Neighbor effect: penumbra-dose exposed neighbor cells contribute to the enhanced survival of high-dose targeted cells

Novel treatment planning approaches to enhance the therapeutic ratio: targeting the molecular mechanisms of radiation therapy

Radiation acts not only through cell death but has also angiogenic, immunomodulatory and bystander effects. The realization of its systemic implications has led to extensive research on the combination of radiotherapy with systemic treatments, including immunotherapy and antiangiogenic agents. Parameters such as dose, fractionation and sequencing of treatments are key determinants of the outcome. However, recent high-quality research indicates that these are not the only radiation therapy parameters that influence its systemic effect. To effectively integrate systemic agents with radiation therapy, these new aspects of radiation therapy planning will have to be taken into consideration in future clinical trials. Our aim is to review these new treatment planning parameters that can influence the balance between contradicting effects of radiation therapy so as to enhance the therapeutic ratio.

Radiation-induced rescue effect

Radiation-induced rescue effect (RIRE) refers to the phenomenon in which detrimental effects in targeted irradiated cells are reduced upon receiving feedback signals from partnered non-irradiated bystander cells, or from the medium previously conditioning these partnered non-irradiated bystander cells. For convenience, in the current review we define two types of RIRE: (i) Type 1 RIRE (reduced detrimental effects in targeted cells upon receiving feedback signals from bystander cells) and (ii) Type 2 RIRE (exacerbated detrimental effects in targeted cells upon receiving feedback signals from bystander cells). The two types of RIRE, as well as the associated mechanisms and chemical messengers, have been separately reviewed. The recent report on the potential effects of RIRE on the traditional colony-formation assays has also been reviewed. Finally, future priorities and directions for research into RIRE are discussed.

Rescue Effect Inherited in Colony Formation Assays Affects Radiation Response

It is well known that nonirradiated cells can exhibit radiation damage (bystander effect), and recent findings have shown that nonirradiated cells may help protect irradiated cells (rescue effect). These findings call into question the traditional view of radiation response: cells cannot be envisioned as isolated units. Here, we investigated traditional colony formation assays to determine if they also comprise cellular communication affecting the radiation response, using colony formation assays with varying numbers of cells, modulated beam irradiation and media transfer. Our findings showed that surviving fraction gradually increased with increasing number of irradiated cells. Specifically, for DU-145 human prostate cancer cells, surviving fraction increased 1.9-to-4.1-fold after 5-12 Gy irradiation; and for MM576 human melanoma cells, surviving fraction increased 1.9-fold after 5 Gy irradiation. Furthermore, increased surviving fraction was evident after modulated beam irradiation, where irradiated cells could communicate with nonirradiated cells. Media from dense cell culture also increased surviving fraction. The results suggest that traditional colony formation assays comprise unavoidable cellular communication affecting radiation outcome and the shape of the survival curve. We also propose that the increased in-field surviving fraction after modulated beam irradiation is due to the same effect.