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Efficacy and Tolerance of IMRT Boost Compared to IORT Boost in Early Breast Cancer: A German Monocenter Study. Cancers (Basel) 2022; 14:cancers14246196. [PMID: 36551680 PMCID: PMC9776951 DOI: 10.3390/cancers14246196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/01/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The aim of this retrospective study is to compare the two boost subgroups, IORT or IMRT, in terms of overall survival (OS), progression-free survival (PFS), cosmesis, and acute and late toxicity. It shall be shown whether and which of the boost techniques offers better results with respect to the facial points, since there are already many studies on applying boost to the tumor bed after/during breast conserving surgery, and there are few which compare the different techniques. For this comparison, two subgroups of 76 patients each (n = 152), treated between 2002 and 2015, were enrolled in the study. In one subgroup, the 9 Gy boost was intraoperatively administered after complete removal of the primary tumor, while the other subgroup received the boost of 8.4 Gy percutaneously and simultaneously integrated into the tumor bed after breast conserving surgery. Both subgroups have subsequently undergone whole breast irradiation (WBI) of 50.4/50 Gy in 1.8−2 Gy per fraction. OS and the incidence of late toxicity did not differ between the two subgroups and no risk factor was found regarding PFS. Acute toxicities initially occurred significantly less (p < 0.001) in the IORT subgroup; however, after WBI took place, this difference vanished. Therefore, boost application by means of IORT or IMRT can be considered equivalent.
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Dróżdż A, Waluś M, Zieliński M, Malesa B, Kruszyna-Mochalska M, Kulcenty K, Adamczyk B, Nowaczyk P, Malicki J, Pracz J. Verification of electron beam parameters in an intraoperative linear accelerator using dosimetric and radiobiological response methods. Rep Pract Oncol Radiother 2021; 26:1029-1034. [PMID: 34992877 PMCID: PMC8726448 DOI: 10.5603/rpor.a2021.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The availability of linear accelerators (linac) for research purposes is often limited and therefore alternative radiation sources are needed to conduct radiobiological research. The National Centre for Radiation Research in Poland recently developed an intraoperative mobile linac that enables electron irradiation at energies ranging from 4 to 12 MeV and dose rates of 5 or 10 Gy/min. The present study was conducted to evaluate the electron beam parameters of this intraoperative linac and to verify the set-up to evaluate out-of-field doses in a water phantom, which were determined through dosimetric and biological response measurements. MATERIALS AND METHODS The distribution of radiation doses along and across the radiation beam were measured in a water phantom using a semiconductor detector and absolute doses using an ionisation chamber. Two luminal breast cancer cell lines (T-47D and HER2 positive SK-BR-3) were placed in the phantom to study radiation response at doses ranging from 2 to 10 Gy. Cell response was measured by clonogenic assays. RESULTS AND CONCLUSION The electron beam properties, including depth doses and profiles, were within expected range for the stated energies. These results confirm the viability of this device and set-up as a source of megavoltage electrons to evaluate the radiobiological response of tumour cells.
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Affiliation(s)
| | - Martyna Waluś
- National Centre for Nuclear Research, Otwock-Swierk, Poland
| | | | - Bożena Malesa
- National Centre for Nuclear Research, Otwock-Swierk, Poland
| | - Marta Kruszyna-Mochalska
- Medical Physics Department, Greater Poland Cancer Centre, Poznan, Poland
- Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Beata Adamczyk
- Breast Surgical Oncology Department, Greater Poland Cancer Centre, Poznan, Poland
| | - Piotr Nowaczyk
- Breast Surgical Oncology Department, Greater Poland Cancer Centre, Poznan, Poland
| | - Julian Malicki
- Medical Physics Department, Greater Poland Cancer Centre, Poznan, Poland
- Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek Pracz
- Department of Nuclear Equipment HITEC, National Centre For Nuclear Research, Swierk, Poland
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Ciabattoni A, Gregucci F, Fastner G, Cavuto S, Spera A, Drago S, Ziegler I, Mirri MA, Consorti R, Sedlmayer F. IOERT versus external beam electrons for boost radiotherapy in stage I/II breast cancer: 10-year results of a phase III randomized study. Breast Cancer Res 2021; 23:46. [PMID: 33849606 PMCID: PMC8045244 DOI: 10.1186/s13058-021-01424-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/31/2021] [Indexed: 01/09/2023] Open
Abstract
Background Intraoperative radiotherapy with electrons (IOERT) boost could be not inferior to external beam radiotherapy (EBRT) boost in terms of local control and tissue tolerance. The aim of the study is to present the long-term follow-up results on local control, esthetic evaluation, and toxicity of a prospective study on early-stage breast cancer patients treated with breast-conserving surgery with an IOERT boost of 10 Gy (experimental group) versus 5 × 2 Gy EBRT boost (standard arm). Both arms received whole-breast irradiation (WBI) with 50 Gy (2 Gy single dose). Methods A single-institution phase III randomized study to compare IOERT versus EBRT boost in early-stage breast cancer was conducted as a non-inferiority trial. Primary endpoints were the evaluation of in-breast true recurrences (IBTR) and out-field local recurrences (LR) as well as toxicity and cosmetic results. Secondary endpoints were overall survival (OS), disease-free survival (DFS), and patient’s grade of satisfaction with cosmetic outcomes. Results Between 1999 and 2004, 245 patients were randomized: 133 for IOERT and 112 for EBRT. The median follow-up was 12 years (range 10–16 years). The cumulative risk of IBTR at 5–10 years was 0.8% and 4.3% after IOERT, compared to 4.2% and 5.3% after EBRT boost (p = 0.709). The cumulative risk of out-field LR at 5–10 years was 4.7% and 7.9% for IOERT versus 5.2% and 10.3% for EBRT (p = 0.762). All of the IOERT arm recurrences were observed at > 100 months’ follow-up, whereas the mean time to recurrence in the EBRT group was earlier (55.2 months) (p < 0.05). No late complications associated with IOERT were observed. The overall cosmetic results were scored as good or excellent in physician and patient evaluations for both IOERT and EBRT. There were significantly better scores for IOERT at all time points in physician and patient evaluations with the greatest difference at the end of EBRT (p = 0.006 objective and p = 0.0004 subjective) and most narrow difference at 12 months after the end of EBRT (p = 0.08 objective and p = 0.04 subjective analysis). Conclusion A 10-Gy IOERT boost during breast-conserving surgery provides high local control rates without significant morbidity. Although not significantly superior to external beam boosts, the median time to local recurrences after IOERT is prolonged by more than 4 years.
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Affiliation(s)
| | - Fabiana Gregucci
- Department of Radiation Oncology, Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy.
| | - Gerd Fastner
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Silvio Cavuto
- Infrastructure Research and Statistics, Clinical Trials and Statistics Unit, AUSL-IRCCS, Reggio Emilia, Italy
| | - Antonio Spera
- Department of Radiotherapy, San Giovanni di Dio Hospital, ASP Agrigento, Agrigento, Italy
| | - Stefano Drago
- Department of Breast and Reconstructive Surgery, Sando Pertini Hospital, Rome, Italy
| | - Ingrid Ziegler
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | | | - Rita Consorti
- Medical Physics Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Felix Sedlmayer
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
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Linares-Galiana I, Berenguer-Frances MA, Cañas-Cortés R, Pujol-Canadell M, Comas-Antón S, Martínez E, Laplana M, Pérez-Montero H, Pla-Farnós MJ, Navarro-Martin A, Nuñez M, Both B, Guedea F. Changes in peripheral immune cells after intraoperative radiation therapy in low-risk breast cancer. JOURNAL OF RADIATION RESEARCH 2021; 62:110-118. [PMID: 33006364 PMCID: PMC7779348 DOI: 10.1093/jrr/rraa083] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/07/2020] [Indexed: 05/15/2023]
Abstract
A detailed understanding of the interactions and the best dose-fractionation scheme of radiation to maximize antitumor immunity have not been fully established. In this study, the effect on the host immune system of a single dose of 20 Gy through intraoperative radiation therapy (IORT) on the surgical bed in low-risk breast cancer patients undergoing conserving breast cancer has been assessed. Peripheral blood samples from 13 patients were collected preoperatively and at 48 h and 3 and 10 weeks after the administration of radiation. We performed a flow cytometry analysis for lymphocyte subpopulations, natural killer cells (NK), regulatory T cells (Treg) and myeloid-derived suppressor cells (MDSCs). We observed that the subpopulation of NK CD56+high CD16+ increased significantly at 3 weeks after IORT (0.30-0.42%, P < 0.001), while no changes were found in immunosuppressive profile, CD4+CD25+Foxp3+Helios+ Treg cells, granulocytic MDSCs (G-MDSCs) and monocytic MDSCs (Mo-MDSCs). A single dose of IORT may be an effective approach to improve antitumor immunity based on the increase in NK cells and the non-stimulation of immunosuppressive cells involved in immune escape. These findings support future combinations of IORT with immunotherapy, if they are confirmed in a large cohort of breast cancer patients.
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Affiliation(s)
- Isabel Linares-Galiana
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
- Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - Miguel Angel Berenguer-Frances
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
- Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - Rut Cañas-Cortés
- Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - Monica Pujol-Canadell
- Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - Silvia Comas-Antón
- Radiation Oncology Department, Hospital Germans Trias i Pujol, Institut Català d'Oncologia (ICO), Carretera de Canyet, s/n, 08916 Badalona, Spain
| | - Evelyn Martínez
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - Maria Laplana
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - Héctor Pérez-Montero
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - María Jesús Pla-Farnós
- Gynecology Department, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arturo Navarro-Martin
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
- Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - Miriam Nuñez
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
- Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
| | - Brigitte Both
- Medical Affairs & Professional Education, Business Sector Radiotherapy, Medical Technology Business Group, Carl Zeiss Meditec AG, ZEISS Group, Rudolf-Eber-Straße 11 Oberkochen, Germany
| | - Ferran Guedea
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
- Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098 Barcelona, Spain
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Wang L, Zhu M, Cui Y, Zhang X, Li G. Efficacy analysis of intraoperative radiotherapy in patients with early-stage breast cancer. Cancer Cell Int 2020; 20:446. [PMID: 32943994 PMCID: PMC7488558 DOI: 10.1186/s12935-020-01533-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 09/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background To analyze the clinical efficacy of intraoperative radiotherapy (IORT) after breast-conserving surgery (BCS) in patients with early-stage breast cancer (BC), and to investigate the relationship between its influencing factors and clinical efficacy and prognosis. Methods A total of 73 patients with early-stage BC who underwent IORT after BCS in our hospital were selected in this research. Results Kaplan-Meier survival analysis was used to analyze the related factors of BCS and IORT of disease-free survival (DFS) and overall survival (OS). It was found that only age (χ2 = 14.035, P = 0.003) was statistically positively correlated with the patient’s DFS, and local recurrence and metastasis rate and mortality were higher in patients over 70 years old. Log rank test was used to analyze multiple factors. Only the diameter of the applicator (χ2 = 70.378, P < 0.05) was statistically significant with wound complications, and the larger the diameter, the higher incidence of wound complications. The remaining risk factors did not increase the incidence of wound complications. COX multivariate analysis showed that age was an independent risk factor for DFS rate and the risk factor had no significant effect on the OS rate of patients undergoing IORT after BCS. Conclusions IORT may be a safe form of treatment for the selected patients with early-stage BC, and can achieve satisfactory esthetic effect. Larger applicator diameters may increase the incidence of wound complications. Age is an independent risk factor for DFS in early-stage BC patients undergoing IORT after BCS.
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Affiliation(s)
- Lin Wang
- Radiotherapy Inpatient Ward II, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450000 Henan China
| | - Minmin Zhu
- Radiotherapy Inpatient Ward II, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450000 Henan China.,Nanshi Hospital of Nanyang, Nanyang, Henan China
| | - Yuelong Cui
- Anyang District Hospital of Puyang, Anyang, Henan China
| | - Xudong Zhang
- Radiotherapy Inpatient Ward II, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450000 Henan China
| | - Guowen Li
- Radiotherapy Inpatient Ward II, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450000 Henan China
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Kulcenty K, Piotrowski I, Rucinski M, Wroblewska JP, Jopek K, Murawa D, Suchorska WM. Surgical Wound Fluids from Patients with Breast Cancer Reveal Similarities in the Biological Response Induced by Intraoperative Radiation Therapy and the Radiation-Induced Bystander Effect-Transcriptomic Approach. Int J Mol Sci 2020; 21:ijms21031159. [PMID: 32050557 PMCID: PMC7037222 DOI: 10.3390/ijms21031159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/12/2022] Open
Abstract
In patients with breast cancer who undergo breast-conserving surgery (BCS), more than 90% of local recurrences occur in the same quadrant as the primary cancer. Surgical wound fluids (SWF) are believed to play a role in this process by inducing an inflammatory process in the scar tissue area. Despite strong clinical data demonstrating the benefits of intraoperative radiotherapy (IORT), the biological basis underlying this process remains poorly understood. Ionizing radiation (IR) directly affects cells by damaging DNA, thereby altering the cell phenotype. IR directly affects cancer cells and also influences unirradiated cells located nearby, a phenomenon known as the radiation-induced bystander effect (RIBE), significantly modifying the tumor microenvironment. We hypothesized that SWF obtained from patients after BCS and IORT would induce a radiobiological response (due to RIBE) in unirradiated cells, thereby modifying their phenotype. To confirm this hypothesis, breast cancer cells were incubated with SWF collected from patients after BCS: (1) without IORT (wound fluid (WF) group), (2) with IORT (radiotherapy wound fluid (RT-WF) group), and (3) WF with conditioned medium from irradiated cells (WF+RIBE group) and then subjected to microarray analysis. We performed gene set enrichment analysis to determine the biological processes present in these cells. This analysis showed that the RT-WF and WF+RIBE groups shared common biological processes, including the enhancement of processes involved in cell-cycle regulation, DNA repair, and oxidative phosphorylation. The WF group was characterized by overrepresentation of pathways involved in the INF-α and INF-γ response, inflammatory response, and the IL6 JAK/STAT3 signaling pathway. These findings show that MDA-MB-468 cells stimulated with surgical wound fluids obtained from patients who underwent BCS plus IORT and from cells stimulated with SWF plus RIBE share common biological processes. This confirms the role of the radiation-induced bystander effect in altering the biological properties of wound fluids.
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Affiliation(s)
- Katarzyna Kulcenty
- Radiobiology Laboratory, Greater Poland Cancer Centre, Garbary 15 Street, 61-866 Poznań, Poland; (I.P.), (W.M.S.)
- Department of Electroradiology, Poznań University of Medical Sciences, Garbary 15 Street, 61-866 Poznań, Poland
- Correspondence:
| | - Igor Piotrowski
- Radiobiology Laboratory, Greater Poland Cancer Centre, Garbary 15 Street, 61-866 Poznań, Poland; (I.P.), (W.M.S.)
- Department of Electroradiology, Poznań University of Medical Sciences, Garbary 15 Street, 61-866 Poznań, Poland
| | - Marcin Rucinski
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-781 Poznan, Poland; (M.R.); (K.J.)
| | - Joanna Patrycja Wroblewska
- Department of Pathology, Poznan University Medical Sciences and Greater Poland Cancer Center, Garbary 15 Street, 61-866 Poznań, Poland;
| | - Karol Jopek
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-781 Poznan, Poland; (M.R.); (K.J.)
| | - Dawid Murawa
- Department of Surgery and Oncology, Faculty of Medicine and Health Sciences, University of Zielona Góra, Licealna 9/9, 65-417 Zielona Góra, Poland,
- Department of Breast Cancer Surgery, Greater Poland Cancer Centre, Garbary 15 Street, 61-866 Poznań, Poland
| | - Wiktoria Maria Suchorska
- Radiobiology Laboratory, Greater Poland Cancer Centre, Garbary 15 Street, 61-866 Poznań, Poland; (I.P.), (W.M.S.)
- Department of Electroradiology, Poznań University of Medical Sciences, Garbary 15 Street, 61-866 Poznań, Poland
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Kulcenty K, Piotrowski I, Wróblewska JP, Wasiewicz J, Suchorska WM. The Composition of Surgical Wound Fluids from Breast Cancer Patients is Affected by Intraoperative Radiotherapy Treatment and Depends on the Molecular Subtype of Breast Cancer. Cancers (Basel) 2019; 12:cancers12010011. [PMID: 31861498 PMCID: PMC7016654 DOI: 10.3390/cancers12010011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 11/16/2022] Open
Abstract
Invasive oncological procedures affect the remaining tumor cells by increasing their survival, proliferation, and migration through the induction of wound healing response. The phenomena of local relapse after breast-conserving surgery (BCS) has resulted in a series of research and clinical trials with the aim of assessing whether localized intraoperative radiotherapy (IORT), may be beneficial in inhibiting local recurrences. Therefore, it is essential to assess the impact of intraoperative radiotherapy in modulating the immunological response and wound healing process. Thus, we decided to perform a quantitative analysis of the composition of surgical wound fluids (SWF) in two groups of breast cancer (BC) patients: those treated with BCS followed by IORT, and those who underwent BCS alone. We found that several cytokines, which are believed to have anti-tumor properties, were highly expressed in the luminal A breast cancer subtype in the IORT treatment group. Interestingly, we also found significant differences between IORT patients with tumors of different molecular subtypes. Based on these findings, we hypothesized that IORT treatment might be beneficial in changing the tumor bed microenvironment, making it less favorable for tumor recurrence due to decreased concentration of tumor-facilitating cytokines, especially in the luminal A subtype of BC.
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Affiliation(s)
- Katarzyna Kulcenty
- Radiobiology Lab, Department of Medical Physics, Greater Poland Cancer, 61-866 Poznań, Poland; (I.P.); (W.M.S.)
- Department of Electroradiology, Poznan University of Medical Sciences, ul. Garbary 15, 61-866 Poznan, Poland
- Correspondence:
| | - Igor Piotrowski
- Radiobiology Lab, Department of Medical Physics, Greater Poland Cancer, 61-866 Poznań, Poland; (I.P.); (W.M.S.)
- Department of Electroradiology, Poznan University of Medical Sciences, ul. Garbary 15, 61-866 Poznan, Poland
| | - Joanna Patrycja Wróblewska
- Department of Pathology, Poznan University of Medical Sciences and Greater Poland Cancer Center, ul. Garbary 15, 61-866 Poznan, Poland;
| | - Janusz Wasiewicz
- Department of Breast Cancer Surgery, Greater Poland Cancer Centre, ul. Garbary 15, 61-866 Poznań, Poland;
| | - Wiktoria Maria Suchorska
- Radiobiology Lab, Department of Medical Physics, Greater Poland Cancer, 61-866 Poznań, Poland; (I.P.); (W.M.S.)
- Department of Electroradiology, Poznan University of Medical Sciences, ul. Garbary 15, 61-866 Poznan, Poland
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Radiobiological models in prediction of radiation cardiotoxicity. Rep Pract Oncol Radiother 2019; 25:46-49. [PMID: 31889920 DOI: 10.1016/j.rpor.2019.12.001] [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: 07/15/2019] [Accepted: 12/04/2019] [Indexed: 12/16/2022] Open
Abstract
Coronary disease induced by previous radiotherapy is the most common cause of death among patients treated with radiotherapy for cancer. Risk factors that may affect the frequency and intensity of radiotherapy's cardiac toxicity are primarily the radiation dose and the volume of the heart exposed to radiation. The prolonged survival time of patients after radiotherapy, but also the intensive development of modern radiotherapy techniques results in the necessity of precise estimation of both tumor control probability, and the risk of normal tissue damage, thus the models describing the probability of complications in normal tissues have also been developed. The response from the cardiovascular system to high-dose radiation is known and associated with a pro-inflammatory response. However, the effect of low doses may be completely different because it induces an anti-inflammatory response. Also, there is no unambiguous answer to the question of whether RICD is a deterministic effect. Moreover, there is a lack of literature data on the use of known radiobiological models to assess the risk of cardiovascular complications. The models described are general and concerns any healthy tissue. Therefore, when planning treatment for patients, particular attention should be paid to the dose and area of the heart to be irradiated.
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Partl R, Regitnig P, Lukasiak K, Winkler P, Kapp KS. Incidence of Morphea following Adjuvant Irradiation of the Breast in 2,268 Patients. Breast Care (Basel) 2019; 15:246-252. [PMID: 32774218 DOI: 10.1159/000502030] [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: 03/18/2019] [Accepted: 07/09/2019] [Indexed: 12/25/2022] Open
Abstract
Background Morphea of the breast is an autoimmune reaction of the subcutaneous connective tissue which can be triggered by exposure to ionizing radiation. The literature suggests incidence rates of 1:500 to 1:3,000 which, however, do not seem to match the very small number of cases reported. Objectives The aim of the present study was to determine the incidence of morphea following irradiation of the breast in order to generate more evidence about the frequency of this serious and mutilating complication. Method Retrospective analysis of patient data who underwent adjuvant radiotherapy in the period 2009-2018 following breast-conserving surgery and who made use of the recommended radiooncology follow-up examinations in 2018. Analysis was done by descriptive statistics. Results Of a total of 5,129 patients who had undergone radiotherapy over a 10-year period, follow-up data were available in 2,268 patients. In 2,236 patients (98.6%) the breast had been irradiated using conventional fractionation schemes with a total dose of 50-50.4 Gy; 32 (1.4%) were given a total dose of 40.05 Gy in 15 fractions. During the observation period, 6 patients were diagnosed with morphea (4 unilateral and 2 bilateral) by punch biopsies resulting in a cumulative incidence proportion of 0.26% (95% CI: 0.24-0.28), translating into 1 case for every 378 irradiated patients. Conclusions In the case studies reported to date, morphea is described as a very rare complication. In contrast, our data suggest a cumulative incidence of 1:378, which is higher than other authors have estimated. This leads us to suspect that in a large number of patients, morphea is incorrectly diagnosed as an infection (in the early stages) and radiation-induced fibrosis (in later stages).
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Affiliation(s)
- Richard Partl
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Comprehensive Cancer Center Graz (CCC), Graz, Austria
| | - Peter Regitnig
- Institute of Pathology, Medical University of Graz, Comprehensive Cancer Center Graz (CCC), Graz, Austria
| | - Katarzyna Lukasiak
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Comprehensive Cancer Center Graz (CCC), Graz, Austria
| | - Peter Winkler
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Comprehensive Cancer Center Graz (CCC), Graz, Austria
| | - Karin Sigrid Kapp
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Comprehensive Cancer Center Graz (CCC), Graz, Austria
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Wound fluids collected postoperatively from patients with breast cancer induce epithelial to mesenchymal transition but intraoperative radiotherapy impairs this effect by activating the radiation-induced bystander effect. Sci Rep 2019; 9:7891. [PMID: 31133667 PMCID: PMC6536501 DOI: 10.1038/s41598-019-44412-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/16/2019] [Indexed: 02/07/2023] Open
Abstract
Wound fluids (WF) are believed to play a role in the local recurrences by inducing an inflammatory process in scar tissue area. Given that most local relapse in primary breast cancer patients occur within the scar tissue area, researchers have investigated whether localized radiotherapy, such as intraoperative radiotherapy (IORT), could be more effective than postoperative RT in inhibiting local tumor recurrence. The epithelial-mesenchymal transition (EMT) program plays a critical role in promoting metastasis in epithelium-derived carcinoma. Given this background the main aim of the present study was to determine the mechanisms by which IORT decreases the tumorigenic potential of WF. We assumed that postoperative fluids from patients would activate the radiation-induced bystander effect (RIBE) in treated cells, thus altering the tumor microenvironment. To confirm this hypothesis, WF collected from patients after breast conserving surgery (BCS) alone, after BCS followed by IORT treatment or WF from BCS patients together with RIBE medium were incubated with MCF7 and MDA-MB-468 cells. Changes in the CSC phenotype, in EMT program and potential to migrate were performed to determine the possible role of WF on the migration of breast cancer cells. Our findings show that wound fluids stimulate the CSC phenotype and EMT program in breast cancer cell lines. This effect was partially abrogated when the cells were incubated in wound fluids collected from patients after breast-conserving surgery followed by IORT. Additionally, we confirmed the role of radiation-induced bystander effect in altering the properties of the WF to induce the CSC phenotype and EMT program.
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Bradley JA. The current status of intraoperative radiation therapy in breast cancer: Challenges and promises. Breast J 2018; 24:713-714. [PMID: 30221437 DOI: 10.1111/tbj.13071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Julie A Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
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Salerno C, Vento AR, Giacchino M, Lissidini G, Galimberti V, Corso G. Intra-operative radiotherapy management for breast cancer treatment in patients with pseudoxanthoma elasticum: A case report. Breast J 2017; 24:385-387. [PMID: 29105951 DOI: 10.1111/tbj.12944] [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: 06/29/2017] [Revised: 10/19/2017] [Accepted: 06/30/2017] [Indexed: 10/18/2022]
Abstract
Pseudoxanthoma elasticum is a systemic metabolic disease presenting calcifications and progressive fragmentation of elastic fibers. Actually, no targeted therapies are available for the treatment; only prevention of complications is possible. Classically, pseudoxanthoma elasticum is a "benign" disease, without cancer association. Herein, we reported a singular association of pseudoxanthoma elasticum with breast carcinoma, describing the clinical management, in particular intra-operative treatment, focusing on intra-operative radiotherapy since no specific guidelines are available in literature.
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Affiliation(s)
- Carmela Salerno
- Division of Surgical Senology, European Institute of Oncology, Milano, Italy
| | - Anna Rita Vento
- Division of Surgical Senology, European Institute of Oncology, Milano, Italy
| | - Maria Giacchino
- Division of Surgical Senology, European Institute of Oncology, Milano, Italy
| | - Germana Lissidini
- Division of Surgical Senology, European Institute of Oncology, Milano, Italy
| | - Viviana Galimberti
- Division of Surgical Senology, European Institute of Oncology, Milano, Italy
| | - Giovanni Corso
- Division of Surgical Senology, European Institute of Oncology, Milano, Italy
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