhibitor administration on lung tissue injury in a mouse model and its potential mechanism. METHODS In all, 20 C57BL/6J mice were randomly divided into four groups with five mice in each group: control group, PD-1 inhibitor group, irradiation group, and irradiation combined with PD-1 inhibitor group. Hematoxylin-eosin staining of the lung tissue was performed 30 days after the end of irradiation to evaluate the morphological and pathological changes in the tissue. Masson staining and analysis of hydroxyproline were used to evaluate the degree of pulmonary fibrosis. The levels of transforming growth factor-β1 (TGF-β1) and tumor necrosis factor α(TNF-α) were evaluated by Enzyme-Linked immunosorbent assay (ELISA). CD3+, CD4+, and CD8+ T lymphocytes in the lung tissue were detected by immunohistochemistry. The expression levels of TGF-β1, Smad3, cGAS, and STING in the lung tissue were evaluated by Western blotting. RESULTS The lung injury scores and pulmonary fibrosis indices in the irradiation group were higher than those in the control group. Meanwhile, lung pneumonia score, pulmonary fibrosis index, percentage of CD4 cells and expression of TGF-β1, p-Smad3, and STING in the lung tissue of mice in irradiation combined with PD-1 inhibitor group were higher than those in the other three groups. CONCLUSION Lung injury and pulmonary fibrosis were induced by whole chest X-ray irradiation in mice, and PD-1 inhibitor could aggravate lung injury and pulmonary fibrosis in mice. Thus, radiotherapy combined with PD-1 inhibitors may affect the immune inflammatory microenvironment in the lung tissues of mice by activating TGF-β1/Samd3 and cGAS/STING signaling pathways, thus aggravating lung tissue damage induced by radiation.
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Affiliation(s)
- Leili Wang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China; Department of Oncology, Liuzhou People's Hospital, Liuzhou, China
| | - Weidong Zhao
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Xin Ning
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Cailan Wang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Shixiong Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China.
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Kim KH, Pyo H, Lee H, Oh D, Noh JM, Ahn YC, Kim CG, Yoon HI, Lee J, Park S, Jung HA, Sun JM, Lee SH, Ahn JS, Park K, Ku BM, Shin EC, Ahn MJ. Association of T Cell Senescence with Radiation Pneumonitis in Patients with Non-small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 115:464-475. [PMID: 35896144 DOI: 10.1016/j.ijrobp.2022.07.018] [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: 03/08/2022] [Revised: 06/07/2022] [Accepted: 07/13/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Associations between immunosenescence and radiation pneumonitis (RP) are largely unknown. We aimed to identify a peripheral blood T cell senescence biomarker to predict RP in patients with non-small cell lung cancer (NSCLC). METHODS AND MATERIALS Patients with locally advanced NSCLC who received definitive concurrent chemoradiotherapy (dCRT) were prospectively registered (cohort 1, n=23; cohort 2, n=31). Peripheral blood was collected at baseline, during dCRT, and at 1 month post-dCRT. Patients were dichotomized to grade ≥2 (G2+) RP and grade 0-1 (G0-1) RP. Flow cytometry was performed to assess phenotypes and functional properties of T cell subsets. RP incidence was estimated via competing risk analysis. RESULTS Five and six patients exhibited G2+ RP following dCRT in cohorts 1 and 2, respectively. Patients with G2+ RP exhibited a more aged T cell pool and higher frequencies of senescent CD57+CD28-CD8+ T cells than patients with G0-1 RP at baseline, during dCRT, and at 1 month post-dCRT. These senescent cells exhibited increased granzyme B, IFN-γ, and TNF-α production. Higher baseline frequency of CD57+CD28-CD8+ T cells was an independent predictor of G2+ RP (hazard ratio, 8.42; 95% confidence interval, 2.58-27.45; P<0.001). Recursive partitioning analysis revealed three distinct risk groups stratified by baseline CD57+CD28-CD8+ T cell frequency and lung V20 Gy, with 1-year cumulative G2+ RP incidences of 50.0%, 16.7%, and 0% for high-, intermediate-, and low-risk groups, respectively (P=0.002). CONCLUSIONS Higher baseline frequencies of CD57+CD28-CD8+ T cells correlated with increased G2+ RP risks. Our results suggest the need for further investigation of the role of T cell senescence on radiation-induced organ damage.
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Affiliation(s)
- Kyung Hwan Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hongryull Pyo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hoyoung Lee
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chang Gon Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jiyun Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea; Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sehhoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun-Ae Jung
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong-Mu Sun
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keunchil Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bo Mi Ku
- Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eui-Cheol Shin
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Fuentes A, Hyde D, Johnson I, Haston CK. Acute Radiation-Induced Hematopoietic Depletion Does Not Alter the Onset or Severity of Pneumonitis in Mice. Radiat Res 2021; 196:297-305. [PMID: 34129665 DOI: 10.1667/rade-20-00291.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/24/2021] [Indexed: 11/03/2022]
Abstract
Survival from partial-body irradiation (PBI) may be limited by the development of the late lung injury response of pneumonitis. Herein we investigated the hypothesis that acute hematopoietic depletion alters the onset and severity of lung disease in a mouse model. To establish depletion, C3H/HeJ mice received 8 Gy PBI with shielding of only the tibiae, ankles and feet. One week after irradiation, blood lymphocyte and neutrophil counts were each significantly reduced (P < 0.04) in these mice compared to levels in untreated controls or in mice receiving 16 Gy to the whole thorax only. All 8 Gy PBI mice survived to the experimental end point of 16 weeks postirradiation. To determine whether the hematopoietic depletion affects lung disease, groups of mice received 8 Gy PBI plus 8 Gy whole-thorax irradiation (total lung dose of 16 Gy) or 16 Gy whole-thorax irradiation only. The weight loss, survival to onset of respiratory distress (P = 0.17) and pneumonitis score (P = 0.96) of mice that received 8 Gy PBI plus 8 Gy whole-thorax irradiation were not significantly different from those of mice receiving 16 Gy whole-thorax irradiation only. Mice in respiratory distress from PBI plus whole-thorax irradiation had significantly reduced (P = 0.02) blood monocyte counts compared to levels in distressed, whole-thorax irradiated mice, and symptomatic pneumonitis was associated with increased blood neutrophil counts (P = 0.04) relative to measures from irradiated, non-distressed mice. In conclusion, survivable acute hematopoietic depletion by partial-body irradiation did not alter the onset or severity of lethal pneumonitis in the C3H/HeJ mouse model.
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Affiliation(s)
- Alejandra Fuentes
- Department of Physics, IK Barber Faculty of Science, University of British Columbia Okanagan, Kelowna, Canada V1V 1V7
| | - Derek Hyde
- Department of Physics, IK Barber Faculty of Science, University of British Columbia Okanagan, Kelowna, Canada V1V 1V7
| | - Ian Johnson
- Department of Physics, IK Barber Faculty of Science, University of British Columbia Okanagan, Kelowna, Canada V1V 1V7
| | - Christina K Haston
- Department of Physics, IK Barber Faculty of Science, University of British Columbia Okanagan, Kelowna, Canada V1V 1V7
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Ziegeltrum J, Galster M, Meyer C, Horneber M. Strahlentherapie-assoziierte Pneumonitiden. IM FOKUS ONKOLOGIE 2021. [PMCID: PMC8211967 DOI: 10.1007/s15015-021-3498-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jutta Ziegeltrum
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Abteilung für Strahlentherapie, Klinikum Nürnberg Nord, Prof.-Ernst-Nathan-Str. 1, 90419 Nürnberg, Germany
| | - Marco Galster
- Institut für Radiologie und Nuklearmedizin, Klinikum Nürnberg, Prof.-Ernst-Nathan-Str. 1, 90419 Nürnberg, Germany
| | - Christian Meyer
- Institut für Pathologie, Klinikum Nürnberg, Prof.-Ernst-Nathan-Str. 1, 90419 Nürnberg, Germany
| | - Markus Horneber
- Klinikum Nürnberg, Univ. Klinik f. Inn. Medizin 5, Paracelsus Med. Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419 Nürnberg, Germany
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Chemotherapy-induced changes in bronchoalveolar lavage fluid CD4 + and CD8 + cells of the opposite lung to the cancer. Sci Rep 2020; 10:19927. [PMID: 33199774 PMCID: PMC7670451 DOI: 10.1038/s41598-020-76752-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 10/26/2020] [Indexed: 11/08/2022] Open
Abstract
Published articles support the effect of chemotherapy in the immune environment of tumors, including lung carcinomas. The role of CD4 + T-cells is crucial for expansion and accumulation of other antigen-specific immune cells, and the participation of CD8 + cells in tumor killing activity has been confirmed by many studies. However, little is known about the effect of chemotherapy on the healthy lung parenchyma from lung cancer patients, and whether there are differences between the different chemotherapy compounds used to treat this patient population. The aim of our study was to explore the effect of chemotherapy on CD4 + and CD8 + cells in the bronchoalveolar lavage fluid (BALF) of the healthy lung in patients treated with standard chemotherapy regimens. Fifteen patients underwent BAL, in the healthy lung before and after six chemotherapy courses. Platinum-based regimens included vinolerbine (VN) in 6 patients, gemcitabine (GEM) in 4 patients and etoposide (EP) in 5 patients. All patients but one were males and smokers (93%). The median age of patients was 56 years (42-75). No significant difference was noted in the patients' age between the three treated groups. Furthermore, between the three groups, no significant changes in the means of CD4 + and CD8 + cells were noted. However, when we compared the mean CD4 + cells before and after chemotherapy within each group, changes were noted when comparing VN before versus after (p = 0.05), GEM before versus after (p = 0.03), and EP before versus after (p = 0.036). In our pilot study, changes were noted in BALF CD4 + cells for the three most applied regimens at the normal lung parenchyma.
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Gao Y, Wu X, Li Y, Li Y, Zhou Q, Wang Q, Wei C, Shi D, Xie C, Pan H. The Predictive Value of MLR for Radiation Pneumonia During Radiotherapy of Thoracic Tumor Patients. Cancer Manag Res 2020; 12:8695-8701. [PMID: 33061568 PMCID: PMC7518777 DOI: 10.2147/cmar.s268964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/27/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose To evaluate the predictive value of blood lymphocyte, monocyte to lymphocyte ratio (MLR), and neutrophil to lymphocyte ratio (NLR) for radiation pneumonia (RP) in patients with thoracic tumors receiving radiotherapy. Patients and Methods The clinical data of 65 patients with thoracic tumor (esophageal cancer, lung cancer) treated by radiotherapy in our hospital were retrospectively analyzed. Patients were divided into the RP group and the non-RP group according to the Common Terminology Criteria for Adverse Events (CTCAE 5.0). Data on blood cell counts, including lymphocytes, monocytes, and neutrophils, were collected before (0 weeks) and after 1, 2, and 4 weeks of radiotherapy. Results Of the 65 patients enrolled, 27 developed radiation pneumonia and 38 did not. Patients’ clinical factors, including age, TNM stage, tumor type, underlying lung disease, and history of smoking, had no correlation with RP. ANOVA of repeated measurement data showed that the changes of MLR in the group with RP during radiotherapy were significantly different from those in the non-RP group (P<0.05). The RP prediction model based on the identified risk factors was established using receiver operator characteristic curves. The results showed that the area under the curve for the monocyte to lymphocyte ratio was 0.755 (95% CI, 0.63–0.87, P=0.000), and the best cutoff point for MLR was 0.426. Conclusion MLR could predict radiation pneumonia in patients with thoracic tumor radiotherapy and achieve early monitoring, early prevention, and treatment.
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Affiliation(s)
- Ya Gao
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xinyi Wu
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yunhao Li
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yifei Li
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Qingyu Zhou
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Qiongqiong Wang
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Chaoyi Wei
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Deli Shi
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Congying Xie
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Huanle Pan
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
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Kesim S, Ones T, Eryuksel E, Baltacioglu F, Tureli D, Ozguven S, Erdil TY. Unexpected radiation pneumonitis after SIRT with significant decrease in DLCO with internal radiation exposure: a case report. BMC Med Imaging 2020; 20:52. [PMID: 32429910 PMCID: PMC7236282 DOI: 10.1186/s12880-020-00452-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background In the last years, Selective Internal Radiation Therapy (SIRT), using biocompatible Yttrium-90 (90Y) labeled microspheres have emerged for the treatment of malignant hepatic tumors. Unfortunately, a significant part of 90Y-labeled microspheres may shunt to the lungs after intraarterial injection. It can be predictable by infusing technetium-99 m-labeled macro-aggregated albumin particles through a catheter placed in the proper hepatic artery depending on the lobe to be treated with performing a quantitative lung scintigraphy. Radiation pneumonitis (RP) can occur 1 to 6 months after the therapy, which is a rare but severe complication of SIRT. Prompt timing of steroid treatment is important due to its high mortality rate. On the other hand, pulmonary diffusion capacity measured by carbon monoxide (DLCO) is an excellent way to measure the diffusing capacity because carbon monoxide is present in minimal amount in venous blood and binds to hemoglobin in the same manner as oxygen. Some authors reported that the most consistent changes after radiation therapy (RT) are recorded with this quantitative reproducible test. The relationship between the proportional reductions in DLCO and the severity of RP developing after this therapy may prove to be clinically significant. Case presentation We herein present a patient who developed RP after SIRT that could be quantified using DLCO. To the best of our knowledge, this case is the first who developed unexpected RP after SIRT with significant decrease in DLCO with internal radiation exposure. Conclusions RP is a very rare complication and may lead to a fatal outcome. Decline in DLCO could be a valuable parameter for follow-up and to identify potential candidates for RP and could be also another trigger for administration of steroid therapy with prompt timing in this patient group.
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Affiliation(s)
- Selin Kesim
- Department of Nuclear Medicine, Marmara University Istanbul Pendik Education and Research Hospital, Fevzi Çakmak Mah. Muhsin Yazicioglu Cad. No:10 Ust Kaynarca / Pendik, 34899, Istanbul, Turkey
| | - Tunc Ones
- Department of Nuclear Medicine, Marmara University Istanbul Pendik Education and Research Hospital, Fevzi Çakmak Mah. Muhsin Yazicioglu Cad. No:10 Ust Kaynarca / Pendik, 34899, Istanbul, Turkey.
| | - Emel Eryuksel
- Department of Pulmonary and Critical Care, Marmara University Istanbul Pendik Education and Research Hospital, Istanbul, Turkey
| | - Feyyaz Baltacioglu
- Department of Radiology, Marmara University Istanbul Pendik Education and Research Hospital, Istanbul, Turkey
| | - Derya Tureli
- Department of Radiology, Marmara University Istanbul Pendik Education and Research Hospital, Istanbul, Turkey
| | - Salih Ozguven
- Department of Nuclear Medicine, Marmara University Istanbul Pendik Education and Research Hospital, Fevzi Çakmak Mah. Muhsin Yazicioglu Cad. No:10 Ust Kaynarca / Pendik, 34899, Istanbul, Turkey
| | - Tanju Yusuf Erdil
- Department of Nuclear Medicine, Marmara University Istanbul Pendik Education and Research Hospital, Fevzi Çakmak Mah. Muhsin Yazicioglu Cad. No:10 Ust Kaynarca / Pendik, 34899, Istanbul, Turkey
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Mehta AK, Khan Z, Deepak J. An 81-Year-Old Man With Shortness of Breath After Chemotherapy and Radiation Therapy for Lung Cancer. Chest 2020; 156:e63-e67. [PMID: 31511162 DOI: 10.1016/j.chest.2019.04.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022] Open
Abstract
CASE PRESENTATION An 81-year-old man was admitted for evaluation of progressive dyspnea over the previous 4 weeks. He initially noticed dyspnea when walking briskly, but this progressed to dyspnea after only walking several feet. He also endorsed a dry cough without hemoptysis. Review of systems revealed a history of intermittent low-grade fevers, malaise, and nonexertional chest pain. He had been treated for a urinary tract infection twice over the past 3 weeks with prolonged courses of levofloxacin; while his urinary symptoms improved, his respiratory symptoms did not. Medical history was pertinent for lung adenocarcinoma stage IIIb status post right upper lobectomy 10 years prior with recurrence of lung adenocarcinoma in the right lower lobe and was recently diagnosed with stage 1 primary pancreatic adenocarcinoma. He had been a longstanding tobacco smoker but quit two decades ago. Treatment of his recurrent lung adenocarcinoma included four cycles of carboplatin-pemetrexed over the preceding 5 months and intensity-modulated radiation therapy totaling 60 Gy over 30 fractions to his right lower lobe 2 months prior to presentation. He also received stereotactic body radiation therapy totaling 45 Gy over five fractions to his pancreas.
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Affiliation(s)
- Atul K Mehta
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, MD.
| | - Zulqarnain Khan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Janaki Deepak
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, MD
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Zhou P, Chen L, Yan D, Huang C, Chen G, Wang Z, Zhong L, Luo W, Chen D, Chun C, Zhang S, Li G. Early variations in lymphocytes and T lymphocyte subsets are associated with radiation pneumonitis in lung cancer patients and experimental mice received thoracic irradiation. Cancer Med 2020; 9:3437-3444. [PMID: 32207253 PMCID: PMC7221303 DOI: 10.1002/cam4.2987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/29/2022] Open
Abstract
There were no ideal markers to predict the development of radiation pneumonitis (RP). We want to investigate the value of variations of lymphocytes and T lymphocyte subsets in predicting RP after radiotherapy (RT) of lung cancer based on previous clinical findings. A total of 182 lung cancer patients who received RT were retrospectively analyzed. Circulating lymphocytes and T lymphocyte subsets were measured before, during, and after RT. Patients were evaluated from the start of RT to 6 months post‐RT. A mice model with acute radiation‐induced lung injury was established and circulating lymphocytes were measured weekly until 8 weeks after irradiation. Univariate and multivariate analyses were adopted to identify risk factors of RP. Lymphocyte levels significantly decreased (P < .001) in patients before RP symptoms developed that also was able to be seen in the mice model and the values recovered during remission of symptoms. The decrease in lymphocyte count reflected the severity of RP. Meanwhile, CD4+ T lymphocyte count was significantly lower during the occurrence of symptoms in patients with RP than in those without RP (P < .001), and it improved along with RP recovery. Levels of lymphocytes and CD4+ T lymphocyte subsets proved as independent predictors of RP. Here we showed that lower peripheral blood levels of lymphocytes and CD4+ T lymphocyte were associated with an increased risk of RP, which was validated by this mice model, and thus are associated with differences in radiation‐induced lung toxicity among individuals and help identify those who are susceptible to developing RP after RT.
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Affiliation(s)
- Pu Zhou
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Lu Chen
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Dong Yan
- Institute for Pathology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Changlin Huang
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Guangpeng Chen
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Zhiyi Wang
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Liangzhi Zhong
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Wen Luo
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Diangang Chen
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chui Chun
- Institute for Radiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Shushu Zhang
- Institute for Radiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Guanghui Li
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
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de Leve S, Wirsdörfer F, Jendrossek V. The CD73/Ado System-A New Player in RT Induced Adverse Late Effects. Cancers (Basel) 2019; 11:cancers11101578. [PMID: 31623231 PMCID: PMC6827091 DOI: 10.3390/cancers11101578] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 02/06/2023] Open
Abstract
Radiotherapy (RT) is a central component of standard treatment for many cancer patients. RT alone or in multimodal treatment strategies has a documented contribution to enhanced local control and overall survival of cancer patients, and cancer cure. Clinical RT aims at maximizing tumor control, while minimizing the risk for RT-induced adverse late effects. However, acute and late toxicities of IR in normal tissues are still important biological barriers to successful RT: While curative RT may not be tolerable, sub-optimal tolerable RT doses will lead to fatal outcomes by local recurrence or metastatic disease, even when accepting adverse normal tissue effects that decrease the quality of life of irradiated cancer patients. Technical improvements in treatment planning and the increasing use of particle therapy have allowed for a more accurate delivery of IR to the tumor volume and have thereby helped to improve the safety profile of RT for many solid tumors. With these technical and physical strategies reaching their natural limits, current research for improving the therapeutic gain of RT focuses on innovative biological concepts that either selectively limit the adverse effects of RT in normal tissues without protecting the tumor or specifically increase the radiosensitivity of the tumor tissue without enhancing the risk of normal tissue complications. The biology-based optimization of RT requires the identification of biological factors that are linked to differential radiosensitivity of normal or tumor tissues, and are amenable to therapeutic targeting. Extracellular adenosine is an endogenous mediator critical to the maintenance of homeostasis in various tissues. Adenosine is either released from stressed or injured cells or generated from extracellular adenine nucleotides by the concerted action of the ectoenzymes ectoapyrase (CD39) and 5′ ectonucleotidase (NT5E, CD73) that catabolize ATP to adenosine. Recent work revealed a role of the immunoregulatory CD73/adenosine system in radiation-induced fibrotic disease in normal tissues suggesting a potential use as novel therapeutic target for normal tissue protection. The present review summarizes relevant findings on the pathologic roles of CD73 and adenosine in radiation-induced fibrosis in different organs (lung, skin, gut, and kidney) that have been obtained in preclinical models and proposes a refined model of radiation-induced normal tissue toxicity including the disease-promoting effects of radiation-induced activation of CD73/adenosine signaling in the irradiated tissue environment. However, expression and activity of the CD73/adenosine system in the tumor environment has also been linked to increased tumor growth and tumor immune escape, at least in preclinical models. Therefore, we will discuss the use of pharmacologic inhibition of CD73/adenosine-signaling as a promising strategy for improving the therapeutic gain of RT by targeting both, malignant tumor growth and adverse late effects of RT with a focus on fibrotic disease. The consideration of the therapeutic window is particularly important in view of the increasing use of RT in combination with various molecularly targeted agents and immunotherapy to enhance the tumor radiation response, as such combinations may result in increased or novel toxicities, as well as the increasing number of cancer survivors.
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Affiliation(s)
- Simone de Leve
- Institute of Cell Biology (Cancer Research), University Hospital Essen, 45122 Essen, Germany.
| | - Florian Wirsdörfer
- Institute of Cell Biology (Cancer Research), University Hospital Essen, 45122 Essen, Germany.
| | - Verena Jendrossek
- Institute of Cell Biology (Cancer Research), University Hospital Essen, 45122 Essen, Germany.
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Venema CM, de Vries EFJ, van der Veen SJ, Dorrius MD, van Kruchten M, Schröder CP, Hospers GAP, Glaudemans AWJM. Enhanced pulmonary uptake on 18F-FES-PET/CT scans after irradiation of the thoracic area: related to fibrosis? EJNMMI Res 2019; 9:82. [PMID: 31444658 PMCID: PMC6708021 DOI: 10.1186/s13550-019-0549-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/05/2019] [Indexed: 12/29/2022] Open
Abstract
Rationale The use of 16α-[18F]fluoro-17β-estradiol (FES) positron emission tomography (PET) in clinical dilemmas and for therapy decision-making in lesions expressing estrogen receptors is growing. However, on a considerable number of FES PET scans, previously performed in a research and clinical setting in our institution, FES uptake was noticed in the lungs without an oncologic substrate. We hypothesized that this uptake was related to pulmonary fibrosis as a result of radiation therapy. This descriptive study therefore aimed to investigate whether radiation therapy in the thoracic area is possibly related to enhanced pulmonary, non-tumor FES uptake. Methods All FES-PET/CT scans performed in our institution from 2008 to 2017 were retrospectively analyzed. Scans from patients who had received irradiation in the thoracic area prior to the scan were compared to scans of patients who had never received irradiation in the thoracic area. The primary outcome was the presence of enhanced non-tumor FES uptake in the lungs, defined as visually increased FES uptake in the absence of an oncologic substrate on the concordant (contrast-enhanced) CT scan. All CT scans were evaluated for the presence of fibrosis or oncologic substrates. Results A total of 108 scans were analyzed: 70 scans of patients with previous irradiation in the thoracic area and 38 of patients without. Enhanced non-tumor FES uptake in the lungs was observed in 39/70 irradiated patients (56%), versus in 9/38 (24%) of non-irradiated patients. Fibrosis was present in 37 of the 48 patients with enhanced non-tumor FES uptake (77%), versus in 15 out of 60 (25%) patients without enhanced non-tumor uptake, irrespective of radiotherapy (p < 0.001). Conclusion After irradiation of the thorax, enhanced non-tumor uptake on FES-PET can be observed in the radiation field in a significant proportion of patients. This seems to be related to fibrosis. When observing enhanced FES uptake in the lungs, this should not be interpreted as metastases. Information on recent radiation therapy or history of pulmonary fibrosis should therefore be taken into consideration.
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Affiliation(s)
- C M Venema
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - E F J de Vries
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - S J van der Veen
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M D Dorrius
- Medical Imaging Center, Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M van Kruchten
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - C P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - G A P Hospers
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - A W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands.
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Respiratory Tract Diseases That May Be Mistaken for Infection. PRINCIPLES AND PRACTICE OF TRANSPLANT INFECTIOUS DISEASES 2019. [PMCID: PMC7119916 DOI: 10.1007/978-1-4939-9034-4_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lemay AM, Haston CK. A Chromosome 6, not Natural Killer Cell, Contribution to Radiation- and Bleomycin-Induced Lung Disease in Mice. Radiat Res 2018; 190:605-611. [DOI: 10.1667/rr15144.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Anne-Marie Lemay
- Departments of Human Genetics and Medicine and the Meakins-Christie Laboratories, McGill University, Montreal, Canada
| | - Christina K. Haston
- Departments of Human Genetics and Medicine and the Meakins-Christie Laboratories, McGill University, Montreal, Canada
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15
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Guerriero G, Battista C, Montesano M, Carino R, Primavera A, Costantino S, Spoto S, D'Angelillo RM, Altomare V. Unusual Complication after Radiotherapy for Breast Cancer Bronchiolitis Obliterans Organizing Pneumonia Case Report and Review of the Literature. TUMORI JOURNAL 2018; 91:421-3. [PMID: 16459640 DOI: 10.1177/030089160509100508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Breast-conserving surgery and postoperative radiotherapy play an important role in the treatment of early breast cancer. Bronchiolitis obliterans with organizing pneumonia (BOOP) is an uncommon syndrome reported to be one of the complications of adjuvant radiotherapy. We report the case of a 71-year-old woman who developed cough, dyspnea and fever three weeks after radiation therapy to the left breast for breast carcinoma. Chest X-ray and computed tomography scan demonstrated alveolar opacities within both lungs. Antibiotic therapy against any probable septic pathology did not improve the symptoms, while corticosteroid treatment resulted in rapid clinical improvement together with regression of the pulmonary opacities. Irradiation was thought to be the cause of the migratory pneumonitis, hence this case was clinically diagnosed as radiation-induced migratory pneumonitis similar to BOOP, without lung biopsy. The present case suggests that one should be mindful of this disease when treating patients with a history of irradiation to the breast. BOOP promptly responds to systemic corticosteroid therapy with rapid improvement of symptoms and regression of the pulmonary opacities.
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Affiliation(s)
- Gabriella Guerriero
- Surgical Science Department, Policlinico Umberto I, La Sapienza University, Rome, Italy.
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Abstract
Normal tissue injury from irradiation is an unfortunate consequence of radiotherapy. Technologic improvements have reduced the risk of normal tissue injury; however, toxicity causing treatment breaks or long-term side effects continues to occur in a subset of patients. The molecular events that lead to normal tissue injury are complex and span a variety of biologic processes, including oxidative stress, inflammation, depletion of injured cells, senescence, and elaboration of proinflammatory and profibrogenic cytokines. This article describes selected recent advances in normal tissue radiobiology.
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Affiliation(s)
- Deborah E Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - James B Mitchell
- Radiation Biology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Ones T, Eryuksel E, Baltacioglu F, Ceyhan B, Erdil TY. The effect of selective internal radiation therapy with yttrium-90 resin microspheres on lung carbon monoxide diffusion capacity. EJNMMI Res 2017; 7:103. [PMID: 29285636 PMCID: PMC5746495 DOI: 10.1186/s13550-017-0353-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/15/2017] [Indexed: 01/27/2023] Open
Abstract
Background Selective internal radiation therapy (SIRT) with embolization of branches of the hepatic artery is a valuable therapeutic tool for patients with hepatic malignancies; however, it is also associated with lung injury risk due to shunting. Diffusion capacity of the lungs for carbon monoxide (DLCO) is a clinically significant lung function test, and worsening in DLCO is suggested to reflect a limited gas exchange reserve caused by the potential toxicity of chemoradiotherapy or it may be a marker of related lung injury. This study aimed to examine the changes in DLCO during SIRT with resin microspheres in newly treated and retreated patients. Forty consecutive patients who received SIRT for a variety of malignant conditions were included. All subjects were treated with Yttrium-90 labelled resin microspheres. DLCO tests were performed after the procedures. In addition, patients were specifically followed for radiation pneumonitis. Results The mean DLCO did not significantly change after the first (82.8 ± 19.4 vs. 83.1 ± 20.9, p = 0.921) and the second treatments (87.4 ± 19.7 vs. 88.6 ± 23.2, p = 0.256). Proportion of patients with impaired DLCO at baseline was not altered significantly after the first (37.5 vs. 45.0%, p = 0.581) and the second treatments (27.3 vs. 27.3%, p = 1.000). Also, percent change in DLCO values did not correlate with radiation dose, lung shunt fraction, or lung exposure dose (p > 0.05 for all comparisons). None of the patients developed radiation pneumonitis. Conclusions Our results suggest that no significant change in DLCO in association with SIRT occurs, both after the first or the second treatment sessions. Further larger studies possibly with different protocols are warranted to better delineate DLCO changes after SIRT in a larger spectrum of patients.
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Affiliation(s)
- Tunc Ones
- Department of Nuclear Medicine, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey.
| | - Emel Eryuksel
- Department of Pulmonary and Critical Care, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey
| | - Feyyaz Baltacioglu
- Department of Radiology, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey
| | - Berrin Ceyhan
- Department of Pulmonary and Critical Care, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey
| | - Tanju Yusuf Erdil
- Department of Nuclear Medicine, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey
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Mothersill C, Rusin A, Fernandez-Palomo C, Seymour C. History of bystander effects research 1905-present; what is in a name? Int J Radiat Biol 2017; 94:696-707. [DOI: 10.1080/09553002.2017.1398436] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - Andrej Rusin
- Department of Biology, McMaster University, Hamilton, Canada
| | | | - Colin Seymour
- Department of Biology, McMaster University, Hamilton, Canada
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Yamagishi T, Kodaka N, Kurose Y, Watanabe K, Nakano C, Kishimoto K, Oshio T, Niitsuma K, Matsuse H. Analysis of predictive parameters for the development of radiation-induced pneumonitis. Ann Thorac Med 2017; 12:252-258. [PMID: 29118857 PMCID: PMC5656943 DOI: 10.4103/atm.atm_355_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION: Prevention and effective treatment of radiation-induced pneumonitis (RP) could facilitate greater use of radiation therapy (RT) for lung cancer. The purpose of this study was to determine clinical parameters useful for early prediction of RP. METHODS: Blood sampling, pulmonary function testing, chest computed tomography, and bronchoalveolar lavage (BAL) were performed in patients with pathologically confirmed lung cancer who had completed ≥60 Gy of RT, at baseline, shortly after RT, and at 1 month posttreatment. RESULTS: By 3 months post-RT, 11 patients developed RP (RP group) and the remaining 11 patients did not (NRP group). RT significantly increased total cell counts and alveolar macrophages in BAL of the NRP group, whereas lymphocyte count was increased in both groups. Matrix metallopeptidase-9 (MMP-9) increased and vascular endothelial growth factor decreased significantly in the BAL fluid (BALF) of the RP group following RT. Serum surfactant protein D (SP-D) increased significantly in the NRP group. SP-D in BALF from the RP group increased significantly with a subsequent increase in serum SP-D. Pulmonary dilution decreased similarly in both groups of patients. CONCLUSIONS: Increased SP-D in BALF, rather than that in serum, could be useful biomarkers in predicting RP. The MMP-9 in BALF might play a role in the pathogenesis of RP. Pulmonary dilution test may not be predictive of the development of RP.
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Affiliation(s)
- Toru Yamagishi
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Norio Kodaka
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yoshiyuki Kurose
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kayo Watanabe
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Chihiro Nakano
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kumiko Kishimoto
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Takeshi Oshio
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kumiko Niitsuma
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Hiroto Matsuse
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
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The Th1/Th17 balance dictates the fibrosis response in murine radiation-induced lung disease. Sci Rep 2017; 7:11586. [PMID: 28912510 PMCID: PMC5599556 DOI: 10.1038/s41598-017-11656-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/25/2017] [Indexed: 01/02/2023] Open
Abstract
Radiotherapy can result in lung diseases pneumonitis or fibrosis dependent on patient susceptibility. Herein we used inbred and genetically altered mice to investigate whether the tissue adaptive immune response to radiation injury influences the development of radiation-induced lung disease. Six inbred mouse strains were exposed to 18 Gy whole thorax irradiation and upon respiratory distress strains prone to pneumonitis with fibrosis presented an increased pulmonary frequency of Thelper (Th)17 cells which was not evident in strains prone solely to pneumonitis. The contribution of Th17 cells to fibrosis development was supported as the known enhanced fibrosis of toll-like receptor 2&4 deficient mice, compared to C57BL/6J mice, occurred with earlier onset neutrophilia, and with increased levels of pulmonary Th17, but not Th1, cells following irradiation. Irradiated Il17−/− mice lacked Th17 cells, and were spared both fibrosis and pneumonitis, as they survived to the end of the experiment with a significantly increased pulmonary Th1 cell frequency, only. Interferon-γ−/− mice, deficient in Th1 cells, developed a significantly enhanced fibrosis response compared to that of C57BL/6J mice. The tissue adaptive immune response influences the pulmonary disease response to radiotherapy, as an increased Th17 cell frequency enhanced and a Th1 response spared, fibrosis in mice.
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Prévention médicale et traitement des complications pulmonaires secondaires à la radiothérapie. Cancer Radiother 2017; 21:411-423. [DOI: 10.1016/j.canrad.2017.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/13/2017] [Accepted: 03/24/2017] [Indexed: 12/12/2022]
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Abstract
Radiation-induced lung injury is a well-known complication of thoracic radiation for patients with breast, lung, thymic, and esophageal malignancies, and mediastinal lymphomas. Improvements in radiation technique, as well as the understanding of the pathophysiology of radiation injury, have led to lower rates of pneumonitis and improved symptom control. Here, the authors provide an overview of the pathophysiology, diagnosis, and management of patients with radiation pneumonitis as a complication of treatment of chest malignancies.
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Affiliation(s)
- Trevor J Bledsoe
- Department of Therapeutic Radiology, Smilow Cancer Hospital at Yale-New Haven, 35 Park Street, Ste LL 513, New Haven, CT 06511, USA
| | - Sameer K Nath
- Department of Therapeutic Radiology, Smilow Cancer Hospital at Yale-New Haven, 35 Park Street, Ste LL 513, New Haven, CT 06511, USA.
| | - Roy H Decker
- Department of Therapeutic Radiology, Smilow Cancer Hospital at Yale-New Haven, 35 Park Street, Ste LL 513, New Haven, CT 06511, USA
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Wirsdörfer F, Jendrossek V. The Role of Lymphocytes in Radiotherapy-Induced Adverse Late Effects in the Lung. Front Immunol 2016; 7:591. [PMID: 28018357 PMCID: PMC5155013 DOI: 10.3389/fimmu.2016.00591] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/29/2016] [Indexed: 12/31/2022] Open
Abstract
Radiation-induced pneumonitis and fibrosis are dose-limiting side effects of thoracic irradiation. Thoracic irradiation triggers acute and chronic environmental lung changes that are shaped by the damage response of resident cells, by the resulting reaction of the immune system, and by repair processes. Although considerable progress has been made during the last decade in defining involved effector cells and soluble mediators, the network of pathophysiological events and the cellular cross talk linking acute tissue damage to chronic inflammation and fibrosis still require further definition. Infiltration of cells from the innate and adaptive immune systems is a common response of normal tissues to ionizing radiation. Herein, lymphocytes represent a versatile and wide-ranged group of cells of the immune system that can react under specific conditions in various ways and participate in modulating the lung environment by adopting pro-inflammatory, anti-inflammatory, or even pro- or anti-fibrotic phenotypes. The present review provides an overview on published data about the role of lymphocytes in radiation-induced lung disease and related damage-associated pulmonary diseases with a focus on T lymphocytes and B lymphocytes. We also discuss the suspected dual role of specific lymphocyte subsets during the pneumonitic phase and fibrotic phase that is shaped by the environmental conditions as well as the interaction and the intercellular cross talk between cells from the innate and adaptive immune systems and (damaged) resident epithelial cells and stromal cells (e.g., endothelial cells, mesenchymal stem cells, and fibroblasts). Finally, we highlight potential therapeutic targets suited to counteract pathological lymphocyte responses to prevent or treat radiation-induced lung disease.
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Affiliation(s)
- Florian Wirsdörfer
- Institute of Cell Biology (Cancer Research), University Hospital Essen , Essen , Germany
| | - Verena Jendrossek
- Institute of Cell Biology (Cancer Research), University Hospital Essen , Essen , Germany
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Lim JH, Nam HS, Kim HJ, Choi CH, Park IS, Cho JH, Ryu JS, Kwak SM, Lee HL. Migratory eosinophilic alveolitis caused by radiation therapy. J Thorac Dis 2015; 7:E117-21. [PMID: 26101656 DOI: 10.3978/j.issn.2072-1439.2015.05.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 04/10/2015] [Indexed: 11/14/2022]
Abstract
Although radiation pneumonitis is usually confined to irradiated areas, some studies have reported that radiation-induced lymphocytic alveolitis can also spread to the non-irradiated lung. However, there have been few reports of radiation-induced eosinophilic alveolitis. We report the case of a 27-year-old female with radiation pneumonitis, occurring 4 months after radiation therapy for cancer of the left breast. Clinical and radiological relapse followed withdrawal of corticosteroids. Examination of bronchoalveolar lavage (BAL) in patchy airspace consolidations revealed increased eosinophil counts. Finally, clinical and radiological signs resolved rapidly after reintroduction of corticosteroids. Eosinophilic alveolitis may be promoted by radiation therapy. In the present case report, possible mechanisms for radiation-induced eosinophilic alveolitis are also reviewed.
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Affiliation(s)
- Jun Hyeok Lim
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Hae-Seong Nam
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Hun Jung Kim
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Chang-Hwan Choi
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - In-Suh Park
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jae Hwa Cho
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jeong-Seon Ryu
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Seung Min Kwak
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Hong Lyeol Lee
- 1 Division of Pulmonology, Department of Internal Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
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Abstract
Organizing pneumonia is a particular type of inflammatory and reparative reaction of the lung parenchyma characterized by fibroblast proliferation in the distal airspaces with overall preservation of the lung architecture. When microscopic, it is an asymptomatic and nonspecific reaction of little clinical significance accompanying many pathological processes. When macroscopic and affecting large portions of the lung parenchyma, it manifests by restrictive ventilatory defect and gas exchange impairment leading to dyspnea, cough, hypoxemia, alveolar opacities at chest imaging, and symptoms of systemic inflammation such as fever, malaise, and weight loss. This picture constitutes the clinico-pathological syndrome of organizing pneumonia, which has been recognized and characterized as a distinct entity in the past 30 years. Although the classical features of organizing pneumonia are increasingly familiar to chest physicians, and the efficacy of corticosteroid treatment makes it appear at first sight as an easy problem to resolve, atypical clinical presentations, similarities with other diseases, severe forms, histological variants, side effects of therapy, and relapses can make the management more difficult than initially expected. This chapter will address the classical and less common features of organizing pneumonia, and will provide practical clues to the diagnosis and management of this disorder.
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Affiliation(s)
- Vincent Cottin
- grid.413858.3Rare Pulmonary Diseases, Hôpital Louis Pradel, Lyon, France
| | | | - Luca Richeldi
- grid.5491.90000000419369297Respiratory Medicine, University of Southampton, Southampton, United Kingdom
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Otani K, Nishiyama K, Ito Y, Kawaguchi Y, Inaji H. Steroid treatment increases the recurrence of radiation-induced organizing pneumonia after breast-conserving therapy. Cancer Med 2014; 3:947-53. [PMID: 24799363 PMCID: PMC4303162 DOI: 10.1002/cam4.255] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/09/2014] [Accepted: 03/28/2014] [Indexed: 11/07/2022] Open
Abstract
Radiation-induced organizing pneumonia (RIOP) is an important complication of postoperative radiotherapy for breast cancer. Unfortunately, conventional corticosteroid therapy is frequently associated with relapses. The aim of this retrospective study was to evaluate the outcomes of steroid treatment in patients with RIOP. In total, 26 patients diagnosed with RIOP from among 2404 women who received radiotherapy after breast-conserving surgery for breast cancer were included and classified into steroid (n = 7) and nonsteroid (n = 19) groups. Serum, sputum, and bronchoalveolar lavage composition; subjective symptoms (cough, fever, and dyspnea); migratory progression; and RIOP relapse were compared between the groups. Treatment type did not affect the duration of the subjective symptoms, which was 1.6 and 1.7 months for the steroid and nonsteroid groups, respectively. In contrast, RIOP relapse and new pulmonary lesions developed in five patients in the steroid group and only three patients in the nonsteroid group (P = 0.014). By assessing RIOP duration as the time to resolution of symptoms and discontinuation of therapy, the median duration of RIOP was significantly longer in the steroid (17.1 months) than that in the nonsteroid group (2.3 months, P = 0.005), primarily because of frequent relapses. After remission, persistent pulmonary dysfunction did not occur in the nonsteroid group. This single-center retrospective study demonstrates that steroid therapy results in frequent relapses and significantly prolongs RIOP duration. Corticosteroid treatment is considered a critical factor in RIOP recurrence.
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Affiliation(s)
- Keisuke Otani
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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Wirsdörfer F, Cappuccini F, Niazman M, de Leve S, Westendorf AM, Lüdemann L, Stuschke M, Jendrossek V. Thorax irradiation triggers a local and systemic accumulation of immunosuppressive CD4+ FoxP3+ regulatory T cells. Radiat Oncol 2014; 9:98. [PMID: 24766907 PMCID: PMC4011772 DOI: 10.1186/1748-717x-9-98] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/09/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Lymphocyte infiltration is a common feature of radiation-induced pneumonitis and fibrosis, but their contribution to the pathogenic processes is still unclear. Here, we addressed the impact of thorax irradiation on the T cell compartment with a focus on immunosuppressive regulatory T cells (Treg). METHODS C57BL/6 wild type mice (WT) received anesthesia only (sham controls, 0 Gy) or were exposed to a single dose of whole thorax irradiation (15 Gy). Immune cells from lung tissue, spleen, and cervical lymph nodes were collected 10 to 84 days post-irradiation and phenotypically characterized by flow cytometry. RESULTS Whole thorax irradiation provoked an increased influx of CD3+ T cells at 42 and 84 days post-irradiation. In contrast, local irradiation caused a sustained reduction in CD3+ T cells in peripheral lymphoid tissues. Interestingly, we observed a significant local and systemic increase in the fraction of CD4+ T cells expressing the transcription factor forkhead box P3 (FoxP3), the phenotypic marker for murine Treg, at day 21 post-irradiation. The accumulation of Treg was associated with increased levels of T cells expressing surface proteins characteristic for recruitment and immunosuppressive activity, e.g. CD103, CTLA-4 and CD73. Importantly, Treg isolated at this time point were able to suppress CD4+ effector T cells to a similar extent as Treg isolated from control mice. CONCLUSIONS The response of the adaptive immune system to whole thorax irradiation is characterized by local immunoactivation and systemic immunosuppression. The transient accumulation of immunosuppressive CD4+ FoxP3+ Treg may be required to protect the lung against excessive inflammation-induced tissue damage. Further investigations shall define the mechanisms underlying the accumulation of Treg and their role for the pathogenesis of radiation-induced lung disease.
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Affiliation(s)
| | | | | | | | | | | | | | - Verena Jendrossek
- Department of Molecular Cell Biology, Institute of Cell Biology (Cancer Research), Medical Faculty, University of Duisburg-Essen, Virchowstrasse 173, 45122, Essen, Germany.
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Paun A, Bergeron ME, Haston CK. NKT deficient mice are not spared lung disease after exposure to thoracic radiotherapy. Radiat Res 2014; 181:369-75. [PMID: 24701965 DOI: 10.1667/rr13581.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The specific pathways through which radiation produces the lung injuries of pneumonitis (alveolitis) and fibrosis are unknown but may involve an altered immune response. In this study, we investigated the hypothesis that the radiation-induced lung phenotype of Ja18(-/-) mice [which lack invariant natural killer T (iNKT) cells] is altered relative to that of C57BL/6J genetic background strain. After 18 Gy whole-thorax irradiation male C57BL/6J mice succumbed to respiratory distress at 28-30 weeks postirradiation and although confirmed by flow cytometric analysis to be deficient in iNKT cells, the postirradiation survival of Ja18(-/-) mice was not significantly different from that of C57BL/6J mice (P = 0.87). Histologically, the lungs of both C57BL/6J and Ja18(-/-) mice developed fibrosing alveolitis over a similar time course with the same severity (P = 0.15). Analysis of the bronchoalveolar lavage revealed that the C57BL/6J mice and female Ja18(-/-) mice succumbed to respiratory distress with neutrophil numbers exceeding those of the Ja18(-/-) male mice and untreated control mice. In conclusion, the radiation-induced lung disease of Ja18(-/-) mice did not significantly differ from that of C57BL/6J mice.
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Affiliation(s)
- Alexandra Paun
- a Department of Human Genetics, McGill University, Montreal, Quebec H2X 2P2, Canada
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Kelsey CR, Vujaskovic Z, Jackson IL, Riedel RF, Marks LB. Lung. ALERT • ADVERSE LATE EFFECTS OF CANCER TREATMENT 2014. [PMCID: PMC7121399 DOI: 10.1007/978-3-540-75863-1_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The lungs are particularly sensitive to RT, and are often the primary dose-limiting structure during thoracic therapy. The alveolar/capillary units and pneumocytes within the alveoli appear to be particularly sensitive to RT. Hypoxia may be important in the underlying physiology of RT-associated lung injury. The cytokine transforming growth factor-beta (TGF-β), plays an important role in the development of RT-induced fibrosis. The histopathological changes observed in the lung after RT are broadly characterized as diffuse alveolar damage. The interaction between pre-treatment PFTs and the risk of symptomatic lung injury is complex. Similarly, the link between changes in PFTs and the development of symptoms is uncertain. The incidence of symptomatic lung injury increases with increase in most dosimetric parameters. The mean lung dose (MLD) and V20 have been the most-often considered parameters. MLD might be a preferable metric since it considers the entire 3D dose distribution. Radiation to the lower lobes appears to be more often associated with clinical symptoms than is radiation to the upper lobes. This might be related to incidental cardiac irradiation. In pre-clinical models, there appears to be a complex interaction between lung and heart irradiation. TGF-β has been suggested in several studies to predict for RT-induced lung injury, but the data are still somewhat inconsistent. Oral prednisone (Salinas and Winterbauer 1995), typically 40–60 mg daily for 1–2 weeks with a slow taper, is usually effective in treating pneumonitis. There are no widely accepted treatments for fibrosis. A number of chemotherapeutic agents have been suggested to be associated with a range of pulmonary toxicities.
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Martínez Pérez C, Gumbau Puchol V, Basés Valenzuela C, Villalba Ferrer F, Fuster Diana C. Radiation pneumonitis after breast-conserving surgery for cancer. Cir Esp 2013; 93:e91-3. [PMID: 24211121 DOI: 10.1016/j.ciresp.2013.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 05/29/2013] [Accepted: 05/30/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Carolina Martínez Pérez
- Unidad Funcional de Mama, Cirugía General y Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - Verónica Gumbau Puchol
- Unidad Funcional de Mama, Cirugía General y Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - Carla Basés Valenzuela
- Unidad Funcional de Mama, Cirugía General y Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - Francisco Villalba Ferrer
- Unidad Funcional de Mama, Cirugía General y Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - Carlos Fuster Diana
- Unidad Funcional de Mama, Cirugía General y Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España
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Farr KP, Khalil AA, Knap MM, Møller DS, Grau C. Development of radiation pneumopathy and generalised radiological changes after radiotherapy are independent negative prognostic factors for survival in non-small cell lung cancer patients. Radiother Oncol 2013; 107:382-8. [PMID: 23726117 DOI: 10.1016/j.radonc.2013.04.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 03/02/2013] [Accepted: 04/14/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE To investigate the risk factors for radiation pneumopathy (RP) and survival rate of non-small cell lung cancer patients with RP and generalised interstitial lung changes (gen-ILC). MATERIAL AND METHODS A total of 147 consecutive patients receiving curative radiotherapy were analysed. RP was graded according to Common Terminology Criteria for Adverse Events v. 3. Computed tomography images were assessed for the presence of gen-ILC after radiotherapy. Univariate and multivariate analyses were performed to identify significant factors. RESULTS Median follow-up was 16.2 months (range 1.4-58.6). Radiological changes after radiotherapy were confined to high dose irradiation volume in 111 patients, while 31 patients developed gen-ILC. Dosimetric parameters and level of C-reactive protein before radiotherapy were significantly associated with severe RP. Development of gen-ILC (p=0.008), as well as severe RP (p=0.03) had significant negative impact on patients' survival. These two factors remained significant in the multivariate analysis. CONCLUSIONS Severe radiation pneumopathy and generalised radiographic changes were significant independent prognostic factors for survival. More studies on pathophysiology of radiation induced damage are necessary to fully understand the mechanisms behind it.
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Murai T, Shibamoto Y, Nishiyama T, Baba F, Miyakawa A, Ayakawa S, Ogino H, Otsuka S, Iwata H. Organizing pneumonia after stereotactic ablative radiotherapy of the lung. Radiat Oncol 2012; 7:123. [PMID: 22853821 PMCID: PMC3480881 DOI: 10.1186/1748-717x-7-123] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/17/2012] [Indexed: 01/22/2023] Open
Abstract
Background Organizing pneumonia (OP), so called bronchiolitis obliterans organizing pneumonia after postoperative irradiation for breast cancer has been often reported. There is little information about OP after other radiation modalities. This cohort study investigated the clinical features and risk factors of OP after stereotactic ablative radiotherapy of the lung (SABR). Methods Patients undergoing SABR between 2004 and 2010 in two institutions were investigated. Blood test and chest computed tomography were performed at intervals of 1 to 3 months after SABR. The criteria for diagnosing OP were: 1) mixture of patchy and ground-glass opacity, 2) general and/or respiratory symptoms lasting for at least 2 weeks, 3) radiographic lesion in the lung volume receiving < 0.5 Gy, and 4) no evidence of a specific cause. Results Among 189 patients (164 with stage I lung cancer and 25 with single lung metastasis) analyzed, nine developed OP. The incidence at 2 years was 5.2% (95% confidence interval; 2.6-9.3%). Dyspnea were observed in all patients. Four had fever. These symptoms and pulmonary infiltration rapidly improved after corticosteroid therapy. Eight patients had presented with symptomatic radiation pneumonitis (RP) around the tumor 2 to 7 months before OP. The prior RP history was strongly associated with OP (hazard ratio 61.7; p = 0.0028) in multivariate analysis. Conclusions This is the first report on OP after SABR. The incidence appeared to be relatively high. The symptoms were sometimes severe, but corticosteroid therapy was effective. When patients after SABR present with unusual pneumonia, OP should be considered as a differential diagnosis, especially in patients with prior symptomatic RP.
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Affiliation(s)
- Taro Murai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
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Singh P, Lenox R. Bilateral Lymphocytic Alveolitis From Stereotactic Body Radiation for Lung Cancer: An Unreported Occurrence. Chest 2010. [DOI: 10.1378/chest.10947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Thomas DM, Fox J, Haston CK. Imatinib therapy reduces radiation-induced pulmonary mast cell influx and delays lung disease in the mouse. Int J Radiat Biol 2010; 86:436-44. [PMID: 20470194 DOI: 10.3109/09553001003674863] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Radiotherapy can induce the inflammatory response of alveolitis and the excessive repair response of fibrosis through incompletely defined mechanisms. In previous murine studies we showed the alveolitis response to thoracic irradiation to correlate with pulmonary mast cell numbers and fibrosis severity to partially depend on the extent of alveolitis. Herein we investigate whether the mast cell blocker imatinib reduces the alveolitis and/or fibrosis response to irradiation. MATERIAL AND METHODS Mice of three strains received 18 Gy whole thorax irradiation and a subset of these were treated with imatinib (100 mg/kg) daily from the day of irradiation until euthanasia due to the presentation of distress symptoms. RESULTS Imatinib treatment increased the post irradiation survival time of the mice by an average of 23% and significantly reduced the pulmonary mast cell influx. The alveolitis and fibrosis phenotypes, evident histologically, were not altered by imatinib treatment in mice euthanised upon presentation of respiratory distress. The imatinib treated mice did, however, have less disease than did mice receiving radiation alone, when both groups were assessed at a common time point. CONCLUSIONS We conclude that imatinib treatment reduces radiation-induced mast cell influx into the lungs and delays the alveolitis or fibrosis response of mice.
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Affiliation(s)
- David M Thomas
- Department of Medicine, McGill University, Montreal, Quebec, Canada
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Um SJ, Lee SK, Yang DK, Son C, Roh MS, Kim KN, Lee KN, Choi PJ. Fatal interstitial lung disease after erlotinib administration in a patient with radiation fibrosis. CLINICAL RESPIRATORY JOURNAL 2009; 3:181-4. [PMID: 20298401 DOI: 10.1111/j.1752-699x.2008.00115.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Soo-Jung Um
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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Park KJ, Oh YT, Kil WJ, Park W, Kang SH, Chun M. Bronchoalveolar lavage findings of radiation induced lung damage in rats. JOURNAL OF RADIATION RESEARCH 2009; 50:177-182. [PMID: 19377267 DOI: 10.1269/jrr.08089] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Radiation induced lung damage is a main dose limiting factor when irradiating the thorax. Although Bronchoalveolar lavage (BAL) is a valuable tool for studying the mechanisms in pulmonary disorders, there are only a few studies about the BAL findings of radiation-induced lung damage. We evaluate the BAL findings for the evaluation of radiation-induced lung damage. Sprague-Dawley rats received 20 Gy of radiation to the right lung and control group were sham irradiated. BAL was performed for the right and left lungs separately 3, 7, 14, 28, and 56 days after radiation. The cells in the BAL fluid were counted and the concentrations of protein, NO, and TGF-beta in the BAL fluid were measured. Lung tissues were removed after BAL and stained with hematoxylin-eosin (H-E) and trichrome. From 2 weeks, histological findings showed definite lung damage. The protein level and TGF-beta in BAL fluid from the irradiated lung peaked at 4 and 8 weeks, respectively, after radiation. Total cell count in BAL fluid from both sides of lungs was increased from 2 weeks and continued to increase at 8 weeks after irradiation. NO in BAL fluid from both sides of lungs peaked at 4 weeks after irradiation. The protein level and TGF-beta were increased in BAL fluid from irradiated lungs. However, alveolar cells and NO increased in BAL fluid from both irradiated and non-irradiated lungs. BAL is a valuable tool for the evaluation of radiation induced lung damage.
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Affiliation(s)
- Kwang-Joo Park
- Department of Radiation Oncology, Pulmononary Medicine, Ajou University School of Medicine, Suwon, Korea
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Cornelissen R, Senan S, Antonisse IE, Liem H, Tan YKY, Rudolphus A, Aerts JGJV. Bronchiolitis obliterans organizing pneumonia (BOOP) after thoracic radiotherapy for breast carcinoma. Radiat Oncol 2007; 2:2. [PMID: 17201913 PMCID: PMC1780052 DOI: 10.1186/1748-717x-2-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 01/03/2007] [Indexed: 11/16/2022] Open
Abstract
Common complications of thoracic radiotherapy include esophagitis and radiation pneumonitis. However, it is important to be aware of uncommon post-radiotherapy complications such as bronchiolitis obliterans organizing pneumonia (BOOP). We report on two patients with carcinoma of the breast who developed an interstitial lung disease consistent with BOOP. BOOP responds to treatment with corticosteroids and the prognosis is generally good despite of the need for long-term administration of corticosteroids as relapses can occur during tapering of steroids. This report provides guidelines for the evaluation and treatment of patients with pulmonary infiltrates after radiotherapy.
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Affiliation(s)
- Robin Cornelissen
- Dept of Pulmonary Diseases, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
- Dept of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Suresh Senan
- Dept of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Imogeen E Antonisse
- Dept of Radiation Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hauw Liem
- Dept of Pulmonary Diseases, Lievensberg Hospital, Bergen op Zoom, The Netherlands
| | - Youke KY Tan
- Dept of Pulmonary Diseases, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Arjan Rudolphus
- Dept of Pulmonary Diseases, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Joachim GJV Aerts
- Dept of Pulmonary Diseases, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
- Dept of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
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Affiliation(s)
- Matthew K W Lo
- Department of Radiation Oncology, Wellington Blood & Cancer Centre, Capital & Coast District Health Board, Wellington Hospital, Wellington South, New Zealand
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Arpin D, Perol D, Blay JY, Falchero L, Claude L, Vuillermoz-Blas S, Martel-Lafay I, Ginestet C, Alberti L, Nosov D, Etienne-Mastroianni B, Cottin V, Perol M, Guerin JC, Cordier JF, Carrie C. Early variations of circulating interleukin-6 and interleukin-10 levels during thoracic radiotherapy are predictive for radiation pneumonitis. J Clin Oncol 2006; 23:8748-56. [PMID: 16314635 DOI: 10.1200/jco.2005.01.7145] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate variations of circulating serum levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNFalpha), and interleukin-10 (IL-10) during three-dimensional conformal radiation therapy (3D-CRT) in patients with non-small-cell lung cancer and correlate these variations with the occurrence of radiation pneumonitis. PATIENTS AND METHODS Ninety-six patients receiving 3D-CRT for stage I to III disease were evaluated prospectively. Circulating cytokine levels were determined before, every 2 weeks during, and at the end of treatment. Radiation pneumonitis was evaluated prospectively between 6 and 8 weeks after 3D-CRT. The predictive value of clinical, dosimetric, and biologic (cytokine levels) factors was evaluated both in univariate and multivariate analyses. RESULTS Forty patients (44%) experienced score 1 or more radiation pneumonitis. No association was found between baseline cytokine levels and the risk of radiation pneumonitis. In the whole population, mean levels of TNFalpha, IL-6, and IL-10 remained stable during radiotherapy. IL-6 levels were significantly higher (P = .047) during 3D-CRT in patients with radiation pneumonitis. In the multivariate analysis, covariations of IL-6 and IL-10 levels during the first 2 weeks of 3D-CRT were evidenced as independently predictive of radiation pneumonitis in this series (P = .011). CONCLUSION Early variations of circulating IL-6 and IL-10 levels during 3D-CRT are significantly associated with the risk of radiation pneumonitis. Variations of circulating IL-6 and IL-10 levels during 3D-CRT may serve as independent predictive factors for this complication.
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Affiliation(s)
- Dominique Arpin
- Department of Pneumology, Hôpital de la Croix Rousse, 103 Grande Rue de la Croix Rousse, 69317 Lyon Cedex 04, France.
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Hassaballa HA, Cohen ES, Khan AJ, Ali A, Bonomi P, Rubin DB. Positron Emission Tomography Demonstrates Radiation-Induced Changes to Nonirradiated Lungs in Lung Cancer Patients Treated With Radiation and Chemotherapy. Chest 2005; 128:1448-52. [PMID: 16162742 DOI: 10.1378/chest.128.3.1448] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To determine whether acute changes in shielded lungs can be detected by positron emission tomography (PET) after radiation therapy. DESIGN Retrospective cohort study. SETTING University-affiliated medical center. PATIENTS Sixteen patients undergoing radiation therapy for lung cancer who had PET scans after receiving treatment. INTERVENTIONS None. MEASUREMENTS AND RESULTS Thirteen of 16 patients (81.2%) showed increased (18)fluoro-2-deoxyglucose uptake in shielded nonirradiated lung in the following four distinct patterns: (1) contralateral peripheral pleural uptake in 5 of 16 patients (31.2%); (2) ipsilateral peripheral pleural uptake in 5 of 16 patients (31.2%); (3) bilateral peripheral pleural uptake in 1 of 16 patients (6.2%); and (4) bilateral diffuse background uptake in 1 of 16 patients (6.2%). This last patient developed clinically evident radiation pneumonitis. CONCLUSIONS Increased lung metabolic activity can be demonstrated in the nonirradiated lung in patients who have undergone radiation therapy for lung cancer and can be detected by PET scanning. PET scanning of lungs in irradiated patients may provide an early demonstrable barometer of pulmonary toxicity. If verified, this imaging tool could prove to be useful in monitoring patients receiving radiation therapy for thoracic malignancies and may have predictive value for subsequent fibrosis. PET scanning may also be an important tool in future studies to further elucidate the pathogenetic mechanism of radiation-induced lung injury.
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Affiliation(s)
- Hesham A Hassaballa
- Section of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL, USA.
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Abratt RP, Morgan GW, Silvestri G, Willcox P. Pulmonary complications of radiation therapy. Clin Chest Med 2004; 25:167-77. [PMID: 15062608 DOI: 10.1016/s0272-5231(03)00126-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
There have been important developments in understanding the difference in pathogenesis and clinical significance between acute or sporadic pneumonitis and late radiation fibrosis. Corticosteroid therapy and other forms of therapy are useful in the treatment of acute pneumonitis. Late radiation fibrosis is refractory to treatment; therefore, minimizing the likelihood of developing it is particularly important. Baseline lung assessments are appropriate in patients who are clinically at risk. A new development is the use of the DVH to compare radiation treatment plans to minimize the volume of normal lung irradiated in patients who are at risk. It is hoped that the study of mechanisms that lead to the development of radiation fibrosis will point the way to possible future therapies. Patients who are included in studies of novel irradiation treatments for lung cancer need, in particular, to be monitored for late radiation lung toxicity.
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Affiliation(s)
- Raymond P Abratt
- Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Observatory 7925, Cape Town, South Africa.
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González-Sanchis A, Bautista D, Pallardó Y, Sancho R. Asociación entre la incidencia de alteraciones tomográficas pulmonares y el volumen pulmonar irradiado en pacientes con cáncer de mama. RADIOLOGIA 2004. [DOI: 10.1016/s0033-8338(04)77992-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- Eric Magaña
- Department of Internal Medicine-Pulmonary, Allergy, Critical Care, University of New Mexico School of Medicine, Albuquerque, NM 87131-5271, USA
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Stone HB, McBride WH, Coleman CN. Modifying normal tissue damage postirradiation. Report of a workshop sponsored by the Radiation Research Program, National Cancer Institute, Bethesda, Maryland, September 6-8, 2000. Radiat Res 2002; 157:204-23. [PMID: 11835685 DOI: 10.1667/0033-7587(2002)157[0204:mntdp]2.0.co;2] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Late effects that develop in normal tissues adjacent to the tumor site in the months to years after radiotherapy can reduce the quality of life of cancer survivors. They can be dose-limiting and debilitating or life-threatening. There is now evidence that some late effects may be preventable or partially reversible. A workshop, "Modifying Normal Tissue Damage Postirradiation", was sponsored by the Radiation Research Program of the National Cancer Institute to identify the current status of and research needs and opportunities in this area. Mechanistic, genetic and physiological studies of the development of late effects are needed and will provide a rational basis for development of treatments. Interdisciplinary teams will be needed to carry out this research, including pathologists, physiologists, geneticists, molecular biologists, experts in functional imaging, wound healing, burn injury, molecular biology, and medical oncology, in addition to radiation biologists, physicists and oncologists. The participants emphasized the need for developing and choosing appropriate models, and for radiation dose-response studies to determine whether interventions remain effective at the radiation doses used clinically. Both preclinical and clinical studies require long-term follow-up, and easier-to-use, more objective clinical scoring systems must be developed and standardized. New developments in biomedical imaging should provide useful tools in all these endeavors. The ultimate goals are to improve the quality of life and efficacy of treatment for cancer patients treated with radiotherapy.
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Affiliation(s)
- Helen B Stone
- Radiation Research Program, National Cancer Institute, 6130 Executive Boulevard, 6010, Bethesda, Maryland 20892-7440, USA.
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Abstract
Classical radiation pneumonitis has been described after single dose whole lung irradiation in experimental animals where above a threshold dose of irradiation, there is a sigmoid dose response curve with increasing morbidity and mortality. After clinical fractionated irradiation, however, acute radiation pneumonitis consisting of cough shortness of breath and patchy radiological changes, occurs in <10% of patients, has dyspnoea out of proportion to the volume of lung irradiated and usually resolves completely without long-term effects. There is increasing evidence that this represents a bilateral lymphocytic alveolitis or hypersensitivity pneumonitis and has been termed sporadic pneumonitis. Late radiation toxicity results in pulmonary fibrosis. This is a consequence of repair, which is initiated by tissue injury within the radiation portal. It follows release of chemotactic factors for fibroblasts including transforming growth factor-beta, fibronectin and platelet derived growth factor. Radiation fibrosis is the clinically more significant syndrome for patients. It may result in progressive dyspnoea and mortality in patients. The most predictable change in laboratory lung function tests is a decrease in transfer factor due to damage at the capillary-alveolar level. It also results in decreased lung compliance, which will affect the total lung capacity and the forced vital capacity. The forced expiratory volume in 1 s is less affected, although this seems to depend on the volume of lung irradiated. There is also a decrease in perfusion in the irradiated lung. Radiation fibrosis seems to depend, amongst other factors, on the volume of lung, which is irradiated above a threshold of 20-30 Gy. The morbidity of radiation fibrosis may therefore be minimized by the use of dose volume histogram to minimize the volume of normal lung irradiated in patients at high risk, e.g., patients with who present with poor lung function. The importance of the baseline perfusion in the irradiated areas continues to be studied.
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Affiliation(s)
- Raymond P Abratt
- Department of Radiation Oncology, Groote Schuur Hospital, University of Cape Town, Observatory 7925, Cape Town, South Africa.
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Takahashi H, Imai Y, Fujishima T, Shiratori M, Murakami S, Chiba H, Kon H, Kuroki Y, Abe S. Diagnostic significance of surfactant proteins A and D in sera from patients with radiation pneumonitis. Eur Respir J 2001; 17:481-7. [PMID: 11405529 DOI: 10.1183/09031936.01.17304810] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Radiation pneumonitis (RP) is the most common complication of radiotherapy for thoracic tumours. The aim of this study was to evaluate the significance of pulmonary surfactant proteins (SP)-A and SP-D as new serum markers for RP. Twenty-five patients with lung tumour, who had received radiotherapy, were studied. At the completion of radiotherapy, the presence of RP was judged by chest plain radiography and chest high resolution computed tomography (HRCT). RP findings detected on chest plain radiography were seen in only three of 12 patients in whom RP was detected by HRCT. Nevertheless, both SP-A and SP-D concentrations in sera from the patients with RP were significantly higher than those from the 13 patients without RP (p = 0.0065, p = 0.0011, respectively). As with SP-A, ratios of SP-D at the completion, compared to at the initiation (1 week post/pre ratio), were also significantly higher in patients with RP than in patients without RP. When a post/pre ratio > 1.6 was considered positive, the SP-A and SP-D assays showed an 83% and 85% specificity, respectively. In conclusion, serum assays of surfactant proteins A and D may be of diagnostic value for detection of radiation pneumonitis, even when the radiographic change is faint.
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Affiliation(s)
- H Takahashi
- Third Dept of Internal Medicine, Sapporo Medical University School of Medicine, Japan
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Fujita J, Bandoh S, Ohtsuki Y, Dobashi N, Hiroi M, Takeuchi T, Fukunaga Y, Miyaue H, Onishi S, Ishida T, Takahara J. The role of anti-epithelial cell antibodies in the pathogenesis of bilateral radiation pneumonitis caused by unilateral thoracic irradiation. Respir Med 2000; 94:875-80. [PMID: 11001079 DOI: 10.1053/rmed.2000.0858] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Two cases of bilateral radiation pneumonitis associated with unilateral thoracic irradiation against lung cancer are described. Both patients died of respiratory failure and autopsy was performed. Histologically, bilateral diffuse alveolar damage was demonstrated in both cases, associated with marked organization of hyaline membrane in one case (case 1). In addition, numerous hyperplastic type II pneumocytes which strongly expressed cytokeratins 8, 18 and 19 were observed. In both patients' sera, antibodies against cytokeratin 8, 18 and 19 were demonstrated by a Western immunoblot. The possible association between autoantibodies to cytokeratins and diffuse alveolar damage observed in patients with bilateral radiation pneumonitis are discussed.
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Affiliation(s)
- J Fujita
- First Department of Internal Medicine, Kagawa Medical University, Japan
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Rolla G, Ricardi U, Colagrande P, Nassisi D, Dutto L, Chiavassa G, Bucca C. Changes in airway responsiveness following mantle radiotherapy for Hodgkin's disease. Chest 2000; 117:1590-6. [PMID: 10858388 DOI: 10.1378/chest.117.6.1590] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
UNLABELLED STUDY OBJECTIVES To investigate whether mantle radiotherapy (MRT) for the lung, through its proinflammatory effects, can induce an increase in airway responsiveness. DESIGN Follow-up of the changes in lung function and methacholine responsiveness in patients 1, 6, 12, and 24 months after they underwent MRT. PATIENTS Thirteen nonasthmatic patients with bulky Hodgkin's lymphoma who were scheduled for MRT. MEASUREMENTS AND RESULTS Chest radiographs, lung function tests, methacholine thresholds of the bronchi (the provocative dose of methacholine causing a 10% fall in FEV(1) [PD(10)]) and central airway (the provocative dose of methacholine causing a 25% fall in the maximal mid-inspiratory flow [PD(25)MIF(50)]), and the provocative dose of methacholine causing five or more coughs (PDcough) were serially assessed. One month after patients underwent MRT, there were significant decreases in PD(10) (mean [+/- SEM], 2,583 +/- 414 microg to 1,512 +/- 422 microg, respectively; p < 0.05), PD(25)MIF(50) (mean 2,898 +/- 372 microg to 1,340 +/- 356 microg, respectively; p < 0.05), and PDcough (mean 3,127 +/- 415 microg to 1,751 +/- 447 microg; p < 0.05), which were independent of the decrease in FEV(1) and reversed within 6 months in all patients but three. Six months after undergoing MRT, four patients showed radiation-induced lung injury (RI) on chest radiographs, which subsequently evolved into fibrosis. These patients had greater decreases in vital capacity, FEV(1), MIF(50), and methacholine thresholds than those without RI, and this persisted up to 2 years after they had undergone MRT. One year after the patients underwent MRT, a close relationship was found overall between the change in FEV(1) and those in both PD(10) (r = 0.733; p = 0.004) and PD(25)MIF(50) (r = 0.712; p = 0.006). CONCLUSIONS : MRT triggers an early transient increase in airway responsiveness, which reverses spontaneously. In patients with RI, the persistence of airway dysfunction long after undergoing MRT may depend on airway remodeling from radiation fibrosis.
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Affiliation(s)
- G Rolla
- Department of Biomedical Sciences and Human Oncology, University of Torino, Italy
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Affiliation(s)
- J F Cordier
- Service de Pneumologie, Hôpital Louis Pradel, Université Claude Bernard, 69394 Lyon Cedex, France
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