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Yamada T, Kawamura M, Oie Y, Kozai Y, Okumura M, Nagai N, Yanagi Y, Nimura K, Ishihara S, Naganawa S. The current state and future perspectives of radiotherapy for cervical cancer. J Obstet Gynaecol Res 2024. [PMID: 38885951 DOI: 10.1111/jog.15998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/25/2024] [Indexed: 06/20/2024]
Abstract
Radiotherapy is an effective treatment method for cervical cancer and is typically administered as external beam radiotherapy followed by intracavitary brachytherapy. In Japan, center shielding is used in external beam radiotherapy to shorten treatment time and reduce the doses delivered to the rectum or bladder. However, it has several challenges, such as uncertainties in calculating the cumulative dose. Recently, external beam radiotherapy has been increasingly performed with intensity-modulated radiotherapy, which reduces doses to the rectum or bladder without center shielding. In highly conformal radiotherapy, uncertainties in treatment delivery, such as inter-fractional anatomical structure movements, affect treatment outcomes; therefore, image-guided radiotherapy is essential for appropriate and safe performance. Regarding intracavitary brachytherapy, the use of magnetic resonance imaging-based image-guided adaptive brachytherapy is becoming increasingly widespread because it allows dose escalation to the tumor and accurately evaluates the dose delivered to the surrounding normal organs. According to current evidence, a minimal dose of D90% of the high-risk clinical target volume is significantly relevant to local control. Further improvements in target coverage have been achieved with combined interstitial and intracavity brachytherapy for massive tumors with extensive parametrical involvement. Introducing artificial intelligence will enable faster and more accurate generation of brachytherapy plans. Charged-particle therapies have biological and dosimetric advantages, and current evidence has proven their effectiveness and safety in cervical cancer treatment. Recently, radiotherapy-related technologies have advanced dramatically. This review provides an overview of technological innovations and future perspectives in radiotherapy for cervical cancer.
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Affiliation(s)
- Takehiro Yamada
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mariko Kawamura
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yumi Oie
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuka Kozai
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masayuki Okumura
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoya Nagai
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Yanagi
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Radiology, Toyota Memorial Hospital, Toyota, Japan
| | - Kenta Nimura
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Radiology, Tosei General Hospital, Seto, Japan
| | - Shunichi Ishihara
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Hasegawa T, Someya M, Tsuchiya T, Kitagawa M, Fukushima Y, Gocho T, Mafune S, Okuda R, Kaguchi J, Ohguro A, Kamiyama R, Ashina A, Toshima Y, Hirohashi Y, Torigoe T, Sakata KI. Identification and Quantification of Radiotherapy-related Protein Expression in Cancer Tissues Using the Qupath Software and Prediction of Treatment Response. In Vivo 2024; 38:1470-1476. [PMID: 38688633 PMCID: PMC11059912 DOI: 10.21873/invivo.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND/AIM Automated measurement of immunostained samples can enable more convenient and objective prediction of treatment outcome from radiotherapy. We aimed to validate the performance of the QuPath image analysis software in immune cell markers detection by comparing QuPath cell counting results with those of physician manual cell counting. PATIENTS AND METHODS CD8- and FoxP3-stained cervical, CD8-stained oropharyngeal, and Ku70-stained prostate cancer tumor sections were analyzed in 104 cervical, 92 oropharyngeal, and 58 prostate cancer patients undergoing radiotherapy at our Institution. RESULTS QuPath and manual counts were highly correlated. When divided into two groups using ROC curves, the agreement between QuPath and manual counts was 89.4% for CD8 and 88.5% for FoxP3 in cervical cancer, 87.0% for CD8 in oropharyngeal cancer and 80.7% for Ku70 in prostate cancer. In cervical cancer, the high CD8 group based on QuPath counts had a better prognosis and the low CD8 group had a significantly worse prognosis [p=0.0003; 5-year overall survival (OS), 65.9% vs. 34.7%]. QuPath counts were more predictive than manual counts. Similar results were observed for FoxP3 in cervical cancer (p=0.002; 5-year OS, 62.1% vs. 33.6%) and CD8 in oropharyngeal cancer (p=0.013; 5-year OS, 80.2% vs. 47.2%). In prostate cancer, high Ku70 group had worse and low group significantly better outcome [p=0.007; 10-year progression-free survival (PFS), 56.0% vs. 93.8%]. CONCLUSION QuPath showed a strong correlation with manual counting, confirming its utility and accuracy and potential applicability in clinical practice.
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Affiliation(s)
- Tomokazu Hasegawa
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan;
| | - Masanori Someya
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takaaki Tsuchiya
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Mio Kitagawa
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuki Fukushima
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshio Gocho
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shoh Mafune
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ryuu Okuda
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Juno Kaguchi
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsuya Ohguro
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ryo Kamiyama
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ayato Ashina
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuka Toshima
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshihiko Hirohashi
- Department of Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Torigoe
- Department of Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Koh-Ichi Sakata
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Someya M, Hasegawa T, Nakamura AJ, Tsuchiya T, Kitagawa M, Gocho T, Mafune S, Ikeuchi Y, Tauchi H, Sakata KI. Prediction of late adverse events in pelvic cancer patients receiving definitive radiotherapy using radiation-induced gamma-H2AX foci assay. JOURNAL OF RADIATION RESEARCH 2023; 64:948-953. [PMID: 37839163 PMCID: PMC10665300 DOI: 10.1093/jrr/rrad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/21/2023] [Indexed: 10/17/2023]
Abstract
Radiation can induce DNA double-stranded breaks, which are typically detected by the fluorescence of phosphorylated histone H2AX. In this study, we examined the usefulness of the dynamics of radiation-induced gamma-H2AX foci of peripheral blood lymphocytes (PBLs), as a marker of DNA repair ability, in predicting late adverse events from radiotherapy. A total of 46 patients with cervical, vaginal and anal canal cancers treated with radical radiotherapy between 2014 and 2019 were included in this analysis. Concurrent chemotherapy was administered in 36 cases (78.3%). Peripheral blood was obtained before treatment, and then irradiated ex vivo with 1 Gy X-ray. The ratio of radiation-induced gamma-H2AX foci in PBLs measured at 30 min and at 4 h was defined as the foci decay ratio (FDR). With a median follow-up of 54 months, 9 patients (19.6%) were observed to have late genitourinary or gastrointestinal (GU/GI) toxicity. The FDR ranged from 0.51 to 0.74 (median 0.59), with a significantly higher incidence of Grade 1 or higher late adverse events in the FDR ≥ 0.59 group. In multivariate analysis, FDR ≥ 0.59 and hypertension also emerged as significant factors associated with the development of late toxicities. Overall, our results suggest that measurement of radiation-induced gamma-H2AX foci in PBLs may predict the risk of late GU/GI toxicities from chemoradiotherapy, which can enable tailoring the radiation dose to minimize adverse effects.
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Affiliation(s)
- Masanori Someya
- Department of Radiology, School of Medicine, Sapporo Medical University, S1W16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Tomokazu Hasegawa
- Department of Radiology, School of Medicine, Sapporo Medical University, S1W16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Asako J Nakamura
- Department of Biological Sciences, College of Sciences, Ibaraki University, Bunkyo 2-1-1, Mito, Ibaraki 310-8512, Japan
| | - Takaaki Tsuchiya
- Department of Radiology, School of Medicine, Sapporo Medical University, S1W16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Mio Kitagawa
- Department of Radiology, School of Medicine, Sapporo Medical University, S1W16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Toshio Gocho
- Department of Radiology, School of Medicine, Sapporo Medical University, S1W16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Sho Mafune
- Department of Radiology, School of Medicine, Sapporo Medical University, S1W16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Yutaro Ikeuchi
- Department of Radiology, School of Medicine, Sapporo Medical University, S1W16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Hiroshi Tauchi
- Department of Biological Sciences, Faculty of Sciences, Ibaraki University, Bunkyo 2-1-1, Mito, Ibaraki 310-8512, Japan
| | - Koh-ichi Sakata
- Department of Radiology, School of Medicine, Sapporo Medical University, S1W16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
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Someya M, Hasegawa T, Tsuchiya T, Kitagawa M, Fukushima Y, Gocho T, Mafune S, Ikeuchi Y, Kozuka Y, Idogawa M, Hirohashi Y, Torigoe T, Iwasaki M, Matsuura M, Saito T, Sakata KI. Predictive value of an exosomal microRNA-based signature for tumor immunity in cervical cancer patients treated with chemoradiotherapy. Med Mol Morphol 2023; 56:38-45. [PMID: 36367588 DOI: 10.1007/s00795-022-00338-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022]
Abstract
Resistance of cervical cancer to radiotherapy with concurrent chemotherapy (CCRT) results in a poor prognosis. To identify new biomarkers for predicting the treatment response and prognosis, we explored exosomal microRNA (miRNA) expression signatures associated with the outcome of cervical cancer patients treated with CCRT. Exosomes were isolated from the plasma of 45 patients prior to CCRT during 2014-2020, and miRNA analysis was performed by next-generation sequencing. At a median follow-up of 38 months, 26 patients were recurrence free, 15 patients had died of the disease, and 4 patients received salvage chemotherapy due to distant metastasis. Of the 2522 miRNAs detected, 9 (miR-148a-5p, 1915-3p, 3960, 183-5p, 196b-5p, 200c-3p, 182-5p, 374a-5p, and 431-5p) showed differential expression between the recurrence-free and recurrence groups. Patients were divided into high- and low-risk groups according to the cutoff of the miRNAs-based risk score calculated from respective expression levels. The high-risk group had significantly worse disease-specific survival than the low-risk group (p < 0.001). In addition, miR-374a-5p and miR-431-5p expression showed a weak inverse correlation with tumor-infiltrating CD8+ and FOXP3+ T cells, suggesting a potential inhibitory effect on CCRT by suppressing tumor immunity. This miRNA signature could improve non-invasive monitoring and personalized treatment for cervical cancer.
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Affiliation(s)
- Masanori Someya
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan.
| | - Tomokazu Hasegawa
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Takaaki Tsuchiya
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Mio Kitagawa
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Yuki Fukushima
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Toshio Gocho
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Shoh Mafune
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Yutaro Ikeuchi
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Yoh Kozuka
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Masashi Idogawa
- Department of Medical Genome Sciences, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshihiko Hirohashi
- Department of Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Torigoe
- Department of Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masahiro Iwasaki
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Motoki Matsuura
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Koh-Ichi Sakata
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
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Comparative Analysis of 60Co and 192Ir Sources in High Dose Rate Brachytherapy for Cervical Cancer. Cancers (Basel) 2022; 14:cancers14194749. [PMID: 36230672 PMCID: PMC9563337 DOI: 10.3390/cancers14194749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/24/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
High-dose-rate (HDR) brachytherapy (BT) is an essential treatment for cervical cancer, one of the most prevalent gynecological malignant tumors. In HDR BT, high radiation doses can be delivered to the tumor target with the minimum radiation doses to organs at risk. Despite the wide use of the small HDR 192Ir source, as the technique has improved, the HDR 60Co source, which has the same miniaturized geometry, has also been produced and put into clinical practice. Compared with 192Ir (74 days), 60Co has a longer half-life (5.3 years), which gives it a great economic advantage for developing nations. The aim of the study was to compare 60Co and 192Ir sources for HDR BT in terms of both dosimetry and clinical treatment. The results of reports published on the use of HDR BT for cervical cancer over the past few years as well as our own research show that this treatment is safe and it is feasible to use 60Co as an alternative source.
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Machine Learning of Dose-Volume Histogram Parameters Predicting Overall Survival in Patients with Cervical Cancer Treated with Definitive Radiotherapy. JOURNAL OF ONCOLOGY 2022; 2022:2643376. [PMID: 35747125 PMCID: PMC9213181 DOI: 10.1155/2022/2643376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/14/2022] [Accepted: 05/12/2022] [Indexed: 12/24/2022]
Abstract
Purpose To analyze the effects of dosimetric parameters and clinical characteristics on overall survival (OS) by machine learning algorithms. Methods and Materials 128 patients with cervical cancer were treated with definitive pelvic radiotherapy with or without chemotherapy followed by image-guided brachytherapy. The elastic-net models with integrating DVH parameters and baseline clinical factors, only DVH parameters and only baseline clinical factors were constructed in 5-folds cross-validations for 100 iteration bootstrapping, and then were compared using concordance index (C-index) criteria. Finally, the selected important factors were used to build multivariable Cox-pH models for OS and also shown in nomograms for clinical usage. Results The median OS occurred was 25.78 months with 25 (19.53%) deaths. The elastic-net models integrating clinical and DVH factors had the best prediction performances (C-index 0.76 in the train set and C-index 0.74 in the test set). Three important factors were selected, including baseline hemoglobin level as the protective factor, primary tumor volume (GTV_P) volume, and body V5 as the risk factors. The final multivariable Cox-pH models were constructed using these important factors and had prediction performance (C-index: 0.78, 95%CI: 0.73–0.81). Conclusions This is the first attempt to establish elastic-net models to study the contributions of DVH parameters for predicting OS in patients with cervical cancer. These results can facilitate individualized tailoring of radiation treatment in cervical cancer patients.
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Someya M, Tsuchiya T, Fukushima Y, Hasegawa T, Hori M, Kitagawa M, Gocho T, Mafune S, Ikeuchi Y, Hirohashi Y, Torigoe T, Iwasaki M, Matsuura M, Saito T, Matsumoto Y, Sakata KI. Prediction of treatment response from the microenvironment of tumor immunity in cervical cancer patients treated with chemoradiotherapy. Med Mol Morphol 2021; 54:245-252. [PMID: 33963949 DOI: 10.1007/s00795-021-00290-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/29/2021] [Indexed: 12/12/2022]
Abstract
To supplement clinical decision-making in the management of cervical cancer, various prognostic factors, including tumor immune microenvironments, were examined in patients with cervical cancer treated with definitive chemoradiotherapy. We retrospectively analyzed the expression of CD8, FoxP3, HLA-1, PD-L1, and XRCC4 in 100 cases of cervical cancer. The observed tumor immune microenvironments were also classified into three types: inflamed, excluded, and cold type. Less FoxP3+ T cells and cold-type tumor were found to be poor prognostic factors in addition to non-SCC, large pre-treatment tumor volume, and three or less cycles of concurrent chemotherapy based on multivariate analysis. Cold-type tumors had significantly worse prognoses than the other two types, whereas inflamed- and excluded-type tumors showed similar 5-year disease-specific survival (P < 0.001; 0% vs. 60.3% vs. 72.3%). Radiotherapy could overcome the inhibitory immune microenvironment that occurs in excluded type. Individualized combination therapy adapted to pre-treatment tumor immunity may be necessary to improve radiotherapy outcomes in cervical cancer.
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Affiliation(s)
- Masanori Someya
- Department of Radiology, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Takaaki Tsuchiya
- Department of Radiology, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Yuki Fukushima
- Department of Radiology, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Tomokazu Hasegawa
- Department of Radiology, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Masakazu Hori
- Department of Radiology, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Mio Kitagawa
- Department of Radiology, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Toshio Gocho
- Department of Radiology, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Shoh Mafune
- Department of Radiology, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Yutaro Ikeuchi
- Department of Radiology, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Yoshihiko Hirohashi
- Department of Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Torigoe
- Department of Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masahiro Iwasaki
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Motoki Matsuura
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshihisa Matsumoto
- Institute of Innovative Research Laboratory for Advanced Nuclear Energy, Tokyo Institute of Technology, N1-30 2-12-1 Ookayama, Meguro-ku, Tokyo, 152-8550, Japan
| | - Koh-Ichi Sakata
- Department of Radiology, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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Someya M, Tsuchiya T, Fukushima Y, Hasegawa T, Takada Y, Hori M, Miura K, Kitagawa M, Gocho T, Hirohashi Y, Torigoe T, Iwasaki M, Matsuura M, Saito T, Sakata KI. Association between cancer immunity and treatment results in uterine cervical cancer patients treated with radiotherapy. Jpn J Clin Oncol 2020; 50:1290-1297. [PMID: 33089868 DOI: 10.1093/jjco/hyaa149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/27/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To evaluate proteins related to tumor immune response and treatment outcome from radiotherapy for uterine cervical cancer patients. METHODS We performed a retrospective immunohistochemical staining of 81 patients with uterine cervical cancer who underwent definitive radiotherapy. We examined the expression of programmed death ligand 1, human leukocyte antigen class I, tumor-infiltrating CD8+, and forkhead box P3+ (FoxP3+) T cells in tumor tissues. RESULTS In biopsy specimen, patients with a higher number of CD8+ T cells and FoxP3+ T cells had a better disease-specific survival than patients with a lower number of CD8+ T cells and FoxP3+ cells (P = 0.018 and P = 0.009). Multivariate analysis showed that equivalent dose in 2 Gy fractions (EQD2) of the minimum dose to 90% of the high-risk clinical target volume, FoxP3+ T cells and expression of human leukocyte antigen class I were significant prognostic factors. When the EQD2 is 70 Gy or more, a higher local control rate is obtained regardless of the number of CD8- or FoxP3-positive cells. When EQD2 is <70 Gy, the number of CD8-positive cells has a significant impact on treatment outcome: the recurrence rate (local recurrence rate + distant metastasis rate) was 46.2% in the group with a CD8 value of 230 or higher, whereas the recurrence rate was 75.7% in the group with a CD8 value of less than 230. CONCLUSION The combination of CD8 or FoxP3 with EQD2 can be potentially useful to predict the treatment results of radiotherapy for cervical cancer, leading to individualized optimal selection of treatment for cervical cancer.
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Affiliation(s)
- Masanori Someya
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takaaki Tsuchiya
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuki Fukushima
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomokazu Hasegawa
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yu Takada
- Department of Radiation Oncology, Sapporo City General Hospital, Sapporo, Japan
| | - Masakazu Hori
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Katsutoshi Miura
- Department of Radiation Oncology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Mio Kitagawa
- Department of Radiation Oncology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Toshio Gocho
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshihiko Hirohashi
- Department of Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Torigoe
- Department of Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masahiro Iwasaki
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Motoki Matsuura
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Koh-Ichi Sakata
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Kusada T, Toita T, Ariga T, Kudaka W, Maemoto H, Makino W, Ishikawa K, Heianna J, Nagai Y, Aoki Y, Murayama S. Definitive radiotherapy consisting of whole pelvic radiotherapy with no central shielding and CT-based intracavitary brachytherapy for cervical cancer: feasibility, toxicity, and oncologic outcomes in Japanese patients. Int J Clin Oncol 2020; 25:1977-1984. [PMID: 32852648 PMCID: PMC7572338 DOI: 10.1007/s10147-020-01736-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/23/2020] [Indexed: 10/31/2022]
Abstract
BACKGROUND This prospective study investigated the feasibility, toxicity, and oncologic outcomes of definitive radiotherapy (RT) consisting of whole pelvic radiotherapy with no central shielding (noCS-WPRT) and CT-based intracavitary brachytherapy (ICBT) in Japanese patients with cervical cancer. METHODS Patients with cervical cancer of FIGO stages IB1-IVA were eligible. The treatment protocol consisted of noCS-WPRT of 45 Gy in 25 fractions and CT-based high dose-rate ICBT of 15 or 20 Gy in 3 or 4 fractions prescribed at point A. The prescribed ICBT dose was decreased if the manual dwell time/position optimization failed to meet organs-at-risk constraints. Graphical optimization and additional interstitial needles were not applied. RESULTS We enrolled 40 patients. FIGO stages were IB1: 11, IB2: 13, IIA2: 1, IIB: 11, IIIB: 3, and IVA: 1. Median (range) pretreatment tumor diameter was 47 (14-81) mm. Point A doses were decreased in 19 of 153 ICBT sessions (12%). The median follow-up duration was 33 months. The 2-year rates of pelvic control, local control (LC), and progression-free survival were 83%, 85%, and 75%, respectively. Pre-ICBT tumor diameter, high-risk clinical target volume (HR-CTV), total HR-CTV D90, and overall treatment time (OTT) significantly affected LC. Late adverse events (grade ≥ 3) were observed in 3 patients (2 in the bladder, 1 in the rectum). CONCLUSIONS Definitive RT consisting of noCS-WPRT and CT-based ICBT was feasible for Japanese patients with cervical cancer. To further improve LC, additional interstitial needles for patients with a large HR-CTV and shorter OTT should be considered.
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Affiliation(s)
- Takeaki Kusada
- grid.267625.20000 0001 0685 5104Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
| | - Takafumi Toita
- Radiation Therapy Center, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, 904-2293, Japan.
| | - Takuro Ariga
- grid.267625.20000 0001 0685 5104Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
| | - Wataru Kudaka
- grid.267625.20000 0001 0685 5104Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
| | - Hitoshi Maemoto
- grid.267625.20000 0001 0685 5104Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
| | - Wataru Makino
- grid.267625.20000 0001 0685 5104Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
| | - Kazuki Ishikawa
- grid.267625.20000 0001 0685 5104Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
| | - Joichi Heianna
- grid.267625.20000 0001 0685 5104Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
| | - Yutaka Nagai
- Department of Obstetrics and Gynecology, Nanbu Medical Center/Nanbu Child Medical Center, 118-1 Arakawa, Shimajiri, Okinawa 901-1193 Japan
| | - Yoichi Aoki
- grid.267625.20000 0001 0685 5104Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
| | - Sadayuki Murayama
- grid.267625.20000 0001 0685 5104Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
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