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Mota S, Ward EP, Bartolone SN, Chancellor MB, Zwaans BMM. Identification of Molecular Mechanisms in Radiation Cystitis: Insights from RNA Sequencing. Int J Mol Sci 2024; 25:2632. [PMID: 38473879 PMCID: PMC10932361 DOI: 10.3390/ijms25052632] [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: 02/01/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Pelvic cancer survivors who were treated with radiation therapy are at risk for developing (hemorrhagic) radiation cystitis (RC) many years after completion of radiation therapy. Patients with RC suffer from lower urinary tract symptoms, including frequency, nocturia, pelvic pain, and incontinence. In advanced stages, hematuria can occur, potentially escalating to life-threatening levels. Current therapeutic options for RC are limited, partly due to ethical concerns regarding bladder biopsy in patients with fragile bladder tissue. This study aimed to leverage our established preclinical model to elucidate the molecular pathways implicated in radiation-induced tissue changes in the bladder. Female C57Bl/6 mice received a single dose of 40 Gy using CT-guided imaging and a two-beam irradiation approach using the SARRP irradiator. Bladders from irradiated and age-matched littermate controls were harvested at 1 week [n = 5/group] or 6 months [n = 5/group] after irradiation, RNA was harvested, and mRNA sequencing was performed at paired-end 150bp on the Illumina NovaSeq6000 with a target of 30 million reads per sample. Following RNA sequencing, thorough bioinformatics analysis was performed using iPathwayGuide v2012 (ADVAITA Bioinformatics). Findings of the RNA sequencing were validated using qPCR analysis. At 1 week post-irradiation, altered gene expression was detected in genes involved in DNA damage response, apoptosis, and transcriptional regulation. By 6 months post-irradiation, significant changes in gene expression were observed in inflammation, collagen catabolism, and vascular health. Affected pathways included the p53, JAK-STAT, and PI3K-Akt pathways. These findings were validated in vivo in bladder tissues from our preclinical model. This is the first study to determine the molecular changes in the bladder in response to radiation treatment. We have successfully pinpointed several pathways and specific genes that undergo modification, thereby contributing to the progression of radiation cystitis. These insights enhance our understanding of the pathophysiology of radiation cystitis and may ultimately pave the way to the identification of potential new therapeutic targets.
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Affiliation(s)
- Sabrina Mota
- Department of Urology, William Beaumont University Hospital, Corewell Health System, Royal Oak, MI 48073, USA
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester Hills, MI 48309, USA
| | - Elijah P. Ward
- Department of Urology, William Beaumont University Hospital, Corewell Health System, Royal Oak, MI 48073, USA
| | - Sarah N. Bartolone
- Department of Urology, William Beaumont University Hospital, Corewell Health System, Royal Oak, MI 48073, USA
| | - Michael B. Chancellor
- Department of Urology, William Beaumont University Hospital, Corewell Health System, Royal Oak, MI 48073, USA
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester Hills, MI 48309, USA
| | - Bernadette M. M. Zwaans
- Department of Urology, William Beaumont University Hospital, Corewell Health System, Royal Oak, MI 48073, USA
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester Hills, MI 48309, USA
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Eaton SE, Kaczmarek J, Mahmood D, McDiarmid AM, Norarfan AN, Scott EG, Then CK, Tsui HY, Kiltie AE. Exploiting dietary fibre and the gut microbiota in pelvic radiotherapy patients. Br J Cancer 2022; 127:2087-2098. [PMID: 36175620 PMCID: PMC9727022 DOI: 10.1038/s41416-022-01980-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 02/03/2023] Open
Abstract
With an ageing population, there is an urgent need to find alternatives to current standard-of-care chemoradiation schedules in the treatment of pelvic malignancies. The gut microbiota may be exploitable, having shown a valuable role in improving patient outcomes in anticancer immunotherapy. These bacteria feed on dietary fibres, which reach the large intestine intact, resulting in the production of beneficial metabolites, including short-chain fatty acids. The gut microbiota can impact radiotherapy (RT) treatment responses and itself be altered by the radiation. Evidence is emerging that manipulation of the gut microbiota by dietary fibre supplementation can improve tumour responses and reduce normal tissue side effects following RT, although data on tumour response are limited to date. Both may be mediated by immune and non-immune effects of gut microbiota and their metabolites. Alternative approaches include use of probiotics and faecal microbiota transplantation (FMT). Current evidence will be reviewed regarding the use of dietary fibre interventions and gut microbiota modification in improving outcomes for pelvic RT patients. However, data regarding baseline (pre-RT) gut microbiota of RT patients and timing of dietary fibre manipulation (before or during RT) is limited, heterogenous and inconclusive, thus more robust clinical studies are required before these strategies can be applied clinically.
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Affiliation(s)
- Selina E Eaton
- Medical School, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Justyna Kaczmarek
- Medical School, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Daanish Mahmood
- Medical School, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Anna M McDiarmid
- Medical School, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Alya N Norarfan
- Medical School, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Erin G Scott
- Medical School, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Chee Kin Then
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, OX3 7DQ, UK
| | - Hailey Y Tsui
- Medical School, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Anne E Kiltie
- Rowett Institute, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
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Meng X, Wang N, Yu M, Kong D, Zhang Z, Chang X, Guo Y, Li Y. Development of a nomogram for predicting grade 2 or higher acute hematologic toxicity of cervical cancer after the pelvic bone marrow sparing radiotherapy. Front Public Health 2022; 10:993443. [PMID: 36159246 PMCID: PMC9501870 DOI: 10.3389/fpubh.2022.993443] [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: 07/13/2022] [Accepted: 08/16/2022] [Indexed: 01/26/2023] Open
Abstract
Background Acute hematologic toxicity (HT) is a common complication during radiotherapy of cervical cancer which may lead to treatment delay or interruption. Despite the use of intensity-modulated radiation therapy (IMRT) with the pelvic bone marrow (PBM) sparing, some patients still suffer from acute HT. We aimed to identify predictors associated with HT and develop a nomogram for predicting grade 2 or higher (G2+) acute HT in cervical cancer following the PBM sparing strategy. Methods This study retrospectively analyzed 125 patients with cervical cancer who underwent IMRT with the PBM sparing strategy at our institution. Univariate and multivariate logistic regression, best subset regression, and least absolute shrinkage and selection operator (LASSO) regression, respectively, were used for predictor screening, and Akaike information criterion (AIC) was used to determine the best model for developing the nomogram. Finally, we quantified the risk of G2+ acute HT based on this model to establish a risk stratification. Results The independent predictors used to develop the nomogram were histological grade, pre-radiotherapy chemotherapy, pre-radiotherapy HT, and radiotherapy [IMRT alone vs. concurrent chemoradiotherapy (CCRT)] which were determined by the univariate and multivariate logistic regression with the minimum AIC of 125.49. Meanwhile, the heat map showed that there is no multicollinearity among the predictors. The nomogram was well-calibrated to reality, with a Brier score of 0.15. The AUC value was 0.82, and the median Brier score and AUC in 1000 five-fold cross-validation were 0.16 and 0.80, respectively. The web version developed together was very easy to use. The risk stratification indicated that high-risk patients (risk point > 195.67) were more likely to develop G2+ acute HT [odds ratio (OR) = 2.17, 95% confidence interval (CI): 1.30-3.05]. Conclusion This nomogram well-predicted the risk of G2+ acute HT during IMRT in cervical cancer after the PBM sparing strategy, and the constructed risk stratification could assist physicians in screening high-risk patients and provide a useful reference for future prevention and treatment strategies for acute HT.
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Affiliation(s)
- Xiangdi Meng
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China
| | - Nan Wang
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China
| | - Meng Yu
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China
| | - Dechen Kong
- Clinical School, Weifang Medical University, Weifang, China
| | - Zhengtao Zhang
- Clinical School, Weifang Medical University, Weifang, China
| | - Xiaolong Chang
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China
| | - Yinghua Guo
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China
| | - Yang Li
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China,*Correspondence: Yang Li
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Fosså SD, Dahl AA, Børge Johannesen T, Gjelsvik YM, Holck Storås A, Myklebust TÅ. Late Adverse Health Outcomes and Quality of Life after Curative Radiotherapy+ long-term ADT in Prostate Cancer Survivors:Comparison with men from the General Population. Clin Transl Radiat Oncol 2022; 37:78-84. [PMID: 36093341 PMCID: PMC9450064 DOI: 10.1016/j.ctro.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/24/2022] Open
Abstract
More than 5 years after radiotherapy for prostate cancer ) 54 % elderly patients report at least one moderate or big problem within the urinary, bowel or sexual domain. (Controls : 30%) Such problems reduce Quality of Life., which, however ,is similar in the two cohorts , the least difference observed within the sexual domain.
Background Few studies have described the impact of urinary, bowel and sexual Adverse Health Outcomes (AHOs) on Quality of Life (QoL) in Prostate Cancer Survivors living for more than 5 years after curative radiotherapy (“long-term PCaSs”), and compared the findings with those in men from general population. Here we assess self-reported AHOs in such PCaSs focusing on the association between problem experience and QoL. The findings are compared to corresponding symptoms in age-similar men from the general population without a PCa diagnosis (Norms). Methods Nine years (mean) after curative radiotherapy 1231 PCaSs and 3156 Norms completed the EPIC-26 questionnaire and the EORTC QLQ-C30 instrument. Domain Summary Scores (DSSs) for the urinary, bowel and sexual domains, the percentages of moderate/big dysfunctions and the proportions of overall problems were determined. Inter-cohort differences were interpreted based on cut-off values for published Minimal Clinically Important Differences (MCIDs). Multivariable linear regression models analyzed the associations between QoL and domain-related overall problems. Results Only the inter-cohort differences regarding bowel and sexual DSSs exceeded the respective MCIDs. Among PCaSs 54% had at least one moderate/big problem (Norms: 30%). In PCaSs and Norms, QoL increased with decreasing urinary and bowel problems, For sexuality this association was weaker in Norms and was almost lacking in PCaSs. Multivariable-adjusted QoL was similar in PCaSs and Norms, with general health being the strongest covariate. Conclusions During follow-up of long-term PCaSs health professionals should be aware of the survivors’ persisting moderate/big urinary, bowel or sexual problems associated with reduced QoL. In particular , alleviation of urinary and bowel problems can increase the men’s QoL.
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Sholklapper T, Creswell M, Cantalino J, Markel M, Zwart A, Danner M, Ayoob M, Yung T, Collins B, Kumar D, Aghdam N, Rubin RS, Hankins R, Suy S, Collins S. Ejaculatory Function Following Stereotactic Body Radiation Therapy for Prostate Cancer. J Sex Med 2022; 19:771-780. [PMID: 35305936 DOI: 10.1016/j.jsxm.2022.02.018] [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: 09/26/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ejaculatory dysfunction is an important male quality of life issue which has not yet been studied in the setting of prostate stereotactic body radiation therapy (SBRT). AIM The purpose of this study is to evaluate ejaculatory function following SBRT for prostate cancer. METHODS Two hundred and thirty-one patients on a prospective quality of life study with baseline ejaculatory capacity treated with prostate SBRT from 2013 to 2019 were included in this analysis. Ejaculation was assessed via the Ejaculation Scale (ES-8) from the Male Sexual Health Questionnaire. Patients completed the questionnaire at 1, 3, 6, 9, 12, 18, and 24 months post-SBRT. Elderly patients (Age > 70) and those who received hormonal therapy were excluded from analysis. Patients were treated to 35-36.25 Gy in 5 fractions delivered with the CyberKnife Radiosurgical System (Accuray). OUTCOMES Ejaculatory function was assessed by ES-8 scores (range 4-40) with lower values representing increased interference or annoyance. RESULTS Median age at the time of treatment was 65 years. Median follow up was 24 months (IQR 19-24.5 months). 64.5% of patients had ED at baseline (SHIM < 22). The 2-year anejaculation rate was 15%. Mean composite ES-8 scores showed a decline in the first month following treatment then stabilized: 30.4 (start of treatment); 26.5 (1 month); 27.6 (3 month); 27.0 (6 month); 26.2 (9 month); 25.4 (12 month); 25.0 (18 month) and 25.4 (24 month). White race, higher pre-treatment SHIM (≥22), and higher ES-8 (≥31) at treatment start were significantly associated with a decreased probability of a clinically significant decline. Patient-reported ejaculate volume was significantly reduced at all time points post-SBRT. Ejaculatory discomfort peaked at 1 month and 9 months post-SBRT. Prior to treatment, 8.0% of men reported that they were very to extremely bothered by their ejaculatory dysfunction. The number of patients reporting this concern increased to 14.4% at one year and dropped to 11% at 24-months post-SBRT. CLINICAL TRANSLATION Patients undergoing prostate SBRT may experience meaningful changes in ejaculatory function and should be counseled on the trajectory of these side effects. STRENGTHS & LIMITATIONS This was a retrospective analysis of a prospectively maintained database. Subjective questionnaire responses captured limited aspects of ejaculatory function in this cohort. CONCLUSION The high incidence of moderate to extreme bother in ejaculatory function before and after SBRT suggests a need for novel approaches to improving ejaculation. Sholklapper T, Creswell M, Cantalino J, et al. Ejaculatory Function Following Stereotactic Body Radiation Therapy for Prostate Cancer. J Sex Med 2022;19:771-780.
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Affiliation(s)
- Tamir Sholklapper
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Michael Creswell
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Jonathan Cantalino
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Michael Markel
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Alan Zwart
- Julius L. Chambers Biomedical Biotechnology Research Institute, North Carolina Central University, Durham, NC, USA
| | - Malika Danner
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Marilyn Ayoob
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Thomas Yung
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Brian Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Deepak Kumar
- Julius L. Chambers Biomedical Biotechnology Research Institute, North Carolina Central University, Durham, NC, USA
| | - Nima Aghdam
- Department of Radiation Medicine, Beth Israel Deaconess, Boston, MA, USA
| | - Rachel S Rubin
- Department of Urology, Georgetown University Hospital, Washington, DC, USA
| | - Ryan Hankins
- Department of Urology, Georgetown University Hospital, Washington, DC, USA
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Sean Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA.
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Corrigan KL, De B, Rooney MK, Ludmir EB, Das P, Smith GL, Taniguchi CM, Minsky BD, Koay EJ, Koong AC, Holliday EB. Patient-Reported Outcomes Following Chemoradiation in Patients with Anal Cancer: A Qualitative Analysis. Adv Radiat Oncol 2022; 7:100986. [PMID: 35662810 PMCID: PMC9157211 DOI: 10.1016/j.adro.2022.100986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022] Open
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