Conformal Radiation Therapy or Stereotactic Body Radiation Therapy: Institutional Experience in the Management of Colorectal Liver Metastases by Radiation Therapy

Synthesis, Antitumor of Sinomenine Derivatives and Apoptotic Induction via IL-6/PI3K/Akt/NF-κB Signaling Pathway in MCF-7 Cells

Natural products have been widely considered as an important resource for new drugs or lead compounds. Sinomenine (SIN) and its derivatives exert antitumor activity via regulation of inflammatory mediators. For these reasons we synthesized three series of SIN derivatives (compounds 4a-i, 7a-c and 11a-c) as antitumor agents from this natural product. All compounds were prepared by the modification at the C1 and C4 positions of A ring, the C4 position of A ring and the C6 and C7 positions of C ring, respectively. All the derivatives were subjected to in vitro antitumor activity against HeLa, A549, HepG-2, MCF-7 and HT-29 cell lines. To observe the apoptotic induction of SIN derivatives and its mechanism, fluorescent staining and western bolt were carried out for active compound against MCF-7. Based on the screening results, most of SIN derivatives showed better antitumor activity than SIN. Some of them were found to possess broad spectrum antitumor activity. Most notably, 11c exhibited obvious antitumor activity in both cell lines with IC50 value less than 11 μM. Besides, 11c induced apoptosis of MCF-7 in a dose-dependent manner. Western blot assay demonstrated that 11c inhibited IL-6-mediated activation of PI3K/Akt pathway. A docking study revealed that 11c had stronger binding interaction with the residues of IL-6 than SIN. All these results indicate that 11c may be a potential anti-breast cancer agent by directly targeting IL-6.

Direct visualization and correlation of liver stereotactic body radiation therapy treatment delivery accuracy with interfractional motion

This study used the visualization of hypo‐intense regions on liver‐specific MRI to directly quantify stereotactic body radiation therapy (SBRT) spatial delivery accuracy. Additionally, the interfractional motion of the liver region was determined and compared with the MRI‐based evaluation of liver SBRT spatial treatment delivery accuracy. Primovist^®‐enhanced MRI scans were acquired from 17 patients, 8–12 weeks following the completion of liver SBRT treatment. Direct visualization of radiation‐induced focal liver reaction in the form of hypo‐intensity was determined. The auto‐delineation approach was used to localize these regions, and center‐of‐mass (COM) discrepancy was quantified between the MRI hypo‐intensity and the CT‐based treatment plan. To assess the interfractional motion of the liver region, a planning CT was registered to a Cone Beam CT obtained before each treatment fraction. The interfractional motion assessed from this approach was then compared against the localized hypo‐intense MRI regions. The mean ± SD COM discrepancy was 1.4 ± 1.3 mm in the left‐right direction, 2.6 ± 1.8 mm in an anteroposterior direction, and 1.9 ± 2.6 mm in the craniocaudal direction. A high correlation was observed between interfractional motion of visualized hypo‐intensity and interfractional motion of planning treatment volume (PTV); the quantified Pearson correlation coefficient was 0.96. The lack of correlation was observed between Primovist^® MRI‐based spatial accuracy and interfractional motion of the liver, where Pearson correlation coefficients ranged from −0.01 to −0.26. The highest random and systematic errors quantified from interfractional motion were in the craniocaudal direction. This work demonstrates a novel framework for the direct evaluation of liver SBRT spatial delivery accuracy.

Resectability and Ablatability Criteria for the Treatment of Liver Only Colorectal Metastases: Multidisciplinary Consensus Document from the COLLISION Trial Group

The guidelines for metastatic colorectal cancer crudely state that the best local treatment should be selected from a ‘toolbox’ of techniques according to patient- and treatment-related factors. We created an interdisciplinary, consensus-based algorithm with specific resectability and ablatability criteria for the treatment of colorectal liver metastases (CRLM). To pursue consensus, members of the multidisciplinary COLLISION and COLDFIRE trial expert panel employed the RAND appropriateness method (RAM). Statements regarding patient, disease, tumor and treatment characteristics were categorized as appropriate, equipoise or inappropriate. Patients with ECOG≤2, ASA≤3 and Charlson comorbidity index ≤8 should be considered fit for curative-intent local therapy. When easily resectable and/or ablatable (stage IVa), (neo)adjuvant systemic therapy is not indicated. When requiring major hepatectomy (stage IVb), neo-adjuvant systemic therapy is appropriate for early metachronous disease and to reduce procedural risk. To downstage patients (stage IVc), downsizing induction systemic therapy and/or future remnant augmentation is advised. Disease can only be deemed permanently unsuitable for local therapy if downstaging failed (stage IVd). Liver resection remains the gold standard. Thermal ablation is reserved for unresectable CRLM, deep-seated resectable CRLM and can be considered when patients are in poor health. Irreversible electroporation and stereotactic body radiotherapy can be considered for unresectable perihilar and perivascular CRLM 0-5cm. This consensus document provides per-patient and per-tumor resectability and ablatability criteria for the treatment of CRLM. These criteria are intended to aid tumor board discussions, improve consistency when designing prospective trials and advance intersociety communications. Areas where consensus is lacking warrant future comparative studies.