1
|
Tewari AB, Saini A, Sharma D. Extirpating the cancer stem cell hydra: Differentiation therapy and Hyperthermia therapy for targeting the cancer stem cell hierarchy. Clin Exp Med 2023; 23:3125-3145. [PMID: 37093450 DOI: 10.1007/s10238-023-01066-5] [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: 12/09/2022] [Accepted: 04/02/2023] [Indexed: 04/25/2023]
Abstract
Ever since the discovery of cancer stem cells (CSCs), they have progressively attracted more attention as a therapeutic target. Like the mythical hydra, this subpopulation of cells seems to contribute to cancer immortality, spawning more cells each time that some components of the cancer cell hierarchy are destroyed. Traditional modalities focusing on cancer treatment have emphasized apoptosis as a route to eliminate the tumor burden. A major problem is that cancer cells are often in varying degrees of dedifferentiation contributing to what is known as the CSCs hierarchy and cells which are known to be resistant to conventional therapy. Differentiation therapy is an experimental therapeutic modality aimed at the conversion of malignant phenotype to a more benign one. Hyperthermia therapy (HT) is a modality exploiting the changes induced in cells by the application of heat produced to aid in cancer therapy. While differentiation therapy has been successfully employed in the treatment of acute myeloid leukemia, it has not been hugely successful for other cancer types. Mounting evidence suggests that hyperthermia therapy may greatly augment the effects of differentiation therapy while simultaneously overcoming many of the hard-to-treat facets of recurrent tumors. This review summarizes the progress made so far in integrating hyperthermia therapy with existing modules of differentiation therapy. The focus is on studies related to the successful application of both hyperthermia and differentiation therapy when used alone or in conjunction for hard-to-treat cancer cell niche with emphasis on combined approaches to target the CSCs hierarchy.
Collapse
Affiliation(s)
- Amit B Tewari
- Institute of Nano Science and Technology (INST), Knowledge City, Sector 81, Mohali, Punjab, 140306, India
| | - Anamika Saini
- Institute of Nano Science and Technology (INST), Knowledge City, Sector 81, Mohali, Punjab, 140306, India
| | - Deepika Sharma
- Institute of Nano Science and Technology (INST), Knowledge City, Sector 81, Mohali, Punjab, 140306, India.
| |
Collapse
|
2
|
Brummelhuis ISG, Crezee J, Witjes JA. Evaluation of thermal dose effect in radiofrequency-induced hyperthermia with intravesical chemotherapy for nonmuscle invasive bladder cancer. Int J Hyperthermia 2023; 40:2157498. [PMID: 36755433 DOI: 10.1080/02656736.2022.2157498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
PURPOSE In nonmuscle invasive bladder cancer (NMIBC) patients who fail standard intravesical treatment and are unfit or unwilling to undergo a radical cystectomy, radiofrequency (RF)-induced hyperthermia combined with intravesical chemotherapy (RF-CHT) has shown promising results. We studied whether higher thermal dose improves clinical NMIBC outcome. METHODS AND MATERIALS The cohort comprised 108 patients who started with RF-CHT between November 2013 and December 2019. Patients received intravesical mitomycin-C or epirubicin. Bladder hyperthermia was accomplished with an intravesical 915 MHz RF device guided by intravesical thermometry. We assessed the association between thermal dose parameters (including median temperature and Cumulative Equivalent Minutes of T50 at 43 °C [CEM43T50]) and complete response (CR) at six months for patients with (concomitant) carcinoma in situ (CIS), and recurrence-free survival (RFS) for patients with papillary disease. RESULTS Median temperature and CEM43T50 per treatment were 40.9 (IQR 40.8-41.1) °C and 3.1 (IQR 0.9-2.4) minutes, respectively. Analyses showed no association between any thermal dose parameter and CR or RFS (p > 0.05). Less bladder spasms during treatment sessions was associated with increased median temperature and CEM43T50 (adjusted OR 0.01 and 0.34, both p < 0.001). CONCLUSIONS No significant association between thermal dose and NMIBC outcome was found. Possibly thermal dose effect in patients of the current cohort exceeds a certain threshold value. On the other hand, occurrence of bladder spasms had a thermal dose limiting effect. We advise to treat patients with temperatures >40.5 °C for at least 45 min while respecting individual tolerability, including occurrence of bladder spasms.
Collapse
Affiliation(s)
- Iris S G Brummelhuis
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johannes Crezee
- Department of Radiotherapy, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
3
|
Avoiding Pitfalls in Thermal Dose Effect Relationship Studies: A Review and Guide Forward. Cancers (Basel) 2022; 14:cancers14194795. [PMID: 36230717 PMCID: PMC9562191 DOI: 10.3390/cancers14194795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
The challenge to explain the diffuse and unconclusive message reported by hyperthermia studies investigating the thermal dose parameter is still to be unravelled. In the present review, we investigated a wide range of technical and clinical parameters characterising hyperthermia treatment to better understand and improve the probability of detecting a thermal dose effect relationship in clinical studies. We performed a systematic literature review to obtain hyperthermia clinical studies investigating the associations of temperature and thermal dose parameters with treatment outcome or acute toxicity. Different hyperthermia characteristics were retrieved, and their influence on temperature and thermal dose parameters was assessed. In the literature, we found forty-eight articles investigating thermal dose effect relationships. These comprised a total of 4107 patients with different tumour pathologies. The association between thermal dose and treatment outcome was the investigated endpoint in 90% of the articles, while the correlation between thermal dose and toxicity was investigated in 50% of the articles. Significant associations between temperature-related parameters and treatment outcome were reported in 63% of the studies, while those between temperature-related parameters and toxicity were reported in 15% of the studies. One clear difficulty for advancement is that studies often omitted fundamental information regarding the clinical treatment, and among the different characteristics investigated, thermometry details were seldom and divergently reported. To overcome this, we propose a clear definition of the terms and characteristics that should be reported in clinical hyperthermia treatments. A consistent report of data will allow their use to further continue the quest for thermal dose effect relationships.
Collapse
|
4
|
Verdegaal ELJMM, Howarth GS, McWhorter TJ, Delesalle CJG. Is Continuous Monitoring of Skin Surface Temperature a Reliable Proxy to Assess the Thermoregulatory Response in Endurance Horses During Field Exercise? Front Vet Sci 2022; 9:894146. [PMID: 35711810 PMCID: PMC9196037 DOI: 10.3389/fvets.2022.894146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Hyperthermia is a performance and welfare issue for exercising horses. The thermoregulatory stressors associated with exercise have typically been estimated by responses in the laboratory. However, monitoring surface skin temperature (Tsk) coincident with core temperature (Tc) has not previously been investigated in horses exercising in the field. We investigated the suitability of monitoring surface Tsk as a metric of the thermoregulatory response, and simultaneously investigated its relationship with Tc using gastrointestinal (GI) temperature. We evaluated Tsk in 13 endurance horses competing during four endurance rides over 40 km (n = 1) or a total of 80 km (n = 12) distance. Following each 40-km loop, the horses were rested for 60 min. Tsk and Tc were continuously recorded every 15 s by an infrared thermistor sensor located in a modified belt and by telemetric GI pill, respectively, and expressed as mean ± SD. The net area under the curve (AUC) was calculated to estimate the thermoregulatory response to the thermal load of Tsk over time (°C × minutes) using the trapezoidal method. The relationship between Tsk and Tc was assessed using scatterplots, paired t-test or generalized linear model ANOVA (delta Tsk) (n = 8). Ambient temperature ranged from 6.7°C to 18.4°C. No relationship was found between Tsk and Tc profiles during exercise and recovery periods, and no significant difference between delta Tsk results was detected when comparing exercise and rest. However, time to maximum Tsk (67 min) was significantly reduced compared to Tc (139 min) (p = 0.0004) with a significantly lesser maximum Tsk (30.3°C) than Tc (39°C) (p = 0.0002) during exercise. Net AUC Tsk was 1,164 ± 1,448 and −305 ± 388°C × minutes during periods of exercise and recovery, respectively. We conclude that Tsk monitoring does not provide a reliable proxy for the thermoregulatory response and horse welfare, most probably because many factors can modulate Tsk without directly affecting Tc. Those factors, such as weather conditions, applicable to all field studies can influence the results of Tsk in endurance horses. The study also reveals important inter-individual differences in Tsk and Tc time profiles, emphasizing the importance of an individualized model of temperature monitoring.
Collapse
Affiliation(s)
- Elisabeth-Lidwien J. M. M. Verdegaal
- Equine Health and Performance Centre, University of Adelaide, Adelaide, SA, Australia
- Department of Translational Physiology, Infectiology and Public Health, Research Group of Comparative Physiology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
- *Correspondence: Elisabeth-Lidwien J. M. M. Verdegaal
| | - Gordon S. Howarth
- Equine Health and Performance Centre, University of Adelaide, Adelaide, SA, Australia
- Gastroenterology Department, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Todd J. McWhorter
- Equine Health and Performance Centre, University of Adelaide, Adelaide, SA, Australia
| | - Catherine J. G. Delesalle
- Department of Translational Physiology, Infectiology and Public Health, Research Group of Comparative Physiology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| |
Collapse
|
5
|
A Novel Framework for the Optimization of Simultaneous ThermoBrachyTherapy. Cancers (Basel) 2022; 14:cancers14061425. [PMID: 35326574 PMCID: PMC8946271 DOI: 10.3390/cancers14061425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 12/15/2022] Open
Abstract
In high-dose-rate brachytherapy (HDR-BT) for prostate cancer treatment, interstitial hyperthermia (IHT) is applied to sensitize the tumor to the radiation (RT) dose, aiming at a more efficient treatment. Simultaneous application of HDR-BT and IHT is anticipated to provide maximum radiosensitization of the tumor. With this rationale, the ThermoBrachyTherapy applicators have been designed and developed, enabling simultaneous irradiation and heating. In this research, we present a method to optimize the three-dimensional temperature distribution for simultaneous HDR-BT and IHT based on the resulting equivalent physical dose (EQDphys) of the combined treatment. First, the temperature resulting from each electrode is precomputed. Then, for a given set of electrode settings and a precomputed radiation dose, the EQDphys is calculated based on the temperature-dependent linear-quadratic model. Finally, the optimum set of electrode settings is found through an optimization algorithm. The method is applied on implant geometries and anatomical data of 10 previously irradiated patients, using reported thermoradiobiological parameters and physical doses. We found that an equal equivalent dose coverage of the target can be achieved with a physical RT dose reduction of 20% together with a significantly lower EQDphys to the organs at risk (p-value < 0.001), even in the least favorable scenarios. As a result, simultaneous ThermoBrachyTherapy could lead to a relevant therapeutic benefit for patients with prostate cancer.
Collapse
|
6
|
Present Practice of Radiative Deep Hyperthermia in Combination with Radiotherapy in Switzerland. Cancers (Basel) 2022; 14:cancers14051175. [PMID: 35267486 PMCID: PMC8909523 DOI: 10.3390/cancers14051175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Moderate hyperthermia is a potent and evidence-based radiosensitizer. Several indications are reimbursed for the combination of deep hyperthermia with radiotherapy (dHT+RT). We evaluated the current practice of dHT+RT in Switzerland. METHODS All indications presented to the national hyperthermia tumor board for dHT between January 2017 and June 2021 were evaluated and treatment schedules were analyzed using descriptive statistics. RESULTS Of 183 patients presented at the hyperthermia tumor board, 71.6% were accepted and 54.1% (99/183) finally received dHT. The most commonly reimbursed dHT indications were "local recurrence and compression" (20%), rectal (14.7%) and bladder (13.7%) cancer, respectively. For 25.3% of patients, an individual request for insurance cover was necessary. 47.4% of patients were treated with curative intent; 36.8% were in-house patients and 63.2% were referred from other hospitals. CONCLUSIONS Approximately two thirds of patients were referred for dHT+RT from external hospitals, indicating a general demand for dHT in Switzerland. The patterns of care were diverse with respect to treatment indication. To the best of our knowledge, this study shows for the first time the pattern of care in a national cohort treated with dHT+RT. This insight will serve as the basis for a national strategy to evaluate and expand the evidence for dHT.
Collapse
|
7
|
Clinical Evidence for Thermometric Parameters to Guide Hyperthermia Treatment. Cancers (Basel) 2022; 14:cancers14030625. [PMID: 35158893 PMCID: PMC8833668 DOI: 10.3390/cancers14030625] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 01/01/2023] Open
Abstract
Hyperthermia (HT) is a cancer treatment modality which targets malignant tissues by heating to 40-43 °C. In addition to its direct antitumor effects, HT potently sensitizes the tumor to radiotherapy (RT) and chemotherapy (CT), thereby enabling complete eradication of some tumor entities as shown in randomized clinical trials. Despite the proven efficacy of HT in combination with classic cancer treatments, there are limited international standards for the delivery of HT in the clinical setting. Consequently, there is a large variability in reported data on thermometric parameters, including the temperature obtained from multiple reference points, heating duration, thermal dose, time interval, and sequence between HT and other treatment modalities. Evidence from some clinical trials indicates that thermal dose, which correlates with heating time and temperature achieved, could be used as a predictive marker for treatment efficacy in future studies. Similarly, other thermometric parameters when chosen optimally are associated with increased antitumor efficacy. This review summarizes the existing clinical evidence for the prognostic and predictive role of the most important thermometric parameters to guide the combined treatment of RT and CT with HT. In conclusion, we call for the standardization of thermometric parameters and stress the importance for their validation in future prospective clinical studies.
Collapse
|
8
|
Verdegaal ELJMM, Howarth GS, McWhorter TJ, Boshuizen B, Franklin SH, Vidal Moreno de Vega C, Jonas SE, Folwell LE, Delesalle CJG. Continuous Monitoring of the Thermoregulatory Response in Endurance Horses and Trotter Horses During Field Exercise: Baselining for Future Hot Weather Studies. Front Physiol 2021; 12:708737. [PMID: 34512382 PMCID: PMC8427666 DOI: 10.3389/fphys.2021.708737] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/29/2021] [Indexed: 11/15/2022] Open
Abstract
Establishing proper policies regarding the recognition and prevention of equine heat stress becomes increasingly important, especially in the face of global warming. To assist this, a detailed view of the variability of equine thermoregulation during field exercise and recovery is essential. 13 endurance horses and 12 trotter horses were equipped with continuous monitoring devices [gastrointestinal (GI) pill, heartrate (HR) monitor, and global positioning system] and monitored under cool weather conditions during four endurance rides over a total of 80 km (40 km loops) and intense trotter track-based exercise over 1,540 m. Recordings included GI temperature (T c ), speed, HR and pre- and post-exercise blood values. A temperature time profile curve of T c was constructed, and a net area under the curve was calculated using the trapezoidal method. Metabolic heat production and oxygen cost of transport were also calculated in endurance horses. Maximum T c was compared using an independent samples t-test. Endurance horses (mean speed 14.1 ± 1.7 km h-1) reached mean maximum T c (39.0 ± 0.4°C; 2 × 40 km in 8 horses) during exercise at 75% of completion of T c exercise and T c returned to baseline within 60 min into recovery. However, the mean T c was still 38.8 ± 0.4°C at a HR of 60 bpm which currently governs "fit to continue" competition decisions. Trotters (40.0 ± 2.9 km h-1) reached a comparable mean max T c (38.8 ± 0.5°C; 12 horses) always during recovery. In 30% of trotters, T c was still >39°C at the end of recovery (40 ± 32 min). The study shows that horses are individuals and thermoregulation monitoring should reflect this, no matter what type of exercise is performed. Caution is advised when using HR cut-off values to monitor thermal welfare in horses since we have demonstrated how T c can peak quite some time after finishing exercise. These findings have implications for training and management of performance horses to safeguard equine welfare and to maximize performance.
Collapse
Affiliation(s)
- Elisabeth-Lidwien J. M. M. Verdegaal
- Equine Health and Performance Centre, University of Adelaide, Adelaide, SA, Australia
- School of Animal and Veterinary Sciences, Roseworthy Campus, University of Adelaide, Adelaide, SA, Australia
- Research Group of Comparative Physiology, Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Gordon S. Howarth
- School of Animal and Veterinary Sciences, Roseworthy Campus, University of Adelaide, Adelaide, SA, Australia
| | - Todd J. McWhorter
- School of Animal and Veterinary Sciences, Roseworthy Campus, University of Adelaide, Adelaide, SA, Australia
| | - Berit Boshuizen
- Research Group of Comparative Physiology, Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Samantha H. Franklin
- Equine Health and Performance Centre, University of Adelaide, Adelaide, SA, Australia
- School of Animal and Veterinary Sciences, Roseworthy Campus, University of Adelaide, Adelaide, SA, Australia
| | - Carmen Vidal Moreno de Vega
- Research Group of Comparative Physiology, Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Stacey E. Jonas
- School of Animal and Veterinary Sciences, Roseworthy Campus, University of Adelaide, Adelaide, SA, Australia
| | - Louise E. Folwell
- School of Animal and Veterinary Sciences, Roseworthy Campus, University of Adelaide, Adelaide, SA, Australia
| | - Catherine J. G. Delesalle
- Research Group of Comparative Physiology, Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| |
Collapse
|