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Norollahi SE, Yousefzadeh-Chabok S, Yousefi B, Nejatifar F, Rashidy-Pour A, Samadani AA. The effects of the combination therapy of chemotherapy drugs on the fluctuations of genes involved in the TLR signaling pathway in glioblastoma multiforme therapy. Biomed Pharmacother 2024; 177:117137. [PMID: 39018875 DOI: 10.1016/j.biopha.2024.117137] [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: 05/28/2024] [Revised: 07/04/2024] [Accepted: 07/10/2024] [Indexed: 07/19/2024] Open
Abstract
One of the most lethal and aggressive types of malignancies with a high mortality rate and poor response to treatment is glioblastoma multiforme (GBM). This means that modernizing the medications used in chemotherapy, in addition to medicines licensed for use in other illnesses and chosen using a rationale process, can be beneficial in treating this illness. Meaningly, drug combination therapy with chemical or herbal originations or implanting a drug wafer in tumors to control angiogenesis is of great importance. Importantly, the primary therapeutic hurdles in GBM are the development of angiogenesis and the blood-brain barrier (BBB), which keeps medications from getting to the tumor. This malignancy can be controlled if the drug's passage through the BBB and the VEGF (vascular endothelial growth factor), which promotes angiogenesis, are inhibited. In this way, the effect of combination therapy on the genes of different main signaling pathways like TLRs may be indicated as an impressive therapeutic strategy for treating GBM. This article aims to discuss the effects of chemotherapeutic drugs on the expression of various genes and associated translational factors involved in the TLR signaling pathway.
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Affiliation(s)
- Seyedeh Elham Norollahi
- Cancer Research Center and Department of Immunology, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Bahman Yousefi
- Cancer Research Center and Department of Immunology, Semnan University of Medical Sciences, Semnan, Iran
| | - Fatemeh Nejatifar
- Department of Hematology and Oncology, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Rashidy-Pour
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran.
| | - Ali Akbar Samadani
- Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran.
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Troschel FM, Troschel BO, Kloss M, Troschel AS, Pepper NB, Wiewrodt RG, Stummer W, Wiewrodt D, Theodor Eich H. Cervical body composition on radiotherapy planning computed tomography scans predicts overall survival in glioblastoma patients. Clin Transl Radiat Oncol 2023; 40:100621. [PMID: 37008514 PMCID: PMC10063381 DOI: 10.1016/j.ctro.2023.100621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Background and purpose Glioblastoma (GBM) patients face a strongly unfavorable prognosis despite multimodal therapy regimens. However, individualized mortality prediction remains imprecise. Harnessing routine radiation planning cranial computed tomography (CT) scans, we assessed cervical body composition measures as novel biomarkers for overall survival (OS) in GBM patients. Materials and methods We performed threshold-based semi-automated quantification of muscle and subcutaneous fat cross-sectional area (CSA) at the levels of the first and second cervical vertebral body. First, we tested this method's validity by correlating cervical measures to established abdominal body composition in an open-source whole-body CT cohort. We then identified consecutive patients undergoing radiation planning for recent GBM diagnosis at our institution from 2010 to 2020 and quantified cervical body composition on radiation planning CT scans. Finally, we performed univariable and multivariable time-to-event analyses, adjusting for age, sex, body mass index, comorbidities, performance status, extent of surgical resection, extent of tumor at diagnosis, and MGMT methylation. Results Cervical body composition measurements were well-correlated with established abdominal markers (Spearman's rho greater than 0.68 in all cases). Subsequently, we included 324 GBM patients in our study cohort (median age 63 years, 60.8% male). 293 (90.4%) patients died during follow-up. Median survival time was 13 months. Patients with below-average muscle CSA or above-average fat CSA demonstrated shorter survival. In multivariable analyses, continuous cervical muscle measurements remained independently associated with OS. Conclusion This exploratory study establishes novel cervical body composition measures routinely available on cranial radiation planning CT scans and confirms their association with OS in patients diagnosed with GBM.
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Affiliation(s)
- Fabian M. Troschel
- Department of Radiation Oncology, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
- Corresponding author at: Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Benjamin O. Troschel
- Department of Radiation Oncology, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Maren Kloss
- Department of Neurosurgery, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Amelie S. Troschel
- Department of Medicine II, Klinikum Wolfsburg, Sauerbruchstraße 7, 38440 Wolfsburg, Germany
| | - Niklas B. Pepper
- Department of Radiation Oncology, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Rainer G. Wiewrodt
- Pulmonary Research Division, Münster University, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
- Department of Pulmonary Medicine, Mathias Foundation, Hospitals Rheine and Ibbenbueren, Frankenburgsstrasse 31, 48431 Rheine, Germany
| | - Walter Stummer
- Department of Neurosurgery, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Dorothee Wiewrodt
- Department of Neurosurgery, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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Martino T. Novel baseline biomarkers should predict recurrence of glioblastoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:571-573. [PMID: 36893042 DOI: 10.1002/jcu.23401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/18/2023]
Affiliation(s)
- Tommaso Martino
- Neuroscience Department (Head of Department: Dr. Ciro Mundi), Policlinico Riuniti of Foggia, S.C. Ospedaliera di Neurologia, Foggia, Italy
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Id Said B, Chen H, Jerzak KJ, Warner E, Myrehaug S, Tseng CL, Detsky J, Husain Z, Sahgal A, Soliman H. Trastuzumab emtansine increases the risk of stereotactic radiosurgery-induced radionecrosis in HER2 + breast cancer. J Neurooncol 2022; 159:177-183. [PMID: 35715667 DOI: 10.1007/s11060-022-04055-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/01/2022] [Indexed: 12/22/2022]
Abstract
INTRODUCTION In this study, we investigate factors associated with radionecrosis (RN) in HER2 + (human epidermal growth factor receptor 2) patients with brain metastases (BrM) treated with stereotactic radiosurgery (SRS). METHODS Patients with HER2 + breast cancer BrM treated with SRS (2010-2020) were identified from an institutional database. The incidence of RN was determined per treated BrM according to serial imaging and/or histology. Factors associated with RN such as age, RT dose, BrM volume, and initiation of Trastuzumab Emtansine (T-DM1) were investigated with univariate and multivariable analyses (MVA). RESULTS 67 HER2 + patients with 223 BrM were identified. 21 patients (31.3%) were treated with T-DM1 post-SRS, including 14 patients (20.9%) who received T-DM1 within 12 months of SRS. The median follow-up was 15.6 (interquartile range (IQR) 5.4-35.3) months. The overall probability of RN post-SRS was 21.6% (95% confidence interval (CI) 2.7-10.7), and the 1 and 2 year risk was 6.7% (95% CI 2.7-10.7) and 15.2% (95% CI 9.2-21.3). MVA identified T-DM1 treatment post-SRS (hazard ratio (HR) 2.5, 95% CI 1.2-5.3, p = 0.02) and equivalent dose in 2 Gy fractions (EQD2) > 90 Gy2 (HR 2.4, 95% CI 1.1-5.1, p = 0.02) as predictors of RN. Patients treated with T-DM1 and SRS had a 29.9% (95% CI 15.3-44.6%) probability of RN, with a 25.2% (95% CI 12.8-37.6%) risk at 1- and 2 years post-T-DM1. The majority of RN were symptomatic (71%), with a median time to RN of 4.8 months. CONCLUSION T-DM1 exposure post-SRS was associated with a higher risk of RN among patients with HER2 + BrM.
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Affiliation(s)
- Badr Id Said
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, 2075 Bayview Ave., T2 181, Toronto, ON, M4N 3M5, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, 2075 Bayview Ave., T2 181, Toronto, ON, M4N 3M5, Canada
| | - Katarzyna J Jerzak
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, ON, Canada
| | - Ellen Warner
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, ON, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, 2075 Bayview Ave., T2 181, Toronto, ON, M4N 3M5, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, 2075 Bayview Ave., T2 181, Toronto, ON, M4N 3M5, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, 2075 Bayview Ave., T2 181, Toronto, ON, M4N 3M5, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, 2075 Bayview Ave., T2 181, Toronto, ON, M4N 3M5, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, 2075 Bayview Ave., T2 181, Toronto, ON, M4N 3M5, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, 2075 Bayview Ave., T2 181, Toronto, ON, M4N 3M5, Canada.
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Iqubal A, Iqubal MK, Sharma S, Wasim M, Alfaleh MA, Md S, Baboota S, Ali J, Haque SE. Pathogenic mechanisms and therapeutic promise of phytochemicals and nanocarriers based drug delivery against radiotherapy-induced neurotoxic manifestations. Drug Deliv 2022; 29:1492-1511. [PMID: 35543534 PMCID: PMC9103628 DOI: 10.1080/10717544.2022.2064562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Radiotherapy is one of the extensively used therapeutic modalities in glioblastoma and other types of cancers. Radiotherapy is either used as a first-line approach or combined with pharmacotherapy or surgery to manage and treat cancer. Although the use of radiotherapy significantly increased the survival time of patients, but its use has been reported with marked neuroinflammation and cognitive dysfunction that eventually reduced the quality of life of patients. Based on the preclinical and clinical investigations, the profound role of increased oxidative stress, nuclear translocation of NF-kB, production of proinflammatory cytokines such as TNF-α, IL-6, IL-β, increased level of MMPs, increased apoptosis, reduced angiogenesis, neurogenesis, and histological aberrations in CA1, CA2, CA3 and DG region of the hippocampus have been reported. Various pharmacotherapeutic drugs are being used as an adjuvant to counteract this neurotoxic manifestation. Still, most of these drugs suffer from systemic adverse effect, causes interference to ongoing chemotherapy, and exhibit pharmacokinetic limitations in crossing the blood-brain barrier. Therefore, various phytoconstituents, their nano carrier-based drug delivery systems and miRNAs have been explored to overcome the aforementioned limitations. The present review is focused on the mechanism and evidence of radiotherapy-induced neuroinflammation and cognitive dysfunction, pathological and molecular changes in the brain homeostasis, available adjuvants, their limitations. Additionally, the potential role and mechanism of neuroprotection of various nanocarrier based natural products and miRNAs have been discussed.
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Affiliation(s)
- Ashif Iqubal
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Mohammad Kashif Iqubal
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India.,Product Development Department, Sentiss Research Centre, Sentiss Pharma Pvt Ltd, Gurugram, India
| | - Sumit Sharma
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Mohd Wasim
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Mohamed A Alfaleh
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.,Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Shadab Md
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.,Center of Excellence for Drug Research & Pharmaceutical Industries, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sanjula Baboota
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Javed Ali
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Syed Ehtaishamul Haque
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
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Role of Radiotherapy in Breast Cancer. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Wang H, Xu Z, Grantham K, Zhou Y, Cui T, Zhang Y, Liu B, Wang X, Vergalasova I, Reyhan M, Weiner J, Danish SF, Yue N, Nie K. Performance assessment of two motion management systems for frameless stereotactic radiosurgery. Strahlenther Onkol 2021; 197:150-157. [PMID: 33047151 PMCID: PMC7840652 DOI: 10.1007/s00066-020-01688-8] [Citation(s) in RCA: 6] [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: 07/06/2020] [Accepted: 08/24/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND/PURPOSE Frameless stereotactic radiosurgery (SRS) requires dedicated systems to monitor patient motion in order to avoid inaccurate radiation delivery due to involuntary shifts. The purpose of this study is to assess the accuracy and sensitivity of two distinct motion monitoring systems used for frameless SRS. METHODS A surface image-guided system known as optical surface monitoring system (OSMS), and a fiducial marker-based system known as high definition motion management (HDMM) as part of the latest Gamma Knife Icon® were compared. A 3D printer-based cranial motion phantom was developed to evaluate the accuracy and sensitivity of these two systems in terms of: (1) the capability to recognize predefined shifts up to 3 cm, and (2) the capability to recognize predefined speeds up to 3 cm/s. The performance of OSMS, in terms of different reference surfaces, was also evaluated. RESULTS Translational motion could be accurately detected by both systems, with an accuracy of 0.3 mm for displacement up to 1 cm, and 0.5 mm for larger displacements. The reference surface selection had an impact on OSMS performance, with flat surface resulting in less accuracy. HDMM was in general more sensitive when compared with OSMS in capturing the motion, due to its faster frame rate, but a delay in response was observed with faster speeds. Both systems were less sensitive in detection of superior-inferior motion when compared to lateral or vertical displacement directions. CONCLUSION Translational motion can be accurately and sensitively detected by OSMS and HDMM real-time monitoring systems. However, performance variations were observed along different motion directions, as well as amongst the selection of reference images. Caution is needed when using real-time monitoring systems for frameless SRS treatment.
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Affiliation(s)
- Hao Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, 195 Little Albany St., New Brunswick, NJ, USA
| | - Zhiyong Xu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Kevin Grantham
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, 195 Little Albany St., New Brunswick, NJ, USA
| | - Yongkang Zhou
- Department of Radiation Oncology, Zhongshan Hospital, Shanghai, China
| | - Taoran Cui
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, 195 Little Albany St., New Brunswick, NJ, USA
| | - Yin Zhang
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, 195 Little Albany St., New Brunswick, NJ, USA
| | - Bo Liu
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, 195 Little Albany St., New Brunswick, NJ, USA
| | - Xiao Wang
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, 195 Little Albany St., New Brunswick, NJ, USA
| | - Irina Vergalasova
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, 195 Little Albany St., New Brunswick, NJ, USA
| | - Meral Reyhan
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, 195 Little Albany St., New Brunswick, NJ, USA
| | - Joseph Weiner
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, 195 Little Albany St., New Brunswick, NJ, USA
| | - Shabbar F Danish
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ning Yue
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, 195 Little Albany St., New Brunswick, NJ, USA
| | - Ke Nie
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, 195 Little Albany St., New Brunswick, NJ, USA.
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Yashavarddhan MH, Sharma AK, Chaudhary P, Bajaj S, Singh S, Shukla SK. Development of hematopoietic syndrome mice model for localized radiation exposure. Sci Rep 2021; 11:89. [PMID: 33420217 PMCID: PMC7794306 DOI: 10.1038/s41598-020-80075-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/03/2020] [Indexed: 11/09/2022] Open
Abstract
Current models to study the hematopoietic syndrome largely rely on the uniform whole-body exposures. However, in the radio-nuclear accidents or terrorist events, exposure can be non-uniform. The data available on the non-uniform exposures is limited. Thus, we have developed a mice model for studying the hematopoietic syndrome in the non-uniform or partial body exposure scenarios using the localized cobalt60 gamma radiation exposure. Femur region of Strain 'A' male mice was exposed to doses ranging from 7 to 20 Gy. The 30 day survival assay showed 19 Gy as LD100 and 17 Gy as LD50. We measured an array of cytokines and important stem cell markers such as IFN-γ, IL-3, IL-6, GM-CSF, TNF-α, G-CSF, IL-1α, IL-1β, CD 34 and Sca 1. We found significant changes in IL-6, GM-CSF, TNF-α, G-CSF, and IL-1β levels compared to untreated groups and amplified levels of CD 34 and Sca 1 positive population in the irradiated mice compared to the untreated controls. Overall, we have developed a mouse model of the hematopoietic acute radiation syndrome that might be useful for understanding of the non-uniform body exposure scenarios. This may also be helpful in the screening of drugs intended for individuals suffering from radiation induced hematopoietic syndrome.
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Affiliation(s)
- M H Yashavarddhan
- National Institute of Cancer Prevention & Research, Indian Council of Medical Research, Sector-39, Noida, Uttar Pradesh, 201301, India
| | - Ajay Kumar Sharma
- Institute of Nuclear Medicine and Allied Sciences, Defence Research and Development Organisation, Brig. S K Mazumdar Marg, Timarpur, Delhi, 110054, India
| | - Pankaj Chaudhary
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Sania Bajaj
- Institute of Nuclear Medicine and Allied Sciences, Defence Research and Development Organisation, Brig. S K Mazumdar Marg, Timarpur, Delhi, 110054, India
| | - Sukhvir Singh
- Institute of Nuclear Medicine and Allied Sciences, Defence Research and Development Organisation, Brig. S K Mazumdar Marg, Timarpur, Delhi, 110054, India
| | - Sandeep Kumar Shukla
- Institute of Nuclear Medicine and Allied Sciences, Defence Research and Development Organisation, Brig. S K Mazumdar Marg, Timarpur, Delhi, 110054, India.
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Becker HM. Carbonic anhydrase IX and acid transport in cancer. Br J Cancer 2020; 122:157-167. [PMID: 31819195 PMCID: PMC7051959 DOI: 10.1038/s41416-019-0642-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/29/2019] [Accepted: 10/22/2019] [Indexed: 02/07/2023] Open
Abstract
Alterations in tumour metabolism and acid/base regulation result in the formation of a hostile environment, which fosters tumour growth and metastasis. Acid/base homoeostasis in cancer cells is governed by the concerted interplay between carbonic anhydrases (CAs) and various transport proteins, which either mediate proton extrusion or the shuttling of acid/base equivalents, such as bicarbonate and lactate, across the cell membrane. Accumulating evidence suggests that some of these transporters interact both directly and functionally with CAIX to form a protein complex coined the 'transport metabolon'. Transport metabolons formed between bicarbonate transporters and CAIX require CA catalytic activity and have a function in cancer cell migration and invasion. Another type of transport metabolon is formed by CAIX and monocarboxylate transporters. In this complex, CAIX functions as a proton antenna for the transporter, which drives the export of lactate and protons from the cell. Since CAIX is almost exclusively expressed in cancer cells, these transport metabolons might serve as promising targets to interfere with tumour pH regulation and energy metabolism. This review provides an overview of the current state of research on the function of CAIX in tumour acid/base transport and discusses how CAIX transport metabolons could be exploited in modern cancer therapy.
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Affiliation(s)
- Holger M Becker
- Institute of Physiological Chemistry, University of Veterinary Medicine Hannover, D-30559, Hannover, Germany.
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Gamma Knife radiosurgery: Scenarios and support for re-irradiation. Phys Med 2019; 68:75-82. [PMID: 31760329 DOI: 10.1016/j.ejmp.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 09/16/2019] [Accepted: 11/01/2019] [Indexed: 12/25/2022] Open
Abstract
Stereotactic radiosurgery (SRS) involves the focal delivery of large, cytotoxic doses of radiation to small targets within the brain, often located in close proximity to radiosensitive normal tissue structures and requiring very low procedural uncertainties to perform safely. Historically, neurosurgeons considered SRS as a one-time, single session procedure. However therapeutic advances and a better understanding of the clinical response to SRS have caused a renewal of interest in a variety of re-irradiation scenarios; including re-irradiation of the same target after prior SRS, SRS treatments after prior broad-field radiation, hypofractionated treatments, and volume-staged treatments. Re-irradiation may in some cases require even greater effort towards minimizing treatment uncertainties as compared to one-time-only treatments. Gamma Knife radiosurgery (GKRS) has evolved over time in ways that directly supports many re-irradiation scenarios while helping to minimize overall procedural uncertainty.
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Abstract
Radiation therapy (RT) is an effective treatment for patients with either nonfunctioning or secreting pituitary adenomas unsuccessfully treated by surgery and/or medical therapy, resulting in local control of 90-95% at 5-10 years and variable normalization of hormonal hypersecretion for patients with GH-, ACTH-, and prolactin-secreting adenomas in the range of 40-80% at 5 years; however, its use has been limited because of concerns regarding potential late toxicity of radiation and delayed efficacy in normalization of hormone hypersecretion. In the last decades, there have been advances in all aspects of radiation treatment, including more accurate immobilization, imaging, treatment planning and dose delivery. RT has evolved with the development of highly conformal stereotactic techniques and new planning and dose delivery techniques, including intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT). All these new techniques allow precise and sharply focused radiation delivery reducing the dose to surrounding critical neurovascular and brain structures, and potentially limiting the long-term consequences of radiation treatments. In this review, we present a critical analysis of the more recent available literature on the use of RT in patients with both nonfunctioning and secreting pituitary adenomas, focussing particularly on the risk/benefit ratio of modern radiation techniques.
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Affiliation(s)
- Giuseppe Minniti
- Radiation Unit, UPMC Hillman Cancer Center, San Pietro Hospital, Rome, Italy.
| | - John Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Divneet M, Quoc-Anh H, Betsy W, Gia J, Denise R, Christopher W, Yi SK. Comparison of two thermoplastic immobilization mask systems in daily volumetric image guided radiation therapy for head and neck cancers. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aad574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Kallis K, Kreppner S, Lotter M, Fietkau R, Strnad V, Bert C. Introduction of a hybrid treatment delivery system used for quality assurance in multi-catheter interstitial brachytherapy. ACTA ACUST UNITED AC 2018; 63:095008. [DOI: 10.1088/1361-6560/aabb5a] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
PURPOSE OF REVIEW Skull base reirradiation is challenging due to complex anatomy, enrichment of treatment-resistant clonogens, and increased risk of severe treatment complications. Without local therapy, early mortality is certain and tumor progression can result in debilitating symptoms. Modern radiotherapy advancements, such as image-guided radiation therapy (IGRT), intensity-modulated radiation therapy (IMRT), particle therapy, and stereotactic radiation therapy (SRT), are attractive for skull base reirradiation. RECENT FINDINGS Although limited by their retrospective nature and heterogeneous patient populations, several studies have demonstrated that reirradiation with these highly conformal techniques is feasible. Compared to IMRT or particle therapy reirradiation, SRT reirradiation appears promising with lower toxicity and increased convenience. Here, we provide thorough explanations for each technology and summarize the most relevant and recent studies, with particular attention to efficacy and toxicity. Skull base reirradiation using these extremely conformal therapy techniques requires meticulous treatment planning and should be delivered by experienced teams.
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Rubinstein AE, Ingram WS, Anderson BM, Gay SS, Fave XJ, Ger RB, McCarroll RE, Owens CA, Netherton TJ, Kisling KD, Court LE, Yang J, Li Y, Lee J, Mackin DS, Cardenas CE. Cost-effective immobilization for whole brain radiation therapy. J Appl Clin Med Phys 2017; 18:116-122. [PMID: 28585732 PMCID: PMC5874864 DOI: 10.1002/acm2.12101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/24/2017] [Accepted: 04/05/2017] [Indexed: 11/23/2022] Open
Abstract
To investigate the inter‐ and intra‐fraction motion associated with the use of a low‐cost tape immobilization technique as an alternative to thermoplastic immobilization masks for whole‐brain treatments. The results of this study may be of interest to clinical staff with severely limited resources (e.g., in low‐income countries) and also when treating patients who cannot tolerate standard immobilization masks. Setup reproducibility of eight healthy volunteers was assessed for two different immobilization techniques. (a) One strip of tape was placed across the volunteer's forehead and attached to the sides of the treatment table. (b) A second strip was added to the first, under the chin, and secured to the table above the volunteer's head. After initial positioning, anterior and lateral photographs were acquired. Volunteers were positioned five times with each technique to allow calculation of inter‐fraction reproducibility measurements. To estimate intra‐fraction reproducibility, 5‐minute anterior and lateral videos were taken for each technique per volunteer. An in‐house software was used to analyze the photos and videos to assess setup reproducibility. The maximum intra‐fraction displacement for all volunteers was 2.8 mm. Intra‐fraction motion increased with time on table. The maximum inter‐fraction range of positions for all volunteers was 5.4 mm. The magnitude of inter‐fraction and intra‐fraction motion found using the “1‐strip” and “2‐strip” tape immobilization techniques was comparable to motion restrictions provided by a thermoplastic mask for whole‐brain radiotherapy. The results suggest that tape‐based immobilization techniques represent an economical and useful alternative to the thermoplastic mask.
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Affiliation(s)
- Ashley E Rubinstein
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - W Scott Ingram
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Brian M Anderson
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Skylar S Gay
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xenia J Fave
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Rachel B Ger
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Rachel E McCarroll
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Constance A Owens
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Tucker J Netherton
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Kelly D Kisling
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Laurence E Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Yuting Li
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Joonsang Lee
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dennis S Mackin
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos E Cardenas
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
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16
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Melatonin as an anti-inflammatory agent in radiotherapy. Inflammopharmacology 2017; 25:403-413. [DOI: 10.1007/s10787-017-0332-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/19/2017] [Indexed: 02/07/2023]
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17
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Kothari N, Anaya DA. Multidisciplinary Management of Rectal Cancer with Synchronous Resectable Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0346-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Lee H, Fahimian BP, Xing L. Binary moving-blocker-based scatter correction in cone-beam computed tomography with width-truncated projections: proof of concept. Phys Med Biol 2017; 62:2176-2193. [PMID: 28079527 DOI: 10.1088/1361-6560/aa5913] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This paper proposes a binary moving-blocker (BMB)-based technique for scatter correction in cone-beam computed tomography (CBCT). In concept, a beam blocker consisting of lead strips, mounted in front of the x-ray tube, moves rapidly in and out of the beam during a single gantry rotation. The projections are acquired in alternating phases of blocked and unblocked cone beams, where the blocked phase results in a stripe pattern in the width direction. To derive the scatter map from the blocked projections, 1D B-Spline interpolation/extrapolation is applied by using the detected information in the shaded regions. The scatter map of the unblocked projections is corrected by averaging two scatter maps that correspond to their adjacent blocked projections. The scatter-corrected projections are obtained by subtracting the corresponding scatter maps from the projection data and are utilized to generate the CBCT image by a compressed-sensing (CS)-based iterative reconstruction algorithm. Catphan504 and pelvis phantoms were used to evaluate the method's performance. The proposed BMB-based technique provided an effective method to enhance the image quality by suppressing scatter-induced artifacts, such as ring artifacts around the bowtie area. Compared to CBCT without a blocker, the spatial nonuniformity was reduced from 9.1% to 3.1%. The root-mean-square error of the CT numbers in the regions of interest (ROIs) was reduced from 30.2 HU to 3.8 HU. In addition to high resolution, comparable to that of the benchmark image, the CS-based reconstruction also led to a better contrast-to-noise ratio in seven ROIs. The proposed technique enables complete scatter-corrected CBCT imaging with width-truncated projections and allows reducing the acquisition time to approximately half. This work may have significant implications for image-guided or adaptive radiation therapy, where CBCT is often used.
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Affiliation(s)
- Ho Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
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19
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Boman E, Kapanen M, Laaksomaa M, Mäenpää H, Hyödynmaa S, Kellokumpu-Lehtinen PL. Treatment accuracy without rotational setup corrections in intracranial SRT. J Appl Clin Med Phys 2016; 17:86-94. [PMID: 27455488 PMCID: PMC5690032 DOI: 10.1120/jacmp.v17i4.6149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/23/2016] [Accepted: 02/22/2016] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to evaluate the impact of actual rotational setup errors on dose distributions in intracranial stereotactic radiotherapy (SRT) with different alternatives for treatment position selection. A total of 38 SRT fractions from 18 patients were retrospectively evaluated with rotational setup errors obtained from actual treatments. The planning computed tomography (CT) images were rotated according to online cone‐beam CT (CBCT) images and the dose distribution was recalculated to the rotated CT images using three different patient positionings derived from: 1) an automatic 6D match neglecting rotation correction (Auto6D); 2) an automatic 3D match (Auto3D); and 3) a manual 3D match from actual treatment (Treat3D). The mean conformity index (CI) was 0.92 for the original plans and 0.91 for the Auto6D plans. The mean CI decreased significantly (p<0.01) to 0.78 and 0.80 for the Auto3D and the Treat3D plans, respectively. The mean minimum dose of the planning target volume (PTVmin) was 91.9% of the prescribed dose for the original plans and 92.1% for the Auto6D plans, while for the Auto3D and the Treat3D plans PTVmin decreased significantly (p<0.01) to 78.9% and 80.2%, respectively. No significant differences were seen between the Auto6D and the original treatment plans in terms of the dose parameters. However, the Auto3D and the Treat3D plans were statistically significantly inferior (p<0.01) to the Auto6D and the original plans. In addition, a significant negative correlation (p<0.01,|r|>0.38) was found in the Auto3D and the Treat3D cases between the rotation error and CI, PTVmin or minimum dose of gross tumour volume. In SRT, a treatment plan of comparable quality to 6D rotation correction can be achieved by using 6D registration without a rotational correction in the selection of patient positioning. This was demonstrated for typical rotation errors seen in clinical practice. PACS number(s): 87.55, 87.57
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20
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Frings K, Gruber S, Kuess P, Kleiter M, Dörr W. Modulation of radiation-induced oral mucositis by thalidomide : Preclinical studies. Strahlenther Onkol 2016; 192:561-8. [PMID: 27282278 DOI: 10.1007/s00066-016-0989-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/26/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE Oral mucositis is a common, dose-limiting early side effect of radio(chemo)therapy for head-and-neck tumors. The epithelial radiation response is accompanied by changes in the inflammatory signaling cascades mediated by the transcription factor nuclear factor-kappa B (NF-κB). The present study was initiated to determine the effect of the NF-κB inhibitor thalidomide on the clinical manifestation of oral mucositis in the established mouse tongue model. MATERIALS AND METHODS Treatment protocols comprised single dose irradiation and daily fractionated irradiation (5 fractions of 3 Gy/week) over 1 (days 0-4) or 2 weeks (days 0-4, 7-11), alone or in combination with daily thalidomide application (100 mg/kg intraperitoneally) over varying time intervals. Fractionation protocols were terminated by graded local radiation doses (day 7/14) to generate full dose-effect curves. Tongue epithelial ulcerations, corresponding to confluent mucositis, served as the clinically relevant endpoint. RESULTS Thalidomide application did not show a significant radioprotective potential when administered in combination with single dose irradiation. Thalidomide in combination with one week of fractionated irradiation significantly increased the isoeffective top-up doses. Similar results were observed during two weeks of fractionated irradiation in all but one experiment. CONCLUSION Thalidomide treatment demonstrated a significant mucositis-ameliorating effect during fractionated irradiation, which is likely to result from NF-κB inhibition. However, further mechanistic studies are required to define the underlying mechanisms of the observed mucoprotective effect.
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Affiliation(s)
- Katharina Frings
- Platform Radiooncology and Nuclear Medicine, Department for Companion Animals and Horses, University of Veterinary Medicine of Vienna, Vienna, Austria.,Department of Radiotherapy, ATRAB - Applied and Translational Radiotherapy, Medical University of Vienna/General Hospital of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sylvia Gruber
- Department of Radiotherapy, ATRAB - Applied and Translational Radiotherapy, Medical University of Vienna/General Hospital of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Peter Kuess
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Miriam Kleiter
- Platform Radiooncology and Nuclear Medicine, Department for Companion Animals and Horses, University of Veterinary Medicine of Vienna, Vienna, Austria
| | - Wolfgang Dörr
- Department of Radiotherapy, ATRAB - Applied and Translational Radiotherapy, Medical University of Vienna/General Hospital of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.
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21
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Wang N, Feng Y, Zeng L, Zhao Z, Chen T. Functionalized Multiwalled Carbon Nanotubes as Carriers of Ruthenium Complexes to Antagonize Cancer Multidrug Resistance and Radioresistance. ACS APPLIED MATERIALS & INTERFACES 2015; 7:14933-14945. [PMID: 26107995 DOI: 10.1021/acsami.5b03739] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Multidrug resistance and radioresistance are major obstacles for successful cancer therapy. Due to the unique characteristics of high surface area, improved cellular uptake, and the possibility to be easily bound with therapeutics, carbon nanotubes (CNTs) have attracted increasing attention as potential nanodrug delivery systems. In this study, a CNT-based radiosensitive nanodrug delivery system was rationally designed to antagonize the multidrug resistance in hepatocellular carcinoma. The nanosystem was loaded with a potent anticancer ruthenium polypyridyl complex (RuPOP) via π-π interaction and formation of a hydrogen bond. The functionalized nanosystem (RuPOP@MWCNTs) enhanced the cellular uptake of RuPOP in liver cancer cells, especially drug-resistant R-HepG2 cells, through endocytosis. Consistently, the selective cellular uptake endowed the nanosystem amplified anticancer efficacy against R-HepG2 cells but not in normal cells. Interestingly, RuPOP@MWCNTs significantly enhanced the anticancer efficacy of clinically used X-ray against R-HepG2 cells through induction of apoptosis and G0/G1 cell cycle arrest, with the involvement of ROS overproduction, which activated several downstream signaling pathways, including DNA damage-mediated p53 phosphorylation, activation of p38, and inactivation of AKT and ERK. Moreover, the nanosystem also effectively reduces the toxic side effects of loaded drugs and prolongs the blood circulation in vivo. Taken together, the results demonstrate the rational design of functionalized carbon nanotubes and their application as effective nanomedicine to overcome cancer multidrug resistance.
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Affiliation(s)
- Ni Wang
- Department of Chemistry, Jinan University, Guangzhou 510632, China
| | - Yanxian Feng
- Department of Chemistry, Jinan University, Guangzhou 510632, China
| | - Lilan Zeng
- Department of Chemistry, Jinan University, Guangzhou 510632, China
| | - Zhennan Zhao
- Department of Chemistry, Jinan University, Guangzhou 510632, China
| | - Tianfeng Chen
- Department of Chemistry, Jinan University, Guangzhou 510632, China
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22
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Dieterich S, Zwingenberger A, Hansen K, Pfeiffer I, Théon A, Kent MS. INTER- AND INTRAFRACTION MOTION FOR STEREOTACTIC RADIOSURGERY IN DOGS AND CATS USING A MODIFIED BRAINLAB FRAMELESS STEREOTACTIC MASK SYSTEM. Vet Radiol Ultrasound 2015; 56:563-9. [DOI: 10.1111/vru.12271] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 04/05/2015] [Indexed: 12/27/2022] Open
Affiliation(s)
- Sonja Dieterich
- Department of Radiation Oncology; UC Davis School of Medicine; Sacramento CA
| | - Allison Zwingenberger
- Department of Surgical and Radiological Sciences; UC Davis School of Veterinary Medicine 1 Shields Ave; Davis CA
| | - Katherine Hansen
- Department of Surgical and Radiological Sciences; UC Davis School of Veterinary Medicine 1 Shields Ave; Davis CA
| | - Isabella Pfeiffer
- The William R. Prichard Veterinary Medical Teaching Hospital; UC Davis School of Veterinary Medicine 1 Shields Ave; Davis CA
| | - Alain Théon
- Department of Surgical and Radiological Sciences; UC Davis School of Veterinary Medicine 1 Shields Ave; Davis CA
| | - Michael S. Kent
- Department of Surgical and Radiological Sciences; UC Davis School of Veterinary Medicine 1 Shields Ave; Davis CA
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23
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Infusino E, Trodella L, Ramella S, D'Angelillo RM, Greco C, Iurato A, Trodella LE, Nacca A, Cornacchione P, Mameli A. Estimation of patient setup uncertainty using BrainLAB Exatrac X-Ray 6D system in image-guided radiotherapy. J Appl Clin Med Phys 2015; 16:5102. [PMID: 26103179 PMCID: PMC5690103 DOI: 10.1120/jacmp.v16i2.5102] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 11/18/2014] [Accepted: 11/10/2014] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to evaluate setup uncertainties for brain sites with ExacTrac X‐Ray 6D system and to provide optimal margin guidelines. Fifteen patients with brain tumor were included in this study. Two X‐ray images with ExacTrac X‐Ray 6D system were used to verify patient position and tumor target localization before each treatment. The 6D fusion software first generates various sets of DRRs with position variations in both three translational and three rotational directions (six degrees of freedom) for the CT images. Setup variations (translation and rotation) after correction were recorded and corrected before treatment. The 3D deviations are expressed as mean±standard deviation. The random error (Σ(σi)), systematic error (μi), and group systematic error (M(μi)) for the different X‐ray were calculated using the definitions of van Herk.(1) Mean setup errors were calculated from X‐ray images acquired after all fractions. There is moderate patient‐to‐patient variation in the vertical direction and small variations in systematic errors and magnitudes of random errors are smaller. The global systematic errors were measured to be less than 2.0 mm in each direction. Random component of all patients are smaller ranging from 0.1–0.3 mm small. The safety margin (SM) to the lateral, is 0.5 mm and 2.6 mm for van Herk(1) and Stroom et al.,(2) respectively, craniocaudal axis is 1.5 mm and 3.4 mm, respectively, and with respect to the antero–posterior axis, 2.3 mm and 3.9 mm. Daily X‐ray imaging is essential to compare and assess the accuracy of treatment delivery to different anatomical locations. PACS number: 87.55.D
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24
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Minniti G, Clarke E, Scaringi C, Enrici RM. Stereotactic radiotherapy and radiosurgery for non-functioning and secreting pituitary adenomas. Rep Pract Oncol Radiother 2014; 21:370-8. [PMID: 27330422 DOI: 10.1016/j.rpor.2014.09.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 07/28/2014] [Accepted: 09/16/2014] [Indexed: 11/18/2022] Open
Abstract
Radiotherapy (RT) is frequently employed in patients with residual or recurrent pituitary adenoma with excellent rates of tumor control and remission of hormonal hypersecretion. Advances in RT have improved with the use of stereotactic techniques either as fractionated stereotactic radiotherapy (FSRT) or stereotactic radiosurgery (SRS), all aiming to improve the dose distribution to the tumor while reducing the amount of normal brain receiving significant doses of radiation. We provide an overview of the recent published literature on the long-term efficacy and adverse effects of stereotactic irradiation in nonfunctioning and secreting pituitary adenomas. Both techniques are associated with excellent clinical outcomes; however, advantages and drawbacks of each of these techniques in terms of local control, hormonal excess normalization, and radiation-induced toxicity remain a matter of debate. In clinical practice, single-fraction SRS may represent a convenient approach to patients with small and medium-sized pituitary adenoma away at least 2 mm from the optic chiasm, whereas FSRT is preferred over SRS for lesions >2.5-3 cm in size and/or involving the anterior optic pathway.
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Affiliation(s)
- Giuseppe Minniti
- Department of Radiation Oncology, Sant' Andrea Hospital, University of Rome Sapienza, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - Enrico Clarke
- Department of Radiation Oncology, Sant' Andrea Hospital, University of Rome Sapienza, Rome, Italy
| | - Claudia Scaringi
- Department of Radiation Oncology, Sant' Andrea Hospital, University of Rome Sapienza, Rome, Italy
| | - Riccardo Maurizi Enrici
- Department of Radiation Oncology, Sant' Andrea Hospital, University of Rome Sapienza, Rome, Italy
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25
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Cellini F, Morganti AG, Genovesi D, Silvestris N, Valentini V. Role of microRNA in response to ionizing radiations: evidences and potential impact on clinical practice for radiotherapy. Molecules 2014; 19:5379-401. [PMID: 24879584 PMCID: PMC6271831 DOI: 10.3390/molecules19045379] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/17/2014] [Accepted: 04/23/2014] [Indexed: 01/06/2023] Open
Abstract
MicroRNAs (miRNA) are small, non-coding, RNAs with gene expression regulator roles. As an important class of regulators of many cellular pathways, miRNAs are involved in many signaling pathways and DNA damage repair processes, affecting cellular radiosensitivity. Their role has led to interest in oncological implications to improve treatment results. MiRNAs represent a great opportunity to enhance the efficacy of radiotherapy treatments-they can be used to profile the radioresistance of tumors before radiotherapy, monitor their response throughout the treatment, thus helping to select intensification strategies, and also to define the final response to therapy along with risks of recurrence or metastatization. Even though many interesting studies support such potential, nowadays most studies on patient data are limited to experiments profiling tumor aggressiveness and response to radiotherapy. Moreover many studies report different although not conflicting results on the miRNAs evaluated for each tumor type. Without doubt, the clinical potential of such molecules for radiotherapy is striking and of high interest.
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Affiliation(s)
- Francesco Cellini
- Radiation Oncology Department, Policlinico Universitario Campus Bio-Medico; Via Álvaro del Portillo 200, 00144 Rome, Italy.
| | - Alessio G Morganti
- Radiotherapy Department, Università Cattolica del Sacro Cuore; Fondazione di Ricerca e Cura "Giovanni Paolo II", Largo Agostino Gemelli 1, 86100 Campobasso, Italy.
| | - Domenico Genovesi
- Radiation Oncology Department, Università "G. D'Annunzio"; Via dei Vestini 31, 66100 Chieti, Italy.
| | - Nicola Silvestris
- Medical Oncology Unit - Cancer Institute "Giovanni Paolo II"; Viale Orazio Flacco, 65, 70124 Bari, Italy.
| | - Vincenzo Valentini
- Radiation Oncology Department, Università Cattolica del Sacro Cuore; L.go Francesco Vito 1, 00168 Roma, Italy.
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Kocher M, Wittig A, Piroth MD, Treuer H, Seegenschmiedt H, Ruge M, Grosu AL, Guckenberger M. Stereotactic radiosurgery for treatment of brain metastases. A report of the DEGRO Working Group on Stereotactic Radiotherapy. Strahlenther Onkol 2014; 190:521-32. [PMID: 24715242 DOI: 10.1007/s00066-014-0648-7] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 02/25/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND This report from the Working Group on Stereotaktische Radiotherapie of the German Society of Radiation Oncology (Deutsche Gesellschaft für Radioonkologie, DEGRO) provides recommendations for the use of stereotactic radiosurgery (SRS) on patients with brain metastases. It considers existing international guidelines and details them where appropriate. RESULTS AND DISCUSSION The main recommendations are: Patients with solid tumors except germ cell tumors and small-cell lung cancer with a life expectancy of more than 3 months suffering from a single brain metastasis of less than 3 cm in diameter should be considered for SRS. Especially when metastases are not amenable to surgery, are located in the brain stem, and have no mass effect, SRS should be offered to the patient. For multiple (two to four) metastases--all less than 2.5 cm in diameter--in patients with a life expectancy of more than 3 months, SRS should be used rather than whole-brain radiotherapy (WBRT). Adjuvant WBRT after SRS for both single and multiple (two to four) metastases increases local control and reduces the frequency of distant brain metastases, but does not prolong survival when compared with SRS and salvage treatment. As WBRT carries the risk of inducing neurocognitive damage, it seems reasonable to withhold WBRT for as long as possible. CONCLUSION A single (marginal) dose of 20 Gy is a reasonable choice that balances the effect on the treated lesion (local control, partial remission) against the risk of late side effects (radionecrosis). Higher doses (22-25 Gy) may be used for smaller (< 1 cm) lesions, while a dose reduction to 18 Gy may be necessary for lesions greater than 2.5-3 cm. As the infiltration zone of the brain metastases is usually small, the GTV-CTV (gross tumor volume-clinical target volume) margin should be in the range of 0-1 mm. The CTV-PTV (planning target volume) margin depends on the treatment technique and should lie in the range of 0-2 mm. Distant brain recurrences fulfilling the aforementioned criteria can be treated with SRS irrespective of previous WBRT.
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Affiliation(s)
- Martin Kocher
- Department of Radiation Oncology, University Hospital Cologne, Joseph-Stelzmann-Str. 9, 50924, Köln, Germany,
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27
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Sutandyo N, Ramli R, Sari L, Soeis DS. Profile and Survival of Tongue Cancer Patients in "Dharmais" Cancer Hospital, Jakarta. Asian Pac J Cancer Prev 2014; 15:1971-5. [DOI: 10.7314/apjcp.2014.15.5.1971] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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28
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Amelio D, Winter M, Habermehl D, Jäkel O, Debus J, Combs SE. Analysis of inter- and intrafraction accuracy of a commercial thermoplastic mask system used for image-guided particle radiation therapy. JOURNAL OF RADIATION RESEARCH 2013; 54 Suppl 1:i69-i76. [PMID: 23824130 PMCID: PMC3700507 DOI: 10.1093/jrr/rrt038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/11/2013] [Accepted: 03/21/2013] [Indexed: 06/02/2023]
Abstract
The present paper reports and discusses the results concerning both the inter- and intrafraction accuracy achievable combining the immobilization system employed in patients with head-and-neck, brain and skull base tumors with image guidance at our particle therapy center. Moreover, we investigated the influence of intrafraction time on positioning displacements. A total of 41 patients treated between January and July 2011 represented the study population. All the patients were immobilized with a tailored commercial thermoplastic head mask with standard head-neck rest (HeadSTEP(®), IT-V). Patient treatment position was verified by two orthogonal kilovoltage images acquired through a ceiling imaging robot (Siemens, Erlangen, Germany). The analysis of the applied daily corrections during the first treatment week before and after treatment delivery allowed the evaluation of the interfraction and intrafraction reproducibility of the thermoplastic mask, respectively. Concerning interfraction reproducibility, translational and rotational systematic errors (Σs) were ≤ 2.2 mm and 0.9º, respectively; translational and rotational random errors (σs) were ≤ 1.6 mm and 0.6º, respectively. Regarding the intrafraction accuracy translational and rotational Σs were ≤ 0.4 mm and 0.4º, respectively; translational and rotational σs were ≤ 0.5 mm and 0.3º, respectively. Concerning the time-intrafraction displacements correlation Pearson coefficient was 0.5 for treatment fractions with time between position checks less than or equal to median value, and 0.2 for those with time between position controls longer than the median figure. These results suggest that intrafractional patient motion is smaller than interfractional patient motion. Moreover, we can state that application of different imaging verification protocols translate into a relevant difference of accuracy for the same immobilization device. The magnitude of intrafraction displacements correlates with the time for short treatment sessions or during the early phase of long treatment delivery.
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Affiliation(s)
- Dante Amelio
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany.
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Wissel T, Bruder R, Schweikard A, Ernst F. Estimating soft tissue thickness from light-tissue interactions--a simulation study. BIOMEDICAL OPTICS EXPRESS 2013; 4:1176-1187. [PMID: 23847741 PMCID: PMC3704097 DOI: 10.1364/boe.4.001176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 06/09/2013] [Indexed: 06/02/2023]
Abstract
Immobilization and marker-based motion tracking in radiation therapy often cause decreased patient comfort. However, the more comfortable alternative of optical surface tracking is highly inaccurate due to missing point-to-point correspondences between subsequent point clouds as well as elastic deformation of soft tissue. In this study, we present a proof of concept for measuring subcutaneous features with a laser scanner setup focusing on the skin thickness as additional input for high accuracy optical surface tracking. Using Monte-Carlo simulations for multi-layered tissue, we show that informative features can be extracted from the simulated tissue reflection by integrating intensities within concentric ROIs around the laser spot center. Training a regression model with a simulated data set identifies patterns that allow for predicting skin thickness with a root mean square error of down to 18 µm. Different approaches to compensate for varying observation angles were shown to yield errors still below 90 µm. Finally, this initial study provides a very promising proof of concept and encourages research towards a practical prototype.
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Affiliation(s)
- Tobias Wissel
- Institute for Robotics and Cognitive Systems, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany
- Graduate School for Computing in Medicine and Life Sciences, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany
| | - Ralf Bruder
- Institute for Robotics and Cognitive Systems, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany
| | - Achim Schweikard
- Institute for Robotics and Cognitive Systems, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany
| | - Floris Ernst
- Institute for Robotics and Cognitive Systems, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany
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Rosenfelder NA, Corsini L, McNair H, Pennert K, Aitken A, Lamb CM, Long M, Clarke E, Murcia M, Schick U, Burke K, Ashley S, Khoo, V, Brada M. Comparison of setup accuracy and intrafraction motion using stereotactic frame versus 3-point thermoplastic mask-based immobilization for fractionated cranial image guided radiation therapy. Pract Radiat Oncol 2013; 3:171-179. [DOI: 10.1016/j.prro.2012.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 06/07/2012] [Accepted: 06/11/2012] [Indexed: 11/24/2022]
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Hypofractionated stereotactic radiotherapy and continuous low-dose temozolomide in patients with recurrent or progressive malignant gliomas. J Neurooncol 2012; 111:187-94. [DOI: 10.1007/s11060-012-0999-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 10/31/2012] [Indexed: 02/06/2023]
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Walter F, la Fougère C, Belka C, Niyazi M. Technical Issues of [(18)F]FET-PET Imaging for Radiation Therapy Planning in Malignant Glioma Patients - A Review. Front Oncol 2012; 2:130. [PMID: 23061046 PMCID: PMC3463828 DOI: 10.3389/fonc.2012.00130] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 09/14/2012] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Walter
- Department of Radiation Oncology, University of Munich Munich, Germany
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Inata H, Semba T, Itoh Y, Kuribayashi Y, Murayama S, Nishizaki O, Araki F. Development of a phantom to evaluate the positioning accuracy of patient immobilization systems using thermoplastic mask and polyurethane cradle. Med Phys 2012; 39:4219-27. [PMID: 22830755 DOI: 10.1118/1.4728978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The purpose of this study was to develop a new phantom to evaluate the positioning accuracy of patient immobilization systems. METHODS The phantom was made of papers formed into a human shape, paper clay, and filling rigid polyester. Acrylonitrile butadiene styrene (ABS) pipes were inserted at anterior-posterior (A-P) and right-left (R-L) directions in the phantom to give static load by pulling ropes through the pipes. First, the positioning precision of the phantom utilizing a target locating system (TLS) was evaluated by moving the phantom on a couch along inferior-superior (I-S), A-P, and R-L directions in a range from -5 mm to +5 mm. The phantom's positions detected with the TLS were compared with values measured by a vernier caliper. Second, the phantom movements in a tensile test were chosen from patient movements determined from 15 patients treated for intracranial lesions and immobilized with a thermoplastic mask and polyurethane cradle. The phantom movement was given by minimum or maximum values of patient movements in each direction. Finally, the relationship between phantom movements and the static load in the tensile test was characterized from measurements using the new phantom and the TLS. RESULTS The differences in all positions between the vernier caliper measurement and the TLS detected values were within 0.2 mm with frequencies of 100%, 95%, and 90% in I-S, A-P, and R-L directions, respectively. The phantom movements according to patient movements in clinical application in I-S, A-P, and R-L directions were within 0.58 mm, 0.94 mm, and 0.93 mm from the mean value plus standard deviation, respectively. The regression lines between the phantom movements and static load were given by y = 0.359x, y = 0.241x, and y = 0.451x in I-S, A-P, and R-L directions, respectively, where x is the phantom movement (mm) and y is the static load (kgf). The relationship between the phantom movements and static load may represent the performance of inhibiting patient movements, so the accuracy of the immobilization system in the intracranial lesion will be estimated in advance by basic tensile test on the new phantom. CONCLUSIONS The newly developed phantom was useful to evaluate the accuracy of immobilization systems for a Cyberknife system for intracranial lesions.
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Affiliation(s)
- Hiroki Inata
- Department of Radiology, Saiseikai Imabari Hospital, Imabari, Ehime, Japan
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Rosenfelder NA, Corsini L, McNair H, Pennert K, Burke K, Lamb CM, Aitken A, Ashley S, Khoo V, Brada M. Achieving the relocation accuracy of stereotactic frame-based cranial radiotherapy in a three-point thermoplastic shell. Clin Oncol (R Coll Radiol) 2012; 25:66-73. [PMID: 22795232 DOI: 10.1016/j.clon.2012.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 03/25/2012] [Accepted: 06/26/2012] [Indexed: 12/25/2022]
Abstract
AIMS To compare the accuracy of fractionated cranial radiotherapy in a standard three-point thermoplastic shell using daily online correction with accuracy in a Gill-Thomas-Cosman relocatable stereotactic frame. MATERIALS AND METHODS All patients undergoing fractionated radiotherapy for benign intracranial tumours between March 2009 and August 2010 were included. Patients were immobilised in the frame with those unable to tolerate it immobilised in the shell. The ExacTrac imaging system was used for verification/correction. Daily online imaging before and after correction was carried out for shell patients and systematic and random population set-up errors calculated. These were compared with frame patients who underwent standard departmental imaging/correction with fractions 1-3 and weekly thereafter. Set-up margins were calculated from population errors. RESULTS Systematic and random errors were 0.3-0.7 mm/° before correction and 0.1-0.2 mm/° after correction in all axes in the frame, and 0.6-1.5 mm/° before correction and 0.1-0.4 mm/° after correction in the shell. Isotropic margins required for patient set-up could be reduced from 2 mm to <1 mm in the frame and from 5 mm to <1 mm in the shell. CONCLUSION Similar set-up accuracy can be achieved in the standard thermoplastic shell as in a relocatable frame despite less precise immobilisation. The use of daily online correction precludes the need for larger set-up margins.
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Affiliation(s)
- N A Rosenfelder
- Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, London, UK.
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Minniti G, Scaringi C, Amelio D, Maurizi Enrici R. Stereotactic Irradiation of GH-Secreting Pituitary Adenomas. Int J Endocrinol 2012; 2012:482861. [PMID: 22518123 PMCID: PMC3296430 DOI: 10.1155/2012/482861] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 12/14/2011] [Indexed: 01/02/2023] Open
Abstract
Radiotherapy (RT) is often employed in patients with acromegaly refractory to medical and/or surgical interventions in order to prevent tumour regrowth and normalize elevated GH and IGF-I levels. It achieves tumour control and hormone normalization up to 90% and 70% of patients at 10-15 years. Despite the excellent tumour control, conventional RT is associated with a potential risk of developing late toxicity, especially hypopituitarism, and its role in the management of patients with GH-secreting pituitary adenomas remains a matter of debate. Stereotactic techniques have been developed with the aim to deliver more localized irradiation and minimize the long-term consequences of treatment, while improving its efficacy. Stereotactic irradiation can be given in a single dose as stereotactic radiosurgery (SRS) or in multiple doses as fractionated stereotactic radiotherapy (FSRT). We have reviewed the recent published literature on stereotactic techniques for GH-secreting pituitary tumors with the aim to define the efficacy and potential adverse effects of each of these techniques.
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Affiliation(s)
- G. Minniti
- Department of Neuroscience, Neuromed Institute, 86077 Pozzilli, Italy
- Department of Radiation Oncology, Sant'Andrea Hospital, University Sapienza, 00189 Rome, Italy
- *G. Minniti:
| | - C. Scaringi
- Department of Radiation Oncology, Sant'Andrea Hospital, University Sapienza, 00189 Rome, Italy
| | - D. Amelio
- ATreP, Agenzia Provinciale per la Protonterapia, 38122 Trento, Italy
| | - R. Maurizi Enrici
- Department of Radiation Oncology, Sant'Andrea Hospital, University Sapienza, 00189 Rome, Italy
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Theelen A, Martens J, Bosmans G, Houben R, Jager JJ, Rutten I, Lambin P, Minken AW, Baumert BG. Relocatable fixation systems in intracranial stereotactic radiotherapy. Accuracy of serial CT scans and patient acceptance in a randomized design. Strahlenther Onkol 2011; 188:84-90. [PMID: 22194025 DOI: 10.1007/s00066-011-0018-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 06/28/2011] [Indexed: 12/25/2022]
Abstract
PURPOSE The goal was to provide a quantitative evaluation of the accuracy of three different fixation systems for stereotactic radiotherapy and to evaluate patients' acceptance for all fixations. METHODS A total of 16 consecutive patients with brain tumours undergoing fractionated stereotactic radiotherapy (SCRT) were enrolled after informed consent (Clinical trials.gov: NCT00181350). Fixation systems evaluated were the BrainLAB® mask, with and without custom made bite-block (fixations S and A) and a homemade neck support with bite-block (fixation B) based on the BrainLAB® frame. The sequence of measurements was evaluated in a randomized manner with a cross-over design and patients' acceptance by a questionnaire. RESULTS The mean three-dimensional (3D) displacement and standard deviations were 1.16 ± 0.68 mm for fixation S, 1.92 ± 1.28 and 1.70 ± 0.83 mm for fixations A and B, respectively. There was a significant improvement of the overall alignment (3D vector) when using the standard fixation instead of fixation A or B in the craniocaudal direction (p = 0.037). Rotational deviations were significantly less for the standard fixation S in relation to fixations A (p = 0.005) and B (p = 0.03). EPI imaging with off-line correction further improved reproducibility. Five out of 8 patients preferred the neck support with the bite-block. CONCLUSION The mask fixation system in conjunction with a bite-block is the most accurate fixation for SCRT reducing craniocaudal and rotational movements. Patients favoured the more comfortable but less accurate neck support. To optimize the accuracy of SCRT, additional regular portal imaging is warranted.
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Affiliation(s)
- A Theelen
- Department of Radiation-Oncology (MAASTRO), GROW (School for Oncology & Developmental Biology), Maastricht University Medical Centre, Dr Tanslaan 12, 6229, Maastricht, The Netherlands
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Nikolajek K, Kufeld M, Muacevic A, Wowra B, Niyazi M, Ganswindt U. Spinal radiosurgery--efficacy and safety after prior conventional radiotherapy. Radiat Oncol 2011; 6:173. [PMID: 22177519 PMCID: PMC3264666 DOI: 10.1186/1748-717x-6-173] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 12/16/2011] [Indexed: 12/25/2022] Open
Abstract
Background Conventional external beam radiotherapy is a standard procedure for treatment of spinal metastases. In case of progression spinal cord tolerance limits further radiotherapy in pre-irradiated areas. Spinal stereotactic radiotherapy is a non-invasive option to re-treat pre-irradiated patients. Nevertheless, spinal radiosurgery results in relevant dose deposition within the myelon with potential toxicity. Aim of the study was to retrospectively analyse the efficacy and feasibility for salvage radiosurgery of spinal metastases. Methods During a period of 4 years (2005-2009) 70 lesions in 54 patients were treated in 60 radiosurgery sessions and retrospectively analysed. Clinical (pain, sensory and motor deficit) and radiological (CT/MRI) follow-up data were collected prospectively after radiosurgery. Pain - as main symptom - was classified by the Visual Analogue Scale (VAS) score. Every patient received single session radiosurgery after having been treated first-line with conventionally fractionated radiotherapy. Kaplan-Meier method and life tables were used to analyse freedom from local failure and overall survival. Results At a median follow-up of 14.5 months the actuarial rates of freedom from local failure at 6/12/18 months were 93%, 88% and 85%, respectively. The median radiosurgery dose was 1 × 18 Gy (range 10-28 Gy) to the median 70% isodose. The VAS score of patients with pain (median 6) dropped significantly (median 4, p = 0.002). In 6 out of 7 patients worse sensory or motor deficit after SRS was caused by local or distant failures (diagnosed by CT/MRI). One patient with metastatic renal cell carcinoma developed a progressive complete paraparesis one year after the last treatment at lumbar level L3. Due to multiple surgery and radiosurgery treatments at the lumbar region and further local progression, the exact reason remained unclear. Apart from that, no CTC grade III or higher toxicity has been observed. Conclusions By applying spinal radiosurgery relevant radiation doses can be limited to small parts of the myelon. This prevents myelopathic side effects and makes it an effective and safe treatment option for well-suited patients. Especially for previously irradiated patients with local failure or pain salvage SRS represents a valuable treatment option with high local control rates, low toxicity and significant pain reduction.
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Affiliation(s)
- Katharina Nikolajek
- Department of Radiation Oncology, Ludwig-Maximilians-University, Campus Grosshadern, Marchioninistr, 15, 81377 München, Germany
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Minniti G, Scaringi C, Enrici RM. Radiation techniques for acromegaly. Radiat Oncol 2011; 6:167. [PMID: 22136376 PMCID: PMC3275813 DOI: 10.1186/1748-717x-6-167] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 12/02/2011] [Indexed: 11/28/2022] Open
Abstract
Radiotherapy (RT) remains an effective treatment in patients with acromegaly refractory to medical and/or surgical interventions, with durable tumor control and biochemical remission; however, there are still concerns about delayed biochemical effect and potential late toxicity of radiation treatment, especially high rates of hypopituitarism. Stereotactic radiotherapy has been developed as a more accurate technique of irradiation with more precise tumour localization and consequently a reduction in the volume of normal tissue, particularly the brain, irradiated to high radiation doses. Radiation can be delivered in a single fraction by stereotactic radiosurgery (SRS) or as fractionated stereotactic radiotherapy (FSRT) in which smaller doses are delivered over 5-6 weeks in 25-30 treatments. A review of the recent literature suggests that pituitary irradiation is an effective treatment for acromegaly. Stereotactic techniques for GH-secreting pituitary tumors are discussed with the aim to define the efficacy and potential adverse effects of each of these techniques.
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Affiliation(s)
- Giuseppe Minniti
- Department of Neuroscience, Neuromed Institute, Pozzilli, IS, Italy.
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Minniti G, Scaringi C, Clarke E, Valeriani M, Osti M, Enrici RM. Frameless linac-based stereotactic radiosurgery (SRS) for brain metastases: analysis of patient repositioning using a mask fixation system and clinical outcomes. Radiat Oncol 2011; 6:158. [PMID: 22085700 PMCID: PMC3253058 DOI: 10.1186/1748-717x-6-158] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 11/16/2011] [Indexed: 11/21/2022] Open
Abstract
Purpose To assess the accuracy of patient repositioning and clinical outcomes of frameless stereotactic radiosurgery (SRS) for brain metastases using a stereotactic mask fixation system. Patients and Methods One hundred two patients treated consecutively with frameless SRS as primary treatment at University of Rome Sapienza Sant'Andrea Hospital between October 2008 and April 2010 and followed prospectively were involved in the study. A commercial stereotactic mask fixation system (BrainLab) was used for patient immobilization. A computerized tomography (CT) scan obtained immediately before SRS was used to evaluate the accuracy of patient repositioning in the mask by comparing the isocenter position to the isocenter position established in the planning CT. Deviations of isocenter coordinates in each direction and 3D displacement were calculated. Overall survival, brain control, and local control were estimated using the Kaplan-Meier method calculated from the time of SRS. Results The mean measured isocenter displacements were 0.12 mm (SD 0.35 mm) in the lateral direction, 0.2 mm (SD 0.4 mm) in the anteroposterior, and 0.4 mm (SD 0.6 mm) in craniocaudal direction. The maximum displacement of 2.1 mm was seen in craniocaudal direction. The mean 3D displacement was 0.5 mm (SD 0.7 mm), being maximum 2.9 mm. The median survival was 15.5 months, and 1-year and 2-year survival rates were 58% and 24%, respectively. Nine patients recurred locally after SRS, with 1-year and 2-year local control rates of 91% and 82%, respectively. Stable extracranial disease (P = 0.001) and KPS > 70 (P = 0.01) were independent predictors of survival. Conclusions Frameless SRS is an effective treatment in the management of patients with brain metastases. The presented non-invasive mask-based fixation stereotactic system is associated with a high degree of patient repositioning accuracy; however, a careful evaluation is essential since occasional errors up to 3 mm may occur.
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Affiliation(s)
- Giuseppe Minniti
- Department of Radiation Oncology, Sant' Andrea Hospital, University Sapienza, Rome, Italy.
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Minniti G, Clarke E, Cavallo L, Osti MF, Esposito V, Cantore G, Cappabianca P, Enrici RM. Fractionated stereotactic conformal radiotherapy for large benign skull base meningiomas. Radiat Oncol 2011; 6:36. [PMID: 21486436 PMCID: PMC3094366 DOI: 10.1186/1748-717x-6-36] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 04/12/2011] [Indexed: 11/16/2022] Open
Abstract
Purpose to assess the safety and efficacy of fractionated stereotactic radiotherapy (FSRT) for large skull base meningiomas. Methods and Materials Fifty-two patients with large skull base meningiomas aged 34-74 years (median age 56 years) were treated with FSRT between June 2004 and August 2009. All patients received FSRT for residual or progressive meningiomas more than 4 centimeters in greatest dimension. The median GTV was 35.4 cm3 (range 24.1-94.9 cm3), and the median PTV was 47.6 cm3 (range 33.5-142.7 cm3). Treatment volumes were achieved with 5-8 noncoplanar beams shaped using a micromultileaf collimator (MLC). Treatment was delivered in 30 daily fractions over 6 weeks to a total dose of 50 Gy using 6 MV photons. Outcome was assessed prospectively. Results At a median follow-up of 42 months (range 9-72 months) the 3-year and 5-year progression-free survival (PFS) rates were 96% and 93%, respectively, and survival was 100%. Three patients required further debulking surgery for progressive disease. Hypopituitarism was the most commonly reported late complication, with a new hormone pituitary deficit occurring in 10 (19%) of patients. Clinically significant late neurological toxicity was observed in 3 (5.5%) patients consisting of worsening of pre-existing cranial deficits. Conclusion FSRT as a high-precision technique of localized RT is suitable for the treatment of large skull base meningiomas. The local control is comparable to that reported following conventional external beam RT. Longer follow-up is required to assess long term efficacy and toxicity, particularly in terms of potential reduction of treatment-related late toxicity.
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Affiliation(s)
- Giuseppe Minniti
- Department of Radiation Oncology, Sant' Andrea Hospital, Università degli Studi di Roma La Sapienza, Rome, Italy.
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Ryu DS, Baek GO, Kim EY, Kim KH, Lee DS. Effects of polysaccharides derived from Orostachys japonicus on induction of cell cycle arrest and apoptotic cell death in human colon cancer cells. BMB Rep 2010; 43:750-5. [DOI: 10.5483/bmbrep.2010.43.11.750] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Minniti G, Armosini V, Salvati M, Lanzetta G, Caporello P, Mei M, Osti MF, Maurizi RE. Fractionated stereotactic reirradiation and concurrent temozolomide in patients with recurrent glioblastoma. J Neurooncol 2010; 103:683-91. [DOI: 10.1007/s11060-010-0446-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Accepted: 10/21/2010] [Indexed: 12/20/2022]
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Combined atorvastatin and ramipril mitigate radiation-induced impairment of dentate gyrus neurogenesis. J Neurooncol 2010; 101:449-56. [DOI: 10.1007/s11060-010-0282-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 06/21/2010] [Indexed: 12/13/2022]
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