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Sahai A, Dixit R, Choudhary R, Marfatia H, Mohapatra P. Clinical Conundrum: Unveiling a Unique Presentation of Hypopharyngeal Carcinoma. Cureus 2024; 16:e57727. [PMID: 38711727 PMCID: PMC11073763 DOI: 10.7759/cureus.57727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/08/2024] Open
Abstract
Dysphagia is a common symptom encountered in clinical practice, typically associated with a wide range of etiologies, including structural abnormalities, inflammatory conditions, neoplasms, and neurological disorders. However, the combination of subcutaneous emphysema, vocal cord palsy, enlarged arytenoids, and pooling of saliva in a dysphagic patient represents a rare and intriguing presentation. A 33-year-old female presented at a tertiary care hospital in Western India with hoarseness of voice, difficulty in swallowing, productive cough, and neck pain for two months with an abrupt increase in the severity of all symptoms in two days. A history of chewable tobacco use for six years was disclosed. Clinical evaluation revealed a thin build with platynychia and conjunctival pallor, dental staining, drooling of saliva, the presence of extensive subcutaneous emphysema on palpation of the neck, and absent laryngeal crepitus. Endoscopic evaluation was suggestive of right vocal cord palsy and enlarged, congested arytenoid cartilages, post-cricoid growth with pooling of saliva in bilateral pyriform fossae. A CT scan of the neck showed a 2x3 cm neoplastic growth in the hypopharynx, with subcutaneous emphysema and free air foci in the head and neck region, prompting an immediate tracheostomy and biopsy of the hypopharyngeal growth with Ryle's tube insertion. Squamous cell carcinoma was confirmed on the biopsy report. Due to its rarity, the possible underlying cause of idiopathic subcutaneous emphysema should be sought whenever encountered in clinical practice since these patients are potentially misdiagnosed. A high index of suspicion among clinicians, along with a consideration of the constellation of other symptoms and clinical features of a possible underlying hypopharyngeal cancer whenever encountering such patients is of key importance for prompting further investigations and treatment.
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Affiliation(s)
- Anoushka Sahai
- Otolaryngology - Head and Neck Surgery, Seth GS Medical College and KEM Hospital, Mumbai, IND
| | - Ritika Dixit
- Otolaryngology - Head and Neck Surgery, Seth GS Medical College and KEM Hospital, Mumbai, IND
| | - Rekha Choudhary
- Otolaryngology - Head and Neck Surgery, Seth GS Medical College and KEM Hospital, Mumbai, IND
| | - Hetal Marfatia
- Otolaryngology - Head and Neck Surgery, Seth GS Medical College and KEM Hospital, Mumbai, IND
| | - Prateek Mohapatra
- Otolaryngology - Head and Neck Surgery, Seth GS Medical College and KEM Hospital, Mumbai, IND
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Guan Z, Liu J, Zheng L. Effect of radiotherapy on head and neck cancer tissues in patients receiving radiotherapy: a bioinformatics analysis-based study. Sci Rep 2024; 14:6304. [PMID: 38491080 PMCID: PMC10943217 DOI: 10.1038/s41598-024-56753-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
Radiotherapy is pivotal in treating head and neck cancers including nasopharyngeal, tongue, hypopharyngeal, larynx, maxillary sinus, parotid gland, and oral cancers. It holds the potential for curative effects and finds application in conjunction with chemotherapy, either as a radical method to preserve organ function or as an adjuvant postoperative treatment. We used bioinformatics analysis to investigate the effects of radiotherapy on head and neck cancer tissues in patients who had received radiotherapy. In this study, the expression and mutation profiles of The Cancer Genome Atlas-Head-Neck Squamous Cell Carcinoma were downloaded from the UCSC-Xena database, categorizing patients into two groups-those receiving radiotherapy and those not receiving radiotherapy. Subsequently, differential expression analysis and gene set enrichment analysis (GSEA) were performed. Following this, single-sample GSEA (ssGSEA) scores related to glucose and lipid metabolism were compared between the two groups. Additionally, immune cell infiltration analysis and single-cell verification were performed. Finally, the mutation profiles of the two groups were compared. The analyses revealed that patients receiving radiotherapy exhibited prolonged survival, enhanced apoptosis in head and neck cancer tissue, and diminished keratinocyte proliferation and migration. A comparison of ssGSEA scores related to glucose and lipid metabolism between the two groups indicated a reduction in glycolysis, tricarboxylic acid cycle activity, and fat synthesis in tissues treated with radiotherapy, suggesting that radiotherapy can effectively inhibit tumour cell energy metabolism. Analyses of immune cell infiltration and single-cell verification suggested decreased infiltration of immune cells post-radiotherapy in head and neck cancer tissues. A comparison of mutation profiles revealed a higher frequency of TP53, TTN, and CDKN2A mutations in patients receiving radiotherapy for head and neck cancer. In conclusion, the bioinformatics analyses delved into the effect of radiotherapy on patients with head and neck carcinoma. This study provides a theoretical framework elucidating the molecular mechanisms underlying radiotherapy's efficacy in treating head and neck cancer and presents scientific recommendations for drug therapy following radiotherapy.
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Affiliation(s)
- Zhenjie Guan
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jie Liu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshedong Road, Zhengzhou, 450052, Henan, China
| | - Lian Zheng
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshedong Road, Zhengzhou, 450052, Henan, China.
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Lee N, Schoder H, Beattie B, Lanning R, Riaz N, McBride S, Katabi N, Li D, Yarusi B, Chan S, Mitrani L, Zhang Z, Pfister DG, Sherman E, Baxi S, Boyle J, Morris LGT, Ganly I, Wong R, Humm J. Strategy of Using Intratreatment Hypoxia Imaging to Selectively and Safely Guide Radiation Dose De-escalation Concurrent With Chemotherapy for Locoregionally Advanced Human Papillomavirus-Related Oropharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2016; 96:9-17. [PMID: 27511842 PMCID: PMC5035649 DOI: 10.1016/j.ijrobp.2016.04.027] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/29/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To report a small substudy of an ongoing large, multi-arm study using functional imaging to assess pre-/intratreatment hypoxia for all head and neck cancer, in which we hypothesized that pre- and early-treatment hypoxia assessment using functional positron emission tomography (PET) imaging may help select which human papillomavirus (HPV)-positive (HPV(+)) oropharyngeal cancer (OPC) patients can safely receive radiation de-escalation without jeopardizing treatment outcomes. METHODS AND MATERIALS Patients with HPV(+) oropharyngeal carcinoma were enrolled on an institutional review board-approved prospective study of which de-escalation based on imaging response was done for node(s) only. Pretreatment (18)F-fluorodeoxyglucose and dynamic (18)F-FMISO (fluoromisonidazole) positron emission tomography (PET) scans were performed. For patients with pretreatment hypoxia on(18)F-FMISO PET (defined as a >1.2 tumor to muscle standard uptake value ratio), a repeat scan was done 1 week after chemoradiation. Patients without pretreatment hypoxia or with resolution of hypoxia on repeat scan received a 10-Gy dose reduction to metastatic lymph node(s). The 2-year local, regional, distant metastasis-free, and overall survival rates were estimated using the Kaplan-Meier product-limit method. A subset of patients had biopsy of a hypoxic node done under image guidance. RESULTS Thirty-three HPV(+) OPC patients were enrolled in this pilot study. One hundred percent showed pretreatment hypoxia (at primary site and/or node[s]), and among these, 48% resolved (at primary site and/or node[s]); 30% met criteria and received 10-Gy reduction to the lymph node(s). At the median follow-up of 32 months (range, 21-61 months), the 2-year locoregional control rate was 100%. One patient failed distantly with persistence of hypoxia on (18)F-FMISO PET. The 2-year distant metastasis-free rate was 97%. The 2-year OS rate was 100%. Hypoxia on imaging was confirmed pathologically. CONCLUSIONS Hypoxia is present in HPV(+) tumors but resolves within 1 week of treatment in 48% of cases either at the primary site and/or lymph node(s). Our 100% locoregional control rate suggests that intratreatment functional imaging used to selectively de-escalate node(s) to 60 Gy was confirmed safe using our stringent imaging criteria. Intratreatment functional imaging warrants further study to determine its ultimate role in de-escalation treatment strategies.
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Affiliation(s)
- Nancy Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
| | - Heiko Schoder
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Brad Beattie
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ryan Lanning
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Nora Katabi
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Duan Li
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Brett Yarusi
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Susie Chan
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Lindsey Mitrani
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - David G Pfister
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Eric Sherman
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Shrujal Baxi
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jay Boyle
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Luc G T Morris
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Richard Wong
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - John Humm
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
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Theurer JA, Yoo J, Nichols AC. Human papillomavirus-related oropharyngeal squamous cell carcinoma: a new context for dysphagia rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0058-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bossi P, Locati LD, Licitra L. Biological agents in head and neck cancer. Expert Rev Anticancer Ther 2014; 7:1643-50. [DOI: 10.1586/14737140.7.11.1643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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van der Molen L, van Rossum MA, Rasch CRN, Smeele LE, Hilgers FJM. Two-year results of a prospective preventive swallowing rehabilitation trial in patients treated with chemoradiation for advanced head and neck cancer. Eur Arch Otorhinolaryngol 2013; 271:1257-70. [PMID: 23892729 DOI: 10.1007/s00405-013-2640-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/12/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands,
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Pre- and Posttreatment Voice and Speech Outcomes in Patients With Advanced Head and Neck Cancer Treated With Chemoradiotherapy: Expert Listeners’ and Patient’s Perception. J Voice 2012; 26:664.e25-33. [DOI: 10.1016/j.jvoice.2011.08.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 08/30/2011] [Indexed: 11/19/2022]
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Mazeron R, Tao Y, Lusinchi A, Bourhis J. Current concepts of management in radiotherapy for head and neck squamous-cell cancer. Oral Oncol 2009; 45:402-8. [PMID: 19375379 DOI: 10.1016/j.oraloncology.2009.01.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Radiotherapy plays a key role in the management of early stage and locally advanced head and neck squamous-cell carcinomas (HNSCC) either alone or, more frequently combined with surgery and/or chemotherapy. Several approaches have been developed to improve its efficacy while maintaining acceptable toxicities, such as altered fractionated radiotherapy or concomitant chemoradiotherapy which have both improved the anti-tumor efficacy of radiotherapy. Of particular interest is concomitant chemoradiotherapy (CT-RT) which is the most commonly used approach in locally advanced disease. Taxanes and platinum-based induction chemotherapy could constitute an option in the treatment of locally advanced HNSCC and it's contribution before concomitant RT-CT is currently under investigation. More recently, epidermal growth factor receptor (EGFr) molecular targeting with cetuximab combined with radiotherapy has been successfully tested in a large randomized trial and this combination constitutes a new option, especially for patients with medical co-morbidities. Finally management of treatment related acute or late toxicity remains an important issue and in the last decade major achievements have been obtained in this field especially using intensity modulated radiotherapy (IMRT).
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Affiliation(s)
- Renaud Mazeron
- Department of Radiotherapy, Institute Gustave-Roussy, 39 Rue Camille-Desmoulins, Villejuif 94805, France
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Vidal L, Gillison ML. Human papillomavirus in HNSCC: recognition of a distinct disease type. Hematol Oncol Clin North Am 2009; 22:1125-42, vii. [PMID: 19010263 DOI: 10.1016/j.hoc.2008.08.006] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Strong epidemiologic and molecular data now support the conclusion that human papillomavirus (HPV) infection is responsible for a distinct form of head and neck squamous cell carcinoma (HNSCC), independent from the traditional risk factors of tobacco and alcohol use. Patients with HPV-positive HNSCC have a different clinical presentation and better clinical outcomes than those with HPV-negative HNSCC. A diagnosis of HPV-positive HNSCC is associated not only with therapeutic relevance, but also has important implications for future prevention and screening strategies.
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Affiliation(s)
- Laura Vidal
- Department of Medical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
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Loeffler-Ragg J, Schwentner I, Sprinzl GM, Zwierzina H. EGFR inhibition as a therapy for head and neck squamous cell carcinoma. Expert Opin Investig Drugs 2008; 17:1517-31. [PMID: 18808311 DOI: 10.1517/13543784.17.10.1517] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Improved understanding of disease biology of head and neck squamous cell carcinoma (HNSCC) with nearly universal expression of EGFR has led to the introduction of targeted therapies to interrupt signalling of this negative prognostic marker. OBJECTIVE We performed a literature review on the mechanisms and efficacy of anti-EGFR antibodies and EGFR tyrosine kinase inhibitors in patients with locally advanced or recurrent/metastatic HNSCC. RESULTS/CONCLUSION Clinical trials in HNSCC have administered EGFR directed drugs as single agents, in combination with chemotherapy or radiotherapy and demonstrated a good safety profile with antitumour activity in a subgroup of patients. The biology of responsiveness is still unclear, although there is growing evidence of an association of skin toxicity or presence of shorter EGFR intron 1 cytosine-adenine repeats with positive outcome.
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Affiliation(s)
- Judith Loeffler-Ragg
- Innsbruck Medical University, Department of Internal Medicine, Anichstrasse 35, 6020 Innsbruck, Austria
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Santos ES, Perez C, Donald CE, Raez LE. Targeting important pathways in head and neck cancer: from the bench to the clinic. Expert Rev Anticancer Ther 2008; 8:1819-35. [PMID: 18983242 DOI: 10.1586/14737140.8.11.1819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Radiation therapy as single or combined modality (concurrent chemoradiotherapy) has been the cornerstone of treatment for squamous cell carcinoma of the head and neck for a long time. Fortunately, advances in tumor biology have provided new insights of tumor proliferation, metastases, migration and cell cycle regulation. The success seen with the use of cetuximab alone or in combination with conventional treatments has led the roadmap to discover other potential target mechanisms which may translate into better response rate with less local and systemic toxicity and improved overall survival. In this review, we discuss other cellular pathways that have shown to be involved in the carcinogenesis of squamous cell carcinoma of the head and neck and the actual efforts to target these mechanisms.
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Affiliation(s)
- Edgardo S Santos
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA.
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Garden AS, Harris J, Trotti A, Jones CU, Carrascosa L, Cheng JD, Spencer SS, Forastiere A, Weber RS, Ang KK. Long-term results of concomitant boost radiation plus concurrent cisplatin for advanced head and neck carcinomas: a phase II trial of the radiation therapy oncology group (RTOG 99-14). Int J Radiat Oncol Biol Phys 2008; 71:1351-5. [PMID: 18640496 DOI: 10.1016/j.ijrobp.2008.04.006] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 03/23/2008] [Accepted: 04/07/2008] [Indexed: 11/29/2022]
Abstract
PURPOSE The feasibility of combining concomitant boost-accelerated radiation regimen (AFX-C) with cisplatin was previously demonstrated in this Phase II trial. This article reports the long-term toxicity, relapse patterns, and survival in patients with advanced head and neck carcinoma. METHODS AND MATERIALS Between April and November 2000, 84 patients with Stage III-IV HNC were enrolled, and 76 patients were analyzable. Radiation consisted of 72 Gy over 6 weeks. Cisplatin dose was 100 mg/m(2) on Days 1 and 22. Tumor and clinical status were assessed, and acute-late toxicities were graded. RESULTS The median follow-up for surviving patients is 4.3 years. The 2- and 4-year locoregional failure rates were 33% and 36%, respectively, and the 2- and 4-year survival rates were 70% and 54%, respectively. The worst overall late Grade 3 or 4 toxicity rate was 42%. The prevalence rates of a gastrostomy at any time during follow-up, at 12 months, and at 48 months were 83%, 41%, and 17%, respectively. Five of 36 patients (14%) alive and without disease at last follow-up were gastrostomy-tube dependent. CONCLUSION These data of long-term follow-up of patients treated with AFX-C with cisplatin show encouraging results with regard to locoregional disease control and survival, with few recurrences after 2 years. The late toxicity rates are relatively high. However, although prolonged dysphagia was noted in our preliminary report, its prevalence does decreased over time. A Phase III trial comparing AFX-C plus cisplatin against standard radiation plus cisplatin has completed accrual.
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Affiliation(s)
- Adam S Garden
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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Harrington K, Jankowska P, Hingorani M. Molecular Biology for the Radiation Oncologist: the 5Rs of Radiobiology meet the Hallmarks of Cancer. Clin Oncol (R Coll Radiol) 2007; 19:561-71. [PMID: 17591437 DOI: 10.1016/j.clon.2007.04.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Accepted: 04/20/2007] [Indexed: 12/25/2022]
Abstract
Recent advances in our understanding of the biology of cancer have provided enormous opportunities for the development of novel therapies against specific molecular targets. It is likely that most of these targeted therapies will have only modest single agent activities but may have the potential to accentuate the therapeutic effects of ionising radiation. In this introductory review, the 5Rs of classical radiobiology are interpreted in terms of their relationship to the hallmarks of cancer. Future articles will focus on the specific hallmarks of cancer and will highlight the opportunities that exist for designing new combination treatment regimens.
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Affiliation(s)
- K Harrington
- The Institute of Cancer Research, Targeted Therapy Laboratory, Cancer Research UK, Centre for Cell and Molecular Biology, London, UK.
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