Expression of vascular endothelial growth factor and its correlation with clinical symptoms and endoscopic findings in patients with chronic radiation proctitis

Evaluating the Predictive Value of the Dose-volume Parameters and Vascular Endothelial Growth Factor Expression on Rectal Toxicity in Prostate Cancer Patients

Background

The response to radiation varies widely among people. Despite recent advances to conform the dose distribution to the tumor volume, it is still impossible to perform radiotherapy based on the biological characteristics of each individual. In this case, identifying a biomarker can be a step toward personalizing treatment. This research was carried out to evaluate the predictive value of dose-volume parameters and vascular endothelial growth factor (VEGF) expression on rectal proctitis toxicity in prostate cancer patients.

Materials and Methods

Eighteen patients with prostate cancer who underwent helical tomotherapy were included in the study. VEGF serum level before and after treatment was obtained. Furthermore, dosimetric parameters, including rectal volume, maximum dose, V50, V60, V65, V70, and V75 were extracted. Spearman's correlation coefficient of VEGF-related and dosimetric parameters with the grade ≥1 rectal proctitis was calculated.

Results

In the rectal toxicity group, the mean value of VEGF increased significantly after treatment compared to before (P = 0.008). Despite lower values of pre- and post-treatment VEGF in the toxicity group, this difference was not statistically significant (P > 0.05). Among the dosimetric parameters, only V65 had a significantly higher value in the toxicity group (P = 0.033). The highest correlation coefficients were obtained for pretreatment VEGF values and V65 (-0.446 and 0.450).

Conclusion

The results of the study confirm the correlation of VEGF expression with the pathobiology process of rectal radiation proctitis. However, the pathobiology process of radiation proctitis is complicated. More research is needed to prove the involvement of VEGF expression in the early detection of proctitis.

Novel mechanisms underlying inhibition of inflammation-induced angiogenesis by dexamethasone and gentamicin via PI3K/AKT/NF-κB/VEGF pathways in acute radiation proctitis

Acute radiation proctitis (ARP) is one of the most common complications of pelvic radiotherapy attributed to radiation exposure. The mechanisms of ARP are related to inflammation, angiogenesis, and so on. In this study we evaluated the effect of dexamethasone (DXM) combined with gentamicin (GM) enema on ARP mice, and explored its possible mechanisms by transcriptome sequencing, western blot and immunohistochemistry. C57BL/6 mice were randomly divided into 3 groups: healthy control group, ARP model group, and DXM + GM enema treatment group. ARP mice were established by using a single 6 MV X-ray dose of 27 Gy pelvic local irradiation. Transcriptome sequencing results showed that 979 genes were co-upregulated and 445 genes were co-downregulated in ARP mice compared to healthy mice. According to gene ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis, we firstly found that PI3K/AKT/NF-κB/VEGF pathways were mostly correlated with the inflammation-induced angiogenesis in ARP mice. PI3K/AKT pathway leads to the activation of NF-κB, which promotes the transcription of VEGF and Bcl-2. Interestingly, symptoms and pathological changes of ARP mice were ameliorated by DXM + GM enema treatment. DXM + GM enema inhibited inflammation by downregulating NF-κB and upregulating AQP3, as well as inhibited angiogenesis by downregulating VEGF and AQP1 in ARP mice. Moreover, DXM + GM enema induced apoptosis by increasing Bax and suppressing Bcl-2. The novel mechanisms may be related to the downregulation of PI3K/AKT/NF-κB/VEGF pathways.

A Ten-year-long Update on Radiation Proctitis Among Prostate Cancer Patients Treated With Curative External Beam Radiotherapy

This comprehensive synopsis summarizes the most relevant information obtained from a systematic analysis of studies of the last decade on radiation proctitis, one of the most feared radioinduced side effects among prostate cancer patients treated with curative external beam radiotherapy. The present review provides a useful support to radiation oncologists for limiting the onset or improving the treatment of radiation proctitis. This work shows that the past decade was a harbinger of significant new evidence in technological advances and technical tricks to avoid radiation proctitis, in addition to dosimetric perspectives and goals, understanding of pathogenesis, diagnostic work-up and treatment. We believe that a well-rounded knowledge of such an issue is fundamental for its appropriate management.