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Dehne S, Kirschner L, Strowitzki MJ, Kilian S, Kummer LC, Schneider MA, Michalski CW, Büchler MW, Weigand MA, Larmann J. Low intraoperative end-tidal carbon dioxide levels are associated with improved recurrence-free survival after elective colorectal cancer surgery. J Clin Anesth 2024; 96:111495. [PMID: 38733708 DOI: 10.1016/j.jclinane.2024.111495] [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: 08/17/2023] [Revised: 04/24/2024] [Accepted: 05/04/2024] [Indexed: 05/13/2024]
Abstract
STUDY OBJECTIVE Higher levels of carbon dioxide (CO2) increase the invasive abilities of colon cancer cells in vitro. Studies assessing target values for end-tidal CO2 concentrations (EtCO2) to improve surgical outcome after colorectal cancer surgery are lacking. Therefore, we evaluated whether intraoperative EtCO2 was associated with differences in recurrence-free survival after elective colorectal cancer (CRC) surgery. DESIGN Single center, retrospective analysis. SETTING Anesthesia records, surgical databases and hospital information system of a tertiary university hospital. PATIENTS We analyzed 528 patients undergoing elective resection of colorectal cancer at Heidelberg University Hospital between 2009 and 2018. INTERVENTIONS None. MEASUREMENTS Intraoperative mean EtCO2 values were calculated. The study cohort was equally stratified into low-and high-EtCO2 groups. The primary endpoint measure was recurrence-free survival until last known follow-up. Groups were compared using Kaplan-Meier analysis. Cox-regression analysis was used to control for covariates. Sepsis, reoperations, surgical site infections and cardiovascular events during hospital stay, and overall survival were secondary outcomes. MAIN RESULTS Mean EtCO2 was 33.8 mmHg ±1.2 in the low- EtCO2 group vs. 37.3 mmHg ±1.6 in the high-EtCO2 group. Median follow-up was 3.8 (Q1-Q3, 2.5-5.1) years. Recurrence-free survival was higher in the low-EtCO2 group (log-rank-test: p = .024). After correction for confounding factors, lower EtCO2 was associated with increased recurrence-free survival (HR = 1.138, 95%-CI:1.015-1.276, p = .027); the hazard for the primary outcome decreased by 12.1% per 1 mmHg decrease in mean EtCO2. 1-year and 5-year survival was also higher in the low-EtCO2 group. We did not find differences in the other secondary endpoints. CONCLUSIONS Lower intraoperative EtCO2 target values in CRC surgery might benefit oncological outcome and should be evaluated in confirmative studies.
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Affiliation(s)
- Sarah Dehne
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Lina Kirschner
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Moritz J Strowitzki
- Heidelberg University, Medical Faculty Heidelberg, Department of General, Visceral, and Transplantation Surgery, Heidelberg, Germany
| | - Samuel Kilian
- Heidelberg University, Medical Faculty Heidelberg, Institute of Medical Biometry, Heidelberg, Germany
| | - Laura Christine Kummer
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Martin A Schneider
- Heidelberg University, Medical Faculty Heidelberg, Department of General, Visceral, and Transplantation Surgery, Heidelberg, Germany
| | - Christoph W Michalski
- Heidelberg University, Medical Faculty Heidelberg, Department of General, Visceral, and Transplantation Surgery, Heidelberg, Germany
| | - Markus W Büchler
- Heidelberg University, Medical Faculty Heidelberg, Department of General, Visceral, and Transplantation Surgery, Heidelberg, Germany
| | - Markus A Weigand
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Jan Larmann
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany.
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Sancho-Muriel J, Guerrero-Antolino P, Cholewa H, Flor Lorente B. Total pelvic exenteration extended to pelvic bones with subsequent VRAM flap reconstruction in patient with recurrent anal squamous cell carcinoma following chemoradiotherapy. BMJ Case Rep 2024; 17:e258643. [PMID: 39025796 DOI: 10.1136/bcr-2023-258643] [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] [Indexed: 07/20/2024] Open
Abstract
Anal squamous cell carcinoma, typically associated with human papillomavirus infection, remains a rare malignancy. This article outlines a case of local recurrence in a male patient with a history of HIV and hepatitis C virus infection, previously treated with chemoradiotherapy. Extensive tumour involvement called for total pelvic exenteration extended to anterior osteomuscular compartment and genitalia. The surgical approach involved multidisciplinary collaboration and detailed preoperative planning using three-dimensional reconstruction. Key surgical considerations comprised the following: achieving tumour-free margins (R0 resection), extensive osteotomies and intricate pelvic floor reconstruction with prosthetic mesh and flap reconstruction. The procedure successfully yielded an R0 resection, maintaining adequate lower limb functionality. Our case report underscores the benefits of pelvic exenteration in locally advanced or recurrent pelvic tumours, invariably following careful patient selection and exhaustive preoperative studies.
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Affiliation(s)
- Jorge Sancho-Muriel
- Coloproctology Unit, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | | | - Hanna Cholewa
- Coloproctology Unit, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | - Blas Flor Lorente
- Coloproctology Unit, Hospital Politécnico y Universitario La Fe, Valencia, Spain
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Amarnath SR. The Role of Intraoperative Radiotherapy Treatment of Locally Advanced Rectal Cancer. Clin Colon Rectal Surg 2024; 37:239-247. [PMID: 38882939 PMCID: PMC11178387 DOI: 10.1055/s-0043-1770718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Intraoperative radiation therapy (IORT) has been used in the treatment of locally advanced and recurrent rectal cancers for the last several decades. Given the heterogeneity of patients treated and different indications for use and dosing at different institutions, it has been difficult to discern if IORT adds any appreciable benefit to standard of care therapies. Herein, the rationale for IORT in rectal cancer is discussed along with the most modern and best available data in 2023. IORT is likely indicated in patients with locally advanced and locally recurrent rectal cancer with threatened margins (R0 or R1 resection) to help improve local control. High-quality imaging and multidisciplinary discussion are necessary to ensure optimal patient selection. Appropriate counseling of the patient and excellent team communication are of the utmost importance given the challenging nature of these cases and the prognostic implications of R1 and R2 resections in this patient population.
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Affiliation(s)
- Sudha R. Amarnath
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio
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Franciosini G, Carlotti D, Cattani F, De Gregorio A, De Liso V, De Rosa F, Di Francesco M, Di Martino F, Felici G, Pensavalle JH, Leonardi MC, Marafini M, Muscato A, Paiar F, Patera V, Poortmans P, Sciubba A, Schiavi A, Toppi M, Traini G, Trigilio A, Sarti A. IOeRT conventional and FLASH treatment planning system implementation exploiting fast GPU Monte Carlo: The case of breast cancer. Phys Med 2024; 121:103346. [PMID: 38608421 DOI: 10.1016/j.ejmp.2024.103346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/13/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
Partial breast irradiation for the treatment of early-stage breast cancer patients can be performed by means of Intra Operative electron Radiation Therapy (IOeRT). One of the main limitations of this technique is the absence of a treatment planning system (TPS) that could greatly help in ensuring a proper coverage of the target volume during irradiation. An IOeRT TPS has been developed using a fast Monte Carlo (MC) and an ultrasound imaging system to provide the best irradiation strategy (electron beam energy, applicator position and bevel angle) and to facilitate the optimisation of dose prescription and delivery to the target volume while maximising the organs at risk sparing. The study has been performed in silico, exploiting MC simulations of a breast cancer treatment. Ultrasound-based input has been used to compute the absorbed dose maps in different irradiation strategies and a quantitative comparison between the different options was carried out using Dose Volume Histograms. The system was capable of exploring different beam energies and applicator positions in few minutes, identifying the best strategy with an overall computation time that was found to be completely compatible with clinical implementation. The systematic uncertainty related to tissue deformation during treatment delivery with respect to imaging acquisition was taken into account. The potential and feasibility of a GPU based full MC TPS implementation of IOeRT breast cancer treatments has been demonstrated in-silico. This long awaited tool will greatly improve the treatment safety and efficacy, overcoming the limits identified within the clinical trials carried out so far.
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Affiliation(s)
- G Franciosini
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy
| | - D Carlotti
- Operative Research Unit of Radiation Oncology, Fondazione Policlinico Universitatio Campus-Bio Medico, Rome, Italy
| | - F Cattani
- Unit of Medical Physics, European Institute of Oncology IRCCS, Milan, Italy
| | - A De Gregorio
- National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy; Sapienza, University of Rome, Department of Physics, Rome, Italy
| | - V De Liso
- S.I.T. Sordina IORT Technologies S.p.A, Aprilia, Italy
| | - F De Rosa
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy
| | | | - F Di Martino
- Centro Pisano Multidisciplinare sulla Ricerca e Implementazione Clinica della Flash Radiotherapy (CPFR), Pisa, Italy; University of Pisa, Department of Physics, Pisa, Italy; Azienda Ospedaliero Universitaria Pisa (AOUP), Fisica Sanitaria, Pisa, Italy; National Institute of Nuclear Physics, INFN, Section of Pisa, Pisa, Italy
| | - G Felici
- S.I.T. Sordina IORT Technologies S.p.A, Aprilia, Italy
| | - J Harold Pensavalle
- S.I.T. Sordina IORT Technologies S.p.A, Aprilia, Italy; Centro Pisano Multidisciplinare sulla Ricerca e Implementazione Clinica della Flash Radiotherapy (CPFR), Pisa, Italy; National Institute of Nuclear Physics, INFN, Section of Pisa, Pisa, Italy
| | - M C Leonardi
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - M Marafini
- National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy; Museo Storico della Fisica e Centro Studi e Ricerche "E. Fermi", Rome, Italy
| | - A Muscato
- National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy; Specialty School of Medical Physics, La Sapienza University of Rome, Rome, Italy
| | - F Paiar
- Centro Pisano Multidisciplinare sulla Ricerca e Implementazione Clinica della Flash Radiotherapy (CPFR), Pisa, Italy; Azienda Ospedaliero Universitaria Pisa (AOUP), Fisica Sanitaria, Pisa, Italy
| | - V Patera
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy
| | - P Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | - A Sciubba
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Frascati National Laboratories (LNF), Rome, Italy
| | - A Schiavi
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy
| | - M Toppi
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy
| | - G Traini
- National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy
| | - A Trigilio
- Sapienza, University of Rome, Department of Physics, Rome, Italy; National Institute of Nuclear Physics, INFN, Frascati National Laboratories (LNF), Rome, Italy
| | - A Sarti
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy.
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Pouyanrad Z, Shamsaei Zafarghandi M, Setayeshi S. A Novel Treatment Planning Design for Intraoperative Electron Radiation Therapy (IOERT) using an Electronic Board. J Biomed Phys Eng 2024; 14:119-128. [PMID: 38628890 PMCID: PMC11016823 DOI: 10.31661/jbpe.v0i0.2109-1405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 05/19/2022] [Indexed: 04/19/2024]
Abstract
Background Intraoperative Irradiation Therapy (IORT) refers to the delivery of radiation during surgery and needs the computed- thickness of the target as one of the most significant factors. Objective This paper aimed to compute target thickness and design a radiation pattern distributing the irradiation uniformly throughout the target. Material and Methods The Monte Carlo code was used to simulate the experimental setup in this simulation study. The electron flux variations on an electronic board's metallic layer were studied for different thicknesses of the target tissue and validated with experimental data of the electronic board. Results Based on the electron number for different Poly Methyl Methacrylate (PMMA) phantom thicknesses at various energies, 6 MeV electrons are suitable to determine the target thickness. Uniformity in radiation and corresponding time for each target were investigated. The iso-dose and percentage depth dose curves show that higher energies are suitable for treatment and distribute uniform radiation throughout the target. Increasing the phantom thickness leads to rising radiation time based on the radiation time corresponding to these energies. The tissue thickness of each section is determined, and the radiation time is managed by scanning the target. Conclusion Calculation of the thickness of the remaining tissue and irradiation time are needed after incomplete tumor removal in IORT for various remaining tissues. The patients should be protected from overexposure to uniform irradiation of tissues since the radiation dose is prescribed and checked by an oncologist.
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Affiliation(s)
- Zahra Pouyanrad
- Department of Energy Engineering and Physics, Amirkabir University of Technology, Tehran, Iran
| | | | - Saeed Setayeshi
- Department of Energy Engineering and Physics, Amirkabir University of Technology, Tehran, Iran
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Piqeur F, Peulen HM, Cnossen JS, Bimmel-Nagel CCH, Rutten HJ, Burger JW, Verrijssen ASE. Post-operative complications following dose adaptation of intra-operative electron beam radiation therapy in locally advanced or recurrent rectal cancer. J Contemp Brachytherapy 2024; 16:85-94. [PMID: 38808205 PMCID: PMC11129652 DOI: 10.5114/jcb.2024.139276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/11/2024] [Indexed: 05/30/2024] Open
Abstract
Purpose The benefit of intra-operative radiotherapy (IORT) in the treatment of locally advanced rectal cancer (LARC) or locally recurrent rectal cancer (LRRC) lie in its ability to provide high-dose of radiation to limited at-risk volume, thereby eliminating microscopic disease and decreasing toxicity. A comparative study between high-dose-rate (HDR) brachytherapy, named intra-operative brachytherapy (IOBT), and intra-operative electron radiotherapy (IOERT) was performed showing favorable LRFS after IOBT, possibly due to a higher surface dose that is inherent in IOBT technique. The IOERT technique in Catharina Hospital Eindhoven was adapted to increase the surface dose, aiming to improve local control. Post-operative complications due to an increased radiation dose remain the matter of concern. This retrospective study was performed to compare complication rates before and after adapted IOERT dose. Material and methods All patients undergoing surgery with IOERT for LARC or LRRC from September 2019 until July 2023, were considered. Patients selected until August 31, 2021 were included in control cohort (n = 108), and those chosen from September 1, 2021 onwards were included in intervention cohort (n = 92). Perioperative and (major) post-operative complications were classified retrospectively, during admission, at 30 days, and at 90 days. Results In LARC patients, a decrease in post-operative complications was observed (p = 0.009). 19% of LARC patients experienced major post-operative surgical complications, i.e., Clavien-Dindo grade 3b-5, regardless of treatment group. No difference in major 90-day complications was noted (p = 0.142). In LRRC patients, the use of induction chemotherapy decreased from 78% to 29% (p < 0.001), which complicated comparison. However, no difference in major post-operative complications was observed at 30 days (p = 0.222) or 90 days (p = 0.977) after surgery. Conclusions Increased surface dose of IOERT does not seem to lead to an increase in post-operative complications. Further research is needed to evaluate the efficacy of dose adaptation in IOERT to improve local oncological control rates. Routine evaluation of CTCAE scores in follow-up will help uncover possible long-term radiation-induced toxicity.
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Affiliation(s)
- Floor Piqeur
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Heike M.U. Peulen
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jeltsje S. Cnossen
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Harm J.T. Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
- GROW School of Oncology and Reproduction, University of Maastricht, Maastricht, The Netherlands
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Zhao X, Meng Q, Zhou M, Luo J, Hu L. Optimal treatment strategy and prognostic analysis for patients with non-metastatic pT4 colon adenocarcinoma. Front Oncol 2024; 13:1342289. [PMID: 38260849 PMCID: PMC10802841 DOI: 10.3389/fonc.2023.1342289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Objective This study endeavored to explore the optimal treatment strategy and conduct a prognostic analysis for patients diagnosed with pT4M0 (pathologic stage T4) colon adenocarcinoma (COAD). Methods and materials A total of 8,843 patients diagnosed with pT4M0 COAD between January 2010 and December 2015 were included in this study from the Surveillance, Epidemiology, and End Results (SEER) database. These patients were randomly divided into a training set and an internal validation set using a 7:3 ratio. Variables that demonstrated statistical significance (P<0.05) in univariate COX regression analysis or held clinical significance were incorporated into the multivariate COX regression model. Subsequently, this model was utilized to formulate a nomogram. The predictive accuracy and discriminability of the nomogram were assessed using the C-index, area under the curve (AUC), and calibration curves. Decision curve analysis (DCA) was conducted to confirm the clinical validity of the model. Results In the entire SEER cohort, the 3-year overall survival (OS) rate (74.22% vs. 63.20%, P<0.001) and the 3-year cancer-specific survival (CSS) rate (76.25% vs. 66.98%, P<0.001) in the surgery combined with postoperative adjuvant therapy (S+ADT) group surpassed those in the surgery (S) group. Multivariate COX regression analysis of the training set unveiled correlations between age, race, N stage, serum CEA (carcinoembryonic antigen), differentiation, number of resected lymph nodes, and treatment modalities with OS and CSS. Nomograms for OS and CSS were meticulously crafted based on these variables, achieving C-indexes of 0.692 and 0.690 in the training set, respectively. The robust predictive ability of the nomogram was further affirmed through receiver operating characteristic (ROC) and calibration curves in both the training and validation sets. Conclusion In individuals diagnosed with pT4M0 COAD, the integration of surgery with adjuvant chemoradiotherapy demonstrated a substantial extension of long-term survival. The nomogram, which incorporated key factors such as age, race, differentiation, N stage, serum CEA level, tumor size, and the number of resected lymph nodes, stood as a dependable tool for predicting OS and CSS rates. This predictive model held promise in aiding clinicians by identifying high-risk patients and facilitating the development of personalized treatment plans.
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Affiliation(s)
- Xinyue Zhao
- Graduate School of Dalian Medical University, Dalian, China
- Department of Radiation Oncology, Changzhou No. 2 People’s Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Qinghong Meng
- Department of Radiation Oncology, Changzhou No. 2 People’s Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Mengyun Zhou
- Department of Radiation Oncology, Changzhou No. 2 People’s Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Judong Luo
- Department of Radiation Oncology, Changzhou No. 2 People’s Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Lijun Hu
- Department of Radiation Oncology, Changzhou No. 2 People’s Hospital Affiliated to Nanjing Medical University, Changzhou, China
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Sriramulu S, Malayaperumal S, Banerjee A, Anbalagan M, Kumar MM, Radha RKN, Liu X, Zhang H, Hu G, Sun XF, Pathak S. AEG-1 as a Novel Therapeutic Target in Colon Cancer: A Study from Silencing AEG-1 in BALB/c Mice to Large Data Analysis. Curr Gene Ther 2024; 24:307-320. [PMID: 38783530 DOI: 10.2174/0115665232273077240104045022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/15/2023] [Accepted: 12/07/2023] [Indexed: 05/25/2024]
Abstract
BACKGROUND Astrocyte elevated gene-1 (AEG-1) is overexpressed in various malignancies. Exostosin-1 (EXT-1), a tumor suppressor, is an intermediate for malignant tumors. Understanding the mechanism behind the interaction between AEG-1 and EXT-1 may provide insights into colon cancer metastasis. METHODS AOM/DSS was used to induce tumor in BALB/c mice. Using an in vivo-jetPEI transfection reagent, transient transfection of AEG-1 and EXT-1 siRNAs were achieved. Histological scoring, immunohistochemical staining, and gene expression studies were performed from excised tissues. Data from the Cancer Genomic Atlas and GEO databases were obtained to identify the expression status of AEG-1 and itsassociation with the survival. RESULTS In BALB/c mice, the AOM+DSS treated mice developed necrotic, inflammatory and dysplastic changes in the colon with definite clinical symptoms such as loss of goblet cells, colon shortening, and collagen deposition. Administration of AEG-1 siRNA resulted in a substantial decrease in the disease activity index. Mice treated with EXT-1 siRNA showed diffusely reduced goblet cells. In vivo investigations revealed that PTCH-1 activity was influenced by upstream gene AEG-1, which in turn may affect EXT-1 activity. Data from The Cancer Genomic Atlas and GEO databases confirmed the upregulation of AEG-1 and downregulation of EXT-1 in cancer patients. CONCLUSIONS This study revealed that AEG-1 silencing might alter EXT-1 expression indirectly through PTCH-1, influencing cell-ECM interactions, and decreasing dysplastic changes, proliferation and invasion.
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Affiliation(s)
- Sushmitha Sriramulu
- Department of Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Kelambakkam, Chennai 603103, India
| | - Sarubala Malayaperumal
- Department of Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Kelambakkam, Chennai 603103, India
| | - Antara Banerjee
- Department of Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Kelambakkam, Chennai 603103, India
| | - Muralidharan Anbalagan
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Makalakshmi Murali Kumar
- Department of Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Kelambakkam, Chennai 603103, India
| | - Rajesh Kanna Nandagopal Radha
- Department of Pathology, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Kelambakkam, Chennai 603103, India
| | - Xingyi Liu
- Center for Systems Biology, Department of Bioinformatics, School of Basic Medicine and Biological Sciences, Suzhou, China
| | - Hong Zhang
- School of Medicine, Institute of Medical Sciences, Orebro University, SE-701 82 Orebro, Sweden
| | - Guang Hu
- School of Medicine, Institute of Medical Sciences, Orebro University, SE-701 82 Orebro, Sweden
| | - Xiao-Feng Sun
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Surajit Pathak
- Department of Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Kelambakkam, Chennai 603103, India
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Markov AG, Livanova AA, Fedorova AA, Kravtsova VV, Krivoi II. Chronic Ouabain Targets Pore-Forming Claudin-2 and Ameliorates Radiation-Induced Damage to the Rat Intestinal Tissue Barrier. Int J Mol Sci 2023; 25:278. [PMID: 38203449 PMCID: PMC10778734 DOI: 10.3390/ijms25010278] [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: 11/04/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Ionizing radiation (IR) causes disturbances in the functions of the gastrointestinal tract. Given the therapeutic potential of ouabain, a specific ligand of the Na,K-ATPase, we tested its ability to protect against IR-induced disturbances in the barrier and transport properties of the jejunum and colon of rats. Male Wistar rats were subjected to 6-day intraperitoneal injections of vehicle or ouabain (1 µg/kg/day). On the fourth day of injections, rats were exposed to total-body X-ray irradiation (10 Gy) or a sham irradiation. Isolated tissues were examined 72 h post-irradiation. Electrophysiological characteristics and paracellular permeability for sodium fluorescein were measured in an Ussing chamber. Histological analysis and Western blotting were also performed. In the jejunum tissue, ouabain exposure did not prevent disturbances in transepithelial resistance, paracellular permeability, histological characteristics, as well as changes in the expression of claudin-1, -3, -4, tricellulin, and caspase-3 induced by IR. However, ouabain prevented overexpression of occludin and the pore-forming claudin-2. In the colon tissue, ouabain prevented electrophysiological disturbances and claudin-2 overexpression. These observations may reveal a mechanism by which circulating ouabain maintains tight junction integrity under IR-induced intestinal dysfunction.
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Affiliation(s)
- Alexander G. Markov
- Department of General Physiology, St. Petersburg State University, 199034 St. Petersburg, Russia; (A.A.L.); (A.A.F.); (V.V.K.); (I.I.K.)
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Jasinski V, Hahn L, Goyal U. Definitive Chemoradiation for Colon Cancer: a Case Report. J Gastrointest Cancer 2023; 54:1353-1355. [PMID: 36715960 DOI: 10.1007/s12029-023-00912-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 01/31/2023]
Affiliation(s)
| | | | - Uma Goyal
- Department of Radiation Oncology, Banner MD Anderson Cancer Center and University of Arizona College of Medicine, Phoenix, 5555 W. Thunderbird Rd, Glendale, AZ, 85306, USA.
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Adebayo AS, Agbaje K, Adesina SK, Olajubutu O. Colorectal Cancer: Disease Process, Current Treatment Options, and Future Perspectives. Pharmaceutics 2023; 15:2620. [PMID: 38004598 PMCID: PMC10674471 DOI: 10.3390/pharmaceutics15112620] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/28/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
Colorectal cancer (CRC) is one of the deadliest malignancies in the US, ranking fourth after lung, prostate, and breast cancers, respectively, in general populations. It continues to be a menace, and the incidence has been projected to more than double by 2035, especially in underdeveloped countries. This review seeks to provide some insights into the disease progression, currently available treatment options and their challenges, and future perspectives. Searches were conducted in the PubMed search engine in the university's online library. The keywords were "Colorectal Cancer" AND "disease process" OR "disease mechanisms" OR "Current Treatment" OR "Prospects". Selection criteria were original articles published primarily during the period of 2013 through 2023. Abstracts, books and documents, and reviews/systematic reviews were filtered out. Of over 490 thousand articles returned, only about 800 met preliminary selection criteria, 200 were reviewed in detail, but 191 met final selection criteria. Fifty-one other articles were used due to cross-referencing. Although recently considered a disease of lifestyle, CRC incidence appears to be rising in countries with low, low-medium, and medium social demographic indices. CRC can affect all parts of the colon and rectum but is more fatal with poor disease outcomes when it is right-sided. The disease progression usually takes between 7-10 years and can be asymptomatic, making early detection and diagnosis difficult. The CRC tumor microenvironment is made up of different types of cells interacting with each other to promote the growth and proliferation of the tumor cells. Significant advancement has been made in the treatment of colorectal cancer. Notable approaches include surgery, chemotherapy, radiation therapy, and cryotherapy. Chemotherapy, including 5-fluorouracil, irinotecan, oxaliplatin, and leucovorin, plays a significant role in the management of CRC that has been diagnosed at advanced stages. Two classes of monoclonal antibody therapies have been approved by the FDA for the treatment of colorectal cancer: the vascular endothelial growth factor (VEGF) inhibitor, e.g., bevacizumab (Avastin®), and the epidermal growth factor receptor (EGFR) inhibitor, e.g., cetuximab (Erbitux®) and panitumumab (Verbitix®). However, many significant problems are still being experienced with these treatments, mainly off-target effects, toxic side effects, and the associated therapeutic failures of small molecular drugs and the rapid loss of efficacy of mAb therapies. Other novel delivery strategies continue to be investigated, including ligand-based targeting of CRC cells.
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Affiliation(s)
- Amusa S. Adebayo
- College of Pharmacy, Howard University, 2400 6th St NW, Washington, DC 20059, USA; (K.A.); (S.K.A.); (O.O.)
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Agas RAF, Tan J, Xie J, Van Dyk S, C H Kong J, Heriot A, Ngan SY. Intensification of Local Therapy With High Dose Rate, Intraoperative Radiation Therapy (HDR-IORT) and Extended Resection for Locally Advanced and Recurrent Colorectal Cancer. Clin Colorectal Cancer 2023; 22:257-266. [PMID: 37100642 DOI: 10.1016/j.clcc.2023.03.002] [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: 12/11/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND We report our long-term experience with high dose rate intraoperative radiotherapy (HDR-IORT) in a single, quaternary institution. PATIENTS/METHODS From 2004 to 2020, 60 HDR-IORT procedures for locally advanced colorectal cancer (LACC) and 81 for locally recurrent colorectal cancer (LRCC) were done in our institution. Preoperative radiotherapy was done prior to majority of the resections (89%, 125/141). Sixty-nine percent (58/84) of the resections involving pelvic exenterations had >3 en bloc organs resected. HDR-IORT was delivered using a Freiburg applicator. A single 10 Gy fraction was delivered. Margin status was R0 and R1 in 54% (76/141) and 46% (65/141) of the resections, respectively. RESULTS With a median follow-up time of 4 years, 3-, 5-, and 7- year, overall survival (OS) rates were 84%, 58%, and 58% for LACC and 68%, 41%, and 37% for LRCC, respectively. Local progression-free survival (LPFS) rates were 97%, 93%, and 93% for LACC and 80%, 80%, 80% for LRCC, respectively. For the LRCC group, an R1 resection was associated with worse OS, LPFS, and progression-free survival (PFS), preoperative EBRT was associated with improved LPFS and PFS, and ≥2 years disease-free interval was associated with improved PFS. The most common severe adverse events were postoperative abscess (n = 25) and bowel obstruction (n = 11). There were 68 grade 3 to 4 and no grade 5 adverse events. CONCLUSIONS Favorable OS and LPFS can be achieved for LACC and LRCC with intensive local therapy. In patients with risk factors for poorer outcomes, optimization of EBRT and IORT, surgical resection, and systemic therapy are required.
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Affiliation(s)
- Ryan Anthony F Agas
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Jennifer Tan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jing Xie
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sylvia Van Dyk
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Joseph C H Kong
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Alexander Heriot
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Samuel Y Ngan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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Vashishat A, Singh A, Kurmi BD, Gupta GD, Singh D. A short appraisal of polylactic-co-glycolic acid based polymer nanotechnology for colon cancer: recent advances and literature evidences. Ther Deliv 2023; 14:459-472. [PMID: 37559461 DOI: 10.4155/tde-2023-0027] [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] [Indexed: 08/11/2023] Open
Abstract
The currently available formulations provided non-targeted treatment of colon cancer, the deadliest cancer variant. Due to biopharmaceutical hindrances, the majority of the drugs are unable to reach the target site. Polylactic-co-glycolic acid (PLGA) is one of the versatile polymers in cancer treatment, diagnostics and theranostics. The unique mechanism of surface modifications in PLGA properties in colon cancer has been a keen interest to be used in different nanoparticles for improving biopharmaceutical attributes. The ongoing use of these smart nano-carriers has allowed targeted delivery of several active components on a wide scale. The main goal of this review is to compile information on PLGA-based nanocarriers which possess several desirable properties for drug delivery applications, including biocompatibility, biodegradability and tunable drug-release kinetics.
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Affiliation(s)
- Abhinav Vashishat
- Department of Pharmaceutics, ISF College of Pharmacy, GT Road, Moga, Punjab, 142001, India
| | - Amrinder Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab, 140417, India
| | - Balak Das Kurmi
- Department of Pharmaceutics, ISF College of Pharmacy, GT Road, Moga, Punjab, 142001, India
| | - Ghanshyam Das Gupta
- Department of Pharmaceutics, ISF College of Pharmacy, GT Road, Moga, Punjab, 142001, India
| | - Dilpreet Singh
- University Institute of Pharmaceutical Sciences, Chandigarh University, Gharuan, Mohali, 140413, India
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Hall J, Wilson J, Shumway J, Yanagihara TK, Tepper J, Calvo B, Wang AZ, Pearlstein K, Wang K, Kim HJ. Outcomes of surgical resection and intraoperative electron radiotherapy for patients with para-aortic recurrences of gastrointestinal and gynecologic malignancies. Radiat Oncol 2023; 18:94. [PMID: 37268927 DOI: 10.1186/s13014-023-02289-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/25/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Para-aortic lymph node (PALN) metastases from primary pelvic malignancies are often treated with resection, but recurrence is common. We report toxicity and oncologic outcomes for patients with PALN metastases from gastrointestinal and gynecologic malignancies treated with resection and intraoperative electron radiotherapy (IORT). METHODS We retrospectively identified patients with recurrent PALN metastases who underwent resection with IORT. All patients were included in the local recurrence (LR) and toxicity analyses. Only patients with primary colorectal tumors were included in the survival analysis. RESULTS There were 26 patients with a median follow up of 10.4 months. The rate of para-aortic local control (LC) was 77% (20/26 patients) and the rate of any cancer recurrence was 58% (15/26 patients). Median time from surgery and IORT to any recurrence was 7 months. The LR rate for those with positive/close margins was 58% (7/12 patients) versus 7% (1/14 patients) for those with negative margins (p = 0.009). 15% (4/26 patients) developed surgical wound and/or infectious complications, 8% (2/26 patients) developed lower extremity edema, 8% (2/26 patients) experienced diarrhea, and 19% (5/26 patients) developed an acute kidney injury. There were no reported nerve injuries, bowel perforations, or bowel obstructions. For patients with primary colorectal tumors (n = 19), the median survival (OS) was 23 months. CONCLUSIONS We report favorable LC and acceptable toxicity for patients receiving surgical resection and IORT for a population that has historically poor outcomes. Our data show disease control rates similar to literature comparisons for patients with strong risk factors for LR, such as positive/close margins.
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Affiliation(s)
- Jacob Hall
- Department of Radiation Oncology, University of North Carolina School of Medicine, 101 Manning Drive CB #7512, Chapel Hill, NC, 27514, USA.
| | - Jessica Wilson
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - John Shumway
- Department of Radiation Oncology, University of North Carolina School of Medicine, 101 Manning Drive CB #7512, Chapel Hill, NC, 27514, USA
| | - Ted K Yanagihara
- Department of Radiation Oncology, University of North Carolina School of Medicine, 101 Manning Drive CB #7512, Chapel Hill, NC, 27514, USA
| | - Joel Tepper
- Department of Radiation Oncology, University of North Carolina School of Medicine, 101 Manning Drive CB #7512, Chapel Hill, NC, 27514, USA
| | - Benjamin Calvo
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Andrew Z Wang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kevin Pearlstein
- Department of Radiation Oncology, University of North Carolina School of Medicine, 101 Manning Drive CB #7512, Chapel Hill, NC, 27514, USA
| | - Kyle Wang
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - Hong Jin Kim
- Division of Surgical Oncology, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
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Calvo FA, Ayestaran A, Serrano J, Cambeiro M, Palma J, Meiriño R, Morcillo MA, Lapuente F, Chiva L, Aguilar B, Azcona D, Pedrero D, Pascau J, Delgado JM, Aristu J, Prezado Y. Practice-oriented solutions integrating intraoperative electron irradiation and personalized proton therapy for recurrent or unresectable cancers: Proof of concept and potential for dual FLASH effect. Front Oncol 2022; 12:1037262. [PMID: 36452493 PMCID: PMC9703091 DOI: 10.3389/fonc.2022.1037262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background Oligo-recurrent disease has a consolidated evidence of long-term surviving patients due to the use of intense local cancer therapy. The latter combines real-time surgical exploration/resection with high-energy electron beam single dose of irradiation. This results in a very precise radiation dose deposit, which is an essential element of contemporary multidisciplinary individualized oncology. Methods Patient candidates to proton therapy were evaluated in Multidisciplinary Tumor Board to consider improved treatment options based on the institutional resources and expertise. Proton therapy was delivered by a synchrotron-based pencil beam scanning technology with energy levels from 70.2 to 228.7 MeV, whereas intraoperative electrons were generated in a miniaturized linear accelerator with dose rates ranging from 22 to 36 Gy/min (at Dmax) and energies from 6 to 12 MeV. Results In a period of 24 months, 327 patients were treated with proton therapy: 218 were adults, 97 had recurrent cancer, and 54 required re-irradiation. The specific radiation modalities selected in five cases included an integral strategy to optimize the local disease management by the combination of surgery, intraoperative electron boost, and external pencil beam proton therapy as components of the radiotherapy management. Recurrent cancer was present in four cases (cervix, sarcoma, melanoma, and rectum), and one patient had a primary unresectable locally advanced pancreatic adenocarcinoma. In re-irradiated patients (cervix and rectum), a tentative radical total dose was achieved by integrating beams of electrons (ranging from 10- to 20-Gy single dose) and protons (30 to 54-Gy Relative Biological Effectiveness (RBE), in 10-25 fractions). Conclusions Individual case solution strategies combining intraoperative electron radiation therapy and proton therapy for patients with oligo-recurrent or unresectable localized cancer are feasible. The potential of this combination can be clinically explored with electron and proton FLASH beams.
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Affiliation(s)
- Felipe A Calvo
- Department of Radiation Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Adriana Ayestaran
- Department of Radiation Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Javier Serrano
- Department of Radiation Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Mauricio Cambeiro
- Department of Radiation Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Jacobo Palma
- Department of Radiation Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Rosa Meiriño
- Department of Radiation Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Miguel A Morcillo
- Medical Applications Unit, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain
| | - Fernando Lapuente
- Department of Surgery, Clinica Universidad de Navarra, Madrid, Spain
| | - Luis Chiva
- Department of Gynecology and Obstretics, Clinica Universidad de Navarra, Madrid, Spain
| | - Borja Aguilar
- Department of Medical Physics, Clinica Universidad de Navarra, Madrid, Spain
| | - Diego Azcona
- Department of Medical Physics, Clinica Universidad de Navarra, Madrid, Spain
| | - Diego Pedrero
- Department of Medical Physics, Clinica Universidad de Navarra, Madrid, Spain
| | - Javier Pascau
- Department of Bioengineering and Aerospace Engineering, Universidad Carlos III de Madrid, Madrid, Spain
| | - José Miguel Delgado
- Department of Radiation Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Javier Aristu
- Department of Radiation Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Yolanda Prezado
- Translational Research Department. Institut Curie, Université PSL, CNRS UMR, Inserm, Signalisation, Radiobiologie et Cancer, Orsay, France.,Université Paris-Saclay, CNRS UMR, Inserm, Signalisation, Radiobiologie et Cancer, Orsay, France
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Re-resection of Microscopically Positive Margins Found on Intraoperative Frozen Section Analysis Does Not Result in a Survival Benefit in Patients Undergoing Surgery and Intraoperative Radiation Therapy for Locally Recurrent Rectal Cancer. Dis Colon Rectum 2022; 65:1094-1102. [PMID: 35714345 DOI: 10.1097/dcr.0000000000002349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Intraoperative frozen-section analysis provides real-time margin resection status that can guide intraoperative decisions made by the surgeon and radiation oncologist. For patients with locally recurrent rectal cancer undergoing surgery and intraoperative radiation therapy, intraoperative re-resection of positive margins to achieve negative margins is common practice. OBJECTIVE This study aimed to assess whether re-resection of positive margins found on intraoperative frozen-section analysis improves oncologic outcomes. DESIGN This is a retrospective cohort study. SETTINGS This study was an analysis of a prospectively maintained multicenter database. PATIENTS All patients who underwent surgical resection of locally recurrent rectal cancer with intraoperative radiation therapy between 2000 and 2015 were included and followed for 5 years. Three groups were compared: initial R0 resection, initial R1 converted to R0 after re-resection, and initial R1 that remained R1 after re-resection. Grossly positive margin resections (R2) were excluded. MAIN OUTCOME MEASURES The primary outcome measures were 5-year overall survival, recurrence-free survival, and local re-recurrence. RESULTS A total of 267 patients were analyzed (initial R0 resection, n = 94; initial R1 converted to R0 after re-resection, n = 95; initial R1 that remained R1 after re-resection, n = 78). Overall survival was 4.4 years for initial R0 resection, 2.7 years for initial R1 converted to R0 after re-resection, and 2.9 years for initial R1 that remained R1 after re-resection ( p = 0.01). Recurrence-free survival was 3.0 years for initial R0 resection and 1.8 years for both initial R1 converted to R0 after re-resection and initial R1 that remained R1 after re-resection ( p ≤ 0.01). Overall survival did not differ for patients with R1 and re-resection R1 or R0 ( p = 0.62). Recurrence-free survival and freedom from local re-recurrence did not differ between groups. LIMITATIONS This study was limited by the heterogeneous patient population restricted to those receiving intraoperative radiation therapy. CONCLUSIONS Re-resection of microscopically positive margins to obtain R0 status does not appear to provide a significant survival advantage or prevent local re-recurrence in patients undergoing surgery and intraoperative radiation therapy for locally recurrent rectal cancer. See Video Abstract at http://links.lww.com/DCR/B886 . LA RERESECCIN DE LOS MRGENES MICROSCPICAMENTE POSITIVOS ENCONTRADOS DE MANERA INTRAOPERATORIA MEDIANTE LA TCNICA DE CRIOSECCIN, NO DA COMO RESULTADO UN BENEFICIO DE SUPERVIVENCIA EN PACIENTES SOMETIDOS A CIRUGA Y RADIOTERAPIA INTRAOPERATORIA PARA EL CNCER RECTAL LOCALMENTE RECIDIVANTE ANTECEDENTES:El análisis de la ténica de criosección para los margenes positivos encontrados de manera intraoperatoria proporciona el estado de la resección del margen en tiempo real que puede guiar las decisiones intraoperatorias tomadas por el cirujano y el oncólogo radioterapeuta. Para los pacientes con cáncer de recto localmente recurrente que se someten a cirugía y radioterapia intraoperatoria, la re-resección intraoperatoria de los márgenes positivos para lograr márgenes negativos es una práctica común.OBJETIVO:Evaluar si la re-resección de los márgenes positivos encontrados en el análisis de la ténica por criosecciónde manera intraoperatorios mejora los resultados oncológicos.DISEÑO:Estudio de cohorte retrospectivo.AJUSTES:Análisis de una base de datos multicéntrica mantenida de forma prospectiva.POBLACIÓN:Todos los pacientes que se sometieron a resección quirúrgica de cáncer de recto localmente recurrente con radioterapia intraoperatoria entre 2000 y 2015 fueron incluidos y seguidos durante 5 años. Se compararon tres grupos: resección inicial R0, R1 inicial convertido en R0 después de la re-resección y R1 inicial que permaneció como R1 después de la re-resección. Se excluyeron las resecciones de márgenes macroscópicamente positivos (R2).PRINCIPALES MEDIDAS DE RESULTADO:Supervivencia global a cinco años, supervivencia sin recidiva y recidiva local.RESULTADOS:Se analizaron un total de 267 pacientes (resección inicial R0 n = 94, R1 inicial convertido en R0 después de la re-resección n = 95, R1 inicial que permaneció como R1 después de la re-resección n = 78). La supervivencia global fue de 4,4 años para la resección inicial R0, 2,7 años para la R1 inicial convertida en R0 después de la re-resección y 2,9 años para la R1 inicial que permaneció como R1 después de la re-resección ( p = 0,01). La supervivencia libre de recurrencia fue de 3,0 años para la resección inicial R0 y de 1,8 años para el R1 inicial convertido en R0 después de la re-resección y el R1 inicial que permaneció como R1 después de la re-resección ( p ≤ 0,01). La supervivencia global no difirió para los pacientes con R1 y re-resección R1 o R0 ( p = 0,62). La supervivencia libre de recurrencia y la ausencia de recurrencia local no difirieron entre los grupos.LIMITACIONES:Población de pacientes heterogénea, restringida a aquellos que reciben radioterapia intraoperatoria.CONCLUSIONES:La re-resección de los márgenes microscópicamente positivos para obtener el estado R0 no parece proporcionar una ventaja de supervivencia significativa o prevenir la recurrencia local en pacientes sometidos a cirugía y radioterapia intraoperatoria para el cáncer de recto localmente recurrente. Consulte Video Resumen en http://links.lww.com/DCR/B886 . (Traducción-Dr. Daniel Guerra ).
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Shine RJ, Glyn T, Frizelle F. Pelvic exenteration: a review of current issues/controversies. ANZ J Surg 2022; 92:2822-2828. [PMID: 35490337 DOI: 10.1111/ans.17734] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/09/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
Management of advanced or recurrent pelvic cancer has evolved dramatically over the past few decades. Patients who were previously considered inoperable are now candidates for potentially curative surgery and avoid suffering with intractable symptoms. Up to 10% of primary rectal cancers present with isolated advanced local disease and between 10% and 15% of patients develop localized recurrence following proctectomy. Advances in surgical technique, reconstruction and multidisciplinary involvement have led to a reduction in mortality and morbidity and culminated in higher R0 resection rates with superior longer-term survival outcomes. Recent studies boast over 50% 5-year survival for rectal with an R0 resection. Exenteration has cemented itself as an important treatment option for advanced primary/recurrent pelvic tumours, however, there are still a few controversies. This review will discuss some of these issues, including: limitations of resection and the approach to high/wide tumours; the role of acute exenteration; re-exenteration; exenteration in the setting of metastatic disease and palliation; the role of radiotherapy (including intra-operative and re-irradiation); management of the empty pelvis; and the impact on quality of life and function.
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Affiliation(s)
- Rebecca J Shine
- Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Tamara Glyn
- Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand.,Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Frank Frizelle
- Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand.,Department of Surgery, University of Otago, Christchurch, New Zealand
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Modulating the Antioxidant Response for Better Oxidative Stress-Inducing Therapies: How to Take Advantage of Two Sides of the Same Medal? Biomedicines 2022; 10:biomedicines10040823. [PMID: 35453573 PMCID: PMC9029215 DOI: 10.3390/biomedicines10040823] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/17/2023] Open
Abstract
Oxidative stress-inducing therapies are characterized as a specific treatment that involves the production of reactive oxygen and nitrogen species (RONS) by external or internal sources. To protect cells against oxidative stress, cells have evolved a strong antioxidant defense system to either prevent RONS formation or scavenge them. The maintenance of the redox balance ensures signal transduction, development, cell proliferation, regulation of the mechanisms of cell death, among others. Oxidative stress can beneficially be used to treat several diseases such as neurodegenerative disorders, heart disease, cancer, and other diseases by regulating the antioxidant system. Understanding the mechanisms of various endogenous antioxidant systems can increase the therapeutic efficacy of oxidative stress-based therapies, leading to clinical success in medical treatment. This review deals with the recent novel findings of various cellular endogenous antioxidant responses behind oxidative stress, highlighting their implication in various human diseases, such as ulcers, skin pathologies, oncology, and viral infections such as SARS-CoV-2.
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Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative. Cancers (Basel) 2022; 14:cancers14051161. [PMID: 35267469 PMCID: PMC8909015 DOI: 10.3390/cancers14051161] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 12/12/2022] Open
Abstract
Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multidisciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments.
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Garcia-Gil R, Casans S, Edith Navarro A, García-Sánchez AJ, Rovira-Escutia JJ, Garcia-Costa D, Sanchis-Sánchez E, Pérez-Calatayud I, Pérez-Calatayud J, Sanchis E. Embedded bleeding detector into a PMMA applicator for electron intraoperative radiotherapy. Phys Med 2022; 94:35-42. [PMID: 34995976 DOI: 10.1016/j.ejmp.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/29/2021] [Accepted: 12/29/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of this work is to present a ready to industrialize low-cost and easy-to-install bleeding detector for use in intraoperative electron radiation therapy (IOERT). The detector works in stand-alone mode and is embedded into a translucent polymethylmethacrylate (PMMA) applicator avoiding any contact with the patient, which represent a novelty compared to previous designs. The use of this detector will prevent dose misadministration during irradiation in the event of accumulation of fluids in the applicator. METHODS The detector is based on capacitive sensor and wireless power-supply electronics. Both sensor and electronics have been embedded in the applicator, so that any contact with the patient would be avoided. Since access to the tumor can be done through different trajectories, the detector has been calibrated for different tilting angles. RESULTS The result of the calibration provides us with a fit curve that allows the interpolation of the results at any angle. Comparison of estimated fluid height vs real height gives an error of 1 mm for tilting angles less than 10° and 2 mm for tilting angles greater than 15°. This accuracy is better than the one required by clinic. CONCLUSIONS The performance of the bleeding detector was evaluated in situ. No interference was observed between the detector and the beam. In addition, a user-friendly mobile application has been developed to help the surgical team making decisions before and during irradiation. The measurement provided by the mobile application was stable during the irradiation process.
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Affiliation(s)
| | - Silvia Casans
- Department of Electronic Engineering, University of Valencia, Spain
| | - A Edith Navarro
- Department of Electronic Engineering, University of Valencia, Spain
| | | | - Juan J Rovira-Escutia
- Centro Nacional de Dosimetría, Instituto Nacional de Gestión Sanitaria, Valencia, Spain
| | | | | | | | - José Pérez-Calatayud
- Department of Radiation Oncology, La Fe Hospital, Valencia, Spain; Department of Radiation Oncology, Clínica Benidorm, Alicante, Spain; IRIMED Joint Research Unit IIS La Fe - University of Valencia, Spain
| | - Enrique Sanchis
- Department of Electronic Engineering, University of Valencia, Spain; IRIMED Joint Research Unit IIS La Fe - University of Valencia, Spain.
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Dragojevic S, Ji J, Singh PK, Connors MA, Mutter RW, Lester SC, Talele SM, Zhang W, Carlson BL, Remmes NB, Park SS, Elmquist WF, Krishnan S, Tryggestad EJ, Sarkaria JN. Preclinical Risk Evaluation of Normal Tissue Injury With Novel Radiosensitizers. Int J Radiat Oncol Biol Phys 2021; 111:e54-e62. [PMID: 34400266 PMCID: PMC8764622 DOI: 10.1016/j.ijrobp.2021.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 12/14/2022]
Abstract
Genotoxic damage induced by radiation triggers a highly coordinated DNA damage response, and molecular inhibitors of key nodes within this complex response network can profoundly enhance the antitumor efficacy of radiation. This is especially true for drugs targeting the catalytic subunit of DNA-dependent protein kinase, which is a core component of the nonhomologous end-joining DNA repair pathway, and ataxia telangiectasia mutated, which coordinates cell cycle arrest, apoptosis, and DNA repair functionalities after radiation exposure. Unlike the more modest in vitro radiosensitizing effects seen with classic sensitizing agents such as cisplatin, 5-fluorouracil, or taxanes, DNA-dependent protein kinase or ataxia telangiectasia mutated inhibitors provide much more robust sensitizing effects in vitro, as might be anticipated from targeting these key DNA repair modulators. However, patients with homozygous inactivating mutations of ataxia telangiectasia mutated or mice with homozygous defects in DNA-dependent protein kinase (severe combined immunodeficiency) have profoundly enhanced acute normal tissue radiation reactions. Therefore, there is significant potential that the combination of small molecule inhibitors of these kinases with radiation could cause similar dose-limiting acute normal tissue toxicities. Similarly, although less understood, inhibition of these DNA repair response pathways could markedly increase the risk of late radiation toxicities. Because these potent radiosensitizers could be highly useful to improve local control of otherwise radiation-resistant tumors, understanding the potential for elevated risks of radiation injury is essential for optimizing therapeutic ratio and developing safe and informative clinical trials. In this review, we will discuss 2 straightforward models to assess the potential for enhanced mucosal toxicity in the oral cavity and small intestine established in our laboratories. We also will discuss similar strategies for evaluating potential drug-radiation interactions with regard to increased risks of debilitating late effects.
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Affiliation(s)
- Sonja Dragojevic
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Jianxiong Ji
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota,Department of Neurosurgery, Qilu Hospital and Institute of Brain and Brain-Inspired Science, Cheeloo College of Medicine, Shandong University, Jinan, China,Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Pankaj K. Singh
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida
| | | | - Robert W. Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Scott C. Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Surabhi M. Talele
- Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota
| | - Wenjuan Zhang
- Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota
| | - Brett L. Carlson
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Sean S. Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - William F. Elmquist
- Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida
| | | | - Jann N. Sarkaria
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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22
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Radiation-Induced Senescence Reprograms Secretory and Metabolic Pathways in Colon Cancer HCT-116 Cells. Int J Mol Sci 2021; 22:ijms22094835. [PMID: 34063570 PMCID: PMC8124941 DOI: 10.3390/ijms22094835] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 01/10/2023] Open
Abstract
Understanding the global metabolic changes during the senescence of tumor cells can have implications for developing effective anti-cancer treatment strategies. Ionizing radiation (IR) was used to induce senescence in a human colon cancer cell line HCT-116 to examine secretome and metabolome profiles. Control proliferating and senescent cancer cells (SCC) exhibited distinct morphological differences and expression of senescent markers. Enhanced secretion of pro-inflammatory chemokines and IL-1, anti-inflammatory IL-27, and TGF-β1 was observed in SCC. Significantly reduced levels of VEGF-A indicated anti-angiogenic activities of SCC. Elevated levels of tissue inhibitors of matrix metalloproteinases from SCC support the maintenance of the extracellular matrix. Adenylate and guanylate energy charge levels and redox components NAD and NADP and glutathione were maintained at near optimal levels indicating the viability of SCC. Significant accumulation of pyruvate, lactate, and suppression of the TCA cycle in SCC indicated aerobic glycolysis as the predominant energy source for SCC. Levels of several key amino acids decreased significantly, suggesting augmented utilization for protein synthesis and for use as intermediates for energy metabolism in SCC. These observations may provide a better understanding of cellular senescence basic mechanisms in tumor tissues and provide opportunities to improve cancer treatment.
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23
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Liu B, Ge L, Wang J, Chen YQ, Ma SX, Ma PL, Zhang YQ, Yang KH, Cai H. Efficacy and safety of intraoperative radiotherapy in rectal cancer: A systematic review and meta-analysis. World J Gastrointest Oncol 2021; 13:69-86. [PMID: 33510850 PMCID: PMC7805273 DOI: 10.4251/wjgo.v13.i1.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/06/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In recent years, intraoperative radiotherapy (IORT) has been increasingly used for the treatment of rectal cancer. However, the efficacy and safety of IORT for the treatment of rectal cancer are still controversial.
AIM To evaluate the value of IORT for patients with rectal cancer.
METHODS We searched PubMed, Embase, Cochrane Library, Web of Science databases, and conference abstracts and included randomized controlled trials and observational studies on IORT vs non-IORT for rectal cancer. Dichotomous variables were evaluated by odds ratio (OR) and 95% confidence interval (CI), hazard ratio (HR) and 95%CI was used as a summary statistic of survival outcomes. Statistical analyses were performed using Stata V.15.0 and Review Manager 5.3 software.
RESULTS In this study, 3 randomized controlled studies and 12 observational studies were included with a total of 1460 patients, who are mainly residents of Europe, the United States, and Asia. Our results did not show significant differences in 5-year overall survival (HR = 0.80, 95%CI = 0.60-1.06; P = 0.126); 5-year disease-free survival (HR = 0.94, 95%CI = 0.73-1.22; P = 0.650); abscess (OR = 1.10, 95%CI = 0.67-1.80; P = 0.713), fistulae (OR = 0.79, 95%CI = 0.33-1.89; P = 0.600); wound complication (OR = 1.21, 95%CI = 0.62-2.36; P = 0.575); anastomotic leakage (OR = 1.09, 95%CI = 0.59-2.02; P = 0.775); and neurogenic bladder dysfunction (OR = 0.69, 95%CI = 0.31-1.55; P = 0.369). However, the meta-analysis of 5-year local control was significantly different (OR = 3.07, 95%CI = 1.66-5.66; P = 0.000).
CONCLUSION The advantage of IORT is mainly reflected in 5-year local control, but it is not statistically significant for 5-year overall survival, 5-year disease-free survival, and complications.
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Affiliation(s)
- Bin Liu
- Gansu Provincial Hospital, General Surgery Clinical Medical Center, Lanzhou 730000, Gansu Province, China
| | - Long Ge
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Jing Wang
- Gansu University of Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
| | - Ya-Qiong Chen
- Gansu Provincial Hospital, General Surgery Clinical Medical Center, Lanzhou 730000, Gansu Province, China
| | - Shi-Xun Ma
- Gansu Provincial Hospital, General Surgery Clinical Medical Center, Lanzhou 730000, Gansu Province, China
| | - Pei-Lan Ma
- Gansu Provincial Hospital, General Surgery Clinical Medical Center, Lanzhou 730000, Gansu Province, China
| | - Yun-Qiang Zhang
- Gansu Provincial Hospital, General Surgery Clinical Medical Center, Lanzhou 730000, Gansu Province, China
| | - Ke-Hu Yang
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Hui Cai
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
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24
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ESTRO/ACROP IORT recommendations for intraoperative radiation therapy in primary locally advanced rectal cancer. Clin Transl Radiat Oncol 2020; 25:29-36. [PMID: 33005755 PMCID: PMC7519207 DOI: 10.1016/j.ctro.2020.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/06/2020] [Indexed: 01/13/2023] Open
Abstract
Carcinoma of the rectum is a heterogeneous disease. The clinical spectrum identifies a subset of patients with locally advanced tumours that are close to or involve adjoining structures, such as the sacrum, pelvic sidewalls, prostate or bladder. Within this group of patients categorized as "locally advanced", there is also variability in the extent of disease with no uniform definition of resectability. A practice-oriented definition of a locally advanced tumour is a tumour that cannot be resected without leaving microscopic or gross residual disease at the resection site. Since these patients do poorly with surgery alone, irradiation and chemotherapy have been added to improve the outcome. Intraoperative irradiation (IORT) is a component of local treatment intensification with favourable results in this subgroup of patients. International guidelines (National Comprehensive Cancer Network (NCCN) guidelines) currently recommend the use of IORT for rectal cancer resectable with very close or positive margins, especially for T4 and recurrent cancers. We report the ESTRO-ACROP (European Society for Radiotherapy and Oncology - Advisory Committee on Radiation Oncology Practice) recommendations for performing IORT in primary locally advanced rectal cancer.
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25
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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer. Dis Colon Rectum 2020; 63:1191-1222. [PMID: 33216491 DOI: 10.1097/dcr.0000000000001762] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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26
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Wang L, Wang H, Jiang Y, Ji Z, Guo F, Jiang P, Li X, Chen Y, Sun H, Fan J, Li W, Li X, Wang J. The efficacy and dosimetry analysis of CT-guided 125I seed implantation assisted with 3D-printing non-co-planar template in locally recurrent rectal cancer. Radiat Oncol 2020; 15:179. [PMID: 32711542 PMCID: PMC7382046 DOI: 10.1186/s13014-020-01607-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 06/30/2020] [Indexed: 01/31/2023] Open
Abstract
Background Locally recurrent rectal cancer (LRRC) after surgery or external beam radiotherapy (EBRT) is a serious challenge for which no standard treatment is defined. In the present study, we investigated the feasibility of computed tomography (CT)-guided radioactive 125I seed (RIS) implantation assisted with three-dimensional printing non-coplanar template (3D-PNCT) in LRRC patients who previously received surgery or EBRT. Methods Sixty-six patients with LRRC treated by CT-guided RIS implantation in our institute from December 2015 to May 2019 were included. The treatment procedure included: preoperative CT localization, planning design, the printing of 3D individualized template, CT-guided RIS implantation assisted with 3D-PNCT, and postoperative dose evaluation. Therapeutic outcomes including local control (LC) and overall survival (OS) were retrospectively evaluated, as well as side effects. Results All the patients had previously received surgery or EBRT. The median follow-up time was 12.2 (range, 2.5–35.9) months. The median radioactive activity of a single RIS was 0.6 (range, 0.43–0.72) mCi. The median number of RIS was 60, ranging from 10 to 175. The dosimetric parameters included D90 (140.7 ± 33.1) Gy, D100 (90.3 ± 138.6) Gy, and V100 (91.0 ± 13.3) %. Pain relief was achieved in 85.1% (40/47) of patients. Besides, 9.1% (6/66) of patients had severe side effects (≥grade 3), including perianal skin ulcer in 1 case, fistula, radiation proctitis, and intestinal obstruction each in two cases. Median OS time was 14.7 (95% confidence interval (CI): 13.0–16.3) months, and median LC time was 12.2 (95% CI: 9.1–15.2) months. Univariate analysis revealed that when D90 > 130 Gy or D100 > 55 Gy or V100 > 90%, the LC time was remarkably prolonged. However, none of the parameters significantly affected OS. Conclusions CT-guided RIS implantation assisted with 3D-PNCT is an effective and safe salvage treatment strategy for patients with LRRC after EBRT or surgery. D90, D100, and V100 can be used as prognostic predictors. Trial registration NCT03890926.
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Affiliation(s)
- Lu Wang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Hao Wang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Zhe Ji
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Fuxin Guo
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Xuemin Li
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Yi Chen
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Jinghong Fan
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Weiyan Li
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Xu Li
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
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27
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Pérez-Calatayud J, Sanchis-Sánchez E, Collado J, González V, Pérez-Calatayud I, Pérez-Calatayud MJ, Chimeno J, Carmona V, Luis Bonet-Sancho J, García-Sánchez AJ, Sanchis E. Phantom development for daily checks in electron intraoperative radiotherapy with a mobile linac. Phys Med 2020; 76:109-116. [PMID: 32673822 DOI: 10.1016/j.ejmp.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE IORT with mobile linear accelerators is a well-established modality where the dose rate and, therefore, the dose per pulse are very high. The constancy of the dosimetric parameters of the accelerator has to be checked daily. The aim of this work is to develop a phantom with embedded detectors to improve both accuracy and efficiency in the daily test of an IORT linac at the surgery room. METHODS The developed phantom is manufactured with transparent polymethyl methacrylate (PMMA), allocating 6 parallel-plate chambers: a central one to evaluate the on-axis beam output, another on-axis one placed at a fixed depth under the previous one to evaluate the energy constancy and four off-axis chambers to evaluate the flatness and symmetry. To analyse the readings a specific application has been developed. RESULTS For all chambers and energies, the mean saturation and polarization corrections were smaller than 0.7%. The beam is monitored at different levels of the clinical beam. Output, energy constancy and flatness correlate very well with the correspondent values with the complete applicator. During the first six months of clinical use the beam dosimetric parameters showed excellent stability. CONCLUSIONS A phantom has been developed with embedded parallel plate chambers attached to the upper applicator part of an IORT linac. The phantom allows a very efficient setup reducing the time to check the parameters. It provides complete dosimetric information (output, energy and flatness) with just one shot and using ionization chambers with minimum saturation effect, as this highly pulsed beam requires.
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Affiliation(s)
- José Pérez-Calatayud
- Department of Radiation Oncology, La Fe Polytechnic and University Hospital, Valencia, Spain
| | | | - Javier Collado
- Department of Electronic Engineering, University of Valencia, Spain
| | - Vicente González
- Department of Electronic Engineering, University of Valencia, Spain
| | - I Pérez-Calatayud
- Department of Electronic Engineering, University of Valencia, Spain.
| | - M J Pérez-Calatayud
- Department of Radiation Oncology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - José Chimeno
- Department of Radiation Oncology, La Fe Polytechnic and University Hospital, Valencia, Spain
| | - Vicente Carmona
- Department of Radiation Oncology, La Fe Polytechnic and University Hospital, Valencia, Spain
| | | | | | - Enrique Sanchis
- Department of Electronic Engineering, University of Valencia, Spain
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28
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Shen Z, Chen Y, Li L, Liu L, Peng M, Chen X, Wu X, Sferra TJ, Wu M, Lin X, Cheng Y, Chu J, Shen A, Peng J. Transcription Factor EBF1 Over-Expression Suppresses Tumor Growth in vivo and in vitro via Modulation of the PNO1/p53 Pathway in Colorectal Cancer. Front Oncol 2020; 10:1035. [PMID: 32676457 PMCID: PMC7333669 DOI: 10.3389/fonc.2020.01035] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/26/2020] [Indexed: 01/12/2023] Open
Abstract
Early B cell factor 1 (EBF1) has been identified as an upstream transcription factor of the potential oncogene PNO1 and is involved in the growth of colorectal cancer (CRC) cells. However, its expression, biological function, and underlying mechanism of action in most solid tumors remain largely unknown. We postulated that EBF1 has a role in the pathophysiology of CRC. Analysis of EBF1 mRNA expression in CRC tumor samples from several public databases and directly from banked tissues revealed that EBF1 mRNA expression is lower in CRC tissue compared to non-cancerous colorectal tissue. Survival analysis of multiple datasets revealed that low EBF1 expression was correlated with shorter overall survival, relapse-free survival, and event-free survival in CRC patients. Transduction of lentivirus encoding full length EBF1 followed by in vitro and in vivo assays demonstrated that EBF1 over-expression in CRC cell lines suppresses cell growth by inhibiting cell viability, cell survival, and induces cell cycle arrest and apoptosis. Mechanistic investigation indicated that EBF1 over-expression down-regulates PNO1 mRNA and protein expression, as well as transcriptional activity while up-regulating the expression of p53 and p21 proteins. These findings suggest that EBF1 is a novel potential tumor suppressor in CRC with prognostic value for the identification of patients at high-risk of relapse.
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Affiliation(s)
- Zhiqing Shen
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Youqin Chen
- Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, United States
| | - Li Li
- Department of Health Management, Fujian Provincial Hospital, Fuzhou, China
| | - Liya Liu
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Meizhong Peng
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiaoping Chen
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiangyan Wu
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Thomas J Sferra
- Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, United States
| | - Meizhu Wu
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiaoying Lin
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ying Cheng
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jianfeng Chu
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Aling Shen
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jun Peng
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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29
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Calvo FA, Sole CV, Rutten HJ, Dries WJ, Lozano MA, Cambeiro M, Poortmans P, González-Bayón L. ESTRO/ACROP IORT recommendations for intraoperative radiation therapy in locally recurrent rectal cancer. Clin Transl Radiat Oncol 2020; 24:41-48. [PMID: 32613091 PMCID: PMC7320231 DOI: 10.1016/j.ctro.2020.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 12/28/2022] Open
Abstract
Multimodal strategies have been implemented for locally recurrent rectal cancer scheduled for complete surgical resection. Irradiation and systemic therapy have been added to improve the oncological outcome, as surgery alone was associated with a poor prognosis. Intraoperative irradiation (IORT) is a component of irradiation intensification. Long-term cancer control and a higher survival rate were consistently reported in patients who had IORT as a component of their multidisciplinary treatment. The experience reported by expert IORT groups is reviewed and recommendations to guide clinical practice are explained in detail.
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Affiliation(s)
- Felipe A. Calvo
- Department of Oncology, Clínica Universidad de Navarra, Universidad de Navarra, Madrid, Spain
- School of Medicine, Complutense University, Madrid, Spain
- Institute for Sanitary Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Corresponding author at: Department of Oncology, Clínica Universidad de Navarra, Madrid, Spain.
| | - Claudio V. Sole
- Department of Radiation Oncology, Instituto de Radiomedicina, Santiago, Chile
- Institute for Sanitary Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Harm J. Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
- GROW: School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands
| | - Wim J. Dries
- Departments of Medical Physics and Radiotherapy, Catharina Hospital, Eindhoven, the Netherlands
| | - Miguel A. Lozano
- Department of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mauricio Cambeiro
- Department of Oncology, Clínica Universidad de Navarra, Universidad de Navarra, Madrid, Spain
| | - Philip Poortmans
- Department of Radiation Oncology, Institut Curie, Paris, France
- Paris Sciences & Lettres - PSL University, Paris, France
| | - Luis González-Bayón
- Institute for Sanitary Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of General Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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30
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Ma L, Qiang J, Yin H, Lin L, Jiao Y, Ma C, Li X, Dong L, Cui J, Wei D, Sharma AM, Schwartz DL, Gu W, Chen H. Low-kilovolt x-ray intraoperative radiotherapy for pT3 locally advanced colon cancer: a single-institution retrospective analysis. World J Surg Oncol 2020; 18:132. [PMID: 32552838 PMCID: PMC7301558 DOI: 10.1186/s12957-020-01903-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Patients with locally advanced colon cancer (LACC) treated with surgery had a high risk of local recurrence. The outcomes can vary significantly among patients with pT3 disease. This study was undertaken to assess whether low-kilovolt (kV) x-ray intraoperative radiotherapy (IORT) can achieve promising results compared with electron beam IORT (IOERT) and whether specific subgroups of patients with pT3 colon cancer may benefit from low-kV x-ray IORT. Methods We retrospectively reviewed 44 patients with pT3 LACC treated with low-kV x-ray IORT. Clinicopathologic characteristics were analyzed to identify patients that could potentially benefit from low-kV x-ray IORT. The Kaplan-Meier survival analysis was used to assess overall survival (OS) and progression-free survival (PFS). Correlation analysis was used to discover the association of multiple factors to the results of treatment represented by the values of OS and PFS. Results The median follow-up of patients was 20.5 months (range, 6.1–38.8 months). At the time of analysis, 38 (86%) were alive and 6 (14%) had died of their disease. The 3-year Kaplan-Meier of PFS and OS for the entire cohort was 82.8% and 82.1%, respectively. At median follow-up, no in-field failure within the low-kV x-ray IORT field had occurred. Locoregional and distant failure had occurred in 2 (5%) patients each. The rate of perioperative 30-day mortality was 0%, and the morbidity rate was 11%. Five patients experienced 7 complications, including 4 early complications (30 days) and three late complications (> 30 days) leading early and late morbidity rates of 9% and 7%, respectively. Conclusion Patients with LACC who had undergone an additional low-kV x-ray IORT can achieve encouraging locoregional control, PFS, OS, and distant control without an increase in short-term or long-term complications. Low-kV x-ray IORT can be considered as part of management in pT3 LACC.
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Affiliation(s)
- Li Ma
- Center of Integrative Research, The First Hospital of Qiqihar, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China.,Affiliated Qiqihar Hospital, Southern Medical University, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China.,Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, 956 Court Avenue, Memphis, TN, 38163, USA
| | - Junhao Qiang
- Center of Integrative Research, The First Hospital of Qiqihar, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China.,Affiliated Qiqihar Hospital, Southern Medical University, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China
| | - Heliang Yin
- Center of Integrative Research, The First Hospital of Qiqihar, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China.,Affiliated Qiqihar Hospital, Southern Medical University, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China.,Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, 956 Court Avenue, Memphis, TN, 38163, USA
| | - Lin Lin
- Center of Integrative Research, The First Hospital of Qiqihar, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China.,Affiliated Qiqihar Hospital, Southern Medical University, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China.,Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, 956 Court Avenue, Memphis, TN, 38163, USA
| | - Yan Jiao
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, 956 Court Avenue, Memphis, TN, 38163, USA
| | - Changying Ma
- Center of Integrative Research, The First Hospital of Qiqihar, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China.,Affiliated Qiqihar Hospital, Southern Medical University, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China
| | - Xinwei Li
- Center of Integrative Research, The First Hospital of Qiqihar, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China.,Affiliated Qiqihar Hospital, Southern Medical University, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China
| | - Li Dong
- Center of Integrative Research, The First Hospital of Qiqihar, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China.,Affiliated Qiqihar Hospital, Southern Medical University, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China
| | - Jinglin Cui
- Center of Integrative Research, The First Hospital of Qiqihar, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China.,Affiliated Qiqihar Hospital, Southern Medical University, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China
| | - Dongmei Wei
- Center of Integrative Research, The First Hospital of Qiqihar, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China.,Affiliated Qiqihar Hospital, Southern Medical University, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China
| | - Ankur M Sharma
- Department of Radiation Oncology, University of Tennessee Health Science Center, 920 Madison Avenue, Memphis, TN, 38163, USA
| | - David L Schwartz
- Department of Radiation Oncology, University of Tennessee Health Science Center, 920 Madison Avenue, Memphis, TN, 38163, USA
| | - Weikuan Gu
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, 956 Court Avenue, Memphis, TN, 38163, USA. .,Research Service 151, VA Medical Center, 1030 Jefferson Avenue, Memphis, TN, 38104, USA.
| | - Hong Chen
- Center of Integrative Research, The First Hospital of Qiqihar, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China. .,Affiliated Qiqihar Hospital, Southern Medical University, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China.
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Potemin S, Kübler J, Uvarov I, Wenz F, Giordano F. Intraoperative radiotherapy as an immediate adjuvant treatment of rectal cancer due to limited access to external-beam radiotherapy. Radiat Oncol 2020; 15:11. [PMID: 31924250 PMCID: PMC6954580 DOI: 10.1186/s13014-020-1458-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Neoadjuvant external-beam radiotherapy (EBRT) with concomitant chemotherapy is the current standard-of-care for locally-advanced rectal cancer. Intraoperative radiotherapy (IORT) is to date only recommended for pelvic recurrences or incompletely resectable tumors. We here report on patients with stage II/III rectal cancer that were treated with IORT in a regional Russian university center due to limited access to EBRT. METHODS We retrospectively analyzed data from patients that were diagnosed with locally-advanced rectal cancer and underwent surgery from December 2012 to October 2016 at a regional oncological center in Russia (Krasnodar). During this period, access to EBRT was limited due to a temporary lack of a sufficient number of EBRT facilities. Patients unable to travel to a distant radiotherapy site received IORT alone, those that could travel received neoadjuvant external beam (chemo-) radiotherapy. Factors of interest were tumor stage, tumor differentiation, resection status, surgery type and neoadjuvant or adjuvant chemotherapy. We assessed local progression-free survival (L-PFS), PFS and overall survival (OS). RESULTS A total of 172 patients were included in this analysis. Of those, 92 (53.5%) were treated with IORT alone (median dose: 15 Gy [8.4-17 Gy]) and 80 (46.5%) received both neoadjuvant EBRT (median dose: 50.4 Gy [40-50.4 Gy]) and IORT (median dose: 15 Gy [15-17 Gy]). The median age was 65 years [33-82]. The median follow-up was 23 months [0-63 months]. The incidence of toxicity was low in both groups with an overall complication rate of 5.4%. Local PFS at 4 years was comparable with 59.4% in the IORT group and 65.4% in the IORT/EBRT group (p = 0.70). Similarly, there was no difference in OS or PFS (p = 0.66, p = 0.51, respectively). CONCLUSIONS IORT is a valuable option for patients with locally-advanced rectal cancer in the absence of access to EBRT.
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Affiliation(s)
- Sergey Potemin
- Department of Colorectal Surgery, Regional Oncological Center of Krasnodar, Krasnodar, Russia
| | - Jens Kübler
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Ivan Uvarov
- Department of Colorectal Surgery, Regional Oncological Center of Krasnodar, Krasnodar, Russia
| | - Frederik Wenz
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Frank Giordano
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Avanzo M, Dassie A, Chandra Acharya P, Chiovati P, Pirrone G, Avigo C, Barresi L, Dang Quoc S, Fiagbedzi E, Navarria F, Palazzari E, Bertola G, De Paoli A, Stancanello J, Sartor G. Electron radiotherapy (IOERT) for applications outside of the breast: Dosimetry and influence of tissue inhomogeneities. Phys Med 2020; 69:82-89. [PMID: 31841774 DOI: 10.1016/j.ejmp.2019.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/17/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The purpose of study is to investigate the dosimetry of electron intraoperative radiotherapy (IOERT) of the Intraop Mobetron 2000 mobile LINAC in treatments outside of the breast. After commissioning and external validation of dosimetry, we report in vivo results of measurements for treatments outside the breast in a large patient cohort, and investigate if the presence of inhomogeneities can affect in vivo measurements. METHODS AND MATERIALS Applicator factors and profile curves were measured with a stereotactic diode. The applicators factors of the 6 cm flat and beveled applicators were also confirmed with radiochromic films, parallel-plate ion chamber and by an external audit performed with ThermoLuminescent Dosimeters (TLDs). The influence of bone on dose was investigated by using radiochromic films attached to an insert equivalent to cortical bone, immersed in the water phantom. In vivo dosimetry was performed on 126 patients treated with IOERT using metal oxide-silicon semiconductor field effect transistors (MOSFETs) placed on the tumor bed. RESULTS Relatively small differences were found among different detectors for measurements of applicator factors. In the external audit, the agreement with the TLD was mostly within ±0.2%. The largest increase of dose due to the presence of cortical bone insert was +6.0% with energy 12 MeV and 3 cm applicator. On average, in vivo dose was significantly (+3.1%) larger than prescribed dose. CONCLUSION IOERT in applications outside the breast results in low discrepancies between in vivo and prescribed doses, which can be also explained with the presence of tissue inhomogeneity.
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Affiliation(s)
- Michele Avanzo
- Department of Medical Physics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy.
| | - Andrea Dassie
- Department of Medical Physics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | | | - Paola Chiovati
- Department of Medical Physics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Giovanni Pirrone
- Department of Medical Physics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Cinzia Avigo
- Medical Physics, ULSS 1 Dolomiti- S. Martino Hospital, Medical Physics Department, Belluno, Italy
| | - Loredana Barresi
- Department of Medical Physics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Soai Dang Quoc
- Medicinal Supplies, Medical Physics Division, Hanoi Oncology Hospital, Hanoi, Vietnam
| | | | - Federico Navarria
- Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Elisa Palazzari
- Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Giulio Bertola
- Surgical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Antonino De Paoli
- Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | | | - Giovanna Sartor
- Department of Medical Physics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
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Lee DJ, Waters PS, Larach JT, McCormick JJ, Heriot AG, Warrier SK. Pelvic sidewall excision with en bloc complete sciatic nerve resection in locally re-recurrent rectal cancer. ANZ J Surg 2019; 90:1202-1204. [PMID: 31637834 DOI: 10.1111/ans.15512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 09/03/2019] [Accepted: 09/15/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Dewei J Lee
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Peadar S Waters
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - José T Larach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Jacob J McCormick
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Alexander G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Satish K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
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Sanchis E, Casans S, García-Gil R, Martos J, Sanchis-Sánchez E, Pérez-Calatayud I, José Pérez-Calatayud M, Pérez-Calatayud J. Improving bleeding detector features for electron intraoperative radiotherapy. Phys Med 2019; 65:150-156. [PMID: 31473502 DOI: 10.1016/j.ejmp.2019.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/22/2019] [Accepted: 08/23/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The aim of this work is to improve the potential bleeding detection during intraoperative radiotherapy with linac polymethyl methacrylate applicators (PMMA), based on one previously developed. The improvements carried out have been focused on: i) minimizing the impact of the detector on the visual through the plastic applicators and ii) avoiding the asymmetry in the detection capability when the applicator is tilted. METHODS Simulations have been made to select the geometry that provides a reduced visual impact on the applicator as well as allowing an independent response with the tilting angle of the applicator. A low-noise circuit for signal conditioning has been developed. Measurements have been made on three setups: 10 cm, 7 cm and 4 cm applicator diameters, 0° and 45° tilted. RESULTS The detector has a visibility through the applicator greater than 50%. Due to the geometry, optimal detection is ensured regardless of its orientation when the applicator is tilted. It is possible to detect the presence of fluid well below the typical perturbing fluid depth established by the clinic (1-1.5 cm). CONCLUSIONS The detector can distinguish the presence of around 0.5 cm of fluid depth while showing a high visual field through the PMMA applicators and providing a measure that does not depend on the detector orientation when the applicator is tilted. The prototype is ready for its industrialization by embedding it into the applicator for clinical use. The detector would have a significant impact on both the quality assurance and the outcome of the treatment.
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Affiliation(s)
- Enrique Sanchis
- Department of Electronic Engineering, University of Valencia, E-46100, Spain; IRIMED Joint Research Unit (IIS La Fe - UV), Valencia, Spain.
| | - Silvia Casans
- Department of Electronic Engineering, University of Valencia, E-46100, Spain
| | - Rafael García-Gil
- Department of Electronic Engineering, University of Valencia, E-46100, Spain
| | - Julio Martos
- Department of Electronic Engineering, University of Valencia, E-46100, Spain
| | - Enrique Sanchis-Sánchez
- Department of Physical Therapy, University of Valencia, E-46010, Spain; IRIMED Joint Research Unit (IIS La Fe - UV), Valencia, Spain
| | | | | | - José Pérez-Calatayud
- Department of Radiation Oncology, La Fe Polytechnic and University Hospital, Valencia E-46026, Spain; IRIMED Joint Research Unit (IIS La Fe - UV), Valencia, Spain
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Detector for monitoring potential bleeding during electron intraoperative radiotherapy. Phys Med 2019; 57:95-99. [PMID: 30738538 DOI: 10.1016/j.ejmp.2018.12.010] [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: 07/10/2018] [Revised: 10/30/2018] [Accepted: 12/15/2018] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The aim of this work is to develop a bleeding detector integrated into the acrylic circular applicators for specific mobile linacs. Thus, a bleeding detector has been developed based on a capacitive sensor to be used with plastic applicators, as in the case of LIAC HWL from Sordina IORT Technologies SpA. According to the clinical impact, we have selected 0.5 cm as the minimum depth of fluid that should be detected. METHODS An experiment was developed using water-simulating blood. Two setups were considered: non-beveled applicators with 7 cm and 10 cm diameter. Measurements were done for applicators 0° and 45° tilted, both with respect to the horizontal surface, in order to mimic the worst clinical scenario according to the irradiation gantry and applicator bevel angle. The behavior of the detector under irradiation was analyzed and the impact of the stray radiation on the detector was also evaluated. RESULTS The detector was able to distinguish the presence of liquid at a minimum height of 0.5 cm. A linear behavior was obtained for both setups. We have also verified that the LIAC HWL radiation does not affect the measurements nor does the detector interfere with the stray radiation. The bleeding detector is a quasi-digital capacitive sensor with low-cost, high linearity, and easy to install. CONCLUSIONS With this detector it is possible to perform a continuous monitoring of the liquid measurements even during the irradiation phase. Thus, it can operate not only as a pre-treatment detector but also as a continuous one.
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Zyxin promotes colon cancer tumorigenesis in a mitotic phosphorylation-dependent manner and through CDK8-mediated YAP activation. Proc Natl Acad Sci U S A 2018; 115:E6760-E6769. [PMID: 29967145 DOI: 10.1073/pnas.1800621115] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Zyxin is a member of the focal adhesion complex and plays a critical role in actin filament polymerization and cell motility. Several recent studies showed that Zyxin is a positive regulator of Yki/YAP (Yes-associated protein) signaling. However, little is known about the mechanisms by which Zyxin itself is regulated and how Zyxin affects Hippo-YAP activity. We first showed that Zyxin is phosphorylated by CDK1 during mitosis. Depletion of Zyxin resulted in significantly impaired colon cancer cell proliferation, migration, anchorage-independent growth, and tumor formation in xenograft animal models. Mitotic phosphorylation is required for Zyxin activity in promoting growth. Zyxin regulates YAP activity through the colon cancer oncogene CDK8. CDK8 knockout phenocopied Zyxin knockdown in colon cancer cells, while ectopic expression of CDK8 substantially restored the tumorigenic defects of Zyxin-depletion cells. Mechanistically, we showed that CDK8 directly phosphorylated YAP and promoted its activation. Fully activated YAP is required to support the growth in CDK8-knockout colon cancer cells in vitro and in vivo. Together, these observations suggest that Zyxin promotes colon cancer tumorigenesis in a mitotic-phosphorylation-dependent manner and through CDK8-mediated YAP activation.
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Rad ZP, Yazdani MR, Zafarghandi MS. WITHDRAWN: Using electrical feedback to determine the optimized energy for measuring the target tissue in intraoperative radiation therapy (IORT). Radiat Phys Chem Oxf Engl 1993 2018. [DOI: 10.1016/j.radphyschem.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Dalle Ore CL, Ames CP, Magill ST, Deviren V, Aghi MK, Lau D. Initial Experience with Intraoperative Phosphorous-32 Brachytherapy During Resection of Malignant Spinal Tumors. World Neurosurg 2018; 115:e785-e793. [PMID: 29702311 DOI: 10.1016/j.wneu.2018.04.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Brachytherapy is a major adjuvant modality for neoplasms, but few have trialed its use for spinal tumors. This study examines perioperative and oncologic outcomes of patients with malignant spinal tumors who underwent resection with intraoperative phosphorous-32 (P32) brachytherapy. METHODS Consecutive adult patients who underwent P32 brachytherapy during malignant spinal tumor resection were retrospectively identified from 2014 to 2015. Complications, tumor recurrence, and survival were reviewed. A comprehensive review of the literature was performed. RESULTS A total of 8 patients were included. Average age was 54.3 years, and 25.0% were males. Tumor types included metastatic leiomyosarcoma, chordoma, multifocal recurrent ependymomas, breast metastasis, malignant meningioma, and myxofibrosarcoma. One-half of patients underwent en bloc tumor resection. P32 plaques were applied to 2 sites per patient for mean 13.1 minutes per site with a goal penetration of 10 Gy to 1-mm depth. Perioperative complications occurred in 3 patients (37.5%), including a persistent cerebral spinal fluid leak, deep infection requiring reoperation, and sacral insufficiency fracture. At a mean 25.6 months follow-up, local recurrence rate was 25.0%, and overall survival was 75.0%. Mean time to recurrence was 14.4 months. Survival at 6, 12, 18, and 24 months was 100.0%, 100.0%, 85.7%, and 71.4%, respectively. CONCLUSIONS The use of P32 is safe and feasible. P32 intraoperative brachytherapy does not seem to increase the rate of complications. The sample size of this series is small with heterogeneity in tumor type, but recurrence and survival outcomes seem promising compared with previous reports. Further clinical trials are needed.
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Affiliation(s)
- Cecilia L Dalle Ore
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Stephen T Magill
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Vedat Deviren
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Manish K Aghi
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Darryl Lau
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
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Sethi A, Emami B, Small W, Thomas TO. Intraoperative Radiotherapy With INTRABEAM: Technical and Dosimetric Considerations. Front Oncol 2018; 8:74. [PMID: 29632850 PMCID: PMC5879442 DOI: 10.3389/fonc.2018.00074] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/05/2018] [Indexed: 01/01/2023] Open
Abstract
Purpose We evaluate dose characteristics and clinical applications of treatment accessories used in intraoperative radiotherapy (IORT) and make site-specific recommendations for their optimal use. Methods and materials Dose measurements were performed for a low energy (50 kV) X-ray INTRABEAM source. For spherical, flat, surface, and needle applicators, the following dosimetric parameters were measured: depth-dose (DD) profiles, surface dose (Ds), output factors (OF), and target dose homogeneity (DH). Optical density versus exposure calibration films were employed to obtain 2-dimensional dose distributions in planes parallel and perpendicular to beam direction. Film results were verified via repeat dose measurements with a parallel-plate ionization chamber in a custom water tank. The impact of applicator design on dose distributions was evaluated. Results Spherical applicators are commonly used for treating the inner-surface of breast lumpectomy cavity. Flat and surface applicators provide uniform planar dose for head and neck, abdomen, and pelvis targets. Needle applicators are designed for kypho-IORT of spinal metastasis. Typically, larger applicators produce a more homogeneous target dose region with lower surface dose, but require longer treatment times. For 4-cm diameter spherical, flat, and surface applicators, dose rates (DR) at their respective prescription points were found to be: 0.8, 0.3, and 2.2 Gy/min, respectively. The DR for a needle applicator was 7.04 Gy/min at 5 mm distance from the applicator surface. Overall, film results were in excellent agreement with ion-chamber data. Conclusion IORT may be delivered with a variety of site-specific applicators. Appropriate applicator use is paramount for safe, effective, and efficient IORT delivery. Results of this study should help clinicians assure optimized target dose coverage and reduced normal tissue exposure.
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Affiliation(s)
- Anil Sethi
- Loyola University Medical Center, Maywood, IL, United States
| | - Bahman Emami
- Loyola University Medical Center, Maywood, IL, United States
| | - William Small
- Loyola University Medical Center, Maywood, IL, United States
| | - Tarita O Thomas
- Loyola University Medical Center, Maywood, IL, United States
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Moussavi M, Haddad F, Rassouli FB, Iranshahi M, Soleymanifard S. Synergy between Auraptene, Ionizing Radiation, and Anticancer Drugs in Colon Adenocarcinoma Cells. Phytother Res 2017; 31:1369-1375. [PMID: 28675489 DOI: 10.1002/ptr.5863] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 06/10/2017] [Accepted: 06/11/2017] [Indexed: 11/10/2022]
Abstract
Colorectal cancer is a growing health concern with increasing mortality rates, and resistance to anticancer drugs and radiotherapy is a serious drawback in its treatment. Auraptene is a natural prenyloxycoumarin with valuable anticancer effects. The aim of current study was to determine the synergy between auraptene, ionizing radiation, and chemotherapeutic drugs in colon adenocarcinoma cells for the first time. To do so, HT29 cells were treated with combination of auraptene + cisplatin, + doxorubicin, or + vincristine. Furthermore, cells were pretreated with nontoxic auraptene and then exposed to various doses of X-radiation. Assessment of cell viability not only indicated significant (p < 0.05) synergic effects of auraptene and anticancer agents, also revealed more significant (p < 0.01) increase in the toxicity of applied radiations in auraptene pretreated cells. Interesting synergy between auraptene and radiotherapy was then confirmed by morphological alterations, DAPI staining, and flow cytometric analysis of the cell cycle. Moreover, real-time reverse transcription polymerase chain reaction analysis indicated significant (p < 0.01) overexpression of p21, but not GATA6, in auraptene pretreated cells after radiotherapy, and also significant (p < 0.01) down regulation of CD44 and ALDH1 by auraptene. According to present results, auraptene could be considered as an effective natural coumarin to improve the outcome of current chemoradiotherapy options. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Mahdi Moussavi
- Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Farhang Haddad
- Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Fatemeh B Rassouli
- Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran.,Cell and Molecular Biotechnology Research Group, Institute of Biotechnology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mehrdad Iranshahi
- Biotechnology Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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En Bloc Pancreaticoduodenectomy for Locally Advanced Right Colon Cancers. Int J Surg Oncol 2017; 2017:5179686. [PMID: 28751989 PMCID: PMC5511679 DOI: 10.1155/2017/5179686] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/04/2017] [Indexed: 12/02/2022] Open
Abstract
Locally advanced right colon cancer may invade adjacent tissue and organs. Direct invasion of the duodenum and pancreas necessitates an en bloc resection. Previously, this challenging procedure was associated with high morbidity and mortality; however, today, this procedure can be done more safely in experienced centers. The aim of this study is to report our experience on en bloc right colectomy with pancreaticoduodenectomy for locally advanced right colon cancers. Between 2000 and 2012, 5 patients underwent en bloc multivisceral resection. No major morbidities or perioperative mortalities were observed. Median disease-free survival time was 24.5 months and median overall survival time was 42.1 (range: 4.5–70.4) months in our series. One patient lived 70 months after multivisceral resection and underwent cytoreductive surgery and total pelvic exenteration during the follow-up period. In locally advanced right colon tumors, all adhesions should be considered as malign invasion and separation should not be done. The reasonable option for this patient is to perform en bloc pancreaticoduodenectomy and right colectomy. This procedure may result in long-term survival with acceptable morbidity and mortality rates. Multidisciplinary teamwork and multimodality treatment alternatives may improve the results.
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Zhao X, Wang J, Xiao L, Xu Q, Zhao E, Zheng X, Zheng H, Zhao S, Ding S. Effects of 17-allylamino-17-demethoxygeldanamycin on the induction of apoptosis and cell cycle arrest in HCT-116 cells. Oncol Lett 2017; 14:2177-2185. [PMID: 28789442 PMCID: PMC5530076 DOI: 10.3892/ol.2017.6442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 01/06/2017] [Indexed: 12/11/2022] Open
Abstract
The present study investigated the effects of HSP90 inhibitor 17-allylamino-17-demethoxygeldanamycin (17-AAG) on apoptosis and the cell cycle of the HCT-116 human colon carcinoma cell line, with the aim of elucidating their underlying mechanisms. MTT was used to examine the inhibitory effects of 17-AAG on the proliferation of HCT-116 cells at various time points and doses. The cells were stained with Annexin V-fluorescein isothiocyanate/propidium iodide and evaluated by flow cytometry. The expression of signal transducer and activator of transcription (STAT)3, cyclin D1, cytochrome c (cyt-c), caspase 9 and caspase 3 at the mRNA and protein level was determined using reverse transcription-polymerase chain reaction and western blotting. Treatment with 17-AAG at a concentration of 1.25-20 mg/l for 24 and 48 h significantly inhibited the proliferation of HCT-116 cells in a time-dependent and concentration-dependent manner. Treatment with 17-AAG at concentrations of 1.25, 2.5 and 5 mg/l for 48 h significantly induced apoptosis and cell cycle arrest in HCT-116 cells. Exposure to 17-AAG at concentrations of 1.25, 2.5 and 5 mg/l for 48 h significantly downregulated the mRNA and protein expression of STAT3 and cyclin D1, but upregulated cyt-c, caspase 9 and caspase 3 in a concentration-dependent manner in HCT-116 cells. Therefore 17-AAG is able to inhibit cell proliferation, inducing apoptosis and G1 stage cell cycle arrest by downregulating the expression of cyclin D1, and promoting the mitochondria apoptosis by downregulating STAT3 in HCT-116 cells.
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Affiliation(s)
- Xuerong Zhao
- Department of Immunology, Chengde Medical University, Chengde, Hebei 067000, P.R. China
| | - Jianping Wang
- Department of Immunology, Chengde Medical University, Chengde, Hebei 067000, P.R. China
| | - Lijun Xiao
- Department of Immunology, Chengde Medical University, Chengde, Hebei 067000, P.R. China
| | - Qian Xu
- Department of Fundamental Research, Chengde Medical University, Chengde, Hebei 067000, P.R. China
| | - Enhong Zhao
- The Third Department of Surgery, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, P.R. China
| | - Xin Zheng
- The Third Department of Surgery, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, P.R. China
| | - Huachuan Zheng
- Cancer Research Center, The First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Shuang Zhao
- Cancer Research Center, The First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Shi Ding
- Pharmocology Department, Chengde Medical University, Chengde, Hebei 067000, P.R. China
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Continuous Effect of Radial Resection Margin on Recurrence and Survival in Rectal Cancer Patients Who Receive Preoperative Chemoradiation and Curative Surgery: A Multicenter Retrospective Analysis. Int J Radiat Oncol Biol Phys 2017; 98:647-653. [PMID: 28581407 DOI: 10.1016/j.ijrobp.2017.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 03/03/2017] [Accepted: 03/07/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To elucidate the proper length and prognostic value of resection margins in rectal cancer patients who received preoperative chemoradiotherapy (CRT) followed by curative total mesorectal excision (TME). METHODS AND MATERIALS A total of 1476 rectal cancer patients staging cT3-4N0-2M0 were analyzed. All patients received radiation dose of 50.4 Gy in 28 fractions with concurrent 5-fluorouracil or capecitabine. Total mesorectal excision was performed 4 to 8 weeks after radiation therapy. RESULTS The recurrence-free survival (RFS) at 5 years showed a significant difference between 3 groups: patients with circumferential resection margin (CRM) ≤1 mm, CRM 1.1 to 5 mm, and CRM >5 mm (46.2% vs 68.6% vs 77.5%, P<.001). Patients with CRM ≤1 mm showed a significantly higher cumulative incidence of locoregional recurrence (P<.001) and distant metastasis (P<.001) at 5 years compared with the other 2 groups. Patients with CRM 1.1 to 5 mm showed a significantly higher cumulative incidence of distant metastasis (P<.001), but not locoregional recurrence (P=.192), compared with those with CRM >5 mm. Distal resection margin (≤5 vs >5 mm) did not show any significant difference in cumulative incidence of locoregional recurrence (P=.310) and distant metastasis (P=.926). CONCLUSION Rectal cancer patients with CRM ≤1 mm are a high-risk group, with the lowest RFS. Patients with CRM 1.1 to 5 mm may be at intermediate risk, with moderately increased distant recurrence. Distal resection margin was not significantly associated with RFS in rectal cancer after neoadjuvant CRT and total mesorectal excision.
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