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Azria D, Michalet M, Riou O, Bourgier C, Brengues M, Sroussi Y, Gourgou S, Farcy-Jacquet MP, Kotzki L, Ozsahin M. Radiation-induced lymphocyte apoptosis assay: Primetime for routine clinical use? Cancer Radiother 2024:S1278-3218(24)00125-2. [PMID: 39304399 DOI: 10.1016/j.canrad.2024.06.002] [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: 05/14/2024] [Accepted: 06/11/2024] [Indexed: 09/22/2024]
Abstract
The impact of curative radiotherapy mainly depends on the total dose delivered to the tumor. However, despite recent technological advances, the dose delivered to surrounding healthy tissues may reduce the therapeutic ratio of many radiation treatments. In the same population treated at one center with the same technique, individual radiosensitivity clearly exists, particularly in terms of late side effects that are, in principle, non-reversible. This article details the history of the radiation-induced lymphocyte apoptosis assay, from preclinical data to multicenter clinical trials. It puts the performance of such assays into perspective to define the optimal clinical situations for its use in daily practice.
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Affiliation(s)
- David Azria
- Inserm U1194, Institut de recherche en cancérologie de Montpellier (IRCM), université de Montpellier, avenue des Apothicaires, 34298 Montpellier, France; Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier, France; Fédération universitaire d'oncologie radiothérapie, Institut de cancérologie du Gard, CHU de Nîmes, rue Henri-Pujol, 30000 Nîmes, France.
| | - Morgan Michalet
- Inserm U1194, Institut de recherche en cancérologie de Montpellier (IRCM), université de Montpellier, avenue des Apothicaires, 34298 Montpellier, France; Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier, France
| | - Olivier Riou
- Inserm U1194, Institut de recherche en cancérologie de Montpellier (IRCM), université de Montpellier, avenue des Apothicaires, 34298 Montpellier, France; Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier, France
| | - Céline Bourgier
- Inserm U1194, Institut de recherche en cancérologie de Montpellier (IRCM), université de Montpellier, avenue des Apothicaires, 34298 Montpellier, France; Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier, France
| | - Muriel Brengues
- Inserm U1194, Institut de recherche en cancérologie de Montpellier (IRCM), université de Montpellier, avenue des Apothicaires, 34298 Montpellier, France
| | - Yohann Sroussi
- Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier, France
| | - Sophie Gourgou
- Unité de biométrie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier, France
| | - Marie-Pierre Farcy-Jacquet
- Fédération universitaire d'oncologie radiothérapie, Institut de cancérologie du Gard, CHU de Nîmes, rue Henri-Pujol, 30000 Nîmes, France
| | - Léa Kotzki
- Fédération universitaire d'oncologie radiothérapie, Institut de cancérologie du Gard, CHU de Nîmes, rue Henri-Pujol, 30000 Nîmes, France
| | - Mahmut Ozsahin
- Department of Radiation Oncology, hôpital Riviera-Chablais, Rennaz, Switzerland
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Pham TN, Coupey J, Thariat J, Valable S. Lymphocyte radiosensitivity: An extension to the linear-quadratic model? Radiother Oncol 2024; 198:110406. [PMID: 38925262 DOI: 10.1016/j.radonc.2024.110406] [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: 03/06/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND AND PURPOSE The linear-quadratic (LQ) model has been pivotal for evaluating the effects of radiation on cells, but it is primarily characterized by linear responses, which has exhibited limitations when applied to lymphocyte data. The present research aims to address these limitations and to explore an alternative model extended from the conventional LQ model. MATERIALS AND METHODS Literature providing lymphocyte counts from assays investigating apoptosis and survival after in vitro irradiation was selected. To address the nonlinearity in lymphocyte responses to radiation, we developed a saturation model characterized by a negative exponential relationship between radiation dose and cellular response. We compared the performance of this saturation model against that of conventional models, including the LQ model and its variants (linear model LM and linear-quadratic-cubic model LQC), as well as the repair-misrepair (RMR) model. The models were evaluated based on prediction-residual plots, residual standard errors, and the Akaike information criterion (AIC). We applied the saturation model to two additional datasets: (1) a dataset from the existing literature that assessed stimulated and unstimulated human lymphocytes exposed to gamma irradiation in vitro and (2) a novel dataset involving T lymphocytes from rodent spleens after exposure to various radiation types (X-rays and protons). RESULTS The literature (n = 15 out of 2342) showed that lymphocyte apoptosis varies with dose, time and experimental conditions. The saturation model had a lower AIC of 718 compared to the LM, LQ, LQC and RMR models (AIC of 728, 720, 720 and 734, respectively). The saturation model had a lower residual error and more consistent error distribution. Integrating time as a covariate, the saturation model also had a better AIC for demonstrating time-dependent variations in lymphocyte responses after irradiation. For datasets involving unstimulated lymphocytes before irradiation, the saturation model provided a more accurate fit than did the LM, LQ, and RMR models. In these cases, the fit of the saturation model was comparable to that of the LQC model but offered an advantage when extrapolating to higher doses, where the LQC model might underestimate survival. For stimulated lymphocytes, which are radioresistant, all the models approximated the LM. Both the LQ and saturation models indicated greater radiosensitivity to protons in vitro. CONCLUSION The new "saturation model" performed better than the LQ model in quantifying lymphocyte apoptosis and survival, estimating time dependency and assessing the role of radiation modalities or lymphocyte stimulation. Further experiments are warranted to experimentally explore the validity of the saturation model as a promising alternative in the clinical setting.
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Affiliation(s)
- Thao-Nguyen Pham
- Université de Caen Normandie, CNRS, Normandie Université, ISTCT UMR6030, GIP CYCERON, F-14000 Caen, France; Laboratoire de Physique Corpusculaire, UMR6534 IN2P3/ENSICAEN, France - Normandie Université, France
| | - Julie Coupey
- Université de Caen Normandie, CNRS, Normandie Université, ISTCT UMR6030, GIP CYCERON, F-14000 Caen, France
| | - Juliette Thariat
- Laboratoire de Physique Corpusculaire, UMR6534 IN2P3/ENSICAEN, France - Normandie Université, France; Department of Radiation Oncology, Centre François Baclesse, Caen, Normandy, France.
| | - Samuel Valable
- Université de Caen Normandie, CNRS, Normandie Université, ISTCT UMR6030, GIP CYCERON, F-14000 Caen, France.
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Kubo Y, Yamamoto H, Matsubara K, Hashimoto K, Tanaka S, Shien K, Suzawa K, Miyoshi K, Okazaki M, Sugimoto S, Katsui K, Hiraki T, Kiura K, Toyooka S. Impact of the neutrophil-to-lymphocyte ratio on patients with locally advanced non-small cell lung cancer who suffer radiation pneumonitis during the course of induction chemoradiotherapy followed by surgery. Surg Today 2024; 54:995-1004. [PMID: 38451313 DOI: 10.1007/s00595-024-02816-y] [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: 10/22/2023] [Accepted: 01/04/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE Radiation pneumonitis (RP) is an obstacle for patients after surgery following induction chemoradiotherapy for locally advanced non-small cell lung cancer (LA-NSCLC). We performed a comparative analysis of the association between clinicopathological factors, including the neutrophil-to-lymphocyte ratio (NLR) and prognosis, in LA-NSCLC patients with or without RP during induction chemoradiotherapy followed by surgery. METHODS The subjects of this analysis were 168 patients undergoing trimodality therapy for LA-NSCLC between January, 1999 and May, 2019. Patients were divided into two groups: the RP group (n = 41) and the non-RP group (n = 127). We compared the clinicopathological factors including the NLR between the groups and analyzed the association between the NLR and prognosis. RESULTS The RP group had more patients with tumors located in the lower lobe, more bilobar resections, shorter operative times, no implementation of postoperative adjuvant chemotherapy, and a higher postoperative NLR than the non-RP group. There were no significant differences in serious postoperative complications and the prognosis. Patients with a low postoperative NLR had a significantly better prognosis in the non-RP group, and a trend toward a better prognosis even in the RP group. CONCLUSION Postoperative NLR may be a useful prognostic factor, even for patients who suffer RP after trimodality therapy for LA-NSCLC.
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Affiliation(s)
- Yujiro Kubo
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromasa Yamamoto
- Department of Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
- Center for Clinical Genetics and Genomic Medicine, Shimane University Hospital, 89-1 Enya-Cho, Izumo, Shimane, 693-8501, Japan.
| | - Kei Matsubara
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Kohei Hashimoto
- Department of Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shin Tanaka
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Kazuhiko Shien
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Ken Suzawa
- Department of Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kentaroh Miyoshi
- Department of Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Mikio Okazaki
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | - Kuniaki Katsui
- Division of Radiation Oncology, Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Takao Hiraki
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Katsuyuki Kiura
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Touraine C, Winter A, Castan F, Azria D, Gourgou S. Time-Dependent ROC Curve Analysis for Assessing the Capability of Radiation-Induced CD8 T-Lymphocyte Apoptosis to Predict Late Toxicities after Adjuvant Radiotherapy of Breast Cancer Patients. Cancers (Basel) 2023; 15:4676. [PMID: 37835370 PMCID: PMC10571898 DOI: 10.3390/cancers15194676] [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: 08/10/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Late fibrosis can occur in breast cancer patients treated with curative-intent radiotherapy. Predicting this toxicity is of clinical interest in order to adapt the irradiation dose delivered. Radiation-induced CD8 T-lymphocyte apoptosis (RILA) had been proven to be associated with less grade ≥2 late radiation-induced toxicities in patients with miscellaneous cancers. Tobacco smoking status and adjuvant hormonotherapy were also identified as potential factors related to late-breast-fibrosis-free survival. This article evaluates the predictive performance of the RILA using a ROC curve analysis that takes into account the dynamic nature of fibrosis occurrence. This time-dependent ROC curve approach is also applied to evaluate the ability of the RILA combined with the other previously identified factors. Our analysis includes a Monte Carlo cross-validation procedure and the calculation of an expected cost of misclassification, which provides more importance to patients who have no risk of late fibrosis in order to be able to treat them with the maximal irradiation dose. Performance evaluation was assessed at 12, 24, 36 and 50 months. At 36 months, our results were comparable to those obtained in a previous study, thus underlying the predictive power of the RILA. Based on specificity and cost, RILA alone seemed to be the most performant, while its association with the other factors had better negative predictive value results.
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Affiliation(s)
- Célia Touraine
- Biometrics Unit, Cancer Institute of Montpellier (ICM), University Montpellier, 34090 Montpellier, France; (C.T.); (F.C.); (S.G.)
- French National Platform Quality of Life and Cancer, 34090 Montpellier, France
- Desbrest Institute of Epidemiology and Public Health (IDESP), University Montpellier, INSERM, 34090 Montpellier, France
| | - Audrey Winter
- Biometrics Unit, Cancer Institute of Montpellier (ICM), University Montpellier, 34090 Montpellier, France; (C.T.); (F.C.); (S.G.)
- French National Platform Quality of Life and Cancer, 34090 Montpellier, France
| | - Florence Castan
- Biometrics Unit, Cancer Institute of Montpellier (ICM), University Montpellier, 34090 Montpellier, France; (C.T.); (F.C.); (S.G.)
| | - David Azria
- Radiotherapy Unit, Cancer Institute of Montpellier (ICM), University Montpellier, 34090 Montpellier, France;
| | - Sophie Gourgou
- Biometrics Unit, Cancer Institute of Montpellier (ICM), University Montpellier, 34090 Montpellier, France; (C.T.); (F.C.); (S.G.)
- French National Platform Quality of Life and Cancer, 34090 Montpellier, France
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Kerns SL, Hall WA, Marples B, West CML. Normal Tissue Toxicity Prediction: Clinical Translation on the Horizon. Semin Radiat Oncol 2023; 33:307-316. [PMID: 37331785 DOI: 10.1016/j.semradonc.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Improvements in radiotherapy delivery have enabled higher therapeutic doses and improved efficacy, contributing to the growing number of long-term cancer survivors. These survivors are at risk of developing late toxicity from radiotherapy, and the inability to predict who is most susceptible results in substantial impact on quality of life and limits further curative dose escalation. A predictive assay or algorithm for normal tissue radiosensitivity would allow more personalized treatment planning, reducing the burden of late toxicity, and improving the therapeutic index. Progress over the last 10 years has shown that the etiology of late clinical radiotoxicity is multifactorial and informs development of predictive models that combine information on treatment (eg, dose, adjuvant treatment), demographic and health behaviors (eg, smoking, age), co-morbidities (eg, diabetes, collagen vascular disease), and biology (eg, genetics, ex vivo functional assays). AI has emerged as a useful tool and is facilitating extraction of signal from large datasets and development of high-level multivariable models. Some models are progressing to evaluation in clinical trials, and we anticipate adoption of these into the clinical workflow in the coming years. Information on predicted risk of toxicity could prompt modification of radiotherapy delivery (eg, use of protons, altered dose and/or fractionation, reduced volume) or, in rare instances of very high predicted risk, avoidance of radiotherapy. Risk information can also be used to assist treatment decision-making for cancers where efficacy of radiotherapy is equivalent to other treatments (eg, low-risk prostate cancer) and can be used to guide follow-up screening in instances where radiotherapy is still the best choice to maximize tumor control probability. Here, we review promising predictive assays for clinical radiotoxicity and highlight studies that are progressing to develop an evidence base for clinical utility.
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Affiliation(s)
- Sarah L Kerns
- Department of Radiation Oncology, the Medical College of Wisconsin, Milwaukee, WI.
| | - William A Hall
- Department of Radiation Oncology, the Medical College of Wisconsin, Milwaukee, WI
| | - Brian Marples
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
| | - Catharine M L West
- Division of Cancer Sciences, the University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, Manchester, UK
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Shi C, Zhang Q, Yao Y, Zeng F, Du C, Nijiati S, Wen X, Zhang X, Yang H, Chen H, Guo Z, Zhang X, Gao J, Guo W, Chen X, Zhou Z. Targeting the activity of T cells by membrane surface redox regulation for cancer theranostics. NATURE NANOTECHNOLOGY 2023; 18:86-97. [PMID: 36536041 DOI: 10.1038/s41565-022-01261-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/12/2022] [Indexed: 06/17/2023]
Abstract
T cells play a determining role in the immunomodulation and prognostic evaluation of cancer treatments relying on immune activation. While specific biomarkers determine the population and distribution of T cells in tumours, the in situ activity of T cells is less studied. Here we designed T-cell-targeting fusogenic liposomes to regulate and quantify the activity of T cells by exploiting their surface redox status as a chemical target. The T-cell-targeting fusogenic liposomes equipped with 2,2,6,6-tetramethylpiperidine (TEMP) groups neutralize reactive oxygen species protecting T cells from oxidation-induced loss of activity. Meanwhile, the production of paramagnetic 2,2,6,6-tetramethylpiperidine 1-oxyl (TEMPO) radicals allows magnetic resonance imaging quantification of the T cell activity. In multiple mouse models, the T-cell-targeting fusogenic liposomes led to efficient tumour inhibition and to early prediction of radiotherapy outcomes. This study uses a chemical targeting strategy to measure the in situ activity of T cells for cancer theranostics and may provide further understanding on engineering T cells for cancer treatment.
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Affiliation(s)
- Changrong Shi
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Qianyu Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Yuying Yao
- Department of Minimally Invasive Interventional Radiology, State Key Laboratory of Respiratory Disease, School of Biomedical Engineering & the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fantian Zeng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Chao Du
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Sureya Nijiati
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Xuejun Wen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Xinyi Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Hongzhang Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Haoting Chen
- Department of Minimally Invasive Interventional Radiology, State Key Laboratory of Respiratory Disease, School of Biomedical Engineering & the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhide Guo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Xianzhong Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Jinhao Gao
- State Key Laboratory of Physical Chemistry of Solid Surfaces & The Key Laboratory for Chemical Biology of Fujian Province, Department of Chemical Biology, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, China
| | - Weisheng Guo
- Department of Minimally Invasive Interventional Radiology, State Key Laboratory of Respiratory Disease, School of Biomedical Engineering & the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
| | - Xiaoyuan Chen
- Departments of Diagnostic Radiology, Chemical and Biomolecular Engineering, and Biomedical Engineering, Yong Loo Lin School of Medicine and College of Design and Engineering, National University of Singapore, Singapore, Singapore.
- Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Nanomedicine Translational Research Program, NUS Center for Nanomedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Institute of Molecular and Cell Biology, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore.
| | - Zijian Zhou
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, China.
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The Normal, the Radiosensitive, and the Ataxic in the Era of Precision Radiotherapy: A Narrative Review. Cancers (Basel) 2022; 14:cancers14246252. [PMID: 36551737 PMCID: PMC9776433 DOI: 10.3390/cancers14246252] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: radiotherapy is a cornerstone of cancer treatment. When delivering a tumoricidal dose, the risk of severe late toxicities is usually kept below 5% using dose-volume constraints. However, individual radiation sensitivity (iRS) is responsible (with other technical factors) for unexpected toxicities after exposure to a dose that induces no toxicity in the general population. Diagnosing iRS before radiotherapy could avoid unnecessary toxicities in patients with a grossly normal phenotype. Thus, we reviewed iRS diagnostic data and their impact on decision-making processes and the RT workflow; (2) Methods: following a description of radiation toxicities, we conducted a critical review of the current state of the knowledge on individual determinants of cellular/tissue radiation; (3) Results: tremendous advances in technology now allow minimally-invasive genomic, epigenetic and functional testing and a better understanding of iRS. Ongoing large translational studies implement various tests and enriched NTCP models designed to improve the prediction of toxicities. iRS testing could better support informed radiotherapy decisions for individuals with a normal phenotype who experience unusual toxicities. Ethics of medical decisions with an accurate prediction of personalized radiotherapy's risk/benefits and its health economics impact are at stake; (4) Conclusions: iRS testing represents a critical unmet need to design personalized radiotherapy protocols relying on extended NTCP models integrating iRS.
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Mališić E, Petrović N, Brengues M, Azria D, Matić IZ, Srbljak Ćuk I, Kopčalić K, Stanojković T, Nikitović M. Association of polymorphisms in TGFB1, XRCC1, XRCC3 genes and CD8 T-lymphocyte apoptosis with adverse effect of radiotherapy for prostate cancer. Sci Rep 2022; 12:21306. [PMID: 36494413 PMCID: PMC9734114 DOI: 10.1038/s41598-022-25328-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
The genetic background of each person might affect the severity of radiotherapy (RT)-induced normal tissue toxicity. The aim of study was to evaluate the influence of TGFB1 C-509T and Leu10Pro, XRCC1 Arg280His and XRCC3 Thr241Met polymorphisms as well as the level of radiation-induced CD8 T-lymphocyte apoptosis (RILA) on adverse effects of RT for prostate cancer (PCa). The study included 88 patients with localized or locally advanced PCa who were treated with RT. The polymorphisms were determined by PCR-RFLP analysis on DNA from peripheral blood mononuclear cells. RILA values were measured by flow cytometry. We found that CT genotype of TGFB1 C-509T could be protective biomarker for acute genitourinary (GU) and gastrointestinal (GI) radiotoxicity, while Thr variant of XRCC3 Thr241Met could predict the risk for acute GU radiotoxicity. Correlation between RILA values and toxicity was not detected. Univariate logistic regression analysis showed that Gleason score and risk group were risk factors for late GU, while for late GI radiotoxicity it was diabetes mellitus type 2. However, in multivariate model those were not proven to be significant and independent risk factors. Identification of assays combination predicting individual radiosensitivity is a crucial step towards personalized RT approach.
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Affiliation(s)
- Emina Mališić
- grid.418584.40000 0004 0367 1010Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11 000 Belgrade, Serbia
| | - Nina Petrović
- grid.418584.40000 0004 0367 1010Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11 000 Belgrade, Serbia ,grid.7149.b0000 0001 2166 9385“VINČA“ Institute of Nuclear Sciences-National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Muriel Brengues
- grid.121334.60000 0001 2097 0141IRCM, INSERM, University Montpellier, ICM, Montpellier, France
| | - David Azria
- grid.121334.60000 0001 2097 0141IRCM, INSERM, University Montpellier, ICM, Montpellier, France
| | - Ivana Z. Matić
- grid.418584.40000 0004 0367 1010Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11 000 Belgrade, Serbia
| | - Ivana Srbljak Ćuk
- grid.418584.40000 0004 0367 1010Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11 000 Belgrade, Serbia
| | - Katarina Kopčalić
- grid.418584.40000 0004 0367 1010Department of Radiation Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Tatjana Stanojković
- grid.418584.40000 0004 0367 1010Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11 000 Belgrade, Serbia
| | - Marina Nikitović
- grid.418584.40000 0004 0367 1010Department of Radiation Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia ,grid.7149.b0000 0001 2166 9385Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Xu Z, Yang L, Yu H, Guo L. A machine learning model for grade 4 lymphopenia prediction during pelvic radiotherapy in patients with cervical cancer. Front Oncol 2022; 12:905222. [PMID: 36185193 PMCID: PMC9524190 DOI: 10.3389/fonc.2022.905222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background/purpose Severe lymphopenia during pelvic radiotherapy (RT) predicts poor survival in patients with cervical cancer. However, the risk of severe lymphopenia has not been well predicted. We developed a machine learning model using clinical and dosimetric information to predict grade 4 (G4) lymphopenia during pelvic RT in patients with cervical cancer. Methods This retrospective study included cervical cancer patients treated with definitive pelvic RT ± induction/concurrent chemotherapy. Clinical information and a set of dosimetric parameters of external beam radiotherapy plan were collected. G4 lymphopenia during RT, which was also referred to as G4 absolute lymphocyte count (ALC) nadir, was defined as ALC nadir <0.2 × 109 cells/L during RT according to Common Terminology Criteria for Adverse Events (CTCAE) v4.03. Elastic-net logistic regression models were constructed for the prediction of G4 lymphopenia during pelvic RT using a repeated cross-validation methodology. Results A total of 130 patients were eligible, and 43 (33.1%) patients had G4 lymphopenia during RT. On multivariable analysis, G4 ALC nadir was associated with poor overall survival (OS) [hazard ratio (HR), 3.91; 95% confidence interval (CI), 1.34–11.38, p = 0.01]. Seven significant factors [Eastern Cooperative Oncology Group (ECOG) performance score, pre-RT hemoglobin, pre-RT lymphocytes, concurrent chemotherapy, gross tumor volume of regional lymphadenopathy (GTV_N volume), body volume, and maximum dose of planning target volume receiving at least 55 Gy (PTV_5500 Dmax)] were obtained by elastic-net logistic regression models and were included in the final prediction model for G4 ALC nadir. The model’s predicting ability in test set was area under the curve (AUC) = 0.77 and accuracy = 0.76. A nomogram of the final predicting model was constructed. Conclusions This study developed and validated a comprehensive model integrating clinical and dosimetric parameters by machine learning method, which performed well in predicting G4 lymphopenia during pelvic RT for cervical cancer and will facilitate physicians to identify patients at high risk of G4 lymphopenia who might benefit from modified treatment approaches.
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Affiliation(s)
- Zhiyuan Xu
- Clinical Oncology Center, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
- Shenzhen Key Laboratory of Translational Research on Recurrent/Metastatic Cancer, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Li Yang
- Clinical Oncology Center, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
- Shenzhen Key Laboratory of Translational Research on Recurrent/Metastatic Cancer, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Hao Yu
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- *Correspondence: Linlang Guo, ; Hao Yu,
| | - Linlang Guo
- Department of Pathology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Linlang Guo, ; Hao Yu,
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10
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Zhang XZ, Tao SP, Liang SX, Chen SB, Liu FS, Jiang W, Chen MJ. Nomogram based on circulating lymphocyte subsets for predicting radiation pneumonia in esophageal squamous cell carcinoma. Front Immunol 2022; 13:938795. [PMID: 36105795 PMCID: PMC9465326 DOI: 10.3389/fimmu.2022.938795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Currently, the relationship between radiation pneumonia (RP) and circulating immune cell in patients with esophageal squamous cell carcinoma (ESCC) remains unclear. This study aimed to explore the relationship between RP and circulating lymphocyte subsets in patients with ESCC receiving chemoradiotherapy (CRT), and develop a nomogram model to predict RP. Since we should implement clinical intervention to ≥ grade 2 RP, a nomogram model for ≥ grade 2 RP was also established to provide an early warning. Patients and methods This study retrospectively included 121 patients with ESCC receiving CRT from Guangxi Medical University Cancer Hospital from 2013 to 2021. Independent factors associated with occurrence of RP and ≥ grade 2 RP were identified by univariate and multivariate logistic regression analysis in the training cohort, and incorporated into nomograms. The predictive accuracy and discrimination of the model was assessed using Concordance Index (C-index), calibration curve and decision curve analysis (DCA). And each model was internally validated. Additionally, to verify the optimized predictive performance of the nomograms, the area under the ROC curve (AUC) of each nomogram was compared to that of single independent risk factors, lung V10 and lung V20, respectively. Moreover, each model was further evaluated for risk stratification to identify populations at high risk of RP and ≥ grade 2 RP. Results Multivariate analysis suggested that TNM stage, post-RT percentage of CD8+ T cell, and lung V15 were independent predictive factors of RP. Besides, pre- and post-RT percentage of CD8+ T cell, and V15 were independent factors of ≥ grade 2 RP. The C-indexes of RP and ≥ grade 2 RP nomograms were 0.809 (95% CI: 0.715-0.903) and 0.787 (95% CI: 0.685-0.889) in the training cohort, respectively. And the C-indexes of RP and ≥ grade 2 RP nomograms were 0.718 (95% CI: 0.544-0.892) and 0.621 (95% CI: 0.404-0.837) in the validation cohort, respectively. The calibration curves showed that the predicted values of model agreed well with actual observations. Moreover, DCA results indicated the applicability and accuracy of the models to predict RP and ≥ grade 2 RP. After stratification, the incidence of the high-risk group was significantly higher than that of the low-risk group with respect to either RP or ≥ grade 2 RP. Conclusion TNM stage, post-RT percentage of CD8+ T cell, and lung V15 were the independent predictors of RP toxicity. Pre- and post-RT percentage of CD8+ T cell, and lung V15 were the independent factors of ≥ grade 2 RP toxicity. The nomograms based on circulating lymphocyte subsets can robustly predict RP and ≥ grade 2 RP, guiding clinicians in risk stratification and early intervention.
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Affiliation(s)
- Xiao-zhen Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Su-ping Tao
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Shi-xiong Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Shu-bin Chen
- Department of Respiratory Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Fu-shuang Liu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Wei Jiang
- Department of Respiratory Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
- *Correspondence: Mao-jian Chen, ; Wei Jiang,
| | - Mao-jian Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Respiratory Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
- *Correspondence: Mao-jian Chen, ; Wei Jiang,
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11
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Lapierre A, Bourillon L, Larroque M, Gouveia T, Bourgier C, Ozsahin M, Pèlegrin A, Azria D, Brengues M. Improving Patients' Life Quality after Radiotherapy Treatment by Predicting Late Toxicities. Cancers (Basel) 2022; 14:2097. [PMID: 35565227 PMCID: PMC9099838 DOI: 10.3390/cancers14092097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 11/26/2022] Open
Abstract
Personalized treatment and precision medicine have become the new standard of care in oncology and radiotherapy. Because treatment outcomes have considerably improved over the last few years, permanent side-effects are becoming an increasingly significant issue for cancer survivors. Five to ten percent of patients will develop severe late toxicity after radiotherapy. Identifying these patients before treatment start would allow for treatment adaptation to minimize definitive side effects that could impair their long-term quality of life. Over the last decades, several tests and biomarkers have been developed to identify these patients. However, out of these, only the Radiation-Induced Lymphocyte Apoptosis (RILA) assay has been prospectively validated in multi-center cohorts. This test, based on a simple blood draught, has been shown to be correlated with late radiation-induced toxicity in breast, prostate, cervical and head and neck cancer. It could therefore greatly improve decision making in precision radiation oncology. This literature review summarizes the development and bases of this assay, as well as its clinical results and compares its results to the other available assays.
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Affiliation(s)
- Ariane Lapierre
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
- Department of Radiotherapy-Oncology, Lyon-Sud Hospital Center, 69310 Pierre-Bénite, France
| | - Laura Bourillon
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | - Marion Larroque
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | - Tiphany Gouveia
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | - Céline Bourgier
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | | | - André Pèlegrin
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | - David Azria
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
| | - Muriel Brengues
- IRCM, INSERM, University Montpellier, ICM, 34298 Montpellier, France; (A.L.); (L.B.); (M.L.); (T.G.); (C.B.); (A.P.); (D.A.)
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12
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李 婷, 周 建, 王 晴. [Pneumocystis jirovecii Pneumonia in Patients with Lung Cancer: A Review]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:272-277. [PMID: 35340199 PMCID: PMC9051306 DOI: 10.3779/j.issn.1009-3419.2022.101.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/02/2022] [Accepted: 02/06/2022] [Indexed: 11/09/2022]
Abstract
In recent years, with the widespread use of immunodepressant agents, Pneumocystis jirovecii pneumonia (PJP) has been significantly found in non-human immunodeficiency virus (HIV) patients, such as those with malignancies, post-transplantation and autoimmune diseases. Although the risk factors and management of PJP have been extensively studied in the hematologic tumor and post-transplant populations, the research on real tumor cases is insufficient. Lung cancer has been the most common tumor with the highest number of incidence and death worldwide, and the prognosis of lung cancer patients infected with PJP is poor in clinical practice. By reviewing the previous studies, this paper summarized the epidemiology and clinical manifestations of PJP in lung cancer patients, the risk factors and possible mechanisms of PJP infection in lung cancer patients, diagnosis and prevention, and other research progresses to provide reference for clinical application.
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Affiliation(s)
- 婷 李
- />310000 杭州,浙江大学医学院附属第一医院呼吸与危重症医学科Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, China
| | - 建英 周
- />310000 杭州,浙江大学医学院附属第一医院呼吸与危重症医学科Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, China
| | - 晴 王
- />310000 杭州,浙江大学医学院附属第一医院呼吸与危重症医学科Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, China
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13
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Yang L, Xu Z, Ma L, Liu Q, Chang AT, Wang Q, Zha J, Zhang J, Jiang X, Zhang J, Kong FM(S, Guo L. Early onset of severe lymphopenia during definitive radiotherapy correlates with mean body dose and predicts poor survival in cervical cancer. Cancer Biomark 2022; 34:149-159. [PMID: 35094986 PMCID: PMC9108612 DOI: 10.3233/cbm-210292] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND: Lymphopenia during definitive radiotherapy (RT) has been shown to reduce survival in patients with cervical cancer. However, there are few studies on the significance of onset time of lymphopenia during RT in patients with cervical cancer. OBJECTIVE: This study aimed to exam the prognostic significance of early onset of severe lymphopenia (EOSL) during definitive RT in patients with cervical cancer. METHODS: Newly diagnosed cervical cancer patients treated with definitive RT from January 2015 to December 2019 were eligible for this retrospective study. EOSL was defined as first onset of grade 3–4 lymphopenia ⩽ 3 weeks from the start of RT. Mean body dose (MBD) was the mean radiation dose absorbed by the body during the whole course of external beam RT (EBRT) and was directly obtained from the dose volume histogram (DVH) of the EBRT planning. Logistic regression analysis and restricted cubic spline (RCS) models were applied to assess relationships between clinicopathological factors and EOSL. Survival analysis was performed using Kaplan-Meier curves and log-rank test. A COX regression model was developed to predict overall survival (OS). RESULTS: A total of 104 patients were included and 59.6% had EOSL. MBD (P= 0.04), concurrent cisplatin (P= 0.011), and pre-RT absolute lymphocyte count (ALC) (P= 0.001) were associated with EOSL. A linear relationship (P for non-linearity = 0.803) between MBD and risk of EOSL was found. Patients with EOSL had decreased OS (2-yr 75.1% vs 91.1%, P= 0.021) and progression-free survival (PFS) (2-yr 71.2% vs 83.7%, P= 0.071). An OS prediction COX model was developed with C-index of 0.835 and AUC of 0.872. CONCLUSIONS: EOSL during definitive RT correlates with MBD and predicts poor survival in patients with cervical cancer.
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Affiliation(s)
- Li Yang
- Department of Pathology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
- Clinical Oncology Center, the University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Zhiyuan Xu
- Clinical Oncology Center, the University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Linyu Ma
- Clinical Oncology Center, the University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Qin Liu
- Clinical Oncology Center, the University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Amy T.Y. Chang
- Clinical Oncology Center, the University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, China
- Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Qian Wang
- Clinical Oncology Center, the University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jiandong Zha
- Clinical Oncology Center, the University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jinliang Zhang
- Clinical Oncology Center, the University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Xiaoqin Jiang
- Clinical Oncology Center, the University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jingjing Zhang
- Clinical Oncology Center, the University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Feng-Ming (Spring) Kong
- Clinical Oncology Center, the University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, China
- The University of Hong Kong Li Ka Shing Medical School, Hong Kong, China
| | - Linlang Guo
- Department of Pathology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
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14
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Lapierre A, Gourgou S, Brengues M, Quéro L, Deutsch É, Milliat F, Riou O, Azria D. Tumour and normal tissue radiosensitivity. Cancer Radiother 2021; 26:96-103. [PMID: 34953704 DOI: 10.1016/j.canrad.2021.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The place of personalized treatments is highly increasing in medical and radiation oncology. During the last decades, a huge number of assays have been developed to predict responses of normal tissues and tumours. These tests have not yet been included into daily clinical practice but the recent developments of radiation oncology are paving the way of personalized strategies including the risk of tumour recurrence and normal tissue reactions. Concerning tumor radiosensitivity prediction, no test are currently used, even if the radiosensitivity index and the genome-based model for adjusting radiotherapy dose assays seem the most promising with level II of evidence. Commercial developments are under progress. Concerning normal tissue radiosensitivity prediction, single nucleotide polymorphims of prostate cancer patients and radiation-induced CD8 T-lymphocyte apoptosis breast and prostate assays are of level I of evidence. They can be proposed before the beginning of radiotherapy in order to propose personalized treatments according to both risks of tumour and normal tissue radiosensitivity. Commercial developments are also under way.
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Affiliation(s)
- A Lapierre
- IRCM, Institut de recherche en cancérologie de Montpellier, Inserm U1194, INCa_Inserm_DGOS_12553, université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Département de radiothérapie oncologie, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université de Lyon, 69000 Lyon, France
| | - S Gourgou
- Unité de biométrie, ICM, Institut régional du cancer Montpellier, université de Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France
| | - M Brengues
- IRCM, Institut de recherche en cancérologie de Montpellier, Inserm U1194, INCa_Inserm_DGOS_12553, université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, ICM, Institut régional du cancer Montpellier, université de Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France
| | - L Quéro
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefeaux, 75475 Paris, France
| | - É Deutsch
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - F Milliat
- Laboratoire de radiobiologie des expositions médicales, Institut de radioprotection et de sûreté nucléaire (IRSN), 31, avenue de la Division-Leclerc, 92260 Fontenay-aux-Roses, France
| | - O Riou
- IRCM, Institut de recherche en cancérologie de Montpellier, Inserm U1194, INCa_Inserm_DGOS_12553, université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, ICM, Institut régional du cancer Montpellier, université de Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France
| | - D Azria
- IRCM, Institut de recherche en cancérologie de Montpellier, Inserm U1194, INCa_Inserm_DGOS_12553, université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, ICM, Institut régional du cancer Montpellier, université de Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France.
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Zhang X, Yang D, Jiang Y, Huang L, Wang C, Tao D, Liu X, Lei Y, Wu Y, Zhou W. Comparison of Radiation Pneumonitis in Lung Cancer Patients Treated with HT versus IMRT and Circulating Lymphocyte Subsets as Predicting Risk Factors. J Inflamm Res 2021; 14:4205-4215. [PMID: 34483676 PMCID: PMC8409515 DOI: 10.2147/jir.s328955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/10/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose We sought to compare the symptomatic radiation pneumonitis (RP) in lung cancer patients treated with helical tomotherapy (HT) versus intensity-modulated radiotherapy (IMRT), and examine the predictive value of circulating lymphocyte subsets affecting the occurrence of RP. Patients and Methods Circulating lymphocyte subsets, clinical characteristics, dosimetric parameters and pulmonary function were collected from 130 lung cancer patients treated with HT (n = 53) or IMRT (n = 77) from 2016 through 2020. Symptomatic RP was compared between groups. Binary logistic regression was used to identify predictors of RP. Results The IMRT group had larger planning target volume (319.9 vs 240.8 cc, P = 0.041); more ECOG performance status 0–1 (96.1% vs 79.2%, P = 0.002); more stage III–IV disease (94.8% vs 37.6%, P = 0.028); and more combined systemic therapy (85.7% vs 69.8%, P = 0.022). Grade ≥2 RP were comparable between IMRT and HT groups (16.9% vs 15.1%, P = 0.785). For stage III–IV disease, IMRT was associated with lower lung V10 (31.9% vs 35.8%, P = 0.047) and lower incidence of grade 5 RP (0% vs 9.1%, P = 0.018). All lymphocyte subsets reduced after radiotherapy. The decrease degree of total T cell count and CD4+ T cell count were larger after IMRT than HT (P = 0.043, P = 0.021). In univariate analysis, the smoking status, lower baseline FEV1, and higher total T cell count, higher CD8+ T cell count, lower total B cell count, lower CD4+/CD8+ ratio after radiotherapy were associated with the development of grade ≥2 RP. The higher CD8+T cell count after radiotherapy was the only risk factor associated with grade ≥2 RP in multivariable analysis (OR 1.003; 95% CI: 1.000–1.005; P = 0.044). Conclusion IMRT was associated with lower lung V10 and less grade 5 RP than HT for stage III–IV lung cancer. Higher CD8+ T cell count after radiotherapy was associated with an increased risk of RP. HT may better preserve total T cell and CD4+ T cell than IMRT.
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Affiliation(s)
- Xin Zhang
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Dingyi Yang
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Yong Jiang
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Luo Huang
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Can Wang
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Dan Tao
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Xianfeng Liu
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Yongyang Lei
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Yongzhong Wu
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Wei Zhou
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
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Proof of Concept of a Binary Blood Assay for Predicting Radiosensitivity. Cancers (Basel) 2021; 13:cancers13102477. [PMID: 34069662 PMCID: PMC8160794 DOI: 10.3390/cancers13102477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 12/24/2022] Open
Abstract
Radiation therapy (RT), either alone or in combination with surgery and/or chemotherapy is a keystone of cancers treatment. Early toxicity is common, sometimes leading to discontinuation of treatment. Recent studies stressed the role of the phosphorylated ATM (pATM) protein in RT-toxicity genesis and its ability in predicting individual radiosensitivity (IRS) in fibroblasts. Here we assessed the reliability of the pATM quantification in lymphocytes to predict IRS. A first retrospective study was performed on 150 blood lymphocytes of patients with several cancer types. Patients were divided into 2 groups, according to the grade of experienced toxicity. The global quantity of pATM molecules was assessed by ELISA on lymphocytes to determine the best threshold value. Then, the binary assay was assessed on a validation cohort of 36 patients with head and neck cancers. The quantity of pATM molecules in each sample of the training cohort was found in agreement with the observed Common Terminology Criteria for Adverse Events (CTCAE) grades with an AUC = 0.71 alone and of 0.77 combined to chemotherapy information. In the validation cohort, the same test was conducted with the following performances: sensitivity = 0.84, specificity = 0.54, AUC = 0.70 and 0.72 combined to chemotherapy. This study provides the basis of an easy to perform assay for clinical use.
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Dröge LH, Hennies S, Lorenzen S, Conradi LC, Quack H, Liersch T, Helms C, Frank MA, Schirmer MA, Rave-Fränk M, Beißbarth T, Wolff HA. Prognostic value of the micronucleus assay for clinical endpoints in neoadjuvant radiochemotherapy for rectal cancer. BMC Cancer 2021; 21:219. [PMID: 33663399 PMCID: PMC7931609 DOI: 10.1186/s12885-021-07914-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 02/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background The question whether lymphocyte radiosensitivity is representative of patients’ response to radiotherapy (RT) remains unsolved. We analyzed lymphocyte cytogenetic damage in patients who were homogeneously treated with preoperative radiochemotherapy (RCT) for rectal cancer within clinical trials. We tested for interindividual variation and consistent radiosensitivity after in-vivo and in-vitro irradiation, analyzed the effect of patients’ and RCT characteristics on cytogenetic damage, and tested for correlations with patients’ outcome in terms of tumor response, survival and treatment-related toxicity. Methods The cytokinesis-block micronucleus cytome (CBMNcyt) assay was performed on the peripheral blood lymphocytes (PBLCs) of 134 patients obtained before, during, at the end of RCT, and during the 2-year follow-up. A subset of PBLCs obtained before RCT was irradiated in-vitro with 3 Gy. RCT included 50.4 Gy of pelvic RT with 5-fluorouracil (5-FU) alone (n = 78) or 5-FU plus oxaliplatin (n = 56). The analyzed variables included patients’ age, gender, RT characteristics (planning target volume size [PTV size], RT technique), and chemotherapy characteristics (5-FU plasma levels, addition of oxaliplatin). Outcome was analyzed as tumor regression, patient survival, and acute and late toxicity. Results Cytogenetic damage increased significantly with the radiation dose and varied substantially between individuals. Women were more sensitive than men; no significant age-dependent differences were observed. There was a significant correlation between the cytogenetic damage after in-vitro irradiation and in-vivo RCT. We found a significant effect of the PTV size on the yields of cytogenetic damage after RCT, while the RT technique had no effect. Neither the addition of oxaliplatin nor the 5-FU levels influenced cytogenetic damage. We found no correlation between patient outcome and the cytogenetic damage. Conclusions We found consistent cytogenetic damage in lymphocytes after in-vivo RCT and in-vitro irradiation. Gender was confirmed as a well-known, and the PTV size was identified as a less well-known influencing variable on lymphocyte cytogenetic damage after partial-body irradiation. A consistent level of cytogenetic damage after in-vivo and in-vitro irradiation may indicate the importance of genetic factors for individual radiosensitivity. However, we found no evidence that in-vivo or in-vitro irradiation-induced cytogenetic damage is an adequate biomarker for the response to RCT in rectal cancer patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-07914-5.
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Affiliation(s)
- Leif Hendrik Dröge
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Steffen Hennies
- University Medical Center Göttingen, Göttingen, Germany.,Department of Radiology, Nuclear Medicine and Radiotherapy, Radiology Munich, 80333, Munich, Germany
| | - Stephan Lorenzen
- Institute of Medical Bioinformatics, University Medical Center Göttingen, Göttingen, Germany.,Department of Molecular Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Lena-Christin Conradi
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Henriette Quack
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Torsten Liersch
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Christian Helms
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Miriam Alice Frank
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Markus Anton Schirmer
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Margret Rave-Fränk
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Tim Beißbarth
- Institute of Medical Bioinformatics, University Medical Center Göttingen, Göttingen, Germany
| | - Hendrik Andreas Wolff
- University Medical Center Göttingen, Göttingen, Germany.,Department of Radiology, Nuclear Medicine and Radiotherapy, Radiology Munich, 80333, Munich, Germany.,Department of Radiotherapy and Radiation Oncology, University Medical Center Regensburg, Regensburg, Germany
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18
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DNA Damage Baseline Predicts Resilience to Space Radiation and Radiotherapy. Cell Rep 2020; 33:108434. [PMID: 33242409 PMCID: PMC7784531 DOI: 10.1016/j.celrep.2020.108434] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/22/2020] [Accepted: 11/04/2020] [Indexed: 12/11/2022] Open
Abstract
Deep space exploration will require real-time, minimally invasive monitoring of astronaut health to mitigate the potential health impairments caused by space radiation and microgravity. Genotoxic stress in humans can be monitored by quantifying the amount of DNA double-strand breaks (DSBs) in immune cells from a simple finger prick. In a cohort of 674 healthy donors, we show that the endogenous level of DSBs increases with age and with latent cytomegalovirus infection. To map the range of human responses to space radiation, we then study DSB induction and repair in immune cells from 319 healthy donors after the cells are exposed to galactic cosmic ray components and lymphocytes from 30 cancer patients after radiotherapy. Individuals with low baseline DSB have fewer clinical complications, enhanced DNA damage repair responses, and a functional dose-dependent cytokine response in healthy donor cells. This supports the use of DSB monitoring for health resilience in space.
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19
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Gao Y, Wu X, Li Y, Li Y, Zhou Q, Wang Q, Wei C, Shi D, Xie C, Pan H. The Predictive Value of MLR for Radiation Pneumonia During Radiotherapy of Thoracic Tumor Patients. Cancer Manag Res 2020; 12:8695-8701. [PMID: 33061568 PMCID: PMC7518777 DOI: 10.2147/cmar.s268964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/27/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose To evaluate the predictive value of blood lymphocyte, monocyte to lymphocyte ratio (MLR), and neutrophil to lymphocyte ratio (NLR) for radiation pneumonia (RP) in patients with thoracic tumors receiving radiotherapy. Patients and Methods The clinical data of 65 patients with thoracic tumor (esophageal cancer, lung cancer) treated by radiotherapy in our hospital were retrospectively analyzed. Patients were divided into the RP group and the non-RP group according to the Common Terminology Criteria for Adverse Events (CTCAE 5.0). Data on blood cell counts, including lymphocytes, monocytes, and neutrophils, were collected before (0 weeks) and after 1, 2, and 4 weeks of radiotherapy. Results Of the 65 patients enrolled, 27 developed radiation pneumonia and 38 did not. Patients’ clinical factors, including age, TNM stage, tumor type, underlying lung disease, and history of smoking, had no correlation with RP. ANOVA of repeated measurement data showed that the changes of MLR in the group with RP during radiotherapy were significantly different from those in the non-RP group (P<0.05). The RP prediction model based on the identified risk factors was established using receiver operator characteristic curves. The results showed that the area under the curve for the monocyte to lymphocyte ratio was 0.755 (95% CI, 0.63–0.87, P=0.000), and the best cutoff point for MLR was 0.426. Conclusion MLR could predict radiation pneumonia in patients with thoracic tumor radiotherapy and achieve early monitoring, early prevention, and treatment.
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Affiliation(s)
- Ya Gao
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xinyi Wu
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yunhao Li
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yifei Li
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Qingyu Zhou
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Qiongqiong Wang
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Chaoyi Wei
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Deli Shi
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Congying Xie
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Huanle Pan
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
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20
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Cullen D, Bryant J, Maguire A, Medipally D, McClean B, Shields L, Noone E, Bradshaw S, Finn M, Dunne M, Shannon AM, Armstrong J, Howe O, Meade AD, Lyng FM. Raman spectroscopy of lymphocytes for the identification of prostate cancer patients with late radiation toxicity following radiotherapy. TRANSLATIONAL BIOPHOTONICS 2020. [DOI: 10.1002/tbio.201900035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Daniel Cullen
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Physics and Clinical and Optometric Sciences Technological University Dublin Dublin Ireland
| | - Jane Bryant
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
| | - Adrian Maguire
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Physics and Clinical and Optometric Sciences Technological University Dublin Dublin Ireland
| | - Dinesh Medipally
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Physics and Clinical and Optometric Sciences Technological University Dublin Dublin Ireland
| | - Brendan McClean
- Department of Medical Physics Saint Luke's Radiation Oncology Network Dublin Ireland
| | - Laura Shields
- Department of Medical Physics Saint Luke's Radiation Oncology Network Dublin Ireland
| | - Emma Noone
- Clinical Trials Unit Saint Luke's Radiation Oncology Network at St Luke's Hospital Dublin Ireland
| | - Shirley Bradshaw
- Clinical Trials Unit Saint Luke's Radiation Oncology Network at St Luke's Hospital Dublin Ireland
| | - Marie Finn
- Clinical Trials Unit Saint Luke's Radiation Oncology Network at St Luke's Hospital Dublin Ireland
| | - Mary Dunne
- Clinical Trials Unit Saint Luke's Radiation Oncology Network at St Luke's Hospital Dublin Ireland
| | | | - John Armstrong
- Cancer Trials Ireland Dublin Ireland
- Department of Radiation Oncology Saint Luke's Radiation Oncology Network at St Luke's Hospital Dublin Ireland
| | - Orla Howe
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Biological and Health Sciences Technological University Dublin Dublin Ireland
| | - Aidan D. Meade
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Physics and Clinical and Optometric Sciences Technological University Dublin Dublin Ireland
| | - Fiona M. Lyng
- Radiation and Environmental Science Centre Focas Research Institute, Technological University Dublin Dublin Ireland
- School of Physics and Clinical and Optometric Sciences Technological University Dublin Dublin Ireland
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21
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Meehan J, Gray M, Martínez-Pérez C, Kay C, Pang LY, Fraser JA, Poole AV, Kunkler IH, Langdon SP, Argyle D, Turnbull AK. Precision Medicine and the Role of Biomarkers of Radiotherapy Response in Breast Cancer. Front Oncol 2020; 10:628. [PMID: 32391281 PMCID: PMC7193869 DOI: 10.3389/fonc.2020.00628] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/06/2020] [Indexed: 12/24/2022] Open
Abstract
Radiotherapy remains an important treatment modality in nearly two thirds of all cancers, including the primary curative or palliative treatment of breast cancer. Unfortunately, largely due to tumor heterogeneity, tumor radiotherapy response rates can vary significantly, even between patients diagnosed with the same tumor type. Although in recent years significant technological advances have been made in the way radiation can be precisely delivered to tumors, it is proving more difficult to personalize radiotherapy regimens based on cancer biology. Biomarkers that provide prognostic or predictive information regarding a tumor's intrinsic radiosensitivity or its response to treatment could prove valuable in helping to personalize radiation dosing, enabling clinicians to make decisions between different treatment options whilst avoiding radiation-induced toxicity in patients unlikely to gain therapeutic benefit. Studies have investigated numerous ways in which both patient and tumor radiosensitivities can be assessed. Tumor molecular profiling has been used to develop radiosensitivity gene signatures, while the assessment of specific intracellular or secreted proteins, including circulating tumor cells, exosomes and DNA, has been performed to identify prognostic or predictive biomarkers of radiation response. Finally, the investigation of biomarkers related to radiation-induced toxicity could provide another means by which radiotherapy could become personalized. In this review, we discuss studies that have used these methods to identify or develop prognostic/predictive signatures of radiosensitivity, and how such assays could be used in the future as a means of providing personalized radiotherapy.
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Affiliation(s)
- James Meehan
- Translational Oncology Research Group, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark Gray
- Translational Oncology Research Group, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom.,The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Carlos Martínez-Pérez
- Translational Oncology Research Group, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom.,Breast Cancer Now Edinburgh Research Team, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom
| | - Charlene Kay
- Translational Oncology Research Group, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom
| | - Lisa Y Pang
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer A Fraser
- School of Applied Science, Sighthill Campus, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Amy V Poole
- School of Applied Science, Sighthill Campus, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Ian H Kunkler
- Cancer Research UK Edinburgh Centre and Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Simon P Langdon
- Cancer Research UK Edinburgh Centre and Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - David Argyle
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Arran K Turnbull
- Translational Oncology Research Group, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom.,Breast Cancer Now Edinburgh Research Team, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom
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22
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Zhou P, Chen L, Yan D, Huang C, Chen G, Wang Z, Zhong L, Luo W, Chen D, Chun C, Zhang S, Li G. Early variations in lymphocytes and T lymphocyte subsets are associated with radiation pneumonitis in lung cancer patients and experimental mice received thoracic irradiation. Cancer Med 2020; 9:3437-3444. [PMID: 32207253 PMCID: PMC7221303 DOI: 10.1002/cam4.2987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/29/2022] Open
Abstract
There were no ideal markers to predict the development of radiation pneumonitis (RP). We want to investigate the value of variations of lymphocytes and T lymphocyte subsets in predicting RP after radiotherapy (RT) of lung cancer based on previous clinical findings. A total of 182 lung cancer patients who received RT were retrospectively analyzed. Circulating lymphocytes and T lymphocyte subsets were measured before, during, and after RT. Patients were evaluated from the start of RT to 6 months post‐RT. A mice model with acute radiation‐induced lung injury was established and circulating lymphocytes were measured weekly until 8 weeks after irradiation. Univariate and multivariate analyses were adopted to identify risk factors of RP. Lymphocyte levels significantly decreased (P < .001) in patients before RP symptoms developed that also was able to be seen in the mice model and the values recovered during remission of symptoms. The decrease in lymphocyte count reflected the severity of RP. Meanwhile, CD4+ T lymphocyte count was significantly lower during the occurrence of symptoms in patients with RP than in those without RP (P < .001), and it improved along with RP recovery. Levels of lymphocytes and CD4+ T lymphocyte subsets proved as independent predictors of RP. Here we showed that lower peripheral blood levels of lymphocytes and CD4+ T lymphocyte were associated with an increased risk of RP, which was validated by this mice model, and thus are associated with differences in radiation‐induced lung toxicity among individuals and help identify those who are susceptible to developing RP after RT.
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Affiliation(s)
- Pu Zhou
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Lu Chen
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Dong Yan
- Institute for Pathology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Changlin Huang
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Guangpeng Chen
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Zhiyi Wang
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Liangzhi Zhong
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Wen Luo
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Diangang Chen
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chui Chun
- Institute for Radiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Shushu Zhang
- Institute for Radiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Guanghui Li
- Institute for Cancer Research in People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China
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23
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Chaouni S, Lecomte DD, Stefan D, Leduc A, Barraux V, Leconte A, Grellard JM, Habrand JL, Guillamin M, Sichel F, Laurent C. The Possibility of Using Genotoxicity, Oxidative Stress and Inflammation Blood Biomarkers to Predict the Occurrence of Late Cutaneous Side Effects after Radiotherapy. Antioxidants (Basel) 2020; 9:antiox9030220. [PMID: 32156042 PMCID: PMC7139389 DOI: 10.3390/antiox9030220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 12/18/2022] Open
Abstract
Despite the progresses performed in the field of radiotherapy, toxicity to the healthy tissues remains a major limiting factor. The aim of this work was to highlight blood biomarkers whose variations could predict the occurrence of late cutaneous side effects. Two groups of nine patients treated for Merkel Cell Carcinoma (MCC) were established according to the grade of late skin toxicity after adjuvant irradiation for MCC: grade 0, 1 or 2 and grade 3 or 4 of RTOG (Radiation Therapy Oncology Group)/EORTC (European Organization for Research and Treatment of Cancer). To try to discriminate these 2 groups, biomarkers of interest were measured on the different blood compartments after ex vivo irradiation. In lymphocytes, cell cycle, apoptosis and genotoxicity were studied. Oxidative stress was evaluated by the determination of the erythrocyte antioxidant capacity (superoxide dismutase, catalase, glutathione peroxidase, reduced and oxidized glutathione) as well as degradation products (protein carbonylation, lipid peroxidation). Inflammation was assessed in the plasma by the measurement of 14 cytokines. The most radiosensitive patients presented a decrease in apoptosis, micronucleus frequency, antioxidant enzyme activities, glutathione and carbonyls; and an increase in TNF-a (Tumor Necrosis Factor a), IL-8 (Interleukin 8) and TGF-β1 (Transforming Growth Factor β1) levels. These findings have to be confirmed on a higher number of patients and before radiotherapy and could allow to predict the occurrence of late skin side effects after radiotherapy.
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Affiliation(s)
- Samia Chaouni
- ABTE-EA4651, ToxEMAC, Normandie University, UNICAEN, UNIROUEN, 14000 Caen, France, (S.C.)
| | - Delphine Dumont Lecomte
- ABTE-EA4651, ToxEMAC, Normandie University, UNICAEN, UNIROUEN, 14000 Caen, France, (S.C.)
- Radiotherapy Department, Hôpital Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
| | - Dinu Stefan
- ABTE-EA4651, ToxEMAC, Normandie University, UNICAEN, UNIROUEN, 14000 Caen, France, (S.C.)
- Radiotherapy Department, Cancer Centre François Baclesse, 14000 Caen France
| | - Alexandre Leduc
- ABTE-EA4651, ToxEMAC, Normandie University, UNICAEN, UNIROUEN, 14000 Caen, France, (S.C.)
| | - Victor Barraux
- Medical Physics Department, Cancer Centre François Baclesse, 14000 Caen, France,
| | - Alexandra Leconte
- Clinical Research Department, Cancer Centre François Baclesse, 14000 Caen, France, (A.L.)
| | - Jean-Michel Grellard
- Clinical Research Department, Cancer Centre François Baclesse, 14000 Caen, France, (A.L.)
| | - Jean-Louis Habrand
- ABTE-EA4651, ToxEMAC, Normandie University, UNICAEN, UNIROUEN, 14000 Caen, France, (S.C.)
- Radiotherapy Department, Cancer Centre François Baclesse, 14000 Caen France
| | - Marilyne Guillamin
- IFR ICORE-Flow Cytometry Platform, Normandie University, UNICAEN, 14000 Caen, France,
| | - François Sichel
- ABTE-EA4651, ToxEMAC, Normandie University, UNICAEN, UNIROUEN, 14000 Caen, France, (S.C.)
- Cancer Centre François Baclesse, 14000 Caen, France
| | - Carine Laurent
- ABTE-EA4651, ToxEMAC, Normandie University, UNICAEN, UNIROUEN, 14000 Caen, France, (S.C.)
- SAPHYN/ARCHADE (Advanced Resource Centre for HADrontherapy in Europe), Cancer Centre François Baclesse, 14000 Caen, France
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24
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Averbeck D, Candéias S, Chandna S, Foray N, Friedl AA, Haghdoost S, Jeggo PA, Lumniczky K, Paris F, Quintens R, Sabatier L. Establishing mechanisms affecting the individual response to ionizing radiation. Int J Radiat Biol 2020; 96:297-323. [PMID: 31852363 DOI: 10.1080/09553002.2019.1704908] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: Humans are increasingly exposed to ionizing radiation (IR). Both low (<100 mGy) and high doses can cause stochastic effects, including cancer; whereas doses above 100 mGy are needed to promote tissue or cell damage. 10-15% of radiotherapy (RT) patients suffer adverse reactions, described as displaying radiosensitivity (RS). Sensitivity to IR's stochastic effects is termed radiosusceptibility (RSu). To optimize radiation protection we need to understand the range of individual variability and underlying mechanisms. We review the potential mechanisms contributing to RS/RSu focusing on RS following RT, the most tractable RS group.Conclusions: The IR-induced DNA damage response (DDR) has been well characterized. Patients with mutations in the DDR have been identified and display marked RS but they represent only a small percentage of the RT patients with adverse reactions. We review the impacting mechanisms and additional factors influencing RS/RSu. We discuss whether RS/RSu might be genetically determined. As a recommendation, we propose that a prospective study be established to assess RS following RT. The study should detail tumor site and encompass a well-defined grading system. Predictive assays should be independently validated. Detailed analysis of the inflammatory, stress and immune responses, mitochondrial function and life style factors should be included. Existing cohorts should also be optimally exploited.
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Affiliation(s)
| | - Serge Candéias
- CEA, CNRS, LCMB, University of Grenoble Alpes, Grenoble, France
| | - Sudhir Chandna
- Division of Radiation Biosciences, Institute of Nuclear Medicine & Allied Sciences, Delhi, India
| | - Nicolas Foray
- Inserm UA8 Unit Radiations: Defense, Health and Environment, Lyon, France
| | - Anna A Friedl
- Department of Radiation Oncology, University Hospital, LMU, Munich, Germany
| | - Siamak Haghdoost
- Cimap-Laria, Advanced Resource Center for HADrontherapy in Europe (ARCHADE,), University of Caen Normandy, France.,Centre for Radiation Protection Research, Department of Molecular Bioscience, Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Penelope A Jeggo
- Genome Damage and Stability Centre, School of Life Sciences, University of Sussex, Brighton, UK
| | - Katalin Lumniczky
- Department of Radiation Medicine, Division of Radiobiology and Radiohygiene, National Public Health Center, Budapest, Hungary
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25
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Consequences of Pelvic Radiotherapy on Urinary Function in Women. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00565-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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26
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Nguyen HQ, Belkacemi Y, Mann C, Hoffschir F, Kerbrat S, Surenaud M, Zadigue P, de La Taille A, Romeo PH, Le Gouvello S. Human CCR6+ Th17 Lymphocytes Are Highly Sensitive to Radiation-Induced Senescence and Are a Potential Target for Prevention of Radiation-Induced Toxicity. Int J Radiat Oncol Biol Phys 2019; 108:314-325. [PMID: 31689464 DOI: 10.1016/j.ijrobp.2019.10.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE This study addresses the sensitivity of different peripheral CD4+ T-lymphocyte subsets to irradiation (IR) and identifies potential targets for the prevention or treatment of radiation-induced toxicity. METHODS This study was performed on peripheral blood mononuclear cells or sorted peripheral memory lymphocytes of CCR6+ mucosa-homing Th17/CCR6negTh and regulatory T subtypes of healthy volunteers. Cells were irradiated with a 2 Gy with or without pharmacologic inhibitors of different signaling pathways. Senescence of irradiated cells was assessed by resistance to apoptosis and determination of various senescence-associated biomarkers (senescence associated b-galactosidase activity, p16Ink4a-, p21Cdkn1a-, gH2A.X-, H2A.J expression). Cytokine production was measured in supernatants of irradiated cells by Luminex technology. RESULTS Not all CD4+ memory T lymphocyte subsets were equally radiosensitive. High sensitivity of CCR6+Th17 lymphocytes to IR-induced senescence was shown by expression of the histone variant H2A.J, higher SA-b-Gal activity, and upregulation of p16Ink4a and p21Cdkn1a expression. Lower Annexin V staining and cleaved caspase-3, and higher expression of antiapoptotic genes Bcl-2 and Bcl-xL LF, showed that CCR6+Th17 lymphocytes were more resistant to IR-induced apoptosis than CCR6neg memory Th and regulatory T lymphocytes. After a 2 Gy IR, both CCR6+Th17 and CCR6neg cells acquired a moderate senescence-associated secretory phenotype, but only CCR6+Th17 cells secreted interleukin 8 (IL-8) and vascular endothelial growth factor-A (VEGF-A). Pharmacologic targeting of reactive oxygen species (ROS), mitogen-activated protein kinases (MAPKs), and mammalian target of rapamycin (mTOR) signaling pathways prevented the expression of senescent markers and IL-8 and VEGF-A expression by CCR6+Th17 cells after IR. CONCLUSIONS This study suggests that IR induces senescence of CCR6+Th17 lymphocytes associated with secretion of IL-8 and VEGF-A that may be detrimental to the irradiated tissue. ROS-MAPKs signaling pathways are candidate targets to prevent this CCR6+Th17-dependent radiation-induced potential toxicity. Finally, the ratio of circulating H2A.J+ senescent CCR6+ Th17/CD4+ T lymphocytes may be a candidate marker of individual intrinsic radiosensitivity.
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Affiliation(s)
- Hoang Quy Nguyen
- INSERM U955, Equipe 07, Créteil, France; Université de Paris Est, Faculté de Médecine, Créteil, France
| | - Yazid Belkacemi
- INSERM U955, Equipe 07, Créteil, France; Université de Paris Est, Faculté de Médecine, Créteil, France; APHP, Hôpitaux Universitaires Henri Mondor, Service d'UROLOGIE, Créteil, France.
| | - Carl Mann
- Institut de Biologie Intégrative de la Cellule, CEA, CNRS, Université de Paris-Sud, Université de Paris-Saclay, Gif-sur-Yvette Cedex, France
| | | | | | | | - Patricia Zadigue
- INSERM U955, Equipe 07, Créteil, France; Université de Paris Est, Faculté de Médecine, Créteil, France
| | - Alexandre de La Taille
- INSERM U955, Equipe 07, Créteil, France; Université de Paris Est, Faculté de Médecine, Créteil, France; INSERM UMR955 Team 16, Créteil, France
| | - Paul-Henri Romeo
- CEA/DRF/IBFJ/iRCM/LRTS/Inserm U967, Fontenay-aux-Roses Cedex, France; Inserm U967, Fontenay-aux-Roses Cedex, France; Université de Paris-Diderot, Paris, France; Université Paris-Sud, Paris, France; Université de Paris-Saclay, Cedex, France; Equipe labellisée Ligue contre le Cancer, Cedex, France
| | - Sabine Le Gouvello
- Université de Paris Est, Faculté de Médecine, Créteil, France; INSERM UMR955 Team 04, Créteil, France; APHP, Hôpital H. Mondor, A. Chenevier, Département de Biologie et Pathologie, Créteil, France
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Palumbo E, Piotto C, Calura E, Fasanaro E, Groff E, Busato F, El Khouzai B, Rigo M, Baggio L, Romualdi C, Zafiropoulos D, Russo A, Mognato M, Corti L. Individual Radiosensitivity in Oncological Patients: Linking Adverse Normal Tissue Reactions and Genetic Features. Front Oncol 2019; 9:987. [PMID: 31632918 PMCID: PMC6779824 DOI: 10.3389/fonc.2019.00987] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/16/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction: Adverse effects of radiotherapy (RT) significantly affect patient's quality of life (QOL). The possibility to identify patient-related factors that are associated with individual radiosensitivity would optimize adjuvant RT treatment, limiting the severity of normal tissue reactions, and improving patient's QOL. In this study, we analyzed the relationships between genetic features and toxicity grading manifested by RT patients looking for possible biomarkers of individual radiosensitivity. Methods: Early radiation toxicity was evaluated on 143 oncological patients according to the Common Terminology Criteria for Adverse Events (CTCAE). An individual radiosensitivity (IRS) index defining four classes of radiosensitivity (highly radiosensitive, radiosensitive, normal, and radioresistant) was determined by a G2-chromosomal assay on ex vivo irradiated, patient-derived blood samples. The expression level of 15 radioresponsive genes has been measured by quantitative real-time PCR at 24 h after the first RT fraction, in blood samples of a subset of 57 patients, representing the four IRS classes. Results: By applying univariate and multivariate statistical analyses, we found that fatigue was significantly associated with IRS index. Interestingly, associations were detected between clinical radiation toxicity and gene expression (ATM, CDKN1A, FDXR, SESN1, XPC, ZMAT3, and BCL2/BAX ratio) and between IRS index and gene expression (BBC3, FDXR, GADD45A, and BCL2/BAX). Conclusions: In this prospective cohort study we found that associations exist between normal tissue reactions and genetic features in RT-treated patients. Overall, our findings can contribute to the identification of biological markers to predict RT toxicity in normal tissues.
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Affiliation(s)
- Elisa Palumbo
- Department of Radiotherapy, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Celeste Piotto
- Department of Radiotherapy, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Enrica Calura
- Department of Biology, University of Padua, Padua, Italy
| | - Elena Fasanaro
- Department of Radiotherapy, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Elena Groff
- Department of Radiotherapy, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Fabio Busato
- Department of Radiotherapy, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Badr El Khouzai
- Department of Radiotherapy, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Michele Rigo
- Department of Radiotherapy, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Laura Baggio
- Department of Radiotherapy, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Demetre Zafiropoulos
- National Laboratories of Legnaro, Italian Institute of Nuclear Physics (LNL-INFN), Padua, Italy
| | - Antonella Russo
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | | | - Luigi Corti
- Department of Radiotherapy, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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28
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[Predictive assays for responses of tumors and normal tissues in radiation oncology]. Cancer Radiother 2019; 23:666-673. [PMID: 31451357 DOI: 10.1016/j.canrad.2019.07.152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/07/2019] [Indexed: 11/24/2022]
Abstract
The impact of curative radiotherapy depends mainly on the total dose delivered homogenously in the target volume. Tumor sensitivity to radiotherapy may be particularly inconstant depending on location, histology, somatic genetic parameters and the capacity of the immune system to infiltrate the tumor. In addition, the dose delivered to the surrounding healthy tissues may reduce the therapeutic ratio of many radiation treatments. In a same population treated in one center with the same technique, it appears that individual radiosensitivity clearly exists, namely in terms of late side effects that are in principle non-reversible. This review details the different radiobiological approaches that have been developed to better predict the tumor response but also the radiation-induced late effects.
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Lacombe J, Brengues M, Mangé A, Bourgier C, Gourgou S, Pèlegrin A, Ozsahin M, Solassol J, Azria D. Quantitative proteomic analysis reveals AK2 as potential biomarker for late normal tissue radiotoxicity. Radiat Oncol 2019; 14:142. [PMID: 31399108 PMCID: PMC6688300 DOI: 10.1186/s13014-019-1351-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 08/01/2019] [Indexed: 12/27/2022] Open
Abstract
Background Biomarkers for predicting late normal tissue toxicity to radiotherapy are necessary to personalize treatments and to optimize clinical benefit. Many radiogenomic studies have been published on this topic. Conversely, proteomics approaches are not much developed, despite their advantages. Methods We used the isobaric tags for relative and absolute quantitation (iTRAQ) proteomic approach to analyze differences in protein expression levels in ex-vivo irradiated (8 Gy) T lymphocytes from patients with grade ≥ 2 radiation-induced breast fibrosis (grade ≥ 2 bf+) and patients with grade < 2 bf + after curative intent radiotherapy. Patients were selected from two prospective clinical trials (COHORT and PHRC 2005) and were used as discovery and confirmation cohorts. Results Among the 1979 quantified proteins, 23 fulfilled our stringent biological criteria. Immunoblotting analysis of four of these candidate proteins (adenylate kinase 2, AK2; annexin A1; heat shock cognate 71 kDa protein; and isocitrate dehydrogenase 2) confirmed AK2 overexpression in 8 Gy-irradiated T lymphocytes from patients with grade ≥ 2 bf + compared with patients with grade < 2 bf+. As these candidate proteins are involved in oxidative stress regulation, we also evaluated radiation-induced reactive oxygen species (ROS) production in peripheral blood mononuclear cells from patients with grade ≥ 2 bf + and grade < 2 bf+. Total ROS level, and especially superoxide anion level, increased upon ex-vivo 8 Gy-irradiation in all patients. Analysis of NADPH oxidases (NOXs), a major source of superoxide ion in the cell, showed a significant increase of NOX4 mRNA and protein levels after irradiation in both patient groups. Conversely, only NOX4 mRNA level was significantly different between groups (grade ≥ 2 bf + and grade < 2 bf+). Conclusion These findings identify AK2 as a potential radiosensitivity candidate biomarker. Overall, our proteomic approach highlights the important role of oxidative stress in late radiation-induced toxicity, and paves the way for additional studies on NOXs and superoxide ion metabolism. Electronic supplementary material The online version of this article (10.1186/s13014-019-1351-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jérôme Lacombe
- IRCM, INSERM, University Montpellier, ICM, Montpellier, France
| | - Muriel Brengues
- IRCM, INSERM, University Montpellier, ICM, Montpellier, France
| | - Alain Mangé
- IRCM, INSERM, University Montpellier, ICM, Montpellier, France
| | - Céline Bourgier
- IRCM, INSERM, University Montpellier, ICM, Montpellier, France
| | | | - André Pèlegrin
- IRCM, INSERM, University Montpellier, ICM, Montpellier, France
| | | | - Jérôme Solassol
- IRCM, INSERM, University Montpellier, ICM, Montpellier, France.,Department of Pathology and Onco-Biology, CHU Montpellier, Montpellier, France
| | - David Azria
- IRCM, INSERM, University Montpellier, ICM, Montpellier, France. .,Department of Radiation Oncology, ICM, 34298, Montpellier Cedex 5, France.
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Bourgier C, Lemanski C, Draghici R, Castan F, Fenoglietto P, Bons F, Farcy-Jacquet MP, Brengues M, Gourgou S, Ozsahin M, Azria D. [Individual modification of the dose, volume and fractionation of breast radiotherapy]. Cancer Radiother 2019; 23:778-783. [PMID: 31378461 DOI: 10.1016/j.canrad.2019.06.004] [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: 06/05/2019] [Accepted: 06/26/2019] [Indexed: 11/26/2022]
Abstract
Randomized trials demonstrated similar overall survival between mastectomy and breast-conservative surgery followed by adjuvant radiation therapy. Breast-conservative surgery, with adjuvant radiation therapy, with or without neoadjuvant systemic therapy has become the standard of care for women with early or locally advanced breast cancer. Nevertheless, certain cardiac, lung or cutaneous toxicities may alter the long-term body image and the quality of life of a limited number of patients who consider having had "overtreatment" or treatment outside the best knowledge of science. In case of low-risk breast cancer, several trials have evaluated the carcinologic outcome in absence of radiation therapy after breast-conservative surgery. Local recurrences increased in case of breast-conservative surgery alone but without impact on overall survival. Multiple debates have emerged in order to select the most appropriate evaluation criteria. Finally, a large consensus has considered that reducing local recurrences is important but with modern technologies and after identifying patients of individual radiosensitivity. Indeed, in case of a low absolute risk of local recurrence, radiation therapy techniques have been developed to allow a focal treatment especially for patients with high risk of developing late effects. This kind of compromise takes into account the reduction risk of local recurrences but also the probability of developing radiation-induced cutaneous sequelae. In the same way, for patients considered at high risk of recurrence, the huge volumes need specific techniques to better cover the targets while protecting the surrounding critic organs such as heart and lung. Intensity-modulated radiation therapy and the local high boost may help to decrease local recurrences of these more extended and aggressive diseases while considering the individual radiosensitivity that paves the way of long-term sequelae. In this article, we detail a personalized approach of breast radiation therapy considering the absolute risk of local recurrences and the probability of radiation-induced toxicity appearance.
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Affiliation(s)
- C Bourgier
- Institut de recherche en cancérologie de Montpellier (IRCM), rue Croix-Verte, 34298 Montpellier, cedex 5, France; Inserm U1194, rue Croix-Verte, 34298 Montpellier, cedex 5, France; Université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier, cedex 5, France
| | - C Lemanski
- Institut de recherche en cancérologie de Montpellier (IRCM), rue Croix-Verte, 34298 Montpellier, cedex 5, France; Inserm U1194, rue Croix-Verte, 34298 Montpellier, cedex 5, France; Université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier, cedex 5, France
| | - R Draghici
- Institut de recherche en cancérologie de Montpellier (IRCM), rue Croix-Verte, 34298 Montpellier, cedex 5, France; Inserm U1194, rue Croix-Verte, 34298 Montpellier, cedex 5, France; Université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier, cedex 5, France
| | - F Castan
- Unité de biométrie, Institut régional du cancer Montpellier (ICM), rue Croix-Verte, 34298 Montpellier cedex 05, France
| | - P Fenoglietto
- Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier, cedex 5, France
| | - F Bons
- Fédération universitaire d'oncologie radiothérapie, institut de cancérologie du Gard, CHU de Nîmes, rue Henri-Pujol, 30000 Nîmes, France
| | - M-P Farcy-Jacquet
- Fédération universitaire d'oncologie radiothérapie, institut de cancérologie du Gard, CHU de Nîmes, rue Henri-Pujol, 30000 Nîmes, France
| | - M Brengues
- Institut de recherche en cancérologie de Montpellier (IRCM), rue Croix-Verte, 34298 Montpellier, cedex 5, France; Inserm U1194, rue Croix-Verte, 34298 Montpellier, cedex 5, France; Université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France
| | - S Gourgou
- Unité de biométrie, Institut régional du cancer Montpellier (ICM), rue Croix-Verte, 34298 Montpellier cedex 05, France
| | - M Ozsahin
- Service de radio-oncologie, Centre hospitalier universitaire vaudois, rue du Bugnon 46, 1011 Lausanne, Suisse
| | - D Azria
- Institut de recherche en cancérologie de Montpellier (IRCM), rue Croix-Verte, 34298 Montpellier, cedex 5, France; Inserm U1194, rue Croix-Verte, 34298 Montpellier, cedex 5, France; Université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier, cedex 5, France; Fédération universitaire d'oncologie radiothérapie, institut de cancérologie du Gard, CHU de Nîmes, rue Henri-Pujol, 30000 Nîmes, France.
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Gomolka M, Blyth B, Bourguignon M, Badie C, Schmitz A, Talbot C, Hoeschen C, Salomaa S. Potential screening assays for individual radiation sensitivity and susceptibility and their current validation state. Int J Radiat Biol 2019; 96:280-296. [PMID: 31347938 DOI: 10.1080/09553002.2019.1642544] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose: The workshop on 'Individual Radiosensitivity and Radiosusceptibility' organized by MELODI and CONCERT on Malta in 2018, evaluated the current state of assays to identify sensitive and susceptible subgroups. The authors provide an overview on potential screening assays detecting individuals showing moderate to severe early and late radiation reactions or are at increased risk to develop cancer upon radiation exposure.Conclusion: It is necessary to separate clearly between tissue reactions and stochastic effects such as cancer when comparing the existing literature to validate various test systems. Requirements for the assays are set up. The literature is reviewed for assays that are reliable and robust. Sensitivity and specificity of the assays are regarded and scrutinized for modifying factors. Accuracy of an assay system is required to be more than 90% to balance risks of adverse reactions against risk to fail to cure the cancer. No assay/biomarker is in routine use. Assays that have shown predictive potential for radiosensitivity include SNPs, the RILA assay, and the pATM assay. A tree of risk guideline for radiologists is provided to assist medical treatment decisions. Recommendations for effective research include the setup of common retrospective and prospective cohorts/biobanks to validate current and future tests.
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Affiliation(s)
- Maria Gomolka
- Federal Office for Radiation Protection, Neuherberg, Germany
| | - Benjamin Blyth
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Christophe Badie
- Cancer Mechanisms and Biomarkers Group, Radiation Effects Department Centre for Radiation, Chemical and Environmental Hazards Public Health England, Didcot, United Kingdom
| | - Annette Schmitz
- Institut de Radiobiologie Cellulaire et Moléculaire, Institut de Biologie François Jacob, Direction de la Recherche Fondamentale, CEA, Paris, France
| | - Christopher Talbot
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
| | - Christoph Hoeschen
- Faculty of Electrical Engineering and Information Technology, Institute for Medical Technology, Otto-von-Guericke-University, Magdeburg, Germany
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Tamarat R, Benderitter M. The Medical Follow-up of the Radiological Accident: Épinal 2006. Radiat Res 2019; 192:251-257. [PMID: 31265787 DOI: 10.1667/rr15262.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Radia Tamarat
- Radioprotection and Nuclear Safety Institute (IRSN), Health Division, Fontenay-aux-Roses, France
| | - Marc Benderitter
- Radioprotection and Nuclear Safety Institute (IRSN), Health Division, Fontenay-aux-Roses, France
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Fhoghlú MN, Barrett S. A Review of Radiation-Induced Lymphocyte Apoptosis as a Predictor of Late Toxicity After Breast Radiotherapy. J Med Imaging Radiat Sci 2019; 50:337-344. [PMID: 31176443 DOI: 10.1016/j.jmir.2019.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/28/2019] [Accepted: 02/20/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Improved survivorship in patients with breast cancer means many are currently living with the late effects of radiotherapy, particularly fibrosis. Personalized treatment is not currently considered for patients with breast cancer. Radiation-induced lymphocyte apoptosis (RILA), a predictive assay, could offer a novel approach in predicting patients at a higher risk of developing this late toxicity and therefore improving informed decision-making. MATERIALS AND METHODS A systematic search of PubMed and Embase was performed and eight clinical trials were identified that investigate RILA as a predictor of late breast fibrosis after radiotherapy. RESULTS Median RILA scores were lower in patients who experienced ≥ grade 2 fibrosis than in patients who experienced ≥ grade 1. A clear inverse relationship between RILA scores and late toxicity was reported in the literature; however, there were several other confounding factors involved in the development of fibrosis. CD8 lymphocytes were reported to have superior sensitivity and specificity over CD4 lymphocytes. CONCLUSION RILA was reported to be an effective biomarker in predicting fibrosis in breast cancer but other factors also need to be considered before clinical implementation.
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Affiliation(s)
- Meadhbh Ní Fhoghlú
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sarah Barrett
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland.
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34
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Multi-centre technical evaluation of the radiation-induced lymphocyte apoptosis assay as a predictive test for radiotherapy toxicity. Clin Transl Radiat Oncol 2019; 18:1-8. [PMID: 31341970 PMCID: PMC6610684 DOI: 10.1016/j.ctro.2019.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 11/21/2022] Open
Abstract
The RILA assay is the leading candidate biomarker for radiotherapy toxicity. We describe work to standardise its use across multiple centres. Patient factors including smoking and arthritis were found to affect RILA score. RILA predicts acute breast pain but not other acute end-points. This work establishes the basis for implementing the assay clinically.
Predicting which patients will develop adverse reactions to radiotherapy is important for personalised treatment. Prediction will require an algorithm or nomogram combining clinical and biological data. The radiation-induced lymphocyte apoptosis (RILA) assay is the leading candidate as a biological predictor of radiotherapy toxicity. In this study we tested the potential of the assay for standardisation and use in multiple testing laboratories. The assay was standardised and reproducibility determined using samples from healthy volunteers assayed concurrently in three laboratories in Leicester (UK), Mannheim (Germany) and Montpellier (France). RILA assays were performed on samples taken prior to radiotherapy from 1319 cancer patients enrolled in the REQUITE project at multiple centres. The patients were being treated for breast (n = 753), prostate (n = 506) or lung (n = 60) cancer. Inter-laboratory comparisons identified several factors affecting results: storage time, incubation periods and type of foetal calf serum. Following standardisation, there was no significant difference in results between the centres. Significant differences were seen in RILA scores between cancer types (prostate > breast > lung), by smoking status (non-smokers > smokers) and co-morbidity with rheumatoid arthritis (arthritics > non-arthritics). An analysis of acute radiotherapy toxicity showed as expected that RILA assay does not predict most end-points, but unexpectedly did predict acute breast pain. This result may elucidate the mechanism by which the RILA assay predicts late radiotherapy toxicity. The work shows clinical trials involving multiple laboratory measurement of the RILA assay are feasible and the need to account for tumour type and other variables when applying to predictive models.
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Moreno-Villanueva M, Zhang Y, Feiveson A, Mistretta B, Pan Y, Chatterjee S, Wu W, Clanton R, Nelman-Gonzalez M, Krieger S, Gunaratne P, Crucian B, Wu H. Single-Cell RNA-Sequencing Identifies Activation of TP53 and STAT1 Pathways in Human T Lymphocyte Subpopulations in Response to Ex Vivo Radiation Exposure. Int J Mol Sci 2019; 20:ijms20092316. [PMID: 31083348 PMCID: PMC6539494 DOI: 10.3390/ijms20092316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/02/2019] [Accepted: 05/06/2019] [Indexed: 11/16/2022] Open
Abstract
Detrimental health consequences from exposure to space radiation are a major concern for long-duration human exploration missions to the Moon or Mars. Cellular responses to radiation are expected to be heterogeneous for space radiation exposure, where only high-energy protons and other particles traverse a fraction of the cells. Therefore, assessing DNA damage and DNA damage response in individual cells is crucial in understanding the mechanisms by which cells respond to different particle types and energies in space. In this project, we identified a cell-specific signature for radiation response by using single-cell transcriptomics of human lymphocyte subpopulations. We investigated gene expression in individual human T lymphocytes 3 h after ex vivo exposure to 2-Gy gamma rays while using the single-cell sequencing technique (10X Genomics). In the process, RNA was isolated from ~700 irradiated and ~700 non-irradiated control cells, and then sequenced with ~50 k reads/cell. RNA in each of the cells was distinctively barcoded prior to extraction to allow for quantification for individual cells. Principal component and clustering analysis of the unique molecular identifier (UMI) counts classified the cells into three groups or sub-types, which correspond to CD4+, naïve, and CD8+/NK cells. Gene expression changes after radiation exposure were evaluated using negative binomial regression. On average, BBC3, PCNA, and other TP53 related genes that are known to respond to radiation in human T cells showed increased activation. While most of the TP53 responsive genes were upregulated in all groups of cells, the expressions of IRF1, STAT1, and BATF were only upregulated in the CD4+ and naïve groups, but were unchanged in the CD8+/NK group, which suggests that the interferon-gamma pathway does not respond to radiation in CD8+/NK cells. Thus, single-cell RNA sequencing technique was useful for simultaneously identifying the expression of a set of genes in individual cells and T lymphocyte subpopulation after gamma radiation exposure. The degree of dependence of UMI counts between pairs of upregulated genes was also evaluated to construct a similarity matrix for cluster analysis. The cluster analysis identified a group of TP53-responsive genes and a group of genes that are involved in the interferon gamma pathway, which demonstrate the potential of this method for identifying previously unknown groups of genes with similar expression patterns.
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Affiliation(s)
- Maria Moreno-Villanueva
- NASA Johnson Space Center, Houston, TX 77058, USA.
- Human Performance Research Center, University of Konstanz, 78457 Konstanz, Germany.
| | - Ye Zhang
- NASA Kennedy Space Center, Cape Canaveral, FL 32899, USA.
| | | | - Brandon Mistretta
- Department of Biology and Biochemistry, University of Houston, Houston, TX 77204, USA.
| | - Yinghong Pan
- Department of Biology and Biochemistry, University of Houston, Houston, TX 77204, USA.
| | - Sujash Chatterjee
- Department of Biology and Biochemistry, University of Houston, Houston, TX 77204, USA.
| | - Winston Wu
- Department of Computer Science, Johns Hopkins University, Baltimore, MD 21218, USA.
| | - Ryan Clanton
- NASA Johnson Space Center, Houston, TX 77058, USA.
| | | | | | - Preethi Gunaratne
- Department of Biology and Biochemistry, University of Houston, Houston, TX 77204, USA.
| | | | - Honglu Wu
- NASA Johnson Space Center, Houston, TX 77058, USA.
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Mirjolet C, Merlin JL, Truc G, Noël G, Thariat J, Domont J, Sargos P, Renard-Oldrini S, Ray-Coquard I, Liem X, Chevreau C, Lagrange JL, Mahé MA, Collin F, Bonnetain F, Bertaut A, Maingon P. RILA blood biomarker as a predictor of radiation-induced sarcoma in a matched cohort study. EBioMedicine 2019; 41:420-426. [PMID: 30827931 PMCID: PMC6442988 DOI: 10.1016/j.ebiom.2019.02.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose Radiation-induced sarcoma (RIS) is a rare but serious event. Its occurrence has been discussed during the implementation of new radiation techniques and justified appropriate radioprotection requirements. New approaches targeting intrinsic radio-sensitivity have been described, such as radiation-induced CD8 T-lymphocyte apoptosis (RILA) able to predict late radio-induced toxicities. We studied the role of RILA as a predisposing factor for RIS as a late adverse event following radiation therapy (RT). Patients and methods In this prospective biological study, a total of 120 patients diagnosed with RIS were matched with 240 control patients with cancer other than sarcoma, for age, sex, primary tumor location and delay after radiation. RILA was prospectively assessed from blood samples using flow cytometry. Results Three hundred and forty-seven patients were analyzed (118 RIS patients and 229 matched control patients). A majority (74%) were initially treated by RT for breast cancer. The mean RT dose was comparable with a similar mean (± standard deviation) for RIS (53.7 ± 16.0 Gy) and control patients (57.1 ± 15.1 Gy) (p = .053). Median RILA values were significantly lower in RIS than in control patients with respectively 18.5% [5.5–55.7] and 22.3% [3.8–52.2] (p = .0008). Thus, patients with a RILA >21.3% are less likely to develop RIS (p < .0001, OR: 0.358, 95%CI [0.221–0.599]. Conclusion RILA is a promising indicator to predict an individual risk of developing RIS. Our results should be followed up and compared with molecular and genomic testing in order to better identify patients at risk. A dedicated strategy could be developed to define and inform high-risk patients who require a specific approach for primary tumor treatment and long term follow-up.
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Affiliation(s)
- C Mirjolet
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France
| | - J L Merlin
- Department of Biopathology, Université de Lorraine, CNRS UMR 7039 CRAN, Institut de Cancérologie de Lorraine, Nancy, France
| | - G Truc
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France
| | - G Noël
- Department of Radiation Oncology, Paul Strauss Center, Strasbourg, France
| | - J Thariat
- Department of Radiation Oncology, Antoine Lacassagne center, Nice, France; Department of Radiation Oncology, François Baclesse Center, Caen, France
| | - J Domont
- Department of Oncology, Gustave Roussy, Villejuif, France
| | - P Sargos
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - S Renard-Oldrini
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, NANCY, France
| | - I Ray-Coquard
- Department of Radiation Oncology, Léon Berard Center, Université Claude Bernard, Lyon, France
| | - X Liem
- Department of Radiation Oncology, Oscar Lambret Center, Lille, France
| | - C Chevreau
- Department of Radiation Oncology, IUCT Oncopole, Toulouse, France
| | - J L Lagrange
- Department of Radiation Oncology, Henri Mondor Hospital, Créteil, France
| | - M A Mahé
- Department of Radiation Oncology, ICO René Gauducheau, Saint Herblain, France
| | - F Collin
- Department of Biopathology, Georges François Leclerc Cancer Center, Dijon, France
| | - F Bonnetain
- Department of Statistics, Georges François Leclerc Cancer Center, Dijon, France
| | - A Bertaut
- Department of Statistics, Georges François Leclerc Cancer Center, Dijon, France
| | - P Maingon
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France; Department of Radiation Oncology, Sorbonne Université, GHU La Pitié Salpêtrière Charles Foix, Paris, France.
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Veldwijk MR, Seibold P, Botma A, Helmbold I, Sperk E, Giordano FA, Gürth N, Kirchner A, Behrens S, Wenz F, Chang-Claude J, Herskind C. Association of CD4 + Radiation-Induced Lymphocyte Apoptosis with Fibrosis and Telangiectasia after Radiotherapy in 272 Breast Cancer Patients with >10-Year Follow-up. Clin Cancer Res 2019; 25:562-572. [PMID: 30327309 DOI: 10.1158/1078-0432.ccr-18-0777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/10/2018] [Accepted: 10/11/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Radiation-induced lymphocyte apoptosis (RILA) has been suggested as a predictive assay for adverse late reactions after radiotherapy. Thus, low RILA values of T-lymphocyte subpopulations have been associated with increased risk for various endpoints at 2 to 3 years of follow-up. The purpose was to test if such associations persist for specific endpoints (subcutaneous fibrosis, telangiectasia) in breast cancer patients with at least 10 years of follow-up.Experimental Design: Two hundred and seventy-two female patients who had received breast-conserving therapy within the German ISE study were included (median follow-up: 11.6 years). Radiotherapy-induced side effects were scored according to the Late Effects in Normal Tissues-Subjective, Objective, Management, and Analytic (LENT-SOMA) classification system. RILA in the CD4+, CD8+, and natural killer (NK) subpopulations from peripheral blood was analyzed by flow cytometry. Multivariate predictive modeling was performed including relevant clinical risk factors. RESULTS Low CD4+ RILA was associated with increased risk for both fibrosis (P = 0.011) and telangiectasia (P < 0.001). For fibrosis, the association was stronger outside the surgical area (Fibout; P = 0.004) than within (Fibin; P = 0.17). Predictive multivariate modeling including clinical risk factors yielded OR of 3.48 (95% confidence interval, 1.84-6.58) for any fibrosis and 8.60 (2.71-27.3) for telangiectasia. Addition of CD4+ RILA to the clinical variables improved discrimination (c statistics) from 0.62 to 0.68 for any fibrosis, 0.62 to 0.66 for Fibin, 0.61 to 0.69 for Fibout, and from 0.65 to 0.76 for telangiectasia. CD8+ and NK RILA were not significantly associated with radiotherapy-related late reactions. CONCLUSIONS The results provide first evidence that low CD4+ RILA is associated with increased subcutaneous fibrosis and telangiectasia even after 10 years. This supports the potential usefulness for predicting individual clinical risk.
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Affiliation(s)
- Marlon R Veldwijk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Akke Botma
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Irmgard Helmbold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elena Sperk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicole Gürth
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anne Kirchner
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Cancer Epidemiology Group, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Germany
| | - Carsten Herskind
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Chua KLM, Yeo ELL, Shihabudeen WA, Tan SH, Shwe TT, Ong EHW, Lam PYP, Soo KC, Soong YL, Fong KW, Tan TWK, Wee JTS, Chua MLK. Intra-patient and inter-patient comparisons of DNA damage response biomarkers in Nasopharynx Cancer (NPC): analysis of NCC0901 randomised controlled trial of induction chemotherapy in locally advanced NPC. BMC Cancer 2018; 18:1095. [PMID: 30419858 PMCID: PMC6233280 DOI: 10.1186/s12885-018-5005-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inter-patient heterogeneity in radiation-induced DNA damage responses is proposed to reflect intrinsic variations in tumour and normal tissue radiation sensitivity, but the prediction of phenotype by a molecular biomarker is influenced by clinical confounders and assay reproducibility. Here, we characterised the intrapatient and inter-patient heterogeneity in biomarkers of DNA damage and repair and radiation-induced apoptosis. METHODS We enrolled 85 of 172 patients with locally advanced nasopharynx cancer from a randomised controlled phase II/III trial of induction chemotherapy added to chemo-radiotherapy. G0 blood lymphocytes were harvested from these patients, and irradiated with 1, 4, and 8 Gy ex vivo. DNA damage induction (1 Gy 0.5 h) and repair (4 Gy 24 h) were assessed by duplicate γH2AX foci assays in 50-100 cells. Duplicate FLICA assays performed at 48 h post-8 Gy were employed as surrogate of radiation-induced apoptosis; %FLICA-positive cells were quantified by flow cytometry. RESULTS We observed limited intrapatient variation in γH2AX foci and %FLICA readouts; median difference of duplicate foci scores was - 0.37 (IQR = - 1.256-0.800) for 1 Gy 0.5 h and 0.09 (IQR = - 0.685-0.792) for 4 Gy 24 h; ICC of ≥0.80 was observed for duplicate %FLICA0Gy and %FLICA8Gy assays of CD4+ and CD8+ T lymphocytes. As expected, we observed wide inter-patient heterogeneity in both assays that was independent of intrapatient variation and clinical covariates, with the exception of age, which was inversely correlated with %FLICAbackground-corrected (Spearman R = - 0.406, P < 0.001 [CD4+]; R = - 0.220, P = 0.04 [CD8+]). Lastly, an exploratory case-control analysis indicates increased levels of γH2AX foci at 4 Gy 24 h in patients with severe late radiotherapy-induced xerostomia (P = 0.05). CONCLUSION Here, we confirmed the technical reproducibility of DNA damage response assays for clinical implementation as biomarkers of clinical radiosensitivity in nasopharynx cancer patients.
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Affiliation(s)
- Kevin Lee Min Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
| | - Eugenia Li Ling Yeo
- Division of Medical Sciences, National Cancer Centre, Singapore, Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
| | - Waseem Ahamed Shihabudeen
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
| | - Sze Huey Tan
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, Singapore, Singapore
| | - Than Than Shwe
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
| | - Enya Hui Wen Ong
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
| | - Paula Yeng Po Lam
- Division of Cellular and Molecular Research, National Cancer Centre, Singapore, Singapore
| | - Khee Chee Soo
- Division of Medical Sciences, National Cancer Centre, Singapore, Singapore
- Division of Surgical Oncology, National Cancer Centre, Singapore, Singapore
| | - Yoke Lim Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
| | - Kam Weng Fong
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
| | - Terence Wee Kiat Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
| | - Joseph Tien Seng Wee
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
| | - Melvin Lee Kiang Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- Division of Medical Sciences, National Cancer Centre, Singapore, Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
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Vogin G, Merlin JL, Rousseau A, Peiffert D, Harlé A, Husson M, Hajj LE, Levitchi M, Simon T, Simon JM. Absence of correlation between radiation-induced CD8 T-lymphocyte apoptosis and sequelae in patients with prostate cancer accidentally overexposed to radiation. Oncotarget 2018; 9:32680-32689. [PMID: 30220974 PMCID: PMC6135683 DOI: 10.18632/oncotarget.26001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/04/2018] [Indexed: 01/16/2023] Open
Abstract
Purpose 454 patients with prostate adenocarcinoma were accidentally overexposed to radiation in Epinal hospital, France, between August 1999 and January 2007. We aimed toevaluate whether radiation-induced CD4 or CD8 T-lymphocyte apoptosis (RILA) correlates with the severity of radiation toxicity. Methods Between 2007 and 2013, all patients who received more than 108% of the prescribed radiation dose, after correction of the treatment plan, were convened, and blood was sampled at 6-months follow-up. Maximal Digestive toxicity (MDT) and maximal urinary toxicity (MUT) were graded using the Common Terminology Criteria for Adverse Events (NCI-CTCAE) v3.0 scale. RILA was assessed using flow cytometry. Results 245 patients were included in our study. After a median follow-up of 4.8 years, the MDT and MUT reached grade 3-4 in 37 patients and 56 patients, respectively. Patients with prostatectomy exhibited a statistically higher grade of MUT compared with those treated with definitive radiotherapy (p=0.03). The median RILA values were 11.8% and 15.3% for CD4 and CD8 T-lymphocytes, respectively. We found no significant correlation between CD4 or CD8 RILA and either MDT or MUT. Conclusion RILA does not correlate with the inter-individual variation in MDT or MUT in the largest cohort of patients overexposed to radiation. The magnitude of the overdosage probably overrides biological predictors of toxicity, including individual radiosensitivity.
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Affiliation(s)
- Guillaume Vogin
- Institut de Cancérologie de Lorraine, Département de Radiothérapie, 54500 Vandœuvre-lès-Nancy, France.,UMR 7365 CNRS-Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Jean-Louis Merlin
- Université de Lorraine, Faculté de Pharmacie, 54000 Nancy, France.,CNRS UMR 7039 CRAN Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France.,Institut de Cancérologie de Lorraine, Service de Biopathologie, 54500 Vandœuvre-lès-Nancy, France
| | - Alexandra Rousseau
- APHP, Unité de Recherche Clinique de l'Est Parisien (URC-Est), Hôpital Saint Antoine, 75012 Paris, France
| | - Didier Peiffert
- CNRS UMR 7039 CRAN Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Alexandre Harlé
- Institut de Cancérologie de Lorraine, Département de Radiothérapie, 54500 Vandœuvre-lès-Nancy, France.,UMR 7365 CNRS-Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France.,Université de Lorraine, Faculté de Pharmacie, 54000 Nancy, France
| | - Marie Husson
- Université de Lorraine, Faculté de Pharmacie, 54000 Nancy, France
| | - Labib El Hajj
- CNRS UMR 7039 CRAN Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Mihai Levitchi
- CNRS UMR 7039 CRAN Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Tabassome Simon
- APHP, Unité de Recherche Clinique de l'Est Parisien (URC-Est), Hôpital Saint Antoine, 75012 Paris, France
| | - Jean-Marc Simon
- APHP, Hôpital Universitaire de la Pitié Salpêtrière, Service de Radiothérapie, 75013 Paris, France
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Nguyen HQ, To NH, Zadigue P, Kerbrat S, De La Taille A, Le Gouvello S, Belkacemi Y. Ionizing radiation-induced cellular senescence promotes tissue fibrosis after radiotherapy. A review. Crit Rev Oncol Hematol 2018; 129:13-26. [PMID: 30097231 DOI: 10.1016/j.critrevonc.2018.06.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 06/08/2018] [Accepted: 06/15/2018] [Indexed: 02/06/2023] Open
Abstract
Ionizing radiation-exposure induces a variety of cellular reactions, such as senescence and apoptosis. Senescence is a permanent arrest state of the cell division, which can be beneficial or detrimental for normal tissue via an inflammatory response and senescence-associated secretion phenotype. Damage to healthy cells and their microenvironment is considered as an important source of early and late complications with an increased risk of morbidity in patients after radiotherapy (RT). In addition, the benefit/risk ratio may depend on the radiation technique/dose used for cancer eradication and the irradiated volume of healthy tissues. For radiation-induced fibrosis risk, the knowledge of mechanisms and potential prevention has become a crucial point to determining radiation parameters and patients' intrinsic radiosensitivity. This review summarizes our understanding of ionizing radiation-induced senescent cell in fibrogenesis. This mechanism may provide new insights for therapeutic modalities for better risk/benefit ratios after RT in the new era of personalized treatments.
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Affiliation(s)
- Hoang Quy Nguyen
- University of Paris Saclay, University of Paris Est Créteil (UPEC), France, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam; INSERM U955 Team 07, Créteil, France
| | - Nhu Hanh To
- INSERM U955 Team 07, Créteil, France; APHP, Department of Radiation Oncology and Henri Mondor Breast Cancer and, Henri Mondor University Hospital, University of Paris Est Créteil (UPEC), France
| | | | - Stéphane Kerbrat
- INSERM U955 Team 04, University of Paris Est Créteil (UPEC), France
| | - Alexandre De La Taille
- INSERM U955 Team 07, Créteil, France; APHP, Department of Urology, Henri Mondor University Hospital, University of Paris Est Créteil (UPEC), Créteil, France
| | - Sabine Le Gouvello
- INSERM U955 Team 04, University of Paris Est Créteil (UPEC), France; APHP, Department of Biology & Pathology, Henri Mondor University Hospital, University of Paris Est Créteil (UPEC), Créteil, France
| | - Yazid Belkacemi
- INSERM U955 Team 07, Créteil, France; APHP, Department of Radiation Oncology and Henri Mondor Breast Cancer and, Henri Mondor University Hospital, University of Paris Est Créteil (UPEC), France.
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In Reply to Azria et al. Int J Radiat Oncol Biol Phys 2018; 101:491-492. [DOI: 10.1016/j.ijrobp.2018.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/09/2018] [Indexed: 11/16/2022]
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Ferlazzo ML, Bourguignon M, Foray N. Functional Assays for Individual Radiosensitivity: A Critical Review. Semin Radiat Oncol 2018; 27:310-315. [PMID: 28865513 DOI: 10.1016/j.semradonc.2017.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A complete understanding of the mechanisms of the response to radiation would help in a better evaluation of the radiation-induced risks. To this aim, individual radiosensitivity, that is, the proneness to radiation-induced tissue reactions attributable to cell death, has been documented since the beginning of the 20th century. For several decades, developing informative predictive assays has been one of the most important challenges of radiobiologists. This article is a critical review devoted to the major functional assays to predict radiosensitivity and their strengths and weaknesses, notably those based on the quantification of clonogenic cell survival, micronuclei, p21 expression, apoptosis, chromosome and DNA repair, and signaling. Genomic approaches of radiosensitivity are reviewed in another article of this issue.
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Affiliation(s)
- Mélanie L Ferlazzo
- Inserm, UMR 1052, Groupe de Radiobiologie, Centre de Recherche sur le Cancer, Lyon, France
| | - Michel Bourguignon
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay aux Roses, France
| | - Nicolas Foray
- Inserm, UMR 1052, Groupe de Radiobiologie, Centre de Recherche sur le Cancer, Lyon, France.
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Azria D, Brengues M, Gourgou S, Bourgier C. Personalizing Breast Cancer Irradiation Using Biology: From Bench to the Accelerator. Front Oncol 2018; 8:83. [PMID: 29675397 PMCID: PMC5895767 DOI: 10.3389/fonc.2018.00083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/12/2018] [Indexed: 11/30/2022] Open
Abstract
While adjuvant treatments of early breast cancers (BCs) had significantly improved patients’ overall survival, some of them will still develop locoregional relapses and/or severe late radio-induced toxicities. Here, we propose to review how to personalize locoregional treatment by identifying patients at high and low risk of locoregional relapse, patients at risk of late radio-induced side effects. We will, therefore, discuss how to enhance BC radiosensitivity. Finally, we will address how personalized radiotherapy could be implemented in prospective clinical trials.
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Affiliation(s)
- David Azria
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Montpellier, France.,Université de Montpellier, Montpellier, France.,Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Muriel Brengues
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Montpellier, France
| | - Sophie Gourgou
- Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Celine Bourgier
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Montpellier, France.,Université de Montpellier, Montpellier, France.,Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
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Bourgier C, Castan F, Riou O, Nguyen TD, Peignaux K, Lemanski C, Lagrange JL, Kirova Y, Lartigau E, Belkacemi Y, Rivera S, Noël G, Clippe S, Mornex F, Hennequin C, Gourgou S, Brengues M, Fenoglietto P, Ozsahin EM, Azria D. Impact of adjuvant hormonotherapy on radiation-induced breast fibrosis according to the individual radiosensitivity: results of a multicenter prospective French trial. Oncotarget 2018; 9:15757-15765. [PMID: 29644007 PMCID: PMC5884662 DOI: 10.18632/oncotarget.24606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/25/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To evaluate risk of severe breast fibrosis occurrence in patients treated by breast-conserving surgery, adjuvant radiotherapy and hormonotherapy (HT) according to individual radiosensitivity (RILA assay). RESULTS HT- and RILAhigh were the two independent factors associated with improved breast-fibrosis free survival (BFFS). BFFS rate at 36 months was lower in patients with RILAlow and HT+ than in patients with RILAhigh and HT- (75.8% and 100%, respectively; p = 0.004, hazard ratio 5.84 [95% confidence interval (CI) 1.8-19.1]). Conversely, BFFS at 36 months was comparable in patients with RILAhigh and HT+ and in patients with RILAlow and HT- (89.8% and 93.5%, respectively; p = 0.39, hazard ratio 1.7 [95% CI 0.51-5.65]), showing that these two parameters influenced independently the occurrence of severe breast fibrosis. BFFS rate was not affected by the HT type (tamoxifen or aromatase inhibitor) and timing (concomitant or sequential with radiotherapy). CONCLUSIONS HT and RILA score independently influenced BFFS rate at 36 months. Patients with RILAhigh and HT- presented an excellent BFFS at 36 months (100%). MATERIALS AND METHODS Breast Fibrosis-Free Survival (BFFS) rate was assessed relative to RILA categories and to adjuvant HT use (HT+ and HT-, respectively) in a prospective multicentre study (NCT00893035) which enrolled 502 breast cancer patients (456 evaluable patients). Breast fibrosis was recorded according to CTCAE v3.0 grading scale; RILA score was defined according to two categories (<12%: RILAlow; ≥12%: RILAhigh).
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Affiliation(s)
- Céline Bourgier
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Florence Castan
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Olivier Riou
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | | | | | - Claire Lemanski
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | | | | | | | | | | | | | | | | | | | - Sophie Gourgou
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Muriel Brengues
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Pascal Fenoglietto
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | | | - David Azria
- Institute de Recherche en Cancérologie de Montpellier, Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
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Beschel LM, Leu M, Reichardt SD, Rave-Fränk M, Schirmer MA, Stadelmann C, Canis M, Wolff HA, Reichardt HM. T cell abundance in blood predicts acute organ toxicity in chemoradiotherapy for head and neck cancer. Oncotarget 2018; 7:65902-65915. [PMID: 27589568 PMCID: PMC5323201 DOI: 10.18632/oncotarget.11677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 08/15/2016] [Indexed: 01/10/2023] Open
Abstract
Treatment of head and neck squamous cell carcinoma (HNSCC) by chemoradiotherapy (CRT) often results in high-grade acute organ toxicity (HGAOT). As these adverse effects impair the patients' quality of life and the feasibility of the planned therapy, we sought to analyze immunological parameters in tumor material and blood samples obtained from 48 HNSCC patients in order to assess the potential to predict the individual acute organ toxicity. T cells in the tumor stroma were enriched in patients developing HGAOT whereas levels of soluble factors in the plasma and gene expression in whole blood did not coincide with the occurrence of acute organ toxicity. In contrast, the frequency and absolute numbers of selected leukocyte subpopulations measured in samples of peripheral blood mononuclear cells (PBMCs) directly before the beginning of CRT were significantly different in patients with HGAOT as compared to those without. When we validated several potential markers including the abundance of T cells in a small prospective study with 16 HNSCC patients, we were able to correctly predict acute organ toxicity in up to 81% of the patients. We conclude that analysis of PBMCs by fluorescence-activated cell sorting (FACS) might be a convenient strategy to identify patients at risk of developing HGAOT caused by CRT, which might allow to adapt the treatment regimen and possibly improve disease outcome.
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Affiliation(s)
- L Milena Beschel
- Institute for Cellular and Molecular Immunology, University Medical Center, Georg-August-University Göttingen, Germany
| | - Martin Leu
- Department of Radiotherapy and Radiooncology, University Medical Center, Georg-August-University Göttingen, Germany
| | - Sybille D Reichardt
- Institute for Cellular and Molecular Immunology, University Medical Center, Georg-August-University Göttingen, Germany
| | - Margret Rave-Fränk
- Department of Radiotherapy and Radiooncology, University Medical Center, Georg-August-University Göttingen, Germany
| | - Markus A Schirmer
- Department of Radiotherapy and Radiooncology, University Medical Center, Georg-August-University Göttingen, Germany.,Institute of Clinical Pharmacology, University Medical Center, Georg-August-University Göttingen, Germany
| | - Christine Stadelmann
- Institute of Neuropathology, University Medical Center, Georg-August-University Göttingen, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Georg-August-University Göttingen, Germany
| | - Hendrik A Wolff
- University Medical Center, Georg-August-University Göttingen, Germany.,Present address: Strahlentherapie Radiologie München, Germany
| | - Holger M Reichardt
- Institute for Cellular and Molecular Immunology, University Medical Center, Georg-August-University Göttingen, Germany
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Wang WA, Lai LC, Tsai MH, Lu TP, Chuang EY. Development of a prediction model for radiosensitivity using the expression values of genes and long non-coding RNAs. Oncotarget 2018; 7:26739-50. [PMID: 27050376 PMCID: PMC5042011 DOI: 10.18632/oncotarget.8496] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/14/2016] [Indexed: 12/21/2022] Open
Abstract
Radiotherapy has become a popular and standard approach for treating cancer patients because it greatly improves patient survival. However, some of the patients receiving radiotherapy suffer from adverse effects and do not obtain survival benefits. This may be attributed to the fact that most radiation treatment plans are designed based on cancer type, without consideration of each individual's radiosensitivity. A model for predicting radiosensitivity would help to address this issue. In this study, the expression levels of both genes and long non-coding RNAs (lncRNAs) were used to build such a prediction model. Analysis of variance and Tukey's honest significant difference tests (P < 0.001) were utilized in immortalized B cells (GSE26835) to identify differentially expressed genes and lncRNAs after irradiation. A total of 41 genes and lncRNAs associated with radiation exposure were revealed by a network analysis algorithm. To develop a predictive model for radiosensitivity, the expression profiles of NCI-60 cell lines along, with their radiation parameters, were analyzed. A genetic algorithm was proposed to identify 20 predictors, and the support vector machine algorithm was used to evaluate their prediction performance. The model was applied to 2 datasets of glioblastoma, The Cancer Genome Atlas and GSE16011, and significantly better survival was observed in patients with greater predicted radiosensitivity.
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Affiliation(s)
- Wei-An Wang
- Graduate Institute of Biomedical Electronics and Bioinformatics and Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Liang-Chuan Lai
- Bioinformatics and Biostatistics Core, Center for Genomic Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Physiology, National Taiwan University, Taipei, Taiwan
| | - Mong-Hsun Tsai
- Bioinformatics and Biostatistics Core, Center for Genomic Medicine, National Taiwan University, Taipei, Taiwan.,Institute of Biotechnology, National Taiwan University, Taipei, Taiwan
| | - Tzu-Pin Lu
- Institute of Epidemiology and Preventive Medicine, Department of Public Health, National Taiwan University, Taipei, Taiwan
| | - Eric Y Chuang
- Graduate Institute of Biomedical Electronics and Bioinformatics and Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan.,Bioinformatics and Biostatistics Core, Center for Genomic Medicine, National Taiwan University, Taipei, Taiwan
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TNFSF10/TRAIL regulates human T4 effector memory lymphocyte radiosensitivity and predicts radiation-induced acute and subacute dermatitis. Oncotarget 2017; 7:21416-27. [PMID: 26982083 PMCID: PMC5008295 DOI: 10.18632/oncotarget.7893] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/18/2016] [Indexed: 12/31/2022] Open
Abstract
Sensitivity of T4 effector-memory (T4EM) lymphocytes to radiation-induced apoptosis shows heritability compatible with a Mendelian mode of transmission. Using gene expression studies and flow cytometry, we show a higher TNF-Related Apoptosis Inducing Ligand (TRAIL/TNFSF10) mRNA level and a higher level of membrane bound TRAIL (mTRAIL) on radiosensitive compared to radioresistant T4EM lymphocytes. Functionally, we show that mTRAIL mediates a pro-apoptotic autocrine signaling after irradiation of T4EM lymphocytes linking mTRAIL expression to T4EM radiosensitivity. Using single marker and multimarker Family-Based Association Testing, we identified 3 SNPs in the TRAIL gene that are significantly associated with T4EM lymphocytes radiosensitivity. Among these 3 SNPs, two are also associated with acute and subacute dermatitis after radiotherapy in breast cancer indicating that T4EM lymphocytes radiosensitivity may be used to predict response to radiotherapy. Altogether, these results show that mTRAIL level regulates the response of T4EM lymphocytes to ionizing radiation and suggest that TRAIL/TNFSF10 genetic variants hold promise as markers of individual radiosensitivity.
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48
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Pereira S, Bodgi L, Duclos M, Canet A, Ferlazzo ML, Devic C, Granzotto A, Deneuve S, Vogin G, Foray N. Fast and Binary Assay for Predicting Radiosensitivity Based on the Theory of ATM Nucleo-Shuttling: Development, Validation, and Performance. Int J Radiat Oncol Biol Phys 2017; 100:353-360. [PMID: 29353653 DOI: 10.1016/j.ijrobp.2017.10.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/02/2017] [Accepted: 10/10/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE To examine the possibility of predicting clinical radiosensitivity by quantifying the nuclear forms of autophosphorylated ATM protein (pATM) via a specific enzyme-linked immunosorbent assay (ELISA). METHODS AND MATERIALS This study was performed on 30 skin fibroblasts from 9 radioresistant patients and 21 patients with adverse tissue reaction events. Patients were divided into 2 groups: radioresistant (toxicity grade <2) and radiosensitive (toxicity grade ≥2). The quantity of nuclear pATM molecules was assessed by the ELISA method at 10 minutes and 1 hour after 2 Gy and compared with pATM immunofluorescence data. RESULTS The pATM ELISA data were in quantitative agreement with the immunofluorescence data. A receiver operating characteristic analysis was applied first to 2 data sets (a training set [n=14] and a validating [n=16] set) and thereafter to all the data with a 2-fold cross-validation method. The assay showed an area under the curve value higher than 0.8, a sensitivity of 0.8, and a specificity ranging from 0.75 to 1, which strongly documents the predictive power of the pATM ELISA. CONCLUSION This study showed that the assessment of nuclear pATM quantity after 2 Gy via an ELISA technique can be the basis of a predictive assay with the highest statistical performance among the available predictive approaches.
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Affiliation(s)
- Sandrine Pereira
- Institut National de la Santé et de la Recherche Médicale, Radiobiology Group, Cancer Research Centre of Lyon, Unité Mixte de Recherche 1052, Institut National de la Santé et de la Recherche Médicale, Lyon, France; Neolys Diagnostics, Lyon, France
| | - Larry Bodgi
- Institut National de la Santé et de la Recherche Médicale, Radiobiology Group, Cancer Research Centre of Lyon, Unité Mixte de Recherche 1052, Institut National de la Santé et de la Recherche Médicale, Lyon, France; Neolys Diagnostics, Lyon, France
| | - Mirlande Duclos
- Institut National de la Santé et de la Recherche Médicale, Radiobiology Group, Cancer Research Centre of Lyon, Unité Mixte de Recherche 1052, Institut National de la Santé et de la Recherche Médicale, Lyon, France; Neolys Diagnostics, Lyon, France
| | - Aurélien Canet
- Institut National de la Santé et de la Recherche Médicale, Radiobiology Group, Cancer Research Centre of Lyon, Unité Mixte de Recherche 1052, Institut National de la Santé et de la Recherche Médicale, Lyon, France; Neolys Diagnostics, Lyon, France; Université de Lyon, Institut Camille Jordan, Université de Lyon, Villeurbanne, France
| | - Mélanie L Ferlazzo
- Institut National de la Santé et de la Recherche Médicale, Radiobiology Group, Cancer Research Centre of Lyon, Unité Mixte de Recherche 1052, Institut National de la Santé et de la Recherche Médicale, Lyon, France
| | - Clément Devic
- Institut National de la Santé et de la Recherche Médicale, Radiobiology Group, Cancer Research Centre of Lyon, Unité Mixte de Recherche 1052, Institut National de la Santé et de la Recherche Médicale, Lyon, France
| | - Adeline Granzotto
- Institut National de la Santé et de la Recherche Médicale, Radiobiology Group, Cancer Research Centre of Lyon, Unité Mixte de Recherche 1052, Institut National de la Santé et de la Recherche Médicale, Lyon, France
| | | | - Guillaume Vogin
- Institut National de la Santé et de la Recherche Médicale, Radiobiology Group, Cancer Research Centre of Lyon, Unité Mixte de Recherche 1052, Institut National de la Santé et de la Recherche Médicale, Lyon, France
| | - Nicolas Foray
- Institut National de la Santé et de la Recherche Médicale, Radiobiology Group, Cancer Research Centre of Lyon, Unité Mixte de Recherche 1052, Institut National de la Santé et de la Recherche Médicale, Lyon, France.
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Pavlopoulou A, Bagos PG, Koutsandrea V, Georgakilas AG. Molecular determinants of radiosensitivity in normal and tumor tissue: A bioinformatic approach. Cancer Lett 2017; 403:37-47. [DOI: 10.1016/j.canlet.2017.05.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 12/13/2022]
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50
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Flippot R, Massard C, Auclin E, Azria D, Bourien H, Rochigneux P, Schernberg A, Verlingue L, Zafrani L, Vignot S. Quelle vision des biomarqueurs en 2017 ? Promesses et défis de la médecine personnalisée en oncologie. Bull Cancer 2017; 104:735-743. [DOI: 10.1016/j.bulcan.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022]
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